Using rabbits as experimental animals the authors observed the influence of blood transfusion on the life span of red cells by varying the amount of blood given or withdrawn. The final stage of red cell kinetics was also investigated, and the following results were obtained.
In the group of animals receiving only simple transfusions no remarkable shortening in the life span of red cells was observed as compared with the controls, although there is a tendency to be shortened when the amount transfused is great. In exchange transfusion the life span is remarkably shortened, the greater the amount so given, the shorter the span becomes. In small transfusions, no effects are noted. The destruction of red cells is gradually accelerated up to 10-15 days, thereafter becoming less marked. Thus, it may be concluded that the life span of transfused red cells is reduced in the body when the amount of blood transfused is excessive.

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1) Blood withdrawal causes depression of jugular arterial pressure, reducing the volume of the spleen at the same time.
2) By blood transfusion jugular arterial pressure is raised and simultaneously the splenic volume is increased.
3) When a large amount of excess blood is transfused, the spleen attains its maximum volume when the transfused blood reaches about one-half the volume of circulating blood volume of experimental animal.
4) Although plasma expander causes the elevation of jugular arterial blood pressure and the increase of splenic volume, the usual amount given by transfusion causes only a slight increase in the splenic volume.
5) No changes are produced in the splenic volume by exchange transfusion. In replacement transfusion of plasma expander, the only remarkable change is in venous waves. Exchange transfusion causes such changes in the splenic volume only in response to changs in blood pressure.
6) The spleen controls the mechanism of active mobilization of blood into the circulatory system in addition to the passive storage of circulating blood.
7) From these facts, it is concluded that blood transfusion should aim at maintaining the balance which is liable to be lost by hemorrhage during operations so as to allow the spleen to perform its normal function as a storage organ. Due precautions must be taken so that the amount of blood transfused should not exceed one-half the amount of the total circulation blood volume.

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Concerning the indications for intraarterial transfusion for hemorrhagic shock conflicting results have been obtained by many investigators. In this study, attempts were made to compare the effectiveness of intraarterial and intravenous transfusions under the same conditions, using blood pressure, circulating blood volumes in jugular and femoral arteries, total circulating blood volume, cardiac output, cerebral circulation, blood oxygen content and respiration as indicators. Reduction in blood volume necessary for inducing hemorrhagic shock was also investigated. The results were as follows:
1) Shock was induced by acute bleeding of 30cc/kg for 6 minutes.
2) In the case of retrograde intraarterial transfusion using peripheral arteries some of the transfused blood went back into the arteries, but it reentered the venous system through the capillaries and returned to the right atrium. No difference was observed between intraarterial and intravenous transfusions in regard to the behavior and effectiveness of the transfused blood.
3) In the case of transfusion into the jugular artery improvement of the cerebral circulation was observed, probably owing to its location, but the effect was only transient. When other arteries were used the effects were almost the same as those obtained when the corresponding veins were used.
4) The above mentioned advantages of intraarterial transfusion were especially evident when the upper portion of aorta was used. In this case, not only was the cerebral circulation improved but also blood circulation and anoxia at the time of shock were improved because the principal organs were infused directly by circulating blood.

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In various diseases, the life-span of transfused red cells and the external organ counts were examined by Cr⁵¹ method.
1. The half survival time without the correction for Cr⁵¹ elution was normally 23-28 days, and relative radioactivity values were: liver or spleen/precordium, 0.8-1.0.
2. The diminished survival of patient's own and transfused red cells by extrinsic factors was seen in myeloid leukemia and malignant tumors, but after the removal of the tumors, the cells showed the normal survival. Some cases of aplastic anemia showed very rapid destruction of red cells accompanied by the Cr⁵¹ accumulation in the area of the spleen. Splenectomy can be mentioned in Banti's syndrome which showed the similar pattern.
3. After the provoked attack of paroxysmal cold hemoglobinuria Cr⁵¹ accumulated in the area of the liver, but in a case of idiopathic hemolytic anemia it was noted in the area of the spleen, Therefore, it seems possible that the destroyed red cells are handled by the liver or spleen,
4. The spleen plays a very important role in the seriously shortened life-span of transfused red cells by anti-Rh antibodies in recipient's serum, however, in splenectomized case, the liver performs the same function.
5. The use of group O blood for transfusion to patients of groups/AB, A and B was followed by the temporary shortening of the life-span of recipient's red cells and the Cr⁵¹ accumulation in the areas of the spleen and liver. It is considered for some reasons that the diminished survival was caused by anti-A and B atypical antibodies.
6. The accelerated destruction of transfused red cells was also observed after massive blood transfusions, even though the compatible cross-matching was done correctly.

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The author examined the haptoglobin (Hp) type of Japanese by means of Smithies' zone electrophoresis in starch gel. The results are as follows:
1) In 232 normal adults, 24 showed Hp 1-1 type, 87 Hp 2-1 type and 121 Hp 2-2 type. The gene frequencies are calculated to be Hp¹: 0.291 and Hp²: 0.709. The Hp¹ frequency of Caucasian and African races previously reported is not lower than one of the Japanese encountered in this study.
2) No relation is revealed between the Hp types and the sex, pregnancy, ABO or Rh blood types and serum protein concentration.
3) No determinable Hp pattern is detected in cord bloods or bloods of newborn within 5 days of birth.
4) By transfusions of the plasma of different Hp types no causal reaction seems to be provoked. In massive transfusions Hp patterns of recipients are influenced by donors' Hp types and show the Hp patterns like those given by the mixed sera in vitro. The modified patterns disappear in about 2 days. The relative rapid disappearance of transfused Hp may be chiefly due to increased haemolysis in vivo.

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