If you want to
donate blood you have to have some basic requirements:
·
Be at least 18 years of age; upper age 60 years.
·
Weight at least 47 kg for male and 45 kg for female.
·
Blood pressure & pulse, body temperature would be
normal.
·
Be in generally good health and feeling well
·
Skin: the venipuncture site should be free of any
lesion or scar of needle pricks indicative of addiction to
narcotics or frequent blood donations as in the case of
professional blood donors.
·
Be free from any blood bearing diseases malaria,
syphilis, gonorrhea, hepatitis B, C, AIDS, skin diseases,
Rheumatic fever, abnormal blood losing tendency like hemophilia.
·
Last date of donation is of four months back.
·
For female who are not pregnant and are not in
menstruation.
1.
one can donate a bag of whole blood after every four
months
2.
each time 340 to 400 ml of blood is collected which is 1/20
of total blood. For platelet amount of collection is max 450 ml.
3.
it takes only 6 to 10 minutes for donation
4.
it is only ‘your will’ to donate blood.
Who should not donate blood?
The most
important thing to always remember is that by accepting your blood
there is no risk of us either harming you or the patients who
potentially receives your blood. You should not donate blood if
·
You have already given blood in last 12 weeks (normally you
should wait 16 weeks)
·
You have a chesty cough, sore throat or active cold
sore (the end of a cold is ok)
·
You are currently taking antibiotics or you have
just finished a course within the last seven days.
·
You have had hepatitis or jaundice in the last 12 months
like wise any body piercing or tattoos or you have
received a blood transfusion yourself.
·
If you are pregnant or you are a woman who have had a
baby in the last 9 month.
You
should never give blood if
·
You carry the hepatitis-B virus, the hepatitis-C
virus or HIV virus.
·
You are a man who’s had sex with another man, even
safe sex using condom.
·
You’ve ever workd as a prostitute
·
You’ve ever injected yourself with drugs even once.
You
should not give blood for 12 months after sex with:
·
A man has had sex with another man (if you are a
female)
·
A prostitute
·
Anyone who has ever injected themselves with drugs
·
Anyone with hemophilia or a related blood clotting
disorder
·
Anyone of any race who has been sexually active in Africa (apart
from Morocco, Algeria, Libya, Tunisia or Egypt) in
the past years. The main route of HIV infection in Africa is
through heterosexual sex.
In developed countries whole blood is rarely used in this days.
They separated the blood components and give different patients.
But in our country more than 95% transfusion is whole blood
transfusion. Although cell separator machines are now available in
few blood centers, it is still too costly for poor patients.
One of the keys to a good
blood transfusion is starting with good Blood. There is a massive
effort to make sure that “the blood supply is safe that it has
been”. There are three types of blood donors…
a) Voluntary blood donors: As a rule, a great percentage of better
quality blood comes from volunteer donors. There should be more
and more massive effort to recruit this class of donors.
Volunteer’s donors are very important because the incidence of
blood-transmitted diseases is much less in blood drawn from
volunteers.
b) Replacement donors: Blood donors who donate their blood as a
replacement for their own blood or that of a friend/ relative are
called replacement donors.
C) Professional blood donors: Blood donors who get either monetary
benefits or helps of various other kinds in return for the blood
that they donate. Such donors are statically more likely to carry
infection. There blood is more likely to be a lower standard, as
they tend to donate more frequently
What is Apheresis?
Aphaeresis, an
increasingly common procedure, is the process of removing a
specific component of the blood, such as platelets, and returning
the remaining components, such as red blood cells and plasma, to
the donor. This process allows more of one particular part of the
blood to be collected than could be separated from a unit of whole
blood. Aphaeresis is also performed to collect red blood cells,
plasma (liquid part of the blood), and granulocytes (white blood
cells).
The aphaeresis donation procedure takes longer than that for whole
blood donation. A whole blood donation takes about 5–10 minutes to
collect the blood, while an aphaeresis donation may take about one
to two hours.
What tests are performed on donated blood?
After blood has been
drawn, it is tested for ABO group (blood type) and Rh type
(positive or negative), as well as for any unexpected red blood
cell antibodies that may cause problems in a recipient. Screening
tests also are performed for evidence of donor infection with
hepatitis B and C viruses, human immunodeficiency viruses HIV. The
specific tests currently performed are listed below:
• Hepatitis B surface antigen (HBsAg)
• Hepatitis B core antibody (anti-HBc)
• Hepatitis C virus antibody (anti-HCV)
• HIV antibody (anti-HIV)
• Tests for STDs
• Test for Malarial Parasite.
How is blood stored and used?
Each unit of whole blood normally is separated into several components.
Red blood cells may be stored under refrigeration for a
maximum of 42 days, or they may be frozen for up to 10 years. Red cells carry
oxygen and are used to treat anemia. Platelets are important
in the control of bleeding and are generally used in patients with leukemia and
other forms of cancer. Platelets are stored at room temperature and may be kept
for a maximum of five days. Fresh frozen plasma, used to
control bleeding due to low levels of some clotting factors, is kept in a
frozen state for usually up to one year. Cryoprecipitated AHF,
which contains only a few specific clotting factors, is made from fresh frozen
plasma and may be stored frozen for up to one year. Granulocytes are sometimes used to fight infections, although
their efficacy is not well established. They must be transfused within 24 hours
of donation.
Other products manufactured from blood include albumin, immuno
globulin, specific immune globulins, and clotting factor concentrates.
Commercial manufacturers commonly produce these blood products.
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BLOOD COMPONENTS
Background
Blood may be transfused as whole blood or as one of its
components. Because patients seldom require all of the components
of whole blood, it makes sense to transfuse only that portion
needed by the patient for a specific condition or disease. This
treatment, referred to as “blood component therapy,” allows
several patients to benefit from one unit of donated whole blood.
Blood components include red blood cells, plasma, platelets, and
cryoprecipitate antihemophilic factor (AHF). Up to four components
may be derived from one unit of blood. Unfortunately in our
country Blood component therapy is rare and more than 90 percent
transfusion is of whole blood. And for this our requirement of
whole blood is higher.
Whole blood is a living tissue that circulates through the heart,
arteries, veins, and capillaries carrying nourishment,
electrolytes, hormones, vitamins, antibodies, heat, and oxygen to
the body's tissues. Whole blood contains red blood cells, white
blood cells, and platelets suspended in a fluid called plasma.
If blood is treated to prevent clotting and permitted to stand
in a container, the red blood cells, which weigh more than the
other components, will settle to the bottom; the plasma will stay
on top; and the white blood cells and platelets will remain suspended
between the plasma and the red blood cells. A centrifuge may be
used to hasten this separation process. The platelet-rich plasma
is then removed and placed into a sterile bag, and it can be used
to prepare platelets and plasma or cryoprecipitated AHF. To obtain
platelets, the platelet-rich plasma is centrifuged, causing the
platelets to settle at the bottom of the bag. Plasma and platelets
are then separated and made available for transfusion. The plasma
also may be pooled with plasma from other donors and further processed,
or fractionated, to provide purified plasma proteins such as albumin,
immunoglobulin (IVIG), and clotting factors.
Red blood
cells are perhaps the most
recognizable component of whole blood. Red blood cells contain
hemoglobin, a complex iron-containing protein that carries oxygen
throughout the body and gives blood its red color. The percentage
of blood volume composed of red blood cells is called the “hematocrit.”
The average hematocrit in an adult male is 47 percent. There are
about one billion red blood cells in two to three drops of blood,
and, for every 600 red blood cells, there are about 40 platelets
and one white cell. Manufactured in the bone marrow, red blood
cells are continuously being produced and broken down. They live
for approximately 120 days in the circulatory system and are eventually
removed by the spleen.
Red blood cells are prepared from whole blood by removing the
plasma, or the liquid portion of the blood. They can raise the
patient's hematocrit and hemoglobin levels while minimizing an
increase in volume.
Patients who benefit most from transfusions of red blood cells
include those with chronic anemia resulting from disorders such
as kidney failure, malignancy, or gastrointestinal bleeding and
those with acute blood loss resulting from trauma or surgery.
Since red blood cells have reduced amounts of plasma, they are
well suited for treating anemia patients who have congestive heart
failure or who are elderly or debilitated; these patients might
not tolerate the increased volume provided by whole blood.
Improvements in cell preservative solutions over the last 15
years have increased the shelf life of red blood cells from 21
to 42 days. Red blood cells may be treated and frozen for extended
storage (up to 10 years).
Plasma
is the liquid portion of the
blood — a protein-salt solution in which red and white blood
cells and platelets are suspended. Plasma, which is 90 percent
water, constitutes about 55 percent of blood volume. Plasma contains
albumin (the chief protein constituent), fibrinogen
(responsible, in part, for the clotting of blood), globulins
(including antibodies), and other clotting proteins.
Plasma serves a variety of functions, from maintaining a satisfactory
blood pressure and volume to supplying critical proteins for blood
clotting and immunity. It also serves as the medium of exchange
for vital minerals such as sodium and potassium, thus helping
maintain a proper balance in the body, which is critical to cell
function. Plasma is obtained by separating the liquid portion
of blood from the cells. Plasma is usually not used for transfusion
purpose but is fractionated (separated) into specific products
such as albumin, specific clotting factor concentrates and IVIG
(intravenous immune globulin).
Fresh frozen plasma is plasma frozen within hours after donation
in order to preserve clotting factors, stored for one to seven
years, and thawed before it is transfused. It is most often used
to treat certain bleeding disorders, when a clotting factor or
multiple factors are deficient and no factor-specific concentrate
is available. It also can be used for plasma replacement via a
process called plasma exchange.
Cryoprecipitated AHF
is the portion
of plasma that is rich in certain clotting factors, including
Factor VIII, fibrinogen, von Willebrand factor, and Factor XIII.
Cryoprecipitated AHF is removed from plasma by freezing and then
slowly thawing the plasma. It is used to prevent or control bleeding
in individuals with hemophilia and von Willebrand’s disease,
which are common, inherited major coagulation abnormalities. Its
use in these conditions is reserved for times when viral-inactivated
concentrates containing Factor VIII and von Willebrand factor
are unavailable and plasma components must be used. It may also
be used as hemostatic preparation [fibrin sealant or fibrin glue]
in surgery.
Platelets
(or
thrombocytes) are very
small cellular components of blood that help the clotting process
by sticking to the lining of blood vessels. Platelets are made
in the bone marrow and survive in the circulatory system for an
average of 9–10 days before being removed from the body
by the spleen. The platelet is vital to life, because it helps
prevent massive blood loss resulting from trauma, as well as blood
vessel leakage that would otherwise occur in the course of normal,
day-to-day activity. Units of platelets are prepared by using
a centrifuge to separate the platelet-rich plasma from the donated
unit of whole blood. The platelet-rich plasma is then centrifuged
again to concentrate the platelets further.
Platelets also may be obtained from a donor by a process known
as apheresis, or plateletpheresis. In this process, blood is drawn
from the donor into an apheresis instrument, which, using centrifugation,
separates the blood into its components, retains the platelets,
and returns the remainder of the blood to the donor. The resulting
component contains about six times as many platelets as a unit
of platelets obtained from whole blood. Platelets are used to
treat a condition called thrombocytopenia, in which there is a
shortage of platelets, and in patients with abnormal platelet
function. Platelets are stored at room temperature for up to five
days.
White blood cells
are responsible
for protecting the body from invasion by foreign substances such
as bacteria, fungi, and viruses. The majority of white blood cells
are produced in the bone marrow, where they outnumber red blood
cells by two to one. However, in the blood stream, there are about
600 red blood cells for every white blood cell. There are several
types of white blood cells; Granulocytes and macrophages protect
against infection by surrounding and destroying invading bacteria
and viruses, and lymphocytes aid in immune defense.
Granulocytes can be collected by apheresis or by centrifugation
of whole blood. They are transfused within 24 hours after collection
and are used for infections that are unresponsive to antibiotic
therapy. The effectiveness of white blood cell transfusion is
still being investigated.
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TESTING OF DONOR BLOOD FOR INFECTIOUS
DISEASE
Hepatitis B Surface Antigen
(HBsAg)
The hepatitis B virus, which mainly infects the liver, has an
inner core and an outer envelope (the surface). The HBsAg test
detects the outer envelope, identifying an individual infected
with the hepatitis B virus. Hepatitis B can cause inflammation
of the liver, and in the earliest stage of the disease, infected
people may feel ill or even have yellow discoloration of the skin
or eyes, a condition known as jaundice.
Fortunately, most patients recover completely and test negative
for HBsAg within a few months after the illness. A small percentage
of people become chronic carriers of the virus, and in these cases,
the test may remain positive for years. Chronically infected people
can develop severe liver disease as time passes, and need to be
followed carefully by an experienced doctor.
Antibodies to the Hepatitis B Core
(Anti-HBc)
The anti-HBc test detects an antibody to the hepatitis B virus
that is produced during and after infection. If an individual
has a positive anti-HBc test, but the HBsAg test is negative,
it may mean that the person once had hepatitis B, but has recovered
from the infection. Of the individuals with a positive test for
anti-HBc, many have not been exposed to the hepatitis B virus.
This kind of test result is called a false positive,
and although the individual may be permanently deferred from donating
blood, it is unlikely that the person’s health will be negatively
affected. (Note: This antibody is not produced following vaccination
against hepatitis B. Hepatitis B vaccination, by itself, will
rarely cause the HbsAg test to be positive for a few days after
the shots.)
Antibodies to the Hepatitis C Virus
(Anti-HCV)
This test is used to screen donors for the hepatitis C virus
(HCV). It works by detecting antibodies manufactured by the body
in reaction to portions of the virus called antigens.
HCV causes inflammation of the liver, and up to 80 percent of
those exposed to the virus develop chronic infection. Eventually,
up to 20 percent of people with HCV may develop cirrhosis of the
liver or other severe liver diseases. As in other forms of hepatitis,
individuals may be infected with the virus, but may not realize
they are carriers since they do not have any symptoms. Because
of the risk of serious illness, people with HCV need to be followed
closely by a physician with experience evaluating this infection.
Antibodies to the Human Immunodeficiency Virus, Types
1 and 2 (Anti-HIV-1, -2)
This test is designed to detect antibodies directed against
antigens of the HIV-1 or HIV-2 viruses. HIV-1 is much more common
in the United States, while HIV-2 is prevalent in Western Africa.
Donors are tested for both viruses because both are transmitted
by infected blood, and a few cases of HIV-2 have been identified
in US residents. Both of these viruses can cause acquired immunodeficiency
syndrome, or AIDS.
Confirmatory Testing
All of the above tests are referred to as
screening
tests, and are designed to detect as many infections
as possible. Because these tests are so sensitive, some donors
may have a false positive result, even when the donor was never
exposed to the particular infection. In order to sort out true
infections from false positive test results, screening tests that
are reactive may be followed up with more specific tests called confirmatory tests. Thus, confirmatory
tests help determine whether a donor is truly infected.
If the test result from a donated unit of blood is abnormal
for any of these disease markers, the unit is discarded and the
donor is notified. The donor’s name is then added to a donor
deferral list and is prohibited from donating blood indefinitely.
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TRANSFUSION-TRANSMITTED DISEASES
Viruses
Hepatitis
Hepatitis was the first documented transfusion-transmitted disease.
Many of the current practices for diminishing risk in transfusion
medicine are based on the experiences of controlling the transmission
of hepatitis.
Hepatitis viruses, which infect the liver, fall primarily into
two groups: viruses with a chronic course that can readily be
transmitted by blood transfusion (hepatitis B and C) and viruses
that cause only acute disease and are rarely transmitted by transfusion
(hepatitis A and E).
Hepatitis A Virus
(HAV)
Hepatitis A (HAV) infection is rarely transmitted through blood
transfusion; it is usually spread by contaminated food and water.
A
vaccine recently developed for HAV has replaced immune globulin
as a pre-exposure prophylactic measure for people at a high risk
for acquiring this infection, although the latter remains useful
after exposure.
Hepatitis B Virus
(HBV)
Transmission of hepatitis B virus
(HBV) is rare because of routine
testing of blood for the HBsAg and hepatitis B core antibody,
donor screening and deferral for risk of HBV infection, and the
use of only altruistic volunteer blood donors. HBV is a major
cause of acute and chronic hepatitis.
Hepatitis C Virus
(HCV)
Hepatitis C, formerly known as non-A, non-B hepatitis, was discovered
in the late 1980s, and all blood donations have been screened
for it since 1990. Acute hepatitis C virus (HCV) is a relatively
mild infection, and most people are unaware they have become infected;
however, HCV becomes chronic in 80 percent of those infected.
In the general population, 1.8 percent of the population has some
evidence of HCV-infection. While the rate of new HCV infections
is falling rapidly due to behavior changes and blood screening,
HCV is an important source of serious chronic liver disease, which
often develops decades after the initial exposure to the virus.
HIV (Human Immunodeficiency Virus)
Transfusion transmission of HIV, the virus that causes AIDS,
has been almost completely eradicated, since blood banks began
interviewing donors about at-risk behaviors and a blood test became
available in early 1985. The HIV antibody tests, used on every
blood donation since then, have undergone continuous improvement.
Transfusion medicine
specialists are continually researching new technologies to further
reduce the transmission of HIV. Examples of technologies on the
horizon include methods to kill viruses in donated blood (called
viral inactivation) and blood component substitutes.
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Blood groups
Blood transfusions
were first attempted around 1600 by transferring animal blood into
human. It proved disastrous. In the early 1800s, an English
obstetrician, James Blundell came up with the idea of human blood
for human beings. But unto early 1900s, the result just depends on
the fate…
In 1901 Karl Land Steiner discovered that when the blood of one
human being was transfused with that of another human being
differences in their blood might be the cause of shock, jaundice
and the blood disorder hemoglobinuria that had resulted through
earlier blood transfusions.
Land Steiner classified human blood into A,B and O groups and
demonstrated that transfusions between humans of the group A or B
did not result in the destruction of new blood cells and that this
catastrophe occurred only when a person was transfused with the
blood of a person belonging at a different group. A. Decastrello
and A. Struli found a fourth main blood type AB in 1902.
The Rh blood group system was discovered in 1939&40 by Karl Land
Steiner, Alex Wiener, Philip Levine and R. E. Stetson. By this
time many other minor groups were discovered.
Blood has major and minor grouping. Major grouping is ABO/Rh
grouping. Simply think your blood is tested for ABO/Rh. These
tests identify your blood type. You may have A, B, O, or AB types
blood and may be Rh positive or negative. This basis of the blood
group tests is the presence of specific substances or antigens on
the surface of red blood cells. If only A antigen is present you
are of A type. If only B antigen is present you are of B type. If
both are present you are AB type. If neither is present you are O
type. At the same time, if major Rh antigen is present you are Rh+,
for example O+, A+, B+, AB+, if not then you are Rh-, such as A-,
B-, AB-, O-
There are more than 600 other antigens that have been identified
on red blood cells. These subtypes are important but often not
considered. And for this minor antigen Cross Matching is done
before transfusion….
• 17% of global population in developed countries benefits from
approximately 60% of the 75 million units of blood donated each
year in the world.
• 83% of the global population living in developing countries has
access to 40 % of the blood supply and this blood is collected in
60% cases from paid or replacement donors rather than from
voluntary non remunerated low risk blood donors. More over it is
not tested for transfusion- transmissible infection in more than
43% cases. Avoiding the transfusion of infection by blood & blood
product is other major safety issue. It is conservatively
estimated that approximately 5% of HIV infections worldwide are
transmitted through the transfusion of contaminated blood & blood
products.
Top uses of blood:
1)
Straight in general surgery ~23%
2)
General medical ~15%
3)
Cardio thoracic ~13%
4)
Orthopedics ~11%
5)
Hematology ~9%
6)
Accident and Emergency ~8%
7)
Kidney, Neonatal & Pediatrics ~6%
8)
Intensive care ~4%
9)
Obstetrics& gynecology ~3.5%
10)
Others ~7.5%
The theory of
evolution:
Oh, yes! One more thing about blood
grouping, an interesting subject of evolution. Many published
studies over recent years have shown that Chimpanzees mostly have
blood type A, almost no blood type O, but never blood type B. the
other great Ape, the Gorilla most have blood type B, almost no
blood type O but never blood type A. in this “man-apes” species
said to be the ancestors of man, theirs no blood type AB in
either. Generally speaking, man has both blood type A, B and AB, O
in man by far the most common in virtually every racial group.
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Fresh and Safe Blood
Fresh blood means
blood collected not before than 12 hours. It's better to transfuse
blood as early as possible after collection. However it takes one
to several hours to make some necessary examinations, which are
prerequisite for transfusion. It's better to use fresh blood for
all kind of operations and other requiring situations. For
performing Heart surgery, kidney dialysis, cesarean operation,
Fresh blood is a must. For Dengue patients, Thalassemea patient,
patients with hemophilia must use fresh blood. Now a day in our
country fresh Blood is more preferable in all cases to stored
Blood. According to medical personnel fresh blood is much better
in all cases than stored blood. This is why Badhan is working for
fresh blood only.
Safe Blood is the
one that doesn’t harm the receiver and the donor as well, is free
from infective agents or other harmful agents. In a general sense
blood from a person bearing sound health having no
infection/infectious deceases that have ideal percentage of blood
components may be considered as safe blood. All blood is tested
before transfusion for infective agents.
So fresh and safe
blood is the one that is fresh as safe.
On the contrary,
if a blood donor has any infective agents in his blood if he/she
is a drug abuser/sex abuser, his blood might not be safe and
dangerous for recipient.
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Blood facts in general
• There is no
substitute for human blood.
• Blood makes up about 7% of your body’s weight
• An average adult has about 6-8 liters of blood.
• Blood carries oxygen and nutrients to all cells of the body.
• Blood carries carbon dioxide and other waste products back to
the lungs, kidney and liver for disposal.
• Blood fights against infection and helps healing wounds.
• There are four main blood types A, B, AB, O.
• Each blood type is either Rh positive or negative
• The three main types of cells making up our blood are white
blood cells, red blood cells and platelets. • There are about one
billion red blood cells in a few drops of whole blood,
• Red blood cells live about 120 days in our bodies,
• Red blood cells can be stored under normal conditions for up to
42 days.
• Frozen red blood cells can be stored for ten years and more.
• Platelets must be used within five days.
• Platelets are small blood cells that assist in the process of
blood clotting helping these with Leukemia and other cancer
controlling bleeding.
• Plasma, the fourth major component of blood is a sticky, pale
yellow fluid mixture of water, proteins and salts. It is 95%
water. The other 5% is made up of nutrients, proteins and
hormones.
• Blood plasma constitutes 55% of the volume of human blood.
• Plasma helps maintain blood pressure carries blood cells,
nutrients, enzymes and hormones
And supplies critical blood proteins for blood clotting and
immunity.
• Type AB plasma has been considered as the universal blood plasma
type and therefore AB plasma is given to patients with any blood
type.
• Frozen plasma can be stored for up to one year.
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HIGHLIGHTS OF TRANSFUSION MEDICINE
HISTORY
1628
English physician William Harvey discovers
the circulation of blood. Shortly afterward, the earliest known
blood transfusion is attempted.
1665 The first recorded successful blood transfusion
occurs in England: Physician Richard Lower keeps dogs alive by
transfusion of blood from other dogs.
1667 Jean-Baptiste Denis in France and Richard
Lower in England separately report successful transfusions from
lambs to humans. Within 10 years, transfusing the blood of animals
to humans becomes prohibited by law because of reactions.
1795 In Philadelphia, American physician Philip
Syng Physick, performs the first human blood transfusion, although
he does not publish this information.
1818 James
Blundell, a British obstetrician,
performs the first successful transfusion of human blood to a
patient for the treatment of postpartum hemorrhage. Using the
patient's husband as a donor, he extracts approximately four ounces
of blood from the husband's arm and, using a syringe, successfully
transfuses the wife. Between 1825 and 1830, he performs 10 transfusions,
five of which prove beneficial to his patients, and publishes
these results. He also devises various instruments for performing
transfusions and proposed rational indications.
1840 At St. George's School in London, Samuel
Armstrong Lane, aided by consultant Dr. Blundell, performs the
first successful whole blood transfusion to treat hemophilia.
1867 English surgeon Joseph Lister uses antiseptics
to control infection during transfusions.
1873-1880 US physicians transfuse milk (from
cows, goats, and humans).
1884 Saline infusion replaces milk as a “blood
substitute” due to the increased frequency of adverse reactions
to milk.
1900 Karl
Landsteiner, an Austrian physician,
discovers the first three human blood groups, A, B, and C. Blood
type C was later changed to O. His colleagues Alfred Decastello
and Adriano Sturli add AB, the fourth type, in 1902. Landsteiner
receives the Nobel Prize for Medicine for this discovery in 1930.
1907 Hektoen suggests that the safety of transfusion
might be improved by crossmatching blood between donors and patients
to exclude incompatible mixtures. Reuben Ottenberg performs the
first blood transfusion using blood typing and crossmatching in
New York. Ottenberg also observed the mendelian inheritance of
blood groups and recognized the “universal” utility
of group O donors.
1908 French surgeon Alexis Carrel devises a
way to prevent clotting by sewing the vein of the recipient directly
to the artery of the donor. This vein-to-vein or direct method,
known as anastomosis, is practiced by a number of physicians,
among them J.B. Murphy in Chicago and George Crile in Cleveland.
The procedure proves unfeasible for blood transfusions, but paves
the way for successful organ transplantation, for which Carrel
receives the Nobel Prize in 1912.
1908 Moreschi describes the antiglobulin reaction.
The antiglobulin is a direct way of visualizing an antigen-antibody
reaction that has taken place but is not directly visible. The
antigen and antibody react with each other, then, after washing
to remove any unbound antibody, the antiglobulin reagent is added
and binds between the antibody molecules that are stuck onto the
antigen. This makes the complex big enough to see.
1912 Roger Lee, a visiting physician at the
Massachusetts General Hospital, along with Paul Dudley White,
develops the Lee-White clotting time. Adding another important
discovery to the growing body of knowledge of transfusion medicine,
Lee demonstrates that it is safe to give group O blood to patients
of any blood group, and that blood from all groups can be given
to group AB patients. The terms "universal donor" and
"universal recipient" are coined.
1914 Long-term anticoagulants, among them sodium
citrate, are developed, allowing longer preservation of blood.
1915 At Mt. Sinai Hospital in New York, Richard
Lewisohn uses sodium citrate as an anticoagulant to transform
the transfusion procedure from direct to indirect. In addition,
Richard Weil demonstrates the feasibility of refrigerated storage
of such anticoagulated blood. Although this is a great advance
in transfusion medicine, it takes 10 years for sodium citrate
use to be accepted.
1916 Francis Rous and J.R.Turner introduce
a citrate-glucose solution that permits storage of blood for several
days after collection. Allowing for blood to be stored in containers
for later transfusion aids the transition from the vein-to-vein
method to indirect transfusion. This discovery also allows for
the establishment of the first blood depot by the British during
World War I. Oswald Robertson, an American Army officer, is credited
with creating the blood depots.
1927-1947 The MNSs and P systems are discovered.
MNSs and P are two more blood group antigen systems — just
as ABO is one system and Rh is another.
1932 The first blood bank is established in
a Leningrad hospital.
1939/40 The Rh blood group system is discovered
by Karl Landsteiner, Alex Wiener, Philip Levine, and R.E. Stetson
and is soon recognized as the cause of the majority of transfusion
reactions. Identification of the Rh factor takes its place next
to the discovery of ABO as one of the most important breakthroughs
in the field of blood banking.
1940 Edwin Cohn, a professor of biological
chemistry at Harvard Medical School, develops cold ethanol fractionation,
the process of breaking down plasma into components and products.
Albumin, a protein with powerful osmotic properties, plus gamma
globulin and fibrinogen are isolated and become available for
clinical use. John Elliott develops the first blood container,
a vacuum bottle extensively used by the Red Cross.
1943 The introduction by
J.F. Loutit and Patrick
L. Mollison of acid citrate dextrose (ACD) solution, which reduces
the volume of anticoagulant, permits transfusions of greater volumes
of blood and permits longer term storage.
1943 P. Beeson publishes the classic description
of transfusion-transmitted hepatitis.
1945 Coombs,
Mourant, and Race describe the
use of antihuman globulin (later known as the “Coombs Test”)
to identify “incomplete” antibodies.
1950 In one of the single most influential
technical developments in blood banking, Carl Walter and W.P.
Murphy, Jr., introduce the plastic bag for blood collection. Replacing
breakable glass bottles with durable plastic bags allows for the
evolution of a collection system capable of safe and easy preparation
of multiple blood components from a single unit of whole blood.
Development of the refrigerated centrifuge in 1953 further expedites
blood component therapy
1959 Max Perutz of Cambridge University deciphers
the molecular structure of hemoglobin, the molecule that transports
oxygen and gives red blood cells their color.
1960 The AABB begins publication of
TRANSFUSION,
the first American journal wholly devoted to the science of blood
banking and transfusion technology. In this same year, A. Solomon
and J.L. Fahey report the first therapeutic plasmapheresis procedure
— a procedure that separates whole blood into plasma and
red blood cells.
1961 The role of platelet concentrates in reducing
mortality from hemorrhage in cancer patients is recognized.
1962 The first antihemophilic factor
(AHF)
concentrate to treat coagulation disorders in hemophilia patients
is developed through fractionation.
1964 Plasmapheresis is introduced as a means
of collecting plasma for fractionation.
1965 Judith G. Pool and Angela E. Shannon report a method for
producing Cryoprecipitated AHF for treatment of hemophilia.
1967 Rh immune globulin is commercially introduced
to prevent Rh disease in the newborns of Rh-negative women.
1969 S. Murphy and F. Gardner demonstrate the
feasibility of storing Platelets at room temperature, revolutionizing
platelet transfusion therapy.
1970 Blood banks move toward an all-volunteer
blood donor system.
1971 Hepatitis B surface antigen
(HBsAg) testing
of donated blood begins.
1972 Apheresis is used to extract one cellular
component, returning the rest of the blood to the donor.
1979 A new anticoagulant preservative, CPDA-1,
extends the shelf life of whole blood and red blood cells to 35
days, increasing the blood supply and facilitating resource sharing
among blood banks.
Early 1980s With the growth of component therapy,
products for coagulation disorders, and plasma exchange for the
treatment of autoimmune disorders, hospital and community blood
banks enter the era of transfusion medicine, in which doctors
trained specifically in blood transfusion actively participate
in patient care.
1981 First Acquired Immune Deficiency Syndrome
(AIDS) case reported.
1983 Additive solutions extend the shelf life
of red blood cells to 42 days.
1984 Human Immunodeficiency Virus (HIV) identified
as cause of AIDS
1985 The first blood-screening test to detect
HIV is licensed and quickly implemented by blood banks to protect
the blood supply.
1987 Two tests that screen for indirect evidence
of hepatitis are developed and implemented, hepatitis B core antibody
(anti-HBc) and the alanine aminotransferase test (ALT).
1989
Human-T-Lymphotropic-Virus-I-antibody (anti-HTLV-I) testing of donated blood begins.
1990 Introduction of first specific test for
hepatitis C, the major cause of “non-A, non-B” hepatitis.
1992 Testing of donor blood for HIV-1 and HIV-2
antibodies (anti-HIV-1 and anti-HIV-2) is implemented.
1996 HIV p24 antigen testing of donated blood
begins. Although the test does not completely close the HIV window,
it shortens the window period.
1998 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.
1999 Blood community begins implementation
of Nucleic Acid Amplification Testing (NAT) under the FDA’s
Investigational New Drug (IND) application process. NAT employs
a testing technology that directly detects the genetic materials
of viruses like HCV and HIV.
2002 West Nile virus identified as transfusion
transmissible.
2002 Nucleic acid amplification test (NAT)
for HIV and HCV was licensed by the Food and Drug Administration.
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