You’ve Got Red On You: Blood, Bleeding, and Transfusion

Join Brodie, Josh, and James as they dive into the science, stories, and myths of blood transfusions—from trauma to surgery, childbirth, and beyond. Learn why blood saves lives, what really happens in the hospital, and why your donation matters. Entertaining, educational, and just a little bit bloody.

Episode Transcript

(00:02):
There's a crumpled motorcycle, a pair of gloves, a single shoe.
A paramedic is crouched next to someone on the ground, shouting at vitals.
Pressure's dropping.
No radio Pulse moments later in the trauma bay, it's chaos, but controlled chaos.
Nurses are hanging fluids.
Someone's cutting off a leather jacket.
A surgeon's asking for an ultrasound.
You hear someone say, we need blood.

(00:22):
Now, you've probably seen the scene on tv, but here's what you don't see.
The patient has already lost more than half of their blood, so they're going into shock.
Organs are starting to shut down and their blood isn't clotting anymore.
Every second counts, and in those moments, it's not some miracle drug that saves them.
It's not a machine.
It's blood.
Blood that was donated by someone weeks ago, processed, typed, tested, and stored, and now it's flowing into their veins.

(00:49):
Today on not another medical podcast, we're talking about blood transfusions.
When we give blood, why we give blood, and how this incredible, simple concept replacing what's lost has become one of the most powerful tools in modern medicine.
We'll talk about trauma and surgery, childbirth and cancer, and everything in between.
We'll unpack the science, the risks, the myths, and what's changing in the world of transfusions because whether it's a dramatic trauma or a quiet hospital room, when someone's life is on the line, blood can be the difference between survival and goodbye.

(01:20):
Let's get into it. 22 00:01:37,28.732553439 --> 00:01:41,297.0919475 and opinions expressed in this podcast are those of the hosts and guests do not reflect the official policies or positions of any affiliated institutions or organizations. 23 00:01:41,513.75861417 --> 00:01:45,913.75861417 This podcast is for informational, educational, and entertainment purposes only, and it is not intended to provide medical advice, diagnosis, or treatment. 24 00:01:46,197.0919475 --> 00:01:53,355.54467862 Listeners should consult their own healthcare professionals for any medical concerns, I'm Josh Levitt, an internal medicine physician. 25 00:01:54,534.54467862 --> 00:01:54,684.54467862 I. 26 00:01:54,684.54467862 --> 00:01:56,304.54467862 am James Jung, a general surgeon. 27 00:01:57,558.04467862 --> 00:01:58,68.04467862 And I am Brody. 28 00:01:58,68.04467862 --> 00:02:02,538.04467862 Nolan, an emergency doctor, and this is not another medical podcast. 29 00:02:03,283.51258674 --> 00:02:06,288.51258674 That was a good cold, open Brody, like I was, I was really hooked into it. 30 00:02:07,28.51258674 --> 00:02:08,5.01258674 it's, Thanks guys. 31 00:02:08,318.51258674 --> 00:02:11,848.51258674 it is a, it's a little seriousness in a levity filled podcast. 32 00:02:12,200.01258674 --> 00:02:12,440.01258674 Mm-hmm. 33 00:02:12,758.51258674 --> 00:02:13,48.51258674 Yeah. 34 00:02:13,110.01258674 --> 00:02:15,945.01258674 And a and a, a smidge of, a smidge of lemonade, if you will, in there. 35 00:02:16,125.01258674 --> 00:02:17,165.01258674 So, thanks again. 36 00:02:17,165.01258674 --> 00:02:21,175.01258674 This is episode two, I guess to our listeners, if we have any by now. 37 00:02:21,685.01258674 --> 00:02:33,505.01258674 And it's, I'm kind of surprised we actually made it through the first episode without talking about probably the most important thing in medicine, which is what is the best medical TV show. 38 00:02:34,585.01258674 --> 00:02:36,475.01258674 So, I know my answer. 39 00:02:37,13.51258674 --> 00:02:40,555.01258674 not, not I gotta, I gotta, I gotta throw it out to the group here. 40 00:02:41,548.51258674 --> 00:02:42,238.51258674 Scrubs. 41 00:02:42,833.51258674 --> 00:02:43,163.51258674 Yeah. 42 00:02:44,200.01258674 --> 00:02:44,968.51258674 Josh, Yeah. 43 00:02:44,973.51258674 --> 00:02:46,133.51258674 I, I, I think, doubt. 44 00:02:46,318.51258674 --> 00:02:53,158.51258674 without a doubt, but like also, we haven't watched any new medical episodes since our mezcal days probably. 45 00:02:53,158.51258674 --> 00:02:53,428.51258674 Right. 46 00:02:53,428.51258674 --> 00:02:54,778.51258674 Which is like 20 years ago. 47 00:02:56,165.01258674 --> 00:02:56,695.01258674 well, I. 48 00:02:56,828.51258674 --> 00:02:57,938.51258674 us every episode. 49 00:02:57,938.51258674 --> 00:03:02,468.51258674 You age us more and more i'm glad we got like a three to three doctors on this podcast. 50 00:03:02,468.51258674 --> 00:03:04,958.51258674 I'll agree that Scrubs is the best medical show. 51 00:03:05,8.51258674 --> 00:03:05,278.51258674 Yeah. 52 00:03:05,448.51258674 --> 00:03:12,853.51258674 Yeah, you, I, so at every phase in my life slash medical journey, I've watched it again it, it holds up. 53 00:03:12,943.51258674 --> 00:03:15,733.51258674 And I just started watching it again like a couple months ago. 54 00:03:16,3.51258674 --> 00:03:16,903.51258674 It still holds up. 55 00:03:17,173.51258674 --> 00:03:18,565.01258674 yeah, Amazing. 56 00:03:18,595.01258674 --> 00:03:28,6.51258674 I think change, you know? I think I've watched it all in its entirety, like four or five times around similar Josh, like a, during the different stages for everything, so, Yeah. 57 00:03:28,277.24780742 --> 00:03:28,617.81416553 yeah. 58 00:03:29,277.81416553 --> 00:03:30,147.81416553 Happy birthday Josh. 59 00:03:31,216.31416553 --> 00:03:33,671.31416553 Yeah, we share similar birthdays, Yep. 60 00:03:33,856.31416553 --> 00:03:35,716.31416553 you know, only like 20 years apart. 61 00:03:35,876.31416553 --> 00:03:37,226.31416553 happy birthday to both of us. 62 00:03:37,966.31416553 --> 00:03:46,631.31416553 I mean, Did you do anything? 1950s, again, listeners, we are what, five years apart, James? yeah, exactly. 63 00:03:46,781.31416553 --> 00:03:47,781.31416553 Well, five years. 64 00:03:48,81.31416553 --> 00:03:51,771.31416553 mean significant, but not that far apart. 65 00:03:53,91.31416553 --> 00:03:56,671.31416553 Did you do anything special, Josh? It is not significant. 66 00:03:56,671.31416553 --> 00:03:57,331.31416553 You stop it. 67 00:03:59,391.31416552 --> 00:04:00,51.31416553 Not yet. 68 00:04:00,51.31416553 --> 00:04:09,927.81416552 Actually this weekend we are getting some babysitters for both kids and we are just whatever, we don't have our two kids with Not going to parent for a night. 69 00:04:10,616.31416553 --> 00:04:11,366.31416553 no. 70 00:04:11,366.31416553 --> 00:04:12,416.31416552 So I don't know. 71 00:04:12,466.31416552 --> 00:04:13,606.31416552 we're going out for dinner. 72 00:04:13,606.31416552 --> 00:04:17,441.31416553 We're gonna listeners, you're gonna, you're gonna know my sports preference here. 73 00:04:17,471.31416553 --> 00:04:19,941.31416553 The leaf game is on Saturday night, so Yeah. 74 00:04:20,171.31416553 --> 00:04:21,927.81416553 That may clinch the Mm-hmm. 75 00:04:22,631.31416553 --> 00:04:24,491.31416553 so you know, it's gonna be an awesome weekend. 76 00:04:24,671.31416553 --> 00:04:25,332.81416553 What about Yeah. 77 00:04:25,332.81416553 --> 00:04:27,137.81416553 After having said that, they're gonna tank and. 78 00:04:29,1.31416553 --> 00:04:29,61.31416553 Yeah. 79 00:04:29,61.31416553 --> 00:04:30,771.31416553 There, there are three, three up. 80 00:04:30,821.31416553 --> 00:04:31,392.81416553 I'm Yeah. 81 00:04:31,481.31416553 --> 00:04:32,322.81416553 of you right Okay. 82 00:04:32,322.81416553 --> 00:04:34,572.81416553 So, so as of today, three up. 83 00:04:35,592.81416552 --> 00:04:37,602.81416552 We'll see what it's like by the time this episode comes out. 84 00:04:39,241.31416553 --> 00:04:43,302.81416552 yeah, there'll be a lot of And I say this as a non-committal sports fan, none of this means anything to me. 85 00:04:43,352.81416552 --> 00:04:43,502.81416552 Good. 86 00:04:45,446.31416552 --> 00:04:45,866.31416553 sports. 87 00:04:46,131.31416552 --> 00:04:51,1.31416552 So I, I went to Vegas last week and with some of my family members. 88 00:04:51,481.31416552 --> 00:04:51,751.31416552 Yeah. 89 00:04:51,751.31416552 --> 00:04:51,931.31416552 Yeah. 90 00:04:51,931.31416552 --> 00:05:05,541.31416552 Well, I mean, you know, when you're younger you know, it's, it's actually, I was thinking that the last time I went to Vegas with, with you guys for Tom's Bachelor, just stop this conversation right here and not proceed any further. 91 00:05:08,516.31416552 --> 00:05:09,566.31416553 You know, it's yeah. 92 00:05:09,656.31416552 --> 00:05:09,746.31416553 Yeah. 93 00:05:09,746.31416553 --> 00:05:16,646.31416552 I mean, it's totally different vibe, you know, my family like, you know, with my parents and our son and my sister came from New York. 94 00:05:16,646.31416552 --> 00:05:21,866.31416552 Like it is a, there's a side of Vegas that I didn't know, which is like, it's a really foodie place. 95 00:05:21,916.31416552 --> 00:05:27,16.31416552 You know, it's somewhat kid friendly other than the fact that people are smoking inside the casinos all the time. 96 00:05:27,386.31416552 --> 00:05:27,986.31416552 Which I. 97 00:05:28,406.31416552 --> 00:05:32,141.31416552 Totally forgot that they, it still exists, I didn't know that but a thing. 98 00:05:32,356.31416552 --> 00:05:32,616.31416552 yeah. 99 00:05:32,616.31416552 --> 00:05:35,406.31416552 You like, you could still smoke inside the casino. 100 00:05:35,436.31416552 --> 00:05:41,546.31416552 Like, you know, you walk around with the stroller with all these kids and then there are people just smoking you know, just like right next to you. 101 00:05:41,826.31416552 --> 00:05:47,758.7476256 It's a, it's a different place, what are your thoughts on this? You know you know, individual freedom. 102 00:05:49,260.55923161 --> 00:05:51,130.55923161 Thank you for not alienating anybody. 103 00:05:51,695.55923161 --> 00:05:54,715.55923161 Well, sounds like everybody had a good week then, Roddy. 104 00:05:54,715.55923161 --> 00:05:58,872.05923161 Anything special? Yeah, no, I'm gonna pass on that one. 105 00:05:58,992.05923161 --> 00:06:01,932.05923161 I did not have a birthday or a trip to Vegas, but that's okay. 106 00:06:02,242.05923161 --> 00:06:03,857.05923161 It's biking and barbecue season now. 107 00:06:03,947.05923161 --> 00:06:04,277.05923161 Great. 108 00:06:04,610.55923161 --> 00:06:06,25.55923161 Hopefully there's a little bit of sunshine. 109 00:06:06,797.05923161 --> 00:06:07,97.05923161 Yeah. 110 00:06:07,140.55923161 --> 00:06:07,870.55923161 Yeah, Yeah. 111 00:06:08,150.55923161 --> 00:06:09,620.55923161 I forgot before we get into it. 112 00:06:09,650.55923161 --> 00:06:14,560.55923161 I'm on a weird nights combination, so I I don't know if it's night or day right now. 113 00:06:14,920.55923161 --> 00:06:22,647.05923161 I'm a little delirious, so if I say anything completely offside, we'll make sure to highlight it in the, in the editing. 114 00:06:22,720.55923161 --> 00:06:23,830.55923161 it in there, please. 115 00:06:24,30.55923161 --> 00:06:28,135.55923161 How is it different from the other episodes? Yeah. 116 00:06:28,375.55923161 --> 00:06:28,825.55923161 Fair. 117 00:06:29,487.05923161 --> 00:06:30,477.05923161 With the challenge for the viewers. 118 00:06:30,477.05923161 --> 00:06:30,777.05923161 Yeah. 119 00:06:30,987.05923161 --> 00:06:33,235.55923161 Who worked last night? Yep. 120 00:06:33,297.05923161 --> 00:06:34,527.05923161 you tell? Yeah. 121 00:06:34,585.55923161 --> 00:06:36,795.55923161 really actually, that's a, that'd be a fun little test. 122 00:06:36,795.55923161 --> 00:06:37,305.55923161 All right. 123 00:06:37,365.55923161 --> 00:06:37,890.55923161 We can get going. 124 00:06:37,937.05923161 --> 00:06:40,547.05923161 All right, so with that, we're gonna get back to it. 125 00:06:41,117.05923161 --> 00:06:42,227.05923161 Back to blood bleeding. 126 00:06:42,257.05923161 --> 00:06:46,895.55923161 One of my favorite things to talk about, and so, you know, this is, I think it's a really important it's bleeding. 127 00:06:48,227.05923161 --> 00:06:51,647.05923161 stabbing leads to bleeding, bleeding leads to need blood. 128 00:06:51,647.05923161 --> 00:06:53,117.05923161 It's all a very common theme for me. 129 00:06:53,207.05923161 --> 00:06:53,387.05923161 Yeah. 130 00:06:53,645.55923161 --> 00:06:53,765.55923161 Yeah. 131 00:06:53,815.55923161 --> 00:06:57,735.55923161 But we know that, bleeding itself happens for a bunch of different reasons. 132 00:06:57,735.55923161 --> 00:07:04,780.55923161 Obviously a lot of the reasons that I see bleeding in the emergency department or more as a result or direct result of trauma or injury. 133 00:07:04,830.55923161 --> 00:07:07,530.55923161 But we see lots of other reasons why people would bleed. 134 00:07:07,630.55923161 --> 00:07:20,250.55923161 And so I don't know if Josh, if you want to kind of maybe dive into some of the cases that you might have that reasons why people that don't have an injury might need something like a blood transfusion might run into issues with bleeding that you could see. 135 00:07:21,59.05923161 --> 00:07:21,839.05923161 Yeah, for sure. 136 00:07:21,999.05923161 --> 00:07:26,19.05923161 And just a reminder to listeners, so Brody, Brody is an emerge and a trauma doctor. 137 00:07:26,19.05923161 --> 00:07:28,119.05923161 So he sees a lot of the big bad bleeding. 138 00:07:28,489.05923161 --> 00:07:31,249.05923161 James is a surgeon, so he causes a lot of bleeding. 139 00:07:33,409.05923161 --> 00:07:35,355.55923161 You like that? James is the problem. 140 00:07:35,944.05923161 --> 00:07:38,884.05923161 And I, I'm an internal medicine doctor, so I run away from bleeding. 141 00:07:38,944.05923161 --> 00:07:42,144.05923161 But a lot of my patients have low blood levels. 142 00:07:42,874.05923161 --> 00:07:44,134.05923161 they may or may not be bleeding. 143 00:07:44,134.05923161 --> 00:07:49,704.05923161 So should I talk a little bit about why I see low blood levels or stick to kind of the bleeding things? Yeah, the low blood levels is probably great. 144 00:07:49,754.05923161 --> 00:07:51,704.05923161 Yeah, so I think James will talk about this. 145 00:07:51,704.05923161 --> 00:08:00,864.05923161 So on the bleeding front, we see a lot of what we call GI bleeds, gastrointestinal bleeds, so a lot of bleeding through the gut, and that can really happen anywhere from mouth to the bum. 146 00:08:01,584.05923161 --> 00:08:03,704.05923161 And James, maybe you'll, touch on that a little more. 147 00:08:04,354.05923161 --> 00:08:11,634.05923161 So an internal medicine, the kind of bleeding we see are the ones that can be fixed by or looked at by putting cameras into the stomach. 148 00:08:11,634.05923161 --> 00:08:14,424.05923161 So things like ulcers, which everybody hears about. 149 00:08:15,24.05923161 --> 00:08:19,154.05923161 And James sees a lot more of these, but cancers, so things like that. 150 00:08:19,154.05923161 --> 00:08:21,14.05923161 And we're, we're not gonna be all inclusive here. 151 00:08:21,274.05923161 --> 00:08:25,354.05923161 There's about a thousand other reasons I see low blood levels that don't have to do with bleeding. 152 00:08:26,284.05923161 --> 00:08:30,244.05923161 I think a big one that patients probably don't realize, is any. 153 00:08:31,154.05923161 --> 00:08:36,914.05923161 inflammatory condition, anything that causes inflammation in the body can actually lower blood over time. 154 00:08:38,364.05923161 --> 00:08:39,684.05923161 you have an infection. 155 00:08:39,684.05923161 --> 00:08:40,884.05923161 Your blood levels can be lower. 156 00:08:40,884.05923161 --> 00:08:43,194.05923161 You have cancers, your blood levels can be lower. 157 00:08:43,194.05923161 --> 00:08:48,564.05923161 You have, liver disease or kidney disease or all sorts of things. 158 00:08:48,564.05923161 --> 00:08:51,474.05923161 Your blood levels lower for various reasons. 159 00:08:52,209.05923161 --> 00:08:58,659.05923161 And there's this whole world of this thing called hepcidin, which you, you may start hearing about more and more in the future. 160 00:08:58,929.05923161 --> 00:09:01,779.05923161 It kind of regulates how we take in iron and how the blood levels are. 161 00:09:02,149.05923161 --> 00:09:08,89.05923161 But without getting into details there, there are tons of different reasons your blood levels can be low beyond bleeding. 162 00:09:08,359.05923161 --> 00:09:08,659.05923161 Mm-hmm. 163 00:09:09,145.55923161 --> 00:09:16,955.55923161 You're talking about the patients like who have chronic conditions, you know, who also are found to have low blood level or anemia, right. 164 00:09:17,25.55923161 --> 00:09:17,685.55923161 it is. 165 00:09:17,685.55923161 --> 00:09:21,360.55923161 and the reality is even with acute more sudden conditions, Mm-hmm. 166 00:09:21,405.55923161 --> 00:09:25,210.55923161 a pretty quick decrease in your hemoglobin, in your blood levels. 167 00:09:25,340.55923161 --> 00:09:31,220.55923161 But yeah, the chronic conditions, we definitely see just lower baseline levels of hemoglobin of, of blood level. 168 00:09:32,5.55923161 --> 00:09:34,885.55923161 Yeah, so I think that's a, is a really important distinction. 169 00:09:34,885.55923161 --> 00:09:50,295.55923161 You know, there's an acute blood loss so, you know, losing blood quickly you know, and Brody and I see this more often, you know, the trauma or the injury That results in, active bleeding, you know, whether it's during surgery not my surgery, but other people's surgery. 170 00:09:50,455.55923161 --> 00:09:56,865.55923161 Or if there's an injury from trauma, whether it's car accidents or, or penetrating trauma like Stabbing. 171 00:09:57,305.55923161 --> 00:10:15,95.55923161 And then there's the chronic ones that are more related to, you know, whether you have chronic kidney disease or, malignancy cancer where the blood level is chronically low so I think that's the important distinction because how patients present, with low blood level is different, right. 172 00:10:16,72.05923161 --> 00:10:16,732.05923161 Yeah, totally. 173 00:10:16,732.05923161 --> 00:10:22,672.05923161 And I think for, for the listeners, you know, when we test someone's blood levels, we test a number of different markers. 174 00:10:22,672.05923161 --> 00:10:29,147.05923161 For the most part, when we think about someone who's has anemia we're worried about their blood levels are too low, we're usually talking with their hemoglobin level. 175 00:10:29,247.05923161 --> 00:10:32,897.05923161 Which is probably the one of the terms you've probably seen and before that's been reported there. 176 00:10:33,147.05923161 --> 00:10:37,167.05923161 And yeah, I think to add to that as well, again, besides like obviously in the emergency department, we see a lot of,. 177 00:10:37,247.05923161 --> 00:10:38,357.05923161 Trauma and injury. 178 00:10:38,637.05923161 --> 00:10:54,687.05923161 I think the other one, and certainly like a worldwide cause of mortality too, is, is pregnancy related bleeding, right? so your postpartum hemorrhage that we can have and, you know it's another big cause of bleeding kind of worldwide and the need for needing things like blood transfusion and replacing blood afterwards. 179 00:10:55,495.55923161 --> 00:10:59,737.05923161 Postpartum meaning after delivery, right? Yes, yes. 180 00:10:59,767.05923161 --> 00:11:16,208.55923161 for those who didn't study Latin, Can I just, a, a big thing that I'm I'll highlight quickly here is when, when we test blood levels, if you listeners, if you guys ever get your blood tested, you're gonna see this whole paper long list of things that they test in your blood. 181 00:11:16,598.55923161 --> 00:11:21,38.55923161 And like there are some main ones that we look at, like the hemoglobin, that's a blood level we're talking about here. 182 00:11:21,773.55923161 --> 00:11:27,113.55923161 gonna see all these other things in there that for the most part, doctors don't use outta very specialized settings. 183 00:11:27,293.55923161 --> 00:11:35,633.55923161 So you might see things called like MCH or MCHC, and they may look abnormal on your blood test, but I just caution you that we don't actually use those. 184 00:11:35,633.55923161 --> 00:11:39,323.55923161 We don't, for the most part, know what they mean in our worlds. 185 00:11:39,713.55923161 --> 00:11:44,483.55923161 So if you see something abnormal there, ask your doctor, but it's usually not something you have to worry about. 186 00:11:45,640.05923161 --> 00:11:45,940.05923161 Totally. 187 00:11:45,940.05923161 --> 00:11:46,780.05923161 that's a really good point. 188 00:11:46,860.05923161 --> 00:11:52,790.05923161 And so, I think of certainly there's ways to test if someone is anemic or low on blood. 189 00:11:52,890.05923161 --> 00:11:55,680.05923161 And there's also some signs or symptoms or clinical markers that. 190 00:11:55,755.05923161 --> 00:12:06,814.05923161 They might see I think, you know, in those acute settings where someone has an acute bleed, so again someone with maybe a liver that's bleeding into their belly after having been in a motor vehicle collision, often they have an elevated heart rate. 191 00:12:06,814.05923161 --> 00:12:08,554.05923161 Their blood pressure might be down. 192 00:12:08,714.05923161 --> 00:12:09,674.05923161 The patient might feel. 193 00:12:09,704.05923161 --> 00:12:10,214.05923161 Dizzy. 194 00:12:10,214.05923161 --> 00:12:12,944.05923161 They might feel lightheaded, they might feel like they're going to pass out. 195 00:12:12,974.05923161 --> 00:12:16,544.05923161 There might actually be kind of going in and out of consciousness or passing out. 196 00:12:16,544.05923161 --> 00:12:23,374.05923161 So these are some of the things that you might see if either you yourself are having a massive bleeding or come across someone who has sustained a big injury and it's bleeding. 197 00:12:23,952.55923161 --> 00:12:28,722.55923161 I was just, I was gonna say, I feel dizzy and lightheaded and like I'm gonna pass out right now. 198 00:12:30,522.55923161 --> 00:12:34,514.05923161 Could I be bleeding or is this my overnight week? Yeah, exactly. 199 00:12:34,667.55923161 --> 00:12:36,22.55923161 Depends Yeah, did last night. 200 00:12:38,382.55923161 --> 00:12:39,269.05923161 Sorry, yeah. 201 00:12:39,299.05923161 --> 00:12:46,259.05923161 Working working nights also makes you feel like most of the things that we're gonna be talking about on podcast, which is like kind of awful and shitty. 202 00:12:46,439.05923161 --> 00:12:49,229.05923161 So kudos to the shift workers and night workers out there. 203 00:12:49,877.55923161 --> 00:12:50,447.55923161 Yes. 204 00:12:50,497.55923161 --> 00:13:00,307.55923161 Brody, so first of all, you know, average human being has about five liters of blood, right? And then tell us about how much blood you have to lose to have some of these symptoms. 205 00:13:00,497.55923161 --> 00:13:06,177.55923161 if you lose just a little bit, define the little bit like where you feel okay. 206 00:13:06,187.55923161 --> 00:13:15,499.05923161 is that normal? Yeah, so, I think most people tend to compensate pretty well up to about 500, milliliters or half a liter of. 207 00:13:15,524.05923161 --> 00:13:16,274.05923161 Blood loss. 208 00:13:16,354.05923161 --> 00:13:21,528.07323161 And that's how much we do a blood donation right? So most people can go in, they give a donation they walk out, they're feeling okay. 209 00:13:21,558.07323161 --> 00:13:28,938.07323161 So for the most part, we tend to have that reserve and ability to compensate pretty well for about half a liter of blood loss. 210 00:13:28,938.07323161 --> 00:13:32,868.07323161 And after that kind of the half a liter to a liters worth, then we start to see. 211 00:13:32,991.57323161 --> 00:13:35,418.07323161 is about a pint, right? You got it. 212 00:13:35,418.07323161 --> 00:13:35,538.07323161 Yeah. 213 00:13:35,538.07323161 --> 00:13:37,188.07323161 You can pour it into your pine glass. 214 00:13:37,188.07323161 --> 00:13:38,238.07323161 Yeah, probably don't drink it. 215 00:13:38,238.07323161 --> 00:13:39,18.07323161 I wouldn't recommend. 216 00:13:39,18.07323161 --> 00:13:39,798.07323161 Recommend that. 217 00:13:39,798.07323161 --> 00:13:42,588.07323161 And if you're donating blood, definitely don't donate it into a blood glass. 218 00:13:42,588.07323161 --> 00:13:44,148.07323161 I would walk out of that building. 219 00:13:45,141.57323161 --> 00:13:45,561.57323161 yeah. 220 00:13:45,561.57323161 --> 00:13:45,562.57323161 Yeah. 221 00:13:45,646.57323161 --> 00:13:46,488.07323161 on the vampires. 222 00:13:46,726.57323161 --> 00:13:47,566.57323161 vampires. 223 00:13:47,616.57323161 --> 00:13:47,736.57323161 Yeah. 224 00:13:47,736.57323161 --> 00:13:51,966.57323161 So, in the us we still use these standardized measures. 225 00:13:52,216.57323161 --> 00:13:58,896.57323161 But for average listener, half a liter is about like 17 fluid ounces or a pint or 16.9. 226 00:13:59,366.57323161 --> 00:14:01,376.57323161 So just wanna, keep everyone informed. 227 00:14:01,728.07323161 --> 00:14:07,708.07323161 And then once you get over that kind of pint or so of blood loss, then you start to see some of those other symptoms. 228 00:14:07,708.07323161 --> 00:14:15,108.07323161 So you'd expect your heart rate to be up a little bit, kind of like you're going to the gym, working pretty hard, but you know, maybe not necessarily doing like a full hit kind workout. 229 00:14:15,188.07323161 --> 00:14:17,648.07323161 Your blood pressure's still probably normal at that time. 230 00:14:17,648.07323161 --> 00:14:21,818.07323161 You're still probably maintaining, speaking normally and not passing out at that point in time. 231 00:14:22,93.07323161 --> 00:14:27,693.07323161 But then once you get to that one and certainly to two liters in, that's where we really see abnormalities in your blood pressure. 232 00:14:27,693.07323161 --> 00:14:33,73.07323161 People start to not have enough blood to bring oxygen to their brain or to their heart. 233 00:14:33,73.07323161 --> 00:14:36,853.07323161 And that's where people can really run into issues where it starts to affect the other organs. 234 00:14:36,853.07323161 --> 00:14:46,63.07323161 And that's where you see people not being as responsive or, at risk for things like death and dying because they don't have sufficient ways to bring oxygen to the critical organs that need it. 235 00:14:46,361.57323161 --> 00:14:46,541.57323161 Yeah. 236 00:14:46,541.57323161 --> 00:14:59,183.07323161 So, I think it's important to talk about like, what does blood do, right? Like to your body, do we need this? Maybe Brody, can you talk about what are the functions of the blood? So I think there's a couple of things. 237 00:14:59,183.07323161 --> 00:15:05,213.07323161 You know, the, probably the most important thing is just bringing oxygen and nutrients to all your organs, right? I mean, without that you can't think. 238 00:15:05,213.07323161 --> 00:15:06,503.07323161 Without that, your heart can't beat. 239 00:15:06,773.07323161 --> 00:15:08,303.07323161 So really you need oxygen. 240 00:15:08,403.07323161 --> 00:15:15,203.07323161 You know in, in your blood to be able to, to do all the things on really like a cellular level that that you need to do. 241 00:15:15,503.07323161 --> 00:15:19,878.07323161 So you know, you can think of blood kind of as like the Uber for oxygen and blood, if you will. 242 00:15:19,978.07323161 --> 00:15:20,848.07323161 Getting it there. 243 00:15:20,898.07323161 --> 00:15:22,38.07323161 No delivery fees though. 244 00:15:22,188.07323161 --> 00:15:22,338.07323161 Yeah. 245 00:15:23,286.57323161 --> 00:15:24,726.57323161 you gotta tip the blood as well. 246 00:15:25,273.07323161 --> 00:15:26,3.07323161 Yeah, exactly. 247 00:15:26,566.57323161 --> 00:15:28,696.57323161 And there's a search pricing joke somewhere in here. 248 00:15:28,696.57323161 --> 00:15:29,866.57323161 I just don't know what it is. 249 00:15:31,518.07323161 --> 00:15:34,718.07323161 And then the second thing that blood does, it helps kind of Take out the trash. 250 00:15:34,718.07323161 --> 00:15:37,98.07323161 all the stuff your body's creating, you don't need to get rid of. 251 00:15:37,98.07323161 --> 00:15:42,768.07323161 you've eaten your food and now you're kind of throwing your garbage out and it helps bring it to the different organs that get rid of those things. 252 00:15:42,768.07323161 --> 00:15:45,198.07323161 Usually that will be like the liver in your kidneys. 253 00:15:45,448.07323161 --> 00:15:46,828.07323161 So it helps with that aspect. 254 00:15:47,248.07323161 --> 00:15:52,68.07323161 The third thing is around preventing infection and really fighting off germs in the body. 255 00:15:52,68.07323161 --> 00:15:58,378.07323161 So within the blood you have your white blood cells and those are kind of infection fighting cells or inflammation kind of cells. 256 00:15:58,378.07323161 --> 00:16:02,28.07323161 So those help to fight off different attacks within your body and keep us from getting sick. 257 00:16:03,83.07323161 --> 00:16:15,683.07323161 And then, you know, lastly, it helps you form blood clots so that if you hurt yourself and you're bleeding, then you're able to stop that bleeding and kind of form really like, internal bandages if you will, or external bandages if you're bleeding outside. 258 00:16:17,141.57323161 --> 00:16:17,801.57323161 Oh, I like that. 259 00:16:17,861.57323161 --> 00:16:19,196.57323161 That's a, that's Yeah. 260 00:16:19,571.57323161 --> 00:16:19,811.57323161 there. 261 00:16:19,861.57323161 --> 00:16:20,251.57323161 Yeah. 262 00:16:20,356.57323161 --> 00:16:20,926.57323161 Question for you. 263 00:16:20,926.57323161 --> 00:16:32,216.57323161 So we talked about blood loss and besides seeing how much someone is losing, which often you don't have the benefit of doing, how do you guys look at how much blood someone has lost? What are you gonna look at in the trauma bay, for example, Brody. 264 00:16:33,553.07323161 --> 00:16:49,203.0732316 Yeah, so I, we actually do a really bad job at this and we've taken, you know, there's been lots of studies that, you know, we'll take an actual pint glass of a red colored liquid, throw it on the floor, throw it on a mat, and say, how much is that? And universally, we're actually really bad at predicting how much blood loss there is. 265 00:16:49,546.5732316 --> 00:16:51,935.0732316 this is what medical research is Yeah, serious. 266 00:16:51,975.0732316 --> 00:16:53,445.0732316 Red food coloring and throwing it around. 267 00:16:53,785.0732316 --> 00:17:01,225.0732316 Or like how many sponges are soaked with blood again, and as a whole, we're actually really bad at figuring out how much liquid's on the ground or, or things like that. 268 00:17:01,375.0732316 --> 00:17:06,493.5732316 So what? it like outside, right, like even when there's an actual blood that you see, right? Yeah, that's right. 269 00:17:06,493.5732316 --> 00:17:11,863.5732316 James, all of your surgeries, you talk about estimated blood loss and that one of the things that are it's, usually commented on in your notes. 270 00:17:12,82.0732316 --> 00:17:14,642.0732316 I always say it's minimal because it's true. 271 00:17:14,877.0732316 --> 00:17:21,717.0732316 So as someone who helps surgical patients with medical problems, the estimated blood loss is always zero from the surgeon side. 272 00:17:22,437.0732316 --> 00:17:25,647.0732316 And in my experience, you're always lying. 273 00:17:26,158.5732316 --> 00:17:26,308.5732316 Yeah. 274 00:17:27,362.0732316 --> 00:17:30,302.0732316 Yeah, I mean, it's almost impossible to estimate really. 275 00:17:30,302.0732316 --> 00:17:42,92.0732316 Well, sometimes when we use suction devices that collects blood and then you could measure it, you know but you know, there oftentimes when we use suction to suction out the blood. 276 00:17:42,327.0732316 --> 00:17:47,877.0732316 But we also instill normal saline to wash things out, and then that gets sucked out as well. 277 00:17:47,997.0732316 --> 00:17:51,597.0732316 And then, so that adds to, you know, the, what's been collected. 278 00:17:51,907.0732316 --> 00:17:57,57.0732316 So, you know, there are ways that we want to be able to estimate it and, you know, in my research we've been using. 279 00:17:57,372.0732316 --> 00:18:02,472.0732316 Machine learning to kind of, estimate how much blood loss there is in the computer screen. 280 00:18:02,632.0732316 --> 00:18:12,2.0732316 So, you know, when we do minimally invasive surgery, you know, we have the video camera looking at the surgical field and you could kind of estimate it, but even that is not really that great. 281 00:18:12,282.0732316 --> 00:18:14,52.0732316 So, you know, it's a big challenge. 282 00:18:14,412.0732316 --> 00:18:17,312.0732316 So for us, the answer is the Lord the better. 283 00:18:18,383.5732316 --> 00:18:24,813.5732316 I will say this is, a little bit dark but we don't have really fancy ways for estimating blood loss to emerge, so it comes down to smell. 284 00:18:25,143.5732316 --> 00:18:31,383.5732316 And this is something that, like, if there's been a substantial amount of bleeding, especially like on the floor. 285 00:18:31,743.5732316 --> 00:18:42,213.5732316 There's a very distinct smell that I didn't know that blood had, but when you can smell the blood in the room, it's like this very potent, clearly metallic irony, kinda smell to it. 286 00:18:42,543.5732316 --> 00:18:44,823.5732316 That's when I'm like, this person has bled a lot. 287 00:18:45,502.0732316 --> 00:18:45,922.0732316 Yeah. 288 00:18:46,83.5732316 --> 00:18:49,813.5732316 So that's, that's, that's my, my spidey sense version of too much bleeding. 289 00:18:50,162.0732316 --> 00:18:56,942.0732316 Yeah, so we're relying on our ability to smell as Yeah, estimate of how much blood loss there is. 290 00:18:57,433.5732316 --> 00:18:59,83.5732316 we just need like sniffing dogs in the emerge. 291 00:18:59,83.5732316 --> 00:19:00,73.5732316 They can sniff up bedbugs. 292 00:19:00,73.5732316 --> 00:19:02,53.5732316 I'm sure they can sniff out blood anyways. 293 00:19:02,132.0732316 --> 00:19:03,773.5732316 sure they'll do a Than surgeons. 294 00:19:06,365.0732316 --> 00:19:07,355.0732316 all right, so all right. 295 00:19:07,355.0732316 --> 00:19:09,365.0732316 So we've had someone, they're bleeding a bunch. 296 00:19:09,415.0732316 --> 00:19:10,975.0732316 They need a blood transfusion. 297 00:19:11,75.0732316 --> 00:19:35,960.0732316 Maybe just a bit before that, what are, like, what are the blood types that people have? Or what are some of the important, you know, you hear about, what blood group are you? What blood type are you? what are those things like? for, for listeners, I think it's important to, describe that, when we talk about blood we often refer to the red blood cells, right? Like, that's the red blood cells are the oxygen carrying red cells and then the antigens. 298 00:19:36,200.0732316 --> 00:19:39,800.0732316 Antigens are just proteins that are stuck on the surface of this red blood cells. 299 00:19:39,800.0732316 --> 00:19:43,0.0732316 Red blood cells kind of look like a donut without a full hole. 300 00:19:43,840.0732316 --> 00:19:46,870.0732316 like a little deep depressed in the middle, right. 301 00:19:47,55.0732316 --> 00:19:57,155.0732316 Yeah and then the antigens are these proteins that, you know, if you have a antigen type A, you know, your blood type is A, if you have anti type B, you know, it's B. 302 00:19:57,335.0732316 --> 00:20:02,615.0732316 If you have both, it's like ab and then if you're, if there's lack of the antigen, it's O right. 303 00:20:02,915.0732316 --> 00:20:05,735.0732316 And then the RH is another RHD antigen. 304 00:20:06,10.0732316 --> 00:20:10,750.0732316 And then you could have positive or positive meaning you have one, a negative, meaning you don't have one. 305 00:20:10,750.0732316 --> 00:20:13,790.0732316 So I think that's at the highest level. 306 00:20:13,790.0732316 --> 00:20:16,730.0732316 That's kind of how they're classified and it helps with transfusion. 307 00:20:16,975.6635653 --> 00:20:18,475.6635653 those are the red blood cells. 308 00:20:18,475.6635653 --> 00:20:24,135.6635653 And then, within the blood overall, there's the fluid part, which is the plasma. 309 00:20:24,495.6635653 --> 00:20:28,135.6635653 And then there are some factors for clotting, like, cryoprecipitates. 310 00:20:28,135.6635653 --> 00:20:31,835.6635653 And then there are platelets as well which, maybe we'll talk about a little bit later. 311 00:20:31,835.6635653 --> 00:20:34,295.6635653 So that's kind of the blood in the nutshell. 312 00:20:34,605.6635653 --> 00:20:35,145.6635653 Overall. 313 00:20:35,557.9044987 --> 00:20:35,857.9044987 Yeah. 314 00:20:36,37.9044987 --> 00:20:37,627.9044987 And so when you. 315 00:20:37,762.9044987 --> 00:20:44,482.9044987 Give a blood transfusion, right? Often they, they take your blood and they spin it down into kinda those different things that James is talking about. 316 00:20:44,482.9044987 --> 00:20:55,72.9044987 So you've got your red blood cells, which primarily we're then treating for anemia or trying to help with that oxygen delivery to your, to your organs. 317 00:20:55,322.9044987 --> 00:20:58,442.9044987 You have plasma which again have those proteins in it that help your. 318 00:20:58,687.9044987 --> 00:21:04,867.9044987 Blood clot and then platelets, which are kind of like the sticky band-aids that again help, help form clots within the body. 319 00:21:05,287.9044987 --> 00:21:14,347.9044987 What's interesting and sometimes challenging when you have somebody who's bleeding is, you know, obviously they bleed all of the blood, not just red blood cells, or not just plasma, not just platelets. 320 00:21:14,677.9044987 --> 00:21:20,587.9044987 So the other challenge is as patients bleed, the more they bleed, the thinner their blood becomes. 321 00:21:20,687.9044987 --> 00:21:29,627.9044987 Right, because your body starts using up all these proteins that help create these blood clots, and then that uses them up so they're not there anymore. 322 00:21:29,627.9044987 --> 00:21:33,287.9044987 You actually become deficient or deplete of some of those proteins. 323 00:21:33,737.9044987 --> 00:21:37,367.9044987 And so there's sometimes that people that have had massive bleeding. 324 00:21:37,717.9044987 --> 00:21:49,667.9044987 That even if you get control of the bleeding, let's say their liver was severely injured, but you've now got control of that bleeding, through surgery, they might actually just bleed to death because they don't have the ability to form clots anymore. 325 00:21:49,697.9044987 --> 00:21:51,527.9044987 'cause they, their blood becomes so thin from it. 326 00:21:51,887.9044987 --> 00:22:01,67.9044987 I think that's where sometimes transfusions become a bit challenging in trying to kind of give back the, the entirety of, of that blood that was that's been bleeding. 327 00:22:01,256.4044987 --> 00:22:01,676.4044987 Mm-hmm. 328 00:22:02,156.4044987 --> 00:22:02,516.4044987 That's cool. 329 00:22:02,521.4044987 --> 00:22:02,881.4044987 So. 330 00:22:03,206.4044987 --> 00:22:19,976.4044987 I'm guessing Brody, especially in the trauma center, you guys have these massive bleeding protocols, transfusion protocols where you're not just giving those red blood cells, you're giving back plasma, you're giving back platelets, and it's all probably relatively standardized about how much of each you give when someone comes in with a big bleed. 331 00:22:20,767.9044987 --> 00:22:27,777.9044987 Yeah, there's been a lot of work really over the last decade or two in trying to, to do just that, Josh, to kind of standardize how we treat bleeding patients. 332 00:22:27,967.9044987 --> 00:22:29,317.9044987 And this is not just outta trauma. 333 00:22:29,317.9044987 --> 00:22:36,727.9044987 This is also, again, for those, you know, patients that have significant bleeding after childbirth or with JA gastrointestinal bleeding or major bleeding. 334 00:22:36,727.9044987 --> 00:22:39,357.9044987 And in surgery we try to find ways to do it. 335 00:22:39,357.9044987 --> 00:22:39,747.9044987 What is. 336 00:22:40,2.9044987 --> 00:22:43,242.9044987 Interesting is they've looked at the, the ratio. 337 00:22:43,242.9044987 --> 00:22:56,542.9044987 So how many units of red blood cells should you give to how many units of plasma, to how many units of platelets? And it looks like if you're giving someone closer to what would be the entirety of all of the blood or whole blood that seems to be kind of the best option for people. 338 00:22:56,752.9044987 --> 00:22:58,672.9044987 Which is a little bit interesting historically. 339 00:22:58,702.9044987 --> 00:23:01,792.9044987 'cause you know, blood transfusion started as whole blood transfusion. 340 00:23:01,792.9044987 --> 00:23:09,412.9044987 Like really, it got, its, its kick in really kinda World War I with like, literally like, you know, in the field armed to arm transfusions of just whole blood. 341 00:23:09,412.9044987 --> 00:23:11,932.9044987 Obviously the safety of transfusions was a little bit different. 342 00:23:12,832.9044987 --> 00:23:14,692.9044987 But it is a little bit of like what's old is new again. 343 00:23:14,692.9044987 --> 00:23:18,202.9044987 We're starting to see now this emergence of whole blood as a single. 344 00:23:18,324.5711654 --> 00:23:27,134.5711654 Product so you don't eat your blood and people don't spin it down into these different things and just giving whole blood back to treat, especially kind of like the, the trauma bleeding patients. 345 00:23:28,578.0711654 --> 00:23:29,28.0711654 Brody. 346 00:23:29,78.0711654 --> 00:23:57,114.5711654 So when somebody gives blood, right? And then it's spun down, separated into like red blood cells, plasma platelets, cryo what's the purpose like of that? Like, you know, is it for storage or, you know, like, you know, why do we spit it down? I think it's a combination of storage and safety and kind of responding to individual's needs, right? If you have someone who needs a blood transfusion because they have anemia, like a low hemoglobin I. 347 00:23:57,424.5711654 --> 00:24:07,904.5711654 Let's say from a cancer for example they probably don't need plasma or platelets or actually giving them plasma or platelets could potentially expose them to risks that they may not need. 348 00:24:08,174.5711654 --> 00:24:11,864.5711654 So by separating into it, you're able to really give back just the stuff that you need. 349 00:24:11,864.5711654 --> 00:24:13,694.5711654 And yes, for some people you need all of those things. 350 00:24:13,694.5711654 --> 00:24:17,984.5711654 For a lot of people they may not, and so I think that that's certainly one of the driver things. 351 00:24:17,984.5711654 --> 00:24:19,934.5711654 And then definitely around storage as well. 352 00:24:19,984.5711654 --> 00:24:24,604.5711654 we know that things like plasma for example, we can freeze and then just thought when we need to. 353 00:24:24,934.5711654 --> 00:24:30,184.5711654 Whereas things like platelets, we keep them at room temperature, but only, they're only good for a couple of days. 354 00:24:30,214.5711654 --> 00:24:31,834.5711654 Red blood cells go in the fridge again. 355 00:24:31,834.5711654 --> 00:24:36,944.5711654 They're good for maybe about a month or so, but there's some challenges with the storage for a lot of these. 356 00:24:38,243.0711654 --> 00:24:49,493.0711654 So some of the components can be frozen and kept a little longer, but some components cannot be like red blood cells cannot be frozen, you know, you can't just thaw it and then use it, so it has to be in the fridge. 357 00:24:49,493.0711654 --> 00:24:50,993.0711654 So shell life is lower. 358 00:24:51,303.0711654 --> 00:24:56,89.5711654 Same thing with platelets, right? Like, in the room temperature and their shell life is lower, right? Hmm. 359 00:24:56,389.5711654 --> 00:25:00,559.5711654 And now interestingly, we're seeing actually what is like a freeze dried product. 360 00:25:00,559.5711654 --> 00:25:03,649.5711654 So the same way you have space food that you can reconstitute with some water. 361 00:25:03,649.5711654 --> 00:25:05,229.5711654 We have the same thing with plasma. 362 00:25:05,229.5711654 --> 00:25:07,629.5711654 And again, this, we actually were doing this during World War ii. 363 00:25:07,929.5711654 --> 00:25:12,9.5711654 through the University of Toronto, we made a whole bunch of such a freeze dried plasma, these giant glass bottles. 364 00:25:12,9.5711654 --> 00:25:15,549.5711654 We're sending it over to the battlefield and we're seeing a resurgence of that again. 365 00:25:15,829.5711654 --> 00:25:34,159.5711654 Because now we're able to, have hospitals, smaller community hospitals, or maybe some very remote or rural places that don't have access to, a blood bank or these capabilities to store blood the way that we're talking about, they might be able to store something that can, Hang out on a shelf for a year. 366 00:25:34,219.5711654 --> 00:25:39,949.5711654 And you just recon, you know, you shake it together with some sterile water and you're able to get some of these things back and going. 367 00:25:40,963.0711654 --> 00:25:43,843.0711654 So I, I'll just use this as a public service announcement. 368 00:25:43,953.0711654 --> 00:25:44,523.0711654 Donate blood. 369 00:25:44,523.0711654 --> 00:25:47,553.0711654 Everybody like all of these things, comes from you. 370 00:25:47,853.0711654 --> 00:25:53,28.0711654 So donate, Yeah, just so just along the same line, you just to provide some. 371 00:25:53,323.0711654 --> 00:25:59,643.0711654 Key statistics here in the us more than 4 million people receive blood transfusions every year. 372 00:25:59,673.0711654 --> 00:26:03,873.0711654 that's a significant amount percentage of Americans that require blood transfusion. 373 00:26:04,183.0711654 --> 00:26:09,483.0711654 every two seconds there's a need for, blood transfusion in the us. 374 00:26:09,693.0711654 --> 00:26:10,773.0711654 So think about that. 375 00:26:10,823.0711654 --> 00:26:17,188.0711654 yeah, These are not stuff that, we could make in factories or big pharmas are making this in their labs. 376 00:26:17,488.0711654 --> 00:26:19,708.0711654 This is something that, it's in you to give. 377 00:26:19,888.0711654 --> 00:26:22,564.5711654 So Oh, Can we say that? right. 378 00:26:22,564.5711654 --> 00:26:23,959.5711654 So it'll be very happy that you. 379 00:26:24,169.5711654 --> 00:26:29,788.0711654 You said that, Or, or it's copyrighted and we're about to yeah, is it copyrighted? But it's easier to give. 380 00:26:29,788.0711654 --> 00:26:31,288.0711654 So yeah, everybody, yeah. 381 00:26:31,433.0711654 --> 00:26:37,673.0711654 known, little known fact that when James is operating, the need for blood goes up tenfold during those days. 382 00:26:37,723.0711654 --> 00:26:38,383.0711654 oh, come on. 383 00:26:39,271.5711654 --> 00:26:39,661.5711654 Okay. 384 00:26:39,661.5711654 --> 00:26:40,711.5711654 I am done with those jokes. 385 00:26:40,891.5711654 --> 00:26:41,461.5711654 I had to. 386 00:26:43,3.0711654 --> 00:26:43,273.0711654 Yeah. 387 00:26:43,513.0711654 --> 00:26:45,223.0711654 James is someone else who to give some blood. 388 00:26:45,283.0711654 --> 00:26:48,943.0711654 You know, there's always, risks to any sort of medical procedure or things that are done. 389 00:26:49,43.0711654 --> 00:27:01,61.5711654 Are you able to maybe just talk a little bit on some of the risks or you're consenting someone to surgery through that process, you might have the time to talk about, the need that you might need blood during the surgery and what are some risks? Like what do you, what do you tell patients? Yeah. 390 00:27:01,81.5711654 --> 00:27:02,726.5711654 So first of all, I tell them that. 391 00:27:03,606.5711654 --> 00:27:05,676.5711654 You're an excellent surgeon and you're not going to need blood. 392 00:27:07,875.0711654 --> 00:27:09,125.0711654 occasion, Two stories. 393 00:27:09,546.737832 --> 00:27:10,936.737832 who's telling the truth? Yeah. 394 00:27:10,936.737832 --> 00:27:15,676.737832 But you know, every time we consent patients for major operation and when I. 395 00:27:16,446.737832 --> 00:27:20,166.737832 Think about major operations is any operations that requires general anesthesia. 396 00:27:20,326.737832 --> 00:27:32,236.737832 you know, there's always an opportunity for severe bleeding to occur outside of James's or but, you know because of that, you know, we, we always consent to patients for blood transfusion. 397 00:27:32,446.737832 --> 00:27:36,346.737832 And we do talk about some of the potential risks related to the blood transfusion. 398 00:27:36,686.737832 --> 00:27:38,906.737832 And the most common being is just. 399 00:27:39,231.737832 --> 00:27:50,651.737832 You know, the reaction that you have because you're getting blood cell that's being transfused and it just causes fever or chills, you know, that kind of adverse reaction. 400 00:27:50,651.737832 --> 00:27:53,651.737832 So we call that febrile nonhemolytic reaction. 401 00:27:53,961.737832 --> 00:27:55,311.737832 Febrile meaning fever. 402 00:27:55,776.737832 --> 00:27:59,176.737832 Nonhemolytic meaning the red blood cells are not being destroyed. 403 00:27:59,426.737832 --> 00:28:01,646.737832 It's just the reactions that you get with transfusion. 404 00:28:01,976.737832 --> 00:28:05,756.737832 And this is the most common, it occurs in about one in 300 transfusions. 405 00:28:06,126.737832 --> 00:28:10,246.737832 And then you could have some allergic reaction, you could have allergic reaction, similar thing. 406 00:28:10,526.737832 --> 00:28:15,156.737832 so it could be mild immune reaction mostly related to the plasma proteins. 407 00:28:15,346.737832 --> 00:28:19,846.737832 so patients could have rash or itching, just like Allergy season. 408 00:28:20,266.737832 --> 00:28:25,496.737832 the rate of this happening, varies, but it's about, 1% to 0.1%. 409 00:28:26,456.737832 --> 00:28:32,36.737832 one of the more common, side effects of transfusion but still, you know, uncommon overall. 410 00:28:32,636.737832 --> 00:28:33,386.737832 And then there. 411 00:28:33,661.737832 --> 00:28:36,641.737832 Very uncommon ones like hemolytic reactions. 412 00:28:36,641.737832 --> 00:28:40,421.737832 So hemolytic meaning, you know, destruction of the red blood cells. 413 00:28:40,701.737832 --> 00:28:47,271.737832 And it could occur in more delayed fashion, which is in one in 10,000 transfusion. 414 00:28:47,601.737832 --> 00:28:54,401.737832 Or it could happen acutely, a few hours or, within day transfusion it is just one in 70,000. 415 00:28:55,941.737832 --> 00:29:05,646.737832 Thankfully, with modern medicine and science the risk of, infection like HIV or hepatitis B or hepatitis C you know, getting that from transfusion. 416 00:29:05,891.737832 --> 00:29:13,61.737832 For HIV, it's about, it's less than one in 2 million transfusions, so quite rare. 417 00:29:13,61.737832 --> 00:29:13,661.737832 Thankfully. 418 00:29:14,141.737832 --> 00:29:18,161.737832 Hepatitis B is about one in a million transfusion as well. 419 00:29:18,221.737832 --> 00:29:21,731.737832 And this is because, you know, the blood banks do rigorous testing. 420 00:29:22,161.737832 --> 00:29:24,471.737832 And because of that it's extremely rare. 421 00:29:24,941.0544827 --> 00:29:32,926.0544827 And I think what's really important to know here, and I talk about this to all the patients that I have to give blood to, is we go over these possible reactions and side effects. 422 00:29:33,376.0544827 --> 00:29:43,516.0544827 But I often say like, listen, if we're having this conversation, the risk of not getting blood is much, much, much higher than the risk of all these things. 423 00:29:43,516.0544827 --> 00:29:53,776.0544827 So the risk of not getting blood strokes, heart attacks, organ failure, death, that kind of thing, we're not giving blood just because we like to give blood, we give it 'cause you absolutely need it. 424 00:29:54,326.0544827 --> 00:29:57,176.0544827 So definitely you gotta know about these risks. 425 00:29:57,236.0544827 --> 00:30:01,196.0544827 The reality is the majority of blood transfusions go perfectly smoothly. 426 00:30:01,586.0544827 --> 00:30:08,306.0544827 And just practically all it is, is you have an IV in your arm, you're putting blood through that iv, you probably won't even feel it going in. 427 00:30:09,276.0544827 --> 00:30:12,576.0544827 people who have low blood and get blood, they often feel better pretty quickly after it. 428 00:30:13,361.0544827 --> 00:30:13,931.0544827 Very quickly. 429 00:30:13,931.0544827 --> 00:30:16,121.0544827 Yeah, you're, you're definitely right, Josh. 430 00:30:16,181.0544827 --> 00:30:22,881.0544827 just like anything in healthcare, right, whether you take medication or not, there's always benefits and risks. 431 00:30:23,131.0544827 --> 00:30:30,741.0544827 And often, we are recommending blood transfusion because the benefits certainly outweigh the potential risks. 432 00:30:31,121.0544827 --> 00:30:37,221.0544827 You know, if you have anemia, like low blood level especially acutely meaning, from. 433 00:30:37,421.0544827 --> 00:30:47,141.0544827 Active blood loss and if it's not stopped appropriately or, timely, it could lead to serious damage to your organs and eventually to death. 434 00:30:47,451.0544827 --> 00:30:56,631.0544827 So the potential complications of blood transfusion are much lower than, the risks of not receiving blood, in a timely manner. 435 00:30:58,21.0544827 --> 00:31:01,681.0544827 and I think it's important to say here, James is a very good surgeon. 436 00:31:01,681.0544827 --> 00:31:07,291.0544827 Everybody, we are messing with him, but I figure we gotta tell you, if you ever show up with Dr. 437 00:31:07,291.0544827 --> 00:31:09,181.0544827 Jung there, you are lucky there. 438 00:31:09,181.0544827 --> 00:31:09,751.0544827 I've said it. 439 00:31:10,566.0544827 --> 00:31:12,276.0544827 And now nobody believes this. 440 00:31:15,392.5544827 --> 00:31:20,182.5544827 This part of the broadcast brought to you by yeah. 441 00:31:20,197.5544827 --> 00:31:26,417.5544827 I do think touching on, on what you talked about, James, how you know patients are often concerned about some of the infectious disease risks. 442 00:31:26,447.5544827 --> 00:31:29,897.5544827 I do think it's important to route that in an, in a little bit of history as well. 443 00:31:29,927.5544827 --> 00:31:33,77.5544827 And in for context, it wasn't that long ago, like it was in the 1980s that. 444 00:31:33,517.5544827 --> 00:31:36,762.5544827 You know, we actually did have a blood contamination crisis in Canada. 445 00:31:36,832.5544827 --> 00:31:37,132.5544827 Right. 446 00:31:37,132.5544827 --> 00:31:45,772.5544827 And so we saw, I think there were up to 2000 Canadians that were infected with HIV from the blood supply at that time, and at least 30,000 maybe more, that were infected with hepatitis C. 447 00:31:46,132.5544827 --> 00:31:48,682.5544827 But you know, we, we learned a lot from that experience. 448 00:31:48,712.5544827 --> 00:32:03,732.5544827 We have now developed, you know, or implemented actually a whole different guard and change of now actually having a national, blood service as well as all that routine testing, which has really driven down those risks of getting any of those things to, to, yeah, kind of being kind of really negligible. 449 00:32:03,982.5544827 --> 00:32:13,812.5544827 But I I, I do understand, you know, historically when you have that, you know, a lot of people that are still actually, you know unfortunately experiencing some of the the reals of, of having receiving blood at that time when it wasn't as safe. 450 00:32:14,76.0544827 --> 00:32:20,176.0544827 Yeah, there are people who still, remember those days and fear for, something similar to occur. 451 00:32:20,926.0544827 --> 00:32:43,277.5544827 Can I share something incredibly embarrassing about blood and transfusing and donating blood specifically? So anyone who's seen me, obviously, like I'm of a very pale complexion and, Some, some of Past have said translucent, some of us, not me, Another sign, we didn't talk about this earlier, but another sign often of being anemic if you are pale. 452 00:32:43,937.5544827 --> 00:32:48,377.5544827 So my first time donating blood, I'm all hooked up. 453 00:32:48,387.5544827 --> 00:32:52,877.5544827 they take their pint from me and I'm sitting there and the nurse is like, oh, you look pretty pale. 454 00:32:52,877.5544827 --> 00:32:56,207.5544827 Are you feeling okay? And I was like, oh, this is just my normal color. 455 00:32:58,307.5544827 --> 00:33:04,532.5544827 And I go to stand up and sure enough, like my vision tunnels, I can't hear anything. 456 00:33:04,532.5544827 --> 00:33:06,452.5544827 I get sweaty and I pass out. 457 00:33:06,452.5544827 --> 00:33:09,302.5544827 So somehow she still knew I was gonna be that person. 458 00:33:09,302.5544827 --> 00:33:12,392.5544827 And I like to this day, cannot donate blood without passing out. 459 00:33:12,422.5544827 --> 00:33:17,702.5544827 I have like aggressively hydrated, like gone for like a steak dinner beforehand. 460 00:33:18,92.5544827 --> 00:33:22,892.5544827 Like it doesn't matter what my, my body just does not So, give my blood out. 461 00:33:23,206.0544827 --> 00:33:24,491.0544827 Brody Give yeah. 462 00:33:24,671.0544827 --> 00:33:30,667.5544827 So, Brody, are you seeing that there are different levels of paleness? Yeah. 463 00:33:32,76.0544827 --> 00:33:35,391.0544827 There's, I don't know what that is, but if you're paler than me, you probably need blood. 464 00:33:35,571.0544827 --> 00:33:38,54.5544827 That's my, like lifeless, pale. 465 00:33:38,809.5544827 --> 00:33:39,561.0544827 And then yeah. 466 00:33:39,739.5544827 --> 00:33:40,999.5544827 the next step from there. 467 00:33:41,301.0544827 --> 00:33:41,511.0544827 Yeah. 468 00:33:41,661.0544827 --> 00:33:45,501.0544827 These are the, the two decision rules you need for whether you need blood transfusion. 469 00:33:45,501.0544827 --> 00:33:53,91.0544827 Are you paler than me? And doesn't smell like iron in your room? Those are the only tv, no ai, no machine learning. 470 00:33:53,224.5544827 --> 00:33:53,949.5544827 for transfusion. 471 00:33:54,329.5544827 --> 00:33:55,29.5544827 You got it here. 472 00:33:55,581.3162269 --> 00:33:55,881.3162269 Oh man. 473 00:33:55,941.3162269 --> 00:33:56,241.3162269 All right. 474 00:33:56,661.3162269 --> 00:33:57,561.3162269 This is great guys. 475 00:33:57,951.3162269 --> 00:33:58,551.3162269 I appreciate that. 476 00:33:58,551.3162269 --> 00:33:59,631.3162269 Let's, let's wrap it up. 477 00:33:59,871.3162269 --> 00:34:04,426.3162269 What are some takeaways? I Well, people need blood to live. 478 00:34:04,986.3162269 --> 00:34:05,436.3162269 yeah. 479 00:34:05,521.3162269 --> 00:34:08,581.3162269 losing it or it's lower for any other reason. 480 00:34:08,661.3162269 --> 00:34:15,691.3162269 You in the future, some of you may be asked to get a blood transfusion and know that it's important you get it. 481 00:34:16,711.3162269 --> 00:34:20,551.3162269 It is not risk free, but it is pretty amazingly safe. 482 00:34:20,821.3162269 --> 00:34:23,921.3162269 And the risk of not getting blood in those situations is really high. 483 00:34:23,921.3162269 --> 00:34:29,731.3162269 So, if that ever comes up, I hope it doesn't to you, but just remember this podcast. 484 00:34:29,963.1197003 --> 00:34:37,948.1197003 Yeah, this is, an issue for everyone, a lot of the listeners will say, oh, like, I've never had blood trans fusion, you know, or required one in the past. 485 00:34:37,998.1197003 --> 00:34:45,138.1197003 But chances of you requiring one, statistically speaking, is moderately high and. 486 00:34:45,738.1197003 --> 00:34:46,878.1197003 You can't predict that. 487 00:34:46,878.1197003 --> 00:34:53,978.1197003 a lot of the reasons for requiring blood transfusions is from injuries like trauma or, you know, during surgery. 488 00:34:53,978.1197003 --> 00:34:57,158.1197003 And more and more patients require surgical care. 489 00:34:58,478.1197003 --> 00:35:02,318.1197003 Or it could be from things like cancer that you never thought you could have. 490 00:35:02,598.1197003 --> 00:35:11,878.1197003 So because of that everyone is dependent on blood and everyone is dependent on kindness of each others to donate their blood. 491 00:35:12,868.1197003 --> 00:35:14,368.1197003 It's in you to give. 492 00:35:14,632.2871168 --> 00:35:19,432.2871168 We're laughing 'cause if you're in Canada, that's our, our national service motto. 493 00:35:21,22.2871168 --> 00:35:24,82.2871168 No, I I think it's, it's a great happy point to, to end on there, James. 494 00:35:24,82.2871168 --> 00:35:24,412.2871168 Right. 495 00:35:24,522.2871168 --> 00:35:29,982.2871168 Yeah, we, it, it's, it's so critically important for people in a very timely sense. 496 00:35:30,92.2871168 --> 00:35:40,802.2871168 And we're also so always critically low on levels of blood, right? Like in general across the country, we often have like just a few days worth of blood supply for what we need. 497 00:35:40,802.2871168 --> 00:35:45,782.2871168 We're never really sitting in excess of any sort of extra blood to, to not be used. 498 00:35:45,892.2871168 --> 00:35:53,192.2871168 So yeah, if, if you are able to donate blood even if you pass out, you know, doing it, I still highly recommend it. 499 00:35:53,910.7871168 --> 00:36:00,820.7871168 guys, I think if we get a hundred listeners that write in that say we want Brody to donate blood, you have to donate blood. 500 00:36:00,820.7871168 --> 00:36:02,290.7871168 Brody and I. 501 00:36:02,290.7871168 --> 00:36:05,900.7871168 maybe we film it, maybe we send Yeah, or maybe not. 502 00:36:05,900.7871168 --> 00:36:07,50.7871168 But I want to see this happen. 503 00:36:07,287.2871168 --> 00:36:12,187.2871168 my wife can vouch for me passing out when it happened, so, I'll happily do it again with you guys. 504 00:36:13,113.1148235 --> 00:36:13,473.1148235 All right. 505 00:36:13,473.1148235 --> 00:36:20,58.1148235 Well, this is really a, good topic to talk about and thank you Roddy for picking this topic and this is really fun. 506 00:36:20,879.6148235 --> 00:36:21,149.6148235 Great. 507 00:36:21,243.1148235 --> 00:36:22,263.1148235 It was bloody good. 508 00:36:22,481.9013841 --> 00:36:22,661.9013841 Hey. 509 00:36:23,430.4013841 --> 00:36:27,805.4013841 No, no, I That's vouch for that. 510 00:36:27,895.4013841 --> 00:36:28,105.4013841 out. 511 00:36:28,451.9013841 --> 00:36:28,751.9013841 Thanks boys.