UP FRONT
Book Review
Nine Pints of Liquid Gold
In this edition, ASH Clinical News Editor-in-Chief Mikkael A. Sekeres, MD, MS,
reviews Nine Pints, an account of the science, politics, and social history of blood.
Have you read any hematology-related books recently? Let us know what we should
read and review by emailing us at [email protected].
IMAGINE OUR SWASHBUCKLING heroine
has just landed on the floor of a temple,
having descended from an opening at
its peak. Let’s call her “Indira Jones,” the
famous archeologist and adventurer. She
wears a cotton poplin field shirt, brown
leather jacket, weathered shoulder bag,
and rumpled brown fedora – accessorized
with a bullwhip. The room is dark, so she
lights a torch to better assess this new en-
vironment. She immediately recoils when
she sees that she is surrounded – not by
snakes, but by leeches.
“Leeches,” she mutters, shaking her head
in disgust. “Why did it have to be leeches?”
In the book Nine Pints: A Journey
Through the Money, Medicine, and
Mysteries of Blood, our intrepid heroine
is not the fictitious Indira Jones, but the
author Rose George, who explores the
biology, politics, economics, and societal
squeamishness toward this lifeblood of
hematologists everywhere: blood.
Some basic facts about our liquid gold
have a “wow” factor to the uninitiated that
also remind those of us in our chosen field
why any book about the topic is so inher-
ently interesting: The bone marrow produc-
es two million blood cells every second, and
each day our blood travels approximately
12,000 miles around the human body. A
human heart, which beats an average of
75 times each minute, pumps a quart of
blood every 10 seconds, while a whale’s
heart, which is the size of a Mini Cooper,
beats five times per minute but pumps 58
gallons with every beat. Blood is transfused
worldwide approximately once every three
seconds; in the U.S., this translates to 13.6
million units of red blood cells each year.
The prevalence of blood types themselves
vary geographically and ethnically.
Ms. George takes the reader through
the history of the organized donation, stor-
age, and delivery of blood and blood prod-
ucts, starting in the late 17th century with
English physician Richard Lower, MD,
and King Louis XIV’s court physician
Jean-Baptiste Denys. Denys performed
an early first human blood transfusion,
transfusing calf blood into Antoine Mauroy,
a “madman” who might benefit from the
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ASH Clinical News
animal’s calming influences. Mr. Mauroy
survived, despite a transfusion reaction, and
the field was off and, if not running, flowing.
Innovation often arises from despera-
tion. The obstetrician James Blundell, MD,
who worked in Edinburgh in the early 19th
century, had seen too many of his patients
die from postpartum hemorrhage; to treat
these women, he transfused 10 of his pa-
tients with blood from other humans. Two
were already dead; three others died, but
five survived. By World War I, base hospi-
tals on the Western Front were transfusing
50 to 100 pints of blood daily. Soon after,
something truly revolutionary occurred:
the organization of a pool of volunteers to
donate blood.
At the time, hospitals in New York were
paying $100 per pint of blood. A Massachu-
setts law even mandated that donors receive
$25 and a pint of whiskey. Such incentives
introduced risky donation practices and
a reticence to disclose medical conditions
that could make the donated blood unsafe.
In the 1920s, Percy Oliver, a British
civil servant, maintained the first data-
base of willing donors, which consisted
of a bunch of index cards with names and
contact information. A decade later, Janet
Vaughan, DBE, FRS, a British patholo-
gist who already had written a hematology
textbook, saw the looming catastrophe in
casualties that World War II would bring
with it. She spearheaded the organization
of the collection and storage of blood for
those with battle injuries, delivered to de-
pots using ice cream vans. The Army Blood
Transfusion Service collected 100 pints of
blood daily at the outbreak of war. By war’s
end, it averaged 1,300 donations daily.
Which brings us to leeches ... Ms. George
writes about infections borne in the
bloodstream, such as HIV (which perhaps
goes a bit afield of the book’s topic), and
of the freshwater, multisegmented annelid
worms that live off the fluid. She visits
Biopharm, located in the southwest of
Wales, one of the few companies world-
wide that grow leeches intended for me-
dicinal purposes, such as enhancing the
solvency of tissue grafts. It takes two years
to grow each of these bloodsuckers, and if
you’re wondering,
they are intended
for single use only;
after having fed
and dropped off,
they are “disposed
of ” in an alcohol
solution. Her
description of the
darkened room
filled with leech
tanks is suffi-
ciently creepy that
I felt the need to
regularly check my
back as I read it,
lest it be covered
with the creatures
à la Humphrey
Bogart in the 1951
movie The African
Queen.
A good portion
of Nine Pints is de-
voted to the stigma
surrounding the
most common
cause of blood
loss in humans:
menstruation.
In Nepal, Ms.
title: Nine Pints: A Journey Through the Money, Medicine,
George is aghast
and Mysteries of Blood
that women are
author: Rose George
length: 353 pages
still expected
published: October 2018, Metropolitan Books
to sleep outside
their homes, often
for eschewing what had been up until that
in rough shacks, for days at a time each
point the socially acceptable, but biologi-
month until their bleeding has stopped.
cally weird, color of blue.
In India, a 2010 study reported that 23
Ms. George’s book spans centuries
percent of schoolgirls missed school or
and covers many continents. At times it is
dropped out altogether because they were
overly passionate, occasionally snarky, and
menstruating. The causes include inad-
oversimplifies medical approaches (such are
equate facilities at schools, some of which
the scabs invariably acquired, though, by
lack habitable bathrooms; the high cost of
the combination of a medical reader and a
sanitary pads; and societal shame around
nonmedical writer). Overall it is a good read
menstruation, with a view that women
and educated me about aspects of blood I
having their periods are “dirty.”
hadn’t considered before, and it hopefully
Seem outlandish? Well, it was only
will educate the public about the collective
in 2017 that the first advertisement for a
health imperative of blood donation.
sanitary pad, anywhere, dared to demon-
It sure didn’t make leeches any more
strate the effectiveness of the pad using a
lovable, however. ●
red-colored liquid. Kudos to Bodyform
March 2019