The controversy of unmodified versus citrated blood transfusion in the early 20th century

Abstract

Many strides were made in the field of blood transfusion before and during World War I. However, it was not until after the war that one of the most exciting and controversial episodes in the field of blood transfusion occurred. Review of the literature revealed the 1920s to be a tumultuous era filled with conflicting opinions concerning the safest method to perform blood transfusions. Early investigators used fresh unmodified blood for patient to patient transfusions. Later groups advocated the use of preserved blood for transfusions in order to permit its widespread availability. However, for many years, sodium citrate blood preservation techniques led to an unacceptable level of transfusion reactions. When bacterial pyrogens in the storage apparatus were identified as the source of side effects, the citrate method of transfusion gained widespread acceptance.

Who is my stranger? Origins of the gift in wartimeLondon, 1939‐45

“…Indirect methods, which began surpassing direct techniques from around 1911, involved drawing blood into graduated metal or glass containers with a cannula syringe (Maluf : 94‐101). In 1915, Richard Lewisohn, a surgeon at the Mount Sinaii Hospital in New York, proposed mixing withdrawn blood with a diluted sodium citrate solution to prevent clotting, an innovation that simplified the technique of blood transfer and allowed surgeons to preserve blood outside the body, clot free, for longer periods (Lewisohn ; Wain ) . In all cases, transfusion involved the issuing of blood from one individual to another at the time of an operation, usually in close, if not immediate, proximity…”