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Appendix B

Contents

APPENDIX B

Circular Letters, European Theater

The following circular letters, all from the Office of the Chief Surgeon, Services of Supply, Headquarters, European Theater of Operations, U.S. Army, dealt with blood and plasma in the theater.

1942

Letter No. 52, 22 October, subject: Continuation of Blood Banks in American Army Hospitals. This letter authorized the establishment or continuation of hospital blood banks in active cooperation with local medical authorities. Instructions were given for the organization of panels of donors, for the use of British equipment, and for assistance by U.S. Army officers at the weekly bleedings in British Emergency Medical Service centers. When U.S. Army hospitals wanted blood, it would be available to them from Emergency Medical Service sources. This letter was rescinded with the publication of Circular Letter No. 51, 5 April 1943.

Letter No. 58 (Supply No. 11), 27 October, subject: Blood Plasma. This letter contained instructions for the requisitioning of blood plasma in accordance with Circular Letter No. 47 (Supply No. 8), 19 October 1942. Wet plasma could be secured only at Medical Section Depot G-35. Except in "extenuating circumstances," neither type of plasma was to be requisitioned from British sources. This letter was rescinded with the publication of Circular Letter No. 54, paragraph 2, 9 April 1943.

1943

Letter No. 51, 5 April, subject: Arrangements for Blood Banks and Transfusion in U.S. Army Hospitals. This letter has been abstracted in connection with hospital blood banks (p. 473). It was specified in it that, to set up a blood bank, a hospital must have suitable refrigeration.

Letter No. 84, 19 May, subject: Recording of Transfusions with Dried Serum and Prepared Blood Plasma. This letter provided for the details of these procedures to be entered on the field medical card or any other report used in place of the official records. It was rescinded by Circular Letter No. 80, 10 June 1944.

Letter No. 124, 18 August, subject: Allowance of Item No. 16089, Serum, Normal Human Plasma, Dried-Unit Package.

Letter No. 174, 28 November, subject: Schools and Courses of Instruction for Medical Department Personnel in ETO. The general purpose of this letter was to set forth the purpose and scope of American and British schools providing courses of instruction available to Medical Department personnel in the theater. It also established and clarified the procedures to be followed in utilizing these facilities.

Paragraph 4d described the 7-day courses of instruction offered at the British Army Blood Supply Depot School for medical officers at the Southmead Hospital, Bristol, Gloucester. The courses included the principles and technique of bleeding, processing, storage, refrigeration, and shipping of whole blood, together with the clinical aspects of shock and of whole blood transfusions. Opening dates and allotments for the courses were announced periodically to the major commands and base sections by Headquarters, Services of Supply.


814

1944

Letter No. 71, 15 May, subject: Principles of Surgical Management in the Care of Battle Casualties. Paragraph 3 of this letter dealt with the ratio of blood to plasma, procurement of blood within the unit, procurement of blood from the European theater blood bank, and its handling and storage after procurement.

Letter No. 80, 10 June, subject: Policies and Procedures Governing Care of Patients in ETO. Paragraph 1 of Section III, "Administrative Directives Pertaining to Professional Care," dealt with blood transfusion in general and station hospitals. The subjects covered included facilities, donors, equipment, storage of blood, technique of collecting and administering blood, laboratory controls, cleaning of sets, records, and filters. This circular letter also dealt with plasma therapy.

Letter No. 131, 8 November, subject: Care of Battle Casualties. Paragraph 6 of this circular letter dealt with whole blood transfusions and covered the sources of blood (from the Zone of Interior and the European theater blood bank), indications for transfusion, ratio of plasma and blood, and a warning that vasoconstriction might explain an initially normal blood pressure reading in a patient who was in need of blood.

Administrative Memorandum No. 150, Office of the Chief Surgeon, European Theater of Operations, U.S. Army, 27 November. This memorandum dealt with transfusion reactions and their management. Instructions were also given in it for weekly reports on the total blood used in each hospital, the total number of reactions, and the details of each reaction. These details were to include the source and age of the blood; the source of the set; the type of reaction; the amount of blood given before the reaction occurred; and the management of the reaction, with the results of therapy.

1945

Letter No. 23, 17 March, subject: Care of Battle Casualties. Paragraph 1 of this circular letter described the technique of a test for differentiating between pyrogenic and hemolytic transfusion reactions. It also described alkalinization in lower nephron nephrosis and deaths after transfusion.

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