The give and take of blood banking

March 1, 2010

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Upon completion of this article, the
reader will be able to:

  1. Be aware of blood donation requirements and statistics.
  2. Recognize infectious-disease risks of donated blood.
  3. Identify most needed blood types.
  4. Be familiar with different rules for military transfusions.

A month from now, retired Air Force Staff Sgt. Dennis
Provencher will make his way to the American Red Cross Center on Camp
Foster in Okinawa to donate yet another pint of his blood. In 2004,
Guinness World Records recognized him as having donated more blood than
anybody else. “I challenge anyone to catch me,” he told Stars and
on Feb. 12.1

As with all blood donations, Provencher's is separated
into packed red blood cells, fresh frozen plasma, and platelets — any unit
of which could technically save someone's life. He enlisted in the Air Force
in 1951 in his home state of New Hampshire, and has donated blood since his
transfer to Okinawa in 1961. A radio operator during his service, Provencher
says he fell in love with the island and its people; he extended his
assignment long enough to retire there in 1971.1

According to the American Red Cross, if a person begins
donating blood at age 17 and donates every 56 days until he reaches 76, he
will have donated 48 gallons of blood, potentially helping save more than
1,000 lives.2 At 76, Provencher has given 34 gallons of blood in
the last 46 years. He is one of a small band of long-term blood donors.1

An Ohio man, Alan Whitney, makes a habit of donating
platelets and is now working his way across the country to get the word out
that others, too, should donate. Whitney undertook his goal to donate in all
50 states, starting in Pennsylvania in 2007; and on Feb. 10, Oregon was his
35th. He sat in a chair to donate platelets for the 647th time at age 71,
having been a volunteer in blood banks in one form or another for the past
45 years.3

Would-be donors banned

While these “feel-good” stories of regular and even
enthusiastic donors give the impression that America has no donor problems,
nothing could be further from the truth. Out of its estimated 309 million
citizens, the United States had only 9.5 million donors in 2006.2
While approximately 37% of the U.S. population is eligible to give
blood, only 5% actually donate, while the number of transfusions nationwide
increases by 9% every year.2,4

In the world of blood-donor collection, certain people
are denied from time to time, or permanently, the opportunity to give blood.
Despite technological advances and the precautions to ensure a safe blood
supply, for example, federal policy permanently denies homosexual men,
intravenous drug users, or anyone who has been paid for sex from donating
blood. The Food and Drug Administration (FDA) — the organization responsible
for federally regulating the blood supply — adopted the policy in 1983 to
reduce the risk of transmitting HIV/AIDS via blood transfusion.4
Among other blood-related organizations, the American Red Cross has
denounced the ban, calling it “medically and scientifically unwarranted
because all donated blood has undergone testing since 2007.”5

At the University of South Dakota (USD), blood drives
have been a joint operation with the Siouxland Community Bank and the Sioux
Falls Community Blood Bank. During the 2008-2009 school year, USD donated
628 units of blood, but members of the campus 10% Society complained that
the policy is not fair since, in the words of a freshman student, “For this
ban to make sense, it would have to be a ban of all sexually active people
and even then, there is a chance of failure.” San Jose State University
announced in 2008 that the FDA policy violated the school's
non-discrimination policy regarding sexual orientation, thus, there would be
no more school-sponsored blood drives. Several other universities have
followed suit.5 The FDA has not changed its rules; and from time
to time cites the fact that it would if given data that showed doing so
would not pose a “significant and preventable” risk to blood recipients.6

Diseases that preclude donation

Other groups are also banned from donating blood, such as
those whose blood may carry diseases other than HIV/AIDS. In years past,
blood donors discovered to have hepatitis B antibodies were warned that a
second positive test result would disallow their continued participation.
Perhaps 200,000 Americans have been banned from giving blood because of
repeated false-positive tests for hepatitis B, according to the FDA. In the
late 1980s and the 1990s, as many as 21,500 Americans were turned away every
year because of false-positive hepatitis B tests, but the FDA proposed
allowing some people who initially test positive for hepatitis B to donate.
A new test for hepatitis B is much more specific. People who test positive
on the first test could be tested again eight weeks later with the more
specific test. If that test is negative, they would be allowed to donate

The United States also banned blood donations from people
who spent six months or more cumulatively in Britain between 1980 and 1996.
The ban was employed when speculation spread that a British man who received
blood in 1997 and developed variant Creutzfeldt-Jakob Disease (vCJD or “mad
cow disease”) six years later may have contracted it from an infected
transfusion.8 Despite little evidence at the time that new
variant Creutzfeldt-Jakob Disease might be transmitted by blood or plasma,
an FDA advisory panel voted in 1999 to prohibit donations from that category
of people.9 vCJD transmission via blood transfusion was finally
confirmed in 2003.

Cutaneous Leishmaniasis,or L Major was
a concern during large-scale 1990 and 1991 U.S. military
operations in Saudi Arabia, Kuwait, and Iraq and was, at one time, listed by
the U.S. Army Medical Research and DevelopmentCommand as a
possible health threat to U.S. troops in Somalia.Persian Gulf
veterans were banned from donating blood in the early 1990s. The fear that
Leishmania tropica, a parasite transmitted by sandflea (Phlebotomus
) bites, could be spread through transfusions,
prompted a14-month ban for these veterans, beginning Nov. 12, 1991.10

In 2003, the World Health Organization diagnosed more
than 200,000 citizens of Kabul, Afghanistan, with Cutaneous Leishmaniasis.
Late that year, the FDA held a blood-banking seminar to discuss the
possibility of contamination of the U.S. blood supply by Leishmaniasis. It
was there that the FDA decided a lifetime ban on blood donations from
persons from Iraq diagnosed with Leishmaniasis should be imposed, because
there is no guarantee of a 100% sterile cure of any version of Leishmaniasis.
Later, the Pentagon made the same policy for U.S. troops.11

The recession finds a drop in blood donations

The American Red Cross says the number one reason donors
say they give blood is because they want to help others; the two most common
reasons cited by people who do not give blood are they never thought
about it or they do not like needles.2 During the past year,
blood donations have fallen low enough to prompt directors of various blood
banks to tap into national stockpiles through the busy spring season.
Florida is one example. Because of the recession, blood drives at
Florida businesses — normally suppliers of approximately 40% of the blood
used at local hospitals — have dropped substantially. Many businesses have
closed or had substantial layoffs. Those that have not closed have fewer
employees left to donate.12

Florida's blood shortages are linked to the recession,
even though the nation's blood supply remains adequate. In some areas of the
state where seasonal visitors to RV parks are recruited for blood drives,
previous donors have not made the annual trek to the Sunshine State because
of the economy. Some Florida blood banks are now making trips to high
schools where ad campaigns encourage younger donors, since state law allows
students as young as 16 to give blood. Currently, teens make up 10% of the
state's blood supply.12

Facts about blood donation

According to the American Red Cross, type O-negative
blood (red cells) can be transfused to patients of all blood types; it is
always in great demand and often in short supply. Only 7% of people in the
U.S. have O-negative blood type. Type AB-positive plasma can be transfused
to patients of all other blood types; AB plasma is also usually in short
supply, since only 3% of people in the U.S. have the AB-positive blood type.
The blood used in an emergency is already on the shelves before the event
occurs.2 Statistics show that 25% or more of us will require
blood at least once in our lifetime.4

The upside to regular blood donation includes a
mini-physical with each visit to the blood bank. Many blood banks offer
childcare, on-site bloodmobiles, or convenient parking. Whole blood donation
only takes approximately 45 to 60 minutes.4 Donating blood is a
safe, simple four-step process: registration, medical
history and mini-physical, donation, and refreshments. A sterile needle is
used only once for each donor and then discarded.2 Because there
is a lag time after exposure before infectious-disease tests become
positive, all donors are also questioned closely about possible recent
exposure to infectious diseases.11 After blood is drawn, it is
tested for ABO group (blood type) and RH type (positive or negative), as
well as for any unexpected red blood cell antibodies that may cause problems
for the recipient. Screening tests are also performed for: 

  • hepatitis B surface antigen (HBsAg);
  • hepatitis B core antibody (anti-HBc);
  • hepatitis C virus antibody (anti-HCV);
  • HIV-1 and HIV-2 antibody (anti-HIV-1 and anti-HIV-2);
  • HTLV-I and HTLV-II antibody (anti-HTLV-I and
  • serologic test for syphilis;
  • nucleic-acid amplification testing (NAT) for HIV-1 and HCV;
  • NAT for West Nile virus (WNV) (this test is not required by the FDA); and
  • anitbody test for Trypanosoma cruzi, the agent of Chagas' disease (this test is also not required by FDA).13

The Red Cross' fact sheet cites statistics that more than
hint at the importance of volunteer donors: Every two seconds someone in the
U. S. needs blood, and more than 38,000 blood donations are needed every
day. More than 80,000 sickle-cell patients can require blood transfusions
throughout their lives. More than 1 million people are diagnosed with cancer
each year, many of whom need blood during chemotherapy treatments. A single
car-accident victim can require as many as 100 pints of blood. 2
The Centers for Disease Control and Prevention says the U.S. blood supply is
the safest in the world. But blood cannot be manufactured — it can only come
from generous donors.2


  1. Orr M. Retired airman on Okinawa holds Guinness World
    Record in blood donation. Stars and Stripes. February 13, 2010: . Accessed
    February 15, 2010
  2. American Red Cross. Blood Facts and Statistics. .
    Accessed February 15, 2010.
  3. Hintze H. Ohio Man Donates Blood Platelets in 35
    States. KEZI.COM 24/7 Nonstop News. .
    Accessed February 15, 2010.
  4. Mayo Clinic. Did You Know? . Accessed February
    15, 2010.
  5. Goetzinger N. Gay men still banned from giving blood.
    Volante Verve. February 10, 2010. .
    Accessed February 15, 2010.
  6. The Associated Press. FDA says gay men still can't
    donate blood. Accessed
    February 15, 2010.
  7. USA TODAY staff. A better life: Morning rounds:
    Giving blood, discriminating against fat people.
  8. Ault A. FDA bans UK blood donation. Nature
    5;720(1999). doi:10.1038/10429
  9. Food & Drug Administration.
    BloodBlood/QuestionsaboutBlood/DonatingBlood/default.htm .
    Accessed February 15, 2010.
  10. Gunby P. Desert Storm Veterans Now May Donate
    Blood; Others Call for Discussion of Donor Tests
    . JAMA. 1993;269(4):451-452.
  11. Leishmaniasis in Iraq from the Gulf War to OIF. .
    Accessed February 15, 2010.
  12. Scott A. Drop in blood donors linked to recession.
    February 1, 2010. Sarasota Herald-Tribune. P. 1.
  13. AABB. Blood Donation FAQs.
    . Accessed February 15, 2010.
Walking blood banks: screening blood in the battlefield

By Col. Francisco J. Rentas, Maj. David A. Lincoln, Lt. Cmdr. Corey R. Jenkins,
Lt. Col. Robert J. O'Connell, and Maj. Robert G. Gates

Care for severely injured combat casualties relies
heavily on blood product transfusion.1-3 Fresh whole blood
(FWB) has been used in many military conflicts to resuscitate
casualties. Its use in civilian settings is limited due to the wide
availability of fractionated components derived from whole blood and
provided for specific indications. In combat, blood requirements may
exhaust pre-screened component therapy supplies, and in other cases,
needed components may be unavailable at a particular location.4
In these settings, FWB may be the only source of blood components
available for the management of hemorrhagic shock and its associated
coagulopathy in casualties. The physician practice of collecting and
transfusing FWB supports hemostatic-resuscitation techniques performed
in concert with aggressive surgical control of bleeding. This is a
clinical decision usually made in the middle of a mass casualty.

Current and evolving trauma doctrine emphasizes broad
distribution of medical assets to allow rapid initiation of damage-control
resuscitation and surgery.5 There is little doubt that the
proximity of emergency care to casualties has contributed favorably to low
combat-fatality rates during the current conflicts in Iraq and Afghanistan.6
Geographic dispersal, however, adds to the already challenging, immense, and
intermittent demands that may prevent adequate provision of blood components
which have been pre-screened for transfusion-transmitted disease (TTD)
pathogens in accordance with the U.S. Food and Drug Administration
(FDA)-approved standard of care.

When there are not enough properly screened blood
products available to care for casualties arriving at military treatment
facilities during combat, U.S. military doctrine allows the use of
unscreened (by U.S. FDA standards), voluntarily donated, and freshly
collected blood products to save patient lives. Donors for emergency blood
collections are usually military members who are co-located with the medical
unit at the time of need, more commonly referred to as “the walking blood

Current Clinical Practice Guidelines in Iraq and
Afghanistan, clearly state that it is not appropriate to use FWB as an
alternative to more stringently controlled blood products for patients who
do not have severe, immediate life-threatening injuries. Fresh whole blood
is to be used only when other blood products are unable to be delivered at a
rate to sustain the resuscitation of an actively bleeding patient, when
specific stored blood components are not available (e.g., pRBCs, platelets,
Cryo, FFP) or when stored components are not adequately resuscitating a
patient with an immediate life-threatening injury.

Since the need for FWB cannot be predicted, a contingency
operational plan is developed by the medical staff to include the
laboratory/blood bank, and surgical and anesthesia providers. If practical,
a pre-screened donor pool using the blood donation questionnaire and
pre-testing for all required FDA transfusion-transmitted disease markers is
performed. The safest donor candidate is one with recent laboratory
confirmation of blood group/type and no evidence of TTD.

In addition, where feasible, on-site testing of potential
blood donors using rapid screening assays for infectious diseases (i.e.,
HIV, HBV, and HCV) is performed before FWB is transfused. Regardless of
whether rapid testing is performed pre- or post-transfusion, these tests are
not licensed for donor screening, and samples must be sent to a reference
laboratory for FDA-approved blood-donor testing. A mechanism is in place to
ensure both the recipient and donor can be notified should the results be
positive for infectious disease. In fact, all U.S. recipients of FWB in
theater are required to be tested initially and at three, six, and 12 months
after transfusion according to current policy.

In an emergency, ABO/Rh of donors may be established via
local testing or previous donor history. Identification tags (“dog tags”)
for ABO/Rh verification should be utilized as a last resort only.
Retrospective testing for infectious-disease markers is performed on all
donor specimens. This testing is completed at an FDA-approved, Department of
Defense-sanctioned laboratory in accordance with FDA and AABB standards. In
addition, several countermeasures are required of potential blood donors of
blood products collected in theater in the U.S. military. These include HIV
force screening of all military personnel every two years, HIV
theater-entrance screening 90 days prior to deployment, and compulsory
hepatitis B vaccination.

The use of FWB has been independently associated with
improved survival of patients and will continue to have a place in
combat-casualty care.7 Current TTD countermeasures and
risk-mitigation strategies will continue to be evaluated for improvement.
This includes continued evaluation of quick and effective rapid-test
methodologies that are sensitive, specific and, hopefully, FDA-approved for
donor testing in the future.

Col. Francisco J. Rentas, Maj. David A. Lincoln, and Lt. Cmdr.
Corey R. Jenkins
, are
located at the Armed Services Blood Program Office in Falls Church, VA.
Lt. Col. Robert J. O'Connell is with the
Department of Retrovirology at Walter Reed Army Institute of Research in
Rockville, MD, and Maj. Robert G. Gates is located at the Dwight D. Eisenhower Army Medical Center in Augusta, GA.


  1. Beekley AC. Damage control resuscitation: a sensible
    approach to the exsanguinating surgical patient. Crit Care Med.
  2. Blackbourne LH. Combat damage control surgery.
    Crit Care Med
    . 2008;36:S304-310.
  3. Perkins JG, Cap AP, Weiss BM, Reid TJ, Bolan CD.
    Massive transfusion and nonsurgical hemostatic agents. Crit Care Med.
  4. Kauvar DS, Holcomb JB, Norris GC, Hess JR. Fresh
    whole blood transfusion: a controversial military practice. J Trauma.
  5. Burris DG, Rich NM, Sturtz DL. Surgical research at
    the Uniformed Services University: one graduate's perspective—from
    student to Chief, Division of Surgical Research. Mil Med.
  6. Eastridge BJ, Jenkins D, Flaherty S, Schiller H,
    Holcomb JB. Trauma system development in a theater of war: Experiences
    from Operation Iraqi Freedom and Operation Enduring Freedom. J Trauma.
    2006;61:1366-1372; discussion 72-73.
  7. Spinella PC, Perkins JG, Grathwohl, KW, Beekley, AC, Holcomb, JB. Warm
    Fresh Whole Blood Is Independently Associated With Improved Survival for
    Patients With Combat-Related Traumatic Injuries. J Trauma. 2009;66:S69-76.
Blood timeline
c. 500 BCE: Alcmaeon, Croton, Greece, observes when he dissects animals that arteries and veins are dissimilar.

c. 400 BCE: Hippocrates suggests the body is comprised of four humors: blood, phlegm,
black bile, yellow bile. Further, imbalance among the four humors causes
disease. Hippocrates and his followers set out principles forming the basis
of much of Western medicine, including physicians' adherence to a strict
ethical code of conduct.

c. 350 BCE: Aristotle believes that the heart is the central organ of the body and —
based on his dissections of different animals — a three-chambered organ,
even in humans.

300 BCE: Herophilus of Chalcedon, one of the first Greek anatomists to publicly
dissect human cadavers, determines arteries are thicker than veins and carry

c. 130-200 BCE: Galen [Claudius Galenus], one of the most important and influential
physicians next to Hippocrates, dissects and experiments on animals, proving
arteries contain blood. Galen suggests that arteries and veins are
completely distinct. His ideas form the core of the medical canon for

mid-1200s: Ibn al-Nafis, physician and author from Cairo, Egypt, discovers and
describes the flow of blood to and from the lungs: pulmonary circulation.

1553: Spanish physician and theologian Michael Servetus refutes Galen's theory by suggesting blood flows from one side of the heart to the other via the lungs instead of through the wall between the ventricles.

1628: British physician William Harvey publishes
Anatomical Treatise on the Movement of the Heart and Blood in Animals
he explains that blood circulates within the body and is pumped by the

1658: Jan Swammerdam, a 21-year-old Dutch microscopist, is thought to be the first
person to observe and describe red blood cells.

1661: Italian anatomist Marcello Malpighi observes through a rudimentary
microscope, the capillary system.

1665: Richard Lower in England performs the first recorded blood transfusion in
animals. With a crude syringe of goose quill and bladder, he connects the
jugular vein of a dog he has bled to the neck artery of second dog,
resuscitating the former.

1667: In June, French physician Jean-Baptiste Denis transfuses a teenage boy suffering from a persistent fever with nine ounces of lamb's blood. He attaches the lamb's carotid artery to a vein in the boy's forearm, without the patient suffering any negative consequences. He uses the procedure on several other patients, until Antoine Mauroy, dies after two transfusions of calf's blood in December. In 1668, Denis sues Mauroy's widow for slandering his reputation. In 1670, the case prompts the French Parliament's ban on all transfusions involving humans. In England and Rome, similar actions are taken.

1667: Before the Royal Society in England, Drs. Richard Lower and Edmund King give
Arthur Coga, an indigent former cleric, a transfusion of several ounces of
sheep's blood for a fee of 20 shillings; the patient recovers nicely.

1674: Unaware Swammerdam and Malpighi, Anton van Leeuwenhoek, a Dutch
linen-draper-turned-microscopist, provides a more precise description of red
blood cells, approximating their size to 25,000 times smaller than a fine
grain of sand.

1771: In Experimental Enquiry into the Properties of the
, British anatomist William Hewson details his research on blood coagulation. He succeeded at arresting clotting and isolating a substance from plasma he called “coagulable lymph,” now known as fibrogen, a key protein in the clotting process.

1795: A footnote in a medical journal credits Philadelphia physician Philip Syng
Physick for performing the first human-to-human blood transfusion.

1881: British obstetrician and physiologist James Blundell performs the first
recorded human-to-human blood transfusion. Using a syringe, he injects a
patient suffering from internal bleeding with 12 to 14 ounces of blood from
several donors. The patient dies after initially showing improvement.

1874: Sir William Osler observes small cell fragments from bone marrow make up the
bulk of clots formed in blood vessels; these will come to be called

1901: Austrian physician Karl Landsteiner publishes a paper detailing his
discovery of the three main human blood groups: A, B, and C (he later
changes C to O). He charts the regular pattern of reaction that occurs when
he mingles the serum and red cells of an initial set of six blood specimens.
Red cells agglutinate when serum from group A is mixed with the red cells of
a second group B. Similarly, group B serum causes the red cells of group A
to agglutinate, but the red cells of a third group C never clump when mixed
with the serum of group A or B. Based on these results, he deduces that two
different types of antibodies exist to cause agglutination, one in group A,
another in group B, and both together in group C.

1902: Alfred von Decastello and Adriano Sturli (Landsteiner's colleagues) identify
fourth blood group: AB that causes agglutination in red cells of groups A
and B.

1907: Dr. Ludvig Hektoen of Chicago recommends checking the blood of donors and
recipients for signs of incompatibility (or cross matching) prior to
transfusion. At Mount Sinai Hospital in New York, Dr. Reuben Ottenberg
performs the first transfusion using cross matching and, over the next
several years, successfully uses the procedure in 128 cases, virtually
eliminating transfusion reactions.

1914: Almost simultaneously, Albert Hustin of Brussels and Luis Agote of Buenos
Aires discover that adding sodium citrate to blood will prevent it from

1915: Dr. Richard Lewisohn at Mount Sinai Hospital in New York formulates the
optimum concentration of sodium citrate that can be mixed with donor blood
to prevent coagulation but pose no danger to the recipient:.2%. Dr. Richard
Weil determines that citrated blood can be refrigerated and stored for a few
days and then successfully transfused.

1916: At the Rockefeller Institute in New York, Francis Peyton Rous and J.R.
Turner develop a citrate-glucose solution that allows blood to be stored for
a few weeks after collection and still remain viable for transfusion.

1917: While serving in the U.S. Army, Dr. Oswald Robertson, familiar with the work
of Drs. Rous and Turner, collects and stores type O blood with
citrate-glucose solution in advance of the arrival of casualties during the
Battle of Cambrai in World War I. Thereby, he establishes the first blood

1922: Percy Lane Oliver begins operating a blood-donor service out of his home in London. He recruits volunteers who agree to be on 24-hour call and to travel to local hospitals to give blood as the need arises. Volunteers are screened for disease, tested for blood type; names are entered into phone logs, so volunteers can be quickly contacted when blood is required.

1930: On March 23, at the Sklifosovsky Institute in Moscow, Dr. Serge Yudin is the
first to test the efficacy of transfusing humans with cadaver blood. He
successfully resuscitates a young man slashed both his wrists attempting
suicide by injecting him with 420 cc of blood from a cadaver of a
60-year-old man, who died after being hit by an omnibus. The Soviets are the
first to establish a network of facilities to collect and store blood for
use in transfusions at hospitals.

1935: Anesthesiologists at Mayo Clinic in Rochester, MN, organized a transfusion
service in 1933 and are now the first to store citrated blood and utilize it
for transfusions within a hospital setting in the U.S.

1936: In August during the Spanish Civil War, Physician Federico Duran-Jorda establishes the Barcelona Blood-Transfusion Service. The service collects blood, tests it, pools it by blood group, preserves and stores it in bottles under refrigeration, and with vehicles fitted with refrigerators, transports it to front-line hospitals. At the same time, Canadian surgeon Dr. Norman Bethune, a volunteer with the Republican Army, organizes a similar mobile blood service in Madrid: The Spanish-Canadian Blood Transfusion Institute.

1937: Dr. Bernard Fantus coins the term “blood bank” to describe the blood
donation, collection, and preservation facility he starts as director of
Therapeutics at Cook County Hospital in Chicago, IL.

1939: Drs. Philip Levine and R.E. Stetson uncover an unknown antibody in the blood
of a woman who has given birth to a stillborn, and postulate that a factor
in the fetus' blood, inherited from the father, triggers the antibody
production in the mother.

1940: Drs. Karl Landsteiner and Alex Wiener discover the Rh blood group, through experiments with the red blood cells of Rhesus monkeys, and identify the antibody found by Levine and Steston to be anti-Rh. Meanwhile, a plasma shortage in Britain during World War II prompts the U.S. to organize the Plasma of Britain campaign, run by Dr. Charles Drew from a central laboratory at Presbyterian Hospital in New York. Building on techniques already developed to separate and preserve blood plasma, which is a viable substitute for whole blood, Dr. Drew devises a modern and highly sterile system to process, test, and store plasma for shipment overseas by the Red Cross. At the same time, searching for a durable substitute for liquid plasma, Harvard biochemist Edwin Cohn invents a method to separate out its different proteins or fractions. In a series of steps that are repeated, with slight variations in temperature and chemical conditions, plasma is mixed with the solvent ethyl alcohol and centrifuged. Through this process dubbed fractionation, Cohn and his team are able to isolate the plasma components fibrinogen (Fraction I), gamma globulin (Fraction II and III), and albumin (Fraction V). Each of these fractions are thought to contain different therapeutic properties, with albumin holding the most promise.
1941: In January, at the behest of the Surgeon General of the U.S. Army and Navy, the American Red Cross agrees to organize a civilian blood donor service to collect blood plasma for the war effort. The first center opens in New York on February 4, and the Red Cross collects over 13 million units of blood over the course of the war. Philadelphia surgeon Dr. Isidor Ravdin successfully treats victims of the Pearl Harbor attack with albumin to increase blood volume.

1943: In his report in the Journal of the American Medical Association, Dr. Paul
Beeson links the occurrence of jaundice in seven cases to blood or plasma
transfusions the patients receive a few months prior, providing the
quintessential description of transfusion-transmitted hepatitis.

1947: As an alternative to the Red Cross blood centers being set up across the
country in the post-war period, directors of independent, community blood
banks join together to form a national network of blood banks called the
American Association of Blood Banks.

1948: Dr. Carl W. Walter, a trained surgeon, develops a plastic bag for the
collection of blood which revolutionizes blood collection. Glass bottles —
fragile and susceptible to contamination — prompted him to devise a
stronger, more portable plastic container.

1959: Through the use of X-ray crystallography, in which X-rays are beamed on
crystals to reveal the distribution of their atoms, Dr. Max Perutz working
at Cambridge University, England, is able to unravel the structure of
hemoglobin, the protein within red blood cells that carries oxygen.

1965: Dr. Judith Pool, an American physiologist at Stanford University, discovers
that slowly thawed frozen plasma yields deposits high in Factor VIII (or
Antihemophilic Factor). The deposits called cryoprecipitates (or cryo) are
found to have much greater clotting power than plasma and given to
hemophiliacs to stop bleeding episodes. It prevents the need for
hemophiliacs to travel to the hospital to be treated, since cyro can be kept
frozen at home and infused, after being thawed, by a physician.

late-1960s: Drs. Kenneth M. Brinkhous of the University of North Carolina at Chapel Hill and Edward Shanbrom of Hyland Laboratories produce a highly concentrated form of Factor VIII by pooling large quantities of plasma that generate vast amounts of cyro, which are then redissolved, treated, filtered, and centrifuged. The resulting powder's clotting power is 100 times stronger than raw plasma, easily stored in a portable vial, and can be injected with a syringe by hemophilia patient.

1971: Dr. Baruch Blumberg of the National Institutes of Health (NIH) identifies a
substance on the surface of the hepatitis B virus that triggers the
production of antibodies. His work leads to the development of a test to
detect the presence of hepatitis B antibodies, thereby identifying infected
donors; the test is mandated by the FDA.

1981: The first cases of a syndrome initially called Gay-Related Immunodeficiency
Disease (GRID), due to its prevalence among gay men, are reported. It is
later renamed Acquired Immune Deficiency Syndrome (AIDS).

1982: When hemophiliacs also begin to develop GRID, Dr. Bruce Evatt, a specialist
in hemophilia at the Centers for Disease Control and Prevention (CDC),
begins to suspect that the syndrome may be blood borne and presents his
theories at a meeting of a group of the U.S. Public Health Service in July.

1983: Researchers at Dr. Luc Montagnier's lab at the Institut Pasteur, in France,
isolate the virus that causes AIDS. They locate it in the swollen lymph node
in the neck of a Parisian AIDS patient and label it lymphadenopathy-associated
virus (LAV).

1984: Dr. Robert Gallo of the NIH announces that he has identified the virus that
causes AIDS, which he calls (human T-cell lymphotropic virus (HTLV III).

1985: After dozens of Americans are infected with AIDS from blood transfusions,
the first blood-screening test to detect the presence or absence of HIV
antibodies — the ELISA test — is licensed by the U.S. government on March 2.
The test is universally adopted by American blood banks and plasma centers.
A legal battle over who deserves credit for the discovery of the AIDS virus
finally ends in 1987 when the U.S. and French governments agree to share
credit and royalties from the sales of test kits for the virus.

1987-2002: A series of more sensitive tests are developed and implemented to screen
donated blood for infectious diseases: two tests that screen for indirect
evidence of hepatitis; the Human T-Lymphotropic-Virus-I-antibody
(anti-HTLV-I) test; the hepatitis C test; the HIV-1 and HIV-2 antibodies
test; the HIV p24 antigen test; and Nucleic Acid Amplification Testing (NAT)
that directly detects the genetic material of viruses like HCV and HIV.

Note: The material contained in
this history was extracted from Red Gold: The Epic Story of Blood in the
Blood History Timeline at  on February 15, 2010.