August 17, 1912
The time is not yet at hand when final statements as to the definite indications for direct transfusion of blood can be made. In secondary anemia, such as results from traumatic hemorrhage, from post-partum hemorrhage, and from other conditions, if would often be desirable to transfuse after the bleeding has been controlled, if the technic were as simple as, for instance, the intravenous injection of salt solution. Unfortunately, we are not yet in possession of a technic for transfusion which is easily mastered; the operation is not without considerable difficulty—even some danger to the patient. It should be remembered always that the selection of a donor is a most important matter, requiring special care. All this does not mean that recent accomplishments in this field are insignificant, but rather that the ultimate goal desired is not attained. With the present technic, probably only three classes of patients with secondary anemia should be considered as fit subjects for transfusion: those who have bled so profusely that their life is in jeopardy; those who have lost much blood and are suffering from uncontrollable hemorrhage, and those who require some operation or other while in a state of very grave anemia. The practice of transfusion of patients suffering from moderately severe hemorrhage such as may be associated with extrauterine pregnancy is not generally commendable because it leads to a routine performance of transfusion, when in reality control of the bleeding is all that is necessary. When transfusion becomes a simpler matter than now, many patients no doubt may be transfused with benefit, but at present the operation with the selection of the donor is so complicated as to be employed only after careful deliberation. In other kinds of cases, such as pernicious anemia, Hodgkin's disease, and chronic infections with a hopeless outlook, e. g., tuberculosis with advanced anemia, evidence is still wanting that transfusion is of any real benefit. At the most, the improvement resulting has been simply temporary. Perhaps the outlook in tuberculosis is a little more favorable; here the content of the blood in complement is low and as transfusion tends to increase complement, theoretically it would be beneficial. The outcome of repeated transfusions in tuberculosis and other similar diseases may be awaited with interest.