Blood transfusion and blood substitutes in the XIX century as a non-linear path of translational medicine
Abstract
The article examines the process of becoming transfusiology as an independent science, based on forming two new areas of therapy: intravenous administration of blood and saline solutions. In the course of a retrospective multicenter cohort study of the results of these operations performed in the XIX century, the reasoning of the formation of scientifically sound principles underlying the development of evidence-based transfusiology in the XX century was revealed. It is shown how, under the influence of laboratory and clinical experiments, initially methods of unequal mechanism of action and scope (in the opinion of specialists of the XIX century) consistently began to be used for similar diseases, and then acquired specific features of transfusion therapy aimed at compensating hypovolemia with blood substitutes and correcting blood composition by hemotransfusion. The analysis of this process from the point of view of the mechanism of transmission of scientific knowledge allows us to single out two stages. In the first half of the XIX century the laboratory experience was transferred directly to the patient’s bedside, bypassing the stage of clinical experiment. Therefore, this period is characterized by a wide range of therapeutic indications for transfusion therapy in various critical conditions. Secondly, the empirical clinical experience obtained became the basis for theoretical discussions held by physiologists about the causes of pathological conditions and differences in the effectiveness of saline solution infusions and hemotransfusions in case of various diseases. The introduction or rejection of the use of new methods in medical practice at this time was determined due to accumulation and analysis of extensive clinical experience. The formation of transfusion therapy in the XIX century disrupted the linear course of translational medicine, demonstrating the reverse sequence of stages in the formation of clinical medicine. At the same time, the empirical introduction of new therapeutic methods stimulated on the one hand the study of pathophysiological basics of the diseases in treatment of which the former were used, on the other hand — the definition of the theoretical foundations of the mechanism of their action.
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