Resuscitation : equipment, organization, training, and procedures / [the War Office].
- Date:
- 1944
Licence: Public Domain Mark
Credit: Resuscitation : equipment, organization, training, and procedures / [the War Office]. Source: Wellcome Collection.
47/96 page 41
![4] is plasma, and does not present the difficulty of post-filtration clotting. The yield per donor is approximately the same as with plasma. Danger of hemolytic reaction from agglutinin content is overcome by pooling the serum until the titre has been reduced to a negligible point. On the other hand, there is much experimental and some clinical evidence to show that the incidence of reactions following massive transfusions is greater than with citrated plasma. More experience is necessary before the merits of the two fluids can be confidently assessed. Serum should be stored in a cool, dark place but there is no objection to storing in a refrigerator, except that the bottle has then to be heated before use. Dried Serum and Dried Plasma Drying is accomplished by a low temperature, low-pressure process which does not denature the protein. The material will keep indefinitely in any climate provided drying is complete, and this includes replacement of the air in the bottle with pure dry nitrogen. Sealing has to be very efficient. Dried plasma and serum are the safest materials for transfusion work in the field. The dried product is reconstituted to its original volume by adding the requisite amount of pyrogen-free sterile distilled water (p. 47) or glucose-saline. Solution is effected in a few minutes, and the resulting fluid is somewhat turbid but this turbidity is normal and does not prohibit use. Once reconstituted the fluid should be used within an hour or so otherwise the added water gives opportunity for any chance contaminating bacteria to multiply to a dangerous degree. The reconstituted product should never be put away for future use, but in the dried state it keeps indefinitely without refrigeration. If the seal of the bottle be imperfect, humid air may enter the bottle, particularly in tropical climates. In these circumstances the plasma eventually becomes denatured. When this is so, a gel is formed on reconstitution and the material is unfit for use. It was originally thought that serum reconstituted at quadruple strength would be particularly effective, especially with burns, in withdrawing plasma from an injured area which would contribute to blood-volume restoration, but experience has shown that such high concentrations of serum are associated with a large incidence of reactions. Reconstituted dried plasma or serum is an efficient blood-volume restoring fluid; the dried products of 400 c.cm. of fluid plasma or serum are supplied in standard 540-c.cm. blood transfusion bottles and should be reconstituted to a volume of 400 c.cm. Under most service conditions the bottles of the dried product have to be accompanied by a bottle of fluid suitable for reconstitution. The bulk to be transported is therefore double that of the fluid products. Saline, Glucose and Glucose-saline The solutions used for intravenous hydration are isotonic with blood. Nowadays, the same solutions are issued for the recon- stitution of dried plasma, in order that distilled water (which is equally efficient) may not be administered by itself in mistake for an isotonic crystalloid solution. For rectal administration, half](https://iiif.wellcomecollection.org/image/b32174664_0047.jp2/full/800%2C/0/default.jpg)
