Hemolytic transfusion reactions remain as a major safety consideration for blood transfusion. Clerical errors of patient identification and sample labeling remain the primary cause of mistransfusion of ABO-incompatible units. Non-ABO hemolytic reactions have surpassed ABO incompatibility as a leading cause of transfusion-related fatality.1
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.
The leading cause of transfusion related fatality in the United States is TRALI. Redirecting blood from female donors away from transfusable plasma products has reduced, but not eliminated the incidence of TRALI mediated by leucocyte reactive antibodies, (HLA) primarily because female donors have remained eligible to donate apheresis platelets. New mitigation strategies will eliminate this eligibility unless the female is tested and found to be negative for HLA antibodies.
Transfusion-associated sepsis (TAS), from bacterial contamination of apheresis platelets, continues to be a major safety issue in transfusion, despite culturing of all apheresis blood products. International travel and emerging pathogens not addressed by existing screening mechanisms will increasingly limit suitable blood donors. These and other pressures on the blood supply make patient blood management, bloodless surgical techniques, and pathogen inactivation imperative strategies in the future of transfusion medicine.
HISTORY OF BLOOD TRANSFUSION
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 seventeenth 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 nineteenth 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 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 blood, by means of calcium chelation was a landmark discovery, as ...