Paul V. Strumia

Significance of Measurement of Plasma Volume and of Indirect Estimation of Red Cell Volume

Total blood volume (TBV) and red cell volume (RCV) determinations have become an established diagnostic procedure in a variety of conditions; they are being used increasingly to estimate the requirement of blood transfusion. A common laboratory practice is to determine indirectly the RCV and/or the TBV by measuring the plasma volume (PV) and the venous hematocrit (VH). This procedure is technically simple and has been made popular by a number of semiautomatic electronic devices. In the healthy population we find results of the direct and the indirect measure of the RCV to be not statistically different, although they may differ by as much as ± 10% in individual cases. Larger discrepancies between the results of the two methods have been reported in patients by numerous investigators.

Preservation of Whole Blood in Frozen State for Transfusion

Addition of sugars to whole citrated human blood permits freezing and thawing with recovery of a large percentage of erythrocytes. Survival of erythrocytes thus frozen, transfused without further modification after thawing, has been satisfactory after 6 months of storage at –93�C.

Transfusion of Long Stored Whole Blood or Washed Red Blood Cells Incubated with Adenine and Inosine

Full unit autotransfusions of long stored ACD blood, incubated with adenine and inosine at 37 C., were given to healthy young male volunteers. Red cells of blood stored for 35 days showed, after regeneration, a significant increase in ATP and a 24‐hour posttransfusion survival of 78.8 per cent (70.9–85.9%); red cells of blood stored for 42 days, thus regenerated, showed a similar increase in ATP and a 24‐hour posttransfusion survival of 75.6 per cent (71.5–80.6%). These results were not significantly different from those obtained with 10‐ml token autotransfusions of blood similarly treated, the posttransfusion survival of red cells in token transfusions being 78.8 per cent for blood stored 35 days prior to regeneration with adenineinosine and 74 per cent for blood stored for 42 days prior to regeneration. Available data on toxicity of adenine and inosine have been critically reviewed: Chance of direct toxic effects with the small amounts involved may be dismissed when few transfusions are involved; however, uric acid overload must be considered when multiple transfusions are required within a short period of time. A single washing with saline‐glucose solution reduces by 90 per cent the concentration of un‐metabolized adenine and inosine, and of the product of their metabolism, hypoxanthine. The washing procedure involves a loss of only 0.55 per cent of the total red blood cell population; washing additionally reduces the amount of free hemoglobin. Washing has no effect on the ATP or red blood cell viability, and is recommended when multiple transfusions of cells treated with adenine and inosine are required in a short period of time.

Effect of Lactose, Dextran and Albumin on Recovery and Survival of Frozen Red Cells

We have studied the effect of albumin and dextran, with and without previous modification with lactose, on the recovery and posttransfusion survival of red cells subjected to rapid freezing and thawing.

Agglutinability of Red Cells After Long-Term Storage in the Frozen State

A description of a simple method for preservation of red cells modified by lactose‐dextrose solution in the frozen state at —93 C. The agglutinability as measured by a titration of anti‐sera vs. fresh and frozen cells was maintained after periods of storage of up to three years for the blood factors A, B, C, D, E, c, e, K, k, M, N, and Fya. S and s were also still reactive after freezing and thawing.

ALTERATIONS IN BANKED BLOOD, WITH SPECIAL REFERENCE TO HEMOSTASIS.

A review of the literature on the subject of coagulation factors in stored blood and of the effect of massive transfusions of stored blood in hemostasis reveals profound differences of opinion. Tullis’ studied platelets separated by elution from cation-exchange resins and stored in a medium containing sterile gelatin solution a t refrigerator temperature. In vitro studies included evaluation of the morphology, of the clot-promoting ability, and of the thromboplastic activity of platelets. Platelets were assayed in a two-stage prothrombin-conversion system: the prothrombin-conversion activity was found to be preserved for 10 weeks. On the basis of these in vitro studies and of results of four platelet transfusions to two patients with thrombocytopenia due to marrow failure, t he author concluded tha t platelets appear to be metabolically relatively inert and to be susceptible to preservation for periods of time f a r in excess of the other cellular elements. Soulier e t al.? found tha t in stored blood, Factor V was reduced to about 25 per cent in 21 days ; Factor I1 was practically unchanged fo r up to 21 days, while Factor VII increased perceptibly. Factor VIII was found to be diminished, but a n exact measurement was not possible because of the increasing “global” thromboplastic activity. This they attr ibuted to a thromboplastic factor present in stored blood, even af te r removal of platelets. In the experience of Soulier, clot retraction was greatly diminished at one week and practically zero at 21 days. Seventy-five per cent of the platelets were found present in the blood af te r 21 days of storage. Mustard,:’ in 1956, noted contrasting results in the reported studies of platelet survival and presented a detailed critical study of platelet survival in vitro by a battery of tests including platelet counts, platelet morphology, calcium-clotting time, prothrombin consumption, one-stage prothrombin time and alumina/plasma-thromboplastin activity. The authors found an “unexpectedly” good survival of platelets. These amounted to a n average of 50 per cent at seven days; 16-41 per cent at 21 days. They found tha t a f te r the first three days, platelet count becomes very variable. One interesting observation is tha t the thromboplastin generated by platelets stored 21 days was 56-170 per cent of tha t of the first day. The calcium-clotting time was found to remain normal for the entire period of storage, whereas the prothrombin-consumption time was consistently more than 60 seconds. One important statement is tha t platelets during collection are subject to