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HANDBOOK OF PHYSIOLOGY 



CIRCULATION I 



platelet function. The authors considered that dex- 

 tran infusions were contraindicated in patients 

 with known bleeding tendency or to whom large 

 transfusions of whole blood had been given, or those 

 in whom surgery was contemplated. In summary, it 

 appears that dextran is most likely of the plasma ex- 

 panders studied to cause prolongation of the bleeding 

 time following intravenous infusion. Polyvinyl- 

 pyrrolidone is the next most likely agent to cause this 

 hemostatic defect. Gelatin and albumin are relatively 

 innocuous in this regard. 



Blood Constituents 



A number of authors have studied the effect of the 

 plasma volume expanders upon the constituents of 

 the blood. Handford and associates (45) infused 4% 

 glycerol pectate in amounts equivalent to 5 % of body 

 weight in normal dogs. These workers found changes 

 in plasma protein levels which were entirely due to 

 dilution. Increase of the erythrocyte sedimentation 

 rate was seen in human subjects infused with pectin. 

 Carbone and associates (2 1 ) gave patients infusions 

 of 1000 ml 6% dextran in saline daily for 4 to 15 days. 

 A fall in serum protein, hematocrit, zinc turbidity, 

 and in serum cholinesterase occurred. Serum globulin 

 decreased more than the serum albumin in all sub- 

 jects, including those with liver disease. The authors 

 thought that not all of the fall in the protein was due 

 to hemodilution. They believed that the decrease in 

 serum cholinesterase suggested decreased albumin 

 synthesis. Jaenike & Waterhouse (61) gave daily in- 

 fusions of 6 % dextran in physiological saline to five 

 patients at the rate of 1000 to 2000 ml day for 2 to 10 

 days. The hematocrits fell in all subjects and were 

 still decreased in four subjects observed 40 days later. 

 The serum protein fell in all subjects during the period 

 of dextran administration, and in four it rose above 

 control level 13 to 23 days after dextran. Jackson & 

 Frayser (58) gave dogs i g of acacia per kg 

 body weight intravenously daily for 20 days. The total 

 plasma proteins decreased more than would be ex- 

 pected from a dilution effect alone. The plasma vol- 

 ume returned to normal in 7 days, but the serum pro- 

 teins were low for many weeks. Immediately after 

 acacia the plasma albumins were often below 2 g/ioo 

 ml. The plasma cholesterol also decreased and then 

 increased as the proteins increased. The platelets 

 fell in some instances. Hematocrits and hemoglobins 

 fell strikingly and then rose pari passu witli the serum 

 proteins. They concluded that the body compensates 



for acacia infusion by storing or destroying plasma 

 proteins which are then slowly regenerated. Globulin 

 and fibrinogen were decreased as well as albumin. 

 The total osmotic pressure was actually lowered 

 during the period when plasma acacia and proteins 

 were both decreased. Metcalf & Rousselot (74) gave 

 500 ml of 6 % dextran in saline to 1 2 convalescent pa- 

 tients. There was no essential change in serum pro- 

 teins or chloride, sodium, or potassium levels in the 

 serum. Fowler and associates (31) studied the serum 

 electrolytes in dogs bled 80 ml /kg with simultaneous 

 partial blood volume replacement by 60 ml/kg body 

 weight of 6 % dextran in 5 % dextrose. These animals 

 showed a decrease of serum sodium from a control 

 level of approximately 1 50 meq/liter to approximately 

 1 1 5 meq/liter at 5 min. The serum sodium slowly re- 

 turned toward normal over a period of 24 hours. 

 Serum potassium levels were only slightly decreased, 

 but serum calcium levels were decreased from an 

 average of 10 mg/ 100 ml blood to an average of 5.7 

 mg/ioo ml and were still below normal at 48 hours. 

 Serum chloride decreased from 114 meq liter to 87 

 meq/liter at 5 min, with a return toward normal in 

 about 2 hours. Hardwicke and associates (46) showed 

 that infusions of 700,000, 220,000, and 124,000 molec- 

 ular weight dextran increased the erythrocyte sedi- 

 mentation rate in proportion to their concentration. 

 The increase in sedimentation rate was greater for a 

 given concentration with higher molecular weight 

 dextran. Roche and co-workers (89) showed that 500 

 ml of 6^; dextran intravenously did not interfere 

 with typing, crossmatching, or Rh determination of 

 blood. Five hundred to 1500 ml of dextran given to 

 patients in shock also did not interfere with these de- 

 terminations. Thrower & Gampbell (104) showed 

 that the erythrocyte sedimentation rate increased 

 with infusions of 500 to 1500 ml of 3.5*^0 PVP given 

 to four subjects. There was no evidence of hemolysis 

 and the blood grouping reactions were not disturbed. 

 Christie and associates (22) gave dogs 4.5 g/kg body 

 weight of 1 5 "^ acacia in distilled water, showing that 

 there was a decrease in hemoglobin and hematocrit 

 with an increase in sedimentation rate. The oxygen 

 content of the arterial blood fell out of proportion to 

 the fall in hemosjiobin. Jacobson & Smyth (60) used 

 ^% osseous gelatin in isotonic saline (Upjohn). They 

 gave 56 injections of 450 to 1000 ml to 45 subjects. 

 Fifty others received gelatin for shock. The erythro- 

 cyte sedimentation rate increased in 12 subjects 

 studied. Greenman and associates (42) gave 8 pa- 

 tients 375 to 1000 ml of 12% sodium-free dextran in 

 88 to 350 min. Five of these subjects were edematous. 



