Emergency care for transfusion complications. Complications during blood transfusion, (hemotransfusion shock, pyrogenic and allergic reactions). Principles of treatment of transfusion shock

Blood transfusion is a safe method of therapy under certain conditions, violation of them provokes complications and post-transfusion reactions. The following errors lead to them: non-compliance with the rules of blood preservation, incorrect determination of the blood group, incorrect technique, disregard for contraindications to transfusion. Thus, in order to prevent complications and reactions during blood transfusion, a certain set of rules should be strictly followed.

Indications for blood transfusion

Indications for this manipulation are determined by the goal to be achieved: increasing the activity of blood coagulation in case of its loss, replenishing the missing. Vital indications include:

• acute bleeding;
• severe anemia;
• traumatic surgery.

Other indications include:

• intoxication;
• blood pathology;
• purulent-inflammatory processes.

Contraindications

Among the contraindications are the following ailments:

• septic endocarditis;
• hypertension of the third stage;
• pulmonary edema;
• glomerulonephritis in acute form;
• violation of cardiac activity;
• general amyloidosis;
• bronchial asthma;
• violation of cerebral circulation;
• allergy;
• severe renal failure;
• thromboembolic disease.

When analyzing contraindications, special attention should be paid to allergic and transfusiological history. However, with vital (absolute) indications for transfusion, blood is transfused, despite the presence of contraindications.

Transfusion procedure algorithm

In order to avoid errors and complications during blood transfusion, the following sequence of actions should be observed during this procedure:

• Preparing the patient for it consists in determining the blood group and Rh factor, as well as identifying contraindications.
• For two days take a general blood test.
• Immediately before the transfusion, the individual should urinate and have a bowel movement.
• Carry out the procedure on an empty stomach or after a poor breakfast.
• Choose the method of transfusion and transfusion medium.
• Determine the suitability of blood and its components. Check the expiration date, the integrity of the packaging, storage conditions.
• They make a determination of the blood group of the donor and recipient, which is called the control.
• Check for compatibility.
• If necessary, determine compatibility by Rh factor.
• Prepare a disposable system for transfusion.
• Transfusion is carried out, after the introduction of 20 ml, the transfusion is stopped and a sample is taken for biological compatibility.
• Watch for the transfusion.
• After the procedure is completed, an entry is made in the medical records.

Classification of complications in blood transfusion

According to the systematization developed by the Institute of Hematology and Blood Transfusion, all complications are divided into groups, depending on the factors that provoked them:

• transfusion of blood incompatible with the Rh factor and group;
• massive blood transfusions;
• errors in transfusion technique;
• transfer of infectious agents;
• post-transfusion metabolic disorders;
• transfusion of low-quality blood and its components.

Classification of post-transfusion complications

Among the post-transfusion complications associated with blood transfusion, the following are distinguished:

• Transfusion shock caused by inappropriate blood transfusion. This is a very dangerous complication and the severity is mild, moderate, severe. Of decisive importance is the rate of administration and the amount of transfused incompatible blood.
• Post-transfusion shock - occurs when a blood group is compatible with a transfusion.
• Transfer of infection along with the blood of a donor.
• Complications arising from errors made in the technique of blood transfusion.

Currently, the risk of developing hemotransfusion and posttransfusion shock is almost reduced to zero. This was achieved by the correct organization of the process during transfusion.

Symptoms of post-transfusion shock

Symptoms of complications after blood transfusion appear after the introduction of 30-50 ml. The clinical picture is as follows:

• tinnitus;
• pressure reduction;
• discomfort in the lumbar region;
• chest tightness;
• headache;
• dyspnea;
• severe pain in the abdomen and increasing pain in the lumbar spine;
• the patient cries out in pain;
• loss of consciousness with involuntary defecation and urination;
• cyanosis of the lips;
• frequent pulse;
• a sharp reddening, and further blanching of the face.

In rare cases, ten to twenty minutes after a blood transfusion, with a complication of this nature, a fatal outcome may occur. Often the pain subsides, the work of the heart improves, consciousness returns. In the next period of shock, there is:

• leukopenia, which is replaced by leukocytosis;
• jaundice is little expressed, may be absent;
• an increase in temperature to 40 and above degrees;
• hemoglobinemia;
• kidney dysfunction that progresses;
• oliguria is replaced by anuria, and in the absence of timely measures, death occurs.

This period is characterized by slowly emerging oliguria and pronounced changes in urine - the appearance of protein, an increase in specific gravity, a cylinder and erythrocytes. A mild degree of post-transfusion shock differs from the previous ones in a slow course and a rather late onset of symptoms.

Therapy at the first sign of transfusion shock

• cardiovascular - "Uabain", "Korglikon";
• "Norepinephrine" to increase pressure;
• antihistamines - "Suprastin" or "Diphenhydramine", from corticosteroids "Hydrocortisone" or "Prednisolone" is preferable.

The above means slow down the reaction rate of antigen-antibodies and stimulate vascular activity. The movement of blood through the vessels, as well as microcirculation, is restored with blood substitutes, saline solutions, and Reopoliglyukin.

With the help of drugs "Sodium lactate" or "Sodium bicarbonate" remove the products of destruction of red blood cells. Diuresis is supported by Furosemide, Mannitol. In order to relieve spasm of the renal vessels, a pararenal bilateral blockade with Novocaine is performed. In case of respiratory failure, the individual is connected to a ventilator.

In the absence of the effect of the ongoing pharmacotherapy of acute renal failure, as well as an increase in autointoxication (uremia), hemosorption (removal of toxic substances from the bloodstream), hemodialysis is indicated.

Bacterial toxic shock

Such a complication of blood transfusion and blood substitutes is quite rare. Its provocateur is the blood infected in the process of harvesting and storage. A complication appears during the transfusion period or thirty to sixty minutes after it. Symptoms:

• severe chills;
• a sharp jump in pressure down;
• excitation;
• temperature rise;
• loss of consciousness;
• thready pulse;
• incontinence of feces and urine.

The blood that did not have time to be transfused is sent for bacteriological examination, and when the diagnosis is confirmed, therapy is started. To do this, use drugs that have a detoxifying, anti-shock and antibacterial effect. In addition, cephalosporin and aminoglycoside antibacterial agents, blood substitutes, electrolytes, analgesics, detoxifiers, anticoagulants and vasoconstrictors are used.

Thromboembolism

Such a complication after a blood transfusion is provoked by blood clots that have come off from the affected vein as a result of a transfusion or blood clots that have arisen during its improper storage. Blood clots, clogging blood vessels, provoke a heart attack (ischemia) of the lung. The individual has:

• chest pain;
• a dry type of cough later turns into a wet one with the release of bloody sputum.

An x-ray shows focal inflammation of the lungs. When initial symptoms appear:

• the procedure is stopped;
• connect oxygen;
• administer cardiovascular drugs, fibrinolytics: "Streptokinase", "Fibrinolysin", anticoagulants "Heparin".

Massive blood transfusion

If for a short period (less than 24 hours) blood is poured in a volume of two or three liters, then such manipulation is called massive blood transfusion. In this case, blood from different donors is used, which, together with its long storage period, provokes the occurrence of massive blood transfusion syndrome. In addition, other reasons also influence the occurrence of such a serious complication during blood transfusion:

• ingestion of sodium nitrate and blood decay products in large quantities;
• negative impact of chilled blood;
• a large volume of fluid entering the bloodstream overloads the cardiovascular system.

Acute dilatation of the heart

Contributes to the emergence of such a condition is a fairly rapid flow of a large volume of canned blood with a jet injection or by pressurizing. Symptoms of this complication during blood transfusion are manifested:

• the appearance of pain in the right hypochondrium;
• cyanosis;
• shortness of breath;
• increase in heart rate;
• a decrease in arterial and an increase in venous pressure.

When the above symptoms appear, the procedure is stopped. Bloodletting is carried out in an amount of not more than 300 ml. Next, the introduction of medicines from the group of cardiac glycosides begins: "Strophanthin", "Korglikon", vasoconstrictor drugs and "Sodium chloride".

Potassium and nitrate intoxication

When transfusing canned blood, which has been stored for more than ten days, in a fairly large volume, potassium intoxication of a severe form may develop, leading to cardiac arrest. To prevent complications during blood transfusion, it is recommended to use the one that was stored for no more than five days, as well as to use red blood cells, washed and thawed.

The state of nitrate intoxication occurs during a massive transfusion. The dose of 0.3 g/kg is recognized as toxic. Severe poisoning develops as a result of the accumulation of sodium nitrate in the recipient and its entry into a chemical reaction with calcium ions in the blood. Intoxication is manifested by the following symptoms:

• low pressure;
• convulsions;
• increase in heart rate;
• arrhythmia;
• jitter.

In severe condition, the above symptoms are accompanied by swelling of the brain and lungs, dilated pupils are observed. Prevention of complications during blood transfusion is as follows. During the period of blood transfusion, it is necessary to inject a drug called "Calcium Chloride". For these purposes, a 5% solution is used at the rate of 5 ml of the drug for every 500 ml of blood.

Air embolism

This complication occurs when:

• violation of the technique of blood transfusion;
• incorrect filling of the medical device for transfusion, as a result, air is present in it;
• premature termination of a blood pressure transfusion.

Air bubbles, once in a vein, then penetrate into the right half of the heart muscle and then clog the trunk or branches of the pulmonary artery. The flow of two or three cubic centimeters of air into the vein is enough to cause an embolism. Clinical manifestations:

• pressure drops;
• shortness of breath appears;
• the upper half of the body becomes bluish;
• a sharp pain is felt in the sternum;
• there is a cough;
• increase in heart rate;
• there is fear and anxiety.

In most cases, the prognosis is poor. If these symptoms appear, you should stop the procedure and start resuscitation, including artificial respiration and the administration of medications.

homologous blood syndrome

With massive blood transfusion, the development of such a condition is possible. During the procedure, blood from different donors is used, compatible in group and Rh factor. Some recipients develop a complication in the form of a homologous blood syndrome due to individual intolerance to plasma proteins. It manifests itself with the following symptoms:

• shortness of breath;
• moist rales;
• cold to the touch dermis;
• pallor and even cyanosis of the skin;
• decrease in arterial and increase in venous pressure;
• weak and frequent heartbeats;
• pulmonary edema.

With an increase in the latter, the individual has moist rales and turbulent breathing. Hematocrit falls, compensation for blood loss from the outside cannot stop a sharp decrease in BCC in the body. In addition, the process of blood clotting is slowed down. The cause of the syndrome lies in microscopic thrombi, immobility of red blood cells, accumulation of blood and microcirculation failures. Prevention and treatment of complications during blood transfusion is reduced to the following manipulations:

• It is necessary to infuse donor blood and blood substitutes, i.e., carry out combined therapy. As a result, blood viscosity will decrease, and microcirculation and fluidity will improve.
• Compensate for the lack of blood and its components, taking into account the circulating volume.
• You should not try to completely replenish the level of hemoglobin during massive transfusion, since its content of about 80 g / l is quite enough to support the transport function of oxygen. The missing volume of blood is recommended to be filled with blood substitutes.
• To transfuse the individual with absolutely compatible transfusion media, washed and thawed red blood cells.

Infectious complications during blood transfusion

During transfusion, various pathogens of infectious diseases can be transferred along with the blood. Often this phenomenon is associated with the imperfection of laboratory methods and the latent course of the existing pathology. The greatest danger is viral hepatitis, which an individual becomes ill in two to four months after transfusion. The transmission of cytomegalovirus infection occurs along with the white blood cells of the peripheral blood, so that this does not happen, special filters must be used that will delay them, and only platelets and erythrocytes will be transfused.

Such a measure will significantly reduce the risk of infection in the patient. In addition, a dangerous complication is HIV infection. Due to the fact that the period during which antibodies are formed is from 6 to 12 weeks, it is impossible to completely eliminate the risk of transmission of this infection. Thus, in order to exclude complications during the transfusion of blood and its components, this procedure should be performed exclusively for health reasons and with a comprehensive screening of donors for viral infections.

Hemotransfusion shock is a collective concept that combines a number of similar clinical conditions that occur in response to super-strong effects on the body of various factors, with hypotension, a critical decrease in blood flow in the tissues, the development of tissue hypoxia and hypothermia.

When transfusing blood, one should take into account the possible development of this severe condition.

Etiology

This transfusion complication appears due to a violation of the rules for the manipulation of blood or its components, errors in determining the blood group and the compatibility of the recipient's and donor's blood components.

The main factors leading to the development of a shock state are: the ABO antigenic system and the Rh factor system. There are also a huge number of other antigenic systems, but they rarely give such a complication.

Pathogenesis

Shock is a type II allergic reaction - cytotoxic. It develops immediately during the transfusion or after a certain time after the procedure.

The development of hemolysis inside the vessels during blood infusion is possible if the erythrocytes begin to break down when they are incompatible with the antigenic profile of the recipient's plasma.

The basis for the development of a state of shock is the breakdown of erythrocytes. This process leads to the release of specific substances that provoke vasospasm, and then their pathological expansion. The permeability of the vascular wall increases, which leads to the release of plasma into the tissues and thickening of the blood.

The release into the blood of a large number of substances that contribute to the formation of blood clots leads to the development of DIC. Its pathogenesis is characterized by an initial increase in blood clotting with the formation of many small blood clots.

After consumption, when the blood can no longer clot, massive bleeding occurs. There is a violation of blood flow in small vessels, which leads to an insufficient supply of oxygen to the internal organs, and, consequently, to their damage.

All organs are affected, including the kidneys. In their glomeruli, hemoglobin decay products accumulate, which leads to a drop in the rate of blood filling and the development of kidney failure.

shock clinic

There are 3 stages that appear with incompatibility:

1. Actually a shock.
2. Pathology from the side of the kidneys, which is expressed by acute insufficiency.
3. Recovery period.

The state of shock can last from several minutes to a couple of hours. A clear relationship can be traced between the appearance of symptoms of hemotransfusion shock and the transfusion

The patient's condition is initially characterized by a feeling of anxiety, unreasonable excitement, pain in the chest, abdominal and lumbar pain, chills, respiratory failure, blue skin.

Low back pain is one of the most characteristic features of the development of this complication. Subsequently, vascular disorders begin to appear.

Typical symptoms:

1. Tachycardia.
2. A sharp drop in blood pressure.
3. The appearance of signs of acute heart failure.

A frequent manifestation is a change in the skin of the patient's face (redness, which is replaced by pallor), skin spotting, dyspeptic disorders, fever, inability to control urination.

Symptoms of hemotransfusion shock - which develops inside the vessels, and. Its manifestations:

• Free hemoglobin to blood.
• Hemoglobin in the urine.
• Hyperbilirubinemia.
• Jaundice.
• Hepatomegaly.
• The color of the urine changes: a brownish tint appears (urinalysis shows proteinuria and altered red blood cells).

As a result of hemolysis and the development of DIC, a violation of the blood coagulation system occurs, which is expressed by increased bleeding and the occurrence of hemorrhagic diathesis.

With the infusion of blood during surgical interventions performed using general anesthesia, the symptoms may be erased. Surgeons may notice abnormal bleeding from the wound and urine the color of meat slops.

Anesthesiologists focus on the sharp drop in blood pressure. The duration and severity of pathological processes depends on the number of injected incompatible red blood cells, the characteristics of the pathological process in the patient and his well-being before transfusion.

Degrees

There are 3 degrees of shock, the definition of which is based on systolic pressure:

• I st. - SBP above 90 mm Hg. Art.
• II Art. - SBP is between 71 and 90 mm Hg. Art.
• III Art. - SBP below 70 mm Hg. Art.

The possible outcome of shock is directly proportional to the course and duration of the reduced pressure. Most often, anti-shock measures allow you to reverse changes in the vessels and prevent complications of this condition.

Associated features

After a while, fever, yellow color of the eyeballs, constant headaches are possible. This indicates the development of acute renal failure (ARF). It manifests itself in the form of three subsequent phases: oligo- or anuria, polyuria and the recovery phase.

Against the background of unchanged states of hemodynamics, there is a sharp decrease in the amount of urine excreted, initial signs of body watering are observed, and the level of creatinine, urea and potassium in plasma increases (oliguria phase).

After some time, recovery of diuresis is observed. Despite this, a high content of trace elements in the blood may persist (polyuria phase). In the future, with a favorable outcome, the filtration capacity of the kidneys is restored.

This pathological state ends with the restoration of all pathological processes in the body (the period of convalescence).

Transfusion shock is a condition that requires emergency care. The algorithm of actions in this situation can be represented as follows:

• Removal of the patient from a state of shock.
• Measures to prevent pathological changes in important organs and their correction.
• Relief of developing DIC.
• Prevention of the development of acute renal failure.

If adverse symptoms appear, the first action of a nurse or doctor is to stop the transfusion procedure and replace the system with salt solutions.

The most important factor is time: the faster medical interventions are performed, the better the prognosis for the patient.

Infusion therapy

All shock treatment regimens begin with infusions.

First of all, it is necessary to replenish the volume of circulating blood (BCC) and restore the hemostatic function (dextrans with a molecular weight of 40-70 thousand units are used - reopoliglyukin, gelatinol).

An early infusion of a 4% solution of sodium bicarbonate or lactosol is also shown. Thus, compensation of metabolic acidification of the blood is ensured, synthesis of hematin hydrochloride does not occur.

Subsequently, crystalloids are infused (with a solution of 0.9% sodium chloride or Ringer's solution) to reduce the amount of free Hb and prevent the destruction of fibrinogen. The amount of infused drugs must necessarily be controlled by the volume of diuresis and pressure values.

Medical therapy

It is necessary to raise the patient's blood pressure, as well as to ensure normal renal blood flow. The triad of standard anti-shock drugs: prednisolone (a glucocorticosteroid to increase blood pressure), furosemide (a diuretic), and eufillin (a phosphodiesterase inhibitor). Antihistamines and opioid painkillers (fentanyl) are also used.

Efferent Methods

An effective method of anti-shock therapy is plasmapheresis - the removal of about 2 liters of plasma, followed by the infusion of fresh frozen plasma and colloidal solutions. Symptomatic correction of disorders of the internal organs.

If necessary, prescribe means that stimulate the activity of important body systems. With the appearance of symptoms characteristic of a decrease in the respiratory function of the lungs, it is possible to transfer the patient to a ventilator. In severe anemia (hemoglobin concentration less than 70 g / l), it is possible to transfuse washed erythrocytes that are compatible in terms of blood type with the patient's erythrocytes.

Correction of the hemostasis system

Anticoagulants are used, fresh frozen plasma is transfused, and antienzymatic drugs (gordox) are used to inhibit fibrinolysis.

Since the development of acute renal failure is possible in the future, the treatment of hemotransfusion shock is also aimed at correcting the functional state of the kidneys. Apply furosemide, mannitol and make a correction with solutions of crystalloids.

If there is no effect, hemodialysis may be used.. During the recovery period, specific symptoms are treated.

Prevention

To avoid the development of shock during transfusion, you need to follow some rules (this is a kind of prevention):

• Before blood infusion, a detailed history should be taken, in which it is important to focus on previous transfusions or infusions.
• Follow all the rules for testing for compatibility (if there are errors or inaccuracies, repeat the procedure).

Indications for blood transfusion

In addition to the development of a state of shock, other complications associated with the infusion of blood components are also possible. It can be pyrogenic or allergic reactions, thrombosis or acute aneurysm. Therefore, it is important to be careful and apply only for certain indications.

Absolute readings:

1. Massive blood loss (more than 15% of BCC).
2. shock states.
3. Severe traumatic operations with heavy bleeding.

Relative readings:

1. anemia.
2. Severe intoxication.
3. Violation of the hemostasis system.

Contraindications

There are also a number of restrictions. Absolute contraindications:

• Acute heart failure.
• Myocardial infarction.

Relative contraindications:

• Heart defects.
• The presence of thrombi or emboli in the vascular circulation.
• Cerebral circulation disorders.
• Tuberculosis.
• Renal or liver failure.

It is important to know that if there are absolute indications, then the blood or its components are transfused in any case. Even if there are contraindications.

Conclusion

Blood transfusion shock is a serious and not the only complication that occurs during transfusions, therefore, even in an emergency, all necessary tests should be carefully carried out and the rules of blood transfusions should be observed.

If signs of transfusion shock are observed, it is important to start treatment as soon as possible, which will improve the prognosis for the patient.

Hemotransfusion shock manifests itself in the first minutes when blood of an incompatible group is introduced into the human body. This condition is characterized by an increase in heart rate, difficulty breathing, a drop in blood pressure, impaired activity of the cardiovascular system, loss of consciousness, and involuntary discharge of urine and feces.

Reasons for the development of post-transfusion shock

Transfusion shock occurs when incompatible blood is transfused, if the group, Rh factor or other isoserological signs have been determined incorrectly. Also, shock can be caused by a transfusion of compatible blood in cases where:

• insufficiently studied the patient's condition;
• the blood used for transfusion is of poor quality;
• there is an incompatibility between the proteins of the recipient and the donor.

Transfusion shock

In most cases, immediately after the patient's condition temporarily improves, but later there is a picture of serious damage to the kidneys and liver, which sometimes ends in death. Acute kidney dysfunction is accompanied by the appearance of a further decrease and complete cessation of urination. You can also observe the appearance of signs of intravascular hemolysis and acute renal dysfunction.

Depending on the level of pressure of the patient, there are three stages of post-transfusion shock:

• 1st - pressure up to 90 mm Hg. Art.;
• 2nd - up to 70 mm Hg. Art.;
• 3rd - below 70 mm Hg. Art.

The severity of the state of hemotransfusion shock and its consequences directly depend on the disease itself, on the patient's condition, his age, anesthesia and the amount of blood transfused.

With the development of transfusion shock in a patient, he needs the following emergency care:

1. The introduction of sympatholytic, cardiovascular and antihistamines, corticosteroids and inhalation of oxygen.
2. Transfusion of polyglucin, blood of a suitable group in a dosage of 250-500 ml or plasma in the same amount. The introduction of a 5% bicarbonate solution or a 11% solution in an amount of 200-250 ml.
3. Perirenal bilateral according to Vishnevsky A.V. (introduction of novocaine solution 0.25-0.5% in the amount of 60-100 ml).

In most cases, such anti-shock measures lead to an improvement in the patient's condition.

But the main anti-shock measure is exchange blood transfusion as the most effective therapeutic agent to prevent kidney damage at an early stage of complications. Exchange transfusion is performed only after a thorough examination of the donor and recipient. For this procedure, only fresh blood is used at a dosage of 1500-2000 ml.

Hemotransfusion shock in the acute stage requires immediate treatment. With the development of anuria with azotemia, the "artificial kidney" apparatus is currently being successfully used, with the help of which the patient's blood is purified from toxic products.

Blood transfusion is a safe method of therapy with careful observance of the rules. Violation of transfusion rules, underestimation of contraindications, errors in transfusion technique can lead to post-transfusion complications.

The nature and severity of complications are different. They may not be accompanied by serious violations of the functions of organs and systems and do not pose a danger to life. These include pyrogenic and mild allergic reactions. They develop shortly after transfusion and are expressed in an increase in body temperature, general malaise, weakness. Chills, headache, itching of the skin, swelling of certain parts of the body (Quincke's edema) may appear.

To share pyrogenic reactions accounts for half of all complications, they are mild, moderate and severe. With a mild degree, body temperature rises within 1 ° C, headache, muscle pain occur. Reactions of moderate severity are accompanied by chills, an increase in body temperature by 1.5-2 ° C, an increase in heart rate and respiration. In severe reactions, stunning chills are observed, body temperature rises by more than 2 ° C (40 ° C and above), severe headache, muscle and bone pain, shortness of breath, cyanosis of the lips, tachycardia are noted.

The cause of pyrogenic reactions are the decay products of plasma proteins and leukocytes of donor blood, the waste products of microbes.

When pyrogenic reactions appear, the patient should be warmed, covered with blankets and heating pads should be applied to the legs, hot tea should be given to drink, NSAIDs should be given. With reactions of mild and moderate severity, this is enough. In case of severe reactions, the patient is additionally prescribed NSAIDs in injections, 5-10 ml of a 10% calcium chloride solution is injected intravenously, and a dextrose solution is dripped. To prevent pyrogenic reactions in severe anemic patients, washed and thawed erythrocytes should be transfused.

allergic reactions- a consequence of the sensitization of the recipient's body to Ig, more often they occur with repeated transfusions. Clinical manifestations of an allergic reaction: fever, chills, general malaise, urticaria, shortness of breath, suffocation, nausea, vomiting. Antihistamines and desensitizing agents (diphenhydramine, chloropyramine, calcium chloride, glucocorticoids) are used for treatment, and vasotoninizing agents are used for symptoms of vascular insufficiency.

When transfusing antigenically incompatible blood, mainly according to the AB0 system and the Rh factor, transfusion shock. Its pathogenesis is based on rapidly advancing intravascular hemolysis of transfused blood. The main causes of blood incompatibility are errors in the actions of a doctor, violation of the rules of transfusion.

Depending on the level of reduction in SBP, there are three degrees of shock: I degree - up to 90 mm Hg; II degree - up to 80-70 mm Hg; III degree - below 70 mm Hg.

During hemotransfusion shock, periods are distinguished: 1) hemotransfusion shock itself; 2) the period of oliguria and anuria, which is characterized by a decrease in diuresis and the development of uremia; the duration of this period is 1.5-2 weeks; 3) diuresis recovery period - characterized by polyuria and a decrease in azotemia; its duration is 2-3 weeks; 4) recovery period; proceeds within 1-3 months (depending on the severity of renal failure).

Clinical symptoms of shock may occur at the start of the transfusion, after a transfusion of 10–30 ml of blood, at the end of the transfusion, or shortly thereafter. The patient shows anxiety, complains of pain and a feeling of tightness behind the sternum, pain in the lower back, muscles, sometimes chills. There is shortness of breath, difficulty breathing. The face is hyperemic, sometimes pale or cyanotic. Nausea, vomiting, involuntary urination and defecation are possible. The pulse is frequent, weak filling, blood pressure goes down. With a rapid increase in symptoms, death can occur.

When incompatible blood is transfused during surgery under anesthesia, the manifestations of shock are often absent or mild. In such cases, blood incompatibility is indicated by an increase or decrease in blood pressure, increased, sometimes significantly, bleeding of tissues in the surgical wound. When the patient is taken out of anesthesia, tachycardia, a decrease in blood pressure are noted, and acute respiratory failure is possible.

Clinical manifestations of hemotransfusion shock during transfusion of blood incompatible with the Rh factor develop 30-40 minutes later, and sometimes several hours after the transfusion, when a large amount of blood has already been transfused. This complication is difficult.

When removing the patient from shock, acute renal failure may develop. In the first days, a decrease in diuresis (oliguria), a low relative density of urine, and an increase in uremia are noted. With the progression of acute renal failure, there may be a complete cessation of urination (anuria). The content of residual nitrogen and urea, bilirubin increases in the blood. The duration of this period in severe cases lasts up to 8-15 and even up to 30 days. With a favorable course of renal failure, diuresis is gradually restored and a period of recovery begins. With the development of uremia, patients may die on the 13-15th day.

At the first signs of transfusion shock, blood transfusion should be immediately stopped and, without waiting for the cause of incompatibility to be clarified, intensive therapy should be started.

1. Strofantin-K, lily of the valley glycoside are used as cardiovascular agents, norepinephrine is used for low blood pressure, diphenhydramine, chloropyramine or promethazine are used as antihistamines, glucocorticoids (50-150 mg of prednisolone or 250 mg of hydrocortisone) are administered to stimulate the vascular activity and slowing down the antigen-antibody reaction.

2. To restore hemodynamics, microcirculation, blood-substituting fluids are used: dextran [cf. they say weight 30,000-40,000], saline solutions.

3. In order to remove hemolysis products, Povidone + Sodium chloride + Potassium chloride + Calcium chloride + Magnesium chloride + Sodium bicarbonate, bicarbonate or sodium lactate is administered.

4. Furosemide, mannitol are used to maintain diuresis.

5. Urgently carry out a bilateral lumbar procaine blockade to relieve spasm of the renal vessels.

6. Patients are given humidified oxygen for breathing, and in case of respiratory failure, mechanical ventilation is performed.

7. In the treatment of transfusion shock, early plasma exchange is indicated with the removal of 1500-2000 ml of plasma and its replacement with fresh frozen plasma.

8. The ineffectiveness of drug therapy for acute renal failure, the progression of uremia serve as indications for hemodialysis, hemosorption, plasmapheresis.

If shock occurs, resuscitation is carried out in the institution where it happened. Treatment of renal failure is carried out in special departments for extrarenal blood purification.

Bacterial toxic shock observed extremely rarely. It is caused by infection of the blood during harvesting or storage. The complication occurs directly during transfusion or 30-60 minutes after it. Immediately appear shaking chills, high body temperature, agitation, blackout of consciousness, frequent thready pulse, a sharp decrease in blood pressure, involuntary urination and defecation.

To confirm the diagnosis, bacteriological examination of the blood left after transfusion is of great importance.

Treatment involves the immediate use of anti-shock, detoxification and antibacterial therapy, including painkillers and vasoconstrictors (phenylephrine, norepinephrine), blood-substituting fluids of rheological and detoxification action (dextran [average molecular weight 30,000-40,000], Povidone + Sodium chloride + Potassium chloride + Calcium chloride + Magnesium chloride + Sodium bicarbonate), electrolyte solutions, anticoagulants, broad-spectrum antibiotics (aminoglycosides, cephalosporins).

The most effective is the early addition of complex therapy with exchange transfusions.

Air embolism can occur when transfusion technique is violated - improper filling of the transfusion system (air remains in it), untimely cessation of blood transfusion under pressure. In such cases, air can enter the vein, then into the right half of the heart and then into the pulmonary artery, blocking its trunk or branches. For the development of an air embolism, a single-stage entry of 2-3 cm 3 of air into a vein is sufficient. Clinical signs of air embolism of the pulmonary artery are severe chest pain, shortness of breath, severe cough, cyanosis of the upper half of the body, weak frequent pulse, and a drop in blood pressure. Patients are restless, grabbing their chests with their hands, experiencing a feeling of fear. The outcome is often unfavorable. At the first signs of embolism, it is necessary to stop the blood transfusion and start resuscitation measures: artificial respiration, the introduction of cardiovascular agents.

Thromboembolism when blood is transfused, it occurs as a result of embolism with blood clots formed during its storage, or blood clots that have come off from a thrombosed vein when blood is poured into it. The complication proceeds as an air embolism. Small blood clots clog small branches of the pulmonary artery, a lung infarction develops (chest pain; cough, initially dry, then with bloody sputum; fever). X-ray examination determines the picture of focal pneumonia.

At the first signs of thromboembolism, immediately stop the blood infusion, use cardiovascular agents, inhalation of oxygen, infusions of fibrinolysin [human], streptokinase, sodium heparin.

Massive blood transfusion is considered a transfusion, in which for a short period of time (up to 24 hours) donor blood is introduced into the bloodstream in an amount exceeding 40-50% of the BCC (usually 2-3 liters of blood). When transfusing such an amount of blood (especially long-term storage), received from different donors, it is possible to develop a complex symptom complex called syndrome of massive blood transfusion. The main factors determining its development are the effect of chilled (refrigerated) blood, the intake of large doses of sodium citrate and blood decay products (potassium, ammonia, etc.) that accumulate in the plasma during its storage, as well as a massive intake of fluid into the bloodstream, which leads to an overload of the cardiovascular system.

Acute dilatation of the heart develops when large doses of canned blood quickly enter the patient's blood during its jet transfusion or injection under pressure. There are shortness of breath, cyanosis, complaints of pain in the right hypochondrium, frequent small arrhythmic pulse, lowering blood pressure and increasing CVP. If there are signs of cardiac overload, the infusion should be stopped, bloodletting (200-300 ml) should be performed and cardiac (strophanthin-K, lily of the valley glycoside) and vasoconstrictors, 10% calcium chloride solution (10 ml) should be administered.

Citrate intoxication develops with massive blood transfusion. The toxic dose of sodium citrate is considered to be 0.3 g/kg. Sodium citrate binds calcium ions in the recipient's blood, hypocalcemia develops, which, along with the accumulation of citrate in the blood, leads to severe intoxication, the symptoms of which are tremor, convulsions, increased heart rate, lowering blood pressure, and arrhythmia. In severe cases, pupillary dilatation, pulmonary and brain edema join. To prevent citrate intoxication, it is necessary to inject 5 ml of a 10% solution of calcium chloride or a solution of calcium gluconate during blood transfusion for every 500 ml of preserved blood.

Due to the transfusion of large doses of canned blood with a long shelf life (more than 10 days), severe potassium intoxication, which leads to ventricular fibrillation, and then to cardiac arrest. Hyperkalemia is manifested by bradycardia, arrhythmia, myocardial atony, and an excess of potassium is detected in a blood test. Prevention of potassium intoxication is the transfusion of blood of short periods of storage (3-5 days), the use of washed and thawed erythrocytes. For therapeutic purposes, infusions of 10% calcium chloride, isotonic sodium chloride solution, 40% dextrose solution with insulin, cardiac preparations are used.

With massive blood transfusion, in which blood is transfused that is compatible in group and Rh-affiliation from many donors, due to individual incompatibility of plasma proteins, a serious complication may develop - homologous blood syndrome. Clinical signs of this syndrome are pallor of the skin with a bluish tinge, frequent weak pulse. Blood pressure is lowered, CVP is increased, multiple small bubbling wet rales are determined in the lungs. Pulmonary edema may increase, which is expressed in the appearance of coarse bubbling wet rales, bubbling breathing. There is a drop in hematocrit and a sharp decrease in BCC, despite adequate or excessive compensation for blood loss; slowing blood clotting time. The syndrome is based on microcirculation disorders, erythrocyte stasis, microthrombosis, and blood deposition.

Prevention of the syndrome of homologous blood provides for the replacement of blood loss, taking into account the BCC and its components. The combination of donor blood and blood-substituting fluids of hemodynamic (anti-shock) action (dextran [average molecular weight 50,000-70,000], dextran [average molecular weight 30,000-40,000]) is very important, improving the rheological properties of blood (its fluidity ) due to dilution of shaped elements, reduction of viscosity, improvement of microcirculation.

If a massive transfusion is necessary, one should not strive for a complete replenishment of the hemoglobin concentration. To maintain the transport function of oxygen, a level of 75-80 g / l is sufficient. The missing BCC should be replenished with blood-substituting fluids. An important place in the prevention of homologous blood syndrome is occupied by autotransfusion of blood or plasma, i.e. transfusion to the patient of an absolutely compatible transfusion medium, as well as thawed and washed erythrocytes.

infectious complications. These include the transmission of acute infectious diseases with blood (flu, measles, typhoid, brucellosis, toxoplasmosis, etc.), as well as the transmission of diseases spread by the serum route (hepatitis B and C, AIDS, cytomegalovirus infection, malaria, etc.).

Prevention of such complications comes down to a careful selection of donors, sanitary and educational work among donors, a clear organization of the work of blood transfusion stations, donor centers.

Transfusion shock is the result of errors made by medical personnel when transfusing blood or its components. Transfusion from the Latin transfusio - transfusion. Hemo - blood. So blood transfusion is a blood transfusion.

The procedure of transfusion (blood transfusion) is performed only in a hospital by trained doctors (in large centers there is a separate doctor - a transfusiologist). The preparation and conduct of the transfusion procedure requires a separate explanation.

In this article, we will focus only on the consequences of the mistakes made. It is believed that blood transfusion complications in the form of blood transfusion shock in 60 percent of cases occur precisely because of an error.

Transfusion shock is a consequence of immune and non-immune causes.

Immune causes include:

• Incompatibility of blood plasma;
• Incompatibility of the group and the Rh factor.

Non-immune causes are as follows:

• The entry into the blood of substances that increase body temperature;
• Transfusion of infected blood;
• Disruptions in blood circulation;
• Non-compliance with the rules of transfusion.

For reference. The main and most common cause of this complication is non-compliance with the technique of blood transfusion. The most common medical errors are incorrect blood typing and violations during compatibility tests.

How transfusion shock develops

Hemotransfusion shock is one of the most life-threatening condition of the victim, which manifests itself during or after blood transfusion.

After incompatible donor blood enters the recipient's body, an irreversible process of hemolysis begins, which manifests itself in the form of destruction of red blood cells - erythrocytes.

Ultimately, this leads to the appearance of free hemoglobin, resulting in impaired circulation, thrombohemorrhagic syndrome is observed, and the level of blood pressure is significantly reduced. Multiple dysfunctions of internal organs and oxygen starvation develop.

For reference. In a state of shock, the number of hemolysis components increases, which cause a pronounced spasm of the walls of blood vessels, and also cause an increase in the permeability of the vascular walls. Then the spasm turns into paretic expansion. Such a difference in the states of the circulatory system is the main cause of the development of hypoxia.

In the kidneys, the concentration of decay products of free hemoglobin and formed elements increases, which, together with the contraction of the walls of blood vessels, leads to the ontogenesis of renal failure.

As an indicator of the degree of shock, the level of blood pressure is used, which begins to fall as shock develops. It is believed that during the development of shock there are three degrees:

• first. Mild degree, at which the pressure drops to the level of 81 - 90 mm. rt. Art.
• second. The average degree at which the indicators reach 71 - 80 mm.
• third. Severe degree, in which the pressure drops below 70 mm.

The manifestation of a blood transfusion complication can also be divided into the following stages:

• The onset of a shock post-transfusion state;
• The occurrence of acute renal failure;
• Stabilization of the patient's condition.

Symptoms

• Short-term emotional arousal;
• Difficulty breathing, shortness of breath;
• The manifestation of cyanosis in the skin and mucous membranes;
• Fever due to chill;
• Muscular, lumbar and chest pains.

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Spasms in the lower back primarily signal the beginning of transformations in the kidneys. Ongoing changes in blood circulation are manifested in the form of a noticeable arrhythmia, blanching of the skin, sweating and a steady decrease in blood pressure levels.

If, at the first symptoms of hemotransfusion shock, the patient was not provided with medical assistance, then the following symptoms occur:

• Due to the uncontrolled growth of free hemoglobin, signs of hemolytic jaundice are born, characterized by yellowing of the skin and whites of the eyes;
• Actually, hemoglobinemia;
• The occurrence of acute renal failure.

Not so often, experts noticed the manifestation of such signs of hemotransfusion shock as hyperthermia, vomiting, numbness, uncontrolled muscle contraction in the limbs and involuntary bowel movements.

If a blood transfusion is performed to a recipient who is under anesthesia, then hemotransfusion shock is diagnosed by the following signs:

• Decreased blood pressure;
• Uncontrolled bleeding in the operated wound;
• Dark brown flakes are seen in the urinary catheter.

Important! The patient, who is under the influence of anesthesia, cannot report his state of health, therefore, the responsibility for the timely diagnosis of shock lies entirely with the medical staff.

First aid for shock

In order to avoid the development of oxygen starvation, it is necessary to adjust the supply of humidified oxygen using a mask. The doctor should begin monitoring the volume of urine formed, and also urgently call laboratory assistants to take blood and urine for an early complete analysis, as a result of which the values ​​\u200b\u200bof the content will be known. erythrocytes , free hemoglobin, fibrinogen.

For reference. If there are no reagents in the laboratory at the time of diagnosing post-transfusion shock to establish compatibility, then the proven Baxter method, which has been used in field hospital settings, can be used. It is necessary to inject 75 ml of donor material into the victim, and after 10 minutes to take blood from any other vein.

The test tube must be placed in a centrifuge, which, using centrifugal force, will separate the material into plasma and shaped elements. When incompatible, the plasma acquires a pink tint, while in the normal state it is a colorless liquid.

It is also desirable to immediately measure the central venous pressure, acid-base balance and electrolyte levels, as well as conduct electrocardiography.

Prompt anti-shock measures in most cases lead to an improvement in the patient's condition.

Treatment

Once the emergency response to shock has been taken, there is an urgent need to restore the main blood indicators.