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Blood transfusion: Yesterday, today, and tomorrow

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Abstract

The evolution of blood transfusion practice into modern transfusion medicine is reported. The impact of great wars on the technique of blood storage and organization of blood supply is discussed. The progress of immunotechnology and fractionation of plasma contributed greatly to contemporary transfusion medicine and the implementation of blood and plasma component therapy. Three basic indications for use of blood in surgery are summarized: restoration of acute loss of circulating blood volume, improvement of oxygen transport, and delivery and correction of coagulation disorders. Some factors arising from storage lesion of blood (citrate intoxication, 2,3-DPG depletion, cellular aggregates) are described. The recent research in blood transfusion refers particularly to red cell substitutes. The oxygen-carrying solutions, perfluorocarbons, stroma-free hemoglobin, and current research on artificial red cells are discussed. The in vitro culturing, recombinant DNA technology, and the practical application of monoclonal antibodies in clinical practice are emphasized. The advent of great technological advances in transfusion medicine makes it possible to predict several future developments. Blood will be substituted by oxygen carriers, human protein and cells by biotechnological and genetic engineering. The education of tomorrow's surgeons must be adapted to the recent progress and advances of transfusion medicine.

Résumé

L'évolution de la transfusion sanguine dans la pratique médicale moderne est rapportée. L'impact des grandes guerres sur la technique de conservation du sang et l'organisation de l'approvisionnement du sang sont discutés. Les progrès de l'immunotechnologie et du fractionnement des composants plasmatiques ont contribué à l'établisement de la transfusion moderne et à la mise en oeuvre du traitement par les constituants plasmatiques. Les indications majeures de la transfusion en chirurgie sont au nombre de trois: restauration immédiate de toute perte rapide et abondante du sang circulant, amélioration du transport de l'oxygène, correction des troubles de la coagulation. Quelques faits anormaux imputables à la conservation du sang (intoxication citratée, agrégats de cellules, déplétion du 2,3-DPG érythrocytaire) sont décrits. La recherche récente concernant la transfusion sanguine est consacrée particulièrement à l'étude des substituts érythrocytaires. Les solutions transportant l'oxygène, le perfluorocarbone, la SFHS, les hématies artificielles sont étudiées. La culture cellulaire in vitro, la technologie de recombinaison de l'ADN, l'emploi d'anticorps monoclonaux sont également analysés. Des progrès technologiques nouveaux dans la pratique de la transfusion laissent présager de futurs développements. Le sang sera remplacé par des transporteurs d'oxygène, par des protéines et des cellules fournies par les méthodes génétiques et la biotechnologie. L'éducation des chirurgiens de demain doit être adaptée en fonction de ces nouvelles données.

Resumen

Se informa la evolución de la práctica de transfusión sanguínea hacia la moderna medicina de transfusiones. El impacto de las grandes guerras sobre las técnicas de almacenamiento y la organización de la distribución de sangre es revisado. El progreso de la inmunotecnología y el fraccionamiento del plasma ha contribuído grandemente al desarrollo de la moderna medicina de transfusiones y al perfeccionamiento de la terapia con componentes de plasma y de sangre. Se resumen 3 indicaciones básicas para el uso de sangre en cirugía: restauración de la pérdida aguda de volumen circulatorio, mejoramiento del transporte de oxígeno, y corrección de alteraciones de la coagulación. Se describen algunos factores derivados de la lesión de la sangre por almacenamiento (intoxicación por citrato, depleción de 2,3-DPG, agregados celulares). La investigación reciente en transfusión se refiere principalmente a los sustitutos de glóbulos rojos. Se discute el desarrollo de las soluciones capaces de transportar oxígeno, los perfluorocarbonos, la hemoglobina libre de estroma y la investigación contemporánea sobre células artificiales, con énfasis en los cultivos in vitro, la tecnología de DNA recombinante, y la aplicación práctica de anticuerpos monoclonales en la práctica clínica. El advenimiento de grandes avances tecnológicos en la medicine de transfusiones hace posible predecir algunos desarrollos futuros. La sangre será sustituída por sustancias transportadoras de oxígeno, la proteína humana y las células mediante ingeniería biotecnológica y genética. La educación de los cirujanos del mañana debe ser adaptada a los progresos y avances recientes de la medicina de transfusiones.

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Correspondence to Witold J. Rudowski M.D..

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Rudowski, W.J. Blood transfusion: Yesterday, today, and tomorrow. World J. Surg. 11, 86–93 (1987). https://doi.org/10.1007/BF01658466

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Keywords

  • Oxygen Carrier
  • Transfusion Medicine
  • Circulate Blood Volume
  • Transfusion Practice
  • Blood Storage