BLOOD BANKS MARK 80TH ANNIVERSARY

April 5, 2017 • By James Berger, Senior Advisor for Blood and Tissue Policy, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services and Elizabeth Phelan, Fellow, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services

Jim Berger, MS, MT (ASCP), SBB, Senior Advisor for Blood Policy

Earlier this month, we marked the 80^th anniversary of the world’s first blood bank. It’s hard to overstate the importance of blood banking in the history of modern medicine, or the changes that have occurred in blood banking and transfusion in the last century.

Today, blood collecting centers collect and screen blood for infectious diseases, and blood banks store blood, ensuring that blood is available when patients need it for transfusions or other medical procedures. On average, every two seconds someone in the U.S. receives a blood transfusion. Today, the nation’s approximately 3,400 blood banks play a vital role in our nation’s healthcare system. Blood collecting centers carefully screen all donated blood for hepatitis B, hepatitis C, HIV, Zika, and other viruses and infectious agents. Ensuring that safe blood and tissue products are available when they are needed is important to the health and wellbeing of Americans. In addition to the HIV and viral hepatitis activities you may be familiar with, the Office of HIV/AIDS and Infectious Disease Policy coordinates HHS activities related to blood and tissue safety and availability.

Dr. Bernard Fantus (photo courtesy of Smithsonian Institution Archive.) Image #SIA2008-0526

Eighty years ago, Dr. Bernard Fantus established the first blood bank at Cook County Hospital in Chicago, Illinois, on March 16, 1937. This blood bank allowed blood to be stored for a then-unheard of 10 days inside the hospital. This technical achievement was a drastic improvement over the standard practice of the era: direct blood transfusion from donor to patient. Prior to blood banks, a roster of volunteer blood donors was kept at hospitals, with both their blood type and phone number. When a patient needed blood, the hospital would call one of these volunteers and ask them to rush to the hospital to donate. However, with the establishment of blood banks, donors could instead donate at their convenience and doctors no longer had to scramble to find a matched donor for their patients. Now blood banks could maintain an inventory of different blood types, available when needed. Dr. Fantus’ blood bank was nothing short of revolutionary.

Since Dr. Fantus’ innovation, blood banks have become the standard worldwide and each year, almost 5 million Americans alone need blood transfusions. Doctors and patients alike rely on the readily available supply of blood for treatments of a wide range of diagnoses. Blood banking has also allowed for the development of many surgeries common today, which would have been impossible without it. In addition to acute illness, millions of people who suffer from blood disorders benefit from frequent blood transfusion or blood-derived products.

The technology of blood banking has come a long way as well. In Dr. Fantus’ time, whole blood could be stored for only 10 days; today it can be maintained for up to 35 days. When blood is split into its components, standard practice today, red blood cells can last up 42 days and plasma can last up to one year. Our knowledge of blood types has expanded too, improving cross-matching and reducing severe reactions.

The layers of safety built into our systems for collection and storage of blood have also evolved substantially over the decades since the establishment of that first blood bank. For example, when Dr. Fantus started banking blood, no screening tests for infectious diseases had been developed. Indeed, most of the blood-borne infectious diseases that we are most concerned about today had yet to be discovered. Today, we have comprehensive system for making sure that blood is safe. It includes donor eligibility criteria and screening questions (e.g., health history, risk behaviors, travel), donor deferral guidelines, and testing donated blood for infectious agents, including HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), Zika, and other infectious agents.

These protections have eliminated the spread of known infections by blood transfusion. Many people in the United States and around the world contracted HIV from a blood transfusion or blood products before testing became available in 1985 and blood products used by hemophiliacs were sterilized with heat. In the U.S., it is estimated that more than 14,000 persons have contracted HIV from blood or blood products, most of them prior to 1985. Now, the risk of contracting HIV from a blood transfusion is extremely low. According to NIH’s National Heart, Lung, and Blood Institute, the risk of catching a virus from a blood transfusion is very low. Your risk of getting HIV from a blood transfusion is lower than your risk of getting killed by lightning. Only about one in 2 million donations might carry HIV and transmit HIV if given to a patient. Because of this success and the continued improvement of HIV screening tests, the FDA has changed its donor deferral rules for men who have sex with men.

“The safety of the blood supply has significantly improved since the advent of blood banks in 1937. While performing their life-saving work ensuring that safe blood and blood products are available in all states, blood banks also have been partners throughout our national responses to HIV and viral hepatitis,” noted Dr. Richard Wolitski, Director of the HHS Office of HIV/AIDS and Infectious Disease Policy. “The blood supply is an invaluable resource that exists for the public good. I am worried today, however, that economic conditions are changing and that the survival of some of these blood collecting centers could be at stake. This is an issue that is being assessed by the Advisory Committee on Blood and Tissue Safety Availability that advises the Secretary of Health and Human Services as well as the Blood, Organ, Tissue Senior Executive Council that coordinates these efforts across HHS.

In addition to economic issues, blood centers are certain to face new and unknown challenges as new infections emerge that are transmitted by blood, blood products, and tissue. The field is looking ahead to solutions that might allow blood centers to prevent transmission of new infections even before they have been recognized.

One of those new technologies is pathogen inactivation technology, which is making the blood products safer yet. This pathogen inactivation process destroys many viruses, including HIV, HBV, and HCV. In principle, pathogen inactivation technologies have the potential to make the blood supply safe by broadly reducing or eliminating infectious organisms without the need to screen or test for specific pathogens. Currently, the FDA has only approved pathogen reduction technology for platelets and plasma. Work is being conducted to obtain pathogen reduction technology for red blood cells and whole blood. This is important as it would destroy pathogens from donors who do not appear symptomatic for known infectious diseases as well as any emerging infectious disease where a screening test has not yet been identified.

Although it is not clear what opportunities and challenges the future will bring, the next 80 years of blood banking are certain to be as transformative as Dr. Fantus’ innovation. But one thing is certain: the life-saving work that lies ahead will be built upon his revolutionary idea to start a blood bank and on the commitment and hard work of the dedicated people who operate the nation’s blood centers that continue that work today.