The rise and fall of heterologous transfusion.

Now a routine lifesaving treatment, blood transfusion between humans became a safe procedure only after many early therapeutic disasters. Performed between different species, heterologous transfusions actually succeeded homologous transfusions, those performed between members of the same species. In the early history of transfusion, both homologous and heterologous transfusions were performed in many clinical settings. Early clinicians were unable to distinguish between deaths caused by baseline illness and those resulting from transfusions. This report examines both early experiments with homologous transfusion between animals and later efforts investigating and finally abandoning heterologous transfusion. Topics explored include: 1) contributions and lessons learned from key individuals, 2) how these researchers suggested, performed, advocated, or challenged the practice of heterologous transfusion, and 3) why heterologous transfusions were even considered as a mode of therapy.

Erythroblastosis fetalis--the discovery and partial elimination of rhesus incompatibility--the origins of exchange transfusion in Australia.

The first 2 exchange transfusions in Australia for Rhesus-induced erythroblastosis (hemolytic disease of the newborn) were conducted in the 9 mth period from December 1945 to August 1946. These pioneering endeavours in medical research were undertaken by 3 transfusionists who were, or had been, directors of the Red Cross Blood Transfusion Service in Australia. Called "substitution transfusion" or "exsanguination transfusion" they were conducted prior to the international publication of the first case series of exchange transfusions for "Rhesus Disease". The first successful exchange transfusion in Australia, and one of the first in the world, was performed by Dr George Kelsall at the King Edward Memorial Hospital for Women, in Perth. Dr Kelsall had monitored pregnancies with serum raised himself from blood from a Rhesus monkey in the Perth Zoo. The second exchange transfusion, and the first with volume-monitoring, was successfully undertaken in Brisbane by Dr Eric Shaw, pathologist and Director of the Queensland Red Cross Blood Transfusion Service, and Dr Noel Gutteridge, a former Director and senior pathologist of Brisbane. Dr Kelsall's pioneering transfusion in Perth was a direct non-anticoagulated transfusion which was undertaken within minutes of birth and was completed within 5 min. The first volume-controlled exchange transfusion, in which the input-discard volumes were matched, used a plastic tube obtained from the Telephone Branch of the Postmaster General's Department, and employed citrated blood. These heroic exchanges (heroic for the infants and families concerned as well as for the operators) form a significant milestone in the history of blood transfusion, serology and preventive medicine in Australia.

Dr. James A. Wolff. I. Early progress in treatment of Rh hemolytic disease.

Dr. James Wolff's interest in hematology began while he was assigned on the transfusion service in a field hospital in the European Theatre during World War II. His interest was increased during his pediatric residency at the Boston Children's Hospital (1945-1947). At that time, Dr. Louis Diamond was involved in his important studies on treatment of erythroblastosis fetalis by exchange transfusion. Drs. Farber and Diamond were also involved with the initial clinical trials of aminopterin for the treatment of acute leukemia. The concept of treating erythroblastosis fetalis by exchange transfusion grew from our understanding of the pathophysiology of this disease, as first explained by Philip Levine and Alexander Wiener. Three techniques of exchange transfusion were tried. Diamond's umbilical catheter technique, because of its relative ease and simplicity and because it could be used for multiple exchanges, soon became the accepted method for treating infants with erythroblastosis fetalis.