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 inAmerican Army Hospitals. This letter authorized the establishment orcontinuation of hospital blood banks in active cooperation with local medicalauthorities. Instructions were given for the organization of panels of donors,for the use of British equipment, and for assistance by U.S. Army officers atthe weekly bleedings in British Emergency Medical Service centers. When U.S.Army hospitals wanted blood, it would be available to them from EmergencyMedical Service sources. This letter was rescinded with the publication ofCircular Letter No. 51, 5 April 1943.
Letter No. 58 (Supply No. 11), 27 October, subject: Blood Plasma. This lettercontained instructions for the requisitioning of blood plasma in accordance withCircular Letter No. 47 (Supply No. 8), 19 October 1942. Wet plasma could besecured only at Medical Section Depot G-35. Except in "extenuatingcircumstances," neither type of plasma was to be requisitioned from Britishsources. This letter was rescinded with the publication of Circular Letter No.54, paragraph 2, 9 April 1943.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 andTransfusion in U.S. Army Hospitals. This letter has been abstracted inconnection with hospital blood banks (p. 473). It was specified in it that, toset up a blood bank, a hospital must have suitable refrigeration.
Letter No. 84, 19 May, subject: Recording of Transfusions with Dried Serumand Prepared Blood Plasma. This letter provided for the details of theseprocedures to be entered on the field medical card or any other report used inplace of the official records. It was rescinded by Circular Letter No. 80, 10June 1944.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 forMedical Department Personnel in ETO. The general purpose of this letter was toset forth the purpose and scope of American and British schools providingcourses of instruction available to Medical Department personnel in the theater.It also established and clarified the procedures to be followed in utilizingthese facilities.
Paragraph 4d described the 7-day courses of instruction offered at theBritish Army Blood Supply Depot School for medical officers at the SouthmeadHospital, Bristol, Gloucester. The courses included the principles and techniqueof 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 themajor commands and base sections by Headquarters, Services of Supply.
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1944
Letter No. 71, 15 May, subject: Principles of Surgical Management in theCare of Battle Casualties. Paragraph 3 of this letter dealt with the ratio ofblood to plasma, procurement of blood within the unit, procurement of blood fromthe European theater blood bank, and its handling and storage after procurement.
Letter No. 80, 10 June, subject: Policies and Procedures Governing Care ofPatients in ETO. Paragraph 1 of Section III, "Administrative DirectivesPertaining to Professional Care," dealt with blood transfusion in generaland 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 circularletter also dealt with plasma therapy.
Letter No. 131, 8 November, subject: Care of Battle Casualties. Paragraph 6of this circular letter dealt with whole blood transfusions and covered thesources of blood (from the Zone of Interior and the European theater bloodbank), indications for transfusion, ratio of plasma and blood, and a warningthat vasoconstriction might explain an initially normal blood pressure readingin 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 ofthis circular letter described the technique of a test for differentiatingbetween pyrogenic and hemolytic transfusion reactions. It also describedalkalinization in lower nephron nephrosis and deaths after transfusion.
