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Early references to "transfusion" practices have been recorded as early as 43 B.C. when, according to legend, the witch Medea replaced all the blood from Jason's father with a magic brew.  Wealthy Romans drank the blood of slain gladiators as a cure for epilepsy.  Druids, then Anglo-Saxons, practiced blood-letting with leeches.  This practice rarely had medical value, except in a patient whose circulation was overloaded with blood.  Such blood-letters became known as "leeches."  There is a story that Pope Innocent VIII, in 1492, received blood from three 10-year-old boys murdered in a last minute effort to save his life.  (The Pope either refused to drink the blood of the slain boys and died, or he drank this blood but died anyway!)

In 1628, William Harvey demonstrated that blood circulates.  the first transfusion from dog-to-dog was completed in England in 1665 by Richard Lower. Excited by the work of Harvey and others, Lower went on to transfuse animal blood into a human in 1667. This transfusion was not used as fluid replacement but as an attempt to alter the mental characteristics of the patient. The result, not surprisingly, was unimpressive.  It could have been fatal if the methods used had been adequate to permit the flow of larger amounts of blood.

During this time, a French physician named Jean-Baptiste Denis transfused sheep's blood into a 15-year-old-boy.  The boy was allegedly "cured" and Denis went on to perform several more transfusions.  At one point, he transfused a man who later died, and the widow sued Denis.  After a considerable controversy, the Paris Society of Physicians in 1678 declared all transfusions illegal.  Other countries, such as England, soon followed suit, and transfusion was not practiced for some fifty years.

In 1818, a French physician named James Blundell wrote that species lines should not be crossed when transfusing blood. He performed the first human-to-human transfusion on a mother who had lost large quantities of blood during childbirth.  A donor's artery was opened, the spurting blood was caught in a cup and sent through tubing inserted into the patient's vein. The amount transfused was estimated by timing.  Usually the blood clotted in the tubing before it could get into the patient, probably a fortunate occurrence because of the high rate of blood group incompatibility.  Blundell had some success with this type of transfusion, but animal blood was used into the20th century.

It was realized that, to insure successful transfusions, drawn blood must not be exposed too long or it would clot.  A variety of ingenious items were used to increase the flow included stopcocks, valves, syringes and quills.

At the turn of the century, vein-to-vein transfusion was practiced by highly skilled surgeons, but the amount of blood being transfused could still only be estimated.

Some relief from this difficulty followed the discovery in 1911that paraffin slowed the clotting process. A Y-shaped tube coated with wax was connected to a vein of the patient and one of the donor.  A syringe was attached to this apparatus, and, by alternating the opening and closing of several valves, blood was transfused.  Thus, the amount of blood being received by the patient could actually be measured for the first time.

Karl Landsteiner discovered blood groups in 1901. he investigated the reactions between the red cells and serum of the blood in 22 of his co-workers and found that the serum from some subjects clumped the red cells of certain other subjects.  This observation eventually led to blood group classification in the ABO system known as O, A, B or AB types.

In 1914, it was found that sodium citrate would keep the blood from clotting when added to donate blood.  This permitted donated blood to be stored in a bottle for later transfusion.

During World War I, use of citrate-glucose solution as a preservative and anticoagulant was introduced by a Canadian Army medical officer.  In 1943, British physicians found that by adding acid to citrate-dextroxe (sugar) solution, blood could be stored three weeks.  After the war, this acid-citrate-dextroxe (ACD) solution was widely accepted as the standard for 21-day preservation of blood in blood banks.

Several other important discoveries helped bring blood transfusion to its present-day standards.  A second human blood group system, called Rh (for the Rhesus monkey), was discovered in 1943. Plastic donor bags, instead of bottles for blood storage, were developed by 1949, alleviating the high cost of re-sterilization of bottle and tubing previously used.  Recently, with the addition of adenine to CPD solution, the expiration date of whole blood and red cells was extended to 35 days. Adenine supplies the red cells with a sufficient source of energy to permit longer storage.

Today, one unit of whole blood can be separated into components which can be used to treat several patients with different blood needs. This practice of transfusing patients with components provides maximum efficiency  for blood resources management.

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