JAMA Revisited

September 29, 1923 and has until recently been the procedure of choice. Unfortu-
nately, the coagulation of blood cannot be retarded by chemi-
The Status of Blood Transfusion cal agents without alteration of some of its biochemical and
biologic properties. For example, sodium citrate leads to
Novel procedures in medical practice find application so
destruction of the blood platelets, which apparently play an
promptly in these days that the scientific progress that they
important part in the coagulation of the blood. The hemo-
represent is all too often soon forgotten. There is another as-
static properties of the circulation thus become impaired.
pect to the employment of new methods and new drugs that
The added chemical also develops anticomplementary prop-
cannot always be so easily dismissed. Few innovations have
erties in the plasma, and reduces the phagocytic and opsonic
been so thoroughly studied or so satisfactorily standardized
powers of the blood.…The corpuscles are said to become
and controlled at the time of their introduction into practical
more friable—a result particularly undesirable in combating
medicine as to render them perfect or even fool-proof in the
certain types of anemia. There are other occasional systemic
hands of the uncritical practitioner. Consequently, the new-
“reactions,” varying from slight malaise to severe chills
est acquisitions to the healing art may sometimes become po-
and febrile symptoms, that may give the operator consider-
tential menaces until their limitations have been made clear.
able concern.
The use of the roentgen rays in the period following their dis-
Much effort is being expended to learn how to avert or com-
covery was attended by many serious accidents. New chemi-
bat such untoward phenomena. This has led to improvement
cal compounds that give great promise of unusual potencies
in the transfusion of whole blood without the use of an added
are sometimes found to have limitations in their usefulness
anticoagulant. The procedure has recently been enthusiasti-
represented by unexpected idiosyncrasy in patients, or occa-
cally lauded by Brines,1 as the result of his experience. The re-
sional “side-reactions” that limit their usefulness.…Only a sur-
actions following the use of unmodified blood are said to be
vey over a longer experience enables the clinician to balance
fewer and milder than those following the citrate method.
advantages against disadvantages and thus learn the method
Brines remarks that while the latter should not be aban-
of choice in a given emergency.…
doned, the whole blood method should, whenever possible,
Transfusion in man no longer is primarily a problem of
be substituted for it; however, there is never a time when
blood vessel surgery, as it was fifteen years ago. The indirect
citrated blood is as good as whole blood.
method of transferring blood from one person to another has
The indications for transfusion have become so varied and
come into deserved vogue. A surgeon has remarked that the
numerous, and its usefulness so gratifying that it seems worth
practice of entering the vessels with needles instead of using
while to remind our readers of how much this helpful proce-
the scalpel has removed much of the danger of infection and
dure really may mean to a patient. As Brines has succinctly
injury to both the donor and the recipient. When blood ves-
stated the effects:
sel surgery was resorted to, the number of times an indi-
“Transfusion corrects disturbed circulatory balance; pro-
vidual could give or receive blood was limited. Aside from the
vides increased oxygen transportation to the tissues; in-
difficulties of instrumental technic, two outstanding factors
creases, to a greater extent than do lactates, calcium salts or
have interfered with universal success: first, the tendency of
any other substances, the coagulability of the blood, and tides
the blood to clot rapidly, and second, the hemolysis pro-
the patient over a critical period, until his blood-forming cen-
duced because of the incompatibility of bloods. The latter dif-
ters can take up their burden or he acquires the proper resis-
ficulty must be met at present by special care in the choice of
tance. It combats infection by increasing the general resis-
the donor of the blood. The serologic aspects of transfusion
tance and by the bactericidal action of the whole blood. It
have been studied assiduously in recent years after the dis-
restores the bulk of the blood, but more especially the red cor-
covery of the unlike agglutinating reactions of the bloods of
puscles; and it is important to note that young erythrocytes
different persons. Blood incompatibilities between donor and
are better oxygen carriers than old ones.”
recipient can now be largely avoided. The “typing” of serums
has become well standardized so that professional or semi-
JAMA. 1923;81(13):1114-1115.
professional donors can be satisfactorily “listed” for prompt
use. An hour’s preparation or less may then suffice for an emer-
Published Online: October 12, 2023. doi:10.1001/jama.2023.17939
gency transfusion.
The problem of clotting has not been so satisfactorily 1. Brines, O. A.: The Transfusing of Unmodified Blood, Arch. Surg. 7: 306 (Sept.)
solved. The citrate method has, it is true, had large success, 1923.

Editor’s Note: JAMA Revisited is transcribed verbatim from articles published Section Editor: Jennifer Reiling, Assistant Editor.
previously, unless otherwise noted.

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