Blood Transfusions
The first blood transfusions were not performed as treatment for
blood loss. Jean Baptiste Denis (1625–1704) from Montpellier, France administered
lamb's blood[189]
to a demented patient with the
idea of transferring the attributes of the donating animal to the recipient. Although
the first patient survived, a subsequent transfusion resulted in death. Denis was
tried for murder, and although he was acquitted, the procedure was condemned and
prohibited by the Faculty of Medicine in Paris. Physicians in the 18th and 19th
centuries were more prone to remove, rather than administer, blood.
Successful blood transfusions were performed by James Blundell
[190]
(1790–1877), who experimented with blood
transfusions in animals and rejected the idea of animal-to-human transfusions. Blundell
recorded 10 human-to-human transfusions between 1818 and 1828 and recognized that
acute blood loss was the primary reason for transfusion. Five of those 10 patients
died after the transfusion, possibly as a result of incompatible blood.
In 1900, Karl Landsteiner[191]
(1868–1943) described three blood groups: A, B, and O; the fourth blood group
(AB) was described by A. V. Decastello[192]
2 years
later. George W. Crile (1865–1943) performed the first transfusion of human
blood after a preceding compatibility test in 1906. Discovery of the Rh antigens
was delayed until 1939.
One hundred years ago, the accepted method of transfusing blood
was to surgically anastomose the artery of the donor to the vein of the patient.
This method required a long and delicate operation, and there was no way to measure
the amount of blood transfused. Blood could not be removed from the body without
defibrination, a process that often produced serious reactions and air embolization.
In 1914, Albert Hustin[193]
(1882–1967) noticed
that when sodium citrate was added to blood, it prevented coagulation, and with the
addition of dextrose by P. Rous and J. R. Turner in 1916,[194]
storage of blood products for up to 21 days became a reality.[195]
The familiar drip chamber for estimating infusion rates was devised by R. Laurie
in 1909.[196]
The effect of these advancements
in the use of blood products on the practice of anesthesia is apparent by comparing
the American textbook by Gwathmey,[146]
dated 1914,
in which there is no mention of blood administration, with that of John S. Lundy
[197]
(1894–1972), dated 1945, which contains
an extensive chapter on the subject. Lundy was an early proponent of blood transfusions
and opened the first blood bank in the United States at the Mayo Clinic in 1935.
The effect of two World Wars on the practice of anesthesia in the United States
can be appreciated by comparing these two books.
With the rise of hepatitis and human immunodeficiency virus contaminants
of homologous blood, a new look at an old technique,[198]
autologous transfusion, was begun in 1970. In that year, G. Klebanoff described
a disposable autologous transfusion system manufactured by Bentley Laboratories.
[199]
Klebanoff reported[200]
on its use in 53 patients with no deaths if the total volume of blood replaced was
less than 3500 mL. Malcolm D. Orr first reported cell-washing techniques in 1975
using the Haemonetics cell-washing system.[201]
This system obviated some of the problems when blood was filtered, but
not washed, after retrieval from the surgical wound. From these early reports, it
became apparent that washed and concentrated red cells obtained from the surgical
site could provide safe alternatives to homologous transfusions. The "cell saver"
method of autologous blood transfusion has become an integral part of intraoperative
fluid management when large volumes of blood loss are anticipated.
Coagulopathies often develop during large-volume blood transfusions,
and their diagnosis and prompt treatment significantly contribute to survival during
major surgery. Ron Miller and colleagues[202]
recognized
thrombocytopenia as one of the earliest defects in coagulation after massive blood
loss. Advances in specific blood component therapy[203]
[204]
have also contributed to maintenance of normal
blood coagulability during large-volume blood loss.
