TRANSFUSION OF BLOOD 829 



when to push transfusion in the treatment of anemia, and when little may 

 be expected from the procedure. For example, if the metabolism is 

 minus 10, only temporary comfort to the patient is to be expected. If 

 the result is plus 10 more will be accomplished by transfusion. Trans- 

 fusion provides relief for certain compensatory phenomena such as in- 

 creased pulse rate and increased ventilation of the lungs, but the demand 

 of the tissues for increased oxygen may continue for days after the trans- 

 fusion. Transfusion is regarded by these authors as a measure by which 

 early cases of pernicious anemia may be assisted toward a remission. 

 Studies at the Massachusetts General Hospital, yet incomplete, tend to 

 show that the basal metabolism is not always indicative of what trans- 

 fusion will accomplish in anemia. 



Little is known as to the effect of transfusion upon nitrogen metab- 

 olism. Mosenthal(c?) found a lowered nitrogen balance after transfusion, 

 owing to the output in the urine of the nitrogen contained in the trans- 

 fused blood. In dogs, Haskins(a) found that transfusion after hem- 

 orrhage does not prevent the destruction of protein which occurs as a result 

 of hemorrhage. 



7. The Effect upon the More Immediate Symptomatology. Symp- 

 tomatic improvement following transfusion depends not only upon the 

 cause of the anemia but also upon the state of the patient The greatest 

 clinical change is seen in patients transfused after sudden loss of much 

 blood. The usual signs of restlessness, rapid pulse, increased respiration 

 and sweating, are improved at once or entirely relieved. A general sense 

 of well being is substituted for a state of anxiety, and a condition of 

 doubtful outcome may be changed at once to one having a favorable prog- 

 nosis. The improvement is due to a number of complex factors, chief 

 among which is the increased efficiency of the circulation as manifested 

 by higher blood pressure in certain cases, slower pulse rate, and increased 

 oxygen carrying power of the blood. 



The more immediate symptomatic improvement in chronic anemia is 

 not so pronounced, owing to structural changes in the body and to the 

 probable persistence of the cause of the anemia, toxic or otherwise. 



Weakness, palpitation, dyspnea, and visual and auditory disturbances 

 are often relieved. If fever is present due to the blood condition, the 

 temperature may subside after transfusion. Improvement of appetite and 

 diminution of gastrointestinal symptoms frequently occur shortly after 

 transfusion, especially in states of chronic anemia. Although achylia 

 may persist in pernicious anemia the stomach distress present before 

 transfusion may entirely disappear afterward. Troublesome diarrhea 

 occasionally met with in pernicious anemia may also be controlled. It has 

 been shown that the kidney function is deficient in chronic anemia, and, 

 among other benefits that result from transfusion is improvement in the 

 functional state of the kidneys. 



