“ Dedicated to my son, Kiril, who, as a toddler,followed me to the waiting ambulance and in his

childish naivety asked if he could come and donatesome of his blood to help ?! “

The author of this book, professor Petkan ProdanovM.D. is Doctor of Medical Sciences. He received the titleDoctor honoris causa for the discovery of new bloodgroup variant whilst working in Czechoslovakia. The American Biographical Institute nominatedhim as the “ Outstanding Man of the Century” andawarded him a gold medal for Bulgaria because of hisnumerous works published in international journals andreferenced in textbooks and monographs, and hisinvitations to chair European and international medicalforums.

Apart from his scientific work, as head of theCentre for Transfusion Haematology, Chair of the ExpertCouncil on Transfusion Haematology under the Ministryof Health and Honorary Blood Donor of the Republic ofBulgaria, he dedicated his practical work to the highlyhumane movement for voluntary gratuitous blooddonation and to the fight against the anti-humane bloodtrade.

With remarkable style and notable ease, the author transforms his scientific knowledge ina popular form and presents it as a bouquet of curious facts, which every modern personshould learn in order to get to know him/herself and to understand the secrets, hidden in theirown blood.

INSTEAD OF A FOREWORD

I had written a wonderful foreword how, since the dawn of time people have beeninterested in the secrets of blood. Without knowing them, they suspected that blood hadmagical properties, etc, etc. Suddenly I remembered no one reads forewords anymore. Acurious librarian had glued the introductory pages of hundreds of books before realizing hissuspicions were justified. Perhaps these books are still distributed this way. Suddenly I feltterrified. Not with regard to the forewords – “may they rest in peace”, but with regard to the“afterwords”! Besides, there was no need for an experiment. It was enough for me to realizehow I read my newspaper - skipping from one headline to the next. From capital letters toeven bigger capital letters. And every now and then I focus on some article that is of personalinterest. Is there anyone at all nowadays who reads everything line by line, instead ofscratching the surface like a hen in order to find and “peck” the seed they’re interested in?

It was as if I had taken a cold shower. I felt sorry for all my hard work, for the pages ofcarefully selected information in my head full of scientific files. For the Sisyphean labour inorder to transform it into a comprehensible form and present it as a bunch of curious factsfor all those things each modern person should learn in order to get to know him/herself andto understand the secrets, hidden in his/her own blood.

But how? How do I challenge the modern-day reader to dig into the pages of such abooklet – where he can easily stumble into terminology that requires patient clarificationbefore getting to the most important and interesting part?

Eureka! – someone had shouted once.Eureka! – I also tried to shout as I got the obvious thought that the modern-day reader

has to be influenced through modern-day means. Instead of the boring “contents” –blockbusting titles! Titles with “traction” that will deaerate the arroused interest and will “suckit in” to the explanatory text with the hope that the following lines are also going to be read.

Actually, here is how the contents of the first chapter would look like if presented inthe news:

Scientific magic! Scientists-magicians transform the blood group O into A or B intest tubes by adding sugar!

The blood of a newborn is changed twice because of the blood group of thefather! Is the father to be blamed?

Young lady SEEKS a Rh negative HUSBAND!Is there a blood-group apartheid?In Japan job candidates are selected according to their blood groups!Can a mother A and a husband B have a O child? Or…?!The A and B blood groups have been attacked with enzymes in order to become

universal!Blood-group diets offered! Should we match our diet to our blood group?By putting my hand on my left where my heart is, I promise you will find the

information behind the blockbusting titles if you turn the following pages.If you read carefully the explanations of a few terms, you will be able to understand

and appreciate the magnitude of the discoveries which became beneficial for humanity andlit the way of humanism through the century that has just passed.

But first a little history…

1

THE STORY OF BLOOD IS EVERYWHERE

2

On the verge of the 20th century in the quietlaboratories ofVienna's Institute of Pathology, as if he has losttrack of time, a tall, thin man, with stern, sad eyes,is trying to get access to the eternal secrets ofblood. Together with his colleague Dr. Sturli, Dr.Karl Landsteiner is obsessed with the work on hislatest experiment to such an extent that it is notbefore 8.30 p.m. on December 31st when they stopto rest and realize that in fact these are the very lasthours of the century, which will later stamp theirnames down in history in golden letters. Theexperiment is not over yet and after a short breakthe quiet hum of the centrifuges and the rattle of thelaboratory glassware once again disrupt the silenceof the long deserted institute. Tired, but satisfied,the two midnight workers part, not forgetting to wisheach other a “Happy New Year”!

Before we take a look at the nature of the experiments carried out during thatmemorable New Year’s Eve, we need to be prepared. Like alpinists, holding their breath infront of a majestic peak, we need to stop and inspect our “equipment” in the previous basecamp.

As your trusted “Sherpa” I will help you climb the peaks of knowledge. The roadahead requires us to be “well-trained” for the right terminology, mostly in order to understandthe finding of Landois, who discovered that the antibodies hidden in the blood serum ,manifest themselves by clotting (agglutinating) the antigens on the erythrocytes…

As you can see, several “foreignisms” have “managed to get in the “game”. Forscience, on whose door we’ve knocked, they are a mundane part of the daily work. Some ofyou know that the blood cells float in the blood plasma, but you may not realize that when theblood clots after an injury or a blood-draw, the plasma turns into serum. Most of you areaware that the red blood cells are also called erythrocytes. But you are hardly aware thatthey have different specific substances “mounted” on them, which are called “antigens”. Theirformation is individual and depends on our own set of genes – carriers of buildinginformation. Transforming the information encoded in them, the numerous genes “build up”lots of antigens and thus they create an unimaginable mosaic, which is typical of eachhuman and makes him/her stand apart from all other individuals. This very individuality is thereason why these antigens that have entered the blood circulation of another person areconsidered “foreign” and his/her immune system produces protective antibodies.

When these antibodies attack red blood cells, carriers of foreign antigens, theyinvisibly stick onto them (fig. 1-a). After that they clot them (fig. 1-b) and gradually formcluster-like piles, which can be seen with a naked eye. This cluster-like “clotting” of the redblood cells by the invisible antibodies hiding in someone’s blood serum has turned into oneof the main methods for their visualization and “exposure”.

3

Fig. 1

In his classically simple experiment, which continues to be considered one of thegreatest discoveries of the past century, Landsteiner collects blood from himself and fromsome of his colleagues and begins to relate the serum of each sample consecutively to allblood samples. He discovers that in some cases the serums clot the erythrocytes they arerelated to and in others they don’t. Comparing the results, he sub-divides them into threegroups, which he labels with the first letters of the Latin alphabet – A, B, C (the C was laterreferred to as O ). With this he proves the existence of individual differences in the humanblood and suggests that they are the reason for the numerous unsuccessful bloodtransfusions from one person to another.

So, with his publication in 19011, he announces a discovery, which has turned thecherished dream of people for blood transfusion into a real opportunity. Two years later, hiscolleagues Decastello and Sturli discover the fourth, less common blood group – AB. Withthis the circle is closed and the human blood begins to be classified into groups, labelledaccording to an international agreement with the symbols A, B, O and AB.

In this way a simplified system was created. It caused a revolution in the medicalpractice because it traces the roads for development of modern surgery, which is impossiblewithout the knowledge about them. Landsteiner became not only one of the most renownedmedical scientists, but also one of the greatest benefactors of mankind. Today, in thenumerous surgery rooms all over the world, where the rescue blood flows into the veins ofmillions and millions of people in need in order to return their hope and life, the shadow of therescuer Karl Landsteiner, who made this possible, is always nearby, even though theycannot see him, even though they haven’t even heard about him.

1 Ueber Agglutinationserscheinungen normalen menschlichen Blutes 4

THE STAIRS OF SCIENTIFIC KNOWLEDGE

The explanation about the human individuality, reflected initially in the three bloodgroups, is a wonderful example that discoveries are not usually independent, on the contrary– they are mutually connected. Landois describes the clotting of the red blood cells causedby antibodies. Using this, Landsteiner discovers the three blood groups. His colleagesDecastello and Sturli describe the fourth. In fact, it turns out that science is one endlessrelay. One person discovers one thing, another learns about it, “steps” on it, continues anddiscovers a second one, etc. As an exception, the four blood groups are “rediscovered” in1907 by the Czech psychiatrist Dr. Janský and three years later in the USA by Moss. Thelack of good communications limits the information about these additional discoveries thatbecome mutually known only later.

In 1930 Landsteiner was awarded the Nobel Prize not only for discovering them first,but also because of their significance for blood transfusion and his overall work, whichincludes a multitude of remarkable studies in the area of immunology.

Indeed, when we look back at the past century, packed with notable scientificachievements, some of which also threaten us with destruction, we cannot but feel in awe oftwo of them – the discovery of the blood groups and the antibiotics, which turned intobeneficence for humanity and thanks to which the lives of millions and millions of people inthe world have been and continue to be saved.

5

THE SECRETS OF THE ICEBERG

“Individual differences in human blood”, reflected in the four blood groups have turned to beonly the tip of a huge iceberg, whose size below the water surface seems boundless. It isenough to mention that if we consider only 100 of the numerous group antigens (more than270), combined in 25 different systems, we can get so many unique individual combinationsthat the number of people who differ in only one of them will reach and surpass thisincredible number – one followed by 70 zeros. The huge variety, together with the numerousDNA configurations and fingerprints, makes each human being unique (with the exception, ofcourse, of identical twins).

One of the first surprises of the iceberg was the discovery that blood groups arehereditary. They constitute a blood-group “system” (something like a gene “family”) thatincludes three “members” A, B and O, out of which on your two hereditary units2 there are 6possible combinations with the four blood groups (AA, AO, BB, BO, AB and OO). Their threemodifications are called “alleles”, in order to show that they are related. The A and B genesare equal3 and they manifest in every test. Their “lazy” relative – the O gene, which isinactive, has unequal4 position with regard to its superior relatives and cannot be found in atest when combined with them (AO, BO). Because it does not produce anything, the gene ismanifested only when they are absent (OO). The ABO “family”, together with thousands of others, is located in the ninth chromosomepair (one inherited from the mother and one from the father) that gives them shelter like “twinskyscrapers”. There it has reserved “one-room apartments”5, in which only one of the three“relatives” can be accommodated. So, if you have inherited from your mother the A gene,situated at the family apartment of her 9th chromosome, and the B gene from your father,located at the same “address” in the opposite 9th "skyscraper", under the influence of theinformation contained in both genes, A and B substances (antigens) will be created on yourerythrocytes and the test will show that your blood type is AB. However, if one of the"apartments" accommodates the O gene instead of the B, then you will be assigned to groupA (AO) because the partnering gene is inactive and does not manifest itself. Only if thegenes in both the mother’s and the father’s chromosomes are O (OO), the test will classifyyou as a “O”.

Now you can understand there is no place for doubt and jealousy, if your wife is A(AO), you are B (BO), and your child turns out to be O (OO). From the mother'schromosomes, carriers of A and O, and from yours - of B and O, the chromosomes that havebeen transferred to the child are simply those that have been hidden under the shadow oftheir dominating relatives - the 0 genes, which come “out of nowhere” into the “world” as anindependent group O (OO) and puzzle the parents.

However, be careful! If you both are “O”, then any child that does not have your bloodgroup will be a valid reason for divorce!

In the same manner you can understand how a talent suddenly “pops up” in thefamily of otherwise ordinary people, which talent has been transferred for generations, butuntil this moment has been “overshadowed” by its dominating relatives. And vice-versa.

2 chromosomes3 codominant4 recessive5 loci 6

The discovery that the anti-A and anti-B antibodies in the human blood serums are not“natural" but immune caused a new “boom”. They are created by the immune system uponcontact with numerous microorganisms and substances, containing A, B and H-like antigens.Children are born without their own antibodies. (Sometimes antibodies that have passedthrough the mother’s placenta can be found as a temporary defence). If the child belongs tothe group A, with the development of its own immune system, upon contacts with A and B-like substances,he/she can create antibodies only against the B substances that are foreignto him/her. This is why in the A group we find anti-B antibodies. Due to the samereasons,only anti-A antibodies can be found in individuals from the B group. The O that haveneither A, nor B antigens, have bigger defence possibilities and both anti-A and anti-Bantibodies are formed in their blood. The AB blood groups are most at a disadvantagebecause the production of antibodies against A and B antigens would be equal to a biologicalcatastrophe for them. Maybe this is the reason why in the process of evolution they havebecome a rare blood group. Now you can understand why they have the advantage of being“universal recipients”if blood transfusion is necessary. We can make a transfusion oferythrocytes from A and B blood groups because they do not contain antibodies against theirantigens. On the contrary, the O are the “universal donors” because the O erythrocytes don’thave antigens that can be “attacked” by the anti-A or anti-B antibodies of the other groups (Band A).

It was also found that most people secrete blood-group substances in their bodyfluids (saliva, gastric juice, urine, tears, breast milk and even pleural effusions).

The circle was closed by the discovery of the group antigens in the body tissues. Itwas even proven that they appear in the fetus before the formation of erythrocytes. Itbecame known that the “blood” groups are actually body groups. However, the previouswidely accepted term “blood”, even though inaccurate, continues to be used.

DEPTH PROBE

And so, several decades after their discovery, still nothing was known about thechemical nature of the “blood” group substances (antigens). The big interest in this directionin the following years provoked such remarkable experiments that, should you wish to learnmore about them, their description will probably seem like science fiction to you.

7

At first, five sugars6 were insolated through a chemical analysis, which you do notneed to memorize. Little chemical imagination is enough to see them as hexagonal buildingblocks made of sugar.

The results were disappointing because in each of the groups the same five “sugars”were found (fig. 2) in almost equal amounts.

Fig. 2The secret was probably hidden in their structural arrangement. In other words, the

biochemical “building” of each group, even though built with the same building materials,differs from the rest by its own architecture.

Clarification in this respect appeared with the discovery of substances7 that arecapable of “splitting off” single “sugars” from the whole “construction” of the different groups.

It was determined that some of them “cut” from the A groups a “sugar”8, marked as A– which is predetermining9 because after its separation the A group disappears and a newgroup takes its place – marked as H (fig. 3).

Fig. 3

Other enzymes “cut” off the B-groups another predetermining sugar10, after which Bdisappears and the H appears again like the phoenix (fig. 4).

6 alpha and beta galactose, fucose, galactosamine and glucosamine7 Enzymes8 Galactosamine9 Immunodominant10 Galactose 8

Fig. 4

When the group H, “unmasked” in this way, is “attacked” with a third type of enzymes,a typical H group sugar11 is separated and the substance without group belonging is finally“revealed” (fig. 5).

Fig.5

Thus it became known not only which “sugars” correspond to which groups, but alsothat what is important for them is their “floor” distribution over the H group, which in fact hasturned out to be their precursor. In this way, the A and B genes are not able to “build” the Aand B groups, unless the independent H gene provides them with a “foundation”.

HIGHER LEVEL – ONLY FOR THE MOST CURIOUSFor those of you we will add that the H gene consists of two varieties: H - active and

h-inactive, similar to the “0” gene, whereas there are three possible combinations: HH, Hh,hh. In the extremely rare cases when H is missing (hh), despite the presence of A and/or Bgenes, the respective A, B or AB groups cannot be “built” because they lack a foundation. Atthe surface they look like a 0, but in fact they are blood group 0h “Bombay” (named after thecity in which it was first discovered). The lazy O gene does not care whether there is or isn’tH below it, because it does not build anything. But its very “transparency” allows us to “see”whether in a 0 group there is H or whether it is missing (Oh).

11 Fucose 9

The “Bombay” 0h blood group horrifies the blood donation centers! Besides anti-A andanti-B, the people belonging to this group also have anti-H antibodies, which were formeddue to the lack of H and upon contact with H-like substances found in the environment. Ifnecessary, they cannot receive a transfusion even with the universal 0 group because theywill attack the H, contained in it. Luckily, their frequency is insignificant. When necessary, a“Bombay Oh” blood donor should be sought through the international blood bank! We shouldalso consider the possibility of preparing “super universal” O erythrocytes, in which the H-specificity has been “removed” via enzyme processing.

This does not exhaust the mysteries around the “centenarian” blood group systemABO (H). On the contrary, the “unraveling” of its biochemical structure has stirred“archeological” interest to its biological past. It is reasonable to suggest that the A and Bgroups have developed out of the H-predecessor as a result of mutations in the process ofevolution. Evidence for this is supported by the subgroups A1 and A2, as well as the rarelyfound weak variants of the A sequence12 and B13. In them we find unused quantity of H,compensating the not fully developed A, which gradually decreases and disappears at the“top” specificities A1 and B that have developed last.

New archeological “boom” occured when Levine found an A2-like blood group that didnot have unused quantity of H (Levin Ah). This gave us ground to suggest that the reason forthis “weakness” was probably due to an insufficiency of the substance-predecessor H andnot to an A “weak” gene. The discovery of an even weaker variant B by Prodanov (ProdanovBh), also lacking H, gave him reason to suggest that the weak variants of H actually repeatthe characteristics of the ones from A and B. This was confirmed by the description of new Ahand Bh variants from the sequence14, predicted by Prodanov.

All of these “archeological” discoveries gave us reason to conclude that thesubstance-predecessor H was also created in the process of evolution through mutationsfrom yet unknown “ancient” specificity.

OPEN SESAME!

Before I take you through the next “labyrinth” I should share with you my experiencein Japan where I had a chance to visit the “Museum of the Human Body”, which does nothave a match in terms of a popular scientific attraction.

An escalator takes you to the entrance, which in fact is shaped like a human mouthwith the size of a portal. You enter and after the pharinx you stop at a crossroad where roadsigns politely direct you to the windpipe and the lungs, covered in alveoli, and after that theytake you to the cardiovascular system. In this science-fiction walk, should you be curious,“roadside” videos offer you information about the physiological functions of the organ you findyourself in. The journey continues through the maze of the digestive tract and finishes withthe anus that takes you back into the outside world with eyes that see more clearly thestructure of their own body.

You could understand my hint that it would be difficult to continue my story with onlywords and materials at hand. But it is worth to invite you to one more excursion in the bloodgroups’ jungle, so that you can learn about the new brilliant experiments that dazzled theinhabitants of the scientific world. And why not dazzle you as well?! Moreover, you know thekey words to this treasury of knowledge. It is enough to say: “Open Sesame!”

It all started with the discovery that the genes – carriers of building information –“command” only protein building materials. Because the hexagonal bricks for the A, B and Hgroups are “sugars”, it was necessary to assume that the passing15 of the orders is done

12 A 3, A x, A end, A m, A el13 B 3, B x, B end, B m, B el14 H2, H 3, H x, H end, H m, H el15 transfer 10

through an “intermediary”. This assumption was confirmed when in the serums of peoplefrom the different groups were discovered corresponding substances16, produced to thedictation of their respective genes and “licensed” to carry out the respective constructioninstead of them.

So, the circle was closed and all elements needed for one of the most amazingbiochemical experiments of the century became known and available.

So now, we deliver from the respective biochemical company the predeterminingsugar for group A in the form of a powder17. We collect serum from a blood group A donorthat contains the A enzyme18, ensuring its “building process”. We wash out erythrocytes fromO-group and add the “sugar” and the serum. We stir them well and “hocus-pocus-preparatus”– we discover that they turned from O to group A. We can hardly believe our eyes! (fig. 6)

Fig. 6We repeat the experiments by mixing a new portion of the same O-erythrocytes with

B-sugars and group B serum. We cheer again because now the O-erythrocytes have“acquired” a group B-affiliation (fig. 7).

Fig. 7

Now that we have both predetermining19 sugars and serums with A and Btransferases, contained in AB groups, it is curious to see what will happen if they are mixedsimultaneously with the same zero erythrocytes. There is no mistake! As expected, theerythrocytes have turned from O to AB!

Huge success for the immunohematology, immunogenetics and biology, next tosensation!

16 enzymes-“transferases”17 immunodominant18 A-transferase19 immunodominant 11

WOULD YOU BELIEVE?The four groups have drawn the attention of curious side “observers”. They had tried

to find a connection, starting from the different illnesses and getting to the peculiarities of thecharacter and the need to match them to our diet.

Naturally, the researches looking for correlation with illnesses deserved the mostattention.

Dr. Janský did not find an association with neurological and psychological diseases,although he rediscovered the four blood groups. Later, statistical surveys demonstrated acorrelation between cancer diseases and group A, as well as between stomach ulcer andgroup O. Nowadays these observations have not been confirmed. The only indisputableconnection that remains is the one between the blood groups and the so called hemolyticdisease of the newborn20, which you will learn more about in the next chapter.

We should also consider the popular claims that we need to match our diet to our owngroup. These hypotheses are based on the fact that many plants contain phytoantibodiesdirected against the antigens A, B and H, found in the human erythrocytes and tissues. Inrelation to this many books are being published with tips and cooking recipes, “matched” tothe four blood groups. The authors of these commercial publications forget that the watersoluble group A, B and H-substances are present in big amounts in all body fluids andparticularly in the stomach juice where they neutralize each antibody, aimed against them.Not to mention the unique destructive acidity of the juice itself. Following such “tips” is notonly unreasonable, but also risky, especially for people with diseases that require specialdietary regimens, as for example people suffering from diabetes and children with metabolicand enzyme diseases.

We should also pay attention to the attempts for a “blood psychological analysis”,widely popular in Japan. For several decades Masahiko Nomi’s school and his foundation“ABO-society” is looking for a connection between character and blood groups by means ofstatistical analysis.

According to these studies, the O group is the group of the leaders. It includespolitical leaders, general directors, high rank military men, large industrialists, captains ofsports teams, heads of dynasties and other leading figures (but also mobsters). They areworkaholics, filled with ambitions. Smart, perceptive, but authoritarian, they are haughty andsometimes rude. In normal life they turn out to be good as head of a family, without beingfaithful spouses. They are gourmands and have a strongly developed instinct of self-preservation.

The people belonging to group A demonstrate an ability to plan things, to prepare andimplement them perfectly. Orderliness, rightfulness and clarity are what they excel in. Theyare diligent, careful and serious, and have an excellent command of their emotions. Theirself-control makes them capable of taking responsibilities and making right decisions inextreme situations. This is why they are irreplaceable as pilots, public transport drivers,diplomats, lawyers and accountants. They are people who rely on memory to the point ofrancor. In comparison to the “ideologists and leaders” of the O group, they are the secondtype of people needed for the systematic transformation of ideas into actions.

On its part, group B includes the freedom-loving people for which laws, standards andrules are seen as obstacles in life. They possess extraordinary intuition and analyticalabilities. They impress with their keenness of observation to a great extent and the Japaneseauthors are convinced that should Sherlock Holmes, Maigret and Hercule Poirot have beenreal, they would be bound to belong to group B. Overall, this type includes numerous talents,artists and remarkable designers. However, they are sometimes unpredictable, disorganizedand even irresponsible.

Religious and spiritual leaders, shamans, medicine-men and “fortune-tellers” belongto the rarest blood group AB. Among them are preachers, different reformers and leaders ofsects. It is believed that intuition and sensitivity are in the basis of their character. As

20 a disease that destroys the red blood cells of the newborn 12

psychologists and strategists that are able to analyze various situations, they often possessamazing perceptiveness. They are people who do not share, although they are kind andgood company with a sense of humor. They are too calm, slow in their actions and oftenundisciplined.

All these analyses of the blood type character, although interesting, are not based onscientific proof. However, many people may “see” themselves in and be amazed from thenumerous statistical correlations. The ones that do not find similarities can only shrug theirshoulders and smile condescendingly.

13

SAFARI IN THE BLOOD-GROUP JUNGLE

14

One way or another, the story of the blood groups does not finish here. In order to geta satisfactory minimum knowledge, we need to embark on a new journey. This time it is asafari in the jungle of another important blood-group system that divides people into positiveand negative. So, we head off on a hunting trip for monkeys and in fact for a specific species– registered and labeled as “Macacus rhesus”. Naughty, cheerful monkeys, average in size,which in their capacity of preferred research animals have helped humanity discover not onlya new blood-group system, but also prepare a vaccine against the terrifying infantileparalysis.

Our journey back in time will begin in the laboratories of the Rockefeller Institute inUSA and its vivarium, which saves us the trip to Africa. Here, we will gladly meet our oldacquaintance – Dr. Landsteiner. From a short interview with his biographers we understandthat he has long abandoned Austria and crossed the ocean at the invitation of one of thelargest research institutes in the world where he worked until the end of his professionalcareer.

We find ourselves at the beginning of 1940, far from the “roar and smoke” ofbelligerent Europe. In the laboratories of the Rockefeller Institute, together with his collegueAlexander Wiener, Landsteiner is completing a new significant experiment. They haveinjected blood from the Rhesus monkey to rabbits in order to provoke generation ofantibodies against it. They want to find out whether the antibodies against the monkey’serythrocytes will also agglutinate human erythrocytes. i.e. if there will be something incommon between the monkey’s blood and human blood. And there is! The “custom” madeantibodies against the monkeys agglutinate not only monkeys’erythrocytes but also theerythrocytes of 85% of the people.

Brilliant experiment and amazing results! New blood group system is discovered,which is called Rh in “honor” of the Rhesus monkey. So, people are divided into Rh (+),Rhesus positive and Rh (-), Rhesus negative.

The great significance of this blood “watershed” will become clearer after we learnabout a mysterious disease, causing destruction of the erythrocytes of the fetus while it is stillin its mother’s womb or right after it is brought into the world. Every year thousands ofpregnant women in the world lose their cherished offspring in this tragic way. One such casewith a dead fetus was also accompanied by a hemorrhage that required blood transfusion.The woman in labor was 0 and received blood from her husband, who was also 0. After thetransfusion a serious reaction occurred, which threatened the mother with death as well.Philip Levine undertook to examine this incident and after that his name remained in thehistory of medicine. In the serum of the woman in labor he discovered antibodies thatagglutinate not only the erythrocytes of the dead fetus, but also the ones of the father and85% of other randomly selected people. This gave him reason to suggest that the reason forthe stillbirth is a factor that is missing in the blood of the mother, but can be found in theerythrocytes of the fetus, inherited by the father. So, he clarified the mechanism of themysterious disease that is nowadays known as hemolytic disease of the newborn.Unfortunately, he did not give names either to the antibody, or to the factor, and was not ableto compare them to the ones discovered by Landsteiner and Wiener.

On his part, Wiener continued to develop his studies profoundly on the newlydiscovered factor. He managed to reveal that there are serious complications,often with afatal outcome after a transfusion of Rh positive blood to Rh negative persons.

So, little by little it became clear that there are no “natural” antibodies in the blood ofRh(-) individuals because there are no Rh-like antigens in other body tissues or in theenvironment. They can be “created” by the immune system of the organism only if Rh (+)erythrocytes get into the blood circulation of Rh (-) individuals.

15

Usually, this happens during the “impetuous” birth when erythrocytes from the fetus“squeeze” through “holes” in the placenta into the blood of the Rh negative mother. If theycarry a Rh positive “mark”, inherited from the father, the immune system of the mother“scans” them as “foreign” and begins producing antibodies.

Most often they “barge in” through the placenta into the blood circulation of thenewborn on a mass scale during the birth process. The baby is born normally and hours afterthat the insidious antibodies begin to destroy its erythrocytes. It turns yellow from thedisintegrated products and if the jaundice is strong, it can “impregnate” the brain and thenewborn could die. This was the lot of many newborns in the world before Levine discoveredthe cause.

Now you can take a deep breath and heave a sigh of relief because now we are notonly able to diagnose the dangerous antibodies before birth, but also to eliminate them bychanging the blood of the newborn through a blood transfusion “exchange”. The affectederythrocytes are “taken out” slowly through a vein in the umbilical cord and safe Rh negativeblood is transfused in their place. Blood from several such donors is usually enough to savea baby’s life and bring back the smile of the worried parents. The technologies in this spherehave advanced to such an extent that today it is possible to make the exchange bloodtransfusion in the mother’s womb, in order to prevent a stillbirth.

Still, there remains the question whether the Rh negative young woman should“select” her future husband according to his Rh factor, so that similar incidents with the futureoffspring could be avoided.

Oh, no! The blood-group “racism” has been prevented even at its inception becausebesides an effective treatment with exchange blood transfusions, nowadays it is alsopossible to carry out prophylaxis of the hemolytic disease of the newborn. It is made with“anti-D gamma globulin” (RhGAMRh(D)) , which is a concentrate of anti-D (Rh) antibodies. Itis injected to Rh negative women after each birth, so it can destroy the Rh (+) erythrocytesthat have “wangled through” the fetus.

However, pay attention to this, young Rh (-) ladies! Should you for any reasonterminate a pregnancy earlier, do not forget to make this prophylaxis because in case of anabortion it is also possible for Rh (+) erythrocytes to enter your blood circulation.

The problems with the Rhesus factors in the blood transfusion practice do not lookthat optimistic. Nowadays, transfusion of Rh (+) blood to Rh (-) patient is unthinkable andstrictly contra-indicated because it can cause life-threatening incidents. The smallerpercentage of Rh negative donors (15-20%), combined with the rarer AB group (5-6%) andthe need for transfusion of liters of blood to save the life of such patients, create riskysituations with regard to the blood supply of the healthcare institutions. Not to mentionemergency cases, when the time needed for determining the blood group and the Rh factorcould cost the life of the patient. And this is when a system with the life-saving universal 0 Rhnegative blood should be used! But from where? From which pharmacy?

There is such a pharmacy, of course! Otherwise, how could we save, both in the pastand present, the life of millions of people in the world?! However, you will not find thispharmacy in the streets and the boulevards because it is hidden in the hearts of the peopleand its name is “Pharmacy of philanthropy and mutual aid”! But more on this later…

THE TRUTH AND ONLY THE TRUTH…

I had sworn even before writing these lines that I would always stand by the truth,however unbelievable it may seem to the reader at first, by trying to “translate” into acomprehensible language even the most complex scientific “puns”. Therefore, I think that it isnot fair to close this chapter of human knowledge before sharing at least with the mostinquisitive of you the latest “news” on the “Rhesus” blood-group system.

As it often happens in medicine, 2 and 2 does not always equal 4, so this area wasalso “flooded” by so many new things that they almost “washed away” our initial idea of it.

16

Surprise № 1 hit us when it became known that not the antibody “produced”experimentally by Landsteiner and Wiener, but the one described, however not named byLevine, reveals the true human factor, incorrectly labeled as Rhesus. Don’t worry! Don’t jumpup! In honor of Landsteiner and Wiener, today it is renamed with their initials LW and the truefactor discovered by Levine is marked with the symbol D. The universally accepted divisionof people into Rh (+) and Rh (-) remained for “general usage”. We can imagine what “letter-bound mess” we would be in, if we begin to change nomenclatures in the “middle of theroad”.

We were hit by a new torrent of surprises when it became known that the “family”includes another four antigens: C, E, c, e. One fine lot that has antigen power, not like theone of their “chief” D, but sufficient to require compliance in cases of blood transfusion.

Nowadays if staff in blood centers have to respond to a request for “Rh negative”blood, it means they should look for blood that does not contain D, C or E factors. For them,“negative” are only the carriers of the weaker blood antigens (c,e).

You should bear in a stoic manner the information that nowadays the number of theeven weaker antigens includes a total of over 45 “relatives”!

Here you could reasonably exclaim: “What the heck! What happened with the Rh-negative factor? Are there negative individuals at all?” The answer is: Yes! There are! Theyare marked as Rhnull and none of the known antigens can be found on their erythrocytes.Luckily, they are very rare! Otherwise, the search for compatible blood for them would turninto an international problem.

This “lyrical scientific digression” in the name of truth was shared with you for yourgeneral health knowledge and your own use. The specialists are the ones left to worry whenhaving to comply with it. To everyone else, uninitiated in the secrets of the blood groups, wecould only tell: “The mistake remains correct! You are either Rh (+) or Rh (-) !”

ALCHEMY OF THE SCIENTIFIC WORKSWhen I began the story of the blood groups I had the great desire to also reveal the

“energy” source which inexorably stimulates people to discover newer and newer things, andwhich inspires them to build roads through the endless science jungle or to “climb” its peaks.This is an urge that “obliterates” the sense of time to an extent that makes them forget NewYear’s Eve celebrations, carried away during one of the many experiments in the laboratoriesof an empty institute. A description, which I suppose I have impressed you with at thebeginning of the book; however, it is not fiction, but an extract from Dr. Sturli’s memoriesabout Dr. Landsteiner.

In regard to this, I will try to share with you the feeling of satisfaction that fills theresearcher when his/her creative idea becomes reality. It is almost indescribable; however, Iwill make an effort to share it with you. I will do so by comparing it for example to what thephotographer-artist feels when, gazing over the developing tray in the dark red room, s/heanxiously observes how. over the photosensitive paper. the outline of his creative visiongradually appears, which the eye has tried to capture with the blink of the camera. Or when,staring in the test-tubes or the glass with reactive mixture under the microscope, you wait tosee the result of the thought or vision set in them. A unique experience! And once the newidea is visualized by a confirming reaction, this experience begins to haunt you for life. Youfall into the magnetic field of creativity, even though just as a tiny chip or as a little fly,fluttering steadily around the light in the darkness. This is so consuming that you begin towonder whether nature, which has created the attraction between the sexes, in order topreserve the human kind through the “orgasm” of creativity does not also guarantee scientificand artistic development. In fact, the piety for scientific work is an inner need.

17

An elusive urge to transform the accumulated knowledge, experience and perceptions into anew form, which will reflect on a higher level some correlations, interdependences that haveremained hidden, unrealized until that time, but which have also been a clear stimulus forsearching a way out into the new. In this urge, in this inner need intertwine ethical,aesthetical and emotional motives, which turn into satisfaction . The human thought has itsown architecture. The new idea, the formulated hypothesis provoke aesthetic feelings andultimately all this ends with a feeling of having fulfilled one’s duty to his/her fellow humanbeings. Without a doubt, there is a difference between the works of science and the works ofart. However, fundamentally they are united by the fact that they are works, i.e. the result of acreative process. In this sense, what is common in both cases is the creative impulse. Thedifferences manifest themselves in the way they are reflected. After the creative process isover, the inner satisfaction with the creation is again one and the same.

I hope that through this digression I have managed to clarify the “energy” source, setinside the individuals, which makes them devote their life selflessly to science or art,regardless of the scope of their achievements. The energy source, thanks to which humanculture has been and still is developing.

18

WHAT DO WE KNOW AND WHAT IS IT THAT WE DO

NOT KNOW ABOUT OUR OWN BLOOD?

19

For thousands of years people have not known anything about the blessed liquid thatran in their bodies and irrigated with vital juices each and every part of them, despite the factthat they had written their history with blood. The only thing they understood was the fact thatwhen they bleed, the organism sank into oblivion and died. Maybe this is the reason whythey attributed magical qualities to the blood, offering sacrifices with the hope to ingratiatethe elements, which they identified it with. It was not until 1613 when William Harvey openedthe door to the troublesome secrets of blood when he found the incomprehensible paths ofblood circulation. Paths, which later on the human knowledge ran on; nowadays it makes usstand in front of the blood autoanalyzer in expectation to find out the status of our health.Which has obligingly hosted your blood sample with its typical …click…click …click… …clack… it spits out a long strip of paper with a baffling series of approbations, digits and diagrams,which make your hair stand on end before you understand what is hidden behind them. Andthere is a reason for that! These “doodles” are what the history of modern medical knowledgeabout blood is coded in, and we “collide” willingly or not quite so, with them in our life markedby vicissitudes, among which the health-related ones are of primary importance. Of course, itis not possible to penetrate their depths without being experts who have dedicated their livesto that task. But can we not at least take a peek, not only out of curiosity, but also out ofhunger for health culture?

Of course, it is possible! And this is the objective I have set, despite the fact that itwould be difficult for me to transform into a “speleologist” in order to accompany you, withouta threat of “overloading you with information” during the walk we are going to take in the“caves” which hide the numerous secrets of blood.

THE FEDERAL REPUBLIC OF THE BLOODLet us start with the simplest – is it really red? Are we precise when we assess

something as “bloody red”? In order to gain assurance, it is best to visit some of the blooddonation centers and peek at its heart – the freezer room, where the life-saving bags of bloodare kept. We will have to put on something warm, since their favorite temperatures rangebetween 2 and 6 degrees Celsius. In the cool silence of this storage of humanity we meet thedonated and preserved in plastic bags of blood. Let us take one of them and raise it to thelight. There, taken out of the strong current of the blood circulation, waiting for a newsalvation journey, it has settled to camp in layers, in which each of its components hasformed its own “camp” in correspondence with its weight. On top of all it has settled its golden-yellow billows – the blood plasma21. Somecompare its color to straw. For some reason I find this to be “simplified” and underestimating.As I am familiar with the multitude of its functions, not limited to transpiration, I would like toexpress my amazement by including a hint of evaluation in qualifying it as “golden”. The mostnumerous and the heaviest of all – the “title-holders” - the red blood cells have settled at thebottom, as if to highlight their importance not only in terms of quantity. Above them, like amodest off-white shroud, completing the blood “three-color banner”, are spread the whiteblood cells – the leucocytes. The colorless blood platelets – the thrombocytes, settled in thelower levels of the plasma, occupy a position that cannot be seen by the human eye. In fact,behind this peculiar yellow-white-red “banner” is hidden an amazing “federal republic of theblood”, in which each component is “autonomous” in terms of its functions and at the sametime subject to the federal laws.

21 The liquid component of blood 20

THE RIVER OF LIFEThe role of the unifying factor for this amazing cohabitation is performed, without any

doubt, by the “river of life”- the golden-yellow plasma. Its transportation functions are usednot only by the blood cells that “swim” in it. Together with them, invisibly dissolved, move theproducts of digestion as well, minerals, salts, vitamins, hormones, antibodies and othercomponents without which our existence is impossible. Equally important is the backtransportation, through which the by-products, after being processed by the liver, are takenout to be “disposed of” by the kidneys. Its composition includes, together with water (90%),some 6-10% proteins (albumin, fibrinogen and other factors of the blood-clotting process).Their fast recovery after dosed donation of plasma allows it to be transfused to save the lifeof countless burns and trauma victims, as well as for surgical interventions. Through specialprocessing, it is possible to isolate and use for targeted treatment almost all of its importantcomponents.

THE RED ARMY OF BLOODAnother “brotherhood” factor is the fact that all cellular elements originate in the bone

marrow of a single parent cell. From there, under the auspice of four different hormones they“set off” to the four directions of the blood micro world. Under the influence of theerythropoietin (well known not only to doctors but also to coaches and athletes as doping),the erythrocytes begin to form, and during a period of one week they undergo a series oftransformations. In this period they manage not only to fill up their “tanks” with hemoglobin,but also to reorganize themselves by throwing out the unnecessary production “facilities”22.The repair, after which they enter the blood circulation, makes them look like a doubleconcave facade. (fig.8)

Fig.8

This allows them not only to have the largest exchange surface but also to possessextreme flexibility. Thank to the latter, they can even squeeze through capillaries narrowerthan they are, in order to supply the invigorating oxygen to the farthest parts of our bodies. Ofcourse, we all know that this happens thanks to the hemoglobin. The iron molecules in it turnout to be a wonderful mean of transportation, which binds tirelessly oxygen from thecapillaries of the lung alveoli and transports it to the cells of the different body tissues. The“emptied” molecules afterwards “load up” the accumulated carbon dioxide (CO2) and carry itback to the lungs so we can dispose of it. An amazing transportation company that makes nounnecessary runs. Having in mind that every erythrocyte contains about 270 millionhemoglobin molecules and a cubic millimeter of erythrocytes contains from 4 to 5 million ofthem, with about 5 liters of blood in the organism we can imagine the colossal activitypermanently done by this company! It is not by chance that in 1962 the grateful humanity

22 Nuclei, mitochondria, etc. 21

awarded a Nobel Prize for the deciphering of the hemoglobin structure23. Afterwards it wasimmortalized in an attractive iron and glass sculpture24 (Fig.9) and was praised in a wonderfulsong by the rock band Placebo25.

Fig.9

But you should not think that the hemoglobin has no flaws! What is especiallydangerous is its affinity to the toxic carbon oxide (CO). This affinity is 230 times bigger thanthe affinity to oxygen. Due to this, wherever hemoglobin meets it, it forgets its “weddingvows” and binds permanently with it. As a result, the respiratory functions are endangered.Especially those of the smokers due to the incomplete combustion of cigarettes! For themore ardent smokers, the respiratory deprivation can get as high as 20%. The great EmilZola was murdered when they blocked the chimney of his bedroom and he suffocated in hissleep with the carbon oxide of the resulting incomplete combustion of his own fireplace! Thisdanger in closed rooms is affecting, although to a lesser degree, not only the smokers butalso the bystanders. This is the reason why in many countries draconic measures arealready in place for the absolute ban on smoking in public places and “tempting” thehemoglobin.

Not to mention the dangers that lie in wait on every city street, behind every modernmachine, even an act of clumsiness that can harm us and cause bigger or smaller loss ofblood. Here again we are bound to admire the thoughtful Nature which has programmedevery human being to be oversupplied with blood, to be ready to meet and eliminate adverseevents. Every second our organism produces 2 million erythrocytes which are deposited inthe spleen, from where, in turns, each involving only 1/5 of all available cells, they enter theblood circulation. Only if there is an emergency alarm the rest “rush in” to replace the bloodlosses. It is these reserve and excess quantities that the medical practice uses for dosedblood collection in blood donation, which, without harming the healthy organism, save thelives of those in need. The reserves, unfortunately, are also used as doping! A liter of bloodis collected from the athlete and the erythrocytes from it are preserved by freezing in order tobe transfused immediately before the competition event. The unscrupulous coaches forgetthat by that time the collected blood has already been replaced and the transfused quantities,even though untraceable, together with the simulating effect create a risk for the health of theathlete by increasing the viscosity of his/her blood.

The red blood cells, of course, are not eternal. As any vital formation they also “tire”and wear out. After about 120 days of exhausting activity, they start to change gradually,which is a signal for the control bodies in the spleen to start delicately their decomposition toprimal proteins and iron from which they resurrect like the “phoenix bird” in the bone marrow.

23 M.Perutz, J.Kendrev.24 J.V.-Andreae25 “Hemoglobin is the key to a healthy heart beat.” 22

THE BLOOD HEDGEHOGSIn the depths of the bone marrow, under the influence of another “founder”

hormone26, grow megacells, in which 5000-10 000 daughter formations mature, known forsome reason as blood platelets27. Because of their peculiar “oval” shape and their manypseudopods that resemble spikes I would rather compare them to blood “hedgehogs”(Fig.10).

Keen to break “free”, they can hardly wait for their maturity and tear downenergetically the bursting mother cell28, so that they can “rush” to the circulation and carry ona 10-day relay-race in place of their already exhausted brothers.

Although huge scientific efforts have been invested in their study in the past one-hundred years, I find it difficult to explain to you whether the numerous spikes that are notprickly but rather “adhesive” are used for “hand-to-hand” action or for antennae. Moreprobably for both. Their functions could be compared, in terms of speed and effectiveness,only to those of the fire command and the flying squads. Wherever there is a “hole” thatthreatens with loss of blood, they are not only omnipotent but also captivating in their self-sacrifice. With their own “bodies” they try to close the hole by holding “hands” with theirpseudopods. At the same time they cry out a frantic biochemical “howl” which spreads to the“ears” of all around them and starts a hard-to-describe cascade of counter actions,summarized humbly in the term “blood clotting”. In the advanced “mess” in fact there is apedantic rule of order which astonishes with its consistence. Activated by the contact with thegapping breakage of the internal surface of a blood vessel or by the incoming air in case of asuperficial wound, they transmit their own SOS signal, which is most quickly replied to by thefibrinogen29 that “loiters” around. It transforms into fibrin fibers which embrace the location ofthe accident like a “web”. The net, of course, also catches accidental “passers-by”, mostlyerythrocytes, which, willingly or not, have to take part in the forming dense matter. With theadded participation of the alerted cascade of plasma factors, the fibrinogen gradually tightensand forms a “plug”, big enough to “plug” the unwanted hole. After the rescue measures arecompleted, the plug takes the form of a dense matter30 inside the harmed blood vessel and ifthe accident has taken place on the surface of the skin, you will assess it as a “scab” which

26 Thromobopoietin27 Thrombocytes28 Megakariocyte29 A blood-clotting factor that is dissolved in the blood30 thrombus 23

will fall off in a couple of days. Remarkable mechanisms which keep watch for the “integrity”of our precious organism under the auspice of the blood 'hedgehogs'.

But beware! There are concealed dangers which people nowadays should be awareof if they want to be “up-to-date” with their health and the threatening socially significantdiseases31. Unfortunately, our “hedgehogs” have a proven connection with this entire“menagerie”. What is particularly dangerous is their affinity to “get carried away”, when incase of a completely unharmed surface of blood vessels, under the influence of yet unknownpseudoalarms, they begin to form thrombi. This is an absolutely undesirable “initiative”because the blood flow could “sweep” them away and they can clot a blood vessel that feedsparticularly important parts of the heart or the brain, thus causing a heart attack or a stoke.This is why you have been advised to take aspirin every day if you are at risk! Together withothers, this well-known medicine in the age of retirement suddenly “rejuvenated” when itbecame known that it can “gently” decrease the clotting properties of the blood. Can youalready guess how? By attacking and causing irrevocable accidents in the functions ofthrombocytes. Their normal number, which ranges from 150 000 – 450 000 in a cubicmillimeter decreases significantly. But since this is the “set objective”, keeping them in thelower range is desirable. This, of course, is risky, since once the count reaches 20 000, thereis a danger of serious hemorrhages. This is why the prophylaxis of heart attacks, strokes andother thrombi-causing diseases requires systematic control. And of course, you should nottake aspirin unless you have a doctor’s recommendation to do so!

You already know what dangers “mine” the opposite case. The significant decrease inthe thrombocytes count is an alarming signal for a complete series of diseases related tothem. Besides, some of the biggest achievements in the area of cardiac surgery,transplantations and the treatment of cancer cannot do without the support of thrombocytestransfusions. Not to mention wounds and burn cases, where the successful treatment isunthinkable without them. Do not be quick to despair! The wise nature has also planned anemergency exit from these situations. It has been established that, luckily, the organismrecovers dosed “removals” of thrombocytes within 48 hours, which allows healthy people todonate rescue “portions” of hedgehogs every 2 weeks. But more on this later.

To ”top” it all, there have been “signals”recently that our common acquaintances“smuggle” agents that are related to sleep patterns, appetite, biological rhythms and even ourmood. Of course, it is not right to list them before the undertaken intensive scientific“investigation” is completed. Let us have patience and do not deviate from the upcoming,equally interesting walk in the lobbies of the defensive bodies of our own “Federal republic ofblood”.

THE WHITE ARMYThe soldiers from the “white” army originate, like all other blood elements, from the

founders, the bone marrow stem cells. Their further destiny to build the immunity, subject tostrict military rules, is much more different and diverse. Fixed and colored under an ordinarymicroscope, even at first glance we can differentiate them in two main groups on the basis ofthe presence or absence of spot-like granules in their protoplasm. But the secrets hidden inthese peculiarities of theirs were unveiled only in the last decades thanks to the hugeadvances in the areas of genetics, immunology and electronic microscopy.

It was established that their development is done under the management of the so-called Major Histocompatibility Complex32. Its genetic “trust”, which represents the humanleukocyte groups33, is located in the 6-th chromosome and has 9 staff genes, and who knowshow many temporary staff members34. To know in details their functions and the consequent

31 Arthrosclerosis, cardio-vascular and brain-vascular threats, cancer32 MHC33 The blood groups of the white blood cells, marked as HLA34 Alleles 24

activities is a task of the experts in the field of medical biology. In my capacity of a “guide” Iwill satisfy your curiosity without going in details, and in order to make them comprehensible,I will compare some of the more complex things to commonly-known events, institutions andplayers.

So, this complex actually carries out the functions of the Central Intelligence Agency.Why, you may ask? Because every foreign aggressor35 should not only be investigated, butalso destroyed. What is more, the CIA observes and eliminates not only every implantedforeign tissue but also every “dissident” cell that tries to “deviate” on the road to cancergenesis and turn into a cancer cell. These extremely important duties are performed by the“white army” whose count, compared to the “red” army, is 1:700.

We can understand how this happens only if we trace, even superficially, theobjectives set by the “Agency” and the manner in which they are implemented.

The first and foremost objective is to “legalize” its own cells by verifying their“citizenship” with a special sign, so that they can move freely and unpunished on its territory.This is a task of the “passport service” in which participate the HLA family – the genes. They“anchor” in the cellular membrane of every cell with nucleus a “protein identity card” whichstands out as a “road sign” and demonstrates its citizenship. The groups in it are organizedin such a way, that they present an unique for the organism combination, similar tofingerprints.

For its subordinates, the Agency also provides specialization in accordance with stricthierarchical rules. It is proper to meet the regular “small” and “big” representatives of the law and orderfirst– the phages36. Out of these, figuratively speaking “eating” cells, the most numerous arethe so-called “microphages”37. When they receive a signal that “diversionists” have intrudedthe organism, they set off in a hurry to the crime scene like a flying squad. They immediatelyidentify the intruder on the basis of its untypical “facade” and literally eat it up and digest it38.Unfortunately, they can destroy only 1-3 pathogens and afterwards they die. Their task is tohold back the “enemy” on the site of intrusion until the arrival of the second defensiveechelon – the macrophages39. Due to their large size, they “drag” along only 8-10 hours laterand find the crime scene “rotting” with their dead brothers. Impressed with the battleenvironment, they immediately rush in to help the microphages. Unlike them, they can“gobble up” not only up to 100 times more pathogens (Fig. 11) but also summon throughspecial signals the next participants in the united line of defense.

Fig. 11

Before we meet them, we should not fail to notice another amazing function of themacrophages – their job as “garbage pickers”. After the battle is over, they clear away the“remains” before they “decompose” and harm the organism. But this is just “in addition” totheir permanent duties to remove the “retiring” cells, which range from 50 to 70 billion perday. It has been calculated that the “processed” mass of cells for a period of one year of ateenager, for example, is equal to his weight !!! This colossal activity is feasible only due tothe so-called programmed death40. When this happens, after the cellular structures are

35 Bacteria, viruses and other microorganisms that cause diseases, commonly known aspathogenic.36 Gr. phagos - eat37 Neutophilic granulocytes38 Phagocityze39 Monocytes40 Apoptosis 25

“eaten up”, they are “taken down” to their components through a series of biochemicalprocesses. Thanks to this, the organism is not “polluted” and harmed by waste materials butuses them for recycling. In this way, thousands of years before we think of separating wastein different containers, our organisms have used this economic cycle.

Our acquaintances, the macrophages, which account for 2-8% of the white armyranks, live only for a couple of days when the “tomahawk” of war is unburied. In “peace” theycan reach “retirement” age after several months or a year. Usually they are located in thelungs and liver, the nervous system, the spleen and other strategic places where they carryout the functions of patrol officers, very often bearing different names according to theirlocation.

Due to their low qualifications, the phages can identify the aggressors only on thebasis of their “shape” and they can make mistakes. In the process of evolution other, morespecific molecular mechanisms for identifications have also been developed, which requiredadditional specialization of some of the white army soldiers.

Even in the early stages, some of them, known as lymphocytes are “sent” for trainingin a special “police academy” located in the thymus41.

Some of them enroll in the management classes, where they learn to help bycontrolling and activating the other cells of the immune system, and this is why they arecalled “helpers42” but in fact are “conductors” of the immunological orchestra!

Others turn to the specialized “antiviral school”. Here special protein “receptors” are'anchored' in their membranes– something like “night vision goggles”. With them theyrecognize the cells that are affected by viruses. Armed with special “bio-bullets” in the school,they approach the infected cell and shoot directly at it. They rupture the membrane and injectan enzyme that destroys everything around it. The effect resembles the so-called dumdumbullets, and as a result the cell makes a self-sacrifice in order to eliminate the viruses thathave multiplied inside it. Due to these qualities, the graduates of the antiviral school arecaller “killers”43. To call killers the heroic cells that protect us against viruses for which nomedicines have been discovered yet is, to put it mildly, inappropriate. Nevertheless, at least itis descriptive.

The training of both groups ends with a class in “computer” literacy. You should notbe amazed! Thousands of years before the modern widely-spread methods for crimeidentification have been developed, the organism has developed an excellent system of itsown. After the victorious battle against the aggressor, its most active defenders continue theirlives as “memory” cells. In case of a new intrusion they not only identify it, but alsoimmediately start to produce the means it has been eliminated with the previous time. Thisprovides a secondary immune response which is much faster and efficient than the first one.This is what we try to provoke with vaccination.

After sitting a very strict “state exam”, the graduated (2-10%) lymphocytes are sent towork in the peripheral lymphatic organs44. Those who fail the exam are subject to“programmed” death ! ! !

Unfortunately, the graduates of the “police academy” who build the tissue immunityare able to identify only aggressors with protein structure. In terms of pathogens with otherchemical composition they are helpless. This is the reason why in the process of evolutionthe bone marrow has organized something like a “College in total identification”. Thoselymphocytes which enroll there are trained to literally identify all existing antigens. Eachcollege student receives an individual receptor, which is an antibody anchored in itsmembrane that is sensitive to only one of the countless natural antigens. Armed in thismanner, they are sent to the spleen where after the traditional tough “state exam” theygraduate as B45-lymphocytes.

41 An internal organ behind the breastbone42 Helpers of Th43 Killers- Tk44 Lymph nodes, spleen, tonsils, etc.45 Eng. From bone marrow. 26

Every day millions of them carry out a thorough immunological monitoring in order tofind their match. Fortunately, the majority of them remain “virgin”. However, if one of themmeets the foreign antigen it is sensitive to, it “eats it up” immediately. As a result, itsprotoplasm bulges and transforms it into a plasmatic cell, which produces countlessantibodies against the aggressor. Like the well-known firing weapons, the intenselymultiplying plasmatic cells start to “fire out” the produced antibodies without even changingtheir location, thus gradually “building” the so-called humoral immunity against the invaders.

Unstimulated B-lymphocyte plasmocyte

Fig.12

The antibodies themselves have a double action. They do not only adhere to thesurface of the pathogen “under fire”, but also neutralize its harmful influence. Byaccumulating on it, they “hem” its surface and thus attract the attention of the omnipotentmacrophages, which like vacuum-cleaners suck up “the set” and clean the crime scene.

I suppose you are tired by the trip in the depths of modern immunology but it wasworthy to get familiar with the amazing defensive mechanisms nature has provided us with inorder to ensure our survival.

Of course, it could not imagine that human science will get ahead of the slowevolution pace and with its successes in the area of transplantation will clash with theclassical protective mechanisms, which acknowledge as their “own” only an organ that istransplanted from an identical twin. The “diplomatic” attempts to soften this confrontationachieved quite a few successes. First, by finding the most compatible donor in terms ofblood groups. In the “negotiations” regarding the acceptance of the organ transplant not verydiplomatic means had to be used to suppress its natural immune protection46. Unfortunately,their application is a mixed blessing and “lets loose” proneness to infections.

THE KEY OF LIFEThe daring human mind searched for new exits from this unfavorable situation which

directed its attention to the key of life – the stem cell.The studies of the problem how humans develop from a single cell and how the

healthy cells replace the damaged ones have outlined possibilities for “cell” therapy47 andhave turned into one of the “hottest” research areas of modern biology. You have probablylearned from the media that a “restoration” (regenerative) field is emerging in medicine andyou are filled with hope that new treatments can be found for some malignant diseases. Thisis why I offer you to make a short “pause” and take a look at these exciting perspectives.

46 Immune suppressors, chemotherapy and ray therapy47 Treatment with cells. 27

Fig. 13

Two mysterious characteristics of the stem cells, isolated from human embryos, havemagically focused the attention of the researchers. Their ability to reproduce and differentiate(fig. 13). To produce more than 200 types of cells, each of which starts its own path ofdevelopment in order to create the respective mature offspring, a tissue or an organ.Transferred into a special laboratory “incubator”48 that provides them with everything theyneed to “grow”, they continue to reproduce on and on. Towards the sixth month, they alreadyshape a “forever young” cell line, which includes millions of stem cells. Their identity does notchange in the process of reproduction and makes some scientists assume it carries thesecret of immortality. But it is also a secret why they “refuse” to differentiate under laboratoryconditions. The clarification of this important problem was delayed due to the storming“bioethical” disputes surrounding the redundant embryonic cells, which the artificialinsemination clinic donates for scientific purposes instead of destroying them. Of course, withthe explicit agreement of the respective couples. “The seed of discord” hides in the fact thatsome see them not as a “set of cells”, but as a “life”, which we should not interfere with. Itturns out, for these people it is better for the “life” to be destroyed, instead of being used toserve science and help save the lives of people who need it! It is up to you to decide – who isright and who is wrong?

Of course, sources of stem cells were also sought in adults. Besides the well-knownfounding cells of the blood from the bone marrow, similar ones were also discovered inalmost all other tissues. Unlike the universal49 embryonic cells, however multi-directional50

they are, they are able to differentiate only in cells that are typical of the respective tissue.The stem cells isolated from the umbilical cord and the placenta turned out to be a muchmore promising finding. Easily separated, frozen, they can be stored for years as an“insurance” against future illnesses of the newborn. Their biggest advantage is that in case oftransplantation they are going to be “welcomed” as its own by the child’s immune system.Specialized “banks” have been springing like mushrooms – for a reasonable fee they canprovide you with peace of mind for at least the next 20 years.

The constant attempts to decipher the signal that “talks” the founding cells intodifferentiation have rewarded the researchers not only with success, but also with surprises.It turned out that when influenced in a certain way, the stem cells of the bone marrow can“transform” not only into blood cells, but also into nerve cells and vice-versa. A flow ofsurprises was unleashed, which made it clear that the founding cells have “plastic”characteristics, which under certain conditions allow them to go through the most unexpectedtransformations.

48 Laboratory device for growing and reproducing cells49 pluripotent50 multipotent 28

With the progress of genetic engineering a biotechnology for medicinal “cloning”through “transfer of nuclei from somatic cells”51 was developed. Together with it newreligious-ethical protests came out, but with them came also a volcano of hope. Theexperiments use a somatic cell from a donor (for example, Mr. Petrov), whose nucleus isisolated and transferred into the “arms” of an ovum (from Miss Ivanova). It has beenprepared in advance, whereby its nucleus is removed and it is “set” to accept “lovingly” thenucleus of the “fiancée” recommended by the respective laboratory matchmaking agency.Sheltered into the respective “incubator”, 5-6 days after the “wedding”, the “bride” developsthe desired embryo. I suppose this is how this experiment is seen by its adversaries, whoignore two extremely important details. It is not about a living being, but about a “bunch” ofabout 100-150 cells, reproduced not in a mother’s womb, but under laboratory conditions.They carry only the genetic information of “Mr. Petrov”. They are urged to transform, forexample, into cardiac muscle cells and when transplanted into his sick heart, they will be metas one of its “own” and will start to work undisturbed for its healing. (fig. 14)

Fig. 14

The debates were put to an end by a new biotechnology for production of “inducedstem cells”52. An achievement, which. with its perspectives. has caused a “boom” not only inthe field of science. Thanks to it, a grown cell from any human tissue can “rejuvenate” tosuch an extent that it can practically turn into an embryonic cell. With the help of specialgenes53 “jumping over each other, specific genetic factors are “planted” at the nucleus of thegrown cell. They “wake up” sleeping segments in its genome and reprogram it so that it canturn back to its initial embryonic position. Thus embryonic cells are“fabricated”, which do notprovoke the “moralists” because neither human ova, nor human embryos are used. They donot “provoke” the immune system either, because they are its own. The first experimentswere with skin biopsies. But it turned out that the source could also be the root of a singlehuman hair!

51 Somatic cell nuclear transfer52 Induced pluripotent stem cells - iPSC53 transposons 29

This is a triumph for genetic engineering that outlines fantastic perspectives forrestoration medicine! It is an amazing “dance” that turns a hair cell of a patient into a stemcell, which transforms into a muscle or another type of cell and is sent to pulsate in his sickheart or somewhere else. This is a method that plants the seeds of hope for successfulfuture tissue therapy for more than 70 diseases that are yet incurable, among which rank theconsequences of heart attacks, strokes, diabetes, Alzheimer’s disease, Parkinson’s diseaseand many others!

Hosanna!54 … Mankind is on its way to realize its dream of longevity! …

54 [Greek] Save, relig. Praise 30

… MY GOD, THERE IS TO MUCH PAIN IN THIS WORLD ! ...

31

THE STORY OF A POSTER

Looking through the works of the great Yordan Yovkov, I am once again drawn to hisshort story “Along the wire” (“White Swallow”). Once again my soul is shaken by theunfortunate family, hoping that their child will be healed if she sees the miraculous whiteswallow. And again I think about “the wire”, which traces the road of hope. There arecountless swallows perched on it. The poor sick girl is constantly turned towards it, staringsadly at the swallows. So many, but all of them black! Only the approaching steps of the manfrom the other village take her eyes off the wire, so that she can utter the heartbreakingquestion “Will I see it, uncle?”

“You will see it, child! You will see it! I saw it, and you will see it, too!” – the answer ofthe compassionate peasant sounds as an epitome of human empathy. The echo of hiswords: “Follow the wire, follow the wire…”, warmed up by his human kindness, echoes backafter them as “Follow the hope, follow the hope”… Yes, hope is what provides support in thetragic situation of these unfortunate people, who are powerless and helpless before humanfate, but who do not accept it.

E. Bosyatski (Along the wire)

And suddenly I realize why this story influences me so much!I know this girl! She has severe anemia55 and her life constantly depends on whether

there will be a “handful” of blood for her to go on.I know these girls! The girls, whose eyes stare childishly at my white coat, which

represents hope as a white swallow for them, from a very early age.I also know the boys and the slightly husky voice of one of them, whispering

accusingly to life: “You are healthy, help me!” haunts me in my dreams and often wakes meup with cold sweat on my forehead, and makes me think whether I have done everythingpossible to help them. Whether I have made enough effort to share their pain with thepeople, so that they can come to the rescue.

Finally I understand that this is the pain that Yovkov has concentrated in hisheartbreaking story. And gradually I am taken by the wish to disconcentrate it and somehowsend it “along the wire” of philanthropy to everyone. So that they can realize that the “white

55 sickle-cell 32

swallow” does exist for the unfortunate children, but in order for it to fly, they should lend ahelping hand. To donate a stream of their own blood and give the children some hope forlonger life .

But how do I do this? Maybe with a poster?!The fantastic illustration of the story which by a few strokes of the pencil depicts the

drama in the startling work of fiction and makes you feel the creaking of the cart along theendless fields of Dobrudzha is not good for this purpose.

The white bird of hope should have a central place and should show the road to thelife-saving blood drops with its determined flight. The road to people’s hearts, so that it canprovoke their love of mankind!

The idea somehow emerges on its own, but how do I find a picture of a flyingswallow? I seek advice from a friend of mine – a photographer. It is not impossible, but it ishard and requires time! I head out to the Institute for Ornithology at the Bulgarian Academyof Sciences. The Director is compassionate to the idea and leads me to their library. Out ofthe shelves start pouring books that have sheltered between their pages all kinds ofswallows. Dozens of varieties. Perched on wires, in nests, flying off, flying around. I thankhim for the understanding, promise to send them a poster and leave the academy with abunch of copies under my arm. Among them is also my prima donna. The beauty, headingout determined into the skies!

From there on it is a matter of technology. We get into the publishing room with therespective expert and the desired vision takes shape onto the screen. But is it enough! Couldwe leave out the cry that came right from the heart from the peasant?

… MY GOD, THERE IS TOO MUCH PAIN IN THIS WORLD!...

You want to learn something more about it ? The pain ! Do you want to see withyour own eyes how much more pain is there in this God’s world, so that you can be sure?Come along with me! After all, I am your guide and there is no more need for me to changemy role any more. Now I am on my own ground. Put on the white coats. Put a face mask inyour pockets, just in case. Hurry up ! We head out on a visitation along the cry of thesirens.

We step on the gas in order to “stick” to the ambulance that has just set off and usethe road that has been freed by its siren. It takes a left turn at full speed, gives a left turnsignal and the direction is clear – the maternity ward. They have been expecting us! Not us,but the priceless blood bag they carry in front of us. The door opens with the touch of thebell. Holding our breath, we creep in. We stop before the glass wall of the maternity ward.Inside the battle continues. Placental abruption! Sixth consecutive blood bag is being used!Under pressure! You stand dumbstruck, don’t you? Hold on, hold on! Wait! I am stopping youbecause I am sure you will never forget the moment of “resurrection”. When the eyes of theyoung unfortunate woman, sunk into the nothingness, open once again for life! This iswonderful, isn’t it ! Even divine !

Do you want to know who helped rescue her ? There are no names on the bloodbags. Only a numerical code representing nameless Humans !

We go back. But why does this man walk back and forth so anxiously in front of thedoor of the micropediatrics ward ? Shall we have a look ? For your guide, who is responsiblefor the donation and transfusion of the life-giving liquid, all doors are open. Just take out themasks and put on the gaiters. Through the glass of the department you will see how theblood of a newborn is being replaced. Fortunately, only a little” blood is needed for thisheroic for the size of the child’s organism therapy. From just a few donors! But Rh (-). Thefather outside is eager to be “the savior”, but he is Rh (+) and is not compatible. He’s beentactfully advised to donate blood for someone esle, who needs it, while the doctors recoverthe life of his beloved child.

33

We leave with brightened faces, but let’s not hurry. We still have not looked into the dwellingsof the main “consumer” – the surgical ward. We are warmly welcomed. They know why weare here and lead us to the surgery block. Now it is “calm”. They are operating on for a“rebellious” ulcer, which has refused to stop bleeding despite the liters of blood transfused.The affected blood vessel should be surgically “corrected”, of course under the “curtain” ofblood transfusion. …Drip, drip, drip… We cannot hear from behind the glass, but we can see!The “dripping” will continue after the operation to recover the losses.

Wait a second! The mobile phone in my pocket begins to vibrate restlessly. I stepaside and answer it. They are calling from the center. A car accident! The ambulances now'cry' on the way to the traumatology ward. The accompanying colleague gives me aquestioning look. If the accident is big, soon the operating rooms here could be “covered” ininjured people.

The traumatology ward cares little about us! “Live” scenes from “ER” can be seen! Itis a pity that the access of the journalists’ cameras is limited only to the scene of the accidentand they do not follow what is happening to the victims. They do not follow the sirens of theambulances like we do.

The accident has affected “only” two people. Two teams are working at the sametime. Universal blood is being transfused until their blood groups and Rhesus factor aredetermined. Whispering, I explain what very few people know. The hand of the surgeoncannot operate before the anti-shock and replacement effect of the transfused blood begins.Every surgical intervention is related to inevitable new blood losses! In the battle between lifeand death, the battlefield is, directly and indirectly speaking, “stained with blood”. I drawaside and lead my group that has “become lost for words” into “calmer” waters. On the wayout, I open one by one the doors of the hospital rooms for them. Here are the results of the“successful” battles – limbs, stretched into extensions, plastered parts of tortured beings. Iam too hard-hearted for a guide, am I not ? ! No, I am not! I am just wondering when thedriving tests will end with such educational visits!

It is time to give my “tourists” a little break, but we cannot easily skip the oncologyclinic nearby. I solemnly swear that there will be no more operating rooms. We are headingtowards the internal medical ward. Along the corridors we meet weak elderly figures withpale faces and headscarves. Here, after the end of a surgical treatment, they are furthertreated with chemotherapy or only with it should the cancer be inaccessible. The doctor incharge greets us with a smile and to lighten up the tense atmosphere overloads us withoptimistical results of the treatment carried out. The difficulty comes from the fact that themedicines, which destroy the “aggressive young cancer cells”, also affect, however to alesser degree, the patient's blood. Several liters of blood and at least 10 doses platelets areneeded for the treatment of one patient only. The problem is where do we get them from?!Sometimes these are lonely elderly people! Should we leave them to the mercy of faithwithout lending out a helping hand? Isn’t this the same as if they are buried alive? And theresults from the treatment, as we have already heard, recover lost health, if not completely,then to a sufficient degree. Without realizing it, we begin thinking about our own“hedgehogs”, which nature has given us in excess!

We say thank you and we “slip” outside. We are welcomed by a lovely spring sun. Lifeis good!

We do not want more ambulances and head out to the base on foot.The shady boulevard takes us to the city center, far from the noisy transport artery. At

the even shadier square, mothers are slowly pushing strollers and are taking their childrenfor a walk. Some of them are trying to walk!

Under the hospitable crowns of the plane-trees many café tables allure our eyes. Wecheerfully cross the kingdom of calm and set off, not too excited, but firmly resolved to followthe planned scenario until the end. Even though now it seems to be “the harrowing of hell”.

34

“WHEN THUNDER STRIKES, HOW THE ECHO DIESAWAY”

It is quiet at the reception of the blood donation ward, but there is a sense of tension.The looks! We are met by a flock of worried looks. The news of a beloved one or a commonacquaintance, who has suffered a misfortune, has struck these people as thunder from aclear sky.

The door opens. A woman with a desperate look comes out. Not fit for a blood donor!What now? She does not lose time. She rushes outside to search for friends and relatives.

The door opens again. It is followed by tense, inquisitive looks as if this is acompetition. But a completion, in which life has to win! He is fit, but is not the same bloodgroup! The “white coat” reassures him that since they are many, he will be able to make atrade and takes him to the “donation room”. His pace is hesitant, but his feelings win overand he enters together with the nurse.

They find time to invite us as well into the waiting room for those people who havealready donated blood. Their sleeves are still rolled over the arms, temporarily tightened by abandage. They are offered a refreshing snack. They do not feel like it. The worry and tensionabout the fate of the beloved ones do not leave their faces. They are in a hurry to know! Theyare delicately held in the room. After all, this is the first time they are donating blood. Thereflex replacement of the donated blood by the reserve blood requires a little peace andmonitoring. They stay distrustful because they do not feel anything, but the “white coats”don’t want even the slightest percentage of some temporary indisposition to cast a shadowover the hundred-year reputation of blood donation as a harmless act. The minutes havepassed and the impatient ones leave, seen off with gratitude by the accompanying staff. Thetension stubbornly persists. The door opens and new “rolled up” sleeves go in.

My “tourists”, shocked by the final of today’s “walk”, want to take part in the blooddonation. Surprisingly I refuse with the argument that they are not completely ready yet. Thiscourse is aimed higher. Blood donation due to “specific feelings” and for “a specific case” isnot the highest form of humanism. Sometimes it is even dangerous for the injured person. Intheir strong desire, in order for them not to be rejected, close friends and relatives sometimesconceal illnesses and circumstances, which can cause harm, instead of providing help…

My explanations cease because of an approaching cry from a siren which stops infront of the building. I lead them to the expedition. We go in together with the greenishbundle, containing the next written demand “for life”. It is the insatiable operating roomsagain. The door of the chamber opens for the umpteenth time...

On the faces of my “tourists” I see shadows of overexertion. I realize that theencounter with human misfortune that slightly opened the curtain to our daily lives could turnout to be too dramatic even for “thrill seekers”. I invite them for a cup of tea a little furtherfrom the “conveyor”, in the staff “recreation” room, which for some reason is empty. We helpourselves and “park” chaotically around the block table with colorful tablecloths. The sips ofrefreshing fluids and the “calm” atmosphere gradually decrease the tension and encourageme to continue the story of the endless series of suffering, which fate can put on everyone’scourse of life.

I remind them that today’s “harrowing of hell” is in fact within the boundaries of themost ordinary blood donation and blood transfusion ward56 in a district hospital. But it is the“forefront” of the battle for saving the lives of hundreds and thousands of people, who aresuddenly in need of help. Here and now. In the closest operating room. To the closest“pharmacy of philanthropy”, from which one can get the life-saving fluid, provided someonehas stretched out a helping hand to donate it.

56 Transfusion Hematology Departementr at Multiprofile Hospital for Active Treatment 35

Deep in the “rear” are the large centers with considerably bigger possibilities andtechnology. They are designed to answer the needs of specialized medical institutes in thecountry. The needs which are also large-scale. For a single cardiac surgery, besides theblood, the cardiac operating room also requires 6 “doses” of platelets. In burns cases,besides big quantities of plasma, the staff needs 20 more units of them. In organtransplantations their quantity increases to 30 and for bone marrow transplantations itreaches 120. Yes! 120!!!

Once again the tension and bewilderment shows on their faces! They bombard mewith questions. I need to untimely start a new chapter on the subject of philanthropy. Toreveal the secrets of “saving” in blood transfusion. To remind that the catchphrase “Evenalone, a warrior is a warrior!” is also valid in the medical practice. In the so called “componenttherapy” because the different patients need different blood compounds. Even “overloading”them with the rest of the components could do harm. In some cases, the “war is waged” onlythrough the multimillion army of the red blood cells “concentrates”, in others through plasmatransfusion, and in third cases through the specialized quick reaction forces of the well-known blood “hedgehogs” – the platelets. What follows is the imminent question – could wealso “isolate” the required quantity of them on the spot? Yes, we can, but at the rate of atablespoonfull from one sack of donated blood, and for the preparation of a single active“dose” we need at least 6 such “tablespoonfulls”. On their faces I see how their personal“computers” begin to work: One dose platelets is derived from 6 sacks of donated blood! The120 doses (times 6) required for a single bone marrow transplantation – from 720 blooddonors! Oh, my God! Oh, my!

However, the balance ends with: a life free of leukemia! And what if in this “case” itconcerns your own life or the life of your child?!

I have to reassure them once again, but it is obvious that the “excursion” has tocontinue at the “upper floors” of philanthropy. Together with my memories, I have to transferthem as in a “magic carpet ride” to the blood donation center in Baltimore, which providesblood and blood compounds for Washington and the Institutes of the U.S. Academy ofScience in Bethesda that are situated some 60 km away. Together with a colleague of mine,I am invited by the U.S. Red Cross to discuss the problems of the bone marrowtransplantations. Right now I am heading out to the ward57 where, with the help of specialequipment, doses of platelets are being donated. It uses the simple principle that each bloodcompound is of different weight. The machines are “smart” centrifuges, in which a stream ofblood from the donor enters through an inlet. Its compounds are divided. The desired part isdrawn out and the rest is returned back to his/her organism. Through the swing door weenter into a spacious room. It is furnished with 12 ergonomic lounge chairs, on which thedonors are sitting comfortably. Next to each of them, as a “bedside table”, is the respectivemachine to which they are connected. In front of them is a television with a DVD on. Some ofthem are watching a movie; others are speaking with one another. The accompanyingcolleague satisfies my curiosity and asks one obviously bored donor how he feels. He looksat him with amazement and wonders how he knew he had troubles on the stock market;maybe he has some problems of his own? With shared smiles we clarify themisunderstanding. I realize it is best to answer the questions myself. My next question iswhether I could also donate “a portion” of platelets for those in need. We have to contact the“head” of the department. Oh, yes! But right now it is not possible. The lounge chairs arereserved for two weeks ahead. When she learns that I come from distant Europe, which shehas a great desire to visit, she makes additional checks. With a victorious smile she informsme that I am lucky. Someone had asked for his appointment to be moved at a later date.They ask me if I have donated blood before. I explain that I am a regular donor and calculatethat I have already “shed” over 30 liters. And again I get the friendly smiles. I am one ofthem! I anticipate the next question and add that I have not taken aspirin. They accompanyme to the laboratory and get the sample to an autoanalyzer. We do not waste time waitingand continue the walk, which takes us to the next ward for donating blood plasma. And it is

57 For apheresis 36

again a spacious room with more than 12 lounge chairs. Here the “crowd” is even bigger!The reason, however paradoxical it might sound, is that the needs for plasma areconsiderably bigger that the ones for erythrocyte concentrates. Not only because plasma hasa wider application, but because it is also a “raw material” and vital agents for the medicalpractice are made out of it. Here the medical “economy” is involved again. If we get plasmafrom blood that has been donated directly, after we separate and gather the necessaryquantities, there can still be an excess of erythrocyte concentrates. With the development oftechnology and the opening of plasma donation, the desired balance is achieved. Moreover,while blood donation is made after a two month pause, liters of plasma can be donated everymonth. After all, 90% of it is water and the proteins and minerals contained in it are naturallyrestored with food.

In fact, besides the talk about these problems, there is nothing new to be seen. Nextto the lounge chairs there are the same “smart” centrifuges, which are switched to separatethe plasma and to return the other blood compounds to the donor. I am being informed thatmost of the plasmapheresis sectors belong to the respective pharmaceutical companies.

We have some more time and head off to the blood donation center. Again, smilesare everywhere. The atmosphere is cheerful. Not a single worried look. No tension. No oneworries about anyone.

Even though I can guess what the answer will be, I ask a smiling man of my age, whois looking at me, who he is donating blood for. Who for? How should he know? Isn’t that thejob of the doctors? They know whom to give his blood to. I can also see bewilderment on theface of the colleague who accompanies me. I am trying to explain our practice of donation byclose friends and relatives when blood is needed. He cannot understand at all how I amgoing to “rush” into donating blood for someone when I learn this person has got injured! Andhow will it help him/her when at that very moment it has to be tested, processed and ready tobe injected in his/her vein?! This is a preparation that requires a day, sometimes even more!

Obviously even the most ordinary American knows the fate of the blood he donates.Its erythrocytes “head out” to replace a blood loss. The separated plasma, if not directed tothe veins of a burns victim, is poured into the common “pot”, where, when it has reached acertain tonnage, it turns into numerous irreplaceable medicines. In fact, everyone stretchingout a helping hand is donating life-giving fluid which is divided into streams, whichparticipate in the restoration of the life of not one, but often of several people in need. That iswhy they do not ask where the blood will be used but instead are left with a sense of fulfilledduty to humankind.

We are told that the results from my test are good and the lounge chair is free.Please, take a seat!

I make myself comfortable and extend my hand. I observe the manipulation carefully.I am amazed. Obviously the staff working at blood donation centers around the world areequally good! I felt only the puncture of the needle and no pain. Of course, the wonderfulmaterials, from which the modern blood-letting systems are made, contribute to this. Not tomention they are sterile and disposable, which rules out the possibility for transfer of anyinfections. I am told that the “vessel” in which the material will go is also individual.

I feel all right. The difference from the regular blood donation is that the automaticcollection of the 6 “tablespoonfulls” of platelets takes more time. Enough for me to watch amovie. They offer me all possible genres. Starting with the traditional action movies andgetting to the romantic stories and music mixes. Smiling “in sync” I politely decline. Hereeveryone is smiling! Smiling is contageous. As if I am not at a blood donation center, but inthe kingdom of smiles, politeness and cordial manners. I said 'no' to the movie because itwas clear that the colleague “attached” to me has no intention of abandoning me into thehands of the “fairies” who monitor the donation process. The professional talks are yet tobegin.

With the typical American love of shocking numbers, he pours at me statistical data.Blood transfusion is needed every 4 seconds in America. Four doses or about two liters ofblood are needed on average to restore the health of a patient.

37

The growing need surpasses the 13 million doses of blood donated annually. These figuresdo not include the need for platelet concentrates at the cardiac operating room fortransplantations and for cancer treatment. They do not include the vital plasma agents. It wascalculated that 85% of the people will need a blood transfusion within 75 years.

The “cannonade” quiets down for a moment. It is obvious that it is spread through allinformation sources on one occasion or another. Yes, it is true! – modestly confirms thecolleague. Otherwise, how would we be able to depend on people’s sympathy?

During the pause I find the courage to inquire about the issue of paid blood. He looksat me with astonishment and replies abruptly:

“There is no doctor in the U.S., who will agree to make a transfusion with such blood!”He asks me even more astonished if I am familiar with the statistics that testify of 50%

more complications and transfer of unwanted infections and diseases upon transfusion ofpaid blood?!

I know this, of course. But what and how am I supposed to explain to him about theblood trade in our country! I feel that I am “blushing”! I hope this does not show on my face.After all, right now my blood circulation is under control?!I get out of the awkward situation by changing the subject to the blood tests beforetransfusion. It is my turn to be amazed! They are exactly twice as much and much morereliable than the ones we make, despite their blood donation being a 100% gratuitous! I amat a loss for words!

My colleague is curious to learn something more about blood donation in our country.Our talk continues under the noise of the periodical clicking of the equipment controlled bythe member of staff on duty who unplugs me from the system after its final signal. I feelperfectly well, but they are not in a hurry to “kick me out” of the lounge chair. They give me athank you document about the donation and another one for excusing my hours of absencefrom work. On the way out they give me a book of tickets for the subway and attach to mysleeve a round “sticker” with a readable, creative inscription “TODAY I DONATEDPLATELETS FOR THE FIGHT WITH CANCER!”

Before we realize it, the work day is over. We meet again with my female colleague,whose interests are slightly different, and we head out to the subway. It is the rush hour. Allthe seats on the train are occupied, so we hold on to the closest hanging “hand-straps”. Aftera few seconds some of the people sitting around suddenly get up and offer their seats. Not tomy lady colleague, but to me! It is embarrassing and I wonder how to get out of this awkwardsituation?! And suddenly I “snap”! They have seen from the sticker that I had given plateletsfor the fight with cancer. Oh, my God! The Americans stand up to give me, the unknowncitizen coming from who knows where, their seat!

My “tourists” are holding their breath! And suddenly they also stand up!I also rise to my feet, in order to join this symbolic homage to humanity!They thank me with warm handshakes and I let them go. On the way out, they are

seen off by the row of posters with the white swallow of hope and the cry common to allmankind “My god, there is too much pain in this world!” As always we remain at our post, where the lines between day and night are so“washed away” that in time you get used to it and stop paying any attention. Even though thedifference is huge, for you it becomes “all the same” – whether you are at work for some“from – to” hours or whether you are awakened by the alarming ring of the telephone. Evenwhen you splash your face with cold water to wipe away the pitiful remains of the sleep, youare worried not so much about the “stress” you have just experienced, but about the thingsthat wait in front of you. Under the silent light signals of the ambulance car, you once againrealize that in order to save a life in danger you don’t have to count on your own hand, like asurgeon, but on the philanthropy of others.

38

AN ENIGMA CALLED PHILANTHROPY!39

Medical statistics show clearly and unequivocally that if only 5% of the people in theworld donate blood, the demand for blood and blood compounds will be fully met for allmankind!

But how do we find them, how to make these five percent stand out? Without a doubt,they are everywhere among us. Nevertheless, I feel color-blind58. As if the number is writtenin dots of the same color and I cannot tell it apart from the rest of the dots in different colors.Maybe Diogenes59 was also color-blind, when he was searching with a lantern for the Humanamong the people?

The idea of the lantern possesses me. If I also take it symbolically, will I be able tosolve the enigma that excites me so much as a doctor and moves me from a pure humanepoint of view?!

This reminds me of the border I had to cross in order to participate in a congress ofthe blood-donor-associations in neighboring Greece. While the border control checks weretaking place, I had a look at the materials I had prepared. Maybe because I was at theborder, among the comparative columns with data the differences stood out even more! Howis it possible that our border town “struggles” because of a blood shortage for its own citizensand tries to compensate this with indecent trade, and just a “stone throw away” from herethere is a Greek town full of volunteers? It is unacceptable for the difference to be hidden inthe soil or in the border barrier! Obviously there should be another, invisible line?!

I cross both and I am hugged by my friends on the other side. We take offimmediately. We find the hall full of delegates. I ask them not to put me in the presidium butnext to the interpreters who wait for me. Stavri is an economist, married to a fellow student inBulgaria, and the charming lady engineer next to him is just his opposite. What they have incommon is that they are both blood donors.

They interpret for me a multitude of amazing facts. I am familiar with the blooddonation practices in most countries in Europe, USA and even Japan.In those countries it isnot only done without compensation, but it fluctuates insignificantly within the universal 5%(50 per 1000 people). However, the statement I hear at the moment makes me stand on myfeet together with everyone else. In the town of Feres the blood donors are 200 per 1000 ! ! !Is this perhaps an “epidemic”? Is there a “virus” of philanthropy?! Another enigma is added tothe one about the borderline!

I sit down with mixed feelings because I am once again overwhelmed by thenightmare I had on my way to the National Center of Transfusion Hematology in Sofia. Closeto the sidewalk a young woman was walking unsteadily and as a doctor I could not pass herby without helping. She could “collapse” any moment on the ground. Gripping my arm, shesuddenly burst into tears. I try to console her. Little by little, I understand that her child isabout to have a heart surgery and she has to provide blood for it. She turned out to beunsuitable, her husband donated some, but it was not enough. They have told her to go tothe “market” next to the National Center, where the blood traders are circling like “vultures”.They are armed with mobile phones, organized as drug lords. They have asked her for animpossible amount of money. She had to bargain with them to reduce the price. Theyanswered: “How much do you value the life of your child and can you afford to be stingy?”.So she ran away terrified. Back then I swore to myself! Until the end of my life, however shortit might be, I will fight with “tooth and nail” against them and the rotten system that createsthem!

The interpreters, puzzled at the temporary “switch off”, are worried. I try to reassurethem with a “wry” smile and began listening to the debates again. The main problem is howto extend the movement. How to attract followers.

58 Person, who cannot distinguish between colors. 4059 Ancient Greek philosopher

At the end, I am also invited to say a few words. I look around the auditorium, whichawaits my speech with curiosity, and to the interpreter’s horror I drop the preliminary“agenda” and begin to speak on the subject that interests me at the moment.

I inform them that I have participated in many international scientific congresses, but Ihave never been to a

CONGRESS OF GOOD PEOPLEThey become all ears. I am instantly motivated. Could we call with a different name

the people who, without asking for whom, lend out a helping hand? Isn’t this in fact theultimate philanthropy?!

I am being applauded! I also applaud them!The question is, I continue, how to convince the bystanders to follow our example?

How to neutralize the natural anxiety from the first step towards this?It has been proved dozens of times that donating doses of blood is harmless.

However, only two need no support by figures and scientific arguments.For a century millions of people in the world have been donating blood and no one,

nowhere has ever heard of anyone who suffered by this. On the contrary!And secondly, the doctors who know best the functions of the human body are blood

donors themselves.They applaud me again. By the time they quietened down a surprising argument

comes to mind.You probably know – I turn to the auditorium again – that the average life expectancy

for women is considerably higher than it is for men? The closest explanation that comes tomind is that nature has given them this advantage because they reproduce the human kind!Undoubtedly! However, nowadays, when it is already known that blood donation in dosesstrengthens the defensive mechanisms of the organism we can make one more assumption.The women in their active age are the ones that each month naturally “donate” blood. Maybethis is what raises the “bar” of their immunity and complements the lack of “equinox” betweenmen and women!?

The auditorium starts “buzzing” like a beehive. Even I am bewildered by my idea.What we as men are left with – I continue after they quietened down, - except to catch

up with them while they do not lag behind and continue to get younger!I leave the chair together with the interpreter. We are surrounded by a crowd and a

bilingual noise.

PHONEY CIVILIZATIONAfter the congress, we retire with our friends to exchange views. They are interested

in our problems and are willing to help. I tell them with bitterness how with the establishmentof market economy, the belief that one can trade in blood started to “reign” in our country. Noone “rushed forward” to say that in the countries with the most developed market economiesit is forbidden by law because the commercially-oriented blood trader covers willfully pastand current diseases and vices. Instead, we started to reassure ourselves that we haveintroduced the tests that diagnose the most dangerous of them. Without openly explainingthat in other countries, where they use twice as many and much more sensitive methods,they cannot exclude the so called “window” periods during which the infection is present butcannot be determined. We conceal that the main requirement for the blood to be safe is for itto be provided from safe, selfless donors!

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I explain how in our region we have organized a Mutual Aid Blood Donor Fund “Idonate today in order to get help tomorrow.” Every healthy citizen can join it by signing acontract and by donating gratuitously blood, which later on, if needed, the Fund shall providefrom other members for him/her and for close friends or family that he/she had indicated. Inthis way, driven by humane reasons and because of their personal and family interest,hundreds of citizens have joined it after its purpose was explained to them. Unfortunately, itsbig potential could be realized only if it extends on a national level.

They share my excitement and mention that in the past they had similar misfortunes,but the state has taken the control in its own hands and with the help of public organizationsthey have reached the current success. They have no doubts that as an EU member, we willalso implement national measures in our country for the liquidation of this medico-socialparadox.

The conversation calms down. We discuss future possibilities. They offer theirexperience, but also expect a reaction from us. I feel their sympathies that as a man ofscience I have devoted myself to purely practical problems. I promise I will use their sharedexperience, but I will also think of a joint project for both sides. We part cordially.

I am again at the borderline. Hopeful, but without having solved the enigma.

YOUNG PEOPLE – THE STEM CELL OF HUMAN SOCIETY On my way back, possibilities unfold in my mind as a kaleidoscope. It all started

under the auspices of the great organizations of the Red crosses and crescent, which as theconscience of mankind also sheltered this highly humane task. Today hundreds of blood-donor associations from all over the world have joined their efforts. How can we walk thebeaten track faster and even search for new roads to philanthropy? Where is the key tosolving the problem? Where? Where?

And suddenly I go back to science! To the omnipresent stem cell. The young peopleare the stem cell of human society, are they not, the one that immortality and possibilities foruniversal development are hidden in. It should get help in order to help philanthropy grow!

From here on, it is a pleasure for me to take on this task. I develop a project foreducation of young people. Together we decide to organize a transborder youth movementfor voluntary gratuitous blood donation “Good-hearted brothers and sisters “. It will includethree age groups. The youngest joined by the desire “I want to know, so I can be ready” willparticipate in a children’s drawing competition on the subject: “Blood donation – source ofphilanthropy”. The essay competition for the next group will be under the motto “I know and Iam ready”. The eldest will participate in a popular quiz on blood donation and bloodtransfusion under the logo “I know, I can and I donate from the heart”. The idea is as follows:if they are convinced in this manner, to join the voluntary blood donors when they grow older.The project is approved by the blood donor associations in Haskovo region and in theneighboring Evros region and is already effective.

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With a drop of your blood save the flowers of life - the children in needGergana Naneva, V grade

Blood is priceless, just like friendship, love and life!

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Is it not a wonder?!Your blood pulsating in somebody else

Bringing back the life to himAnd the faith in good

To resurrect the innocent and pure laugh of a child To brush away the tears of devastation from the face of someone’s mother

WHAT ARE YOU GOING TO SAY, D I O G E N E S?

Is it really time to turn off the “lanterns” after the VII-th grade student Gabriela wrotethe above line in her essay “Blood donation – a source of philanthropy”?

Or could we do so on the grounds of the V-th grader Gergana, who won a prize onthe same subject?!

I am sorry you could not share the excitement I felt when, after a talk about blooddonation in front of Bulgarian students from the higher grades, their idea burst out like ageyser of philanthropy - in the days, dedicated to the Bulgarian Christmas, together with thetext messages for the needy, to stretch out a hand that gives life. An initiative that lead the“Good-hearted brothers and sisters” to the forefront of the national humanitarian wave.

It was amazing. To watch how youth and beauty intertwine with philanthropy. How theBlood donation ward, filled with noise and laughter, could hardly welcome the coming youngpeople?

They were coming in as if it were a party. But a party, unique in its humanity. In frontof me, stands Daniella with a box of chocolates to treat me for her 19th birthday which shecelebrated by donating blood. It turns out she is not the only one. Two months ago, Ivana didthe same, on the same occasion. She feels great and now she is again a part of the blooddonor group. Lively groups form here and there, from the Language High School, theMathematical High School and the Vocational School in Woodworking, who wait and rush fortheir turn to donate. They are joined by Nikola from Paris, a volunteer in the Youth Centerprogramme.

Little by little the lively noise dies out. They go home with the promise to come againfor the Bulgarian Easter. The echo resounds after them. As a slogan for a new poster:

“My God, there is so much hope in this world!”

I have no more to say. I put down the quill with a feeling that I have fulfilled my dutyas a doctor, a blood donor and now, as an amateur writer.

The feeling is great!2009-2010, Haskovo, Bulgaria, EU

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TABLE OF CONTENTS

INSTEAD OF A FOREWORD ................................................................................................1THE STORY OF BLOOD IS EVERYWHERE .........................................................................2THE STAIRS OF SCIENTIFIC KNOWLEDGE........................................................................5THE SECRETS OF THE ICEBERG .......................................................................................6DEPTH PROBE......................................................................................................................7HIGHER LEVEL – ONLY FOR THE MOST CURIOUS...........................................................9OPEN SESAME! .................................................................................................................. 10WOULD YOU BELIEVE? .....................................................................................................12SAFARI IN THE BLOOD-GROUP JUNGLE .........................................................................14THE TRUTH AND ONLY THE TRUTH… .............................................................................16ALCHEMY OF THE SCIENTIFIC WORKS ...........................................................................17WHAT DO WE KNOW AND WHAT IS IT THAT WE DO .................................................. 19NOT KNOW ABOUT OUR OWN BLOOD?........................................................................... 19THE FEDERAL REPUBLIC OF THE BLOOD.......................................................................20THE RIVER OF LIFE............................................................................................................21THE RED ARMY OF BLOOD............................................................................................... 21THE BLOOD HEDGEHOGS.................................................................................................23THE WHITE ARMY ..............................................................................................................24THE KEY OF LIFE ............................................................................................................... 27THE STORY OF A POSTER................................................................................................ 31“WHEN THUNDER STRIKES, HOW THE ECHO DIES AWAY” ...........................................35AN ENIGMA CALLED PHILANTHROPY! ............................................................................. 39PHONEY CIVILIZATION ......................................................................................................41YOUNG PEOPLE – THE STEM CELL OF HUMAN SOCIETY .............................................42WHAT ARE YOU GOING TO SAY, D I O G E N E S?.......................................................... 44

ТHE STORY ABOUT T BLOOD GROUP,BLOOD AND PHILANTHROPY

Petkan Prodanov

The front cover, posters and fig. 2-7 are arranged by author’s ideas. The cartoons are taken fromadvertising edition of Dade Reagents Inc. & Merz + Dade Inc. and fig. 8-14 are from Wikipedia,

Internet.

First edition2011

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