Application in Man of Method for Continuous Reciprocal Transfusion of Blood. ∗ †

Abstract

Purified heparin, by prolonging the coagulation time of blood, has reduced the technical difficulties and made feasible the continuous reciprocal transfusion of blood in man. Thalhimer, Solandt and Best, 1 using a uremic and a normal dog and employing purified heparin as an anticoagulant, conducted a reciprocal transfusion for 27 hours, reducing the blood urea from high levels to normal without injury to the normal dog. Prinzmetal 2 carried out exchange transfusions in the investigation of arterial hypertension in patients with inoperable cancer. We have been unable however, to find any instance in which the work of Thalhimer et al. was applied in man.

Heparin (10,000 Toronto units in 1,000 cc normal saline) was given intravenously at approximately the rate of 40 drops per minute to the normal donor and to the patient for 20 minutes before and throughout the transfusion. An additional 2,000 units were given intravenously to each individual as the transfusion was started, and repeated 30 minutes later. This maintained the blood coagulation time between 20 and 30 minutes. The median basilic veins of the two, a uremic patient and a normal donor, were then connected by a suitable rubber tubing filled with heparin in saline. The tubes passed through a roller pump which milked forward the same quantity of blood in opposite directions. A 400 mm manometer was placed between the pump and the recipient (1B and 2C), thus providing a sensitive indicator of any obstruction in the needle and at the same time a safeguard against undue increasing pressure in the receiving vein (Fig. 1).

Sufficient bicarbonate of soda was given to the donor and the recipient to make the urine alkaline as a preparatory measure.