IMMUNOHEMATOLOGY

HISTORY & MILESTONES IN BLOOD BANKING

3RD YEAR | 2ND SEMESTER | PRELIMS | LECTURE LESSON 01 WEEK 01
CORPUZ | ENCISO | FERNANDEZ | MARCELO | OLVIDO

OUTLINE Blood of 3 Young Men

I. History & Milestones  Given to sick Pope Innocent VIII through oral route
A. Blood Banking  All 4 men died
Giacomo di San Genesio
HISTORY& MILESTONES  Pope’s Physician
 Gave the Pope blood transfusion orally
Problems Encountered
BLOOD BANKING
 Clotting
 Incompatibility
Pre-history  Methods and Devices
 Drinking of blood of various animals  Availability and Preservation
 Infusion of wine and urine  Disease Transmission
Metamorphosis  Other Transfusion Reactions
 Description of the first infusion by Ovid, Circa 43 BC  Circulatory Overload

Biblical Reference 1628

Leviticus 17:11-12 OT  Discovery of blood circulation
 For the life of the flesh is in the blood; and I have given it William Harvey
to you upon the altar to make atonement for your souls; For  English Physician, discovered blood circulation in 1613
it is the blood that maketh atonement by reason of the life.  Earliest known blood transfusion is attempted
Therefore, I said unto the children of Israel: no soul of you  His findings of how to properly stop blood flow to an arm
shall eat blood, neither shall any stranger that sojourneth
among you eat blood 1655
 1st recorded successful animal to animal blood transfusion
1300
Richard Lower
Peter of Abano  English Physician
 Describes the cure for the adverse consequences of  Keeps the dogs alive by transfusion of blood from other
drinking menstrual blood dogs
 “Drink powdered daisies with water of honey, and copulate
freely with young girls” 1667
Jean-Baptiste Denise (France) & Richard Lower (England)
2500 BC  Separately reported successful transfusions from lambs to
humans
Contributor Description Within 10 Years
Egyptians Use bleeding  Transfusing the blood of animals to humans becomes
prohibited by law due to reactions
Tomb Illustration in Depicts a patient being bled from the foot
Memphis, Egypt and neck
1795
Philip Syng Physick (Philadelphia)
23 to 79 AD
 American Physician
Pliny the Elder
 Claims to perform the 1 st human to human blood
 Author, naturalist, and natural philosopher transfusion (does not publish this information)
 Naval and army commander of the early Roman empire
 Described mad rush of spectators into arenas to drink the
blood of fallen gladiators 1818
o To cure epilepsy  1st successful transfusion of human blood to a patient
o To impart strength James Blundell
 British Obstetrician
1433 – 1499  Performed the 1st successful blood transfusion to treat
postpartum hemorrhage
Marsilio Ficino
o Husband is Donor – 4 oz of blood was extracted
 Italian scholar and Catholic priest who was one of the most using a syringe
influential humanist philosophers of the early Italian o Between 1825 and 1830 – he performs 5/10
Renaissance
beneficial transfusions
 Promoted drinking young blood as means to regain o Devised various instruments for transfusions and
youthful vigor
rational indications

1492
1840
 1st historical transfusion attempt St. George’s School in London
  Samuel Armstrong Lane, aided by consultant Dr. Blundell Lee Lead to the term “universal donor” and
performs the 1st successful whole blood transfusion to treat “universal recipient”
hemophilia
1913
1867
Reuben Ottenberg
Joseph Lister  Performs the 1st blood transfusion using blood typing and
 English Surgeon rudimentary cross-matching in New York
 Uses antiseptics to control infection during transfusions  Observed Mendelian inheritance of blood groups
 Recognized “universal” utility of group O donors
1869
Braxton Hicks 1915
 Uses sodium phosphate
Contributor Description
1873 – 1880
Richard Lewisohn 1
Mt. Sinai Hospital
US Physicians 2
Uses Na citrate as anticoagulant
 Transfuse milk from cow, goats, and humans (progress from direct to indirect
transfusion)
1884 Richard Weil Demonstrates the feasibility of
George Hayem refrigerated storage of such
 Saline infusion replaces milk as “blood substitute” due to anticoagulated blood
increased frequency of adverse reactions to milk Take Note
1
It took 10 years for sodium citrate use to be accepted
1900
Karl Landsteiner 1916
 Austrian Physician Francis Rous & JR Turner
 Discovers 1st three human blood groups ABC  Introduced citrate-glucose solution (storage of blood for
 Blood Type C – later changed to O several days)
Alfred Decastello & Adriano Sturli  Discovery also allows for establishment of 1 st blood depot
 AB – 4th type in 1902 by the British during World War I
Oswald Robertson
1907  American Army Officer
 Credited with creating blood depots
Hektoen
 Suggests that the safety of transfusion might be improved
by cross-matching 1927 – 1947
Karl Landsteiner & Philip Levine
1908  Discovered MNSs and P systems which are two more
blood group antigen systems
Edward Lindemann
 Multiple Syringes
Alexis Carrel 1930s
 French Surgeon  RBC membrane better understood
 Devises a way to prevent clotting o Metabolism
o Sewing the vein of the recipient directly to the o Deformability
artery of the donor o Permeability
 Anastomosis – vein to vein or direct method, was practiced
by a number of physicians 1932
 Procedure proves unfeasible for blood transfusion Leningrad Hospital
o Paves the way for successful organ
 1st hospital-based blood depot is established
transplantation
o Carrel receives Nobel Prize in 1912
1937
Moreschi
 Describes Anti-human Globulin (AHG) Reaction – direct  Separation of plasma by republicans in the Spanish Civil
way of visualizing Ag-Ab reaction that has taken place but War (uses farmer’s dairy cream separator)
is not directly visible Bernard Fantus
 Antigen-antibody (Ag-Ab) react with each other, then  Director of therapeutics at the Cook County Hospital in
washed to remove any unbound antibody Chicago
 AHG Reagent – added and binds between Ab that are stuck  Establishes the 1st hospital blood bank in the US
onto the Ag  Creating a hospital laboratory that can preserve and store
donor blood
1912 o Fantus originates the term “blood bank”

1939 – 1940
Contributor Description
Philip Levine & Rufus Stetson
1
Roger Lee Develops Lee-White clotting time
2  Described Rh Blood Group System
Paul Dudley White
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  Recognized as the cause of the majority of transfusion 1947
reactions American Association of Blood Banks (AABB)
 Identification of the Rh Blood Group System takes its place  Formed to promote common goals among blood banking
next to ABO as one of the most important breakthroughs in practitioners and the blood donating public
blood transfusion
 Journal of Clinical Investigation
AABB
1940 (Part 1)  For monitoring and accredditation
Edwin Cohn
 Professor of biological chemistry at Harvard Medical 1949 – 1950
School
US Blood Collection System
 Develops cold ethanol fractionation
o Process of breaking down plasma into  1,500 hospital blood banks
components and products  46 community blood centers
Albumin  31 American Red Cross regional blood centers
 Protein with powerful osmotic properties
 Gamma globulin and fibrinogen are isolated and become 1950
available for clinical use Audrey Smith
John Elliott  Reports the use of glycerol as cryoprotectant for freezing
 Develops the 1st blood container vacuum bottle red blood cell
o Can store RBC from 7 to 10 years
1940 (Part 2) Carl Walter & WP Murphy, Jr.
 US government establishes a nationwide program for the  Introduce the plastic bag for blood collection
collection of blood o Safe and easy preparation of multiple blood
components from a single unit of whole blood
Charles R. Drew
 Develops the “Plasma for Britain” program
o Pilot project to collect blood for shipment to the 1953
British Isles Development of Refrigerated Centrifuge
 The American Red Cross participates  Further expedites blood components
o Collecting 13 million units of blood by the end Take Note
World War II  Bottles cannot be centrifuged
AABB Clearinghouse Established
1941  Provides a centralized system for exchanging blood among
Isodor Ravdin blood banks
 Philadelphian Surgeon  Clearinghouse is now called the National Blood Exchange
 Treats victims of Pearl Harbor attack with Cohn’s albumin
for shock Mid 1950s
Albumin (Plasma Expanders) Blood Use Enters its Most Explosive Growth Period
 Injected into the bloodstream  In response to the heightened demand created by open-
 Absorbs liquid from surrounding tissues which prevents heart surgery and advances in trauma care patients
blood vessels from collapsing
 A finding associated with shock 1957
Levine et al
AABB Form its Committee on Inspection & Accreditation
 Demonstrated isoimmunisation to the D antigen
 To monitor the implementation of standards for blood
o Primary cause of HDFN
banking
 This was frequently misdiagnosed as caused by
CPD
Seronegative
 Introduced by Gibson
 Started with sodium sulfate
1943
JF Loutif & Patrick L. Mollison
1958
 Introduce acid citrate dextrose solution
AABB
o Reduces the volume of anticoagulant
o Permits transfusions of greater volumes of blood  Publishes its 1st edition of Standards for a Blood
and permits longer term storage Transfusion Service
 Now entitled “Standards for Blood Banks and Transfusion
Paul Beeson
Services”
 Publishes the classic description of transfusion-transmitted
hepatitis
 Bremmen shipyard outbreak affected 18,000 workers 1959
Max Perutz (Cambridge University)
1945  Interprets the molecular structure of hemoglobin
o Molecule that transports oxygen and gives red
Coombs, Mourant, & Race
blood cells their color
 Describe the use of antihuman globulin – later known as
the Coombs test
o To identify “incomplete” antibodies 1960
AABB

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  Begins publication of “Transfusion”
o 1st American journal wholly devoted to the 1977
science of blood banking and transfusion WHO Directive
technology
 Encourage all countries to be self-sufficient in blood and
A. Solomon & JL Fahey blood products to prevent the spread of new pathogens
 Reported the 1st therapeutic plasmapheresis procedure
1979
1961
Citrate Phosphate Dextrose Adenine Solution (CPDA-1)
 Role of platelet concentrates in reducing mortality from  New anticoagulant preservative
hemorrhage in cancer patients is recognized  Extends the shelf life of whole blood and red blood cells to
35 days
1962
Fractionation Early 1980s
 1st antihemophilic factor (AHF) concentrate to treat Era of Transfusion Medicine
coagulation disorders in hemophilia patients is developed  Hospital and community blood banks enter this era with:
US o Growth of component therapy
 There were 4,400 hospital blood banks, 123 community o Products for coagulation disorders
blood centers, and 55 American Red Cross blood centers o Plasma exchange for the treatment of
o Collecting a total of 5 to 6 million units of autoimmune disorders
blood/year  Doctors trained specifically in blood transfusion actively
participate in patient care
1964
Plasmapheresis 1981
 Introduced as a means of collecting plasma for  1 Acquired Immune Deficiency Syndrome (AIDS) case
st

fractionation reported
1983
1965
 Additive solutions extend the shelf life of red blood cells to
Judith G. Pool & Angela E. Shannon 42 days
 Report a method for producing Cryoprecipitated AHF for British Blood Transfusion Society (BBTS)
treatment of hemophilia  Launched
 1st President was prof. Fred Stratton
1966 Dr. Kary Banks Mullis
Wegmann & Smithies  Describes the Polymerase Chain Reaction (PCR)
 Describe an antiglobulin test in microplates
1984
1967 Human Immunodeficiency Virus (HIV)
Rh Immune Globulin  Identified as cause of AIDS
 Commercially introduced to prevent Rh disease in the
newborns of Rh-negative women 1985
 1st blood-screening test to detect HIV is licensed and
1969 quickly implemented by blood banks to protect the blood
S. Murphy & F. Gardner supply
 Demonstrate the feasibility of storing platelets at room National External Quality Assessment Service (NEQAS)
temperature revolutionizing platelet transfusion therapy  Started in UK

1970 1987
Blood Banks  2 tests that screen for indirect evidence of Hepatitis are
 Move toward an all-volunteer blood donor system developed and implemented
o Hepatitis B Core Antibody (Anti-HBc)
1971 o Alanine Aminotransferase Test (ALT)
Hepatitis B Surface Antigen (HbsAg)
 Testing of donated blood begins in the UK 1989
 It was already being done in Portugal  Human T Lymphotropic-Virus-I-Antibody (anti-HTLV-I)
testing of donated blood begins
1972
Apheresis 1990
 Used to extract one cellular component Introduction of 1 Specific Test for Hepatitis C
st

 Returns the rest of the blood to the donor  Major cause of “non-A, non-B” hepatitis
o Hepatitis C virus had, at that time, not been
1975 isolated
Lapierre et al
Georges Kohler & Cesar Milstein
 Described the production of monoclonal antibodies
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  Describe Gel Test – forerunner of today’s column  AABB receives $2.4 Million CDC grant to reduce
agglutination technique (CAT) transfusion-transmitted HIV in Africa and South America

1992 2005
 Testing of donor blood for HIV-1 & HIV-2 antibodies Food & Drug Administration (FDA)
(Anti-HIV-1 and Anti-HIV-2) is implemented  Clears apheresis platelets collected with certain systems for
routine storage and patient transfusion up to 7 days when
1996 tested with a microbial detection system release test
FDA’s Center for Biologics Evaluation & Research
 HIV p24 antigen testing of donated blood begins
o Test does not completely close the HIV window  Publishes compliance program guidance for inspection of
o It shortens the window period human cells, tissues, and cellular and tissue-based products
(HCT/Psfi)
 Solvent detergent treatment of plasma products
AABB
 Founding member Tibor Greenwalt dies
1997
FDA Approves the 1st West Nile Virus (WNV) Blood Test
US Government  To screen donors of blood, organs, cells, & tissues
 Issues two reports suggesting ways to improve blood safety
including regulatory reform
National Blood Data Resource Center
 Founded by AABB to:
o Collect
o Analyze
o Distribute data on all aspects of blood banking
and transfusion medicine
1998
Hepatitis C Virus (HCV) Lookback Campaign
 A public health effort to alert anyone who may have been
exposed to the hepatitis C virus (HCV) through blood
transfusions before July 1992 so they can receive medical
counseling and treatment if needed
Nucleic Acid Test (NAT) Testing for Hepatitis C
 Was introduced

1999
Blood Community
 Begins implementation of Nucleic Acid Amplification
Testing (NAT) under the FDAs Investigational New Drug
(IND) application process
 NAT employs testing technology, directly detects genetic
materials of viruses like HCV and HIV
 Universal leucodepletion of cellular blood products in the
UK
 Use of non-UK sourced plasma

2002
West Nile Virus
 Identified as transfusion transmissible
Nucleic Acid Amplification Test (NAT)
 For HIV and HCV was licensed by the FDA

2003
 1st West Nile virus positive unit of blood intercepted
 Issued – Guidance on Implementation of New Bacteria
Reduction and Detection Standards
1st National Blood Foundation Forum
 Unites leaders in Blood Bank and Transfusion Medicine
Food & Drug Administration (FDA)
 Issues final guidance regarding “Revised
Recommendations for the Assessment of Donor Suitability
and Blood and Blood Product Safety in cases of known or
suspected WN Virus Infection”

2004

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