5 ms·

Blood is highly complicated. I think the HN audience understands it at a level of "blood is red cells, white cells, and platelets", but that's really not the w

by bdg 4y ago

Blood is highly complicated. I think the HN audience understands it at a level of "blood is red cells, white cells, and platelets", but that's really not the whole picture. Blood also has plasma which is composed of gas, nutrients, proteins, ions, and water. We can actually refine blood plasma down to a state where it's basically 100% safe even if someone with "bad blood" donated it. These 4 different blood components all get seperated at the lab, frozen for storage, and turned into individual products which can be mixed+matched depending on medical need. Don't get me wrong, growing red cells in a lab is awesome, but I don't see it the same way a lot of comments in this thread do (solving a storage issue, saving a lot of lives, etc). I think the realistic applications of lab-grown-blood over the next 15 years will be closer to treating rare diseases or possibly rare blood types (some people exist outside the typical A, B, AB, O groupings). I don't see this fixing logistics or supply/demand issues in the next 15 years, especially with how highly regulated the blood supply is in any first world nation.

cookieswumchorr 4y ago
the application i immediately thought about is disaster medicine. This is when you need huge amounts of blood, and my guess is that it can be less perfect, when there is simply no other choice to save lives. An inferior substitute is better than nothing
- 6stringmerc 4y ago
  Yeah field work sounds great for this! Stabilize then treat. Good observation.
- est31 4y ago
  What about coagulation? It is needed in situations where you have acute blood loss, and plasma contains the coagulation factors. You already probably want to give your patient coagulants in such a situation but I don't know if those are enough on their own or they need cooperation from existing factors in the plasma.
- kibwen 4y ago
  I think it might be the opposite, actually. In a disaster, when you need a sudden surge of supply, you're not going to have time to scale up your production. Even if we had reliable supplies of synthetic blood, I think disasters are always going to call for mass donations from the old-fashioned blood producers.
  - deleted 4y ago
    [deleted]
  - Forgeties79 4y ago
    > I think disasters are always going to call for mass donations from the old-fashioned blood producers. Maybe I’m parroting an incorrect bar top factoid, but isn’t it usually the case that they need the blood before the disaster? That when events like 9/11 occur and people rush to donate blood, it’s not actually going to do much for the immediate problem?
    - ebiester 4y ago
      Yes and no. It won't do much for the immediate problem, but you're about to go through a lot more blood and will need to replenish the stores.
    - tyre 4y ago
      With 9/11 specifically it didn’t do much for the immediate problem because there wasn’t much need for blood. People crushed under the weight of the towers weren’t bleeding out, they were just dead.
- Cthulhu_ 4y ago
  That's also where blood plasma comes in, which can be donated once a month (as opposed to blood which is only a few times a year). I mean if this can be scaled up to producing gallons an hour in the field then sure, but we're a ways away from that still.
bearmode 4y ago
There is a LOT more to blood! There are a total of 36 different blood group systems, with the most important being the ABO group that everyone knows gives you your A, B, O, or AB blood, and the (RHD gene of the) Rh group that gives you the + or - part of it. When given a single transfusion, a patient can usually be given blood based on the ABO and +/- part of the Rh groups alone, but there's more to the Rh system than most people know. As well as the RHD gene, there's also the RHCE gene. The RHD gene can either be present (D, gives you positive blood) or not present (d, gives you negative blood), but the RHCE gene can give you one of four variations of the C, c, E and e antigens. When the two genes combine, you can have any of the following combinations: Dce, DCe, DcE, DCE, dce, dCe, dcE, dCE (which were given simplified names: Ro, R1, R2, Rz, r, r', r", ry respectively). When patients have to be given regular blood transfusions, especially on a long-term basis, the blood they receive has to be more precisely matched. That's often why there's always a huge push for black donors - because many black people suffer from sickle cell anaemia, for which the treatment is regular blood transfusions, they need blood that better matches their own.
- junon 4y ago
  This is fascinating, thanks for sharing. Are there more groups than just A, B and O?
  - bearmode 4y ago
    The ABO group system relates to a gene called ABO, which gives you your A, B, AB, or O type. I'm not aware of any other blood types in that system (though I'm just an eager blood donor, not a haematologist). There are lots of other systems though that add up to make your blood what it is. There's the Rhesus (Rh) system I mentioned before, but the main ones also include the MNS system, the P system, the Lutheran system, the Kell system, the Lewis system, the Duffy system, and the Kidd system. As far as I know, Kell is the third most immunogenic system after ABO and Rhesus.
  - roywiggins 4y ago
    They apparently discover new sets of blood groups every few years, there are some vanishingly rare types. https://www.wired.com/story/new-blood-types/ https://www.wired.com/story/new-blood-types/
Blikkentrekker 4y ago
> We can actually refine blood plasma down to a state where it's basically 100% safe even if someone with "bad blood" donated it. Do you have a source on this? Given that many blood donation facilities still refuse many “risk groups”, which honestly always carried the stench of politics to me how arbitrarily they are selected, from donating blood?
- bdg 4y ago
  I'm concerned that someone might take my previous statement and assume this means all blood donations are safe -- they're not. Without a bunch of steps in place they're horrifyingly risky, and our screening technology is not good enough. I'll explain more in a moment. To answer your direct question, in Toronto there was a doctor who wanted to open a pay-for-plasma clinic like they have in the US. In Canada, blood donations are not paid for which is one of the core reasons the supply is considered to be safer than other first world countries. The regulators shut it down and stopped him, not because of cleaning the plasma from the blood, but for policy reasons. Back to the point about safe blood... Being a person who is allowed to donate blood is not related to this cleaning process but statistics about risk and also related to costs. So this is part of why there are no plasma clinics in Canada. The blood donation is tested, but the tests don't catch everything. Really horrible diseases can test negative, which is why the process to donate blood includes an interview to categorize a high risk donor. This is why they don't let you donate blood when you have been living in europe for many years, have tattoos, multiple sexual partners, or had male-with-male sex. A lot of people hear about this and are totally outraged and jump to assumptions that the blood donation system is stuck in some anti-gay-rights 1900s puritan mindset, but that's not what's going on. People regularly walk into blood donor clinics, lie about their high risk factors because they want to "prove a point", the tests for things like HIV can't always catch it all the time (especially in early stages; stages where there are no symptoms), and one blood donation could actually make it to several other people (like a baby, a motorcycle accident victim, and a surgery patient). It happens regularly enough that your nation's blood supply has a "lookback/traceback" program where they have 10-100 people who sit there all day working on cases and sending letters to people who received bad blood, and it can even come up 5+ years later when someone who donated blood in 2015 just got a diagnosis in 2020, all those people in the "bloodline" get notified, banned from the system, and advised to get tested too. Doctors depend on multiple layers of checks to keep the blood supply clean, one of them is a statistical layer, one is a testing layer, one is the processing to keep the blood clean/safe, another is policy. Please don't interpret my point about plasma being highly cleanable to mean that all blood components in general can be safely received from the homeless.
WeylandYutani 4y ago
Don't homeless people in America sell their blood for money? Was a bit of a scandal when it ended up in my country. Might as well buy organs from the Chinese lol.
- cguess 4y ago
  You can donate plasma for money, yes. It's not just homeless people, rarely it is. College students trying to make drinking money and such are very common. It's considered less exploitative because the cells are pumped back in, with just the plasma being kept for later use. You cannot sell whole blood donations though by law, that's all volunteer.
- CapitalistCartr 4y ago
  Yes, plasma. I did it when I was poor(er). It's hard as we age, but it pays.
  - kulahan 4y ago
    I did this when I was young. I used to joke that all my furniture was paid for with "blood money". Years later I read a report that there were some negative side-effects being discovered for people who donated for very long periods of time, so I guess I'm glad I stopped. Looking back, the idea of selling body parts, even if it's "just plasma" still feels icky to me.
- pkaye 4y ago
  US is one of the 5 countries (US, Germany, Austria, Hungary and Czesh Republic) that pays for plasma donations. It represents 60%+ of plasma donations worldwide. Most other countries other than the 5 don't sufficiently produce plasma domestically to supply their needs and must import it. It appears some compensation is needed for people to donations sufficiently. The Plasma is broken down it various components used to treat all types of diseases. During the pandemic there were all kinds of worldwide shortages of plasma products because US plasma donations went down. Other countries should reconsider their approach to plasma donations to reduce risks of shortages. https://www.euractiv.com/section/health-consumers/news/us-blood-shortage-crisis-leaves-eu-patients-vulnerable/ https://www.euractiv.com/section/health-consumers/news/us-bl...

by bdg 4y ago

cookieswumchorr 4y ago

the application i immediately thought about is disaster medicine. This is when you need huge amounts of blood, and my guess is that it can be less perfect, when there is simply no other choice to save lives. An inferior substitute is better than nothing

6stringmerc 4y ago
Yeah field work sounds great for this! Stabilize then treat. Good observation.
est31 4y ago
What about coagulation? It is needed in situations where you have acute blood loss, and plasma contains the coagulation factors. You already probably want to give your patient coagulants in such a situation but I don't know if those are enough on their own or they need cooperation from existing factors in the plasma.
kibwen 4y ago
I think it might be the opposite, actually. In a disaster, when you need a sudden surge of supply, you're not going to have time to scale up your production. Even if we had reliable supplies of synthetic blood, I think disasters are always going to call for mass donations from the old-fashioned blood producers.
- deleted 4y ago
  [deleted]
- Forgeties79 4y ago
  > I think disasters are always going to call for mass donations from the old-fashioned blood producers. Maybe I’m parroting an incorrect bar top factoid, but isn’t it usually the case that they need the blood before the disaster? That when events like 9/11 occur and people rush to donate blood, it’s not actually going to do much for the immediate problem?
  - ebiester 4y ago
    Yes and no. It won't do much for the immediate problem, but you're about to go through a lot more blood and will need to replenish the stores.
  - tyre 4y ago
    With 9/11 specifically it didn’t do much for the immediate problem because there wasn’t much need for blood. People crushed under the weight of the towers weren’t bleeding out, they were just dead.
Cthulhu_ 4y ago
That's also where blood plasma comes in, which can be donated once a month (as opposed to blood which is only a few times a year). I mean if this can be scaled up to producing gallons an hour in the field then sure, but we're a ways away from that still.

bearmode 4y ago

There is a LOT more to blood! There are a total of 36 different blood group systems, with the most important being the ABO group that everyone knows gives you your A, B, O, or AB blood, and the (RHD gene of the) Rh group that gives you the + or - part of it. When given a single transfusion, a patient can usually be given blood based on the ABO and +/- part of the Rh groups alone, but there's more to the Rh system than most people know. As well as the RHD gene, there's also the RHCE gene. The RHD gene can either be present (D, gives you positive blood) or not present (d, gives you negative blood), but the RHCE gene can give you one of four variations of the C, c, E and e antigens. When the two genes combine, you can have any of the following combinations: Dce, DCe, DcE, DCE, dce, dCe, dcE, dCE (which were given simplified names: Ro, R1, R2, Rz, r, r', r", ry respectively). When patients have to be given regular blood transfusions, especially on a long-term basis, the blood they receive has to be more precisely matched. That's often why there's always a huge push for black donors - because many black people suffer from sickle cell anaemia, for which the treatment is regular blood transfusions, they need blood that better matches their own.

junon 4y ago
This is fascinating, thanks for sharing. Are there more groups than just A, B and O?
- bearmode 4y ago
  The ABO group system relates to a gene called ABO, which gives you your A, B, AB, or O type. I'm not aware of any other blood types in that system (though I'm just an eager blood donor, not a haematologist). There are lots of other systems though that add up to make your blood what it is. There's the Rhesus (Rh) system I mentioned before, but the main ones also include the MNS system, the P system, the Lutheran system, the Kell system, the Lewis system, the Duffy system, and the Kidd system. As far as I know, Kell is the third most immunogenic system after ABO and Rhesus.
- roywiggins 4y ago
  They apparently discover new sets of blood groups every few years, there are some vanishingly rare types. https://www.wired.com/story/new-blood-types/ https://www.wired.com/story/new-blood-types/

Blikkentrekker 4y ago

> We can actually refine blood plasma down to a state where it's basically 100% safe even if someone with "bad blood" donated it. Do you have a source on this? Given that many blood donation facilities still refuse many “risk groups”, which honestly always carried the stench of politics to me how arbitrarily they are selected, from donating blood?

bdg 4y ago
I'm concerned that someone might take my previous statement and assume this means all blood donations are safe -- they're not. Without a bunch of steps in place they're horrifyingly risky, and our screening technology is not good enough. I'll explain more in a moment. To answer your direct question, in Toronto there was a doctor who wanted to open a pay-for-plasma clinic like they have in the US. In Canada, blood donations are not paid for which is one of the core reasons the supply is considered to be safer than other first world countries. The regulators shut it down and stopped him, not because of cleaning the plasma from the blood, but for policy reasons. Back to the point about safe blood... Being a person who is allowed to donate blood is not related to this cleaning process but statistics about risk and also related to costs. So this is part of why there are no plasma clinics in Canada. The blood donation is tested, but the tests don't catch everything. Really horrible diseases can test negative, which is why the process to donate blood includes an interview to categorize a high risk donor. This is why they don't let you donate blood when you have been living in europe for many years, have tattoos, multiple sexual partners, or had male-with-male sex. A lot of people hear about this and are totally outraged and jump to assumptions that the blood donation system is stuck in some anti-gay-rights 1900s puritan mindset, but that's not what's going on. People regularly walk into blood donor clinics, lie about their high risk factors because they want to "prove a point", the tests for things like HIV can't always catch it all the time (especially in early stages; stages where there are no symptoms), and one blood donation could actually make it to several other people (like a baby, a motorcycle accident victim, and a surgery patient). It happens regularly enough that your nation's blood supply has a "lookback/traceback" program where they have 10-100 people who sit there all day working on cases and sending letters to people who received bad blood, and it can even come up 5+ years later when someone who donated blood in 2015 just got a diagnosis in 2020, all those people in the "bloodline" get notified, banned from the system, and advised to get tested too. Doctors depend on multiple layers of checks to keep the blood supply clean, one of them is a statistical layer, one is a testing layer, one is the processing to keep the blood clean/safe, another is policy. Please don't interpret my point about plasma being highly cleanable to mean that all blood components in general can be safely received from the homeless.

WeylandYutani 4y ago

Don't homeless people in America sell their blood for money? Was a bit of a scandal when it ended up in my country. Might as well buy organs from the Chinese lol.

cguess 4y ago
You can donate plasma for money, yes. It's not just homeless people, rarely it is. College students trying to make drinking money and such are very common. It's considered less exploitative because the cells are pumped back in, with just the plasma being kept for later use. You cannot sell whole blood donations though by law, that's all volunteer.
CapitalistCartr 4y ago
Yes, plasma. I did it when I was poor(er). It's hard as we age, but it pays.
- kulahan 4y ago
  I did this when I was young. I used to joke that all my furniture was paid for with "blood money". Years later I read a report that there were some negative side-effects being discovered for people who donated for very long periods of time, so I guess I'm glad I stopped. Looking back, the idea of selling body parts, even if it's "just plasma" still feels icky to me.
pkaye 4y ago
US is one of the 5 countries (US, Germany, Austria, Hungary and Czesh Republic) that pays for plasma donations. It represents 60%+ of plasma donations worldwide. Most other countries other than the 5 don't sufficiently produce plasma domestically to supply their needs and must import it. It appears some compensation is needed for people to donations sufficiently. The Plasma is broken down it various components used to treat all types of diseases. During the pandemic there were all kinds of worldwide shortages of plasma products because US plasma donations went down. Other countries should reconsider their approach to plasma donations to reduce risks of shortages. https://www.euractiv.com/section/health-consumers/news/us-blood-shortage-crisis-leaves-eu-patients-vulnerable/ https://www.euractiv.com/section/health-consumers/news/us-bl...