Dr. Gerald Sandler stood at the delivery entrance of Georgetown University Hospital in Washington - waiting anxiously for a truck with type O blood.
Inside the building, three patients were losing lots of it - two in surgery and one with a medical emergency. They were quickly running through the type O stock, and Sandler, who's in charge of Georgetown's blood supply, called the Red Cross Blood Center in Baltimore for an emergency delivery. He was down to his last unit.
The Red Cross van was on its way from Baltimore, carrying an insulated chest stocked with blood bags. But traffic was backed up, and the van was inching along. Nervously, Sandler went down to the delivery entrance. "I was literally standing at the door to make sure the blood came directly in," he recalled.
The story ends happily - the truck arrived before the blood ran out, and Sandler got it to his patients, all of whom survived.
But what didn't happen that weekday in August easily could have, according to those who gather and distribute the region's blood supply. The Northeast and other urban regions face a serious, chronic blood shortage that could have disastrous consequences. Many officials warn that in the wrong circumstances - a disaster or an unlucky spate of accidents and surgeries - a hospital could run out of blood, and patients could die.
Behind the shortage is an unusual convergence of bad luck, bad planning and long-term medical and social trends. Among the causes: new restrictions on donors, the war in Iraq, a growing demand for blood, and anger at and suspicion of the agencies that collect it.
"If people think this is just crying wolf, they're wrong," said Thomas Scalea, chief physician of the Maryland Shock Trauma Center.
In August, trying to save an accident victim with massive hemorrhaging, Shock Trauma found itself down to its last few units of type O blood.
(A unit refers to any of the three products generated from a pint of donor's blood - about a half-pint each of red cells and plasma, and a half-cup of platelets.)
"I wondered, `Is this guy going to die because we don't have enough blood?' That's real," Scalea said. As it turned out, the hospital had just enough to treat the patient, who later died from his injuries.
Officials at the Red Cross and area hospitals say the shortage is the worst they've seen. "The last four to six months we have had a real problem," said Karen King, associate medical director of the Johns Hopkins Hospital blood bank. "It is a constant struggle to put blood on the shelves."
Blood donations typically ebb and flow during the year, and spot shortages aren't unusual. Often, the supply wanes over the summer and holidays as potential donors travel out of town or have other things on their minds. But the current drought extends beyond seasonal shortfalls.
"We have a half-day supply, and sometimes less than that," said Gary Ouellette, director of the Greater Chesapeake and Potomac Red Cross Region, which provides almost 2,000 units of blood daily to hospitals and clinics in Washington, Baltimore and most of Maryland. Ideally, he'd like a week's backup.
To make up the shortfall, the Chesapeake Red Cross imports blood from other regions. This is not unusual - because urban areas use more blood and collect less, they're net importers, particularly from rural areas, which tend to use less blood and collect more.
What's different now is the size of the deficit. So far this year, the Chesapeake region has imported 65,000 units of blood - 20,000 more than it imported during all of 2002. Imports now account for 15 percent of the region's blood use.
Another reason for the shortage: It's tougher to give blood. Over the past year, the Red Cross and independent blood banks established new rules and tests that have cut the potential donor pool by as much as 10 percent.
For example, concerned that the human variety of mad cow disease could contaminate the U.S. supply, blood banks here no longer accept blood from those who have lived in England for more than three months between 1980 and 1996, or from anyone who has lived in Europe for five years since 1980.
Donor centers are also testing for the West Nile virus and turning away donors who have been to SARS-affected regions such as Toronto, Singapore or southern China.
`Playing the odds'
While a few critics call these rules an overreaction, most blood bank officials say they're prudent and necessary. But even proponents agree that the rules have cut deeply into collections.
"We're playing the odds. We don't want a terrible disease in our blood supply. But these restrictions eat away at our base," said Joan Gibble, who manages the Chesapeake Red Cross blood supply.
With a large, affluent population that tends to travel for work or pleasure, the Baltimore-Washington area has been hit particularly hard by the foreign exclusions, Ouellette said.