Friday, May 16, 2008

Those were the days, my friends

Something a bit lighter this month to celebrate springtime and fall, depending on your hemisphere....

This feature in the May issue of Transfusion caught my eye:

  • Transfusion Medicine History Illustrated, Ruth Sanger, a rare early photograph
The photo shows Ruth Sanger (1918 - 2001), a giant of the transfusion medicine field, performing blood typing tests in the lab, circa 1946.

The photo and accompanying synopsis of her life's work brought to mind a book that I had read and enjoyed many years ago:

  • Blood Groups in Man by Race, R. R. and Sanger, R.
First published in 1950, the 6th and final edition of BGIM came out in1975. The textbook was easy to read and humourous in spots as the authors clearly had a great sense of humour. The blood group findings were totally based on manual agglutination techniques, which as with many good things became outdated because of technological advancement, in this case when molecular genetics techniques appeared in 1980s.

Co-authored by Rob Race, the man she was to marry in 1956, BGIM was an extension of Sanger's PhD thesis on
“The Multiplicity of Blood Group Systems.”

See a review of the 2nd edition by WM Mollison: J Clin Pathol 1954 Nov; 7(4): 357.

BGIM was one of several bibles that I decided to read cover-to-cover (just for fun on my own time) when I began my blood bank career:

  • Blood Transfusion in Clinical Transfusion by P.L. (Patrick) Mollison
  • Applied Blood Group Serology by Peter Issitt
With these books out of print and of historical interest, I wonder how many of today's blood bankers would recognize the names of pioneers like Ruth Sanger, Rob Race and Patrick Mollison? Moreover, how many people even read today's blood bank textbooks just for fun, or at all?

If reading is a lost art, the history of our field will grow ever dimmer, which is unfortunate. See,
for example:

How Coombs conceptualized the antiglobulin test while riding on a wartime train in England:

How the Fisher-Race theory of Rh inheritance came about by Race discussing the problem of Rh inheritance with the mathematician R.A. Fisher in a Cambridge pub over pints of beer:
On a personal level, two of my earlier blogs about life in the old days seem apt:
And for a real blast from the past
  • Schmidt PJ, Greenwalt TJ. Hints to blood groupers, 1950. Transfusion 2006; 46(3): 448-53.
Abstract:

Sixty years ago, the premier blood grouping laboratory was that of Robert Race in London. Agglutination tests and blood grouping had provided breakthroughs in immunology, genetics, and the solution of clinical problems. The significance of immunohematology was recognized by the clinical hematology community as a potent force in the expanding field of disorders of the
blood and blood-forming organs.

The instructions by Race to his London workers entitled Hints to Blood Groupers provide a picture of the immunohematology laboratory even before automation and differed slightly from the American techniques that derived from Landsteiner. Before agglutination is replaced in the near future by the emergence of molecular methods, the detailed method of a superb laboratory is recorded.

If you can access the full text of Hints to Blood Groupers, it's worthwhile. Two tidbits (from 60 years ago!) that foreshadow the documentation requirements of a quality system:

  • Always control every serum. If say one of the controls is, unavoidably, elderly, note this down (subsequent inspectors of your protocols should know this).
  • Look carefully at your results and repeat any dubious ones, as soon as possible. Repeat again if necessary and make new protocols for the repeats. It is no good saying you have repeated it and get the same results. That would soon be forgotten if not written down.
Or how about, If you want to speak to a person working, try to see when it will cause least disturbance....

Priceless!


As an aside, I love molecular diagnostics. How methods such as PCR work (scroll & click on arrow to start animation) are fascinating and the benefits to science and society are indisputable, including the ability to close the "window of negativity" for HIV, HCV, and other infections in blood donors.

The history of the discovery of the polymerase chain reaction makes interesting reading. See, for example, Kary Mullis's acceptance speech when awarded the 1993 Nobel Prize in Chemistry for his discovery of PCR

This story, disputed by others, was also told earlier by the controversial Mullis in Scientific American:

  • Mullis, K. The unusual origin of the polymerase chain reaction." Sci Am 1990; 262: 56.
Regardless of loving biotechnology, I think that dudes like Willy Flegel and Greg Denomme are going a Taq, err...tad too far when they try to relegate routine serological methods in the transfusion service lab to the trash bin of technological history.
Cheers, Pat (aka Terminus Taquaticus)