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MEDICAL DEPARTMENT
UNITED STATES ARMY
IN WORLD WAR II

BLOOD PROGRAM IN WORLD WAR II

by Brigadier General Douglas B. Kendrick,MC, USA

Administering plasma to wounded man at 7th Infantry aid station, Sant`Agata.

Contents

Chapter

               Transfusion Before World War I
               Blood Transfusion in World War I
               Spanish Civil War (1936-39)
               Blood for Britain
               The British Blood Program in World War II
               The Soviet Union Blood Program in World War II
               The German Experience in World War II
               Other Sources of Blood

II. Shock

               Historical Note
               Observations Between the World Wars
               Initial Concepts of Shock and Shock Therapy in World War II
               Studies on Shock, National Research Council
               Evolution of the Concept and Therapy of Shock in the Mediterranean Theater
               Special Studies
               The Board for the Study of the Severely Wounded
               Ebert-Emerson Study

III. The Evolution of the Use of Whole Blood in Combat Casualties

               Development of the Concept
               The Role of the National Research Council
               The Evolution of the Concept of Whole Blood Replacement in the Mediterranean Theater
               Comment

IV. Administrative Considerations in the Zone of Interior

               Army Medical School
               Office of The Surgeon General
               National Research Council
               National Institute of Health
               Legal Aspects of the Blood and Plasma Program
               Training
               Office of Civilian Defense
               Plasma for Allied Nations
               Offers From Other Countries
               Supplies of Plasma for Zone of Interior Hospitals
               Provision of Whole Blood in Zone of Interior Hospitals
               Recommendations

V. The American National Red Cross

               The First Steps of the Program
               Implementation of the Program
               Organization and Personnel
               Reorganization
               Blood Donor Centers
               Mobile Units
               Conferences
               Campaigns for Blood Donors
               Other Aspects of the Program
               The Total Program
               The End Result

VI. Blood Donors and the Technique of Collection of Blood

               Requirements for Blood Donors
               Donors With Special Diseases
               Routine of Donation
               Technique of Collection of Blood
               Reactions to Donations
               Regeneration of Hemoglobin

VII. Plasma Equipment and Packaging, and Transfusion Equipment

Part I. Plasma Equipment and Packaging

Original Packages
Development of Standard Package
Components of the Plasma Package
The Larger Plasma Package
Packaging of Dried Plasma for Zone of Interior Use
Proposed Changes

Part II. Transfusion Equipment for the Oversea Program

General Considerations
Development of Equipment
Design of Field Transfusion Unit in European Theater
Expendable Transfusion Equipment

Part III. Albumin Packaging

VIII. Transportation and Refrigeration

Preliminary Specifications
Transportation in the Zone of Interior
Status of Refrigeration, 1943-August 1944
The Airlift to the European Theater
Studies on Unrefrigerated Blood Flown to the European Theater
Expendable Refrigeration Containers for the Oversea Airlifts

IX. Preservative Solutions

Definitions and Criteria
Historical Note
Transportability of Whole Blood
Development of Preservative Solutions
Tests of Efficiency of Preservative Solutions
Special Studies

X. Laboratory Techniques and Special Laboratory Studies

Blood Typing of Military Personnel
Development of Typing Sera
Typing Errors
The Rh Factor
Screening Test for O Blood
Hematocrit Determinations
Dye Measurement of Blood Volume
Titration of Blood
Studies on A and B Substances
Studies of Cell Survival After Transfusion
Serologic Testing for Syphilis

XI. The Plasma Program

Historical Note
General Considerations
Forms of Plasma
Frozen Plasma
Liquid Plasma
Concentrated Plasma
Dried Plasma
Commercial Processing of Dried Plasma
Additives
Filters
Mass Production of Dried Plasma
Expansion of Requirements
Equipment for the Plasma Program
Other Production Difficulties
Testing
Inspection of Processing Laboratories
Yields of Plasma From Blood
Accounting Practices
Losses
Disposition of Surplus Plasma
Offers and Proposals
Red Blood Cell Residua

XII. The Bovine and Human Albumin Programs

Part I. Bovine Albumin

Development of Program
Progress of Program
Clinical Testing
Termination of Program
Later Developments

Part II. Human Serum Albumin

Historical Note
Laboratory Development
Clinical Testing
Recommendation of Serum Albumin to the Armed Forces
Commercial Production
Army Requisitions for Serum Albumin
Techniques of Plasma Fractionation
Refrigeration
Additives
Further Clinical Studies
Termination of Program

XIII. Byproducts of Plasma Fractionation

General Considerations
Hemoglobin
Globin
Immune Serum Globulin
Fibrin Foam and Fibrin Film

XIV. Blood Substitutes and Other Intravenous Fluids

Part I. Blood Substitutes

General Considerations
Gelatin
Pectin
Other Blood Substitutes

Part II. Other Intravenous Fluids

Salt Solution
Gum Acacia
Sodium Bicarbonate
Complaints

XV. The Mediterranean (Formerly North African) Theater of Operations

Part I. Fifth U.S. Army

Evolution of Policies
Early Experiences
First Planning for a Theater Blood Bank
Establishment of Blood Bank at 15th Medical General Laboratory
The 6713th Blood Transfusion Unit (Overhead)
Training
Transportation and Refrigeration
Air Transportation
Distribution
Donors
Selection of Type O Blood
Technique of Collection of Blood
Laboratory Tests
Facilities
Equipment
Preservatives
Statistical Data
Hospital Experiences
Survey of Blood Program
Comment

Part II. Seventh U.S. Army

Organization
Personnel
Operations
Air Transport
Forward Distributing Section
Base Bleeding Section
Transfer to ETOUSA
Donors
Equipment
Refrigeration and Transportation
Statistical Data
Clinical Considerations

XVI. The European Theater of Operations

Part I. General Considerations

Special Circumstances in the European Theater
Education and Indoctrination

Part II. Initial Activities in the Zone of Interior for anOversea Transfusion Service

Background of Project
First Proposal, October 1943
Actions on Proposal
Revival of Proposal, April 1944
Request for Oversea Mission
Recommendations by Surgery Division, OTSG

Part III. Initial Activities in the European Theater

Initial Provision of Blood and Plasma
Training in British Blood Supply Depot
Appointment of Consultant on Transfusion and Shock
Hospital Blood Banks
Increasing Awareness in the European Theater of the Need for Whole Blood
D-day and After
Implementation of the Whole Blood Proposal
Comment

Part IV. Definitive Actions in the Zone of Interior for anOversea Transfusion Service

Revival of Proposal for Airlift of Blood to Europe
Preparations for Airlift
First Shipments

Part V. The European Theater Blood Bank

Section I. Establishment

Preliminary Planning
Organization and Function

Section II. 152d Station Hospital Blood Bank, United Kingdom Section

Conversion of 152d Station Hospital to Blood Bank Purposes
Personnel
Operational Structure
Progress Report
Further Planning for Operation OVERLORD
Major Elements of the Final Plan
The Invasion

Section III. 127th Station Hospital Blood Bank, United KingdomSection

Authorization
Conversion of Facilities and Personnel
Training
Operation

Section IV. 152d Station Hospital Blood Bank, Continental Section

Movement to the Continent
Permanent Location
Operations

Section V. Activities of the European Theater Blood BankDetachments

152d Station Hospital Blood Bank
127th Station Hospital Blood Bank

Part VI. Blood Donors in the European Theater

First Provisions for Blood Donors
Formal Planning for the BloodSupply
Initial Results
Postinvasion Donations
Blood and Plasma Donations toBritish
Prisoner-of-War Donors
Payment of Donors
Compensation for Accidents

Part VII. Practical Considerations of the Blood Program inETOUSA

Preliminary Planning for the Airlift to the Continent
Airlift to the Continent After D-day
Other Means of Transportation
Airlift From the Zone of Interior
Reports and Estimates
Refrigeration and Transportation
Field Transfusion Units
Role of the Supply Division in the Whole Blood Program
Security Measures
Housekeeping Arrangements
Early Operational Difficulties
Inquiry Into Efficiency of Airlift to European Theater
Clinical Problems

Part VIII. Statistical Data

Quantitative Use of Blood
Critique on the Use of Blood on the Continent
Airlift to the European Theater
Production of ETOUSA Blood Bank
Use of Blood in Army Installations
Losses of Preserved Blood
Odd Bloods
Serologically Positive Blood
Summarized Statistical Experiences

Part IX. Special Experiences

Field Hospitals
General Hospitals

Part X. Statement of the Theater General Board

Contents
Recommendations
Comment

XVII. The Pacific Areas and the China-Burma-India Theater

The New South Wales Red Cross Blood Transfusion Service
Planning for Local Supplies of Blood
Blood Supply From Australia
27th General Hospital Blood Bank
Staff Visit to Pacific Areas by Army and Navy Consultants in Shock and Transfusion
Donors
Equipment
The Airlift of Blood to the Pacific
Advance Base Blood Bank Facility No. 1
Leyte
Luzon
Iwo Jima
Okinawa
Termination of Airlift
Statistical Data
Clinical Considerations
Plasma
Other Replacement Agents
Conclusions
Operation OLYMPIC
China-Burma-India Theater

XVIII. Reactions to, and Complications of, Blood and Plasma Transfusions

General Considerations
Allergic Reactions
Pyrogenic Reactions
Hemolytic Reactions
Special Theater Experiences
Reactions From Contaminated Blood
Lower Nephron Nephrosis
Southwest Pacific Area
Plasma Transfusion Reactions
Homologous Serum Jaundice

XIX. General Considerations of Shock Therapy

Principles of Resuscitation
Resuscitation
Technical Considerations
Use of Blood in Zone of Interior Hospitals
Plasma Therapy
Serum Albumin Therapy
Management of Special Types of Wounds
Administrative Considerations

XX. The Blood, Plasma, and Related Programs in the Korean War

Part I. Administrative Background

General Considerations
The Interim Between the Wars
Initial Steps in the National Blood Procurement Program
Report of Task Group
Implementation of Task Group Proposals
National Research Council
The American Red Cross Participation

Part II. The Whole Blood Program

Section I. Blood Procurement in Japan

Initiation of Program
Subsequent Developments
Japanese Donors
Publicity
Statistical Data

Section II. The Development of the Whole Blood Program in theZone ofInterior

The First Year
The Armed Forces Blood Donor Program
The National Blood Program

Section III. The Oversea Airlift to Korea

General Considerations
Processing Laboratory, Travis Air Force Base
Laboratory Routine
Statistical Data

Section IV. The Whole Blood Oversea Experience

Estimate of Needs
Distribution
Survey of Whole Blood Experience, Far East Command
Statistical Data

Section V. Equipment and Refrigeration for Airlift

Plastic Containers
Refrigerated Shipping Containers
Refrigeration Facilities in the Far East

Section VI. Techniques of Preservation

Preservative Solutions
Red Blood Cell Preservation
Exchange Resins
Freezing

Part III. The Plasma Program

Plasma Supplies Between the Wars
Stockpiles and Future Requirements
Procurement of Plasma
Serum Hepatitis

Part IV. The Plasma Fractionation Program

Serum Albumin
Globin
Gamma Globulin
Red Blood Cells
Cadaveric Blood

Part V. The Plasma-Expanders Program

Bibliography
Gelatin and Oxypolygelatin
Polyvinylpyrrolidone (Periston, PVP)
Dextran
Fat Emulsions

Part VI. Clinical Considerations

Therapeutic Principles and Practices
Investigations

APPENDIXES

A    Circular Letters, Mediterranean Theater
B    Circular Letters, European Theater
C    Circular Letters, Pacific Areas

Illustrations

Figure

Tables
Number

1    American Red Cross blood donor centers
2    Summarized data on activities of American Red Cross blood donor centers
3    Production report of American Red Cross blood donor centers, 1941-45
4    Production report of American Red Cross blood donor centers, 1941-43
5    Production report of American Red Cross blood donor centers, 1941-44
6    Errors in blood grouping determinations
7    Results of testing commercially produced lots of plasma in Army MedicalSchool
8    Distribution of causes of losses in total bloods collected in World WarII
9    Results of clinical testing of bovine albumin, 1941
10 Accepted production of normal human serum albumin, 1942-43
11 Summarized report of albumin production to 1945
12 Effect of storage temperatures on stability of crystalline human albumin
13 Effect of storage temperatures on viscosity of crystalline human albumin
14 Production of 6713th Blood Transfusion Unit (Ovhd.), 1944-45
15 Distribution of bloods collected by 6713th Blood Transfusion Unit (Ovhd.),1944-45
16 Blood shipments by 6825th Blood Transfusion Company (Non-T/O), 1944-45
17 Use of blood in Italy, 1943-44
18 Estimated demands for whole blood, April 1944
19 Response to request for type O blood donors in United Kingdom, spring 1944
20 Consolidated report of monthly shipments of blood to ETOUSA, Army Whole Blood ProcurementService, 1944-45
21 Production and distribution of blood, ETOUSA Blood Bank, 1944-45
22 Delivery of blood to using hospital units, ETOUSA, 1944-45
23 Ratios of bloods delivered to admissions to forward hospitals, First U.S.Army, 1944-45
24 Ratios of bloods delivered to admissions to forward hospitals, Third U.S.Army, 1944-45
25 Ratios of bloods delivered to admissions to forward hospitals, SeventhU.S. Army, 1944-45
26 Ratios of bloods delivered to admissions to forward hospitals, Ninth U.S.Army, 1944-45
27 Ratios of blood delivered to admissions to forward hospitals, all U.S.Armies, ETOUSA, 1944-45
28 Reactions to transfusions in field hospitals, ETOUSA
29 Reactions to transfusions in evacuation hospitals, ETOUSA
30 Reactions to transfusions in general and station hospitals, ETOUSA
31 Influence of local preparation of transfusion sets on pyrogenicreactions
32 Development of hepatitis in hospitalized patients, European and Mediterranean theaters, 1944
33 Survey of hepatitis in Zone of Interior general hospitals, 1945
34 Authorized collection of blood from Japanese nationals and other shortdonors
35 Type distribution of blood collected in Japan, 1951
36 Receipts of blood, Tokyo Blood Depot, 1951-52
37 Ratio of blood issued to wounded in action, 1951-52
38 Remaining usable days of blood received from Zone of Interior and shippedto Korea, 1951
39 Distribution of blood by Tokyo Blood Depot, 1951-52
40 Results of inoculation of volunteers with serum from six donorssuspected of having hepatitis
41 Results of ultraviolet irradiation of infected pooled plasma
42 Results of heating infected pooled plasma at 60? C

Charts
Number

1    Organization chart, Transfusion Branch, Surgical Consultants Division,Office of The Surgeon General, 1944
2    Organization chart, American Red Cross Blood Donor Service, 1941
3    Organization chart, American Red Cross Blood Donor Service, 1942
4    Line chart for calculating plasma proteins, hemoglobin and hematocrit fromspecific gravities of blood and plasma
5    Line chart for calculating percentages of normal plasma proteins andhemoglobin from specific gravities of blood and plasma
6    Hemolytic effect of various diluting solutions
7    Fractionation of plasma
8    Diagram of blood transfusion service for field army, NorthAfrican theater, 1944
9    Operations chart, Whole Blood Service, European theater, 1943
10 Procurement and distribution of whole blood, European theater, 1944-45
11 Structural organization of blood and blood derivatives program, 1949
12 Structural organization of blood and blood derivatives program, 1950
13 Structural organization of blood and blood derivatives program, 1952
14 Organization for distribution of whole blood for Korea

Maps
Number

1    Movement of whole blood in Mediterranean theater
2    Flight plan of airlift of blood from Zone of Interior to the European Continent
3    Operations map showing movement of ADSEC mobile blood depots on theEuropean Continent
4    Distribution of blood in Southwest Pacific
5    Itinerary of Army-Navy bloodand plasma personnel in Pacific areas, 1944
6    Flight plan for distribution of blood to Pacific from U.S. west coast
7    Flight plan for airlift of blood from Zone of Interior to Korea

Prepared and published under the direction of
Lieutenant General Leonard D. Heaton
The Surgeon General, United States Army

Editor in Chief
Colonel John Boyd Coates, Jr., MC, USA

Associates Editor
Elizabeth M. McFetridge, M.A.

OFFICE OF THE SURGEON GENERAL
DEPARTMENT OF THE ARMY
WASHINGTON, D.C., 1964

BLOOD PROGRAM IN WORLD WAR II

Supplemented by Experiences in the Korean War

The Historical United, United States Army Medical Service

Colonel John Boyd Coates, Jr., MC, USA, Director
Charles J. Simpson, Executive Director
Lieutenant Colonel William P. Chambers, MSC, USA, Special Assistant toDirector
Lieutenant Colonel Frederick Bell, Jr., MSC, USA, Chief, Special ProjectsBranch
Charles M. Wiltse, Ph. D., Litt. D., Chief, Historians Branch
Ernest Elliott, Jr., Chief, Editorial Branch
Lieutenant Colonel Jerome Rudberg, MSC, USA, Chief, Information ActivitiesBranch
Roderick M. Engert, Chief, General Reference and Research Branch
Hazel G. Hine, Chief, Administrative Branch

Library of Congress Catalog Card Number: 64-60006

For sale by the Superintendent of Documents, U.S. GovernmentPrinting Office
Washington, D.C. 20402