A History of Blood BankingA History of Blood Banking Julianna Clark-Wronski, MD, Usha Nimmagadda, MD, M. Ramez Salem, MD, N. Nick Knezevic, MD, PhD

Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657 USA

Abstract

References

We performed a literature search of PubMed and Ovid databases to identify several landmark discoveries and innovations responsible for paving the way for successful blood banking. Prior to the twentieth century successful blood transfusions and blood banking were beyond the scope of medicine. Even though there were no formal blood banks established until 1947, the prolonged storage of blood was possible with the development of sodium citrate in 1915. With World War (WW) II experience and the disaster in Texas in 1947, community blood banks were established improving the safety of blood administration.

Blood Storage

In 1915 two key developments took place. First was use of sodium citrate as an anticoagulant which transformed blood transfusion procedures from a direct (vein-to-vein) to an indirect method. Secondly the feasibility of refrigerated storage of anticoagulated blood was demonstrated allowing for further prolongation of storage. Two years later development of citrate-glucose solution extended the time preservation for several days.1,2

Loutit and Mollison introduced acid-citrate-dextrose (ACD) as a preservative in 1943 permitting blood storage for 21 days.Glycerol techniques were applied to the freezing of red blood cells (RBCs) in the 1950s. The glass bottle was abandoned in favor of the plastic blood bag invented by the Fenwal Company allowing for increased ease of blood component separation.1,3 Development of plastic bags in the 1950s not only eliminated problems associated with turbulence, foaming and pyrogenic reactions but also made it easier to divide whole blood into multiple components.Frozen RBCs became clinically useful in 1960s. In 1970, citrate phosphate-dextrose solution replaced the ACD solution as a preservative, and in 1977, citrate phosphate-dextrose adenine-1 (CPDA-1) solution extended the storage of blood from 21 to 35 days. Introduction of Adsol solution in 1983. further extended the storage time to 45 days.

Explosion of the Grandcamp Freighter

A key player during the WWI was Oswald Hope Robertson, a medical researcher and U.S. Army officer who established “blood depots” in field hospitals which resulted in saving lives of many soldiers wounded in battle. He is now recognized as the creator of the first blood bank.1,4

During World War II Charles R. Drew improved techniques for blood storage by establishing an early prototype for collection, storage and testing of blood in the UK thereby developing large-scale blood banks early in World War II. He set up a similar program for the US Army in New York. It is because of his contributions that by the end of World War II, the US military directed the largest chain of distribution for plasma and other blood components.1

By the end of the war the American Red Cross had organized a civilian blood donor service that collected over 13 million units of blood. It was also at the end of the war that the first community based blood center opened in San Francisco. During the following few years, multiple hospital and community blood banks were established across the United States increasing the frequency and number of transfusions performed every year.1,2,5

After conclusion of the second World War, one of the final steps leading to formation of a national blood banking system occurred as a result of a national disaster. In April 1947, explosion of the French freighter Grandcamp occurred in Texas City secondary to ignition of fertilizer when sailors were smoking in the hold. That disaster resulted in 3500 injured civilians and included 600 fatalities.

Overwhelmed by the number of critical and non-critical patients requiring blood transfusions, Joe Hill MD, William Buchanan Blood Center, Dallas TX arranged for transport of the necessary blood products from Dallas to Galveston via the US Coast Guard, and established a Blood Bank Institute in Dallas.3

1. Diamond LK. JAMA 1965; 193:128-32.2. Schmidt PJ. Transfusion 2000; 40:608-12.3. Teague BT & Levin WC. Transfusion 1997; 37 1209-10.4. Hess JR & Schmidt PJ. Transfusion 2000; 40:110-3.5. Moore SB. Transfusion Medicine Reviews 2005; 19:241-5.

Cook County Hospital, Chicago, IL

View of Explosion from John Sealy Hospital, Galveston TX

Lessons Learned During World Wars

Establishment of Community Blood Banks

Establishment of In-Hospital Blood Banks

While Dr. Robertson was establishing battlefield transfusion cellars, physicians at the Mayo Clinic, Rochester MN were studying the effects of blood transfusions. The Mayo Clinic was an ideal location to examine blood transfusion methods because more than 1000 transfusions were taking place at the Mayo Clinic between 1915 and 1918 when blood donation was treated as a surgical procedure.4

In the year following establishment of Mayo Clinic’s in-hospital transfusion service, Dr. Bernard Fantus established the first true blood bank at Chicago's Cook County Hospital.

The Blood Bank Institute established the American Association of Blood Banking (AABB), a governing body overseeing standards of practice for blood banks in November 1947. Formation of the AABB facilitated continued development of blood banking as a medical specialty in its own right. Over the last several decades tremendous progress has been made. During the last twenty years, improved donor testing techniques, conservative utilization and prolonged storage of blood products have all contributed to a higher standard of care.

American Association of Blood Banking

Because of difficulties associated with donor retention, Mayo Clinic sought advice from a group of anesthesiologists headed by Dr. John S. Lundy but it was not until 1933 that Mayo Clinic’s Section of Anesthesia assumed formal responsibility for blood transfusions. By 1935, Dr. Lundy’s system allowed for storage of citrated blood for regular use in transfusions making it the first such service within a hospital setting in the United States.5