Conclusion of Quality Alternatives to Transfusion

While adults accommodate a low hemoglobin level, what of children? Dr. James A. Stockman III says:  "With few exceptions, infants born prematurely will experience a decline in hemoglobin in the first one to three  months . . . The indications for transfusion in the nursery setting are not well defined. Indeed, many infants seem to tolerate remarkably low levels of hemoglobin concentration  with no apparent clinical difficulties." -Pediatric Clinics of North America, February 1986. 

Such information does not mean that nothing need be done when a person loses a lot of blood in an accident or during surgery.  If the loss is rapid and great, a person's blood pressure drops, and he may go into shock.  What is primarily needed is that the bleeding be stopped and the volume in his system be restored.  That will serve to prevent shock and keep the remaining red cells and other components in circulation. 

Volume replacement can be accomplished without using whole blood or plasma.  Various non-blood fluids are effective volume expanders.  The simplest is saline (salt) solution, such as dextran, Haemaccel, and lactated  Ringer's solution. Hetastarch (HES) is a newer volume expander, and "It can be safely recommended for those [burn] patients who object to blood products."  (Journal of Burn Care and Rehabilitation, January/February 1989)  Such fluids have definite advantages.  "Crystalloid solutions [such as normal saline and lactated Ringer's solution ] Detran and HES are relatively nontoxic and inexpensive, readily available, and can be stored at room temperature, require no compatibility testing and are free of the risk of transfusion-transmitted disease." -Blood Transfusion Therapy-A Physician's Handbook, 1989. 

You may ask, though,'Why do non-blood replacement fluids work well, since I need red cells to get oxygen throughout my body?'  As  mentioned, you have oxygen-carrying reserves.  If you lose blood, marvelous compensatory mechanisms start up.   Your heart pumps more blood with each beat.  Since the lost blood was replaced with a suitable fluid, the now diluted blood flows more easily, even in the small vessels.  As a result of chemical changes, more oxygen is released to the tissues.  These adaptations are so effective that if only have of your red cells remain, oxygen deliver may be about 75 percent of normal.  A patient at rest uses only 25 percent of the oxygen available in his blood.  And most general anesthetics reduce the body's need for oxygen.  

Next time: Quality Alternatives to Transfusion - HOW CAN DOCTORS HELP?

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