Planning for the Worst: Blood Transfusion During Deep Space Exploration

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There has never once been a situation where an astronaut required a blood transfusion in space, but as NASA and other stakeholders look ahead to a future in which brave explorers set out into deep space for months or even years, they see the low, but real, risk of dangerous blood loss as a contingency that must be planned for. After all, losing a crewmember during a mission could be catastrophic.

And so, with the help of NASA Flight Surgeon David Reyes and other experts at NASA's Johnson Space Center, the U.S. Army, and the University of Texas, Case Western Reserve University School of Medicine medical resident Elizabeth Nowak researched and determined the optimal plan for conducting blood transfusions during extended space missions.

Their work will be published in October's edition of the journal Transfusion.

To find the best way to conduct blood transfusions in space, the researchers examined methods currently used at remote settings on Earth. One solution, utilized on battlefields, at Antarctic research stations, and even on cruise ships, seemed the most optimal. It's called a "walking blood bank," which is somewhat of a euphemism – humans are literally the "walking blood banks."

"The implementation of walking blood banks (WBBs) allows for direct, person-to-person transfusion of fresh whole blood. WBBs are advantageous in austere settings because participants serve as a source for blood, eliminating the need to store and refrigerate blood products," the authors explained.

In space, you could call them "Floating Blood Banks."

The tools required would be fairly basic. The International Space Station medical kit already contains catheters, pressure bags, gauze, and syringes, amongst other necessary supplies. The only other items needed are a three-way stopcock and a blood collection bag with anticoagulant.

Most preparation for a floating blood bank would come during crew selection and training. Astronauts' blood would need to be extensively screened and they would need to be taught how to carry out a transfusion. Two crewmembers with universal blood type O could serve as donors. Alternatively, all personnel could have at least one "buddy" matched for blood type, or everyone could be the same blood type.

The authors worked up a flow chart for activation of a floating blood bank during a mission.

Steps in the activation of the floating blood bank. Likely resembles a possible algorithm for any austere environment, but with addition of mission and microgravity specific requirements.

Advanced methods for storing blood could eventually become amenable for deep space situations, the researchers say. It may one day be possible to send self-donated "lyophilized" (freeze dried and powdered) blood that can be reconstituted on a mission. But for now, a floating blood bank is by far the best option for extended explorations to Mars, Saturn's moon Titan, or beyond.

Source: Nowak et al. "Blood transfusion for deep space exploration." Transfusion. October 2019. https://doi.org/10.1111/trf.15493

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