The belief that human blood has rejuvenating property is as old as civilization. Blood was regarded as a fluid of infinite complexity, the very essence of life. The blood of each person seemed to carry in it the secrets of individuality. The idea of blood transfusion appeared in the 15th and 16th century with the belief that it has also life saving properties. With this idea in mind Pope Innocent VIII was given blood from three unfortunate young persons in 1542, probably to drink as they had no knowledge about circulation of blood in the human body. Unfortunately, all four of them died. The theory of circulation of blood in the human body was established by William Harvey in 1628. The first documented experimental blood transfusion in dog was performed by Richard Lower in the middle of 17th century.

After having knowledge of circulatory systems in human body Dr Jean Denys in 1704 tried to transfuse animal blood into human being. The person died due to haemolytic transfusion reaction. Although the person died, yet Deny’s account of the case is the first classical clinical description of haemolytic transfusion reaction. Denys was accused of murder and no one further attempted any experiment on blood transfusion for a long time. In the 18th and early 19th century (1790- 1877) it was Dr James Blundell who along with Dr Leacock concluded after several experiments that only human blood can be used for transfusion into human being. Blundell performed about ten transfusions on women dying of post partum haemorrhage. Blood was given directly from donor to recipient with a special syringe as anticoagulant preservative solution as well as storage facilities were not in existence. Blood group was not discovered. Few of the transfused patient fortunately survived and rest died due to incompatibility of blood.

It was Karl Landsteiner who laid the foundation of modern blood transfusion by discovering the ABO blood group systems in 1901. In 1914, A Hustin and L Agote discovered that citrate solution could be used as an anticoagulant for blood. Two years later, Rouse and Turner found that glucose can be used for extending the life span of erythrocyte under storage condition. Thereafter, Dr Norman Bethun, a Canadian doctor established the first blood storage system at Barcelona City Blood Bank in 1936, during civil war in Spain. In the true sense it was the world’s first blood bank.

Forty years after the discovery of ABO system, Karl Landsteiner along with his associates (A Weiner, Phillips Levine, etc) established the Rh system in 1940 for which he was awarded Nobel prize in Medicine. Rh system is important because haemolytic disease of newborn may occur in Rh negative pregnant women with Rh positive foetus and also Rh antibodies may develop in Rh negative patients if Rh positive blood is given.

In India, the first blood bank was established in Kolkata during the Second World War in 1942 to meet the demand for the wounded jawans.

J Loutit and P Mollison developed acid, dextrose, citrate (ACD) solution for red cell storage in 1943. Whole blood could be preserved for 21 days at 40C by using 14ml of this solution per 100ml of blood. It is believed that people who belonged to common group ‘O' could give their blood to anyone whatsoever. This view reached its widest acceptance in the early 1940s, when hundreds of thousand bottles of group ‘O' blood were given as a general panacea for the injuries of war victims with satisfactory results. As a result of this experiences a generation of medical men has grown up believing that blood transfusion is one of the simplest form of therapy. But these view of blood has to be reconciled with the growing knowledge of its intense complexity of transfusion. Only the knowledge of ‘ABO' and ‘Rh' system is not adequate for the transfusionist. The role of other blood group system is by no means negligible.

Up to 1960 whole blood transfusion were given for the treatment of acute blood loss or for the relief of chronic anaemia. Platelet and leucocyte transfusion were not attempted and plasma fraction were not available. Only a few red cell antigen system were recognized and leucocytes and platelet antigen were unknown. It was understood that syphilis and malaria could be transmitted by transfusion and it had recently been discovered that hepatitis virus could also be transmitted, although no test for the virus was available.

Till early 1970, blood for transfusion were collected in glass bottles with ACD solutions and transfused without any test for infection markers. Blood transfusion services have gained special significance in the recent years and forms a vital part of national health care programme of any country. Several major changes have taken place in the blood transfusion services across the globe for safe and beneficial transfusions. These are:

• Blood donated only from voluntary non-remunerated donors.

• Availability of better anticoagulant, preservative solution.

• Testing for transfusion transmitted diseases

• Introduction of disposable plastic bags.

• Invention of many sophisticated, automated equipment.

In India, professional blood donors (sellers) were banned by supreme court since January 1, 1998 to sell their blood. In a country, after switching from paid professional to voluntary donors the incidence of post-transfusion diseases could remarkably be reduced. So, all the concerned persons should emphasize on voluntary blood donation.

In 1949, Dr Carl Walter deduced that a flexible, disposable and a collapsible bag would prevent all the associated complication of glass bottle collection leading to the invention of the first plastic bag. In 1960, introduction of disposable plastic bags revolutionized the working of the blood bank. The changeover from glass bottles to plastic bags helped in the use of component of blood to a greater extent and also helped in better safety procedures. Plastic bags with integral tubing system and with better anticoagulant preservative solution were commercially made available for separation of various components of blood as well as to enhance the shelf life of blood cells. The development of cryobiology has enabled the preservation of blood and its components for prolonged storage for years.

Recent development of the blood transfusion practices is based upon the recommendation of the International Society of Blood Transfusion and Immunohaematology (ISBTI) and the World Health Organization (WHO). As per recommendation, all donors should fulfil certain criteria and all donated blood should be screened for transfusion transmitted diseases using most appropriate and effective assays for mandatory testing of HIV I & II, Hepatitis B and C viruses, syphilis and malaria. Only if these tests are negative, then compatibility test should be done before issuance to the recipient.

Blumberg, in 1965, isolated Hepatitis B virus in an Australian aborigin and found that it is transmitted through blood. The screening of blood for its surface antigen was introduced in 1968 by Okuchi et al. After the discovery of AIDS in 1981, the blood transfusion services gained special attention and was accepted as a separate specialty — transfusion medicine. The causative organism for AIDS identified in 1983 and the ELISA screening test for HIV antibodies was made available in 1985. In 1989, Hepatitis C virus was identified as a major cause for non-A, non-B hepatitis. The screening tests for its antibodies were introduced in 1990.

Since, Dr James Blundell’s first experimental transfusion of human blood into human being in 1870 lots of remarkable achievement in the field of transfusion medicine had occurred and currently transfusion medicine involve mobilization and selection of peripheral blood progenitor (stem) cell for transplantation, storage and transplantation of umbilical cord blood and manipulation of mononuclear cell biculture and gene insertion to offer potential therapies for wide range of diseases.

Hopefully, we can think for some major changes in the field of transfusion medicine. A day will come when artificial blood from culture plate will be developed. Genetically modified blood cells are targeted for production in laboratory. Although it sounds fantasy, progress can be expected in near future.

Dr Dwijendra Nath Sarma