The control of bleeding episodes in haemophilia and the prevention of excessive haemorrhage after surgical procedures depend chiefly on raising the patient's plasma factor VIII concentration to an appropriate haemostatic level, and maintaining this so long as the likelihood of bleeding continues. With whole plasma it is impossible to achieve levels much above 25%, or to maintain values constantly above about 10 % for more than two or three days, without overloading the patient's circulation. In (Pool and Shannon, 1965) Approximately 500 ml. of blood was taken from each donor into a double pack (Fenwal JD-2) by a clean venepuncture. Continuous gentle agitation ensured thorough mixing of the blood and the acid-citrate-dextrose anticoagulant throughout the bleeding. At the end of the blood donation 5 ml. of wellmixed blood was run back out of the pack for factor VIII assay. The blood pack and assay sample were then rapidly cooled to 2-4' C. in a water-bath containing melting crushed ice, and kept at this temperature until they could be transferred to a precooled centrifuge at 40 C. The pack was then centrifuged for 30 minutes at 1,600 g to obtain the maximum yield of platelet-poor plasma, while the assay sample was centrifuged and assayed immediately for factor VIII.Not more than 280 ml. of plasma, free of red cells and buffy coat, was transferred to the 300-ml. satellite pack, which was placed in a cardboard carton and immersed in a mixture of solid CO2 and ethanol at about -70°C. in a large vacuum flask, leaving the attached main blood pack on the bench beside it. The plasma was allowed to remain in the freezing mixture for at least 10 minutes, and then both packs, still joined Rapid MethodBlood was taken into 500-ml. single packs (Fenwal JA-2C), which were handled and centrifuged as in the slow method, described above, to obtain platelet-poor plasma. As much plasma as possible (260-340 ml.) was then transferred to a 600-ml. transfer pack (Fenwal TA-1), which was flattened between two sheets of copper mesh and frozen at about -700 C.In this way, plasma froze as a thin slab more rapidly than in the 300-ml. transfer pack used in the slow method.The plasma was allowed to remain in the freezing mixture for six minutes, and was then transferred to a water-bath at 6-80 C. As soon as the outer layer of plasma began to thaw, the pack was gently kneaded to enable thawing to continue as evenly and rapidly as possible throughout the pack. This process ensured complete thawing of the plasma within 90 minutes. The pack was then centrifuged at 1,600 g for 15 to 20 minutes, and the supernatant plasma removed, leaving 5-15 ml. in the pack with the cryoprecipitate. As double-pack units with attached 600-ml. transfer packs were not available, this was not a closed system and so the plasma was not returned to the red cells.If not used immediately the cryoprecipitate was snap-frozen at -700 C. before storing at -30°C. until use. Administration of ConcentrateAll concentrates were administered intravenously by syringe within ha...

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It is our opinion that only isotonic solutions should be utilized for epidural injections and that hypo-or hypertonic ones should be avoided. Prevention is always better than any cure. References 1. Cohn AI, Levesque PR. Saline versus water for epidural injection [letter]. 2. Miguel R, Morse S, Murtagh FR. Pain upon injection in the epidural space. 3. Mondadori E. Anestesia extradural, tese. Rio de Janeiro: Jornal do 4. Lund PC. Peridural analgesia and anesthesia. Springfield, 1 L Charles C

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