Jayant Radhakrishnan
Chicago, Illinois, United States

There are those who claim that the first blood collection and transfusion services were started by Percy Oliver of the Camberwell Division of the British Red Cross in 1921¹ and not by Dr. Bernard Fantus at the Cook County Hospital, Chicago in 1937. However, everyone agrees that the term “Blood Bank” was coined by Dr. Fantus, and indeed the one at the Cook County Hospital was run for more than three decades in the manner of a financial institution. For elective use blood could only be obtained (withdrawn) if friends and family had made directed donations (deposits). The account of the medical or surgical service requesting blood could not be overdrawn. It was the responsibility of the service to ensure that the rules were followed.

A senior surgeon was in charge of the blood bank in the 1950s and 60s. Consequently, it was the General Surgery Chief Resident on call for a given twenty-four hours, also known as The Night Surgeon, who was responsible for ensuring that either directed donations were made or the blood was paid for. Thus, when going off call the next day the chief resident would empty out a pocketful of money from their white coat in the blood bank. In the 1970s the practice of paying for blood, obtained by the blood bank from professional donors, was discontinued for fear that diseases would be transmitted to recipients, and all donations had to be voluntary. Because of the great need for blood at the hospital, major elective operations continued to be cancelled for lack of blood if the service did not secure donations. At times an individual’s well-wishers paid professional donors on the sly to claim to be a friend or relative of the patient and to donate a unit.

Just like the County of Cook, the hospital also was a hotbed of politics and intrigue. Patronage jobs and “feather bedding” were the norm. A particularly obvious example was that only designated elevator operators could press the buttons on the many automatic elevators in the complex; except on Election Day when many employees, particularly the elevator operators, were conspicuously absent since their jobs were contingent upon mobilizing the vote for the Democratic machine of Cook County.

In the late 1960s the main front-page exposé in one of the major Chicago daily newspapers was that a senior surgeon had written a check on the blood bank’s financial account for down payment on a condominium in Colorado, on a Friday. Legend has it that when checked on Monday morning the money was present in the blood bank account. When the surgeon was eventually exonerated, the paper had a brief announcement next to the obituaries. Whether intended or not it was an ironic epitaph, since the surgeon’s career at the County Hospital had expired upon publication of the exposé.

In 1974 Telischi² covered details of the blood bank’s history including techniques used, lessons learned, decline of the facility due to lack of finances, and eventual resurrection of the blood bank. But for some reason she relegated a major advance made there to an afterthought at the end of the article. This innovation was the establishment, in 1972, of the first ever component-based frozen blood bank. This novel concept had already been tested in the Vietnam War by Lieutenant Commander Gerald S. Moss at the Navy Station Hospital in DaNang, Vietnam.³ Units of Group O and Rh, Kell, and Duffy negative blood were collected in acid citrate dextrose solution in Boston. The red cells were separated from plasma and washed to remove anti-A and anti-B isoagglutinins, platelets, clotting factors, and bacteria and viruses. They were then placed in a specially designed freezing bag and glycerolized with a special solution of sugars to maintain osmotic equilibrium, and ethylenediaminetetraacetic acid (Na₂EDTA) to prevent development of Coombs-positive red cells. After mixing for ten minutes the bags were stored in a freezer at -80°C. The units were air transported to DaNang in polystyrene containers packed with dry ice. Thus, large quantities of O negative red cells were available when required and blood components were not wasted since they were selectively administered only when indicated. Another benefit was that each component was stored for optimal survival. Usually when whole blood is stored at the usual 2-6°C it has to be used within forty-two days, while frozen packed red cells can be preserved for four to eight months at -80°C. Also, with usual methods of storage only a few viable platelets and labile clotting factors remain in the bag after twenty-four hours. On the other hand, when components are separated, platelets can be stored at 20-24°C for five days, cryoprecipitate for a year, and if stored below -30°C, fresh frozen plasma is good for thirty-six months.

In Vietnam they determined that with this technique in vitro red cell loss was 26.7% and supernatant hemoglobin was 54 mg per unit. In thirty-six injured soldiers who required multiple transfusions the hemoglobin rose 3.68 mg per 100 mL per unit administered, serum bilirubin rose 0.28 mg per 100 mL per unit administered, and renal function was not impaired, unlike what happened in the Korean conflict upon resuscitation with whole blood. Renal function may also have been protected in part because initial resuscitation in Vietnam was carried out with normal saline. Dr. Moss instituted this process at the Cook County Hospital when he took over as Chief of Surgery since quite a few patients required multiple transfusions, particularly in the trauma unit. However, the process of collection, freezing, and thawing is more expensive than it is to store liquid blood; hence short-term financial considerations overruled long-term advantages. The enterprise faded into oblivion once Dr. Moss left the institution.

The hospital was a haven for characters, but according to Dr. Herand Abcarian, the retired Chief of Surgery at the University of Illinois-Chicago and an alumnus of the Cook County Hospital Surgical Residency, Colorectal Fellowship, and later the Chief of Colorectal Surgery at the hospital, the most unique of all was “S”. He was the night technician in the blood bank and a live wire, extremely efficient, hardworking, and knowledgeable. He would tour the operating rooms to personally evaluate the abilities of surgeons. Regardless of the number of units of blood requested by the surgeon for a particular case, he supplied what he believed would be needed by that surgeon and he was usually correct. He was not above favoring those he liked over ones he was indifferent to. When he had some free time during the shift, he would practice tai chi. If one walked into the blood bank while he was practicing it was safest to let him complete his set of movements. Perhaps the most telling story is that he became irritated with a surgical attending about some matter long since forgotten and clocked him. He then straddled the surgeon, who was flat on his back on the ground, and was readying himself to clobber him again when the surgeon noticed that “S” was bug-eyed and he diagnosed hyperthyroidism. I have it on good authority that after radioactive iodine treatment “S” was never the active, efficient, super technician he had been. I doubt there has ever been another occasion where a thyroid problem was diagnosed with the doctor lying supine on the floor and the patient upright.

Even if Dr. Fantus did not establish the first blood bank in the world he definitely created the most unique one.

References

1. Hillyer CD, Silberstein LE, Ness PM, Anderson KC, Roback JD (Eds) 2007. Blood Banking and Transfusion Medicine: Basic Principles and Practice, 2^nd. Edition. Philadelphia PA, Churchill Livingstone Elsevier.
2. Telischi M: Evolution of Cook County Hospital blood bank 1974. Transfusion 14;623-628.
3. Moss GS, Valeri CR, Brodine CE 1968. Clinical experience with the use of frozen blood in combat casualties. New Eng J Med 278;747-752.