The hazards of blood transfusion in historical perspective

Abstract

The beginning of the modern era of blood transfusion coincided with World War II and the resultant need for massive blood replacement. Soon thereafter, the hazards of transfusion, particularly hepatitis and hemolytic transfusion reactions, became increasingly evident. The past half century has seen the near eradication of transfusion-associated hepatitis as well as the emergence of multiple new pathogens, most notably HIV. Specific donor screening assays and other interventions have minimized, but not eliminated, infectious disease transmission. Other transfusion hazards persist, including human error resulting in the inadvertent transfusion of incompatible blood, acute and delayed transfusion reactions, transfusion-related acute lung injury (TRALI), transfusion-associated graft-versus-host disease (TA-GVHD), and transfusion-induced immunomodulation. These infectious and noninfectious hazards are reviewed briefly in the context of their historical evolution.

Figure 1

Au antigen discovery. An Australian aborigine (top) and the precipitin line formed between the aboriginal serum and that of a multiply transfused patient with hemophilia (bottom). The precipitin failed to stain for lipid, but stained red with the azocarmine counterstain for protein. Reprinted with permission of Nature Publishing Group from Alter HJ and Houghton M, Hepatitis C virus and eliminating posttransfusion hepatitis (Nat Med. 2000;6:1082-1086).

Figure 2

The decreasing incidence of transfusion-associated hepatitis in blood recipients monitored prospectively. Incidence, traced from 1969 to 1998, demonstrates a decrease in risk from 33% to nearly zero. Arrows indicate main interventions in donor screening and selection that effected this change. Reprinted with permission of Nature Publishing Group from Alter HJ and Houghton M, Hepatitis C virus and eliminating post-transfusion hepatitis (Nat Med. 2000;6:1082-1086).

Figure 3

Sketch of Blundell's gravitator. Blood from the donor dripped into a cup fixed several feet above the arm of the recipient and was directed through tubing into the recipient's vein. Adapted from Blundell J, Observations on transfusion (Lancet. 1828;2:321) with permission from Elsevier. Illustration by Marie Dauenheimer.