TRANSFUSION OF BLOOD 839 



definite. In practice it is always expedient to discard as a donor one 

 whose blood causes any doubt about his group or about the reaction of his 

 cells with the patient's serum. 



VII. Reactions from Transfusion 



Previously, the beneficial effects of transfusion have been discussed. 

 It is now necessary to point out the harmful effects which may result from 

 this procedure. If a donor is used who is not healthy, syphilis, malaria 

 and other diseases may be transferred to the patient. Hypertransfusion 

 has been previously referred to and can always be avoided. Reactions 

 due to incompatibility of blood, as shown in vitro, may occur if improper 

 tests are made. The deleterious effects of transfusions done with com- 

 pletely proper technic are those in the nature of a reaction from some un- 

 known alteration in the transfused blood, and, in some instances, depen- 

 dent upon the state of the patient. Such reactions are very rarely serious. 



1. Reactions Due to Recognized Incompatibility. Reactions re- 

 sulting from the transfer of blood incompatible with that of the patient's, 

 in that iso-agglutination or iso-hemolysis occurs, may vary from a state of 

 temporary discomfort to a grave disturbance which may be fatal. The 

 reasons for variations in the degree is due, at least in part, to quantitative 

 variations in the amounts of the factors involved in iso-agglutination and 

 iso-hemolysis. The selection of donors by means of proper agglutination 

 tests eliminates reactions of this type. Very rarely, as is referred to below, 

 similar hemolytic reactions may occur when bloods apparently have been 

 properly tested. 



When blood is given to an individual whose serum can agglutinate 

 the donor's red cells, the symptoms due to this incompatibility may develop 

 after a very small amount of blood has been injected. Typically this 

 reaction may be described as follows: The patient becomes restless, com- 

 plains of pain in the back, develops an increased respiratory and pulse 

 rate and may soon vomit and have a chill followed by a sharp rise of 

 temperature. With hemolysis, jaundice may develop rapidly and become 

 severe, and the urine may be scanty and filled with hemoglobin. The 

 patient may become unconscious and appear as in shock. Death may 

 follow rapidly or within a few days, though the severity of the reaction is 

 usually over within twenty-four hours and the patient much more usually 

 recovers than dies. The temperature often remains elevated for several 

 days and the jaundice may persist for a similar length of time. The 

 degree of anemia following severe reactions is usually more pronounced 

 than before transfusion. Occasionally, such a reaction is followed by in- 

 tense activity of the bone marrow and a surprisingly rapid improvement 

 in the anemia occurs. 



