The anemia of trauma.

By ELIZABETH TOPLEY AND RUSCOE CLARKE K EITH’2 in 1919 reported the plasma volume and hematocrit of a few battle casualties, and showed that primary hemorrhage was the main factor underlyinsg their subsequent anensia. Observations by Granst and Reeve,” Dacie amid Honser,6 Vaughani,’7 Crosby ansd Howard4 and others have defined the position in greater detail especially ins war insjuries: but consfusion still exists on the relative contribution of differemit factors to the anemia of trauma. This confusion is partly due to mistrust of the reliability of plasnia volume estimates on which the evidensce of earlier workers had to be based, and partly to lack of precise data on the importamice of factors other thans primary blood loss-such as a later increased destructions of red cells (Crosby amid Howard,4 Editorial8), impaired hemoglobini synthesis (Vaughant7) or changes ins plasma volume. Many patients with moderate imsjuries have developed clinical sepsis which itself is responsible for a further fall in red cell volume amid hemoglobin level. This paper is an attempt to define more precisely the relative importamice of differemit factors ins the anemia of trauma. It reports the sequensce of hernatologic findings following civilian traumisa ins patiemsts whose red cell volumes at the end of primary treatnsent varied widely both above and below normal. In 20 patiensts three or more red cell amid plasma volume estimates were carried out at varying periods after inijury. Oms these and 37 other patients repeated observations were made of the hemoglobins, red cell count, reticulocyte count and transsfused cell count.