Blood bank notes: and passed urine “black as soot.

” Miraculously, the patient

History not only survived this hemolytic transfusion reaction, but
also appeared to be cured, showing “a surprising calmness,
l 1492-Pope Innocent VII drank the blood from 3 and a great presence of mind”
young boys in. Unfortunately, all died. The idea that
l Also, later in 1667, Richard Lower successfully
infusion of blood could be beneficial did not emerge
transfused a Cambridge University student described
until the 17th century.
as “cracked a little in the head” with sheep’s blood
l (c. 450 bc) - Time of Hippocrates disease was
believed to be caused by an imbalance of the four humours- FIRST HUMAN-TO-HUMAN TRANSFUSION
blood, phlegm, yellow bile, and black bile. Of these, blood
was the most important l After being banned for more than 150 years, the use
of blood transfusion was revived during the late 18th
l Late 18th century- The most popular treatment for century. The first human- to-human transfusion had been
most ailments was blood letting. Without the correct performed by Philip Syng Physick, the “Father of American
understanding of blood circulation, intravenous blood Surgery,” in 1795,
infusion could not even be imagined
l In 1816, John Henry Leacock,presented his
l 1628- This changed with William Harvey’s dissertation “On the Transfusion of Blood in Extreme Cases
description of the circulatory system. Harvey’s identification of Haemorrhage.” Leacock subsequently performed and
of separate yet connected arterial and venous systems in his published a set of ani- mal experiments that proved that the
De Motu Cordis paved the way for an entirely new arena of donor and recipient must be of the same species.
blood investigation
l Although Leacock apparently went no further with the
l In 1666, Richard Lower successfully transfused blood experiments, his work inspired James Blundell, an
from one dog to another, which led Samuel Pepys to obstetrician and physiologist to carry out additional
speculate on the potential benefits of human transfusion, investigations.
stating that “bad blood” might be mended by “borrowing”
blood “from a better body.” l Blundell began attempting human-to-human
transfusion in cases that were otherwise hopeless. Over a
THE FIRST ANIMAL-TO-HUMAN TRANSFUSIONS decade, he performed 10 such transfusions, all without
l June 15, 1667- The first published animal-to-human success. However, in August 1825, Blundell successfully
transfusion, by Jean Baptiste Denis, a physician to Louis transfused a woman dying from postpartum hemorrhage
XIV, on a 16-year-old boy who had been “tormented with a with blood from her husband. Other successes followed,
contumacious and violent fever.” The boy had been treated including 3 cases of postpartum hemorrhage, and a young
with multiple bleeds, following which “his wit seemed boy who was hypovolemic following amputation of his leg.
wholly sunk, his memory perfectly soft, and his body so
heavy and drowsie that he was not fit for any thing.” Denis l Significant progress in understanding the basis for the
attributed these symptoms to the bloodletting he had incompatibility between species was made by Emil Ponfick
received. As treatment, Denis exchanged 3 ounces of the and Leonard Landois in the late 1800s.
boy’s blood for 9 ounces of lamb’s blood. Denis chose
animal blood because he believed it purer than that of l 1st revelation came from Ponfick- observed red cell
humans due to man’s “debauchery and irregularities in lysis in the blood of a dead woman who received
eating and drinking” and reasoned that if man could use sheep’s blood. From animal experiments, Ponfick
animal milk as nutrient, animal blood would be safe. found that incompatible transfusions were associated
Following the infusion of lamb’s blood, the patient with hemorrhage and “congestion” of the kidneys,
complained about “a great heat along his arm,” but lungs, and liver. He also recognized that the red urine
otherwise suffered no ill effects that transfused animals excreted was caused by
hemoglobinuria, not hematuria.
l Denis subsequently performed such transfusions on
three more patients, the last of which resulted in the first l Landois’s observation that human red cells would
mal- practice suit for blood transfusion lyse when mixed in vitro with the sera of other
animals set the stage for the study of the immunologic
l Antoine Mauroy a madman who was brought to Denis basis of blood incompatibility.
after he was found wandering the streets in winter of 1667.
Mauroy had suffered for years from severe “phrensies,”
during which he would beat his wife, strip off his clothes,
DISCOVERY OF ABO BLOOD GROUPS
and run through the streets, setting house fires. At this time, 1901- Karl Landsteiner’s landmark discovery of ABO blood
blood was believed to affect one’s temperament and groups. Landsteiner, noticed that human blood mixed in test tubes
character; therefore, it was reasoned that blood transfusion with other specimens of human blood sometimes resulted in
could be used to treat mental ailments agglutination. By incubating red cells from some individuals with
serum from others, he identified agglutination patterns, leading to
l Denis’s patron, Monsieur de Montmort, proposed the initial identification of three blood groups, A, B, and C (C was
transfusing Mauroy to allay the “heat of his blood.” Denis later renamed O).
transfused Mauroy with calf’s blood, hoping that the calf ’s In 1902- Alfred Decastello and Adriano Sturli, two of
docile nature would be imparted to Mauroy. Although the Landsteiner’s former students, found the fourth blood group, AB.
patient complained of heat moving up his arm, he tolerated DISCOVERY OF RH BLOOD GROUPS
the transfusion well. A few days later, a second, larger ABO blood group typing was not sufficient to prevent many fatal
transfusion was performed. This time, however, the patient hemolytic transfusion reactions. In 1939 Philip Levine published a
complained of great pains in his kidneys, The transfusion report of post-transfusion hemolysis in a blood group O patient
was quickly discontinued, after which the patient vomited who received blood from her blood group O husband. Levine
found that incubation of the patient’s serum with her husband’s l 1915 - Richard Weil found that citrated blood could
red cells resulted in agglutination. The name of the offending be refrigerated for several days before use.
antibody came from parallel experiments conducted by
Landsteiner and Alex Wiener in which anti- bodies produced by l 1916 - Rous and Turner introduced citrate dextrose
immunization of rabbits and guinea pigs with blood from rhesus solution for perservation of blood. Dsadv: difficult to prepre
monkeys caused red cell agglutination of 85% of humans tested. and requires a large volume of preservative solution in
Those individuals whose red cells were agglutinated by these relation to the amount of blood. (only available through
antibodies were classified as rhesus (Rh) positive. most of WW2)
Levine was able to show that Rh antibodies were the main cause
of serious hemolytic disease of the newborn (erythroblastosis l Lewinsohn and Weil, as well as Rous and Turner,
fetalis). Later, it was appreciated that the Rh system is composed found that addition of dextrose to citrate would preserve
of numerous alleles. The current system of nomenclature—c, C, d, blood for up to 2 weeks. This permitted the first transfusion
D, e, E—was proposed in 1944 by Cambridge geneticist Sir
of stored blood in WWI by an American army physician,
Ronald Fisher.
BLOOD COAGULATION, PRESERVATION, AND Oswald Robertson who transfused 20 casualties on 22
STORAGE occasions during the battle of Cambrai in November 1917.
l Clotting remained a significant problem. A variety of Nine of the 20 recipients lived.
devices, involving valves, syringes, and tubing, were
l 1943 - Loutit and Mollison of England introduced the
invented to facilitate the collection and infusion of blood
formula for the perservative acid citrate dextrose (ACD), 3-4
from one individual to another, including two invented by
weeks storage, could be autoclaved, easy preparation,
Blundell—the “Gravitator” and the “Impellor.” The impellor
smaller volume of solution relative to the amount of blood.
consisted of a double-walled funnel in which the outer
compartment was filled with warm water. The donor blood l 1957 - Gibson introduced an improved preservative
flowed into the funnel, was sucked into a syringe, and was solution citrate phosphate dextrose. (CPD) solution was
forced along tubing into a cannula inserted into the patient’s subsequently adopted after studies showed blood could be
vein by means of two oppositely acting spring valves below stored for up to 28 days with better red cell survival than
the funnel ACD.
l Gesellius used an equally complex device, in which l Long-term red cell preservation by freezing began in
the donor’s back was lanced multiple times and capillary 1950, when Smith and colleagues showed that glycerol
blood extracted using suction cups could prevent freeze–thaw damage.
l James Aveling used a simpler method for direct blood Important dates:
transfusion from a donor using two silver can- nulae,
inserted into the recipient and donor, and connected by 1492 1st blood transfusion
rubber tubing with a compressible bulb in the middle to 1667 - 1829 Donation was banned
promote and sustain flow.The Aveling device is featured in 1628 Harvey Discovered circulation of
the first known photograph of an actual blood transfusion, blood
taken at Bellevue Hospital in New York City in the 1870s 1665 - 1666 Wilkins and Dog to dog transfusion
(1876) the first photo of blood transfusion. Richard Lower
1667 Jean Baptiste Denise Animals to humans
l In 1908, Alexis Carrel, a French researcher working 1795 Philip Syng Physick Humans to humans
perfected a surgical technique for the direct anastomosis of 1818 James Blundell Obstetrician; human to
donor artery to recipient vein.Although highly effective at human (post-partim women)
providing blood to the patient without clotting, performance
of this technique required tremendous skill. Further, it 1901 Karl Landsteiner ABO discovery, serious
required donors willing to undergo the painful procedure. It rnx’s w/ incompatible
was also impossible to accurately estimate the amount of transfusion, won Nobel
blood passed from donor to recipient; donors often became prize
hypotensive or recipients developed circulatory overload. 1902 Alfred von Descatello Human red cells designated
AB blood group
l Edward E. Lindenmann- Vein to vein by multiple 1907, New York, Dr. Reuben Crossmatching
syringes and speial canulla Ottenberg

Dr, Ludvig Hekteon of Checking of blood donors

l Unger - Syringe valve apparatus
Chicago and recipients for signs pf
CITRATE ANTICOAGULATION incompatibility
l 1869- Attempts to find a non toxic anticoagulant
began by Braxton Hicks, who experi- mented with 1940, Landsteiner and Weiner RH antigen system
phosphate of soda (sodium phosphate). Unfortunately, none Edward E. Lindenmann Vein to vein by multiple
of the four patients in whom it was used survived. syringes and speial canulla
l 1914 - Albert Hustin reported the first human Unger Syringe valve apparatus
transfusion using citrated blood,(sodium citrate as an
anticoagulant solution for transfusions) 1869, Braxton Hicks Sodium Phosphate as
anticoagulant
l 1915 - Richard Lewisohn proved minimum amt. of
citrate needed for anticoagulation (0.2% sodium citrate 1914, Albert Hustin Sodium Citrate
solution) was effective while having no toxicity in small
amounts, even when as much as 2500mL of citrated blood Rous and Turner Citrate Dextrose Solution
were transfused.
 for preservation of blood

1943, Loutit and Mollison Acid citrate dextrose (acd)

(England)

1957, Gibson Improved citrate-phosphate-

dextrose (cpd) less acidic

1936, 1st blood bank Barcelona, Spanish Civil

War

WWii Stimulated blood

preservation research

Charles Drew Developed techniques

1937, Dr. Charles Drew Appointed director for

American Red Cross Blood
Bank

1947 Blood banks were

established in the major
cities of America