Blood brothers under the skin

BLOOD has always been a powerful symbol, as in blood brother, blue blood, blood feud.

Today it is one of the world's most precious liquids: derivatives of a barrel of oil are worth $42, those of the same amount of blood more than $67,000.

Most of Douglas Starr's new book deals with blood transfusion. Pioneered in 1665 by Sir Christopher Wren in animals, it was banned all over Europe by the Pope after fatalities in humans and not re- established until 1818. James Blundell, a Guy's doctor, then used transfusion for women dying from haemorrhage after childbirth. Even so, three problems remained: connecting the donor to the patient, stopping blood from clotting, and preventing the life- threatening clumping of donor cells in the patient's body. Two factors - research and war - lay behind the breakthrough. At first, donor and patient were linked directly by a tube; later, bottles and plastic bags were developed for storage. Adding sodium citrate was found to stop blood clotting. And the discovery of different blood groups led to lifesaving crossmatching between donor blood and patient. In the First World War a few doctors realised that transfusion could save lives. After the war, a Barts surgeon, Geoffrey Keynes, sponsored a rota of voluntary donors in Camberwell. The expansion of this idea, together with the development of blood banks in Russia, showed their worth - particularly in wartime Spain, during the Blitz and on the Normandy beaches. Further research showed how blood could be separated into different cells and plasma. Post-war, plasma itself was fractionated into different proteins, such as antibodies, and, eventually and crucially, into antihaemophilic globulin. The latter could be injected to normalise the lives of patients with haemophilia, the bleeding disorder which afflicted the last heir to the Russian throne. Despite the breakthrough, tragedy followed. National policies over collecting and processing blood varied. Britain and France had centrally run schemes using volunteers. The United States, however, saw blood as a commodity. Collection was left to the markets, with no official control and subsequent scams. Business boomed in the 1960s and 1970s, and, faced with shortages and helping supply the rest of the world, the US started paying donors. Money tempted many new donors from skid row and the Third World. Such donors might be carriers of hidden infections, as might donors who were gay. Suddenly the risk of disease transmitted by transfusion of blood or antihaemophilic concentrates dramatically increased. Among these risks were serum hepatitis - a virus inflammation of the liver, which killed the comedian Danny Kaye. Hepatitis, however, is not necessarily fatal: the next hidden risk, HIV infection, is. From 1982 more than 5,000 people in Europe and 20,000 in the US died of transfusion-related Aids before tests for HIV were developed. Starr is good at documenting this story. The various policies, muddles, disputes, and hush-ups again reflected national characteristics. Many countries, for example, introduced automatic compensation for victims. In the US, however, haemophiliacs with HIV still have to sue individually. Scotland had the spare capacity to supply pure antihaemophilic globulin to England (whose new factory was years behind schedule). But this would have meant overtime and negotiations with the unions, unthinkable in the Thatcher era. In France, where (against advice) much of the risk came from using prisoner donors, a show trial of some distinguished haematologists, resulting in prison sentences, recalled the Dreyfus scandal. With much new material, Starr commendably shows that all countries made mistakes - and, faced with a threat, would we do better today? A professor of journalism, he writes taut prose, and I noted only trivial errors. For example, listing the scams, he fails to mention a London haematologist sent to prison for fractionating plasma in his dirty garage. I doubt too whether, with its horrendous traffic problems, the inhabitants of Salisbury (where blood was stored for D-day) would agree that it still has "uncommon serenity". But, that said, Starr's book is an enthralling read.

Copyright 1999
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