The results of a blood transfusion upon a patient suffering from
acute anæmia are, indeed, amongst the most dramatic effects to be
obtained in the whole range of surgery. Within a few minutes of its
commencement the whole aspect of the patient alters. His respiration
becomes deep and regular, his restlessness disappears, colour
returns to his face, his pulse rate falls, and he begins to take an
intelligent interest in his surroundings. These changes taking place
within a period of fifteen minutes may well strike an onlooker as
little short of miraculous. Shortly afterwards the patient may fall
into a natural sleep, a sure sign that the normal circulation has
been restored to the exhausted central nervous system.
In considering how much blood should ordinarily be given in the
treatment of acute anæmia, experience is a safer guide than any
theoretical considerations. Nevertheless, it is worth while to
inquire briefly into the experimental and theoretical basis upon
which the treatment of acute anæmia rests. It is difficult to
estimate accurately the total quantity of blood in the body of an
adult, but it has been variously stated by physiologists to be
from a twentieth to a tenth part of the body weight, or, in liquid
measure, from 3 to 6 litres (approximately 5 to 10 pints). This
has been estimated in several ways, the results of which show some
discrepancy. A figure approaching the higher one was obtained long
ago by the direct method of washing out the blood from the bodies
of executed criminals. Recently it has been claimed by Haldane that
these determinations were inaccurate; by means of his carbon monoxide
method, with the details of which we are not concerned here, he has
estimated that the blood volume is but one-twentieth of the body
weight, or in very stout persons is even as low as one-thirtieth.
Still more recently Haldane’s estimation has been challenged in
its turn by observers who have injected a dye into the circulation
and have then determined its degree of concentration in the blood
by means of colorimetric comparisons. It is evident that if the
dilution which occurs when a known quantity of dye is injected can
be accurately estimated, then the total volume of circulating fluid
can be calculated. This method could not be used until a non-toxic,
non-diffusable dye had been discovered, but it was found in 1915 that
“vital red” fulfilled these requirements (143). The results obtained
in this way show that those originally given by the direct method
were substantially correct. The blood volume was found to vary from
1/13 to 1/10·5 of the body weight; on the average it amounted to
5,350 cc., or 85 cc. per kilogram of body weight. These observations
have been in their turn criticized (114), but only to the extent
of reducing the amount by 1/10. It may therefore be assumed that,
according to the most recent work, the blood volume is from 5 to 6
litres, or, approximately, 8 to 10 pints.
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