Method of exchange blood transfusion. Blood transfusion - rules

The method of direct blood transfusion for therapeutic purposes was used in the early stages of the development of clinical transfusiology. According to the definition of S.I. Spasokukotsky, direct blood transfusion is “a transfusion of pure, unmixed, warm and undamaged blood, performed before the onset of coagulation.”

The absolute indications for direct blood transfusion are:

1. Failure of complex hemostatic therapy for acute afibrinogenemic, fibrinolytic bleeding;
2. The absence and impossibility of obtaining canned blood in case of emergency replacement of massive blood loss;
3. Bleeding in patients with hemophilia in the absence and impossibility of obtaining antihemophilic plasma drugs.

Direct blood transfusions can be considered relatively indicated for:

1. Radiation sickness;
2. For aplasia of hematopoiesis of any other etiology;
3. For purulent diseases (staphylococcal pneumonia, sepsis) in children.

Direct blood transfusion is contraindicated:

1. In the presence of acute or chronic infectious, viral and rickettsial diseases in both the donor and the recipient.

An exception may be direct blood transfusion in newborns and young children with purulent-septic diseases, in whom transfusion is carried out with a syringe in a volume of no more than 50 ml, when general communication is excluded

bloodstream of the donor and recipient.

2. From donors who have not undergone a medical examination;
3. In the absence of proper equipment and trained specialists capable of performing direct blood transfusion.

A donor for direct blood transfusion can be a person at least 18 years of age who has agreed to voluntarily give his blood and whose medical examination has not revealed a contraindication to donating blood.

For direct blood transfusion, it is advisable to involve persons no older than 40-45 years old, physically strong, which can have a certain psychotherapeutic effect on sick recipients.

Direct blood transfusion, like transfusion of preserved blood, is a responsible operation. Transplantation of homologous tissue is associated with a number of dangers due to both the biological effect of foreign tissue on the recipient's body and technical errors in the operation itself.

Complications associated directly with the transfusion method itself boil down to blood clotting in the system during transfusion. The use of devices that provide constant continuous blood flow in the system during transfusion prevents this complication to a certain extent. The silicone coating on the inner surface of the drainage tubes significantly reduces the risk of blood clots forming in them.

Blood clotting in the system creates the risk of pulmonary embolism when the clot is pushed from the apparatus into the recipient's vascular bed.

Pulmonary embolism is manifested by sudden, acute pain in the chest, and the patient feels a feeling of lack of air. This is usually accompanied by a drop in blood pressure, cyanosis of the lips, acrocyanosis, anxiety, fear of death, agitation, and increased sweating. As a result of increased pressure in the superior vena cava system, purplish cyanosis of the face, neck and upper chest, and swelling of the jugular veins are often observed.

Therapeutic measures for the development of this formidable complication should consist of immediately stopping direct blood transfusion, intravenously administering to the patient a solution of promedol in a dose of 1 ml of 1-2% (10-20 kg) and atropine - 0.3-0.5 ml.

A good therapeutic effect in the acute period of pulmonary embolism is provided by intravenous administration of antipsychotics - dehydrobenzperidol and fentanyl at a dose of 0.05 ml/kg of each drug.

To combat the resulting respiratory failure, it is necessary to carry out oxygen therapy - inhalation of humidified oxygen through a nasal catheter or mask.

Sometimes this alone is enough to bring the patient out of a serious condition in the acute period of pulmonary embolism. Further treatment of this complication is based on the use of direct anticoagulants that prevent the “growth” of the embolus, fibrinolytic agents (fibrinolysin, streptase), which help restore the patency of the blocked vessel, and symptomatic agents aimed at maintaining cardiac activity, blood circulation and gas exchange in the body. Air embolism, usually caused by errors in the technique of direct blood transfusion, is no less dangerous. Air can get into the system due to insufficient sealing of connections, careless filling of the system leaving air bubbles in it, or the use of opaque tubes that prevent observation of the degree of filling of the system. To prevent this complication, it is necessary to carefully check the strength and tightness of the connections of all elements of the system, and carefully ensure that the system is completely filled with saline before use. When using opaque tubing, a glass tube should be installed on the section of the system going to the recipient.

The clinical picture of air embolism resembles that of pulmonary embolism, but the pain syndrome is usually not pronounced. Characteristic are sonorous, clapping heart tones. Hemodynamic disturbances and respiratory failure are pronounced. If the volume of air introduced does not exceed 3 ml,

these disorders can quickly resolve spontaneously. With the rapid introduction of more than 3 ml of air, a sudden stop of blood circulation may occur, requiring a full range of resuscitation measures.

Direct blood transfusion is the direct transfusion of blood from a donor to a recipient, while unchanged whole blood enters the patient’s body without any additives related to the stabilization (preservation) of blood. Direct blood transfusion is carried out in compliance with all the rules for transfusion of canned blood.

This method is used for special indications, more often when the patient’s blood coagulation system is impaired and there is ongoing bleeding. This may occur in hemophilia, fibrinolysis or hypocoagulation associated with diseases such as hypoplastic anemia, thrombocytopathy.

Direct blood transfusion completely preserves all factors of the coagulation system and helps stop bleeding in the recipient. Direct blood transfusion has proven to be highly effective in performing exchange transfusion in severely burned patients.

Direct blood transfusion has a number of negative aspects: it is technically more complex; it is necessary to place the donor next to the patient, which can be psychologically negative; in addition, there is a risk of infection of the donor if the recipient has an infectious disease, since their vascular systems are actually connected by equipment tubes.

From the standpoint of modern transfusiology, this method of blood transfusion should be considered a reserve, and it should be used only when it is impossible to correct the recipient’s blood coagulation system in another way (by introducing antihemophilic globulin, fibrinogen, platelet mass, cryoprecipitate).

Direct blood transfusion can be performed using special devices or syringes.

Hardware method of direct blood transfusion.

There are special devices (PKP-210, PKPU), in which finger pumps are used for continuous blood pumping. In this case, the vascular systems of the donor and recipient are connected by a continuous tube passing through this pump, which is precisely a negative point in terms of infection of the donor, if the recipient has a latent infectious disease. Therefore, this method is practically not used at present. The syringe method is safer.

Syringe method of direct blood transfusion.

Direct blood transfusion in this way is carried out in compliance with all the rules of asepsis when performing operations. Blood transfusion is carried out by a doctor and a nurse, who takes blood from the donor’s vein with a syringe (20 ml) and gives it to the doctor, and he infuses the blood into the patient’s vein. For the safety of the donor, each portion of blood collection is carried out with a new syringe, so direct blood transfusion requires a large number of them (20-40 pieces).

In the first three portions of blood taken, syringes are preliminarily filled with 2 ml of 4% sodium citrate, since these portions are administered slowly, with an interval of three minutes (biological test), so it is necessary to prevent blood clotting. During such a transfusion, syringes are constantly connected and disconnected from needles inserted into the vein, so there must be a tube between the syringe and the needle, which is clamped during these periods. Direct blood transfusion by syringe method should be performed without haste, rhythmically. Blood is taken from the donor and injected into the recipient in a stream by gently pressing the syringe plunger.

This technique has become most widespread due to the possibility of procuring large quantities of donor blood from almost any group.

When performing CPD, you must adhere to the following basic rules:

· blood is transfused to the recipient from the same vessel into which it was prepared when it was taken from the donor;

· immediately before blood transfusion, the doctor performing this operation must personally verify that the blood prepared for transfusion meets the following requirements: to be benign (without clots and signs of hemolysis, etc.) and compatible with the recipient’s blood.

Blood transfusion into a peripheral vein

There are two methods used to transfuse blood into a vein: venipuncture and venesection. The latter method is chosen, as a rule, if the first is practically inaccessible.

Most often, the superficial veins of the elbow are punctured due to the fact that they are more pronounced than other veins, and technically this manipulation rarely causes difficulties.

Blood is transfused either from plastic bags or from glass vials. For this purpose, special systems with filters are used. The procedure for working with the systems is as follows:

1. After opening the sealed bag, the roller clamp on the plastic tube is closed.

2. A plastic dropper cannula is used to pierce either the blood bag or the stopper of the vial containing blood. The blood vessel is turned over so that the dropper is at the bottom and suspended in an elevated position.

3. The dropper is filled with blood until the filter is completely closed. This prevents air bubbles from the system from entering the vessels.

4. The plastic sheath of the metal needle is removed. The roller clamp is released and the system tube is filled with blood until it appears in the cannula. The clamp closes.

5. The needle is inserted into the vein. To regulate the infusion rate, change the degree of closure of the roller clamp.

6. If the cannula becomes clogged, the infusion is temporarily stopped by closing the roller clamp. The IV line is gently squeezed to dislodge the clot through the cannula. After its removal, the clamp opens and the infusion continues.

If the dropper overflows with blood, which prevents precise regulation of the infusion rate, then it is necessary:

1. close the roller clamp;

2. Gently squeeze the blood from the dropper into a bottle or bag (the dropper shrinks);

3. Place the blood vessel in a vertical position;

4. Unclench the dropper;

5. Place the vessel with blood in the position for infusion and adjust the infusion speed with a roller clamp, as indicated above.

During transfusion, care must be taken to ensure the continuity of the flow of transfused blood. This is largely determined by the technique of venipuncture. First of all, you need to apply the tourniquet correctly. In this case, the hand should not be pale or cyanotic, arterial pulsation should remain, and the vein should be well filled and contoured. Venous puncture is carried out conventionally in two steps: a puncture of the skin above the vein and a puncture of the vein wall with the insertion of a needle into the lumen of the vein.

To prevent the needle from leaving the vein or the cannula from the needle, the system is fixed to the skin of the forearm using an adhesive patch or bandage.

Typically, venipuncture is performed with a needle disconnected from the system. And only after drops of blood enter from the lumen of the needle, a cannula from the system is connected to it.

Direct blood transfusion

Transfusion is a method of treatment through blood transfusion. Direct blood transfusion in modern medicine is rarely used and in exceptional cases. Already at the beginning of the 20th century, the first blood transfusion institute was created (Moscow, Hematological Research Center of the Russian Academy of Medical Sciences). In the 30s, on the basis of the Central Regional Leningrad Institute of Blood Transfusion, prospects for using not only the whole mass, but also individual fractions, especially plasma, were identified, and the first colloidal blood substitutes were obtained.

Types of blood transfusion

In clinical practice, there are a number of treatment methods: direct blood transfusion, indirect, exchange and autohemotransfusion.

The most common method is indirect transfusion of components: fresh frozen plasma, platelets, erythrocytes and leukocytes. Most often they are administered intravenously, using a special sterile system that is connected to a container with transfusion material. Methods of intra-aortic, bone and intra-arterial routes for introducing the erythrocyte component are also known.

The exchange transfusion is carried out by removing the patient's blood and simultaneously introducing donor blood in the same volume. This type of treatment is used in cases of deep toxicity (poisons, tissue breakdown products, geomolysis). Most often, the use of this method is indicated for the treatment of newborns with hemolytic disease. To avoid complications that are provoked by sodium citrate present in the collected blood, it is additionally practiced to add 10% calcium chloride or gluconate in the required proportions (10 ml per liter).

The safest method of PC is autohemotransfusion, since in this case the material for administration is the previously prepared blood of the patient himself. A large volume (about 800 ml) is gradually preserved and, if necessary, supplied to the body during surgery. With autohemotransfusion, the transfer of viral infectious diseases is excluded, which is possible in the event of a donor mass.

Indications for direct blood transfusion

Today, there are no clear and generally accepted criteria for determining the categorical use of direct transfusion. Only some clinical problems and diseases can be identified with high probability:

with large blood losses of patients with hemophilia, in cases of lack of special hemophilic drugs;
with thrombocytopenia, fibrolysis, afibrinogenemia - a violation of the blood coagulation system, if hemostatic treatment is unsuccessful;
absence of canned fractions and whole mass;
in case of traumatic shock, accompanied by high blood loss and lack of effect from transfusion of prepared canned material.

The use of this method is also permissible for diseases of radiation sickness, hematopoietic aplasia, sepsis and staphylococcal pneumonia in children.

Contraindications for direct transfusion

Direct blood transfusion is unacceptable in the following cases:

Lack of proper medical equipment and specialists capable of performing the procedure.
Medical tests for donor diseases.
The presence of acute viral or infectious diseases of both participants in the procedure (donor and recipient). This does not apply to children with purulent-septic diseases, when the material is supplied in small doses of 50 ml via a syringe.

The entire procedure takes place in specialized medical centers, where medical examinations of both the donor and recipient are carried out.

What type of donor should you be?

First of all, people aged 18 to 45 years old who are in good physical health can become donors. Such people can join the ranks of volunteers who simply want to help their neighbors, or they help for a fee. Specialized departments often have a personnel reserve ready to provide assistance to the victim in case of urgent need. The main condition for a donor is his preliminary medical examination and clinical analysis to ensure the absence of diseases such as syphilis, AIDS, hepatitis B.

Before the procedure, the donor is provided with sweet tea and white flour bread, and afterward is shown a hearty lunch, which is usually provided by the clinic free of charge. Rest is also indicated, for which the administration of the medical institution issues a certificate of exemption from work for one day to be presented to the company management.

Exfusion conditions

Direct blood transfusion is not possible without clinical tests of the recipient and the donor. The attending physician, regardless of preliminary data and entries in the medical book, is obliged to conduct the following studies:

determine the recipient and donor group according to the AB0 system;
conduct the necessary comparative analysis of the biological compatibility of the group and the Rh factor of the patient and the donor;
carry out a biological test.

It is permissible to supply whole transfusion medium only with an identical group and Rh factor. Exceptions are the supply of Rh-negative group (I) to a patient with any group and Rh in a volume of up to 500 ml. Rh-negative A(II) and B(III) can also be transfused into a recipient with AB (IV), both Rh negative and Rh positive. As for a patient with AB (IV) positive Rh factor, any of the groups is suitable for him.

In case of incompatibility, the patient experiences complications: metabolic disorders, kidney and liver functioning, blood transfusion shock, failure of the cardiovascular, nervous systems, digestive organs, respiratory problems and hematopoiesis. Acute vascular hemolysis (decomposition of red blood cells) leads to long-term anemia (2-3 months). Other types of reactions are also possible: allergic, anaphylactic, pyrogenic and antigenic, which require immediate medical treatment.

Transfusion methods

To perform direct transfusion, there must be sterile facilities or operating rooms. There are several ways to transfer transfusion media.

Using a syringe and a rubber tube, the doctor and assistant carry out step-by-step blood transfer. T-shaped adapters allow you to carry out the entire procedure without replacing the syringe. To begin with, sodium chloride is infused into the patient, at the same time the nurse takes material from the donor with a syringe, where 2 ml of 4% sodium citrate is added to prevent the blood from clotting. After feeding with the first three syringes at intervals of 2-5 minutes, if a positive reaction is noted, clean material is gradually supplied. This is necessary to adapt the patient and check for compatibility. The work is done synchronously.
The most popular device for transfusion is PKP-210, which is equipped with a manually controlled roller pump. The sinusoidal course of the transfusion medium from the donor veins to the recipient veins is produced according to a sinusoidal pattern. To do this, it is also necessary to make a biological test with an accelerated rate of transfusion and a slowdown after each feed. With the help of the device it is possible to pour ml per minute. Complications can arise in the case of blood clotting and the appearance of blood clots, which contribute to the appearance of pulmonary embolism. Modern materials make it possible to minimize the threat of this factor (the tubes for feeding the mass are siliconized from the inside).

The material is published for informational purposes only and under no circumstances can it be considered a substitute for medical consultation with a specialist in a medical institution. The site administration is not responsible for the results of using the posted information. For questions regarding diagnosis and treatment, as well as prescribing medications and determining their dosage regimen, we recommend that you consult a doctor.

Blood transfusion methods

The following blood transfusion methods exist:

Direct transfusion

With homologous transfusion, blood is transfused from a donor to a recipient without the use of anticoagulants. Direct blood transfusion is carried out using conventional syringes and their modifications, using special preparations.

availability of special equipment;
participation of several persons in case of transfusion using syringes;
transfusion is performed in a stream to avoid blood clotting;
the donor must be close to the recipient;
relatively high probability of the donor becoming infected with the recipient's infected blood.

Currently, direct blood transfusion is used extremely rarely, only in exceptional cases.

Reinfusion

During reinfusion, a reverse transfusion of the patient's blood is carried out, which was poured into the abdominal and chest cavities during injury or surgery.

The use of intraoperative blood reinfusion is indicated for blood loss exceeding 20% of the circulating blood volume: cardiovascular surgery, ruptures during ectopic pregnancy, orthopedic surgery, traumatology. Contraindications include bacterial contamination of the blood, ingress of amnitotic fluid, and the inability to wash off blood spilled during surgery.

The blood poured into the body cavity differs in composition from the circulating blood - it has a reduced content of platelets, fibrinogen, and a high level of free hemoglobin. Currently, special automatic devices are used that suck blood from the cavity, then the blood enters a sterile reservoir through a filter with pores of 120 microns.

Autohemotransfusion

During autohemotransfusion, a transfusion of canned blood from the patient is carried out, which is prepared in advance.

Blood is collected by simultaneous sampling before surgery in a volume of 400 ml.

eliminates the risk of blood infection and immunization;
efficiency;
good clinical effect of survival and usefulness of red blood cells.

Indications for autohemotransfusion:

planned surgical operations with estimated blood loss of more than 20% of the total circulating blood volume;
pregnant women in the third trimester if there are indications for elective surgery;
the impossibility of selecting an adequate amount of donor blood if the patient has a rare blood type;
patient refusal of transfusion.

Autohemotransfusion methods (can be used separately or in various combinations):

3-4 weeks before the planned operation, 1-1.2 liters of canned autologous blood or 1 ml of autoerythrocyte mass is prepared.
Immediately before the operation, ml of blood is collected with mandatory replenishment of temporary blood loss with saline solutions and plasma substitutes while maintaining normovolemia or hypervolemia.

The patient must give written consent (recorded in the medical history) for the collection of autologous blood.

With autodonation, the risk of post-transfusion complications is significantly reduced, which increases the safety of transfusion for a particular patient.

Autodonation is usually practiced between the ages of 5 and 70 years, the limit is limited by the physical and somatic condition of the child, the severity of peripheral veins.

Restrictions on autohemotransfusion:

the volume of a single blood donation for persons weighing more than 50 kg should not exceed 450 ml;
the volume of a single blood donation for persons weighing less than 50 kg is no more than 8 ml per 1 kg of body weight;
persons with a body weight of less than 10 kg are not allowed to donate;
The hemoglobin level of the autodonor before blood donation should not be lower than 110 g/l, hematocrit - not lower than 33%.

During blood donation, plasma volume, total protein and albumin levels are restored after 72 hours, so the last blood donation before a planned operation cannot be performed earlier than 3 days. It must be remembered that each blood draw (1 dose = 450 ml) reduces iron reserves by 200 mg, so taking iron supplements is recommended before donating blood.

Contraindications to autodonation:

foci of infection or bacteremia;
unstable angina;
aortic stenosis;
sickle cell arrhythmia;
thrombocytopenia;
positive test for HIV, hepatitis, syphilis.

Exchange blood transfusion

With this method of blood transfusion, a transfusion of canned blood is carried out, with simultaneous exfusion of the patient’s blood, thus, complete or partial removal of blood from the recipient’s bloodstream occurs, with simultaneous adequate replacement with donor blood.

Exchange blood transfusion is performed in case of endogenous intoxication to remove toxic substances, in case of hemolytic disease of the newborn, in case of incompatibility of the blood of mother and child according to the Rh factor or group antigens:

Rh conflict occurs when a fetus in a Rh-negative pregnant woman has Rh-positive blood;
An ABO conflict occurs if the mother has Oαβ(I) blood type, and the child has Aβ(II) or Bα(III) blood type.

Absolute indications for exchange transfusion in the first day of life in full-term newborns:

the level of indirect bilirubin in umbilical cord blood is more than 60 µmol/l;
the level of indirect bilirubin in peripheral blood is more than 340 µmol/l;
hourly increase in indirect bilirubin over 4-6 hours is more than 6 µmol/l;
hemoglobin level is less than 100 g/l.

Indirect blood transfusion

This method is the most common method of blood transfusion due to its availability and ease of implementation.

Methods of administering blood:

The most common method of administering blood is intravenous, for which the veins of the forearm, dorsum of the hand, leg, and foot are used:

Venipuncture is performed after pre-treating the skin with alcohol.
A tourniquet is applied above the intended puncture site in such a way that it compresses only the superficial veins.
A skin puncture is made from the side or above the vein, 1-1.5 cm below the intended puncture.
The tip of the needle is advanced under the skin to the wall of the vein, followed by puncture of the venous wall and insertion of the needle into its lumen.
If long-term transfusion is required over several days, the subclavian vein is used.

Indirect transfusion of blood and its components.

Transfusion of canned blood into a vein has become most widespread due to the ease of implementation and the improvement of methods for mass procurement of canned blood. Transfusion of blood from the same vessel in which it was collected is the rule. Blood is transfused by venipuncture or venesection (when closed venipuncture is not possible) into one of the superficial, most pronounced saphenous veins of the limb, most often the veins of the elbow. If necessary, puncture of the subclavian and external jugular vein is performed.

Currently, for blood transfusion from a glass bottle, plastic systems with filters are used, and from a plastic bag, the PK 22-02 system, manufactured in sterile packaging in factories, is used.

The continuity of the flow of transfused blood largely depends on the venipuncture technique. Correct application of the tourniquet to the limb and appropriate experience are necessary. The tourniquet should not overtighten the limb; in this case, there is no pallor or cyanosis of the skin, arterial pulsation is preserved, and the vein is well filled and contoured. A vein puncture is performed with a needle with an attached transfusion system in two steps (with appropriate skill, they constitute one movement): a puncture of the skin on the side or above the vein 1-1.5 cm below the intended vein puncture* with the needle tip moving under the skin to the venous wall, puncturing the vein wall and inserting a needle into its lumen. The system with a needle is fixed on the skin of the limb using a patch.

In medical practice, when indicated, other routes of administration of blood and erythromass are also used: intra-arterial, intra-aortic, intraosseous.

The method of intra-arterial transfusions is used in cases of terminal conditions with shock and acute blood loss, especially in the stage of cardiac and respiratory arrest. This method allows you to transfuse a sufficient amount of blood in the shortest possible time, which cannot be achieved by intravenous infusions.

For intra-arterial blood transfusions, systems without a dropper are used, replacing it with a short glass tube for control, and a rubber balloon with a pressure gauge is attached to the cotton filter to create a pressure of domm Hg in the bottle. Art., which allows for 2-3 minutes. inject ml of blood. A standard technique is used to surgically expose one of the arteries of the limb (preferably the artery located closer to the heart). Intra-arterial blood transfusion can also be performed during limb amputations - into the artery of the stump, as well as during ligation of arteries in case of traumatic damage. Repeated arterial blood transfusions can be performed in a total dose of up to 100 mL.

Blood transfusion into the bone marrow (sternum, iliac crest, calcaneus) is indicated when intravenous blood transfusion is not possible (for example, with extensive burns). Bone puncture is performed under local anesthesia.

Exchange blood transfusion.

Exchange blood transfusion is the partial or complete removal of blood from the recipient's bloodstream with its simultaneous replacement with an adequate or greater volume of donor blood. The main purpose of this operation is to remove, along with the blood, various poisons (in case of poisoning, endogenous intoxication), breakdown products, hemolysis and antibodies (in case of hemolytic disease of the newborn, blood transfusion shock, severe toxicosis, acute renal failure, etc.).

The combination of bloodletting and blood transfusion cannot be reduced to simple substitution. The effect of this operation is a combination of substitution and detoxification effects. Two methods of exchange blood transfusions are used: continuous-simultaneous - the transfusion rate is commensurate with the exfusion rate; intermittent-sequential - blood is removed and introduced in small doses intermittently and sequentially into the same vein.

For exchange blood transfusion, freshly collected blood (taken on the day of surgery), selected according to the ABO system, Rh factor and Coombs reaction, is preferable. It is also possible to use canned blood with short shelf life (5 days). To perform the operation, it is necessary to have a set of sterile instruments (for venous and arteriosection) and a system for drawing and transfusion of blood. Blood transfusion is performed into any superficial vein, and bloodletting is carried out from large venous trunks or arteries, since due to the duration of the operation and breaks between its individual stages, blood clotting can occur.

A big disadvantage of exchange transfusions, in addition to the danger of massive transfusion syndrome, is that during the period of bloodletting, the donor’s blood is partially removed along with the patient’s blood. For complete blood replacement, a portion of donor blood is required. Exchange blood transfusion has been successfully replaced by intensive therapeutic plasmapheresis with the removal of up to 2 liters of plasma per procedure and its replacement with rheological plasma substitutes and fresh frozen plasma, hemodialysis, hemo- and lymphosorption, hemodilution, the use of specific antidotes, etc.

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Transfusiology

Transfusiology (from Latin transfusio “transfusion” and -ology from ancient Greek λέγω “I speak, inform, tell”) is a branch of medicine that studies the issues of transfusion (mixing) of biological and body fluids that replace them, in particular blood and its components , blood groups and group antigens (studied in hemotransfusiology), lymph, as well as problems of compatibility and incompatibility, post-transfusion reactions, their prevention and treatment.

Story

1628 - English physician William Harvey makes a discovery about blood circulation in the human body. Almost immediately after this, the first attempt at blood transfusion was made.
1665 - The first officially registered blood transfusions are carried out: the English doctor Richard Lower successfully saves the lives of sick dogs by transfusing them with the blood of other dogs.
1667 - Jean-Baptiste Denis in France and Richard Lower in England independently record successful blood transfusions from sheep to humans. But over the next ten years, animal-to-human transfusions were banned by law due to severe negative reactions.
1795 - In the USA, the American doctor Philip Syng Physick conducts the first blood transfusion from person to person, although he does not publish information about this anywhere.
1818 - James Blundell, a British obstetrician, performs the first successful human blood transfusion on a patient with postpartum hemorrhage. Using the patient's husband as a donor, Blundell took almost four ounces of blood from his arm and used a syringe to infuse it into the woman. From 1825 to 1830, Blundell performed 10 transfusions, five of which helped patients. Blundell published his results and also invented the first convenient instruments for drawing and transfusing blood.
1832 - St. Petersburg obstetrician Andrei Martynovich Wolf, for the first time in Russia, successfully transfused the blood of her husband to a woman in labor with obstetric hemorrhage and thereby saved her life. Wolf used a device and technique for transfusion that he received from the pioneer of world transfusiology, James Blundell.
1840 - At St. George's School in London, Samuel Armstrong Lane, under the leadership of Blundell, conducts the first successful blood transfusion to treat hemophilia.
1867 - English surgeon Joseph Lister first uses antiseptics to prevent infection during blood transfusions.
1873-1880 - American transfusiologists are trying to use cow's, goat's and human milk for transfusions.
1884 - Saline solutions replace milk in transfusions because milk causes too many rejection reactions.
1900 - Karl Landsteiner (German: Karl Landsteiner), an Austrian doctor, discovers the first three blood groups - A, B and C. Group C will later be replaced by O. For his discoveries, Landsteiner received the Nobel Prize in 1930.
1902 - Landsteiner's colleagues Alfred de Castello (Italian: Alfred Decastello) and Adriano Sturli (Italian: Adriano Sturli) add a fourth to the list of blood types - AB.
1907 - Hektoen suggests that the safety of transfusions can be improved if the blood of the donor and recipient is tested for compatibility to avoid complications. Reuben Ottenberg in New York performs the first blood transfusion using the cross-matching method. Ottenberg also noted that blood type is inherited according to Mendel’s principle and noted the “universal” suitability of blood of the first group.
1908 - French surgeon Alexis Carrel developed a way to prevent clotting by suturing the recipient vein directly to the donor artery. This method, known as the direct method, or anastomosis, is still practiced by some transplant doctors, including J.B. Murphy in Chicago and George Crile in Cleveland. This procedure proved unsuitable for blood transfusions, but was developed as a method of organ transplantation, and it was for this that Carrel received the Nobel Prize in 1912.
1908 - Moreschi describes the antiglobulin reaction. Typically, when an antigen-antibody reaction occurs, it cannot be seen. Antiglobulin is a direct way to visualize the antigen-antibody reaction. The antigen and antibody react with each other, then, after removing the antibodies that were not involved in the reaction, an antiglobulin reagent is added and attached between the antibodies that are attached to the antigen. The formed chemical complex becomes large enough to be examined.
1912 - Roger Lee, a physician at the Massachusetts General Hospital, and Paul Dudley White introduce the so-called “Lee-White clotting time” into laboratory research. Another important discovery is made by Lee, experimentally proving that blood of the first group can be transfused to patients with any group, and any other blood group is suitable for patients with the fourth blood group. Thus, the concepts of “universal donor” and “universal recipient” were introduced.
1914 - Long-term anticoagulants were invented and put into use, making it possible to preserve donor blood, and among them sodium citrate.
1915 - At Mount Sinai Hospital in New York, Richard Levison first uses citrate to replace direct blood transfusions with indirect ones. Despite the significance of this invention, citrate was introduced into mass use only 10 years later.
1916 - Francis Roos and D. R. Turner first use a solution of sodium citrate and glucose, allowing blood to be stored for several days after donation. Blood begins to be stored in closed containers. During the First World War, Great Britain uses a mobile blood transfusion station (Oswald Robertson is considered to be the creator).

Types of blood transfusion

Intraoperative reinfusion

Intraoperative reinfusion is a method based on the collection of blood spilled into the cavity (abdominal, thoracic, pelvic cavity) during surgery, and the subsequent washing of red blood cells and returning them to the bloodstream.

Autohemotransfusion

Autohemotransfusion is a method in which the patient is both a donor and a recipient of blood and its components.

Homologous blood transfusion

Direct blood transfusion

Direct blood transfusion is the direct transfusion of blood from a donor to a recipient without stabilization or preservation.

Indirect blood transfusion

Indirect blood transfusion is the main method of blood transfusion. This method uses stabilizers and preservatives (citrate, citrate-glucose, citrate-glucose phosphate preservatives, adenine, inosine, pyruvate, heparin, ion exchange resins, etc.), which makes it possible to prepare blood components in large quantities, as well as store it for a long time time.

Exchange blood transfusion

During exchange blood transfusion, a simultaneous infusion of donor blood is performed with the recipient's blood being collected. Most often, this method is used for hemolytic jaundice of newborns, massive intravascular hemolysis and severe poisoning.

Blood products

Blood components

Red blood cell mass is a blood component consisting of red blood cells (70-80%) and plasma (20-30%) with an admixture of leukocytes and platelets.
Erythrocyte suspension is a filtered erythrocyte mass (the admixture of leukocytes and platelets is lower than in the erythrocyte mass) in a resuspension solution.
Red blood cell mass washed from leukocytes and platelets (EMOLT) - red blood cells washed three or more times. Shelf life: no more than 1 day.
Thawed, washed erythrocytes are erythrocytes that have undergone cryopreservation in glycerol at a temperature of -195°C. When frozen, the shelf life is unlimited, after defrosting - no more than 1 day (repeated cryopreservation is not allowed).
Leukocyte mass (LM) is a transfusion medium with a high content of leukocytes.
Platelet mass is a suspension (suspension) of viable and hemostatically active platelets in plasma. It is obtained from fresh blood using plateletpheresis. Shelf life is 24 hours, and in a thrombomixer - 5 days.
Plasma is the liquid component of blood, obtained by centrifuging and settling. Native (liquid), dry and fresh frozen plasma is used. When transfusing plasma, the Rh factor (Rh) is not taken into account.

Complex blood products

Complex action drugs include plasma and albumin solutions; they simultaneously have a hemodynamic and anti-shock effect. The greatest effect is caused by fresh frozen plasma due to the almost complete preservation of its functions. Other types of plasma - native (liquid), lyophilized (dry) - largely lose their medicinal properties during the manufacturing process, and their clinical use is less effective. Fresh frozen plasma is obtained by plasmapheresis (see Plasmapheresis, cytapheresis) or centrifugation of whole blood with rapid subsequent freezing (in the first 1-2 hours from the moment of blood collection from the donor). It can be stored for up to 1 year at 1°-25° and below. During this time, all blood coagulation factors, anticoagulants, and components of the fibrinolysis system are preserved in it. Immediately before transfusion, the freshly frozen plasma is thawed in water at a temperature of 35-37° (to speed up the thawing of the plasma, the plastic bag in which it is frozen can be kneaded in warm water with your hands). Plasma should be transfused immediately after warming during the first hour in accordance with the attached instructions for use. Fibrin flakes may appear in thawed plasma, which does not prevent its transfusion through standard plastic systems with filters. Significant turbidity and the presence of massive clots indicate that the plasma is of poor quality: in this case, it cannot be transfused.

Hemodynamic drugs

These drugs serve to replenish the circulating blood volume (CBV), have a persistent volemic effect, and retain water in the vascular bed due to osmotic pressure. The volumetric effect is 100-140% (1000 ml of the injected solution replenishes the bcc by 1000-1400 ml), the volumetric effect is from three hours to two days. There are 4 groups:

albumin (5%, 10%, 20%)
gelatin-based preparations (Gelatinol, Gelofusin)
dextrans (Polyglukin, Reopoliglyukin)
hydroxyethyl starches (Stabizol, Hemohes, Refortan, Infucol, Voluven)

Crystalloids

They differ in electrolyte content. Volumetric effect is 20-30% (1000 ml of injected solution replenishes the bcc by 200-300 ml), volumetric effect is minutes. The most famous crystalloids are saline solution, Ringer's solution, Ringer-Locke solution, Trisol, Acesol, Chlosol, Ionosteril.

Blood substitutes for detoxification action

Preparations based on polyvinylpyralidone (Hemodez, Neogemodez, Periston, Neocompensan).

Tissue incompatibility syndrome

Tissue incompatibility syndrome develops when the blood of the donor and recipient is incompatible in one of the immune systems as a result of the recipient’s body’s reaction to an introduced foreign protein.

Homologous blood syndrome

Homologous blood syndrome is characterized by impaired microcirculation and transcapillary exchange as a result of increased blood viscosity and blockage of the capillary bed by microaggregates of platelets and erythrocytes.

Massive blood transfusion syndrome

Massive blood transfusion syndrome occurs when the volume of blood transfused exceeds 50% of the blood volume.

Transmission syndrome

Transmission syndrome is characterized by the transfer of pathogenic factors from donor to recipient.

Indirect blood transfusion

Indirect blood transfusion, haemotransfusio indirecta - transfusion of blood previously taken from a donor. For the purpose of indirect blood transfusion, freshly stabilized and preserved blood is used.

Soon after collection from the donor, the blood must be stabilized using a six percent sodium citrate solution in a ratio of one to ten.

In most cases, pre-canned blood is transfused, since it can be stored for a long time and even transported over long distances. Blood is preserved using solutions of glucose, sucrose, glucose citrate solutions SCHOLIPK-76, L-6, etc. Blood that was diluted with solutions in a ratio of one to four retains its properties for twenty-one days.

Blood that has been treated with a cation exchange resin, absorbs calcium ions and releases sodium ions into the blood, is deprived of the ability to clot. After adding electrolytes, glucose and sucrose, the blood is stored for twenty-five days.

However, that's not all. Glucose and glycerin are added to freshly frozen red blood cells, leukocytes, and platelets, which allows the composition to be stored for up to five years.

Canned blood intended for indirect transfusion must be stored in a refrigerator at a temperature of at least six degrees Celsius. Indirect blood transfusion is much simpler than direct transfusion. This method makes it possible to organize the necessary blood supplies in advance, as well as simply regulate the speed of transfusion, the amount of blood infused, and also avoid a number of complications that could arise with direct blood transfusion. With an indirect blood transfusion, the recipient does not produce red blood cells.

Moreover, it is indirect transfusion that allows the use of cadaveric blood, as well as blood that was obtained by bloodletting. Naturally, this blood is carefully processed.

Indirect blood transfusion has saved the lives of many recipients, as it allows for the most accurate selection of compatible blood.

Types of blood transfusion

Blood transfusion is a method that consists of introducing into the bloodstream of the patient (recipient) whole blood or its components collected from the donor or the recipient himself, as well as blood spilled into the body cavity during injuries and operations.

Types of blood transfusion: direct, indirect, exchange, autohemotransfusion.

Direct blood transfusion. It is carried out using special equipment from the donor to the patient. Before the procedure, the donor is examined in accordance with job descriptions. This method can only transfuse whole blood - without a preservative. The route of transfusion is intravenous. This type of blood transfusion is used in the absence of fresh frozen plasma, red blood cells or cryoprecipitate in large quantities, in case of sudden large massive blood loss.

Indirect blood transfusion. Perhaps the most common method of transfusion of blood and its components (erythrocytes, platelets or leukocytes, fresh frozen plasma). The route of transfusion is usually intravenously, using a special disposable blood transfusion system, to which a bottle or plastic container with a transfusion medium is connected. There are also other ways of introducing this blood and red blood cells - intra-arterial, intra-aortic, intraosseous.

Exchange blood transfusion. Partial or complete removal of blood from the recipient’s bloodstream while simultaneously replacing it with donor blood in an adequate volume. This procedure is performed to remove various poisons, tissue decay products, and hemolysis from the body.

Autohemotransfusion - transfusion of one's own blood. prepared in advance before surgery, using a preservative solution. When transfusing such blood, complications associated with blood incompatibility and transmission of infections are excluded. This ensures better functional activity and survival of red blood cells in the recipient’s vascular bed.

Indications for this type of blood transfusion are: the presence of a rare blood type, the inability to select a suitable donor, as well as surgical interventions in patients with impaired liver or kidney function.

Contraindications include severe inflammatory processes, sepsis, severe liver and kidney damage, as well as significant cytopenias.

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Content

Blood transfusion is the introduction into the body of whole blood or its components (plasma, red blood cells). This is done for many diseases. In areas such as oncology, general surgery and neonatal pathology, it is difficult to do without this procedure. Find out in what cases and how blood is transfused.

Blood transfusion rules

Many people do not know what blood transfusion is and how this procedure occurs. Treatment of a person with this method begins its history far back in antiquity. Medieval doctors widely practiced such therapy, but not always successfully. Hemotransfusiology begins its modern history in the 20th century thanks to the rapid development of medicine. This was facilitated by the identification of the Rh factor in humans.

Scientists have developed methods for preserving plasma and created blood substitutes. Widely used blood components for transfusion have gained recognition in many branches of medicine. One of the areas of transfusiology is plasma transfusion; its principle is based on the introduction of fresh frozen plasma into the patient’s body. The blood transfusion method of treatment requires a responsible approach. To avoid dangerous consequences, there are rules for blood transfusion:

1. Blood transfusion must take place in an aseptic environment.

2. Before the procedure, regardless of previously known data, the doctor must personally conduct the following studies:

determination of group membership according to the AB0 system;
determination of the Rh factor;
check if the donor and recipient are compatible.

3. It is prohibited to use material that has not been tested for AIDS, syphilis and serum hepatitis.

4. The mass of material taken at a time should not exceed 500 ml. It must be weighed by a doctor. It can be stored at a temperature of 4-9 degrees for 21 days.

5. For newborns, the procedure is carried out taking into account individual dosage.

Compatibility of blood groups during transfusion

The basic rules of transfusion provide for strict blood transfusions according to groups. There are special schemes and tables for matching donors and recipients. According to the Rh system (Rh factor), blood is divided into positive and negative. A person who has Rh+ can be given Rh-, but not vice versa, otherwise this will lead to red blood cells sticking together. The presence of the AB0 system is clearly demonstrated by the table:

	Agglutinogens	Agglutinins

Based on this, it is possible to determine the main patterns of blood transfusion. A person with an O (I) group is a universal donor. The presence of AB (IV) group indicates that the owner is a universal recipient; he can receive an infusion of material from any group. Holders of A (II) can be transfused with O (I) and A (II), and people with B (III) can be transfused with O (I) and B (III).

Blood transfusion technique

A common method of treating various diseases is indirect transfusion of fresh frozen blood, plasma, platelets and red blood cells. It is very important to carry out the procedure correctly, strictly according to the approved instructions. This transfusion is done using special systems with a filter; they are disposable. The attending physician, and not the junior medical staff, bears full responsibility for the patient’s health. Blood transfusion algorithm:

Preparing the patient for blood transfusion includes taking a medical history. The doctor finds out whether the patient has chronic diseases and pregnancies (in women). Takes the necessary tests, determines the AB0 group and the Rh factor.
The doctor selects donor material. It is assessed for suitability using a macroscopic method. Double-checks using the AB0 and Rh systems.
Preparatory measures. A number of tests are carried out to determine the compatibility of the donor material and the patient using instrumental and biological methods.
Carrying out transfusion. The bag with the material must remain at room temperature for 30 minutes before transfusion. The procedure is carried out with a disposable aseptic dropper at a speed of 35-65 drops per minute. During the transfusion, the patient must be absolutely calm.
The doctor fills out the blood transfusion protocol and gives instructions to junior medical staff.
The recipient is monitored throughout the day, especially closely for the first 3 hours.

Blood transfusion from a vein into the buttock

Autohemotransfusion therapy is abbreviated as autohemotherapy; it is a blood transfusion from a vein into the buttock. It is a healing treatment procedure. The main condition is an injection of your own venous material, which is carried out into the gluteal muscle. The buttock should warm up after each injection. The course is 10-12 days, during which the volume of injected blood material increases from 2 ml to 10 ml per injection. Autohemotherapy is a good method of immune and metabolic correction of one’s own body.

Direct blood transfusion

Modern medicine uses direct blood transfusion (directly into a vein from the donor to the recipient) in rare emergency cases. The advantages of this method are that the source material retains all its inherent properties, but the disadvantage is the complex hardware. Transfusion using this method can cause the development of embolism of veins and arteries. Indications for blood transfusion: disorders of the coagulation system when other types of therapy have failed.

Indications for blood transfusion

Main indications for blood transfusion:

large emergency blood losses;
purulent skin diseases (pimples, boils);
DIC syndrome;
overdose of indirect anticoagulants;
severe intoxication;
liver and kidney diseases;
hemolytic disease of newborns;
severe anemia;
surgical operations.

Contraindications to blood transfusion

There is a risk of serious consequences as a result of blood transfusion. The main contraindications to blood transfusion can be identified:

It is prohibited to carry out blood transfusion of material incompatible with the AB0 and Rh systems.
Absolutely unsuitable is a donor who has autoimmune diseases and fragile veins.
Detection of grade 3 hypertension, bronchial asthma, endocarditis, and cerebrovascular accidents will also be contraindications.
Blood transfusions may be prohibited for religious reasons.

Blood transfusion - consequences

The consequences of blood transfusion can be both positive and negative. Positive: rapid recovery of the body after intoxication, increased hemoglobin, cure for many diseases (anemia, poisoning). Negative consequences may arise as a result of violations of blood transfusion techniques (embolic shock). A transfusion may cause the patient to exhibit signs of diseases that were present in the donor.

Video: blood transfusion station

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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Blood transfusion, types, direct and indirect blood transfusion

Types of blood transfusion. There are four types of blood transfusion: direct, indirect, reverse and exchange-substitution.

Direct blood transfusion. With this type of transfusion, blood is administered directly from the donor to the victim using special equipment. Direct transfusion is technically difficult to perform and is therefore rarely used.

Indirect blood transfusion. This is a blood transfusion in which the donor and the patient are separated in time. Blood from the donor is first collected into plastic bags with a capacity of 250 and 500 ml, which contain a stabilizing solution that prevents blood clotting and the loss of clots.

Blood is stored in refrigerators, strictly maintaining +4°C.

At the site of administration, indirect blood transfusion can be intravenous, intraarterial, or intraosseous. Based on the speed of administration, a distinction is made between jet and drip methods.

Reverse blood transfusion (reinfusion). In this case, the patient’s own blood, poured into the serous cavities (thoracic, abdominal), is used for transfusion.

Exchange-replacement blood transfusion. Consists of bloodletting and transfusion of canned blood in small portions (200-300 ml).

V.P. Dyadichkin

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