The nuclear detonations in August 1945 at Hiroshima and Nagasaki (at 16 and 21 Kt equivalent respectively) killed at least 110,000 citizens immediately: an estimated further 130,000 died by the end of 1945. It is possible that somesurvivors of the immediate blast and radiation damage but who died in the following weeks may have been saved with the help of an effective supply of blood products for transfusion.
This paper explores the possibilities and challenges which would face the organisations involved in transfusing blood or blood products as part of the clinical management of survivors of a hostile detonation of multiple nuclear weapons, such as described by Helfand (2012).
Since 1945 transfusion services have become much more sophisticated in their science and practice; it may be that current organisations could give a better response in the 21st century than their predecessors in the mid-20th century. However, the reality is that in the face of the challenges of a nuclear conflict and consequent famine over wide areas, a complete breakdown of the provision of safe blood and blood products for transfusion must be expected. Indeed, there can be no adequate global medical response to even a regional nuclear war. So prevention is key and diplomatic efforts to secure a nuclear weapon free world as soon as possible are paramount and must start in a meaningful way without delay.