Blood and blood substitutes for treating hemorragic shock

Blood substitute products for the treatment of hemorrhagic shock are discussed with regard to their composition, physical and therapeutic characteristics, adverse effects, cost, and market availability. Commercially available plasma expanders discussed include blood derivatives (whole blood, packed red blood cells, plasma, normal human serum albumin, and plasma protein fraction), synthetic colloids (dextrans 40 and 70) and a balanced salt solution (lactated Ringer's injection). Plasma substitutes alone are administered until the hematocrit falls below 30% of coagulation difficulties develop. Normal serum albumin 5% and plasma protein fraction 5% are excellent colloidal plasma expanders without the potential hazard of hepatitis. Lactated Ringer's injection is the fluid of choice to replace lost blood up to 10% of the vascular volume.