News: What's Your Type?
FARAH PROVINCE, Afghanistan — Wearing my body armour and helmet and carrying my rifle, pistol and camera, I climbed into an M1151 up armoured humvee for a mission outside the wire of Forward Operating Base Farah.
When my gunner entered the vehicle through the turret I instantly saw his boots. In fact, the gunner's legs, boots and occasionally his hands are all I ever really see of my gunner on missions, except when I dismount and see him peeking down at me. But something caught my eye on this particular morning; a very decorative "A+" was drawn on the top of his combat boot.
After that mission, I began to watch for where service members displayed their blood type.
Walking by a construction site on the FOB, I spied Soldiers on top of a roof wearing tan shirts with bold stencils announcing their blood type, "B POS", or "O NEG".
Waiting in line to wash my hands at the dining facility, I met an Air Force Airman whose blood type was sewn under his name on the patch on his chest.
Blood type is pressed into the metal of our dog tags, written on a strap on our helmets and even tattooed into some servicemembers' skin.
Blood, an oxygen carrying liquid, is vital to life. We all know that. But for American service members, it's vital for them to see their families again, vital for them to return home.
The average person has approximately five liters of blood.
"Cardiac output, the output of your pump, [the heart], changes depending on what your body needs and it can be anywhere between three to ten liters a minute," said U.S. Navy Lt. Cmdr. Jeremy Hackworth, an anaesthesiologist assigned to the Forward Surgical Team at FOB Farah. "If you just got blown up by an IED, [improvised explosive device], your heart's probably pumping closer to ten liters than three so you have less than a minute before you bleed out."
Though time is critical when someone is bleeding heavily, the medical staff at the Forney Clinic, located on FOB Farah, will always type a patient's blood to either discover or verify that person's type before treating them with a bag of blood. Why? Because giving the wrong blood type will, in fact, kill the patient.
"As soon as they come in we cut off the clothes, put in an IV and then use the IV for drawing the blood," said U.S. Navy Petty Officer 2nd Class Eric Ward, a corpsman with the FST. "I'd say when the patient gets here, within three to five minutes that patient is already being typed," he said.
The different blood types are o-negative, o-positive, a-negative, a-positive, b-negative, b-positive, ab-negative and ab-positive.
When you examine how the human body uses blood, you can begin to understand how blood can be tailored to treat a critically wounded patient.
After a qualified person donates his or her blood, the blood is separated into one of three substances, packed red blood cells that increase a patient's oxygen carrying capacity, platelets for clotting, or fresh frozen plasma, which includes proteins that work with the platelets to form clots.
Hackworth compares the human vascular system to a railway system. The vessels are the train track and the components of the blood are the train.
He refers to red blood cells that carry the oxygen as boxcars.
"We can pull out the platelets and store them in a bag," said Hackworth. "We can pull out the proteins that cause clotting and store them in a bag. We can just put the boxcars in a bag and that way when you come in and you're having a problem, we can draw your blood and say, 'Oh, she's got low boxcars, she's got plenty of platelets and plenty of proteins, all she needs is the boxcars'," Hackworth said.
The universal donor for PRBCs is o-negative which all people can have. However, for plasma, the ab type, either positive or negative, is considered the universal donor. One might think, why worry about blood type then, just give everyone o-negative boxcars and ab plasma.
But, it's supply that is the issue.
The most common blood type varies from region to region and storing blood can be problematic. When the clinic on FOB Farah runs out of the universal donor blood or specific plasma they have on hand, they must either get more blood flown in on a medical evacuation flight or initiate the "walking blood bank."
"In the banked blood you have universal donors and universal accepters," Hackworth said, "in whole blood you don't. You have to match very specifically in whole blood."
Blood from a direct donor given immediately to a patient is also called fresh blood. But "whole blood" is a more proper term since the blood is not broken out into individual parts like the stored blood.
Donors for the "walking blood bank" must first fill out a questionnaire. Second, their blood is typed to verify it's the same as the patient's and third, the donor's blood is screened using a rapid test kit for infectious diseases. Because the risk of passing on infectious diseases is greater through using the "walking blood bank," it is seen as a medical last resort and all the stored blood would have to be exhausted before the donors are paged.
Arguably, why then do we wear our blood type all over our bodies? The medical facility caring for any one of us will type our blood as soon as we arrive and in the mean time, they will give us universal donor blood or plasma until our type test card develops. So why the infatuation in the U.S. military to ensure our blood type is prominently displayed?
The most common answer I received could be summed up this way, "So if I get blown up, they know what blood to give me." A sobering thought.
But perhaps the best conclusion can be drawn from a tactical medical professional's perspective.
"The redundancy of blood type patches and or dog tags are less for the accuracy during a physical blood transfusion and more in line with the need required due to high stress treatment scenarios," said a U.S. Special Operations Forces medic.
He then described a situation all military members deployed to Afghanistan wouldn't want to find themselves in. He explained that if someone is wounded in the field and he doesn't have the means to type that patient nor the time to find the injured members dog tags, he appreciates the blood type displayed in numerous places. "The bigger the better," he said.
So I guess what it really comes down to is this.
Until the war is over and all our military men and women are safely home, blood type, whether it is sewn, drawn, stencilled, imprinted, tattooed and otherwise scribed on our persons is the combat zone's most popular accessory and I need to find a marker so I can add an "O+" to my boots.
Date Posted:01.02.2010 22:14
Location:FARAH PROVINCE, AF
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