Blood—Bank On It

Who was the ‘father’ of blood banking and where on Earth was the first blood bank established? We look for answers in the curious life stories of four largely unsung physicians. Without the ability to bank blood, the benefit of transfusion would be lost to the majority of those who need it. While we start with a brief history of blood transfusion, the main story here is the evolution of those miraculous storehouses known as ‘blood banks’. 

William Harvey is a god of medicine. He described the circulation of blood in 1628, De Motu Cordis, is the namesake of the esteemed Harveian Orations, and was named by one famous historian to a list of the ten most influential people of the second millennium.  It would be decades before attempts were made to transfuse blood.

First came transfusion between dogs in 1656, then a few years later, from lambs to humans. The first documented human to human success was that of Dr. Blundell in 1818. He gave a patient with postpartum hemorrhage the blood of her husband. Further progress would await for the next century.

Transfusions eventually became safer with the knowledge of blood groups that allowed for compatibility testing (Landsteiner 1901), and more practical with the use of anticoagulants that permitted storage (Lewisohn 1915). Donor and patient no longer needed to be tethered as blood trickled from one to the other. It could now be bagged in plastic, stacked in rows, vetted and labelled with great specificity, awaiting a patient’s name for just-in-time delivery.

The availability of abundant and safe blood was achieved over decades through the efforts of hundreds of doctors and scientists. Four of them surface as especially important in the task of taking ‘blood bank’ from concept to reality.

THE FIRST BLOOD BANK—SORT OF

220px-Bernard_M._Fantus.jpg
 

Bernard Fantus

My introduction to blood bank history was as an intern at Cook County Hospital in Chicago. My outpatient duties took place in the Fantus Center. I came to learn that Bernard Fantus (1879–1940) had also been an intern at Cook County. Later, as professor of therapeutics at the University of Illinois and Rush Medical College he was famous for the notion that ‘a spoonful of sugar helps the medicine go down’, and as a humanist. But along the way he founded the first blood bank—in the United States—at Cook County.

Mindful of the bloodshed in the Spanish Revolution, he was eager to find a way to store blood for remote use. On on March 15, 1937 the doors opened, with Dr. Elizabeth Schermer in charge of the laboratory. His daughter suggested he call it a blood ‘bank’. Fantus had done his research, both in lab and in the literature. He was spurred on by a growing impetus in the United States (see Dr. Drew, below) and by successes reported out of Russia, our next stop on the tour.

 

Sergei Yudin

Yudin’s story is told in detail and with earned reverence by two ethnic Russian physicians in an issue of Surgery. Yudin (1891–1954) was not just a Russian surgeon, he was the Russian Surgeon. He was both a combat (wounded three times) and academic surgeon (Rein prize, All-Soviet Surgical Society for best surgical publication in 1924-1925). Prolific in both operating and publishing, his treatment of gastric surgery, spinal anesthesia and gunshot wounds revised practice at home and in the West. But his fate was a cruel one. Branded a dissident, Stalinists tried to expurgate his works. Part of his political undoing were his travels to, and strong ties with, the West–including friendships and mutual respect with the likes of the Mayo bothers, Harvey Cushing and William Osler. 

Jailed for three years as a spy, it is said that he used toilet paper on which to write two books, one of which was Twenty years’ experience with conservation, storing and transfusion of cadaveric blood. His transfusion facility is often cited as the first blood bank in the world. As to cadaveric blood, it is enlightening that he once wrote “It was difficult for Crile [American surgeon] to understand that, due to poverty in Russia … the opportunity for blood transfusion is very limited. We operate for free, but nobody would give blood for free!”.

WAR, THE MOTHER OF INVENTION

 

Oswald Robertson

We have seen that war drove a sense of urgency about storing blood. And such was the case with Oswald Robertson (1886–1966), who it can be argued, established the real first blood bank in the world–on the battlefield. (Not to be confused with the Canadian Lieutenant Lawrence Bruce Robertson, who championed transfusion by pushing syringes of blood on the battlefield in WWI).

Robertson was brought from his native England to California when not two years old. He became the quintessential American—curious, inventive, and industrious. His career had an “Arrowsmith–like” quality, a wide–ranging search for fulfillment, from research in famous labs to public service. He explored the new biology of the Twenties: antisera, infections, and hematology. Also like Arrowsmith, he married a nurse and eventually retired to a personal lab in the woods. 

His biography published by the National Academy of Sciences is thorough and engaging. We learn that his innovative role in blood banking seemed a matter of being in the right two places at the right time. 

After his house officership he was appointed as an assistant … at the Rockefeller Institute for Medical Research … in the laboratories of Dr. Peyton Rous … when World War I called for his services on the Harvard team of Dr. Harvey Cushing. … he initiated experiments to learn whether a fluid devised by Rous in the laboratory to preserve human blood cells in vitro had a practical use for transfusions at the battle front … He demonstrated that the preserved cells were indeed an acceptable substitute, and Robertson now is recognized as the creator of the first blood bank.

 DETERMINATION AND DISCRIMINATION

 

Charles Drew

To review: blood banking requires the preservation, screening, and distribution of safe viable blood cells. This requires both technical knowledge and organization skills. These attributes and a dogged devotion to the cause earned one doctor the title ‘the father of blood banking’—Charles Drew (1904–1950). The circumstances of his death became an urban legend, now dispelled. His life however was a well documented exercise in the rewards of true grit.

He was tough. Any black man in that era who wanted to be a surgeon had to be. “In surgical circles, Drew's performance on the oral part of the exam [Surgical Boards], in which he confidently lectured his examiners about fluid balance and management of shock, became as legendary as his athletic feats had been at Amherst.”

Against prevailing prejudices, he earned a training spot in 1938 at Columbia. The famous surgeon George Whipple mentored him. He was assigned to the laboratory of John Scudder, studying the problems of shock, transfusion and blood banking.

By then It was known that sodium citrate could keep blood from clotting and dextrose could keep the cells alive for two weeks. He was aware of Robertson's success with 22 battlefield transfusions of stored blood and the Russian experience with cadaveric blood. 

Drew’s contribution to the effort was an exhaustive study of best practices, resulting in a doctoral thesis entitled “Banked Blood”, as well as the highly successful Blood for Britain program, the invention of the ‘Blood Mobile”, and a daughter named—with clear intent—“Bebe”.

Drew became a leader in medical education and Chief of Surgery at Howard. Despite his achievements he was not eligible to join the AMA. No black doctors were. He spoke out for years on the unscientific practice by the Red Cross of segregating blood donations. 

On his way to an annual free clinic celebration he was mortally injured in a car accident. The myth that the staff of the regional hospital refused to give him blood because he was a black man does fit a narrative of tragic irony. But it has been soundly refuted, based on family testimony, in One Blood: the Death and Resurrection of Charles R. Drew. The Charles R. Drew Papers are on file with the National Library of Medicine.

Timelines

"Blood Getting" Lab Week Power Point (S. Parker MD - Hospital of Central Connecticut)
AABB History American Association of Blood Banks

Reading

The Dying Tents of WW1 a play Kindle Edition. Raymond Towey.

This is a play based on the other Robertson. Kindle $1.

"The term Dying Tent used in World War 1 refers to the moribund ward in the Casualty Clearing Stations where triaged terminal casualties were sent to die often of blood loss."

THE THERAPY OF THE COOK COUNTY HOSPITAL BLOOD PRESERVATION

"Chicago 1937. Included in an issue of The Journal of the American Medical Association, Vol. 109, No. 2 at pp.128-131. GM 2026. The first Blood Bank. The complete issue, which has several articles, has been removed from a bound volume and rebound in later wraps. Text Fine but 4 large binding holes cut in left margin of all pages."

Transfusion of Cadaver Blood. Pamphlet – 1936. Sergei Sergeievich YUDIN.

The first person account of this seminal program.

One Blood: The Death and Resurrection of Charles R. Drew. Spencie Love.

"One Blood traces both the life of the famous black surgeon and blood plasma pioneer Dr. Charles Drew and the well-known legend about his death. On April 1, 1950, Drew died after an auto accident in rural North Carolina. Within hours, rumors spread: the man who helped create the first American Red Cross blood bank had bled to death because a whites-only hospital refused to treat him."