Blood derivatives and fractions

 

This week, the discussion of blood medicine moved from academic to personal.

If you are a regular reader of this space, you know my feelings about blood. I’ve written more than a dozen columns about it. Here are links to some of those columns:

Advances in Blood Medicine

Government, Parental Rights and Medical Treatment

Hyperbaric Oxygen Therapy for Blood Loss

Why Blood is Bad Emergency Medicine

You Must Know about TXA Before Your Next Operation

Spread the word: Transfusion is NOT a “life-saving procedure”

 

The reason I said it went from academic to personal: My wife is preparing for hip replacement surgery, and we had a pre-op meeting at the hospital. I nearly always accompany her to such meetings to make sure we ask enough questions and to compare notes afterward.

But this time, when her name was called, the nurse made it clear I was not included in the invitation. When Wifey came out, she told me the nurse questioned her about her stand on blood.

“Are you sure you want to refuse all blood and blood derivatives?”

My wife wasn’t sure she’d heard correctly. “Derivatives?”

“Because we can just get rid of that form you signed, if you wish. No one has to know,” the nurse went on.

When my wife explained she wanted no blood or blood components, but that she might accept some fractions on a case-by-case basis, depending on what the fraction was, the nurse claimed she was unfamiliar with the terms “components” and “fractions”. 

I’m profoundly glad I wasn’t there for that conversation. The nurse would no doubt have been offended at my loudly questioning how she could possibly have ever passed her Medical Ethics class.

Did we get it wrong? Has medicine moved on from “components” and “fractions” to “derivatives”?

No. Medical science decidedly has not. But in a world where people claim to be confused about their pronouns, word definitions are not as clear-cut as they used to be.

It could have been simple vagueness on the part of the person who designed the form. That seems unlikely. Could it be that the hospital is trying to get patients to sign something that lets them off the hook for not precisely following the patient’s wishes?

If you sign the form as written, you have severely restricted what the institution can use to treat you. But if you don’t sign it as written, they may well give you blood.  

“Blood derivatives” is a commonly used billing term that includes whole blood and the four major blood components – plasma, red blood cells, white blood cells, and platelets – as well as the blood fractions made from those components. So of course you are not going to give permission to be treated with any and all “blood derivatives”. But you may not want to blanketly rule out all fractions, either.

Without a clearer definition you could be cutting yourself off from literally dozens of fractionated medicines: clotting factors for when your wound won’t seal up; and the opposite - medications for when you have thrown or they’re afraid you might throw a dangerous clot; and dozens of other blood-derived medications for use in rarer circumstances.

Whole blood is rarely transfused anymore. At a blood collection center, a single unit of blood is treated to break it into 3 parts: the red blood cells are collected; the platelets are also collected out separately. The remainder… the plasma, still containing the white blood cells (called Leucocytes), clotting factors, and other more esoteric derivatives may or may not be further treated.

The plasma may be treated by freezing and thawing, a process called cryoprecipitation. At the proper in-between temperature they can lift out some of the clotting factors, though they are still somewhat contaminated with some plasma and some white cells. That product is called cryoprecipitate. The remaining plasma is called cryosupernatant. Both these products have significant risk of transmitting disease.

The majority of the cryosupernatant in the U.S. market is shipped to a manufacturer to be “pooled”. The pool is comprised of donations from thousands or even tens of thousands of individuals. Most of the individual units have been tested for: Lymphotropic virus, HIV, Hepatitis B & C, Syphilis, Chagas disease, West Nile virus and Babesia.

However, no testing is done for over 60 known blood-borne diseases. In some cases, because there is no test; in other cases, because the blood collection center deems the risk to be remote. A collection site in Oregon isn’t going to check for Chikungunya, a disease common in Latin America (even though my brother-in-law who lives in Oregon has it.) ONE of the units going into the pool may well carry one of those diseases. It if does, it pollutes the entire pool.  One unit of blood containing Chikungunya or Parvovirus or Malaria or yellow fever could potentially spread that virus to every one of the thousands of patients who receive blood-based medicine manufactured from that pool.

Most fractional blood derivatives have trade names, like Zemaira, Albuminex, or Corifact. All are supposed to come with a Drug Fact Sheet.

The Drug Fact Sheet for Zemaira, for example (a medication for people with emphysema), says:

“Because Zemaira is made from human blood, it may carry a risk of transmitting infectious agents, e.g., viruses, and theoretically the Creutzfeldt-Jakob disease (CJD).” (CJD, in case you’re unfamiliar, used to be called Mad Cow disease.) “The risk of transmitting an infectious agent has been reduced by screening plasma donors for prior exposure to certain viruses, by testing for the presence of certain current virus infections and by inactivating and removing certain viruses. Despite these measures, such products can still potentially transmit disease.”

Has anyone ever been diagnosed with Mad Cow from taking Zemaira? I don't know. However, it is listed there because people have contracted CJD from transfusions of various blood components.

Some derivative Drug Fact Sheets specifically mention, ‘pooled blood’, or they may have the warning similar to ‘you could get Mad Cow’; others seem to be more adamant that their product when used correctly is totally free of any threat of catching something from someone else. Here’s the pertinent part of the label from a product called Kedbumin:

“Albumin is a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases and variant Creutzfeldt-Jakob disease (vCJD). There is a theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD), but if that risk actually exists, the risk of transmission would also be considered extremely remote. No cases of transmission of viral diseases, CJD or vCJD have ever been identified for licensed albumin.”

However, the FDA warning label for albumin says:

“Albumin (Human) 25% is made from human plasma. Products made from human plasma may contain infectious agents, such as viruses, that can cause disease. The risk that such products will transmit an infectious agent has been reduced by screening plasma donors for prior exposure to certain viruses, by testing for the presence of certain current virus infections, and by inactivating certain viruses by pasteurization. Despite these measures, such products can still potentially transmit disease.”

So, I suppose if you need albumin, Kedbumin might be a better choice...maybe? Still, a study about albumin said:

“For patients with hypovolaemia there is no evidence that albumin reduces mortality when compared with cheaper alternatives such as saline. There is no evidence that albumin reduces mortality in critically ill patients with burns and hypoalbuminaemia. The possibility that there may be highly selected populations of critically ill patients in which albumin may be indicated remains open to question.”

What about blood derivatives that are not made from pooled blood?

One type of antithrombin is created by inserting the human DNA that forms antithrombin into a female goat. After some time has elapsed, the milk of the goat will have human antithrombin in it which can be extracted for use as a blood thinner.It is called a blood derivative, but clearly it is far removed from blood.

If you get bit by a rattlesnake you may, depending on your health, need antivenin. Antivenin is made by injecting a small amount of a given species of snake’s venom into a horse, waiting a few days for the horse to build up antibodies, then drawing blood from the horse and filtering out some of its antibodies. Antivenins for other poisonous bites are made similarly.

Every unfamiliar medication your doctor prescribes, you'll want to ask if it is a blood derivative. They're not necessarily all bad. In some cases, depending on how you live, you might be taking greater risks every day. But certainly it is better to be educated. Read your medicine's warning material. If it is a blood derivative it will include the disclaimer, “Because yada-yada is made from human blood it may carry a risk…” or wording to that effect.

“Blood and blood products are likely always to carry an inherent risk of infectious agents. Therefore, zero risk may be unattainable. The role of FDA is to drive that risk to the lowest level reasonably achievable.” – fda.gov

If it is a blood-derived medicine, you might want to ask your doctor if there is another medication, that does roughly the same thing, that is not a blood derivative, such as a synthetic, a recombinant, or some other product. Ask if your need for this medication is life-threatening or if it is merely advisable. Research it yourself to get a better understanding of what it will or won’t do for you. 

I spent many, many hours researching this. The first thing I learned is that it is a really complicated subject. But don't let that put you off. The second thing I learned is that you can understand it if you keep looking things up. Hopefully, this column will serve as a starting point for your research. 

Please copy and share the link to this article with all your friends.  You might keep one of them from catching Chikungunya. 

Please leave a comment.

 Bill K. Underwood is the author of several novels and one non-fiction self-help book, all available at Amazon.com. You can help support this site by purchasing one of his books.

 

 

 

Abortion and Christians

 

Isn’t it amazing how the world can change in just a couple months? 

Conservative politicians found ways to pass laws that seemed to contradict the Roe V. Wade ruling. They used their political power to put biased judges into what was previously seen as a bastion of political neutrality, the Supreme Court. The Court overturned Roe V. Wade. Millions of voters began protesting the loss of their ‘rights’ and began threatening to vote those politicians out of office. So now many of those same politicians, who claimed they were only doing the 'Christian' thing, are back-pedaling, changing their stance on abortion, and trying to distance themselves from the Roe v. Wade fallout they instigated.

This is not a discussion of the pro-life/pro-choice debate. That discussion is purely political, not biblical. I want no part of it, no matter how loudly politicians try to attach ‘Christianity’ to it.

The word ‘abortion’ is in the Bible, but not in its 21^st century meaning. In English Bibles that translate the Hebrew word shakhal as abortion, the context makes clear it refers to what today is called a miscarriage: that is, an accidental, unwanted loss of a pregnancy, not a purposeful termination of one.

The Bible does not say, ‘Thou shalt not commit abortion.’ But neither does it say that until childbirth a pregnant woman has complete autonomy over her body, including the fetus she’s carrying.

So does that mean the Bible is silent on the subject of terminating pregnancies? Not at all. Let’s take a look at what the Bible does say about pregnancy and childbirth and see what principles it contains.  

The very first childbirth mentioned in the Bible is that of Cain. On that occasion Eve remarked, “I have brought forth a man with the help of Jehovah.” (Genesis 4:1) The statement could be misleading: Eve no longer had a relationship with Jehovah. It’s not impossible that she was crediting the miracle of birth to Jehovah even though she was no longer in His favor. Or, it being probably the most pain she or Adam had ever experienced, she may have been crediting Jehovah with keeping her alive through the ordeal. Far more likely, however, is that she believed (based on Genesis 3:15) that this man-child would be the savior who would get them out of this mess they’d gotten themselves into. She was, not surprisingly, wrong about that. 

But that attitude – that somehow the next child born would be the one to fix Adam and Eve’s colossal mistake – persisted throughout Bible times. 

For Israelite mothers, bearing a child was a sacred experience; being barren was viewed as a curse. Pregnancies were a blessing. Harming a pregnancy was a crime, potentially a capital crime. (Exodus 21:22-25)

Children are consistently described as ‘an inheritance’, ‘a gift’, ‘a favor’, from God - by those in an approved relationship with the God of the Bible. However, we also read in the Bible about those with a different view.

People who abandoned Jehovah and turned to worshiping pagan gods such as Molech would voluntarily toss their infants into the burning lap of a huge metal cow-headed image of their god. (Jeremiah 32:35) I cannot imagine how parents who loved their children did so. I suspect that most of those pagans who practiced this secretly viewed those babies, like mothers seeking abortion today, as an inconvenience.

If the Bible contained a “Thou Shalt Not...” for every possible scenario it would be so long that it wouldn’t fit on any library shelf in the world. More than that: would a list of thou-shalt-nots really draw you closer to God? There’s a story that as his death was approaching, comedian W. C. Fields was seen reading the Bible. When asked what he was looking for so late in his life, his reply was, “Loopholes.”

If you approach the Bible with an open mind and the intent to find out how to be acceptable to God, you’ll find principles that you can apply in every situation. Those principles make clear that God views life as a gift and children as an inheritance. 

I hesitate to think what He views politicians as.

For Part One of this column, click here. Feel free to leave a polite comment. Comments are monitored, so don't waste your time trying to post spam.

Bill K. Underwood is the author of several books, all available at Amazon.com. You can help support this site by purchasing one of his books.

Does a fetus have human rights?

 

Today I learned something new: A human being is not the same thing as a human person. Seriously.

This column is not intended to be a political statement. I’m neither Republican nor Democrat. I am assiduously neutral as to politics. 

The Supreme Court, I’ve discovered, is not. Their decision to end Roe v. Wade had everything to do with politics and nothing to do with their respect for life.  If they respected life they would not have ruled, in the same week, that state laws restricting guns are unconstitutional.

But the Roe v. Wade decision created such a furor in the news I couldn’t help thinking, ‘Surely, in this scientific age, the legal status of a fetus has been well established?’

Apparently not.

Scientifically, a human being is an individual of any size or age with 46 chromosomes. When 23 male chromosomes in a human sperm cell unite with 23 female chromosomes in a human ovum, within 24 hours a human being comes into existence. It is unique, different from both its mother and its father. It will remain a unique, individual human being until the day it dies, and neither scientists nor lawyers debate that.

It is first dubbed a zygote, then a blastocyst, then an embryo, then a fetus. But all its genetic details, from hair color to eye color to male or female gender – even some thought processes – are written down in its DNA from Day One. While it draws nutrients from its mother, Science acknowledges that its growth is governed and controlled, not by its mother’s body, but by its own DNA. It is a unique human being.

The loud chant that is heard at every women’s rights protest, “MY body, MY choice!” is just not scientifically accurate. After Day One, that blastocyst is its own body, living within hers. It is more separate from her body than if she had a conjoined twin.

This is a medical fact, not a religious opinion. Dr. Herbert Ratner wrote that "It is now of unquestionable certainty that a human being comes into existence precisely at the moment when the sperm combines with the egg." Dr. Bradley M. Patten from the University of Michigan wrote in Human Embryology that the union of the sperm and the ovum "initiates the life of a new individual." And John L. Merritt, MD and his son J. Lawrence Merritt II, MD, present the idea that if "the breath of life [referenced at Genesis 2:7] is oxygen, then a blastocyst starts taking in the breath of life from the mother's blood the moment it successfully implants in her womb.”

When a fertility clinic fertilizes several eggs they are all, scientifically speaking, human beings. The one that gets implanted into a womb may well grow. At some point in its growth it will obtain the status of human person. The legal and medical status of the other fertilized eggs? Human beings, but not human persons.

Many human beings die before their mothers even know they exist. About 1/3 of all zygotes don’t last more than a few days. Of those that reach blastocyst stage roughly half fail to implant on the uterine wall. But if one does implant it becomes an embryo, and by week 11, a fetus.

Some are lost for no known reason. Some are lost because of something in the mother’s diet or water or air or activities, or some complete mystery that happens to her, without any knowledge on her part. Others are lost because the mother suspects or knows she’s pregnant and doesn’t want to be, and she takes some action that results in the death of the human being growing inside her.

If a fetus had human rights, at some point her intentional actions would become no different than those of a criminal whose assault of a pregnant woman results in the termination of her pregnancy – the criminal can be charged under the federal “Unborn Victims of Violence act” (H.R. 503, 2001). If the fetus has no human rights, how can a criminal be charged with harming it?

At what point does a human being become a human person?

Some argue that taking the first breath makes a being a person; others say No, personhood starts with brain activity; still others create philosophical lines between ‘potential human’ and ‘human person’.

The doctors cited above made clear that breathing isn’t the start: a blastocyst is taking in the breath of life from its mother’s bloodstream. 

The 'brain activity' camp doesn’t have a decent argument, either: If a fetus doesn’t become a person until it has “rational attributes” as they contend – a sense of self, the ability to interact intelligently with the external world – then  there are an enormous number of already-born folks – from brain damaged to severely autistic to Alzheimer’s victims, and others – who could be labeled non-persons, having no life rights, because of having lost their rational attributes. Most infants, for that matter, don’t have a ‘sense of self’ separate from their mothers prior to about two years of age. That’s what the ‘terrible twos’ is all about... a baby’s discovery of itself as an individual. If that definition were correct, no one could be charged with a crime for throwing a teething baby in the garbage!

Feminist professor Mary Anne Warren asserts that a fetus has no rights. “There is only room for one person with rights within a single human skin,” she says. Hmmm... I have to come back to the "conjoined twins" argument again.

Militant abortion rights activist Peter Singer, director of the grossly misnamed Center for Human Values at Princeton University, goes beyond even Ms. Warren. He says that dogs, pigs, apes, monkeys and other creatures may be persons; but that some human beings, including fetuses, disabled human adults, and even normal human babies who haven’t yet demonstrated a sense of self, should not automatically  be considered persons. An article published in the Journal of Medical Ethics in 2012 quoted several other medical authorities holding the same opinion, some suggesting that defective babies could be used for medical experimentation or organ harvesting.

Speaking on the subject of babies born as they were about to be aborted, (something, again, I hadn’t thought about before sitting down to write this but that is apparently quite common) Singer defended infanticide. "We cannot coherently hold that it is all right to kill a fetus a week before birth, but as soon as the baby is born everything must be done to keep it alive. If… the fetus does not have the same claim to life as a person, it appears that the newborn baby does not either."

Medical science has reached the point where 60-70% of preemies born at 24 weeks survive. According to Singer, nothing should be done to keep those kids alive.

Regular readers of this column know my beliefs are not based on which way the wind of human thought is blowing, but on what the Bible says about a subject. Does the Bible have anything to say about abortion? Are Christians anti-abortion? Are anti-abortionists Christian?

It’s going to require a Part Two to deal with all that.

Bill K. Underwood is the author of several novels and one non-fiction self-help book, all available at Amazon.com. You can help support this site by purchasing a book.

Are we witnessing the beginning of World War Three?

 

My whole life, "World War Three" has always been shorthand for total nuclear annihilation. It became an expression, like hell freezing over, or when pigs fly. 

For most of us common folk, it wasn’t a reality. It didn’t have any literal meaning. The theory was that, once one nuclear missile was launched, all of them, in every country that had them, would be launched, leading to total global annihilation. We learned expressions like “nuclear winter,” and “mutually assured destruction.” Surely no one would actually do that, we reasoned. The way we dealt with that unimaginable threat was to move it, in our minds, to the level of a nightmare, fantasy, and finally to several Hollywood storylines, which only went to prove that it was unthinkable. 

There surely would never actually be a World War Three, right? And when the Berlin Wall fell, we told ourselves, ‘See? Nothing to worry about.’

Albert Einstein famously said, “I don’t know what weapons will be used in World War 3, but World War 4 will be fought with sticks and stones.”

But what if Einstein was wrong?

The problem with making WWIII the ultimate bogeyman is that it minimizes the millions of lives lost and the massive destruction that has happened over and over again since the end of WWII in places like Korea, Vietnam, Cuba, Panama, Grenada, the Falkland Islands, Kenya, Cyprus, Ireland, Bosnia, Kosovo, Syria, Libya, Yemen, Afghanistan, Iraq, Sierra Leone, Sudan, Congo... ‘At least it wasn’t World War Three, right?’

Winston Churchill and other notables have said, ‘Those who forget history are doomed to repeat it.’ Putin and I are the same age, so I know he remembers Winston Churchill. But neither of us was alive back when Hitler was more than just ink on the pages of a history book.

World War I wasn’t called that while it was going on. Initially, it was simply called “the July Crisis.” But then other players joined. Russia threw its weight behind Serbia, prompting Germany to back Austria-Hungary, which caused Britain and France to join the Serbs and Russians against the Germans. By the end of 1914, it was being called the World War. You can read a column I wrote about the first World War, and the Church's involvement in it, here.

When Hitler invaded Poland on September 1, 1939, no one immediately announced WWII. A week later, when Time magazine used the term ‘World War II’, it was in a speculative sense, similar to the way I used the term World War III in my headline. But it caught on.

So far in the current crisis, Putin has thrown a significant military attack at Ukraine, killing thousands, similar to how Hitler threw his “blitzkrieg” (lightning attack) at Poland. Ukraine’s president Zelensky has warned that if Ukraine falls, Putin will push into Poland, Moldova, Finland, Sweden and Norway, as well as points south. Turkey must know it is a desirable target as well because of its control of access into and out of the Black Sea. Talking heads have opined that Putin won’t resort to nukes unless he feels that an enemy invasion onto Russian soil threatens Russia’s “soul”, its identity as a nation. And it’s not World War Three unless it goes nuclear, right? Right?

The majority of the world’s governments have strongly condemned the attack on Ukraine. They are sending money and weapons to Ukraine, freezing Russian assets, squeezing off shipments of goods into Russia, and refusing to buy goods from Russia. As I noted in my previous column, Russia was voted out of the Human Rights council at the U.N., and some nations have called for Russia's removal from the Security Council. On the other hand, Russia does have some allies in Belarus, Armenia, Iran and Syria, who might back Putin's push into other countries.

 At what point would we start calling it World War Three?

If you’ve read this column before, you know the focus is, not simply world events, but how those world events fulfill Bible prophecy. Does the current situation have anything to do with Bible prophecy?

Jesus foretold as part of his sign of “the last days” that people would see wars. ‘So what,’ you may say. ‘There have always been wars.’ True. But notice how he worded it in Matthew 24:6. “You will continually hear of wars and rumors of wars. See that you are not frightened, for those things must take place, but that is not yet the end of the age.” (Amplified Bible)

There were wars in Jesus’ day. He knew there would continue to be wars until the ‘end of the age.’ That’s why he gave a multi-part sign. But note how he continued: “For nation shall be roused up against nation, and kingdom against kingdom: and there shall be famines, and pestilences, and earthquakes, in diverse places.” (Luke 21:10,11, Haweis NT) These have been dubbed ‘the Big Four’ features of the sign of the last days: war, famine, pestilences (like the pandemic) and earthquakes. 

The huge war between England and France in the late 1700s/early 1800s had many believing they were seeing the Big Four. that conflict between Wellington and Napoleon drew in Spain, Portugal, Germany, Russia, Denmark, Sweden, Austria, America and other countries. Accompanying the war was famine as farmers became soldiers and fields were left uncultivated, and soldiers stripped the foodstuffs from the countries they ravaged. Pestilence rose in the form of widespread diseases among the soldiers in the camps on both sides, which quickly spread to nearby civilians. There was even an earthquake in Crete that killed 2,000 people. 

But Bible scholars knew something was still missing.

In Matthew 24:14 Jesus added one more detail to watch for: “This good news of the kingdom will be preached throughout the whole world as a testimony to all the nations, and then the end of the age will come.” John Calvin who lived in a turbulent time in the 1500s wrote that “to this day not even the slightest report concerning Christ has reached the Antipodes [what came to be called Australia] and other very distant nations.” Matthew Poole, a Bible commentator who wrote in the late 1600’s, recognized that ‘all nations’ meant the entire earth.  “Though the Holy Scriptures, and ecclesiastical historians, give us a somewhat large account of the gospel being preached in Europe, Asia, and in Africa, yet we have little account from any of them of its being preached in America.” In 1706, Matthew Henry wrote, “The gospel shall be preached, and that work carried on ...so that all nations, first or last, shall have either the enjoyment, or the refusal, of the gospel.” In the mid-1850s commentator Campbell Morgan wrote: “Some claim that this has already been done, and that therefore the end of the age is necessarily close at hand. This conclusion is open to grave doubt.”

Is there still ‘grave doubt’? In the century-and-a-half since Morgan’s time, the good news has literally reached every nation. The Bible is the most widely translated book in the world, by a huge margin. The most widely translated website on the internet is jw.org, whose entire mission is the preaching of the good news of the kingdom.  

Another reason to give thought to World War Three: serious students of the Bible are watching for the fulfillment of Paul’s words at 1 Thessalonians 5:3. “For when they shall say: Peace and tranquility; then sudden destruction will come upon them, as travail upon a woman with child; and they shall not escape.”

The greatest cry of peace in recent history was the end of World War 2. And that obviously was not the fulfillment of 1 Thessalonians 5:3, since the end didn't happen afterward... Perhaps because Matthew 24:14 had yet to be fulfilled. But that is no longer the case.

If this war in Ukraine grows into World War Three, could the announcement of the war's end be the expected cry of peace?

Time will tell. Click here to go to Part Two.

Bill K. Underwood is the author of several books, all available at Amazon.com. You can support this site by purchasing a book.