Direct blood transfusion: indications, technique. Blood transfusion - rules

To compensate for blood loss, various methods of blood transfusion can be used: direct, indirect, exchange or autohemotransfusion. With direct transfusion, transfusion is carried out by directly pumping blood from the donor's bloodstream to the patient. In this case, preliminary stabilization and preservation of blood is not performed.

When is a direct blood transfusion performed? Are there any contraindications for such blood transfusions? How is a donor selected? How is a direct blood transfusion performed? What complications can occur after blood transfusion? You can get answers to these questions by reading this article.

Indications

One of the indications for direct blood transfusion is prolonged bleeding in hemophilia

Direct blood transfusion is indicated in the following clinical cases:

• prolonged and not amenable to hemostatic correction of bleeding with;
• ineffectiveness of hemostatic treatment for problems (afibrinogenemia, fibrinolysis,), diseases of the blood system, massive blood transfusions;
• III degree, accompanied by a loss of more than 25-50% of the volume of circulating blood and the ineffectiveness of blood transfusions;
• lack of canned blood or fractions necessary for hemotransfusion.

Direct blood transfusion is sometimes performed for staphylococcal in children, sepsis, hematopoietic aplasia, and radiation sickness.

Contraindications

Direct blood transfusion is not prescribed in the following cases:

• lack of qualified personnel and equipment for the procedure;
• unexamined donor;
• acute infectious diseases in a donor or patient (this restriction is not taken into account in the treatment of children with purulent-septic pathologies, when blood transfusion is performed in small portions of 50 ml using a syringe).

How is a donor prepared?

A donor can be a person 18-45 years old who has no contraindications for donating blood and has the results of a preliminary examination and tests for the absence of hepatitis B and. Usually, in specialized departments, a donor is selected according to a special personnel reserve, focusing on his readiness to provide assistance to the patient and the blood type.

On the day of direct blood transfusion, the donor is given tea with sugar and white bread. After the procedure, he is given a hearty lunch and a certificate of release from work is issued for rest after blood sampling.

How is a direct blood transfusion performed?

Direct blood transfusion is performed in a special sterile facility or in an operating room.

Regardless of the entries in the medical books on the day of the procedure, the doctor is obliged to conduct the following studies:

• blood tests of the donor and the patient for group and Rh factor;
• comparison of the biological compatibility of these indicators;
• biological test.

If the blood of the donor and the patient are compatible, direct blood transfusion can be performed in two ways:

• using syringes and a rubber tube;
• through a special apparatus (more often for these purposes, the PKP-210 device with a roller pump and manual control is used).

Direct blood transfusion using syringes is carried out as follows:

1. 20-40 syringes of 20 ml each, needles with rubber tubes for vein puncture, clamps and gauze balls are laid out on a table covered with a sterile sheet. All items must be sterile.
2. The patient lies on a bed or operating table. He is placed on a drip for intravenous administration of saline.
3. The gurney with the donor is placed next to the patient.
4. Blood for infusion is drawn into a syringe. The rubber tube is clamped with a clamp, and the doctor injects blood into the patient's vein. At this time, the nurse fills the next syringe and then work continues synchronously. In the first three portions of blood to prevent its clotting, 2 ml of a 4% solution of sodium citrate is added and the contents of the syringe are injected slowly (20 ml in 2 minutes). After that, a break is made for 2-5 minutes. This measure is a biological test and in the absence of deterioration in the patient's health, the doctor continues direct blood transfusion until the required volume of blood is injected.

For hardware direct blood transfusion, the donor and the patient are prepared in the same way as for the syringe method. The procedure is then carried out as follows:

1. To the edge of the manipulation table, which is installed between the donor and the patient, the PKP-210 apparatus is attached in such a way that the blood enters the patient's vein when the handle is rotated.
2. The clinician calibrates the device to calculate the number of turns of the handle required to pump 100 ml of blood, or the volume of blood pumped per 100 turns of the handle.
3. The patient's vein is punctured and a small volume of saline is infused.
4. A puncture of the donor vein is performed and the taking part of the tube from the device is attached to the end of the needle.
5. A triple accelerated administration of 20-25 ml of blood is carried out with interruptions after each portion.
6. In the absence of deterioration in the patient's well-being, hemotransfusion is continued until the required volume of donor blood is injected. The standard transfusion rate is usually 50-75 ml of blood per minute.

Complications

Blood clotting in the transfusion system can cause pulmonary embolism

During direct blood transfusion, complications may develop due to technical errors in the procedure itself.

One such complication may be blood clotting in the transfusion system itself. To prevent this error, devices that are capable of providing a continuous flow of blood should be used. They are equipped with tubes, the inner surface of which is coated with silicone, which prevents the formation of blood clots.

The presence of blood clots in the transfusion system may result in the clot being pushed into the patient's bloodstream and the development of pulmonary embolism. With this complication, the patient has a feeling of anxiety, excitement, fear of death. Due to embolism, there are chest pains, cough and. The patient's neck veins swell, the skin becomes wet with sweat and turns blue in the face, neck and chest.

The appearance of symptoms of pulmonary embolism requires the immediate cessation of blood transfusion and emergency measures. For this, the patient is given a solution of promedol with atropine, antipsychotics (fentanyl, dehydrobenzperidol). Manifestations of respiratory failure are eliminated by inhalation of humidified oxygen through nasal catheters or a mask. Later, fibrinolytic drugs are also prescribed to the patient to restore the patency of the vessel blocked by the embolus.

In addition to pulmonary embolism, direct blood transfusion may be complicated by air embolism. With its development, the patient develops severe weakness, dizziness (up to fainting) and chest pain. The pulse becomes arrhythmic, and sonorous clapping tones are determined in the heart. When more than 3 ml of air enters the bloodstream, the patient experiences a sudden circulatory arrest.

With an air embolism, direct blood transfusion is stopped and resuscitation is immediately started. To prevent an air bubble from entering the heart, the patient is laid on his left side and his head is lowered. Subsequently, this accumulation of air is retained in the right atrium or ventricle and removed by puncture or aspiration through the catheter. With signs of respiratory failure, oxygen therapy is performed. If, due to an air embolus, circulatory arrest occurs, then cardiopulmonary resuscitation measures are taken (ventilation and indirect heart massage, the introduction of funds to stimulate the activity of the heart).

Library Surgery Blood transfusion, types, direct and indirect blood transfusion

Blood transfusion, types, direct and indirect blood transfusion

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

Direct blood transfusion. With this type of transfusion, blood is injected directly from the donor to the victim with special equipment. Direct transfusion is technically difficult and 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 pre-taken into plastic bags with a capacity of 250 and 500 ml, which contain a stabilizing solution that prevents blood clotting and clotting.

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

At the injection site, indirect blood transfusion can be intravenous, intra-arterial, intraosseous. According to the speed of administration, jet and drip methods are distinguished.

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

Exchange-replacing blood transfusion. It consists in bloodletting and transfusion of preserved blood in small portions (200-300 ml).

V.P. Dyadichkin

"Blood transfusion, types, direct and indirect blood transfusion" article from the section

This technique has become the most widely used due to the possibility of harvesting large amounts of donor blood of almost any group.

The NPC must adhere to the following basic rules:

The 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 make sure that the blood prepared for transfusion meets the following requirements: be benign (without clots and signs of hemolysis, etc.) and compatible with the recipient's blood.

Blood transfusion into a peripheral vein

Two methods are used for transfusion of 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 bend are punctured due to the fact that they are more pronounced than the rest of the veins, and technically this manipulation rarely causes difficulty.

Blood is transfused either from plastic bags or from glass vials. To do this, use special systems with filters. The procedure for working with systems is as follows:

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

2. The plastic cannula of the dropper pierces either the blood bag or the cork of the vial containing the blood. The vessel with blood is turned over so that the dropper was 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 entering the vessels from the system.

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

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

6. If the cannula becomes clogged, stop the infusion temporarily by closing the roller clamp. The dropper is gently squeezed to expel the clot through the cannula. After it is removed, the clamp opens and the infusion continues.

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

1. close the roller clamp;

2. gently squeeze the blood from the dropper into a vial or bag (the dropper shrinks);

3. set the vessel with blood in a vertical position;

4. open the dropper;

5. Place the blood vessel in the infusion position and adjust the infusion rate with the roller clamp as above.

When transfusing, it is necessary to take care of the continuity of the flow of transfused blood. This is largely determined by the technique of venipuncture. First of all, you need to correctly apply the tourniquet. In this case, the arm should not be pale or cyanotic, arterial pulsation should be maintained, and the vein should fill and contour well. Vein puncture is carried out conditionally in two steps: skin puncture over the vein and vein wall puncture with the introduction of a needle into the vein lumen.

To prevent the exit of the needle from the vein or the cannula from the needle, the system is fixed on the skin of the forearm with an adhesive patch or bandage.

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

Direct blood transfusion

Transfusion - a method of treatment by 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 institute of blood transfusion 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 the use of 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 methods of treatment: direct blood transfusion, indirect, exchange and autohemotransfusion.

The most common method is indirect transfusion of components: fresh frozen plasma, platelet, erythrocyte and leukocyte masses. Most often they are administered intravenously using a special sterile system that is connected to a container with transfusion material. There are also known methods of intra-aortic, bone and intra-arterial routes of input of the erythrocyte component.

The way of exchange transfusion is carried out by removing the patient's blood and parallel introduction of donor blood in the same volume. This type of treatment is used in case of deep toxicity (poisons, tissue decay products, geomolysis). Most often, the use of this method is indicated for the treatment of newborns with hemolytic disease. In order to avoid complications that are provoked by sodium citrate in the prepared blood, the addition of 10% chloride or calcium gluconate in the required proportions (10 ml per liter) is additionally practiced.

The safest method of s.c. is autohemotransfusion, since in this case the pre-prepared blood of the patient himself serves as the material for administration. A large volume (about 800 ml) is conserved in stages and, if necessary, during the surgical intervention, it is supplied to the body. With autohemotransfusion, the transfer of viral infectious diseases is excluded, which is possible in the case of the receipt of donor mass.

Indications for direct blood transfusion

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

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

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

Direct transfusion contraindications

Direct blood transfusion is unacceptable in the following cases:

1. Lack of proper medical equipment and specialists capable of carrying out the procedure.
2. Medical tests for diseases of the donor.
3. 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 through a syringe.

The whole procedure takes place in specialized medical centers, where a medical examination of both the donor and the recipient is carried out.

Who should be the donor?

First of all, people aged 18 to 45 who are in good physical health can become donors. Such people can join the ranks of volunteers who simply want to help their neighbor, or help for a fee. In specialized departments, there is often a personnel reserve ready to provide assistance to the victim in case of urgent need. The main condition for the donor is his preliminary medical examination and clinical analysis for 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 after the procedure, a hearty lunch is shown, which is usually provided by the clinic free of charge. Rest is also shown, for which the administration of the medical institution issues a certificate of exemption from work for one day to provide to the company's management.

Exfusion conditions

Direct blood transfusion is impossible without clinical analyzes of the recipient and the donor. The attending physician, regardless of the preliminary data and records 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 acceptable to supply a whole transfusion medium only with an identical group and Rh factor. Exceptions are the supply of a 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 to a recipient with AB(IV), both Rh-negative and Rh-positive. As for the 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, hemotransfusion shock, failure of the cardiovascular, nervous systems, digestive organs, problems with breathing and hematopoiesis. Acute vascular hemolysis (erythrocyte breakdown) leads to prolonged anemia (2-3 months). Another type of reaction is also possible: allergic, anaphylactic, pyrogenic and antigenic, which require immediate medical treatment.

Transfusion methods

For direct transfusion, there must be sterile stations or operating rooms. There are several ways to transfer the transfusion medium.

1. With the help of a syringe and a rubber tube, a phased transfer of blood is carried out by the doctor and assistant. T-shaped adapters allow you to carry out the entire procedure without changing the syringe. To begin with, sodium chloride is injected 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 so that the blood does not clot. After giving the first three syringes with breaks of 2-5 minutes, if a positive reaction is noted, pure material is gradually fed. This is necessary to adapt the patient and check for compatibility. The work is done synchronously.
2. The most popular transfusion device is the PKP-210, which is equipped with a manually adjustable roller pump. The sinusoidal course of the transfusion medium from the veins of the donor to the veins of the recipient is performed according to a sinusoidal pattern. To do this, it is also necessary to make a biological sample with an accelerated rate of pouring of the ml and slowing down after each supply. With the help of the device it is possible to pour ml per minute. Complications can occur 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 (tubes for supplying mass are siliconized from the inside).

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Blood transfusion methods

There are the following methods of blood transfusions:

Direct transfusion

With homologous transfusion, blood is transfused from the donor to the 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 with syringes;
• transfusion is performed in a jet to avoid blood clotting;
• the donor must be close to the recipient;
• relatively high probability of infection of the donor with infected blood of the recipient.

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

reinfusion

With reinfusion, a reverse transfusion of the patient's blood is carried out, which poured into the abdominal, chest cavities during an injury or operation.

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 are - bacterial contamination of the blood, the ingress of amnitic fluid, the inability to wash the blood that has poured out during the operation.

The blood that has poured into the body cavity differs in its 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

With autohemotransfusion, the patient's canned blood is transfused, which is prepared in advance.

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

• eliminates the risk of blood infection and immunization;
• profitability;
• good clinical effect of survival and usefulness of erythrocytes.

Indications for autotransfusion:

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

Methods of autohemotransfusion (can be used separately or in various combinations):

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

The patient must necessarily give written consent (recorded in the medical history) for the preparation 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 at the age of 5 to 70 years, the limit is limited by the physical and somatic condition of the child, the severity of peripheral veins.

Restrictions to 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 - no more than 8 ml per 1 kg of body weight;
• persons weighing less than 10 kg are not allowed to donate;
• the level of hemoglobin in an autodonor before blood donation should not be lower than 110 g/l, hematocrit should not be lower than 33%.

When donating blood, the plasma volume, the level of total protein and albumin is 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 stores by 200 mg, therefore iron preparations are recommended before blood donation.

Contraindications to autodonation:

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

Exchange transfusion

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

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

• Rh conflict occurs when the Rh-negative pregnant fetus has Rh-positive blood;
• An ABO conflict occurs if the mother has an Oαβ(I) blood type, and the child has an 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 cord blood is more than 60 µmol/l;
• the level of indirect bilirubin in the peripheral blood is more than 340 µmol/l;
• hourly increase in indirect bilirubin for 4-6 hours more than 6 µmol/l;
• hemoglobin level 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.

Ways to administer blood:

The most common way to administer blood is intravenous, for which the veins of the forearm, back of the hand, lower leg, foot are used:

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

Indirect transfusion of blood and its components.

Transfusion of canned blood into a vein has become the most widespread due to the ease of implementation and the improvement of methods for the mass preparation of canned blood. Transfusion of blood from the same vessel into which it was harvested is the rule. Blood is transfused by venipuncture or venesection (when closed venipuncture is impossible) into one of the superficial, most pronounced saphenous veins of the limb, most often the veins of the elbow. If necessary, a puncture of the subclavian, external jugular vein is performed.

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

The continuity of the flow of transfused blood largely depends on the technique of venipuncture. Proper tourniquet application and appropriate experience are required. The tourniquet should not overtighten the limb, in this case there is no pallor or cyanosis of the skin, arterial pulsation is preserved, the vein is well filled and contoured. Vein puncture is performed with a needle with an attached system for transfusion in two steps (with the appropriate skill, they make up one movement): skin puncture 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, puncture of the vein wall and insertion of a needle into its lumen. The system with a needle is fixed on the skin of the limb with a patch.

In medical practice, for indications, 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 vial. Art., which allows for 2-3 minutes. inject ml of blood. Use the standard technique of surgical exposure of 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 injury. Repeated arterial blood transfusions can be performed in a total dose of doml.

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

Exchange transfusion.

Exchange transfusion - partial or complete removal of blood from the recipient's bloodstream with simultaneous replacement with an adequate or exceeding volume of donor blood. The main purpose of this operation is to remove various poisons along with the blood (for poisoning, endogenous intoxications), decay products, hemolysis and antibodies (for 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 effect. Two methods of exchange blood transfusions are used: continuous-simultaneous - the rate of transfusion is commensurate with the rate of exfusion; intermittent-sequential - the removal and introduction of blood is carried out in small doses intermittently and sequentially into the same vein.

For exchange transfusion, freshly prepared 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 of short shelf life (5 days). For the operation, it is necessary to have a set of sterile instruments (for vene- and arteriosection) of a system for taking and transfusing blood. Blood transfusion is performed into any superficial vein, and bloodletting is carried out from large venous trunks or arteries, since blood coagulation may occur due to the duration of the operation and interruptions between its individual stages.

A big disadvantage of exchange transfusions, in addition to the danger of massive transfusion syndrome, is that during the period of bloodletting, along with the patient's blood, the donor's blood is also partially removed. For a complete replacement of blood, a donation of blood is required. Exchange transfusion was successfully replaced by intensive therapeutic plasmapheresis with withdrawal 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 -logy from other Greek λέγω “I say, tell, tell”) is a branch of medicine that studies the issues of transfusion (mixing) of biological and body fluids replacing 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 a 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 (Fr. 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, transfusions from animals to humans were banned by law due to severe adverse reactions.
• 1795 - In the US, the American physician Philip Syng Physick conducts the first human-to-human blood transfusion, although he does not publish information about this anywhere.
• 1818 - James Blundell, a British obstetrician, performs the first successful transfusion of human blood on a patient with postpartum hemorrhage. Using the patient's husband as a donor, Blundell took nearly four ounces of blood from his arm and injected it into the woman with a syringe. Between 1825 and 1830, Blundell performed 10 transfusions, five of which helped patients. Blundell published his results and also invented the first handy instruments for taking and transfusing blood.
• 1832 - St. Petersburg obstetrician Andrey Martynovich Wolf for the first time in Russia successfully transfused the blood of her husband to a woman in labor with obstetric bleeding and thereby saved her life. Wolf used for transfusion the apparatus and technique he received from the pioneer of world transfusiology, James Blundell.
• 1840 - At St. George's School in London, Samuel Armstrong Lane, led by Blundell, performs 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 milk for transfusions - cow, goat and human.
• 1884 - Saline solutions replace milk in transfusions because there are too many rejection reactions to milk.
• 1900 - Karl Landsteiner (German: Karl Landsteiner), an Austrian doctor, discovers the first three blood types - A, B and C. Group C will then be replaced by O. Landsteiner received the Nobel Prize in 1930 for his discoveries.
• 1902 - Landsteiner's colleagues Alfred de Castello (Italian Alfred Decastello) and Adriano Sturli (Italian Adriano Sturli) add a fourth to the list of blood groups - AB.
• 1907 - Hektoen suggests that the safety of transfusions can be improved if the blood of the donor and recipient is matched to avoid complications. Reuben Ottenberg in New York performs the first blood transfusion using the cross-matching method. Ottenberg also noted that the blood group is inherited according to Mendel's principle and noted the "universal" suitability of the blood of the first group.
• 1908 - French surgeon Alexis Carrel (fr. Alexis Carrel) developed a way to prevent clotting by sewing the recipient's vein directly to the donor's artery. This method, known as the direct method or anastomosis, is still practiced by some transplant physicians, including J.B. Murphy in Chicago and George Crile in Cleveland. This procedure proved unsuitable for blood transfusions, but developed as a method of organ transplantation, and it was for it that Carrel received the Nobel Prize in 1912.
• 1908 Moreschi describes the antiglobulin reaction. Usually, when an antigen-antibody reaction occurs, it cannot be seen. Antiglobulin is a direct way to visualize an antigen-antibody reaction. The antigen and antibody react with each other, then, after removing the antibodies that did not participate 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 seen.
• 1912 - Roger Lee, physician at the Massachusetts Community Hospital, together with Paul Dudley White introduce the so-called "Lee-White clotting time" into laboratory research. Another important discovery is made by Lee, who experimentally proves that blood of the first type can be transfused to patients with any group, and any other blood type is suitable for patients with the fourth blood type. Thus, the concepts of "universal donor" and "universal recipient" are introduced.
• 1914 - Long-term anticoagulants were invented and put into operation, which made it possible to preserve donated blood, among them sodium citrate.
• 1915 - At Mount Sinai Hospital in New York, Richard Levison first uses citrate to replace direct blood transfusion with indirect. Despite the importance of this invention, citrate was introduced into mass use only after 10 years.
• 1916 - Francis Roos and D.R. Turner first use a solution of sodium citrate and glucose to store blood 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 the creator).

Types of blood transfusion

Intraoperative reinfusion

Intraoperative reinfusion is a method based on taking blood that has poured into the cavity (abdominal, thoracic, pelvic cavity) during surgery, and 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 a direct blood transfusion from a donor to a recipient without stabilization and conservation.

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 procure blood components in large quantities, as well as store it for a long time. time.

Exchange transfusion

In exchange transfusion, donor blood is simultaneously infused with the recipient's blood sampling. Most often, this method is used for hemolytic jaundice of newborns, with massive intravascular hemolysis and with severe poisoning.

Blood products

Blood components

• Erythrocyte mass is a blood component consisting of erythrocytes (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.
• Erythrocyte mass washed from leukocytes and platelets (EMOLT) - washed erythrocytes three or more times. Shelf life no more than 1 day.
• Thawed washed erythrocytes - erythrocytes subjected to cryopreservation in glycerol at a temperature of -195°C. In the frozen state, the shelf life is not limited, 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 by thrombocytopheresis. Shelf life - 24 hours, and in a thrombomixer - 5 days.
• Plasma is the liquid component of blood obtained by centrifugation and settling. Apply native (liquid), dry and fresh frozen plasma. When transfusing plasma, the Rh factor (Rh) is not taken into account.

Complex action blood products

Complex drugs include plasma and albumin solutions; they simultaneously have a hemodynamic, anti-shock effect. Fresh frozen plasma causes the greatest effect 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, cytopheresis) or whole blood centrifugation with rapid subsequent freezing (in the first 1-2 hours from the moment blood is taken from the donor). It can be stored up to 1 year at 1°-25° and below. During this time, it retains all blood coagulation factors, anticoagulants, components of the fibrinolysis system. Immediately before transfusion, freshly frozen is thawed in water at t ° 35-37 ° (to accelerate the thawing of 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 the thawed plasma, which does not prevent its transfusion through standard plastic systems with filters. Significant turbidity, the presence of massive clots indicate the poor quality of the plasma: in this case, it cannot be transfused.

Hemodynamic drugs

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

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

Crystalloids

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

Blood substitutes of detoxifying action

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

Syndrome of tissue incompatibility

The tissue incompatibility syndrome develops when the blood of the donor and the recipient is incompatible in one of the immune systems as a result of the reaction of the recipient's body to the injected foreign protein.

homologous blood syndrome

The syndrome of homologous blood is characterized by a violation of microcirculation and transcapillary metabolism as a result of an increase in 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 transfused blood exceeds 50% of the BCC.

transmission syndrome

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

blood transfusion indirect

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.

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

In most cases, pre-preserved blood is transfused, as 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, which has been 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 unable to clot. After adding electrolytes, glucose and sucrose to it, blood is stored for twenty-five days.

However, this is not all. Glucose, glycerin are added to freshly frozen erythrocytes, 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 not lower than six degrees Celsius. Indirect blood transfusion is much simpler than direct blood transfusion. This method provides an opportunity to organize the necessary blood supplies in advance, as well as simply regulate the speed of transfusion, the amount of infused blood, and also avoid a number of complications that could occur with direct blood transfusion. With indirect blood transfusion, the recipient does not form 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 subjected to careful processing.

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

Types of blood transfusion

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

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

Direct blood transfusion. Produced with the help of special equipment from the donor to the patient. Before the procedure, the donor is examined, in accordance with job descriptions. This method can transfuse only whole blood - without preservative. The route of transfusion is intravenous. This type of blood transfusion is used in the absence of fresh frozen plasma, erythrocyte mass or cryoprecipitate in large quantities, with sudden massive blood loss.

Indirect blood transfusion. Perhaps the most common method of transfusion of blood and its components (erythrocyte, platelet or leukocyte mass, fresh frozen plasma). The transfusion route is usually intravenous, using a special disposable blood transfusion system, to which a vial or plastic container with a transfusion medium is connected. There are also other ways of introducing this blood and erythrocyte mass - intra-arterial, intra-aortic, intraosseous.

Exchange transfusion. Partial or complete removal of blood from the bloodstream of the recipient with its simultaneous replacement with donor blood in an adequate volume. This procedure is performed in order to remove various poisons, tissue decay products, hemolysis from the body.

Autohemotransfusion is the transfusion of one's own blood. prepared in advance before the operation, on a preservative solution. When transfusing such blood, complications associated with blood incompatibility, the transfer of infections are excluded. This ensures the best functional activity and survival of erythrocytes in the vascular bed of the recipient.

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

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

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1. By direct connection of the vessels of the donor and the patient:

a) vascular anastomosis;

b) connection of vessels using tubes without devices.

2. With the help of special devices:

a) pumping blood with a system of tubes with a syringe;

b) syringe devices with taps and a switch;

c) devices with two syringes connected to a switch;

d) devices with reconstructed syringes;

e) devices operating on the principle of suction and continuous pumping of blood.

II. Indirect (mediated) blood transfusion

1. Whole blood transfusion (indirect) (without adding stabilizers to it and without processing it):

a) the use of waxed vessels;

b) the use of athrombogenic vessels;

c) the use of siliconized vessels and tubes.

2. Transfusion of blood deprived of the ability to clot:

a) transfusion of stabilized blood;

b) transfusion of defibrinated blood;

c) transfusion of cationic blood.

III. Reverse transfusion (reinfusion) of blood

Blood transfusion from a vial. Before transfusion, the blood in the vial is gently mixed thoroughly. Blood transfusion is performed using factory-made disposable systems. In their absence, the systems are mounted from a rubber or plastic tube with a dropper filter, long and short needles, or two short needles. When using a long needle connected with a short tube to an air filter, air enters the vial turned upside down. In this case, the recipient enters the vein through a short needle of the system. When using two short needles, a tube 20-25 cm long with a filter is attached to one, which serves to enter atmospheric air into the bottle, to the other - a tube 100-150 cm long with a filter and a dropper; at the end of the tube there is a cannula for connection with a needle in the recipient's vein. A short tube with a filter is fixed (with adhesive tape, gauze, etc.) at the bottom of the bottle

horse; the clamps applied earlier are removed first from a long rubber tube, then from a short one, while the long tube is filled with blood. By repeatedly raising and lowering the tube, make sure that the blood has forced all the air out of the tube. After the air is expelled from the system, the clamp is again applied to the long rubber tube. The recipient vein is punctured with a needle and the system is connected to it.

In the case of poor blood flow during transfusion, it is impossible to immediately create increased pressure in the vial, but it is necessary to find out the reason for the cessation or slowing of blood flow in the system. Causes may be the presence of clots in the system or blood, incorrect position of the needle in the vein, or blockage of the lumen of the needle when piercing the cork material.

Blood transfusion from a plastic container. Before a blood transfusion, a long tube is cut off, and the blood in it is used to determine the donor's blood group and conduct a test for individual compatibility and Rh compatibility. The plastic needle of the blood transfusion system is inserted into the fitting of the container, having previously torn off the petals that cover the inlet membrane. The introduction of an air tube into the bag is not required. The system is filled with blood in the same way as when transfusing blood from a vial.

The use of plastic systems for one-time blood transfusion. Blood transfusion system (rice. 8.4) is a tube into which a body with a dropper and a nylon filter is soldered.

The short end of the tube ends with a needle to pierce the vial stopper. The long end of the plastic tube ends with a cannula, on which a small rubber tube and a vein puncture needle are put on. The needle and cannula are covered with protective plastic caps. A filter needle is included with the system. The system is stored in a hermetically sealed polyethylene bag. While maintaining the integrity of the packaging bag, the system is suitable for blood transfusion within the period specified by the manufacturer.

Blood is transfused using a plastic system in the following sequence:

treat the cork of the vial with alcohol or iodine, bending the flaps of the cap;

release the needle at the short end of the system from the cap and pierce the stopper of the vial;

insert an air inlet needle through the stopper into the vial;

clamp the system with a clamp;

turn the vial upside down and fix it in a tripod. To force air out of the filter housing, lift the latter so that the dropper is at the bottom, and the nylon filter is at the top;

remove the clamp and fill the filter housing up to half with blood coming through the dropper. Then the filter housing is lowered and the entire system is filled with blood, after which it is again clamped with a clamp;

release the needle from the cap. A venipuncture is performed, the clamp is removed and, by attaching the cannula, the transfusion is started.

The rate of transfusion is controlled visually by the frequency of drops and is regulated by a clamp.

If during transfusion the patient needs to inject any medicinal substances, they are administered with a syringe, piercing the rubber with a needle.

Rice. 8.4. Disposable system for blood transfusion.

a - (PK 11-01): 1 - vial for blood; 2 - injection needle; 3 - cap for the needle; 4 - knot for fastening the injection needle; 5 - needle for connection to the vial; 6 - dropper with filter; 7 - clamp; 8 - air duct needle;

b - combined system for transfusion of blood and blood-substituting fluids (KR 11-01): 1 - vial for blood; 2 - bottle for blood-substituting fluid; 3 - cap for the needle; 4 - air duct needles; 5 - injection needle; 6 - knot for fastening the injection needle; 7 - clamps; 8 - droppers with a filter; 9 - needles for connection to vials.

section of the system. It is impossible to pierce a plastic tube with a needle, since its wall does not collapse at the puncture site.

8.5.2. Transfusion into a vein

Any superficial vein can be used for blood transfusion. The most convenient for puncture are the veins of the elbow, rear of the hand, forearm, foot. Blood transfusion into a vein can be performed by venipuncture, as well as venesection. For prolonged blood transfusions, catheters made of plastic materials are used instead of needles. Before venipuncture, the operating field is treated with alcohol,

iodine, delimited by sterile material. A tourniquet is applied and venipuncture is performed. When blood appears from the lumen of the needle, a blood transfusion system pre-filled with blood is attached to it. Remove the tourniquet from the hand and the clamp from the system. To avoid displacement and exit of the needle from the vein, the pavilion of the needle and the rubber tube connected to it are fixed to the skin with two strips of an adhesive patch.

For blood transfusion by venesection, the cubital veins, veins of the shoulder, and thigh are most often used. After processing the surgical field, local infiltration anesthesia is performed. A tourniquet is applied, the skin with subcutaneous tissue is dissected and a vein is isolated. Two ligatures are brought under it, the vein is either punctured or opened (an incision is made). At the central end of the vein, a needle (catheter) is fixed with a ligature, the distal end is tied up. The wound is sutured.

In cases where rapid replacement of the volume of lost blood is required or long-term transfusion-infusion therapy is planned, catheterization of the main veins is performed. In this case, preference is given to the subclavian vein. Its puncture can be performed from the supraclavicular or subclavian zones.

8.5.3. Internal bone transfusion

Transfusion of blood and other fluids into the bone marrow cavity is performed if it is impossible to administer them intravenously. For bone puncture it is better to use special needles (Kassirsky, Leontiev). The introduction of blood and other fluids is possible in any bone that is accessible for puncture and contains a spongy substance. However, the most convenient for this purpose are the sternum, the wing of the ilium, the calcaneus, and the greater trochanter of the femur.

The skin is treated with alcohol and iodine, after which anesthesia is performed. With a safety cap, the required length of the needle is set, depending on the thickness of the soft tissues above the puncture site. The cortical layer of the bone is pierced with a drilling motion. The appearance of blood in the syringe indicates that the end of the needle is in the spongy bone. After that, 10-15 ml of a 0.5-1.0% solution of novocaine is injected. After 5 minutes, the system is attached to the needle and blood transfusion is started.

8.5.4. Intra-arterial transfusion

For intra-arterial blood injection, the radial, ulnar or internal tibial arteries are most often used, since they are the most accessible. A puncture or section of an artery is performed. The equipment for intra-arterial blood injection consists of a transfusion system, a pressure gauge and an air injector. The system is mounted in the same way as for intravenous blood transfusion. After filling the system with blood, a rubber tube is attached to the airway needle, connected by a tee to a canister and a pressure gauge.

A clamp is applied to the tube and attached to a needle inserted into the artery. Then a pressure of 60-80 mm Hg is created in the vial. Art. Remove the clamp and within 8-10 seconds bring the pressure to 160-180 mm Hg. Art. in cases of severe shock and in atonal conditions, up to 200-220 mm Hg. Art. - with clinical death.

After the introduction of 50-60 ml of blood, the rubber tube at the needle is pierced and a 0.1% solution of adrenaline is injected with a syringe (with severe shock - 0.2-0.3 ml, with an agonal state - 0.5 ml and with clinical death - 1 ml ). Massive continuous transfusions of blood into an artery, especially blood with adrenaline, can cause prolonged spasm and thrombosis. Therefore, intra-arterial infusion must be performed fractionally, 250-300 ml each, it is advisable to inject 8-10 ml of a 1% solution of novocaine before transfusion. According to indications (absence of pulsation of peripheral arteries), after massive intra-arterial blood transfusions, anticoagulants should be used. After the end of the introduction of blood, the bleeding is stopped by applying a pressure bandage.

8.5.5. Immediate (direct) transfusion

For direct blood transfusions, devices are used, the device of which is based on the use of a syringe and a three-way valve and makes it possible to create a closed system. Blood is transfused by such devices with intermittent current. More modern are devices that allow you to transfuse blood with a continuous current and adjust its speed; the mechanism of their work is based on the principle of a centrifugal pump.

Before starting blood transfusion, the system is filled with 5% sodium citrate solution or isotonic sodium chloride solution with heparin (5000 IU of heparin per 1 liter of isotonic sodium chloride solution). The skin over the recipient's vein is treated in the usual way, a tourniquet is applied, after which a puncture is performed. Then the apparatus is attached, the tourniquet is removed. The operation of the device must be checked by introducing a small amount (5-7 ml) of isotonic sodium chloride solution into the recipient's vein. After a similar treatment of the skin of the elbow joint and the application of a tourniquet, the donor's vein is punctured.

8.5.6. Autotransfusion of blood

Autotransfusion is a transfusion of the patient's own blood taken from him in advance of the operation, immediately before or during the operation. The purpose of autotransfusion is to return blood loss during the operation with your own blood, devoid of the negative properties of donor blood. Autohemotransfusion excludes possible isoserological complications during transfusion of donor blood: immunization of the recipient, development of the homologous blood syndrome, and in addition, it allows to overcome the difficulties of selecting an individual donor for patients with antibodies to erythrocyte antigens that are not included in the AB0 and Rh systems.

8.5.7. Exchange (replacement) transfusion

Partial or complete removal of blood from the recipient's vascular bed with simultaneous replacement with an adequate or exceeding volume of donor blood is used to remove various poisons from the patient's blood (in case of poisoning, endogenous intoxication), metabolic products, hemolysis, antibodies - in hemolytic disease of the newborn, hepatic

transfusion shock, severe toxicosis, acute renal failure.

There is a continuous-simultaneous and intermittent-sequential exchange transfusion of blood. At continuous-simultaneous exchange transfusion the rate of exfusion and transfusion of blood are equal. At intermittent sequential exchange transfusion blood exfusion and transfusion of blood is performed in small doses intermittently and sequentially using the same vein. The exchange transfusion operation begins with bloodletting from the femoral vein or artery. When taken, blood enters a graduated vessel, where negative pressure is maintained by pumping out air. After the removal of 500 ml of blood, the transfusion is started, while bloodletting is continued; while maintaining a balance between exfusion and transfusion. The average rate of exchange transfusion is 1000 ml for 15 minutes. For exchange transfusion, freshly prepared donor blood is recommended, selected according to the antigens of the AB0 system, the Rh factor, the Coombs reaction (an immunological reaction to detect incomplete antibodies to auto- and isoantigens of erythrocytes). However, it is also possible to use canned blood of short shelf life. To prevent hypocalcemia, which can be caused by sodium citrate of preserved blood, a 10% solution of calcium gluconate or calcium chloride is infused (10 ml for every 1500-2000 ml of injected blood). The disadvantage of exchange blood transfusion is post-transfusion reactions (the possibility of massive hemotransfusion syndrome).

The term "massive blood transfusion" implies a complete replacement of the BCC within 24 hours (10 standard packages of whole blood for an adult of average body weight). Recent studies have made it possible to clarify a number of provisions regarding massive blood transfusions. The most important ones are:

coagulation disorders are possible in all cases, but there is no relationship between the volume of blood transfused and the risk of coagulopathy;

the introduction of platelets and fresh frozen plasma at certain intervals during massive blood transfusions also does not reduce the likelihood of developing coagulopathy;

dilutional thrombocytopenia will not develop until the volume of transfused blood exceeds the BCC by 1.5 times;

excessive administration of sodium hydrocitrate can lead to the binding of Ca 2+ in the blood of the recipient and cause hypokalygemia, although the significance of such a reaction is not completely clear today. However, the conversion of sodium hydrocitrate to bicarbonate during metabolism can cause severe metabolic alkalosis;

hyperkalemia with massive blood transfusions is observed quite rarely, but the development of deep metabolic alkalosis may be accompanied by hypokalemia;

when carrying out massive blood transfusions, it is recommended to use a device for warming the blood and filters for the deposition of microaggregates.

8.6. Mandatory tests for blood transfusion

Considering blood transfusion therapy as histocompatible transplantation, which is characterized by a number of serious complications, attention should be paid to the obligatory observance of all the requirements of blood transfusions.

Ten questions a doctor should ask himself before prescribing a transfusion:

What improvement in the patient's condition is expected as a result of transfusion of blood components?

Is it possible to minimize blood loss and avoid transfusion of blood components?

Is it possible to use autohemotransfusion, reinfusion in this case?

What are the absolute clinical and laboratory indications for a patient to prescribe a transfusion of blood components?

Has the risk of transmission of HIV, hepatitis, syphilis or other infection been taken into account through transfusion of blood components?

Is the therapeutic effect of the transfusion expected to be more significant than the risk of possible complications caused by the transfusion of blood components in this patient?

Is there an alternative to transfusion of blood components?

Is there provision for a qualified specialist to observe the patient after the transfusion and immediately respond in case of a reaction (complication)?

Is the indication (justification) for transfusion formulated and recorded in the medical history and application for blood components?

If I needed a transfusion in these circumstances, would I give it to myself?

General provisions. Before blood transfusion, it is necessary to substantiate the indications for the introduction of a transfusion medium in the medical history, determine the dosage, frequency and method of administration, as well as the duration of such treatment. After performing the prescribed therapeutic measures, their effectiveness should be determined based on the study of relevant indicators.

Only a doctor is allowed to independently perform blood transfusion. The person performing the blood transfusion is responsible for the correct implementation of all preparatory measures and the conduct of appropriate studies.

Pre-blood transfusion activities. Before blood transfusion (erythrocytes, leukocytes, platelets, plasma) the doctor must (!):

make sure that the transfused medium is of good quality;

check the group affiliation of the blood of the donor and the recipient, exclude their group and Rh incompatibility;

conduct tests for individual group and Rhesus compatibility;

blood transfusion should be carried out after a triple biological test.

The assessment of the quality of the blood transfusion medium consists of checking the passport, expiration date, tightness of the vessel and macroscopic examination. The passport (label) must contain all the necessary information: the name of the medium, the date of preparation, the group and Rh affiliation, the registration number, the surname and initials of the donor, the surname of the doctor who prepared the blood, and the “sterile” label. The container must be sealed. External examination of the environment should show no signs

hemolysis, foreign inclusions, clots, turbidity and other signs of possible infection.

Immediately before each blood transfusion, the person performing the transfusion compares the group and Rh affiliation of the blood of the donor and the recipient, and also conducts a control determination of the blood group of the donor and recipient using two series of sera or using zoli-clones. Transfusion of the selected transfusion medium is allowed if their group and Rh affiliation coincide with those of the patient.

Test for individual group compatibility (according to the ABO system). On a clean, dry surface of a tablet or plate at room temperature, apply and mix the recipient's serum and donor's blood in a ratio of 10:1. Periodically shaking the plate, observe the progress of the reaction. In the absence of agglutination within 5 minutes, the blood is considered compatible. The presence of agglutination indicates the incompatibility of the blood of the recipient and the donor - such blood cannot be transfused. In doubtful cases, the result of the test is controlled under a microscope: in the presence of coin columns that disappear after the addition of warm (37 ° C) 0.9% sodium chloride solution, the blood is compatible; if agglutinates are visible in a drop of the mixture, which do not disperse when a warm 0.9% sodium chloride solution is added, the blood is incompatible.

Test for compatibility by Rh factor (with a 33% solution of polyglukin in a test tube without heating). To set up a sample, you must have a 33% solution of polyglucin, 0.9% sodium chloride solution, laboratory test tubes, a tripod, the recipient's serum, and donor's blood. The test tubes are labeled with the patient's surname and initials, his blood group and the number of the container (bottle) with donor blood. 2 drops of the patient's blood serum, one drop of donor blood and one drop of 33% polyglucin solution are applied to the bottom of the test tube with a pipette. The contents of the tube are mixed by shaking once. Then the tube is rotated for 5 minutes around the longitudinal axis so that its contents spread (smeared) along the walls of the tube. After that, 2-3 ml of a 0.9% sodium chloride solution is added to the test tube and the contents are mixed by turning the tube three times (shaking is prohibited), viewing it in transmitted light and making a conclusion. The presence of agglutination in the test tube indicates that the donor's blood is incompatible with the patient's blood and should not be transfused. If the contents of the tube remain uniformly colored and there are no signs of erythrocyte agglutination, the donor's blood is compatible with the patient's blood.

biological test. To exclude individual incompatibility, which cannot be detected by previous reactions, a biological sample is produced. It consists in the fact that the first 50 ml of blood is administered to the recipient in 10-15 ml jets at intervals of 3 minutes. The absence of signs of incompatibility after infusion of 50 ml of blood allows blood transfusion without interruption. During the entire operation of blood transfusion, it is necessary to strictly monitor the patient, and if the slightest sign of incompatibility appears, the transfusion should be stopped. In the case of transfusion of several portions of blood from different donors, compatibility tests and a biological test are carried out with each new portion separately. When conducting a biological test (preferably before giving anesthesia to patients scheduled for surgery), it is necessary to monitor the pulse, respiration, appearance of the recipient and listen carefully to his complaints.

Activities carried out during the transfusion. Transfusion of blood and other means should be carried out with strict observance of the rules of asepsis. During blood transfusion, it is necessary to periodically monitor the recipient's well-being and his reaction to transfusion. If tachycardia, back pain, chills and other signs appear that indicate possible incompatibility, poor quality or intolerance to the patient of this environment, the transfusion should be stopped and measures should be taken to find out the causes of the reaction (complications) that have arisen and to carry out the necessary therapeutic measures.

Post-transfusion activities. After blood transfusion, the immediate therapeutic effect is determined, as well as the presence or absence of a reaction (complications). If the blood transfusion was performed under anesthesia, by the end of it it is necessary to carry out a bladder catheterization in order to determine the amount of urine, its color, and the presence of hemoglobinuria or hematuria. After 1, 2, 3 hours after transfusion, body temperature is measured, and by its change, the attending physician makes a conclusion about the presence (absence) of a reaction. One day after the transfusion, it is necessary to conduct a urine test, and after 3 days, a blood test.

Each case of transfusion of blood and its components is recorded in the medical history in the form of a protocol, which reflects: indications for transfusion; reactions (tests) carried out before transfusion (determination of the blood group and Rh factor of the recipient and donor, tests for individual group compatibility and Rh factor, a triple biological test); method and technique of transfusion; dose of transfused blood; passport data of donor blood; transfusion reactions; temperature 1, 2, 3 hours after transfusion; who transfused (full name, position).

The bottle with the rest of the blood and its components (5-10 ml), as well as the test tubes with the blood (serum) of the recipient used for testing for compatibility, is placed in the refrigerator (for 2 days) to check in case of a post-transfusion complication. If a post-transfusion reaction or complication occurs, measures are taken to find out the causes and appropriate treatment is carried out.

8.7. Acute blood transfusion reactions and complications

With massive blood transfusions, 10% of recipients can observe certain adverse reactions and complications (Table 8.4).

Blood transfusion reactions- a symptom complex that develops after blood transfusion, which is not accompanied, as a rule, by serious and prolonged dysfunctions of organs and systems and does not pose an immediate danger to life. Clinically (depending on the cause of occurrence and course), pyrogenic, allergic and anaphylactic blood transfusion reactions are distinguished.

pyrogenic reactions occur 1-3 hours after transfusion due to the introduction of pyrogens into the bloodstream of the recipient or isosensitization to antigens of leukocytes, platelets, plasma proteins.

Depending on the clinical course, 3 degrees of pyrogenic reactions are distinguished: mild, moderate and severe. Light reactions accompanied by an increase in body temperature within 1 ° C, slight malaise; medium reactions- an increase in body temperature by 1.5-2 ° C, chills, increased heart rate and respiration, general malaise; heavy reactions

Table 8.4.Major transfusion reactions and complications

Pyrogenic		Antibodies to donor leukocytes
allergic		Sensitization to donor plasma proteins
Acute lung injury	1:5000 overflow-	Leukoagglutinins in the donor
Acute hemolysis	1:6000 overflow-	AV antibodies to erythrocytes
Toxic and infectious		The poor quality of the transfusion
		that blood
Thromboembolism		Entry into the blood system of clots formed in transfused blood
Air embolism		Errors in transfusion
Acute circulatory		overload of the right atrium and
		left ventricle of the heart with a large volume of blood

tion - an increase in body temperature by more than 2 ° C, chills, headache, cyanosis of the lips, shortness of breath, and sometimes pain in the lower back and bones.

Pyrogenic reactions occur repeatedly in less than 50% of patients and are not a contraindication for repeated blood transfusion. For further blood transfusions with repeated fever, an erythrocyte mass depleted in leukocytes or washed erythrocytes is required.

allergic reactions occur on the first day as a result of the patient's sensitization to antigens of plasma proteins and occur most often with repeated or multiple transfusions of blood or plasma. They are characterized by fever, changes in blood pressure, shortness of breath, nausea, sometimes vomiting, as well as urticaria, itching of the skin. In rare cases, blood and plasma transfusion can cause the development of an anaphylactic-type reaction, the clinical picture of which is characterized by acute vasomotor disorders (anxiety, facial flushing, cyanosis, asthma attacks, increased heart rate, decreased blood pressure).

With mild allergic reactions and the absence of fever, hemotransfusion can be continued. Usually, blood transfusion is stopped when antihistamines are ineffective. Sometimes itching can be stopped by intramuscular injection of 25-50 mg of Diphenhydramine. The drug can also be used prophylactically before transfusion in patients with hypersensitivity. Anaphylactic reactions are eliminated with the help of intensive infusion therapy (preference is given to colloidal solutions) and adrenaline (0.1 ml at a dilution of 1:1000 intravenously or 0.3-0.5 ml subcutaneously). If possible, blood transfusions should be avoided in patients with allergies. If nevertheless it is necessary, then washed erythrocytes should be used. For highly sensitized patients, a deglycerolized red blood cell mass can be specially prepared.

Anaphylactic reactions. The time of occurrence of these reactions is from the first minutes of transfusion to 7 days; the reason is the presence in the recipient's blood of antibodies to immunoglobulins present in the injected medium, and the development of the "antigen-antibody" reaction. The leading symptoms are redness of the face, followed by pallor, suffocation, shortness of breath, tachycardia.

dia, lowering blood pressure, in severe cases - vomiting, loss of consciousness. Sometimes due to isosensitization to immunoglobulin IgA may develop anaphylactic shock.

All administrations of blood products must be authorized by a transfusiologist and should be carried out under his constant supervision. All patients with a history of anaphylaxis are examined for immunoglobulin A deficiency.

If transfusion reactions occur, the transfusion should be immediately stopped and cardiovascular, sedative and hyposensitizing agents should be prescribed. The prognosis is favorable.

For the prevention of blood transfusion reactions needed:

strict observance of all conditions and requirements for the preparation and transfusion of canned blood, its components and preparations - the use of single-use systems for transfusions;

taking into account the state of the recipient before transfusion, the nature of his disease, identifying hypersensitivity, isosensitization;

the use of appropriate blood components;

individual selection of donor blood, its preparations for patients with isosensitization.

Blood transfusion complications- a symptom complex characterized by severe violations of the activity of vital organs and systems, dangerous for the life of the patient.

The main causes of complications:

incompatibility of the blood of the donor and the recipient in terms of erythrocyte antigens (by group factors of the ABO system, Rh factor and other antigens);

poor quality of the transfused blood (bacterial contamination, overheating, hemolysis, protein denaturation due to long-term storage, violation of the temperature regime of storage, etc.);

errors in transfusion (the occurrence of air embolism, circulatory disorders, cardiovascular insufficiency);

massive doses of transfusion;

transmission of pathogens of infectious diseases with transfused blood.

Acute hemolysis occurs when the blood of the donor and the recipient is incompatible according to the ABO system or the Rh factor. The first clinical manifestations of a complication caused by the transfusion of blood incompatible with group factors to the patient occur at the time of transfusion or in the near future after it; with incompatibility by the Rh factor or other antigens - after 40-60 minutes and even after 2-6 hours.

In the initial period, there is pain in the lower back, chest, chills, shortness of breath, tachycardia, decreased blood pressure (in severe cases, shock), intravascular hemolysis, anuria, hemoglobinuria, hematuria. Later - acute hepatic-renal failure (jaundice of the skin and mucous membranes, bilirubinemia, oligoanuria, low urine density, uremia, azotemia, edema, acidosis), hypokalemia, anemia.

The treatment uses large doses of glucocorticoids, respiratory analeptics, narcotic analgesics, medium and low molecular weight colloidal solutions. After stabilization of hemodynamics, force is carried out

diuresis; transfusions of one-group individually selected freshly preserved blood or erythrocytes are also shown.

Acute respiratory failure(ARN) is a fairly rare complication of blood transfusion. ARF can be observed even after a single transfusion of both whole blood and red blood cells. The pathogenesis of ARF is associated with the ability of donated blood antileukocyte antibodies to interact with the recipient's circulating granulocytes. The formed leukocyte complexes enter the lungs, where a number of toxic products released by the cells damage the capillary wall, as a result of which its permeability changes and pulmonary edema develops; while the current picture resembles acute respiratory distress syndrome. Signs of respiratory failure usually develop within 1-2 hours of transfusion. Fever is common, and cases of acute hypotension have been reported. Chest x-ray shows pulmonary edema, but pressure in the pulmonary capillaries remains within normal limits. Although the condition in patients with ARF can be severe, the pulmonary process itself usually resolves within 4-5 days without causing significant damage to the lung tissue.

At the first sign of ARF, the transfusion should be stopped (if it is still ongoing). The main therapeutic measures are aimed at correcting respiratory disorders.

Infectious-toxic shock occurs with the intravascular intake of microorganisms and waste products of microorganisms vegetating in such an environment. It develops at the time of the introduction of the first portions or in the first 4 hours. There is reddening of the face, followed by cyanosis, shortness of breath, and a drop in blood pressure below 60 mm Hg. Art., vomiting, involuntary urination, defecation, loss of consciousness, fever. At a later date (on the 2nd day), toxic myocarditis, heart and kidney failure, and hemorrhagic syndrome are noted. Treatment is the same as for transfusion shock, but antibiotics, cardiac agents are added, if necessary, exchange-replacing blood transfusion, hemosorption.

Such a complication poor quality of transfused blood, its components and preparations is associated with the intravascular intake of erythrocyte destruction products or denatured plasma proteins, albumin (the result of prolonged or improper storage). The complication occurs in the first 4 hours. The clinical picture and treatment are similar to those in hemotransfusion shock.

Thromboembolism occurs when microclots enter the vein, microcirculation is disturbed in the zone of the pulmonary artery or its branches. On the first day, there are pains behind the sternum, hemoptysis, fever; clinically and radiologically - "shock lung", less often heart attack-pneumonia. The treatment is complex, including cardiac agents, respiratory analeptics, anticoagulants of direct and indirect action, fibrinolytics.

Air embolism occurs when air enters the vascular bed at a dose of more than 0.5 ml per 1 kg of body weight; clinically at the time of transfusion, there are chest pains, shortness of breath, pallor of the face, a drop in blood pressure below 70 mm Hg. Art., thready pulse, vomiting, loss of consciousness. Possible paradoxical embolism of cerebral vessels, coronary arteries with the corresponding symptoms. The treatment is complex, taking into account the underlying disease: the introduction of analgesics, cardiac drugs, respiratory analeptics, corticosteroids, oxygen inhalation, if necessary - mechanical ventilation, heart massage, treatment in a pressure chamber.

Development acute circulatory disorders(acute expansion and cardiac arrest) is possible with the rapid introduction of a large number of solutions and, as a result, overload of the right atrium and left ventricle of the heart. During transfusion, shortness of breath, cyanosis of the face, and a decrease in blood pressure to 70 mm Hg occur. Art., frequent pulse of weak filling, CVP above 15 cm of water. Art., pulmonary edema. To stop this condition, it is necessary first of all to stop the introduction of solutions. Introduce corglicon, ephedrine or mezaton, eufillin. If necessary - tracheal intubation, artificial lung ventilation, chest compressions.

Transmissible infectious diseases occur when transferred with blood, its components and preparations of pathogens of AIDS, syphilis, hepatitis B, malaria, influenza, typhus and relapsing fever, toxoplasmosis, infectious mononucleosis. The time of onset of the first symptoms, the clinic and treatment depend on the disease.

8.8. Organization of blood and donation service in Russia

The blood service in the Russian Federation is currently represented by 200 blood transfusion stations (BTS). Methodological guidance and scientific and practical developments in the blood service are carried out by 3 institutes of blood transfusion in Russia: the Central Institute of Blood Transfusion (Moscow), the Russian Research Institute of Hematology and Transfusiology (St. Petersburg), the Kirov Research Institute of Blood Transfusion, and the Center for Blood and Tissues of the Military Medical academy. They also train personnel for the blood service; control the organization of donation, procurement and use of blood and its products; carry out constant communication and interaction with other healthcare institutions on the procurement, storage and use of blood, its components and preparations, as well as blood substitutes.

8.8.1. Tasks of the blood service

The main tasks of the blood service of Russia:

Maintaining a high level of readiness for work in emergency situations and in wartime.

Organization of donation of blood, its components and bone marrow.

Procurement, preservation of donor blood, its components, preparations and bone marrow, their laboratory examination.

Transportation and storage of prepared blood transfusion products.

Provision of canned blood, its components and preparations to medical institutions.

Organization of blood transfusion and blood substitutes in medical institutions.

Analysis of the results of blood transfusion, reactions and complications associated with transfusion of blood and blood substitutes. Development and implementation in practice of measures to prevent them.

Training in transfusiology.

Scientific development of transfusiology problems.

8.8.2. Sources of blood for therapeutic transfusion

The organization of the work of the blood service in the Russian Federation is carried out in accordance with the Law of the Russian Federation No. 5142-1 dated June 9, 1993 "On the donation of blood and its components", "Instructions for the medical examination of donors of blood, plasma, blood cells", approved by the Ministry of Health of the Russian Federation of 05/29/95, "Guidelines for the organization of the blood service" WHO, Geneva (1994).

The ever-increasing demand for blood used for therapeutic purposes forces researchers to constantly look for sources of its production. To date, five such sources are known: volunteer donors; reverse blood transfusion (autoinfusion and reinfusion).

main source blood for transfusion were and remain donors. There are the following categories of donors: active (personnel), donating blood (plasma) 3 times or more a year; reserve donors with less than 3 blood (plasma and cyto) donations per year; immune donors; bone marrow donors; donors of standard erythrocytes; plasmapheresis donors; autodo-burrows.

8.8.3. Recruitment of reserve donors

A donor in our country can be every citizen over the age of 18 who is necessarily healthy, who voluntarily expressed a desire to donate his blood or its components (plasma, erythrocytes, etc.) for transfusion and who has no contraindications to donation for health reasons.

Donor recruitment includes identifying a population of volunteers willing to participate in donation; conducting a preliminary medical selection of candidates for donors; approval of the final list of candidates for donors.

Preliminary medical selection of candidates for donors is carried out in order to identify persons who have temporary and permanent contraindications to donate blood, and to exclude them from participation in donation.

8.8.4. Contraindications for donation

Contraindications to donation are the following diseases and conditions of the body:

diseases transferred regardless of prescription: AIDS, viral hepatitis, syphilis, tuberculosis, brucellosis, tularemia, toxoplasmosis, osteomyelitis, as well as operations for malignant tumors, echinococcus or other reasons with the removal of some large organ - stomach, kidney, gallbladder. Persons who have undergone other operations, including abortion, are allowed to donate no earlier than 6 months after recovery, providing a certificate of the nature and date of the operation;

a history of blood transfusions during the last year;

malaria in the presence of attacks within the last 3 years. Persons returning from malaria endemic countries (tropical and subtropical countries, Southeast Asia, Africa, South and Central America) are not allowed to donate for 3 years;

after other infectious diseases, blood sampling is allowed after 6 months, after typhoid fever - after one year after recovery, after tonsillitis, influenza and acute respiratory diseases - after 1 month after recovery;

poor physical development, exhaustion, beriberi, pronounced dysfunction of the endocrine glands and metabolism;

cardiovascular diseases: vegetovascular dystonia, hypertension II-III degree, coronary heart disease, atherosclerosis, coronary sclerosis, endarteritis, endocarditis, myocarditis, heart defects;

peptic ulcer of the stomach and duodenum, anacid gastritis, cholecystitis, chronic hepatitis, cirrhosis of the liver;

nephritis, nephrosis, all diffuse lesions of the kidneys;

organic lesions of the central nervous system and mental illness, drug addiction and alcoholism;

bronchial asthma and other allergic diseases;

otosclerosis, deafness, empyema of the paranasal sinuses, ozena;

residual effects of iritis, iridocyclitis, choroiditis, abrupt changes in the fundus, myopia more than 6 diopters, keratitis, trachoma;

common skin lesions of an inflammatory, especially infectious and allergic nature, psoriasis, eczema, sycosis, lupus erythematosus, blistering dermatosis, trichophytosis and microsporia, favus, deep mycoses, pyoderma and furunculosis;

periods of pregnancy and lactation (women can be allowed to give blood 3 months after the end of the lactation period, but not earlier than one year after childbirth);

the period of menstruation (blood giving is allowed 5 days after the end of menstruation);

vaccinations (blood sampling from donors who received prophylactic vaccinations with killed vaccines is allowed 10 days after vaccinations, with live vaccines - after 1 month, and after vaccinations against rabies - after 1 year); after blood donation, the donor can be vaccinated no earlier than 10 days later;

feverish state (at a body temperature of 37 ° C and above);

changes in peripheral blood: hemoglobin content below 130 g/l in men and 120 g/l in women, erythrocyte count less than 4.0 10 12/l in men and 3.9 10 12/l in women, erythrocyte sedimentation rate over 10 mm/h in men and 15 mm/h in women; positive, weakly positive and doubtful results of serological tests for syphilis; the presence of antibodies to HIV, hepatitis B antigen, increased bilirubin.

Temporary contraindications to donation According to WHO recommendations, certain medications are used. So, after taking antibiotics, donors are disqualified for 7 days, salicylates - for 3 days from the moment of the last medication.

8.8.5. Procurement and control of donated blood

Preparing donated blood is the central link in the production activities of the entire blood service. It is carried out in order to ensure blood transfusions, the production of compo-

nits and blood products. For blood collection, as a rule, standard equipment is used: polymer containers "Gemakon" 500 and "Gemakon" 500/300 or glass bottles with a capacity of 250-500 ml containing a hemopreservative (glugicir, cytroglucophosphate) and disposable devices such as VK 10-01, VK 10-02 for taking blood in a bottle. Polymeric containers are non-pyrogenic, non-toxic, contain 100 ml of the “Glugitsir” preservative solution and are designed to take 400 ml of blood.

Blood sampling is carried out by a blood collection team at blood collection facilities. Such points can be stationary operating stations for blood transfusion, adapted premises at the departure of the brigade for blood sampling at work.

The layout and size of such facilities should allow for the deployment of work stations for undressing and registering donors; laboratory analysis of blood from donors; medical examination of donors; feeding donors before taking blood; taking blood; rest of donors and providing them with first aid if necessary; dressing of the mobile team personnel.

When choosing premises, they proceed from the need for strict adherence to the rules of asepsis and antisepsis. For these purposes, it is ensured that donors consistently pass through all stages of preparation and implementation of blood collection, with the exception of oncoming flows of donors and their accumulation in various subdivisions of the blood collection point.

Under the operating room, the cleanest, brightest and most spacious room is allocated, which allows deploying the required number of donor sites at the rate of 6-8 m 2 of area for each workplace.

Autoblood harvesting appropriate if expected blood loss is > 10% of BCC. The volume of exfusion is determined depending on the predicted need for these funds for transfusiological support of surgical intervention. Accumulation of up to 1-2.5 liters of autoplasma, 0.5-1.0 liters of autoerythrocytes is acceptable. Autologous blood reinfusion follows the same principles as donor blood transfusion.

Laboratory control of donor blood. Blood after taking from a donor is subjected to laboratory testing, which includes:

determination of blood grouping according to the AB0 system using a cross method or using anti-A and anti-B coliclones; determination of Rh-affiliation of blood;

testing for syphilis using cardiolipin antigen;

a study for the presence of hepatitis B antigen in the reaction of passive hemagglutination or enzyme immunoassay; antibodies to hepatitis C;

determination of antigens and antibodies to the human immunodeficiency virus (HIV);

a qualitative study on alanine aminotransferase (AlAT);

bacteriological control of the prepared blood.

In places endemic for brucellosis, blood serum of donors, in addition,control the reaction of Wright and Heddelson.

8.8.6. Storage and transport of blood

Blood storage is carried out in a specially allocated room (forwarding department) of SP K. Storage facilities for blood and its components are equipped with stationary refrigeration units or electric refrigerators. For short-term storage, thermally insulating containers or other technical means can be used to maintain the temperature at 4 ± 2 °C. In the storage for each blood type, a special refrigerator or a separate place is allocated, marked with the appropriate marking. Each chamber must have a thermometer.

In order to identify possible changes, a blood examination is performed daily. Properly stored and suitable for transfusion, the blood has a clear golden yellow plasma without flakes and turbidity. There should be a clearly defined boundary between the settled globular mass and the plasma. The ratio of globular mass and blood plasma is approximately 1:1 or 1:2, depending on the degree of blood dilution with a preservative solution and its individual biological characteristics. Visible hemolysis (lacquer blood) indicates the unsuitability of the blood for transfusion.

Transportation of blood to medical institutions, depending on the distance, is carried out in thermal containers TK-1M; TK-1; TKM-3.5; TKM-7; TKM-14; refrigerated truck RM-P.