In modern medicine, the blood group procedure is still quite often used - this is the process of its implementation from a healthy donor to a patient with health disorders (recipient). It requires certain rules to be followed, and it is not without complications. Therefore, this operation is carried out with the utmost concentration of attention on the part of medical personnel.
What is needed at the very beginning?
Before starting the transfusion procedure, the doctor will conduct a survey and the necessary studies. The donor or recipient needs to have a passport with him in order to correctly record all the data. If available, a medical specialist will examine the patient or donor, measure the blood pressure and identify possible contraindications.
Transfusion rules
Blood transfusion by blood group is carried out taking into account certain fundamentals. Indications for manipulation, the required dose of the transfused fluid are prescribed by a medical specialist on the basis of clinical data and tests performed. The rules for blood transfusion by group are created for the safety of both the donor and the recipient. The specialist must, regardless of the previously received examinations, personally do the following:
- Find out the group on the AVO system and compare the data with the available readings.
- Find out the characteristics of erythrocytes, both donor and recipient.
- Test for general compatibility.
- Conduct a bioassay.
The process of determining blood affiliation
An important point of transfusion is to determine the identity of the biological fluid and the presence of infections in it. To do this, a blood sample is taken for a general analysis, the amount obtained is divided into two parts and sent for research. In the laboratory, the first will be checked for infections, the amount of hemoglobin, etc. The second is used to determine the blood group and its Rh factor.
Blood types
Blood transfusion by blood group is necessary so that the erythrocytes do not stick together in the patient's body due to the agglutination reaction when the test sample arrives. According to the ABO classification system, the blood groups of the human body are divided into 4 main types. According to the ABO classification, the separation occurs due to the presence of specific antigens - A and B. Each of them is bound to a specific agglutinin: A is bound to α and B to β, respectively. Depending on the combination of these components, the well-known blood groups are formed. The combination of the same components is impossible, otherwise the body will stick together erythrocytes, and it simply will not be able to continue to exist. Due to this, only four known combinations are possible:
- Group 1: no antigens, there are two agglutinins α and β.
- Group 2: antigen A and agglutinin β.
- Group 3: antigen B and agglutinin α.
- Group 4: there are no agglutinins, there are antigens A and B.
Group compatibility
Blood compatibility by transfusion group plays an important role in the operation. In medical practice, transfusion is performed only of the same species compatible with each other. Many people wonder about which blood group they have, but do not understand the process itself. And yet there are also such suitable components. What is a question that has an unambiguous answer. People with the first blood group, due to the absence of antigens, are universal donors, and those with the fourth are considered. The blood group compatibility table serves to understand the blood transfusion process.
Blood type | Who can transfuse (Donor) | Who can be transfused (recipient) |
All groups |
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1 and 2 groups | 2 and 4 groups |
|
1 and 3 groups | 3 and 4 groups |
|
All groups |
Despite the fact that in the modern world there are many ways to treat various diseases, it is still not possible to avoid the transfusion process. The blood group compatibility chart helps medical professionals to carry out the operation correctly, which helps to preserve the life and health of the patient. The ideal transfusion option will always be the use of blood identical in both group and rhesus. But there are times when transfusion is vital to carry out as soon as possible, then universal donors and recipients come to the rescue.
Rhesus factor
During scientific research in 1940, an antigen was found in the blood of a macaque, which later received the name Rh factor. It is hereditary and racial. Those people who have this antigen in their blood are Rh-positive, and in its absence, Rh-negative.
Transfusion Compatibility:
- Rh negative is suitable for transfusion to people with Rh negative;
- Rh positive is compatible with any rhesus blood.
If you use Rh-positive blood for a patient with Rh-negative category, then special anti-Rh-agglutinins will be developed in his blood, and with another manipulation, erythrocytes will stick together. Accordingly, such a transfusion cannot be performed.
Any transfusion is stress for the human body. Whole blood is transfused only if the loss of this biological fluid reaches 25% or more. If less volume is lost, blood substitutes are used. In other cases, transfusion of certain components is indicated, for example, only red blood cells, depending on the type of lesion.
Sample methods
To test for compatibility, the selected serum of the recipient is mixed with the sample from the donor on a sheet of white paper, tilting it in different directions. After five minutes, the results are compared, if the adhesion of erythrocytes has not occurred, the donor and recipient are compatible.
- The donor's erythrocytes, purified with saline, are loaded into a clean test tube, the mass is diluted with a warm gelatin solution and two drops of the recipient's serum. Place the mixture in a water bath for 10 minutes. After this time, it is diluted with saline in the amount of 7 milliliters and mixed thoroughly. If erythrocyte adhesion is not registered, the donor and recipient are compatible.
- In a centrifuge tube, 2 drops of the recipient's serum, 1 drop of polyglucin and 1 drop of the donor's blood are dripped. The tube is placed in a centrifuge for 5 minutes. Then, dilute the mixture with 5 ml of saline, place the tube at a 90 ° angle and check for compatibility. In the absence of adhesion and discoloration, the donor and recipient are compatible.
Bioassay
To remove the risk of complications, a bioassay is performed. For this, a small amount of blood is transfused to the recipient, and his health is monitored for three minutes. In the absence of negative manifestations: an increase in heart rate, respiratory failure, the manipulation is repeated two more times, carefully following the patient. Transfusion can be carried out only when not a single negative manifestation was found, otherwise the operation is not performed.
Methodology
After carrying out all the necessary manipulations to determine the blood group and compatibility, the transfusion itself begins. The injected blood should not be cold, only room temperature is allowed. If the operation is urgent, then the blood is heated in a water bath. The transfusion process is carried out drip using the system, or directly using a syringe. The rate of administration is 50 drops in 60 seconds. During the transfusion, medical specialists measure the patient's pulse and blood pressure every 15 minutes. After the manipulation, the patient is shown rest and medical observation.
Necessity and contraindications
Many people associate blood transfusion with a simple drip of drugs. But this is a complex process in which foreign living cells enter the patient's body. And even with perfectly matched compatibility, there is a risk that the blood may not take root. That is why it is extremely important for doctors to determine that such a procedure cannot be dispensed with. The prescribing specialist must be firmly convinced that other treatments will not be effective. If there is any doubt that the transfusion will be beneficial, it is best not to carry it out.
Consequences of incompatibility
If the compatibility of blood transfusion and blood substitutes was not complete, the recipient may develop negative consequences from such a procedure.
Violations from such an operation can be different, they are associated with problems in internal organs or systems.
There are frequent failures in the work of the liver and kidneys, the metabolism, the activity and work of the hematopoietic organs are disrupted. Changes can also occur in the respiratory and nervous system. Treatment, for any kind of complications, should be carried out as early as possible, under the supervision of a physician.
If incompatibility occurs during the bioassay, the person will also feel negative manifestations, but in a much smaller volume. The recipient may develop chills, pain in the chest and lumbar spine. The pulse will be speeded up, a feeling of anxiety will appear. If these signs are found, transfusion should not be done. Currently, incompatibility with blood transfusion by blood group is practically not found.
Indications... The shock is traumatic, operational. In the complex of anti-shock measures, blood transfusion takes a leading place.
In case of traumatic shock of I degree, it is usually permissible to limit the transfusion of 250-500 ml of blood. In case of shock of the II degree, 500-700 ml of blood is required. In case of shock of the III degree - 1.0-1.5 liters; with IV degree shock - at least 2 liters, of which the first 250-500 ml of blood should be administered intra-arterially; blood transfusion into a vein is performed at the same time.
In traumatic brain injury combined with damage to other organs of the body, it is advisable to use those transfusion media that have not only an anti-shock effect, but also reduce intracranial hypertension. Shown is the transfusion of twice, four times concentrated solutions of dry plasma (that is, plasma dissolved in a 2-4 times smaller amount of liquid than it contained before drying) in a dose of 100-200 ml; 20% albumin solution - 50-400 ml. The use of isotonic solutions, as well as whole blood, especially by the jet method, can increase cerebral hypertension.
For the prevention of operational shock, it is advisable to carry out surgical intervention under the protection of jet-drop blood transfusions, which allows, depending on the intensity of blood loss and disturbances in hemodynamic parameters, to vary the rate of fluid administration. The blood dosage is set individually, depending on the amount of blood loss in the operation and the initial state of the patient.
The alternation of drip and jet methods for the introduction of transfusion fluids allows you to stop the phenomena of acute decompensation of blood circulation and maintain blood pressure above the critical level.
Acute blood loss. If the bleeding is stopped, it is necessary to quickly replace the blood loss. The more blood loss and the sharper the circulatory disturbances, the larger doses of blood should be used to remove the patient from the state of hypoxemia and hypoxia. If blood pressure is determined within 60 mm Hg. Art., and even more so it is not established at all, blood transfusion into the artery (250-500 ml) is indicated. With blood pressure above 70 mm Hg. Art. it is appropriate to switch to a jet intravenous blood transfusion. Raising blood pressure to 90-100 mm Hg. Art. is the basis for the drip method of injecting blood in a dose sufficient for a stable alignment of hemodynamic parameters and compensation for blood loss. The total dosage of transfused blood in acute blood loss depends on the massiveness and speed of bleeding, the degree of anemization and the initial state of the patient.
When the source of bleeding is not eliminated (uterine, pulmonary, gastrointestinal, renal bleeding), then in the absence of sharp shifts in blood pressure for the purpose of hemostasis, it is permissible to limit the transfusion of small amounts of freshly stabilized blood or plasma (100-250 mm). With severe anemization, round-the-clock drip blood transfusion is advisable, preferably freshly prepared, in a dose of up to 1-2 liters per day. If bleeding leads to a sharp drop in blood pressure, and the source of bleeding cannot be eliminated by surgery, then a jet blood transfusion into a vein and even into an artery at a dose of 250-500 ml is indicated. To achieve a more rapid hemodynamic effect, it is appropriate in this case to use polyglucin in a dose of 250-400 ml (see. Blood-substituting fluids). When the blood pressure rises above the critical level (80 mm Hg), the administration of polyglucin should be stopped and the blood transfused should be switched to drip. At the same time, a rapid increase in blood pressure (above 100 mm Hg) should not be allowed.
To ensure hemostasis, it is very important to know the data of the coagulogram in order to identify the deficiency of which factors of the blood coagulation system contribute to bleeding or even cause it, and to use a special transfusion medium for transfusion. So, with a low content of fibrinogen, transfusion of fibrinogen, dry plasma, freshly prepared blood is indicated. With a deficiency of factor VIII, antihemophilic globulin, antihemophilic plasma, blood of several hours of storage, direct blood transfusions are used. For thrombocytopenia, infusion of platelet mass or freshly prepared blood is effective.
The development of post-hemorrhagic anemia as a result of prolonged and repeated bleeding is the basis for multiple drip transfusions of blood (250-400 ml) and erythrocyte mass (125-250 ml) at intervals of 3-5 days.
Blood transfusion is widely indicated in the preparation of patients for surgery and in the postoperative period. In the case of anemization of the patient, it is rational to transfuse blood or erythrocyte mass. To eliminate hypoproteinemia, repeated transfusions of plasma (200-400 ml), albumin (20% solution, 50-100 ml), protein hydrolysates (1000-1500 ml) daily or every other day are appropriate.
Burns. In the treatment of burns, blood transfusion plays an important role both in recent cases and in the further course of burn disease. In period I, blood transfusion serves as a means of combating shock and compensates for hemolysis of erythrocytes, in period II it gives a detoxifying effect, in period III it is used to replenish protein deficiency, stimulate the body's immunobiological reactions and to combat secondary anemia. It is advisable to combine blood transfusion in the first period with the infusion of polyglucin, in the second and third periods - with the infusion of protein hydrolysates.
Purulent-septic processes. Indications for blood transfusion are the presence of intoxication, a decrease in the activity of the immunobiological protective properties of the body, the development of latent and obvious anemia, a violation of protein metabolism with a progressive decrease in blood proteins, especially albumin.
With mild and moderate severity of the purulent-septic process, blood transfusion has a beneficial effect on the general condition of the patient, prevents the transition of "latent" anemia into overt and the development of hypoproteinemia and hypoalbuminemia.
In the postoperative period, as in cases carried out without surgery, repeated blood transfusions are shown at a dose of 250-450 ml, erythrocyte mass - 125-250 ml at intervals of 4-5 days.
When the patient develops the phenomena of hepatitis, glomerulonephritis, nephrosonephritis, lipoid-amyloid nephrosis from the transfusion of globular fluids, it is appropriate to refrain from transfusing globular fluids, and to use agglobular solutions (plasma, albumin).
In case of anaerobic infection, blood transfusion in a dose of 500 ml is indicated in a set of other therapeutic measures. Repeated drip blood transfusions (250-450 ml) in combination with large doses of saline solutions (up to 3-4 liters per day) and anti-gangrenous serum (up to 500 ml) are required.
With peritonitis and intestinal obstruction, active transfusion therapy is aimed at detoxifying the body, restoring circulating blood volume, eliminating dehydration and combating extremely dangerous disorders of the cardiovascular system. From transfusion fluids, repeated transfusions of blood (250 ml), plasma (300-500 ml) in combination with saline isotonic solutions of sodium chloride or glucose (1.5-2 l), protein hydrolysates (1 l), low-molecular solution of polyvinylpyrrolidone (200 -300 ml) etc.
In malignant neoplasms, blood transfusion is indicated in order to prepare for surgery, as well as during the management of the operating and postoperative period, which improves the results of surgical intervention. Use whole blood to combat anemization, replenish blood loss and as a means of hemostasis; transfusion of plasma, albumin - as a means of combating progressive hypoproteinemia, exhaustion. Hemotherapy for inoperable tumors can temporarily improve the general condition, morphological and biochemical parameters of the blood composition of patients.
Blood transfusion is indicated in the acute (subacute) form and in the exacerbation phase of chronic recurrent thrombocytopenic purpura (Werlhof disease).
The hemostatic effect is most pronounced with transfusion of freshly prepared blood (250-500 ml), platelet mass in a dose of at least 2 billion platelets (the amount obtained from 450 ml of blood), direct blood transfusion. It is permissible to use blood of short shelf life (250-500 ml), erythrocyte mass (125-250 ml). The combination of hemotherapy with hormone therapy (prednisolone 30-60 mg per day) increases the hemostatic and antianemic effect. When removing the spleen, jet-drop blood transfusions should be carried out during the entire operation and in the next few hours after it.
Aplastic and hypoplastic anemia. Multiple transfusions of freshly prepared cationic blood (250-450 ml) or direct blood transfusions are shown, transfusions of erythrocyte mass (125-250 ml) are advisable. Selection of a donor for blood transfusion is carried out using the Coombs reaction (see) or washed erythrocytes are transfused. Surgical interventions (splenectomy) in these patients are usually accompanied by large blood loss (up to 1-2 liters), and prolonged use of steroid hormones leads to adrenal atrophy. Therefore, during and after the operation, jet-drip transfusions of large amounts of blood (at least 1-2 liters) should be performed together with prednisolone (30-60 mg per day) and intramuscular injection of 50 mg 3-4 times a day. Fibrinogen infusions are also indicated until blood levels are normalized.
In acute intravascular hemolytic anemia (for example, with the erroneous use of incompatible blood), blood transfusion, especially of the exchange type, is an effective therapeutic measure. In chronic intravascular hemolytic anemia (Markiafava-Micheli disease), blood and plasma transfusion is very often accompanied by increased hemolysis and the development of severe post-transfusion reactions. To prevent the hemolyzing effect of the transfused blood and plasma on the patient's erythrocytes, it is necessary to remove properdin from the transfusion media. This task is achieved either by repeated washing of erythrocytes intended for transfusion, or by transfusion of blood and plasma for a shelf life of more than 7-10 days (properdin is completely inactivated during this period, and the transfusion of such a transfusion medium proceeds without reaction). With intracellular hemolytic anemia, blood transfusion is well tolerated by patients with a congenital form. With acquired hemolytic anemia, blood transfusion is associated with the threat of rapid destruction of the transfused erythrocytes and deterioration of the patient's condition. In such cases, it is necessary to carefully select the donor's blood according to Coombs or use washed erythrocytes for transfusion at a dose of 250 ml. In the case of the immune form, hemotherapy must be combined with the use of steroid hormones.
The indication for blood transfusion in hemolytic anemia is a sharp anemization of the patient, and in the case of surgery - the prevention of surgical and postoperative shock and normalization of the blood composition. Surgical blood loss should be fully compensated for by blood transfusion both during surgery and in the first 24-48 hours. after her. Blood transfusion at a later date (from the 4th-5th day after splenectomy) should be refrained from due to the threat of development of portal vein thrombosis in the postoperative period.
Transfusion of blood, erythrocytes takes one of the leading places in the complex therapy of leukemia, especially with the development of anemization, hemorrhagic phenomena, exhaustion and progressive deterioration of the general condition. Blood and erythrocyte transfusion is also necessary for patients receiving cytostatic therapy and X-ray therapy.
The use of blood transfusion for hemophilia - see Hemophilia.
Blood transfusion is widely used for diseases of the urogenital organs and for operations on them. Indications for blood transfusion during urological operations have been expanded in recent years, and contraindications have been narrowed. Currently, kidney disease, even with decompensation of renal function, is no longer considered a contraindication to blood transfusion. On the contrary, in clinical practice, replacement blood transfusion is widely used as a method of combating renal failure. In renal failure, especially acute, careful selection of donor blood is of particular importance. It is better to use freshly prepared, rather than canned, single-group blood with an individual selection of a donor. Some urological operations (adenomectomy, nephrectomy for kidney tumors) require compulsory blood transfusion. Although blood loss during these operations usually does not exceed 300-500 ml, they are usually performed in elderly patients, often suffering from hemodynamic disorders, for whom compensation for surgical blood loss is a prerequisite.
Contraindications... Blood transfusion is contraindicated in the following diseases: with severe bruises and concussions, hemorrhages and thrombosis of cerebral vessels; with thrombosis of peripheral vessels and acute thrombophlebitis, especially generalized; with severe forms of coronary sclerosis, aneurysm of the aorta and ventricle of the heart; with fresh myocardial infarction; with endocarditis in the active stage with a tendency to thromboembolism; with decompensated heart defects (with severe anemia, slow transfusions of small doses of red blood cells are permissible).
In case of circulatory failure, blood transfusion (better than erythrocyte mass) should be carried out slowly, by the drip method. In case of hypertension and symptomatic hypertension, contraindications to blood transfusion are relative. Contraindications to blood transfusion are also dynamic disorders of cerebral circulation, acute glomerulonephritis (in the initial phase).
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Blood transfusion history
Blood transfusion(blood transfusion) - a medical technology consisting in the introduction into a human vein of blood or its individual components taken from a donor or from the patient himself, as well as blood that has penetrated into the body cavity as a result of trauma or surgery.In ancient times, people noticed that with the loss of a large amount of blood, a person dies. This created the concept of blood as the carrier of life. In such situations, the patient was given fresh animal or human blood to drink. The first attempts at blood transfusion from animals to humans began to be practiced in the 17th century, but they all ended in a deterioration in the condition and death of a person. In 1848, a Treatise on Blood Transfusion was published in the Russian Empire. However, ubiquitous blood transfusion began to be practiced only in the first half of the 20th century, when scientists found out that the blood of people differs in groups. The rules of their compatibility were discovered, substances were developed that inhibit hemocoagulation (blood coagulation) and allow it to be stored for a long time. In 1926, in Moscow, under the leadership of Alexander Bogdanov, the world's first blood transfusion institute (today the Hematological Research Center of Roszdrav) was opened, and a special blood service was organized.
In 1932, Antonin Filatov and Nikolai Kartashevsky for the first time proved the possibility of transfusing not only whole blood, but also its components, in particular plasma; methods of plasma conservation by freeze drying have been developed. Later they also created the first blood substitutes.
For a long time, donated blood was considered a universal and safe means of transfusion therapy. As a result, the point of view was consolidated that blood transfusion is a simple procedure and has a wide range of applications. However, the widespread conduct of blood transfusion led to the emergence of a large number of pathologies, the causes of which were clarified with the development of immunology.
Most major religious denominations did not speak out against blood transfusion, however, the religious organization Jehovah's Witnesses categorically denies the admissibility of this procedure, since the adherents of this organization consider blood to be a vessel of the soul that cannot be transferred to another person.
Today, blood transfusion is considered an extremely responsible procedure for transplanting body tissue with all the ensuing problems - the likelihood of rejection of cells and blood plasma components and the development of specific pathologies, including tissue incompatibility reactions. The main causes of complications resulting from blood transfusion are functionally defective blood components, as well as immunoglobulins and immunogens. When a person is infused his own blood, such complications do not arise.
In order to reduce the risk of such complications, as well as the likelihood of contracting viral and other diseases, in modern medicine it is believed that there is no need for an infusion of whole blood. Instead, the recipient is transfused specifically the missing blood components, depending on the disease. The principle has also been adopted that the recipient should receive blood from the minimum number of donors (ideally from one). Modern medical separators make it possible to obtain various fractions from the blood of one donor, allowing for highly targeted treatment.
Types of blood transfusion
In clinical practice, infusion of erythrocyte suspension, fresh frozen plasma, leukocyte or platelet concentrate is most often in demand. Transfusion of erythrocyte suspension is necessary for anemia. It can be used in combination with substitutes and plasma preparations. Complications are extremely rare with RBC infusion.Plasma transfusion is necessary in case of a critical decrease in blood volume with severe blood loss (especially during childbirth), serious burns, sepsis, hemophilia, etc. In order to preserve the structure and functions of plasma proteins, plasma obtained after blood separation is frozen to a temperature of -45 degrees. However, the effect of correcting blood volume after plasma infusion is short-lived. Albumin and plasma substitutes are more effective in this case.
Platelet infusion is necessary for blood loss due to thrombocytopenia. Leukocyte mass is in demand in case of problems with the synthesis of its own leukocytes. As a rule, blood or its fractions are introduced to the patient through a vein. In some cases, the introduction of blood through an artery, aorta or bone may be required.
The non-frozen whole blood infusion method is called direct. Since this does not provide for blood filtration, the likelihood of small blood clots that form in the blood transfusion system entering the patient's circulatory system sharply increases. This can cause acute blockage of small branches of the pulmonary artery with blood clots. Exchange blood transfusion is a partial or complete withdrawal of blood from the patient's bloodstream with simultaneous replacement of it with the corresponding volume of donor blood - it is practiced to remove toxic substances (in case of intoxication, including endogenous ones), metabolites, products of destruction of erythrocytes and immunoglobulins (in hemolytic anemia of newborns, post-transfusion shock, acute toxicosis, acute renal dysfunction). Therapeutic plasmapheresis is one of the most commonly used methods of blood transfusion. At the same time, simultaneously with the removal of plasma, the patient is transfused in an appropriate volume of erythrocyte mass, freshly frozen plasma, and the necessary plasma substitutes. With the help of plasmapheresis, toxins are removed from the body, missing blood components are introduced, and the liver, kidneys and spleen are cleansed.
Blood transfusion rules
The need for infusion of blood or its components, as well as the choice of method and determination of the dosage of transfusion, are determined by the attending physician on the basis of clinical symptoms and biochemical tests. The doctor performing the transfusion is obliged, regardless of the data of previous studies and analyzes, personally carry out the following research :- determine the patient's blood group according to the ABO system and compare the data obtained with the medical history;
- determine the donor's blood group and compare the obtained data with the information on the container label;
- check the compatibility of the blood of the donor and the patient;
- obtain biological sample data.
Infusion of blood or its fractions is allowed only if the Rh factor of the donor and the recipient coincides. If necessary, it is possible to infuse Rh-negative blood of the first group to a person with any blood group in a volume of up to 0.5 liters (only for adults). Rh-negative blood of the second and third groups can be transfused into a person with the second, third and fourth groups, regardless of the Rh factor. A person with a fourth blood group of positive Rh factor can be transfused with blood of any group.
The erythrocyte mass of Rh-positive blood of the first group can be infused into a patient with any Rh-positive factor. Blood of the second and third groups with Rh-positive factor can be infused into a person with the fourth Rh-positive group. One way or another, a compatibility test is mandatory before transfusion. If rare specific immunoglobulins are found in the blood, an individual approach to blood selection and specific compatibility tests are required.
When transfusion of incompatible blood, as a rule, the following complications develop: :
- post-transfusion shock;
- renal and hepatic impairment;
- metabolic disease;
- disruption of the digestive tract;
- disruption of the circulatory system;
- disruption of the central nervous system;
- respiratory dysfunction;
- violation of hematopoietic function.
- pyrogenic reaction;
- immunogenic response;
- allergy attacks;
Indications for blood transfusion
Acute blood loss is the most common cause of death throughout human evolution. And, despite the fact that for a certain period of time it can cause serious disturbances in vital processes, the intervention of a physician is not always in demand. Diagnosing massive blood loss and prescribing a transfusion has a number of necessary conditions, since it is these particulars that determine the feasibility of such a risky procedure as blood transfusion. It is believed that in case of acute loss of large volumes of blood, transfusion is necessary, especially if the patient has lost more than 30% of its volume within one to two hours.Blood transfusion is a risky and very demanding procedure, so the reasons for it must be compelling enough. If it is possible to conduct effective therapy for the patient without resorting to blood transfusion, or there is no guarantee that it will bring positive results, it is preferable to refuse the transfusion. The appointment of blood transfusion depends on the results that are expected of it: replenishment of the lost blood volume or its individual components; increased hemocoagulation with prolonged bleeding. Among the absolute indications for blood transfusion are acute blood loss, shock, persistent bleeding, severe anemia, severe surgical interventions, incl. with extracorporeal circulation. Frequent indications for transfusion of blood or blood substitutes are various forms of anemia, hematological diseases, purulent-septic diseases, and severe toxicosis.
Contraindications to blood transfusion
The main contraindications for blood transfusion :- heart failure with defects, myocarditis, cardiosclerosis;
- purulent inflammation of the inner lining of the heart;
- hypertension of the third stage;
- violation of blood flow to the brain;
- severe liver dysfunction;
- general violation of protein metabolism;
- allergic condition;
- persons who received blood transfusions in the past (more than 20 days ago), especially if pathological reactions were observed after them;
- women who have experienced difficult childbirth, miscarriages or childbirth in the past with hemolytic disease of the newborn and jaundice of the newborn;
- persons with decaying cancerous tumors, blood pathologies, prolonged septic processes.
Transfusion of blood substitutes
Today, blood substitution fluids are used more often than donated blood and its components. The risk of human infection with the immunodeficiency virus, treponema, viral hepatitis and other microorganisms transmitted during the transfusion of whole blood or its components, as well as the threat of complications that often develop after blood transfusion, make blood transfusion a rather dangerous procedure. In addition, economically the use of blood substitutes or plasma substitutes in most situations is more profitable than transfusion of donated blood and its derivatives.Modern blood substitution solutions perform the following tasks :
- replenishment of the lack of blood volume;
- regulation of blood pressure reduced due to blood loss or shock;
- cleansing the body of poisons in case of intoxication;
- nutrition of the body with nitrogenous, fatty and saccharide micronutrients;
- oxygen supply to the cells of the body.
- hemodynamic (anti-shock) - to correct impaired blood circulation through the vessels and capillaries;
- detoxification - to cleanse the body in case of intoxication, burns, ionizing lesions;
- blood substitutes that feed the body with important micronutrients;
- correctors of water-electrolyte and acid-base balance;
- hemocorrectors - transport of gases;
- complex blood-substituting solutions with a wide spectrum of action.
- the viscosity and osmolarity of blood substitutes must be identical to those of blood;
- they must completely leave the body without negatively affecting organs and tissues;
- blood substitution solutions should not provoke the production of immunoglobulins and cause allergic reactions during secondary infusions;
- blood substitutes must be non-toxic and have a shelf life of at least 24 months.
Blood transfusion from a vein to the buttock
Autohemotherapy is the infusion of a person's venous blood into a muscle or under the skin. In the past, it was considered a promising method for stimulating nonspecific immunity. This technology began to be practiced at the beginning of the 20th century. In 1905, A. Beer was the first to describe the successful experience of autohemotherapy. Thus, he created hematomas that contributed to more effective fracture treatment.Later, to stimulate immune processes in the body, they practiced transfusion of venous blood into the buttock for furunculosis, acne, chronic gynecological inflammatory diseases, etc. Although there is no direct evidence in modern medicine of the effectiveness of this procedure for getting rid of acne, there is a lot of evidence to support its positive effect. The result is usually observed 15 days after the transfusion.
For many years, this procedure, being effective and with minimal side effects, has been used as an adjunct therapy. This continued until the discovery of broad-spectrum antibiotics. However, even after that, for chronic and sluggish diseases, autohemotherapy was also used, which always improved the condition of the patients.
The rules for the transfusion of venous blood into the buttock are not complicated. Blood is withdrawn from the vein and deeply infused into the upper-outer quadrant of the gluteus maximus. To prevent hematomas, the injection site is heated with a heating pad.
The therapy regimen is prescribed by a physician on an individual basis. First, 2 ml of blood is infused, after 2-3 days the dose is increased to 4 ml - thus reaching 10 ml. The autohemotherapy course consists of 10-15 infusions. Independent practice of this procedure is strictly contraindicated.
If, during autohemotherapy, the patient's well-being worsens, the body temperature rises to 38 degrees, tumors and pains appear at the injection sites - with the next infusion, the dose is reduced by 2 ml.
This procedure can be useful for infectious, chronic pathologies, as well as purulent skin lesions. There are no contraindications for autohemotherapy at the moment. However, if any violations appear, the doctor must study the situation in detail.
Intramuscular or subcutaneous infusion of increased blood volumes is contraindicated because in this case, local inflammation, hyperthermia, muscle pain and chills occur. If after the first injection pain is felt at the injection site, the procedure should be postponed for 2-3 days.
When carrying out autohemotherapy, it is extremely important to observe the rules of sterility.
Not all doctors recognize the efficacy of infusing venous blood into the buttock for acne treatment, so this procedure has rarely been prescribed in recent years. In order to treat acne, modern doctors recommend the use of external drugs that do not cause side effects. However, the effect of external agents occurs only with prolonged use.
About the benefits of donation
According to statistics from the World Health Organization, every third inhabitant of the planet needs a blood transfusion at least once in his life. Even a person with good health and a safe field of activity is not immune from injury or illness, in which he will need donated blood.Blood transfusion of whole blood or its components is carried out to persons in critical state of health. As a rule, it is prescribed when the body cannot independently replenish the volume of blood lost as a result of bleeding during injuries, surgical interventions, severe childbirth, and severe burns. People with leukemia or malignant tumors regularly need blood transfusions.
Donated blood is always in demand, but, alas, over time the number of donors in the Russian Federation is steadily decreasing, and blood is always in short supply. In many hospitals, the volume of available blood is only 30-50% of the required amount. In such situations, doctors have to make a terrible decision - which of the patients is to live today and which is not. And first of all, those at risk are those who need blood donations throughout their lives - those suffering from hemophilia.
Hemophilia is a hereditary disease characterized by blood non-clotting. Only men are susceptible to this disease, while women act as carriers. At the slightest wound, painful hematomas develop, bleeding develops in the kidneys, in the digestive tract, in the joints. Without proper care and adequate therapy, by the age of 7-8 years, a boy, as a rule, suffers from lameness. Usually adults with hemophilia are disabled. Many of them are unable to walk without crutches or a wheelchair. Things that healthy people do not attach importance to, such as pulling out a tooth or a small cut, are extremely dangerous for people with hemophilia. All people suffering from this disease need regular blood transfusion. They are usually given drugs made from plasma. A timely transfusion can save the joint or prevent other serious disorders. These people owe their lives to the many donors who have shared blood with them. Usually they do not know their donors, but they are always grateful to them.
If a child suffers from leukemia or aplastic anemia, he needs not only money for medicines, but also donated blood. Whatever medications he uses, the child will die if blood transfusion is not performed on time. Blood transfusion is one of the irreplaceable procedures for blood diseases, without which the patient dies within 50-100 days. With aplastic anemia, the hematopoietic organ - bone marrow, ceases to produce all blood components. These are erythrocytes, which supply the body's cells with oxygen and nutrients, platelets, which stop bleeding, and leukocytes, which protect the body from microorganisms - bacteria, viruses and fungi. With an acute shortage of these components, a person dies from hemorrhages and infections, which do not pose a threat to healthy people. Treatment for this disease consists in measures forcing the bone marrow to resume the production of blood components. But until the disease is cured, the child needs constant blood transfusions. In leukemia, during the period of acute progression of the disease, the bone marrow produces only defective blood components. And after chemotherapy for 15-25 days, the bone marrow is also unable to synthesize blood cells, and the patient needs regular transfusions. Some people need it every 5-7 days, some - every day.
Who can become a donor
According to the laws of the Russian Federation, any capable citizen who has reached the age of majority and has passed a series of medical tests can donate blood. The examination before donating blood is free of charge. It includes:- therapeutic examination;
- hematological blood test;
- blood chemistry;
- a study for the presence of hepatitis B and C viruses in the blood;
- blood test for human immunodeficiency virus;
- a blood test for pale treponema.
What to do before donating blood
Key recommendations :- adhere to a balanced nutrition system, follow a special diet 2-3 days before donating blood;
- drink plenty of fluids;
- do not drink alcohol 2 days before donating blood;
- for three days before the procedure, do not take aspirin, analgesics and medicines that contain the above substances;
- refrain from smoking for 1 hour before giving blood;
- sleep well;
- a few days before the procedure, it is recommended to include in the diet sweet tea, jam, black bread, crackers, dried fruits, boiled cereals, pasta without oil, juices, nectars, mineral water, raw vegetables, fruits (with the exception of bananas).
Donor Benefits
You cannot save lives of people, guided by financial gain. Blood is essential to save the lives of critically ill patients, and there are many children among them. It is scary to imagine what could happen if blood taken from an infected person or drug addict is transfused. Blood is not considered a trade item in the Russian Federation. Money given to donors at transfusion stations is considered compensation for lunch. Depending on the amount of blood withdrawn, donors receive from 190 to 450 rubles.A donor from whom blood was withdrawn in a total volume equal to two maximum doses or more is entitled to certain benefits :
- within six months for students of educational institutions - an increase in the scholarship in the amount of 25%;
- within 1 year - benefit for any disease in the amount of full earnings, regardless of the length of service;
- within 1 year - free treatment in public clinics and hospitals;
- within 1 year - the allocation of preferential vouchers to sanatoriums and resorts.
In medicine, especially emergency conditions, there are many situations when blood transfusion is necessary, indications and contraindications are determined in each case. With massive blood loss, blood transfusion is often the only thing that can save the patient's life.
Blood donors are thoroughly tested for various blood-borne infections. It should be clarified that at present, the use of whole blood for transfusion is extremely rare; its components (erythrocyte mass, plasma, leukocytes, and others) are usually used.
Absolute indications are situations where blood transfusion is vital. There are only three of them - this is a simultaneous loss of more than 15% of the circulating volume, caused by trauma, bleeding, massive tissue damage, or arising during surgery. In addition, the need for transfusion arises in the event of traumatic shock.
Blood loss of more than 15% is considered life-threatening
Blood loss of more than 15% of the BCC leads to serious hemodynamic disturbances, decreased blood supply to tissues, including the brain, and heart rhythm disturbances.
The consequences of oxygen starvation of tissues can become irreparable if the blood volume is not restored in the near future. That is why acute blood loss is considered an absolute indication for blood transfusion.
If blood loss occurs on the surgical table, then the doctor has the opportunity to immediately restore the normal blood volume and avoid dangerous consequences.
In such a situation, the method of autohemotransfusion is often used - collecting the patient's own blood lost during the operation, preparing and transfusing it in the operating room. The advantage of this method is the minimal likelihood of adverse reactions during blood transfusion.
Chronic blood loss is not considered an absolute indication, although the amount of blood lost may be even greater than in acute blood loss. But in this case, blood loss occurs gradually, and the body adapts to the changed conditions, therefore, an urgent need for blood transfusion rarely arises.
Relative indications
Relative indications are indications that do not exclude the replacement of blood transfusion with another medical procedure
- Anemia of various origins. It is preferable to pour the red blood cell mass or suspension. The criterion for the need for blood transfusion is considered to be hemoglobin below 80 g / l; This group includes conditions that can be cured without resorting to blood transfusion, but hemotransfusion in this case will greatly facilitate the patient's condition and accelerate recovery. In some cases, periodic transfusion of blood or blood components is necessary.
- Continuous bleeding, blood clotting disorder - platelet suspension or plasma;
- Long-term inflammatory processes, including those accompanied by severe intoxication, impaired immunity, chronic inflammation with reduced regeneration - leukocyte mass or plasma;
- Poisoning with certain substances - plasma or blood, blood substitutes.
It should be clarified that in the case of relative indications, various factors can play a role in determining the need for transfusion in any given situation. The effectiveness of therapy by other means, the presence of contraindications, and the patient's condition are important. Before prescribing a blood transfusion in this case, the blood transfusion doctor must take into account all important factors.
Contraindications to blood transfusion
There are a number of contraindications for blood transfusion.
There are situations when blood transfusion may not save life, but endanger it, despite strict adherence to all the rules of blood transfusion. As well as readings, they are divided into absolute and relative.
Absolute contraindications - heart or pulmonary failure (or their combination), pulmonary edema, etc. In these cases, blood transfusion leads to a sharp increase in the load on the heart and lungs, which only aggravates the condition.
Therefore, in the presence of relative indications and absolute contraindications, transfusion is not performed. If there are absolute indications and contraindications at the same time (for example, heart failure and trauma), then blood transfusion is mandatory.
The list of relative contraindications is longer. These include diseases leading to significant hemodynamic disturbances, severe cerebrovascular accidents, fresh thrombotic conditions, liver and kidney dysfunctions, allergic diseases and rheumatism, acute disseminated tuberculosis.
The decision on the need for blood transfusion in the presence of relative indications and contraindications is a difficult issue, the decision is made depending on the patient's condition.
Roughly speaking, the transfusiologist must decide which disease is more dangerous for the patient - the one that creates the indications or the one that causes contraindications for blood transfusion. In the case of absolute indications for transfusion, relative contraindications are not significant.
It should also be noted that relative indications for transfusion of blood components are not always a contraindication for transfusion of blood products and blood substitutes.
Groups of dangerous recipients
It is necessary to take into account the outcomes of previous blood transfusions
There are certain groups of recipients whose blood transfusion is associated with an increased risk of an immune response to donated blood. To reduce this risk, it is necessary to take an anamnesis in advance. The risk group includes patients who:
There were transfusions of transfusion media, accompanied by complications, as well as operations and injuries, in which transfusion could be prescribed;
There are allergic and autoimmune diseases (including those of the next of kin);
In women - complications of pregnancy, stillbirth, the birth of children with severe pathologies, the presence of Rh-conflict.
Patients with a history of any of the above are called recipients. In this case, blood transfusion is more often replaced by the use of blood substitutes, if possible. In order to avoid transfusion complications, the determination of the blood group and the Rh factor is carried out in the patient every time he is admitted to the hospital.
From the video you will learn about the blood transfusion procedure:
Transfusiology (transfusio - transfusion, logos - doctrine) - the science of transfusion of blood, its components and preparations, blood substitutes for therapeutic purposes by influencing the composition of blood, biological fluids of the body.
Blood transfusion - a powerful means of treating a wide variety of diseases, and in a number of pathological conditions (bleeding, anemia, shock, major surgical operations, etc.) - the only and so far irreplaceable means of saving the lives of patients. Blood, its components and preparations obtained from blood are widely used not only by surgeons, traumatologists, obstetricians, gynecologists, but also by therapists, pediatricians, infectious disease specialists, and doctors of other specialties.
The interest of doctors in blood transfusion for the treatment of patients has been known for a long time - such attempts are mentioned by Celsus, Homer, Pliny, and others.
In Ancient Egypt, 2000-3000 BC. they tried to transfuse blood from healthy people to sick people, and these attempts were sometimes curious, sometimes tragic. Of great interest was the transfusion of the blood of young animals, more often lambs, to a sick or infirm old man. The blood of animals was preferred for the reasons that they are not subject to human vices - passions, excesses in food, drink.
In the history of blood transfusion, three periods can be distinguished, sharply differing in time: the 1st period lasted several millennia - from ancient times to 1628, when the 2nd period began with the discovery of blood circulation by Harvey. Finally, the third - the shortest, but the most significant period, is associated with the name of K. Landsteiner, who discovered in 1901 the law of isohemagglutination.
The second period in the history of blood transfusion was characterized by the improvement of the technique of blood transfusion: blood was transfused from a vein into a vein using silver tubes, and the syringe method was also used; the volume of transfused blood was determined by the decreasing weight of the lamb. Based on the teachings of Harvey, the French scientist Jean Denis in 1666 for the first time performed a blood transfusion to a person, albeit unsuccessfully. The empirical approach to blood transfusion nevertheless made it possible to accumulate certain
shared experience. So, the appearance of anxiety, redness of the skin, chills, tremors were regarded as blood incompatibility, and the blood transfusion was immediately stopped. The number of successful blood transfusions was small: by 1875, 347 cases of human blood transfusion and 129 of animal blood were described. In Russia, the first successful blood transfusion after bleeding during childbirth was carried out in 1832 by G. Wolf in St. Petersburg.
In 1845, I.V. Buyalsky, believing that over time they will take a worthy place among operations in emergency surgery.
In 1847, the work of A.M. Filomafitsky "Treatise on blood transfusion as the only means in many cases to save a dying life", in which from the standpoint of science of that time, the indications, the mechanism of action, and methods of blood transfusion were set forth. Naturally, both the stated mechanism and practical recommendations were based mainly on empirical research methods and did not ensure the safety of blood transfusion. From 1832 to the end of the 19th century, only 60 blood transfusions were carried out, of which 22 were performed by S.P. Kolomnin, a contemporary of N.I. Pirogov.
The modern period in the theory of blood transfusion begins in 1901 - the time when K. Landsteiner discovered blood groups. Having identified various isoagglutination properties of human blood, he established three types (groups) of blood. Y. Jansky in 1907 was allocated IV blood group. In 1940 K. Landsteiner and A.S. Wiener discovered the Rh factor (Rh factor).
Blood groups are divided taking into account the presence of antigens (agglutinogens A and B) in human erythrocytes and, accordingly, antibodies (agglutinins α and β) in the blood serum. Upon contact of agglutinogens and agglutinins of the same name, the reaction of agglutination (gluing) of erythrocytes occurs, followed by their destruction (hemolysis). In the blood of every person there can be only agglutinogen and agglutinin of different names. According to Yansky, four blood groups are identified; in clinical practice, the concept of "blood group according to the AB0 system" is used.
An important stage in blood transfusiology is the property of sodium citrate (sodium citrate), discovered by A. Yusten (Hustin A, 1914), to prevent blood clotting. This served as the main prerequisite for the development of indirect blood transfusion, since it became possible to procure blood for future use, store it and use it as needed. Sodium citrate is still used as the main part of blood preservatives.
A lot of attention was paid to the issues of blood transfusion in our country - the contribution of the surgeons of the 19th century G. Wolf, S.P. Kolomnina, I.V. Buyalsky, A.M. Filomafitsky, as well as V.N. Shamova, S.S. Yudina, A.A. Bagdasarov and others. Scientific development of blood transfusion issues and practical application of the method began in our country after the first publications of V.N. Shamov (1921). In 1926, the Institute of Blood Transfusion was organized in Moscow. In 1930 in Kharkov and in 1931 in Leningrad, similar institutes began to work, at present there are such institutes in other cities. In regional centers, methodological and organizational work is carried out by regional blood transfusion stations. A special contribution to the development and implementation of the cadaveric blood transfusion method was made by V.N. Shamov and S.S. Yudin.
Currently, transfusiology has developed into an independent science (the doctrine of blood transfusion) and has emerged as a separate medical specialty.
SOURCES OF BLOOD
Blood, its preparations and components are widely used in medical practice for the treatment of various diseases. Blood collection, preservation, separation into components and preparation of drugs are carried out by blood transfusion stations or special departments in hospitals. To obtain blood products, special separating, freezing, and lyophilizing installations are used. The main source of blood is donors. In our country, donation is voluntary: any healthy citizen can become a donor. The health status of donors is determined during the examination. Be sure to conduct a von Wassermann reaction to syphilis, a study on the carriage of hepatitis and HIV viruses.
For transfusion can be used waste blood, in this case, placental blood is of paramount importance. Previously, blood was used obtained from bloodletting, which was used to treat patients with eclampsia, with hypertensive crisis. From waste blood, preparations are prepared - protein, thrombin, fibrinogen, etc. Placental blood is collected immediately after the birth of the child and the ligation of the umbilical cord. With the observance of asepsis, the blood flowing from the vessels of the umbilical cord is collected in special vessels with a preservative. Up to 200 ml of blood is obtained from one placenta. The blood of each parturient woman is collected in separate vials.
The idea of \ u200b \ u200buse and method of preparation, storage and transfusion cadaveric blood belongs to our compatriot V.N. Shamov. Did a lot for the wide practical use of cadaveric blood S.S. Yudin. They use blood from the corpses of practically healthy people who died suddenly, without prolonged agony, from accidental causes (closed traumatic injuries, acute heart failure, myocardial infarction, cerebral hemorrhage, electric shock). The blood of those who died from infectious, oncological diseases, poisoning (except alcoholic ones), blood diseases, tuberculosis, syphilis, AIDS, etc. is not used. The blood of the suddenly deceased differs in that it does not clot within 1-4 hours after death due to fibrin loss (defibrinated blood). Blood is taken no later than 6 hours after death. Blood flowing from the veins on its own is collected in special containers in compliance with the rules of asepsis and used for transfusion or preparation of components or blood products. From a corpse, you can get from 1 to 4 liters of blood. The blood obtained from different sources is packaged at the blood collection stations, the group (according to the AB0 system) and rezusprofitness is checked, the presence of hepatitis and HIV viruses in the blood is excluded. Ampoules or blood bags are marked with the indication of volume, date of procurement, group and Rh-affiliation.
An important source of blood is sick, from whom, in the preoperative period, blood is withdrawn with its subsequent conservation and transfusion to him during the operation (autohemotransfusion).
It is possible to use blood poured into serous cavities (pleural, abdominal) for diseases or traumatic injuries - autologous blood. Such blood does not require compatibility testing and causes fewer transfusion reactions.
THE MECHANISM OF ACTION OF THE BLOOD INFLUENCE
Blood transfusion is essentially a living tissue transplant with complex and varied functions. Blood transfusion makes it possible to replenish the lost BCC, which determines the restoration of blood circulation, activation of metabolism, improvement of the transport role of blood in the transfer of oxygen, nutrients, and metabolic products. This is the substitutional (substitutional) role of blood transfused. With the latter, enzymes, hormones, involved in many functions of the body, are introduced. The transfused blood for a long time retains its functional
nal ability due to corpuscular elements, enzymes, hormones, etc. Thus, erythrocytes for 30 days are able to carry a functional load - to bind and carry oxygen. The phagocytic activity of leukocytes also persists for a long time.
An important property of transfused blood is the ability to increase hemostatic (hemostatic) blood function. This is especially important in cases of disorders in the blood coagulation system observed in such pathological processes as hemophilia, cholemia, hemorrhagic diathesis, as well as bleeding. The hemostatic effect of transfused blood is due to the introduction of blood coagulation factors. The most pronounced hemostatic effect is exerted by fresh blood or blood that has not been stored for long (up to several days).
Detoxification effect transfused blood is determined by dilution of toxins circulating in the recipient's blood, absorption of some of them by blood cells and proteins. At the same time, it is important to increase the transport of oxygen as an oxidizer of a number of toxic products, as well as the transfer of toxic products to organs (liver, kidneys), which ensure the binding or elimination of toxins.
The transfused blood has immunocorrective action: neutrophils are introduced into the body, providing phagocytosis, lymphocytes (T-, B-cells), which determine cellular immunity. Humoral immunity is also stimulated due to the introduction of immunoglobulins, interferon and other factors.
Thus, the mechanism of action of transfused blood is complex and diverse, which determines the therapeutic effectiveness of blood transfusion in clinical practice in the treatment of a wide variety of diseases: not only surgical, but also internal, infectious, etc.
BASIC HEMOTRANSFUSION MEDIA
Tinned blood
Prepared using one of the preservative solutions. The role of a stabilizer is played by sodium citrate, which binds calcium ions and prevents blood clotting, the role of a preservative is dextrose, sucrose, etc. Antibiotics are part of the preservative solutions. Preservatives are added in a ratio of 1: 4 to blood. Store blood at a temperature of 4-6 ° C. Blood, preserved with glugitsir solution, is stored for 21 days, with tsiglufad solution - 35 days. In preserved blood, factors of hemostasis and im-
Moon factors, oxygen binding function is maintained for a long period. Therefore, in order to stop bleeding, blood is transfused with a shelf life of no more than 2-3 days, for the purpose of immunocorrection - no more than 5-7 days. In case of acute blood loss, acute hypoxia, it is advisable to use blood of short (3-5 days) shelf life.
Fresh citrate blood
A 6% sodium citrate solution is used as a stabilizing solution in a ratio of 1:10 to blood. Such blood is used immediately after harvesting or in the next few hours.
Heparinized blood
Heparinized blood is used to fill heart-lung machines. Sodium heparin with dextrose and chloramphenicol is used as a stabilizer and preservative. Heparinized blood is stored at 4 ° C. Shelf life - 1 day.
Blood components
In modern conditions, the components (separate constituent parts) of the blood are mainly used. Whole blood transfusions are performed less and less frequently due to possible post-transfusion reactions and complications due to the large number of antigenic factors present in whole blood. In addition, the therapeutic effect of component transfusions is higher, since a targeted effect on the body is carried out. There are certain testimony to component transfusion: in case of anemia, blood loss, bleeding, transfusions of erythrocyte mass are indicated; with leukopenia, agranulocytosis, immunodeficiency state - leukocyte mass; with thrombocytopenia - platelet mass; with hypodisproteinemia, disorders of the coagulation system, deficiency of BCC - blood plasma, albumin, protein.
Component blood transfusion therapy allows to obtain a good therapeutic effect with less blood consumption, which is of great economic importance.
Erythrocyte mass
The erythrocyte mass is obtained from whole blood, from which 60-65% of the plasma has been removed by settling or centrifugation. She is excellent
It is derived from donor blood by a smaller plasma volume and a high concentration of erythrocytes (hematocrit number 0.65-0.80). Available in vials or plastic bags. Store at 4-6 ° C.
Erythrocyte suspension
Erythrocyte suspension is a mixture of erythrocyte mass and preservative solution in a 1: 1 ratio. The stabilizer is sodium citrate. Store at 4-6 ° C. The shelf life is 8-15 days.
Indications for transfusion of erythrocyte mass and suspension are bleeding, acute blood loss, shock, diseases of the blood system, anemia.
Frozen red blood cells
Frozen erythrocytes are obtained by removing leukocytes, platelets and plasma proteins from the blood, for which the blood is subjected to 3-5 times washing with special solutions and centrifugation. Freezing of erythrocytes can be slow - in electric refrigerators at temperatures from -70 to -80 ° C, as well as fast - using liquid nitrogen (temperature -196 ° C). Frozen red blood cells are stored for 8-10 years. To defrost erythrocytes, the container is immersed in a water bath at a temperature of 45 ° C and then washed from the enclosing solution. After thawing, erythrocytes are stored at a temperature of 4 ° C for no more than 1 day.
The advantage of thawed erythrocytes is the absence or low content of sensitizing factors (plasma proteins, leukocytes, platelets), coagulation factors, free hemoglobin, potassium, serotonin. This determines the indications for their transfusion: allergic diseases, post-transfusion reactions, patient sensitization, cardiac, renal failure, thrombosis, embolism. You can use the blood of a universal donor and avoid massive blood transfusion syndrome. Washed native or thawed erythrocytes are transfused to patients in the presence of incompatibility for leukocyte antigens of the HLA system or sensitized to plasma proteins.
Platelet mass
The platelet mass is obtained from the plasma of canned donor blood, stored for no more than 1 day, by light centrifugation. Store it at a temperature of 4? C for 6-8 hours, at a temperature
at a temperature of 22 ° C - 72 hours. It is advisable to use a freshly prepared mass. The lifespan of transfused platelets is 7-9 days.
Indications for transfusion of platelet mass are thrombocytopenia of various origins (diseases of the blood system, radiation therapy, chemotherapy), as well as thrombocytopenia with hemorrhagic manifestations in massive blood transfusions for acute blood loss. When transfusing platelet mass, it is necessary to take into account group (according to the AB0 system) compatibility, compatibility according to the Rh factor, conduct a biological test, since when receiving platelet mass, an admixture of donor blood erythrocytes is possible.
Leukocyte mass
Leukocyte mass is an environment with a high content of leukocytes and an admixture of erythrocytes, platelets and plasma.
The preparation is obtained by settling and centrifugation. Store in vials or plastic bags at a temperature of 4-6 ° C for no more than 24 hours, it is more expedient to pour freshly prepared leukocyte mass. When transfusing, one should take into account the group and Rh-belonging of the donor and recipient, and, if necessary, the compatibility of the HLA antigens. A biological compatibility test is mandatory. Transfusions of leukocyte mass are indicated in diseases accompanied by leukopenia, in agranulocytosis, inhibition of hematopoiesis caused by radiation and chemotherapy, in sepsis. Possible reactions and complications in the form of shortness of breath, chills, fever, tachycardia, falling blood pressure.
Blood plasma
Liquid blood plasma (native) is obtained from whole blood by either settling or centrifugation. Plasma contains proteins, a large number of biologically active components (enzymes, vitamins, hormones, antibodies). Use it immediately after receiving (no later than 2-3 hours). If a longer storage is required, freezing or drying (lyophilization) of plasma is used. Available in bottles or plastic bags of 50-250 ml. Frozen plasma is stored at a temperature of -25 ° C for 90 days, at a temperature of -10 ° C for 30 days. Before use, it is thawed at a temperature of 37-38 ° C. Signs of unsuitability of plasma for transfusion: the appearance in it of massive clots, flakes, color change to a dull grayish-brown, unpleasant odor.
Plasma is used to compensate for plasma loss in case of BCC deficiency, shock, to stop bleeding, and complex parenteral nutrition. Indications for transfusion are blood loss (if it exceeds 25% of the BCC), transfusions of plasma, whole blood, erythrocyte mass are combined), shock (traumatic, surgical), burn disease, hemophilia, severe purulent-inflammatory diseases, peritonitis, sepsis. Contraindications for plasma transfusion are severe allergic diseases.
The usual doses of transfused plasma are 100, 250 and 500 ml, in the treatment of shock - 500-1000 ml. Transfusion is carried out taking into account the group (AB0) compatibility of the donor and recipient. A biological test is required.
Dry plasma
Dry plasma is obtained from frozen under vacuum conditions. Available in bottles with a capacity of 100, 250, 500 ml. The shelf life of the drug is 5 years. Before use, dilute with distilled water or isotonic sodium chloride solution. Indications for use are the same as for native or frozen plasma, except that the use of dry plasma for hemostatic purposes is ineffective. A biological test is carried out.
Blood preparations Albumen
Albumin is obtained by fractionation of plasma. Applied in solutions containing 5, 10, 20 g of protein (albumin 97%) in 100 ml of solution. Produced in the form of 5%, 10%, 20% solutions in vials with a capacity of 50, 100, 250, 500 ml. After pouring into vials, they are pasteurized in a water bath at 60 ° C for 10 hours (in order to avoid the risk of transmission of serum hepatitis). The drug has pronounced oncotic properties, the ability to retain water and thereby increase the BCC, have an anti-shock effect.
Albumin is prescribed for various types of shock, burns, hypoproteinemia and hypoalbuminemia in patients with tumor diseases, severe and prolonged pyoinflammatory processes, plasmapheresis. In combination with transfusion of blood and erythrocyte mass, albumin has a pronounced therapeutic effect in blood loss, post-hemorrhagic anemia. Transfusions of the drug are indicated for hypoalbuminemia - the content of albumin is less than 25 g / l. Dose:
20% solution - 100-200 ml; 10% - 200-300 ml; 5% - 300-500 ml and more. The drug is injected drip at a speed of 40-60 drops per minute, in shock - jet. A biological test is shown.
Relative contraindications for albumin transfusion are severe allergic diseases.
Protein
Protein is a 4.3-4.8% isotonic solution of stable pasteurized human plasma proteins. It contains albumin (75-80%) and stable α- and β-globulins (20-25%). The total amount of protein is 40-50 g / l. In terms of therapeutic properties, protein is close to plasma. Available in bottles of 250-500 ml. The indications for protein use are the same as for plasma. The daily dose of the drug in patients with hypoproteinemia is 250-500 ml of solution. The drug is administered over several days. In severe shock, massive blood loss, the dose can be increased to 1500-2000 ml. Protein must be used in combination with donor blood or erythrocyte mass. It is administered by drip, in case of severe shock or low blood pressure - by jet.
Cryoprecipitate
Cryoprecipitate is prepared from blood plasma, released in 15 ml vials. The drug contains antihemophilic globulin (VIII factor), fibrin-stabilizing factor (XII factor), fibrinogen. The use of the drug is indicated for stopping and preventing bleeding in patients suffering from disorders of the blood coagulation system caused by factor VIII deficiency (hemophilia A, von Willebrand disease).
Prothrombin complex
The prothrombin complex is prepared from blood plasma. The drug has a high content of II, VII, K, X factors of the blood coagulation system. It is used to stop and prevent bleeding in patients suffering from hemophilia B, hypoprothrombinemia, hypoproconvertinemia.
Fibrinogen
Fibrinogen is obtained from plasma containing fibrinogen in concentrated form. Used for therapeutic and prophylactic purposes
pour in patients with congenital and acquired hypo- and afibrinogenemia, as well as with profuse bleeding, for the prevention of bleeding in the postoperative period, during and after childbirth.
Thrombin
Thrombin is prepared from plasma, it contains thrombin, thromboplastin, calcium chloride. Available in powder in vials. It is applied topically to stop capillary, parenchymal bleeding in case of extensive wounds, operations on parenchymal organs.
Immunological drugs
Preparations of immunological action are prepared from donor blood: γ-globulin (anti-staphylococcal, anti-tetanus, anti-measles), complex immune preparations - normal human immunoglobulin, normal human immunoglobulin, etc. ... Produced in ampouled form and used for intramuscular or intravenous administration (if indicated).
ANTIGENIC BLOOD SYSTEMS
AND THEIR ROLE IN TRANSFUSIOLOGY
To date, about 500 antigens of blood cells and blood plasma are known, of which more than 250 are erythrocyte antigens. Antigens are linked into antigenic systems. There are more than 40 of them, and half of them are erythrocyte systems. Cell systems play a role in transfusiology. Plasma systems are of no practical importance.
Human erythrocytes contain such systems as AB0, Rh-factor, Kell, Kidd, Lutheran, etc. In transfusiology, the AB0 and Rh-factor systems play the main role. The AB0 system includes agglutinogens (antigens) A and B and agglutinins (antibodies) α and β. Agglutinogens are found in erythrocytes, agglutinins - in blood serum. The simultaneous presence in the blood of the same components (A and α, B and β) is impossible, since their meeting leads to the isohemagglutination reaction.
The ratio of agglutinogens A and B and agglutinins determines the four blood groups.
Group I - I (0): there is no agglutinogen in erythrocytes, but there are α and β agglutinins.
Group II - P (A): erythrocytes contain agglutinogen A, serum - agglutinin β.
Group III - III (H): in erythrocytes - agglutinogen B, in serum - agglutinin α.
Group IV - IV (AB): erythrocytes contain agglutinogens A and B, serum does not contain agglutinins.
The varieties of agglutinogen A - A 1 and A 2 are known. Accordingly, group II (A) has subgroups II (A 1), P (A 2), and group IV (AB) - IV (A 1 B) and IV (A 2 B).
The Rh factor system is represented by six antigens (D, d, C, c, E, e). 85% of people have Rh antigen D in their erythrocytes, and these people are considered Rh positive, 15% of people are Rh negative - their erythrocytes do not have this antigen. Antigen D has the most pronounced antigenic properties. If the Rh antigen enters the blood of an Rh-negative person (as can be the case with a transfusion of Rh-positive blood or during the pregnancy of an Rh-negative woman with an Rh-positive fetus), his body produces antibodies to the Rh factor. When the Rh antigen re-enters the blood of an already sensitized person (blood transfusion, repeated pregnancy), an immune conflict develops. In the recipient, this is manifested by a blood transfusion reaction, up to shock, and in pregnant women it can lead to fetal death and miscarriage or the birth of a child suffering from hemolytic disease.
In human leukocytes, the cell membrane contains the same systems as in erythrocytes, as well as specific antigenic complexes. In total, about 70 antigens were found, united in a number of systems (HLA, NA-NB, etc.), which are not of particular importance in transfusion practice. The HLA system of leukocytes is important in organ and tissue transplantation. When selecting donors, the compatibility of the donor and recipient in the AB0 system, Rh factor and HLA gene complex must be taken into account.
Human platelets contain the same antigens as erythrocytes and leukocytes (HLA), localized in the cell membrane. Platelet antigenic systems Zw, Co, P1 are also known, but in the practice of transfusion and transplantology they have no clinical significance.
More than 200 antigens were found on the surface of blood plasma protein molecules, which are combined into 10 antigenic complexes (Ym, Hp, Yc, Tf, etc.). For clinical practice, the Ym system associated with immunoglobulins (Ig) is important. Plasma antigens are not considered in practical transfusiology.
There are constant innate antibodies in human blood (agglutinins α and β), all other antibodies are unstable - they can be acquired, formed in the body in response to the intake of various antigens (for example, Rh factor) - these are isoimmune antibodies. Antigens are cold antibodies, their specific action (agglutination) is manifested at room temperature; isoimmune antibodies (for example, anti-rhesus) - heat, they show their effect at body temperature.
Antigen-antibody interaction goes through two stages (phases). In the first phase, antibodies are fixed on the blood cell and cause adhesion of shaped elements (agglutination). The addition of the plasma compliment to the antigen-antibody leads to the formation of an antigen-antibody-compliment complex, which lyses the cell membrane (erythrocytes), hemolysis occurs.
Blood antigens during transfusion can be the cause of its immunological incompatibility. The main role in this is played by the antigens of the AB0 system and the Rh factor. If in the blood of the recipient to whom the blood is transfused, the same antigen in erythrocytes and antibodies in the plasma are found, then agglutination of erythrocytes occurs. The same is possible with antigens and antibodies of the same name (A and α, B and β), as well as Rh antigen and anti-rhesus antibodies. For such a reaction, there must be a sufficient amount (titer) of antibodies in the blood serum. This principle is based on Ottenberg's rule, which states that the erythrocytes of the donor blood transfused are agglutinated, since the agglutinins of the latter are diluted with the recipient's blood and their concentration does not reach the level at which they can agglutinate the recipient's erythrocytes. According to this rule, all recipients can be transfused with blood of group 0 (I), since it does not contain agglutinogens. Recipients of AB (IV) group can be transfused with blood of other groups, since it does not contain agglutinins (universal recipient). However, when a large amount of blood is transfused (in particular, with massive blood loss), the agglutinins of the transfused non-group blood entering the body can agglutinate the host's erythrocytes. In this regard, the Ottenberg rule is applicable when transfusing up to 500 ml of donated blood.
The first transfusion of Rh-positive blood to an Rh-negative recipient, not previously sensitized, can proceed without incompatibility, but will lead to the formation of antibodies. Transferring an Rh negative woman sensitized during pregnancy to a Rh positive fetus will result in Rh
incompatibility. When transfusing Rh-negative blood into re-positive recipients, the development of antibodies to weak antigens of the Rh-factor system contained in the transfused blood is not excluded.
Individuals with Rh-negative blood are simultaneously positive for the Rh-antigen, this should be taken into account when transfusing Rh-negative blood into an Rh-positive recipient, since it is possible to cause sensitization of the recipient and create a risk of post-transfusion complications if the recipient is Rh-negative. In this regard, for transfusion, blood should be used strictly of the same name in terms of the Rh factor, taking into account the test for Rh compatibility of the donor and recipient's blood.
Plasma transfusion is carried out taking into account the group (AB0) blood belonging. In extreme situations, it is possible to transfuse AB (IV) plasma to all recipients, plasma A (P) and B (III) - recipients of group 0 (I). Plasma 0 (I) is transfused into recipients of the same blood group.
In accordance with the modern rule of transfusiology, it is necessary to transfuse only one-group (according to the AB0 system) and single-rhesus blood.
In extreme situations, you can transfuse the blood of a universal donor, use the Ottenberg rule, or transfuse Rh-positive blood in a volume of no more than 500 ml. But this is absolutely unacceptable in children.
Determination of blood group and Rh factor
Determination of blood groups by standard isohemagglutinating sera
To determine the blood group, the following equipment is required: two sets of standard hemagglutinating sera I (0), P (A), W (B) of groups of two different series and one ampoule of serum IV (AB) (a dry, clean pipette is dipped into each ampoule with serum ), a bottle with isotonic sodium chloride solution with a pipette, a clean, dry plate, glass slides, sterile lance-shaped needles for piercing the skin of a finger, sterile gauze balls, alcohol. The determination is carried out in a room with good lighting, at a temperature of 15 to 25 ° C.
Each ampoule of standard serum must have a passport-label indicating the blood group, batch number, titer, expiration date,
place of manufacture. It is prohibited to use an ampoule without a label. Standard sera for determining the blood group according to the AB0 system are produced with a specific color marking: I (0) - colorless, P (A) - blue, W (H) - red, IV (AB) - yellow. The marking is available on the label in the form of colored stripes: there are no stripes on the label of serum I (0), serum P (A) - two blue stripes, serum W (B) - three red stripes and serum IV (AB) - four yellow stripes - that color. Serums are stored at a temperature of 4-10 ° C. The serum should be light and transparent, the ampoule should be intact. The presence of flakes, sediment, turbidity are signs of unsuitable whey. The serum titer should be at least 1:32, the activity should be high: the first signs of agglutination should appear no later than 30 s. Serums with an expired shelf life are not suitable for use.
The plate is divided into four squares with a colored pencil and in the clockwise direction the squares I (0), P (A), W (B) are designated. A large drop of serum of two series I (0), P (A), W (B) groups is applied to the corresponding square of the plate with a pipette. The pad of the finger is treated with alcohol and the skin is punctured with a spear-needle. The first drop of blood is removed with a gauze ball, subsequent drops in different corners of the glass slide are sequentially introduced into the serum drops and mixed thoroughly. A drop of the introduced blood should be 5-10 times less than a drop of serum. Then, by shaking the plate, thoroughly mix the blood with the serum. The preliminary results are evaluated after 3 minutes, after which a drop of isotonic sodium chloride solution is added, mixed again by shaking the plate and after 5 minutes the final assessment of the agglutination reaction is carried out (Fig. 37, see color incl.).
With a positive isohemagglutination reaction, flakes and grains from adhered erythrocytes do not diverge when an isotonic sodium chloride solution is added and stirred. In case of a negative reaction, the drops of whey on the plate are transparent, uniformly pink in color, do not contain flakes and grains. The following four combinations of agglutination reactions with standard sera of I (0), P (A), W (B) groups are possible.
1. All three sera in both series do not agglutinate. Test blood - I (0) group.
2. The reaction of isohemagglutination is negative with the serum P (A) of the group of both series and positive with the sera of the I (0) and III (V) groups. Test blood - P (A) group.
3. The reaction of isohemagglutination is negative with the serum of the III (V) group in both series and positive with the serum of the I (0) and III (A) groups. The blood to be examined is of the W (H) group.
4. Sera of I (0), P (A), W (V) groups give a positive reaction in both series. The blood belongs to the IV (AB) group. But before giving such a conclusion, it is necessary to carry out an isohemagglutination reaction with standard serum of group IV (AB) by the same method. A negative isohemagglutination reaction makes it possible to finally assign the blood under study to the IV (AB) group.
The identification of other combinations indicates an incorrect determination of the group affiliation of the patient's blood.
Information about the patient's blood group is entered into the history of the disease, an appropriate note is made on the title page, signed by the doctor who conducted the study, indicating the date of the study.
Errors in determining the group affiliation of blood are possible in situations where, in the actual presence of agglutination, it is not detected or, conversely, agglutination is detected in its actual absence. Undetected agglutination may be due to: 1) weak activity of standard serum or low agglutinability of erythrocytes; 2) an excess amount of test blood added to the standard serum; 3) a delayed agglutination reaction at high ambient temperatures.
To avoid mistakes, it is necessary to use active, with a sufficiently high titer of serum at a ratio of the volume of the studied blood and standard serum 1: 5, 1:10. The study is carried out at a temperature not higher than 25 ° C, the results should be evaluated no earlier than 5 minutes from the start of the study.
The detection of agglutination in its actual absence may be due to the drying of a drop of serum and the formation of "coin" columns of erythrocytes or the manifestation of cold agglutination, if the study is carried out at an ambient temperature below 15 ° C. Adding a drop of isotonic sodium chloride solution to the test blood and serum and conducting studies at a temperature above 15 ° C can avoid these errors. Errors in determining the blood group are always associated with a violation of the research method, therefore, careful observance of all research rules is necessary.
In all doubtful cases, it is necessary to re-study the group affiliation with standard sera of other series or using standard erythrocytes.
Determination of the blood group according to the AB0 system using anti-A and anti-B monoclonal antibodies (anti-A and anti-B tsoliclones)
Anti-A and anti-B tsoliklones are used to determine the human blood group according to the AB0 system instead of standard isohemagglutinating sera by detecting antigens A and B in erythrocytes with standard antibodies contained in tsoliclones.
Monoclonal antibodies anti-A and anti-B are produced by two different hybridomas resulting from the fusion of antibody-producing muscle B-lymphocytes with mouse myeloma cells. The named tsoliclones are diluted ascitic fluid of mice-carriers of hybridoma, containing IgM against antigens A and B. Coliclones give a faster and more pronounced agglutination reaction than standard ABO-sera.
Determine the blood group at a temperature of 15 to 25 ° C. On a porcelain plate or a marked plate, one large drop of anti-A and anti-B tsoliclones is applied, a drop of test blood 10 times smaller is applied next to it and mixed with separate sticks or corners of glass slides. Swing the plate slightly and observe the reaction for 2.5 minutes. The reaction usually occurs in the first 3-5 s and is manifested by the formation of small red aggregates, and then flakes. The following variants of the agglutination reaction are possible.
1. Agglutination is absent with anti-A and anti-B tsoliclones, the blood does not contain agglutinogens A and B - the tested blood of group 1 (0) (Fig. 38, see color incl.).
2. Agglutination is observed with anti-A tsoliclones, erythrocytes of the test blood contain agglutinogen A - the test blood of group P (A).
3. Agglutination is observed with anti-B tsoliclone, erythrocytes of the test blood contain agglutinogen B - the test blood of group III (B).
4. Agglutination is observed with anti-A and anti-B tsoliclones, erythrocytes contain agglutinogens A and B - the blood of group IV (AB) under study (Table 2).
In the presence of an agglutination reaction with anti-A and anti-B tsoliclones [blood group IV (AB)], an additional control study with isotonic sodium chloride solution is performed to exclude nonspecific agglutination. Large drop (0.1 ml)
Table 2.Agglutination reaction of the studied erythrocytes with anti-A and anti-B tsoliclones
isotonic solution is mixed with a small (0.01 ml) drop of the test blood. The absence of agglutination confirms that the blood under study belongs to the IV (AB) group. In the presence of agglutination, the blood group is determined using washed standard erythrocytes.
Anti-A and anti-B cyclones are produced in liquid form in ampoules or vials, the liquid is colored in red (anti-A) and blue (anti-B) colors. Store in a refrigerator at a temperature of 2-8 ° C. Shelf life is 2 years.
Determination of the blood group of the AB0 system by standard washed erythrocytes with a known group affiliation
3-4 ml of blood is taken from the patient's vein into a test tube and centrifuged. On a plate divided into sectors, a drop of serum is applied according to the inscriptions, to which a drop of standard erythrocytes is added 5 times less than a drop of the test serum, the drops are mixed with the angle of the glass slide, the plate is shaken for 3 minutes, then isotonic sodium chloride solution is added drop by drop, continue to mix by rocking and evaluate the results after 5 minutes. There are four options for the agglutination reaction.
1. Agglutination is absent with erythrocytes of the I (0) group and is determined with the erythrocytes of the P (A) and W (B) groups - the blood under study is 1 (0) group.
2. Agglutination is absent with erythrocytes of the 1 (0) and P (A) groups and is determined with the erythrocytes of the III (B) group - the studied blood of the P (A) group.
3. Agglutination is absent with erythrocytes of 1 (0) and W (V) groups and is determined with erythrocytes of group P (A) - the blood of group W (B) being studied.
4. Agglutination is absent with erythrocytes of 1 (0), P (A), W (B) groups - the studied blood of 1V (AB) group.
Determination of the Rh factor
A blood test for Rh-affiliation by the conglutination method is carried out using special anti-Rh sera in laboratory conditions. The group affiliation is preliminarily determined (according to the AB0 system).
Equipment: two different series of standard anti-Rh sera corresponding to the blood group to be determined, or group-compatible standard washed single-group Rh-positive and Rh-negative erythrocytes, a Petri dish, a water bath, serum pipettes, glass slides or glass rods.
On a Petri dish, three large drops of anti-Rh serum of one series are applied in succession and in parallel - three drops of serum of another series, obtaining two horizontal rows of sera. Then, a small drop of the test blood is added to the first vertical row of sera of both series (the ratio of serum and blood is 10: 1 or 5: 1), in the middle row - by the same drop of standard Rh-positive erythrocytes (activity control), in the third row - Rh-negative standard erythrocytes (specificity control). Serum and erythrocytes are thoroughly mixed with a separate glass rod or corner of a glass slide for each drop, the cups are closed with a lid and placed in a water bath at a temperature of 46-48 ° C. After 10 minutes, take into account the result by viewing the cup in transmitted light. In a drop with standard Rh-positive erythrocytes, there should be agglutination, with Rh-negative ones, it is absent. If agglutination is determined in the drops of both series of sera with the studied erythrocytes, the blood is Rh-positive, if it is absent, the blood is Rh-negative.
It should be remembered that it is strictly forbidden to add an isotonic sodium chloride solution to a drop of serum, as is customary in determining the blood group according to the AB0 system using standard sera, as this may disrupt the agglutination reaction.
Errors in determining the Rh factor can be caused by a decrease in the activity of standard anti-Rh sera, a violation of the serum / blood ratio, non-compliance with the temperature regime during the study, a decrease in the exposure time (less than 10 minutes), the addition of isotonic sodium chloride solution, the absence of control samples for activity, and serum specificity, group discrepancies between standard sera and test and standard erythrocytes.
For express method determination of the Rh factor uses a special reagent - anti-Rh 1V (AB) serum, diluted with 20-30% human albumin solution or 30-33% dextran solution [cf. pier weight 50 000-70 000], used as a substance that promotes the aggregation of erythrocytes at room temperature.
A drop of standard serum anti-Rh IV (AB) group is applied to a glass slide or Petri dish and a drop of Rh-negative serum 1V (AB) group, which does not contain antibodies, is applied in parallel. A drop of the test blood is added to them 2-3 times smaller in volume, mixed with the angle of a glass slide, a glass rod or by rocking for 3-4 minutes, after which 1 drop of isotonic sodium chloride solution is added and after 5 minutes the reaction is taken into account. In the presence of agglutination of erythrocytes with anti-Rh serum and its absence with the control serum, the blood is Rh-positive; in the absence of agglutination with both sera, it is Rh-negative. If agglutination occurs with both sera, the reaction should be considered doubtful. For emergency transfusion, only Rh-negative blood should be used, and in its absence, it is possible in a life-threatening situation to transfuse Rh-positive blood after a test for Rh-factor compatibility.
BLOOD TRANSFUSION METHODS
Currently, the following methods of blood transfusion are used:
1) canned blood transfusion (indirect transfusion);
2) exchange transfusions;
3) autohemotransfusion.
In clinical practice, indirect transfusions are mainly used using canned blood and its components.
Rice. 39.Direct blood transfusion using syringes.
Direct blood transfusion
Direct blood transfusion from a donor to a recipient is rarely used. The indications for it are: 1) long-term, not amenable to hemostatic therapy, bleeding in patients with hemophilia; 2) disorders of the blood coagulation system (acute fibrinolysis, thrombocytopenia, afibrinogenemia) after massive blood transfusion and in diseases of the blood system; 3) traumatic shock of the III degree in combination with blood loss of more than 25-50% of the BCC and the lack of effect from the transfusion of canned blood.
The donor for direct transfusion is examined at the blood transfusion station. Immediately before the transfusion, the group and Rh-belonging of the donor and recipient are determined, tests for group compatibility and the Rh-factor are carried out, a biological test is carried out at the beginning of the transfusion. Transfusion is carried out using a syringe or apparatus. Use 20-40 syringes with a capacity of 20 ml, needles for venipuncture with rubber tubes put on their pavilions, sterile gauze balls, sterile clamps such as Billroth's clamps. The operation is performed by a doctor and a nurse. The nurse draws blood from the donor's vein into a syringe, squeezes the rubber tube with a clamp and
passes the syringe to the doctor, who injects blood into the patient's vein (Fig. 39). At this time, the sister draws blood into a new syringe. The work is carried out synchronously. Before the transfusion, 2 ml of 4% sodium citrate solution is drawn into the first 3 syringes to prevent blood coagulation, and the blood from these syringes is injected slowly (one syringe per 2 minutes). Thus, a biological test is performed.
Special devices are also used for blood transfusion.
Exchange transfusion
Exchange transfusion is a partial or complete removal of blood from the recipient's bloodstream and its simultaneous replacement with the same amount of infused blood. Indications for exchange transfusion are various poisoning, hemolytic disease of the newborn, blood transfusion shock, acute renal failure. With exchange transfusion, poisons and toxins are removed along with the exfused blood. Blood infusion is performed with a replacement purpose.
For exchange transfusion, freshly preserved or preserved blood of short shelf life is used. Blood is poured into any superficial vein, exfusion is carried out from large veins or arteries to prevent blood clotting during a long procedure. Removal of blood and infusion of donor blood is carried out simultaneously at an average rate of 1000 ml for 15-20 minutes. For full replacement of blood, 10-15 liters of donor blood is required.
Autohemotransfusion
Autohemotransfusion - transfusion of the patient's own blood taken from him in advance (before the operation), immediately before it or during the operation. The purpose of autohemotransfusion is to compensate the patient for the loss of blood during the operation of his own, devoid of the negative properties of donor blood. Autohemotransfusion eliminates complications possible during donor blood transfusion (immunization of the recipient, development of homologous blood syndrome), and also allows to overcome the difficulties of selecting an individual donor for patients with antibodies to erythrocyte antigens that are not part of the AB0 and Rh system.
Indications for autohemotransfusion are as follows: rare blood group of the patient, impossibility of donor selection, risk of severe post-mortem
transfusion complications, operations accompanied by large blood loss. Contraindications for autohemotransfusion are inflammatory diseases, severe pathology of the liver and kidneys (a patient in the stage of cachexia), late stages of malignant diseases.
Reinfusion of blood
Earlier than others, the method of blood reinfusion, or reverse transfusion of blood, poured into the serous cavities - abdominal or pleural - due to traumatic injury, diseases of internal organs or surgery, became known. Reinfusion of blood is used for disturbed ectopic pregnancy, rupture of the spleen, liver, mesenteric vessels, intrathoracic vessels, and lung. Contraindications for reinfusion are damage to the hollow organs of the chest (large bronchi, esophagus), hollow organs of the abdominal cavity - (stomach, intestines, gallbladder, extrahepatic bile ducts), bladder, as well as the presence of malignant neoplasms. It is not recommended to transfuse blood that has been in the abdominal cavity for more than 24 hours.
To preserve blood, use a special solution in a ratio with blood 1: 4 or a solution of sodium heparin - 10 mg in 50 ml of isotonic sodium chloride solution per bottle with a capacity of 500 ml. Blood is taken with a metal scoop or a large spoon by scooping out and immediately filtered through 8 layers of gauze or using a suction with a vacuum of at least 0.2 atm. The method of blood collection by aspiration is the most promising. The blood collected in vials with a stabilizer is filtered through 8 layers of gauze. Blood is infused through the transfusion system using standard filters.
Reinfusion is very effective in replenishing blood loss during surgery, when blood is collected and poured into the patient, which has poured into the surgical wound. Blood is collected by evacuation into vials with a stabilizer, followed by filtration through 8 layers of gauze and transfusion through a system with a standard microfilter. Contraindications for the reinfusion of blood poured into the wound are blood contamination with pus, intestinal, gastric contents, bleeding during uterine ruptures, and malignant neoplasms.
Autotransfusion of pre-prepared blood
Autotransfusion of pre-harvested blood provides for the exfusion and preservation of blood. Exfusion of blood is most advisable
it is different to carry out 4-6 days before the operation, since during this period, on the one hand, blood loss is restored, and on the other, the properties of the blood taken are well preserved. At the same time, hematopoiesis is affected not only by the movement of interstitial fluid into the bloodstream (as it happens with any blood loss), but also by the stimulating effect of taking blood. With this method of collecting blood, its volume does not exceed 500 ml. With the step-by-step preparation of blood, which is carried out during long-term preparation for the operation, it is possible to collect up to 1000 ml of autologous blood in 15 days and even 1500 ml in 25 days. With this method, 300-400 ml of blood is first taken from the patient, after 4-5 days it is returned to the patient and again taken by 200-250 ml more, repeating the procedure 2-3 times This method allows you to prepare a sufficiently large amount of autologous blood, while it retains its qualities, since its shelf life does not exceed 4-5 days.
Blood is stored in vials using preservative solutions at a temperature of 4 ° C. It is possible to preserve autologous blood for a long time by freezing it at ultra-low temperatures (-196? C).
Hemodilution
One of the ways to reduce surgical blood loss is hemodilution (blood dilution), which is performed immediately before the operation. As a result, during the operation, the patient loses diluted, diluted blood, with a reduced content of formed elements and plasma factors.
Blood for autotransfusion is collected immediately before the operation, when it is exfused from a vein into vials with a preservative and at the same time a hemodilutant containing dextran is injected [cf. pier weight 30 000-40 000], 20% albumin solution and Ringer-Locke solution. With moderate hemodilution (decrease in hematocrit by 1/4), the volume of exfused blood should be within 800 ml, the volume of injected fluid should be 1100-1200 ml (dextran [average mol. Weight 30,000-40,000] - 400 ml, Ringer's solution - Locke - 500-600 ml, 20% albumin solution - 100 ml). Significant hemodilution (decrease in hematocrit by 1/3) involves taking blood within 1200 ml, administration of solutions in a volume of 1600 ml (dextran [average molecular weight 30,000-40,000] - 700 ml, Ringer-Locke solution - 750 ml, 20% albumin solution - 150 ml). At the end of the operation, the autologous blood is returned to the patient.
The hemodilution method can be used before surgery to reduce blood loss and without blood exfusion - due to the introduction of infusion media that are well retained in the vascular bed due to collo-
Ideal properties and increasing the volume of circulating blood (albumin, dextran [average molecular weight 50,000-70,000], gelatin), in combination with saline blood-substituting fluids (Ringer-Locke solution).
Autoplasmotransfusion
Reimbursement of blood loss can be carried out with the patient's own plasma in order to provide the operation with an ideal blood substitute and prevent homologous blood syndrome. Autoplasmotransfusion can be used to compensate for blood loss when harvesting autologous blood. Autoplasma is obtained by plasmapheresis and preserved, a single-stage harmless dose of plasma exfusion is 500 ml. Exfusion can be repeated after 5-7 days. A dextrosocytrate solution is used as a preservative. To compensate for the surgical blood loss, autoplasma is transfused as a blood-substituting fluid or as an integral part of the blood. The combination of autoplasma with washed thawed erythrocytes prevents homologous blood syndrome.
BASIC METHODS OF BLOOD TRANSFUSION
Intravenous blood transfusion
Intravenous is the main route of blood infusion. Most often, puncture of the vein of the elbow or subclavian vein is used, less often they resort to venesection. For puncture of the vein of the elbow bend, a rubber tourniquet is applied to the lower third of the shoulder, the operating field is treated with alcohol or an alcoholic solution of iodine and isolated with sterile linen. Only the veins are squeezed with a tourniquet (the arteries are passable), and when the fingers are squeezed into a fist and the muscles of the forearm are contracted, they are well contoured.
The Dufo needle is taken with the fingers for the pavilion or put on a syringe, pierced the skin, subcutaneous tissue, the needle (about 1 cm) is advanced in the subcutaneous tissue above the vein, its front wall is pierced and then advanced through the vein. The appearance of a stream of blood from the needle when puncturing the vein wall indicates a correctly performed vein puncture. 3-5 ml of blood is taken from the vein for the control determination of the recipient's blood group and testing for compatibility. The tourniquet is then removed and an infusion system, such as isotonic sodium chloride solution, is attached to the needle to prevent needle thrombosis. The needle is fixed to the skin with a strip of adhesive plaster.
After determining the blood group according to the AB0 system and the Rh factor, conducting a compatibility test, connect the blood transfusion system and begin the transfusion.
When it is impossible to puncture superficial veins (collapsed veins in shock, pronounced obesity), venesection is performed. The operating field is treated with alcohol or an alcoholic solution of iodine, isolated with sterile surgical linen. The incision site is infiltrated with 0.25% procaine solution. A tourniquet is applied to the limb without squeezing the arteries. The skin, subcutaneous tissue are dissected and a vein is isolated with tweezers. Two ligatures are brought under it, while the peripheral one serves as a holder. Pulling the vein by the holder, it is punctured with a needle towards the center or the wall is cut with scissors, the needle is inserted and fixed with a central ligature. A blood transfusion system is connected to the needle, 2-3 sutures are applied to the skin.
At the end of the transfusion, when about 20 ml of blood remains in the system, the system is clamped and disconnected, and the needle is removed. The puncture or venesection site is lubricated with an alcoholic solution of iodine and a pressure bandage is applied.
In cases where a long (several days) transfusion of solutions, blood and its components is assumed, puncture of the subclavian or external jugular vein is performed, a special catheter is inserted into the lumen of the vein, which can be in it for a long time (up to 1 month), and a system for blood transfusion or other transfusion media is connected to it, if necessary.
Intra-arterial blood transfusion
Indications: a state of clinical death (respiratory and cardiac arrest) caused by massive massive blood loss; severe traumatic shock with a long-term decrease in SBP to 60 mm Hg, ineffectiveness of intravenous blood transfusions. The therapeutic effect of intra-arterial transfusion is determined by reflex stimulation of cardiovascular activity and restoration of blood flow through the coronary vessels. To achieve the effect, blood is injected at a rate of 200-250 ml for 1.5-2 minutes under a pressure of 200 mm Hg, with the restoration of cardiac activity, the pressure is reduced to 120 mm Hg, and with a clearly defined pulse, they switch to intravenous infusion blood; when the systolic blood pressure is stabilized at the level of 90-100 mm Hg. the needle is removed from the artery.
The system for intra-arterial blood transfusion is similar to that for intravenous administration, with the exception that a Richardson balloon is connected to a long needle inserted into the vial, connected through a T-piece to a pressure gauge (Fig. 40). The artery is punctured through the skin with a Dufo needle or arteriosection is performed.
The femoral and brachial arteries are used for puncture. More often resort to arteriosection, using the radial and posterior tibial arteries for infusion. Operations are performed under local infiltration anesthesia.
When blood is pumped under pressure, there is a great danger of air embolism, therefore, it is necessary to carefully monitor the blood level in the system in order to close it with a clamp in time.
Rice. 40.System for intra-arterial blood transfusion.
Intra-aortic blood transfusion
Intra-aortic blood transfusion is carried out with sudden clinical death, massive bleeding that occurs during thoracic operations. For this purpose, catheters are used, passed into the aorta from peripheral arteries (more often - femoral, less often - brachial) by means of their percutaneous puncture or section. Transfusion is performed under pressure as with intra-arterial blood transfusion using the same system.
Intraosseous administration of transfusion media
This method is used extremely rarely when it is impossible to use another way (for example, with extensive burns). Blood is poured into the sternum, iliac crest, heel bone.
Puncture of the sternum is performed in the position of the patient on the back. The sternum is punctured under local infiltration anesthesia in the area of the handle or its body. To do this, use a special needle with a handle (Kassirsky's needle). The operating field is processed. The puncture is carried out strictly along the midline, the skin and subcutaneous tissue pass with the needle, further resistance is created by the anterior bone plate of the sternum, which is overcome with some effort. The feeling of the needle falling through indicates its passage into the bone marrow. The mandrain is removed, the bone marrow is aspirated with a syringe. The appearance of the latter in the syringe indicates the correct location of the needle. Then 3-5 ml of a 1-2% solution of procaine is injected through a needle into the bone marrow and a blood transfusion system is connected.
The iliac crest is punctured in the middle of the posterior third, since in this place the cancellous bone is of a loose structure, and the infusion is easy.
Blood enters the bone slowly by gravity - 5-30 drops per minute, and it takes 2-3 hours to transfuse 250 ml of blood. To increase the rate of infusion, the bottle is raised on a rack or increased pressure is created in the bottle, forcing air under pressure up to 220 mm Hg. Art.
BASIC STEPS OF THE DOCTOR
AND THE SEQUENCE OF THEIR PERFORMANCE
FOR BLOOD TRANSFUSION
Blood transfusion is a serious operation for the transplantation of human living tissue. This method of treatment is widespread in clinical practice. Blood transfusion is used by doctors of various specialties: surgeons, obstetricians-gynecologists, traumatologists, therapists, etc.
Achievements of modern science, in particular transfusiology, make it possible to prevent complications in blood transfusion, which, unfortunately, still occur and sometimes even end in the death of the recipient. The cause of complications is errors in blood transfusion, which are caused by insufficient knowledge of the basics of transfusion or violation of the rules of blood transfusion technique at various stages. These include incorrect determination of indications and contraindications for transfusion, erroneous determination of group or Rh-affiliation, incorrect testing for the individual compatibility of donor and recipient blood, etc. Us-
infantry determine scrupulous, competent implementation of the rules and reasonable consistent actions of the doctor during blood transfusion.
Determination of indications for blood transfusion
Blood transfusion is a serious intervention for a patient, and the indications for it must be justified. If it is possible to provide effective treatment for the patient without blood transfusion or there is no confidence that it will benefit the patient, it is better to refuse transfusion. Indications for blood transfusion are determined by the pursued goal: the replacement of the missing volume of blood or its individual components, an increase in the activity of the blood coagulation system during bleeding. Acute blood loss, shock, bleeding, severe anemia, severe traumatic operations, including those with artificial circulation, are considered absolute indications. Indications for transfusion of blood and its components are anemia of various origins, blood diseases, pyoinflammatory diseases, and severe intoxication.
Determination of contraindications for blood transfusion
Contraindications for blood transfusion include: 1) decompensation of cardiac activity in heart defects, myocarditis, myocardiosclerosis; 2) septic endocarditis; 3) hypertension stage III; 4) violation of cerebral circulation; 5) thromboembolic disease; 6) pulmonary edema; 7) acute glomerulonephritis; 8) severe liver failure; 9) general amyloidosis; 10) allergic condition; 11) bronchial asthma.
When assessing contraindications for blood transfusion, transfusion and allergological anamnesis is of great importance, i.e. information about past blood transfusions and the patient's reaction to them, as well as the presence of allergic diseases. A group of dangerous recipients is identified. These include patients who in the past (more than 3 weeks ago) received blood transfusions, especially if they were accompanied by unusual reactions; women with a history of dysfunctional childbirth, miscarriages and the birth of children with hemolytic disease and jaundice; patients with disintegrating malignant neoplasms, blood diseases, prolonged suppurative processes. In patients with a history of a blood transfusion reaction and a poor obstetric history,
suspect Rh-factor sensitization. In these cases, blood transfusion is postponed until the situation is clarified (the presence of Rh antibodies or other antibodies in the blood). Such patients must undergo a compatibility reaction in the laboratory using the indirect Coombs reaction.
With absolute vital indications for transfusion (for example, shock, acute blood loss, severe anemia, ongoing bleeding, severe traumatic surgery), blood must be transfused, despite the presence of contraindications. At the same time, it is advisable to select certain components of blood, its preparations, and to carry out preventive measures. In case of allergic diseases, bronchial asthma, when blood transfusion is performed for urgent indications, desensitizing agents (calcium chloride, antigastamines, glucocorticoids) are preliminarily administered to prevent complications, and those that have the least antigenic effect, for example, frozen and washed erythrocytes. It is advisable to combine blood with blood-substituting directional fluids, and use autologous blood during surgical interventions.
Preparing a patient for a blood transfusion
In a patient admitted to a surgical hospital, the blood group and the Rh factor are determined. A study of the cardiovascular, respiratory, and urinary systems is carried out in order to identify contraindications to blood transfusion. A general blood test is done 1-2 days before the transfusion; before the blood transfusion, the patient must empty the bladder and intestines. Transfusion is best done in the morning on an empty stomach or after a light breakfast.
Choice of transfusion medium, method of transfusion
Whole blood transfusion for the treatment of anemia, leukopenia, thrombocytopenia, disorders of the coagulation system with a deficiency of certain blood components is unjustified, since other factors are consumed to replenish certain factors, the introduction of which is not necessary for the patient. The therapeutic effect of whole blood in such cases is lower, and the blood consumption is much higher than with the introduction of concentrated blood components, for example, erythrocyte or leukocyte mass, plasma, albumin, etc. For example, with hemophilia, a patient
only factor VIII needs to be introduced. To cover the body's need for it at the expense of whole blood, several liters of it are needed, and at the same time, this need can be provided with just a few milliliters of antihemophilic globulin. In case of hypo- and afibrinogenemia, up to 10 liters of whole blood must be transfused to replenish the fibrinogen deficiency, but instead, 10-12 g of fibrinogen blood preparation is sufficient. With leukopenia, agranulocytosis, immunodeficiency state, it is advisable to transfuse the leukocyte mass, with anemia - erythrocyte.
Whole blood transfusion can cause sensitization of the patient, the formation of antibodies to blood cells (leukocytes, platelets) or plasma proteins, which is fraught with serious complications in case of repeated blood transfusions or pregnancy.
Whole blood is transfused in case of acute blood loss with a sharp decrease in the BCC, exchange transfusions, artificial circulation during open heart surgery.
When choosing a transfusion medium, you should use the component that the patient needs, using also blood-substituting fluids (Table 3).
The main method of blood transfusion is intravenous drip using a puncture of the saphenous veins. In case of massive and long-term complex transfusion therapy, blood, along with other media, is injected into the subclavian or external jugular vein; in extreme situations, it is injected intra-arterially.
Transfusion volume determined depending on the indications, the selected transfusion medium, the patient's condition. So, in acute blood loss (see Chapter 5), the amount of transfused medium depends on the degree of BCC deficiency. With blood loss of up to 15% of the BCC, blood is not transfused, with a decrease in the hemoglobin content below 80 g / l, with a hematocrit of less than 30, blood transfusion is necessary. With a decrease in BCC by 35-40%, transfusions of plasma and erythrocyte mass or whole blood are indicated. The volume of transfusion, as well as the choice of a blood component, is individual for each disease and for each patient in accordance with the existing treatment program for a particular patient.
Evaluation of the suitability of canned blood and its components for transfusion
Before transfusion, determine the suitability of blood for transfusion (Fig. 41, see color incl.): Check the integrity of the package, the expiration date,
Table 3.The choice of transfusion media for various pathological conditions
blood storage mode (possible freezing, overheating). It is most advisable to transfuse blood with a shelf life of no more than 5-7 days, since with an extension of the shelf life, biochemical and morphological changes occur in the blood, which reduce its positive properties. On a macroscopic assessment, blood should have three layers. At the bottom there is a red layer of erythrocytes, then a thin layer of leukocytes, and on top is a transparent, slightly yellowish plasma. Signs of unsuitability of blood are red or pink staining of plasma (hemolysis), the appearance of flakes in it, turbidity, the presence of a film on the plasma surface (signs of infection
vi), clots (blood clotting). In case of urgent transfusion of unstable blood, part of it is poured into a test tube and centrifuged. Pink staining of plasma indicates hemolysis. During the transfusion of frozen blood components, blood packs are quickly heated to 38 ° C, then the erythrocytes are washed from the used cryoprotectant (glycerol - for erythrocytes, dimethyl sulfoxide - for leukocytes and platelets).
Control determination
blood groups of the recipient and donor
Despite the coincidence of the data in the medical history and those indicated on the package label, it is necessary immediately before transfusion to determine the patient's blood group and taken from the vial for transfusion to him. The determination is made by a doctor who transfuses blood. It is unacceptable to entrust the control determination of the blood group to another doctor or to carry it out in advance. If blood transfusion is carried out for emergency indications, then not only the blood group is determined according to the AB0 system, but also the patient's Rh factor (by the express method). When determining the blood group, it is necessary to follow the relevant rules, the results are evaluated not only by the doctor who transfused the blood, but also by other doctors.
Testing for compatibility
To determine individual compatibility, 3-5 ml of blood is taken from a vein into a test tube and, after centrifugation or settling, one large drop of serum is applied to a plate or plate. A drop of donor blood is applied nearby in a ratio of 5: 1-10: 1, stirred with a corner of a glass slide or a glass rod and observed for 5 minutes, after which a drop of isotonic sodium chloride solution is added and the result is assessed by the presence or absence of agglutination. The absence of agglutination indicates the group compatibility of the donor's and the recipient's blood, its presence indicates incompatibility (Fig. 42, see color incl.). An individual compatibility test should be performed with each vial of blood transfused. Group blood compatibility is schematically shown in Fig. 43.
Determination of blood compatibility by the Rh factor is carried out in the case of an unfavorable transfusion history (post-transfusion reactions during blood transfusions in the past, Rh-conflict
Rice. 43.Blood group compatibility (diagram).
pregnancy, miscarriages), in critical situations when it is impossible to determine the Rh-factor of the recipient's blood, and in the case of forced transfusion of Rh-positive blood to a patient with unknown Rh-affiliation.
Blood is taken from the recipient's vein, as well as to determine individual (group) compatibility, centrifuged. A centrifuge or other glass tube with a capacity of at least 10 ml is used for research. The use of plastic tubes and smaller tubes makes it difficult to evaluate the results. On the test tube, you must indicate the surname, initials, blood group of the patient, surname, initials, blood group of the donor and the number of the container with blood.
On the wall of the test tube with a pipette apply 2 drops of the patient's blood serum, 1 drop of donor blood, 1 drop of 33% dextran solution [cf. pier weight 50 000-70 000], then the test tube is tilted almost to a horizontal position and slowly rotated for 3 minutes so that its contents spread along the walls (this makes the reaction more pronounced). Then add 2-3 ml of isotonic sodium chloride solution to the test tube and mix by inverting the test tube 2-3 times to a horizontal level (do not shake!).
Turning the test tube over, look through it at a light or fluorescent lamp. If the contents of the test tube remain uniformly colored and there are no signs of agglutination, the liquid slightly opalescent when turned over, which means that the donor's blood is compatible with the patient's blood, and there are no isoimmune antibodies in it.
If an agglutination of erythrocytes is observed in the test tube in the form of a suspension of small or large lumps against the background of a clear or completely discolored liquid, then the donor's blood is incompatible with the patient's blood and cannot be transfused (Fig. 44, see color incl.).
This test simultaneously allows to determine the compatibility of blood in the presence of other isoimmune antibodies (Kell, Lutheran, Kidd, etc.), in fact, it can be considered universal for determining the compatibility of blood in the presence of isoimmune sensitization in the recipient.
In cases where true agglutination is detected during tests for group compatibility using the AB0 or Rh factor system, an individual selection of donor blood at the blood transfusion station is required. If the patient's condition requires an emergency blood transfusion, it is selected from the available supply - of the same name in the group and Rh-factor, without waiting for the results of the study and blood flow from the transfusion station. With blood from each vial and serum of the recipient, a test is carried out for group compatibility according to the AB0 system and the Rh factor. If there is no agglutination, this blood can be transfused to the patient, starting the transfusion with a biological sample. If agglutination is detected in samples for group and Rh-affiliation with blood of the same name from all vials from the available blood supply, the latter cannot be transfused without waiting for individually selected blood from the transfusion station.
Having received blood from the transfusion station, it is necessary to perform a control determination of its blood group and Rh factor in the vial, as well as tests for group and Rh compatibility. Only if the group and Rh-belonging of the donor's and the patient's blood coincide and there is no agglutination in the tests for group compatibility according to the AB0 system and the Rh-factor, you can start blood transfusion, starting with a biological sample.
Preparing the system and starting the transfusion
For blood transfusion, a plastic disposable system with a nylon filter is used to prevent blood clots from entering the patient's bloodstream. The system consists of a short tube with a needle and a filter for supplying air to the vial, a long tube for blood infusion with two needles at the ends - for insertion into the vial and for puncture of the patient's vein. The system is equipped with a dropper with a nylon filter and a plate clamp to regulate the injection rate. It is produced in a sterile form in a polyethylene bag, from which it is removed immediately before use.
When assembling a system for blood transfusion, it is necessary to follow the rule: to transfuse blood from the same container in which it was stored after preparation.
When transfusing blood from a plastic bag it is mixed in a bag, a hemostatic clamp is applied to the central outlet tube of the bag, the tube is treated with alcohol or 10% alcohol solution of iodine and cut 1-1.5 cm below the clamp. The safety cap is removed from the cannula of the transfusion system and the system is attached to the bag, connecting the end of the bag tubing and the cannula of the system. The bag is suspended upside down from the stand, the system with the dropper is raised and inverted so that the filter in the dropper is located on top. The clamp is removed from the tube, the IV is half-filled with blood, and the clamp is applied. The system is returned to its original position, the filter in the dropper is at the bottom and must be filled with blood. The clamp is removed and the part of the system located below the filter is filled with blood until the air is completely displaced from it and drops of blood appear from the needle. A few drops of blood from the needle are placed on a plate for control determination of the donor's blood group and testing for compatibility. The absence of air bubbles in the system is determined by eye. The system is ready for transfusion. The infusion rate is adjusted with a clamp. If it is necessary to attach a new bag, the system is closed with a clamp, the tube is closed with a hemostat, the bag is disconnected and replaced with a new one.
For blood transfusion from a standard vial the aluminum cap is removed from the lid, the rubber stopper is treated with alcohol or an alcoholic solution of iodine and pierced with two needles. A short tube for air intake is connected to one of them, the end of which is set above the bottom of the bottle, to the other - a system for single use, the bottle is placed in a tripod upside down. The system is filled with blood in the same way (Fig. 45).
After completing the installation and filling of the system, having determined the group compatibility of blood according to the AB0 system and the Rh factor, proceed directly to the blood transfusion by connecting the system to the needle (if the vein was punctured in advance and blood substituting fluids were poured into it), or the vein is punctured and the system is connected to blood transfusion.
Testing for biological compatibility
Transfusion of blood or its components (erythrocyte mass, erythrocyte suspension, plasma) begins with a biological test. To do this, the first 15-20 ml of blood is injected in a stream and
Rice. 45.System for blood and fluid transfusion: a - assembled system; 1 - needle cap; 2 - a bottle of blood; 3 - a tube for air intake; 4 - air filter; 5 - a tube for transfusion; 6 - clamp for regulating the rate of blood injection; 7 - needle for blood flow from the ampoule; 8 - filter dropper; 9 - a needle for a puncture of a vein; 10 - connecting tube; b - system for blood and fluid transfusion from different bottles.
transfusion is given for 3 minutes, observing the patient's condition (behavior, color of the skin, the state of the pulse, respiration). Increased pulse rate, shortness of breath, difficulty breathing, facial flushing, lowering blood pressure indicate the incompatibility of the blood of the donor and recipient. If there are no signs of incompatibility, the test is repeated twice more and, if there is no reaction, the transfusion is continued. When a triple biological test is carried out in the interval between blood infusions, thrombosis of the needle is possible, in order to avoid which, during this period, a slow drip infusion of blood or blood-substituting fluids is performed.
Monitoring blood transfusion
The transfusion rate is adjusted using a special clamp that squeezes the rubber or plastic tubing of the system. Blood should be injected at a rate of 50-60 drops per minute. If necessary, the clamp is opened completely or a Richardson balloon is connected to force air into the vial (pressure transfusion).
During the entire period of transfusion, it is necessary to monitor the patient, so that at the first signs of a reaction to a transfusion or complications, the infusion should be stopped and treatment measures started.
In case of thrombosis of the needle, you should not try to clean it with a mandrel or, under pressure of blood (solution from a syringe), drive the thrombus into the patient's vein. In such cases, it is necessary to close the infusion system with a clamp, disconnect it from the vein, remove the needle from the vein and apply a bandage to the puncture site, then another needle should be punctured another vein and continue the transfusion.
During transfusion, it is permissible to mix blood with sterile solutions of blood-substituting fluids in sealed standard packages.
When about 20 ml of blood remains in the vial, ampoule, plastic bag, the transfusion is stopped. The needle is removed from the vein and an aseptic bandage is applied to the puncture site. The blood remaining in the vial, without violating asepsis, is placed in a refrigerator, where it is stored at a temperature of 4 ° C for 48 hours. or Rh accessories, checking the compatibility of the transfused blood with the patient's blood).
Registration of blood transfusion
After the completion of the blood transfusion, a record is made in the history of the disease and in a special register for registering blood transfusion, indicating the dose of the transfused blood, its passport data, the results of tests for compatibility, the presence or absence of reactions or complications.
Monitoring the patient after blood transfusion
After transfusion of blood or its components, the patient needs bed rest for 3-4 hours. He is monitored for 24 hours.
a doctor and nurses who find out the patient's complaints, assess his general condition, behavior, appearance, condition of the skin. Every hour for 4 hours, the patient's body temperature is measured, the pulse is counted. The next day, a general analysis of blood and urine is performed. Changes in the patient's behavior, color of the skin (pallor, cyanosis), the appearance of complaints of pain behind the sternum, in the lower back, fever, increased heart rate, drop in blood pressure are signs of a post-transfusion reaction or complication. In such cases, it is necessary to take urgent measures to provide the patient with assistance. The earlier treatment of complications begins, the more favorable the outcome. The absence of these symptoms indicates that the transfusion passed without complications. If within 4 hours after blood transfusion with hourly thermometry, the body temperature did not rise, then we can assume that there was no reaction to the transfusion.
BLOOD TRANSFUSION COMPLICATIONS
Blood transfusion is a safe therapy if the rules are followed carefully. Violation of the rules for transfusion, underestimation of contraindications, errors in the technique of transfusion can lead to post-transfusion complications.
The nature and severity of complications are different. They may not be accompanied by serious dysfunctions of organs and systems and may not pose a threat to life. These include pyrogenic and mild allergic reactions. They develop soon after transfusion and are expressed in an increase in body temperature, general malaise, weakness. Chills, headache, itching of the skin, edema of certain parts of the body (Quincke's edema) may appear.
For a share pyrogenic reactions accounts for half of all complications, they are mild, moderate and severe. With a mild degree, the body temperature rises within 1 ° C, headache, muscle pain occurs. Reactions of moderate severity are accompanied by chills, an increase in body temperature by 1.5-2? C, an increase in pulse and respiration. In severe reactions, tremendous chills are observed, body temperature rises by more than 2 ° C (40 ° C and above), severe headache, pain in muscles, bones, shortness of breath, cyanosis of the lips, tachycardia are noted.
The cause of pyrogenic reactions is the decay products of plasma proteins and leukocytes of donor blood, waste products of microbes.
When pyrogenic reactions appear, the patient should be warmed, covered with blankets and warmers should be applied to the legs, given hot tea, and NSAIDs should be given. For mild to moderate reactions, this is sufficient. In case of severe reactions, the patient is additionally prescribed NSAIDs in injections, 5-10 ml of a 10% solution of calcium chloride is injected intravenously, a dextrose solution is injected dropwise. To prevent pyrogenic reactions in severe anemic patients, washed and thawed erythrocytes should be transfused.
Allergic reactions - a consequence of sensitization of the recipient's body to Ig, more often they occur with repeated transfusions. Clinical manifestations of an allergic reaction: fever, chills, general malaise, urticaria, shortness of breath, choking, nausea, vomiting. For treatment, antihistamines and desensitizing agents are used (diphenhydramine, chloropyramine, calcium chloride, glucocorticoids), with symptoms of vascular insufficiency - vasotonic agents.
With transfusion of antigenically incompatible blood, mainly according to the AB0 system and the Rh factor, it develops blood transfusion shock. Its pathogenesis is based on the rapidly advancing intravascular hemolysis of the transfused blood. The main reasons for blood incompatibility are errors in the actions of the doctor, violation of the rules for transfusion.
Depending on the level of SBP reduction, there are three degrees of shock: I degree - up to 90 mm Hg; II degree - up to 80-70 mm Hg; III degree - below 70 mm Hg
During blood transfusion shock, periods are distinguished: 1) blood transfusion shock itself; 2) the period of oliguria and anuria, which is characterized by a decrease in urine output and the development of uremia; the duration of this period is 1.5-2 weeks; 3) the period of recovery of diuresis - characterized by polyuria and a decrease in azotemia; its duration is 2-3 weeks; 4) recovery period; proceeds within 1-3 months (depending on the severity of renal failure).
Clinical shock symptoms may occur at the beginning of the transfusion, after the transfusion of 10-30 ml of blood, at the end of the transfusion, or shortly thereafter. The patient is anxious, complains of pain and a feeling of tightness behind the sternum, pain in the lower back, muscles, and sometimes chills. Shortness of breath, difficulty in breathing are observed. The face is hyperemic, sometimes pale or cyanotic. Possible nausea, vomiting, involuntary urination and defecation. The pulse is frequent, weak filling, blood pressure goes down. Death can occur if symptoms worsen quickly.
When transfusing incompatible blood during an operation under anesthesia, the manifestations of shock are often absent or mild. In such cases, blood incompatibility is indicated by an increase or decrease in blood pressure, increased, sometimes significantly, tissue bleeding in the surgical wound. When the patient is removed from anesthesia, tachycardia, a decrease in blood pressure, and acute respiratory failure are possible.
Clinical manifestations of blood transfusion shock during transfusion of blood incompatible with the Rh factor develop within 30-40 minutes, and sometimes even several hours after the transfusion, when a large amount of blood has already been transfused. This complication is difficult.
When removing the patient from shock, acute renal failure may develop. In the first days, there is a decrease in diuresis (oliguria), a low relative density of urine, an increase in the phenomena of uremia. With the progression of acute renal failure, there may be a complete cessation of urination (anuria). In the blood, the content of residual nitrogen and urea, bilirubin increases. The duration of this period in severe cases lasts up to 8-15 and even up to 30 days. With a favorable course of renal failure, diuresis is gradually restored and a period of recovery begins. With the development of uremia, patients can die on the 13-15th day.
At the first signs of blood transfusion shock, blood transfusion should be stopped immediately and, without waiting for the cause of incompatibility to be clarified, intensive therapy should be started.
1. Strophanthin-K, lily of the valley glycoside are used as cardiovascular agents, norepinephrine is used for low blood pressure, diphenhydramine, chloropyramine or promethazine are used as antihistamines, glucocorticoids are administered (50-150 mg of prednisolone or 250 mg of hydrocortisone) to stimulate vascular activity and slowing down the antigen-antibody reaction.
2. To restore hemodynamics, microcirculation, blood-substituting fluids are used: dextran [cf. pier weight 30 000-40 000], saline solutions.
3. In order to remove hemolysis products, Povidone + Sodium chloride + Potassium chloride + Calcium chloride + Magnesium chloride + Sodium bicarbonate, bicarbonate or sodium lactate are injected.
4. To maintain diuresis, use furosemide, mannitol.
5. Bilateral lumbar procaine blockade is urgently performed to relieve renal vasospasm.
6. Patients are given humidified oxygen for breathing; in case of respiratory failure, mechanical ventilation is performed.
7. In the treatment of blood transfusion shock, early plasma exchange is indicated with the removal of 1500-2000 ml of plasma and replacing it with freshly frozen plasma.
8. The ineffectiveness of drug therapy for acute renal failure, the progression of uremia are indications for hemodialysis, hemosorption, plasmapheresis.
In case of shock, resuscitation measures are carried out in the institution where it happened. Treatment of renal failure is carried out in special departments for extrarenal blood purification.
Bacterial toxic shock is extremely rare. It is caused by blood infection during harvesting or storage. The complication occurs directly during the transfusion or 30-60 minutes after it. Immediately appear shaking chills, high body temperature, agitation, darkening of consciousness, frequent threadlike pulse, a sharp drop in blood pressure, involuntary urination and defecation.
To confirm the diagnosis, bacteriological examination of blood remaining after transfusion is of great importance.
Treatment involves the immediate use of anti-shock, detoxification and antibacterial therapy, including pain relievers and vasoconstrictors (phenylephrine, norepinephrine), blood-substituting rheological and detoxifying fluids (dextran [average mol. Weight 30,000-40,000], Povidone + Sodium chloride + Potassium chloride + Calcium chloride + Magnesium chloride + Sodium bicarbonate), electrolyte solutions, anticoagulants, broad-spectrum antibiotics (aminoglycosides, cephalosporins).
The most effective early addition to complex therapy with exchange blood transfusions.
Air embolism can occur if the transfusion technique is violated - incorrect filling of the transfusion system (air remains in it), untimely termination of blood transfusion under pressure. In such cases, air can enter the vein, then into the right half of the heart and then into the pulmonary artery, blocking its trunk or branches. For the development of air embolism, a single-stage flow of 2-3 cm 3 of air into the vein is sufficient. Clinical signs of pulmonary artery air embolism are sharp chest pain, shortness of breath, severe cough, cyanosis of the upper half of the body, a weak, rapid pulse, and a drop in blood pressure. The sick are restless, grab hold of themselves
chest, feel a sense of dread. The outcome is often unfavorable. At the first signs of embolism, it is necessary to stop blood transfusion and start resuscitation measures: artificial respiration, the introduction of cardiovascular drugs.
Thromboembolismwhen blood transfusion occurs as a result of embolism by blood clots formed during its storage, or blood clots that have come off a thrombosed vein when blood is injected into it. The complication proceeds as an air embolism. Small blood clots clog small branches of the pulmonary artery, pulmonary infarction develops (chest pain; cough, at first dry, then with bloody sputum; fever). X-ray examination determines the picture of focal pneumonia.
At the first signs of thromboembolism, immediately stop the blood infusion, use cardiovascular drugs, inhalation of oxygen, infusion of fibrinolysin [human], streptokinase, sodium heparin.
Massive blood transfusion is considered to be a transfusion, in which, in a short period of time (up to 24 hours), donor blood is injected into the bloodstream in an amount exceeding 40-50% of the BCC (usually 2-3 liters of blood). When transfusing such an amount of blood (especially long shelf life) received from different donors, a complex symptom complex may develop, called syndrome of massive blood transfusion. The main factors determining its development are the effect of chilled (refrigerated) blood, the intake of large doses of sodium citrate and blood breakdown products (potassium, ammonia, etc.) that accumulate in the plasma during its storage, as well as the massive flow of fluid into the bloodstream, which leads to an overload of the cardiovascular system.
Acute expansion of the heart develops when large doses of canned blood quickly enter the patient's blood during its jet transfusion or injection under pressure. Shortness of breath, cyanosis, complaints of pain in the right hypochondrium, frequent low arrhythmic pulse, lowering blood pressure and increased CVP occur. If there are signs of heart overload, the infusion should be stopped, bloodletting (200-300 ml) should be done and cardiac (strophanthin-K, lily of the valley glycoside) and vasoconstrictor agents, 10% calcium chloride solution (10 ml) should be injected.
Citrate intoxication develops with massive blood transfusion. The toxic dose of sodium citrate is 0.3 g / kg. Sodium citrate binds calcium ions in the recipient's blood, hypocalcemia develops, which, along with the accumulation of citrate in the blood, leads to
severe intoxication, the symptoms of which are tremors, convulsions, increased heart rate, lowering blood pressure, arrhythmia. In severe cases, dilated pupils, pulmonary and cerebral edema join. To prevent citrate intoxication, it is necessary to inject 5 ml of 10% calcium chloride solution or calcium gluconate solution for every 500 ml of preserved blood during blood transfusion.
Due to the transfusion of large doses of canned blood for long periods of storage (more than 10 days), severe potassium intoxication, which leads to ventricular fibrillation, and then to cardiac arrest. Hyperkalemia is manifested by bradycardia, arrhythmia, myocardial atony, and an excess of potassium is detected in the blood test. Prevention of potassium intoxication is blood transfusion of short shelf life (3-5 days), the use of washed and thawed erythrocytes. For therapeutic purposes, infusion of 10% calcium chloride, isotonic sodium chloride solution, 40% dextrose solution with insulin, cardiac drugs are used.
With massive blood transfusion, in which blood is transfused, compatible in group and Rh belonging from many donors, due to individual incompatibility of plasma proteins, a serious complication may develop - homologous blood syndrome. Clinical signs of this syndrome are pallor of the skin with a bluish tinge, frequent weak pulse. Blood pressure is lowered, CVP is increased, multiple fine bubbling moist rales are determined in the lungs. Edema of the lungs may increase, which is expressed in the appearance of large bubbly moist rales, bubbling breath. A drop in hematocrit and a sharp decrease in BCC are noted, despite adequate or excessive compensation for blood loss; slowing down the time of blood clotting. The syndrome is based on microcirculation disorder, erythrocyte stasis, microthrombosis, blood deposition.
Prevention of homologous blood syndrome provides for the replenishment of blood loss, taking into account the BCC and its components. Very important is the combination of donor blood and blood-substituting fluids of hemodynamic (anti-shock) action (dextran [average molecular weight 50,000-70,000], dextran [average molecular weight 30,000-40,000]), which improve the rheological properties of blood ( its fluidity) due to the dilution of shaped elements, reducing the viscosity, improving microcirculation.
If a massive transfusion is necessary, one should not strive for a full replenishment of the hemoglobin concentration. To maintain the transport function of oxygen, a level of 75-80 g / l is sufficient. Vos-
the missing BCC should be filled with blood-substituting fluids. An important place in the prevention of homologous blood syndrome is occupied by autotransfusion of blood or plasma, i.e. transfusion to the patient of an absolutely compatible transfusion medium, as well as thawed and washed erythrocytes.
Infectious complications. These include the transmission of acute infectious diseases with the blood (influenza, measles, typhus, brucellosis, toxoplasmosis, etc.), as well as the transmission of diseases spreading by the serum route (hepatitis B and C, AIDS, cytomegalovirus infection, malaria, etc.).
Prevention of such complications comes down to a careful selection of donors, health education work among donors, a clear organization of the work of blood transfusion stations, donor points.
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