Chapter 83

1. ABO compatibility remains the major safety consideration for blood transfusion. Clerical errors of patient identification and sample labeling remain the primary cause of mistransfusion of ABO-incompatible units.

2. Prestorage leukoreduction of cellular blood products has greatly reduced, but not eliminated, the incidence of febrile reactions, transfusion-related immunosuppression, and cytomegalovirus transmission, and has led to improved outcomes in surgical patients compared to the use of nonleukoreduced products.

3. Redirecting blood from female donors away from transfusable plasma products appears to have reduced the incidence of TRALI mediated by leucocyte reactive antibodies. However, some plasma from female donors remains in platelet and red blood cell products.

4. International travel and associated exposure to pathogens not addressed by existing screening mechanisms will increasingly limit suitable blood donors. These and other pressures on the blood supply make imperative strategies all the more important for blood conservation and promotion of bloodless surgical techniques.

Practical, safe transfusion derives from centuries of experimentation and discovery. Although the first known animal transfusion experiments took place in both England and France in the 17th century, early efforts to translate the technique to humans failed with such spectacular flair that the learned societies on both sides of the English Channel flatly banned the practice.

The first "modern" transfusion is attributed to John Syng Physick in Philadelphia in 1795. English physician James Blundell claimed success for 5 of 10 transfused patients during his professional career (1820-1840).

The 19th century saw the rapid expansion of bacteriology and a growing understanding of antisera. In 1900 Karl Landsteiner significantly advanced the cause of blood compatibility with his landmark discovery of the ABO blood groups, with O being derived from the German "ohne" or without, for which he received the 1930 Nobel Prize in Medicine and Physiology. Four decades later, in collaboration with Alex Weiner, Philip Levine, and R.E. Stetson, Landsteiner played an instrumental role in the recognition of Rh(D), a major cause of hemolytic disease of the newborn (HDN) and non–ABO-related hemolytic transfusion reactions.

Prior to effective schemes for anticoagulation, Alexis Carrel explored vascular anastomosis as a possible strategy for moving blood from donor to recipient. Although eclipsed by other approaches, this pioneering technique formed the basis of contemporary vascular anastomoses in solid-organ transplantation and won Carrel the 1912 Nobel Prize.

The use of citrate to anticoagulate stored blood by means of calcium chelation was a landmark, as heparin was unsuitable to transfuse into bleeding patients and citrate's rapid metabolic elimination in vivo proved ideal for purposes of transfusion. Its adoption paved the way for transition from direct to indirect transfusion. By 1916 Rous and Turner introduced glucose in addition to sodium citrate, extending ex vivo storage by several days.

The first blood depots were established during the First World War by the British and were stocked prior to major campaigns. The Soviets established the first permanent blood bank in a Leningrad hospital in 1932, and ...

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