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‘States of the body really requiring the infusion of blood into the veins are probably rare; yet we sometimes meet with cases in which the patient must die unless such operation can be performed.’ So begins James Blundell’s ‘Observations on transfusion of blood’, published in The Lancet, marking the origins of transfusion medicine as a clinical discipline [1]. Blundell (Figure 1.1) was a prominent London obstetrician who witnessed peripartum haemorrhage and whose interest in transfusion had begun as early as 1817 during his medical education in Edinburgh. He established that transfusions should not be conducted across species barriers and noted that resuscitation from haemorrhage could be achieved using a volume of transfusion that was smaller than the estimated blood loss. Despite life-saving results in some patients, clinical experience with transfusion was restricted by lack of understanding of ABO blood groups – a barrier that would not be resolved for another century.