9 General Introduction “The story of blood is one of metamorphosis, of a liquid that became symbolically transformed as society learned how to deconstruct and manage it.” D. Starr, Preface to “Blood: An Epic History of Medicine and Commerce”, page xv1 1.1 A Brief History of Blood Use In the 199 years since the first successful human-to-human blood transfusion (1825),2 the “story of blood” has evolved dramatically. Blood, in the beginning only perceived as a mysterious spiritual and mystical substance, has become a scientific and strategic material explored and harnessed by mankind over the centuries. The organization of blood establishments (BEs) has transformed as the donation, storage, testing, and transport of blood components have undergone significant changes from its primitive beginnings. This is most evident starting in the 20th century in which transfusion services began to lay the foundation for our modern-day services. As historian Douglas Starr writes, the 20th century saw the transformation of blood from a “scientific curiosity” (then, only recognized as a therapeutic liquid transfusible from one person to another), to a “strategic material” that scientists could master and manage and use for human enterprise.1 This began immediately at the turn of the century; in 1900-1901, a breakthrough came when the first four human blood groups were discovered (A, B, O, AB) and more would be discovered in the decades to come (e.g., Rhesus). This would allow for typing and crossmatching of blood types between donors and recipients to make sure they matched, vastly improving transfusion outcomes. In the early 1920s, no one was storing blood and donors were called upon needed (“donor on the hoof”), which proved to be unreliable and slow for finding compatible blood matching. By the 1930s, a professional donor program had begun in the United States and blood of the living (or dead) was able to be stored in collection facilities. These facilities were named “blood banks,” based on the system of deposits and withdrawals, made possible because blood, for the first time, could be stored using a citrate solution and stockpiled into inventory to be used when needed. Blood banks were begun, first in Russia, then in North America, and they spread rapidly throughout Western countries.1 In the 1940s, the process of plasma fractionation was developed. Whole blood was divided into constituents of erythrocytes (red blood cells), leukocytes (white blood cells), thrombocytes (platelets), and plasma (which can be further fractionated into various proteins, such as albumin, immunoglobulins, and clotting factors). This separation into components allowed for pharmaceutical products to be developed, and these different products became a key medical advantage for the Allies in World
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