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NeoReviews Vol.7 No.2 2006 e67
© 2006 American Academy of Pediatrics

Historical Perspectives

Cured by the Blood: The Story of the First Neonatal Blood Transfusion

	Case Report

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On March 4, 1908, a baby girl was born to healthy parents at a New York Hospital. She weighed 8 lb 12 oz. Other than forceps marks over her cheeks, she appeared healthy.

At 12 hours of age, she developed a hematoma over her tongue. That afternoon, she developed a fever to 102.2°F (39°C). She looked pale and restless and cried continuously. A subcutaneous hematoma was noted behind the left ear, extending down to her neck over the next 36 hours. She passed dark-colored meconium stools, strongly positive for blood. "Intestinal infection" was diagnosed, and she was treated with 30 minims of castor oil and two grains of calcium lactate. She deteriorated over the next 3 days, and appeared "hopeless" on the fourth day. Blood oozed continuously from her nose. Her skin was waxen white, mucous membranes were colorless, and pulse was feeble.

It was clear that the child needed a blood transfusion, but this had never been tried in a newborn. The doctors considered giving her a "direct transfusion" and asked her father to be the donor. He agreed. Surgeons Alexis Carrel and Geo Brewer were summoned from the Rockefeller Institute.

The infant was strapped to an iron board, and an incision was made at the groin region to expose the popliteal vein. Her father’s left radial artery was exposed. With superb dexterity and skill, Dr Carrel carried out a side-to-side anastomosis of the father’s radial artery with the baby’s popliteal vein to effect a transfusion. Neither the father nor the infant was given an anesthetic.

There was no way to assess the volume of blood being transfused, but "sufficient" quantity was allowed to flow into the baby until her color changed from a pale transparent whiteness to a brilliant red, upon which she cried lustily. Then, as if exhausted, she slept peacefully. The blood vessels were sutured. The baby recovered fully and went home a week later. At eight weeks of age, she appeared perfectly healthy.

	Comments and Perspectives

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Several extraordinary features are apparent from the previous case report from Dr Samuel W. Lambert in Medical Records in May, 1908. (1) The dramatic blood transfusion had received media attention, as noted by Dr. Lambert with humility and caution: "Although the case which I have selected to report ... has received some notoriety in the daily press, it seems nevertheless worthy of a careful clinical study." Much of the article discussed the causes of bleeding, including the reasons for bloody stools and melena, rather than the transfusion itself.

From what condition did the child suffer? It is difficult to make a retrospective diagnosis, but despite a few atypical features in its presentation, the most likely diagnosis is hemorrhagic disease of the newborn, which might explain a complete recovery. Unfortunately, this condition had not been known in those days.

It is also remarkable that the doctors considered a blood transfusion and pursued it, even though they lacked the most basic necessary equipment and had no experience whatsoever with transfusion. In fact, in the early 1900s, no needles and syringes were small enough for use in children, let alone for newborns. Perhaps the availability of an expert surgical team nearby encouraged them to undertake such a daring procedure.

For a number of years prior to this case, the visiting French surgeon Alexis Carrel had been perfecting vascular anastomotic techniques. He had worked on laboratory animals, large and small, successfully transplanting kidneys and grafting blood vessels. He was the first to develop subendothelial purse-string suturing techniques that would prevent the formation of scars and vascular stenosis. Carrel was ready and willing to undertake the surgery for a direct transfusion from the father’s radial artery to the infant’s tiny popliteal vein.

Why were no anesthetics used? Topical cocaine drops had been used since the late 1880s for ophthalmologic procedures. In the early 1900s, procaine had been developed and used as a local anesthetic. These drugs, however, were extremely expensive and scarce. A small quantity of cocaine solution was literally worth several-fold its weight in gold. Thus, local anesthetics seldom were used in children.

What of checking for blood groups, cross-matching, using anticoagulants? In 1900, the Viennese pathologist Karl Landsteiner described three blood groups—A, B, and C (later renamed O)—based on whether the red blood cells "agglutinated" (a term he coined) when mixed with the plasma from others. The fourth group, AB, was discovered 2 years later. This brief report in an obscure journal did not receive much attention until blood transfusions became more frequent during the first World War. Mismatched transfusions led to "unexpected" deaths. In 1912, Rueben Ottenberg at New York’s Mount Sinai Hospital studied cross-matching of donor and recipient blood samples and reported that such a test prior to transfusions could save lives. In 1914, Peyton Rouse and Joseph Turner began using citrated physiologic saline as anticoagulant. The anticoagulant heparin was introduced in 1936. Thus, in 1908, checking for blood groups, cross-matching, and using an anticoagulant were simply not the standards of care!

	The Aftermath

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Although safe pediatric transfusions were decades in the making, this landmark procedure in 1908 underscored that blood transfusion, not therapeutic bleeding, can be lifesaving. In 1912, Alexis Carrel received the Nobel Prize in Medicine for his pioneering vascular surgery research. Landsteiner had to wait until 1930 to be so honored with the Nobel Prize for his discovery of the human blood groups.

Tonse N. K. Raju, MD, DCH^*

^* Pregnancy and Perinatology Branch, Center for Developmental Biology and Perinatal Medicine, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md

	Footnotes

 
Author Disclosure

Dr Raju did not disclose any financial relationships relevant to this article.

	Reference

Top Case Report Comments and Perspectives The Aftermath Reference Suggested Reading

 
1. Lambert SW. Melena neonatorum with report of a case cured by transfusion. Med Rec. 1908;73 :885 –887

	Suggested Reading

Top Case Report Comments and Perspectives The Aftermath Reference Suggested Reading

 
Wintrobe MM. Blood, Pure and Eloquent: A Story of Discovery, People and Ideas. New York, NY: McGraw-Hill; 1980

Bradley JA, McGehee H. Two Centuries of American Medicine: 1776–1976. Philadelphia, Pa: WB Saunders; 1976.

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