SCIENTIFIC - MEDICINE, BLOOD TRANSFUSION

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP80-00809A000700230211-0
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 4
• Document Creation Date: December 22, 2016
• Document Release Date: July 12, 2011
• Sequence Number: 211
• Publication Date: July 15, 1955
• Content Type: REPORT

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STAT
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STAT
INFRA-CSSAL TRANSFUSION OF BLOOD AND MEDICINAL LIQUID
Sovetskaya Meditsina, Vol 17, No 9 Ye. N. Kalinovskaya
Moscow, Sep 1953 Candidate of Medical Sciences
Second Surgical Clinic
Institute imeni Sklifosovskiy
In the treatment of anemia produced by a severe hemorrhage, or by a chronic
infection, in which the poorly developed subcutaneous veins have collapsed, a
blood transfusion frequently becomes impossible. Recently, articles have ap-
peared which describe the transfusion of blood and medicinal liquids into the
spongy tissue of bones.
In 1927, Arinkin performed the first intro-ossal puncture to obtain bone
marrow. The first intra-ossal blood transfusion was performed by I. A. Kessir-
skiy in 1942 for the purpose of treating pellagral exsiccosis. He transfused
blood into the sternum at the rate of 100 ml per hour.
An experimental check by Yelizarovskiy and Leont'ev showed that liquids
injected into the spongy tissue of a bone penetrates into a zone thickly in-
terlaced with veins. Here in the cells of the spongy matter are found the
funnel-shaped distended venous capillaries, the so-called sinuses, from which
blood flows into the venous system of the organism. In this case both authors
make the same interesting observation to the effect that when a dyestuff is
introduced into the veins of a cadaver it appears first in the bone marrow,
and then in the venous system, leaving the lymphatic channels free of dyestuff.
Clinical tests of the speed of action of substances introduced intra-
ossally showed that it was equal to the speed of action of substances intro-
duced intravenously. The speed of action depends primarily on the successful
penetration of the needle into the red bone marrow.
Barring any technical mishaps, failure of a bone marrow puncture usually
occurs when the needle penetrates the yellow bone marrow. This type of bone
marrow is rich in fats but not in capillaries. The sternal method of blood
transfusion never gained popularity. This can be attributed to the publica-
tion in world literature of articles describing over 20 cases in which there
were lethal outcomes caused by injuries to organs of the mediastinum during
sternal puncture.
There are numerous other locations in the human skeleton suitable for
intro-ossal transfusion. Frayman advocated the internal surface of the upper
metaphysis of the tibia. Pytel' proposed to inject blood into the crest of
the ilium. Faktorovich proposed the heel bone, and the condyles of the hip.
Gromova suggested the seventh and eighth rib. Levantovskiy suggested the
external ankle bone, and Verkhratskiy the pubic bone. Shklyayev, who per-
formed the largest number of intra-ossal blood and blood substitute trans-
fusions (96 cases) into the heel bone, points out the extreme pain caused
by this procedure. He notes that the pain is not relieved by novocain in-
jections. A transfusion into the heel bone (calcaneus) has to be performed
under pressure, while blood flows into the ilium and tibia by gravity.
The rate of flow (drip method) varies from 12 to 120 drops per minute.
Almost all the authors agree on an average figure of 100 ml per hour.
In intra-ossal transfusions, blood substitutes may be used as well as
blood.
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The intra-ossal transfusion technique has also been rased to administer
anesthetics. The indications for intra-ossal anesthesia and the length of
time it takes for the patient to fall asleep are the same as for the in-
travenous method. The duration of the anesthesia varies from 9 minutes to
1 1/2 hours (Ryzhikov).
The intra-ossal .iethod is also used in urography. Leont'ev introduced
indigo carmine into the sternum. According to Pytel', methylene blue intro-
duced into the crest of the ilium appears in the bladder in 3-4 minutes.
According to the data of Soviet authors, no complications have been
observed during intra-ossal transfusions.
Authors who have worked on the perfection of a method for intra-ossal
transfusion are of the opinion that a special needle with an opening c-i the
side of its shaft, and a mandrin precisely adjusted to the diameter of the
needle, should be used for this procedure.
Some author, (Kassirskiy) Leont'yev) suggested that a movable shield
be put on the needle so that the sternum could be punctured to the exact
depth required to reach the spongy matter. Other authors consider the
reedles of Bier, Rccurd, and Dyufo [Dufeaux ?J as adequate.
In ir.t;?u_; e. ul transfusion into the heel. bone, the needle i. introduced
into the lower surface of the bone, within the area of it: middie third
(Saklyayev). In a ,nncture of the tibia, the needle nhoulu b, introduced
along the internal surface of the upper metaphysic, where sections of the bone
marrow are most accessible. In a puncture of the ilium the needle ie intro-
duced 2 cm from the crest do;rn and towards the back of the bc-!,I.
In all cares of infra-ossal transfusion the epidermis, the -ul.utaneous
cellular tissues, and the reriosteum should be locally anosthesizej b;' a
:.olution of novocain, prier to the puncture.
We admix i?tered a total of 52 intra-ossul transfusions to 25 patients.
The indirrations for thin procedure acre in alt cases: It colla-cr of sub-
cutaneous veins oauLed b, n _rolonged severe infection, the ear?u^tioe of a
patient due to cicatrical cnt.tractfon of the esophabus, or bur> on the
extremities.
Donor's blood, erythrocyte suspension ;';,-r ? b
a,d rirecleo ncr.-
specific serum were used in hhe transfusions. ;iueoce sod ce aci111n were
used in 12 cases. The amount of transfused liqui6 eric,' from 100 to 1,200
ml. One hundred i:illiliterc were transfused in case; where the transfusion
subsequently had to he discontinued owing to a lack of cucces (in carrying
f?: out) or to the slow nerctration of infrequent dro_rs of blood.
Trur, fusf--in :er,+ nadc into variuur, imce.. Ir. all ca:
war rerformed cn'^ t i.CO=cdure
_r local novecair, r_m~st;h.. 'c..
The needla ?,;?u ,cod by Leont'yev wan u^.,d at r;..,.. .
irj'e o needles, tip of which had been filed off, an,, a is 'r' n st..,,jrd
otl;; aJj,.lme
tiller four were used. The transfusions were performed b: ienr; of two airl c ;;ome_
tines fneedles.
Five transfusions ':ere made irao tho t?. rots.:, 1` ;,?;? the = _iu,.t, 20 into
the metaphysic of the tibia, and nine into the heel-
eel bore, 'he -.,?iruc drip
rate was 40 drops per minute., aid the maximum 120-16C dre: per minute.
Transfusions into the heel bone were discontinued sirce the netod was
found to he too painful.
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There were no complications due to intra-ossal transfusions.
Failure was observed in only three cases when acutely ill patients were
admit,;ed to the institute too late, and died as a result of exhaustion caused
by eicatricial obstructions of the esophagus.
Histological examinations of the bones in these cases (Prof A. V. Rysakov)
revaaled marked changes in the structure of the spongy matter of the bones.
These changes probably occurred as a result of severe and prolonged illness, and
prevented the entrance of blood and liquids into the blood stream.
Conclusions
1. The intra-ossal transfusion of blood and medicinal liquids can be
recommended as one method of assisting a patient suffering from a severe hemorr-
hage, from anemia due to a prolonged purulent infection, or from extens
on the extremities. extensive burns
2. An intra-ossal transfusion is a simple procedure, easily performed by
any Practicing physician regardless of his particular field of specialization.
3. Punctures of the sternum are not recommended in the beginning. In order
to acquire the feclin of "striking" the spongy tissue of the bone, punctures
of the ilium or the tibia should be made using standard method. A transfusion
into the heel bones is to be avoided because of the pain inflicted on the patient.
4. In order to insure the complete success of an intra-ossal transfusion,
the needles used should be appropriate. The end of the needle should be ground
at an angle no greater than 60-700. The mandrin should fit exactly.
STAT
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