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The evaluation of the efficacy of whole blood transfusion in augmenting total red cell volume has always been of interest to physicians called upon to care for patients with hemorrhage, burns, blood dyscrasias, or traumatic shock. The establishment of blood banks, resulting in an increasing use of stored blood, has focused more attention on the problem. Military requirements have created a demand for the preservation of whole blood over far longer periods than are required for civilian purposes. The urgent need for better preservative solutions and for the selection of the best conditions for overseas air transport of whole blood for the Armed Forces made it imperative that an accurate method of measuring the post-transfusion survival of stored human erythrocytes be available.The morphological and chemical changes that take place in red cells during storage have been studied by several laboratory methods. The rate. of spontaneous hemolysis, changes in cell dimension, changes in the permeability of the cell membrane, changes in osmotic resistance to hypotonic solutions of NaCl, rate of diffusion of potassium, and disturbances in carbohydrate metabolism have all been proposed as in vitro tests for the evaluation of the ability of stored red cells to survive after transfusion.Each of these tests assays only changes in one functional characteristic of the. erythrocyte and it is for this reason that the opinion has been expressed that in vitro tests fail as a guide to the

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The modern era of blood transfusions was ushered in by the discovery of human red cell groups by Shattock (1) in 1900 and Landsteiner (2) in 1901. Grouping was later systematized by Jansky (3) and Moss (4). In the course of a few years the paraffined tube method of KimptonBrown (5), the multiple syringe technic of Lindeman (6) and the 4-way stopcock apparatus of Unger (7) came into general use in hospitals for direct transfusions. All of these methods required speed in transferring blood from donor to recipient because of the dangers of clotting.Agote (8) and Lewisohn (9) introduced sodium citrate as an anticoagulant. This avoided the hazards of clotting in the interval between drawing and administering blood and yet permitted the observance of aseptic precautions. The procedure was much simpler than the direct methods which required surgical teams and operating room technic.The citrate method came into favor very slowly. Early apparatus described by Hoffman (10) and Brines (11) involved suction for collecting and positive air pressure for injecting. Reactions were common. A review of transfusion procedure by Herr as late as 1925 (12) indicated that the direct was still preferred to the citrate method.The first successful preservation of human whole blood was accomplished in 1916 by Rous and Turner (13) by the addition of dextrose to a sodium citrate anticoagulant. This solution was

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