Use of cadaveric blood transfusion in disasters

Dr Anant Phadke and Dr Ashok Kale

Blood is one component in healthcare that is always in shortage. So one can imagine what the situation will be like at the time of mass disasters. Take for instance the Gujarat earthquake. Thousands of blood-bottles were required to save the lives of injured. No blood bank facilities or blood donations can be mobilized on such a large scale, in the most affected and devastated areas.

Under such circumstances transfusion of blood from those who have just died due to closed head injuries or other closed fatal injuries can be given. In open injuries, there is a risk of infection entering the blood stream. Cadaveric blood transfusion was first successfully tried in the former Soviet Union in the thirties by Dr Yudin and his colleagues in the Sklifosovsky institute inMoscow.

By 1938, his series comprised 2500 cases. Extensive studies including tracer-studies carried out in the erstwhile Soviet Union, as well the extensive use of this blood (27000 transfusions by the sixties) showed that its quite safe and effective to use cadaveric blood. Even though blood clots after death, in about 60-90 minutes, due to “fibrinolysis”, the blood becomes liquid again. This was routinely drained out in the Sklifosovsky institute, within 6 hours of death, yielding about 10-12 bottles of blood. This was followed by infusion of “glucose-phosphate solution” into the carotid artery to ’wash-out’ the cardio-vascular system to obtain diluted blood, which can be used as a plasma expander.

The advantage of cadaveric blood is the large volume that can be tapped from one person. When massive transfusion of many bottles of blood is required, cadaveric blood would be advantageous, as the recipient receives foreign proteins from only one source and hence there are lesser chances of foreign body reactions.

Secondly, unlike the blood from live donors, there is no need to add anticoagulants and hence no risk of citrate toxicity that is associated with massive live donor blood transfusion. Cross matching cost is also reduced. Thirdly, the cost and labour of four mandatory tests done on one sample of blood is common for 10-12 bottles of blood.

The only limitation of cadaveric blood is that it can not be used when fresh blood is required in certain coagulation disorders. Strangely enough, the West has not adopted this technology, though occasional visitors to the Sklifosovsky institute have appreciated it. As early as 1937, the Lancet, the renowned medical journal, wrote, “The use of blood from dead bodies seems to be repugnant to the British mind. It has been overcome in Russia, where is this respect, reason triumphed over instinct”. In the days of cadaver cornea, kidney, skin and liver transplants, cadaver blood should not be a repugnant idea. In disaster situations, there seems to be no better way.

(Dr Ashok Kale is with Akhil Bharatiya Grahak Panchayat and Dr Anant Phadke is with Centre for Enquiry into Health and Allied Themes. They may be contacted at cehatpun@vsnl.coms)