What are people who receive blood for a transfusion called? What is important to know about blood transfusion and donation. Questions and tasks for the chapter "The internal environment of the body"

Blood transfusion are widely used in intensive care, resuscitation, preoperative preparation, during and after surgery, in the treatment of a number of diseases and their complications. The nurse prepares the procedure, helps the doctor, monitors the patient. The order of blood transfusion is regulated by the instruction.

Front blood transfusion necessary:

1. determine the blood type of the patient (recipient);
2. check the compatibility of the blood of the recipient and the donor by group and Rh factor;
3. test for their biological compatibility.

For there is a set (stored in a special refrigerator) of standard sera of groups 0 (I), A (II), B (III) of two different series, standard erythrocytes of groups 0, A, B; white plates or special plexiglass plates with recesses, glass rods, glass slides, eye pipettes, sterile needles for pricking a finger or earlobe, alcohol, tincture of iodine, saline, cotton wool, glass-graph pencil (plates, plates, test tubes are labeled).

For determination of the Rh factor two tubes of the patient's blood are sent to the laboratory: 5-8 ml of blood is taken into one (dry), and 2 ml into the second, filled with 0.5 ml of a 4% solution of sodium citrate. The Rh factor is contained in the red blood cells of most people (85%), whose blood is called Rh positive; in some people (15%) this factor is absent, their blood is Rh-negative. In individuals with Rh-negative blood, transfusions of Rh-positive red blood cells produce antibodies that can cause a severe reaction if they are given repeated transfusions of Rh-positive blood.

In those cases where Rh belonging has to be determined on the spot, you can use the reaction with standard anti-Rh serum (made from the blood of women who have given birth to children with hemolytic jaundice, or from the blood of guinea pigs immunized with monkey blood) and standard erythrocytes (Rh + and Rh -).

Methodology. The recipient's blood is taken into a test tube without adding a stabilizer. After coagulation and retraction of the clot, serum is formed with a suspension of erythrocytes. Drops of anti-Rh sera are applied to the Petri dish, so that in three areas there is a large drop of serum of one series and in three more areas, another. To the first pair of drops of two series of serum, a small drop of the recipient's erythrocytes is added, to the second - Rh-positive erythrocytes (control) and to the third - Rh-negative.

The drops are thoroughly mixed with different sticks (slide glass) and the covered cup is placed in a water bath for 10 minutes. At the end of this period, the result of the reaction is noted. If the recipient's blood agglutinates with anti-Rh sera, it is Rh positive ( see table. 10, scheme 1), in the absence of agglutination, it is Rh-negative ( see table. 10, scheme 2). The control is the reaction with standard Rh-positive erythrocytes, in which agglutination must necessarily occur (2nd line in the diagrams).

Table 10. The reaction for determining the Rh factor by the serum method

Scheme I			Scheme II
	Serum			Serum
		II series		Series I	II series
	agglutination			agglutination
Recipient erythrocytes			Recipient erythrocytes
red blood cells			red blood cells
(Rh+) Erythrocytes (Rh-)			(Rh+) Red blood cells (Rh-)

Having determined the blood type and Rh factor, they select (order) the appropriate donor blood. They check the correctness of the passport data indicated on the vial (ampoule): date of blood sampling, group (colored stripes are put on the label for group II blue, for III - red, for IV - yellow; standard sera are tinted accordingly), the number of the operating journal, the name of the institution, the name of the doctor and the donor.

Then they are convinced of the tightness of the package and macroscopically evaluate the quality of the blood. In well-settled, not agitated blood, two layers are clearly visible - erythrocytes below, and transparent light yellow or greenish plasma without turbidity, flakes, clots on top. Blood with a pink color of plasma (hemolysis), infected (flakes, films, turbidity), with massive clots is not suitable for transfusion. Blood storage is handled by dedicated staff (usually from the operating room). The blood taken out from the refrigerator before transfusion is kept for 1 hour (no more) at room temperature. The day before the transfusion, the patient's blood and urine are taken for analysis, a test tube is filled with blood taken from a vein, labeled and placed in a stand to obtain serum.

Immediately before blood transfusion empty the bladder and measure the temperature of the recipient. The establishment of a blood transfusion system is preceded by an individual compatibility test, which is carried out with serum or (if the serum is not prepared) plasma (centrifuge mixed with sodium citrate blood): a small (1:10) drop of blood is added to a large drop of the recipient's serum (plasma) donor, mix them and after 5 minutes take into account the results of the reaction in the same way as in determining the blood group (see above). If the transfusion is performed on an emergency basis, it is necessary to simultaneously test for compatibility by the Rh factor. It is performed in the same way as the test for individual compatibility, but on a Petri dish the result (absence or presence of agglutination) is taken into account after a ten-minute stay of the dish in a water bath (37-45 °). In the presence of agglutination, the blood is incompatible. There are other, more advanced express methods, but they require special sera.

Having received evidence of the compatibility of the blood of the donor and the recipient, they proceed to the transfusion procedure itself - hemotransfusion. The most common transfusion of blood into a vein is by puncture or section, and in severe cases, blood is injected into an artery. The transfusion set is received in a sterile form (from the operating room, dressing room). Mount the system with sterile hands, involving an assistant who supports the ampoule (vial), removes the outer packaging. It is better to transfuse blood from the same vessel in which it was stored.

At the beginning of the transfusion, a biocompatibility test is carried out; pouring the first 15-25 ml of blood, the system is clamped and the patient's reaction is monitored for 3-5 minutes; the same is done after the introduction of the second and third portions of 25 ml of blood. With incompatibility, transfusion of even small amounts of blood will cause complaints (nausea, pain in the chest, lower back, dizziness, shortness of breath), restless behavior, increased breathing and pulse, pallor of the integument. If there are no complaints, then after the biological test, the transfusion is continued, setting the desired rhythm (with the drip method 30-40 drops per minute), or switching to a jet infusion. After transfusion, the vial (ampoule) with the rest of 5-10 ml of blood is stored in the refrigerator for 24 hours, because if complications arise, it will be necessary to analyze the transfused blood. A day later, the label is removed from the vial (peeled off in water, and then dried) and glued to the medical history.

For at least 2 hours after the transfusion, the patient should not get out of bed. The first portion of post-transfusion urine is shown to the doctor and sent for analysis. They measure the temperature, listen to complaints, monitor the patient's condition and report all deviations from the norm to the doctor.

Among blood transfusion complications, the most severe is post-transfusion shock- associated with transfusion of incompatible blood. Signs: anxiety, pain and tightness in the chest, abdomen, lower back; flushing of the face, alternating with pallor and cyanosis, respiratory distress, a drop in blood pressure, low diuresis (urine due to the admixture of blood has a brown, coffee color and contains a large amount of protein). Further, hemolysis develops, progressive renal failure, which, in the absence of urgent measures, lead to death. Along with general anti-shock measures, an exchange transfusion is carried out, i.e. massive bloodletting and replacement of the released blood with an appropriate amount of one-group (preferably fresh) blood; in case of loss of renal function, an “artificial kidney” is connected.

Due to technical errors associated with the ingress of air, clots into the system, there may be embolism. To avoid these complications, it is necessary to properly fill the system, constantly monitor the progress of the procedure, close the system at the cannula immediately after the last portion arrives (a little blood should remain in the vial). If the blood enters the vein poorly, it is necessary to remove the obstacle: disconnect the system from the vein, check its patency, as well as the position and patency of the needle (catheter) in the vein.

Complications can be caused by transfusion of blood that does not meet the required criteria, namely, overheated or hypothermic, hemolyzed, infected, with clots. Finally, some patients suffer from hypersensitivity to the protein and are prone to anaphylactoid reactions.

Complications should also include febrile reactions caused by the ingestion of pyrogenic substances into the body with poor washing of the system (blood residues). In addition, with massive transfusions of canned blood, a significant amount of sodium citrate (stabilizer) enters the body, which can cause intoxication and lead to a lack of calcium in the body (sodium binds calcium ions in the plasma), and consequently, to impaired blood clotting. For these reasons, exchange hemo-transfusions prefer to use fresh blood; in the absence of such, 10 ml of a 10% solution of calcium chloride should be administered for every 500 ml of blood (into another vein).

according to their medicinal properties, they are divided into anti-shock, detoxifying and intended for parenteral nutrition. By composition, among blood substitutes, saline solutions, preparations made from human and animal blood and combined are distinguished. Blood substitutes can be stored for a long time (several years), transfusion of most drugs does not require determination of the blood group, is simple (some of them can be administered intramuscularly and subcutaneously) and does not cause severe reactions.

In medicine, blood transfusion is called blood transfusion. During this procedure, the patient is injected with blood or its components obtained from a donor or from the patient himself. This method is used today to treat many diseases and to save lives in various pathological conditions.

People tried to transfuse the blood of healthy patients in ancient times. Then there were few successful blood transfusions, more often such experiments ended tragically. Only in the twentieth century, when blood groups (in 1901) and the Rh factor (in 1940) were discovered, did doctors get the opportunity to avoid deaths due to incompatibility. Since then, transfusing it has not become as dangerous as before. The method of indirect blood transfusion was mastered after they learned how to harvest the material for future use. For this, sodium citrate was used, which prevented coagulation. This property of sodium citrate was discovered at the beginning of the last century.

Today, transfusiology has become an independent science and medical specialty.

Types of blood transfusions

There are several ways of blood transfusion:

• indirect;
• direct;
• exchange;
• autohemotransfusion.

Several routes of administration are used:

• into the veins - the most common way;
• into the aorta
• into an artery
• into the bone marrow.

The most commonly used indirect method. Whole blood is used extremely rarely today, mainly its components: fresh frozen plasma, erythrocyte suspension, erythrocyte and leukocyte mass, platelet concentrate. In this case, for the introduction of the biomaterial, a disposable blood transfusion system is used, to which a container or vial with a transfusion medium is connected.

Rarely, direct transfusion is used - directly from the donor to the patient. This type of blood transfusion has a number of indications, among them:

• prolonged bleeding in hemophilia, not amenable to treatment;
• lack of effect from indirect transfusion in a state of shock of the 3rd degree with blood loss of 30-50% of the blood;
• disorders in the hemostasis system.

This procedure is carried out using an apparatus and a syringe. The donor is examined at the transfusion station. Immediately before the procedure, the group and Rh of both participants are determined. Tests for individual compatibility and bioassays are carried out. During direct transfusion, up to 40 syringes (20 ml) are used. Hemotransfusion takes place according to the following scheme: the nurse takes blood from the vein of the donor and passes the syringe to the doctor. While he is introducing the material to the patient, the nurse is gaining the next portion and so on. Sodium citrate is drawn into the first three syringes to prevent clotting.

Exchange transfusion is used for poisoning, hemolytic disease of the newborn, acute renal failure, blood transfusion shock. In this case, blood is partially or completely removed from the patient's bed and at the same time the same volume is replaced.

With autohemotransfusion, the patient is transfused with his own material, which is taken during the operation immediately before the procedure or in advance. The advantage of this method is the absence of complications during blood transfusion. The main indications for autotransfusion are the inability to find a donor, a rare group, the risk of severe complications. There are also contraindications - the last stages of malignant pathologies, severe kidney and liver diseases, inflammatory processes.

Indications for transfusion

There are absolute and particular indications for blood transfusion. The following are absolute:

• Acute blood loss - more than 30% within two hours. This is the most common indication.
• Surgery.
• Incessant bleeding.
• Severe anemia.
• State of shock.

For transfusion, in most cases, not whole blood is used, but its components, such as plasma.

Of the private indications for blood transfusion, the following can be distinguished:

1. Hemolytic diseases.
2. anemia.
3. Severe toxicity.
4. Purulent-septic processes.
5. Acute intoxication.

Contraindications

Practice has shown that blood transfusion is a very responsible tissue transplantation operation with its probable rejection and subsequent complications. There is always a risk of disruption of important processes in the body due to blood transfusion, so it is not indicated for everyone. If the patient requires such a procedure, doctors are required to consider contraindications to blood transfusion, which include the following diseases:

• stage III hypertension;
• heart failure caused by cardiosclerosis, heart defects, myocarditis;
• purulent inflammatory processes in the inner lining of the heart;
• circulatory disorders in the brain;
• allergies;
• violation of protein metabolism.

Disposable systems are used for transfusion

In cases of absolute indications for blood transfusion and the presence of contraindications, transfusion is carried out with preventive measures. For example, the blood of the patient himself is used for allergies.

There is a risk of complications after blood transfusion in the following categories of patients:

• women who have suffered miscarriages, difficult births, who have given birth to children with jaundice;
• people with malignant tumors;
• patients who had complications from past transfusions;
• patients with septic processes of a long course.

Where do they get the material?

Harvesting, separation into components, preservation and preparation of preparations is carried out in special departments and at blood transfusion stations. There are several sources of blood, including:

1. Donor. This is the most important source of biomaterial. They can become any healthy person on a voluntary basis. Donors undergo a mandatory test, during which they are examined for hepatitis, syphilis, and HIV.
2. Waste blood. Most often, it is obtained from the placenta, namely, it is collected from women in labor immediately after childbirth and ligation of the umbilical cord. It is collected in separate vessels in which the preservative is located. Preparations are prepared from it: thrombin, protein, fibrinogen, etc. One placenta can give about 200 ml.
3. Corpse blood. They are taken from healthy people who died suddenly in an accident. The cause of death can be electric shock, closed injuries, cerebral hemorrhages, heart attacks, and more. Blood sampling is carried out no later than six hours after death. Blood flowing out on its own is collected in containers, adhering to all the rules of asepsis, and used to prepare preparations. Thus, you can get up to 4 liters. At the stations where the workpiece passes, it is checked for a group, Rhesus, and the presence of infections.
4. Recipient. This is a very important source. On the eve of the operation, blood is taken from the patient, preserved and transfused. It is allowed to use blood that has spilled into the abdominal or pleural cavity during an illness or injury. In this case, you can not check it for compatibility, various reactions and complications occur less often, it is less dangerous to transfuse it.

Transfusion media

Of the main blood transfusion medium, the following can be mentioned.

Blood preserved

For harvesting, special solutions are used, which includes the preservative itself (for example, sucrose, dextrose, etc.); a stabilizer (usually sodium citrate) that prevents blood clotting and binds calcium ions; antibiotics. The preservative solution is in the blood in a ratio of 1 to 4. Depending on the type of preservative, the workpiece can be stored for up to 36 days. For different indications, material of different shelf life is used. For example, in case of acute blood loss, a medium with a short shelf life (3-5 days) is used.

Transfusion media are in sealed containers

Fresh citrate

Sodium citrate (6%) is added to it as a stabilizer (the ratio with blood is 1 to 10). This medium must be used within a few hours of preparation.

Heparinized

It is stored for no more than a day and is used in heart-lung machines. Sodium heparin is used as a stabilizer and dextrose as a preservative.

Blood components

Today, whole blood is practically not used due to possible reactions and complications that are associated with the numerous antigenic factors that are in it. Component transfusions give a greater therapeutic effect, since they act purposefully. The erythrocyte mass is transfused with bleeding, with anemia. Platelets - with thrombocytopenia. Leukocytes - with immunodeficiency, leukopenia. Plasma, protein, albumin - in violation of hemostasis, hypodysproteinemia. An important advantage of transfusion of components is a more effective treatment at a lower cost. In blood transfusion, the following blood components are used:

• erythrocyte suspension - preservative solution with erythocyte mass (1:1);
• erythrocyte mass - 65% of plasma is removed from whole blood by centrifugation or settling;
• frozen erythrocytes, obtained by centrifugation and blood washing with solutions in order to remove plasma proteins, leukocytes, and platelets from it;
• leukocyte mass obtained by centrifugation and settling (it is a medium consisting of white cells in high concentration with an admixture of platelets, erythrocytes and plasma);
• platelet mass obtained by light centrifugation from canned blood, which was stored for no more than a day, use a freshly prepared mass;
• liquid plasma - contains bioactive components and proteins, it is obtained by centrifugation and settling, used within 2-3 hours after harvesting;
• dry plasma - obtained by vacuum from frozen;
• albumin - obtained by separating plasma into fractions, released in solutions of different concentrations (5%, 10%, 20%);
• protein - consists of 75% albumin and 25% alpha and beta globulins.

Before the procedure, blood compatibility tests of the donor and the recipient must be carried out.

How is it carried out?

During blood transfusion, the doctor must adhere to a certain algorithm, which consists of the following points:

1. Definition of indications, identification of contraindications. In addition, the doctor asks the recipient if he knows what group he has and the Rh factor, whether there were blood transfusions in the past, whether there were any complications. Women receive information about existing pregnancies and their complications (for example, Rhesus conflict).
2. Determination of the group and Rh factor of the patient.
3. They choose which blood is suitable for the group and Rhesus, and determine its suitability, for which they make a macroscopic assessment. It is carried out on the following points: correctness, tightness of the package, expiration date, external compliance. Blood should have three layers: upper yellow (plasma), middle gray (leukocytes), lower red (erythrocytes). Plasma cannot contain flakes, clots, films, it should only be transparent and not red.
4. Checking donor blood using the AB0 system from a vial.
5. Be sure to conduct tests during blood transfusion for individual compatibility in groups at a temperature of 15 ° C to 25 ° C. How and why do they do it? To do this, a large drop of the patient's serum and a small donor blood are placed on a white surface and mixed. Evaluation takes place after five minutes. If erythrocyte agglutination has not occurred, then it is compatible, if agglutination has occurred, then it is impossible to transfuse.
6. Rh compatibility tests. This procedure can be carried out in different ways. In practice, most often a sample is made with a 33 percent polyglucin. Centrifugation is carried out for five minutes in a special test tube without heating. Two drops of the patient's serum and a drop of donor blood and polyglucin solution are dripped to the bottom of the test tube. Tilt the test tube and rotate around the axis so that the mixture is distributed over the walls in an even layer. Rotation continues for five minutes, then add 3 ml of saline and mix without shaking, but by tilting the container to a horizontal position. If agglutination occurs, transfusion is not possible.
7. Conducting a biological test. To do this, the recipient is injected with 10-15 ml of donor blood and monitor his condition for three minutes. This is done three times. If the patient feels normal after such a check, a transfusion is started. The appearance of symptoms in the recipient, such as shortness of breath, tachycardia, flushing of the face, fever, chills, pain in the abdomen and lower back, indicates that the blood is incompatible. In addition to the classic bioassay, there is a hemolysis test, or the Baxter test. At the same time, 30-45 ml of donor blood is injected into the patient, after a few minutes, blood is taken from the patient from a vein, which is then centrifuged and its color is assessed. The usual color indicates compatibility, red or pink indicates the impossibility of transfusion.
8. Transfusion is carried out by drip method. Before the procedure, the bottle with donated blood must be kept at room temperature for 40 minutes, in some cases it is heated to 37°C. A disposable transfusion system equipped with a filter is used. Transfusion is carried out at a rate of 40-60 drops / min. The patient is constantly monitored. Leave 15 ml of the medium in the container and store for two days in the refrigerator. This is done in case an analysis is required due to complications that have arisen.
9. Filling out the medical history. The doctor needs to write down the group and Rh of the patient and the donor, data from each bottle: its number, date of preparation, the name of the donor and his group and Rh factor. Be sure to enter the result of the bioassay and note the presence of complications. At the end, indicate the name of the doctor and the date of the transfusion, put a signature.
10. Observation of the recipient after transfusion. After transfusion, the patient must remain in bed for two hours and be under the supervision of medical personnel for a day. Particular attention is paid to his well-being in the first three hours after the procedure. They measure his temperature, pressure and pulse, evaluate complaints and any changes in well-being, evaluate urination and urine color. The next day after the procedure, a general blood and urine test is performed.

Conclusion

Blood transfusion is a very responsible procedure. Careful preparation is necessary to avoid complications. There are certain risks, despite scientific and technological advances. The doctor must strictly adhere to the rules and schemes of transfusion and carefully monitor the condition of the recipient.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

History of blood transfusion

Blood transfusion(hemotransfusion) is 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 entered the body cavity as a result of trauma or surgery.

In ancient times, people noticed that when a person loses a large amount of blood, a person dies. This created the concept of blood as a carrier of life. In such situations, the patient was given fresh animal or human blood to drink. The first attempts of blood transfusion from animals to humans began to be practiced in the 17th century, but they all ended in deterioration and death of a person. In 1848, the Treatise on Blood Transfusion was published in the Russian Empire. However, blood transfusion began to be practiced everywhere only in the first half of the 20th century, when scientists found out that people's blood differs by groups. The rules for their compatibility were discovered, substances were developed that inhibit hemocoagulation (blood clotting) and allow it to be stored for a long time. In 1926, in Moscow, under the leadership of Alexander Bogdanov, the world's first institute for blood transfusion was opened (today the Hematological Research Center of Roszdrav), a special blood service was organized.

In 1932, Antonin Filatov and Nikolai Kartashevsky proved for the first time the possibility of transfusing not only whole blood, but also its components, in particular plasma; methods have been developed for the conservation of plasma by freeze-drying. 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 fixed 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 of the 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 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 that develop as a result of blood transfusion are functionally defective blood components, as well as immunoglobulins and immunogens. When infusing a person's own blood, such complications do not occur.

In order to reduce the risk of such complications, as well as the likelihood of infection with viral and other diseases, in modern medicine it is considered that there is no need for infusion of whole blood. Instead, the recipient is transfused specifically with the missing blood components, depending on the disease. The principle has also been adopted that a recipient should receive blood from a 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, the infusion of erythrocyte suspension, fresh frozen plasma, leukocyte concentrate or platelets is most often in demand. Transfusion of erythrocyte suspension is necessary for anemia. It can be used in combination with substitutes and plasma preparations. With RBC infusion, complications are extremely rare.

Plasma transfusion is necessary with a critical decrease in blood volume during severe blood loss (especially during childbirth), severe burns, sepsis, hemophilia, etc. In order to preserve the structure and functions of plasma proteins, the plasma obtained after blood separation is frozen to a temperature of -45 degrees. However, the effect of blood volume correction after plasma infusion is short-lived. More effective in this case is albumin and plasma substitutes.

Platelet infusion is necessary for blood loss due to thrombocytopenia. Leukocyte mass is in demand for problems with the synthesis of one's 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 method of infusion of whole blood without freezing is called direct. Since this does not provide for blood filtration, the likelihood of small blood clots that form in the blood transfusion system will enter the patient's circulatory system sharply. This can cause acute blockage of small branches of the pulmonary artery by blood clots. Exchange hemotransfusion is a partial or complete removal of blood from the patient's bloodstream with simultaneous replacement of it with an appropriate volume of donor blood - it is practiced to remove toxic substances (in case of intoxication, including endogenous), metabolites, products of destruction of erythrocytes and immunoglobulins (with 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. In this case, simultaneously with the removal of plasma, the patient is transfused in the appropriate volume of erythrocyte mass, fresh frozen plasma, and the necessary plasma substitutes. With the help of plasmapheresis, toxins are removed from the body, the 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 based on clinical symptoms and biochemical samples. The doctor performing the transfusion is obliged, regardless of the data of previous studies and analyzes, personally carry out the following studies :

1. determine the patient's blood group according to the ABO system and compare the data obtained with the medical history;
2. determine the donor's blood type and compare the data obtained with the information on the container label;
3. check the compatibility of the blood of the donor and the patient;
4. obtain biological sample data.

It is forbidden to transfuse blood and its fractions that have not been tested for AIDS, serum hepatitis and syphilis. Hemotransfusion is carried out in compliance with all necessary aseptic measures. The blood taken from a donor (usually not more than 0.5 l), after mixing with a preservative agent, is stored at a temperature of 5-8 degrees. The shelf life of such blood is 21 days. Erythrocyte mass frozen at -196 degrees can remain good for several years.

Infusion of blood or its fractions is allowed only if the Rh factor of the donor and the recipient match. 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 to a person with the second, third and fourth groups, regardless of the Rh factor. A person with a fourth blood group of a 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 group with a Rh-positive factor. Blood of the second and third groups with an Rh-positive factor can be infused into a person with a fourth Rh-positive group. One way or another, a compatibility test is mandatory before transfusion. When immunoglobulins of rare specificity are detected in the blood, an individual approach to the choice of blood and specific compatibility tests are required.

When transfusion of incompatible blood, as a rule, the following complications develop: :

• post-transfusion shock;
• renal and hepatic insufficiency;
• metabolic disease;
• disruption of the digestive tract;
• disruption of the circulatory system;
• disruption of the central nervous system;
• impaired respiratory function;
• violation of the hematopoietic function.

Organ dysfunctions develop as a result of the active breakdown of red blood cells inside the vessels. Usually the consequence of the above complications is anemia, which lasts 2-3 months or more. If the established norms of blood transfusion are not observed or inadequate indications may also develop non-hemolytic post-transfusion complications :

• pyrogenic reaction;
• immunogenic reaction;
• allergy attacks;

For any blood transfusion complication, urgent treatment in a hospital is indicated.

Indications for blood transfusion

Acute blood loss has been the most common cause of death throughout human evolution. And, despite the fact that for some period of time it can cause serious violations of vital processes, the intervention of a physician is not always in demand. The diagnosis of massive blood loss and the appointment of a transfusion has a number of necessary conditions, since it is these particulars that determine the appropriateness 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 responsible procedure, so the reasons for it must be quite good. If it is possible to effectively treat a patient without resorting to blood transfusion, or there is no guarantee that it will bring positive results, it is preferable to refuse transfusion. The appointment of a blood transfusion depends on the results that are expected from it: replenishment of the lost volume of blood or its individual components; increased hemocoagulation with prolonged bleeding. Among the absolute indications for blood transfusion are acute blood loss, shock, incessant bleeding, severe anemia, major 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 for 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 the blood flow of the brain;
• severe violation of liver function;
• general violation of protein metabolism;
• allergic condition;

When determining contraindications to blood transfusion, it is important to collect information about past transfusions received and the patient's reactions to them, as well as detailed information about allergic pathologies. The risk group was identified among the recipients. It includes :

• 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 a difficult birth, miscarriage or the birth of children with hemolytic disease of the newborn and jaundice of the newborn;
• persons with decaying cancerous tumors, blood pathologies, prolonged septic processes.

With absolute indications for blood transfusion (shock, acute blood loss, severe anemia, incessant bleeding, major surgery), it is necessary to perform the procedure, despite contraindications. At the same time, it is necessary to select specific blood derivatives, special blood substitutes, while carrying out preventive procedures. In case of allergic pathologies, bronchial asthma, when blood transfusion is carried out urgently, special substances (calcium chloride, antiallergic drugs, glucocorticoids) are pre-infused to prevent complications. At the same time, from blood derivatives, those that have a minimal immunogenic effect are prescribed, for example, thawed and purified erythrocyte mass. Often, donated blood is combined with blood-substituting solutions of a narrow spectrum of action, and during surgical operations, the patient's own blood, which has been previously prepared, is used.

Transfusion of blood substitutes

Today, blood-substituting 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 by 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, the use of blood substitutes or plasma substitutes is economically more profitable in most situations than the transfusion of donor blood and its derivatives.

Modern blood-substituting 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 during intoxication;
• nutrition of the body with nitrogenous, fatty and saccharide micronutrients;
• oxygen supply to body cells.

By functional properties, blood-substituting fluids are divided into 6 types :

• hemodynamic (anti-shock) - for the correction of impaired blood circulation through the vessels and capillaries;
• detoxification - to cleanse the body in case of intoxication, burns, ionizing lesions;
• blood substitutes that nourish the body with important micronutrients;
• correctors of water-electrolyte and acid-base balance;
• hemocorrectors - gas transport;
• complex blood-substituting solutions with a wide spectrum of action.

Blood substitutes and plasma substitutes must have certain mandatory characteristics :

• the viscosity and osmolarity of blood substitutes must be identical to those of blood;
• they must completely leave the body, without adversely affecting organs and tissues;
• blood-substituting 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 an 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. In this way, he created hematomas, which contributed to more effective treatment of fractures.

Later, to stimulate immune processes in the body, venous blood transfusion into the buttock was practiced for furunculosis, acne, chronic gynecological inflammatory diseases, etc. Although there is no direct evidence in modern medicine for the effectiveness of this procedure for getting rid of acne, there is a lot of evidence confirming its positive effect. The result is usually observed 15 days after the transfusion.

For many years, this procedure, being effective and having minimal side effects, was used as an adjunct therapy. This continued until the discovery of broad-spectrum antibiotics. However, even after that, in chronic and sluggish diseases, autohemotherapy was also used, which always improved the condition of patients.

The rules for transfusion of venous blood into the buttock are not complicated. Blood is withdrawn from a vein and deeply infused into the upper-outer quadrant of the gluteal muscle. To prevent bruising, the injection site is heated with a heating pad.

The treatment 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 course of autohemotherapy consists of 10-15 infusions. Independent practice of this procedure is strictly contraindicated.

If during autohemotherapy the patient's health worsens, the body temperature rises to 38 degrees, tumors and pains appear at the injection sites - at 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 currently no contraindications for autohemotherapy. However, if any violations appear, the doctor should examine the situation in detail.

Intramuscular or subcutaneous infusion of increased blood volumes is contraindicated, because. this results in local inflammation, hyperthermia, muscle pain, and chills. If after the first injection pain is felt at the injection site, the procedure should be postponed for 2-3 days.

When conducting autohemotherapy, it is extremely important to observe the rules of sterility.

Not all doctors recognize the effectiveness of infusion of venous blood into the buttocks for the treatment of acne, so in recent years this procedure has been rarely prescribed. In order to treat acne, modern doctors recommend the use of external preparations 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.

Hemotransfusion of whole blood or its components is carried out to persons in a 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, difficult childbirth, severe burns. People suffering from leukemia or malignant tumors regularly need blood transfusions.

Donor blood is always in demand, but, alas, over time, the number of donors in the Russian Federation is steadily falling, 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 will live today and who will not. And first of all, at risk are those who need donated blood throughout their lives - those suffering from hemophilia.

Hemophilia is a hereditary disease characterized by blood incoagulability. This disease affects only men, while women act as carriers. At the slightest wound, painful hematomas occur, bleeding develops in the kidneys, in the digestive tract, and in the joints. Without proper care and adequate therapy, by the age of 7-8 years, the boy, as a rule, suffers from lameness. Adults with hemophilia are usually disabled. Many of them are unable to move 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 usually receive transfusions 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 shared their 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 drugs he takes, the child will die if he does not make a blood transfusion in time. Blood transfusion is one of the indispensable procedures for blood diseases, without which the patient dies within 50-100 days. In aplastic anemia, the hematopoietic organ, the bone marrow, ceases to produce all blood components. These are red blood cells that supply the cells of the body with oxygen and nutrients, platelets that stop bleeding, and white blood cells that protect the body from microorganisms - bacteria, viruses and fungi. With an acute deficiency of these components, a person dies from hemorrhages and infections, which do not pose a threat to healthy people. The treatment of this disease consists in measures that force 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 not able to synthesize blood cells, and the patient needs regular transfusions. Some need it every 5-7 days, some - daily.

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;
• examination for the presence of hepatitis B and C viruses in the blood;
• a blood test for the human immunodeficiency virus;
• blood test for treponema pallidum.

These studies are provided to the donor personally, with complete confidentiality. Only highly qualified medical workers work at the blood transfusion station, and only disposable instruments are used for all stages of blood donation.

What to do before donating blood

Key Recommendations :

• stick to a balanced diet, follow a special diet 2-3 days before donating blood;
• drink enough fluids;
• do not drink alcohol 2 days before donating blood;
• within three days before the procedure, do not take aspirin, analgesics and medicines, which include the above substances;
• refrain from smoking 1 hour before giving blood;
• sleep well;
• a few days before the procedure, it is recommended to include 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) in the diet.

It is especially important to adhere to the above recommendations if you are going to take platelets or plasma. Failure to comply with them will not allow efficient separation of the required blood cells. There are also a number of strict contraindications and a list of temporary contraindications in which blood donation is not possible. If you suffer from any pathology not listed in the list of contraindications, or use any medications, the question of the advisability of donating blood should be decided by the doctor.

Donor Benefits

You can't save lives for financial gain. Blood is needed to save the lives of seriously ill patients, and many of them are children. It is scary to imagine what can happen if blood taken from an infected person or a drug addict is transfused. In the Russian Federation, blood is not considered a trade item. Money given to donors at transfusion stations is considered lunch compensation. Depending on the amount of blood withdrawn, donors receive from 190 to 450 rubles.

A donor who has received blood 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 scholarships in the amount of 25%;
• within 1 year - benefits for any diseases in the amount of full earnings, regardless of 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.

On the day of blood sampling, as well as on the day of the medical examination, the donor is entitled to a paid day off.

For the first time, the use of blood for medicinal purposes is described in the works of the Greek poet Homer (VIII century BC) and in the writings of the Greek scientist and philosopher Pythagoras (VI century BC). But in the ancient world, and in the Middle Ages used blood only as a healing drink. In those days, blood was credited with a rejuvenating effect.

The circulatory system in the human body was described in 1628 by the English scientist William Harvey. Harvey discovered the law of blood circulation and deduced the basic principles of the movement of blood in the body. His scientific findings after some time allowed to start developing a method of blood transfusion.

In 1667, French physician Jean-Baptiste Denis, who was the personal physician of King Louis XIV, performed the first documented human blood transfusion. Denis transfused 300 ml of sheep's blood sucked by leeches into a 15-year-old boy who subsequently survived. Later, the scientist made another successful transfusion. However, subsequent experiments on blood transfusion were unsuccessful and always ended in the death of patients. According to one version, the first patients survived thanks to a small amount of transfused blood. It all ended with Denis being accused of murder, but even after receiving an acquittal, the doctor left medical practice.

Rice. 1. An engraving depicting a blood transfusion from a lamb to a person

At the end of the 18th century, it was proved that the failures and severe fatal complications that arose during blood transfusions of animals to humans are explained by the fact that the erythrocytes of the animal stick together and are destroyed in the human bloodstream. At the same time, substances that act on the human body as poisons are released from them. Attempts to transfuse human blood began.

The world's first human-to-human blood transfusion was done in 1819 in England. Obstetrician James Blundell saved the life of one of his patients by transfusing her husband's blood (Fig. 2).

Rice. 2. Engraving depicting blood transfusion from person to person

In Russia, the first successful blood transfusion was performed in 1832 by the St. Petersburg doctor Wolf: a woman survived after a large blood loss.

During the 19th century, despite clear progress, the percentage of failed transfusions remained very high, and this procedure was considered an extremely risky method. Complications were very reminiscent of the effect that was observed after a transfusion of animal blood to a person.

Although blood transfusion experiments continued, it was not until the discovery of blood groups in 1901 and the discovery of the Rh factor in 1940 that the procedure could be carried out without fatal complications.

In 1901, the Austrian physician Karl Landsteiner and the Czech Jan Jansky discovered 4 blood types. These discoveries gave a powerful impetus to research in the field of blood cross-compatibility. Karl Landsteinerdrew attention to the fact that sometimes the serum of one person sticks together the erythrocytes of the blood of another. This phenomenon has been namedagglutination.

In 1907, in New York, the first blood transfusion was performed on a sick person from a healthy person, with a preliminary check of their blood for compatibility.

The doctor Ruben Ottenberg, who performed the transfusion, eventually drew attention to the universal suitability of the I blood group.

Currently, two classifications of a person's blood group are used: AB0 system and Rh system.

Blood groups of the AB0 system

AB0 system was proposed by Karl Landsteiner in 1900.

In erythrocytes, substances of a protein nature were found, which were called agglutinogens(adhesives). There are 2 types: A and B.

Found in blood plasma agglutinins(adhesives) of two types - α and β.

Agglutination occurs when agglutinogens and agglutinins of the same name meet. Plasma agglutinin α glues erythrocytes to agglutinogen A, and agglutinin β glues erythrocytes to agglutinogen B.

Agglutination- agglutination and precipitation of erythrocytes carrying antigens under the action of specific substances of blood plasma -agglutinins.

In one person's blood simultaneously agglutinogens and agglutinins of the same name are never found (A withα and B with β). This can only happen with the wrong blood transfusion. Then comes the agglutination reaction, in which the erythrocytes stick together. Lumps of sticking red blood cells can clog capillaries, which is very dangerous for humans. Following the gluing of erythrocytes, their destruction occurs. Toxic decay products poison the body, causing severe complications up to death.

The agglutination reaction is used to determine blood groups.

Donor- a person who gives his blood for a transfusion.

Recipient- A person who receives a blood transfusion.

Belonging to one or another blood type does not depend on race or nationality. The blood group does not change throughout life.

Blood types	Antigens in red blood cells (agglutinogens)	Plasma antibodies (agglutinins)
I(0)	0	α, β
II(A)	A	β
III(B)	V	α
IV (AB)	A, B	0

There is a certain scheme of blood transfusion by groups (Fig. 3).

Rice. 3. Scheme of blood transfusion.

However, when transfusing large volumes of blood, only the same blood type should be used.

Rh factor

During blood transfusion, even with careful consideration of the group affiliation of the donor and recipient, sometimes there were severe complications caused by rhesus conflict.

In erythrocytes of 85% of people there is a protein, the so-called Rh factor. It is so named because it was first discovered in the blood of the rhesus monkey. In erythrocytes of the blood of 15% of people there is no Rh factor.

Unlike agglutinogens, there are no ready-made antibodies for the Rh factor in the blood plasma of people, but they can form if an Rh-negative person is transfused with Rh-positive blood. Therefore, when transfusing blood, it is necessary to take into account the compatibility of the Rh factor.

Rh-conflict of mother and child

Hemolytic disease of the newborn(mass breakdown of red blood cells) is caused by maternal and fetal Rh incompatibility, when an Rh-positive fetus develops in an Rh-negative mother. The fetal Rh factor protein passes through the placenta into the mother's bloodstream and leads to the formation of Rh antibodies in her blood. Rh antibodies penetrate back into the blood of the fetus and cause agglutination, which leads to severe disorders, and sometimes even death of the fetus.

Only a combination of "Rh-negative mother and Rh-positive father" can lead to the birth of a sick child. Knowledge of this phenomenon makes it possible to plan preventive and therapeutic measures in advance, with the help of which newborns can be saved.

If a person loses a large amount of blood, then the constancy of the volume of the internal environment of the body is disturbed. And therefore, since ancient times, in the case of blood loss, in case of diseases, people tried to transfuse the blood of animals or a healthy person to the sick.

In the written records of the ancient Egyptians, in the writings of the Greek scientist and philosopher Pythagoras, in the works of the Greek poet Homer and the Roman poet Ovid, attempts to use blood for treatment are described. The sick were given to drink the blood of animals or healthy people. Naturally, this did not bring success.

In 1667, in France, J. Denis performed the first intravenous blood transfusion to a person in the history of mankind. The bloodless dying young man was transfused with the blood of a lamb. Although the foreign blood caused a severe reaction, the patient tolerated it and recovered. Success inspired doctors. However, subsequent blood transfusion attempts were unsuccessful. Relatives of the victims initiated legal proceedings against the doctors, and blood transfusions were prohibited by law.

At the end of the XVIII century. it has been proven that the failures and severe complications that arose during the transfusion of animal blood to humans are due to the fact that the animal's red blood cells stick together and are destroyed in the human bloodstream. At the same time, substances that act on the human body as poisons are released from them. They began to try to transfuse human blood.

The world's first human-to-human blood transfusion was done in 1819 in England. In Russia, it was produced for the first time in 1832 by the St. Petersburg doctor Wolf. The success of this transfusion was brilliant: the life of a woman who was near death due to massive blood loss was saved. And then everything went on as before: either a brilliant success, or a serious complication, up to death. Complications were very similar to the effect that was observed after a transfusion of animal blood to a person. This means that in some cases the blood of one person may be alien to another.

A scientific answer to this question was given almost simultaneously by two scientists - the Austrian Karl Landsteiner and the Czech Jan Jansky. They found that people have 4 blood types.

Landsteiner drew attention to the fact that sometimes the blood serum of one person sticks together the erythrocytes of the blood of another (Fig. 10). This phenomenon has been named agglutination. The property of erythrocytes to stick together when they are exposed to plasma or blood serum of another person became the basis for dividing the blood of all people into 4 groups (Table 4).

Why does gluing, or agglutination, of erythrocytes occur?

In erythrocytes, substances of a protein nature were found, which were called agglutinogens(adhesives). There are two types of people. Conventionally, they were designated by the letters of the Latin alphabet - A and B.

In people with blood group I, there are no agglutinogens in erythrocytes, blood of group II contains agglutinogen A, agglutinogen B in erythrocytes of group III, and blood of group IV contains agglutinogens A and B.

Due to the fact that there are no agglutinogens in the erythrocytes of the I blood group, this group is designated as the zero (0) group. Group II due to the presence of agglutinogen A in erythrocytes is designated A, group III - B, group IV - AB.

Found in blood plasma agglutinins(adhesives) of two types. They are denoted by the letters of the Greek alphabet - α (alpha) and β (beta).

Agglutinin α sticks together erythrocytes with agglutinogen A, agglutinin β sticks together erythrocytes with agglutinogen B.

The blood serum of group I (0) contains agglutinins α and β, in the blood of group II (A) - agglutinin β, in the blood of group III (B) - agglutinin α, in the blood of group IV (AB) there are no agglutinins.

You can determine the blood group if you have ready-made blood serum of groups II and III.

The principle of the method for determining the blood group is as follows. Within the same blood group, there is no agglutination (gluing) of red blood cells. However, agglutination can occur, and red blood cells will clump if they enter the plasma or serum of another blood group. Therefore, by combining the blood of the test subject with the known (standard) serum, it is possible, by the agglutination reaction, to decide the question of the blood group belonging to the test. Standard sera in ampoules can be obtained at the station (or points) of blood transfusion.

Experience 10

Apply a drop of serum II and III blood groups on a glass slide with a stick. To avoid mistakes, put the corresponding number of the serum group on the glass next to each drop. Puncture the skin of the finger with a needle and, using a glass rod, transfer a drop of the test blood into a drop of standard serum; Stir the blood into the drop of serum thoroughly with a stick until the mixture is evenly colored pink. After 2 minutes, add 1-2 drops of saline to each of the drops and mix again. Make sure that a clean glass rod is used for each manipulation. Place the glass slide on white paper and examine the results after 5 minutes. In the absence of agglutination, the drop is a uniform cloudy suspension of erythrocytes. In the case of agglutination, the formation of flakes of erythrocytes in a clear liquid can be seen with a simple eye. In this case, 4 options are possible, which allow you to attribute the test blood to one of the four groups. Figure 11 can help you with this question.

If agglutination is absent in all drops, then this indicates that the blood under study belongs to group I. If agglutination is absent in the serum of group III (B) and occurred in the serum of group II (A), then the blood under study belongs to group III. If agglutination is absent in the serum of group II and is present in the serum of group III, then the blood belongs to group II. With agglutination by both sera, one can speak of blood belonging to group IV (AB).

It must be remembered that the agglutination reaction strongly depends on temperature. In the cold, it does not occur, and at high temperatures, erythrocyte agglutination can occur with nonspecific serum. It is best to work at a temperature of 18-22°C.

On average, 40% of people have the I blood group, 39% of the II group, 15% of the III group, and 6% of the IV group.

The blood of all four groups is equally complete in terms of quality and differs only in the properties described.

Belonging to one or another blood group does not depend on race or nationality. The blood group does not change during a person's life.

Under normal conditions, agglutinogens and agglutinins of the same name cannot meet in the blood of the same person (A cannot meet α, B cannot meet β). This can only happen with the wrong blood transfusion. Then the agglutination reaction occurs, the erythrocytes stick together. Lumps of erythrocytes sticking together can clog capillaries, which is very dangerous for humans. Following the gluing of erythrocytes, their destruction occurs. Toxic decay products of red blood cells poison the body. This explains the severe complications and even death in case of improperly performed blood transfusion.

Blood transfusion rules

The study of blood groups made it possible to establish the rules for blood transfusion.

People who donate blood are called donors, and people who are injected with blood - recipients.

When transfusing, it is necessary to take into account the compatibility of blood groups. At the same time, it is important that, as a result of blood transfusion, the donor's erythrocytes do not stick together with the recipient's blood (Table 5).

In Table 5, agglutination is indicated by a plus sign (+) and the absence of agglutination is indicated by a minus sign (-).

The blood of people of group I can be transfused to all people, therefore people with blood group I are called universal donors. The blood of people of group II can be transfused to people with II and IV blood groups, the blood of people of group III - to people with III and IV blood groups.

Table 5 also shows (see horizontally) that if the recipient has I blood type, then only group I blood can be transfused, in all other cases agglutination will occur. People with blood group IV are called universal recipients, since they can be transfused with blood of all four groups, but their blood can only be transfused with people with blood type IV (Fig. 12).

Rh factor

When transfusing blood, even with careful consideration of the group affiliation of the donor and recipient, sometimes there were severe complications. It turned out that in the erythrocytes of 85% of people there is a so-called Rh factor. It is so named because it was first discovered in the blood of the monkey Macacus rhesus. Rh factor - protein. People whose red blood cells contain this protein are called Rh positive. In the red blood cells of 15% of people there is no Rh factor, this is Rh negative people.

Unlike agglutinogens, there are no ready-made antibodies (agglutinins) for the Rh factor in human plasma. But antibodies against the Rh factor can form. If Rh-positive blood is transfused into the blood of Rh-negative people, then the destruction of red blood cells during the first transfusion will not occur, since there are no ready-made antibodies to the Rh factor in the recipient's blood. But after the first transfusion, they are formed, since the Rh factor is a foreign protein for the blood of an Rh-negative person. When Rh-positive blood is transfused again into the blood of an Rh-negative person, the antibodies formed earlier will cause the destruction of the red blood cells of the transfused blood. Therefore, when transfusing blood, it is necessary to take into account the compatibility of the Rh factor.

A very long time ago, doctors turned their attention to a more severe, in the past often fatal disease of infants - hemolytic jaundice. Moreover, several children fell ill in one family, which suggested the hereditary nature of the disease. The only thing that did not fit into this assumption was the absence of signs of illness in the first born child and the increase in the severity of the disease in the second, third and subsequent children.

It turned out that hemolytic disease of the newborn is caused by the incompatibility of the erythrocytes of the mother and fetus according to the Rh factor. This happens if the mother has Rh-negative blood, and the fetus has inherited Rh-positive blood from the father. During the period of intrauterine development, the following occurs (Fig. 13). Fetal erythrocytes that have the Rh factor, entering the mother's blood, whose erythrocytes do not contain it, are "foreign" antigens there, and antibodies are produced against them. But the substances of the mother's blood through the placenta again enter the child's body, now having antibodies against the erythrocytes of the fetus.

There is a Rh conflict, resulting in the destruction of the child's red blood cells and the disease hemolytic jaundice.

With each new pregnancy, the concentration of antibodies in the mother's blood increases, which can even lead to the death of the fetus.

In the marriage of an Rh-negative man to an Rh-positive woman, children are born healthy. Only a combination of "Rh-negative mother and Rh-positive father" can lead to a child's illness.

Knowledge of this phenomenon makes it possible to plan preventive and therapeutic measures in advance, with the help of which 90-98% of newborns can be saved today. To this end, all pregnant women with Rh-negative blood are taken to a special account, their early hospitalization is carried out, Rh-negative blood is prepared in case of a baby with signs of hemolytic jaundice. Exchange transfusions with the introduction of Rh-negative blood save such children.

Methods of blood transfusion

There are two ways of blood transfusion. At direct (immediate) transfusion blood is transfused directly from the donor to the recipient using special devices (Fig. 14). Direct blood transfusion is rarely used and only in special medical institutions.

For indirect transfusion the donor's blood is first collected in a vessel, where it is mixed with substances that prevent its clotting (most often sodium citrate is added). In addition, preservative substances are added to the blood, which allow it to be stored in a form suitable for transfusion for a long time. Such blood can be transported in sealed ampoules over long distances.

When transfusing canned blood, a rubber tube with a needle is placed on the end of the ampoule, which is then inserted into the patient's cubital vein (Fig. 15). A clamp is put on the rubber tube; with its help, you can adjust the rate of blood administration - fast ("jet") or slow ("drip") method.

In some cases, not whole blood is transfused, but its constituent parts: plasma or erythrocyte mass, which is used in the treatment of anemia. Platelet mass is transfused with bleeding.

Despite the great therapeutic value of preserved blood, there is still a need for solutions that can replace blood. Many prescriptions for blood substitutes have been proposed. Their composition is more or less complex. All of them have certain properties of blood plasma, but do not have the properties of formed elements.

Recently, blood taken from a corpse has been used for medicinal purposes. Blood extracted in the first six hours after sudden death from an accident retains all valuable biological properties.

Transfusion of blood or its substitutes has become widespread in our country and is one of the effective ways to save life in case of large blood loss.

Revitalization of the body

Blood transfusion has made it possible to bring back to life people who have clinical death when cardiac activity ceased and breathing stopped; irreversible changes in the body have not yet occurred.

The first successful revival of a dog was made in 1913 in Russia. 3-12 minutes after the onset of clinical death, the dog was injected with blood into the carotid artery towards the heart under pressure, to which substances stimulating cardiac activity were added. Introduced in this way, the blood was sent to the vessels supplying blood to the heart muscle. After some time, the activity of the heart was restored, then breathing appeared, and the dog came to life.

During the Great Patriotic War, the experience of the first successful revivals in the clinic was transferred to the conditions of the front. The infusion of blood under pressure into the arteries, combined with artificial respiration, brought back to life the fighters taken to the field operating room with just stopped cardiac activity and stopped breathing.

The experience of Soviet scientists shows that with timely intervention it is possible to achieve recovery after fatal blood loss, injuries and some poisonings.

Blood donors

Despite the fact that a large number of different blood substitutes have been proposed, natural human blood is still the most valuable for transfusion. It not only restores the constancy of the volume and composition of the internal environment, but also heals. Blood is needed to fill the heart-lung machines, which during some operations replace the heart and lungs of the patient. For the operation of the device "artificial kidney" requires from 2 to 7 liters of blood. A person with severe poisoning is sometimes transfused with up to 17 liters of blood to save. Many people were saved thanks to timely blood transfusion.

People who voluntarily give their blood for transfusion - donors - enjoy deep respect and recognition of the people. Donation is an honorable public function of a citizen of the USSR.

Every healthy person over the age of 18 can become a donor, regardless of gender and occupation. Taking a small amount of blood from a healthy person does not adversely affect the body. The hematopoietic organs easily make up for these small blood losses. About 200 ml of blood is taken from a donor at a time.

If you do a blood test from a donor before and after donating blood, it turns out that immediately after taking blood, the content of erythrocytes and leukocytes in it will be even higher than before taking it. This is explained by the fact that in response to such a small blood loss, the body immediately mobilizes its forces and the blood in the form of a reserve (or depot) enters the bloodstream. Moreover, the body compensates for the loss of blood, even with some excess. If a person regularly donates blood, then after a while the content of red blood cells, hemoglobin and other components in his blood becomes higher than before he became a donor.

Questions and tasks for the chapter "The internal environment of the body"

1. What is called the internal environment of the body?

2. How is the constancy of the internal environment of the body maintained?

3. How can you speed up, slow down or prevent blood clotting?

4. A drop of blood is placed in a 0.3% NaCl solution. What happens in this case with red blood cells? Explain this phenomenon.

5. Why does the number of erythrocytes in the blood increase in the highlands?

6. Which donor's blood can be transfused to you if you have III blood group?

7. Calculate how many percent of the students in your class have blood groups I, II, III and IV.

8. Compare the hemoglobin content in the blood of several students in your class. For comparison, take the experimental data obtained when determining the hemoglobin content in the blood of boys and girls.