Early Experimental History

The 17^th Century is known as a crucial era in human history, marked by a wave of global connectivity and scientific discovery. In this surge came the beginning of transfusion medicine, starting in the year 1628. In this year, anatomist and physician Dr. William Harvey, a researcher in the early mechanics of blood flow, first discovered what we now call the circulatory system. Nearly 30 years later in the year 1666, Dr. Richard Lower reported the first successful blood transfusion between animals. In Dr. Lower’s gruesome dog experiments, he would nearly bleed out a test subject and then transfuse blood from a different dog in order to save the recipient. The following year, the first blood transfusion in a human patient was performed by Jean Baptiste Denis, a French physician. Dr. Denis used twelve ounces of blood from a lamb to heal an ailing man.  Early exploration of blood transfusions led to frequent transfusion related reactions and deaths that occurred during the infancy of the practice.  Experiments continued but, over the ensuing 10-year period, blood transfusions in humans would become prohibited by numerous groups, including some of the largest religious and political organizations of the time.

Over a century later, the first successful transfusion of human blood to a human patient was performed in 1818 by a British obstetrician and researcher named James Blundell. As an obstetrician, Blundell often had patients die in childbirth from severe postpartum hemorrhage and he was thus determined to create a remedy through experimentation with blood transfusion. Using a patient’s husband as a donor, Blundell extracted approximately four ounces of blood from the husband’s arm and successfully transfused the wife using syringes he had invented. He went on to describe indications for blood transfusions and created various instruments to aid in the early transfusion of blood. Other advancements continued, including Samuel Armstrong Lane performing the first successful blood transfusion to treat hemophilia in 1840, and English surgeon Joseph Lister using antiseptics to control infection during transfusions in 1867. Regardless of these advancements, humanhuman blood transfusions remained hazardous and with a high mortality. When far less was understood about the science of blood, scientists and physicians even experimented with using milk or animal blood as a human blood transfusion alternative. It wasn’t until the 20^th century, over 200 years after the first transfusion in a human, that blood transfusions could safely be performed due to the advent of blood typing and crossmatching.

The Advent of Blood Typing and Crossmatching

In the year 1900, additional investigations in the realm of transfusion medicine began, starting with an Austrian physician by the name of Karl Landsteiner. Landsteiner discovered the first three human blood groups, A, B, and C. Landsteiner found that different people had different antigens, or agglutinogens, on the surface of their red blood cells (RBCs), either A agglutinogens, B agglutinogens, or no agglutinogens. Blood group C was eventually renamed as O.  A fourth blood group, named AB, was later added by Landsteiner’s colleagues Alfred Decastello and Adriano Sturli. A few short years later, in 1907, a pathologist by the name of Ludvig Hektoen at Chicago’s Institute for Infectious Diseases proposed the idea of crossmatching blood between donors and patients to exclude incompatible mixtures. Hematologist Reuben Ottenberg then performed the first blood transfusion using blood typing and crossmatching in New York. Ottenberg combined the blood of a woman (the donor) and her spouse (the recipient) and observed the mixture before then performing a successful direct donorrecipient transfusion. This novel idea allowed a more predictably safe blood transfusion and paved the way for a decreased frequency of potentially disastrous acute hemolytic reactions. Surgeons and obstetricians gradually accepted blood typing and crossmatching into their practice over the next four decades and pretransfusion serologic crossmatching was introduced in hospitals across the United States.

Understanding the history of transfusion medicine helps us have a greater appreciation for the great steps forward in the processes that we may otherwise take for granted.  It will be interesting to watch how transfusion medicine further evolves over the coming decades