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Blood in, blood out: Life giving fluid transport

By Staff Sgt. C. Todd Lopez

SOUTHWEST ASIA (Sept. 05, 2004) -- When generals plan for war, they know they're going to need bombs, bullets and beds. One thing they hope they don't need, but definitely want on hand, is blood.

Blood for most of United States Central Command Air Forces' area of responsibility is distributed by the 379th Expeditionary Medical Group Blood Transshipment Center. The facility is really just a K-Span structure with a walk-in cooler and a deep freeze, but the center receives from the United States all the blood that's going to be distributed in the AOR, said 1st Lt. Dan Vince Cruz, the lab officer at the facility.

"We orchestrate the receipt, storage and distribution of blood products in the AOR," Lieutenant Vince Cruz said. "There is a person at the Combined Air Operations Center called the Joint Blood Program Officer Forward. He coordinates movement of blood throughout the AOR. He makes sure the levels are right. If Djibouti is not using a lot of blood, he decreases their level. If somebody attacks there, he increases their level of blood. We adjust the levels all the time."

The center regularly ships blood to both Balad and Talill in Iraq, to Kuwait, to Djibouti and to other areas in the AOR.

The BTC doesn't really store whole blood, the kind drawn straight out of a donor's arm. Instead, the center stores "packed red cells," a condensed version of blood, with most of the liquid removed. The reason blood is condensed is that few people need a transfusion of "whole blood," Lieutenant Vince Cruz said.

"Nobody uses whole blood," he said. "What people do need depends on the injury, however. If somebody is bleeding out a whole bunch, you want to give them the red blood cells, because that is the oxygen carrying component of blood. If you are oozing out blood and can't control bleeding, they may give you platelets. If you are a burn victim, they will give you plasma."

Whole blood is actually turned into many products. The BTC maintains supplies of packed red cells, plasma, and "cryoprecipitate." Plasma is pale and yellow in color and is mostly water. Cryoprecipitate is a kind of clotting factor that can help the body to stop bleeding. While blood cells are stored in a refrigerator and are not frozen, the plasma and cryoprecipitate are stored in a special freezer at -40 C.

Blood comes from the flightline packed in boxes that haven't changed in design since the Korean War. The boxes help protect blood that may have to travel as many as 20 hours from the East Coast to get in theater. To ensure the safety of the supply, each box is equipped with a special indicator that permanently changes color if the contents ever go above a certain temperature.

"We get whole palettes of blood in from the flightline," Lieutenant Vince Cruz said. "It's shipped from McGuire Air Force Base, and each box is packed with ice, so it's good for 48 hours. If the temperature ever goes out of range, the indicator will turn blue. That's how we know it's a bad shipment and that we have to get rid of it."

During transit, blood must be stored at less than 10 C, Lieutenant Vince Cruz said. During storage in his coolers, it must be held at less than 6 C. But temperature is not the only concern for Airmen at the BTC. They also have a system in place to ensure that blood was properly handled during shipment, and that it was not tampered with.

"Two people check each box of blood against a manifest," Lieutenant Vince Cruz said. "The blood has to be in the same order as the manifest. We can tell if it has been tampered with, or if it was treated roughly during shipment, because the blood will get mixed up."

When blood comes in to the center, it is already in the tiny plastic bags that would hang from an IV rack as it is put into a patient. Each "unit" of blood is about 450 milliliters. Lieutenant Vince Cruz said the BTC can store about 3,000 units of blood, meaning the facility has nearly a 360 gallon capacity.

Each unit of blood comes with numerous barcodes attached. One barcode tracks when the blood was made, another tells where it came from, yet another tells the blood type. Each code on each unit is scanned during in-processing. The numbers go into a computer that is part of a network called the Theater Defense Blood Standard System. The system tracks every unit of blood from the moment it is drawn from a person, to the moment it is put into another.

"If you donated blood five times over the last few years, and the sixth time you donate they find out you have hepatitis A, they can go back to all the people that received your blood and notify their doctor that they got blood for a person that tested positive for hepatitis," Lieutenant Vince Cruz said.

The meticulous system the BTC uses to verify the safety of the blood it receives is not unique, Lieutenant Vince Cruz said.

"Everybody packs blood and receives blood the same way," he said. "When it's ready to leave here, we'll pack it up the same way as we received it. That way, we can help those at the receiving end ensure the blood they get from us is as safe as it was when we sent it out."