Denis Chen
Newcastle-under-Lyme, United Kingdom 

Autologous blood transfusion, the infusion of a patient’s own blood, is a relatively recent procedure. It was preceded historically by the classical descriptions of the blood by Hippocrates¹ and Galen²; by the discovery of the circulation of blood by William Harvey and the description of the red blood cells by microscopist Jan Swammerdam⁴; by the efforts of Richard Lower and Jean-Baptiste Denis to transfuse animal blood to humans⁵; and by the first human-to-human allogenic blood transfusion in 1818 by the British obstetrician James Blundell.

For the first human autologous blood transfusion,³ there is sparse evidence, suggesting it was completed in 1795 by Dr. Phillip Syng Physics of Philadelphia. Yet this was only mentioned in the footnotes of the first recorded autologous blood transfusion by James Blundell thirty years later in 1824.⁶ James Blundell achieved this by rinsing vaginal blood-soaked cloths with saline during postpartum haemorrhages and injecting the collected solution back into the circulation. These early autologous blood transfusions had a mortality rate of 75%.^7,8

There was a brief pause in autologous blood transfusions for fifty years until 1874, when William Highmore revived James Blundell’s idea by re-infusing defibrinated and warmed blood lost during postpartum hemorrhage.⁹ Nine years later, William Halsted treated carbon monoxide poisoning by drawing patients’ blood, defibrinating it, and then re-infusing the blood.¹⁰ This was the first therapeutic use of autologous blood transfusions. Milk from cows, goats, and even humans were the original solutions used as blood substitutes; it was only in 1884 that saline replaced milk as many people had experienced adverse reactions.¹¹ In 1885, autologous blood transfusion via femoral injection was used by John Duncan, who performed a leg amputation for a crushing injury, marking the first time autologous transfusion was used for trauma. The results were successful, and the transfusion was deemed a lifesaving decision.¹²

Further progress was made following the discovery of blood groups and cross-matching in 1907.¹³ In 1914 H.J. Theis successfully used intraoperative autologous blood transfusions in treating a ruptured ectopic pregnancy.¹⁴ During this time the first long-term anticoagulants were also developed, permitting prolonged storage of blood and the first transfusion of citrated blood.^15,16 In 1917, C.D. Lockwood completed a successful autologous blood transfusion in the United States for a splenectomy for Banti’s disease.¹⁷

 After World War I, F.C. Grant pioneered autologous blood transfusions in neurosurgery in 1921.¹⁸ Autologous blood transfusions were becoming standard practice by the end of the decade, especially for ruptured ectopic pregnancies.¹⁹ Most fatalities and unfavourable outcomes were attributed to using blood that had pooled in serous cavities for up to three days before reinfusion.^20,21 In the 1930s, autologous blood transfusions continued to be used mainly for splenectomies and in obstetrics and gynecology.^22,23 In 1931, Lincoln Brown and Martin Debenhem successfully used autologous blood transfusion to treat three patients’ hemothoraces.²⁴

World War II (1939–1945) saw massive changes in the use of autologous blood transfusions. With the advent of organized blood banks in 1939, quantities of allogenic blood were now available for the first time. Fortunately, this coincided with Karl Landsteiner’s and Edwin Cohn’s respective discoveries of rhesus factors and cold ethanol fractionation. Cold ethanol fractionation allowed the splitting of plasma into its components, leading to the ability to isolate and collect gamma globulins, albumin, and fibrinogen.²⁵ The sharp increase in allogenic blood availability led to decreased demand for autologous blood.^3,26 But a major milestone for autologous blood transfusion occurred in 1943 when Arnold Griswold developed the first autologous blood salvage device, which collected blood through suction, filtered it through cheesecloths, and reinfused it into the patient using gravity.²⁷

There were still dangers with autologous blood transfusion. During the Korean (1950–1933) and Vietnam Wars (1955–1973), air embolisms, coagulopathy, and hemolysis were all reported in United States soldiers post-transfusion.^3,28 Nevertheless, technology steadily improved and unlocked an entire speciality. In 1953, John H. Gibbon, Jr. invented the cardiopulmonary bypass machine, and in 1968, Dr G. Klebanoff, a U.S Air Force surgeon, created the first commercially available autologous blood transfusion unit, the Bentley Autotransfusion System.²⁹ The system was designed for intraoperative use, where it aspirated, filtered, and then reinfused blood. However, it also required systemic anticoagulation, which increased the risk of intraoperative bleeding and air emboli and often precipitated renal failure due to poor filtration of the reinfused blood.^30,31 Reinfusing blood donated preoperatively was also used in the 1960s and was not associated with the same risks.³² Despite the technological advances, there was waning enthusiasm for autologous blood transfusions, and allogenic blood became the default for most hospitals. Underutilization of autologous blood transfusion continued through the 1970s and 1980s.³³

Only a year after Klebanoff created the Bentley Autotransfusion System, J.D. Wilson and his associates conceived a new red cell salvage concept in 1969. After collecting intraoperative blood during transurethral resections for benign prostatic hypertrophy, they funnelled collected blood into a semicontinuous flow centrifuge, where it was washed with sterile saline; then, it was reinfused into the patient.³⁴ Wilson’s new system resulted in fewer adverse effects in comparison to the Bentley system, which began to be obsolete. In 1976, Haemonetics Corporation released the Cell Saver, which was a commercially available cell salvage machine based on Wilson’s techniques. Around the same time, the Sorensons released their autotransfusion system, decreasing risks of air emboli and improving workflow for transfusion specialists.³⁵

Today, demand for autologous blood transfusions has been revived because of increased awareness of Creutzfeldt-Jakob disease and the expensive processing costs of allogenic blood (leukodepletion, screening, etc.).³⁶ With every new technology released, from the Fresenius HemoCare system, which pioneered continuous autotransfusion in 1995, to Cell Saver II, III, IV and now even Cell Saver V, autologous blood transfusions have continued to become safer and more standard.³⁷

References

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