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As early as World War I, blood transfusions were administered on the battlefield. Knowing that loss of blood was the main factor in causing shock, many understood that it was important to have blood available to wounded troops. Around 1918 still during WWI the American Expeditionary force routinely performed transfusions in its hospitals using citrated blood (blood treated with sodium citrate or citric acid to prevent its coagulation), developed because of the difficulty in storing whole blood and keeping it from going bad.
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