Title: CLINICAL EVALUATION ON NON BLOOD TRANSFUSION OPERATION
Abstract: The author studied upon the clinical cases with more than 200ml. of blood loss in operation without blood transfusion and devised a formula with which the permitted quantity of blood loss can be calculated, in other words, how much blood loss a patient can tolerate without risk during operation and postoperative course. Furthermore, the author discussed control of the postoperative hypovolemia, safety limit of hemodilution, and recovery from it upon the above cases and came to the following conclusions.1) In the early stage after operation, approximately 10% decrease of the total blood volume was found because of functional decrease of the extracellular fluid. As it is difficult to prevent the decrease of the total blood volume even with blood transfusion, it is reasonable to put a landmark around 10% decrease of the total blood volume when surgeons control the hypovolemia after non blood transfusion operation.2) When plasma expander of more than 1.2 times of volume of total blood loss and fluid of 5.0ml/kg/hr were given intravenously in non blood transfusion operation, decrease of the total blood volume was 8% on the average if total blood loss remained within permitted quantity regardless of age and bleeding speed during operation.3) It was established that normal blood constituent was lowered up to 30% without any trouble in both operative and postoperative course.4) During a few days after non blood transfusion operation, the data suggesting low production and accelerating destruction of red blood cells were obtained. Red blood cell volume showed decrease due to blood loss and this was followed by further slight decrease as postoperative course progressed.5) At the beginning of the second postoperative week, production of the red blood cell became remarkably active and the greater was the dilution the faster was the production of red blood cell. The most cases recovered from anemia to normal value at the time of discharge from the hospital.6) From the above data, the author devised the formula which was supposed to be reasonable pathophysiologically.Y=V (1-b/Z)Y: permitted quantity of blood lossV: total blood volumeZ: preoperative hematocritb: possible hematocrit by dilution