Blood banks. Do you have good credit?
The origins of the term "blood bank" provides insights into the earliest methods of blood acquisition and allocation in the hospital.
Until the early 20th century, most blood was transfused directly from donor to recipient. And this was, of course, whole blood. Then, in 1916, Peyton Rous1 and JR Turner described the method by which blood might be stored for later use. But they offered a rather tepid endorsement of its use for transfusion, writing, “kept cells could be utilized for serum reactions, or for culture media, or even under certain circumstances for transfusion.”
Rous and Turner didn’t offer a name for the place in which the blood might be stored or the means by which it would be ordered and obtained for use. In 1937 Bernard Fantus provided answers, describing the implementation of a “blood bank” at Cook County Hospital in Chicago.
In describing his selection of the banking metaphor, he begins by asking, where does one get the blood? His solution: “Just as one cannot draw money from a bank unless one has deposited some, so the blood preservation department cannot supply blood unless as much comes in as goes out.” We call it a blood bank because these early iterations were based on the banking principles of deposit and withdrawal. In Fantus’ blood bank, a doctor could not obtain blood unless they had deposited blood. These deposits could be made at any time, with credits recorded whenever doing so.
Here is a portion of a typical page of the blank bank book, as kept by Fantus.
Notice that a ledger was not always positive. There were times when a service’s balance might run negative. I cannot tell how strictly these doctors were then instructed to make deposits, lest their patients run short on blood.
I’m a bit surprised that Fantus selected a bank as his metaphor, given that the great stock market crash of 1929 had occurred less than a decade earlier. An image of the ensuing run on the banks couldn’t have been the planned expression of his new creation. Still, this is the term Fantus selected and that we continue to use.
Notice that, at the time, hospitals were largely dependent on internal sources of blood. Although the American Red Cross was founded in 1881, it did not begin collecting blood until 1941. Fantus’ Cook County needed a source of blood for their bank. More pointedly, the doctors practicing at Cook County needed a source of blood credits for future withdrawals. Fantus suggested at least five possible sources of these blood credits:
Healthy volunteers. This seems uncontroversial, though I do wonder how often housestaff were those “volunteers.”
Patients with acute heart failure & severe hypertension. Fantus notes that “it should be a rule that practically all patients in need of digitalis should have a preliminary abstraction of blood to unload the heart before stimulating it.” It appears that bloodletting still had a home, even in the 1930s.
Pregnant women. The idea here is that this blood could be stored for use post-partum.
Pre-operative patients. The principle is the same as with women; the deposited blood could be withdrawn for later use post-operatively.
Those who have been saved by blood transfusion. Here, the donation/deposit offers a form of reciprocity, thanking those who had previously made a deposit.
Given the origin of the term, some have suggested “blood bank” be retired. I don’t see that happening. Most, myself included, aren’t familiar with its origins and are unlikely to be bothered by the fact that it no longer describes the ways in which we manage blood receipt in the hospital. That said, I certainly do not pine for a return to the days of a true “blood bank” and the stress of a negative ledger that might bear my name.
Years earlier, Rous had discovered the Rous sarcoma virus that bears his name. For his work on how viruses cause cancer, he received the Nobel Prize in 1966.