Transfusions of Plasma
1940
BMJ (Clinical Research Edition)
The expectation of large numbers of air-raid and military casualties has given a great stimulus to the study of transfusion of blood and of possible substitutes. Stored whole blood as opposed to fresh blood has definitely proved its worth in Russia, Spain, and, more recently, in England and the U.S.A. The use of serum or plasma is now receiving serious consideration. In many cases in which transfusion is given it is probably the fluid elements that produce the desired effect, while the red
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... are of only secondary importan'ce: the plasma proteins are, on theoretical grounds, probably the effective factors in the treatment of shock from wounds and burns and after operation. The mechanism of shock in such conditions is not clearly understood. It is not necessarily the' same in each, but in all' there is a loss of fluid to the tissues from the circulating blood, resulting in a fall of blood pressure. It is essential in treatment not only to replace the circulating fluid but, if possible, to withdraw it from the tissue spaces. This can be done by infusing fluid with a high colloid pressure, and in the past gum acacia has been used for this" purpose, but gum acacia has certain disadvantages. The normal plasma' proteins should theoretically be capable of exerting the same colloid pressure without any injurious effects. H. M. Trusler, H. L. Egbert, and H. S. Williams,' in an elaborate clinical and biochemical study of a series of cases of serious burns treated with whole blood or plasma transfusion, have shown that plasma may play an important therapeutic part in shock from burns. Transfusions of plasma in their patients resulted in withdrawal of fluids from the waterlogged tissues into the circulation. In the Journal of March 9 F. R. Edwards, J. Kay, and T. B. Davie2 described the satisfactory use of plasma in cases of wound shock and post-operative shock, and confirmed the admirable effect of this treatment in shock from burns. A report from J. Elliott and his co-workers3 in the U.S.A. substantiates the claims made for plasma infusion in the case of wound shock. The value of plasma in certain cases would therefore appear to be established. On theoretical grounds, again, serum might be thought to have greater advantages than plasma, since it is not diluted in any way with anti-coagulant solutions. At the moment there is less clinical 'evidence as to the value of serum. Remarkable improvement has been described by Aldrich and his co-workers' in cases of nephrosis treated with highly concentrated I
doi:10.1136/bmj.1.4141.814
fatcat:u5hqihsvsfag5kgs3leijamxoa