Immunohematology L1

Historical Perspectives prelims

BLOOD IN HISTORY Saline infusion was observed to be safer than, and
China, 1000 BC – soul was contained in blood frequently as effective as, blood transfusion.
Egyptians – bathed in blood for health Milk was advocated as a potentially effective infusion,
Romans drinking blood of fallen gladiators to gain strength because it was thought that the “white corpuscles of milk
and vitality and to cure epilepsy
were capable of being transformed into red blood
Ancient greeks believed that blood was formed in heart then
consumed as it flowed out to body in veins, while air was corpuscles.”
passed from lungs to the body in arteries Two instances of successful transfusion, both
Erasistratos (~270 BC) - envisioned the heart as a pump. administered during leg amputation, are documented
Galen (131-201 AD) proved that arteries contain blood, but from the Civil War.
thought that blood was formed in the liver, not suspecting
that arteries and veins are attached.
THE FIRST TRANSFUSION
(1492), Pope Innocent VII – said to received at the behest
of jewish physician, a transfusion of blood of three 10 years
old boys, and all of them died
Although the outcome was unsatisfactory, it was the first
time a blood transfusion was recorded in history
THE FIFTEEN CENTURY
William Harvey – british physician credited w/ the discovery
of the circulation of blood as we know it today 1930 NOBEL PRIZE LAUREATE
- De Motu Cordis (published in 1628) 1900, showed that serum from some individuals could
17th CENTURY agglutinate or hemolyze the red blood cells of certain, but
(1665) RIichard Lower - Credited with performing the first not all, other individuals.
successful blood transfusion (animal to animal) The serum of the latter would likewise agglutinate the red
- Kept exsanguinated dogs alive by connecting the carotid blood cells of the former. Still other individuals’ red cells
artery of the donor dog to the jugular vein of the recipient were unaffected by the serum from either of these.
dog with quill He named these three different types A, B, and C. Today
Christopher Wren and William Boyle - Performed a series of these are types
experiments injecting various medicaments into the veins of RBC PLASMA
dogs utilizing a bladder with an attached quill and the A A Anti B
observing the effects B B Anti A
- Infusion solution included wine, beer, opium, emetics, C to O O Anti A, B
water, nitric acid and sulfuric acid AB A, B O
Wills injected dyes into the blood vessels supplying the brain 1902
in order to trace its vasculature (thus the circle of willis) Sturli and DeCastello - described the fourth blood
group, AB
JEAN BAPTISTE DENIS 1939
Denis and Emmerez - performed a transfusion of lamb Levin and Stetson - describe a severe reaction in a
blood into carotid artery of a young woman in 1667 Type O woman given a transfusion of her husband’s
Denis did a similar transfusion on a 15 yr old boy and later Type O blood following a stillbirth. Her serum
a labourer both of them survived agglutinated 80% of Type O blood
Denis’s fourth transfusion recipient, suffering from luetic 1940
madness, following a symptom-free first transfusion. Landsteiner and Wiener - describe Rh typing
 Developed a hemolytic reaction upon his - This leads to dramatic decrease in the incidence of
second transfusion. hemolytic disease of the newborn.
 His madness seemed improved, so another - Over 250 different antigens categorized into 23 major
transfusion was undertaken which unfortunately discrete systems are now known
proved fatal
This incident led to a prohibition by the French Parliament
of further transfusion (1678)
The British Royal Society (1668) and the Vatican (1669)
had also laid prohibitions against blood transfusions
These prohibitions and the fear of adverse reaction led to a
150year long near complete hiatus in transfusion work,

18TH CENTURY
Transfusions were done only sporadically and were 1914
generally animal to human. Albert Hustin - Reported the first human transfusion
Transfusion was generally thought of as a cure for using citrated blood, he added sodium citrate and
mental aberration or as a youth potion for the aged, glucose to preserve blood
rather than as a treatment for blood loss
Reciprocal transfusions were suggested as a cure for Oswald Hope Robertson - First blood depot
marital discord - The introduction of citrate dextrose solution permitted the storage
Blood was thought to carry the characteristics of the of blood in containers for several days thus opening the way for
donor to the recipient: sheep blood would make a dog the first “Blood Depot” in Britain during World War I
grow wool, hooves, and horns; cat blood would make a - A medical researcher and US army offer who established the
girl feline, etc. depot is now recognised as the creator of first blood bank
1818 - World war I experiences led to the universal adoption of blood
James Blundell - Attempted human-to-human transfusion typing to select blood donors
of a man suffering from gastric carcinoma Rous and turner - Developed a solution of salt, isocitrate and
- He also successfully transfused a patient who had dextrose in order to both anticoagulant and preserve blood
hemorrhaged during childbirth - this method, with minor variations, was used through most of
Blundell’s transfusion devices included the world war II
 impellor - which consisted of a cup, tube, and Loutit and Mollison - Introduced ACD (acid-citrate-dextrose) as
syringe a preservative 1943
 gravitator - consisting of a receptacle held high - Was adopted by the Army in 1945 (1:4 solution:blood ratio)
above the patient with an attached tube through Dr. Charles Dew - An African-American doctor and scientist
- Work on blood storage and blood banks helped to save thousand
which the blood was injected into the patient.
of lives during world war II
19th - Developed ways to process and store blood plasma
1940
Transfusions in the 1800s were plagued by the
complications of transfusion reactions. Edwin Cohn - In 1940 he developed Cold ethanol fractionation
Panum and Landois showed that same species  first cell separator – 1951, Which allowed blood to be
transfusions were more efficacious than interspecies separated into red cells, white cells, platelets and plasma
transfusions.  Cold Ethanol Fraction - Process of breaking down
Landois - noted that in interspecies transfusion red plasma into components and products
blood cells were hemolyzed and white blood cells would 1936
cease their amoeboid motion and die Dr. Norman Bethune - During the Spanish Civil War, he
established the first blood bank at madrid
However, animal to human transfusions were performed
Bernard Faantus - At Chicago’s Cook Country Hospital,
as late as 1890.
established the first hospiital blood bank in the United States on
March 15, 1937.

pg. 1
Immunohematology L1
Historical Perspectives prelims
20th century PLASTIC BLOOD BAGS - Blood was collected into reusable glass
 Compatibility testing bottles in the first half of the 20th century
 Anticoagulant solutions - Pyrogenic reaction from contamination dues to incomplete
 Preservative solutions cleaning were frequent
 Refrigeration - Air embolism was a common complication due to the vacuum
 Blood Banks system used on glass bottles
 Venous access - Trials of plastic were conducted by American Red Cross in 1949
Dr. Carl Waldermar Walter (1952) - Of Harvard medical school, is
 Plastic blood bags
credited with the inventionof the first plastic blood collection bag
 Component administration
- Plastic bag were disposable and, because of their flexibility,
 Infectious disease testing facilitated the separation of blood components and the advent of
 High-risk donor screening component therapy
 Compatibility testing Plasmapheresis (1964) - Introduced for the means of collecting
1900 plasma for fractionation.
Lansteiner - pointed out the importance of his findings in Judith Pool - develops cryoprecipitate for the treatment of
his original paper. hemophilia
S. Murphy and F. Gardener (1969) - Demonstrated the feasibility
1907 of storing platelets at room temp, revolutionizing platelet
Ottenberg and Schultz - were the first to apply this information in transfusion therapy
an actual transfusion. 1981 used of polyvinyl bags - for collection ,storage and
transfusion was legalised.
1911
Hektoen - suggested that blood groups be made the
basis for selection of donors for blood transfusion
World War I experiences led to the universal adoption of
blood typing to select blood donors.

1945
Coombs - Described antiglobulin testing
Blundell had observed the need for rapid transfusion in
order to prevent coagulation
Direct transfusion (artery to vein for speed) was
advocated

ANTICOAGULATION
Bischoff (1835) - Proposed defibrination
Brown- Sequard also experimented with defibrination in
the 1850s.
- Generally accomplished by whipping or twirling the
blood, then removing the clot and transfusing the
remaining fluid
Braxton Hicks - Unsuccessfully used sodium
phosphate
Lewisohn (1914) - Used Citrate.
- Wield noted that citrated blood could be stored in the
refrigerator for several days
Kimpton-Brown transfusion apparatus - Commonly
used before citation
- It consisted of a paraffin-coated gradient glass cylinder
with a horizontal side tube for suction
- It was in use until approximately 1918

PRESERVATION
Rous and Turner - developed a solution of salt,
isocitrate and dextrose in order to both anticoagulate
and preserve blood.
- This mixture made the blood extremely dilute, so it had
to be removed prior to transfusion. (1:1 solution:blood
ratio)
- This method, with minor variations, was used through
most of World War II.
Loutit and Mollison - introduced ACD (acid-citrate-
dextrose) as a preservative in 1943. It was adopted by
the Army in 1945. (1:4 solution:blood ratio)
- ACD preservative was supplanted by citrate-
phosphate dextrose (CPD) in 1957, CPD with adenine
in 1965, and CPD-A1 in the 1980s
- Effective preservation and refrigeration lead to the
ability to bank blood
- Cryoprotective agents, such as glycerol, gain use in
the 1960s, enabling freezing of blood for long-term
storage.
- Blood was collected into reusable glass bottles in
the first half of the twentieth century. The whole blood
was transfused.
- Pyrogenic reactions from contamination due to
incomplete cleaning were frequent.
 Air embolism was a common complication due
to the vacuum systems used on glass bottles
- In 1949, trials of plastic bags were conducted by the
American Red Cross.
- Plastic bags were disposable and, because of their
flexibility, facilitated the separation of blood components
and the advent of component therapy
Beeson (1943) - described posttransfusion hepatitis.
- The donor pool has changed from a frequently paid
group to an mandated voluntary donation system.
- The worldwide pandemic of Human Immunodeficiency
Virus.
- Transition from Blood Banking to Transfusion Medicine.
PLASTIC BLOOD BAGS

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