Naveen Manchanda, MD
M*A*S*H is embedded in America’s collective subconscious as a TV show that exemplified the joie de vivre of military medicine. Of late, the more courageous and gritty aspects of military life are front and center in the eyes of the citizenry. Alongside all of this, military medicine has been on the forefront of advancements in research and clinical care. From the times of Florence Nightingale working with soldiers in the Crimean War to modern day outfits catering to battlefield trauma victims, military medicine has had a lot to teach and enthuse us about modern approaches to patient care.
Active-duty-related military trauma requires rapid action units to resuscitate soldiers who often suffer horrific trauma from blast injuries. Both stanching blood loss and replacing lost blood are challenges that have led to increased insights into best practices to realize successful outcomes. Trauma and its associated bleeding can be overwhelming, and massive transfusions have been widely used to resuscitate victims. Problems with this approach developed in the ’60s after the use of blood transfusions became commonplace in military conflict. Massive transfusions have been the subject of intense study as the question of appropriate ratios of red cells to FFP platelets still remains to be clarified. These developments are germane to the civilian population, although blast injuries and other extensive traumatic injuries seen in the military sectors are uncommon (thankfully).
Exploring the topic of massive transfusions further, today’s Education Session at 2:00 p.m. (Hall F3/F4, Orange County Convention Center) will offer a three-part series on this topic. Drs. John B. Holcomb, Timothy Hannon, and Thomas G. Deloughery will discuss this difficult topic and try to distill the information gained so far into advice for the practicing physician. If you miss the session this afternoon, there will be another chance to catch it tomorrow at 7:30 a.m.
To try and ameliorate this problem of an inadequate supply of red blood cells, researches have also been working on red cell substitutes. Several artificial oxygen carriers have been developed, however, none have had the staying power of the real stuff. The logistics of ensuring a steady supply of red cells for transfusions at distant sectors in the military as well as ensuing adequate supplies in hospitals serving trauma patients is a daunting task. Enter the technology of potentially growing red cells ex vivo. Mesenchymal stem cells, nude mice, and polyurethane-coated collagen come together when the Scientific Committee on Transfusion Medicine presents an exciting series of talks with several speakers from laboratories conducting research on ex vivo expansion bone marrow progenitors (today and tomorrow at 9:30 a.m. in Room 314) Here you will find exciting advances in methods of ex vivo expansion of red cell and mesenchymal cell progenitors while gaining insights into improvements in the technology of self perpetuating red blood cells. “Go Reds” as someone might add.
Dr. Manchanda indicated no relevant conflicts of interest.