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Blood Volume (Parts I and II). By Albert Solomon N. Published by Charles C. Thomas, Springfield, Illinois. Pp. 192; 72 illustrations. Price $8.50.
BOOK REVIEW Blood Volume (Parts I and II). By Solomon N. Albert. Published by Charles C. Thomas, Springfield, Illinois. Pp. 192; 72 illustrations. Price $8.50.
Printed in Great Britain by John Sherratt add Son. Park Road. Altrincham
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on July 16, 2015
Most anaesthetists in training discover quickly that "inexplicable" hypotension or tachycardia, related perhaps to induction of light anaesthesia or to subsequent postural change, responds often to blood transfusion, although there has been no blood loss and the patient appears a reasonable surgical risk. Presumably, Dr. Albert's experience of this situation, and the support of the U.S. Atomic Energy Commission, led him to a special study of blood volume and its clinical measurement; the sort of circumscribed interest eminently suited to an anaesthetist, one might say. Is it typical of the current state of things scientific that this study is of transatlantic origin, or are similar opportunities too rarely sought by British anaesthetists? The first of the two main sections of this book, entitled "Significance of Blood Volume" (69 refs.), begins with an introduction followed by two chapters recapitulating, usefully, some aspects of circulatory physiology; there are, however, too many platitudes such as "Blood, in order to act as a transport system and to fulfil the functions of respiration, nutrition and excretion, must circulate". Then follow short, but more stringent, considerations of normal blood volume and its distribution and regulation. The reader is reminded, for example, that 65-75 per cent of circulating blood volume is contained in the veins, that 10-20 per cent may be held in the lower limbs (which can pool twice this amount) and that an increased blood volume may be associated with hypotension. Under the beading "Classification of Blood Volume" are defined such terms as "Oligocythemic Hyperplasmic Hypovolemia" (treatment=packed red cells), based on the awkward equation "Plasmia+Cythemia=Volemia". A later chapter criticizes the validity of the haematocrit in surgical evaluation (as expected), listing various clinical conditions in which the usual peripheral venous measurement differs more or less from the true "body" haematocrit (the average distribution of red cells to plasma throughout the body). The author points out that in the surgical patient with a haematocrit within the range 30-50 per cent there is a 50 per cent chance that red cell volume is deficient by 20-25 per cent. This, and subsequent chapters relating to the effect of disease
and anaesthesia on blood volume, with some pre- and postoperative indications for its determination, reflect the clinical experience of the author and will agree with the impressions of most anaesthetists—thus, patients with red cell and plasma deficits may be "erroneously labelled as sensitive to depressant drugs". It should be noted that the subject matter of this first section is mostly, and in some cases more extensively, covered in a recent review article by the same author (Anesthesiology, 1963, 24, 231). The greatest potential usefulness of the book is in the second section ("Technology", 56 refs.), particularly if the reader (presumably an anaesthetist) seriously contemplates setting up a technique for blood volume determinations. Herein are supplied sufficient details to give the clinician a starting working knowledge of the theory and technique of blood volume determination as performed by the author—based for greatest reliability on 51 CR tagged red cells. The real impetus is to bring this possibility to the fore—to have blood volume measurements routinely available (but not always used). The cost of the essential Scintillation Counter, EHT supply, and Sealer need not exceed approximately £500 (scarcely more than some ventilators). In the reviewer's opinion, the author makes his point successfully: that blood volume determination should be added to the list of investigations determining fitness for anaesthesia and possible transfusion requirements. This is the line of scientific progress and new knowledge, able, one hopes, to withstand the "clinical" argument that merely to be aware of the possibility of red cell or plasma depletion is to be able to treat the condition successfully. In general, this book maintains the high quality of the "American Lecture Series", although some repeated examples of curious spelling, not readily explained by North American usage, seem to reflect hasty editorial revision. The familiar "abscissa" and "ordinate" are incorrectly used on page 136. The value of the book would be enhanced by a more expanded first section, and by having references within the text rather than merely listed at the end of each main section. Clearly, this work reflects the type of outlet from wholetime anaesthesia which not only adds strength to an anaesthetic department, but is essential if the science of anaesthesia is to have the best recruits. R. A. Millar
Printed in Great Britain by John Sherratt add Son. Park Road. Altrincham
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on July 16, 2015
Most anaesthetists in training discover quickly that "inexplicable" hypotension or tachycardia, related perhaps to induction of light anaesthesia or to subsequent postural change, responds often to blood transfusion, although there has been no blood loss and the patient appears a reasonable surgical risk. Presumably, Dr. Albert's experience of this situation, and the support of the U.S. Atomic Energy Commission, led him to a special study of blood volume and its clinical measurement; the sort of circumscribed interest eminently suited to an anaesthetist, one might say. Is it typical of the current state of things scientific that this study is of transatlantic origin, or are similar opportunities too rarely sought by British anaesthetists? The first of the two main sections of this book, entitled "Significance of Blood Volume" (69 refs.), begins with an introduction followed by two chapters recapitulating, usefully, some aspects of circulatory physiology; there are, however, too many platitudes such as "Blood, in order to act as a transport system and to fulfil the functions of respiration, nutrition and excretion, must circulate". Then follow short, but more stringent, considerations of normal blood volume and its distribution and regulation. The reader is reminded, for example, that 65-75 per cent of circulating blood volume is contained in the veins, that 10-20 per cent may be held in the lower limbs (which can pool twice this amount) and that an increased blood volume may be associated with hypotension. Under the beading "Classification of Blood Volume" are defined such terms as "Oligocythemic Hyperplasmic Hypovolemia" (treatment=packed red cells), based on the awkward equation "Plasmia+Cythemia=Volemia". A later chapter criticizes the validity of the haematocrit in surgical evaluation (as expected), listing various clinical conditions in which the usual peripheral venous measurement differs more or less from the true "body" haematocrit (the average distribution of red cells to plasma throughout the body). The author points out that in the surgical patient with a haematocrit within the range 30-50 per cent there is a 50 per cent chance that red cell volume is deficient by 20-25 per cent. This, and subsequent chapters relating to the effect of disease
and anaesthesia on blood volume, with some pre- and postoperative indications for its determination, reflect the clinical experience of the author and will agree with the impressions of most anaesthetists—thus, patients with red cell and plasma deficits may be "erroneously labelled as sensitive to depressant drugs". It should be noted that the subject matter of this first section is mostly, and in some cases more extensively, covered in a recent review article by the same author (Anesthesiology, 1963, 24, 231). The greatest potential usefulness of the book is in the second section ("Technology", 56 refs.), particularly if the reader (presumably an anaesthetist) seriously contemplates setting up a technique for blood volume determinations. Herein are supplied sufficient details to give the clinician a starting working knowledge of the theory and technique of blood volume determination as performed by the author—based for greatest reliability on 51 CR tagged red cells. The real impetus is to bring this possibility to the fore—to have blood volume measurements routinely available (but not always used). The cost of the essential Scintillation Counter, EHT supply, and Sealer need not exceed approximately £500 (scarcely more than some ventilators). In the reviewer's opinion, the author makes his point successfully: that blood volume determination should be added to the list of investigations determining fitness for anaesthesia and possible transfusion requirements. This is the line of scientific progress and new knowledge, able, one hopes, to withstand the "clinical" argument that merely to be aware of the possibility of red cell or plasma depletion is to be able to treat the condition successfully. In general, this book maintains the high quality of the "American Lecture Series", although some repeated examples of curious spelling, not readily explained by North American usage, seem to reflect hasty editorial revision. The familiar "abscissa" and "ordinate" are incorrectly used on page 136. The value of the book would be enhanced by a more expanded first section, and by having references within the text rather than merely listed at the end of each main section. Clearly, this work reflects the type of outlet from wholetime anaesthesia which not only adds strength to an anaesthetic department, but is essential if the science of anaesthesia is to have the best recruits. R. A. Millar