AW01 Blood Transfusion and Hemorrhage: Past, Present and Future

Abstract

Introduction In the early years of the 19th century, James Blundell reported in the Lancet the earliest clinical application of blood transfusion for the treatment of hemorrhage. Although his initial experiments may appear to us to have burst upon the medical world, Blundell had in fact done years of pre‐clinical research using animal models to establish principles to be brought to the clinic.Methods/Results Today, blood transfusion remains the cornerstone of treatment for serious bleeding – not only to restore oxygen carrying capacity but also to improve hemostasis, arrest hemorrhage, and prevent bleeding. However, the indications for transfusion with FFP or Platelets for the prevention of bleeding remain ill‐defined. In particular, despite the enormous volumes of blood components transfused worldwide, the evidence that commonly used coagulation tests are reliable guides to transfusion with FFP is scant. Recent laboratory and clinical studies have provided some insights into the weaknesses of the coagulation testing as a guide to blood management. Carefully performed randomized clinical trials are needed in order to better understand how to use transfusion to arrest and prevent hemorrhage. One such trial has recently begun in the USA. In the future, improved understanding of hemostasis will likely bring about the use of new biotherapies that Blundell could not possibly have imagined. The application of genomics to hemostasis is expected to uncover genetic polymorphisms that will lead to improved diagnostics and more tailored medical therapeutics.Conclusions While such advances are anticipated, transfusion therapy remains fundamentally important as a life‐saving therapy for bleeding disorders. Moreover, despite our current advanced technologies, hemorrhage during childbirth (which Blundell sought to overcome) remains a devastating problem throughout the world.