Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1978 Oct;188(4):513–520. doi: 10.1097/00000658-197810000-00008

The relationship between transfusion and hypoxemia in combat casualties.

J A Collins, P M James, C E Bredenberg, R W Anderson, C A Heisterkamp, R L Simmons
PMCID: PMC1396844  PMID: 697435

Abstract

The relationship between transfusion and subsequent hypoxemia was examined retrospectively in the records of combat casualties studied by the first three U.S. Army Surgical Research Teams in Vietnam. There was no evident relationship in 425 casualties studied before anesthesia and operation. In 199 casualties studied preoperatively and on at least two of the first three postoperative days, there was no evident relationship in those with injuries not involving the chest or abdomen. Eighteen such casualties received over ten units of blood each (average 24.5) and exhibited subsequent changes in arterial oxygen tension (PaO2) which were indistinguishable from those transfused lesser amounts or not all. Similar observations were made in casualties with injuries to the abdomen, although there was a tendency to lower PaO2 two days after injury in those heavily transfused. In those with thoracic injury, there was statistically significantly lower PaO2 on the first two postoperative days in those heavily transfused. Two possible interpretations are considered, one that blood transfusion contributed to hypoxemia, and alternatively, that a greater magnitude of the injuries accounted for both the worsened hypoxemia and the need for more transfusions. The latter was thought more likely. The differences in PaO2 related to the type of injury exceeded the differences associated with transfusion.

Full text

PDF
513

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alving B. M., Hojima Y., Pisano J. J., Mason B. L., Buckingham R. E., Jr, Mozen M. M., Finlayson J. S. Hypotension associated with prekallikrein activator (Hageman-factor fragments) in plasma protein fraction. N Engl J Med. 1978 Jul 13;299(2):66–70. doi: 10.1056/NEJM197807132990203. [DOI] [PubMed] [Google Scholar]
  2. Berman I. R., Iliescu H., Stachura I. Pulmonary effects of blood container materials. Surg Forum. 1977;28:182–184. [PubMed] [Google Scholar]
  3. Collins J. A., Braitberg A., Butcher H. R., Jr Changes in lung and body weight and lung water content in rats treated for hemorrhage with various fluids. Surgery. 1973 Mar;73(3):401–411. [PubMed] [Google Scholar]
  4. Collins J. A., Gordon W. C., Jr, Hudson T. L., Irvin R. W., Jr, Kelly T., Hardaway R. M., 3rd Inapparent hypoxemia in casualties with wounded limbs: pulmonary fat embolism? Ann Surg. 1968 Apr;167(4):511–520. doi: 10.1097/00000658-196804000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Collins J. A. The acute respiratory distresss syndrome. Adv Surg. 1977;11:171–225. [PubMed] [Google Scholar]
  6. Franciosi R. A., Awer E., Santana M. Interdonor incompatibility resulting in anuria. Transfusion. 1967 Jul-Aug;7(4):297–298. doi: 10.1111/j.1537-2995.1967.tb05520.x. [DOI] [PubMed] [Google Scholar]
  7. Hardaway R. M., Johnson D. G., Houchin D. N., Jenkins E. B., Burns J. W., Jackson D. R. The influence of extracorporeal handling of blood on hemorrhagic shock in dogs. Exp Med Surg. 1965;23(1):28–37. [PubMed] [Google Scholar]
  8. Hechtman H. B., Weisel R. D., Vito L., Ali J., Berger R. L. The independence of pulmonary shunting and pulmonary edema. Surgery. 1973 Aug;74(2):300–306. [PubMed] [Google Scholar]
  9. LEE W. H., Jr, KRUMHAAR D., FONKALSRUD E. W., SCHJEIDE O. A., MALONEY J. V., Jr Denaturation of plasma proteins as a cause of morbidity and death after intracardiac operations. Surgery. 1961 Jul;50:29–39. [PubMed] [Google Scholar]
  10. Martin A. M., Jr, Simmons R. L., Heisterkamp C. A., 3rd Respiratory insufficiency in combat casualties. I. Pathologic changes in the lungs of patients dying of wounds. Ann Surg. 1969 Jul;170(1):30–38. doi: 10.1097/00000658-196907000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. McNamara J. J., Molot M. D., Stremple J. F. Screen filtration pressure in combat casualties. Ann Surg. 1970 Sep;172(3):334–341. doi: 10.1097/00000658-197009000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Miller L. W., Collins J. A., Sherman L., Ladenson J. Massive transfusion in swine. Surg Forum. 1977;28:21–23. [PubMed] [Google Scholar]
  13. Moseley R. V., Doty D. B. Changes in the filtration characteristics of stored blood. Ann Surg. 1970 Mar;171(3):329–335. doi: 10.1097/00000658-197003000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Proctor H. J., Ballantine T. V., Broussard N. D. An analysis of pulmonary function following non-thoracic trauma, with recommendations for therapy. Ann Surg. 1970 Aug;172(2):180–189. doi: 10.1097/00000658-197008000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. RUSH B. F., Jr, WILDER R. J. MORTALITY AND RENAL TUBULAR NECROSIS IN HEMORRHAGIC SHOCK IN DOGS: THE EFFECT OF BLOOD HANDLING. Surg Forum. 1963;14:1–2. [PubMed] [Google Scholar]
  16. Reul G. J., Jr, Greenberg S. D., Lefrak E. A., McCollum W. B., Beall A. C., Jr, Jordan G. L., Jr Prevention of post-traumatic pulmonary insufficency. Fine screen filtration of blood. Arch Surg. 1973 Apr;106(4):386–394. doi: 10.1001/archsurg.1973.01350160008002. [DOI] [PubMed] [Google Scholar]
  17. Serkes K. D., Lang S., Pareira M. D. Enhanced protection with the use of gamma globulin proteins in the treatment of tourniquet shock with plasma expanders. Surgery. 1966 Apr;59(4):566–571. [PubMed] [Google Scholar]
  18. Simmons R. L., Heisterkamp C. A., 3rd, Collins J. A., Bredenberg C. E., Mills D. E., Martin A. M., Jr Respiratory insufficiency in combat casualties. IV. Hypoxemia during convalescence. Ann Surg. 1969 Jul;170(1):53–62. doi: 10.1097/00000658-196907000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Tobey R. E., Kopriva C. J., Homer L. D., Solis R. T., Dickson L. G., Herman C. M. Pulmonary gas exchange following hemorrhagic shock and massive blood transfusion in the baboon. Ann Surg. 1974 Mar;179(3):316–321. doi: 10.1097/00000658-197403000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Wolf C. F., Canale V. C. Fatal pulmonary hypersensitivity reaction to HL-A incompatible blood transfusion:report of a case and review of the literature. Transfusion. 1976 Mar-Apr;16(2):135–140. doi: 10.1046/j.1537-2995.1976.16276155107.x. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES