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A. S. Wiener, M.D.
JAMA. 1941;116(26):2885. doi:10.1001/jama.1941.02820260059022.
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To the Editor:—  I read with interest the report in a recent issue of The Journal (May 3, p. 2015) by Dr. Frank Mayner concerning a death following a transfusion of blood plasma. My purpose in this communication is to offer a possible explanation for the lethal reaction.In describing the collection of blood for the preparation of plasma, the author states that 50 cc. of 2.5 per cent sodium citrate was used for 450 cc. of blood, giving an effective concentration of sodium citrate of 0.25 per cent. This is the minimum concentration originally found effective for citrate transfusions by Dr. Lewisohn, whose idea in setting the concentration so low was to avoid the toxic effect of the citrate ion.It has since been found (1) that, while 0.25 per cent is sufficient for fresh blood transfusions, this concentration does not entirely prevent coagulation but merely retards it; (2)


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