Comparison of the Various Possibilities which are Available for Replacement of Blood Loss

Abstract

Blood is still the most important therapeutic substance for treatment of severe blood losses. Certainly however several restrictions are necessary with regard to the principle that blood should always be replaced with blood. It is certain today that the total hepatitis frequency (non-icteric plus icteric cases) after blood transfusions is much higher than was previously assumed; thus one should stipulate that blood should be given only when the oxygen supply of the organism unconditionally requires it [1654 g, 1654 h]. On the basis of clinical experience and many animal experiments, one may permit the Hct to drop to approximately 30% (or the Hb to 10 g-%) after refilling of the vascular system in patients who have no cardio-pulmonary disease, if perfect pulmonary function is assured and the oxygen requirement is not much increased. This means that with men of “normal” build, blood losses up to about 1½ liters (i. e. about 30% of the BV) may be replaced with erythrocyte-free solutions if there is no preexisting anemia. The other important reason which suggests a modification of the rule cited above is the fact that a patient can not be retransfused with his own blood. The dangers of immunological complications are becoming more and more clear, and it has recently become known that such complications can sometimes also have functional consequences in the form of rapid plasma loss.