Transfusion Medicine - Jeffrey McCullough

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products as nicely described by Kristen Mascotti, whose career has evolved along this pathway. These concepts have extended into clinical care as evidenced by patient blood management.

      At the writing of the first edition, I expected that by now, we would have a red cell substitute oxygen carrier but this has not happened despite considerable investment by several companies. Nor are there “synthetic” platelet products, although exciting developments are underway. While producing blood components such as red cells and platelets from stem cells in a laboratory is scientifically exciting, this is unlikely in the near future.

      There are some interesting cycles in our field of transfusion medicine. Whole blood has evolved from efforts to convert clinicians to the use of packed red cells but now is making a comeback in the management of acute blood loss and trauma. Dr. Stubbs has been a leader in these therapies and provides a nice summary of that in his chapter. Another interesting cycle is platelet storage. In the 1970s, this was done in the refrigerator until the seminal report by Murphy and Gardner, which led to room temperature storage. Cold stored platelets are making a comeback, partly driven by the desire to extend the shelf life and to cope with possible bacterial contamination of the platelet product. Ironically, it appears that cold stored platelets might have special therapeutic advantages. Another interesting cycle is paying donors. When I was a resident, we paid donors at the University of Minnesota hospitals donor center, but this practice was discontinued and considered inappropriate for many years. Now, a plan to pay donors has resurfaced and the first of these high‐quality paid platelet donor centers has been established just about a mile from my house.

      Many of us in the United States have been able to develop a global perspective because of the variety of interactions and friendships that developed during the era reflected by these five for additions. This was also partly facilitated by the President’s Emergency Plan for AIDS Relief (PEPFAR), which provided support for blood banking and transfusion medicine work in many countries and, for instance, made it possible for me to work in Afghanistan along with several other countries in sub‐Saharan Africa.

      Over the years, it has been a pleasure to work with the staff at Wiley, the publisher who has done all additions after the second. They have done a great job of producing, marketing, and distributing these multiple editions of the book.

      Well now it has come to this. It has been a pleasure to write and produce this book for you and an honor that you found it valuable enough to obtain it. I hope this most recent edition will continue to meet your needs and help guide you in your career. I do not know whether there will be a sixth edition and if so whether I will be part of it. So I wish you a successful career and I hope this book might help you along the way.

      My great admiration, affection, and respect for all those who passed through our fellowship program and those of you who have been kind enough to be a colleague and to include me in your life.

      First you were of me and now I am of you.

       Jeffrey McCullough MD

      For centuries, blood has been considered to have mystical properties and has been associated with vitality. In ancient times, bathing in or drinking the blood of the strong was thought to invigorate the weak. For instance, among Ancient Romans it was customary to rush into the arena to drink the blood of dying gladiators [1]; among others, to drink or bathe in blood was thought to cure a variety of ailments [2]. Bleeding was practiced to let out bad blood and restore the balance of humors, thus hopefully returning the patient to health.

      It is not known when and by whom the idea of transfusing blood was developed. It is said that the first transfusion was given to Pope Innocent VIII in 1492. According to this legend, the Pope was given the blood of three boys, whose lives were thus sacrificed in vain [1, 3] because the attempts did not save the Pope. In another version of the story, the blood was intended to be used in a tonic for the Pope, which he refused, thus sparing the boys’ lives [2]. Ironically, the concept of transfusion blood from younger donors to revitalize older individuals has reappeared recently, although without any scientific background or basis.

      Others to whom the idea for blood transfusion is attributed include Hieronymus Cardanus (1501–1576) and Magnus Pegelius. Little is known about Cardanus, but Pegelius was a professor at Rostock, Germany, who supposedly published a book describing the idea and theory of transfusion [1]. It can be substantiated that Andreas Libavius (1546–1616) proposed blood transfusion in 1615 when he wrote:

      Despite these possibilities, it also seems unlikely that the concept of transfusing blood could have developed before William Harvey’s description of the circulation in 1616. Despite Harvey’s description of the circulatory system, there is no evidence that he considered blood transfusion. However, the concept of the “circulation” may have preceded Harvey’s publication. For instance, Andrea Cesalpino (1519–1603), an Italian, used the expression “circulation” and proposed that fine vessels (capillaries) connected the arterial and venous systems [1, 4].

      A number of the major developments that led to the beginning of blood transfusion occurred during the mid‐1600s [1]. In 1656, Christopher Wren, assisted by Robert Boyle, developed techniques to isolate veins in dogs and carried out many studies of the effects of injecting substances into the dogs. It is not clear whether Wren ever carried out blood transfusion between animals. The first successful transfusion from one animal to another probably was done by Richard Lower [1, 5, 6]. Lower [6] demonstrated at Oxford the bleeding of a dog until its strength was nearly gone, but then revitalized the previously moribund dog by exchange transfusion using blood from two other dogs, resulting in the death of the donor animals.

      Subsequently, a controversy developed over who had first done a transfusion. In 1669, Lower contended that he had published the results of transfusion in the Philosophical Transactions of the Royal Society in December 1666. In 1667, Jean Denis of France described his experiments in animals and applied the technique to human, which Lower had accomplished only in animals. Others mentioned as possibly having carried out animal‐to‐animal transfusions about this time are Johann‐Daniel Major of Cologne, Johann‐Sigismund Elsholtz of Berlin, don Robert de Gabets (a monk) in France, Claude Tardy of Paris, and Cassini and Griffone in Italy [1].

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