A Pathophysiological Study on the Massive Blood Transfusion with Special Reference to the Shock Recovery Effect of the Banked Blood and the Fresh Blood.

Abstract

The Author, based on a clinical exprience where a delayed shock ensuing from the massive transfusion of banked blood had been recovered through the transfusion of fresh blood, made an experiment wherein he examined the effect of the transfusion of both banked and fresh blood with respect to the change of circulatory hemodynamics, blood gas composition and acid-base balance to obtain the following conclusion.
1) As regards the circulatory hemodynamics, in consideration of the rate of the recovery of femoral arterial pressure, the fresh blood transfusion shows a better effect. In either case the total peripheral vascular resistance shows a rapid decrease immediately after transfusion, whereas its increase is higher and more rapid in the case of fresh blood transfusion than in the case of banked blood transfusion.
2) The pulmonary arterial pressure has already been begun to rise during the shock, making a more marked rise after both transfusions and falling again later. It is noted however that the comparative rate of increase of the pulmonary arterial pressure vs. the femoral arterial pressure is higher in the case of the banked blood transfusion. The pulmonary vascular resistance shows no perceptible regularity of change after transfusion of banked blood, whereas in the case of fresh blood transfusion it increases rather regularly and then decreases in the like manner.
3) In both cases, the pulmonary blood volume shows more marked increase immediately after transfusion than before bleeding and circulatory blood volume also shows an increase. The relative ratio of increase of the pulmonary blood volume vs. the circulatory blood volume is approximately 1: 3.
4) As regards blood gas composition, in consideration of arterial O₂ content, ₂saturation and A-V ₂ difference, hypoxemia and tissue anoxia is found lasting comparatively longer in the case of banked blood transfusion than in the case of fresh blood transfusion.
5) As regards acid-base balance, the banked blood transfusion maintains metabolic acidosis longer than the fresh blood transfusion and this in higher degrees.
6) In summing up the results in the foregoing, the author concludes that fresh blood transfusion is more effective than banked blood transfusion for the shock recovery, meanwhile, pointing out that rapid transfusion of banked blood in a hemorrhagic shock is one of the factors which cause pulmonary edema. (Author's abstract)