J.Jpn. Surg. Soc.. 56(11): 1496-1521, 1956

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AN EXPERIMENTAL STUDY ON THE EFFECTS IN THE CIRCULATION BY MASSIVE BLOOD TRANSFUSION AND MASSIVE ISOTONIC SALINE INFUSION

Massive blood transfusions and isotonic saline solution infusions by intravenous route were performed experimentally in the groups of healthy dogs, and these effects were observed chiefly on the overload in the circulatory system. Analysis of some of the data suggested:
1) Under pentobarbital anaesthesia 31 dogs were give 1800 cc. (average amounts) of compatible blood at the rate from 0.47cc/kg/min. to 1.67cc/kg/min. None of the dogs died within 24 hours after finishing blood transfusion at slow speed group. On the other hand, about one-third of the group injected at moderate speed and about half of the group injected at rapid speed expired within 24 hours after the blood transfusion. In the group of 8 dogs infused saline solution, no one died at the same amount and rate.
2) Massive blood transfusion produced marked hemoconcentration and, on the other hand, isotonic saline infusion produced definite hemodilution in all cases. By the measurement with P³², escaped reel cell volume from circulatory system was estimated. In the transfusion group, cases showing a large amounts of escaped red ceII volume were found to have poor prognosis. In the infusion group, such a tendency was not found.
3) Studies on cardiopulmonary hemodynamics showed : a) Massive blood transfusion and isotonic saline infusion elevated markedly pulmonary arterial pressure. b) Cardiac output showed a tendency to be increased during each procedure, and was estimated to be up to one and a half times as much as each control value at the half way of each administration both in the blood transfusion group and isotonic saline infusion group. Such an increase of cardiac output was found to be remained in all cases until isotonic saline solution was completely infused. Most of dogs in the blood transfusion group showed such a tendency that cardiac output was decreased after each transfusion.
4) a) From the view point of changes of blood pressures, reactions in the circulatory system might be classified into 5 types. b) Massive blood transfusion and isotonic saline in 70-80% of all cases.
c) By giving massive blood transfusion without generaI anaesthesia dogs showed tachypnea and dyspnea. But none of the dogs showed such a reaction under general anaesthesia.
5) Studies on E.K.G. showed that massive blood transfusion could be a riskful procedure in cases with ST depression. Most of dogs showed a tendency of prolongation of QT interval at the terminal stage of each massive blood transfusion and isotonic saline infusion.
6) Lungs and livers of all the cases showed histoIogically marked congestion, hemorrhage and destruction of structures in the groups of massive blood transfusion. The pathological change was Iess marked in the spleen, and the kidney showed to have just a slight change. Isotonic saline group showed edematous changes in various organs, but no hemorrhage and destruction of structures.
7) While massive isotonic saline infusion might be performed at Iess risk, the massive blood transfusion should be considered to be a more riskful procedure.
(author's abstract)

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