TRANSFUSIOLOGY (Latin transfusio transfusion, mixing + Greek logos the doctrine) — the section of clinical medicine studying the processes arising at purposeful change of structure and physiological properties of blood and extracellular liquid as a result of parenteral administration of transfusion means, withdrawal, addition or replacement of separate components of blood.
Object of research of T. are a way of receiving transfusion means (see) and the mechanism of their impact on an organism. As transfusion means study blood (see), its derivatives, marrow (see) and other hemopoietic fabrics, nek-ry biol. substrates — hydrolysates (see) vegetable and animal protein, various hormones (see), enzymes (see), antigens (see), interferon (see) etc., solutions of salts, colloids, amino acids (see), polypeptides (see Peptides), nucleotides (see. Nucleic acids), alkalis, oxides and other chemical compounds, fatty emulsions, separate chemical elements, antiseptic agents (see), antibiotics (see) etc.
At a research of the mechanism of action of transfusion means reveal patterns of their influence on an organism in general and on its separate systems. Study depth, an orientation, the immediate and long-term results of action of various transfusion means depending on tactics of their use, dosages, combinations, and also from a reference state of an organism and character patol. process.
Problems of modern T. it is possible to divide into three groups. The first group includes justification of requirements to modern transfusion means depending on requirements a wedge, medicine; modeling, synthesis, studying of new transfusion means; establishment of routes of administration of the transfusion means providing their effective to lay down. action and correction of the broken functions of an organism; development of theoretical problems of preparation, conservation, storage of blood and its derivatives (see Conservation of blood), and also hematotherapies (see); forecasting of the directions T. depending on development of biology, medicine, physics, chemistry and other sciences, and also the equipment.
The second group of tasks is connected about a wedge, researches: it includes definition of indications and contraindications to use of transfusion means, justification a wedge, methods and tactics of transfusion therapy at various patol. states, development of requirements to the equipment for performing transfusion therapy, scientific substantiation of measures of prevention of posttransfusion complications in a wedge, practice (see Hemotransfusion).
To tasks, components the third group, belong the organization of donorship (see) and preparations of blood; development and improvement of methods of conservation of blood and marrow; definition of needs of health care for transfusion means and the equipment for performing transfusion therapy; development tekhnol. documentation for industrial production of transfusion means; development of methods of standardization and quality control of transfusion means by their production and storage.
T. develops also the forms of the organization of transfuziologiche-sky service in a health system providing timely use of its achievements in medical practice. The Transfu-ziologichesky service represents system of specialized institutions, tasks to-rykh include the organization of the transfuziologichesky help to patients and providing to lay down. institutions by blood, its derivatives and other transfusion means.
Formation of T. it was caused by requirements of clinic. At first methods T. applied in obstetrics, gynecology, surgery, hematology, therapy, then in pediatrics, anesthesiology, resuscitation, transplantology, and in a crust, use time practically in all fields of medicine.
In the history of development of T. it is possible to allocate two stages. During the first stage by the only method a trance-fuznol. impacts on an organism there was hemotransfusion. To the middle of 20 century in economically developed countries there was well organized service of hemotransfusion. The second stage is carried to the second half of 20 century when in connection with snowballing of medicine requirements to the techniques providing management of vital signs of an organism at difficult surgeries raised. Implementation of methods of fractionation of blood and plasma, development of the medical industry and increase in production of blood-substituting liquids (see) led to the fact that a wedge, the medicine received in the order a broad set of transfusion means with various mechanisms of action. During this period of T. it was finally created as scientific discipline. Problems T. representatives of large surgical schools led by A. N. Filatov, D. M. Grozdov, B. V. Petrovsky, P. A. Kupriyanov, I. S. Kolesnikov, A. N. Berkutov, etc., and also the pathophysiologists investigating questions of microcirculation (see) developed.
Development of cardiovascular surgery resulted in need of providing artificial circulation during operational, interventions. However in this regard there was a problem of danger of massive transfusions of homologous donor blood, excess water loadings, disturbances in system of regulation of aggregate state of blood in the course of the general perfusion. In cardiovascular surgery the major transfuziolo-gichesky schemes and ways of management of hemodilution (see), control methods for it fiziol were developed. adequacy. Further these schemes and methods were applied in other areas of clinical T. Ustanovlena of advantage of hemodilution in the conditions of stabilization of a hemodynamics during heavy operative measures, at prevention of infectious and traumatic toxicosis (see Intoxication), tromboembolic episodes (see the Thromboembolism).
Development of a method of hemodilution was the beginning of development of extensive area of clinical T., received the name «transfusion therapy» or «controlled haemo correction». Transfusion therapy includes methods of a hematotherapy, infusional therapy (see), the managed hemodilution, hemosorption (see t. 10, additional materials), lympho-sorptions (see), a hemodialysis (see), etc. Transfusion therapy provides normalization of gas exchange (respiratory haemo correction), blood circulations (hemodynamic haemo correction), metabolism (metabolic haemo correction). Respiratory haemo correction allows to improve diffusion of oxygen, to regulate dissociation of oxyhemoglobin, to reduce pulmonary and capillary resistance, to increase stability of surfactants (see). During the carrying out hemodynamic haemo correction rheological properties of blood improve, cardiac performance is normalized, energy costs of a myocardium decrease, blood circulation in a mikrotsir-kulyatorny bed improves, aggregation of thrombocytes is eliminated, the lymphokinesis is stimulated, concentration of serotonin decreases, microcoagulation, a vascular spasm is prevented, decreases (at the indication) an antiserum capacity. Metabolic haemo correction provides stabilization of chemical composition of blood, reduction of speed of an exit of cellular enzymes, increase in an alkaline reserve, formation of complexes of toxins with haemo proofreaders, strengthening of excretion of products of exchange.
Program approach in T. assumes the differentiated and individual choice of methods of transfusion therapy. Transfu-ziolog can combine a trance-fuziol. influence to control its efficiency and to manage it that allows to normalize a condition of the patient, to adapt it to the new living conditions caused by a disease. In a crust, time in T. there are several standard programs of transfusion impact on an organism, in to-rykh therapy of effects of severe injuries, shock, posthemorrhagic hypovolemia, a hypoxia, and also hemotransfusionic complications is provided.
224 TRANSFUSION MEANS
In each case transfuziolog shall resolve specifically an issue
of the choice of transfusion means, their dosage, the sequence and a method of introduction, terms of treatment.
Development of urgent problems T. it is carried out by specialized scientific institutions. In the USSR lead agencies are Central the Orders of Lenin and awards of the Labour Red Banner of scientific research institute of hematology and hemotransfusion of M3 of the USSR and Leningrad awards of the Labour Red Banner and the award «Sign of Honour» of scientific research institute of hematology and hemotransfusion of M3 of RSFSR, and also in-you hematology and hemotransfusion in federal republics (see Research institutes).
In the USA large scientific centers of transfusiology function in New York and Washington. In France there is a national transfuziologichesky center, in Bulgaria, GDR, Hungary, Czechoslovakia, Poland, in Cuba and in other countries of the world — in-you hematology and hemotransfusion.
Teaching T. it is carried out in medical higher education institutions at departments of surgery. Professional development of doctors on T. it is carried out in in-ta of improvement of doctors. In 1975 it was created All-Union scientific
about-in hematologists and transfuziolo-g. The first All-Union congress of hematologists and transfuziolog took place in 1979 in Baku. International about-in transfuziolog will systematically organize the international congresses. Questions T. are covered in the «Problems of Hematology and Transfusiology» magazine. Bibliography: Gavrilov O. K. Ocher
ki stories of development and use of hemotransfusion, L., 1968; Goal
of wines G, V. of ides of river. The guide to transfusiology for doctors of departments of hemotransfusion of hospitals, JI., 1975; Gravitational surgery of blood, under the editorship of O. K. Gavrilov, M., 1984; To l and m and nanosecond to and y V. A. and P at d and e in Ya. A. Transfusion therapy at surgical diseases, M., 1984; The Handbook on transfusiology, under the editorship of O. K. Gavrilov, M., 1980; The Guide to the general and clinical transfusiology, under the editorship of; B. V. Petrovsky, M., 1979; The Application guide of blood and blood substitutes, under the editorship of A. N. Filatov, JI., 1973; With and-velyeva G. M. Infusional therapy in obstetrics and gynecology, M., 1976; The Reference book on hemotransfusion and blood substitutes, under the editorship of O. K. Gavrilov, M., 1982; F and l and t about in A. N. and B and l-l yu z e to F. B. The managed hemodilution, JI., 1972; Blood and its disorders, ed. by R. M. Hardisty a. D. J. Weathe-rall, Oxford a. o., 1974; HuestisD. W., Bove J. R. a. Busch S., Practical blood transfusion, Boston, 1976; M about 1 1 i-s about n P. L. Blood transfusion in clinical medicine, Oxford a. lake, 1979.
O. K. Gavrilov.