Pulmonary structural changes following microembolism and blood transfusion. A light and electron microscopic study.

Blood stored under standard blood band conditions develops microaggregates of platelets and leukocytes. Dog lungs were studied by light and electron microscopy at intervals from 48 hours to six days following exchange transfusions of sublethal volumes of such microaggregate-rich blood through either standard or Dacron wool (Swank) transfusion filters. After transfusion through standard filters, the pulmonary microvasculature was extensively occluded by microemboli. Swelling of capillary endothelial cells, interstitial and alveolar edema, and hypoxic changes in types I and II alveolar epithelial cells were noted. Changes then progressively resolved. These detrimental changes were prevented when microaggregates were removed by Dacron wool (Swank) filters. Mechanical occlusion of the pulmonary vasculature probably plays a minor role in initiating the structural changes observed. Release of lysosomes from disintegrating microaggregates is believed to be the significant factor initiating a chain of events leading to progressive pulmonary damage.