HEMOTRANSFUSION

From Big Medical Encyclopedia

HEMOTRANSFUSION (transfusio sanguinis; synonym hemotransfusion) — introduction with the medical purpose to a vascular bed of sick (recipient) of blood of the donor or its components.

The item to. — method of transfusion therapy; this serious intervention, as a result to-rogo is carried out transplantation (change) of allogenic or autogenic fabric. The term «hemotransfusion» combines transfusion to the patient both whole blood, and its cellular components and proteinaceous drugs of plasma.

History

In the history of P. to. distinguish two main periods. The first period — since ancient times before opening of laws of isohemagglutination and group factors of blood (antigens of erythrocytes). In this period it is possible to allocate two stages: the first — lasted from antique times before opening of blood circulation (1628) by U. Garvey; the second — proceeded before opening of group factors of blood (1900) by K. Landshtey-per.

In Hippocrates's works mentioning of use of blood of healthy people for treatment of patients meets. In the Middle Ages and at the beginning of Renaissance of P. to. in vessels of the person did not apply. On the basis of the ideas of the movement of blood in an organism existing before U. Garvey's opening, P. to. could not receive the correct theoretical justification and rational practical application though doctors of Italy and France spoke a possibility of intravascular injection of blood to the person. Opening of blood circulation by U. Garvey poloshit the beginning to scientific approach to a problem P. to. Experimental works on P. to. in 17 century were carried out by English scientists Potter (To. Potter, 1638), Clark (J. Clarke, 1657), Cox (P. Koks, 1665), Louer (R. Lower, 1666), French — Byurdelo (A. Burdelo, 1667), Gabaix (R. Gabet, 1667), Denis (J. - Century of Denis, 1667), Italian — Cassini (G. Cassini, 1668), Magnani (I. Manjani, 1668), German — the Major (J. D. Major, 1667), Etmyuller (M. of Etmuller, 1682), Kauffman (V. of Kaufman, 1683), Purmay-nom (M. of Purmann, 1684).

In 1667 fr. researchers Denis and Emmerez for the first time successfully transfused blood of animal (eanling) to the person. However the fourth transfusion to the next patient ended in 2 months with his death. Hemotransfusions to the person were stopped almost for the whole century.

Attempts to make P. to. renewed at the end of 18 century. Failures of transfusion of a heterogeneous krbva led to a thought of a possibility of transfusion only of human blood. In 1819 the English physiologist and the obstetrician J. Blundell made the first P. to. from the person also offered the person the special device for hemotransfusions.

In domestic literature the first offers P. to. the patient S. F appeared in works of professor of the Kronstadt medical school Matvei Peken (1787) and professor of medicochirurgical academy in St. Petersburg. Hotovitsky (1830). In 1832 Wolf transfused blood to the woman dying after the delivery of uterine bleeding that led to an absolute recovery of the patient. Y. V. Buya-ljsky (1846) insisted on P.'s use to. at treatment of wounded. In 1847 the prosector Moscow un-that I. M. Sokolov for the first time poured blood serum of the person to the patient with cholera.

In Russia the first fundamental work according to P. to. A. M. Fi-lomafitsky's book «The treatise about hemotransfusion as the only means in many cases to save the dying-away life, made in the historical, physiological and surgical relations was...» (1848). In 60 — the 80th 19 century in Russia three important discoveries in the field of hemotransfusion were made: S. P. Kolompin entered a method Intra arterial transfusions, V. V. Sutugin — a method of conservation and V. Rautenberg — a method of chemical stabilization of blood. N. I. Pirogov emphasized P.'s advantage to. at nek-ry wounds in a field situation.

At the end of 19 century A. Schmidt made experiments on studying of the mechanism of a blood coagulation, and P. Ehrlich, I. I. Mechnikov, E. S. London, JI. A. Tarasevich observed hemolysis of erythrocytes during the mixing them with blood serum of various animals.

The second period in the history of P. to., to-ry it is possible to divide into 4 stages, it is connected with development of the doctrine about immunity (see). At the 1st stage (1900 — 1925) the method P. received scientific justification to. and blood-substituting liquids, the equipment P. is developed to. and blood-substituting liquids in the conditions of peace time and in a military situation, P. is for the first time experimentally studied to. taking into account laws of isohemagglutination (see. Hemagglutination ).

The period between 1925 — 1941 makes the 2nd stage, on Krom the problem of donorship, conservation, storage, transportation of blood is solved; indications to P. are defined to. and its efficiency at various diseases.

The period of the Great Patriotic War makes the 3rd stage which is characterized by development and improvement of the organization of service of blood, mass use of P. to. and blood-substituting liquids,

Since 1945 the 4th stage — development of transfusiology in the conditions of a scientific and technological revolution of the second half of 20 century begins.

In 1900 K. Landshteyner opened three blood groups. In 1907 Ya. Yansky and in 1910 Mr. W. L. Moss allocated the fourth blood group. Amer. the surgeon J. Krayl (1907) the first applied the doctrine about blood groups in practice of P. to. (made 61 transfusions of compatible blood).

The important event of the beginning of 20 century should be considered V. A. Yurevi-cha and N. K. Rozengart (1910), Yusten's offer (A. Hustin, 1914), Levisona (R. Lewi-sohn, 1915), Agote (L. Agote, 1915) to use sodium citrate for prevention of a blood coagulation at transfusion; a so-called citrate method P. to. was generally recognized.

In the years of World War I P.'s value was confirmed to. for rescue of life by the seriously wounded in a fighting situation. After war in armed forces of the nek-ry states work on creation of special service L was developed. to.

After Great October socialist revolution of P. to. into the USSR quickly was implemented in to lay down. to the practician. In 1919 N. Shamov, H. N. Elansky, I. R. Pet-rov received the first standard serums for blood typing. V. N. Shamov for the first time manufactured P. in the USSR to. taking into account group factors. P.'s experience to. it was generalized in the monograph H. N. Elansky «Hemotransfusion» (1926). V. N. Shamov (1929) and Page S. Yudin (1930) developed methods of transfusion of posthumous blood.

In 1926 in Moscow the first-ever Ying t of hemotransfusion was created (nowadays Central research the Orders of Lenin and awards of the Labour Red Banner of in-t of hematology and hemotransfusion). After this hemotransfusions in Kharkiv, Leningrad, Tbilisi, Yerevan, Baku, Tashkent, Minsk opened in-you. In many cities appeared blood transfusion stations (see). Development of problems P. to. A. A. Bogdanov, A. A. Bagdasarov, A. A. Bogomolets, A. N. Filatov, E. R. Hesse, S. I. Spasokukotsky, M. P. Konchalovsky, G. M. Mukhadze were engaged. In the USSR the harmonious system of service of blood including blood transfusion stations and specialized offices is created.

In the second half of 20 century ways of conservation of blood are developed at negative temperatures, the drugs of the directed action received by method of fractionation of blood and plasma are implemented into practice.

Thanks to achievements of chemistry there was an opportunity to synthesize the connections modeling separate components of plasma and uniform elements of blood there was a question of creation of artificial plasma and artificial blood.

With development transfusiology (see) in clinic methods of regulation of functions of an organism at operative measures, shock, blood loss are developed and applied new to a transfuziologicheskka, at seriously ill patients with cardiovascular and respiratory insufficiency, in the postoperative period etc. Are implemented in to lay down. to the practician methods of artificial circulation (B. V. Petrovsky), the managed hemodilution, partial perfusion solutions with various pharmaceuticals (spasmolysants, hormones, vitamins, antibiotics, cytostatics, etc.). New devices for P. are created to. with use of glass and polymeric materials (plastic); the method of two-stage preparation of blood offered by I. Pokrovsky, A. E. Kiselyov, etc. is implemented.

Broad development was gained by gratuitous donorship (see), scientific bases to-rogo are developed by L. G. Bogomolova. In the conditions of developed socialist about-va in the USSR there was the most progressive organization of service P. to., completely satisfying all requirements of the Soviet health care.

Types of hemotransfusionic means

In transfuziologichesky practice three types of hemotransfusionic means are used.

1. Whole blood: stored blood of the donor (isogenic, allogenic), svezhetsit-military, blood of the donor for direct transfusion, the frigostable, ge-parinizirovanny, converted (exchange) blood, an autoblood, kationitny, sorbentny, posthumous (fibrinolizny blood), the placental, diluted blood, the scrap, immune and irradiated blood.

2. Cellular components of blood: the eritrotsitny weight, an eritrotsitny suspension, the eritrotsitny weight which is grown poor by leukocytes and thrombocytes, the washed erythrocytes, the defrozen washed erythrocytes, trombotsitny weight, leukocyte weight.

3. Drugs of a blood plasma: plasma native, a concentrate of native plasma, the plasma frozen, plasma anti-hemophilic, the plasma dry (lyophilized), a tromboplaz-ma (the plasma enriched with thrombocytes), immune plasm, serum, albumine, a protein, cryoprecipitate, anti-hemophilic. globulin, prothrombin complex (PPSB), immunoglobulins, fibrinogen, fibrinolysin.

The whole blood

Stored blood of the donor (isogenic, allogenic) is the effective transfusion environment. It is prepared beforehand and preserved on TsOLIP1 solutions { - 7b, glyugitsir, tsitroglyu-kofosfat or LIPK-L-6 (see. Conservation of blood ). Tsitroglyukofosfat allows to keep longer in erythrocytes necessary quantity 2,3-diphosphoglyceric to - you (2, 3-DFG) and ATP, with to-rymi connected oxygen and transport function of erythrocytes. At acute blood loss and a hypoxia it is recommended to use stored blood of small shelf-lifes (on TsOLIPK-76 solution — 3 — 5 days, on a tsitroglyukofosfata — up to 7 — 10 days). The stored blood stored more long term is effective at treatment hron, anemias and blood losses with the phenomena of a moderate hypoxia.

At storage funkts, full value of stored blood decreases: thrombocytes lose the properties in 6 — 8 hours, granulocytes are incapable of phagocytosis in 24 — 48 hours, activity of blood-coagulation factors (VIII and V) hour disappears during the 24th. Admissible shelf-lifes of stored donor blood at t ° 4 — 8 ° — to 21 days.

In a blood channel of the recipient within the first days after transfusion of stored donor blood there is a recovery of the oxygen and transport function of erythrocytes lost in the course of storage, t. to a.'soderzhaniye 2, 3-DFG raises.

Svezhetsitratny blood is prepared just before transfusion on one of the stabilizing solutions.

Blood of the donor for direct transfusion — fresh blood without the stabilizing solution, completely keeps everything biol, substrates, in particular cellular and proteinaceous elements (see. Blood ). A shortcoming it is bystry coagulation in systems and devices for direct transfusion, and also possibility of thromboembolisms.

Frigostable blood prepares on the haemo preservative containing alcohol, in the ratio with blood 1:1. It does not freeze at a temperature — 8 — 14 °. The term of its storage — 45 — 70 days.

The heparinized blood prepares on the stabilizing solution containing heparin, glucose and sodium chloride. Stabilization of 1 l of blood requires 50 — 60 mg of heparin. It can be applied to the cardiopulmonary bypasses (CB). Shelf-life of this blood no more than 24 hours at t ° 4 °.

Converted (exchange) a shelter — the blood containing sodium citrate with addition of heparin and calcium. Before filling of AIK in glyukozotsi-tratny blood on TsOLIPK-76 or TsOLIPK-12A solution (composition of the preserving TsOLIPK-12A solution: lemon to - that anhydrous — 1,5 g, glucose — 6 g, sodium phosphate trisubstituted — 0,2 g, caustic sodium — 0,72 g, the bidistilled water — to 100 ml) heparin and drugs of calcium for neutralization of citrate add.

An autoblood — own blood of the patient prepared beforehand on the preserving solutions (for example, TsOLIPK-76, TsOLIPK-12A) for the purpose of its return transfusion if necessary, napr, at an operative measure, an acute hypoxia. The autoblood can be collected also during operation from a serous cavity (chest and belly), and also at the closed injury (on condition of its sterility) and to reinfuzirovat to the patient. Such blood contains less factors of coagulation therefore it can be prepared without addition of the stabilizer (sodium citrate, heparin, etc.).

Kationitny blood (blood without calcium) is prepared with use of a special ioyoobmennik — the KU-2 cation exchanger connecting calcium of blood. Glucose, sucrose are a part of the preserving solution. The term of its storage at t ° 4 ° — to 20 days

of Sorbentnaya blood is prepared by filtering of blood through a sorbent (phosphate of cellulose — acid phosphate cellulose ether), as a result a cut is extracted calcium of plasma. At the same time in blood the quantity of thrombocytes and leukocytes decreases (respectively by 15 and 10%).

Posthumous (fibrinolizny) blood is removed from a venous bed of suddenly died person in the first 6 — 8 hours after death. Thanks to a phenomenon fibrinolysis (see) posthumous blood is not curtailed therefore does not demand addition in preservative of the stabilizer (see. Conservation of blood, posthumous blood ). Operation of capture of posthumous blood is performed in the conditions of the most strict asepsis. In the operational way bare an internal jugular vein, in its wall do a cut and enter special polyvinyl chloride tubes, the outside ends into it to-rykh are supplied with the two-channel needles directed to a skull and to heart, on tubes impose clips. Towards heart enter the glass cannula connected to the system containing solution for washing of vessels of a corpse into a carotid artery. Polyvinyl chloride tubes connect to bottles or from a plastikatny-ma the bags containing preservative. After that raise the foot end of the operating table, on Krom the corpse lies, remove clips from tubes, and blood from a jugular vein via the wide channel of a two-channel needle comes to bottles by gravity, and via the narrow channel air from a bottle is removed. When blood stops following freely, on tubes impose clips. The table is transferred to horizontal position. Remove clips from washing system, and wash liquid comes to a carotid artery. Washing of a vascular bed is made by 0,9% solution of sodium of chloride (if blood is prepared for processing on drugs) or glyukozosakharozny solution (if blood is supposed to be used for transfusions).

Posthumous blood has more dense plasma and a high rate of a hematocrit, than donor; has high fibrinolitic activity (in the first 70 hours after preparation). Therefore it is recommended to be poured the patient with signs of hypercoagulation. Transfuse to the patient blood only from one corpse that at massive transfusions to reduce danger of the complications connected with administration of incompatible blood. Posthumous blood before transfusion is diluted by 0,9% with solution of sodium chloride (a volume ratio 1: 1).

Placental blood is prepared only from healthy women in labor and at normal childbirth. After the birth of the child and section of an umbilical cord, observing measures of an asepsis, punktirut a needle an umbilical vein and collect blood in a bottle with preservative, to-ry at the same time it is necessary to stir up. Placental blood has the raised hemoglobin content and erythrocytes. Indicators of osmotic resistance of erythrocytes of placental and donor blood are equal, coagulability of placental blood is increased. On antigens of the AB0 system and a Rhesus factor it can differ from maternal blood. Placental blood is rich with microelements of sodium and calcium, inorganic phosphorus, magnesium and copper; the amount of potassium in it is reduced. Placental blood contains sex hormones, enzymes and other biologically active agents.

The diluted blood prepares on the preserving solutions in the ratio 1:1, containing sodium citrate, carbohydrates and salts. Depending on a compounding of these solutions the diluted blood makes unequal impact on the recipient. So, prepared on the solution containing mannitol (see), it possesses the expressed diuretic action.

Scrap blood — the blood received at to lay down. bloodlettings. Has limited use in a wedge, practice.

Immune blood contains in a high caption of an antibody to certain activators inf. diseases or to toxins. Receive immune blood from convalescents after inf. diseases or burns, and also from specially immunizirovanny donors. Reciprocal transfusion (immunotransfusions) is made at burns, staphylococcal and other infections.

The irradiated blood — the blood subject to radiation by short UF-, x-ray and other beams. It is applied restrictedly at nek-ry patol, processes, napr, at malignant tumors.

Cellular components of blood

Eritrotsitnaya weight — the main component of blood remaining after department of plasma (see. Eritrotsitnaya weight ). Has an indicator of a hematocrit to 70%. In unit of its volume there are twice more erythrocytes, than in whole blood, and it is much less than sodium citrate, potassium, sodium, ammonium, proteinaceous antigens and antibodies. The Eritrotsitny weight received from the blood prepared on a tsitroglyukofosfata has higher rates of pH and longer keeps 2,3-DFG in erythrocytes and, therefore, their high oxygen and transport function. The shelf-life of eritrotsitny weight at t ° 4 ° to 21 days

of Eritrotsitnaya a suspension — eritrotsitny weight, in to-ruyu at preparation is added plasma substituting TsOLIPK-8 solution (14 or 15). TsOLIPK-8 solution contains sucrose, glucose, sodium citrate acid, a sulfacetamide of sodium, Rivanolum. Adenine and inosine in addition are a part of TsOLIPK-14 solution (other dena). TsOLIPK-15 solution (inozheladen) contains, besides, to gelatin. A shelf-life — to 21 days Eritrotsitnuyu a suspension can be prepared from eritrotsitny weight just before a hemotransfusion, adding 0,9% solution of sodium chloride, laktasol or Gelatinolum.

The Eritrotsitny weight which is grown poor by leukocytes and thrombocytes prepares from eritrotsitny weight, about a cut after sedimentation or the sparing centrifuging the top skin containing leukocytes and thrombocytes is removed.

The washed erythrocytes receive after their washing 0,9% solution of sodium chloride with the subsequent centrifuging. This Transfusion environment almost does not contain leukocytes and thrombocytes, products of metabolism, protein fractions of plasma having antigenic properties. Washing of erythrocytes reduces risk of infection of the recipient with a virus of hepatitis B. The washed erythrocytes pour during 24 hours after their preparation.

The defrozen washed erythrocytes prepare from the cryotinned erythrocytes stored a long time in special refrigerators (cryobanks). Washing of the thawed erythrocytes from glycerin is made several times at first hyperosmotic solutions, concentration to-rykh is gradually reduced to isotonic (apply solutions with glucose, a mannitol, sodium chloride). After washing prepare a suspension of erythrocytes in equal volume sakharozo - glyukozo - phosphatic salt solution. Store them to 5 days at t ° 4e.

In the erythrocytes prepared in any way at storage contents 2,3-DFG, i.e. oxygen and transport function decreases. For its recovery recommend to add to erythrocytes the solution containing adenine, inosine, pyruvate, phosphates. The erythrocytes processed by it obra-zones received the name «rejuvenated».

The Trombotsitny concentrated mass of thrombocytes (see. Trombotsitnaya weight ), received from whole blood by centrifuging or department from the plasma enriched with thrombocytes, a leykotrom-botsitarny layer by method of a tsita-ferez (see. Plasma exchange ). It is stored at t ° 22 ° in the conditions of smooth rocking 72 hours. One dose (30 — 50 ml) contains about 1,5 X 1011 thrombocytes.

Leukocyte weight — a concentrate of granulocytes and lymphocytes with impurity of thrombocytes and a small amount of erythrocytes (see. Leykokontsentrat ). Receive centrifuging or at the spontaneous (accelerated) sedimentation of blood cells, and also method of a leukopheresis and method of reversible adhesion on special naylonovy filters. A shelf-life of leukocyte weight to 1 days at t ° 4 — 6 °.

Due to the existence in the leukocyte mass of considerable impurity of thrombocytes it is called sometimes tromboleykotsitny weight.

Drugs of a blood plasma

Plasma native — a liquid part of blood (see the Blood plasma), to-ruyu separate from erythrocytes at spontaneous upholding of blood or centrifuging. A shelf-life of native plasma — no more than 3 — 4 days after preparation.

Native plaz m y receive a concentrate after department from fresh plasma of a factor of the VIII blood coagulation and water. The remained components of plasma are condensed approximately twice in comparison with native plasma. The concentrate of native plasma is stored at t ° 4 °, a shelf-life up to 6 months.

The plasma frozen. Receive from native plasma, to-ruyu freeze and store at t ° from — 25 to — 45 °. Shelf-life 1 year.

Plasma anti-hemophilic. Receive during the centrifuging of blood right after capture it from the donor or method of the accelerated sedimentation of erythrocytes (e.g., with the help gelatin). Is not subject to storage. Freezing gives the chance to store it at t ° — 25 ° up to 6 months.

Plasma dry (lyophilized) prepares from native plasma by method lyophilizing (see). A shelf-life — up to 5 years.

Tromboplazma — the native plasma enriched with thrombocytes. Receive during the centrifuging of blood and method of a trombotsitoplazmaferez. A shelf-life at t ° 4 ° to the 24th hour.

Immune plasm. Receive from blood of donors, immunizirovanny against any infection. Anti-staphylococcal plasma is widely used. The term of its storage at t ° — 25 ° up to 6 months.

Serum — the defibrinated native plasma, free of fibrinogen (I), VIII and other blood-coagulation factors. A shelf-life to 3 days.

Albumine — the proteinaceous drug received from plasma of donor blood by method of ethanol fractionation (see. Albumine ). Let out 5; 10; 20 and 25% solutions in bottles with a capacity of 50; 100; 250 and 500 ml. A shelf-life of 3 — 5 years at t ° 4 — 8 °.

The protein is prepared from plasma of scrap blood, including gemolizirovanny. Drug represents 6% solution of plasma proteins, from to-rykh to 80% makes albumine, other 20% — globulins. A shelf-life 3 years at t ° 4 °.

Cryoprecipitate — the proteinaceous drug of isogenic plasma representing a concentrate of a factor of the VIII blood coagulation. Receive drug from freshly frozen donor plasma by method of cryoprecipitation (see. Hemophilia ). Contains 140 PIECES of a factor of the VIII blood coagulation in one dose. Prepare in a liquid and dry look. Dry drug before the use is dissolved by 0,9% with solution of sodium chloride. Liquid drug is stored in the frozen state at a temperature not above — 25 °.

Anti-hemophilic globulin — the drug containing except anti-hemophilic globulin, fibrinogen and other factors. Receive by method of ethanol fractionation of fresh donor plasma. Release in the lyophilized look. Before the use dissolve 0,9% solution of sodium chloride. A shelf-life — 2 years. At storage activity of a factor of the VIII blood coagulation constantly decreases.

A prothrombin complex (PPSB) — the proteinaceous drug of plasma containing in the concentrated look factors II, VII, IX, X blood coagulations.

Immunoglobulin nonspecific is prepared from donor and placental blood serum by method of ethanol fractionation. Drug contains the antibodies developed by the donor as a result of a disease or contact with antigens. Is issued in ampoules on 1,5 and 3 ml. Enter intramusculary. It is stored at t ° 4 ° up to 3 years.

Immunoglobulins specific are prepared from blood serum of immunizirovanny donors. Contain antibodies against that antigen (activator), imparted the Crimea the donor. The specific directed immunoglobulins can be antistaphylococcal, antitetanic, anti-influenza, antismallpox, about-tivokoklyushnymi, etc. (see. Immunoglobulins ).

Fibrinogen is received from fresh donor plasma by method of ethanol fractionation (see Fibrinogen). The bottle with a capacity of 500 ml contains 2 g of the dried-up fibrinogen. Before the use drug is dissolved by 0,9% solution of sodium chloride. Enter intravenously. A shelf-life 2 years at t 4 °.

Fibrinolysin — blood protein. Receive from plasma of donor blood or from serum of placental blood (see. Fibrinolysin, clinical use ). Produce drug in the form of powder in bottles with a capacity of 250 and 500 ml. In one dose there can be from 10 to 30 000 PIECES of specific activity. Before the use drug is dissolved by 0,9% solution of sodium chloride. Enter intravenously kapelno along with heparin (10 000 PIECES of heparin on 20 000 PIECES of fibrinolysin).

The mechanism of effect of the transfused blood

the Transfused whole blood, its components and drugs render a replaceable, hemodynamic, disintoxication, hemopoietic, immunological, haemo static, nutritive (nutritious) and promoting effect on an organism of the recipient. Each type of the transfused blood has the special characteristics and influences an organism of the recipient most optimum in some one or several directions. The whole blood of the donor has the broadest range of action.

Transfusion of donor blood causes various funkts, changes in an organism of the recipient.

N. A. Fedorov on the basis of experimental data put forward the concept of two-phase action of P. to. In the first phase (a phase of oppression) there is a short-term conflict in result of inevitable disturbance of a homeostasis. This phase is short, its symptoms can be expressed in various degree and not always come to light by laboratory and clinical methods of a research. The second phase (phase of stimulation) after transfusion of small and medium doses of blood is more long. At the same time strengthening fiziol is observed, the processes having protective and adaptive value at different types of pathology i.e. there is a functional reorganization of an organism directed to increase in its resistance to various extreme influences. The ratio and expressiveness of these phases depend on a number of conditions — degrees of compatibility of blood of the donor and the recipient, term and a method of conservation of donor blood, and also on reactivity of an organism of the recipient. Special value has the volume of the transfused blood. At the massive hemotransfusion equal to 25 — 50% of the volume of the circulating blood (VCB) of the recipient, the disturbances of different degree of manifestation inherent to the first phase (see below Reactions and complications are noted funkts, at hemotransfusion).

Biol, P.'s effects to. are caused by the most difficult regulatory mechanisms. The transfused blood affects elements of nervous reception, and also fermental and hormonal systems of fabric exchange (a mediator — enzyme — fabric; hormone — enzyme — fabric). The hemotransfusion changes all types of a metabolism at all levels — from organotkanevy to molecular.

Replaceable action

the Whole blood is capable to replace everything morfol. structures and functions of blood of the recipient when they are lost owing to a disease. Absolute replaceable action without any negative effects autologichesky blood (autoblood) possesses. At transfusion of whole donor blood first of all erythrocytes and a blood plasma of the patient are replaced.

A. M. Filomafitsky's (1848) works, Gayema are devoted to studying of replaceable effect of the transfused blood (G. Nauyet, 1882), A. A. Bogomoltsa (1930), A. N. Filatova (1972), R. M. Glantsa (1975), N. A. Fedorova (1979), to-rye showed that at transfusion of whole blood by the patient to acute blood loss there is a filling of blood vessels of the recipient, the venous inflow to the right heart increases, the ABP and a tone of vascular system raises. As a result OTsK, the stroke and minute output of heart increases. By a tracer technique it is proved that erythrocytes of the transfused blood function in a vascular bed of the recipient from 30 to 120 days. Cells of white blood leave a vascular bed soon after transfusion. Existence 2,3-DFG and ATP in erythrocytes of the transfused blood is of great importance for recovery of kislorodnotransportny function of blood of the recipient. The more in erythrocytes 2,3-DFG, the affinity of hemoglobin to oxygen is less, the easier oxygen terminates communication with hemoglobin and passes to fabrics.

According to N. A. Fedorov (1979), proteins of plasma of donor blood circulate in a vascular bed of the recipient of 18 — 36 days. Replaceable action of cellular components and blood preparations is defined them biol, properties and chemical structure. At transfusion of erythrocytes the volume of blood and its gas transmission function is recovered. Transfusion of leukocytes increases immune abilities of an organism. The poured thrombocytes korrigirut system of a blood coagulation. Plasma and albumine possess hemodynamic action. Immunoglobulins of plasma create oroimmunity. The drugs containing major factors of a blood coagulation and a fibrinolysis regulate aggregate state of blood.

In implementation of replaceable effects the major role is played initial funkts, by a condition of an organism (nervous, endocrine and enzymatic systems).

Hemodynamic action

P. to. makes comprehensive impact on cardiovascular system. Experimental and the wedge, researches showed that P. to. the patient with acute blood loss and traumatic shock leads to permanent increase in OTsK, increase in a venous inflow to the right heart, strengthening of cardiac performance and increase in minute volume of blood, strengthening of a blood-groove. In 24 — 48 hours after P. to. at the recipient the strengthened inflow of a fabric lymph to a circulatory bed therefore OTsK increases begins, i.e. in an organism the autogemodi-lyution develops (the positive balance between inflow of a lymph to blood and its outflow is established). Sometimes after a transfusion the volumetric gain of the circulating blood surpasses the volume of the transfused blood.

In system microcirculation (see) there are various hemodynamic phenomena (arterioles and venules extend, the network of capillaries reveals, and in them the movement of blood accelerates, arteriovenous shunts therefore leak of blood from arterial system in venous is reduced are reduced.

The expressed hemodynamic action native and dry plasma, albumine possesses.

Disintoxication action

P. to. (e.g., whole plasma) reduces concentration of poisons (toxins) in blood of the recipient at poisonings and intoxications, it reaches elimination or reduction of intoxication of an organism. Besides, hemotransfusions improve function of a liver and kidneys.

Hemopoietic action

Intensification hemopoiesis (see) the patient as a result of transfusion to it blood of the donor it can be caused by the factors which are formed at destruction of the poured erythrocytes in an organism of the recipient and also the factors which are contained in the poured plasma — erythropoetins (see), leykopoetinam (see), etc.

the Hemotransfusion strengthens Immunological action immunol, properties of an organism of the recipient. Phagocytal activity of leukocytes increases, the opsonic index of blood serum increases (see. Opsonins ), antibody formation is activated. With blood of the donor various antibacterial and anti-toxic antibodies are entered. High immunobiol, action the hyperimmune drugs of plasma received from immunizirovanny donors — anti-staphylococcal, An-tiesherikhioznaya, the antisena purulent, antiburn plasma, immunoglobulins of the directed action possess (anti-staphylococcal, the anticook-lyushny, antitetanic, antismallpox, immunoglobulin an anti-Rhesus factor, etc.).

Haemo static action

Preservation of blood in liquid state and its haemo static function are carried out multicomponent fiziol, system of regulation of aggregate state of the blood (see) representing difficult interaction of the plasma components and factors which are contained in uniform elements of blood and fabrics. This system very much of a labiln also reacts even to minor change of internal environment of an organism. Disturbance of haemo static balance happens at the operative measures which are followed by loss of a large amount of blood and the subsequent its compensation donor blood or an autoblood.

Transfusion of autologichesky blood has a promoting effect on systems of a hemostasis of the recipient, causing the moderate hypercoagulation caused by increase thromboplastic and decrease in anticoagulating activity of blood. It is established that autohemotrasfusions against the background of blood loss are followed by insignificant reduction of quantity of thrombocytes, increase in their functional activity, decrease in fibrinolitic activity of blood and activity of a factor of the XIII fibrillation, increase in concentration of fibrinogen in the posttransfusion period. It is supposed that one of the possible reasons of the expressed activating action of autohemotrasfusions is stimulation of a blood formation and emergence in blood of the recipient of young uniform elements of blood, and also the thrombocytes possessing raised funkts activity. Besides, the autoblood possesses high biol, activity thanks to availability in it of biologically active agents promoting activation of system of a blood coagulation (see. Coagulant system of blood ).

Direct transfusions, and also transfusions of moderate doses of donor blood (a shelf-life of 1 — 3 day) have essential haemo static effect thanks to activation vascular and platelet, and in nek-ry cases coagulative mechanisms hemostasis (see).

The expressed haemo static effect is provided with transfusion of fresh blood, edges contains active pro-coagulants. Good haemo static action fresh plasma, special types of plasma — anti-hemophilic, vika-solo (with phthiocol), haemo static drugs — fibrinogen, cryoprecipitate, a prothrombin complex, the trombotsitny weight and plasma enriched with thrombocytes possess.

Nutritive action

With donor blood the water, proteins, fats, carbohydrates, salts, enzymes and other substances necessary for normalization of metabolic processes are entered into an organism of the recipient. Nutritive effect of whole blood is small; it is reached by transfusion of amino-acid mixes together with carbohydrates, fatty emulsions, vitamins, hormones.

A promoting effect

From positions of the neurohumoral theory, P. to. exerts the stimulating impact on functions of various systems of an organism and exchange processes proceeding in it. N. A. Fedorov in an experiment on dogs established that P. to. causes braking, and then long strengthening of uslovnoreflektorny activity in the beginning. The item to. changes a functional condition of all links of a reflex arc. Hemotransfusions influence endocrine system. So, according to R. M. Glants, in 24 hours after transfusion of donor blood thyritropic function of a hypophysis increases, and in 72 hours — slows down; gonadotropic function, on the contrary, at first is slowed down, and then increases. The hemotransfusion causes phase reaction of a neurohypophysis, edges raises during 3 days, and then gradually is returned to initial level. Also hormonal activity of adrenal glands therefore the content in blood of their hormones increases increases, function of mediator increases) a link simpatiko-adrenalo-howl systems. At a hemotransfusion stimulate I activity thyroid and epithelial bodies, and also the insulyarny device of a pancreas.

The general indications and contraindications to hemotransfusion

P. to. it is shown at krovo-and a plaz-mopoter, shock of various origin, anemias and depressions of a hemopoiesis, hemorrhagic diathesis, thrombocytopenia, a disproteinemia and a hypoproteinemia, disturbance of acid-base equilibrium and electrolytic balance, intoxications, frustration in system of immunity. Transfusion therapy shall be strictly purposeful, corrective specific disorders of functions.

Transfusion of whole blood is appointed according to vital indications (acute blood loss, shock); in other cases blood preparations (see Blood, drugs) and blood-substituting liquids (haemo proofreaders) of the directed or universal action are recommended (see. Blood-substituting liquids).

At acute blood loss with a hypovolemia more than 30% are shown transfusion of whole blood in a complex with blood-substituting liquids (Polyglucinum, reopoliglyukiny, etc.). At a hypovolemia within 15 — 30% use of erythrocytes, albumine and blood-substituting liquids is reasonable; at a hypovolemia to 10 — 15% enter only blood-substituting liquids. For substitution of a plazmopotera enter plasma, albumine, Polyglucinum. At the shock which is followed by acute blood loss apply blood, blood preparations, a shelter the replacing liquids taking into account the size of a loss of blood (in relation to initial OTsK of this patient), conditions of electrolytic balance and acid-base balance. At anemias, thrombocytopenia, a leukopenia transfusions according to eritrotsitny, trombotsitny and leukocyte masses are shown; at hypo - and an aplasia of a hemopoiesis — cellular components of blood, sometimes whole blood.

In complex treatment of hemorrhagic diathesis use anti-hemophilic plasma, fresh native plasma, a concentrate of native plasma, trombotsitny weight. For correction of a disproteinemia and a hypoproteinemia usually recommend a concentrate of native plasma, native plasma, etc. At intoxications exchange hemotransfusions are recommended. At a number of infectious diseases, frustration of system of immunity, inf. a complication of wounds it is possible to apply specific immune plasm, and at sharply expressed leukopenia — leukocyte weight.

A contraindication to transfusion of whole blood is, as a rule, the following patol, states and diseases: acute rheumatism, allergic states, acute diffusion glomerulonephritis, clotting disease, acute frustration of coronary and cerebral circulation, acute and subacute septic endocarditis, circulatory unefficiency II and III stages, fluid lungs, severe damages of a liver, idiopathic hypertensia of the III stage, ostrotekushchy tuberculosis, hemorrhagic vasculitis. The transfusion of whole blood in these cases can cause disturbances of a hemodynamics, fibrinferment, increase of a liver and renal failure, heavy allergic reactions and other frustration.

Methods of hemotransfusion

In a wedge, practice apply the following methods P. to.: direct and indirect transfusion of donor blood, autohemotrasfusion, exchange (zamenny) G1. to., immunotransfusions.

Direct hemotransfusion — direct P. to. from the donor to the recipient. This type of P. to. apply only according to the special indications connected with frustration of system of regulation of aggregate state of blood at the bleedings which are not giving in to any therapy.

Direct P.'s advantages to. consist that transfuse to the patient the fresh blood without stabilizer which completely kept everything biol, substrates. Therefore direct P. to. appoint at bleeding after heart operations in the conditions of artificial circulation, at a Werlhof's disease, hemophilia, secondary fib-to a rinoliza. Nek-ry researchers recommend direct P. to. at heavy traumatic shock, a burn disease, heavy blood loss, at a radial illness.

In the past direct P. to. made direct bonding seams or a tube (rubber, glass, metal) arteries of the donor with a vein of the recipient. Distinguish a discontinuous method of direct P. to., to-ry the continuous method — connection of special devices between the donor and the recipient is carried out by means of the syringe, and. It is the simplest to make direct P. to. syringe with a capacity of 20 ml. Blood is taken from a vein of the donor and at once entered into a vein of the patient. Danger of a method consists in a possibility of formation of blood clots in a needle and the syringe and the subsequent thromboembolism of the right heart and branches of a pulmonary artery of the recipient. Direct P. to. it is possible to carry out by means of a tee and two tubules from the polyvinylchloride or rubber connected to the syringe. The free ends of tubules join the needles entered into veins of the donor and recipient. Tubules serially press. By means of the syringe take blood from the donor through a tubule and give to the recipient through another. It is necessary to consider that during the crossclamping of a tubule blood clot can be formed. The method allows to transfuse to no more than 250 ml blood. For direct P. to. it was offered several spray devices designed io to the principle of a tee (Ttsanka, Braytsev, Anorov, etc.), to-rye have historical value.

I. S. Kolesnikov, etc. developed the automatic devices allowing to make direct P. to. with regulation of speed of a transfusion.

Direct P.'s shortcomings to. are connected with need of a call of the donor suitable on a blood group and a Rhesus factor with use of difficult special devices, with a possibility of education in the device and tubes of the blood clots threatening with thromboembolisms. Difficulties arise also when it is required to pour a large amount of blood (a call at the same time of several donors).

Indirect hemotransfusion — transfusion of stored blood from plastikatny bags («Gema-kon», «Kompoplast») or glass bottles by means of special polyvinyl chloride tubes with needles and droppers (e.g., systems for transfusion of SP-1, SP-2). Systems for P. to. are sterilely packed and intended for disposable.

There are several ways of indirect P. to. — hemotransfusion in a vein, an artery and an aorta of the recipient, Intra bone P. to.

Hemotransfusion in a vein. P. is most often carried out to. in superficial veins of extremities (see the Venipuncture) or subclavial veins, use a jugular vein less often. For carrying out repeated transfusions enter a plastic catheter into a subclavial vein (see Catheterization of veins puncture). At observance of rules of an asepsis, the corresponding care of a catheter the transfusion in a subclavial vein is not followed by complications, to-rye are sometimes observed at repeated P. to. this way.

The hemotransfusion in an outside jugular vein is made slightly above by clavicles. Vienna is squeezed a finger above the place of a puncture, punktirut a needle and after emergence of blood from a gleam of a needle attach system for P. to it to. At insufficiently expressed veins in case of emergency carry out a venosektion of veins of an elbow bend, a forearm, shoulder, the interior of an anklebone, the back of foot (see. Venosektion ).

Hemotransfusion in an artery, an aorta and cardial cavities. The way is developed in the USSR by I. A. Birillo, V. A. Negovsky, B. V. Petrovsky, etc. It was applied in terminal states, at shock, massive blood losses. The naked beam artery punktirutsya more often, and at amputation of extremities the needle is entered into an arterial stump, and into system for vnutriarterial-ny P. to. the manometer and a rubber bulb for build-up of pressure to 180 — 250 mm of mercury are mounted. (P.'s speed to. — 100 — 150 mm in 1 min., a dosage — to 500 ml). Successful transfusions of blood in the general carotid artery and an aorta are described.

Hemotransfusion in peripheral arteries is unsafe in view of thrombosis and is carried out extremely seldom. Also seldom apply P. to. in a left ventricle of heart and in cavernous bodies of a penis.

Drop hemotransfusion is used in need of long hours-long and multidaily introduction of massive amounts of blood and its fractions that is especially important in surgical practice and traumatology. Various droppers and counters, needles cannulas with mandrins, plastic thin catheters are used (see below). At a speed of injection of 35 — 50 thaws a minute for an hour enter 90 — 150 ml of blood, and per day — to 2,5 — 3,0 l of blood.

Intra bone hemotransfusion is applied when intravascular hemotransfusions are complicated or are not shown, napr, at burns, thrombophlebitis. Blood is entered into a breast, spongy substance of combs of an ileal bone, condyles of a femur and shin, a calcaneus by means of special needles (e.g., Kassirsky's needle) for a puncture of a bone, to-rye have the limiter of depth of introduction (see Eagles medical). The plate of compact substance is punctured with effort, then the needle «fails», and from it it is possible to aspirate the syringe suspension of marrow. After introduction through a needle of 5 — 10 ml of 0,5 — 1% of solution of novocaine attach system for P. to. also enter blood under pressure created by the syringe or Richardson's cylinder. Funneled sine of marrowy cavities are well connected with an extra bone venous bed therefore the transfused blood quickly gets into peripheral veins of the patient.

To children up to 3 years blood in a calcaneus is not transfused since it is poorly a vaskulyarizirovana.

Autohemotrasfusion — injection sick to its own blood (see. Autohemotrasfusion ). Such transfusion has a number of advantages before P. to. donor: danger of the complications connected with incompatibility on AB0 antigens and a Rhesus factor and also with infection inf is excluded. diseases, napr, serumal hepatitis, malaria; are absent risk of immunization of the recipient antigens of the donor and posttransfusion reactions and complications (a syndrome of homologous blood). It is noted the expressed wedge, efficiency of autohemotrasfusions, it is especially shown to patients with rare blood groups, sensibilized to rare antigens and allergized.

Most often autohemotrasfusion is used in surgical practice. Blood is prepared from patients beforehand at the rate of 5 ml of blood on 1 kg of weight of the patient. Just before operation the patient can carry out exchange hemotransfusion of 30 — 40% of volume of the blood circulating at it. The received autoblood is poured to the patient at the end of operation.

For preparation of considerable volumes of an autoblood (800 ml and more) use a step and step-by-step method, to-ry consists in alternation before operation of an eksfuziya and a transfusion. Blood is prepared at the same time and preserved in several stages. At the first stage make an eksfuziya of 400 ml of blood of the patient; on the second (in 5 days) — an eksfuziya of 200 ml of blood. At the third stage, to-ry it is carried out in 4 — 7 days after the second stage and for 1 — 2 day before operation, make an eksfuziya of blood to 800 ml with simultaneous transfusion of the autoblood prepared at the previous stages. Thus, the patient can receive up to 800 ml of svezheza-gotovlenny blood during operation. The number of stages can be changed depending on the amount of blood necessary for operation. A step and step-by-step method using plasma exchange (see) and cryoconservations of erythrocytes allows to prepare autoeritrotsita and an autoplazma of the patient. After each eksfuziya plasma is separated centrifuging and frozen at t ° — 20 °, autoeritrotsita can be frozen at ultra-low or moderately low temperatures. The defrozen autoeritrotsita enter at difficult heart, lungs operations, went. - kish. a path, at transplantation of kidneys.

A kind of autohemotrasfusion is reinfusion of the autoblood which streamed in serous cavities at an operative measure. A method most often apply at the broken pipe pregnancy, a gap ah spleens, wounds of a thorax and bodies of a chest cavity. The autoblood is sucked away from a cavity the syringe or drenazhy in a vessel with isotonic solution of sodium chloride and after filtering poured to the patient. Use also special automatic devices for re infusions of blood, to-rye suck away blood from a cavity in a tank with the filter (pore size of 120 microns), then give it to system for P. to. with filters (pore size is up to 20 microns).

Exchange (zamenny) hemotransfusion — partial or full removal of blood from a vascular bed of the recipient with simultaneous substitution by its adequate or exceeding volume of donor blood. This method is applied to removal from blood of the patient of various poisons (at poisonings, endogenous intoxications), products of metabolism, hemolysis, antibodies (at a hemolitic disease of newborns, hemotransfusionic shock, heavy toxicoses, an acute renal failure).

There is continuous and single-step and discontinuous and consecutive exchange P. to. At nepreryvnoodnomomentny exchange P. to. speeds of an eksfuziya and a transfusion of blood are equal. At discontinuous and consecutive exchange P. to. the eksfuziya and a transfusion of blood are made small doses falteringly and pov-ledovatelno with use of the same vein. Exchange P.'s operation to. begins with bloodletting from a femoral vein or an artery. Blood at capture comes to the graduated vessel where negative pressure by pumping out of air is supported. After withdrawal of 500 ml of blood begin a transfusion, at the same time continuing bloodletting; at the same time maintain balance between an ex-fuziyey and a transfusion. Average speed of an exchange transfusion — 1000 ml within 15 min. For exchange P. to. the svezhezago-tovlenny blood of the donor which is picked up for antigens of the AB0 system is recommended (see. Blood groups ), to a Rhesus factor (see), Koombs's reactions (see. Koombs reaction ). However also use of stored blood of small shelf-lifes is possible. For the prevention of a hypocalcemia, edge it can be caused by sodium citrate of stored blood, solution of a gluconate of calcium or calcium chloride pour in 10% (10 ml on each 1500 — 2000 ml of the entered blood). Exchange P.'s lack to. — posttransfusion reactions (possibility of a syndrome of massive hemotransfusions).

Immunotransfusions — reciprocal transfusions, received from donors, immunizirovanny by various antigens. As immune blood in children's practice compatible blood of parents is used.

The equipment of hemotransfusion

Technical means for P. to. it is possible to divide on funkts, to appointment to 6 groups: 1) systems for capture of blood; 2) bottles and plasti-katny bags (containers) with preservative for storage of blood; 3) systems for P. to.; 4) sets for blood typing and a Rhesus factor; 5) devices (supports) and devices for fixing of bottles (plastikatny bags) and systems at the time of P. to.; 6) devices for direct P. to.

Fig. 1. The diagrammatic representation of system for capture of blood (BK 10-01) of single application: 1 — a cap for a needle, 2 — a needle of an air duct, 3 — a needle for connection to a bottle, 4 — a bottle for blood, 5 — a syringe needle.

The system for capture of blood (plastikatny) is intended for an eksfuziya of blood at the donor and filling with blood of a bottle (or two bottles) or a plastikatny bag with preservative. It consists of an airwater tube with a needle for piercing of a stopper of a bottle with preservative and an ex-fusional tube, edges has needles on both ends: one — for a puncture of a vein of the donor, the second — for a puncture of a stopper of a bottle. The system is intended for disposable; are issued the medical industry and have designation B K 10-01 (fig. 1), BK 10-02, B K 20-01. There are systems for capture of blood and at the same time its stabilization on fosfattsellyulozny sorbents. The special cartridge containing a sorbent is inserted into an ex-fusional tube of such system. It is counted on preparation of 250 ml (AF 10-01) and 500 ml (AF 20-01) blood.

Bottles and plastikatny containers for conservation of blood are issued the industry. Glass measured bottles with preservative have the capacity of 250 and 500 ml. Plastikatny containers (single application) are expected 300 ml (Kompoplast-300) and 500 ml (Gemakon-500).

Fig. 2. The diagrammatic representation of the dual container «Gemakon» for capture of blood: 1 — the union for accession of system of hemotransfusion, 2 — a connecting tube, 3 — a plastikatny container for components of blood, 4 — a plastikatny container with preservative, 5 — a syringe needle, 6 — a cap for a syringe needle, 7 — a clip.

Each plastikatny container has a tube with a blood collecting needle from a vein of the donor, output devices, with the help to-rykh a container joins system for hemotransfusion. Dual containers for receiving components of blood, e.g. «Gemakon-500/300» (fig. 2) and «Kompoplast-300/300» are issued. Dual containers are connected by a polymeric tube, through to-ruyu plasma from the first container can be poured in the second.

Fig. 3. The diagrammatic representation of system for hemotransfusion (Personal computer 11-01) of single application: 1 — a bottle for blood, 2 — a syringe needle, 3 — a cap for a needle, 4 — a node for fastening of a syringe needle, 5 — a needle for connection to a bottle, 6 — a dropper with the filter, 7 — a clip, 8 — a needle of an air duct.
Fig. 4. The diagrammatic representation of the combined system for hemotransfusion and blood-substituting liquids (KP 11-01) of single application: 1 — a bottle for blood, 2 — a bottle for blood-substituting liquid, 3 — a cap for a needle, 4 — needles of air ducts, 5 — a syringe needle, 6 — a node for fastening of a syringe needle, 7 — clips, 8 — droppers with the filter, 9 — needles for connection to bottles.

The industry systems for P. are issued to. from plastikatny materials (polyvinylchloride). They are sterile, non-toxical, apiro-genna, are intended for disposable. There are several options of systems: system for P. to. (Personal computer 11-01) from a bottle with a rigid dropper (fig. 3); system for P. to. from a bottle with simultaneous measurement of the venous pressure (Personal computer 11-03); system for P. to. from a bottle with a semifixed dropper (the personal computer 21-01, the personal computer 21-02); system for P. to. from polymeric containers with a rigid dropper (Personal computer 22-02); system for P. to. from polymeric containers with a semifixed dropper (Personal computer 22-02); the combined system for P. to. (KP 11-01) from bottles with rigid (fig. 4) and a semifixed dropper (KP 21-01); system for injection of blood-substituting and infusional solutions from bottles (PR 21-01); system the highway for transfusion of solution from a bottle in a bottle (SM-1); system for dissolution of dry medicines.

Any system for P. to. consists of airwater and infusional tubes. The air duct has on one end a needle for piercing of a stopper of a bottle. The infusional tube on both ends has needles, one — for a puncture of a stopper of a bottle with blood or a plastikatny container, another — for a puncture of a vein of the recipient; on the course of a tube the dropper with kapron or other filter is built in and the clip is imposed.

Sets for blood typing and a Rhesus factor contain standard serums, standard erythrocytes, glass rods, plastic tablets with holes, plates, the water bath, a heater.

Devices for fixing of bottles are issued on a centralized basis the medical industry. In a wedge, practice supports of three types are used: floor, nakrovatny, to the operating table. They are intended for suspension of bottles (plastikatny containers) with the transfusion environment at long injections.

Devices for direct P. to. there can be discrete (spray) and continuous (roller) actions. (1974) offered I. M. Gurtova original type of the device working by the principle of the pump of substitution.

By preparation for P. to. it is necessary to observe the strict sequence. In the beginning define indications to transfusion therapy; develop its specific program (a type of the transfused blood, the sequence, quantity, time of transfusion). Check for suitability bottles, plastikatny containers with transfusion environments, systems for P. to. Bottles and plastikatny containers with the transfusion environment (donor, placental, posthumous blood etc.) are checked by the doctor. Pay attention to tightness of packing, integrity of vessels, correctness of certification (label), a period of validity, macroscopic changes (hemolysis, clots, flakes, discoloration, a deposit, bacterial pollution). Selection of bottles and plastikatny containers with blood make beforehand to sustain the transfusion environment at the room temperature within 30 — 40 min.

Then define a blood group and a Rhesus factor at the patient and the transfused blood from a bottle (a plastikatny container), put a compatibility test of erythrocytes of donor blood with blood serum of the recipient; transfuse blood, odnogroup-pny, compatible on a Rhesus factor. Sometimes selection of blood for the isosensibilized patient presents certain difficulties. In this case blood is selected by stations (department) of P. to., to-rye define at the recipient of an antibody to rare antigens of erythrocytes, antibodies to HLA antigens and antigens of granulocytes.

After that mount bottles, containers and systems for P. to. also place them on supports. Before a transfusion the tube of a bottle is exempted from a pergament cap and paraffin. The aluminum cap is processed by 5 — 10% spirit solution of iodine. Tweezers unbend wings of the central part of an aluminum cap and delete it. The bared rubber bung is processed by 5 — 10% spirit solution of iodine. The stopper is punctured with needles of infusional and airwater tubes. On an infuzioniy tube impose a clip below a dropper on the course of infusion. The bottle is overturned upside down and suspended on a support. Remove a clip from an infusional tube. At emergence of the transfusion environment below the filter the dropper is transferred to horizontal position and filled to a half of volume; again impose a clip below a dropper and transfer it to initial (vertical) position. After that gradually open a clip and fill an infusional tube before emergence of the first drops of the transfusion environment from a needle; then the clip is closed. Carefully examine tubes of system to be convinced that in them there are no air traps. Choose and punktirut a vein for infusion. Remove a clip from an infusional tube and begin injection of the transfusion environment.

At the beginning of P. to. carry out biol, test: to the patient pour struyno 10 — 15 ml of blood, through 3 mp. again enter 10 — 15 ml. After a repeated three-minute break enter 10 — 15 more ml of blood and again observe 3 min. If the patient does not have symptoms of incompatibility of the transfused blood (tachycardia, feeling of heat in all body, an asthma, a hyperemia of the person, a back pain, a stomach), then P. to. continue. At emergence of the first insignificant symptoms of incompatibility of P. to. immediately stop.

At injection to the patient of the transfusion environment from several bottles after emptying of the first bottle impose a clip on an infusional tube below a dropper, take from a stopper of an empty bottle of a needle of an infusional tube and an air duct. Then these needles enter into a stopper of a new bottle (a needle of infusional system from a vein of the patient at the same time do not take), and the transfusion proceeds. P.'s procedure to. from a plastikatny container it is similar. Blood comes to system under pressure of free air on an outer surface of an elastic container therefore the airwater tube is not required. In need of bystry jet administration of blood the additional uniform pressure upon walls of a container is created by palms of a transfuziolog; at the same time the container is in usual situation for transfusion.

Reactions and complications at hemotransfusion

the Clinical picture of reactions and complications at hemotransfusion, their treatment and prevention. The item to. taking into account indications and contraindications, at observance of the established rules on the equipment and methods is safe to lay down. by method. At derogation from these rules hemotransfusionic (posttransfusion) reactions and complications can be observed.

Hemotransfusionic reactions — the symptom complex which is developing after hemotransfusions, not followed, as a rule, by serious and long violations of functions of bodies and systems and not posing direct hazard to life. Clinically (depending on an origin and a current) distinguish the pyrogenic, allergic and anaphylactic gemotraisfu-zionny reactions.

The pyrogenic reactions are shown by a febricula, a fever, fever. Depending on a wedge, currents distinguish three extents of the pyrogenic reactions: easy, moderately severe and heavy. Easy reactions are followed by fervescence within 1 °, an easy indisposition; neutral reactions — fervescence on 1,5 — 2 °, a fever, increase of pulse and breath, a febricula; heavy reactions — fervescence more than on 2 °, a fever, head bolyo, cyanosis of lips, an asthma, sometimes a back pain and bones. The pyrogenic reactions can be a consequence of entering of pyrogens into a circulatory bed of the recipient or an isosensitization to antigens of leukocytes, thrombocytes, plasma proteins.

Allergic reactions are characterized by a feverish condition, change of the ABP, short wind, nausea, sometimes vomiting, and also urticaria, an itch of skin and other symptoms. Allergic reactions result from a sensitization of the patient to antigens of plasma proteins; most often they arise at repeated or repeated transfusions of blood or plasma.

In rare instances P. to. and development of reaction of anaphylactic type, a wedge can cause plasmas, the picture a cut is characterized by acute vasculomotor frustration (concern, face reddening, cyanosis, attacks of suffocation, increase of pulse, decrease in the ABP). Owing to an isosensitization to immunoglobulin A can sometimes develop acute anaphylaxis (see).

At emergence of hemotransfusionic reactions it is necessary to stop immediately a transfusion, apply the cardiovascular, sedative and hyposensibilizing means to their elimination.

Forecast favorable. Are necessary for prevention of hemotransfusionic reactions: strict observance of all conditions and qualifying standards at preparation and transfusion of stored blood, its components and drugs — use for transfusions of systems disposable; the accounting of a condition of the recipient to a transfusion, the nature of his disease, detection of hypersensitivity, an isosensitization; use of the corresponding components of blood; individual selection of donor blood, its drugs for patients with an isosensitization.

Hemotransfusionic complications — the symptom complex which is characterized by heavy disturbances of activity of vitals and systems, life-threatening the patient. Main reasons for complications: incompatibility of blood of the donor and recipient on antigens of erythrocytes (on group factors of the AB0 system, a Rhesus factor and other antigens); a poor quality of the transfused blood (bacterial pollution, overheating, hemolysis, a denaturation of proteins owing to long-term storage, disturbance of a temperature schedule of storage, etc.); errors in carrying out a transfusion (developing of an air embolism, circulator disturbances, cardiovascular insufficiency, etc.); massive doses of a transfusion; underestimation of a condition of the recipient before a transfusion (a hyperreactivity, a sensitization, etc.); transfer of activators inf. diseases with the transfused blood.

Incompatibility of the transfused blood on the AB0 system or a Rhesus factor (see Incompatibility immunological is the most frequent reason of hemotransfusionic complications, at a hemotransfusion). In a wedge, a current of such complication it is possible to allocate hemotransfusionic (posttransfusion) shock and an acute renal failure with the period of an oliguria (or anuries), recovery of a diuresis, recovery (the accounting of these periods matters in the choice of therapy). The first a wedge, manifestations of the complication caused by transfusion to the patient of blood, incompatible on group factors, arise at the time of a transfusion or in the nearest future after it; at incompatibility on a Rhesus factor or other antigens — in 40 — 60 min. and even in 2 — 6 hour. Deterioration in health, constraint in breasts, difficulty of breath, feeling of heat are observed, there are all body pains, hl. obr. in a waist. From objective signs decrease in the ABP, an acute intravascular hemolysis have the greatest value with haemoglobinaemia (see), haemoglobinuria (see) and the disturbance of a hemostasis which is shown the strengthened bleeding from a wound and places of injections. Generalized hemorrhagic diathesis can develop (see. Hemorrhagic diathesis) with profuse!! nasal, went. - kish., and also uterine bleedings. Further the general weakness develops, pulse becomes frequent, the rhythm of cordial activity is sometimes broken; the face reddening which is replaced by blanching is quite often noted, there is nausea, vomiting, a mramornost of integuments, motive excitement, an involuntary urination and defecation. The lethal outcome is possible.

At incompatible blood transfusion the patient in a condition of an anesthesia or against the background of hormonal, radiation therapy reactive manifestations and symptoms of shock most often are absent or are expressed slightly.

Lech. the events held in the early period after incompatible blood transfusion, as a rule, allow to liquidate circulator frustration and to bring the patient out of shock. However through nek-a swarm time after a transfusion can raise body temperature, appear incremental yellowness of scleras and skin, and also a headache. The liver increases in sizes, the content of untied bilirubin in a blood plasma increases. Further into the forefront disorders of function of kidneys act: in urine protein, free hemoglobin, amount of the emitted urine sharply is defined decreases. The acute renal liver failure with a hyperazotemia, disturbance of water and electrolytic balance, acid-base equilibrium, heavy normokhromny or hypochromia anemia develops.

At emergence of hemotransfusionic shock immediate holding resuscitation actions is necessary. Crucial importance at assistance to the patient has a time factor: the earlier help is given, the more favorable there is an outcome. To lay down. actions shall be directed to recovery of OTsK, improvement of rheological properties of blood and microcirculation, disaggregation of uniform elements, removal of toxic products from an organism, maintenance of a diuresis, the prevention intravascularly go blood coagulations, neutralization of proteolytic enzymes and vasoactive substances. For stopping of disturbances of a hemodynamics and microcirculation it is necessary to enter blood-substituting liquids of rheological action (reopoliglyukin, Haemodesum), svezhezagotovlen-ny or freshly frozen plasma, 10 — 20% solution of a seralbumin, isotonic solution of sodium chloride or Ringer's solution.

For the prevention of formation of muriatic hematin in renal tubules intravenously kapelno enter 4% solution of hydrosodium carbonate before emergence of alkali reaction of urine. At the same time carry out stimulation of a diuresis by furosemide (lasixum), to-ry it is necessary to enter intravenously in a dose 80 — 100 mg in combination with 2,4% solution of an Euphyllinum (10 ml). With effect stimulation of a diuresis is continued during 3 days by intramuscular administration of furosemide on 40 mg in 6, 8, 12 hours, gradually reducing a dose of drug, under control of a water balance. The daily urine is supported at the level of 3 — 2,5 l. Effective osmotic diuretic is the mannitol, it is entered intravenously in the form of 15% of solution in a dose of 200 — 400 ml \in the absence of effect and development of an anury further introduction of a mannitol is stopped since it is dangerous in view of threat of development of difficult disturbances of hydration up to a fluid lungs and a brain.

For neutralization of biologically active agents (a histamine, bradikinin, serotonin) Suprastinum or isopromethazine intravenously in 8 hours 2 — 3 times enter. Use of glucocorticoids promotes delay of reaction antigen — an antibody and stimulates a hemodynamics. Prednisolonum in a dose of 50 — 150 mg is entered intravenously repeatedly in the decreasing dosage. For improvement of cordial activity appoint strophanthin or Korglykonum with cocarboxylase.

At development of a hemorrhagic syndrome carry out the therapy including neutralization of fibrinolitic enzymes (Contrykal to 100 000 PIECES a day, Trasylolum to 30 000 PIECES a day), direct transfusion of odnogruppny compatible donor blood, antigemofil-ache plasmas, cryoprecipitate, the native concentrated plasma, trombotsitny weight. During the holding these actions within 1 — 6 hour after incompatible blood transfusion usually it is possible to bring the patient out of a condition of hemotransfusionic shock and to prevent severe damage of kidneys.

Treatment of an acute renal failure (see) is carried out in the department of a hemodialysis equipped with devices artificial kidney (see), having opportunities of identification of antibodies and individual selection of compatible donor blood or the defrozen washed erythrocytes. Transportation of patients in department of a hemodialysis is in most cases carried out on 2 — the 3rd day of a complication. Treatment of an acute renal failure is directed to decrease in a proteinaceous catabolism and removal of products of proteinaceous disintegration, normalization of water, electrolytic balance, acid-base equilibrium and stopping of uraemic intoxication that is reached by the complex therapy including conservative actions (the dosed administration of liquids taking into account their losses, anabolic steroids, a rational diet, etc.), methods out of renal clarification of blood — a hemodialysis (see), peritoneal dialysis (see), hemosorption (see. Hemosorption ).

According to V. A. Agraiyenko and H. N. Skachilova (1979), it is necessary to carry out conservative therapy to the entire periods of an acute renal failure; when she has no due effect, it is necessary to resort to methods of extrarenal clarification of blood.

A wedge, manifestations of the complications connected with a poor quality of the transfused blood are characterized by high fever, development of heavy shock (tachycardia, falling of the ABP, a black-out) and toxicosis with spasms, vomiting, an involuntary urination and defecation.

Lech. events are held immediately and include exchange P. to., introduction of antibiotics of a broad spectrum of activity, antishock blood-substituting liquids of rheological action, disintoxication means, solutions of alkalis, glucocorticoids, cardiovascular and diuretic drugs.

Such hemotransfusionic complication, as air embolism (see), can arise owing to an error in carrying out a transfusion. The wrong filling with blood of system of tubes before a transfusion, its untimely termination during the use of the delivery equipment, low-quality installation of the equipment and systems for P. are the main reasons for this complication to. Lech. actions at an air embolism include an artificial respiration (see), administration of cardiacs.

Thromboembolism (see) arises at hit in a vein of various size of the clots formed in the transfused blood or, more rare, the thrombosed veins of the patient brought with a blood flow from. At the same time the wedge, a picture is characterized by the phenomena of a heart attack of a lung (see Lungs, diseases). Treatment is carried out by soothing, cardiovascular means, and also anticoagulants. The correct stabilization of blood, use of plastikatny systems with the filter, a puncture is necessary for prevention of this complication at P. to. not thrombosed veins.

Acute circulator disorders (acute expansion and a cardiac standstill) during a transfusion can happen owing to an overload of the right auricle and a ventricle in the large volume of the blood which is quickly entered into a venous bed. At the same time there is a difficulty of breath, feeling of constraint in breasts, cyanosis of lips and faces, the progressing falling of cordial activity (see. Heart failure ). The best way of prevention of this complication — a drop method of a transfusion; at jet introduction it is necessary to dose amount of the arriving blood taking into account the stroke and minute output of heart. At emergence of an acute cardiomegaly owing to an overload injection is stopped, enter strophanthin with glucose, furosemide (lasixum) intravenously, if necessary is recommended small bloodletting (see).

The syndrome of massive hemotransfusions is observed in those sluchayakht when in a blood channel of the patient during the short period (to 24 hours) enter stored blood of more than 40 — 50% of OTsK. The main wedge. manifestations of this syndrome are disturbances of a hemodynamics in big and small circles of blood circulation, and also at the level of capillary, organ - a blood-groove. At the same time, despite the massive hemotransfusions exceeding the volume of blood loss often it is not possible to recover OTsK. At patients the vascular collapse, bradycardia, fibrillation of ventricles, an asystolia can develop. In blood the metabolic acidosis, hypocalcemias, a hyperpotassemia, increase in viscosity, hypochromia anemia with leucio-and thrombocytopenia, decrease in content of gamma-globulin and albumine is observed. Disturbances in system of regulation of aggregate state of blood with the advent of bleeding from an operational wound, decrease in content of fibrinogen, components of a prothrombin complex, factor of XIII, numbers of thrombocytes, increase in fibrinolitic activity are characteristic. There are complications from internals: punctulate hemorrhages, are more rare than bleeding from vessels of kidneys and intestines, hepatonephric insufficiency, developments of stagnation and atelectases in lungs, etc. Decrease in immunobiological activity of the recipient is noted (falling of a caption of the agglutinating antibodies in blood, bad healing of a postoperative wound).

In need of bystry elimination of a hypovolemia and filling of a circulatory bed of the patient (at shock, blood loss) it is necessary to use blood substitutes of antishock action in a complex from a svezhezagotovlenny krovyyug and also an autoblood, eritrotsitny weight, the defrozen washed erythrocytes. For the prevention of complications it is important to consider contraindications to P. to. Extra care should be observed when hypersensitivity bolnogog e.g., to proteinaceous drugs is established.

Hit in stored blood of activators inf. diseases happens at capture of blood from the donor who is in an incubation interval of any disease, or from the donor to the disease proceeding without expressed a wedge, pictures. Many inf. diseases (a brucellosis, flu, measles, sypny and a typhinia, natural smallpox, syphilis, malaria, serumal hepatitis), activators to-rykh in an incubation interval of a disease are in blood, can be transmitted in the transfusion way. Majority inf. the diseases arising later P. to., proceeds without features. In some cases duration of an incubation interval changes. Treatment is carried out by the general rules.

The forecast of complications of P. to. serious. Prevention provides them strict observance of rules of preparation, storage, transportation and transfusion of stored blood, its components and drugs, use of systems P. to. disposable, transfusion of the transfusion environment from one bottle only to one patient.

The pathological anatomy of complications at hemotransfusion

the Pathoanatomical research most often reveals a picture of hemotransfusionic shock or an acute renal failure (see). At hemotransfusionic shock into the forefront the acute disorders of blood circulation which are characterized by redistribution of blood with its deposition in internals, disturbance of permeability of vessels and the disseminated intravascular coagulation act. On opening the sharp plethora of lungs, a liver, nights is noted. Punctulate hemorrhages in covers and substance of a brain, easy and other bodies, mucous and serous membranes, and also a hemorrhagic exudate in pleural cavities can be found.

Fig. 5. Microdrug of a brain three hemotransfusionic shock: 1 — pericellular: hypostasis, 2 — hyaline blood clot in a gleam of a vessel, 3 — perivascular hypostasis; coloring hematoxylin-eosine; x 200.

At microscopic examination during the first hours of hemotransfusionic shock vessels of a brain are expanded, full-blooded, perivascular and pericellular hypostasis is noted; in gleams of vessels of a brain and lungs, is more rare than other bodies, reveal amorphous educations — so-called hyaline blood clots (fig. 5). Sharply expanded capillaries of alveolar partitions and larger vessels of lungs contain accumulations of erythrocytes and often segmentoyaderny leukocytes. Places erythrocytes look as dense accumulations as a result of their agglomeration (see. Aggregation of erythrocytes ). Expansion of sinusoid of a liver is combined with a diskompleksation of hepatic beams in the central parts of segments and expansion of perikapillyar-ny spaces, in to-rykh the proteinaceous mass and uniform elements of blood come to light. Gleams of sinusoid contain gemolizirovanny and integral erythrocytes, and also leukocytes, to-rye in places concentrate around star-shaped retikuloendoteliotsit, as if sticking together with them, forming so-called agglyutinatsionny blood clots. Focal swelling of the hepatocytes having light grubosetchaty cytoplasm and eccentric the located kernel is observed.

In the first days of hemotransfusionic shock in kidneys the sharp plethora of a stroma and considerable ischemia of renal balls is noted. In gleams of single tubules and capsules of balls the amorphous mass of hemoglobin and gemolizirovanny erythrocytes are found. Sharp swelling of cells of an epithelium of tubules, in a small part their pycnosis and a lysis of kernels, exfoliating of cells in a gleam of tubules is observed.

Fig. 6. Microdrug of a kidney at the disseminated intravascular coagulation: 1 — a renal ball, 2 — an epithelium of renal tubules, 3 — the mass of fibrin in a gleam of an arteriole renal - a ball; coloring hematoxylin-eosine; X 400.

At hemolysis (see) in gleams of vessels plentiful accumulations of gemolizirovanny erythrocytes and the free hemoglobin which is painted by Lepene's method are distinguishable (see. Lepene way ) in dark brown color. The disseminated intravascular coagulation (see. Hemorrhagic diathesis, syndrome of a defibrination ) it is characterized by existence in vessels of a brain, easy and other bodies, and also in renal tubules (fig. 6) of amorphous mass of fibrin with impurity of leukocytes.

The picture of a hemoglobinuric necrotic nephrosis with sharply expressed dystrophic changes in cells of an epithelium of tubules with sites of a necrobiosis, swelling and exfoliating is characteristic of an acute renal failure; in gleams of capsules of balls and in tubules plentiful accumulations of decomposition products of blood, the created gemoglobinovy and hyaline cylinders come to light. In a stroma of marrow and in tubules of kidneys there are accumulations of leukocytes. These changes are quite often accompanied by heavy necrobiotic changes in a liver.

Morphological changes in kidneys at timely treatment of an acute renal failure can be poorly expressed or be absent.

After P. to., incompatible on the AB0 system, the hemodynamic changes inherent to hemotransfusionic shock are combined with an acute intravascular hemolysis. At the same time the developed picture of a hemoglobinuric nephrosis comes to light. On opening increase in kidneys, deleting of the drawing of a bast layer and emergence of the red striation corresponding to an arrangement of tubules is noted.

At the hemotransfusionic complications connected with P. to., incompatible on a Rhesus factor, hemolysis is sharply expressed. In kidneys against the background of massive removal of decomposition products of blood and heavy dystrophic changes in cells of an epithelium changes in balls in the form of the increased quantity of cells of an endothelium, focal proliferation of elements of the capsule and swelling of membranes are noted. Widespread changes in kidneys are often combined with the expressed dystrophic changes of a liver.

The hemotransfusionic shock developing after transfusion of the substandard bacterial contaminated blood is characterized by deep disturbances of blood circulation with development of hemorrhages in various bodies, a prematurity of destructive changes in vessels and parenchymatous bodies, and also formation of blood clots, in to-rykh in some cases accumulations of microorganisms are found.

In rare instances septic changes develop and there are abscesses.

At transfusion of superheated blood one of frequent complications is widespread thrombosis of vessels (see. Thrombosis ).

Pathoanatomical changes at a syndrome of massive hemotransfusions are characterized by a congestive plethora of bodies, hypostasis of a brain and lungs, emergence of punctulate hemorrhages in a myocardium, lungs, a liver, a spleen, mucous and serous membranes.

For specification a wedge, the diagnosis and differential diagnosis of hemotransfusionic complications, on opening definition of group accessory of blood of a corpse, a research on hemolysis make serol. At suspicion on bacterial pollution of the transfused blood bacterial, a blood analysis and pieces of fabrics and bodies is carried out.

Complications at hemotransfusion in the medicolegal relation

the Lethal outcome at P. to. quite often the court is the cause of appointment. - medical examinations. Expert assessment of deadly complications at P. to. consists first of all in the proof of existence of a complication and its communication with a lethal outcome. Important issue of expert assessment is establishment of the reason of a complication. Can be the reasons of lethal outcomes transfusion of the inogruppny, Rh-incompatible, bakterialno contaminated, gemolizirovanny or superheated blood.

In the first days after transfusion of incompatible and substandard blood death comes from hemotransfusionic shock. If the victim survives, then examination for definition of weight of the caused damage is appointed, at the same time degree of danger of damage to life and degree of the done harm to health of the victim is considered.

Court. - medical diagnosis of a deadly complication at P. to. is based on data of expertize of a corpse, a research of medical documents and the facts of the case.

Morfol, changes at hemotransfusionic shock are not specific. The leading sign of hemotransfusionic shock is the hemoglobinuric nephrosis, diagnosis to-rogo allows to document an intravascular hemolysis and on features patol, changes in kidneys to judge prescription of its development.

For establishment of the reason of a hemotransfusionic complication define group of posthumous blood on the AB0 system and a Rhesus factor accessory, make crops it on microflora, and also investigate on hemolysis and quantitative content of residual nitrogen and urea. For identification of an origin of a complication and a role in it medical personnel carry out the analysis of medical documents (a case history, the out-patient card, the log entry of hemotransfusion, etc.), check of observance of rules of preparation, storage and hemotransfusion in to lay down. establishment.

Final expert assessment of the obtained data is made jointly with participation uninterested in the case of the qualified clinical physician and P. specialist to.

The organization of service of blood

Tasks and structure of service of blood

Service of blood is a part of system of the Soviet health care and represents the special organization designed to provide to lay down. institutions by blood, its drugs and components, and also blood-substituting liquids.

The first institutions of service of blood in the USSR were created in the mid-twenties. The service of blood has an accurate circle of tasks, the harmonious organization and the principles of work checked by extensive experience. Institutions of service of blood of the country plan, complete and consider donor shots, carry out their medical service, carry out preparation and distribution of transfusion means on to lay down. to institutions, exercise control of correctness of use of transfusion means, implement new transfusion drugs in practice, provide advice and will organize transfuziologi-chesky service in to lay down. institutions, conduct scientific research on current questions of P. to., kro-vezamoshchayushchy liquids etc.

The service of blood has the relevant organizational and regular structure, 4 fundamental units are provided in a cut. The first — is presented by in-ta of hematology and hemotransfusion, to-rye carry out scientific research in the field of hematology and P. to. and the methodical management of institutions of service of blood in the republics. The second link consists of republican, regional, regional and city blood transfusion stations (SNK), to-rye prepare blood and receive from it separate components (erythrocytes, leukocytes, thrombocytes, plasma etc.), supply with blood of the enterprise for processing of plasma and provide to lay down. institutions by blood (see. Blood transfusion station ). The third link includes the enterprises for industrial preparation various to lay down. drugs from plasma of donor blood (fibrinogen, albumine, thrombin, immunoglobulin, etc.). The enterprises carry out fractionation of plasma but to the techniques which are specially developed taking into account the need to lay down. networks in these or those proteinaceous drugs. The fourth link would consist of departments of hemotransfusion at and large a wedge, the centers, to-rye perform double function — prepare fresh donor blood, will organize and carry out transfusion therapy in to lay down. establishment. In essence department of hemotransfusion not only receives blood from donors, but also gives specialized transfuziologichesky help, and also specialized treatment by blood and blood-substituting liquids. The general scientific and methodical management of service of blood of the country is performed Central research in-volume of hematology and hemotransfusion.

Equipment and technical means of service of blood, storage and transportation

the Service of blood is equipped with technical means for preparation, storage, fractionation (processing) and transportation of blood and its components. The complex of technical means included special laying for equipment of mobile teams, donor tables, tables for work with sterile material, supports under bottles, glass bottles and plastikatny containers with haemo-preservative, systems for capture of blood, sets of standard serums for definition of blood groups and a Rhesus factor, plaits, sterile linen, the equipped cars and the mobile stations of preparation of blood (MSPB).

For storage of blood at a positive temperature (4 — 6 °) use household refrigerators, and at an ultralow temperature (— 196 °) — the metal containers placed in the special cryocameras filled with liquid nitrogen. The erythrocytes frozen at moderately low temperatures store in refrigerators (to — 80 °).

Fractionation of plasma is carried out on tekhnol, the lines completed with centrifuges, reactors, refrigerating devices, measuring tanks, mixers, barreling and drying apparatuses.

Transportation of blood is made in the thermoisolating containers. For transportation of the prepared blood use the special refrigerator motor transport.

The organization of preparation of blood

Preparation of blood is carried out by a two-stage method. The first stage — preparation of the equipment, preservative for capture of blood and its conservation. This work is carried out at the plants of the medical industry or on large blood transfusion stations. The second stage — preparation and conservation of blood, its laboratory processing — is carried out in stationary conditions at stations and in departments of hemotransfusion or in exit conditions at the enterprises, in educational institutions.

Preparation of blood in stationary conditions is made by the staff of donor department and department of conservation of blood of blood transfusion station. In exit conditions blood is prepared by regular mobile teams, to-rykh doctors, sisters-eksfuzionisty, laboratory assistants, zhgutis-you, the registrar, the packer of blood and the laboratory assistant are a part. The crew develops point of capture of blood, adapting for this purpose workrooms of the enterprises.

Before capture of blood donor (see) is registered, at it define a blood group, a Rhesus factor accessory, a hemoglobin content. The therapist measures to the donor of the ABP, carries out a short survey and survey for establishment of contraindications to donorship, defines a single dose of blood donation (from 250 to 450 ml). Before blood donation the donor receives a light breakfast. Eksfuziya blood will be seen off by the doctor or the experienced nurse. With preservative enter needles of the taking system and an air duct into a bottle. The bottle is put on a special support. Ex-fuzionist deletes a cap from a needle of the taking system, makes a puncture of a vein of the donor and removes clips from the taking system and an air duct. Blood shall come to a bottle a continuous flow. The Eksfuzionist carefully mixes it with the preserving solution. After filling of a bottle on the taking system impose a clip, remove a plait from a shoulder of the donor, remove needles from a vein and from a stopper of a bottle. The blood which remained in system is merged in a bottle satellite for laboratory approbation. In the presence of the donor on both bottles paste brands, labels with passport and group data of the donor.

At preparation of blood in plastic compound-ny a container at first remove a cap from a needle of a donor tube, from it squeeze out air then it is filled with preservative from a container. On a tube impose a clip and punktirut a vein of the donor.

After filling of a container with blood the donor tube is drawn two nodes or made a high-frequency generator in three places. The blood which remained in a tube is intended for laboratory approbation.

Preparation of blood in field conditions is carried out by blood transfusion stations of military-medical service. The field army is supplied with blood due to the centralized deliveries from the back of the country. Institutions of medical service of civil protection receive the blood prepared by the stations and departments of hemotransfusion which are a part of the hospital bases located in country zones.

Documentation of service of blood

For registration of work of stations and departments of hemotransfusion is kept documentation approved by M3 of the USSR. It includes the individual donor card and the registration form of the donor; card of the accounting of isoimmune persons; operational magazine in-that, stations, departments of hemotransfusion; book of the accounting of preparation of receipt and delivery of blood, its components and drugs; magazine of record of results bacterial, control of blood, its components and drugs; the book of registration of the carried-out sterilization; book of registration of marriage of blood, its components and drugs; magazines of registration of a starting material and ready standard serums. In the book of registration of P. would be kept to., its components and drugs. Each transfusion is registered in an insert to the card of the inpatient. In there would be a control magazine for registration of persons, in the passport to-rykh the stamp with designation of group and a Rhesus factor accessory of blood is put.

Hemotransfusion in surgical practice

Hemotransfusions in surgical practice are applied at bleeding and deficit of all OTsK components (volume of erythrocytes, volume of plasma and total amount of blood). To lay down. tactics is various at the stopped and proceeding bleeding. At the stopped bleeding the differentiated component therapy is necessary. At the proceeding bleeding of G1. to. it is shown for fight against an acute hypovolemia and for recovery of a hemostasis. Before an immediate surgery concerning the proceeding internal or outside bleeding resort to transfusion of donor blood at the hypovolemia exceeding 20% of OTsK and which is followed by disturbances of the central hemodynamics. At this P. to. surely combine with transfusion rheological of active means (albumine, a reopoliglyukin, zhelatinolya) and to stuck loidny solutions. Before a hemotransfusion it is necessary to enter blood-substituting liquids (even at the heavy bleeding which is followed by development of hemorrhagic shock) since one of the main mechanisms of regulation of hemodynamic disturbances at blood loss is the spasm of peripheral vessels and centralization of blood circulation. Administration of low-molecular blood-substituting liquids fills shortage of OTsK and increases return to heart of a venous blood, improves conditions of microcirculation. Stored blood has the increased viscosity that in itself can aggravate microcirculator frustration. Therefore to lay down. the effect of a hemotransfusion will be higher after preliminary correction of rheological properties of blood of the recipient.

Disturbances of microcirculation play the leading role at traumatic shock (see), to-ry it is in most cases combined with blood loss (see). Transfusion therapy at the same time is based on the principles artificial hemodilutions (see). In most cases at shock in the I stage there is no need to transfuse donor blood; in II, III, IV stages blood is an obligatory component of therapy, but introduction colloid and a crista of l of loidny drugs always shall precede its transfusion. The amount of donor blood makes usually 25 — 40% of bulk volume of antishock means. Eritrotsitny weight in combination with rheological active a shelter the replacing liquids is successfully used.

At hemorrhagic shock the greatest effect is reached by complex therapy, in to-ruyu include blood, colloid and crystalloid solutions approximately in the ratio 1: 1: 2. The bulk volume of the administered drugs can fluctuate from 120 to 180% in relation to the volume of blood loss.

Hron, the anemia caused by a disease or a recurrence of bleedings from the center of defeat needs correction if at the patient oxygen and transport function of blood (decrease in concentration of hemoglobin lower than 80 — 100 g sharply decreases! l and gema-tokritny number to 25 — 30%). It is more correct to korrigirovat these states transfusion of donor erythrocytes. At such patients often more important it is necessary to consider elimination hypo - and disproteinemias, to-rye cause hypovolemia). Try to obtain it repeated introduction of proteinaceous blood preparations (albumine, a protein) or plasmas that normalizes proteinaceous volemiche-skoye a state by the time of performance of operation.

The program of transfusion therapy during operation depends on a reference state of the patient, volume of blood loss and protective and adaptive reactions of an organism. The initial anemia which is not exceeding 100 g! the l of hemoglobin, itself but itself is not the indication to P. to. along with the beginning of operation. It is more important to provide stability and adequacy of a hemodynamics due to correction proteinaceous volemi-cheskikh disturbances by means of colloid means. In uncomplicated cases, when there is no sudden and big (more than 25% of volume of the circulating blood) blood losses, it is recommended to transfuse donor blood in time or after operation with the purpose of correction of previously created hemodilution improving circulation of erythrocytes and, therefore, the blood of the patient increasing oxygen and transport function.

The volume and speed of hemotransfusion depend on the size of operational blood loss therefore measurement of blood loss should be considered obligatory. The advancing of rate of compensation of blood loss shall be the rule a nek-swarm. The majority of standard operations lasting 1kh/2 — is followed 2 hours by blood loss within 250 — 700 ml. Such rather slow loss of the circulating blood on condition of its adequate compensation colloid and crystalloid solutions, as a rule, does not cause patol, shifts a homeostasis of an organism of the patient and does not need compensation donor blood.

Big (25 — 40% of OTsK) and massive (more than 40% of OTsK) blood loss demands vigorous transfusion therapy, in a cut donor blood or erythrocytes take the important place. At treatment of big and massive blood loss donor blood shall make 40 — 70% of volume of blood loss. At big blood loss the ratio of blood and blood-substituting liquids makes 1:2, at massive — 1:1 or 2:1. The bulk volume of transfusion means shall make 120 — 160% of volume of blood loss; the amount of crystalloid solutions have to be 20 — 40% more, than colloid.

In the early postoperative period the organism needs a large amount of water and electrolytes, to-rye enter parenterally. The item to. it is shown only at decrease in volume of erythrocytes, volume of plasma or OTsK; at deficit only of a globular indicator it is better to pour the erythrocytes divorced reopoliglyukiny in the ratio 1: 1 for improvement of viscosity of blood.

In surgical practice a certain place is taken by transfusion of autologous blood, a cut is carried out at autohemotrasfusion — transfusion of the stored blood which is beforehand prepared from the patient, and reinfusion — the return hemotransfusion, streamed in serous cavities as a result of an injury or operations.

Use of whole donor blood played an extremely important role in development of cardiovascular surgery, especially in formation of a method artificial circulation (see). Due to reduction of capacity of the device, and also in connection with implementation in practice of a method of hemodilution the volume of donor blood for such operations is sharply reduced. Thanks to use of blood-substituting liquids it is possible to manage the small amount of blood necessary for maintenance of a hemodynamics and gas exchange. As a result of it the need for donor blood at open heart operation does not exceed 3 — 4 l.

After extensive operative measures in connection with blood loss and its completion serious changes in system of a hemostasis are possible. In the early postoperative period the most dangerous is diffusion bleeding, emergence a cut connect with a syndrome of the disseminated intravascular blood coagulation. In these cases along with specific therapy direct P. is recommended to.

Hemotransfusion in therapeutic practice

Indications to P. to. and its components in therapeutic practice most often arise at the anemic state which arose against the background of a serious illness of internals (a stomach, kidneys, a liver), cardiovascular system, etc. Transfusion therapy is used also for fight against bleeding and for increase in a host defense of an organism. By means of transfusion means correction macro - and microcirculation, acid-base equilibrium and other disturbances is carried out.

At an iron deficiency anemia of a transfusion of erythrocytes appoint at concentration of hemoglobin in blood less than 60 g! the l and a hematocrit nomas number is lower than 30 — 35%, on condition of inefficiency of medicamentous therapy. Eritrotsitny weight is entered kapelno in a single dose of 125 — 150 bucketed ml in 2 — 3 days, on a course 3 — 4 transfusions.

The hyporegenerative form of anemia gives in to therapy by drugs of a protein and concentrate of native plasma, to-rye have erythropoietic activity. Their single dose makes 150 — 200 ml; enter them intravenously kapelno; on a course of treatment of 4 — 7 doses.

At diseases of a respiratory organs of transfusion of whole blood apply only at the massive bleedings caused by destructive processes in lungs or a bronchial tree (a tumor, abscess, a cavity, gangrene, a heart attack of a lung), a rupture patholologically of the changed large vessel (at Osler's disease, atherosclerosis, bronchiectasias, violent emphysema of lungs, mycotic aneurism, a hemorrhagic vasculitis). In these cases transfuse svezhezagotov-lenny blood; the dosage depends on the size of blood loss, a condition of sick, gematokritny number and OTsK. The expressed hypoproteinemia (less than 60 g/l of protein in plasma) is stopped by a transfusion of native plasma, its concentrate, albumine and a protein. At the staphylococcal complications accompanying diseases of a respiratory organs it is recommended to include administration of anti-staphylococcal plasma, anti-staphylococcal immunoglobulin and other hyperimmune drugs received from plasma of immunizirovanny donors in a complex of therapeutic actions.

At diseases of cardiovascular system Transfusion therapy provides fight against profuse bleedings, hron, anemia, disturbances of protein metabolism, the cardiogenic collapse, shock disseminated by intravascular coagulation. Transfusions of whole blood should be made only according to vital indications and at emergence at sick profuse bleedings of various etiology. Introduction of eritrotsitny weight is shown at anemia with the progressing current because of a septic endocarditis or is long the current rheumatic process.

Transfusion therapy of patients went. - kish. by diseases it is shown at emergence of symptoms of acute bleeding, hron, anemias, proteinaceous insufficiency, intoxications. At profuse ulcer bleedings appoint fresh blood struyno, then kapelno iod control of the ABP, concentration of hemoglobin and gematokritny number. At defeats went. - kish. a path (a peptic ulcer of a stomach or d conducted hell a patina of a rstiy gut, nonspecific ulcer colitis, hron, enteritis, a polypose, di twirl a kuleza, phrenic hernias with persistent macro-and mikrogemorragiyamp) recommend introduction of eritrotsitny weight, edges it is also effective in therapy of post-resection and agastralny anemias (in combination with iron preparations, B6, B12 vitamins, folic to - that).

At hron, gastric bleedings without symptoms of anemia enter native plasma. Appoint 5 — 6 injections of plasma on 200 — 250 ml to a course every other day. Solution of albumine (10% solution on 100 ml) is appointed for correction of the proteinaceous insufficiency accompanying a peptic ulcer of a stomach and duodenum. Plazmo-and an albuminoterapiya are recommended also at hron, went. - kish. diseases with the expressed dehydration, loss of proteins, disturbance of electrolytic balance. Along with transfusions of plasma and albumine apply glyukozosolevy, lactat and salt and other crystalloid solutions to correction of OTsK and electrolytic balance.

At the diseases of a liver which are followed by hemorrhagic complications, an anemic, otechnoastsitichesky state, proteinaceous insufficiency, a hypersplenism, endogenous toxicosis Transfusion therapy is shown. The fresh whole blood and eritrotsitny weight are recommended in the presence of deep anemia and a hemorrhagic syndrome. Also the albuminoterapiya is widely applied plazmo-.

Transfusion therapy is reasonable also at nek-ry diseases of the kidneys (subacute and hron, nephrite, pyelonephritis, whether amyloid - poidny a nephrosis) which are followed by anemia, proteinaceous insufficiency, endogenous toxicosis. Apply the eritrotsitny weight, the washed erythrocytes, plasma, albumine, Haemodesum. At a heavy renal failure in connection with acute and hron, nephrite successfully apply a hemodialysis with use of donor erythrocytes, plasmas, albumine, blood-substituting liquids.

Hemotransfusion in hematologic practice

At patol, states, napr, various anemias, a depression of a hemopoiesis, hemoblastoses, hemorrhagic diathesis connected with disturbance eritro-leucio-and a trombotsits-poeza, for transfusion is used a whole blood or its components. For treatment of anemia at decrease in concentration of hemoglobin 80 g/l along with other means (glucocorticoids, androgens, anabolic hormones, a splenectomy) are lower, to-rye apply in different combinations depending on a form of an anemia, enter the native eritrotsitny weight, the washed and defrozen erythrocytes on 150 — 250 ml and more than 2 times a week. At P. to. selection of eritrotsitny weight for indirect reaction of Koombs is necessary for patients with autoimmune hemolitic anemia.

Absolute indications to transfusion of whole blood arise only at acute posthemorrhagic anemia and in rare situations — at impossibility to pour eritrotsitny weight.

At depressions of a hemopoiesis carry out transfusion therapy by the washed erythrocytes (including defrozen) and other cellular components of blood. At a deep depression of a granulocytopoiesis transfusion of leukocytes in a dose apprx. 10 — 12 billion cells in combination with other actions plays a positive role in prevention inf. complications.

At treatment of hemoblastoses use a whole blood, erythrocytes, leukocyte and trombotsitny weight, drugs of disintoxication action (Haemodesum), hemodynamic blood substitutes.

For fight against bleeding at thrombocytopenia (is more often than not immune genesis) transfusions of sve-zhezagotovlenny trombotsitny weight are justified. At the same time an optimum dose — 200 — 300 billion cells and more. If in 1 — 2 hour after a transfusion the quantity of thrombocytes increases to 30 — 50 thousand in 1 mkl, then the entered dose is sufficient; usually achievement of effect requires 2 — 4 transfusions. With the haemo static purpose enter the svezhezagotovlen-ny plasma enriched with thrombocytes, native plasma, fibrinogen, cryoprecipitate, a concentrate of native plasma. At gematol, patients owing to repeated P. to. and its components the isosensitization can develop. Therefore at deep leucio-and the trombotsitopeniye which are often connected with existence of the corresponding antibodies, recommend to patients transfusions of the leukocyte and trombotsitny weight prepared from the donors who are picked up first of all for antigens of the HLA system among close relatives (brothers, sisters, parents). In the presence of an isosensitization to erythrocytes selection of the transfusion environment for Koombs's reaction is obligatory.

Treatment of hemorrhagic diathesis hemotransfusions is performed taking into account genesis of a disease. At an idiopathic Werlhof's disease (see. Werlhof's disease ) apply transfusions of trombotsitny weight (at small efficiency of corticosteroid hormones and the progressing hemorrhagic syndrome). At the hemorrhagic diathesis caused by a lack of factors of a prothrombin complex hemotransfusions of any shelf-lifes and plasma are recommended. At hypoproconvertinemias (see) recommend a svezhezagotovlenny whole blood and plasma. At hypo-proaktselerinemii (see. Hemorrhagic diathesis) and at an angiohemophilia (see. Angiogemophilia ) pour fresh plasma.

Hemotransfusion in obstetric practice

At pregnancy cardiovascular system gradually adapts to the raised loading, edges it consists of the following factors: development of an uteroplacental circle of blood circulation, increase in OTsK, increase in a peripheral vascular tone. Small fluctuations of indicators of OTsK are at the time of delivery noted; in an early puerperal period there is a considerable decrease in all indicators of OTsK (the mass of the circulating blood, plasma, erythrocytes, hemoglobin). The specified changes at the normal course of childbirth do not go beyond admissible fluctuations and do not demand special correction. At the uncomplicated course of pregnancy, childbirth and a puerperal period of indications to P. to. does not arise. Blood loss during normal childbirth reaches 200 — 400 ml and is physiological.

At the complicated course of pregnancy, childbirth and a puerperal period there can be massive blood loss, for compensation the cut is carried out an urgent hemotransfusion in combination with infusion of blood-substituting liquids hemodynamic (Polyglucinum), rheological (reopoliglyukin) and disintoxication action, and also solutions, corrective water and electrolytic balance. Idiosyncrasy of obstetric bleedings is their suddenness and massiveness. Success of a hemotransfusion at obstetric bleedings first of all depends on timely and adequate compensation of blood loss that is reached by transfusion of odnogruppny donor blood. The hemotransfusion is carried out in intravenously jet, then drop way. The bulk volume of a hemotransfusion, speed and its duration depend on effect of the carried-out therapy. At massive blood loss (more than 25 — 35% of OTsK), prolonged hemorrhagic shock the intravenous hemotransfusion is urgently supplemented with intra arterial P. to.

In the presence at women in labor or women in childbirth of heavy toxicosis compensation of blood loss at massive obstetric bleedings is carried out by hemotransfusion (with a small shelf-life — to 2 — 3 days), blood-substituting liquids and other infusional means in the volume exceeding blood losses) for 30 — 40%. At the same time 25 — 35% of the total amount of transfusion therapy are filled with blood-substituting liquids hemodynamic (Polyglucinum, Gelatinolum, a protein), rheological (reopoliglyukin), disintoxication (Haemodesum, sorbitol) actions.

Direct transfusion of donor blood of 800 — 1000 ml is carried out urgently in the presence of koagulo-patichesky bleeding or at suspicion on its emergence (a hypofibrinogenemia, a secondary fibrinolysis, disturbance of a blood coagulation and for other reasons). All necessary complex of pathogenetic infusional therapy on fight against koagulopatichesky bleeding is at the same time carried out.

After massive blood loss at women in childbirth on 2 — 3 days are celebrated the expressed posthemorrhagic anemia (low indicators of a hematocrit), to-ruyu korrigirut intravenous transfusion of eritrotsitny weight or a suspension, and if necessary repeated hemotransfusions. Doses of eritrotsitny weight, a suspension, donor stored blood and other components of blood (trombotsitny weight, native or dry plasma) select individually.

At the uncomplicated course of Cesarean section blood loss fluctuates from 400 to 800 ml. For adequate compensation of blood loss transfusion of donor blood with the subsequent introduction intravenously kapelno of 400 ml of Polyglucinum is recommended. At inadequate compensation of blood loss during Cesarean section in the next few days (2 — 3 days) after operation at women in childbirth anemia, a hypovolemia low number of a hematocrit, tendency to arterial hypotension is noted. The postoperative period proceeds with complications.

Blood loss at abortion (8 — 10 weeks), a diagnostic scraping of walls of a uterus, mending of a rupture of a crotch (the II—III degree), walls of a vagina and other operations usually does not exceed 100 — 150 ml and does not demand compensation. Need for G1. to. in these cases arises at emergence of complications.

Hemotransfusion in pediatric practice

Hemotransfusionic therapy thanks to a broad spectrum of activity of blood is the integral component to lay down. actions at various diseases of children's age. The main principle of hemotransfusionic therapy children shall have a differentiated use of components of blood and its drugs taking into account the mechanism of their action, requirements of an organism of the sick child and if necessary their combination to blood-substituting liquids of disintoxication and rheological action.

In pediatric practice apply a whole blood, eritro-tsitny weight, the washed erythrocytes, trombotsitny and leukocyte weight, dry and native plasma, antige-mofilny plasma, albumine, immunoglobulins, fibrinogen, a prothrombin complex, anti-haemo-filny globulin.

The absolute indication to transfusion of whole blood is blood loss more than 12% of OTsK; relative — a hemolitic disease of newborns with exchange P.'s need to.; heavy staphylococcal sepsis and staphylococcal destruction at concentration of hemoglobin is lower than 80 g/l.

Eritrotsitny weight is poured at severe forms of scarce anemias, acute and hron, posthemorrhagic anemias, a hemolitic disease newborn, hemolitic anemias, at anemias against the background of a disease of a liver, kidneys, a pulmonary heart, autoimmune general diseases, a paroxysmal night haemoglobinuria, hard proceeding pneumonia. The washed and defrozen erythrocytes enter at listed patol, states, and also at the hemotransfusionic reactions arising at repeated P. to.

Leukocyte weight is appointed at the severe forms of an agranulocytosis and leukopenias which developed against the background of use of tsitostatik. Trombotsitny weight is applied at trombotsitopeniye with hemorrhages.

Indications for use for children of native and dry plasma were wide, to-ruyu appointed with the replaceable purpose at hypoproteinemias of various origin, with the stimulating purpose at acute and hron, inflammatory diseases, infections; for desintoxication at poisonings, toxicoses, a coma. However in connection with danger of infection with a viral hepatitis at plasma transfusion of the indication to its use are considerably narrowed. Instead of it use proteinaceous blood preparations, to-rye possess strictly certain orientation of action. Indications for use of albumine, a protein are traumatic, burn and postoperative shock, toxicoses, is purulent - septic diseases, a hypotrophy, peritonitis, cardiovascular diseases, a hemolitic disease of newborns, diseases of a liver, kidneys, severe forms of pneumonia.

Nonspecific immunoglobulin is entered for the purpose of prevention and treatment of measles, a viral hepatitis; immunoglobulins of the directed action are appointed at the corresponding infections. Immunoglobulin an anti-Rhesus factor-D is applied to prevention of a hemolitic disease of newborns.

Drugs of haemo static action (e.g., fibrinogen) enter generally at afibrinogenemichesky bleedings, the inborn and acquired afibrinogenemiya; anti-hemophilic plasma and anti-haemo-filny globulin — at bleedings, and also for their prevention at operative measures, an exodontia at children with hemophilia And yes an angiohemophilia; a prothrombin complex (PPSB) — at a Cristmas disease, deficit of factors of II, VII, X.

Contraindications to P. to. at children same, as at adults. Agglyu-tinatsionny properties of blood at children of early age are expressed indistinctly in this connection isoserological tests at them should be made very carefully.

At P. to. at children the heavy hemotransfusionic reactions which are not connected with incompatibility of blood on the AB0 system and a Rhesus factor can be observed. In such cases it is necessary with the help immunol, methods of a research to exclude, a sensitization of an organism of the child other erythrocyte antigens, antigens of leukocytes, thrombocytes, edge can develop at nek-ry autoimmune diseases, repeated and massive hemotransfusions.

Biol, a compatibility test, blood at children is carried out the same as at adults, is triple bucketed 2 — 3 min., but at the same time the smaller amount of blood is entered: to children up to 2 years — 2 ml, up to 5 years — 5 ml, up to 10 years — 10 ml, are more senior than 10 years — 15 ml. During the determination of result of test at children subjective data have no crucial importance; objective indicators of incompatibility — tachycardia, decrease in the ABP, and also sharp concern of the child are considered.

At P. to. and its components, and also for the 2, 3, 5 days after a hemotransfusion make blood tests and urine; before and after a hemotransfusion measure the ABP; to and every 2 hour after a hemotransfusion during 6 hours carry out thermometry. For the prevention of vomiting of children pe it is necessary to feed during 1 — 1,5 hour before and after a hemotransfusion.

The dosage of blood and its components depends on age of the child, body weight and disease severity.

Hemotransfusion and its components at children is made most often intravenously (a venipuncture or a venosektion). For a transdermal puncture (see. the Venipuncture, at children ) use veins of a back of the hand, the head (to children up to 6 months), and also elbow veins. Venosektion (see. Venosektion, at children ) it is possible to carry out in any site, but most often use veins of an elbow bend, a forearm or area of an internal anklebone. In some cases carry out a transdermal puncture of an elbow or perednelodyzhechny vein with the subsequent their catheterization.

At seriously ill patients of the children needing a long hemotransfusion carry out catheterization of large veins on Seldingera: the puncture of a subclavial vein is made Seldinger's needle or a needle with a cut at an angle 45 °, to dia. 1,2 — 1,4 mm, to-ruyu stick on bottom edge of a clavicle, on border of an internal and average third, and newborns — an average third have clavicles. Diameter of the entered catheters shall correspond to age of the child (for newborns and babies outer diameter is equal to €, 9 — 1 mm, internal — 0,4 — 0,5 mm, for children years — respectively 1 — 1,3 mm and 0,4 — 0,5 mm are more senior). The newborn the catheter is entered on depth to 6 cm, to children up to 3 years — to 6 — 8 cm, 3 years — to 8 — 10 cm are more senior. Hemotransfusion or its components is carried out kapelno or struyno, however at children of early age the drop way is more preferable. At acute blood loss and shock P. is shown to. before normalization of the ABP struyno, and then kapelno.

The severe forms of pairing jaundice and hemolitic disease of newborns, a renal coma, hemotransfusionic complications connected with transfusion other grupinoy or Rh-incompatible blood, and also poisoning with colchicine, phosphorus, morphine, atropine, mushrooms are the indication for exchange P. to. The amount of the entered blood shall belong to withdrawn as 3:2.

For exchange P. to., and also to children with bleedings, it is purulent - septic diseases recommend to apply svezhetsitratny blood a shelf-life no more than 1 — 3 days. At gematol, diseases it is necessary to transfuse blood a shelf-life no more than 5 — 7 days. A number of researchers at treatment of children with a heavy purulent infection, staphylococcal destruction of lungs, slow hron, inflammatory processes recommend direct P. to. from the donor parent, previously immunizirovanny the adsorbed staphylococcal anatoxin in combination with Prodigiosanum. Due to the risk of infection with serumal hepatitis at direct P. to. careful inspection of the donor on blood transfusion station shall be an indispensable condition.

Hemotransfusion to persons of advanced and senile age

Transfusion therapy at persons of advanced and senile age has a number of the features caused age fiziol, changes.

During the performing transfusion therapy at persons of advanced and senile age it is not necessary to adhere to standard approaches. Funkts, inferiority of cardiovascular system, a respiratory organs and fabric metabolism causes insufficiency of adaptation and adaptive reactions at these patients at an injury, blood loss and others patol, states. The choice of optimum transfusion tactics is defined by it. Atherosclerotic defeat of vessels, delay of a coronary blood-groove, dystrophic changes of a myocardium, a disproteinemia with strengthening of coarse-dispersion fractions of proteins lead to decrease in tolerance to blood loss at these patients; therefore with extra care and care compensation of blood shall be carried out. Incomplete compensation of the lost volume of blood can lead to developing of persistent hypotension with heavy disturbances of fabric metabolism as a result of decrease in nutritive function and a hypoxia of fabrics. Excess volumes of the transfused blood are dangerous by threat of an overload of the right heart with development of acute cardiopulmonary insufficiency.

Measure of prevention of transfusion of excess volume of transfusion environments and overloads of heart at patients of advanced age is constant measurement of the central venous pressure at a transfusion. At the same time for prevention of heart failure it is reasonable to carry out in parallel adequate therapy by cardiovascular means and correction of disturbances of acid-base equilibrium.

In the postoperative period at patients of advanced and senile age Transfusion therapy shall be directed to correction of disturbances of water and electrolytic exchange, acid-base equilibrium and ensuring energy balance (parenteral food). At the same time the volume of transfusions, as a rule, is defined by the volume of fluid losses at this patient (as well as at completion of acute blood loss, transfusion of excess volumes of transfusion environments is dangerous). In need of introduction of large volumes of liquid (e.g., for the purpose of desintoxication) carry surely out forcing of a diuresis. As showed A. A. Chervinsky's researches with sotr. (1972) and I. A. Safina (1974), at intra portal (through an umbilical vein) introduction to 2 — 3 l of liquid at persons of advanced and senile age is not observed considerable fluctuations of the central venous pressure and an overload of heart.

Hemotransfusion at stages of medical evacuation

In system of treatment struck in the war very great value is attached to early transfusion therapy, transfusions of stored blood of small shelf-lifes (to 6 days), its components and drugs, and also blood-substituting liquids.

During the rendering first medical assistance (see) P. is provided to. only 0(1) groups in quantity to 500 ml. Indications — massive blood loss and heavy shock. In difficult conditions at a big flow struck on regimental first-aid posts and groups of the first medical aid the blood-substituting liquids (Polyglucinum, salt solutions, etc.) providing relative stabilization of a hemodynamics at victims for the subsequent their transportation will be preferential applied.

During the rendering the qualified medical care (see) in medical and sanitary battalions and OMO of the indication for P. to. extend. The volume of the transfused blood can make up to 2 l and more. At deficit of blood it is possible to recommend reinfusion of the streamed blood in chest or belly cavities. Such blood is aspirated and stabilized in a standard bottle with preservative of factory preparation or heparin in a dose of 8 — 12 mg in 50 ml of 0,9% of solution of sodium chloride for 500 ml of blood and at once poured to the wounded. Certainly, and at this stage of medical evacuation blood-substituting liquids — plasma, Polyglucinum, reopoliglyukin, glyukozosolevy solutions, etc. will be widely applied.

During the rendering specialized medical care (see) indications to transfusion and infusional therapy usual: here apply stored blood, its components and drugs, blood-substituting liquids (Polyglucinum, reopoliglyukin, Haemodesum), salt solutions (solution a rin-ger-lactate, laktasol, isotonic solution of sodium chloride, etc.), and also hydrolyzates of proteins (Hydrolysinum, a hydrolyzate of casein). At development of secondary anemia in the wounded (burned) hemotransfusions, eritrotsitny weight in doses of 250 — 500 ml and Antianemic means, napr, Haemostimulinum, fer-koven, B12 vitamin are necessary repeated (in 2 — 3 days) (see. Antianemic means ). For treatment of patients with a radial illness use of direct hemotransfusions (0,5 — 0,75 l), and also administration of anti-hemophilic plasma, concentrates of leukocytes and thrombocytes, fibrinogen, immunoglobulins, Haemodesum, saline solutions is reasonable.

During the determination of necessary amount of the transfused blood or blood-substituting liquids, ways of their introduction it is necessary to consider the size of blood loss and degree of its compensation at the previous stages that is established on color of integuments and visible mucous membranes, pulse, the ABP, gematok-ritny number, a hemoglobin content and quantity of erythrocytes, and also degree of injury of an operative measure. However the volume and content of transfusion and infusional therapy in many respects depend on the specific situation developing at stages of medical evacuation (see). In all cases before hemotransfusion, plasmas, erythrocytes, leukocytes or thrombocytes at stages of medical evacuation it is necessary to make sure of their high quality, to check group accessory of blood of the donor and recipient, to carry out tests on individual, group and rezusny compatibility, and also biol, test.

When it is impossible to check group accessory of blood of the recipient, and also in the absence of odnogruppny blood it is admissible according to vital indications to transfuse blood of group 0(1) in a dose to 500 ml.

See also Infusional therapy .



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O. K. Gavrilov; A. P. Gromov (court.), E. P. Ilyin, S. V. Ryzhkov (soldier.), V. A. Klimansky (hir.), H. M. Nemenova (stalemate. An.), H. N. Rasstrigin (academician), H. N. Skachilova (complications), S. K. Tkachenko (ped.), N. A. Fedorov (the mechanism of effect of the transfused blood).

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