January 10, 2009
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Early blood transfusions: from concept to practice

It took several hundred years for successful blood transfusions to come to fruition.

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Although early physicians did not possess a complete understanding of the biological properties of blood, they certainly recognized it as an integral component of the human body. They also viewed blood as having valuable, albeit mysterious, qualities. Eventually, this perception led to the study of and experimentation with blood for medicinal purposes.

However, due to basic misconceptions, many of the first transfusion experiments failed, causing a great deal of physicians to abandon these experiments for more than a century. Nevertheless, with renewed interest, fresh discoveries and increased dedication, not only were the first successful blood transfusions performed but the practice soon became a significant part of modern medicine.

Early experiments and initial theories

Vignettes, in decorative oval borders, showing blood transfusions
Vignettes, in decorative oval borders, showing blood transfusions from animal to human; and from a healthy person and a sick person, arm to arm; and hand to hand.

Source: National Library of Medicine

In 1628, after William Harvey published his book De Motu Cordis in which he describes the human circulatory system as well as his findings on the circulation of blood, researchers commenced experiments involving the intravenous injection of various substances into animals.

Before long, this research progressed into blood transfusions between animals. During this time, Richard Lower, a member of the Oxford Experimental Philosophy Club, was among the first to show that transfusion could be used in cases of severe blood loss by exsanguinating a dog and transfusing it with blood from another. His work ultimately inspired the first animal-to-human blood transfusions.

Additionally, at this time a great deal of the desired use for transfusions was to treat mental illness. This notion evolved from both the humoral theory propounded by the ancient Greeks and Romans as well as their belief that blood absorbed the mental and physical properties of its owner. After reading Lower’s research in the mid-17th century, Jean Denis, professor of philosophy and mathematics at Montpellier in France, began transfusing the blood of animals such as calves and lambs into humans, reasoning that the blood of docile animals could “exert a calming influence on a troubled and deranged mind.”

Although Denis proclaimed positive results, many of his patients who were transfused with animal blood failed to live long after the procedure. Because he and his contemporaries were unaware of the problems with immunity and cross-species transfusion, they were unable to remedy the flaws in their theories.

Then, as a result of deaths related to these transfusions, the French parliament made transfusion a criminal act, the Royal Society in London abandoned its research on the subject and Pope Innocent XI banned the procedure altogether in 1679. The concept of transfusion fell out of popularity and would not resurface again until the 19th century.

New breakthroughs and issues

Despite this long break, in 1818, after developing an interest in transfusion as a means of helping his patients who suffered from postpartum hemorrhage, notable obstetrician James Blundell finally performed the first human-to-human blood transfusion. Following a few experiments demonstrating the fatal effects that human blood had on a dog, Blundell concluded that only human blood should be used when transfusing other humans.

Although Blundell’s discovery was an important advancement, his success inspired more questions than answers about the best methods for blood transfusion. One particular concern required major attention: the matter of coagulation.

During the latter half of the nineteenth century, a rash of theories and apparatuses surfaced as supposed ways of solving the problem of blood clotting in transfusion. For instance, in addition to devices such as Blundell’s “gravitator,” J.H. Aveling, another obstetrician, created a “direct transfusion apparatus” in 1872. The device was comprised of a tube with a central rubber bulb that “provided a pumping action produced by squeezing the bulb together with the tube at alternative sides of the bulb.”

Although the demand for similar equipment attracted many researchers, the use of defibrinated blood emerged as the most popular solution. Numerous techniques for defibrination sprang up during this period as well. Specifically, the initial work of J. Neudorfer in 1860 and the subsequent experiments of Braxton Hicks were the first suggestions of using an “anticoagulant additive.” Both Neudorfer, who recommended sodium bicarbonate as a possibility, and Hicks, who explored sodium phosphate as a potential additive, discovered that their solutions were too toxic and caused severe reactions in patients.

Eventually, nearly 50 years later, in 1915, Richard Lewinsohn of the Mount Sinai Hospital in New York proposed sodium citrate as an anticoagulant. Though at first this formula had limited use because blood still had to be transfused within hours, the next year the addition of dextrose to this solution allowed blood to be stored for up to two weeks. In 1961, citrate-phosphate-dextrose solution became the anticoagulant of choice after studies showed its efficacy in blood stored up to 28 days.

Another vital discovery to advanced blood transfusions was Karl Landsteiner’s classification of the ABO blood groups in 1900. He discovered that people had naturally occurring antibodies in their serum that would react with and destroy donor red cells if the donor was from another blood group. Later, testing for compatibility between donor and recipient became standard care prior to blood transfusions.

The remainder of the 20th century would bring an increase in scientific advances involving blood and blood transfusions. These included blood donations and banks, transfusion services used in wartime and after, and the development and use of fractionated blood products. The development of successful blood transfusion strategies is considered one of the most important medical advances of the last hundred years affecting every other type of medical and surgical specialty. – by Melissa Foster

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