Volume expanders and blood loss

Much research is being conducted into the safe alternatives to blood transfusions. This article will present some of the alternatives being used now as volume expanders and fluid replacements. Substitute blood and others are being studied that hold much promise for the future.

Volume expanders

Volume expanders may be used in acute traumatic blood loss. The greatest need at this time is to stop bleeding and replace volume to prevent circulatory collapse and shock. By providing volume expanders, the remaining red blood cells in the body can still carry oxygen to the tissue of the body. In this process, amazing circulatory compensatory mechanisms take place: the heart pumps a larger quantity of blood with each beat thus delivering oxygen to tissue and organs of the body. With these compensations taking place, a patient can survive with a hemoglobin level one-third that of a healthy person. (“Alternatives to blood transfusions” http://www.wikipedia.com/).


Below is a list of volume expanders that may be used as fluid replacements and may avoid blood transfusions. The first group that will be looked at is crystalloids.

A. Crystalloids -

0.9 Normal sodium (NaCl)  is equivalent to the sodium content in body fluids. This fluid increase the oncotic pressure in the intravascular space - water moves into the intravascular space to increase blood volume.

Lactated Ringer’s is a fluid and electrolyte replenisher that similarly increases the oncotic pressure in the intravascular space - again,  fluid is drawn into the vascular space.

B. Colloids -

Haemaccel is used as a plasma volume substitute in the initial treatment of hypovolemic shock due to hemorrhage or crush injuries.
Produces a significant increase in blood volume, heart output, urine output and oxygen transport.

Gelofusin - Contains modified fluid gelatin which behaves in a similar way to natural plasma albumin.

It is used for shock caused by a reduction in the volume of blood due to excessive blood loss. (“What are non-blood volume expanders?” bloodlessmedicine.org).

Dextran


Large molecules composed of chains of sugar molecules. These are formed as a means of storing food by bacteria and yeast. In purified form, certain dextrans can be used IV to expand a patient’s blood voume in medical emergencies where blood pressure drops to dangerously low levels. (“What are non-blood volume expanders?” bloodless medicine.org).




Hetastarch and Pentastarch

Are solutions of large molecules composed of many smaller molecules. They act by holding blood within the blood vessel thereby expanding blood volume and help maintain blood pressure. These substances also, do not contribute to the blood’s oxygen carrying capacity.

The drawback of volume expanders such as normal saline and lactated ringer’s is that they do nothing to assist in the oxygen carrying capacity of blood. Also, these substances flow in and out of the blood vessels they may initially provide volume expansion, the fluids eventually move out of the blood vessels. (“The right plasma volume expanders” nursing times.com)



Vocabulary

Colloid - is a substance that is microscopically dispersed throughout another one.

Crystalloid - is a substance that in solution can pass through a semi-permeable membrane.

hypovolemia - loss of blood volume.
Intravascular blood - blood volume inside the blood vessels.

Oncotic pressure - Pressure exerted by proteins in blood plasma that tends to pull water into the circulatory system.

Volume expanders - Expands the amount of circulating in the blood volume. Without adequate volume shock and circulatory collapse could occur.

(definitions: med-dictionary.com)

Great and tasty alternatives to milk for the lactose intolerant

Okay, so you know that you are lactose intolerant. As many as 60% if Newark's residents also complain of the uncomfortable gas, bloating, diarrhea and nausea when consuming dairy products.  Does this sentence you to a life of  pain and suffering whenever you have a craving for ice cream, or a bowl or cereal?

Not necessarily, there are a number of tasty new substitutions and alternatives for those with this common problem.  Look at Newark's supermarkets, drug stores and health food stores and you will see shelves of lactaid, the enzyme that aids in the digestion of milk, and popular milk alternatives.  

What are the substitutes?

There are many digestive aids for the consumption of milk and milk products.  However, there is a growing array of popular grain products from which grain milk which is made, that offers a tasty and healthful alternative to milk and dairy. 

Below is a list of some of the more common ones.  

Rice Milk Ice Cream

This is a delicious alternative to ice cream for the lactose intolerant.  It is lactose free and generally allergy free for even the most sensitive people.  Often sweetened with natural sweeteners such as organic brown rice syrup or organic agave syrup.(Agave is a plus as a sweetener since it has a low glycemic index-under 30 and is 40% sweetener than white sugar.  Allaboutagave.com).  It has a light and creamy  texture like ice cream.  1/2 cup contains about 170 calories and only has about 0.5 grams of saturated fat.  "Taste the Dream" produces many flavors such as orange vanilla swirl, mint carob chip, carob almond, cocoa marble fudge and cookies 'n dream.  Most large health food supermarkets carry the different flaovrs such as "Whole Foods."

Almond Milk

Another tasty alternative to cow's milk that is high in protein. Has about 60 calories per serving.   Also comes in vanilla flavor.  Care should be give by the diet conscious however because it is higher in fat than rice milk.  Almond milk also comes fortified with vitamins B-12, vitamin D and calcium.  Contains antioxidants vitamins A and E.  Those who are allergic to nut should exercise caution.  Can also be a little gassy.(Silkpurealmond.com).

Rice Milk

Another wonderful dairy product substitute that does not contain lactose and is very low in fat.  It has less protein than almond milk but is also higher in carbohydrates.  Great for people who have allergies since rice products usually do not cause allergic reactions in most people.  One serving has about eighty calories. Comes in many flavors.  Is also often fortified with calcium and vitamin B-12.

Soy milk

Very popular and is made by soaking the soy beans in water and then grinding them.  Is also often vitamin fortified.  Contains many phytochemicals that are helpful in fighting osteoporosis, aging and heart disease.  However, new studies raised the question as to whether soy has certain natural chemicals  that mimic estrogen and may possibly be linked to breast cancers in some women.  If you are considering trying it, talk with your nutritionist or doctor first.


Oat milk

Light texture with a sweet and mild taste.  It is easily made by grinding up oats and stirring in water.  Oat milk is recommended for the morning cereal, baked goods and other uses where you would use milk.  

So, there you have it.  Above is a list of some of the popular lactose-free substitutes and alternatives. AS with most things, keep your eyes peeled for the new products that are hitting the market.  And, of course, enjoy-they are really delicious.

What you need to know about blood transfusions

Let's look at some of the factors that doctors look at when deciding to give a blood transfusion.  Assuming that this is not an emergency situation, and the patient  is having elective or a non-emergency surgery, the doctor wants to get a look at your lab work.  The information that will follow pertains specifically to your CBC.    This information tells the doctor about the: hemoglobin, hematocrit, white blood cells, red blood cells and platelets, specifically as related to transfusion decision making. Not to simplify a really complex decision such as transfusion because obviously, a lot of factors are involved. Let's look a little closer.

CBC - what information does it yield?

Hemoglobin is the protein in the red blood cell that carries oxygen to the body's cells and tissues. Normal ranges are roughly 13 - 18 grams of hemoglobin in every 100 cubic centimeters of blood for a male, and 12 -16 grams of hemoglobin in every 100 cubic centimeters of blood for a female.  So, just to make lab results jargon clearer, if your doctor were to say that you (a male)  have a hemoglobin of 2, well, you know that this is a cause for concern. You're probably bleeding somewhere.   In the past, hemoglobin (hgb) of 10 was the golden standard for transfusion for surgery.  It has now been found that this is not true.

Another thing that the doctor looks at is the hematocrit which is the concentration of red blood cells in a given amount of blood.  This is usually expressed as a per cent.  Normal ranges are roughly 45-62% for a male and 37-48% for a female. The hematocrit is the proportion by volume of the blood that consists of red blood cells.  Example, 25% means that 25 milliliters of blood per 100 ml consists of RBC. Again, the further the number is from normal, the more the cause for concern.

Platelets are another factor that can influence transfusions. Platelets are the smallest cell-like structures in the blood and are important for clotting. They are expressed as 150,000 - 450,000 per microliter.

Red blood cells are very important as these are the oxygen containing cells of the blood. Normal ranges are 4.2 - 6.9 million/cu mm. Packed red blood cells would most likely be used in traumatic blood loss.

White blood cells are usually involved in fighting infection.  Transfusions are rarely given for these.  Normal ranges are 4,300 -10,800 cells per cu mm. ("Blood transfusions" www.medicinenet.com/hematocrit/article.htm)

Types of transfusions

Whole Blood Transfusion Reasons - This is rare now.  This is blood with all of its components - red blood cells, platelets, plasma, etc.

Packed red blood cells are given to increase the oxygen-carrying capacity of the patient's blood.  This could be low due to loss of blood during trauma, surgery or bleeding internally.

Platelets are transfused when there are problems with clotting.

Fresh frozen plasma may be used to treat an overdose of coumadin, warfarin or other blood thinners.  These problems are diagnosed in the PT (Prothrombin time) or APTT (Activated partial thromboplastin time).

Cryoprecipitate Transfusions are usually given to replace specific clotting factors such as Factor VIII or Factor XIII deficiency.

White blood cell transfusion are given when the body does not respond to appropriate antibiotic treatment.  This is very rare though. ("Blood transfusions" http://www.medicinenet.com/

Summarizing it all

The next article will be discussing some of the basic types of volume replacement as a subsitute for blood.

A brief history of blood transfusions

Many people, probably due to the influence of mainstream western medicine, think of blood transfusions as a   lifesaving medical procedure.  But many would be surprised to find out that the procedure is not as old as thought by some and that it only received widespread use in WWII with the massive injuries and blood loss of soldiers on the battle fields.

Beginning in the 17th century, more sophisticated research into blood transfusion began.  These transfusions took place between animals.  Trials on humans at this time had been unsuccessful and ended in death.

The first documented human transfusion was administered by a Dr. Jean-Baptiste Denys, physician to King Louis XIV of France on June 15, 1667.  He transfused the blood of a sheep into a 15 year old boy who survived the procedure.  He subsequently transfused a laborer, who also survived.  It is speculated that they survived due to the small amount of blood that was actually transfused. Denys next transfused a a Sweded, Baron Bonde.  He received two transfusions and then later died.  Denys' experimientation with transfusing animal blood sparked a heated controversy in France.  In 1670 the procedure was banned. The British Parliament, soon followed suit and the procedure was banned for 150 years.

Richard Lower, a British physician who played a huge part in the development of medical science,   examined the effects of changes in blood volume on circulatory function and studied animals. He is credited with eventually devising instruments that led to actual transfusion of blood.  Lower began to receive attention for these successful procedures and was asked to present his procedures to the Royal Society in December, 1665.

Six months later, Lower performed the first known human transfusion in Britain.  The recipient's name was Arthur Coga, who was allegedly insance.  The scientific community wanted to see the reaction of an interspecies transfusion.  A gentle lamb was used to hopefully calm the violent spirit of the patient. Shortly after this, Lower abandoned his studies due to his growing medical practice.

In the early 19th century, scientists discovered that there were distinctive blood types and the necessity of cross matching to make sure that the blood was suitable to the specific recipient.

Up until this time  many humans died as a result of transfusion due to the lack of knowledge regarding cross matching donor and recipient blood.  Karl Landsteiner is credited with discovering human blood groups and that the mixing of blood from individuals can cause blood clumping or agglutination.  This causes red cells to crack and cause toxic reactions which can be fatal.  He received the Nobel Prize in Physiology and Medicine in 1930.

George Washing Crile in credited with performing the first transfusion in surgery in Cleveland, Ohio.

In  the 1910s, it was discovered that anticoagulants and refrigerating blood made it possible to store it for several days.  This paved the way for blood banks.  The first blood transfusion using stored and cooled blood was performed on January 1, 1916.  Oswald Hope Robertson, a medical researcher and Army officer is credited with establishing the first blood bank while serving in France during WWI.

The first academic institution devoted to the study of blood transfusion was founded by Alexander Bogdanov in Moscow in 1925. As a matter of fact, following the death of Vladimir Lenin, Bogdanov was entrusted with the study of Lenin's brain. Bogdaniv eventually died in 1928 as a result of one of his experiment.  He received the blood of a student suffering from malaria and tuberculosis. 


The first academic institution devoted to the science of blood transfusion was founded by Alexander Bogdanov in Moscow in 1925.

Shortly after this, the United States followed the Soviet Union by setting up a system of blood banks in the 1930s.  In 1937, Bernard Fantus, director of therapeutics at the Cook County Hospital in Chicago established the first hospital blood bank in the UNited States.

Following this, in the early 1940s, Dr. Charles R. Drew's research led to the discovery that blood could be separated in to blood plasma and red blood cells.  Blood could now  lasted longer.

In 1939-1940, the Rhesus blood group system was discovered. The importance of the Rh groups is its role in hemolytic disease of the fetus and newborn.  When an Rh negative mother carries a positive fetus, she can become immunized against the Rh antigen.  In subsequent pregnancies this could be important because the mother can develop an immune response to the Rh antigen. The mother's immune system can attack the baby's red cells through the placenta.This could prove fatal in severe cases.   Credit is given to Karl Landsteiner, Alex Wiener, Philip Levine and R.E. Stetson.

Also during this time the discovering of the acid-citrate-dextrose solution reduced the volume of anticoagulant thereby allowing greater volumes of blood to be transfused.

Source:
" History of blood transfusions" http://www,wikipedia.com/

Blood transfusions - how safe are they?

Blood transfusions are hailed by many as a procedure that is the “gift of life.” The majority of people don’t hesitate to donate blood for a good cause or to take in a blood transfusion at the recommendation of their physician or surgeon. But did you know that, like every medical procedure, there are risks involved? The Creator, Jehovah God, has given man specific mandates against its use. For our safety and well-being these laws were put in place.


This article will explore some commonly held beliefs and investigate some findings and little known facts about the dangers of blood and blood transfusions.

Blood - is it really a “gift of life”?

Blood. To many lay people the word conjures up images of the fluid that runs in our veins carrying nutrients and oxygen to all or our cells, tissues and organs. Many have come to view blood as the all important fluid, in the case of a traumatic event, that potentially can safe the life of a loved one, such as a child or parent. But do the facts really support this view?

Early in the 20th century, scientists deepened man’s understanding of blood. They learned that there are different blood types and that it is vitally important to match a donor’s blood precisely with the recipient’s blood otherwise a severe hemolytic reaction could occur. (A hemolytic reaction is one that is life threatening because red blood cells are destroyed by the immune system).

Scientists are now studying the effects of transfused blood on the immune system. It has been found that when a heart, liver or other organ is transplanted that the immune system of the recipient may sense the foreign tissue and reject it. Blood transfusions are also tissue transplants; logically, the same risks are involved. Even blood that has been properly cross matched can still suppress and affect the immune system. What other thus unknown threats are harbored in blood transfusions? Blood has at least 400 red cells antigens (proteins that can cause an immune response). The seriousness of the situation becomes quite grave considering this information. (‘How can blood save your life?” p.9, Watchtower Bible and Tract Society of Pennsylvania, 1990).

In the Journal “Cancer” (February 15, 1987) A study was done in the Netherland. Patients with colon cancer were studied: and divided into two groups - those who received blood transfusions and those who did not. Over a five year period, it was discovered that those who were transfused had a survival rate of 48%. Those who were not transfused had a 74% survival rate. In another study, physicians at the University of Southern California followed up on one hundred patients who underwent cancer surgery. The recurrence rate for those who received blood was 65% and 14% for those who did not. (“How can blood save your life?” p.9, Watchtower Bible and Tract Society of Pennsylvania).

Studies have long confirmed that blood transfusions compromise the immune system and renders one more susceptible to infections.. According to “The British Journal of Surgery, “August , 1988, “Whereas 23 percent of those who received donor blood during hip-replacement surgery developed infections, those given no blood had no infections at all.”

The incidence for concern over the dangers of blood transfusions are clear.

Is today’s blood supply free from AIDS?

AIDS and hepatitis has cast an ominous light on the blood supply industry. The two diseases are definitely known to be transmitted through blood.

AIDS (acquired immune deficiency disease) is caused the the HIV (human immunodeficiency virus). AIDS was first isolated in 1981. It was not until the next years that health experts learned that the virus could be passed on in blood products. Testing eventually began in 1985.Shortly after this, it was discovered there is a window” period between the first exposure and the development of antibodies to the disease. This could be months!

Even more dangerous is hepatitis B. Many have died from this blood borne disease. For many years, there was no screening available. Finally, a screening test for the disease was formulated and ib the early 1970s blood ws being screened in some lands. Many in the scientific community breathed a sigh of relief. Lo and behold, it was noted that people were still getting hepatitis. The strain was called Non-A, Non-B hepatitis. Today, this is known as hepatitis C. Unfortunately, tests are not always reliable. (“How can blood save your life?” Watchtower Bible and Tract Society of Pennsylvania, 1990).

In summary

In the article, “The dangers of blood transfusions” by Deputy Ma’at-Ra http://www.dherbs.com/ the author points out:

"The American Red Cross accepts blood from damn near anyone today. Crack heads, homeless people, transients, drug fiends, homosexuals, gang-bangers, prostitutes, criminals, etc. All donate blood today especially when money is paid for it.”

 Is this what you want in your body?

Subsequent articles will point out some alternatives to blood.