The Blood Volume and Plasma Protein Levels before and after Gastrectomy

Abstract

EDITORIAL SYNOPSIS This paper is a survey of a series of 185 plasma volume estimations carried out on 75 gastric surgical patients before and after operation at St. James's Hospital in 1958-59. In the majority of cases serum proteins were also measured. The purpose of this work was to study the effects of gastric operations, and especially of partial gastrectomy, on patients' blood volume, the oxygen-carrying capacity of the blood as measured by the total circulating red cell volume, and serum protein content.The importance of plasma volume and of total circulating red cell volume in assessing a patient's pre-operative condition, operative blood loss, and post-operative state is becoming widely accepted in surgical practice. There have, moreover, been indications in the literature (Clark, Nelson, Lyons, Mayerson, and DeCamp, 1947;Mallet-Guy, Devic, and Grangeon, 1950; Mallet-Guy, Devic, and Ricard, 1954; Mallet-Guy, Ricard, and Correard, 1955) that a persistently defective blood volume may account for retardation of recovery after such operations and for some of the manifestations of post-operative ill-health, if not for the dumping syndrome itself.The present account of the work falls naturally into two main sections: 1 The assessment of patients' pre-operative state in relation to body weight, blood volume, and plasma proteins, and 2, their postoperative changes. METHODSOf the numerous existing methods of blood volume estimation we selected the dye dilution method for its relative simplicity and low cost, making it readily available for routine use in any hospital. For the same reason we avoided such time-consuming refinements as extraction procedures (Campbell, Frohman, and Reeve, 1958;Hobsley and Dew, 1958;Jarnum, 1959;Lawrence and Walters, 1959) Hamilton, 1958;Gibson and Evans, 1937a); heavily opalescent specimens were discarded. We used Geigy blue 536 med2. which has the same structural formula as Evans blue. The details of the method used are given in our previous publication (Swan, Allen, and Tanner, 1959).Two hundred and eighty-three plasma volume estimations were carried out using this method on 121 persons. Serum protein levels were determined by the biuret method, and the separation of albumin from globulins was achieved by sodium sulphate precipitation. Plasma volume measurements, and when possible serum protein estimations, were performed three times on each available and willing patient of the series of 75 cases, i.e., shortly before the operation, nine to 10 days after it, and again after an interval of from six to nine months. In this series, 71 % of cases were men and 29% women. Their ages varied from 79 to 17 years, with a peak in the fifth and sixth decades.On the morning of blood volume estimation the patients were instructed to have no breakfast. The first post-operative estimation was done in all cases except two3 at least five days after all parenteral fluids had been stopped. THE 'In one case the interval was four days and in the other three days.