Sign Mississippi Banking Medical History Safe

Industry sign banking mississippi medical history safe

uh my talk today is also going to be a little bit on the fun side it's about blood transfusions so what got me started down this track is this letter from the uh uh uh that's basically a uh three different agencies aabb american blood centers and the american red cross so it's a joint letter and it was sent to the commissioner of the food and drug administration stephen m hahn md and you can read this you know later at your at your leisure but i'll just go ahead and sort of up did i get to it yeah did i have it on there yeah okay um but i'll just do some summarizing if i can um so the letter says that basically they want to maintain a safe and adequate blood supply and it's critical to the health objective need for blood is still there reduced need because of halting of elective cases so that kind of helped out a little bit trauma cancer emergency procedures still are going to exist though i imagine trauma went down a little bit since everybody was staying home these stay at home orders um less people shooting each other uh coveted patients on ecmo will certainly have a need now that wasn't in the letter that's my own editorialization you have patients on ecmo long term there's a good good chance they're going to need a blood transfusion at some point in time donations have been adversely impacted for example schools churches community centers all closed so they're blood drives really and as of march 16th the blood industry and this is their word industry and i put it in quotes as well has seen 000 canceled blood drives me that that that equal essentially 130 000 fewer donations so the potential for more blood drive cancellations was concerning the joint task force on this fewer healthy donors because people were having you know covid and there was a problem um with them getting there because they're sick absenteeism of staff the people that actually run them their ability to draw the blood uh was going to be a problem blood will continue to be needed even as the outbreak grows they pointed out it's a life-saving thing reagents for type and cross match and antibody status were going to be in short supply and they really need to get the message to blood donations to be rather that blood donations are not social gatherings and for the government to do more with messaging so the three the three from the task force the aabb the american blood banks american red cross all said to the to the to the commissioner of the fda you all need the message to let people know that this is not a social gathering we need blood very important so before i get started on the history of blood banking i just want to point out some things trauma continues to be the predominant cause of death for individuals up to the age of 44 years old there were a reported 1.2 million deaths due to road accidents traffic accidents in 2018 globally and even though traumatic brain injury is the leading cause of death from trauma exsanguination continues to play a significant role among patients who arrive at the emergency department for trauma hemorrhage is the leading cause of death within the first hour within the first 24 hours of arrival to the emergency department nearly 50 percent of deaths and are a result of hemorrhage trauma patients also require large amounts of hospital resources and are responsible for using approximately 70 percent of all blood transfused at a trauma center now you look at cardiac surgery and blood transfusions we use about 20 to 25 percent of the nation's blood supply just for cardiac surgery so cardiac surgery and trauma consume a lot of blood transfusions also place a high burden on the cost of treatment one study found this was from england that in the traumatic patient nearly 12 of their total financial cost was due to transfusions thank god they have socialized medicine transfusion protocols from donated cross-matched blood remain the standard of treatment for the hemorrhagic patient although it is not without risk and potential adverse side effects transfusion of donated blood carries the risk of you just described many of them disease transmission citrate toxicity hyperkalemia hypothermia acidosis sepsis respiratory failure and thrombotic complications that's a mouthful for these reasons autotransfusion has widely been known as an alternative or adjunct to cross-match transfusion therapy with fewer risks auto transfusion has not always been a safer procedure however the first known documented procedure of auto transfusion was performed in 1818 by dr james blundell i'm going to show you a picture of him and something about his work don dr blondel b or blondel excuse me became frustrated by the loss of a patient due to uterine hemorrhage blood transfusions have been attempted for many years before dr blundell but he was the first to successfully attempt it from experimentation with canine specimens later he would try his procedure on humans but not without risk the estimated mortality rate from his procedure was a whopping 75 percent thanks to modern advancement of obviously infiltration and sterile techniques and of course you know cell cell salvage machines auto transfusion is widely accepted as a relatively safe procedure so i wanted to lay that foundation if i could but this whole thing started 2500 bc and here's a tomb from egypt on bloodletting or there's not an image but it's just a statement of that but it was though bloodletting was often recommended by physicians it was carried out by barbers eventually symbolized by the red and white stripe barber pole that we're used to seeing today 1897 of course bram stoker has published the dracula taking from blood from other living beings to sustain life of the undead and by the 1800s it was being seriously questioned bloodletting as a good therapy although some people still did believe in it okay and some of it persisted even into the 20th century in 1492 is the first historical transfusion attempt now this is great this is classic so they needed to save pope innocent the eighth so they took three ten-year-old boys they took their blood and infused it into the pope's mouth as he sank into a coma the pope and the boys all died so that's the first historical transfusion attempt in 1667 the first recorded human transfusion uh was documented taking human blood transfusions uh administered in france king louis the fourth doctor transfused blood of a sheep so here is a essentially a xenotransfusion into a 15 year old boy who survived in 1818 the first human to human transfusion was done and this was dr blundell who i just described and there's a picture of dr blundell on the right side so it was 12 to 14 ounces of blood the patient did die though after initially showing improvement of course there was no typing yet we didn't know about antibodies there was a lot of factors involved who knows why the patient actually died but certainly it makes you question what what happened there it wasn't until 1901 that the three main blood groups were discovered it wasn't until 1902 that the fourth blood group a b was identified and it was 1907 when cross matching was finally utilized in 1914 was the first non-direct transfusion what do i mean by that prior to this it was taken directly from the patient into the recipient this was put in a receptacle of some sort uh anticoagulated with sodium citrate and then given later so that's why they call it a non-direct transfusion and in 1917 i'm sure everybody saw the movie 1917 the battle of cambray in world war one the first blood depot was established to prepare for that black battle with uh oh blood uh with the citrate glucose solution because they knew there was going to be massive casualties and massive blood loss at this battle of combre in 1922 blood donor service established in london in 1930 was the first network of blood facilities and in 1935 the first in-hospital blood facilities came into being at the mayo clinic of course in rochester minnesota 1936 barcelona blood transfusion service and that was for the spanish civil war 1937 the term blood bank came to be in 1939 to 40 there was a discovery of the rh blood group so prior to that you didn't know if it was negative or positive so from 1900 1901 with or 1901 and 1902 for the a b type it wasn't until 1939 1940 they discovered about the rh factor positive or negative 1940 u.s sends blood plasma to great britain this was again during the war second world war 1941 red cross organizes blood plasma war effort 43 transfusion transmitted hepatitis is first described 1947 american association of blood banks has founded 1948 development of the plastic bag prior to that it was bottles 1962 america's blood centers are founded 64 community blood center established 71 the cbc moves to current location in dayton ohio 1965 cryo precipitate is developed 71 the fda finally starts to regulate this stuff and in 1971 it is finally tested for hepatitis b 1981 the first case of aids transmission through a blood transfusion 1982 the blood-borne theory blood-borne pathogen theory is established 1983 the ides of aids viruses isolated 84 viruses identified and in 85 the first aids blood screening test is done to make sure that the blood you're getting is not contaminated with hiv 1990 1990 i'm sorry 1999 they started doing nucleic acid amplification testing or nat testing making it more thing but uh but at the end of the day no conversation about blood banking can go finished without talking about charles drew charles drew as you can see here he was an american physician and a physiologist he helped to develop the storage and transportation of fresh frozen plasma which would be needed for the war effort he was the first director of the american red cross blood bank not the american red cross american red cross blood bank very important in 1941 but he resigned from his posts after informed that the military ruled that blood of african americans would only be accepted but would have to be separated or segregated from that of whites and charles drew happened to be african-american so that's pretty damning as far as i'm concerned that's a real it's a real crummy fun fact but what i think that should be said it there was a story that is mythical but it's a story that he was in a car accident because he died very young i think he was 45 years old when he died um he was a very young man uh in 1950 that he supposedly died by being refused blood transfusion somewhere in mississippi ever or automobile accident but that is not a true story so this is a very important slide and why it's important is it shows two things it shows that blood availability i can't get my mouse to work there you go there you go the green are transfused units the red are distributed units or supply now you can see here the amount distributed and the amount used were super tight in 2013 a little bit better here but basically this range is very very narrow and now that's one thing it shows you the other thing it shows you is that as need increases blood drives advertising all the things that marketing that happens usually follows and you're able to get the blood that you need but the blood banks were certainly concerned with covid and how that was going to affect their ability to provide services now blood is an industry and i called it an industry they called it an industry this is very important three non-profit organizations dominate the 2 billion american market for whole whole blood the industry leader is the red cross it has 53 regional blood centers that collect more than half of the nation's blood supply or 6.5 million units a year the red cross's blood services division last year had 741 million in revenues and 14 million in tax-exempt profits meaning excesses of revenues over expenses total revenues raised for its relief services were additionally about 945 million dollars last year this is in 20 i believe 16. so the product that they get and john you pointed this out to me last night the product that they get is a donation now there are costs you got to have the bag you got to have the people you have to have the infrastructure you have to have the van you have to do all the testing you have to have the refrigerators for the storage there certainly are costs associated with obtaining the blood but the product itself is a donation it costs them nothing you pointed that out to me last night they still are under a lot of pressure they rely on donations they have to assure the safety testing 42 days for rbcs but only five days for platelets so these products keep having to be replenished they don't you don't get a product from a patient and you know you're going to use it in fact i didn't put it in here because the talk would go too long but there's a lot of blood gets thrown away preservation and distribution of course are a big thing so we can go into a discussion but there's my talk very interesting joe some neat stuff very neat stuff most of that i had not heard good you heard something new but we talked last night and you had some passion in fact you got me you got me spun up because of your your passion about the uh about blood banking do you do do you want to discuss it since we're here if you want me to oh yeah it's controversial i'm sure but i love controversy that's what controversy sells i have said this to a number of people uh and i have found probably 50 50 at least 50 percent of people that agreed with this point of view and 50 who perhaps did not but the the thing that i've always found unusual and i guess interesting is that the blood banking industry is the only industry that i've ever heard of whose core raw raw product is given to them for free now quickly people run out and say yeah but what of all the buses and the people working and the processing and the screening and the expiration of the thing um yeah the best thing that i could compare this to is the oil industry their raw product needs enormous refinement it needs enormous expense to put wells in tens of hundreds of millions of dollars then they have to pump it from the ground and it's in no condition to be used it's raw crude the refinement that goes on is is huge expense probably 70 80 percent of the cost is refining this crude that comes from the ground so it can be auto fuel and jet fuel and all the different lubricants it's an incredible process incredibly expensive but they don't get it for free i don't know any industry that gets a product for free now here's the thing if if you had not just showed me how incredibly profitable this industry is i might have some sympathy for that they are enormously profitable and and and if you look at the fact that yes they have a lot of costs but what they get paid for their product is enormously profitable they can have a certain percentage of their product go to waste they can have these million dollar buses to go all over the country all over the place doing outside blood drives and all the things that are involved i'm sure it's an enormous operation the screening and everything but the profit that they make from a unit of blood is enormous it's up there with the pharmaceutical industry and the and the uh oil industry companies and you just demonstrated that so you know my only beef is that when they're constantly on the tv saying there's a blood shortage and begging people to come in and donate two hours of their time to donate blood which by the way that's no small needle they stick in your arm for two hours and and they send you away with two crackers and a small three ounces of orange juice on your merry way um you know to me if they were to look into something that would incentivize you know people to donate blood in a better way they would probably never have a shortage yeah that's that's really good so i remember i remember what i remember years ago um and it was a lot of years ago the drill sergeant came in and said that uh he needed volunteers and uh if you were gonna volunteer you had to go over there form a line and uh if you didn't want to volunteer you could stay behind and have a barracks party and uh i was i was not really too dumb a night a of a kid and uh i was like a party okay there's nothing about this place thus far that would make me believe they're gonna have a party so i went over to the volunteer line i didn't know what it was gonna be but i knew it couldn't be as bad as what was gonna happen and uh they put us they heard us on a bus and took us to the hospital and all of us donated blood which was a well listen you can knock it but i'm going to tell you what at that point in time i don't know if that nurse was pretty or not she looked beautiful to me at the time or whoever she was sticking that needle in me but for the orange juice and the cookie that came after and getting to look at her for a short period of time it was well worth the the size needle they stuck in my arm in fact they could have had two when we got back the folks that stayed for the barracks party were still working at the barracks party involved taking cleanser a bucket of water and a toothbrush and scrubbing all of the cracks between the boards of the flooring and the walls and uh they were gonna be there for a long long time they didn't get done that whole night they didn't get done they were they worked all the way until the next day i'm not sure the relevance of that but i thought i'd tell the story that's great i can tell you a story when i was in college um and this might have been when it first came out you remember when plasma donation came out there was no such thing as plasma donation but what you would do is go to the blood bank you would donate a unit of blood sit there for a while while they went back spun it down separated it out reinfused you back your red blood cells then you donated another unit and did the same thing again it was a good two and a half hours while you waited and they paid you forty dollars that was the new thing well let me tell you something i was in college none of my friends donated blood i never thought about it we were too busy we all went down to the plasma center and donated and got our forty dollars so you know when i brought this up that people should be compensated something for donated blood that they would probably have enormous blood bank people have said to me we tried that and we got nothing but homeless people coming and donating blood well when we saw that at college there was lines out the door and you could tell the homeless people from the college students and you know what you have to screen your people better that's my that's my that's my point but i can tell you that if you pay people fifty dollars to donate blood or plasma i'm pretty sure and if you just you would never have a shortage you might have to add some personnel and do some things to screen people better but you wouldn't have a shortage of product ever again well yeah and they claim they claim they've tried that and that's simply not the case but yeah that's a really good that's a really good point because even today you can sell plasma you can't sell whole blobs you can sell plastic which doesn't make any sense to me whatsoever frankly um but it is what it is um i'd love to do a program one day and uh you know i'm gonna look it up and and spend the time to research it but i wonder what the what the uh systems are the regulations and symptoms systems are in different countries because i know that i've done some work down in mexico and uh if you need blood if you're a patient in mexico and need blood people you know or people that you can recruit have to go donate for you there's just not blood available that if you need it it's just at the blood bank so it's a totally different system and it's just seems really wacky but it is what it is and that's just their system i'd be curious to know what the system is around the world because the the ones that sell it what is their risk of disease transmission is it higher is it not higher do they do the same testing i really i really don't know but i do know that the the blood bank system is is enormously profitable that i think your point is is is well stated and obvious um but you can sell plasma but you can't sell platelets and you can't sell uh uh you can't sell whole blood i don't think it makes any sense or sell red blood cells and get your plasma what do you mean what do you mean sell it to who they have plasma centers where you can sell your plasma today oh they pay no they pay you yeah to this day to come and donate plasma yes why don't why is that any different than the other i don't know that's what i was asking i made that's my point is you can you can you're essentially selling your plasma you can you can donate your plasma for pay which is selling it but you can't do that with whole blood it makes no sense well yeah i agree with you dave for a hundred years they've convinced the american public that it's the right thing to do that you're being a a genuine humanitarian that humanitarian you're saving somebody's life and and you know if you knew how much money they made off of you donating that one unit of blood because they break it into four fractions sometimes they break into more than that and each one of those fractions are hundreds of dollars well platelets are are you know yes raw cost to the hospital probably about 300 for pac cells 500 for platelets um ffp i don't i think it's lower maybe 160 to 200 yeah you're probably making about a thousand dollars cryo you're probably making uh a thousand to fifteen hundred dollars a unit i i'm not an expert but i i'm i'm i'm gonna be pretty sure i've read 12 to 1500 is the profit for or the charge anyway not the charge for for for every time you've donated one unit of blood right the blood bank goes out and sells that to hospitals or whoever their clients are for somewhere between 1200 and 1500 dollars right yeah that makes sense and then the hospital's gonna up charge it because now they have administrative costs they have to go through all of the clerical uh aspects of it they have to do uh uh you know they probably have to do some kind of antibody testing on it then they have to you know they have to do a cross match type and cross match with the patient they have to uh uh get it to the to the to the place it needs to be infused then you have the infusion set then you have the nurses infusing it then you have the checks then you have more paperwork and before you know it the patients paid a thousand dollars well you saw what i showed you from england 12 of a trauma patient's total hospital charge 12 comes from just transfusions that's a lot that's a lot for trauma when you have multiple operations surgeries broken bones you know implants all the things that you need with trauma that's that's a that's a remarkably high number that 12 percent come from comes from just transfusions um mikko asked a question though and i don't know that i'm really capable of answering it um he says he wants to know about protocols of blood transfusions on cpb especially in neonates i can answer the question on adults sky's the limit everybody has a different way of looking at it um so it can be as low as six as a transfusion trigger to as high as uh as 21 or 24 as transfusion trigger and i think it can be very patient dependent but in neonates i know they use blood they prime with blood they use a lot of blood um it's a small amount because it's a little teeny baby neonate but um but they use blood on those patients but other than that i i ca i can't answer it i don't do those kind of cases i wouldn't i wouldn't venture to answer not being a pediatric perfusionist i wouldn't want to yeah tell us i'll try to find yeah i'll try to ask the folks down at texas children's meeco and see what i can get and then what i'll do is if you can send me an email to perfusioneducation.com you can see it down there in the in that corner over there um send me an email to that email address i think it's contact contact perfusioneducation.com and i'll try to get that answer to you from the experts down at texas children's all right so with that said john do you have anything else uh no i thought your information was great i think this was yours was too it was fun actually this was a really enjoyable show a lot of blood transfusion uh lectures and i'm using half fall asleep but these were fun yeah this was fun and our system didn't break down so that's a plus and we're finishing on time and i was told earlier that you and i cannot do a program within one hour that there's no way but we're doing it i thought we were supposed to do two hours yet yesterday on friday i thought it was supposed to be two hours no it's it's on the it's on the schedule the schedule was published no it's from it's from it today is from five to six oh yeah yeah it's from five to six yeah it doesn't start my time and end your time since you're on the east coast oh i'm getting told to cut all right we'll see you all tomorrow what's going on tomorrow tuesday i'm doing a talk tomorrow for victoria crumpton victoria can't be here or can't can't come on skype so i'm going to be giving a talk on less invasive cardiac output monitoring tools and the basics of hemodynamic monitoring and critical care unit very useful for for uh perfusionists but also ecmo specialists and critical care nurses if they have such an interest so we'll see and then john i think you come back to us on wednesday don't you no that's patrick thursday yes ph and alpha step blood gas management so you're scheduled thursday from six to seven perfect so we're looking forward to seeing you then once again thank you for being here with us john you're such a huge contributor can't thank you enough and everybody there at home that's been watching or watch us later this afternoon thank you all for being here as well and using us as your resource for perfusion education we appreciate