John G. Gibson

The circulating red cell volume and body hematocrit in normal pregnancy and the puerperium: By direct measurement, using radioactive red cells☆

Dieckmann and Wegner,l Thomson, 2 McLennan and Thouin and Caton, Roby and associates,4 have all measured and reported plasma, whole blood, and red cell volumes during pregnancy. The studies reviewed agree that there is a progressive increase in plasma volume into the third trimester. Indirectly calculated red cell volumes revealed the same progressive increase. There are differences of opinion, however, as to whether there is a statistically significant reduction in plasma and total blood volume prior to delivery. The length of time for plasma and total blood volume to return to normal also varies in the different reports. No doubt part of the disagreement has been the result of too few determinations on the same individual. The lack of a significant number of postpartum observations, especially late postpartum determinations as compared to the prepartum period, adds to the difficulty in interpreting the gestational data. Perhaps if more investigators had used late postpartum observations for a norm rather than a nonpregnant group, the data might have been better evaluated. Rather wide variations in results were also reported. These inconsistencies were due in part to the technical limitations of the dye technique. Also, in a small series extreme individual variations, especially when compared to nonpregnant control groups, are of sufficient degree to affect an arithmetic mean. Indirectly calculated red cell volumes are subject to known inherent errors, and in individual determinations this error may be considerable. The use of nonpregnant groups as controls for comparison limits the evaluation of the data in quantitative terms.

Citrate-Phosphate-Dextrose Solution for Preservation of Human Blood: A Further Report

A comparison of clinically significant in vitro characteristics of ACD and CPD blood is presented.

Simultaneous Determination of the Volume of Red Cells and Plasma for Survival Studies of Stored Blood

A method is described for the determination of the in vivo survival of stored human red cells. Cr51 labeled red cells and I125 labeled human serum albumin are infused simultaneously to esti‐mate the whole blood volume and establish the 100 per cent retention value for subsequent red cell survival determination.

THE MEASUREMENT OF POST-TRANSFUSION SURVIVAL OF PRESERVED STORED HUMAN ERYTHROCYTES BY MEANS OF TWO ISOTOPES OF RADIO-ACTIVE IRON

The evaluation of the efficacy of whole blood transfusion in augmenting total red cell volume has always been of interest to physicians called upon to care for patients with hemorrhage, burns, blood dyscrasias, or traumatic shock. The establishment of blood banks, resulting in an increasing use of stored blood, has focused more attention on the problem. Military requirements have created a demand for the preservation of whole blood over far longer periods than are required for civilian purposes. The urgent need for better preservative solutions and for the selection of the best conditions for overseas air transport of whole blood for the Armed Forces made it imperative that an accurate method of measuring the post-transfusion survival of stored human erythrocytes be available. The morphological and chemical changes that take place in red cells during storage have been studied by several laboratory methods. The rate. of spontaneous hemolysis, changes in cell dimension, changes in the permeability of the cell membrane, changes in osmotic resistance to hypotonic solutions of NaCl, rate of diffusion of potassium, and disturbances in carbohydrate metabolism have all been proposed as in vitro tests for the evaluation of the ability of stored red cells to survive after transfusion. Each of these tests assays only changes in one functional characteristic of the. erythrocyte and it is for this reason that the opinion has been expressed that in vitro tests fail as a guide to the

THE EFFECT OF VARYING TEMPERATURES ON THE POST-TRANSFUSION SURVIVAL OF WHOLE BLOOD DURING DEPOT STORAGE AND AFTER TRANSPORTATION BY LAND AND AIR

The successful establishment of a military whole blood transfusion service is dependent upon reducing damage to the cells from mechanical agitation incident to land, sea, and air transportation to a minimum. Robertson (1) successfully transported whole blood in Rous-Turner solution by ambulance for short distances in World War I. Blood from civilian donor centers was shipped to front lines during the Spanish Civil War (2). Maycock has reported on the use of blood transported in refrigerated trucks during the Battle of Flanders (3). During the invasion of Europe blood banks were in operation in many theatres, blood being obtained from military personnel, a necessarily limited source of supply. The establishment of the American Red Cross Blood Donor Service, taking blood for processing of plasma, afforded a potentially adequate supply source, provided blood could withstand shipment across the Atlantic and far out into the Pacific oceans. The distances involved were so great that air transport was the only feasible means of transportation that would get blood to medical personnel before it had seriously deteriorated. It was obvious that only the best known whole blood preservatives would suffice, and 2 solutions, Alsevers (4) and acid-citrate-dextrose (5), were under consideration by the Armed Forces at the time this study was undertaken. The comparative value of these 2 solutions for depot storage under constant refrigeration has been reported (6), ACD being superior to Alsevers. The survival of these cells in these preservatives after long-range ship-

A Clinical Evaluation of the Use of Citrate-Phosphate-Dextrose Solution in Children

Red cells collected in CPD anticoagulant have been shown to have a mean postinfusion survival of greater than 75 per cent after 28 days of storage at 4C, in contrast to blood collected in ACD solution whose mean survival is less than 70 per cent after 28 days.

Replacement of blood loss during surgical procedures with blood collected in citrate phosphate dextrose solution.

THE practice of giving multiple transfusions of blood, not only for the emergency treatment of severe hemorrhage but also to meet the requirements of elective surgery involving extensive blood loss...

Further Progress in Blood Preservation

AbstractThe beneficial effect on maintenance of viability of human red cells during storage of lessening the Lesion of Collection by means of collection of blood in a citrate-phosphate-dextrose solution in plastic bags is described. The Lesion of Storage was previously described as the intitial damage sustained by red cells during collection due to turbulence and foaming, the wetting characteristics of glass surfaces, and the low pH of ACD.Post-infusion survival studies in humans by the radio-chromium method of blood collected in CPD have shown that 92% of cells are viable after 14 days, 83% after 21 days, and 76% after 30 days of storage at 5°C. These values are higher at all stages of storage than those of ACD bloods collected in glass.The severity of the Lesion of Collection, as evidenced by in vitro observations, is significantly less in bloods collected in CPD in plastic than in ACD in plastic. The severity of the Lesion of Storage of CPD bloods in plastic, as revealed by measurement of osmotic and metabolic behavior, is also less, throughout storage at 5°C up to 32 days, than in ACD bloods in plastic. This difference is reflected in a better maintenance of red cell viability, particularly in the latter stages of storage.The total inorganic phosphate in the plasma of a unit of CPD blood is 0.4 mM higher than that of ACD plasma. This slight increase poses no greater problem of phosphate retention than is currently encountered with ACD blood.