The author made observation on blood replacement frequently required by massive transfusions at the time of surgical operations. The study included also the state of blood pool in visceral tissues. The results may be summarized as follows:
1) The relationship existing among the amount of transfused blood, tissue fluid and blood pool at the time of exchange transfusion and blood loss, may be expressed by the formula: Blood transfused and blood loss/Circulating blood volume Thus, a primary relationship exists when the amount of blood given reaches one-half of that of circulating blood volume, experessed as p=94v-0.05t, which above this the relationship shows an exponential function, p=400^0.6v-0.05t. There is a definite increase in the blood pool of many organs, such as the kidney, liver, spleen and bone marrow.
2) When the amount of blood transfused equals that of circulating blood volume, the rate of blood replacement maintains a primary relationship up to 3/10 quantity is reached, beyond which it becomes an exponential function. Increase in blood content is noted in the spleen, kidney, liver and lung.
3) Form the foregoing facts, it is evident that the volume of blood transfused exceeds by 3/10 beyond one-half, a phenomenon of maldistribution of blood appears and latent or temporary transfusion reactions begin to ensue.
4) In minimal exchange transfusions, in which the amount of blood involved is less than one-half of that of circulating blood, the rate of blood replacement is approximately 44%, and no remarkable changes in organ pools are produced.
5) In exchange transfusions involving only 3/10 the volume of circulating blood, the condition of blood pools in the organs did not show any change different from that seen in excessive transfusions.
6) Blood loss or hemorrhage causes a remarkable increase in the replacement rate.
7) No remarkable stagnation was observed in the lungs of those subjected to massive exchange transfusions, excessive transfusion, minimal exchange transfusions or replacement transfusions following ordinary transfusions.

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