Shock-Like State Due to Transfusion of Blood Contaminated With Gram-Negative Bacilli

WHEN GREAT numbers of certain gram-negative bacilli enter the circulating blood their endotoxin produces hypotension. If the amount or potency of endotoxin is not too great, the hypotension is only moderate and temporary. Treatment with extracts of Pseudomonas aeruginosa in essential hypertension is based on the mild hypotensive effects of endotoxin which has been carefully standardized for clinical use.1Under other conditions endotoxin in the circulating blood may produce an irreversible and severe hypotension leading to a fatal shock-like state. One of the most dramatic causes of this shock-like state is transfusion of blood contaminated by bacteria. Borden and Hall2have recently presented an excellent account of the syndrome arising from the transfusion of contaminated blood. They reported two fatal cases and reviewed the eight additional cases in the literature. The reactions in these cases were all characterized by the transfusion of blood containing Gram-negative bacilli, by peripheral