BLOODLESS MEDICINE and SURGERY
The Growing Demand

Blood Transfusions
A Long History of Controversy

"If red blood cells were a new drug today,
it would be very difficult to get it licensed."
—Dr. Jeffrey McCullough.

IN THE winter of 1667, a violent madman named Antoine Mauroy was brought to Jean-Baptiste Denis, eminent physician to King Louis XIV of France. Denis had the ideal "cure" for Mauroy's mania—a transfusion of calf's blood, which he thought would have a calming effect on his patient. But things did not go well for Mauroy. Granted, after a second transfusion, his condition improved. But soon madness again seized the Frenchman, and before long he was dead.

Even though it was later determined that Mauroy actually died from arsenic poisoning, Denis' experiments with animal blood provoked a heated controversy in France. Finally, in 1670 the procedure was banned. In time, the English Parliament and even the pope followed suit. Blood transfusions fell into obscurity for the next 150 years.

Early Hazards

In the 19th century, blood transfusions made a comeback. Leading the revival was an English obstetrician named James Blundell. With his improved techniques and advanced instruments—and his insistence that only human blood should be used—Blundell brought blood transfusions back into the limelight.

But in 1873, F. Gesellius, a Polish doctor, slowed the transfusion revival with a frightening discovery: More than half the transfusions performed had ended in death. Upon learning this, eminent physicians began denouncing the procedure. The popularity of transfusions once again waned.

Then, in 1878, French physician Georges Hayem perfected a saline solution, which he claimed could serve as a substitute for blood. Unlike blood, the saline solution had no side effects, did not clot, and was easy to transport. Understandably, Hayem's saline solution came to be widely used. Strangely, however, opinion soon favored blood again. Why?

In 1900, Austrian pathologist Karl Landsteiner discovered the existence of blood types, and he found that one type of blood is not always compatible with another. No wonder so many transfusions in the past had ended in tragedy! Now that could be changed, simply by making sure that the blood type of the donor was compatible with that of the recipient. With this knowledge, physicians renewed their confidence in transfusions—just in time for World War I.

		World War II saw an increase in the demand for blood
U.S. National Archives photos

Blood Transfusions and War

During World War I, blood was liberally transfused into wounded soldiers. Of course, blood clots quickly, and previously it would have been all but impossible to transport it to the battlefield. But early in the 20th century, Dr. Richard Lewisohn, of Mount Sinai Hospital in New York City, successfully experimented with an anticoagulant called sodium citrate. This exciting breakthrough was regarded by some doctors as a miracle. "It was almost as if the sun had been made to stand still," wrote Dr. Bertram M. Bernheim, a distinguished physician of his day.

World War II saw an increase in the demand for blood. The public was bombarded with posters bearing such slogans as "Give Blood Now," "Your Blood Can Save Him," and "He Gave His Blood. Will You Give Yours?" The call for blood brought great response. During World War II, some 13,000,000 units were donated in the United States. It is estimated that in London more than 68,500 gallons [260,000 L] were collected and distributed. Of course, blood transfusions carried a number of health risks, as soon became clear.

Blood-Borne Disease

After World War II, great strides in medicine made possible some surgeries that were previously unimaginable. Consequently, a global multibillion-dollar-a-year industry sprang up to supply the blood for transfusions, which physicians began to consider standard operating procedure.

Soon, however, concern over transfusion-related disease came to the fore. During the Korean War, for example, nearly 22 percent of those who received plasma transfusions developed hepatitis—almost triple the rate during World War II. By the 1970's, the U.S. Centers for Disease Control estimated the number of deaths from transfusion-related hepatitis at 3,500 a year. Others put the figure ten times higher.

Thanks to better screening and more careful selection of donors, the number of cases of hepatitis-B contamination declined. But then a new and sometimes fatal form of the virus—hepatitis C—took a heavy toll. It is estimated that four million Americans contracted the virus, several hundred thousand of them through blood transfusions. Granted, rigorous testing eventually reduced the prevalence of hepatitis C. Still, some fear that new dangers will appear and will only be understood when it is too late.

Another Scandal: HIV-Contaminated Blood

In the 1980's, it was found that blood can be contaminated with HIV, the virus that leads to AIDS. At first, blood bankers were loathe to consider that their supply might be tainted. Many of them initially greeted the HIV threat with skepticism. According to Dr. Bruce Evatt, "it was as though someone had wandered in from the desert and said, 'I've seen an extraterrestrial.' They listened, but they just didn't believe it."

Nevertheless, country after country has seen scandals break out exposing HIV-contaminated blood. It is estimated that in France, between 6,000 and 8,000 people were infected with HIV through transfusions that were administered between 1982 and 1985. Blood transfusions are held responsible for 10 percent of HIV infections throughout Africa and for 40 percent of the AIDS cases in Pakistan. Today, because of improved screening, HIV transmission through blood transfusions is rare in developed nations. However, such transmission continues to be a problem in developing nations that lack screening processes.

Understandably, in recent years there has been an increased interest in bloodless medicine and surgery. But is this a safe alternative? The next article discusses this question.