Lawrence N. Button

Acute Hemodynamic Effects of Red Cell Volume Reduction in Polycythemia of Cyanotic Congenital Heart Disease

Acute reduction in red cell volume (RCV) without significant alterations of blood volume in 22 patients with severe polycythemia secondary to cyanotic congenital heart disease resulted in a decrease in peripheral vascular resistance and an increase in stroke volume, systemic blood flow (SBF), and systemic oxygen transport. These changes are probably related to the decreased blood viscosity and yield shear stress associated with lower red cell concentrations. Hypervolemia in hypoxic polycythemia should be maintained in order to sustain an adequate SBF. In contrast to acute phlebotomy which may be expected to decrease blood oxygen content and SBF, the replacement of whole blood with plasma or 5% albumin is shown to result in an increased systemic blood flow and oxygen delivery.

Blood volume changes in cyanotic congenital heart disease

Abstract Simultaneous red cell volume and plasma volume determinations were performed in 20 patients with cyanotic congenital heart disease. Significant hypervolemia was shown to result from an increased red cell volume. Plasma volume may be reduced but usually remains within the normal range. The good correlation between the venous hematocrit and red cell volume per kilogram provides the basis for the estimation of the red cell volume from the venous hematocrit. The common clinical practice of estimating the degree of hypoxemia from the red cell volume (or hematocrit) is at best very gross due to the large variability of the red cell volume at any given level of arterial oxygen saturation in patients with cyanotic heart disease. Red cell volume and plasma volume should be independently and simultaneously measured if accurate estimates of total blood volume changes are desired. Blood volume measurements serve as an index and guide in the medical and surgical treatment of polycythemic cyanotic patients.

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.

New technic for detection of bacterial contamination in a blood bank using plastic equipment.

GROWTH of bacteria in blood during refrigerated storage is a problem in blood banks. Reports of reactions ranging from mild to fatal clinical manifestations after transfusion of contaminated blood ...

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.

The effects of continuous-flow washing on stored red blood cells.

Whole blood and packed cells stored up to 21 days prior to being washed by a continuous‐flow (CF) technic or by batch washing (BW) were found to have an average posttransfusion survival of greater than 70 per cent. CF‐washed red blood cells stored in 5 per cent dextrose and 0.9 per cent saline (5% D&S) wash solution for 24 hours had an average survival of 86 per cent. An average plasma protein dilution of 1:25,000 was obtained with the CF technic as compared to 1:600 with the conventional BW technic. A series of bloods were inoculated either with plasma containing hepatitis‐associated antigen (HAA), cytomegalovirus (CMV) or poliovirus (PVS) and then washed. CMV could not be detected by plaque assay in the washed red blood cells nor could HAA by immunodiffusion, counterimmunoelectrophoresis or radio‐immune assay. The poliovirus‐inoculated washed red blood cells had a marked reduction of the virus when washed by the CF technic as compared to the BW cells. Red blood cells washed by the CF technic did not induce a rise in an AHF inhibitor when transfused into a hemophilic patient with a circulating inhibitor.

The rhesus monkey as a model for evaluation of the preservation of stored whole blood.

Blood was collected into Acid Citrate Dextrose solution (ACD) from a group of 20 large, adult rhesus monkeys. In ten of the experiments, the blood was labeled immediately with radioisotopes and reinfused into the donor monkeys. The other ten blood units were stored at 4 C for 21 days, then tabled and infused into the donor monkeys. In vitro determinations were made immediately after collection and at the end of the storage period and compared with the results obtained in stored human blood.

Rhesus Monkey Platelet Kinetics and Storage

Rhesus monkey platelets that are separated, 51Cr labeled, and transfused provide yields, 1/2; time and survivals similar to those obtained in man. Rhesus platelets prepared and stored at room temperature for three days have 93 per cent of the yield of fresh platelets. When prepared and stored at 4C, the yield is only 54 per cent of fresh platelets. Rhesus repeatedly transfused with platelets from random unmatched donors always have a significant decrease in the platelet 1/2; time and survival. This was observed after the second homologous transfusion in one and after the third in others. The rhesus provides an excellent platelet model with thrombocyte responses mimicking those of man.

Selective Destruction of Reticulocytes (Retics) in Pyruvate Kinase (PK) Deficiency

PK retics lack adequate glycolysis and are peculiarly susceptible to irreversible damage in the spleen because they are dependent upon mitochondrial function for which splenic venous PO2 is insufficient [Blood 34: 861, 1969]. The fraction and mass of PK deficient retics immediately trapped in the spleen should therefore influence clinical severity. A 22-year-old male (J.P.) with icterus and splenomegaly and with RBC PK 0.25 units (normal > 2.0 units) Hgb. 13.3 g% and retics 7% illustrates this mechanism. Mean RBC life span was approximately 100 days (T 1/251Cr = 33 days), but bilirubin turnover (3H bilirubin) was 5 × normal yielding mean RBC life span of only 20 days. ferrokinetics with 59Fe showed plasma iron turnover 5 × normal ; rapid marrow 59Fe uptake, but low cumulative RBC59Fe and immediate splenic sequestration of newly labeled cells. These data provide evidence that the majority of J.P.s newly formed retics were immediately sequestered in the spleen. The remainder survived normally and these were sufficient in number to provide 13.3 g % hemoglobin. That the low PK level in circulating mature J.P. cells did not limit their survival was additionally supported by therapeutic transfusion of J.P. cells to a severely anemic homozygous PK deficient female (C.D.) with much higher RBc PK (0.9 units) but with marked splenomegaly. Isologous survival of J.P. cells in C.D. was only modestly reduced (T 1/2 51Cr RBC = 18 days) whereas the autologous survival of C.D. cells was markedly shortened (T 1/2 = 7 days).Thus low levels of PK need not limit the survival of mature RBC. Retics are much more vuluerable to the block in glycolysis and become irreversibly sequestered in the hypoxic splenic circulation.