Editing Blood transfusion (section)

==== Medical advances ====
[[File:Private Roy W. Humphrey of Toledo, Ohio is being given blood plasma after he was wounded by shrapnel in Sicily on 8-9-43 - NARA - 197268.jpg|thumb|Wounded soldier being given [[blood plasma]] in [[Sicily]], 1943]]
A blood-collection program was initiated{{by whom|date=August 2019}} in the US in 1940 and [[Edwin Cohn]] pioneered the process of [[blood fractionation]]. He worked out the techniques for isolating the [[serum albumin]] fraction of [[blood plasma]], which is essential for maintaining the [[oncotic pressure|osmotic pressure]] in the [[blood vessel]]s, preventing their collapse.

Gordon R. Ward, writing in the correspondence columns of the ''[[British Medical Journal]]'', proposed the use of [[blood plasma]] as a substitute for whole blood and for transfusion purposes as early as 1918. At the onset of [[World War II]], liquid plasma was used in Britain. A large project, known as "Blood for Britain", began in August 1940 to collect blood in [[New York City]] hospitals for the export of plasma to [[United Kingdom|Britain]]. A [[Freeze-drying|freeze-dried]] plasma package was developed by the Surgeons General of the Army and Navy, working with the [[National Research Council (United States)|National Research Council]],<ref>{{Cite book |url=https://books.google.com/books?id=bmtV2HTcZh0C |title=United States Naval Medical Bulletin |date=1942 |publisher=U.S. Government Printing Office |access-date=2022-11-29 |archive-date=2024-03-31 |archive-url=https://web.archive.org/web/20240331133534/https://books.google.com/books?id=bmtV2HTcZh0C |url-status=live }}</ref> which reduced breakage and made transportation, packaging, and storage much simpler.<ref>{{Cite book | chapter-url = http://history.amedd.army.mil/booksdocs/wwii/blood/chapter1.htm | archive-url = https://web.archive.org/web/20060111115330/http://history.amedd.army.mil/booksdocs/wwii/blood/chapter1.htm | archive-date = 11 January 2006 | chapter = Transfusion Before World War I | vauthors = Kendrick DB | title = Blood program in world war II. | publisher = Office of the Surgeon General, Department of the Army | date = 1964 }}</ref>

[[File:Charles R Drew portrait.png|thumb|left|[[Charles R. Drew]] oversaw the production of blood plasma for shipping to Britain during WW2.]]
The resulting dried plasma package came in two tin cans containing 400 mL bottles. One bottle contained enough [[distilled water]] to reconstitute the dried plasma contained within the other bottle. In about three minutes, the plasma would be ready to use and could stay fresh for around four hours.<ref>{{Cite book | chapter-url = http://history.amedd.army.mil/booksdocs/wwii/blood/chapter7.htm | archive-url = https://web.archive.org/web/20060208034909/http://history.amedd.army.mil/booksdocs/wwii/blood/chapter7.htm | archive-date = 8 February 2006 | chapter = Plasma Equipment and Packaging, and Transfusion Equipment | vauthors = Kendrick DB | title = Blood program in world war II. | publisher = Office of the Surgeon General, Department of the Army | date = 1964 }}</ref> Dr. [[Charles R. Drew]] was appointed medical supervisor, and he was able to transform the [[test-tube]] methods into the first successful technique for mass production.

Another important breakthrough came in 1937–40 when [[Karl Landsteiner]] (1868–1943), Alex Wiener, Philip Levine, and R.E. Stetson discovered the [[Rhesus blood group system]], which was found to be the cause of the majority of [[transfusion reaction]]s up to that time. Three years later, the introduction by [[John Freeman Loutit|J.F. Loutit]] and Patrick L. Mollison of [[acid–citrate–dextrose]] (ACD) solution, which reduced the volume of anticoagulant, permitted transfusions of greater volumes of blood and allowed longer-term storage.

Carl Walter and W.P. Murphy Jr. introduced the [[plastic bag]] for blood collection in 1950. Replacing breakable [[glass]] bottles with durable plastic bags made from [[PVC]] allowed for the evolution of a collection system capable of safe and easy preparation of multiple blood components from a single unit of whole blood.

In the field of [[cancer surgery]], the replacement of massive blood-loss became a major problem. The cardiac-arrest rate was high. In 1963 C. Paul Boyan and William S. Howland discovered that the temperature of the blood and the rate of infusion greatly affected survival rates, and introduced blood warming to surgery.<ref>{{cite journal | vauthors = Boyan CP, Howland WS | title = Cardiac arrest and temperature of bank blood | journal = JAMA | volume = 183 | pages = 58–60 | date = January 1963 | pmid = 14014662 | doi = 10.1001/jama.1963.63700010027020 }}</ref><ref>{{cite book |vauthors=Boyan CP |chapter=Massive Blood Transfusions — Warming of Bank Blood |chapter-url=https://link.springer.com/chapter/10.1007/978-3-642-69636-7_21 |doi=10.1007/978-3-642-69636-7_21 |isbn= 978-3-540-13255-4 | veditors = Rupreht J, van Lieburg MJ, Lee JA, Erdman W |publisher= Springer |year= 1985 |pages= 99–101 |title= Anaesthesia: essays on its history}}</ref>

Further extending the shelf-life of stored blood up to 42 days was an anticoagulant preservative, CPDA-1, introduced in 1979, which increased the blood supply and facilitated resource-sharing among blood banks.<ref>{{cite journal | vauthors = Sugita Y, Simon ER | title = The Mechanism of Action of Adenine in Red Cell Preservation | journal = The Journal of Clinical Investigation | volume = 44 | issue = 4 | pages = 629–642 | date = April 1965 | pmid = 14278179 | pmc = 292538 | doi = 10.1172/JCI105176 }}</ref><ref>{{cite journal | vauthors = Simon ER, Chapman RG, Finch CA | title = Adenine in red cell preservation | journal = The Journal of Clinical Investigation | volume = 41 | issue = 2 | pages = 351–9 | date = February 1962 | pmid = 14039291 | pmc = 289233 | doi = 10.1172/JCI104489 }}</ref>

{{As of|2006}} about 15 million units of blood products were transfused per year in the United States.<ref>{{cite news | url= http://www.post-gazette.com/pg/07010/752655-28.stm | title= New rules may shrink ranks of blood donors | date= 2007-01-10 | vauthors= Landro L | newspaper= Wall Street Journal | access-date= 2008-04-05 | archive-date= 2009-08-04 | archive-url= https://web.archive.org/web/20090804060528/http://www.post-gazette.com/pg/07010/752655-28.stm | url-status= dead }}</ref> By 2013 the number had declined to about 11 million units, because of the shift towards [[laparoscopic surgery]] and other surgical advances and studies that have shown that many transfusions were unnecessary. For example, the standard of care reduced the amount of blood transfused in one case from 750 to 200&nbsp;mL.<ref name="Transfusions Decline"/>  In 2019, 10,852,000 RBC units, 2,243,000 platelet units, and 2,285,000 plasma units were transfused in the United States.<ref name=Jones21 />