Current Concepts Review - Blood Transfusion in Orthopaedic Operations*

Abstract

The use of blood transfusion to treat acute blood loss was first reported in the early nineteenth century when Blundell14, known by some as the father of modern autologous transfusion, described the reinfusion of blood resulting from postpartum hemorrhage. Homologous, now properly called allogenic, blood transfusion began in the twentieth century22,25, after Landsteiner72 described blood groups in 1901. In 1937, Cook County Hospital in Chicago opened the first hospital blood bank in order to deal with the increasing demand for blood transfusion. The success of blood transfusion in resuscitating victims of trauma during World War II popularized transfusion for the treatment of blood loss in elective operative procedures after the war. Blood banks and allogenic blood components have had an important impact on operative treatment and health care worldwide. Resuscitation after trauma, radical operations for the treatment of cancer, coronary artery bypass grafting, and transplantation of major organs became not only possible but routine because of the availability of allogenic blood and blood products. However, blood transfusion has been limited by the availability of donor blood. In the 1950's and 1960's, allogenic blood was usually available to meet the demand for blood transfusion, and its use was considered safe according to medical knowledge at that time. Blood donors were usually laborers and factory workers. During the 1970's, this population decreased, as did the availability of allogenic blood, and the demand for blood increased simultaneously. The blood-donor population decreased further in the 1980's, when a general fear of acquiring transmissible diseases was prevalent and donors began to be tested for such diseases, including hepatitis and acquired immunodeficiency syndrome. From 1981 to 1990, the demand for blood transfusion increased 100 per cent, whereas the collection of blood increased only 30 per cent66. In …