Editing Blood transfusion (section)

==== Blood banks in WWI ====
{{Main| Blood bank}}
[[File:Agote 1a transfusión.jpg|thumb|Dr. [[Luis Agote]] (''2nd from right'') overseeing one of the first safe and effective blood transfusions in 1914]]
[[File:Vidro para transfusão de sangue, Centro de Memórias do Curso de Enfermagem da UFES (2).jpg|thumb|Old glass used for blood transfusion]]
While the first transfusions had to be made directly from donor to receiver before [[blood coagulation|coagulation]], it was discovered that by adding [[anticoagulant]] and [[refrigeration|refrigerating]] the blood it was possible to store it for some days, thus opening the way for the development of [[blood bank]]s. [[John Braxton Hicks]] was the first to experiment with chemical methods to prevent the coagulation of blood at [[St Mary's Hospital, London]] in the late-19th century. His attempts, using [[Sodium phosphates|phosphate of soda]], however, proved unsuccessful.

The [[Belgium|Belgian]] doctor [[Albert Hustin]] performed the first non-direct transfusion on March&nbsp;27, 1914, though this involved a diluted solution of blood. The [[Argentina|Argentine]] doctor [[Luis Agote]] used a much less diluted solution in November of the same year. Both used [[Monosodium citrate|sodium citrate]] as an anticoagulant.<ref>{{cite journal|doi= 10.1001/jama.1940.02810160078030|title= Effect of External Temperature on Sedimentation Rate of Red Blood Corpuscles|year= 1940| vauthors = Gordon MB |journal= Journal of the American Medical Association|volume= 114|issue= 16}}</ref>

The [[First World War]] (1914–1918) acted as a catalyst for the rapid development of blood banks and transfusion techniques. [[Francis Peyton Rous]] and Joseph R. Turner at the [[Rockefeller University]] (then The Rockefeller Institute for Medical Research) made the first important discoveries that blood typing was necessary to avoid blood clumping (coagulation) and blood samples could be preserved using chemical treatment.<ref name=":32">{{Cite web |date=2010 |title=The Rockefeller University Hospital Centennial — The First Blood Bank |url=https://centennial.rucares.org/index.php?page=blood_bank |access-date=2022-03-18 |website=centennial.rucares.org |publisher=The Rockefeller University |archive-date=2022-03-31 |archive-url=https://web.archive.org/web/20220331111840/https://centennial.rucares.org/index.php?page=Blood_Bank |url-status=live }}</ref><ref name=":12">{{Cite news | vauthors = Brody JE |date=1970-02-17 |title=Dr. Peyton Rous, Nobel Laureate, Dies |pages=43 |work=The New York Times |url=https://www.nytimes.com/1970/02/17/archives/dr-peyton-rous-nobel-laureate-dies.html |access-date=2022-03-18 |issn=0362-4331}}</ref> Their first report in March 1915 showed that gelatine, agar, blood serum extracts, starch and beef albumin proved to be useless preservatives.<ref>{{Cite journal | vauthors = Rous P, Turner JR |date= March 1915 |title=On the preservation in vitro of living erythrocytes |url=http://ebm.sagepub.com/lookup/doi/10.3181/00379727-12-74 |journal=Experimental Biology and Medicine |volume=12 |issue=6 |pages=122–4 |doi=10.3181/00379727-12-74 |issn=1535-3702 |s2cid=88016286}}</ref>

However, building on the same experiment, they discovered that a mixture sodium citrate and glucose ([[dextrose]]) solution was a perfect preservative; as they reported in February issue of the ''[[Journal of Experimental Medicine]],'' the preserved bloods were just like fresh bloods and that they "function excellently when reintroduced into the body."<ref name=":02">{{cite journal | vauthors = Rous P, Turner JR | title = The Preservation of Living Red Blood Cells in Vitro | journal = The Journal of Experimental Medicine | volume = 23 | issue = 2 | pages = 219–237 | date = February 1916 | pmid = 19867981 | pmc = 2125399 | doi = 10.1084/jem.23.2.219 }}</ref> Blood could be preserved for up to four weeks. An accompanying experiment using citrate-saccharose (sucrose) mixture was also a success which could maintain blood cells for two weeks.<ref>{{cite journal | vauthors = Rous P, Turner JR | title = The Preservation of Living Red Blood Cells in Vitro | journal = The Journal of Experimental Medicine | volume = 23 | issue = 2 | pages = 239–248 | date = February 1916 | pmid = 19867982 | pmc = 2125395 | doi = 10.1084/jem.23.2.239 }}</ref> This use of citrate and sugars, sometimes known as Rous-Turner solution, was the foundation for the development of blood banks and improvement of transfusion method.<ref>{{cite journal | vauthors = Hess JR | title = An update on solutions for red cell storage | journal = Vox Sanguinis | volume = 91 | issue = 1 | pages = 13–19 | date = July 2006 | pmid = 16756596 | doi = 10.1111/j.1423-0410.2006.00778.x | s2cid = 35894834 }}</ref><ref>{{cite journal | vauthors = Hanigan WC, King SC | title = Cold blood and clinical research during World War I | journal = Military Medicine | volume = 161 | issue = 7 | pages = 392–400 | date = July 1996 | pmid = 8754712 | doi = 10.1093/milmed/161.7.392 | doi-access = free }}</ref>

Another discovery of Rous and Turner was the most critical step in the safety of blood transfusion. Rous was well aware that Landsteiner's concept of blood types had not yet found practical value, as he remarked: "The fate of Landsteiner's effort to call attention to the practical bearing of the group differences in human bloods provides an exquisite instance of knowledge marking time on technique. Transfusion was still not done because (until at least 1915), the risk of clotting was too great."<ref name=":42">{{Cite journal | vauthors = Rous P |author-link=Francis Peyton Rous |year=1947 |title=Karl Landsteiner. 1868–1943 |journal=[[Obituary Notices of Fellows of the Royal Society]] |volume=5 |issue=15 |pages=294–324 |doi=10.1098/rsbm.1947.0002 |s2cid=161789667}}</ref> In June 1915, they made a crucial report in the ''[[Journal of the American Medical Association]]'' that agglutination could be avoided if the blood samples of the donor and recipient were tested before. Which they called a rapid and simple method for testing blood compatibility, sodium citrate was used to dilute the blood samples, and after mixing the recipient's and donor's blood in 9:1 and 1:1 parts, blood would either clump or remain watery after 15 minutes. According to their advice, blood without clumping "should always be chosen if possible."<ref>{{Cite journal | vauthors = Rous P, Turner JR |date=1915 |title=A rapid and simple method of testing donors for transfusion |journal=Journal of the American Medical Association |volume=LXIV |issue=24 |pages=1980–2 |doi=10.1001/jama.1915.02570500028011|url=https://zenodo.org/record/2520617 }}</ref>

Canadian doctor and Lieutenant [[Lawrence Bruce Robertson]] became instrumental in persuading the [[Royal Army Medical Corps]] to adopt the use of blood transfusion at the [[Casualty Clearing Station]]s for the wounded. In October 1915, Robertson performed his first wartime transfusion with a syringe to a patient who had multiple shrapnel wounds. He followed this up with four subsequent transfusions in the following months, and his success was reported to Sir [[Walter Morley Fletcher]], director of the [[Medical Research Council (United Kingdom)|Medical Research Committee]].<ref name="star2016">{{Cite web|url=https://www.thestar.com/news/insight/a-canadian-kept-blood-flowing-in-wwi-an-american-got-credit/article_d35d4990-5878-5597-89c8-c7ede343a289.html|archiveurl=https://web.archive.org/web/20170228233233/https://www.thestar.com/news/insight/2016/07/09/a-canadian-kept-blood-flowing-in-wwi-an-american-got-credit.html|url-status=dead|title=A Canadian kept blood flowing in WWI. An American got credit|first=Katie Daubs Feature|last=Writer|date=July 9, 2016|archivedate=February 28, 2017|website=Toronto Star}}</ref>

[[File:Direct-blood-transfusion.jpg|thumb|left|[[World War II]] Russian syringe for direct inter-human blood transfusion]]
Robertson published his findings in the ''[[British Medical Journal]]'' in 1916 and, with the help of a few like-minded individuals (including the eminent physician [[Edward William Archibald]]), was able to persuade the British authorities of the merits of blood transfusion. Robertson went on to establish the first blood-transfusion apparatus at a Casualty Clearing Station on the [[Western Front (World War I)|Western Front]] in the spring of 1917.<ref name=star2016 /><ref name="Pelis">{{cite journal | vauthors = Pelis K | title = Taking credit: the Canadian Army Medical Corps and the British conversion to blood transfusion in WWI | journal = Journal of the History of Medicine and Allied Sciences | volume = 56 | issue = 3 | pages = 238–277 | date = July 2001 | pmid = 11552401 | doi = 10.1093/jhmas/56.3.238 | s2cid = 34956231 }}</ref> Robertson did not test crossmatching so that one died of hemolysis in his 1916 transfusion, and three in 1917.<ref>{{cite journal | vauthors = Stansbury LG, Hess JR | title = Blood transfusion in World War I: the roles of Lawrence Bruce Robertson and Oswald Hope Robertson in the "most important medical advance of the war" | journal = Transfusion Medicine Reviews | volume = 23 | issue = 3 | pages = 232–6 | date = July 2009 | pmid = 19539877 | doi = 10.1016/j.tmrv.2009.03.007 }}</ref>

[[Oswald Hope Robertson]], a medical researcher and [[U.S. Army|U.S.&nbsp;Army]] officer, was attached to the [[RAMC]] in 1917, where he became instrumental in establishing the first blood banks in preparation for the anticipated [[Battle of Passchendaele|Third Battle of Ypres]].<ref>{{cite web|url= https://www.pbs.org/wnet/redgold/history/timeline3.html|title= Red Gold: the Epic Story of Blood|publisher= PBS|access-date= 2017-08-24|archive-date= 2015-05-10|archive-url= https://web.archive.org/web/20150510070430/http://www.pbs.org/wnet/redgold/history/timeline3.html|url-status= live}}</ref> He used sodium citrate as the anticoagulant; blood was extracted from punctures in the [[vein]] and was stored in bottles at British and American Casualty Clearing Stations along the Front. Robertson also experimented with preserving separated [[red blood cell]]s in iced bottles.<ref name="Pelis" /> [[Geoffrey Keynes]], a British surgeon, developed a portable machine that could store blood to enable transfusions to be carried out more easily.