Articles

Now They Get Medicine from Blood

Starting with the stuff in your veins, science has cooked up a whole new batch of lifesavers. They stop bleeding, check measles and mumps, even form sponges you can leave in after an operation

GEORGE H. WALTZ JR. April 1 1949
Articles

Now They Get Medicine from Blood

Starting with the stuff in your veins, science has cooked up a whole new batch of lifesavers. They stop bleeding, check measles and mumps, even form sponges you can leave in after an operation

GEORGE H. WALTZ JR. April 1 1949

Now They Get Medicine from Blood

Starting with the stuff in your veins, science has cooked up a whole new batch of lifesavers. They stop bleeding, check measles and mumps, even form sponges you can leave in after an operation

GEORGE H. WALTZ JR.

THE blanket-swathed man on the ambulance litter was unconscious. He had been badly burned in a factory explosion. The ambulance doctor had given emergency treatment to the burns, but the injured man was sinking so fast there were grave doubts that he would live to reach hospital.

There was no time to lose. The doctor took a vial of colorless liquid from a cabinet in the ambulance. To if he quickly attached a rubber tube fitted wit h a needle which he inserted in the man’s arm. As the liquid flowed from the bottle, the dying man’s pulse quickened and his breathing steadied. Not too many minutes later he was in the hospital’s emergency ward, still alive, and receiving a blood transfusion and thorough burn treatment.

A new medicinea blood medicine— saved that man’s life just as it already has saved the lives of hundreds of thousands suffering from shock or severe burns. The small amount of colorless liquid injected by the ambulance doctor was serum albumin, just one of a series of amazing new medical lifesavers that are now being extracted from human blood. There are six of t hese new blood medicines -serum albumin, gamma globulin, fibrinogen, thrombin, antihemophilic globulin, and concentrated red cells and together t hey are saving more lives than penicillin, streptomycin, or any one of the other so-called miracle drugs. They are medicines that are present in your blood and mine, and science now has found a way (o remove them from the blood in blood banks and put them to work saving lives.

If you are a normal, average-size adult in good health you have about 10 pints of blood circulating through some 60,000 miles of arteries, blood vessels, and capillaries in your body. Your blood accounts for about one thirteenth of your body’s weight (less than that if you are fat). So important is your blood to your well-being that if you should suddenly lose about one third of it death would be only a few hours off— unless that blood were replaced.

Human blood is a mixture. In round figures it consists of 45% solids in the form of red cells, white cells, and platelets, and 55% liquid in the form of plasma. Plasma, in turn, consists of about 92%, water, 7% proteins and 1%, sugar, salt, and other minerals. Proteins in the plasma yield five out of the six new blood medicines. So far, only a bare dozen uses have been found for the 60 or more proteins in human blood, but researchers hope to make much more use of them. Some of the worst killers among our diseases may eventually yield to medicines extracted from human blood.

Modern blood chemistry is a relatively new field of investigation. It was not until the early 1930’s, for instance, that it was discovered that injections of plasma t he liquid part of blood— could be used instead of whole blood in the emergency treatment of hemorrhages, shock, and bad burns. Up until that time, transfusions had to be given direct from a blood donor, which meant that the right donor had to be readily available.

Why is a transfusion necessary in the treatment of hemorrhages, burns and shock? The answer is the same for each to replenish the blood supply. In hemorrhages the loss of blood is evident. A deep burn chars the tissues and cells and in doing

so allows the fluid portion of the blood to leak out, forming the familiar blisters. This fluid must be replaced. In shock, which generally is the result of the loss of blood volume due to hemorrhages or burns, the supply must also be replaced.

The use of plasma was a revolution in the treatment of shock and hemorrhage. Plasma could be dried and be stored safely as a powder for long periods. As a powder it took up little space, yet could be transformed into a liquid again by simply dissolving it in sterile water. Also, since plasma contains none of the substances which determine (he blood group (A, B, AB, and O) into which the various kinds of blood fall, it could be administered to anyone regardless of his blood group. Whole blood transfusions, on the other hand, are safe only when the donor has the same type of blood as the patient. Only whole blood that falls into group “Ü,” like plasma, can be given to anyone regardless of blood type.

Hundreds of thousands of ex-servicemen are walking, working, and living today because of the miracle of plasma transfusions. During the period from 1942 to the surrender of Japan in 1945, more than two million quarts of liquid plasma extracted from whole blood donated by civilians was injected into Allied soldiers.

It was not until 1940 that researchers began to show increased interest in t he basic ingredients that make up human blood and blood plasma. If, they reasoned, plasma, which is 93%, water and minerals and 7% proteins, could replace whole blood for transfusions in cases of shock and burns, it must be proteins, certainly not the water, that turned the major portion of the Continued on page. 55

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trick. Perhaps these blood proteins could be separated from the blood plasma and used as specific medicines for specific treatments. Why give all the proteins if perhaps one or maybe two would do the job?

The needs of war encouraged and speeded up a program of deeper research into the chemistry of the blood proteins. Plasma, though effective as an emergency measure, was spaceand weight-consuming. The plasma powder itself was light and compact but the bottles of sterile water in which it must be dissolved were heavy and bulky. A pint of rehydrated plasma weighs about one pound and takes up about 30 cubic inches. Multiplied by the thousands, that represented considerable tonnage and space for the supply systems of fast-moving armies, navies, and air forces. Military men wanted a streamlined substitute for human blood —something that could easily be stowed on submarines, landing craft, airplanes, and even in the kits of paratroopers !

The first important solution to the problem came from the laboratories of the Department of Physical Chemist rÿ at Harvard University in Boston. For a number of years Dr. Edwin J. Cohn had been experimenting with the blood proteins. By a complicated method performed at temperatures below freezing he was able to separate the plasma proteins into five basic parts. One of these parts was a substance called serum albumin, which is more than half of the proteins in plasma.

Doctors had already found that this serum alhumin was the ingredient most active in making plasma effective as a blood substitute. They knew that serum albumin had the ability to hold water in the blood and prevent it from seeping away through the blood-vessel walls and surrounding tissue. Further tests showed that it also could draw water from the body tissues into the blood and thereby maintain the proper blood volume.

By the winter of 1912 serum albumin was in commercial production being extracted by Dr. Cohn’s methods from the' donated supplies of human blood— and became available to our fighting forces. It not only proved effective in the treatment of shock and burns, but it was extremely compact. A single 100 cubic centimeter bottle (about one fifth of a pint) of serum albumin proved as effective as a full pint of plasma. It weighed only one sixth as much as an equivalent amount of plasma and took up only one fifth the shipping and transport space.

What’s more, serum albumin also saved time. It did not have to be dissolved in water and, since a smaller quantity of liquid could be used, the injection time was greatly reduced. In war, time is an important consideration.

Work for the Byproducts

Now with the war over serum albumin is a potent civilian lifesaver. Compact enough to be carried as easily as a bottle of pills in a doctor’s handbag, it provides a ready emergency means of treating accident victims right at the scene and keeping them alive until they can be moved to a hospital for whole blood transfusions.

And serum albumin is being put to other medical uses. It is proving most valuable in the treatment of cirrhosis of the liver as well as a type of kidney disorder known as nephrosis. In liver

cirrhosis, the damaged organ no longer can manufacture plasma proteins, and injections of serum albumin help to make up the deficit.. Similarly, in nephrosis there is a deficiency of plasma albumin and serum albumin helps to maintain the proper supply.

In the course of developing and producing serum albumin for its important wartime work, medical men became intensely interested in possible uses of other plasma proteins. It seemed wasteful to throw them away as useless byproducts of the serum albumin manufacturing process when they too might be medically valuable.

Some of the byproducts have proved just as important as serum albumin itself.

In surgery, stemming the flow of blood from an incision always has been a problem. Sponges or gauze pads can be used, but they must be removed before the incision can be closed. So great is the chance that a sponge or pad may be overlooked and sewed up in the wound that an operating-room nurse has the job of keeping a close count on them before and during the operation.

Blood, however, has its own built-in sponges in the form of protein substances that readily form blood-stemming clots. Two of these substances— fibrinogen, a plasma protein, and thrombin, a blood chemical—now aid the surgeon. Fibrinogen, extracted from human blood in blood banks, is formed into white foamy sponges. Placed in a surgical wound and soaked with a solution of thrombin, the sponges form a natural blood clot. Being made from blood, the fibrinogen can be sewed up in the wound where eventually they will be absorbed by the body! This fibrin foam is now in the biggest demand of any blood product in Canada dentists as well as doctors are using it,.

Made into a sheet called “fibrin film,” fibrinogen also helps the brain and nerve surgeon. Placed over the exposed brain after an operation, fibrin film serves as an excellent substitute for the brain’s natural protective membrane, which dissolves as nature in time produces a new protective covering. The use of fibrin film prevents the format ion of troublesome adhesions.

Help for the Bleeders

In nerve surgery, fibrin film can be fashioned into tailor-made tubes to be used as temporary outer sheathings for nerves and tendons that have been repaired. Again, because it comes from human blood, it is easily absorbed and eventually disappears completely. Canada’s first supply of fibrin film went to Laval University’s department of surgery about a year ago. At that time the price for a sheet about the size of a page of this magazine was $45. Now the same quantity is available in Canada for $25.50.

This same fraction of human blood that yields the valuable fibrinogen also provides a third important blood medicine — antihemophilic globulin. Until it became possible to extract, this valuable protein from human blood the only treatment for hemophilia, a hereditary blood disease in which the slightest cut or scratch can cause the unfortunate sufferer to bleed to death, was transfusion with whole blood. Because, by heredity, it has afflicted a number of the male members of the interrelated royal families it has come to be known as the “Hapsburg disease.” Before the advent of antihemophilic globukn, it was dangerous for hemophilias to have even minor operations or tooth extractions. Now an injection of antihemophilic globulin can return the hemophiliac’s blood-clotting time

to normal and hold it there for a period of eight hoursenough time to allow him to safely undergo minor surgery. It’s been available in Canada since last I October and was first used at the j Victoria Hospital, London, Ont. j Just as hemophilia is one of the rarest j of disea«», measles is perhaps the most common. And another medicine j extracted from human blood is fast ! proving its worth as preventive, or at I least a moderator, of measles as well as mumps and catarrhal jaundice. This blood medicine is known as gamma I globulin, and it is obtained from that fraction of human blood that contains the disease-fighting antibodies which the human system creates to protect itself against disease.

Sick Children’s Hospital in Toronto has been making limited use of gamma globulin, known commercially as the immune serum globulins, as have also a few pediatricians in other parts of Canada. The whooping-cough form, known as hypertussis, is very expensive ($15 for a normal two-and-a-half cubic centimeter dose, and two shots about 10 days apart are usually required for a successful treatment), but Sick Children’s and a couple of other Canadian hospitals have been employing it in severe whooping-cough cases.

Every adult has antibodies in his blood stream. Each time you have had

a disease, your system and your blood stream have attempted to build up a defense against it. The fact that you got well is proof that your body was entirely successful in building up an immunity to beat back the attack. In some diseases, like measles and mumps, this immunity is lasting, and your blood retains the antibodies capable of fighting off those part icular germs or viruses. If then this gamma globulin is extracted from your blood, it will contain those antibodies. Injected into someone else’s blood stream—say a child who has been exposed to measles—it will help that person to resist the disease.

By carefully selecting donors, blood chemists can produce a variety of gamma globulins each of which has a high' concentration of antibodies to fight some one disease. Researchers hope to be able soon to produce a series of gamma globulins that will be effective in preventing, or at least moderating, such things as scarlet fever, German measles, and the various types of jaundice as well as measles and the mumps.

The four new blood medicines described so far come from the proteins of the blood plasma. The fifth blood medicine—the red cells—comes from the blood’s solid matter. These red cells, left over with the white cells as waste in the process of manufacturing plasma and plasma proteins, are most

valuable in combating anaemia. Injections of red cells obtained from pooled blood go a long way to relieving an anaemic condition temporarily. Several Canadian hospitals have been producing them as a byproduct of plasma.

Although the protein fractions aren’t produced in Canada as yet, they’ve been commercially available through Canadian agencies of U. S. laboratories since May, 1947. However, the Canadian Red Cross hopes to make them available within a few years to Canadian hospitals and doctors—either free or at costs much lower than at present —through its National Blood and Transfusion Service now being organized across the country. When this service begins to function nationally, the Red Cross hopes that one of the country’s leading medical laboratories will install the expensive fractioning equipment and produce the protein fractions under Red Cross supervision as is now being done in the U. S.

Right at the moment, blood research continues forward at a rapid pace. The progress made during the last war is being continued. Researchers have great hopes for the future of the blood medicines. They even have hopes that in blood they yet will find potent chemicals or proteins that will help them to solve the deadly secrets of such widespread killers as the heart diseases, tuberculosis and cancer, jç