Red Cells and Gelatin as the Core of a Unified Program for the National Procurement of Blood Components and Derivatives

Abstract

The use of a gelatin plasma substitute as an integral part of a unified national program for the procurement of blood components and derivatives paves the way for the extensive use of red cell concentrates in the treatment of hemorrhage, the plasma from the original donations being partly diverted to the fractionation program of a national transfusion service. We estimated the potential of such a system paced by the demand for red cells and predicted that the use of 20% of fresh whole blood and 80% concentrates would not increase the demand for albumin, the yield of which would suffice to cover three-quarters of current needs in our country. The actual performance of a program using 85% of red cell concentrates in a university hospital with an exceptionally high incidence of major hemorrhage was analyzed in detail. The use of albumin per unit of transfused red cells rose by 9%. With a nationwide increase of this magnitude, 67% of the demand in our country could still be met and the estimated true need for albumin of 200 kg per million inhabitants and year would be fully covered. The yield of factor VIII is 200--300% of the demand. The determinants of the effects of such a system vary from country to country, but its fundamental potential is obviously considerable.

Impact of the Protein Content of Red Cell Concentrates on the Optimum Use of Blood

“…The effect lies on the borderline RCC-P/RCC +P in table I. With an RCC-70, the patients arrived at this line with an average total serum protein level of 4.7 g%, or a deficit of 0.5 g% relative to the supposedly critical level of 5.2g% [6]. This was considered acceptable because the inflow of proteins from the extravascular space augments the serum protein concentration by approximately 0.5 g% during the first six postoperative hours, i.e.…”

“…For the sake of clarity we must recall certain features of the model system [6]. The first stage of the treatment of hemorrhage in this system involves the exploitation of an initial margin for the use of an erythrocyte-free plasma substitute, the width of that margin being dependent on the pretransfusion hematocrit and serum protein level of the recipient.…”

“…With an RCC-70, this additional deficit averaged 4.8 g per RCC, or a total of 14.4 g for the 3 RCC per recipient within this area. In the previous paper [6], these figures were rounded to 5 and 15 g, respectively,…”

“…In a previous communication [6], we estimated the potential of a blood component program paced by red cell demands for the coverage of national albumin needs and arrived at the prediction that the use of 20% of the donations as fresh whole blood (FWB) and of 80% as red cell concentrates (RCC) could provide substantial coverage without an inherent increase of the demand for that protein. The actual performance of a program using 85% of RCC in a university hospital with an exceptionally high incidence of major hemorrhage was then analyzed in detail.…”

“…The use of human plasma protein solutions per unit of transfused red cells (FWB + RCC) rose from the background figure of 0.89 10-gram units to 0.97 units during 1976, i.e. by 9% during the first calendar year following the introduction of the new system [6]. In 1977, however, only 0.76 10-gram units were used per transfused red cell unit, the usage fraction of RCC remaining at 84.8% [lo].…”