TRANSFUSION ORGANISATION

34 Some time later-I think it was in the early summer examine the blood while it is undisturbed in the bank. of 1930-I outlined my treatment to the late Prof. The common practice of sending a ’nurse or student for Warrington Yorke (who was looking after our tropical a bottle of blood cannot be too strongly condemned. A cases at Liverpool) and I heard later he had adopted it cross-agglutination test of donor’s cells with patient’s I think as a standard treatment for amoebic dysentery. serum must routinely be performed with macroscopic examination after’ 10 minutes at room temperature. you will agree that, in essentials, the so-called " Liverpool " method differs little from the treatment used in this Blood and plasma should be warmed to 37° C. before Ministry ; and that if any name is to be attached to the administration-serious consequences have often retreatment, it should be that of the Ministry of Pensions, sulted from over-heating. Partly used bottles must in which I have had the honour to serve for many years. never be retained for later use. There has been much uncertainty as to the exact Manson-Bahr and I seem to have obtained exactly similar results from the two methods of combined treatpotentialities of blood and plasma. The danger of’ ment, and I can unreservedly support his claim that, overloading should at all times be stressed. In cases while an odd case here and there has relapsed, we have’ where transfusion is necessary the amount should -be yet to meet a case that has not responded to the treat- judged from the patient’s general condition and bloodment, if it is given with meticulous attention to detail. pressure, and the haematological and biochemical May I also correct the report of my remarks in your estimations, and its effect should similarly be assessed. Careful records of all transfusion data may reveal issue of Dec. 9- ? I am made to say that I had encountered’numbers of intractable cases of amoebiasis. What ,weak features in technique bothat the hospital and the I meant to imply was that I was encountering numbers of central laboratory. The principal causes of reactions cases of amoebiasis which were resistant to emetine. appear to be giving blood too quickly, and " pyrogens." Further, that I had tried a number of drugs to influence- A useful rate, other than for massive haemorrhage, is the concomitant bacterial infection. The only drug that 40 drops per minute, particularly where universal blood I have found of any use in this connexion is penicillin. is being employed. It is unwise for hospitals to reAs to conessine, I mentioned, in reply to a question by sterilise transfusion equipment; reactions have often Sir Harold Scott, that I had tried this alkaloid in a been due to this. number of cases after the last war, but had found it to be Regular contact with the officers of the service enables without any effect whatever. the hospital transfusion officer to obtain advice on technique and procedure and discuss advances in transQueen Mary’s (Roehampton) J. GRAHAM WILLMORE. fusion work. In this way the full implications of the Hospital. Rh factor have been impressed on transfusion officers TRANSFUSION ORGANISATION and arrangements made for typing and securing RhSIR,—During tne war 1 nave nad tne opportunity ot negative blood on special demand from the central studying, in the Midland Region, the working of the station. Investigational and follow-up work on jaundice reactions is also a recent result of this liaison. national transfusion organisation set up bv the Ministry of Health, as applied to many hospitals differing in My experience brings out two prime needs-that at all hospitals a particular officer must be responsible administration and facilities. As a result I feel that for transfusion arrangements ; and that where possible more should be known of the well-regulated control transfusions should be planned procedures. maintained by the service over all transfusion fluids and equipment. HAROLD THWAITE. Birmingham. The only stable transfusion material is dried plasma. MALIGNANT MELANOMA This, effectively sealed, can be stored indefinitely within normal extremes of temperature. In the case of blood, SIR,—When I saw the gruesome illustrations and experience shows a maximum life of 14 days to be alarming title of Miss Tod’s paper I knew that we had desirable. Correctly maintained storage conditions to expect anxious inquiries from’ patients with moles on are imperative. A small refrigerator should be reserved- their skin. The paper attracted the attention of several specifically for blood storage. It is not sufficient to popular newspapers sufficiently for them to publish check the temperature from time to time, for variations warnings of the dangers foretold from these blemishes, are frequent. Refrigerators are therefore supplied with and it is regrettable that at least equal publicity was not a maximum and minimum thermometer which is read given to the just and commendable criticism by J. E. M: and noted at each delivery and collection. At the same Wigley and R. T. Brain (Nov. 25) which contains evidtime a record of the numbers and condition of all unused ence that is less inaccurate and certainly more desirable blood is made ; valuable information is thus afforded to for the public. both user and supplier. Permissible temperature variaMiss Tod’s paper attracted attention with the news tion is +2°C to + 70C. Outside this range a raised that a common blemish could by a common treatment be reaction rate is often encountered, particularly in winter converted’into a malignant condition, horrible in appearwith refrigerators in exposed sites. Sometimes heat is ance and outlook ; yet it did not make any real contrirequired to prevent temporary freezing, resulting in bution to its successful treatment. Though moles are haemolysis of the blood. very common, and malignant melanoma very uncomLiquid plasma, in general use in the early days of the mon, the latter do not all originate in pigmented moles. Ministry of Health"s service, suffers from major dis- The primary focus of malignant melanoma may originate advantages, the principal being the inevitable deteriora- at a site without a pre-existing mole ; it may not show tion with storage. Changes like formation of clots and the pigment ; it may be related by the patient to a small development of granularity are greatly accelerated by wound ; and its appearance may not disturb the patient low and variable temperatures. An ever-present danger or suggest to the surgeon the grave lesion, which calls for is the chance of infection, also occurring with bottles of drastic surgery.I The first indication of its gravity may distilled water used for dried plasma reconstitution. be the appearance, in the subcutaneous tissues some Careful inspection of all bottles monthly against a strong distance from the primary focus, of one or more small dark spots which may resemble tattoo spots in their light is the only satisfactory safeguard. It "is dangerousto attempt to differentiate visibly- between granular "- seemingly harmless character ; for there may be no sterile and infected plasma ; crystal clarity of both elevation of the skin over them, and no sign of reaction liquid plasma and distilled water is the criterion for use. in the tissues around. Yet even at this stage radium or A routine for transfusion of blood at these hospitals X-radiation appears to be useless, even when it is pushed has been established. Grouping of the patient is carried to or beyond the limits of skin tolerance, and surgery of out, using a macroscopic technique with serum of high the boldest does not appear to be any more successful. titre supplied by the central laboratory. The officer I have seen cases in which X-radiation has been the main responsible then withdraws the appropriate bottle of cause of pain and distress. On the other hand, pigmented blood from the bank and observes that the plasmamoles may exhibit very ugly and suspicious appearances, cell junction is clearly demarcated and that there is no may haveshown evidence of much recent growth, and trace of haemolysis. Under no circumstances should may have histological features which suggest malignancy, blood be transfused if.it shows haziness or an ill-defined but may yet be cured by local surgical excision. Even the suggestion that trauma can convert a piglayer. Some bacteria may proliferate even at 4° C, but fortunately haemolysis is always concomitant ; it is mented mole into a malignant melanoma has not been therefore essential that a competent person .should established. A common site for moles is the beard area : .-

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