Twenty-seven patients requiring massive transfusions were studied prospectively to determine whether administration of stored, modified whole blood induced a primary disorder of hemostasis evidenced by generalized microvascular oozing. Platelet counts fell in proportion to the number of units of blood transfused. In contrast, the levels of factors V and VIII correlated poorly with the units of blood transfused, 85% of the total variation in the levels being due to influences other than transfused blood. Levels of all other clotting factors were unrelated to the number of units of blood given. Eight patients developed abnormal bleeding. The cause appeared to be dilutional thrombocytopenia in five patients, and DIC in three. In six of the eight, bleeding was controlled with platelet concentrates alone. Two patients were given cryoprecipitate also. The most useful laboratory test for predicting abnormal bleeding was the platelet count. Fibrinogen levels should be followed as an aid in the diagnosis of DIC. The BT, PT, and PTT were not helpful in assessing the cause of bleeding, unless they were greater than 1.5 times the control value. We recommend that any patient receiving massive transfusions who develops diffuse microvascular bleeding be given platelet concentrates. Platelet counts as high as 100,000 may be required to control bleeding from surgical wounds. It is not necessary to supplement transfusions of stored, modified whole blood with fresh blood or fresh frozen plasma.
In this study responses of first-time donors were compared to those of repeating donors. Veteran donors were much less reluctant toward giving blood and anticipated much less difficulty. Veteran donors are much more susceptible to blood bank solicitations. Neophyte donors were influenced by friends to give blood to a greater degree. I t would appear from the data that to recruit a donor the first time the most effective means would be a personal request or urging by friends. After he has given once, however, the donor is induced effectively to continue giving by less personal appeals. Veteran donors possess more accurate knowledge about blood banking and the transfusion process. Neophyte donors are bothered more significantly by the pain involved in giving blood. The veteran g~o u p contained a significantly larger proportion of men. The neophytes were more likely to be younger, unmarried, part-time or not employed, and engaged in blue-collar occupations.THE general hypothesis to which this study addressed itself was the following: T h e procliuity of a potential donor toward giving blood is dependent upon (1) his degree of personal readiness; (2) the conduciveness of his sociocultural environment to giving; and ( 3 ) the Perceiued benefit of the act of giving blood.
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