Blood Basics > Blood in War
Red Cross Blood Donor Service
The following is excerpted from BLOOD PROGRAM IN WORLD WAR II by Douglas Blair Kendrick (pgs. 111-116, 119-120, and 136-137).
Chapter V: The American National Red Cross
Blood Donor Centers
Establishment. -- The first Red Cross blood donor center in the Blood Plasma Program of World War II opened in New York on 4 February 1941. ... The 35th opened in Fort Worth on 10 January 1944. Eleven centers were opened in 1941, 19 in 1942, and 5 in 1943 or early in January 1944. The nine centers opened between 1 December 1941 and 1 February 1942 had all been planned or were in process of establishment before Pearl Harbor. ...
Facilities. -- Five centers occupied the property of local Red Cross chapters during all, or almost all, of their period of operation. Seven occupied donated space and two others space donated for all but a portion of the time. The remainder operated in rented space in stores or office buildings, usually in downtown areas or shopping districts, with public transportation, parking space, and space for trucking facilities. ...
Mobile units ... were operated out of all blood donor centers, the numbers ranging from one to four. At the height of the program, 63 were in operation, and, in all, 47 percent of the blood donations were made through them. These units operated within a radius of 75 miles of the 35 centers, and it was estimated that their use brought 60 percent of the population of the country within range of the Blood Donor Service.
Mobile units had a number of advantages. They gave flexibility to the donor centers in filling their quotas. They materially expanded the territory and population from which donors could be drawn. They also allowed hundreds of Red Cross chapters and their thousands of members to participate in the Blood Donor Service, a participation which, for geographic reasons, would not have been possible otherwise.
Equipment. -- The physical equipment of a mobile unit usually consisted of a 10-ton truck, although some centers continued to use the 1-ton panel truck, which was originally provided, till the end of the war. Many of the trucks were given by civic and other organizations.
Each unit was equipped with folding tables; 10 or 12 specially designed folding cots; four or more portable refrigerators, each with a capacity of 40 bottles of blood; and 9 or 10 boxes that contained all the supplies needed for collecting blood. On the cover of each box was a list of its contents. The truck was so packed that a temporary blood center could be set up almost as soon as the destination was reached. ... A variety of buildings was used -- schoolhouses, assembly halls, parish houses, or available space in an industrial or military establishment. ...
Campaigns for Blood Donors
The American Red Cross Blood Donor Service began with the enormous emotional advantage that donations of blood could save the lives of wounded men. Thousands of persons who could make no other contribution to the war effort gladly gave their blood, and many of them repeated their donations as often as they were permitted. It is ironic, therefore, that from the beginning to the end of the program, the major problem was to obtain an adequate number of donors to meet the requirements. Spontaneous, unsolicited donations were the exception rather than the rule except in special circumstances. Only unceasing efforts enabled the centers to meet their quotas, particularly during lulls in fighting.
The requirements for blood in the 10-month period between the institution of the Blood Donor Service and Pearl Harbor were negligible compared to later demands. Only 28,974 pints of blood were procured during this period, an average of 724 pints per week for the 10 centers then in operation. Only two of these centers had been active during the entire 10 months, and the average amount procured by them was 145 pints per week. Even the largest center, at peak operation during the prewar period, obtained only 441 pints per week.
Donations increased notably immediately after Pearl Harbor, and increased similarly after other severe fighting. After the Normandy invasion, donors poured in from the streets and swamped the telephone lines. During that week, 123,284 pints of blood were collected, and thousands of future appointments were made.
On the other hand, the flow of information concerning the war provided by the free press of the United States sometimes had the effect of a two-edged sword. Immediately after the Normandy landings, for instance, the happy news was received that casualties had been fewer than anticipated. Donations promptly declined sharply and did not again approach the invasion peak until the spectacular race across France began several weeks later.
The pre-Pearl Harbor period had made one thing quite clear, that general publicity must be supplemented by specific recruiting techniques. With spontaneous response apparently depending largely upon the ebb and flow of battle, the greatest single problem was how to maintain an adequate number of donors when the war news was not spectacular.
A second difficulty inherent in the program and not generally clear to the public, in spite of efforts to clarify it, was the necessity for operating each center and each mobile unit on a strict system of weekly quotas. No surpluses could be built up. Planning had to envisage a regular number of donors every day. It was a serious matter when the quotas were not met and also a serious matter when collections exceeded capacity, as they did, for instance, in September 1943.
A part of this same consideration was that blood procurement facilities were necessarily located near processing laboratories. As a result, publicity which would have been gladly provided throughout the country in motion picture theaters, over radio networks, and in similar media had to be used with great care. Only a few experiences were needed to show that national appeals for donors caused confusion and frustration in communities in which facilities for processing blood donations were not available. The closing of collection centers at the height of the fighting also made for difficulties in public relations, perhaps because the reasons -- that special programs, such as the serum albumin program, had been successfully concluded -- were not made as clear as they should have been.
External circumstances also interfered with donations. Plasma deliveries in December 1943 were 40 percent short of the quota because of an epidemic of influenza. On 9 February 1945, a blizzard in the East almost wiped out the donations scheduled for that day and the next several days.
Cancellations of appointments and failures to appear for scheduled appointments were serious losses in themselves, and they also wasted the time of physicians, nurses, and technicians, for they kept other volunteers from using the time scheduled. Some centers found it profitable to send out reminders several days in advance of appointments. About 10 percent of donors who appeared for their appointments had to be rejected for physical reasons.
For these and other reasons, it was necessary to secure an enrollment of about 150 donors to obtain each hundred pints of blood. This meant that the 13,326,242 pints of blood collected during the war by the Red Cross required the enrollment of nearly 19 million persons.
Multiple donors. -- A major source of blood came from multiple donors. Most centers had a special desk at which, before they left, donors were invited to make future appointments. Some donors voluntarily phoned for second appointments. It was estimated that the average donor made two donations. About 10 million gave three donations, 150,000 gave a gallon each, and about 3,000 gave 2 gallons or more. In some centers, multiple donations ran as high as 60 percent of the blood collected. Multiple donations and the publicity which attended them did much to dispel the fear in some minds that giving blood was harmful. ...
The Total Program
The first request for blood for plasma by the Army and the Navy, in February 1941, was for 15,000 pints. In May 1941, when the completion of the first quota had convinced all concerned of the feasibility of the project, an additional 209,000 pints were requested. In December 1941, after Pearl Harbor, another 165,000 pints were requested for the current fiscal year. On 1 January 1943, the request for that calendar year was set at 4 million pints, and the request for the calendar year of 1944 was set at 5 million pints.
The impact of the attack on Pearl Harbor and of the declaration of war against Japan on the emotions and reactions of the U.S. public was reflected in the Blood Donor Service. In November 1941, blood donations had been about 1,200 per week. In December, the weekly donations rose to 4,600. By the end of April, they exceeded 50,000. By September 1943, they had reached 100,000 and they were maintained at or above this weekly level during most of 1944. The largest weekly procurement, 123,284, was for the week ending on 10 June 1945, the amount collected, as already mentioned, being the reflection of the D-day landings on the Normandy beaches. After 21 October 1944, the weekly averages progressively declined, as centers that were no longer needed were closed, and only about 2,000 donations per week were being collected when the project was concluded on 15 September 1945. At the peak of the program, the 6-month period between January and July 1944, total donations averaged 110,923 pints a week. Based on the 48-hour working week then generally in effect, this was approximately 1 pint every 2 seconds.
Distribution. -- Of the more than 13 million pints of blood collected by the Red Cross during World War II, 10,299,470 pints were processed into dried plasma. More than 3 million 250-cc. packages were put up, and more than 2.3 million 500-cc. packages. About 310,135 pints of blood were used in military hospitals in the Zone of Interior, as either liquid plasma or whole blood.
The largest amount of O blood, 14,928 pints, procured in any single week for shipment overseas was collected between 19 and 24 March, during the battle on Iwo Jima. This amount, a daily average of 2,497 pints, was over and above the amounts collected for plasma and serum albumin. In all, 387,462 pints of group O blood were flown overseas, 205,907 to Europe by the Army Air Transport Command, and 181,555 to the Pacific by the Naval Air Transport Service.
Costs. -- The total cost of the Blood Donor Service to the American Red Cross was approximately $15,870,000, about $1.19 per pint of blood collected. Of this amount, about 19 cents was paid from local chapter funds and the remainder by the National Headquarters.
In the original program, the total cost of the operation was borne by the Red Cross. When the project expanded, the costs rose so sharply that, as of 1 September 1942, the Army and the Navy assumed the costs of servicing the collecting equipment, which were added to the expense of processing the blood. As of 1 August 1943, the cost of transporting the blood to the processing laboratories was also assumed by the Government. The cost of servicing the equipment averaged about 60 cents per set, and the cost of transporting each bottle of blood in a refrigerated container was about 15 cents. When blood typing was discontinued on 1 November 1942 ..., for reasons other than expense, the cost fell about 7 cents per donation, for a total of about a half million dollars.
All funds expended by the Red Cross were contributed by the American people. They were carefully supervised and profitably expended, and it is not possible to estimate what they purchased in terms of human lives saved.
The End Result
The Red Cross Blood Donor Service was translated, almost overnight, from a limited peacetime activity to a major national contribution to the military effort. It was enormously successful because of the fine organization of the program; the hard work of those who operated it; the hundreds of thousands of hours contributed by volunteer workers; and, most of all, the voluntary donation of millions of pints of blood by hundreds of thousands of patriotic American citizens, whose gift of themselves saved untold thousands of lives of wounded American troops.
From BLOOD PROGRAM IN WORLD WAR II (SUPPLEMENTED BY EXPERIENCES IN THE KOREAN WAR) by Douglas Blair Kendrick. Washington, D.C.: Office of the Surgeon General, Department of the Army, 1989. (Provided by the Office of Medical History, Office of the Surgeon General/US Army Medical Command.)
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