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by
Rose George
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November 2 - November 16, 2025
The iron in our blood comes from the death of supernovas, like all iron on our planet.
Blood is one of the three main diagnostic tools of a doctor: the others are imaging and a physical exam.
No one knows where blood is made. The answer is: bones, mostly. Inside the bone, in the marrow,
The bone marrow produces two million red blood cells every second. It produces pluripotent stem cells that can become any cell, and red blood cells with no nucleus that can slink and slither through the tiniest of capillaries.
Daily, the blood’s thirty trillion red cells do a full circuit of the body, traveling about twelve thousand miles, three times the distance from my front door to Novosibirsk. The circulatory system of veins, arteries, and capillaries is about sixty thousand miles long, twice the circumference of the earth and more.
We have discovered that blood types can correlate with geography or ethnicity or a particular threat. Forty percent of Caucasians have type A blood, but only 27 percent of Asians.19 The fact that O-type people are more susceptible to cholera was first noticed in 1977. During Peru’s 1991 epidemic, people with O blood were eight times more likely to be hospitalized.
Why we have blood types, why they developed differently in different places at different times: we can still speak theories only in an undertone, not with certainty.
This is not rational. Common sense and blood sometimes repel each other. The Nazis, obsessed with the purity of blood, decided A was Aryan; B was inferior.
The Japanese even now believe that blood type involves far more than what antigens are on the outside of each blood cell. A types are perfectionist, kind, calm even in an emergency, and safe drivers; Bs are eccentric and selfish, but cheery. Os are both vigorous and cautious while ABs, obviously, are complicated.
Our knowledge of blood is wide and unfinished.
White blood cells are removed from all donations—a process called leukodepletion—because it is in white cells that many infections travel, including the prions that cause variant Creutzfeldt-Jakob disease (vCJD), a vile and violent affliction that anyone growing up in the 1980s will visualize as piles of burning cattle and skeletal humans who fall when they walk because their brains are degenerating.
Safe. A blood system that is safe. Governments repeat this as if it can be true, not aspirational. But safety is a relative concept. Blood is a biological product and can never be safe because we can’t plan for the next Zika or Ebola or HIV, until it comes.
They are filled with bags of plasma that should be yellow but isn’t always. My plasma, probably, is green. I’m female and menopausal and taking hormone replacement therapy, and all those factors—along with the contraceptive pill—turn women’s plasma green. Off and odd-looking. They don’t know why, and it doesn’t really matter, as all female plasma is discarded anyway, since NHSBT introduced a policy of “male donor preference” in 2003.
A nation-state needs 1 to 3 percent of its population to give blood to maintain an adequate blood supply,36 the higher the better.
I have grown up in a country with one of the best and safest blood supplies in the world. I have been spoiled. The scientific wizardry of Filton; the efficient blood donation and delivery system. That is not how much of the world gets its blood.
They shouldn’t accept my blood anyway: like anyone else who was born in Britain or living there before 1996, I am a global pariah. Until a cure is found for variant Creutzfeldt-Jakob disease, whose infectious prion particles can live for years undetected in our bodies, my blood is considered unsafe anywhere outside my island.
Altruism, that most obvious motivator (sociologists actually talk of a “warm glow” effect), turns out to be more complicated than we think: countries that have non-remunerated volunteer donor systems can have wildly different rates of donations. In Luxembourg only 14 percent of people give blood; over the border in France, it’s 44 percent. Nor do rates of blood donors match rates of other types of volunteering, which you’d expect if blood donors were just nice people wanting to do good. Instead, as economist Kieran Healey found, what changed donor rates was what kind of institution was
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Retention is what blood authorities dream of. Perfect donors are the ones who come back. They require less testing; they can be relied upon.
The donor base is aging, and younger people are giving less blood.
Southern states routinely segregated “white” and “black” blood. Most admitted their policies had no scientific basis. The Red Cross, which refused donations from African Americans for plasma collection, called its reasoning “a matter of tradition and sentiment rather than of science.”58 The US War Department directed that “for reasons which are not biologically convincing but which are commonly recognized as psychologically important in America, it is not deemed advisable to collect and mix Caucasian and Negro blood indiscriminately for later administration to members of the military
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Antigens and antibodies commoner in black people’s blood make it more appropriate for transfusions for sickle-cell anemia, for example, a genetic condition that produces deformed red blood cells
Black donors are more likely to have the Ro subtype (a version of the rhesus group), and Ro blood is more likely to be used to treat sickle-cell anemia. But only 2 percent of the British population has it.
By Avicenna’s time, the job of bloodletting could be done by medical men but also by barbers. They were used to sharp instruments, and a papal decree forbidding monks from performing medical tasks meant monastery barbers began to diversify into doing small acts of surgery. This practice spread, so that barbers became instead barber-surgeons and formed a guild.
The bleeding barber is the reason modern barbers display red and white striped poles: the pole was a stick for the patient to grip; the white stripes were the bandages, the red stripes the blood. The ball on the top was probably a deformation of the blood-gathering bowl.
Barbers were bloodletters until surgery was established as a profession; there were tussles, and King George II finally put an end to the rivalry by setting up two separate guilds in 1745.26
When they were abundant in European marshes and ponds, leech gatherers would walk bare-legged through ponds to harvest them.
It was an honest occupation but not poetic or bucolic. In France, it was known as “blood fishing.”
The occupation paid badly and was confined to the poorest and most desperate, and it was doomed: by mid-century, the native western European leech was getting scarce.
Airlines are another trouble. There aren’t many medical devices that are alive, so while leeches are medical devices, airlines treat them as livestock, and they don’t like carrying livestock. Some airlines are better than others at keeping their hold temperatures cool in the summer. Boiled leeches are always a possibility.
By all these accounts, persuading a patient to undergo leeching is no more problematic than offering a needle.
Disgust is why the leech has been perverted into a symbol for malignity, parasitism, evil, and corruption, so that its secondary dictionary definition after “parasitic or predatory annelid worm” is “a person who extorts profit from or lives off others.”
I’m not sure, given all the use and abuse that humans have made of leeches, who is the parasite and who the prey.
My favorite suggestion appears in an article in the Lancet of 1849 titled “Leeches Drunk Will Bite Till Sober.”
Plastic surgery nursing does not count as specialized, unlike oncology or midwifery. This is ludicrous, and Reynolds is indignant at it. Leeching is specialized. Not everyone can do it. It’s hard.
Why do patients agree to it? Because they have to. Only patients whose transplantation has failed are offered leech therapy, and the leech is the last resort.
I did not look up from my dinner plate at Janet Vaughan’s portrait and thank her for her role in helping to make blood transfusion standard medical practice. I should have.
In any developed country with good health care and blood to give, someone receives blood every two seconds, more or less.
Yet the system of widespread donation of blood by anonymous volunteers, and its transfusion into people who need it, dates back not even a century.
She saw lines of children sitting up in bed with rheumatic hearts, who would die because there was no National Health Service and good health cost money. She saw that poverty is deadly. “How anyone could do medicine in those days,” she wrote, “and not become a socialist I find hard to understand. What I hated most was people’s acceptance: ‘Yes, I have had seven children and buried six, it was God’s will.’ I hated God’s will with a burning hatred.”
The slums introduced her to politics—the best kind of politics, the kind that saves people—but also to blood, her lifelong scientific interest.
She kept her name, “not for any feminist reasons, but because I had already published several papers, and it seemed a pity to lose my medical identity.” Which is a good feminist reason.
She is angrier about the anemic patients she treated with liver who then said, “Don’t give me any more of that medicine, doctor. It makes me hungry and I can’t afford [to eat].”23 She taught her patients to fight authorities to get extra milk, for the extra iron it would give them. She taught her students that to practice medicine, they must learn to deal with the public assistance board, with bureaucracy, as well as with the hospital dispensary. I like her clear fulmination, which persisted sixty years after the young trainee doctor set out into the slums. I wish she were here to fulminate
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But the wartime spirit of comradeship did not survive the transition to peace, and the notion of an organized system of blood donation faltered.
When it came to storing blood, “the feeling in England,” wrote Victor Horsley Riddell, “is that this is carrying change too far.”58 Surgeons and doctors stuck to what they knew: blood should be used fresh if it was used at all. Fresh blood meant having the donor come to the patient, slice open a vein—the term was “cutting down”—and then convey the blood either by connecting the two veins (direct transfusion) or by using a syringe or pump to transfer the blood (indirect transfusion). Most donors expected money for their blood.
The donor pool was also reduced because doctors wouldn’t consider half the population. Women, the same surgeon believed, would present the “disability of nervousness.” Also, our veins are smaller. In the United States, male donors were preferred because doctors couldn’t bear to cut into a woman’s arm.
selling blood was one of the few sustainable industries in the Depression.
Blood altruism was praised in the press, but the sellers were dominant: even in the 1930s they were powerful enough to form a union.
At the Second International Blood Transfusion Congress in Paris in 1937, the London system, and the concept of a network of voluntary donor panels, was accused of being “hopelessly Utopian.”
Only the Netherlands and Denmark had followed the all-volunteer model of blood donation.
By the final years of interwar peace, there were all-voluntary systems around the country. The British Red Cross Transfusion Service had created a model that was successful and impressive.
