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HEMOGLOBIN AND EFFECT OF TRANSFUSION I n limb injuries, after blood loss there is usually a fairly rapid dilution of blood, first with protein-free or protein-poor fluid, but later chiefly 14 D. P. CUTHBERTSON AND W. J. TILSTONE with fluid containing protein in nearly the same concentration a s the original plasma. During the first 12 hours after injury the average dilution is roughly proportional to the hemorrhage. In fit men a hemoglobin concentration above 14 g/100 ml indicates a previous blood loss of less than 40% of the blood volume; and a hemoglobin concentration below 12 g/100 ml, a previous blood loss of more than 40%.
It appears in the plasma 12-18 hours after the injury and remains detectable for 7-10 days or longer. Adrenalectomy prevents its appearance after injury. It can be restored in the adrenalectomized rat by corticosterone or cortisol. ] There is a linearity of response to graded cortisol treatment in traumatized adrenalectomized animals (B11). The adrenal cortical control of the appearance of slow as-globulin is incomplete in the 2-day postpartum maternal rat, because the globulin can be demonstrated in most adrenalectomized animals in this condition.
I n their multiple but brief measurements of “basal” oxygen consumption by burned patients, beginning soon after trauma and extending through convalescence, Cope et al. (C13) found increments in metabolic rates to plus 3040% above normal early after injury. The oxygen consumption rate gradually declined but continued to be elevated in many patients for as long as 2 months. Although Cope e t al. considered that fever probably played a part, the temperature rises were irregular and did not correlate with the metabolic rate.