“Although special technics to reduce bleeding and operative risk have been employed by others, such as induced hypothermia, deliberately induced hypotension, use of colloid blood expanders, and so on, we have not resorted to such measures. The surgical attack has been that of a most meticulous operative technic with emphasis on sparing every milliliter of blood possible and replacement of blood loss with simple crystalloid solution, namely, lactated Ringer’s solution. The results have been most satisfactory.

“It is gratifying, moreover, not to have to be concerned about such complications of whole-blood transfusion as allergic or hemolytic reactions, renal shutdown, and hepatitis.”

What specific “formula” do these doctors use to replace the blood lost before or during surgery? They say:

“Our own method in caring for these patients has been that of employing only lactated Ringer’s solution for blood replacement. No specific formula is employed, but we generally use three times the volume of this fluid over the sustained blood loss. . . .

“Although isotonic dextrose solution and isotonic saline solution are widely used, a ‘balanced’ formulation is better​—Ringer’s solution contains potassium and calcium in addition to sodium and chloride. It must be noted that the calcium and potassium are present only in ‘physiologic’ concentration and this preparation is not designed for replacing deficits of these ions.

“‘Improved’ Ringer’s solution contains sodium lactate. The customary Ringer’s solution has a slight acidifying effect; the lactated Ringer’s tends to overcome this acidifying influence and is therefore the preferred crystalloid solution for intravenous administration.”

Another practice that has proved very useful has to do with building up the patient’s blood well before, when time permits, and also after surgery. Various nutrients are given to the patient, such as iron, vitamins and amino acids. In this way, although there may be blood loss during surgery, the remaining blood will be better able to carry the load. The nutrients will also help the body to replace lost blood. One doctor who uses this adjunct to the actual operation stated: “It is amazing how fast patients come around” in response to the buildup.