Large Transfusion Research Articles

Platelet Transfusions in Pediatrics

THE transfusion of fresh human platelets has been shown to be an effective and practical way to control the hemorrhagic episodes in thrombocytopenia.1 Recently a variety of technics have been devised for the preparation of platelet concentrates that permit prompt infusion of therapeutically effective amounts of platelets without the delay or circulatory burden of a large whole-blood transfusion.2 3 4 5 6 7 8 9 Of these technics, that of Gardner, Howell and Hirsch10 is most applicable to clinical use and has been modified to suit this study. Selected case reports are cited to illustrate the application of platelet transfusions in the management of medical and surgical . . .

The Hematologic Response to Wounding and to Resuscitation Accomplished by Large Transfusions of Stored Blood: A Study of Battle Casualties in Korea

Abstract 1. During the third winter campaign in Korea, the hematologic reaction to wounding was studied in thirty-seven casualties at the time of initial resuscitation. 2. Of particular interest was the effect of massive transfusions of stored blood. The results of storage of blood—high plasma hemoglobin and potassium, low labile factor activity, nonviable platelets and leukocytes—had little deleterious effect on patients who received as much as 20 to 30 pints in less than six hours. The loss of transfused red cells because of nonviability was no more than expected. 3. At the time of resuscitation and shortly thereafter, there was a remarkable loss of circulating red cell mass in patients with wounds that involved much tissue destruction. It is believed that the loss was due to hemolysis but the mechanism is unknown. The loss of red cells may be so rapid that a patient with bilateral traumatic amputation of the legs and an adequate hemostasis would become severely anemic if one hesitated to use large, rapid transfusions. Patients with severe shock whose wounds involved less tissue damage (lacerated colon, for example) did not destroy red cells in this fashion. After moderate transfusions such patients often became polycythemic. Transfusions had to be carried out rather gingerly because of a tendency to develop signs of congestion. 4. During the early days of recuperation from severe wounds the patients often tended to become anemic. The anemia appeared to be the result of hemolytic processes plus a relative inhibition of red cell formation. 5. Universal donor blood, group O, was used in all transfusions. In patients who are not group O the massive transfusions resulted in the virtual replacement by red cells of another group. The patient’s plasma sometimes contained antibodies against red cells of his hereditary blood group. Gradual hemolysis of native red cells by transfused antibodies was observed. This was not a clinical hemolytic reaction and did not appear to be detrimental to the patient. The presence of the foreign antibodies made it impossible in some cases to crossmatch the patient with blood of his hereditary group and suggested a source of danger in attempting such transfusions. After transfusion with the universal donor blood has begun, it is recommended that no change be made to blood of another group until at least two weeks have elapsed. 6. No incompatible transfusion reactions were encountered. Several hemoclastic reactions may have been caused by gross contamination of the blood stream from the site of wounds or from the peritoneal cavity.

Some Immunohematologic Results of Large Transfusions of Group O Blood in Recipients of Other Blood Groups: A Study of Battle Casualties in Korea

Abstract 1. Following large transfusions of low titer group O blood into patients of group A, B, and AB it was not possible to demonstrate foreign isohemolysins or incomplete antibodies in the serum of recipients. Cold isoagglutinins were frequently demonstrated immediately after the transfusion, but they usually disappeared rapidly. Its several patients the titer of foreign anti-A isoagglutinin was quite high and the antibody persisted in the circulation for several days. It was suggested that the persistence of these agglutinins may have been possible because there was a relatively small amount of A substance in the body of the recipient. Where the transfused isoagglutinins persisted the patients were found to be nonsecretors or weak secretors of A substance in the saliva. 2. In most of these patients there was evidence of a selective destruction of recipient red cells after the transfusion of O blood. This was probably due to the activity of transfused isoantibodies in the plasma of the O blood. This hemolytic activity was observed where it was not possible to demonstrate the presence of foreign isoantibodies. It is suggested that there may exist forms of antibody that cannot be demonstrated by laboratory methods. These antibodies manifest themselves only by causing destruction of red cells in vivo. 3. Clinically the hemolytic disease on the basis of such transfused isoantibodies while causing destruction of native red cells did not threaten the lives or impede the recovery of these patients. No reactions were encountered and none were heard of in Korea that might have been ascribed to a dangerous universal donor. The partition of group O blood into high titer and low titer on the basis of dilution of 1:200 to 1:256 has proved in practice to be safe. 4. The persistence of foreign antibodies after a large transfusion of group O blood may make it impossible to cross match the patient’s blood with blood of his hereditary group. Severe transfusion reactions have occurred when group specific blood has been given following large transfusions of group O blood. It has been recommended that after a large transfusion of group O blood has been given, group specific blood should not be used for at least two weeks.

Wound Healing After Large Blood Transfusions

Wound Healing After Large Blood Transfusions

Limitation of Hemolysis in Experimental Transfusion Reactions Related to Depletion of Complement and Isoantibody in the Recipient: Observations on Dogs Given Successive Transfusions of Incompatible Red Cells Tagged with Radioactive Iron

AbstractEach of 4 dogs was given two successive transfusions of incompatible dog erythrocytes at intervals of ninety or one hundred and twenty minutes. Measurements were made of the concentration of hemoglobin, complement and isoantibody in the plasma or serum of the recipients and of the rate of disappearance of the donated cells labeled with radioactive iron.In each experiment the donated red corpuscles were destroyed much more slowly after the second transfusion than after the first, and the hemoglobinemia produced by the first transfusion was not appreciably augmented by the second transfusion. The successive transfusions at short intervals were considered nearly equivalent to single large transfusions but permitted separate study of the effects produced.The rate of hemolysis was influenced by the initial titers of both antibody and complement. In dogs with high antibody titer, available complement appeared to limit the rate of destruction of incompatible donated cells. In the presence of adequate complement the rate of hemolysis was limited by the disappearance of antibody when the initial titer of antibody was low.Limitation of the degree of hemoglobinemia due to limitation of the rate of destruction of transfused incompatible erythrocytes and the rather efficient clearance of plasma hemoglobin explains in part the failure of some hemolytic transfusion reactions to produce severe or fatal renal damage.It is emphasized that most investigations of hemoglobinuric nephrosis in animals have dealt with the injection of hemoglobin solutions which resulted in hemoglobinemia of much greater intensity than it has been possible to produce by transfusion of large volumes of incompatible red corpuscles.

Purpura Fulminans and its Relation to Scarlatina.

SUMMARYThe object of the present study is a case of purpura fulminans in a boy of 5, treated at the Stockholm Hospital for infectious Diseases. The patient, previously healthy, was taken ill with a fairly mild, although drawn‐out scarlatina infection, which judging from the high sedimentation rate had not healed when after the lapse of 9 weeks erythema exsudativum multiforme supervened and after another week large subcutaneous hemorrhages suddenly appeared, with increasing anemia and deterioration of the general condition leading to death in 3 days, notwithstanding vigorous therapy with inter alia large transfusions. Bleeding, coagulation and prothrombin times were maximally prolonged. The platelet count was not decreased. No bacteria were demonstrable in blood or internal organs but necropsy findings indicated sepsis. In connection with this case a survey was done of the purpura material of the Stockholm Hospital for infectious Diseases from the last 25 years, revealing that no previous case of purpura fulminans had occurred. Six of the purpura cases, all of them mild, were more or less associated with scarlatina and are described in detail. Furthermore, a brief description based on studies in the literature of purpura fulminans is presented, including its relationship to scarlatina, and purpura conditions in general in association with scarlatina. Purpura fulminans stands out as a rare but entirely typical disease, dominated by immense extravasations, with usually a rapid fatal course, generally in association with scarlatina or some other infectious disease. Therapy has in the majority of the cases been hopeless. The etiology is probably toxic‐allergic, with bacteria or bacterial toxins as causative agents, and there is rather a distinction of degree than of form, from the milder purpura Schonlein‐Henoch. A septic pathogenesis may also in a number of instances be considered. Finally, a brief epicrisis of the cases described is presented.

COPPER SULFATE METHOD FOR RAPID ESTIMATION OF WHOLE BLOOD REQUIREMENTS

THIS report is based on a study of severely injured patients admitted to a large general hospital overseas. Of these, 166 had orthopedic injuries of severe degree; 98 others were patients in wards for general surgery. Hemoglobin, hematocrit and plasma protein values were measured before and after surgical treatment, which included particularly the use of large transfusions of whole blood and plasma. The observations indicate that: ( a ) a simple method for measuring hemoconcentration and hemodilution by the copper sulfate specific gravity technic is of great clinical value, ( b ) large amounts of whole blood are needed in the treatment of the severely injured, ( c ) several interesting correlations exist between hematocrit values and changes in plasma protein in these cases. MATERIAL STUDIED One hundred and sixty-six patients with severe orthopedic injuries were studied carefully, and for 91 of these detailed records of all fluids and blood transfusions were recorded. Of these, 45

The Treatment of Carrion's Disease with Large Transfusions 1,2

The Treatment of Carrion's Disease with Large Transfusions 1,2

Treatment of Polycythemia Vera with large Venesections and Plasma Transfusions.

Treatment of Polycythemia Vera with large Venesections and Plasma Transfusions.

TRANSFUSION OF CONDITIONED UNIVERSAL BLOOD

The practice of transfusing blood of group O (IV Moss) to persons belonging to any of the various blood groups is based on the assumption that cells of group O are not hemolyzed or agglutinated by any normal human plasma. The concept of a universal donor as developed by Ottenberg about thirty years ago has had considerable practical application, supported mainly on the theory that the dilution of a donor's blood and the absorption of the isoagglutinins anti-A and anti-B in a patient's plasma and tissue cells would tend to prevent any significant hemolysis or agglutination. While some institutions with large transfusion services are using blood from universal donors without observing an undue reaction rate, hemolytic and other reactions have been reported after transfusion of such blood. They may vary through all degrees of severity, and a good number of representative cases have been reported in the literature. In an

BLOOD TRANSFUSION SYPHILIS

The transmission of syphilis by blood transfusion is extremely rare. In 1935 Jones, Rathmell and Wagner 1 reviewed 21 cases of blood transfusion syphilis and added 4 of their own. Eichenlaub and Stolar, 2 in a more recent survey, reported a total of 41 cases, discussed this clinical accident at length and suggested a method for sterilization of blood from syphilitic donors. In considering proof of transfusion syphilis the following criteria should be met: First, the recipient should have a negative Wassermann reaction before transfusion and a positive serologic reaction after transfusion, with or without a rash or other evidences of syphilis. Second, the donor before transfusion should be a syphilitic person with or without a positive Wassermann reaction or other signs of syphilis as detected by the physical examination or history. One cannot approach this problem without appreciating the danger of blood transfusion. In many large hospitals blood transfusions

Changes of blood volume, hemoglobin and serum protein caused by large transfusions

Changes of blood volume, hemoglobin and serum protein caused by large transfusions

Gross hemorrhage as a complication of peptic ulcer

1. The mortality rate from hemorrhage due to peptic ulcer shows an apparent increase in the last decade. 2. During this period we have observed no hemorrhage deaths in females. 3. In this same interval we have not seen any hemorrhage deaths in either sex from anastomotic ulcer. 4. There have been no deaths from hemorrhage in persons under thirty-five years of age. 5. Prognostically, 45 years seems the critical age for both the medical and the surgical treatment of hemorrhage; the mortality increases very rapidly after middle-life when arteriosclerosis presumably becomes a factor. 6. The restricted use of moderate transfusion is urged. The profligate use of large transfusions is criticized. 7. Our experience with the Meulengracht diet has not been encouraging; starvation in the early period is still preferred. 8. The problem of avitaminosis C, in respect to hemorrhage, requires further study. 9. The significance of urea estimation as a prognostic guide during hemorrhage is not convincing. 10. Surgical mortality in the treatment of hemorrhage, both immediate and shortly after the onset of hemorrhage, is still so high as to discourage its use in any but the most critical situations.