BLood donaTion and coLLecTion

The first documented transfusion of blood in humans occurred in 1667, but it was not until almost 300 years later that transfusion become a therapeutic practicality.1 Landsteiner’s landmark discovery in the early 1900s of blood groups and agglutinating antibodies was the key that unlocked this therapeutic pathway. The development of anticoagulants, blood preservatives, and sterile collection sets in the middle of the 20th century made blood banking possible by enabling the collection and preservation of donor blood for later use. In the past few decades, the complexity of blood banking and blood component therapy has virtually exploded. The recognition of both infectious and noninfectious complications of transfusion led to numerous practice changes involving blood donor screening, component production and modification, compatibility testing, and blood utilization. The menu of blood component options and therapeutic services has progressively expanded, along with efforts to establish evidence-based guidelines for their optimal use. Specialized recommendations have been developed for supporting specific patient populations such as immunosuppressed patients, chronic transfusion recipients, hematopoietic cell transplant recipients, and neonates.2,3 In the United States, all blood establishments (blood banks and transfusion services) are regulated by the US Food and Drug Administration (FDA).4 FDA regulations govern all aspects of blood collection, component processing, storage, compatibility testing, and administration. The FDA requires blood establishments to comply with highly stringent quality assurance standards that ensure control of processes and restrict variability. The AABB (formerly known as the American Association of Blood Banks) issues accreditation standards and recommendations that further establish the standard of practice in the US.5 Today, Transfusion Medicine is itself a Board-recognized clinical specialty. In addition to overseeing the complex donor center and transfusion service operations, Transfusion Medicine physicians are increasingly important participants in the clinical care team. Transfusion Medicine specialists can guide the selection of therapeutic options to best support a patient’s medical needs, and can coordinate the supply and delivery of these blood components and therapeutic services.6 This chapter serves as an introduction to blood components and transfusion services available in the United States.