TKANSFUSION" OF BLOOD 831 



eral hours are almost always fatal, even with repeated transfusions. 

 Large amounts of fluids administered by the alimentary tract may often 

 accomplish the purpose for which transfusion or infusion seems indicated. 



Xo absolute indication for transfusion exists so far as oxygen need is 

 concerned, as long as the hemoglobin remains above 30 per cent. There is 

 abundant evidence to show that animals, after bleeding to as low as 25 

 per cent of hemoglobin, will survive providing the fluid volume of the 

 blood is maintained by intravenous injection of fluid substitutes for 

 blood. In case the hemoglobin is below 30 per cent transfusion should 

 be looked upon as a necessity and not as a matter of choice. Life itself 

 may be immediately endangered, other things being equal, only when the 

 blood contains less than about 30 per cent of hemoglobin. 



As has been mentioned, transfusion may be necessary to control hemor- 

 rhage due to pathological blood defects such as occur in hemophilia, hem- 

 orrhagic disease of the new born, and other hemorrhagic conditions. It is 

 reiterated here that it may be necessary to transfuse more than once to 

 control hemorrhage of this type. Often in hemorrhagic conditions, trans- 

 fusions also must be used in a preventive manner when operation becomes 

 necessary. 



2. Conditions in Which Transfusion is Often Desirable. In the 

 group of conditions now to be discussed transfusion of blood may be done 

 to improve the general state of the patient though the procedure may not 

 be a life-saving one. The articles by Pemberton, Garbat, McClure and 

 Dunn, Lewisohn, Lindeman, Ottenberg and Libman, Bernheim, and 

 Minot, among many others, consider this aspect of transfusion. 



Transfusion in pernicious anemia has been discussed by Anders, 

 and Lee (6), and many others. It is generally agreed that trans- 

 fusion in this disease helps to bring about remissions which probably would 

 not otherwise occur. It appears to make remissions about 10 per cent and 

 perhaps 20 per cent more frequent. It undoubtedly often adds greatly to 

 the comfort of the patient. While remissions may be favored by trans- 

 fusion, the natural course of the disease is not altered by such treatment. 



Transfusion probably should be employed before the stage of great 

 anemia and prostration has developed. The gradual failure of an adequate 

 oxygen supply to the tissues is always critical because of the transforma- 

 tion of normal tissue to fat and water. Good results cannot be expected 

 from any measure of therapy after such changes have occurred in the 

 body. The value of transfusion in pernicious anemia at present is based 

 for the most part upon its use in the treatment of cases in the stage of 

 prostration due to such tissue changes. It is important that the diagnosis 

 of pernicious anemia should be made early, and the cases transfused 

 while the hemoglobin is still at a relatively high level in order to attempt 

 to forestall the inevitable results of anemia. A detailed discussion of 

 transfusion in this disease cannot be entered into here, as it is not our 



