Introduction to Blood Banking and Transfusion Medicine

Blood Groups

Karl Landsteiner, in 1900, demonstrated the presence of the ABO blood group system. In the 1920s, ABO testing became routine. The Rh blood group system was discovered during 1939–40 by Landsteiner, Weiner, Levine, and Stetson, explaining many unexpected transfusion reactions cause. In 1945, Coombs, Mourant, and Race described antihuman globulin sera use to detect IgG antibodies in compatibility testing, thus providing the Coombs test.

Blood Storage

Direct transfusion (donor artery anastamosed to recipient vein) was performed in 1908, and direct transfusion using a three-way stopcock was used until World War II. While sodium citrate as an anticoagulant use was considered in 1914 and used (with glucose) some during World War I to set up blood depots, blood could be typically stored for a few days. In 1943, acid citrate dextrose solution allowed storage for weeks, facilitating blood “banking.” Additionally, acidification of anticoagulant-preservative solution allowed autoclaving and reduced bacterial contamination.

Blood Derivatives

In 1940, Cohn developed cold ethanol fractionation process, allowing plasma to be divided into albumin, gamma globulin, and fibrinogen, among other proteins (called Cohn fractionation). In 1961, Pool and Shannon recognized that the precipitate (cryoprecipitate) that formed when plasma was thawed in the cold contained factor VIII, revolutionizing hemophilia A treatment. In 1985, dry-heated, lyophilized factor VIII and IX concentrates became available. Genetically engineered (recombinant) factor VIII became available in 1993 and factor IX in 1998. Most recently, factor products are engineered without any human components.

In 1967, Rh immune globulin was introduced commercially, near eliminating Rh hemolytic disease of the fetus and newborn.

Blood Component Therapy

Introduction of plastic bags to replace glass bottles for collection and storage in 1950 allowed development of component therapy with use of refrigerated centrifuges to separate components by density and precollection attached satellite bags to store the prepared components. This enabled optimal storage of each component and treatment of patients only with the component they needed.