Critical & Organ Care · 1916
Rous and Turner's citrate-glucose method for storing red blood cells
Blood transfusion in 1915 required a donor in the same room. The procedure linked the donor's vein directly to the recipient's, or used blood drawn only minutes before it was administered, because collected blood clotted rapidly and red cells deteriorated quickly without refrigeration. In high-volume casualty settings, particularly on the Western Front, this logistical constraint meant that transfusion, however useful in principle, could not be provided at scale or in advance of anticipated casualties.
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-glucose solution that served two purposes: citrate chelated calcium and prevented clotting, while dextrose provided metabolic substrate to keep red cells viable. Blood stored in the Rous-Turner solution remained transfusable for roughly two weeks at refrigerator temperature. The timing of the publication, as the Battle of the Somme was producing thousands of casualties per day, was not lost on military medical planners.
The operational translation came quickly. Oswald Robertson, a Canadian-American physician serving with the Royal Army Medical Corps, applied the Rous-Turner method to establish the first blood depot on the Western Front in 1917. He stored group O blood in advance, transported it in chilled containers to casualty clearing stations, and demonstrated that refrigerated stored blood could function in mass-casualty settings as effectively as fresh blood. This was the proof-of-concept that made the blood bank, as a standing institution, conceivable.
Civilian blood banking took root in the 1930s. The Cook County Hospital in Chicago and the Mayo Clinic both established blood banks before 1940, and 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.
Rous and Turner's solution also extended beyond whole blood. Once blood could be stored, it could be separated into components: packed red cells, plasma, and platelets, each with different indications and storage requirements. Component therapy, now standard in virtually every hospital, rests on the same chemical logic that Rous and Turner described in 1916. Rous himself received the Nobel Prize in 1966, though for his earlier work on tumor-inducing viruses rather than for blood preservation.
Key People
- Peyton Rous — Rockefeller Institute virologist who co-developed the citrate-glucose preservation solution
- J. R. Turner — Co-author of the 1916 preservation paper with Rous
- Oswald Robertson — Army physician who established the first stored-blood depot on the Western Front in 1917
Journal of Experimental Medicine, 1916
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