Blood transfusion for deep space exploration

Elizabeth S. Nowak, David P. Reyes, Barbara J. Bryant, Andrew P. Cap, Eric L. Kerstman, Erik L. Antonsen

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Astronauts on exploration missions may be at risk for traumatic injury and medical conditions that lead to life threatening hemorrhage. Resuscitation protocols are limited by the austere conditions of spaceflight. Solutions may be found in low-resource terrestrial settings. The existing literature on alternative blood product administration and walking blood banks was evaluated for applicability to spaceflight. STUDY DESIGN AND METHODS: A literature review was done using PubMed and Google Scholar. References were crosschecked for additional publications not identified using the initial search terms. Twenty-seven articles were identified, including three controlled trials, six retrospective cohort analyses, 15 reviews, one case report, and two experimental studies. RESULTS: Solutions to blood transfusion in austere settings include lyophilized blood products, hemoglobin-based oxygen carriers (HBOCs), and fresh whole blood. Many of these products are investigational. Protocols for walking blood banks include methods for screening and activating donors, transfusion, and monitoring for adverse reactions. Microgravity and mission limitations create additional challenges for transfusion, including baseline physiologic changes, difficulty reconstituting lyophilized products, risk of air emboli during transfusion, equipment constraints, and limited evacuation and surgical options. CONCLUSION: Medical planning for space exploration should consider the possibility of acute blood loss. A model for “floating” blood banks based on terrestrial walking blood bank protocols from austere environments is presented, with suggestions for future development. Constraints on volume, mass, storage, and crew, present challenges to blood transfusion in space and must be weighed against the benefits of expanding medical capabilities.

Original languageEnglish (US)
Pages (from-to)3077-3083
Number of pages7
JournalTransfusion
Volume59
Issue number10
DOIs
StatePublished - Oct 1 2019

Fingerprint

Space Flight
Blood Banks
Blood Transfusion
Walking
Astronauts
Donor Selection
Weightlessness
Embolism
PubMed
Resuscitation
Hemoglobins
Cohort Studies
Air
Hemorrhage
Oxygen
Equipment and Supplies
Wounds and Injuries

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

Cite this

Nowak, E. S., Reyes, D. P., Bryant, B. J., Cap, A. P., Kerstman, E. L., & Antonsen, E. L. (2019). Blood transfusion for deep space exploration. Transfusion, 59(10), 3077-3083. https://doi.org/10.1111/trf.15493

Blood transfusion for deep space exploration. / Nowak, Elizabeth S.; Reyes, David P.; Bryant, Barbara J.; Cap, Andrew P.; Kerstman, Eric L.; Antonsen, Erik L.

In: Transfusion, Vol. 59, No. 10, 01.10.2019, p. 3077-3083.

Research output: Contribution to journalArticle

Nowak, ES, Reyes, DP, Bryant, BJ, Cap, AP, Kerstman, EL & Antonsen, EL 2019, 'Blood transfusion for deep space exploration', Transfusion, vol. 59, no. 10, pp. 3077-3083. https://doi.org/10.1111/trf.15493
Nowak ES, Reyes DP, Bryant BJ, Cap AP, Kerstman EL, Antonsen EL. Blood transfusion for deep space exploration. Transfusion. 2019 Oct 1;59(10):3077-3083. https://doi.org/10.1111/trf.15493
Nowak, Elizabeth S. ; Reyes, David P. ; Bryant, Barbara J. ; Cap, Andrew P. ; Kerstman, Eric L. ; Antonsen, Erik L. / Blood transfusion for deep space exploration. In: Transfusion. 2019 ; Vol. 59, No. 10. pp. 3077-3083.
@article{6092e09eb38e44598bc48106d7c74c57,
title = "Blood transfusion for deep space exploration",
abstract = "BACKGROUND: Astronauts on exploration missions may be at risk for traumatic injury and medical conditions that lead to life threatening hemorrhage. Resuscitation protocols are limited by the austere conditions of spaceflight. Solutions may be found in low-resource terrestrial settings. The existing literature on alternative blood product administration and walking blood banks was evaluated for applicability to spaceflight. STUDY DESIGN AND METHODS: A literature review was done using PubMed and Google Scholar. References were crosschecked for additional publications not identified using the initial search terms. Twenty-seven articles were identified, including three controlled trials, six retrospective cohort analyses, 15 reviews, one case report, and two experimental studies. RESULTS: Solutions to blood transfusion in austere settings include lyophilized blood products, hemoglobin-based oxygen carriers (HBOCs), and fresh whole blood. Many of these products are investigational. Protocols for walking blood banks include methods for screening and activating donors, transfusion, and monitoring for adverse reactions. Microgravity and mission limitations create additional challenges for transfusion, including baseline physiologic changes, difficulty reconstituting lyophilized products, risk of air emboli during transfusion, equipment constraints, and limited evacuation and surgical options. CONCLUSION: Medical planning for space exploration should consider the possibility of acute blood loss. A model for “floating” blood banks based on terrestrial walking blood bank protocols from austere environments is presented, with suggestions for future development. Constraints on volume, mass, storage, and crew, present challenges to blood transfusion in space and must be weighed against the benefits of expanding medical capabilities.",
author = "Nowak, {Elizabeth S.} and Reyes, {David P.} and Bryant, {Barbara J.} and Cap, {Andrew P.} and Kerstman, {Eric L.} and Antonsen, {Erik L.}",
year = "2019",
month = "10",
day = "1",
doi = "10.1111/trf.15493",
language = "English (US)",
volume = "59",
pages = "3077--3083",
journal = "Transfusion",
issn = "0041-1132",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - Blood transfusion for deep space exploration

AU - Nowak, Elizabeth S.

AU - Reyes, David P.

AU - Bryant, Barbara J.

AU - Cap, Andrew P.

AU - Kerstman, Eric L.

AU - Antonsen, Erik L.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - BACKGROUND: Astronauts on exploration missions may be at risk for traumatic injury and medical conditions that lead to life threatening hemorrhage. Resuscitation protocols are limited by the austere conditions of spaceflight. Solutions may be found in low-resource terrestrial settings. The existing literature on alternative blood product administration and walking blood banks was evaluated for applicability to spaceflight. STUDY DESIGN AND METHODS: A literature review was done using PubMed and Google Scholar. References were crosschecked for additional publications not identified using the initial search terms. Twenty-seven articles were identified, including three controlled trials, six retrospective cohort analyses, 15 reviews, one case report, and two experimental studies. RESULTS: Solutions to blood transfusion in austere settings include lyophilized blood products, hemoglobin-based oxygen carriers (HBOCs), and fresh whole blood. Many of these products are investigational. Protocols for walking blood banks include methods for screening and activating donors, transfusion, and monitoring for adverse reactions. Microgravity and mission limitations create additional challenges for transfusion, including baseline physiologic changes, difficulty reconstituting lyophilized products, risk of air emboli during transfusion, equipment constraints, and limited evacuation and surgical options. CONCLUSION: Medical planning for space exploration should consider the possibility of acute blood loss. A model for “floating” blood banks based on terrestrial walking blood bank protocols from austere environments is presented, with suggestions for future development. Constraints on volume, mass, storage, and crew, present challenges to blood transfusion in space and must be weighed against the benefits of expanding medical capabilities.

AB - BACKGROUND: Astronauts on exploration missions may be at risk for traumatic injury and medical conditions that lead to life threatening hemorrhage. Resuscitation protocols are limited by the austere conditions of spaceflight. Solutions may be found in low-resource terrestrial settings. The existing literature on alternative blood product administration and walking blood banks was evaluated for applicability to spaceflight. STUDY DESIGN AND METHODS: A literature review was done using PubMed and Google Scholar. References were crosschecked for additional publications not identified using the initial search terms. Twenty-seven articles were identified, including three controlled trials, six retrospective cohort analyses, 15 reviews, one case report, and two experimental studies. RESULTS: Solutions to blood transfusion in austere settings include lyophilized blood products, hemoglobin-based oxygen carriers (HBOCs), and fresh whole blood. Many of these products are investigational. Protocols for walking blood banks include methods for screening and activating donors, transfusion, and monitoring for adverse reactions. Microgravity and mission limitations create additional challenges for transfusion, including baseline physiologic changes, difficulty reconstituting lyophilized products, risk of air emboli during transfusion, equipment constraints, and limited evacuation and surgical options. CONCLUSION: Medical planning for space exploration should consider the possibility of acute blood loss. A model for “floating” blood banks based on terrestrial walking blood bank protocols from austere environments is presented, with suggestions for future development. Constraints on volume, mass, storage, and crew, present challenges to blood transfusion in space and must be weighed against the benefits of expanding medical capabilities.

UR - http://www.scopus.com/inward/record.url?scp=85073085629&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85073085629&partnerID=8YFLogxK

U2 - 10.1111/trf.15493

DO - 10.1111/trf.15493

M3 - Article

C2 - 31490558

AN - SCOPUS:85073085629

VL - 59

SP - 3077

EP - 3083

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 10

ER -