The History of Phlebotomy

Phlebotomy is a method of drawing or removing blood from a being - human, animal etc. In modern day, phlebotomy is used to detect, identify and treat a plethora or illnesses and diseases. However, that was not originally the case. The practice of phlebotomy (or bloodletting as it was called in its previous era) can be traced back to the times of the egyptians. The Egyptians would take a bath in the blood of healthy individuals and warriors as they thought it would bring health and strength to them. Pliny the Elder and other Romans would drink drink the blood from dying warriors as they, too, believed they could receive strength from blood. Shortly, they believed in order to retain their youth they would have to have “youthful” blood flowing through their bodies.

This brings us to the first transfusion. Pope Innocent VIII was the first recorded bloodletting. He, however, did not survive the procedure nor did the children he transfused from. At this time, there was very little understanding of blood and its components and two fatal mistakes were made. His transfusion came from three children - this means that he had a mix of two to three blood types coursing through his veins and and had produced antibodies to antigens on the red cells that did not match his which cause agglutination in his body. Secondly, the three children died as they transfused too much blood at one time.

Bloodletting then became a way to remove evil spirits from the body as well as certain illnesses and diseases. Yet again, too much blood was being drawn out of people that they grew weak or would get weaker in the days after and eventually succumb to the loss of blood. Transfusions at this point were banned. But people like Libavius and Harvey continued to fight for the importance of transfusions. Libavius wrote articles explaining how transfusions saved lives and Harvey’s theory showed the pattern of circulation via veins.

Noting Harvey’s theory of circulation, Christopher Wren conducted experiments using dogs. He would inject poison into the veins of dogs and see how they reacted. From this experiment it was discovered that the fastest way to achieve a desired effect is to inject it directly into the veins - this gave Wren credit for IV therapy.

Transfusions then moved from simply injecting dogs with fluids (water, milk, wine etc) to transfusion from dog to dog then from animal to human. Denis made three attempts at transfusing from an animal to a human. The first patient ended with a dark urine, the second has increase heart rate, sweating, kidney pain and dark urine and the third patient died. He made the mistake of transfusing from two different species and was ultimately charged for murder. This put a cease on transfusions for nearly 150 years.

After a hiatus from transfusions, Blundell noted that there needed to be a transfusion from the same species. He did human to human transfusions for women who would bleed out during childbirth. With much success, Blundell became the father of modern blood transfusions.

Another problem encountered early in the practice of bloodletting was the blood clotting quickly. As soon as the blood would be taken out of the body it would clot and be rendered useless. Braxton-Hicks began doing research on ways to keep the fluidity of blood. In his attempt he used sodium phosphate as an anticoagulant. However this was detrimental. Sodium phosphate was highly toxic and they ended up killing four people. Then Huston came a short while later and used sodium citrate and glucose. As an anticoagulant, sodium citrate was not harmful or toxic and is still currently being used today. The glucose was used as an added energy source for the red blood cells.

Now we have a method of preserving blood as well as transfusing blood but there is still the problem of blood clotting inside the body. This problem would not be solved until the works of Karl Landsteiner and DeCastello and Sturli was published. Landsteiner discovered and published ABO blood groups - only noting types A, B, and O. DeCastello and Sturli noted that you can have the presence of AB antigens on the surface of the cell. Between the three of them, we now have blood types A, B, O and AB.

Through a collective measures over the years, phlebotomy has gone from unsafe, fatal practices to an intraspecies, meticulated, and screened practice. Blood is drawn - volume specific - for testing purposes as well as for donations. 

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