Blood transfusion service (1941) Pt. 2 of 4

The problem was to keep blood, once it had left the body, as near as possible to its natural state when it is in the body. Certain chemicals had been tried to stop blood clotting, but none was really satisfactory until these men, in different countries but about the same time, discovered that if blood is mixed with a solution of sodium citrate, it does not clot. Blood taken into a solution of sodium citrate is called citrated blood. Thus, the discovery of the blood groups and the prevention of clotting opened up the way to safe blood transfusion. Blood transfusion was widely used for the first time during the First World War. Citrated blood was introduced on the Western Front in 1917 by Dr. Oswald Robertson of Toronto. Transfusions of citrated blood saved many thousands of lives during the war, and doctors throughout the world became familiar with the uses of blood transfusion. When peace came, the value of blood transfusion had been proved. Everywhere, hospitals wanted blood donors who could be called upon at a moment's notice to give their blood. On an evening in October 1921 in the London Borough of Camberwell, a few members of the local branch of the British Red Cross Society were doing their peacetime work under the leadership of a Mr. Percy Oliver. I remember the day well. The telephone bell rang. It was the secretary of King's College Hospital asking if I could send him a blood donor. I told him it was quite impossible, that we were all working men and women and couldn't afford to be laid up. When he said it would only take a few minutes and that the donor would not be laid up at all, I put it to the nurses. I said I would go for one, but they all volunteered in case my blood was of the wrong group. And so, Mr. Oliver worked out a plan for the first blood transfusion service in the world. This is how the voluntary organization of blood donors grew until by 1926, the London Blood Transfusion Service begun by Mr. Oliver had expanded so much that it was officially taken over by the British Red Cross Society. A committee was formed representing doctors, hospitals, and the donors. From supplying one call in 1921, this London service grew to supply 737 in 1926, 2,442 in 1931, and nearly 7,000 in 1938. Similar services were soon organized throughout the country. During the same period, blood transfusion services started in many other countries, but only Denmark and Holland followed Britain's example of voluntary blood giving. Elsewhere, donor panels were on a professional paid basis. The next problem was how to keep blood fresh for days or even weeks after it was taken from the donor. This was necessary in vast countries like Soviet Russia and the United States, where blood had sometimes to be sent long distances. Since 1930, we in the Central Institute for Blood Transfusion in Moscow have been investigating the problem of storing blood. In our vast territories, blood transfusion is widely used in outlying areas where laboratory facilities are not available. In a period of 10 years, the technique of storing blood has been successfully developed. We in the United States started the system of blood banks. They work in this way. Blood is contributed to the bank by every hospital service that may require it, and after tests and grouping, is kept in a refrigerator. When blood is needed for a transfusion, the hospital officer asks the bank cashier for a bottle of blood of the required group. It is debited to the account of that particular hospital and must be replaced by another bottle of blood, though not necessarily the same group. This method was gradually copied in other parts of the world. Stored blood was given its first practical test under war conditions during the Spanish Civil War in 1936. During the Spanish Civil War, I worked for the government in the Barcelona Blood Transfusion Service under Dr. Duran Jordá. Prior to the war, the work done with stored blood in Soviet Russia had been given wide publicity in my country. For the first time, stored blood was used to deal with war casualties in Spain. In Barcelona, we bled some 4,500 civilians into a citrate solution. Our donors were bled at regular intervals of 3 weeks to 1 month. Specially equipped refrigerating lorries took the blood to the front lines. Here, a constant supply of each blood group was kept ready in a chain of refrigerators. And such blood was good for use up to 18 days. During the first year of our war, 1,200 L of blood were sent to the front. Thus, stored blood is invaluable under emergency conditions such as accidents or war, when it is not possible to find donors on the spot.