Armed Services Blood Program
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The Armed Services Blood Program (ASBP) is the official military blood program of the U.S. Since its inception over 50 years ago, the ASBP has collected nearly 5 million units of blood to support military service members and their families in both peace and war. Blood is donated to the ASBP by active duty personnel and their families, government employees, military retirees and civilians.
Today, the ASBP consists of approximately 81 blood banks and blood donor centers (see Blood Donor Centers) worldwide; including 22 Food and Drug Administration licensed blood donor centers.
The Armed Services Blood Program Office (see ASBP Components) is a joint health agency chartered to monitor the implementation of blood program policies established by the [Assistant Secretary of Defense (Health Affairs) and to coordinate the blood programs of the military services (Army, Navy and Air Force) and the unified commands. The U.S. Army Surgeon General, on behalf of the Secretary of the Army, serves as the Executive Agent for the ASBP for administrative support and staff supervision. The Joint Chiefs of Staff, by Memorandum of Understanding, are responsible for the review and provision of guidance in all matters regarding blood support in joint operational planning. The Assistant Secretary of Defense (Health Affairs) provides policy guidance to the Armed Services Blood Program Office. This leadership functions with all of the ASBP components (see ASBP Components) to successfully manage the military blood program. Management authority is delegated to the Secretary of the Army who, as Executive Agent, exercises this authority through the Surgeon General.
- 1 Mission
- 2 Vision
- 3 ASBP Components
- 4 ASBP Directors
- 5 ASBP Blood Distribution System
- 6 ASBP History
- 7 Blood Donor Centers
- 8 Donating Blood and Donor Restrictions
- 9 References
To provide quality blood products and services for all worldwide customers in peace and war.
To be a preeminent quality, cost effective blood system providing blood products and services wherever and whenever needed.
The ASBP is a tri-service program with representatives from the Army, Navy and Air Force, and has many components working together to collect, process, store, distribute and transfuse blood worldwide. It relies on these components to provide quality blood products to active duty services members, veterans, and their families whenever and wherever it is needed. The following nine organization types are integral pieces to the working order of the ASBP and therefore, to ensuring that military members are receiving the life-saving blood they need, when they need it the most.
The Armed Services Blood Program Office (ASBPO) manages the blood program for the Department of Defense. The ASBP was established more than 50 years ago as a joint field operating agency. The office is subject to the authority, direction, and control of the Secretary of Defense through the Assistant Secretary of Defense for Health Affairs and under the operational control of the Joint Chiefs of Staff.
Currently, US Air Force Col. Richard H. McBride, Medical Service Corps, U.S. Air Force is the director of the ASBPO. Reporting to Col. McBride are the deputy directors for policy, operations, and information technology, the blood donor recruiter supervisor, the director of communications, and marketing, and an administrative specialist. The non-commissioned officer-in-charge reports to the deputy director of operations, blood donor recruiters report to the blood donor recruiter supervisor, and the marketing specialist reports to the director of communications and marketing.
Army, Navy and Air Force Service Blood Program Offices manage their respective blood programs and Food and Drug Administration licenses.
There are more than 20 ASBP blood donor centers worldwide. With locations throughout the U.S., one in Germany and one in Japan, the blood donor centers are the key to the success of the military blood program. Each blood donor center collects blood from donors at their locations, then processes, stores and ships the blood and blood products for local use and support of worldwide military operations. They also train medical laboratory personnel in all aspects of blood donor center operations.
On a continuous basis, the blood donor centers are also assigned blood collection and shipment quotas and are asked to provide blood products to the Armed Services Whole Blood Processing Laboratory (ASWBL) to meet worldwide military requirements. In order to maximize the military blood donor base available to the ASBP, blood drives are scheduled and conducted at blood donor center locations throughout the year. Blood donor centers are given preferential access to donors on installations without blood donor centers whenever the donor base is not maximized.
The ASBP established both east and west coast Armed Services Whole Blood Processing Laboratories to facilitate shipping to and from medical treatment facilities within the U.S. and around the world. They are central repositories for both liquid and frozen blood reserves required to support military contingency requirements. They are managed by the Air Force, but staffed by members from all three military branches represented by the ASBP (Army, Navy and Air Force). These laboratories retype blood for ABO and Rh pack, ice and prepare blood for shipment to war zones, and maintain a peacetime inventory of liquid blood for use as a rapid response requirement.
See ASWBPL Origin and History (see ASBP History) for more information regarding progress and accomplishments of the ASWBPL from the establishment of the first lab on the East Coast in 1955 to the dedication of the West Coast lab in 1995.
The Joint Blood Program Office is responsible for the joint blood program management. It functions as part of the unified command surgeon's office and may establish an Area Joint Blood Program Office for regional blood management. It serves as the central point-of-contact to the Armed Services Blood Program Office, and coordinates blood product requirements, distribution and capabilities in war zones, and monitors shortfalls within the unified command.
An Area Joint Blood Program Office can be established by the Joint Blood Program Office during wartime or special operations within the theater of operations. Once established, it coordinates requirements and distribution of all blood products to support blood supply units and medical treatment facilities in a specific area, regardless of the service component. While not all operations will require the establishment of an Area Joint Blood Program Office and it may not be a blood bank specialist, it will have the same responsibilities as the Joint Blood Program Office. Therefore, training and additional guidance from the Joint Blood Program Office is sometimes required. The location of each Area Joint Blood Program Office is designated by the responsible Joint Blood Program Office.
Expeditionary Blood Transshipment Systems are modular and replace the Blood Transshipment Centers and Transportable Blood Transshipment Centers that were previously in use. Each serves as a central receiving point for blood shipments from the ASWBPLs and issues blood shipments to the Blood Supply Units. It is usually staffed by Air Force personnel and located at a major airhead. Managed by the Joint Blood Program Office or an Area Joint Blood Program Office, if established, one or more Expeditionary Blood Transshipment Systems may be located in each theater of operations, but not all will require the use of one.
Blood Product Depots are located within the unified command to maintain large quantities of frozen blood products for use during armed conflicts or emergencies requiring medical support. They hold pre-positioned stocks of frozen blood products intended to absorb initial wartime blood surge requirements until the mobilization of continental U.S. assets can catch up to demand. Subsequent liquid blood supplies come from the blood donor centers in the continental U.S. and are shipped via the ASWBPLs and Blood Transshipment Centers. The depots store frozen blood until required, issue blood as directed, and thaw and deglycerolize frozen red cells and distribute to blood supply units. They are serviced and staffed by a single military branch (Army, Navy or Air Force) but the products are for use by all components in potential theaters of conflict. Any blood maintained at the blood product depots are managed by the Joint Blood Program Office via the Area Joint Blood Program Office.
Blood Support Detachments are an intermediate supply point in the distribution of blood between the Expeditionary Blood Transshipment System and the blood product requestors. They receive, store and distribute blood within a theater of operations. The mission is to collect (in emergency situations only), receive, store, process and distribute blood products to its supported medical treatment facilities within a defined geographical area. The detachments may be fixed or mobile and have the capability to store up to five days of supply of blood products based on the usage rate of its supported mobile treatment facilities. Established by the services as designated by the unified commands, the determination of the numbers and locations are in coordination with the unified command Joint Blood Program Office, the Joint Staff, and the Armed Services Blood Program Office.
A Blood Support Detachment can be identified to support any service branch, up to 12 mobile treatment facilities, and may include forces afloat. Army Blood Platoons, Navy Fleet Hospitals, Naval Amphibious Assault vessels, T-AH Hospital ships, mobile treatment facilities, and Blood Product Depots can all serve as Blood Support Detachments, when designated.
The ASBP is a tri-service blood program that has had leadership from the Army, Navy and Air Force. Below is a list of ASBP directors from 1978 to the present.
- 2012 to present: Col. Richard H. McBride, Biomedical Sciences Corps
- 2008 to 2012: Col. Francisco J. Rentas, Medical Service Corps, U.S. Army
- 2004 to 2008: Cmdr. Michael C. Libby, Medical Service Corps, U.S. Navy
- 2003 to 2004: Lt. Col. Ruth Sylvester, U.S. Air Force, Biomedical Sciences Corps
- 1999 to 2003: Col. Glen M. Fitzpatrick, Medical Service Corps, U.S. Army
- 1995 to 1999: Capt. Bruce D. Rutherford, Medical Service Corps, U.S. Navy
- 1991 to 1995: Lt. Col. Michael J. Ward, U.S. Air Force, Biomedical Sciences Corps
- 1984 to 1991: Col. Anthony Polk, Medical Service Corps, United States Army
- 1982 to 1984: Capt. James Bates, Medical Service Corps, U.S. Navy
- 1978 to 1982: Col. Hubert Wrenn, U.S. Air Force, Biomedical Sciences Corps
- 1973 to 1975: Col. Hal Etter, U.S. Air Force, Biomedical Sciences Corps
- 1972 to 1973: Col. Janice Mendelson, Medical Corps, U.S. Army
- 1971 to 1972: Col. James McCarty, Medical Corps, U.S. Army
- 1966 to 1971: Col. Richard Krakaur, Medical Corps, U.S. Army
- 1964 to 1966: Lt. Col. William Leslie, Medical Corps, U.S. Army
- 1962 to 1964: Lt. Col. Edward O’Shaughnessy, Medical Corps, U.S. Army
ASBP Blood Distribution System
Delivery of quality blood products depends on the individual components of the ASBP Blood Distribution System working together. The diagram below represents how blood (red solid lines), pre-positioned frozen blood (red dotted lines), and reports (blue dotted lines) flow within the system and demonstrates areas where efforts are coordinated (gray dashed lines).
Blood distribution: Blood is collected and processed at supporting bases. Joint Services blood donor centers known as Armed Services Blood Bank Centers or Army, Air Force or Navy Blood Donor Centers (see Blood Donor Centers) send blood collected at their sites to ASWBPLs. When necessary, blood may be acquired from civilian blood donor centers. This blood is also sent to the ASWBPLs.
ASWBPLs send blood into the theater of operations by two methods:
- pre-positioning some frozen blood at Blood Product Depots, or
- sending blood and blood components to Expeditionary Blood Transshipment Systems, which then forward the blood products to the Blood Supply Units.
The Expeditionary Blood Transshipment Systems, Blood Product Depots, and Blood Supply Units then send blood to several groups that transfuse blood to those injured in theater, including: Forward Surgery, Theater Hospitals, En route Care, U.S. Navy Ships, Force Service Support Groups, and Allied/Coalition Hospitals.
Forward surgery units and theater hospitals provide blood to be transfused by first responders (unit level). Force Service Support Groups provide blood to be transfused in U.S. Marine Corps units.
Reports: Reports regarding blood processing, distribution and transfusion are generated by all components. The Armed Services Blood Bank Centers and the Army, Navy and Air Force Blood Donor Centers send reports to the Service Blood Program Offices for the Army, Navy and Air Force. The Service Blood Program Offices and the ASWBPLs send reports to the Armed Services Blood Program Office.
Within theater, the Joint Blood Program Office determines reporting frequency and format. First responders (unit level) send reports to forward surgery units and theater hospitals. U.S. Marine Corps units send reports to Force Service Support Groups. Forward Surgery, Theater Hospitals, En-route Care, U.S. Navy Ships, Force Service Support Groups, and Allied/Coalition Hospitals send reports to Blood Supply Units.
Blood Product Depots send reports to Blood Supply Units. Blood Supply Units send reports to the Expeditionary Blood Transshipment System, which then sends reports to the Joint Task Force/Area Joint Blood Program Offices. The Area Joint Blood Program Offices send reports to the Combatant Command/ Joint Blood Program Office, and then the Joint Blood Program Office sends reports to the Armed Services Blood Program Office. The Armed Services Blood Program Office sends reports to the Joint Staff.
The ASBP celebrates over 50 years of providing blood products to military members and their families.
Military Blood Program Origins in World War II: Throughout World War II, more than 825,000 units were collected in support of troops fighting around the world. Since it could be given to anyone regardless of blood type, only Type O negative blood (see About Blood) was sent into combat zones. On average, each surviving casualty required one unit of whole blood and one unit of plasma during treatment.
In September 1945, with the end of hostilities in World War II, the military began to downsize. In returning to a peacetime posture, the whole blood and plasma programs were quickly phased out.
During the years between World War II and the Korean War, the need for blood in military hospitals was met through individual hospital efforts. There were no plans, military or otherwise, to stockpile reserves of plasma for a national emergency. Indeed, had such a disaster occurred, there would have been no program to put into effect. The whole blood program may have disappeared entirely in the post-war period if not for the stimulus provided by civilian agencies.
Moving Blood Forward in Korea: Blood was collected stateside and funneled to Korea through two points: Travis Air Force Base in California and the 406th General Medical Laboratory in Tokyo, Japan. Estimated requirements were based on experience from World War II. Type O negative blood was preferred as it could be given to recipients of any blood type. Though dog tags listed blood type, there was an 8 percent error rate in the types printed on them. Rather than risk a transfusion reaction, physicians preferred to transfuse only the universal blood type. Using Type O negative blood meant there was no wait for cross-matching, no need for specialized lab techs and fewer units required to maintain adequate stocks. These advantages allowed blood to be available at smaller front line units, where it benefited those injured most.
Another innovation in this era was the transition to plastic containers for blood collection and storage. Not only did the new containers enable preparation of blood components, they also decreased the incidence of septic and embolic complications. Additionally, by replacing breakable glass bottles with durable plastic bags, more units safely reached injured Service members in forward areas.
The use of Type O negative blood and plastic blood bags proved to be a success, and military physicians achieved high marks in safety during the Korean War. In 1952, out of 50,000 transfusions administered, only four major hemolytic reactions resulting in acute renal failure were reported and all were attributable to locally obtained blood. A solid foundation had been laid for military transfusion medicine.
Blood in Vietnam: Initially, almost all blood needs were met by the 406th Medical Laboratory in Japan, with blood donations collected by each of the Services in Okinawa, Japan and Korea. That blood was distributed by the 406th Mobile Medical Laboratory in Saigon to all U.S. and allied forces except the Vietnamese, who had their own system.
By June 1966, though all field medical units were within a 30-minute helicopter flight for blood resupply, the 406th Med Lab could no longer meet blood demand. At this point, a new era began as the ASBP was established to coordinate the drawing of blood in the continental U.S. to meet the shortfall. Blood was sent to the ASWBPL at McGuire Air Force Base in New Jersey for processing before being shipped to medical units in Vietnam.
The advances developed during this period showed that an established military blood program could reduce the burden of using combat troops as donors, supply all blood required through military member donations, distribute all blood types according to the technical level of the transfusing medical unit, and anticipate future need and develop a supply program from the rearward areas in advance of increased demands.
Blood Innovations Support Desert Operations: A key readiness issue was the need to maintain large supplies of blood to meet early shortfalls during a conflict. Though a new anticoagulant developed in 1983 extended the shelf life of treated red blood cells from 21 to 35 days, managing an inventory that expired every 35 days limited the ability to stockpile sufficient reserves. Believing frozen blood could provide a viable solution, the ASBP supported research and development efforts that eventually proved successful in creating a frozen blood product that could be preserved for ten years.
During Operations Desert Storm and Desert Shield, the ASBP sent more than 100,000 units of blood to troops fighting in and around Iraq. Though it was not extensively utilized, having frozen blood available provided an additional safety net for troops engaged in these operations. The ASBP's performance during the conflict proved it could meet peacetime blood needs and manage reserve levels to fulfill its wartime mission.
Today's Armed Services Blood Program: Currently, the ASBP operates more than 20 blood donor centers and 81 transfusion centers in the U.S., Europe and Asia. Two ASWBPLs serve as storage and shipping facilities for contingency blood—both liquid and frozen. A network of Blood Transshipment Centers, Expeditionary Blood Transshipment Systems, Blood Product Depots, and Blood Supply Units are in place or on call at all times to ensure support of front line medical response units anywhere around the globe.
The military community relies upon the many components working together to provide quality blood products to Service members whenever and wherever needed. The ASBP's structure as a joint operation is key to seamless provision of services. Extensive cooperation allows the program to take advantage of the unique capabilities of the blood programs of the military services (Army, Navy, Air Force) and the Combatant Commands.
ASWBPL Origin and History: The plan for a permanent ASWBPL building was developed during the Korean War. The building (now termed ASWBPL-East) was erected in 1955 at McGuire Air Force Base in New Jersey. The cost was approximately $200,000.
The building contains a little more than 7,300 square feet (680 m2) of floor space with several main sections. A section has been added to house freezers for 35,000 frozen blood products. A one million dollar renovation project on the older sections of the building began in 1996 and was completed in 1998. The older section contains:
- Loading platform.
- Cold room with walk-in refrigerators.
- Equipment room with backup power generator and refrigeration units which insured compliance with environmental control standards.
From 1955 to 1966 it was not utilized for receiving, processing, and shipping blood and blood products due to a lack of requirement. During this period it served as an immunization clinic and was also a physical examination center.
Although the Air Force was and still is the Executive Agent for maintaining the ASWBPL, the operational guidance was (is) provided by the Military Blood Program Office (today's Armed Services Blood Program Office). In mid-1966 the ASWBPL was activated by the Military Blood Program in response to increased blood requirements in Vietnam.
Prior to 1966 all whole blood used in the Vietnam combat zone was supplied within Pacific Command's (PACOM) area of responsibility. When blood requirements in Vietnam exceeded PACOM capabilities, the ASWBPL was activated and has remained active ever since, utilizing personnel from the Army, Navy, and the Air Force.
The ASWBPL at McGuire was, and still is, a tri-service activity. During Vietnam, three officers (medical technologists) and 40 enlisted personnel (most lab technicians) were authorized. The director was an Air Force Bio-Medical Science Corps (laboratory officer). The deputy directors were Medical Service Corps Officers of the Army and Navy. Enlisted manning was equal between the three services. Operational control of all assigned personnel was given to the Air Force. Each service had administrative responsibility for their own personnel—the Navy through the Fourth Naval District in Philadelphia, and the Army though the Walson Army Hospital at Fort Dix.
These are the essential elements of the ASBP:
- Requirements for blood in the combat zone are made through unified or specified commands to the Armed Services Blood Program Office.
- The Armed Services Blood Program Office allocates quotas to each Services' (Army, Navy, and Air Force ) Surgeon General.
- Each Surgeon General allocates blood collection quotas to blood donor centers under his/her command.
- Each blood donor center is responsible for soliciting donors, drawing blood, performing initial testing, and shipping the blood to the ASWBPLs.
During Vietnam there were 53 blood donor centers located in the continental U.S. (17 Army, 9 Navy, and 27 Air Force).
The sole mission of ASWBPL was quality control, and demanded that all blood introduced into the combat zone in Vietnam be free of any technical and/or administrative errors. This required meticulous checks and balances throughout processing. Laboratory tests for ABO, Rh and titer of Group O units were performed in accordance with the highest standards. The ASWBPL was fully accredited by the AABB (formerly the American Association of Blood Banks). Checks of all blood received from blood donor centers revealed an error rate of approximately 3 percent. Errors were primarily administrative including improper labeling, erroneous control numbers and inaccurate shipping documents.
About 1 percent was rejected as a result of technical laboratory tests made on each unit. Outbound packaging began when all testing was complete and proper documentation was confirmed. After final inspection, units were placed in special polystyrene containers and packed. There were 21 units of whole blood per container with ice. The sealed containers were then placed on a pallet and netted for loading on the aircraft. The ASWBPL McGuire was conveniently located by the flightline and air freight terminal, and pallets were moved by forklift directly to the aircraft.
The movement of blood during Vietnam was more difficult than it is today because blood collected in earlier anticoagulants was only good for 21 days. Time was a vital factor with planning. Approximately four days were lost by the time the blood was ready for transport overseas.
Blood was flown to South East Asia by C-141 aircraft with a route from McGuire Air Force Base, N.J., to Elmendorf Air Force Base, Alaska, to Yokota Air Base, Japan. At this point the 406th USA Medical Laboratory took custody of the blood. They arranged shipments to Vietnam. The blood was flown to Cam Ranh Bay, Vietnam. Time lapse from McGuire to Vietnam was approximately 20 hours. The United States Army Vietnam Central Blood Bank 6th Convalescent Center took charge of the blood and then distributed it to major blood storage sub-depots. The blood depots supplied blood to about 100 fixed and non-fixed medical treatment facilities throughout South Vietnam.
ASWBPL McGuire's workload varied from 14,885 units in 1966 to 322,190 units in 1968. The largest one month output was 37,707 units. The largest single day was March 2, 1969 when more than 3,000 units of blood were processed. These figures are from June 27, 1966 through Nov. 30, 1969. The ASWBPL was capable of sustaining a workload of 40,000 units per month. Since becoming operational in 1966, ASWBPL processed and moved more blood than in any other war.
Rapid helicopter evacuations, improved field medical surgical techniques and facilities, and a readily available supply of fresh whole blood contributed to lowering the mortality rate due to combat injury. The ASWBPL played a vital role in the unprecedented effectiveness of the medical support combat forces received in Vietnam. In January 1995, ASWBPL-West, Travis Air Force Base, California was completed and personnel began moving into the facility. The facility was required to reduce the ASBP response time in preparing and shipping blood and blood products into the Pacific Theater. Although opened in July, the official dedication ceremony was held on Oct. 19, 1995.
The keynote address at the dedication was made by .Capt. B. D. Rutherford, MSC, USN, director of the ASBP. The address acknowledges the contributions of ASBP staff and lists significant milestones of the ASBP and the ASWBPL.
Blood Program Advances during Vietnam: Although the Military Blood Program played a key role in Vietnam, there were several overall factors in resulting in the low morbidity and mortality rates for the personnel in Vietnam. Rapid evacuation of casualties through the use of helicopters serving as air ambulances took place during the Vietnam War. Ready availability of whole blood and increased use of other blood products also contributed to the low mortality rates. Styrofoam containers allowed storage of blood for 48 to 72 hours at the field level—the first instance of blood being used at the division level. "Field" blood was occasionally given to the wounded prior to evacuation by helicopter aided in stabilizing patients until arrival at a hospital unit. Additionally, blood supply from PACOM in the early years and later from the continental U.S. was always sufficient to meet the increasing demands for blood. The use of whole blood and components was also elevated in Vietnam. Fresh frozen plasma was used for volume replacement and control of bleeding, freshly drawn whole blood was used to provide coagulation factors, and microwave ovens were used to warm blood when body temperatures dropped as a result of extensive transfusion.
Well-established forward hospitals also played an increased role in Vietnam. They made possible the use of sophisticated medical equipment and allowed for the use air conditioning to control extreme heat and humidity in Vietnam. Surgical technologies of the time period were state-of-the-art. Surgeons performed complex surgeries daily and routinely in all hospitals, and vascular surgery was so frequently required that general and orthopedic surgeons became proficient in performing surgeries of this nature. The high-level of the surgical skill maintained despite turnover of medical officers, and newly reporting surgeons were given periods of orientation and training in casualty medicine by attaching them to an experienced team.
There were also improvements in anesthesia during the Vietnam War. This contributed to the low mortality rate because of the widespread use of halothane due to its fast action, ease of administration, non-flammability and reduced side effects. New respiratory assistance devices were tested to reduce the incidence of bacterial contamination in respirator.
ASBP Military History: During the American Civil War there are two recorded cases of blood transfusion for the treatment of hemorrhage following leg amputation.
During World War I, the British attempted direct transfusion with poor results. An American, O. H. Robertson (American) introduced preserved blood for transfusion in front line medicine using citrate solution as a preservative-anticoagulant. Only donors from blood group IV (Type O) were used, eliminating pre-transfusion agglutination tests. Donors were selected from patients with minor wounds. History of venereal disease, malaria, or trench fever excluded the donor. The British adopted Robertson's technique and established trained teams of corpsman and nurses under the supervision of a program officer, distributed blood and coordinated planned distribution locations with line commanders at the battalion and regimental levels, and established specific indications for transfusion.
During the Spanish Civil War from August 1936 through January 1939, the Barcelona Blood Transfusion Service massively recruited donors significantly removed from the fighting front. The donor blood was forward and back typed and pooled by groups so that "very homologous blood is obtained." The Barcelona Blood Transfusion Service followed up on each transfusion and kept records on each donor, each recipient and each tube of blood.
During World War II, in Great Britain, the British Army Transfusion Service was established on the principles that blood was a perishable product with both harmful and beneficial potential, and should be handled only though specialized channels. Because it was thought that armies should be self-contained, the British Army Transfusion Services was organized on three levels—the Home Depot, the Base Transfusion Unit and the Field Transfusion Units. The Home Depot was responsible for personnel training, equipment production and some blood donation. The Base Transfusion Unit was responsible for the distribution of blood products, donor recruitment and blood collection (one per theater of operations), and the Field Transfusion Units were composed of an office and three enlisted personnel responsible for performing all transfusions. Only Group O, low titer, blood was used.
In the Soviet Union, blood was collected through a supply system organized in 1926 by Red Army Lt. Col. A.A. Bagadasarov, who later supervised the blood program during the 1940-41 war against Finland. Fifteen hundred donor centers were organized around the Institute for Blood Transfusion in Moscow. Donation volumes ranged from 225 to 400cc, and were permitted as often as every four to six weeks. A system for storage up to 3½ weeks was developed. The Soviets first performed cadaveric blood transfusion in 1930 and it gained "wide clinical use" in the Soviet Union after 1932.
The U.S. entered World War II without a unified transfusion program. Plasma, not whole blood, was used extensively. When demand overtook supply in the European theater in 1944, airlift capabilities were placed in service. Their application to blood delivery from remote donation centers probably represents the major U.S. contribution to military blood program developments during the war. The American Red Cross collected almost all of the blood used by the U.S.
Blood supplies in the Pacific theater, collected from troops stationed in Australia and New Zealand, were routinely airlifted to forward bases. During the battle for Okinawa alone, 20,000 units were funneled through a central blood bank in Guam by the Navy Air Transport Service and airlifted to advance bases using local air services.
While a prisoner of the Japanese Army in Thailand during World War II, a physician relates some of the experiences and special problems encountered in the collection and administration of blood. In the summer of 1944, the use of fresh, whole blood by transfusion was indicated for several of the prisoners sick in the hospital. In order to perform the transfusion doctors needed a one pint Mason jar with screw-on lid, empty 1,000 ml double-ended ampul, two-foot length of quarter-inch rubber tubing, an inch and a half needle of approximately 18 gauge, a bedding sheet, and a mosquito net. The Mason jar was used for the collection of the donor's blood. Since there were no anticoagulants, the only method to prevent clotting of the blood during collection was defibrination. A dasher cut from tin cans was fabricated, soldered together to resemble a churn with a handle, protruded through a punched hold in the lid. A second hole was made in the lid to accommodate the rubber tubing.
The system had only one large gauge needle and one length of rubber tubing making it necessary to be used as both a donor and recipient set. Dog tags were used to find a prospective donor. Final testing of the blood for compatibility was done by mixing a drop from the finger of each man on a glass slide. A tincture of iodine was used to prepare finger puncture and venipuncture sites. Some eight or nine transfusions were carried out in this manner. According to the author, these were the only transfusion attempted or completed in the entire complex of camps along the Moulmein-Bangkok railway.
The Korean War was the first time a plan for blood detachment and use was in place prior to combat involvement. Civilian collection programs were needed to meet wartime requirements. Agreements were made with the American Hospital Association, American Medical Association, American Red Cross and the AABB to meet increased demands. Almost all of the blood was purchased from the American Red Cross.
Estimated requirements were based on World War II experience. On average, one unit of whole blood plus one unit of plasma or other blood product was required for each surviving casualty. Only Group O blood, typed for Rh, was to be used, stored in ACD and refrigerated. Blood was collected in the U.S. and funneled to Korea through two points, the Travis Air Force Base in California, and the 406th General Medical Laboratory in Tokyo, Japan. Glass bottles were later phased out and replaced by plastic bags. Because the error rate in dog tag identification was high at 8 percent, Rh negative, Group O blood was preferred by physicians. All preserved blood used was universal-donor meaning that there was no wait for a crossmatch, no need for specialized lab technicians, fewer units were required for adequate stocks and stocks could be maintained at smaller frontline units.
In 1952, only four major hemolytic reactions resulting in acute renal failure were reported out of the 50,000 transfusions administered. All four were attributable to locally obtained blood. Low rates of septic and embolic complications were largely through the increased use of plastic containers, which also lengthened shelf life.
Prior to 1966, blood requirements were met almost exclusively by the 406th General Medical Laboratory in Japan, with blood donations collected by the Tri-Services in Japan, Okinawa and Korea. During the Vietnam War, blood was tested for ABO, Rh and syphilis. Group O units with an antibody titer of 1:200 or less were designated universal donor blood. Blood was distributed by the 406th Mobile Medical Laboratory in Saigon to all U.S. and allied forces, except the Vietnamese who had their own system. Prior to April 1965 only Type O blood was brought into Vietnam. Later Type A blood was added, and by the end of 1965, all types were brought in. Medical units were divided by their capacity and crossmatching capabilities. Those that had crossmatching and capabilities and a pathologist were assigned all four types of blood. Units with just crossmatching capabilities received Group A and O blood, and those with no capabilities received only universal donor blood.
By 1966, all field medical units were within a 30-minute helicopter flight for blood resupply. By June 1966, the 406th could no longer meet blood demands, and at this point the Military Blood Program Agency coordinated Tri-Service blood drawing in the continental U.S. Blood was sent to the Armed Services Whole Blood Processing Center at McGuire Air Force Base in New Jersey for processing.
The Vietnam Blood Program was a phenomenal success because the burden of using combat troops for donors was avoided as much as possible, blood types were distributed to the appropriate technical level of the transfusing medical unit, and future requirements were anticipated and a supply program developed from the rearward areas in advance of increased demands. For the first time in military history, every unit of blood used to support e Vietnam War was collected by a country's Military Blood Program and donated free of charge by military personnel, their dependents and civilians employed at military installations. No blood support into Vietnam was provided by the American Red Cross.
After Vietnam, Israel utilized short supply lines and had rapid military accessibility to civilian health care facilities during times of conflict. Personnel maximized the use of products on hand, and utilized highlight motivated civilian donor reserves with close access to the administering facility.
In 1982, in the Falkland Islands, the British used combat troops as donors on board the SS Canberra en route to the invasion. Over 3,200 units of ACD and CPDA preserved blood were supplied by the Army Blood Supply Depot. A 2.7 percent error rate of blood grouping among the units drawn on the SS Canberra underscored the importance of having trained, experienced laboratory personnel as part of the blood logistics team.
Blood Donor Centers
The ASBP operates more than 20 blood donor centers in the U.S. and around the world. Blood donor centers are generally located on or near an Army, Navy or Air Force bases.
Many centers "take the show on the road" and conduct mobile blood drives. Those interested in hosting a blood drive can contact the local blood donor center's recruiter. Recruiters can also assist in scheduling times for groups of donors to give blood at the blood donor center.
In addition to whole blood donation, some blood donor centers offer platelet apheresis donation. One platelet apheresis donation provides as many platelets as six to ten whole blood donations. Platelet donors can also give platelets more frequently than whole blood, up to 24 times per year.
Donating Blood and Donor Restrictions
Most healthy adults are eligible to give blood; however, there are some reasons a person may be deferred from donating — temporarily, indefinitely, or permanently. Deferral criteria have been established for the protection of those donating and those receiving transfusions in accordance with the Food and Drug Administration guidelines, AABB standards, and Department of Defense policies.
Bone Marrow and Organ Donation
The blood donor travel-related deferral criteria do not apply to organ and bone marrow/hematopoietic stem cell donation. Those ineligible to donate blood due to travel to disease-prevalent areas may still be eligible to donate organs and bone marrow.
There are some specific conditions and activities that may prevent a potential donor from being eligible to donate. One reason is travel to areas where illnesses are or have been prevalent. Though most travelers will not become ill, there is a period of time where a traveler may be infected, but not display symptoms. To ensure the health of blood recipients, travelers are deferred from donating until the window where symptoms may appear has passed. See the table below for specific countries of interest.
|Iraq, Afghanistan and other malaria-endemic areas, less than 5 consecutive years||12 months deferral upon return|
|Iraq, Afghanistan and other malaria-endemic areas, more than 5 consecutive years||3 years deferral upon return|
|England from January 1980 - December 1996 for greater than 3 months (cumulative)||Deferred from donating indefinitely|
|Europe from January 1980 - December 1996 for greater than 6 months (cumulative)||Deferred from donating indefinitely|
|Europe from January 1980 – present for greater than 5 years (cumulative)||Deferred from donating indefinitely|
|North of Seoul, Korea (the 37.7 parallel) for less than 5 years (cumulative)||Deferred for 2 years following return|
|North of Seoul, Korea (the 37.7 parallel) for more than 5 years (cumulative)||Deferred for 3 years following return|
|Kuwait||There is no deferral for this travel|
|Qatar||There is no deferral for this travel|
Medical and Other Restrictions
|Previous Donation||8 weeks after last whole blood donation.|
|Piercing, Brand, Tattoo and Permanent Make-up||12 months after getting the piercing, brand, tattoo or permanent make-up.
|Acupuncture||12 months after having acupuncture.
Exception: If acupuncture was performed by a physician using sterile, single-use equipment, you may be eligible to donate.
|Recent Immunizations||Some immunizations do not restrict your ability to donate while other carry up to a 12-month deferral.|
|Medications||Most medications do not disqualify donation.|
|Medical Conditions||Certain medical conditions may restrict your ability to donate for a short or extended period.|
|Pregnancy||Deferred until 6 weeks after the end of the pregnancy.|
|Cold or Flu||Eligible to donate once you have been feeling well for 3 days.|
|Blood Transfusion||12 months following transfusion.|
||12 months after the contact|
|Positive HIV Test||Permanent deferral|
|Viral Hepatitis at age 11 or over||Permanent deferral|
|Positive Hepatitis Test||Permanent deferral|
|Syphilis or gonorrhea||Deferred for 12 months after completion of treatment|
- Armed Services Blood Program. 2010, <http://www.militaryblood.dod.mil> (8 November 2010).
- "ASBP History", Armed Services Blood Program, (2010) <http://www.militaryblood.dod.mil/About/history.aspx> (10 November 2010).
- "ASBP History."
- We Are the Armed Services Blood Program: Press Kit (Armed Services Blood Program, October 2010), 1.
- We Are the Armed Services Blood Program: Press Kit.
- Armed Services Blood Program.
- "Where to Give Blood", Armed Services Blood Program. 2010. <http://www.militaryblood.dod.mil/Donors/where_to_give.aspx#> (8 November 2010).
- "ASBP Components: Armed Services Whole Blood Processing Laboratories", Armed Services Blood Program. 2010. <http://www/militaryblood.dod.mil/About/components.aspx> (8 November 2010).
- "ASBP Components: Area Joint Blood Program Office", Armed Services Blood Program. 2010. <http://www.militaryblood.dod.mil/About/components.aspx> (8 November 2010).
- "ASBP Components: Blood Product Depot", Armed Services Blood Program. 2010. <http://www.militaryblood.dod.mil/About/components.aspx> (9 November 2010).
- "ASBP Components: Blood Support Detachments", Armed Services Blood Program. 2010. <http://www.militaryblood.dod.mil/About/components.aspx> (9 November 2010).
- "ASBP Directors", Armed Services Blood Program. 2010. <http://www.militaryblood.dod.mil/About/directors.aspx> (9 November 2010).
- Brig. Gen. Douglas B. Kendrick, MC, USA, under direction of Lt. Gen. Leonard D. Heaton, Surgeon General. Blood Program in World War II, ed. Col. John Boyd Coates, Jr., MC, USA and Elizabeth M. McFetridge, M.A. (Washington, D.C., Office of the Surgeon General, Department of the Army, 1964).
- Brig. Gen. Douglas B. Kendrick, MC. USA, under direction of Lt. Gen. Leonard D. Heaton, Surgeon General.
- Brig. Gen. Douglas B. Kendrick, MC, USA, under direction of Lt. Gen. Leonard D. Heaton, Surgeon General.
- "Where to Give Blood", Armed Services Blood Program, (2010) <http://www.militaryblood.dod.mil/Donors/where_to_give.aspx#> (2 December 2010).
- "Can I Donate?" Armed Services Blood Program, (2010) <http://www.militaryblood.dod.mil/Donors/can_i_donate.aspx.> (2 December 2010).