INDICATIONS AND CONTRAINDICATIONS FOR HAEMOTRANSFUSION

Continuing from the mechanism of transfused blood motion, there are specific absolute and relative indications for haemotransfusion. But when the query is about haemotransfusion after blood loss, which has an apparent risk to the lifetime of the affected person, any contra-indications should not considered. Indications to haemotransfusion are following:

а) acute anemia (hemorrhagic shock) within the case of a lower within the stage of haemoglobin by 1/4 and a lower in ABP decrease than 80 mmHg. In pediatric observe the next calculation is utilized: the physique weight in kg is multiplied by 25 ml and by the models which doesn’t suffice as much as 10 g% of haemoglobin;

bringing a affected person out of traumatic shock and through giant operations with the aim of preventing towards postoperative shock;

detoxication after poisonings and bacterial insemination, with the aim of immuno-stimulation;

homeostasis disturbances as a result of haemotransfusion corrects the disturbances of water-electrolytic metabolism;

performing homeostasis with the presence of bleeding: the perfect factor on this state of affairs is direct haemotransfusion or fresh-citrate blood introduction;

transfusion of blood and its parts (plasma) after the exhaustion of the organism with the aim of vitamin. Contraindications to haemotransfusion are the next:

а) acute infringement of the liver, kidneys or coronary heart capabilities; inflammatory ailments of the vessels (thrombophlebitis, phlebitis, embolism); allergic circumstances; energetic tuberculosis processes and likewise inflammatory ailments of the lung tissue.

Because it was already marked, all these contra-indications turn out to be relative in instances of acute anemia. Actually, the chance grows; due to this fact it’s potential to use sure blood parts, abrupt transfusion, it’s needed to regulate the pace and amount of blood which is to be given.

METHODS AND TECHNIQUE OF HAEMOTRANSFUSION

Direct, oblique, reverse, change and extra-corporate strategies of haemotransfusion are distinguished.

Direct transfusion is the direct use of the donor’s blood, which is immidiately entered to the affected person avoiding of the preservation stage. Such blood is probably the most priceless, however thus there’s the hazard of infecting the affected person with donor’s ailments about which he couldn’t know himself. A lot of gadgets (Beck’s, Juvalier’s), in addition to syringes are utilized for direct transfusion. The blood switch from the donor to the recipient happens below sterile circumstances.

Oblique methodology: the blood is taken from the donor, combined with a preservative, stored below sure circumstances and after 5–10 days is prepared for transfusion. Single-use techniques, which include a set of tubules and filters, are utilized for oblique transfusions. The system incorporates a manometer and gas-cylinder, which permits the creation of strain (180–200 mmHg) for intra-arterial haemotransfusion.

Trade transfusion, or reinfusion — using blood which was taken from a cavity. In impact that is autotransfusion. Blood with out clots and completely different admixtures is without delay put again into the circulatory system of the affected person. Throughout reinfusion, the blood is filtered via filters and sterile gauze linings; a small quantity of heparin is added. Technically it’s carried out like oblique transfusion. Trade transfusion is utilized throughout acute poisonings (arsenic, mushrooms, carbonic oxide, lead, mercury and different poison). Bloodletting is carried out after which the identical quantity of donor blood is given.

Thus, a system of method to haemotransfusion was established. Earlier than haemotransfusion, the physician ought to use numerous actions:

To find out the indications for haemotransfusion — the aim of transfusion.

To estimate potential contra-indications, choose the strategies ofblood introduction, decide its quantity and pace.

To outline the blood group and Rh-factor of the recipient andthe donor.

To comprehend the direct checks for compatibility, to estimate beforehand the eligibility of blood for transfusion.

To make checks for Rh-compatibility.

To verify the organic compatibility of blood by jet (thrice) introducin of 15–20 ml of blood with intervals of three min.

The particular documentation or particular report of haemotransfusion are crammed in throughout haemotransfusion. For the management of potential issues measuring of the physique temperature in the course of the first 2 h and urine evaluation inside the first day are carried out.

Continuing from numerous indications, it’s potential to use such strategies of coming into blood: intravenous, intraarterial, intraosseous, via cavernous our bodies.

Scientific observe testifies that not at all times it’s essential to transfuse the entire blood. Continuously, a few of its parts are used and typically constituents — preparations of blood that are ready with particular applied sciences.

Blood parts are ready with the assistance of differential centrifugation of the entire blood. Erythromass (erythrocitic suspension, washed erythrocytes), leukomass, thrombomass, and native plasma are blood parts. Erythromass is a preserved blood, from which plasma is eliminated; it’s expedient for anemia. Washed erythrocytes are erythromass the place plasma is totally absent. Erythrocytic suspension is the blood which is disadvantaged of plasma, which is changed with a physiological answer with the addition of chloramphenicolum, rivanol and glucose. Leukocytic-thrombocytic mass obtained after the centrifugation of blood and leukocytes and thrombocytes are separated.

It’s essential to do not forget that all preparations which include erythrocytes are entered into an individual’s organism similar to preserved blood — observing the principles of transfusion and strategy of transfusion. They’re the identical as for preserved blood. Leukocytic-thrombocytic mass is entered with out observing the group sort, utilized 24–72 h from the second of preservation, entered intramuscularly. Native plasma is a fluid a part of the blood with out corpuscular parts. It’s obtained after centrifugation of preserved blood. It’s stored similar to blood, however not more than for 72 h. It’s entered with observing the group sort. Methods of coming into are the identical as for preserved blood.

As we speak, strategies of preserving plasma by freezing or drying have been developed. Dry plasma is stored for 3–6 years. Earlier than software, they dilute it with physiological answer or distilled water. They enter it into an organism the identical approach like blood. Just lately, particular sorts of plasma (antihemophilic, antistaphylococcus, anti-blue-pus) which can be obtained after immunization of donors with weakened toxins — anatoxins of corresponding activators, are extensively used.

Preparations of blood are manufactured from blood plasma. Based on the motion they belong to haemocorrectors (fibrinogen, cryoprecipitate, antihemophilic globulin, fibrinosin, and thrombin) or preparations of complicated motion.

Fibrinogen is excreted from plasma, put into bottles by 1 g and it has no group specificity. Earlier than making use of, it’s diluted with distilled water or a physiological answer, entered intravenously. Fibrinogen is used for getting ready the next medicines of native motion: fibrin movie, organic antiseptic tampon, haemostatic sponge.

Fibrinolysin — an enzyme extracted from plasma, has the property to dissolve blood clots. Correctors of the coagulation system of the blood, equivalent to thrombin, fibrin movie, haemostatic sponge are utilized somewhat extensively to cease bleeding by software.

Albumen, protein, serum, particular immunoglobulin belong to preparations of complicated motion.

Albumen and protein are allotted from plasma as 10% or 25% options, they haven’t any specificity. They’re entered intravenously, extensively utilized for treating numerous intoxications.

Serum is plasma which doesn’t include fibrinogen. Serum is preserved and entered similar to native plasma. Generally calcium, nutritional vitamins, spirit are added.

Particular immunoglobulins (anti-staphylococcus, anti-tetanic, antiinfluenzal, anti-blue-pus) are allotted from plasma of people that had corresponding ailments or have been immunized with weakened toxins. Immunoglobulins haven’t any group specificity, entered intramuscularly.

Blood Substitutes

A few of blood capabilities may be changed with numerous preparations which can be organic or chemical derivatives. Based on the mechanism of motion they’re divided into 4 teams:

Anti-shock (hemodynamical) blood substitutes perform thefunction of filling the circulatory system, restoring the traditional blood quantity which was disturbed on account of blood loss or shock. Low and average-molecular dextran (rheopolyglucin, polyglucin) and compounds of gelatin (gelatinolum, haemogel, plasmogel, and so forth.) belong to this group.

Desintoxication blood substitutes that are utilized in treatingintoxications of assorted genesis (poisoning, endotoxicoses of assorted origin, burn and radiation illness). Compounds of low-molecular polyvinylpyrolidone (haemodes, neohaemodes, periston, neocompensan) or polyvinyl spirit (polydesum) belong to this group.

Preparations for parenteral feeding that are utilized in treating protein insufficiency, and likewise for correcting vitamin in the course of the postoperative interval in sufferers with operations on gastrointestinal tract. Albuminous hydrolysate (casein hydrolysate, hydrolysin, aminocrovin, aminopeptide, amikin, aminosol, aminon), mixes of amino acids (polyamine, moriamin, aminofusin, vamin, friamin), fatty emulsions (lipofundin, intralipid, liposalve), and likewise saccharum and multinuclear spirits (glucose, sorbitol, fructose) belong to this group. Hydrolyzine, hydrolyzate casein, amynocrovin should not utilized now, as they trigger typically collateral reactions and are withdrawn from manufacturing.

Regulators of the water-salt metabolism are utilized for oligemia to extend osmotic strain for treating infringements within the water-electrolytic metabolism, for bettering rheologic properties of the blood. They’re utilized for various sorts of shock: dehydration, intoxication. Varied salt options: Ringer answer, isotonic answer of sodium chloride, trisaminum, lactosolum, disolum, trisolum, chlosolum, and so forth. belong to this group.

Ringer answer: sodium chloride — 8.0 g kalium chloride — 0.075 g calcium chloride — 0.1 g distilled water as much as 1 l Ringer—Lock answer: sodium chloride — 9.0 g sodium bicarbonate — 0.2 g kalium chloride — 0.2 g calcium chloride — 0.2 g glucose — 1 g bidistilled water as much as 1 l Lactasol: sodium chloride — 6.2 g sodium bicarbonate — 0.3 g kalium chloride — 0.3 g calcium chloride — 0.16 g magnesium chloride — 0.1 g sodium lactate — 0.3 g distilled water as much as 1 l

Just lately, blood substitutes with operate of transferring oxygen have been developed and improved medical utilization (hemoglobin emulsion), which is able to appreciably assist in the applying as a substitute of the entire blood within the close to future.

Issues throughout Haemotransfusion and Preventive Measures

Blood and its preparations, that are highly effective stimulators of important exercise of an organism, should not disadvantaged of some detrimental qualities and trigger severe issues. As a rule, the issues come up when below circumstances the principles of haemotransfusion are infringed. Generally underestimation within the situation of the affected person, violation of circumstances of blood preservation and transfusion approach are broken. So, disregard of the ailments from which the donor suffered prior to now, ignoring of numerous clinicalbiochemical investigations of the donor’s blood can result in an infection of the affected person with hepatites, malaria, syphilis, sepsis, AIDS and different infectious ailments.

Incorrect blood preservation, lack of sterility, deranged ratio of preservatives and blood can result in sepsis, thrombembolia. Infringement of the principles for the methods of haemotransfusion could cause irritation of the vascular partitions (phlebitis), air or thrombembolia. Ignoring the accompanying ailments can result in their exacerbation (nephritis, hepatites) or trigger cardiac exercise decompensation in affected person. Beneath lengthy preservation of blood, infringements of the preservation temperature can carry to haemolysis of erythrocytes, change within the protein construction, which is present in pyrogenic reactions. They are often gentle (rise within the physique temperature by 1°С), reasonable (by 1.5–2°С), extreme (larger than by 2°С). Normally these issues are noticed 10–15 min after the beginning of haemotransfusion (fever, ache within the again, faintness). Therapy is in immidiate stoppage of haemotransfusion, introduction of desensitized preparations (chloric calcium, dimedrol, pipolphenum), it’s essential to heat the affected person, to provide pyramidon, analginum. In case of elevated protein sensitivity of an organism and disrespect of organic take a look at there may be allergic reactions, itching, rash, hypostases, rise within the temperature, shortness of breath, and typically anaphylactic shock happens. Thus vomiting, harm in respiration, falling of the arterial strain, bronchospasm, oedema of the lungs could happen. With the presence of those signs transfusion is stopped, the affected person is given the talked about preparations and in a case of anaphylaxis — glucocorticoids, cardiac preparations; sufferers are administered synthetic respiration (equipment).

Probably the most troublesome complication is post-transfusion, or haemotransfusion shock which might come up on account of incompatibility of blood group or Rh-factor, and likewise after the introduction of a considerable amount of haemolyzed blood. Throughout transfusion of incompatible blood fever, faintness, ache within the chest, lower in arterial strain, rise in physique temperature, attributes of kidney irritation (albuminuria, hematuria, oliguria, and typically anuria), jaundice, renal-hepatic block which leads to demise, could develop. It’s essential to do not forget that within the pathogenesis of this complication consists of haemolysis of entered erythrocytes.

Generally this complication develops shortly or can typically seem on the 2nd–third day after haemotransfusion. It relies upon upon the doze of the entered blood. If the affected person was below narcosis or used desensitized preparations, the event of haemotransfusion shock can take a very long time. In case of the incidence of this complication, haemotransfusion ought to be stopped; the affected person is given a big quantity of liquid, desensitized preparations, and pararenal blockade is carried out. Haemodialysis, typically bloodletting and transfusion of the identical group of blood are performed.

If the Rh-factor was decided incorrectly or the take a look at for Rhcompatibility was not performed, Rh-conflict can happen. In newborns this complication is known as haemolytic jaundice, typically it’s known as haemolytic shock. The idea of its growth is the battle of the Rh-factor with the Rh-factor — antibody, thus haemolysis of the erythrocytes of the affected person and the donor happens. The medical image develops somewhat shortly and is much like the medical image of haemotransfusion of one other group. Profitable remedy consists in change haemotransfusion, i.e. bloodletting with the next injection of Rh-negative blood which doesn’t include antibodies.

Energetic alternative of the misplaced blood can result in such issues as citrate intoxication and homologous blood syndrome. Citrate intoxication develops when a big quantity of preserved blood is entered at one time. Hypotension, tachycardia, spasms are discovered. The reason being in intoxication of an organism by sodium citrate. For prevention of this complication, for each 500 ml of preserved blood 10 ml of a ten% answer of calcium chloride are entered. Throughout liquidation of enormous blood loss it’s needed to make use of heparinized blood or direct haemotransfusion.

The homologous blood syndrome develops if for some time frame (days, weeks) a big quantity of blood for liquidation of anemia and blood loss alternative. The idea of this syndrome is the event of incompatibility between leukocytic and thrombocytic antigens. The clinic is thrombocytopenia, leukopenia, the event of DVS-syndrome in numerous organs and techniques of an organism. DVS is a syndrome which is characterised by the event of thromboses towards a background of bleedings and relying upon the place of incidence give the medical image of acute renal, hepatic or lung insufficiency (bulked lung) or sharp infringement of blood circulation within the vessels of the mind (haemorrhage with cerebral ischemia) are discovered. The homologous blood syndrome is the rationale for top lethality. For prevention of its growth throughout liquidation of enormous blood loss, washed erythrocytes must be used for anemia as a substitute of preserved blood. Thus, blood carries out an important operate in an individual’s organism and can be utilized for treating many ailments. Scientific effectivity of haemotransfusion is mostly acknowledged. haemotransfusion had a protracted interval of research of blood properties, mechanisms of motion in an organism. It ought to be utilized in surgical observe all over the place, however it’s needed to stick to indications and contraindications of haemotransfusion and to exactly perform the principles of strategy of haemotransfusion.