Blood is a fluid tissue of a human organism which performs vital capabilities. It’s identified from the course of physiology. Nonetheless, within the clinic we face with this tissue in particular facet as a result of from previous time and to these days it’s a riddle, and the makes an attempt to use it for therapy stay inviting as a result of in some instances they’re magically efficient.
It was thought-about that blood is the supply of life, there’s a soul in it and consequently with blood loss the soul is misplaced additionally. Many researchers related the motion of blood with an individual’s character, pressure and bodily skill. That’s the reason the blood baths in historical Egypt and ingesting of misplaced gladiator’s blood in Rome have been really helpful.
The magical motion of blood was named the Medea’s technique of therapy. Ovidios Nazon describes the makes an attempt of Medea to rejuvenate an previous man with younger blood: “Medea with a sword out the throat of the previous man and let the previous blood pour out, she poured juice in him. After having drunk, together with his mouth or wound, Ezon’s grey hair eliminated and his beard and hair grew to become black. The leanness, in addition to each paleness and decrepitude disappeared. The physique grew to become plump, the wrinkles grew to become easy. Ezon was stunned; he remembered himself like this forty years in the past”.
Definitely, there are plenty of exaggerations on this legend, however the truth that it underlines the vital position of blood within the human life is probably. In 1492 blood was transfused from two younger males to Pope Innokenti VІІІ, aiming to rejuvenate him, however the miracle didn’t happen — the pope died from previous age and the younger males died too.
Makes an attempt to use blood for therapy have been happening. In 1667, the blood of a lamb was efficiently transfused to an individual by physician Deni. Then a interval of failures got here, which for a very long time hampered the usage of blood. The opponents of haemotransfusion thought-about that “lamb’s blood, which was transfused into the vein of an individual, may give him the options of cattle: dullness and cattle inclinations”. From the primary haemotransfusion and to our days haemotransfusiology handed a troublesome, typically tragic path. It has been attributable to the absence of information in anatomy, physiology and the data of the position of blood in a human organism.
Harvey’s discovery (1682) gave a illustration of the blood system; the evaluation of the explanations of unsuccessful transfusions led finally to the opening of agglutination that’s the technique of conglutination of erythrocytes, and, lastly, to the invention of the blood teams.
However on occasion medical doctors transfused blood in instances of emergency, regardless of of prohibition and punishment. J. Blundell (1820) in England, Volf (1832) and O. M. Filomafitsky (1848) in Russia efficiently transfused blood from individual to individual, aiming to elucidate the mechanism of its motion. The start of the earlier century was marked by discovery of the blood teams: 1901 — Okay. Landsteiner (three teams) and 1907 — Ya. Yansky (the fourth group). Mechanisms of motion of transfused blood have been studied (O. M. Filomafitsky), circumstances of its preservation (in 1914, V. Yurevich and M. Rozengard advised the applying of sodium citrate for the prevention of blood coagulation), supply of receiving blood (1919, V. Shamov advised the applying of the cadaveric blood).
The system of group of blood service (1926, on account of O. O. Bogdanov’s efforts the Institute of Haemotransfusion was opened in Moscow for the primary time on this planet) was created and have become stronger.
In the present day the work regarding the examine of the specificity of blood, utility of blood or its sure parts is on.
Now within the medical observe whereas fixing the query of haemotransfusion medical doctors have in mind the options of blood, opened by immunologists. It’s essential to at all times do not forget that blood is a fluid tissue and its transfusion is much like tissue transplantation, wherein over 300 numerous antigens, which kind numerous methods, are revealed. However the clinic takes into consideration not all of them however solely the system which determines the teams of blood and Rhfactor. The blood group is a genetically induced signal, which supplies the affiliation of antigens that are in uniform parts and blood plasma. In 1901, Okay. Landsteiner — a physician from Vienna — opened a phenomenon of agglutination, having distributed folks into three teams of blood. He had discovered that the serum of the primary group agglutinates with erythrocytes of the second and third teams. The serum of the third group agglutinates with erythrocytes of the second group. In a due course Ya. Yansky found additionally the fourth blood group. The same phenomenon was defined by the existence of the AB0 system, in different phrases — it is a set of agglutinins and agglutinogens in a sure particular person.
In response to the statistic knowledge, 42–44% of individuals in Europe have the second blood group, 38–39% — the primary, 12–14% — the third, 4– 6% — the fourth. Every blood group is set by the affiliation of agglutinins and agglutinogens. So, within the first group there are agglutinins α, β and agglutinogen 0; within the second — accordingly β and A, within the third — α and B and within the fourth — АВ0. The blood teams are designated with the presence of agglutinogens: 0 (І); A (ІІ), B (ІІІ), АВ (ІV). Agglutinogens A, B, and 0 are thermolabile natural compounds (glycoprotein). They’re located in erythrocytes and make the antibodies formation. These antigens already seem in a 3-month fetus and don’t change throughout life. It was thought-about earlier than that antigen isn’t current, due to this fact it was designated as 0. Nonetheless, right now it’s identified that there’s an antigen within the first blood group, however it doesn’t produce the agglutination reactions, due to this fact it’s designated as 0 and it isn’t taken into consideration throughout haemotransfusion.
Agglutinins are thermolabile globulins. They exist in plasma and likewise in tissue fluid. Their accumulation in plasma happens regularly, reaching such degree (titer) when they’re able to serving as the rationale of agglutination response. In newborns, the titer is low, however it regularly will increase, reaching a most at 10–20 years. The titer of agglutinin often is in adults from 1:32 as much as 1:128, β — from 1:16 to 1:64. The upper the titer the extra the chance of agglutination response in interference of the identical title agglutinogens of erythrocytes.
Throughout haemotransfusion the Ottenberg’s rule was saved: “Throughout haemotransfusion the erythrocytes that are introducted (agglutinogens) agglutinate as a result of the entered plasma (agglutinins) is diluted within the complete quantity of fluid and their titer turns into inadequate for affected person’s erythrocytes agglutination”. Certainly, medical physicians warned that within the case of acute anemia throughout the try of quick compensation of blood loss with donor blood of the primary group the affected person erythrocytes agglutinated due to the excessive focus of agglutinins which have been entered. That is known as reverse agglutination. Due to this fact, massive quantity of suitable blood was not really helpful to transfuse however so as to add the fluid into the system. Ultimately, the agglutination throughout the transfusion of the identical blood group, particularly the second group was noticed.
Final years researches of immunologists and haemotransfusiologists permit to think about the explanations of those manifestations. It was appeared that there are some subgroups of agglutinogens: А1, А2, А3, А4, Ax, Аz, and so on. The strongest antigen is А1, it exists in roughly 88% of individuals with the second blood group. This antigen serves as the rationale for quick agglutination response. A bit of bit weaker is the motion of А2, which is noticed in 12% of individuals with the second blood group. Different subgroups of antigen A — weak and will not be virtually taken into consideration clinically.
Agglutinogen B has additionally some subgroups (В1, В2, В3), however their titer and antigenic motion is insignificant, due to this fact they aren’t thought-about clinically too.
Antigens А1 and А2 are succesful to supply antibodies in opposition to themselves, which known as extra-agglutinins α1 and α2. Their affiliation and reactions throughout haemotransfusion are unexpected throughout the limits of 1 (second) blood group. So, if the affected person has А1 (II) βα2 blood group, and the donor has А2 (ІІ) β, the agglutination might start due to response of extra-agglutinins α2 of the recipients with the donor’s agglutinogen А2.
Throughout lifetime, when antigens A and B enter an organism, the immune agglutinins α and β are shaped. They enhance the titer of pure agglutinins typically as much as 1:512 after which there isn’t a alternative for it to weaken in a cultivation of liquid of an organism which might result in agglutination. That’s the reason the Ottenberg’s rule begins to unfastened its pressure in observe, and extra usually solely the identical blood group transfusion is mentioned. It’s already grow to be a regulation in youngsters.
Throughout haemotransfusion, not solely the AB0 system but additionally the Rh-factor system is taken into consideration. In 1940 Okay. Landshteiner and A. Wiener, throughout introduction of erythrocytes to a rabbit from an anthropoid ape, revealed that it produces antibodies, that are able to agglutinating erythrocytes. The issue succesful to supply antibodies was present in human blood erythrocytes and just lately in its fluid half. It obtained the title of Rh-factor. The construction of this antigen isn’t fully identified, however it’s thought-about that it’s a polymucoprotein compound. 85% of persons are Rh-positive (their erythrocytes include the Rh-factor), and 15% — Rh-negative. So, throughout haemotransfusion there may be at all times a hazard of the Rh-conflict: whether or not throughout a repeated transfusion to the Rh-negative affected person of Rh-positive blood, whether or not throughout the transfusion of Rh-negative blood which comprises antibodies to a Rh-positive affected person. Such a easy system in fashionable drugs isn’t correct as a result of it has been revealed that an individual has 6 antigens Rh-Hr (D, C, E, d, c, e). The primary three antigens are a model of the Rh-factor: D (Rh0), C (rh’), E (rh”). D is the strongest antigen and E is the weakest one.
Consequently, the presence of antigen D (rh0) is taken into consideration, 2–3% of Rh-negative donors have antigens C (rh’) and E (rh”). That’s the reason the group of donors with Rh-negative blood can deal with those who haven’t any antigens D (rh0), C (rh’), E (rh”), and the recipient must be thought-about Rh-negative provided that he has no antigen D. Thus, in a human blood there might be one sort of Rh-factor or a mixture of a number of sorts and particular antibodies develop to every of them.
The atigens of Hr–Hr0, hr’, hr” system are within the erythrocytes, however their antigenic properties are weak. On the similar time, in case of their presence in a Rh-negative donor throughout haemotransfusion to a Rh-positive recipient, posttransfusion response can happen. It’s vital to recollect about these options of the immune system and through haemotransfusion it’s essential to know the Rh-factor and to conduct assessments on Rh-compatibility, and, typically, it’s higher to transfuse the blood of the identical group and the identical Rh-factor.
Definition of Blood Group
There are some methods of blood group definition: а) with the assistance of normal serums (identified agglutinins); with the assistance of normal erythrocytes (identified agglutinogens); the trendy technique, which is broadly practiced, is the applying of anti-A and anti-B monoclonal antibodies.
It’s essential to estimate the validity of normal serums in definition of the blood group — serum must be clear, haven’t any extra inclusions and correspond to the phrases of preservation. Definition is performed at an ambient temperature (17–20°С), in Petri’s dishes or particular plates. As a rule, serums of first, second and third teams are taken. The serum from the fourth group is utilized as a management. All the time they use serums of two titers; due to this fact two drops of normal serum of each of three teams are placed on the dish. The blood which should be examined is added there (5–10 occasions much less quantity). The serums are combined with the drop of blood and the reply is set by the agglutination response. If the investigated blood is of the primary group, the agglutination isn’t current in any of the serums, if of the second group — agglutination seems with the serum of the primary and third teams, if the blood is of the third group, the agglutination seems within the first and second serum, if agglutination happens in all the serums it’s the fourth group.
Definition of the blood group with the assistance of normal erythrocytes is carried out, as a rule, at haemotransfusion stations, as a result of erythrocytes preservation and transportation is troublesome. It’s essential to do not forget that on this case the agglutinogens are identified, due to this fact, the investigated serum, which is obtained by precipitation or centrifugation of affected person’s blood, is added to the drop of normal erythrocytes.
The outcomes are decided 5 min after mixing the serum and normal erythrocytes. If there may be agglutination with the erythrocytes of the second and third teams, it’s the first blood group. If there may be agglutination of the erythrocytes solely within the third group, the affected person has the second blood group, if agglutination of the erythrocytes of the second group — the third blood group. In case of the absence of agglutination in all of the varieties of normal erythrocytes, the fourth blood group is set. Whereas registering the response, it’s doable to find out agglutination there the place it’s really absent. The explanations for this phenomenon (pseudo-agglutination) might be:
Low temperature within the room (beneath 15°С).
The registration of the response happened later than 5 min —the serum dries out and stimulates agglutination.
At low temperature erythrocytes grow to be “financial columns”, stimulating agglutination; it simply disappears whereas rocking the plate or by including a physiological answer.
Concentrated normal serum.
With presence of immune antibodies within the investigated blood,if the affected person suffers from sepsis, systemic blood illnesses.
Generally agglutination can’t be seen, it occurs beneath the next circumstances:
а) definition of the blood teams is carried out on the temperature increased than 25–30°С;
if the response is taken into consideration sooner than 5 min.
if the titer of agglutinins is low (decrease than 1:32) and thus theblood group is set with the assistance of 1 sequence of serums;
if the ratio of serum-blood isn’t right and the amount of blood is simply too massive.
Probably the most dependable technique of definition of blood group is utilizing cyoclones anti-A and anti-B. They’re the product of hybridome mobile traces, obtained on account of the merge of mouse antibodyproducing B-lymphocytes with cells of mouse myeloma. Cyoclones will not be the merchandise of important exercise of human cells, it’s ascitic diluted liquid from mice — carriers corresponding with the hybridome, which comprises particular antibodies of sophistication M, that are directed in opposition to antigen A and B.
Cyoclones anti-A and B are produced as a liquid in bottles or ampoules of 20, 50, 100 and 200 dozes. The liquid comprises preservatives — 0.1% sodium azide, coloured blue (anti-A) or pink (anti-B). The bottles are saved for 2 years in a fridge on the temperature of +2 to +8°С. In definition of the blood group with native blood with and with out preservatives the most effective outcomes occur at excessive focus of erythrocytes. On the plate, on the room temperature of 15–20°С, 1 drop (0.1 ml) of the anti-A and anti-B cyoclones is put, then the examined blood (the drop must be 10 occasions much less) is combined for 3 min lengthy, waiting for the response. If agglutination isn’t current in each cyoclones, it’s the I blood group; if agglutination happens with anti-A cyoclones, it’s the II group; if with anti-B, it’s the third group, and if agglutination is current in each cyoclones — IV blood group.
Definition of Rh-factor
There are some strategies of Rh-factor definition in human blood. In emergency conditions an express-method is used. To the usual anti-Rhesus-serum of the identical with the investigated blood group the blood is added for definition of Rh-factor. An ordinary serum АВ (ІV), which doesn’t include any antibodies, is used as a management. The response is set throughout 3–5 min. The presence of agglutination of erythrocytes with anti-Rhesus-serum testifies that the blood is Rh-positive, the absence of agglutination — Rh-negative. This technique is allowed solely in particular emergency instances and additional it’s vital to find out Rh-factor by laboratory strategies.
Probably the most dependable technique of Rh-factor definition is the test-tube: the response is performed in suspension of gelatin or polyglukin (conagglutination). Two traces of test-tubes (from two sequence of anti-Rhesus-serum) 3 check tubes in each are taken for investigation. In every check tube 0.1 ml anti-Rhesus-serum of the identical group with the researched blood is poured. Then erythrocytes from the examined blood are added to the primary check tube, normal Rh-positive erythrocytes — to the second, normal Rh-negative erythrocytes — to the third. After that, 2–3 ml of 10% answer of gelatin are added to all check tubes and saved within the thermostat for 1 h on the temperature of 37°С. Dedication of the response is carried out after shaking the check tubes. The presence of agglutination response within the examined blood testifies that the blood is Rh-positive, the second and third check tubes function a management.
Sources of Blood Acquiring
The essential supply for receiving blood is wholesome donors. It’s authorized to take blood from grownup individuals who haven’t suffered from tuberculosis, syphilis, malaria, will not be within the restoration interval after the infectious illness, virus hepatitis. It’s prohibited to take blood from exhausted folks, with metabolism dysfunction, oncologic sufferers and likewise those that undergo from suppuration processes. The one doze of taken blood mustn’t exceed 450 ml. The break between blood taking is 2 months.
The angle in direction of a donor is totally different in several international locations. So, in Italy the donorship is taken into account as an act of “Christian mercy, love and brotherhood”, and the donor who offers blood receives forgiveness of sins. In Holland the one who offers blood 10 occasions receives a medal with Okay. Landsteiner’s picture. In our nation the donor service might be paid if the donor receives materials compensation, and likewise gratuitous if folks give blood every year disinterestedly.
Blood taken from a donor must be saved beneath particular circumstances. The historical past of preservation of blood has begun since 1865, when Physician V. Sutugin purposed to defibrinate and protect blood on the temperature of 0°С. In 1867 Rautenberg advised to combine blood with an answer of carbonic sodium. It prevented it from coagulation. In 1914 Yurevich and Rozengrad advised the applying of sodium citrate within the ratio of 1:10 for stopping blood from coagulation. These days blood is preserved with an answer of glucicir (sodium of hydrocitrate, glucose and distilled water) in response to the calculation of 25 ml for 100 ml of blood. Earlier than preservatives of assorted construction have been utilized. In addition to of preservatives, they contained glucose and chloramphenicol. The blood ready by such a technique is saved in sterile bottles on the temperature of +4–+6°С within the fridge. The time period of preservation is 10–11 days, however the optimum time period is 7 days.
Blood might be preserved by including heparin (50–60 mg for 1 l of blood). This blood is utilized in units of synthetic blood circulation, time period of its preservation — 24 h. The preservation of blood is finished at low temperatures (–196°С). Such frozen blood is appropriate for transfusion in 2 to 10 years. Nonetheless, due to complicated specs on preserving such blood, this technique didn’t have large spreading.
There are additionally different sources of blood acquiring:
Utilized blood is the blood obtained throughout bloodletting regarding totally different illnesses, which don’t affect its construction. For instance, hypertonic illness.
Auto-blood is the blood taken from a affected person earlier than an operation or throughout an operation if it poured into cavities on account of vessels rupturing. This blood mustn’t include any impurities (bile, intestinal and gastric contents, urine).
Umbilical-placental blood. Its utility was advised byprof. M. S. Malinovsky. It comprises an elevated quantity of enzymes, proteins, hormones (folliculinum). The quantity of blood which is taken modifications from 100 as much as 400 ml. In the present day it’s broadly used for getting ready blood parts.
Cadaveric blood. In his works V. Shamov proved that even10–12 h after the dying the blood retains its properties. Due to this fact he advised taking blood from cadavers. They need to be individuals who died in the results of sudden, extra usually traumatic, accidents. The blood is ready beneath sterile circumstances no later than 6–8 h after the dying.
Thus, all of the above acknowledged proves that haemotransfusion has handed by medical to scientifically-grounded strategies of preparations, preservation and utility as a strong medical issue. The system of preparation, preservation and utility of blood was established. In massive hospitals there are stations for blood purveyance. It doesn’t matter what sort of blood preparation must be used, it’s essential to do not forget that the donor’s blood is topic for investigation so as to stop from making hurt to the affected person.
Discovering the mechanism of transfused blood motion ultimately determines the indications for haemotransfusion.
Mechanism of Transfused Blood Motion
The impact of transfused blood relies upon upon the quantity, technique and pace of transfusion. The entered blood has a substitutive, haemostatic motion, will increase metabolism, exhibits immunobiological, desintoxicative and nutritious impact. The essential mechanism of motion transfusing blood is transport of oxygen.
In surgical observe the substitutive motion is a very powerful, blood alternative is important, as a result of it threatens the lifetime of the affected person. Substitute might be carried out rationally, it’s unattainable to compensate 100% of the blood loss. Often, 1/3 of the misplaced blood is transfused, then salty options and once more blood is transfused. The transfused blood irritates the baroreceptors, assists within the tone of the vascular wall, will increase the amount of the circulating blood, respiratory floor of erythrocytes and make affect upon the organs of haemocirculation.
The haemostatic impact is achieved as a result of introduction of coagulation elements of the blood — thrombocytes. Specifically, it’s discovered whereas transfusing contemporary blood (direct or 1–3 days after preservation). Along with the donor’s blood, antibodies, globulins, which make immune correction on the organism of the affected person, are entered. The entered blood replaces protein, carbohydrates and fat. In addition to, protein of the blood adsorbs dangerous substances (poison, bacterial toxins), strengthens metabolism oxidizing processes, excretion of urine, i.e. performs detoxication motion.