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noema
04-21-2012, 12:27 AM
Hello Everyone :)

I have a scene I'd like to do, but am unsure of the plausibility and am hoping for some advice.

My male and female characters are ambushed, there's a fight (knives, swords) which they manage to escape, but in the process she is cut (I had thought somewhere on the neck, but doesn't have to be). The wound doesn't get any major arteries, and the male character doesn't think it is deadly (he is an experienced soldier with some small medical knowledge). They have to get away because there are more bad guys in the area, so he binds the wound and they get out of there. He is carrying her to limit trauma to the wound...?

Now what I want is for her to have some blood clotting disorder. He doesn't notice she is still bleeding as he carries her, by the time he finds somewhere relatively safe, she is passing out from blood loss.

Once he realizes, he is able stop the blood loss (knowledge of herbs in a fantasy world...) But what could he do after that? Is it a lost cause without a transfusion? That would be ideal for the story.
Then, another character 'happens' to come along. This one is the equivalent of a doctor in this world. He can do a transfusion. From a previous scene we know that the male characters blood is compatible with the girls, so the doctor tells him he can use his blood for the transfusion.

Ok so the questions:

- How would one do a transfusion in the field? This is a fantasy world, very high tech, but nature based with some rather intricate magic systems. Just wondering if there are any ideas? I'm sure I can come up with something.

- How much blood loss would the girl need to lose to make her recovery unlikely without a transfusion, and how much would the guy have to give her to bring her back? Would he be ok after this? He wouldn't be able to have a transfusion.

- It would go right along with the setting for there to be some food, a fruit for example, that had properties that would help with blood regeneration. Would that help recovery? Something loaded with iron, b12, folic acid?

- What would their recovery be like? They are in the process of traveling somewhere, so they are going to have to start moving again at some point. How long am I looking to have them laid up before they can start (with many rests) on their way?

- What sort of blood clotting problem would cause something like this? Could she be unaware of it? My dad has Von Willebrand disease, which he wasn't aware of until he went in for surgery... would that work?


Thanks for any help you can give! I'm sure I've missed all sorts of crucial details, so just ask if you need more info. :)

crunchyblanket
04-21-2012, 12:57 AM
How would one do a transfusion in the field? This is a fantasy world, very high tech, but nature based with some rather intricate magic systems. Just wondering if there are any ideas? I'm sure I can come up with something.

I'm assuming the blood would have to be obtained fresh from another person present? Person-to-person transfusion is possible, although we don't practise it anymore due to the high possibility of transmitting infections. You'd also need to be certain the other person is of a compatible blood type (O- blood - 'flying squad blood' - is used in emergency situations. If there's magic in your world, some kind of purification spell might take care of the infection element.



- How much blood loss would the girl need to lose to make her recovery unlikely without a transfusion, and how much would the guy have to give her to bring her back? Would he be ok after this? He wouldn't be able to have a transfusion.

Depends on the person. The body can replace a couple of pints - I think 40-50% blood loss, if I remember my transfusion training, is where major damage can occur if blood is not replaced. Blood pressure drops and organs start to suffer from lack of blood.

The average adult has around 10 pints of blood, which should give you a rough idea of how much a person can lose. In the UK, we usually take 1 pint at donation, but I should imagine a donor could potentially give two or even three, if done over a period of time. Too fast could send the donor into shock.



- It would go right along with the setting for there to be some food, a fruit for example, that had properties that would help with blood regeneration. Would that help recovery? Something loaded with iron, b12, folic acid?

Iron is an important component in replenishing the blood supply. Food alone can't do that, but it can certainly help. That's the good thing about a fantasy setting - you can mess around with biology a little bit.



- What would their recovery be like? They are in the process of traveling somewhere, so they are going to have to start moving again at some point. How long am I looking to have them laid up before they can start (with many rests) on their way?

She wouldn't be feeling better right away. Transfusion itself can cause a host of problems, from blood-borne infection to serious stuff like graft-versus-host. If he's the wrong blood type, she's basically screwed. You've also got to take the injuries into account - they'll still be painful and prone to infection, and with her weakened body and immune system she won't be in much of a state to travel. Short bursts, lots of rest. She'll be poorly but there's always magic ;)



- What sort of blood clotting problem would cause something like this? Could she be unaware of it? My dad has Von Willebrand disease, which he wasn't aware of until he went in for surgery... would that work?

Von Willebrand does present with symptoms, although it's possible she'd never know about it. You could go with something like [/URL][URL="http://en.wikipedia.org/wiki/Bernard%E2%80%93Soulier_syndrome"]Bernard-Soulier syndrome (http://en.wikipedia.org/wiki/Factor_V_Leiden) - principally caused by abnormal platelet function.

noema
04-21-2012, 01:23 AM
Thanks so much for the reply :)


I'm assuming the blood would have to be obtained fresh from another person present? Person-to-person transfusion is possible, although we don't practise it anymore due to the high possibility of transmitting infections. You'd also need to be certain the other person is of a compatible blood type (O- blood - 'flying squad blood' - is used in emergency situations. If there's magic in your world, some kind of purification spell might take care of the infection element.


Yes it would be person to person. We already know their blood type is compatible from something that happened earlier in the story, so that's not a problem.



Von Willebrand does present with symptoms, although it's possible she'd never know about it. You could go with something like [/URL][URL="http://en.wikipedia.org/wiki/Bernard%E2%80%93Soulier_syndrome"]Bernard-Soulier syndrome (http://en.wikipedia.org/wiki/Factor_V_Leiden) - principally caused by abnormal platelet function.


I'll have a look that, thanks :)

debirlfan
04-22-2012, 07:10 AM
Be careful giving her a clotting disease - remember that women bleed on a regular basis, and with a serious clotting problem that could be lethal. You might consider the idea of having some sort of anti-clotting poison on the weapon, instead.

noema
04-22-2012, 08:20 AM
Be careful giving her a clotting disease - remember that women bleed on a regular basis, and with a serious clotting problem that could be lethal. You might consider the idea of having some sort of anti-clotting poison on the weapon, instead.

Thanks, I hadn't thought of that. Excellent point and I'll be sure to look into it.

areteus
04-22-2012, 02:20 PM
If you are looking at a disease like Haemophillia, bear in mind that those who have it in the real world before the use of things like factor VIII often died young (Henry VIII's son is believed to have had this as was the son of Tsar Nicholas III, both died in thier teens) and usually also display other signs of the disease even before they get cut such as spontaneous bruising.

It is also rare for a woman to have haemophillia...

Unless you are cutting a vein or an artery, blood loss will be slight but contiinual bleeding over a number of hours will be very dangerous and risk putting her into irreversible shock (which is the point where either a blood transfusion is needed or she will die and there is nothing any first aid or paramedic assistance can do, especially in a medieval setting...)

Infection is a major risk even without the transfusion (though blood clotting is more severe... this would I suspect require magic of some form...).

Would he not consider stitching the wound to close it if it is severe enough to bleed heavily?

L M Ashton
04-23-2012, 03:57 PM
The water from king coconuts have been used as transfusions in the place of blood plasma or, in your case, to supplement the blood transfusion. You can google that for more info. But that grows in tropical climates, so may or may not help your story.

fdesrochers
04-23-2012, 07:16 PM
Be careful giving her a clotting disease - remember that women bleed on a regular basis, and with a serious clotting problem that could be lethal. You might consider the idea of having some sort of anti-clotting poison on the weapon, instead.

Someone please correct me if I'm wrong (great start I know), but how does a cut to the arm and clotting factors bear any relation to "women bleed on a regular basis." I only mention it because I have two members of my extended family (both women) who have Von Willebrand's.

Another peculiarity. I had a micro-discectomy (spinal surgery) 4 months ago and due to the above-mentioned family history, had to be tested for Von-W. Thankfully tests came back negative, but my surgeon still ended up dealing with more bleeding than expected - I guess they were actually prepping for a transfusion. You could always use this in your scenario (e.g. frustrating that the character doesn't have any specific disease some of her relatives have, but still seems to be bleeding more than normal).

noema
04-24-2012, 12:38 AM
Someone please correct me if I'm wrong (great start I know), but how does a cut to the arm and clotting factors bear any relation to "women bleed on a regular basis." I only mention it because I have two members of my extended family (both women) who have Von Willebrand's.

Another peculiarity. I had a micro-discectomy (spinal surgery) 4 months ago and due to the above-mentioned family history, had to be tested for Von-W. Thankfully tests came back negative, but my surgeon still ended up dealing with more bleeding than expected - I guess they were actually prepping for a transfusion. You could always use this in your scenario (e.g. frustrating that the character doesn't have any specific disease some of her relatives have, but still seems to be bleeding more than normal).

Thanks that's helpful :) I see I'll have to do a bit of searching about women with clotting disorders, just to make sure it's plausible that my character would be unaware of it.

Brigid Barry
04-28-2012, 09:40 PM
Hello Everyone :)

I have a scene I'd like to do, but am unsure of the plausibility and am hoping for some advice.

My male and female characters are ambushed, there's a fight (knives, swords) which they manage to escape, but in the process she is cut (I had thought somewhere on the neck, but doesn't have to be). The wound doesn't get any major arteries, and the male character doesn't think it is deadly (he is an experienced soldier with some small medical knowledge). They have to get away because there are more bad guys in the area, so he binds the wound and they get out of there. He is carrying her to limit trauma to the wound...?

Now what I want is for her to have some blood clotting disorder. He doesn't notice she is still bleeding as he carries her, by the time he finds somewhere relatively safe, she is passing out from blood loss. I assume that by "blood clotting disorder" you have researched into hemophilia, a condition that the blood does not clot and a bruise can kill. Or thrombocytopelia. Instead of "some clotting disorder" you would benefit greatly from researching "actual clotting disorder".

Once he realizes, he is able stop the blood loss (knowledge of herbs in a fantasy world...) Again, you want to see if there is herbal treatment for "actual clotting disorder". But what could he do after that? Is it a lost cause without a transfusion? The average adult has 9 to 12 pints of blood - which more than a gallon. You can lose approximately 40% of your blood volume before your body can no longer compensate, needing you to have a transfusion. Unless she has some internal injuries (which would most likely require surgery to fix and no amount of binding would fix) the male MC would have to be stupid to not notice her losing 1/2 gallon of blood. That would be ideal for the story. As I have been told by people far wiser than me, sometimes you have to do what is real, not what is best for your plot.

Then, another character 'happens' to come along. This one is the equivalent of a doctor in this world. He can do a transfusion. From a previous scene we know that the male characters blood is compatible with the girls, so the doctor tells him he can use his blood for the transfusion. I advise you to look into blood types so you know what the consequences are of using incompatible blood, who is a universal donor and who is a universal recipient. Because you will need to explain how they "know" they are compatible.

Ok so the questions:

- How would one do a transfusion in the field? This is a fantasy world, very high tech, but nature based with some rather intricate magic systems. Just wondering if there are any ideas? I'm sure I can come up with something. Transfusion is done via IV needle into the arm of the person needing the transfusion, so the blood would need to be in a vessel or container. Direct transfusion (which you can research) can lead to the death of the donor because there is no way of measuring how much blood has been taken. http://absolutewrite.com/forums/showthread.php?t=198783 http://en.wikipedia.org/wiki/Blood_transfusion

- How much blood loss would the girl need to lose to make her recovery unlikely without a transfusion, and how much would the guy have to give her to bring her back? Would he be ok after this? He wouldn't be able to have a transfusion. Loss of more than 40%. Since he is bigger than her 40% of his blood is more than 40% of hers. In addition, she doesn't need to be at 100% to survive, she just needs to be more than 60%.

- It would go right along with the setting for there to be some food, a fruit for example, that had properties that would help with blood regeneration. Would that help recovery? Something loaded with iron, b12, folic acid? There are already herbs that help the liver, you should look into some of them. If you are going to use real world herbs you should know their real world properties.

- What would their recovery be like? They are in the process of traveling somewhere, so they are going to have to start moving again at some point. How long am I looking to have them laid up before they can start (with many rests) on their way? She's going to be tired because lack of blood will do that to you.

- What sort of blood clotting problem would cause something like this? Could she be unaware of it? My dad has Von Willebrand disease, which he wasn't aware of until he went in for surgery... would that work? Hemophilia, thrombocytopelia. Or you can Google "blood clotting disorders".


Thanks for any help you can give! I'm sure I've missed all sorts of crucial details, so just ask if you need more info. :)

See above.

Brigid Barry
04-28-2012, 09:44 PM
If you are looking at a disease like Haemophillia, bear in mind that those who have it in the real world before the use of things like factor VIII often died young (Henry VIII's son is believed to have had this as was the son of Tsar Nicholas III, both died in thier teens) and usually also display other signs of the disease even before they get cut such as spontaneous bruising.



King Edward VI died of tuberculosis in his teens, after being sick for at least a year with the disease. He had a "poor costitution" but there is no documentation that he suffered from hemophilia.

Amber Nae
05-15-2012, 08:52 AM
Disseminated intravascular coagulation (DIC), also known as disseminated intravascular coagulopathy or consumptive coagulopathy, is a pathological activation of coagulation (http://en.wikipedia.org/wiki/Coagulation) (blood clotting) mechanisms that happens in response to a variety of diseases. DIC leads to the formation of small blood clots inside the blood vessels throughout the body.[1] (http://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation#cite_note-0) As the small clots consume coagulation proteins and platelets, normal coagulation is disrupted and abnormal bleeding (http://en.wikipedia.org/wiki/Bleeding) occurs from the skin (e.g. from sites where blood samples were taken), the gastrointestinal tract (http://en.wikipedia.org/wiki/Gastrointestinal_tract), the respiratory tract (http://en.wikipedia.org/wiki/Respiratory_tract) and surgical wounds. The small clots also disrupt normal blood flow to organs (such as the kidneys (http://en.wikipedia.org/wiki/Kidney)), which may malfunction as a result.[2] (http://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation#cite_note-1)
DIC can occur acutely but also on a slower, chronic basis, depending on the underlying problem.[3] (http://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation#cite_note-isbn0-7216-7335-X-2) It is common in the critically ill, and may participate in the development of multiple organ failure (http://en.wikipedia.org/wiki/Multiple_organ_dysfunction_syndrome), which may lead to death.[4] (http://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation#cite_note-isbn0-443-07036-9-3)