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The Absorption and Survival of Red Blood Cells Labelled with Chromium51 from the Peritoneal Cavity in Man
Abstract
This is a study of the rate of absorption and period of survival of tagged red blood cells introduced into the peritoneal cavity. The investigation was carried out on to healthy adult males, and the red cells were introduced in the course of operations for inguinal hernia.
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1. It is possible in mixtures of corpuscles of different groups to separate the corpuscles practically quantitatively by treating with a serum that agglutinates the corpuscles of one kind, leaving the others unagglutinated. 2. After a recipient has been transfused with blood of a group other than his own, specimens of his blood treated with a serum that will agglutinate his own corpuscles but not the transfused corpuscles show unagglutinated corpuscles in large numbers. 3. These unagglutinated corpuscles which appear in the recipien's blood after such a transfusion are the transfused corpuscles and their count is a quantitative indicator of the amount of transfused blood still in the recipient's circulation. 4. The life of the transfused corpuscle is long; it has been found to extend for 30 days and more. The beneficial results of transfusion are without doubt not due primarily to a stimulating effect on the bone marrow, but, it is reasonable to assume, to the functioning of the transfused blood corpuscles.
Intraperitoneal injection of red cells tagged with radioiron into dogs with experimental ascites demonstrated that such cells were rapidly transferred into the circulating blood.
When the experimental animals were not actively producing ascitic fluid, 43.4, 67.0, and 56.4 per cent respectively, of the administered radioactive red cells passed to the blood in 72 hours. In the same three dogs during active ascitic fluid formation, 25.9, 51.2, and 38.8 per cent of the administered radioactivity was removed in a similar period.
The amount of radioactivity in the blood stream, consequent on the passage of red cells from the peritoneal cavity into the circulation, becomes nearly constant in 48 hours, whereas for radioactive plasma proteins the plateau is attained in 24 hours (Fig. 1).
In normal dogs (16), the passage of red cells from the peritoneal cavity was complete in 72 hours, while in ascitic dogs, 5 to 47 per cent of the injected tagged red cells remained behind in the peritoneum after the same period.
Cr51 erythrocyte survival times are reported in a group of patients with a variety of abnormal hemoglobin syndromes. Marked decreases in survival time are demonstrated in pure sickle cell anemia. Shortened survival times are reported in one case each of hemoglobin C disease and sickle cell-hemoglobin C disease with compensated hemolysis. Normal survival times are reported in sickle cell trait and hemoglobin C trait.
Red cell life span as measured by the Cr51 technic agrees well with most published reports of survival times in these disorders in cases performed with the Ashby technic. The Cr51 method appears to be as useful in measuring the survival of erythrocytes containing abnormal hemoglobins as it has been shown to be in other hemolytic disorders as well as in normals. Its decided advantages are its simplicity, adaptability, and reliability.
The therapeutic value of blood transfusion in a wide variety of clinical conditions is constantly being more appreciated. In the treatment of anemia, in septicemia and toxemia, in certain nutritional states and in many types of both acute and chronic infection, the value of blood from a suitable donor has been definitely established.
As these conditions affect infants and young children, the benefits of blood transfusion seem to be especially marked.
Unfortunately, the technical difficulties involved in the intravenous administration of blood to infants are so great as practically to limit its frequent use to well equipped hospitals with specially trained staffs, and are such as to preclude its use by the average practitioner. Even under the best of circumstances in hospitals and with the most experienced operators, it is not at all unusual to encounter difficulty in entering a child's vein, especially when it is desirable to do so
Blood transfusion in infants and children is a recognized therapeutic procedure. In the past, the site of transfusion has been limited to the superior longitudinal sinus in the region of the anterior fontanel, or to the direct exposure of some vein, preferably in the elbow.
The anterior fontanel route, popularized by Helmholz¹ in 1915, affords an excellent method in infants in whom this structure is accessible. This approach, however, has its limitations. Fischer,² Lowenburg,³ Unger,⁴ and others, have pointed out the dangers inherent in puncturing the superior longitudinal sinus.
In older infants, those more than 18 months of age, the fontanel is not usually patent, and the only other procedure remaining is the exposure of a vein and the injection of the donor's blood. We need not go into a discussion concerning the technical considerations involved in this method. It is conceded that the number of
In a previous paper¹ an attempt was made to show, by means of experimental data that the intraperitoneal transfusion of freshly citrated blood is a method of distinct value. It was found that it was a safe procedure, simple in its application and clinically effective. It was proposed as a therapeutic procedure of merit in selected cases. It is the purpose of the present paper to report in some detail five cases in which the intraperitoneal route for blood transfusion was utilized.
REVIEW OF LITERATURE The intraperitoneal injection of defibrinated blood was first used clinically by Ponfick² in 1875. Isolated cases have been reported by Golgi and Raggi,³ Magniagalli,⁴ Scottini,⁵ Giovanni,⁶ von Kaczorowski,⁷ Liegl⁸ and Burresi.⁹Careful observations and laboratory data were not given in any of the cases cited. In all instances, defibrinated blood was used. The results obtained were
The absorption of red cells from the normal peritoneum of the dog can be demonstrated by means of red cells labeled with radio-iron incorporated in the hemoglobin of these red cells. Absorption in normal dogs runs from 20 to 100 per cent of the amount given within 24 hours. Dogs rendered anemic by bleeding absorb red cells a little less rapidly-ranging from 5 to 80 per cent of the injected red cells. Doubly depleted dogs (anemic and hypoproteinemic) absorb even less in the three experiments recorded. This peritoneal absorption varies widely in different dogs and even in the same dog at different times. We do not know the factors responsible for these variations but there is no question about active peritoneal absorption. The intact red cells pass readily from the peritoneal cavity into lymph spaces in diaphragm and other areas of the peritoneum. The red cells move along the lymphatics and through the lymph glands with little or no phagocytosis and eventually into the large veins through the thoracic ducts.
Immunology and Cell Biology focuses on the general functioning of the immune system in its broadest sense, with a particular emphasis on its cell biology. Areas that are covered include but are not limited to: Cellular immunology, Innate and adaptive immunity, Immune responses to pathogens,Tumour immunology,Immunopathology, Immunotherapy, Immunogenetics, Immunological studies in humans and model organisms (including mouse, rat, Drosophila etc)
The absorption of particles from the peritoneal cavity by the terminal lymphatics, or lacunes, of the rabbit's diaphragm has been studied with the light and electron microscopes. Absorption occurs predominantly through those parts of the peritoneal surface of the diaphragm which overlie the lymphatic lacunes. These parts are referred to as the lacunar roofs.
The mesothelial cells of the roofs have features which distinguish them from mesothelial cells elsewhere on the peritoneal surface of the diaphragm. The cells are more closely set, stain more darkly, and separate from each other more readily, particularly at the base of the intercellular junctions. They are supported by a lattice of coarse and fine fibres. In the meshes of this lattice mesothelial and lymphatic endothelial cells are separated only by the basement membrane of the mesothelium which in places may be incomplete.
Erythrocytes pass through the roof into the lumen of the lacune through gaps which are formed by separation of the mesothelial cells and of the endothelial cells at the intercellular junctions. Particles of India ink and colloidal particles of thorium dioxide and saccharated iron oxide enter the intercellular spaces of the mesothelium and spread freely within the meshes of the fibre lattice. These particles appear to pass through the mesothelium by a predominantly extracellular pathway and probably enter the lymphatic lumen through temporary channels which are formed by separation of endothelial cells at the intercellular junctions.
Absorbed colloidal particles accumulate in the cytoplasm of mesothelial and lymphatic endothelial cells in the roofs and a proportion of absorbed material may be transported intracellularly through these two layers in cytoplasmic vesicles. Lymphatic endothelial cells at other sites in the diaphragm can take up colloidal particles from the lumen of the lymphatics.
1. The deviation from a rectilinear form of the complex curvilinear curves of erythrocyte decay produced by the in vitro tagging of the cells with Na2Cr51O4 is not a result of the in vitro tagging procedure per se.
2. Human erythrocytes can be tagged its vivo with Na2Cr51O4. One can determine the in vivo survival of such cells if the gamma detecting unit is sufficiently sensitive and the amount of radiochromium used is sufficient. Such decay curves are similar to those produced by the in vitro Cr51 tagging method.
3. The in vivo method permits a study of the life span of erythrocytes in patients who have a very active cold agglutinin or in whom the cells are easily hemolyzed by mechanical trauma.
In preparation for the present study, arc spectrography 3 was used to demonstrate the presence of trace amounts of chromium in human tissues, including the blood. Tissue analyses were performed on samples of normal human blood by means of a colorimetric method (2) with the finding of mean values of 20 y % for packed red cells and 14 y % for plasma. The present report is concerned with a new biological tracer, radioactive chromium (Cr51), which is bound by the red cells and plasma proteins. Both anionic hexavalent (Na2Cr51O4) and cationic trivalent (Cr51Cl3) states of the element have been studied.
The Use of Isotope Chromium 51 as a Label for Red Blood Cells
- MOLLISON
Interpretation of Chromium 51 Survival Curves
- HUGHES-JONES
The Use of Chromium 51 as an Erythrocyte Tagging Agent for the Determination of Red Blood Cell Survival in Vivo
- EBOUGH F. G.