AUTOHEMOTRANSFUSION IN PREVENTING

POSTOPERATIVE LUNG COMPLICATIONS*

MICHAEL W. METTENLEITER, M.D., F.A.C.S.

Instructor in Surgery, New York Post-Graduate HospitaI Medical School and HospitaI

NEW YORK

T
HE administration of bIood as a 4. Intravenous injection of defibrinated
therapeutic agent is a very oId fresh bIood or bIood kept on ice for severa
procedure, and in primary anemic hours or even days.
cases where the repIacement of substance 5. IntradermaI injection of smaI1 quanti-
pIays the main roIe, is, of course, we11 ties I to 2 c.c., of fresh bIood.
known. The appIication we have in mind The intravenous injection occasionaIIy
is the withdrawa of a smaI1 amount of produces tinnitus, paIpitation or other
bIood from the patient’s vein and reinjec- shock symptoms, therefore intramuscuIar
tion directIy into the body. appIication is preferabIe. As much as 40 C.C.
In 1898, Grafstrom and EIfstroml ap- can be injected intramuscuIarIy without
pIied autotransfusion in a case of pneu- technica diffrcuIties or discomfort to the
monia. Ten years Iater BaIfour2 used this patient.
method as a specific therapy. AI1 authors AIthough autohemotherapy was formerIy
empIoyed it pureIy empiricaIIy without used empiricaIIy, we now have a cIear
expIanation of its action. In 1913 autohemo- expIanation for its action.
therapy was advocated by Spiethoff3 in der- The rough constituents of bIood serum
matoIogy and considered an unspecific and the subtIe changes of the various
protein therapy. Autohemotherapy has proteins and derivatives have been brought
since been used extensiveIy in a variety to Iight in recent years. BenhoId4 cIaims
of diseases and conditions. The resuIts were that the various albumins, gIobuIins,
encouraging in postoperative pneumonia, pseudogIobuIins and eugIobuIins possess
furuncuIosis, bronchitis, eczemas and physiochemica1 properties permitting vari-
urticaria. ous graduations from one to the other but
A good resuIt in postoperative Iung stiI1 retaining their separate specific func-
compIications is manifested by the dechne tions. When bIood is empIoyed outside
of temperature within twenty-four to its natura1 pIace in the circuIatory system
forty-eight hours after administration and it becomes quite a different substance for
disappearance of symptoms. the body. Its physica chemistry is changed
There are five different methods of immediateIy after withdrawa from a bIood
appIication : vesse1.
I. Intramuscular injection of defibri- The stimuIating effect of parentera
nated bIood; 20 C.C. of bIood is dehbrinated proteins on the sympathetic and para-
by shaking in a flask with gIassbeads and sympathetic system is demonstrated by the
injected immediately. foIIowing simpIe test: when defibrinated
2. IntramuscuIar injection of 16 C.C. bIood is injected intravenousIy it immedi-
of fresh bIood mixed with 4 C.C. of distiIIed ateIy produces diIatation of the bIood
water. vesse1 and redness of the skin, periphera1
3. IntramuscuIar injection of unaItered from the point of injection. This redness
fresh bIood. changes Iater to a bIuish discoIoration.
* Based upon 300 private surgica1 operations.
321
322 American ~~~~~~~ of surgery MettenIeiter-Autohemotransfusion MAY, 1936

The generaI effects upon the autonomic tion with Kongored (Schurer*) reveaIed a
nervous system are even more striking. greater reserve after autohemotransfusion.
After the injection of defibrinated bIood, Another test utiIizes a bactericida1 index
vascuIar reactions combined with reactions after Wright’s method. After injection
of the respective tissues occur a11 over the the index shows an increase in a few hours
body. and after eight hours reaches a maximum
WidaI and severa others5 observed of 13 to 20 times normaI. Like the increase
a marked decrease in the number of in monocytes, the changes in the bacter-
Ieucocytes in the entire periphera1 vascular icida1 index prove the stimulation of the
system. MuIIer and Petersen6 demonstrated defensive powers of the organism, resuIting
Iater that this periphera1 decrease cor- in higher body resistance.
responds to an increase of these ceIIs in Schurer’s investigations suggest that
the abdomina1 organs. With this increase the absorption of the injected bIood starts
in the number of Ieucocytes in the ab- rather quickIy. We know that the absorp-
dominaI organs there is a corresponding tion of milk, novoprotein and other
increase of the tissue functions, particu- protein substances can be demonstrated
larly the Iiver, acceIerating the biIe secre- after four to six hours.g BIood is absorbed
tion and the detoxication procedures.7 after one hour in suf5cient quantity to
It seems evident that these reactions produce the ferment caIIed gIycyItrypto-
depend upon sympathetic or parasympa- phanase in the bIood stream.
thetic stimuIations initiated by the injec- Stimulation of the bIood forming tis-
tion of defibrinated bIood. This aIso occurs sues in the bone marrow has aIso been
with other proteins. No effect upon the definiteIy recognized after intramuscuIar
vasomotoric system, bIood or tissues takes injections of bIood or other foreign pro-
pIace after injection where the autonomic teins. Hoff9 and severa others couId
nerve suppIy of the respective organs is demonstrate this important symptom as a
severed. part of the therapeutic vaIue of protein
The reticula-endotheIia1 system is aIso therapy.
definiteIy stimulated by autohemotherapy. These concIusions point to the wisdom
Recent investigations give a we11 founded of autohemotransfusion immediateIy after
expIanation for this effect. (Schurer.8) operation in an effort to prevent post-
There is a simple method for testing the operative Iung compIications.
effect of stimuIating subcutaneous tissues We have used autohemotransfusion in a
and ceIIs of vascuIar waIIs. A canthariden- series of 300 surgica1 cases, injecting
pIaster, I sq. cm. in size, is applied on the 20 C.C. fresh bIood intramuscuIarIy immedi-
thigh for twenty-four hours. A vesicIe ateIy after operation. No Iung compIica-
which formed is opened. The fluid is tions, as postoperative bronchitis or pneu-
evacuated and brought into a “U ” tube monia, were observed. Only one case
and centrifuged. The sediment is air dried, deveIoped a smaI1 thrombotic area in one
stained and a differential white blood Iung five days after operation. The opera-
count is done. (Kauffman.) The normaI tions performed were gastroenterostomies,
monocytes incidence is about 3 per cent. choIecystectomies, appendectomies, hys-
After an autohemotransfusion the mono- terectomies, ovariotomies, herniotomies,
cytes in the differential count increase to 22 thyroidectomies, mastectomies, etc., under
per cent in eight hours and 20 per cent are genera1 anesthesia with gas and ether,
stiI1 present after seventy-two hours. The avertin as base and IocaI anesthesia.
curve drops graduaIIy within seven days Postoperative compIications may arise
and returns to normaI after several weeks. with any kind or method of anesthesia,
The reticuIo-endotheIia1 system is aIso but the absence of Iung invoIvements in
abIe to store dyes. Calorimetric determina- our series indicates that autohemotherapy
NEW SERIES VOL. XxX11. No. z Mettenleiter-Autohemotransfusion A merican J~)urnalof Surgery 323

and not the type of anesthesia appIied good resuIts in the prevention of post-
accounted for the good resuks. operative Iung compIications and possibIy
There is sometimes a neghgible amount Iess frequent occurrence of postoperative
of bIood Ieft in the wound, and it has been emboIism.
suggested that the absorption of this
REFERENCES
bIood may render an additiona autotrans-
I. ELFSTROM,C. and GRAFSTROM,A. A preliminary re-
fusion unnecessary. The physiochemica1
port of experiments with heated blood in the treat-
changes in the whole blood and in the ment of croupous pneumonia. N. Y. Med. Jour.,
serum are so deIicate and occur so rapidIy 68: 307, 1898.
2. BALFOUR. &it. med. Jour., 1909. Cit. Hoffheinz, 8.:
that no comparison can be made between
Eigenbluttherapie in der Chirurgie. Ergebn. d.
bIood drawn from a vein and reinjected Cbir. u. Ortb., 22: 152, 1929.
intramuscuIarIy and bIood Ieft in a wound 3. SPIETHOFF, B. Zur therapeutischen Verwendung des
Eigenserums. Miincb. med. Wcbnscbr., 52 I : 19 I 3.
to be absorbed. These two processes
4. CIT. KYLEN. 1st es berechtigt, das BIuteiweiss aIs ein
are entirely different. spezihsches Organ aufzufassen? Med. Klinik, 6:
171. 1935.
CONCLUSION 5. WIDAL, F. L’anaphyIaxie. Presse med., 79: 781, 1921.
6. MUELLER, E. F. and WIENER, P. The mechanism of
I.The intramuscuIar administration of insulin action. Arch. of Int. Med., 37: 4,512, 1926.
20 of autogenous bIood after operation
C.C. 7. MUELLER, E. F. and BRUTT, H.-Die zentraIe Bedeu-
tung der Leber bei der natuerhchen Abwehr van
has a stimuIating effect upon the reticuIo-
Infektionen. Miincb. med. Wcbnscbr., 2044: 1929.
endotheIia1 system and the sympathetic 8. SCHURER-WALDHEIM, F. Ueber die Wirkungsweise
nervous system which in turn increases der EigenbIutbehandIung. Deutscb. Ztscbr. f.
activity and resistance of tissues. Cbir., 239: 352: 1933.
9. HOFF, F. KIinische Beitraege zur Frage der zentral-
2. The method is without danger. This nervoesen ReguIation des BIutes. Klin. Wcbnscbr.,
procedure has been used in 300 cases with 44 1751. 1932.