What is Blood?
Photographers Bruce Wetzel/Harry Schaefer, courtesy National Cancer Institute
A scanning electron microscope image from normal circulating human blood.
It can seem improbable, or even impossible, that an artificial substance could replace something that does all this work and is so central to human life. To understand the process, it helps to know a little about how real blood works. Blood has two main components -- plasma and formed elements. Nearly everything that blood carries, including nutrients, hormones and waste, is dissolved in the plasma, which is mostly water. Formed elements, which are cells and parts of cells, also float in the plasma. Formed elements include white blood cells (WBCs), which are part of the immune system, and platelets, which help form clots. Red blood cells (RBCs) are responsible for one of blood's most important tasks -- carrying oxygen and carbon dioxide.
RBCs are numerous; they make up more than 90 percent of the formed elements in the blood. Virtually everything about them helps them carry oxygen more efficiently. An RBC is shaped like a disc that's concave on both sides, so it has lots of surface area for oxygen absorption and release. Its membrane is very flexible and has no nucleus, so it can fit through tiny capillaries without rupturing.
A red blood cell's lack of nucleus also gives it more room for hemoglobin (Hb), a complex molecule that carries oxygen. It's made of a protein component called a globin and four pigments called hemes. The hemes use iron to bond to oxygen. Inside each RBC are about 280 million hemoglobin molecules.
If you lose a lot of blood, you lose a lot of your oxygen delivery system. The immune cells, nutrients and proteins that blood carries are important, too, but doctors are generally most concerned with whether your cells are getting enough oxygen.
In an emergency situation, doctors will often give patients volume expanders, like saline, to make up for lost blood volume. This helps restore normal blood pressure and lets the remaining red blood cells continue to carry oxygen. Sometimes, this is enough to keep the body going until it can produce new blood cells and other blood elements. If not, doctors can give patents blood transfusions to replace some of the lost blood. Blood transfusions are also fairly common during some surgical procedures.
This process works pretty well, but there are several challenges that can make it difficult or impossible to get patients the blood they need:
- Human blood has to be kept cool, and it has a shelf life of 42 days. This makes it impractical for emergency crews to carry it in ambulances or for medical staff to carry it onto the battlefield. Volume expanders alone may not be enough to keep a badly bleeding patient alive until he reaches the hospital.
- Doctors must make sure the blood is the right type -- A, B, AB or O -- before giving it to a patient. If a person receives the wrong type of blood, a deadly reaction can result.
- The number of people who need blood is growing faster than the number of people who donate blood.
- Viruses like HIV and hepatitis can contaminate the blood supply, although improved testing methods have made contamination less likely in most developed countries.
This is where artificial blood comes in. Artificial blood doesn't do all the work of real blood -- sometimes, it can't even replace lost blood volume. Instead, it carries oxygen in situations where a person's red blood cells can't do it on their own. For this reason, artificial blood is often called an oxygen therapeutic. Unlike real blood, artificial blood can be sterilized to kill bacteria and viruses. Doctors can also give it to patients regardless of blood type. Many current types have a shelf life of more than a year and don't need to be refrigerated, making them ideal for use in emergency and battlefield situations. So even though it doesn't actually replace human blood, artificial blood is still pretty amazing.
We'll look at where artificial blood comes from and how it works in a person's bloodstream next.
US scientists working for the experimental arm of the Pentagon have developed artificial blood for use in transfusions for wounded soldiers in battlefields. The blood cells are said to be functionally indistinguishable from normal blood cells and could end forever the problem of blood donor shortages in war zones and difficulties in transporting blood to remote and inaccessible areas.
The blood is made from hematopoietic stem cells from discarded human umbilical cords, which are turned into large quantities of red blood cells by a method called "blood pharming" that mimics the functions of bone marrow. Pharming is a method of using genetically engineered plants or animals to create medically useful substances in large quantities. Using this process the cells from one umbilical cord can produce about 20 units of blood, which is enough for over three transfusions for injured soldiers in the field.
The blood is being manufactured for the Defense Advanced Research Projects Agency (DARPA) by Ohio company Arteriocyte, which has already submitted samples of O-negative blood to the US Food and Drug Administration (FDA) for evaluation and safety testing. The company received funding of $1.95 million in 2008 to find a way of making large quantities of artificial blood.
Don Brown of Arteriocyte said the method works but the production needs to be scaled up to produce enough blood. Scaling up would also bring the costs per unit (around a pint) down from the current $5,000 to $1,000 or less. The scaling up could involve improving the technology to produce more units from each umbilical cord, or finding a way to make the culture chambers that mimic bone marrow more efficient and therefore cheaper.
Mr Brown said that in war zones it can take three weeks for donated blood (which mostly comes from donations made in the US) to reach patients. It must be used within a week or two to avoid the risk of organ failure or infection that can occur if the blood is stale. There are mobile blood banks in the field, but if there are many injured soldiers, there is often not enough fresh blood available.Human trials of the "pharmed" blood are expected to start in 2013, but the blood could be available for military use within five years. It could also eventually be used in hospitals to make up for shortages of blood. The artificial blood is O-negative, which can be used on all patients, regardless of their blood type.