Wednesday, April 23, 2008

Highlights of Transfusion History

1628 : English physician William Harvey discovers the circulation of blood. Shortly afterward, the earliest known blood transfusion is attempted.

1665: The first recorded successful blood transfusion occurs in England: Physician Richard Lower keeps dogs alive by transfusion of blood from other dogs.

1667 : Jean-Baptiste Denis in France and Richard Lower in England separately report successful transfusions from lambs to humans. Within 10 years, transfusing the blood of animals to humans becomes prohibited by law because of reactions.

1795: In Philadelphia, American physician Philip Syng Physick, performs the first human blood transfusion, although he does not publish this information.

1818: James Blundell, a British obstetrician, performs the first successful transfusion of human blood to a patient for the treatment of postpartum hemorrhage. Using the patient's husband as a donor, he extracts approximately four ounces of blood from the husband's arm and, using a syringe, successfully transfuses the wife. Between 1825 and 1830, he performs 10 transfusions, five of which prove beneficial to his patients, and publishes these results. He also devises various instruments for performing transfusions and proposed rational indications.

1840: At St. George's School in London, Samuel Armstrong Lane, aided by consultant Dr. Blundell, performs the first successful whole blood transfusion to treat hemophilia.

1867: English surgeon Joseph Lister uses antiseptics to control infection during transfusions.

1873-1880: US physicians transfuse milk (from cows, goats, and humans).

1884: Saline infusion replaces milk as a “blood substitute” due to the increased frequency of adverse reactions to milk.

1900 : Karl Landsteiner, an Austrian physician, discovers the first three human blood groups, A, B, and C. Blood type C was later changed to O. His colleagues Alfred Decastello and Adriano Sturli add AB, the fourth type, in 1902. Landsteiner receives the Nobel Prize for Medicine for this discovery in 1930.

1907: Hektoen suggests that the safety of transfusion might be improved by crossmatching blood between donors and patients to exclude incompatible mixtures. Reuben Ottenberg performs the first blood transfusion using blood typing and crossmatching in New York. Ottenberg also observed the mendelian inheritance of blood groups and recognized the “universal” utility of group O donors.

1908: French surgeon Alexis Carrel devises a way to prevent clotting by sewing the vein of the recipient directly to the artery of the donor. This vein-to-vein or direct method, known as anastomosis, is practiced by a number of physicians, among them J.B. Murphy in Chicago and George Crile in Cleveland. The procedure proves unfeasible for blood transfusions, but paves the way for successful organ transplantation, for which Carrel receives the Nobel Prize in 1912.

1908: Moreschi describes the antiglobulin reaction. The antiglobulin is a direct way of visualizing an antigen-antibody reaction that has taken place but is not directly visible. The antigen and antibody react with each other, then, after washing to remove any unbound antibody, the antiglobulin reagent is added and binds between the antibody molecules that are stuck onto the antigen. This makes the complex big enough to see.

1912: Roger Lee, a visiting physician at the Massachusetts General Hospital, along with Paul Dudley White, develops the Lee-White clotting time. Adding another important discovery to the growing body of knowledge of transfusion medicine, Lee demonstrates that it is safe to give group O blood to patients of any blood group, and that blood from all groups can be given to group AB patients. The terms "universal donor" and "universal recipient" are coined.

1914: Long-term anticoagulants, among them sodium citrate, are developed, allowing longer preservation of blood.

1915: At Mt. Sinai Hospital in New York, Richard Lewisohn uses sodium citrate as an anticoagulant to transform the transfusion procedure from direct to indirect. In addition, Richard Weil demonstrates the feasibility of refrigerated storage of such anticoagulated blood. Although this is a great advance in transfusion medicine, it takes 10 years for sodium citrate use to be accepted.

1916: Francis Rous and J.R.Turner introduce a citrate-glucose solution that permits storage of blood for several days after collection. Allowing for blood to be stored in containers for later transfusion aids the transition from the vein-to-vein method to indirect transfusion. This discovery also allows for the establishment of the first blood depot by the British during World War I. Oswald Robertson, an American Army officer, is credited with creating the blood depots. Robertson received the AABB Landsteiner Award in 1958 as developer of the first blood bank.

1927-1947: The MNSs and P systems are discovered. MNSs and P are two more blood group antigen systems - just as ABO is one system and Rh is another.

1939/40: The Rh blood group system is discovered by Karl Landsteiner, Alex Wiener, Philip Levine, and R.E. Stetson and is soon recognized as the cause of the majority of transfusion reactions. Identification of the Rh factor takes its place next to the discovery of ABO as one of the most important breakthroughs in the field of blood banking.

1940: Edwin Cohn, a professor of biological chemistry at Harvard Medical School, develops cold ethanol fractionation, the process of breaking down plasma into components and products. Albumin, a protein with powerful osmotic properties, plus gamma globulin and fibrinogen are isolated and become available for clinical use. John Elliott develops the first blood container, a vacuum bottle extensively used by the Red Cross.

1941: Isodor Ravdin, a prominent surgeon from Philadelphia, effectively treats victims of the Pearl Harbor attack with Cohn's albumin for shock. Injected into the blood stream, albumin absorbs liquid from surrounding tissues, preventing blood vessels from collapsing, a finding associated with shock.

1943: The introduction by J.F. Loutit and Patrick L. Mollison of acid citrate dextrose (ACD) solution, which reduces the volume of anticoagulant, permits transfusions of greater volumes of blood and permits longer term storage.

1943: P. Beeson publishes the classic description of transfusion-transmitted hepatitis.

1945: Coombs, Mourant, and Race describe the use of antihuman globulin (later known as the “Coombs Test”) to identify “incomplete” antibodies.

1950 : Audrey Smith reports the use of glycerol cryoprotectant for freezing red blood cells.

1950: In one of the single most influential technical developments in blood banking, Carl Walter and W.P. Murphy, Jr., introduce the plastic bag for blood collection. Replacing breakable glass bottles with durable plastic bags allows for the evolution of a collection system capable of safe and easy preparation of multiple blood components from a single unit of whole blood. Development of the refrigerated centrifuge in 1953 further expedites blood component therapy.

Mid-1950s: In response to the heightened demand created by open-heart surgery and advances in trauma care patients, blood use enters its most explosive growth period.

1959: Max Perutz of Cambridge University deciphers the molecular structure of hemoglobin, the molecule that transports oxygen and gives red blood cells their color.

1960 : A. Solomon and J.L. Fahey report the first therapeutic plasmapheresis procedure - a procedure that separates whole blood into plasma and red blood cells.

1961: The role of platelet concentrates in reducing mortality from hemorrhage in cancer patients is recognized.

1962 : The first antihemophilic factor (AHF) concentrate to treat coagulation disorders in hemophilia patients is developed through fractionation.

1964 : Plasmapheresis is introduced as a means of collecting plasma for fractionation.

1965 : Judith G. Pool and Angela E. Shannon report a method for producing Cryoprecipitated AHF for treatment of hemophilia.

1967: Rh immune globulin is commercially introduced to prevent Rh disease in the newborns of Rh-negative women.

1969: S. Murphy and F. Gardner demonstrate the feasibility of storing Platelets at room temperature, revolutionizing platelet transfusion therapy.

1970: Blood banks move toward an all-volunteer blood donor system.

1971 : Hepatitis B surface antigen (HBsAg) testing of donated blood begins.

1972 : Apheresis is used to extract one cellular component, returning the rest of the blood to the donor.

1979 : A new anticoagulant preservative, CPDA-1, extends the shelf life of whole blood and red blood cells to 35 days, increasing the blood supply and facilitating resource sharing among blood banks.

Early 1980s: With the growth of component therapy, products for coagulation disorders, and plasma exchange for the treatment of autoimmune disorders, hospital and community blood banks enter the era of transfusion medicine, in which doctors trained specifically in blood transfusion actively participate in patient care.

1981: First Acquired Immune Deficiency Syndrome (AIDS) case reported.

1983: Additive solutions extend the shelf life of red blood cells to 42 days.

1984: Human Immunodeficiency Virus (HIV) identified as cause of AIDS

1985: The first blood-screening test to detect HIV is licensed and quickly implemented by blood banks to protect the blood supply.

1987 : Two tests that screen for indirect evidence of hepatitis are developed and implemented, hepatitis B core antibody (anti-HBc) and the alanine aminotransferase test (ALT).

1989 : Human-T-Lymphotropic-Virus-I-antibody (anti-HTLV-I) testing of donated blood begins.

1990: Introduction of first specific test for hepatitis C, the major cause of “non-A, non-B” hepatitis.

1992 : Testing of donor blood for HIV-1 and HIV-2 antibodies (anti-HIV-1 and anti-HIV-2) is implemented.

1996 : HIV p24 antigen testing of donated blood begins. Although the test does not completely close the HIV window, it shortens the window period.

2002 : West Nile virus identified as transfusion transmissible.

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