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. The "patient-oriented" treatment persisted until the end of the 1890s, passing through the stages of proclaiming the leading vital, then nutritional and then volemic functions of the mysterious fluid tissue of the body. Transfusion of allogeneic and xenogenic native and defibrinated blood did not lead to the expected success. In transfusion therapy, saline infusion has replaced hemotransfusion. The catastrophic increase in the need for donated blood during the First and Second World Wars, amid declining interest in saline transfusion, the study of immunological aspects of donor-recipient pair compatibility, the rejection of direct transfusion, the creation of reliable preservatives and the study of the necessary conditions for storing blood in specialized banks, by the middle of the twentieth century, pushed the main interests into the background a patient instead of a "blood-oriented" approach. The pandemic of blood-borne viral diseases (viral hepatitis, HIV infection) in the 1960s and 1980s exacerbated this trend. The struggle for the safety of blood, its components and preparations was characterized by a decrease in the frequency of using whole blood, focusing on "bloodless techniques and blood-saving procedures." The justification of the safety and effectiveness of such innovations required a complex 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, there has been an increase in interest in the use of warm and modified whole blood in transfusion therapy, and when deciding on treatment with blood infusion, there has been a return to "patient-oriented" technology, as it was back in the 19th century. The program, which is designated as "Patient blood management", basically corresponds to the concept of modern professional ethics about the primacy of the patient's interests.