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To the Editor:—
It was distressing to read the article "Circulating Blood Volume Changes Incident to Major Orthopedic Surgery," by Powers and Hensley, in The Journal, Feb. 7, page 545. The major assumptions made in the article are that (1) any fluid administered into the vascular space remains there as is, in total; (2) iodinated albumin remains in the space to be measured, without leaving the circulation, for about 10 minutes; (3) no compensatory mechanisms are in progress during the surgical and anesthetic procedure, as well as during the mixing period; and (4) technically, a ±6% accuracy is obtainable in vivo.None of these assumptions hold true when an intravascular volume is measured with plasmabound elements. Phenomena of hemodilution and loss of fluid from the intravascular space are constantly in operation and are reflected in plasma volume changes. Whole blood and salt or glucose infusion have varying effects on the
Albert SN. CIRCULATING BLOOD VOLUME CHANGES. JAMA. 1959;170(1):108. doi:10.1001/jama.1959.03010010110019
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