The Story of Blood for Shock Resuscitation: How the Pendulum Swings.

Whole blood transfusion (WBT) began in 1667 as a treatment for mental illness, with predictably poor results. Its therapeutic utility and widespread use were initially limited by deficiencies in transfusion science and antisepsis. James Blundell, a British obstetrician, was recognized for the first allotransfusion in 1825. However, WBT did not become safe and therapeutic until the early 20th century, with the advent of reliable equipment, sterilization, and blood typing. The discovery of citrate preservation in World War I allowed a separation of donor from recipient and introduced the practice of blood banking. During World War II, Elliott and Strumia were the first to separate whole blood into blood component therapy (BCT), producing dried plasma as a resuscitative product for "traumatic shock." During the 1970s, infectious disease, blood fractionation, and financial opportunities further drove the change from WBT to BCT, with few supporting data. Following a period of high-volume crystalloid and BCT resuscitation well into the early 2000s, measures to avoid the resulting iatrogenic resuscitation injury were developed under the concept of damage control resuscitation. Modern transfusion strategies for hemorrhagic shock target balanced BCT to reapproximate whole blood. Contemporary research has expanded the role of WBT to therapy for the acute coagulopathy of trauma and the damaged endothelium. Many US trauma centers are now using WBT as a front-line treatment in tandem with BCT for patients suffering hemorrhagic shock. Looking ahead, it is likely that WBT will once again be the resuscitative fluid of choice for patients in hemorrhagic shock.

Karl Landsteiner: The Discovery of the ABO Blood Group System and its Value for Teaching Medical Students.

With his discovery of the ABO blood group system, Karl Landsteiner laid the foundation for modern day transfusion medicine. This discovery represents the basic knowledge for every blood transfusion. In recent years, certain blood groups have been linked to an increased risk for certain diseases. Hence, teaching the blood group serology is a relevant issue in medical education. In this review, we report about the history of the discovery of the blood groups by Landsteiner, the link of different blood groups to certain diseases and our experiences regarding teaching to medical students.

Blood transfusion; additional historical aspects. Part 1. The birth of transfusion immunology.

The decades around the turn of the 19th into the 20th centuries covered a seminal period in the history of transfusion medicine as there was an increasing appreciation of a potential role in the management of surgical and obstetric bleeding, and also in severe non-surgical anaemias. The main obstacles to transfusing human blood were first the occasional devastating adverse reactions due, we now know, to ABO blood group incompatibility; and second the awkward propensity of shed blood to clot. This article describes in more detail how the pioneers in human transfusion immunology in the late 19th century and early 20th century learnt to recognise and avoid ABO incompatibility, and includes some hitherto obscure and rarely cited material. A companion article (Boulton, 2013, Submitted for publication) describes early attempts to find suitable anticoagulants.

The original blood group pioneers: the Hirszfelds.

Ludwik Hirszfeld, together with his wife Hanka, was the first to study the blood groups in large numbers of subjects (soldiers) during World War I at the Macedonian front. They found significant differences in the distribution of the ABO blood groups, that is, type A was more common in soldiers from North Central Europe, whereas type B was more common in those from Eastern Europe. Their data were later (in the 1920s and 1930s) misused by German nationalists to support the concept of Aryan supremacy. The Hirszfelds also discovered Salmonella paratyphi C, now known as Salmonella hirzfeldi. Their landmark studies drew others to this new field of seroanthropology, most notably Arthur Mourant, as well as Robin Race and Ruth Sanger, who wrote "Blood Groups in Man" detailing the antigenic differences among various peoples.

[Karl Landsteiner discovers the blood groups]. / Karl Landsteiner découvre les groupes sanguins.

The discovery of ABO blood group was a major step in mastering transfusion therapy. Karl Landsteiner (1868-1843) was the author of this discovery. This paper retraces the hard career of this American scientist of Austrian origin, and describes the circumstances that led his research to the discoveries, which were turning points in the history of the immunology.

Historical perspectives in critical care medicine: blood transfusion, intravenous fluids, inotropes/vasopressors, and antibiotics.

Significant progress in critical care medicine has been the result of tireless observation, dedicated research, and well-timed serendipity. This article provides a historical perspective for four meaningful therapies in critical care medicine: blood transfusion, fluid resuscitation, vasopressor/inotropic support, and antibiotics. For each therapy, key discoveries and events that have shaped medical history and helped define current practice are discussed. Prominent medical and social pressures that have catalyzed research and innovation in each domain are also addressed, as well as current and future challenges.

Alexander S. Wiener: the man and his work.

To mark the 100th anniversary of the birth of Alexander Solomon Wiener, a lecture was presented before the 2007 Wiener Award winner's talk at the New York Blood Center. This article is based on that talk. Dr Wiener was very committed to his career and very devoted to his family, and living family members remember him with fondness. He had numerous personal and professional interests. He used his knowledge of blood groups in forensics, parentage studies, testing and monitoring mothers, and treating their babies for erythroblastosis fetalis (now known as hemolytic disease of the fetus and newborn). Dr Wiener's method for exchange transfusion was highly efficient. He appreciated the value of collecting plasma from women whose babies had hemolytic disease and making reagents with it. Indeed, the US National Institutes of Health license he obtained for this function was one before that obtained by ortho diagnostics. He was a stickler for doing tests correctly and insisted on the use of appropriate controls. Toward the end of his career, Dr Wiener became obsessed by the terminology for antigens in the Rh blood group system, but that should not distract from his contributions.

'Incongruous juxtapositions': the chimaera and Mrs McK.

A century ago, the German botanist Hans Winkler (best known for coining the term 'genome') accomplished two novel transplantations. First, he produced a single plant that grafted together two completely disparate species: tomato and nightshade. Second, he chose the descriptive word 'chimaera' to name his innovation, transplanting the term from mythology to biology. This paper features Mrs McK, the first human chimera, and thus follows the term from botany to clinical medicine. Her remarkable story, pieced together from the notes, drafts and correspondence of Robert Race and his colleagues at the MRC Blood Group Unit, draws attention to the significance of names and naming.

Blood group antibodies and their significance in transfusion medicine.

The discovery of almost universally present naturally occurring antibodies in blood plasma led to the discovery of the ABO blood group system which remains, more than 100 years later, the most important and clinically significant of all blood groups. Blood group antibodies play an important role in transfusion medicine, both in relation to the practice of blood transfusion and in pregnancy, but not all are clinically significant. Clinically significant antibodies are capable of causing adverse events following transfusion, ranging from mild to severe, and of causing hemolytic disease of the fetus and newborn following placental transfer from mother to fetus. Assessing the clinical significance of antibodies relies heavily on mode of reactivity and historical data relating to specificity; functional assays are sometimes employed. The principals of methodology for blood typing and antibody identification have changed little over the years, relying mainly on serological methods involving red cell agglutination. The recent advent of blood typing using DNA technology, although still in relative infancy, will surely eventually supersede serology. However, deciding on the clinical significance of an antibody when compatible blood is not immediately available is likely to remain as one of the most common dilemmas facing transfusion practitioners.

Nail patella syndrome revisited: 50 years after linkage.

Nail Patella Syndrome (NPS; OMIM #161200) is a pleiotropic condition, with a classical clinical tetrad of involvement of the nails, knees, elbows and the presence of iliac horns. Kidney disease and glaucoma are now recognised as part of the syndrome. Fifty years ago, James Renwick chose NPS to develop methods of linkage analysis in humans and revealed the third linkage group identified in man--that between NPS and the ABO blood group loci. After a fallow period of some forty years, the gene mutated in NPS has been identified (LMX1B) and the condition serves as a model for understanding the complex relationships between disease loci, modifier genes and the resultant clinical phenotype.