If you give blood, usually it goes into a plastic bag in a fridge until someone needs it. But when you’re deep in the countryside or tundra or out at sea, there’s no hospital—and no blood bank.
So a Pacific Northwest blood network is developing a backpack kit that "takes the banking out of blood banking.”
If you were a fan of the old TV series M*A*S*H, you might remember episodes where the Army field hospital surgeons performed life-saving blood transfusions. In one later episode, guest star Patrick Swayze plays a young soldier who volunteers to donate blood to a critically ill comrade who coincidentally has the same blood type.
"That sort of makes us blood brothers," Swayze's eager character tells the attending physician.
The medical procedure the plot revolves around is in fact sometimes called a "buddy transfusion.” Combat medics have trained how to do this for decades. They rapidly collect and transfuse blood on scene after making a match between donor and patient.
Now the technique is bleeding over into the civilian world where it could potentially save tens of thousands of lives every year.
‘A walking blood bank’
"The military was indeed our model for thinking of how to implement a walking blood bank,” said Linda Barnes, chief operating officer at Bloodworks Northwest in Seattle, formerly the Puget Sound Blood Center.
"Blood banking of stored blood certainly is not going away anytime soon,” Barnes said. “But in low resource settings having banked blood available—and the logistics and the refrigeration required—simply isn't feasible in the near term."
Barnes does a lot of international consulting about strengthening blood systems in places such as Ivory Coast, Kenya, Ukraine and Caribbean islands. One thing from those trips that nagged at her was how many patients in the developing world die each year for lack of blood. Especially women giving birth in developing nations. Nearly 100,000 new mothers perish from profuse bleeding after childbirth alone each year, according to the World Health Organization.
Barnes and a colleague, Dr. Meghan Delaney, challenged themselves if they could build a simple, self-contained blood transfusion kit in a shoebox.
"It felt like doing system strengthening wasn't enough. We weren't getting where we wanted to go," Delaney said.
Thus was born the BloodPak prototype, although it morphed into a backpack-sized kit.
Prototypes and feasibility testing
"We have a donor blood collection system. We have blood typing and disease testing test kits,” Barnes said as she unpacked and explained the many off-the-shelf components stuffed in the padded backpack.
There’s no refrigeration needed for any of this. The Bloodpak comes with step-by-step guidance on a smartphone app. That phone could also be used to send a mass text to registered villagers to come to their clinic to give blood in an emergency—in theory.
"It's one thing of course to have an idea,” Barnes said. “It's another thing to translate it into a practice."
Recently, Bloodworks Northwest demonstrated their prototype to another potential customer, a Seattle company called Remote Medical International. The fast-growing company supplies medical personnel and support for isolated work places.
RMI Clinical Operations Director Loreen Lock foresaw a variety of use cases on oil and gas exploration projects for example, or mining, construction and by military contractors. One thing she brought up was informed consent and the advance legwork that might be needed to deploy this in a civilian setting.
"Part of the discussion evolved into how to do that in the developing world where there are social concerns, religious concerns,” Lock said. “What does the local medicine man, if you will, think of the whole concept? Are they willing to sign off on it or not?"
Bloodworks Northwest just learned they are in line for a roughly $500,000 grant from the British foreign aid department. That will launch the next phase of product development: feasibility and acceptability testing at four rural clinics in western Kenya beginning early next year.
Assessing product demand, Lock says there is undoubtedly great need in sub-Saharan Africa for a portable blood transfusion kit to address postpartum hemorrhaging.
"But the challenge is, is there a market there? There is a difference in that, because can those clinics afford to buy the pack or would it be donors - like foundations or charities - that are purchasing for them?"
Lock said the industrial customers of her medical services company have many fewer people to protect in remote settings, but do have the financial resources to prepare for rare traumas.
"In our sense, the need may be a little bit less, but potentially there is a higher market there," Lock said of the industrial/military arena where RMI operates.
Transfusions at sea
Lock noted that Chinook Medical Gear, a Colorado-based military and law enforcement supplier, has already expanded into the civilian space with blood transfusion kits similar to the Seattle-developed BloodPak, but without smartphone-based user guidance.
Royal Caribbean Cruises Ltd. has equipped all of its ships to do buddy transfusions at sea. In an email, a spokesperson for the Florida-based cruise line wrote that its medical staff assembles its own blood transfusion kits with components sourced from various medical supply companies.
Royal Caribbean Cruises started to do blood transfusions at sea in 2010. In an emergency, the captain comes on the intercom to ask people with blood donor cards to come to the ship's health clinic. The use of on-board donors has saved lives of passengers suffering uncontrolled gastrointestinal bleeding where timely evacuation to shore was not possible. Keeping blood plasma on board for such situations was judged impractical.
Barnes estimated the portable transfusion kit under development by Bloodworks Northwest would cost around $300 once in mass production. A BloodPak contains enough supplies to collect blood from six donors.
Barnes said her team has identified clinics and partners for further field testing in Nepal and Uganda. After the validation phase, she said Bloodworks Northwest would likely partner with a medical supply chain company to commercialize the product.