Posttransfusion hepatitis

Paid-versus-volunteer blood donation in the United States: a historical review

Several points are clear from this historical review. Over 50 years ago the first indications that hepatitis could be transmitted from the serum or plasma of one human to another became evident. This was confirmed in human transfer experiments although the agent causing hepatitis was not known and there was no specific test for what eventually was presumed to be a virus. It soon became clear that hepatitis was a complication of blood and plasma transfusion. Over the course of 10 to 20 years (the 1950s and 1960s) the connection was made between posttransfusion hepatitis and certain high-risk donors and behaviors. Despite the availability of scientific data to support the idea that not all commercial or paid blood donors were associated with higher rates of post-transfusion hepatitis, public opinion and emotions seemed to be a major driving force behind increased government regulation of blood banking. Because there were commercial blood banks that continued to recruit, collect, and pay blood donors from low-income, skid row areas, despite the mounting evidence that such donors clearly harbored higher rates of hepatitis, all commercial blood banks were reduced to that common denominator. Clearly economic factors were also being thrown into the equation. Political and philosophical differences between the major professional organizations involved in blood procurement and recruitment were important factors favoring more government control. The public pressured politicians and government agencies for more regulation and many scientific and medical professionals requested greater regulation. By the early 1970s the die was cast for increased regulation by the federal government.(ABSTRACT TRUNCATED AT 250 WORDS)

Volume expansion and flow promotion in shock

Volume replacement is the most important step in treating hypovolaemic shock.

Blood is needed when the oxygen carrying capacity threatens to fall below a critical level, but has the disadvantage of transmitting virus hepatitis. Anicteric hepatitis is about four times more frequent than the icteric form. Pasteurized plasma protein solution and albumin are free from the risk of transmitting hepatitis virus, and are good volume restorers.

Dextran 70 represents the best artificial colloid with additional anti-thrombotic properties. Dextran 40 is indicated in special situations to promote flow.

There is no proof that large amounts of Ringer solution are superior for treating hypovolaemic shock in man compared with colloids and electrolytes.