Sorry for the long delay in following up on the quotes in question in the old Blood brochure.
Special thanks to AlmostAtheist for taking the time to find the newspaper article from the Columbus, Ohio Dispatch from August 31, 1972. I've transcribed the article in its entirety below.
While the original quote itself is accurate, the context shows that research was underway and being funded to determine whether poor oxygen carrying capacity was actually detrimental to patients receiving blood transfusions.
Also, I finally had the opportunity to find a copy of the journal Anaesthesia (Volume 30, 1975) at the local Health Sciences Library. The editorial that served as the source of another quote in question is also transcribed in its entirety below.
I've highlighted (or at least attempted to ) the text in the source material to colour-match the text in the blood brochure. You'll notice that there is the appearance of the ellipsis [. . .] in the WTS publication, and as it turns out, this was "merely" the reference for the source of the information that preceded it. But check closely ... that source was 21 years old at the time of publication!! Which today is more than 50 years since it was current!!!
Both of these articles discuss only the use of whole blood transfusion, which was the standard of practice at the time. In the meantime, we have learned to separate whole blood into its four major components, and even further into fractions and immune globulins. We'd have to do some further investigating to determine whether this information is even appropriate according to the current standards and practices for Transfusion Medicine in 2006.
So without further ado, here are two of the sources in the Blood brochure, in their entirety, for your reading pleasure.
Will
a transfusion immediately enhance the blood’s oxygen-carrying capacity? 150 Many persons believe that it will, but a recent editorial in Anaesthesia made this significant point: "It is worth remembering also that the haemoglobin of stored, citrated red cells is not fully available for the transfer of oxygen to the tissues for some 24 hours after transfusion
. . . ; rapid blood transfusion must therefore be regarded primarily as a mere volume expander in the initial stages. " 89 Researchers at Ohio State University found that the reason for this is that
chemical changes occur in stored blood. Their investigation showed that
blood stored more than ten days "does not improve or may even worsen oxygen delivery immediately after transfusion." And they found that the oxygen delivery was still below normal twenty-four hours later.90
Anaesthesia
, 1975, Volume 30, pages 149-151
Editorial
'Yet who would have thought the old man to have had so much blood in him'
Macbeth, Act 5, Sc. 1
William Shakespeare (1564-1616)
Patients and medical practitioners in the United Kingdom are extremely fortunate in being served by such a generous corps of voluntary blood donors backed by haematological expertise and blood storage facilities which are second to none. A British blood transfusion is consequently as safe a procedure as anywhere in the World, but this very safety, together with the ready availability of blood which is free to the patient, can easily lead to the profligate use of this valuable, freely donated gift. This is serious when we remember that it costs £15 to £20 per half litre to process. Do we always honestly ask ourselves whether a blood transfusion is absolutely necessary or do we sometimes use this precious fluid just for the pleasure of seeing a ruddy glow come to our patients' cheeks? If we are convinced that a transfusion is really required, do we see that every drop is given to the greatest advantage of the patient, with the least morbidity using the most modern techniques, and are we sure that blood is the great panacea that some would have us believe?
Man is fortunately endowed with at least 25% more haemoglobin than is actually necessary. It can be shown that the ideal balance between oxygen carrying capacity and lowered viscosity promoting flow through the capillaries is achieved at a haematocrit of 30%, rather than at the normal 40% (Gruber, U.F. (1970) British Journal of Hospital Medicine, 4, 631) and much lower levels can be tolerated without cellular damage, provided that adequate inhaled oxygen is administered. Such knowledge is certainly reassuring wherever blood replacement is necessary and blood is not immediately available, but it may be life-saving in extreme stagnant hypoxaemic stock, for in such a condition, the administration of viscous blood as the initial transfusion might tip the patient over into a condition of irreversible disseminated intravascular coagulation (D.I.C.).
Anyone who has worked in less favoured countries, where blood may be scarce due to religious or ethical tabus concerning blood donation, where hepatitis, malaria, syphilis and brucellosis may be endemic, where screening and matching may be unreliable and where the electrical supply of refrigerators may be erratic, will have learned how lethal stored, donor, whole blood can be and may well often choose colloids backed by parenteral iron therapy as a far safer alternative. Many patients undoubtedly die as a result of blood transfusion in such circumstances (if not from infection or incompatibility, then from overloading the heart with cold, viscous blood in an attempt to raise the haemoglobin higher than that which is usual for that particular population); not all of these fatalities are recognised as transfusion deaths as the demise of the patient is often attributed to 'shock' or simply to 'the will of the gods'. The best policy is often to avoid whole blood transfusion -- hypovolaemia being a far more potent killer than anaemia.
Clinicians in more medically sophisticated societies do not often face such extreme dilemmas but they must not allow themselves to live in a fools' paradise. Australian antigen screening is not a guarantee that blood is free from the virus of hepatitis, perhaps 2% of blood is bacterially contaminated and, even though they are rare, laboratory, storage and checking errors occur from time to time. The mortality from blood transfusion is not precisely known in the United Kingdom, but, in the U.S.A., about 3000 persons die per year as a result of it (James (1974) in: Scientific Foundations of Anaesthesia, edited by Scurr and Feldman, 2nd edn, Heineman, London).
Stored blood has other hazards (low ionisable calcium, acidity, high plasma potassium, low platelet conditions, cellular aggregations liable to cause pulmonary microembolism, etc.). Many of the hazards can be mitigated by in-line warming accompanied by filtration, but too many transfusionists of all disciplines still omit the use of the many excellent disposable devices available for warming and filtering blood. There is a danger that some may regard in vitro studies, such as that reported by Desmonts et al., on page 231 of this issue, as evidence that the warming of blood has little practical value; this would be incorrect as such investigations obviously are not intended to take into account the physical benefits of warming blood, nor of the enhanced rate of citrate and other metabolism and buffer activity in vivo if the blood is warmed during administration.
Autotransfusion is rarely used in the United Kingdom (again probably because stored donor blood is free and so readily available), but, if a proper technique is employed, it is a safe and economical method of giving fresh warm, compatible blood in elective operations such as procedures in cardiovascular surgery, in which appreciable haemorrhage can be anticipated, and in conditions where there has been considerable haemorrhage into body cavities. Autotransfusion with sophisticated apparatus is gaining popularity in the United States for economic reasons and Maleki et al. describe how they have successfully employed a simple but effective technique in Iran on page 228 of this number.
It is worth remembering also that the haemoglobin of stored, citrated red cells is not fully available for the transfer of oxygen to the tissues for some 24 hours after transfusion
(Valtis & Kennedy (1954) Lancet, 1, 119); rapid blood transfusion must therefore be regarded primarily as a mere volume expander in the initial stages. There is, therefore, much to be said for using other plasma expanders for blood replacement
during elective operations to replace brisk moderate loss and to reserve whole blood for more leisurely administration in the post-operative period should this be necessary.
Dogmatic aphorisms, like, 'blood must be replaced by blood' and, 'if my patients bled dextran I would give them dextran', are not only rather pompous but can be fallacious also. Blood should be warmed and handled with care, and generally treated with the respect accorded to a rare red wine for, as with wine, abuse and excessive consumption can lead to tragedy.
The Dispatch
Columbus, Ohio
Thursday, August 31, 1972
10-Day-Old Transfused Blood Poor Oxygen Carrier
But Researchers Aren't Sure Whether It's A Big Problem
Blood stored more than 10 days is ineffective in delivering oxygen to tissues for several hours after a transfusion, four Ohio State University doctors have found.
But the researchers are unsure how severe a problem that is for patients receiving stored blood, and they will continue research to find out under federal grants totalling $130,240.
Drs. Philip A. Broberg, Earl N. Metz, Stanley P. Balcerzak and Jerry T. Guy, all of the OSU faculty, reported that patients to whom oxygen delivery is very important, or those who are receiving large amounts of stored blood by transfusion, should get blood stored not more than 24 to 48 hours.
Guy presented a paper on the group's findings Thursday at a meeting of the American Association of Blood Banks and the International Socity of Blood Transfusion in Washington, D.C.
The researchers said oxygen delivery of stored blood is impaired because of a sharp decrease of a molecule called DPG. The molecule aids red cells in releasing oxygen to tissues.
"When the DPG level drops, the red cells hoard oxygen until the molecule is remade in the blood after transfusion," their report said. "Until the DPG level is restored, the tissue oxygen supply remains impaired."
Blood stored more than 10 days "does not improve or may even worsen oxygen delivery immediately after transfusion," they said. The report added that although oxygen delivery of stored blood improves in a few hours, it is still below normal 24 hours after transfusion.Metz said Thursday that most transfusions are given in emergencies, usually when there is a great deal of bleeding.
He said the ultimate aim of his group's study is to determine how important oxygen delivery capacity is immediately after transfusion.
The OSU studies were conducted in anemia patients and in animals by measuring restoration of DPG at one, four, nine and 24 hours after transfusion.
The OSU grants were from the National Heart and Lung Institute and the National Institute of Health.
