Rous and Turner's citrate-glucose method for storing red blood cells

Blood transfusion in 1915 usually needed a donor close at hand. Surgeons either joined the donor's vessel to the recipient's or gave blood mixed with sodium citrate soon after it was drawn; the citrate stopped clotting, but human red cells kept in citrated blood alone broke down within about a week. In high-volume casualty settings, particularly on the Western Front, this meant transfusion could not be prepared in advance of the wounded arriving.

Peyton Rous and J. R. Turner at the Rockefeller Institute in New York addressed the storage problem systematically. Their 1916 paper in the Journal of Experimental Medicine described a citrate and dextrose mixture: citrate prevented clotting, while the sugar protected the red cells. In three parts human blood, two parts 3.8 percent sodium citrate and five parts 5.4 percent dextrose, the red cells stayed intact for about four weeks, and experiments in the second part of the paper showed that preserved cells worked normally when returned to the body. Even so, most wartime transfusions used citrated blood given at once.

Oswald Robertson, an American doctor who had worked with Rous at the Rockefeller Institute, went to France in 1917 with the Harvard medical unit at Base Hospital No. 5. He used only group O donors, collected their blood into glass bottles with the Rous-Turner anticoagulant, kept it cold in ice chests for up to 28 days, and carried it to where the wounded were, sometimes giving it himself under fire. He published the results in the British Medical Journal in 1918 and is credited as the first person to set up a blood bank.

Civilian blood banking took root in the 1930s. In 1937 Bernard Fantus opened the first American civilian blood bank at Cook County Hospital in Chicago, storing whole blood in bottles in a refrigerator for up to 10 days. The approach spread rapidly during World War II, when large-scale blood programs operated on multiple fronts. The citrate-glucose principle was refined over subsequent decades into the anticoagulant-preservative solutions still used today, including citrate-phosphate-dextrose formulations.

Once blood could be stored, it could also be separated into components: packed red cells, plasma, and platelets, each with different indications and storage requirements. Rous received the Nobel Prize in Physiology or Medicine in 1966 for his discovery of tumor-inducing viruses, work he had begun in 1910 with a chicken sarcoma.