Are D-Y-I blood transfusions possible?
February 1, 2010 10:38 AM   Subscribe

What's the bare minimum in equipment necessary for a blood transfusion?

So, my girlfriend recently remarked that her neighbors growing up were both hemophiliacs. I said it would be pretty alarming for a kid to look into their fridge and see packets of emergency blood, since the only explanation that would make sense at that age would be... that they're vampires.

Someone nearby overheard and chastised me for my stupidity, explaining that blood transfusions can only be performed in a hospital. So, mefi, how stupid am I, really?

I know that there are direct and indirect blood transfusions, with direct tranfusions coming from a compatible donor, and indirect tranfusions coming from blood stored in a blood bank. It seems like an indirect transfusion would be possible at home with fairly minimal equipment, and Wikipedia even has a picture of a syringe-like device for direct field transfusions:

So, could a hemophiliac just keep refridgerated blood on hand for use in emergency transfusions following an injury, for example?

If so, how would they perform the transfusion? If not, why couldn't/shouldn't they?
posted by edguardo to Health & Fitness (15 answers total) 1 user marked this as a favorite
Best answer: So, could a hemophiliac just keep refrigerated blood on hand for use in emergency transfusions following an injury, for example?

A hemophiliac wouldn't need or use whole blood. Fresh Frozen Plasma is cheaper, simpler, safer, and longer-lasting than whole blood. FFP was was used before it was feasible to separate and concentrate the particular clotting factors absent in hemophiliacs. For the past few decades hemophilia has been treated with those isolated clotting factors. Some versions are extracted from human blood; others are produced through recombinant DNA.

Whole blood is pretty expensive (~$300 / unit) and only keeps for about a month. It would be expensive and wasteful to keep a lot of whole blood around the house as on-demand treatment for hemophilia.

But, yes, theoretically one could do a blood transfusion at home. There's nothing magical about a hospital. It's just a matter of having the right equipment.
posted by jedicus at 10:58 AM on February 1, 2010

I should add, of course, that whole blood (or more likely packed red blood cells + FFP) would be administered to a hemophiliac if he or she lost a lot of blood, just like anyone else. So whole blood might possibly be kept around for a really bad bleed or if regular treatment wasn't administered fast enough, but it would still be expensive just to keep around the house. And such a situation would likely be a medical emergency, so it would probably be safer to just go straight to the hospital or wait for an ambulance than to attempt a transfusion at home before going to the hospital anyway.
posted by jedicus at 11:05 AM on February 1, 2010

Best answer: Here is a really cool treatise on the history of blood transfusion. I found it while trying to verify something I read in Ripley's Believe It Or Not when I was kid, regarding soldiers bringing sheep into battle with them for transfusion. Fascinating read. At any rate, transfusion wasn't performed widely until the 20th century.

The claim that transfusions can only be performed at a hospital is specious and trivially false. Since IV infusion and syringe injections can be routinely performed safely at home (I learned how to hang an IV bag for myself), transfusions can be performed under similar circumstances. The biggest deal is keeping things clean.
posted by plinth at 11:05 AM on February 1, 2010 [2 favorites]

Blood is perishable and only lasts about 40 days. Having everyone keep a personal supply (which would mostly go to waste), would be problematic in terms of overall blood supply. Hemophiliacs would be using plasma which has a longer storage life.

Another issue is how safely the blood would be stored. It needs to be constantly cold. So if your power was out, you'd need to toss the blood. Tossing unused units brings us to the disposal issue.

Transfusions aren't rocket science, but there's some precision needed. Probably not a DIY project.
posted by 26.2 at 11:06 AM on February 1, 2010

They're totally possible. They may not be practical, but they're certainly possible.

The mechanics of blood transfusions aren't any different from any other kind of intravenous transfusion. A relative of mine was once on daily IV meds, and he brought his IV machine with him when he came to visit. It wasn't blood, but if it had been the procedure wouldn't have been any different.

The complication here is that if you are receiving regular IVs, you tend to get a catheter installed so you don't have to go after a new vein every time you need another round. For normal people this isn't that big of a deal, but that could pose real problems for a hemophiliac. And, as has been mentioned above, whole blood doesn't actually keep very well. Most hemophiliacs receive clotting factor a lot more frequently than they receive whole blood.

Still, I know of no reason why someone with the need for regular transfusions couldn't be trained and equipped to do this at home.
posted by valkyryn at 11:14 AM on February 1, 2010

Best answer: 1) The others are right in noting that the regular transfusion requirements for hemophiliacs relate to replacement of the deficient factors. This usually requires transfusion of something other than whole blood or packed red blood cells. Patients now receive the actual proteins they need specifically, though previously transfusions of plasma or cryoprecipitate were option. In an "emergency" hemophiliacs need hospitals like everyone else.

2) Though transfusions have almost uniformly been performed in outpatient transfusion centers and hospitals in the past, that may be changing more recently. But even so, there were some programs that did manage hemophiliacs in the past with home transfusions (obviously under close monitoring and guidance). See this article published in 1972 by the Duke group on home transfusions.

On the scale of stupidity, I'd say you were a bit off but I've heard a lot stupider.
posted by drpynchon at 11:44 AM on February 1, 2010

Nthing the above. The only thing that I need to add is that there is always the risk of a Transfusion reaction which is why transfusions are so carefully monitored in hospitals. Multiple nurses are often required to transfuse blood, as to prevent any errors. In addition, vital signs are carefully monitored throughout the transfusion.
posted by majikstreet at 11:57 AM on February 1, 2010

Also, in terms of scope of practice, untrained people aren't allowed to stick people with needles for the purpose of an infusion; it needs to be done by a nurse or a doctor (not MA or Nurses Aide or phlebotomist). So you could probably do it at home but you would need an at-home nurse to administer it.
posted by sarahnade at 12:16 PM on February 1, 2010

Having just had two units of blood transfused in a hospital... there was no special technology. They just hooked the bag up to the IV in my hand. They didn't even use the pump machine. Majikstreet makes a point. My vitals were taken hourly to make sure there was no reaction. When they brought the blood, there were two people (a nurse and a rep from the blood bank?) who verified me, my blood type, and the blood type of the donor blood. But after that it was just one nurse administering the transfusion and monitoring me.

The other thing is that once the transfusion is started, it must be completed within three and a half hours because of the de-refrigeration of the donor blood.
posted by kimdog at 12:34 PM on February 1, 2010

the only explanation that would make sense at that age would be... that they're vampires.

Actually, I have a confession. My mother worked for a blood bank in the mid 70's (pre AIDS). When the blood expired, she was allowed to take it home, where she mixed it with water and watered our azaleas with it. But until she got around to fertilizing, she would keep in our fridge.
posted by kimdog at 12:37 PM on February 1, 2010 [4 favorites]

Response by poster: Wow, thanks guys! You have collectively endowed me with l'esprit de l'escalier: I now know everything I should have said in response that day. ;)
posted by edguardo at 1:59 PM on February 1, 2010

Response by poster: Oh, and besides that, I feel like I know quite a bit more about blood transfusions, which is definitely the greater good in comparison.
posted by edguardo at 2:01 PM on February 1, 2010

OMG kimdog that is disgusting...but hilarious. How did the flowers look?
posted by radioamy at 4:14 PM on February 1, 2010

Since this is marked as answered, is it ok to be unhelpful and guess that the flowers looked 'bloody marvellous?'
posted by Hardcore Poser at 5:22 PM on February 1, 2010

They didn't even use the pump machine

Historically, the IV pumps used compression rollers to move the liquid through. This was damaging to the red cells in the blood, so pumps were not used. More modern pumps use different technology, but many nursing policies are still leery about using pumps. And even with modern technologies, the blood is much much thicker than other IV solutions and flows differently. I believe that some special calibration is required to use pumps accurately. It is just as easy to hand regulate a packed cell drip.
posted by SLC Mom at 8:45 PM on February 1, 2010

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