The Preservation of the Coagulation System in Stored Whole Blood
THE problem of hemorrhagic diathesis during massive transfusion therapy has been recognized for several years.1–4 The studies by Stefanini and Chatterjea,1 Krevans and Jackson,3 and Jackson, Krevans, and Conley4 indicated that this phenomenon is dependent on the rapid infusion of large amounts of platelet-poor whole blood. Stefanini, Mednicoff, Salomon, and Campbell2 demonstrated that the abnormal bleeding could be corrected by the immediate infusion of fresh blood platelet concentrates or by closely repeated direct transfusions of fresh whole blood.
Procedures that require large amounts of whole blood, such as open cardiotomy, dialysis, and arterial grafting, have been widely employed at the Cleveland Clinic Hospital for several years. Hemorrhagic diathesis has rarely occurred, because all blood is drawn immediately prior to such scheduled procedures. However, in certain emergency procedures, it was necessary to utilize large quantities of banked blood immediately at hand. In several instances, a hemorrhagic syndrome ensued, similar to the cases reported by Stefanini and associates2, which were characterized by low platelet counts, increased capillary fragility, prolonged bleeding time, prolonged clotting time, and impaired prothrombin consumption. In our cases, the surgical hemorrhage was controlled by utilizing direct blood transfusions.
As the number of such emergency procedures increased, it became apparent that it would be impossible to meet the increased demand for fresh whole blood at any time of the day or night. The urgent problem was to devise a method of administering large volumes of blood of varied storage periods in a manner that would obviate the hemorrhagic syndrome. In . . .