The Riddle of Shock: Blood Transfusion

“I have seen men already like corpses, blanched and collapsed, pulseless and with just perceptible breathing, within two hours of transfusion sitting up in bed smoking, and exchanging jokes before they went to the operating table.”

Dr John A Hayward, Captain in the RAMC 1914-1918

Blood transfusions were introduced in the First World War to resuscitate wounded soldiers so that they were fit enough for surgery or transportation. It was a new technique brought to the British Army by Canadian and American doctors. Its use increased from 1917 after the discovery that sodium citrate would keep donated blood fresh for up to 28 days. Before cannulae were introduced, direct donation (vein-to-vein or artery-to-vein) was used.

By modern standards the amount of blood given in a transfusion was small. 500cc- less than one pint- was considered sufficent to treat shock, and the maximum given was 1000cc. In 2015, the average amount given for each transfusion was 1700cc- almost three pints.

Blood transfusion needles

The first human intravenous transfusion was reported in 1818 by James Blundell, a lecturer in physiology and obstetrics at Guy’s and St Thomas’ Hospital in London.  Karl Lansteiner discovered blood groups in 1901.  Cannulas for blood transfusion were initially made of glass.  In the mid-1920s metal cannulas allowed the veins to be punctured through the skin.

Blood transfusion equipment

This set includes tubing, a glass drip counter and a drip control clip.

Blood transfusion needles with drip counters

Blood transfusion needles with drip counters

Marriott & Kekwick apparatus

Marriott and Kekwick blood transfusion apparatus

In 1935, Marriott and Kekwick of the Middlesex Hospital, London, introduced the principle of continuous infusion of large quantities of blood and described how to do it. Blood flows from the flask. The glass reservoir connects to a drip bulb. During the First World War, ¾ of a pint was considered a large amount.

Glass bottles were replaced by disposable plastic bags from 1975. This allowed far wider and more convenient blood distribution.


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