Happy Father’s Day! In addition to my own dad, today I’m honoring the “father of the blood bank,” Dr. Charles Richard Drew, who deserves a lot more honoring every day. You know all that talk in the news about blood plasma from people who’ve recovered from COVID-19 being used to treat people that have it? That treatment is *plausible* because plasma (the part of blood without the cells) is chock full of antibodies and other goodies. And that treatment – as well as many others – is *possible* because of Charles Drew, who established methods and protocols for safely collecting, preserving, and delivering large amounts of blood and blood plasma – and did it all while facing racism at every step along the way.
The blood banking work started during WWII, when he helped organize and was selected to lead, “Blood for Britain” – a program which collected blood from 14,556 donors and delivered over 6,000 L of plasma solution to Britain from 1940-1941. And then he worked with the American Red Cross and the National Research Council (NRC) to establish large blood banking programs in the US. And you know those big vans that show up for blood drives? You have Drew to thank for those bloodmobiles too!
Before Drew, there was just this scattered system of individual hospitals doing blood transfusions, often directly from one patient to another. And when blood products were stored, there were often issues with the blood getting contaminated of just “getting old.” The government knew that if the wanted to ramp things up, they’d need something a lot more organized than those loosey-goosey set-ups and they definitely couldn’t tolerate those loosey-goosey safety standards. So they called in the pro – Dr. Charles Drew.
Drew did all this amazing stuff, and the government was eager for him to do it, but at the same time, they were refusing outright to take his blood or the blood of any other Black person. And then, when they did start accepting their blood, they insisted on segregating it, while explicitly stating that it wasn’t for any biological reason – it was just that white people wouldn’t want “Black blood” – you can see a military directive quote in the figure.
This was just one example of the racial discrimination Charles Drew faced during his tragically short career (he died in a car crash). And it might have been the final straw when it came from working with the government. After doing all the hard work setting up their programs, Drew resigned from the Red Cross and the NRC when they insisted on adopting the US military’s blood segregation policies. He didn’t publicly state that that was the reason for his resignation, but he later wrote a letter condemning their actions (you can read a quote from it in the figures).
After this likely protest resignation, Charles Drew went to do what he expected to be his greatest contribution to medicine – teaching. He returned to Howard University (he’d worked there before as I will tell you more about later) where he taught a generation of young Black surgeons. He died from a car crash in 1950. There’s this myth that he was denied treatment at a hospital because of his race – but this has been debunked. He did receive treatment – including plasma made possible by his earlier work – but his injuries were too severe.
That’s an overview of Drew’s life & legacy, but there’s a lot more to tell you – both about him and his scientific work. I know I can’t fully do it justice, but here’s a bit more. And if you want to learn even more, I encourage you to check out “The Charles R. Drew Papers” available through the NIH’s website: https://profiles.nlm.nih.gov/spotlight/bg In addition to biographical information, it contains digitized versions of photos (were I got these from), articles, lab notebooks, and more that are physically housed at Howard University’s Moorland-Spingarn Research Center. Most of my information comes from that site unless specified.
Charles Richard Drew was born in Washington, DC, June 3, 1904. You know how a lot of stories about scientists tell you things like “he showed an early aptitude for science” – well, that wasn’t the case with Drew. Instead. Described as “bright” but “not an outstanding student,” in his youth he was more noticed for his aptitude for sports (especially football and track). He was voted “best athlete” in high school and earned an athletic scholarship to Amherst College in Massachusetts, where he enrolled in 1922. At Amherst, he continued to excel in sports to a legendary status, but he decided that he was more interested in the medical field than the football field and, after graduating in 1926, he decided to go to medical school.
But there were a couple of problems with this plan of his – one was $ and the other was racism. To deal with the money problem, he took a job as athletic director and instructor of biology & chemistry at Baltimore’s Morgan State University (then Morgan College). Working there for 2 years, he earned the money needed for med school but now he was faced with finding a med school that would take him. And racism made this difficult.
At the time, the med school options for Black people were severely limited – they could try to snag one of the very few slots afforded them at prominent schools, or they could go to one of the black institutions like Meharry Medical College in Nashville, Tennessee or Howard University College of Medicine in Washington, DC. He applied to Howard, but he was shy a couple of English credits, so they rejected him. Not wanting to wait another year, he instead applied to McGill University Faculty of Medicine in Montréal – Canada was living up to its reputation for being nice and they were known for treating minority students better than in the US. They accepted Drew and, once there, he excelled. He played sports (very well) here, too. But he also did the school stuff really well too, graduating second in his class (of 137 people) in 1933.
After you graduate from the school-y part of med school, you have to do internships & residencies, where you actually work in hospitals and with patients and stuff. Drew did his at Montréal General Hospital, where he worked with Dr. John Beattie, studying how to best treat hypovolemic shock. This is a condition where a patient has low (hypo) blood volume – it can be caused by things like blood loss from trauma or excessive vomiting. And it’s a big problem because blood is the way stuff (oxygen, proteins, hormones) etc. get around your body. And it has to go all around your body over and over and over. And with shock, there’s not enough to go around, but the heart isn’t gonna give up – so it starts pumping really hard trying to keep circulating what little blood there is. Beattie & Drew looked at ways in which you could transfuse fluids into patients in order to bump up the blood volume so the heart can relax and all those molecular cargo can reach their destinations.
You might think you’d need real whole blood for this. But turns out that about half of blood is really just water. If you spin something really really fast in a centrifuge, the heavier stuff will settle at the bottom. When you do this with blood, the red blood cells (aka RBCs or erythrocytes, which do the oxygen-carrying), being heaviest, settle at the bottom. This part of the blood is referred to as the hematocrit and it’s usually ~40-50% of the total blood volume. Then above that is a thin layer of slightly lighter stuff, the “buffy coat” which contains white blood cells (WBCs, aka leukocytes, which do immune system stuff) and platelets. And then above that is a big layer of plasma, which contains water, proteins, salts, hormones, antibodies, etc. Plasma makes up ~55% of the total blood volume and ~92% of plasma is just water. https://bit.ly/2YkVode
In some cases, you want to give a patient whole blood, but when the patient doesn’t need the cells, just the volume and the salts & proteins & other goodies, there are advantages to just giving the plasma. One critical advantage is that you don’t need to worry about matching blood types with plasma. “Blood type” refers to whether there are certain sugars sticking off of the RBCs. If you give someone blood with RBCs studded with sugars that the person’s body doesn’t recognize, the immune system will attack it, which can be deadly. But, with plasma, you’ve removed the RBCs, so you don’t have to worry about that. And you can even combine (aka pool) plasma from multiple donors. Another big advantage of plasma is that it’s a lot more shelf-stable. And you can even inject large amounts of it into muscles, skin, etc., & it’ll find its way into the blood without you having to start an IV. So, lots of benefits for situations like battlefields hospitals…
But we’re not at that point in the story yet. At this point, Drew finishes his residency and now wants to go get further training. But is limited by racism yet again. His work with Beattie got him really interested in transfusion medicine, and he wanted to go train with some of the best, preferably at the Mayo Clinic. But, well, racism… So he went to Howard University, one of those Historically Black Colleges & Universities (HBCUs) I was telling you about yesterday https://bit.ly/hbcustem
He joined the faculty at Howard in 1935 & worked his way up: pathology instructor -> surgical instructor -> chief surgical resident at Freedmen’s Hospital (the hospital associated with Howard). He got a fellowship to train with a famous surgeon named Allen O. Whipple at New York’s Presbyterian Hospital while earning a PhD in medical science from Columbia University. Normally, students in his position would be given some sort of research role dealing with actual patients. But Whipple “stuck” Drew with a non-patient-exposed position, working with John Scudder (Whipple would later come around to Drew and support him greatly). https://bit.ly/3fH5I56
Under Scudder’s mentorship, Drew did his doctoral research on optimizing the collection, storage, and delivery of blood and blood products. He did all that “optimization” work that is so important to science but can be pretty unexciting – and he’d found the best tube types, temperatures, you name it. That was the “boring but necessary” part of his research – the more exciting part was setting up an experimental blood bank at Presbyterian hospital. The blood bank opened in August 1939 and would kinda kick-start all the wartime blood bank ramping up that would come. It would also earn Drew his PhD in June 1940, making him the first African American to earn a medical science PhD from Columbia.
After getting his PhD, he returned to Howard and assistant-professor-ing (now with a wife, Minnie, & daughter, Bebe (for Blood Bank). But he wasn’t at Howard long before Presbyterian called him back because they needed his expertise. Britain needed blood – or at least blood plasma – to treat soldiers in WWII. It was hard enough to give blood to patients in the same hospital as a donor – but now you wanted to give blood to patients on a different continent! And thousands of liters work?! Blood plasma would be much better suited for this than whole blood, but it would still be a tremendous challenge.
As director of the Blood for Britain project, Drew led a program of blood plasma donation from Presbyterian & 5 other New York hospitals to Britain. It wasn’t as simple as just doing some coordination with the hospitals FedEx. The actual shipping was the easy part. He had to make sure that all the blood plasma stayed stable throughout the process and that it didn’t get contaminated with microbes like bacteria or fungi. Basically, he developed a really strict protocol where blood was taken -> the plasma was collected (such as by centrifugation and siphoning it off from the cell stuff) -> plasma from ~8 people was pooled -> this was cultured (a sample of it was placed on bacteria food to see if anything would grow) -> if all good, an antibiotic was added to prevent anything new from growing if it snuck in -> then they waited a week & cultured again to make sure the antibiotic was working and/or nothing had gotten in -> if all good, then they dilute it with saline (salt water) (remember plasma is normally only ~55% of blood volume anyway) -> then they ship it to Britain -> British doctors then culture it one last time before giving it to patients. And all of this stuff is done under sterile conditions.
All this might sound a bit excessive (though maybe not as we look around and see some pretty strict cleaning going on…) but it was crucial. Case in point – some of the plasma in the beginning did get contaminated – which is why they called Drew in full-time and named him director (he had briefly returned to Howard). The Blood for Britain program ended in January 1941, after having collected blood from 14,556 donors and delivered over 6,000 L of plasma solution. (Also during that time, Drew passed his board exams to become a certified surgeon).
And then the US government thought, wow, that worked really well. We should set up something similar for use here in the US. So they started a national blood banking system, jointly sponsored by the American Red Cross and the National Research Council (NRC) and they appointed Drew as assistant director. But they wouldn’t accept his blood. Or that of any other Black person. Then they started taking their blood, but keeping it segregated from the blood of White donors, and only giving it to Black recipients, knowing full well (and acknowledging) that this was due to “psychological” and not “biological” reasons.
Drew resigned from his position with the Red Cross & NRC in 1941. Many reports say that this was a protest resignation, but the NIH site says that there is no official evidence that was the case. Drew didn’t say it publicly at the time, but he later wrote that scathing letter. And later he became active campaigning for the inclusion of Black doctors in medical societies. So you’ve gotta believe the blood segregation played at least some role in his decision.
Anyways, regardless of why he left, he left. And he moved on to what he considered his most important work – training the next generation of young black surgeons as chair of the Department of Surgery and Chief of Surgery at Freemen’s hospital. And he did a tremendous job at it – training some of the best surgeons and instituting protocols and methods at Howard to improve patient care. He no doubt would have continued to contribute greatly to medicine and society as a whole if he hadn’t died tragically young, April 1, 1950.
Want to learn more?
The Charles R. Drew Papers: https://profiles.nlm.nih.gov/spotlight/bg
Charles Drew, an extraordinary life, Saptarshi Biswas & Dannie Perdoma, 2017: https://bit.ly/3fNTOXl
Charles Richard Drew: “Father of the Blood Bank,” ACS: https://bit.ly/3fH5I56
more on HBCUs: https://bit.ly/hbcustem
If you want to learn more about all sorts of things: #365DaysOfScience All (with topics listed) 👉 http://bit.ly/2OllAB0