The third century of blood transfusion. A return to patient-oriented treatment

The principle of treating the patient, not the disease was formulated in the 19th century and reflected, among other things, his current understanding of the nature of diseases, the physiology of blood, and indications for its transfusion. Patient-oriented treatment persisted until the end of the 1890s, passing through the stages of proclaiming first the vital, then the nutritional, and then the volemic functions of the mysterious fluid tissue of the body as predominant. Transfusion of allogeneic and xenogenic, native and defibrinated blood did not lead to the expected success. In transfusion therapy, saline infusion replaced blood transfusions. The catastrophic increase in the demand for donor blood during the First and Second World Wars, coupled with declining interest in saline transfusion, the study of immunological aspects of donor–recipient compatibility, the abandonment of direct transfusion, the development of reliable preservatives, and the investigation of storage conditions for blood in specialized banks — all of these factors, by the mid-20th century, pushed the interests of the patient into the background in favor of a blood-oriented approach. The pandemic of blood-borne viral diseases (viral hepatitis, HIV infection) in the 1960s–1980s exacerbated this trend. The drive for the safety of blood, its components, and preparations was characterized by a decline in the use of whole blood and a focus on bloodless techniques and blood-saving procedures. Establishing the safety and effectiveness of such innovations required a set of special studies based on the principles of evidence-based medicine. At the same time, it became obvious that this approach had never been used to justify the paradigm that previously existed in transfusiology. Since the 2000s, interest in the use of warm and modified whole blood has increased in transfusion therapy, and decisions regarding treatment by blood transfusion have returned to a patient-oriented approach, as was the case in the 19th century. The program known as patient blood management is broadly consistent with the concept in modern professional ethics that prioritizes the patient’s interests.