Lab-grown blood given to people in world-first clinical trial(bbc.com)
bbc.com
Lab-grown blood given to people in world-first clinical trial
https://www.bbc.com/news/health-63513330
120 comments
Something of a minor nit, but the US does not allow blood donors to be paid, only plasma donors.
That's right, and I have taught that point to trainees. However, there is a subtlety and I am sharing it as penance for having taught incorrectly:
The FDA does allows blood donation by paid blood donors. The blood must be labeled as from paid donors, but it is legal.
See https://www.statnews.com/2016/01/22/paid-plasma-not-blood/ for example...
The FDA does allows blood donation by paid blood donors. The blood must be labeled as from paid donors, but it is legal.
See https://www.statnews.com/2016/01/22/paid-plasma-not-blood/ for example...
If we can grow it with whatever factor James Harrison had, that would be another huge benefit.
https://www.cnn.com/2018/05/11/health/james-harrison-blood-d...
https://www.cnn.com/2018/05/11/health/james-harrison-blood-d...
Wow, what a legacy that man left behind. I don't trust the numbers in the article, but even if his impact was a fraction of the 2.4M lives saved, he's had a remarkable impact in Australia. Thanks for sharing!
Obviously if this succeeds, then the life-saving implications are tremendous. It would become practical to keep a stock of lab-grown blood in ambulances, as it can just be rotated out when it expires, but the immediate availability of blood in the field can mean the difference between life and death.
I just hope that blood donation doesn't go away as a result. There are both ethical and personal benefits - ethical, because it's a visceral experience of doing something good for society that most people can do, and with little effort; personal, because of potential health benefits from donating blood, see e.g. https://jamanetwork.com/journals/jamanetworkopen/fullarticle... .
I just hope that blood donation doesn't go away as a result. There are both ethical and personal benefits - ethical, because it's a visceral experience of doing something good for society that most people can do, and with little effort; personal, because of potential health benefits from donating blood, see e.g. https://jamanetwork.com/journals/jamanetworkopen/fullarticle... .
I don’t think this is the right way to think about it. If donating blood is no longer a useful societal good, then there are no ethical benefits. If there are health benefits to bloodletting, then we can do that independently of donating the blood.
And are those substances filtered out before being used? Could a recipient end up with higher concentrations in their blood?
Blood transfusion comes with a bunch of health risks. When it is done you generally have bigger problems than some PFAS accumulation.
Well I do hope that this succeeds beyond the wildest expectations, and blood-donations go the way of the horse[^1]. We can cultivate ethics in everything else.
--------------------------------
[^1]: We still have horses. So there is a chance some people will become recreational vampire-feeders and some people will adopt vampirism as a hobby. Fine, I won't judge.
--------------------------------
[^1]: We still have horses. So there is a chance some people will become recreational vampire-feeders and some people will adopt vampirism as a hobby. Fine, I won't judge.
"So there is a chance some people will become recreational vampire-feeders and some people will adopt vampirism as a hobby. Fine, I won't judge. "
Not very surprising, that is already a thing.
Edit: https://en.m.wikipedia.org/wiki/Clinical_vampirism
Not very surprising, that is already a thing.
Edit: https://en.m.wikipedia.org/wiki/Clinical_vampirism
This is not a solution to a general need for blood, but a need for rare blood types. Hospitals may keep the lab-grown rate blood, but not ambulances.
While your article calls out PFAS in firefighters, there are people who for other reasons need blood letting. It's one of my biggest gripes with blood donation in the US is that those people are prohibited from donating blood because they're getting "value" from doing so (instead of having to pay somebody to draw their blood the red cross would be drawing it for free -- note, the blood isn't unusable for any other reason than drawing it provides value to the donater).
Like you have a population that must give blood by some means and regularly the various blood banks complain about a shortage and they never seem to be able to put two and two together ...
Like you have a population that must give blood by some means and regularly the various blood banks complain about a shortage and they never seem to be able to put two and two together ...
I would love to see more donor centers allow hemochromatosis patients to donate.
I think there is not actually regulatory ban. Last I looked into this, it was because of the conflict of interest - the FDA requires blood from donors with hemochromatosis be labeled as such.
And even that requirement can be worked around. See, for example, https://clinicalcenter.nih.gov/blooddonor/donationtypes/hemo.... Background, most centers charge for therapeutic phlebotomy but obviously not for volunteer blood donation. The exception is permissable if the center agrees to allow the patient's blood to be drawn for free, whether or not they would qualify as a blood donor.
The issue with "getting value" from donating is that people sometimes lie in order to be able to get that value. The downstream issues can be very painful - I have personally taken care of patients who got HIV or hepatitis from blood transfusion. I am pretty sure any of them would emphatically agree it is important to ensure the blood supply is as safe as possible.
So it can be done, but it has to be done carefully.
I think there is not actually regulatory ban. Last I looked into this, it was because of the conflict of interest - the FDA requires blood from donors with hemochromatosis be labeled as such.
And even that requirement can be worked around. See, for example, https://clinicalcenter.nih.gov/blooddonor/donationtypes/hemo.... Background, most centers charge for therapeutic phlebotomy but obviously not for volunteer blood donation. The exception is permissable if the center agrees to allow the patient's blood to be drawn for free, whether or not they would qualify as a blood donor.
The issue with "getting value" from donating is that people sometimes lie in order to be able to get that value. The downstream issues can be very painful - I have personally taken care of patients who got HIV or hepatitis from blood transfusion. I am pretty sure any of them would emphatically agree it is important to ensure the blood supply is as safe as possible.
So it can be done, but it has to be done carefully.
This actually reversed just this year, with most major blood banks (following the example of the Red Cross) now allowing donations from diagnosed hemochromatosis patients.
>>then the life-saving implications are tremendous
Are people in medical settings dying because of a lack of blood? It seems that unless you're in some exotic blood group you will likely find a compatible donor, and it is not clear as to severity of an imperfect match to rarer groups like the mentioned "Bombay" group.
Are people in medical settings dying because of a lack of blood? It seems that unless you're in some exotic blood group you will likely find a compatible donor, and it is not clear as to severity of an imperfect match to rarer groups like the mentioned "Bombay" group.
Your parent is theorizing that people in edge medical settings are. For example, an EMT might not be able to give you a transfusion while you lay bleeding in the dirt, because they may not have twenty units of blood to spare in the bus.
I imagine that donations will continue to be important for a range of subtler purposes, such as using the plasma for immunological stuff.
Donation to get antigens for the RH group to give to RH- mother after a RH+ baby is an important application. For example https://edition.cnn.com/2018/05/11/health/james-harrison-blo...
Right idea, but I think maybe you may have used the wrong word.
The donation is to get antibodies.
Antigens are are the stimulus that causes the body to form antibodies.
We give the Rh- mom antibodies so they bind to antigens on the blood from baby; the idea being that "hiding" the antigens from mom's immune system will prevent her from making her own antibodies.
The donation is to get antibodies.
Antigens are are the stimulus that causes the body to form antibodies.
We give the Rh- mom antibodies so they bind to antigens on the blood from baby; the idea being that "hiding" the antigens from mom's immune system will prevent her from making her own antibodies.
also financial: some people rely on blood donations for extra cash to pay for food and bills. Though, there are better ways to give people opportunities…
People get paid to donate blood?
Not paid to donate blood, as far as I know, but plasma. I did this a handful of times in college for extra cash.
They still pierce you to remove blood and you get paid for it, don't you? I don't think "it's just the plasma" makes much of a difference.
It does with respect to how frequently you're able to donate. In the UK, blood donation can be no more frequent than once every 12 weeks (for men). Plasma can be donated up to once every 2 weeks.
In the US, yes.
Yeah, sounds to me like one of those cases where it's best to have a social reward rather than a financial one.
I believe you can get paid for donating your plasma components.
Germany does.
Germany doesn't. There are some for-profit options for donating blood in Germany but the most widely know way to give blood is with the German Red Cross, which does not pay donors unless you consider a small meal or the occasional swag (e.g. squishy balls) "payment".
As I understand it, some hospitals offer payment for blood donations but if you want to get paid the most reliable options are probably pharmaceutical companies. By number of donors, both are probably eclipsed by the Red Cross though, which by its nature heavily relies on volunteer work.
As I understand it, some hospitals offer payment for blood donations but if you want to get paid the most reliable options are probably pharmaceutical companies. By number of donors, both are probably eclipsed by the Red Cross though, which by its nature heavily relies on volunteer work.
Somebody on Reddit recently did collect what one gets for donating blood in different areas of Germany: https://www.reddit.com/r/de/comments/xoqyay/aufwandsentsch%C...
What you can see from that is that a "Aufwandsentschädigung" of ~20€ is pretty common.
What you can see from that is that a "Aufwandsentschädigung" of ~20€ is pretty common.
We're not disagreeing. These are (university) hospitals and corporations. I've seen numbers indicating that 70% to 80% of blood donations in Germany are done via the German Red Cross. The Red Cross does not pay money for blood donations.
Pre-COVID the German Red Cross often would have a buffet lunch typically consisting of sandwiches and fruit for donors. Since then they seem to have moved to prepackaged lunches and branded giveaways. But never cash money.
Pre-COVID the German Red Cross often would have a buffet lunch typically consisting of sandwiches and fruit for donors. Since then they seem to have moved to prepackaged lunches and branded giveaways. But never cash money.
As a German, I now several people here who donate blood and get paid money for it (e.g. here https://www.blutspendedienst-owl.de/blutspende.html), but more people do indeed donate plasma since they get more money per session and can donate more often (e.g. here: https://www.cslplasma.de/faqs but I don't see their monetary rewards on the page anywhere).
What, where? Most of blood donations are made through the Red Cross, they don't give people anything.
If you wait for the next blood donation to be advertised for you, it will be from the Red Cross or similar and you get a free sandwich or something to that effect. If you actively search for options to donate, chances are it will be at the local hospital that will pay you around 20€ for it and offer much more frequent options.
You don't get paid to donate blood, you get paid for selling your plasma to pharmaceutical companies.
Pretty neat. They take a pint of blood, separate out the stem cells, “guide” aka convert them (not explained, but I think it can be done with gene therapy and complicated physical/chemical treatment) to become red blood cells, and culture those red cells in vats.
World-changing if it works.
World-changing if it works.
The price tag is important. So far, these therapies are expensive. If, in the future, the stem cells can be nudged into their work more cheaply, the effect will be world-changing indeed.
imagine falling into one of those vats, https://ibb.co/zhH2QYX this feeling is more like it
We dodged a bullet! They’re pretty small vats right now. Whew.
"vats" are supposed to mean big vessels. tumblers, glasses, dishes and trays "mean small", just small nitpickings
A vat could be 30 gallons and still not be enough to fall into
Love isn't even a few grams, but you could still fall in love.
you know those buzzkill people who say "you rise in love,not fall in it", eh.
I wonder how long it will take for the technology to reach the point where it’s used for performance enhancement in sports. For example, if these red blood cells can hold a bit more oxygen, that’s an advantage for an endurance athlete.
Athletes already do this - they collect their own blood and store it and then transfuse themselves to supranormal levels prior to their sporting event. Lance Armstrong did this.
Lab grown blood would make this a bit more convenient, albeit at astronomical cost.
Lab grown blood would make this a bit more convenient, albeit at astronomical cost.
I assumed the reason to use their own blood was to avoid detection. Presumably synthetic blood is weird enough that it becomes trivial to detect its presence that would make it a no-go for cheating.
“Synthetic” in this case doesn’t mean that it’s made using an alternative chemical process - it just means they’re not made in bone marrow.
This process filters out stem cells from a blood donation and prevents them from becoming red blood cells long enough to multiply them significantly.
This process filters out stem cells from a blood donation and prevents them from becoming red blood cells long enough to multiply them significantly.
Yes. Some of the proteins in the cells would be different to the host cells, due to the exogenous stem cell source. This might be detectable with mass spectrometry (protein sequencing is otherwise difficult and laborious). There might also be different post translational modifications on the lab cells.
Till you start modifying the body to produce these supercells.
Nowadays they just take EPO
True. I imagine a scenario where the athlete is given supranormal blood without the extra step of collecting from themselves.
This is just me speaking “out loud”. Today, this would be quite expensive. I can see a future where the technology scales and the richer teams/individuals try this out.
This is just me speaking “out loud”. Today, this would be quite expensive. I can see a future where the technology scales and the richer teams/individuals try this out.
The salient point is it's prohibited in sports where it gives you a boost, and there are already ways to do it today.
Lance Armstrong was busted for blood doping. The cutting edge is way beyond that.
> The bulk of blood transfusions will always rely on people regularly rolling up their sleeve to donate.
Who is this line for? It's comically certain about this
Who is this line for? It's comically certain about this
People literally ALWAYS say this when a new disruptive technology comes up. I'm not sure why, maybe people like the idea of stability?
"Digital will never replace film"
"Landlines will always be the majority of calls"
"Computers are cool, but will never replace typewriters"
"Digital will never replace film"
"Landlines will always be the majority of calls"
"Computers are cool, but will never replace typewriters"
I would much prefer: "Hey, your shit's about to get fucked up. Here's what's going to happen:"
This appears to be a transfusion of mature blood cells derived from donor CD34+ hematopoietic stem cells, and it sounds like they're able to collect usable numbers of stem cells from a regular unit of whole blood... but how?
People normally don't have a whole lot of stem cells in the peripheral circulation (if they did, they'd have leukemia). For the purpose of stem cell transplantation, the donor is given medications to mobilize stem cells from the bone marrow before collection. I'm sure they're present in very small numbers in the blood, and perhaps they could be cultured in the lab, but even stem cells become exhausted eventually. This is the innovation, probably.
People normally don't have a whole lot of stem cells in the peripheral circulation (if they did, they'd have leukemia). For the purpose of stem cell transplantation, the donor is given medications to mobilize stem cells from the bone marrow before collection. I'm sure they're present in very small numbers in the blood, and perhaps they could be cultured in the lab, but even stem cells become exhausted eventually. This is the innovation, probably.
The number of circulating CD34+ cells varies by individual, and by age.
I volunteered for an unstimulated collection when we were validating the process of stem cell collection at my work. I was at the upper limit of normal, but I technically had enough in CD34+ cells in my circulation to do a transplant even without stimulation, and I was in my early 30s at the time.
A single CD34+ cell can probably make a lot of RBCs. (Ok, to be pedantic, I'm not 100 percent sure they are really CD34+ cells, I was taught that CD34+ is a marker for myeloblasts, and the cell population you would probably want are the CD34- hematogones as they are self-replenishing. The article didn't seem to say either way).
I volunteered for an unstimulated collection when we were validating the process of stem cell collection at my work. I was at the upper limit of normal, but I technically had enough in CD34+ cells in my circulation to do a transplant even without stimulation, and I was in my early 30s at the time.
A single CD34+ cell can probably make a lot of RBCs. (Ok, to be pedantic, I'm not 100 percent sure they are really CD34+ cells, I was taught that CD34+ is a marker for myeloblasts, and the cell population you would probably want are the CD34- hematogones as they are self-replenishing. The article didn't seem to say either way).
"some groups were "really, really rare" and there "might only be 10 people in the country" able to donate."
oooof.... I knew some blood type was rare, but this is another level.
oooof.... I knew some blood type was rare, but this is another level.
Always reminds me of this:
> Harrison, known as the “Man With the Golden Arm,” has donated blood nearly every week for 60 years. After all those donations, the 81-year-old Australian man “retired” Friday. The occasion marked the end of a monumental chapter. According to the Australian Red Cross Blood Service, he has helped saved the lives of more than 2.4 million Australian babies.
https://www.cnn.com/2018/05/11/health/james-harrison-blood-d...
> Harrison, known as the “Man With the Golden Arm,” has donated blood nearly every week for 60 years. After all those donations, the 81-year-old Australian man “retired” Friday. The occasion marked the end of a monumental chapter. According to the Australian Red Cross Blood Service, he has helped saved the lives of more than 2.4 million Australian babies.
https://www.cnn.com/2018/05/11/health/james-harrison-blood-d...
It's a different case. The article you posted is about someone that has a high level of RH antibodies.
In the main article, the rare blood type is because the the A, B, AB, 0 and RH+/RH- groups are due to 3 antigens (2^3=8). But there are like 20 or 25 more antigens that your blood may or may not have, so there are like 2^23 or 2^28 blood types. Some are very rare, some combinations are very rare. Most of the time the other 20 antigens don't produce a reaction that is so strong [1], so for most transfusions it's enough to classify using the A, B, and RH.
[1] Why? I'd really like to know why, or if I'm oversimplifying too much.
In the main article, the rare blood type is because the the A, B, AB, 0 and RH+/RH- groups are due to 3 antigens (2^3=8). But there are like 20 or 25 more antigens that your blood may or may not have, so there are like 2^23 or 2^28 blood types. Some are very rare, some combinations are very rare. Most of the time the other 20 antigens don't produce a reaction that is so strong [1], so for most transfusions it's enough to classify using the A, B, and RH.
[1] Why? I'd really like to know why, or if I'm oversimplifying too much.
Ask and ye shall receive!
To answer [1] Why?: it's complicated.
There are more than 35 red blood cell groups (see https://www.science.org.au/curious/people-medicine/blood-typ... for a nice writeup). For each of those blood groups, there is more than one possible configuration of some protein or carbohydrate (something like more than one possible genetic sequence leading to more than one kind of molecule on the surface of the RBCs).
And, even with ABO, there can be infrequent variations that make things more complicated (see https://professionaleducation.blood.ca/en/transfusion/best-p... for more).
For the other blood groups, I think every case the groups were identified because a patient somewhere made an antibody, causing either a transfusion reaction (if not tested ahead of time) or, more likely, a positive (incompatible) reaction on in compatibility testing.
Each of those blood groups will have two or more versions. For example, there is the Kell blood group, which has two primary versions: you can express big K, little k, or both as Kell is a codominant system. Most people are homozygous little k (kk). When you are homozygous little k, you can make antibodies to big K (which is expressed on people who are Kk or KK). So, if you are homozygous little k, you are at risk of making antibodies on exposure to big K. Of course, not everyone is either big K or little k, that would be too simple. There are, I think, more than 20 variants of K out there...
More or less, each of those blood groups can cause antibody formation if you lack an antigen on the surface of those antibodies. In practice, the likelihood of an antigen causing antibody formation varies by antigen (the term there is "antigenic"). Also, the immunologic status of the recipient matters - obviously, someone who is immunosuppressed from an organ transplant may be less likely to form antibodies (that's the point of of the immunosuppression). Conversely, some people are more likely than most to form antibodies.
Also, it appears that the immune system is more likely to form antibodies in other blood groups if a person already has antibodies. In practice, there is a recommendation from NHLBI to match for C, E, and K in patients who are going to be transfused often to try to avoid forming new antibodies.
People 'naturally' form antibodies to A and to B antigens that they lack (I am group O and have both anti-A and anti-B antibodies). This is because they are exposed to those antigens in everyday life (the A and B antigen is found on some gut bacteria). And Rh-D is very immunogenic and clinically significant.
When we test blood prior to transfusion, we attempt to identify what antibodies the patient may have. If they have no unexpected antibodies, just honoring blood and Rh-D type is usually enough. If they have unexpected antibodies, we go through a complicated process to identify blood that lacks those antibodies to try to avoid a transfusion reaction.
(Now to modify that testing point, we know some antibodies are not clinically significant - that is, they do not cause significant transfusion reactions. So, we can, if we have to, give blood that is incompatible for clinically insignificant antibodies. We still try to provide blood negative for those antigens because we wouldn't find out this patient is the first to have a clinically significant version of the antibody. Also, the blood tests as incompatible with clinically insignificant antibodies, and we would prefer to give blood that tests as compatible).
Sorry this is rambling a bit - I have to take my daughter to school. Happy to expand/clarify/etc. when I can get back to it.
Source: I am a practicing physician board certified in "Blood Banking/Transfusion Medicine". My statements in this are still likely inaccurate, but hopefully in a useful way. I am not your lawyer, and I am not your physician.
To answer [1] Why?: it's complicated.
There are more than 35 red blood cell groups (see https://www.science.org.au/curious/people-medicine/blood-typ... for a nice writeup). For each of those blood groups, there is more than one possible configuration of some protein or carbohydrate (something like more than one possible genetic sequence leading to more than one kind of molecule on the surface of the RBCs).
And, even with ABO, there can be infrequent variations that make things more complicated (see https://professionaleducation.blood.ca/en/transfusion/best-p... for more).
For the other blood groups, I think every case the groups were identified because a patient somewhere made an antibody, causing either a transfusion reaction (if not tested ahead of time) or, more likely, a positive (incompatible) reaction on in compatibility testing.
Each of those blood groups will have two or more versions. For example, there is the Kell blood group, which has two primary versions: you can express big K, little k, or both as Kell is a codominant system. Most people are homozygous little k (kk). When you are homozygous little k, you can make antibodies to big K (which is expressed on people who are Kk or KK). So, if you are homozygous little k, you are at risk of making antibodies on exposure to big K. Of course, not everyone is either big K or little k, that would be too simple. There are, I think, more than 20 variants of K out there...
More or less, each of those blood groups can cause antibody formation if you lack an antigen on the surface of those antibodies. In practice, the likelihood of an antigen causing antibody formation varies by antigen (the term there is "antigenic"). Also, the immunologic status of the recipient matters - obviously, someone who is immunosuppressed from an organ transplant may be less likely to form antibodies (that's the point of of the immunosuppression). Conversely, some people are more likely than most to form antibodies.
Also, it appears that the immune system is more likely to form antibodies in other blood groups if a person already has antibodies. In practice, there is a recommendation from NHLBI to match for C, E, and K in patients who are going to be transfused often to try to avoid forming new antibodies.
People 'naturally' form antibodies to A and to B antigens that they lack (I am group O and have both anti-A and anti-B antibodies). This is because they are exposed to those antigens in everyday life (the A and B antigen is found on some gut bacteria). And Rh-D is very immunogenic and clinically significant.
When we test blood prior to transfusion, we attempt to identify what antibodies the patient may have. If they have no unexpected antibodies, just honoring blood and Rh-D type is usually enough. If they have unexpected antibodies, we go through a complicated process to identify blood that lacks those antibodies to try to avoid a transfusion reaction.
(Now to modify that testing point, we know some antibodies are not clinically significant - that is, they do not cause significant transfusion reactions. So, we can, if we have to, give blood that is incompatible for clinically insignificant antibodies. We still try to provide blood negative for those antigens because we wouldn't find out this patient is the first to have a clinically significant version of the antibody. Also, the blood tests as incompatible with clinically insignificant antibodies, and we would prefer to give blood that tests as compatible).
Sorry this is rambling a bit - I have to take my daughter to school. Happy to expand/clarify/etc. when I can get back to it.
Source: I am a practicing physician board certified in "Blood Banking/Transfusion Medicine". My statements in this are still likely inaccurate, but hopefully in a useful way. I am not your lawyer, and I am not your physician.
> Sorry this is rambling a bit
Nice write up! I'm happy with the answer, but I'd not mind if you decide to expand it. Anyway, I think it would be more useful if you reply to other questions in this thread, but you already have been doing that. I'll upvote your comment, but this is one of the ocasiones when I'd like a x2 upvote.
Edit: If you don't mind a question: What do you [1] do with the people with big K that want to be blood donors? Ask them not to donate[2]? Do you tell them? Label the blood as big K and be more careful?
[1] "You" as the impersonal "you". I could have written "the system" or something more accurate.
[2] I guess they can donate. Otherwise they will be extremely unhappy.
Nice write up! I'm happy with the answer, but I'd not mind if you decide to expand it. Anyway, I think it would be more useful if you reply to other questions in this thread, but you already have been doing that. I'll upvote your comment, but this is one of the ocasiones when I'd like a x2 upvote.
Edit: If you don't mind a question: What do you [1] do with the people with big K that want to be blood donors? Ask them not to donate[2]? Do you tell them? Label the blood as big K and be more careful?
[1] "You" as the impersonal "you". I could have written "the system" or something more accurate.
[2] I guess they can donate. Otherwise they will be extremely unhappy.
Thanks! Your comments are encouraging.
[1,2]: Most people don't have antibodies, so big K+ blood is fine for most people (we worry about avoiding transfusing big-K positive blood into big-K negative people who will be transfused many times, such as somebody with sickle cell disease, it's not really a major issue for most people getting a rare transfusion).
So, K+ people are definitely allowed to donate. Also, there are people who have antibodies to little-k, and so they would actually need big-K homozygous blood.
When we need blood that is big-K negative, such as for a chronically transfused patient or one with antibodies to big-K, we try find units from people whose units were previously identified to be big-K negative. If they don't have any, the donor center can screen blood for them. We then verify compatibility with a crossmatch (reacting plasma from the patient with RBCs from the unit to make sure there is no reaction).
Remember there are lots of other blood types - big-K is one we have to match sometimes. Little-k is another. There are at least 70 altogether, so we can't really even try to match all of them. Even matching C, E, and K is straining the ability of the system to provide special antigen-negative blood.
It will be interesting to see what the long-term applications of lab-grown blood will be. I do worry about rare blood not being as available.
[1,2]: Most people don't have antibodies, so big K+ blood is fine for most people (we worry about avoiding transfusing big-K positive blood into big-K negative people who will be transfused many times, such as somebody with sickle cell disease, it's not really a major issue for most people getting a rare transfusion).
So, K+ people are definitely allowed to donate. Also, there are people who have antibodies to little-k, and so they would actually need big-K homozygous blood.
When we need blood that is big-K negative, such as for a chronically transfused patient or one with antibodies to big-K, we try find units from people whose units were previously identified to be big-K negative. If they don't have any, the donor center can screen blood for them. We then verify compatibility with a crossmatch (reacting plasma from the patient with RBCs from the unit to make sure there is no reaction).
Remember there are lots of other blood types - big-K is one we have to match sometimes. Little-k is another. There are at least 70 altogether, so we can't really even try to match all of them. Even matching C, E, and K is straining the ability of the system to provide special antigen-negative blood.
It will be interesting to see what the long-term applications of lab-grown blood will be. I do worry about rare blood not being as available.
I wonder if they were able to find additional sources to replace him...
What’s more is that the identities of those people need to be protected lest they be bombarded constantly for lab studies or requests for life saving donations.
Many counties have laws about paying for blood donations and don’t allow donors to be compensated in any way, so they either need to take on the financial burden of flying to wherever their blood is needed or refusing to take on the financial burden and knowingly allowing someone to die.
It’s not fair to them and while most of these laws prevent darker forms of abuse of vulnerable demographics, they don’t really account for cases like donation of rare blood types.
Many counties have laws about paying for blood donations and don’t allow donors to be compensated in any way, so they either need to take on the financial burden of flying to wherever their blood is needed or refusing to take on the financial burden and knowingly allowing someone to die.
It’s not fair to them and while most of these laws prevent darker forms of abuse of vulnerable demographics, they don’t really account for cases like donation of rare blood types.
> so they either need to take on the financial burden of flying to wherever their blood is needed or refusing to take on the financial burden and knowingly allowing someone to die.
Is that a real case or hypothetical? If real, I would like to explore further as it does seem rather inappropriate.
In my experience, the blood can be drawn locally and then sent to the recipient. That's also true for bone marrow & peripheral blood stem cell donations.
Source: I am a transfusion medicine physician.
Is that a real case or hypothetical? If real, I would like to explore further as it does seem rather inappropriate.
In my experience, the blood can be drawn locally and then sent to the recipient. That's also true for bone marrow & peripheral blood stem cell donations.
Source: I am a transfusion medicine physician.
Don't people with such blood groups preserve their own blood for emergencies?
Some can and do, but there are some challenges for it being a general solution:
- Some people don't know they need rare blood (because they didn't have the antibody at first, then found they had it later).
- Some people may donate blood to have it available for a need, then a need comes up (either themselves or someone else). At that point, the blood gets used up - what happens when the need is greater than the number of stored units?
- Some people may not be able to donate. We had a patient with something north of 9 antibodies who, due to sickle cell disease wasn't able to donate - (banking blood for long term storage requires freezing, which doesn't work with blood from patients with sickle cell disease).
- Some people don't know they need rare blood (because they didn't have the antibody at first, then found they had it later).
- Some people may donate blood to have it available for a need, then a need comes up (either themselves or someone else). At that point, the blood gets used up - what happens when the need is greater than the number of stored units?
- Some people may not be able to donate. We had a patient with something north of 9 antibodies who, due to sickle cell disease wasn't able to donate - (banking blood for long term storage requires freezing, which doesn't work with blood from patients with sickle cell disease).
[deleted]
It's well and truly Morbin' time
A nice way to undercut my market of "pay me". Although maybe this will set a price floor above 0 for blood.
> It is hoped the lab-grown blood will be more potent than normal.
Interesting. I've been expecting artificial blood for a while but hadn't considered this angle. Athletes and the wealthy with better performance blood!
Interesting. I've been expecting artificial blood for a while but hadn't considered this angle. Athletes and the wealthy with better performance blood!
You want 28 days later? Because this is how you get 28 days later.
How do you make the stem cells produce the certain rare blood type that you need? What distinguishes it?
The blood group of the person who donated stem cells.
Blood is highly complicated.
I think the HN audience understands it at a level of "blood is red cells, white cells, and platelets", but that's really not the whole picture. Blood also has plasma which is composed of gas, nutrients, proteins, ions, and water. We can actually refine blood plasma down to a state where it's basically 100% safe even if someone with "bad blood" donated it.
These 4 different blood components all get seperated at the lab, frozen for storage, and turned into individual products which can be mixed+matched depending on medical need.
Don't get me wrong, growing red cells in a lab is awesome, but I don't see it the same way a lot of comments in this thread do (solving a storage issue, saving a lot of lives, etc).
I think the realistic applications of lab-grown-blood over the next 15 years will be closer to treating rare diseases or possibly rare blood types (some people exist outside the typical A, B, AB, O groupings). I don't see this fixing logistics or supply/demand issues in the next 15 years, especially with how highly regulated the blood supply is in any first world nation.
I think the HN audience understands it at a level of "blood is red cells, white cells, and platelets", but that's really not the whole picture. Blood also has plasma which is composed of gas, nutrients, proteins, ions, and water. We can actually refine blood plasma down to a state where it's basically 100% safe even if someone with "bad blood" donated it.
These 4 different blood components all get seperated at the lab, frozen for storage, and turned into individual products which can be mixed+matched depending on medical need.
Don't get me wrong, growing red cells in a lab is awesome, but I don't see it the same way a lot of comments in this thread do (solving a storage issue, saving a lot of lives, etc).
I think the realistic applications of lab-grown-blood over the next 15 years will be closer to treating rare diseases or possibly rare blood types (some people exist outside the typical A, B, AB, O groupings). I don't see this fixing logistics or supply/demand issues in the next 15 years, especially with how highly regulated the blood supply is in any first world nation.
There is a LOT more to blood! There are a total of 36 different blood group systems, with the most important being the ABO group that everyone knows gives you your A, B, O, or AB blood, and the (RHD gene of the) Rh group that gives you the + or - part of it.
When given a single transfusion, a patient can usually be given blood based on the ABO and +/- part of the Rh groups alone, but there's more to the Rh system than most people know.
As well as the RHD gene, there's also the RHCE gene. The RHD gene can either be present (D, gives you positive blood) or not present (d, gives you negative blood), but the RHCE gene can give you one of four variations of the C, c, E and e antigens. When the two genes combine, you can have any of the following combinations: Dce, DCe, DcE, DCE, dce, dCe, dcE, dCE (which were given simplified names: Ro, R1, R2, Rz, r, r', r", ry respectively).
When patients have to be given regular blood transfusions, especially on a long-term basis, the blood they receive has to be more precisely matched. That's often why there's always a huge push for black donors - because many black people suffer from sickle cell anaemia, for which the treatment is regular blood transfusions, they need blood that better matches their own.
When given a single transfusion, a patient can usually be given blood based on the ABO and +/- part of the Rh groups alone, but there's more to the Rh system than most people know.
As well as the RHD gene, there's also the RHCE gene. The RHD gene can either be present (D, gives you positive blood) or not present (d, gives you negative blood), but the RHCE gene can give you one of four variations of the C, c, E and e antigens. When the two genes combine, you can have any of the following combinations: Dce, DCe, DcE, DCE, dce, dCe, dcE, dCE (which were given simplified names: Ro, R1, R2, Rz, r, r', r", ry respectively).
When patients have to be given regular blood transfusions, especially on a long-term basis, the blood they receive has to be more precisely matched. That's often why there's always a huge push for black donors - because many black people suffer from sickle cell anaemia, for which the treatment is regular blood transfusions, they need blood that better matches their own.
It's so complicated.
Just one more example: infants express a different set of hemes that have higher oxygen binding affinity. The switch from fetal to adult heme is being investigated as a potential cause of SIDS.
Just one more example: infants express a different set of hemes that have higher oxygen binding affinity. The switch from fetal to adult heme is being investigated as a potential cause of SIDS.
Another comment says this is based on the donor. So, if you can self donate, or find one matching donor, you should be able to get a match every time.
Obviously, custom tailored stuff is likely to take longer to develop, but it seems feasible.
Obviously, custom tailored stuff is likely to take longer to develop, but it seems feasible.
This is fascinating, thanks for sharing. Are there more groups than just A, B and O?
The ABO group system relates to a gene called ABO, which gives you your A, B, AB, or O type. I'm not aware of any other blood types in that system (though I'm just an eager blood donor, not a haematologist).
There are lots of other systems though that add up to make your blood what it is. There's the Rhesus (Rh) system I mentioned before, but the main ones also include the MNS system, the P system, the Lutheran system, the Kell system, the Lewis system, the Duffy system, and the Kidd system. As far as I know, Kell is the third most immunogenic system after ABO and Rhesus.
There are lots of other systems though that add up to make your blood what it is. There's the Rhesus (Rh) system I mentioned before, but the main ones also include the MNS system, the P system, the Lutheran system, the Kell system, the Lewis system, the Duffy system, and the Kidd system. As far as I know, Kell is the third most immunogenic system after ABO and Rhesus.
They apparently discover new sets of blood groups every few years, there are some vanishingly rare types.
https://www.wired.com/story/new-blood-types/
https://www.wired.com/story/new-blood-types/
the application i immediately thought about is disaster medicine.
This is when you need huge amounts of blood, and my guess is that it can be less perfect, when there is simply no other choice to save lives.
An inferior substitute is better than nothing
This is when you need huge amounts of blood, and my guess is that it can be less perfect, when there is simply no other choice to save lives.
An inferior substitute is better than nothing
I think it might be the opposite, actually. In a disaster, when you need a sudden surge of supply, you're not going to have time to scale up your production. Even if we had reliable supplies of synthetic blood, I think disasters are always going to call for mass donations from the old-fashioned blood producers.
> I think disasters are always going to call for mass donations from the old-fashioned blood producers.
Maybe I’m parroting an incorrect bar top factoid, but isn’t it usually the case that they need the blood before the disaster? That when events like 9/11 occur and people rush to donate blood, it’s not actually going to do much for the immediate problem?
Maybe I’m parroting an incorrect bar top factoid, but isn’t it usually the case that they need the blood before the disaster? That when events like 9/11 occur and people rush to donate blood, it’s not actually going to do much for the immediate problem?
Yes and no. It won't do much for the immediate problem, but you're about to go through a lot more blood and will need to replenish the stores.
With 9/11 specifically it didn’t do much for the immediate problem because there wasn’t much need for blood. People crushed under the weight of the towers weren’t bleeding out, they were just dead.
[deleted]
What about coagulation? It is needed in situations where you have acute blood loss, and plasma contains the coagulation factors. You already probably want to give your patient coagulants in such a situation but I don't know if those are enough on their own or they need cooperation from existing factors in the plasma.
That's also where blood plasma comes in, which can be donated once a month (as opposed to blood which is only a few times a year).
I mean if this can be scaled up to producing gallons an hour in the field then sure, but we're a ways away from that still.
I mean if this can be scaled up to producing gallons an hour in the field then sure, but we're a ways away from that still.
Yeah field work sounds great for this! Stabilize then treat. Good observation.
> We can actually refine blood plasma down to a state where it's basically 100% safe even if someone with "bad blood" donated it.
Do you have a source on this? Given that many blood donation facilities still refuse many “risk groups”, which honestly always carried the stench of politics to me how arbitrarily they are selected, from donating blood?
Do you have a source on this? Given that many blood donation facilities still refuse many “risk groups”, which honestly always carried the stench of politics to me how arbitrarily they are selected, from donating blood?
I'm concerned that someone might take my previous statement and assume this means all blood donations are safe -- they're not. Without a bunch of steps in place they're horrifyingly risky, and our screening technology is not good enough. I'll explain more in a moment.
To answer your direct question, in Toronto there was a doctor who wanted to open a pay-for-plasma clinic like they have in the US. In Canada, blood donations are not paid for which is one of the core reasons the supply is considered to be safer than other first world countries. The regulators shut it down and stopped him, not because of cleaning the plasma from the blood, but for policy reasons.
Back to the point about safe blood... Being a person who is allowed to donate blood is not related to this cleaning process but statistics about risk and also related to costs. So this is part of why there are no plasma clinics in Canada.
The blood donation is tested, but the tests don't catch everything. Really horrible diseases can test negative, which is why the process to donate blood includes an interview to categorize a high risk donor. This is why they don't let you donate blood when you have been living in europe for many years, have tattoos, multiple sexual partners, or had male-with-male sex. A lot of people hear about this and are totally outraged and jump to assumptions that the blood donation system is stuck in some anti-gay-rights 1900s puritan mindset, but that's not what's going on.
People regularly walk into blood donor clinics, lie about their high risk factors because they want to "prove a point", the tests for things like HIV can't always catch it all the time (especially in early stages; stages where there are no symptoms), and one blood donation could actually make it to several other people (like a baby, a motorcycle accident victim, and a surgery patient). It happens regularly enough that your nation's blood supply has a "lookback/traceback" program where they have 10-100 people who sit there all day working on cases and sending letters to people who received bad blood, and it can even come up 5+ years later when someone who donated blood in 2015 just got a diagnosis in 2020, all those people in the "bloodline" get notified, banned from the system, and advised to get tested too.
Doctors depend on multiple layers of checks to keep the blood supply clean, one of them is a statistical layer, one is a testing layer, one is the processing to keep the blood clean/safe, another is policy. Please don't interpret my point about plasma being highly cleanable to mean that all blood components in general can be safely received from the homeless.
To answer your direct question, in Toronto there was a doctor who wanted to open a pay-for-plasma clinic like they have in the US. In Canada, blood donations are not paid for which is one of the core reasons the supply is considered to be safer than other first world countries. The regulators shut it down and stopped him, not because of cleaning the plasma from the blood, but for policy reasons.
Back to the point about safe blood... Being a person who is allowed to donate blood is not related to this cleaning process but statistics about risk and also related to costs. So this is part of why there are no plasma clinics in Canada.
The blood donation is tested, but the tests don't catch everything. Really horrible diseases can test negative, which is why the process to donate blood includes an interview to categorize a high risk donor. This is why they don't let you donate blood when you have been living in europe for many years, have tattoos, multiple sexual partners, or had male-with-male sex. A lot of people hear about this and are totally outraged and jump to assumptions that the blood donation system is stuck in some anti-gay-rights 1900s puritan mindset, but that's not what's going on.
People regularly walk into blood donor clinics, lie about their high risk factors because they want to "prove a point", the tests for things like HIV can't always catch it all the time (especially in early stages; stages where there are no symptoms), and one blood donation could actually make it to several other people (like a baby, a motorcycle accident victim, and a surgery patient). It happens regularly enough that your nation's blood supply has a "lookback/traceback" program where they have 10-100 people who sit there all day working on cases and sending letters to people who received bad blood, and it can even come up 5+ years later when someone who donated blood in 2015 just got a diagnosis in 2020, all those people in the "bloodline" get notified, banned from the system, and advised to get tested too.
Doctors depend on multiple layers of checks to keep the blood supply clean, one of them is a statistical layer, one is a testing layer, one is the processing to keep the blood clean/safe, another is policy. Please don't interpret my point about plasma being highly cleanable to mean that all blood components in general can be safely received from the homeless.
So, what I'm to take from this is that though plasma itself can be donated without risk, the other components cannot?
Plasma undergoes extensive processing that inactivates many viruses that would not be inactivated by current blood processing. See https://www.pptaglobal.org/safety-quality/pathogen-safety
Don't homeless people in America sell their blood for money?
Was a bit of a scandal when it ended up in my country. Might as well buy organs from the Chinese lol.
You can donate plasma for money, yes. It's not just homeless people, rarely it is. College students trying to make drinking money and such are very common. It's considered less exploitative because the cells are pumped back in, with just the plasma being kept for later use.
You cannot sell whole blood donations though by law, that's all volunteer.
You cannot sell whole blood donations though by law, that's all volunteer.
US is one of the 5 countries (US, Germany, Austria, Hungary and Czesh Republic) that pays for plasma donations. It represents 60%+ of plasma donations worldwide. Most other countries other than the 5 don't sufficiently produce plasma domestically to supply their needs and must import it. It appears some compensation is needed for people to donations sufficiently. The Plasma is broken down it various components used to treat all types of diseases. During the pandemic there were all kinds of worldwide shortages of plasma products because US plasma donations went down. Other countries should reconsider their approach to plasma donations to reduce risks of shortages.
https://www.euractiv.com/section/health-consumers/news/us-bl...
https://www.euractiv.com/section/health-consumers/news/us-bl...
Yes, plasma. I did it when I was poor(er). It's hard as we age, but it pays.
I did this when I was young. I used to joke that all my furniture was paid for with "blood money". Years later I read a report that there were some negative side-effects being discovered for people who donated for very long periods of time, so I guess I'm glad I stopped. Looking back, the idea of selling body parts, even if it's "just plasma" still feels icky to me.
get ready for "I drain my blood and replace it with synthetic every morning to increase coding efficiency" hn posts in a year or two ...
I wonder if it's white...
> The bulk of blood transfusions will always rely on people regularly rolling up their sleeve to donate.
I always cringe when I read sentences like that. "Always"? Really? How could you possibly know that?
I always cringe when I read sentences like that. "Always"? Really? How could you possibly know that?
...seems likely to always rely on...
Poor expression. (May be completely wrong too for all I know, but I think it's the expression that is rubbing you up the wrong way).
Poor expression. (May be completely wrong too for all I know, but I think it's the expression that is rubbing you up the wrong way).
and 4kb of ram is all you'll ever need!
[deleted]
godmode2019(3)
https://www.bristol.ac.uk/news/2022/november/labblood-study....
> "The lab-grown blood cells are all fresh, so the trial team expect them to perform better than a similar transfusion of standard donated red cells, which contains cells of varying ages. Additionally, if manufactured cells last longer in the body, patients who regularly need blood may not need transfusions as often. That would reduce iron overload from frequent blood transfusions, which can lead to serious complications."
They discuss automating the process, but the costs are still likely to be high as you'd need near-clean-room standards of sterility to avoid contamination problems - although that's also a problem with blood donation. Notably, some countries (incl USA, China) allow people to sell their blood, which tends to draw in poor and desperate people who may be more at risk of having transmissible diseases:
https://www.theatlantic.com/business/archive/2018/03/plasma-...
In the long run however, this might become the normal process. Bio-synthetic blood cell production has been talked about for over 20 years, it's cool to see it actually happening. (Synthetic immune system cells are also an interesting possibility, i.e. white blood cells).