Necessary studies after blood transfusion appointment. Components and composition. Indications and contraindications for blood transfusion in oncology

At this stage, the composition of the infusion is selected. It can be the blood itself, and its components - leukocytes or platelets. It all depends on what the procedure is for. Only a doctor can determine the composition to be administered. So, with anemia, leukopenia and blood clotting disorders, it was the blood components that proved their effectiveness. Even a small amount of such a composition will help solve the existing problem.

Transfusion of blood and its components helps to get rid of serious pathologies, and sometimes it can save a person's life. However, in order to eliminate all dangerous consequences, the procedure should be performed only by a professional after a thorough examination of the patient.

Blood transfusion is a difficult process. It requires strict adherence to established rules, the violation of which often has extremely serious consequences for the patient's life. It is important that medical personnel have the necessary qualifications for this procedure.

Acute blood loss is considered one of the most common causes of mortality. It does not always require a blood transfusion, but it is she who is the main indication for the procedure. It is important to understand that blood transfusion is a responsible manipulation, so the reasons for its implementation must be compelling. If there is a possibility of avoiding it, then doctors will often take such a step.

Giving a blood transfusion to another person depends on the expected results. They may mean replenishing its volume, improving its coagulability, or compensating the body for chronic blood loss. Among the indications for blood transfusion, it should be noted:

• acute blood loss;
• prolonged bleeding, including major surgery;
• severe form of anemia;
• hematological processes.

Types of blood transfusions

Blood transfusion is also called blood transfusion. The most commonly used drugs are erythrocyte, platelet and leukocyte masses, fresh frozen plasma. The first is used to replenish the number of red blood cells and hemoglobin. Plasma is needed to reduce blood loss, treat shock conditions.

It is important to understand that the effect is not always long-lasting, since additional therapy is necessary, especially when a pronounced decrease in circulating blood volume is determined.

What kind of blood to transfuse

Blood transfusion involves the use of such drugs:

• whole blood;
• erythrocyte, leukocyte and platelet masses;
• fresh frozen plasma;
• clotting factors.

The whole one is rarely used due to the fact that it usually requires a large amount of administration. There is also a high risk of transfusion complications. More often than others, a mass depleted of leukocytes is used due to the large number of conditions with a reduced amount of hemoglobin and red blood cells, which indicates blood loss or anemia. The choice of drug is always determined by the disease and condition of the recipient.

For a successful blood transfusion operation, complete compatibility of the blood of the donor and recipient in all factors is necessary. It must match the group, Rh, tests for individual compatibility are also carried out.

Who can't be a donor

WHO statistics claim that blood transfusion is necessary for every third inhabitant of the Earth. This leads to the fact that the need for donor blood is high. With transfusions, the basic requirements for blood transfusion must be strictly observed. Therefore, there are certain requirements for donors. Any adult who must undergo a medical examination can become one.

It is free and includes:

• blood and urine analysis;
• determination of the donor's blood group;
• biochemical examination;
• detection of viral processes - hepatitis, HIV, as well as sexually transmitted diseases.

blood transfusion procedure

The rules of blood transfusion state that manipulation is an operation, although no incisions are made on the patient's skin. The order of the procedure implies its implementation exclusively in a hospital setting. This allows doctors to quickly respond to possible reactions and complications on the introduction of blood.

Before transfusion, the recipient must be examined to establish the presence of various pathologies, diseases of the kidneys, liver, and other internal organs, the state of coagulation factors, and the presence of dysfunctions in the hemostasis system. If the doctor is dealing with a newborn baby, it is necessary to determine the presence of hemolytic disease of the newborn.

It is also important what caused the appointment of the manipulation - whether the need arose as a result of an injury or due to severe organic pathological processes. Violation of the technique of the procedure can cost the patient his life.

Depending on the purpose, the following types of transfusions are distinguished:

• intravenous;
• exchange;
• autohemotransfusion, or autohemotherapy.

During blood transfusion, the condition of the recipient should be carefully monitored.

Taking material

Procurement of blood products is carried out at special donor points or transfusion stations. Biological material is placed in special containers with a hazard symbol indicating the presence of substances inside that can lead to various diseases when in contact with it.

Further, the material is re-tested for the presence of contagious processes, after which such media and preparations as erythrocyte mass, albumins and others are made from it. Freezing of blood plasma is carried out in special freezers, where the temperature can reach -200C. It is important to understand that some components require special handling, some of them can be stored without processing for up to three hours.

Determination of group membership and compatibility

Before the doctor performs the manipulation of blood transfusion, he needs to perform a thorough study of the donor and recipient for compatibility. This is called determining the biological compatibility of people.

1. Identification of the blood group according to the AB0 system, as well as by the Rh factor. It is important to understand that the introduction of Rh-negative blood to a Rh-positive patient is also unacceptable. There is no analogy with the Rhesus conflict in mother and child.
2. After checking by groups, a biological test is performed by mixing the patient's fluids and from the bag. After that, they are heated in a water bath, then the doctor looks at the result for the presence of agglutination.

biological sample

The need for a biological test is due to the fact that there are often situations when complications occurred during the transfusion of one-group blood. In this case, a drop of the recipient's serum and a drop of the donor's erythrocyte mass are mixed in a ratio of 10:1.

blood transfusion

Blood transfusion rules imply the use of disposable medical instruments. Special systems are also needed for the transfusion of blood and its components with a filter that prevents clots from entering the bloodstream.

The principle of infusion is no different from conventional venipuncture. The only caveat is that the drug should be heated in a water bath to room temperature, and also gently mixed.

First, approximately 10-20 milliliters are injected, after which the manipulation is suspended in order to assess the patient's condition. If symptoms such as shortness of breath, rapid breathing, palpitations, pain in the lumbar region develop, the procedure should be stopped immediately. Then the patient is injected with steroid hormones, several ampoules of suprastin solution in order to prevent hemotransfusion shock.

If there are no such symptoms, repeat the introduction of 10-20 milliliters 2 more times in order to finally make sure that there are no unwanted reactions. Preparations for administration to the recipient are administered at a rate of not more than 60 drops per minute.

After a small amount of blood remains in the bag, it is removed and stored for two days. This is necessary so that if complications occur, it is easier to establish their cause.

All data about the procedure should be recorded in the individual card of the inpatient. They indicate the series, number of the drug, the course of the operation, its date, time. The label from the blood bag is pasted there.

Observation

After the manipulation, the patient is assigned a strict bed rest. The next 4 hours it is necessary to measure such indicators as temperature, pulse, pressure. Any deterioration in well-being indicates the development of post-transfusion reactions, which can be extremely severe. The absence of hyperthermia indicates that the transfusion was successful.

Contraindications for blood transfusion

The main contraindications for blood transfusion are as follows.

1. Violation of cardiac activity, especially defects, inflammatory processes, severe hypertension, cardiosclerosis.
2. Pathology of blood flow, especially of the brain.
3. thromboembolic conditions.
4. Pulmonary edema.
5. Interstitial nephritis.
6. Exacerbation of bronchial asthma.
7. Severe allergic reactions.
8. Pathologies of metabolic processes.

The risk group for blood transfusions includes persons who underwent such interventions up to 30 days ago, women who had complications during pregnancy or childbirth, as well as those who gave birth to children with hemolytic disease of the newborn, stage 4 cancer, diseases of the hematopoietic organs, and severe infectious diseases.

How often can a blood transfusion be given?

Blood transfusion is carried out according to indications, so there is no exact data on the frequency of repetition of this manipulation. Usually the procedure is repeated until the patient's condition allows doing without it.

How long does the effect last after a blood transfusion?

The effect of blood transfusion persists depending on the disease that caused its appointment. Sometimes you can get by with one manipulation, in some cases there is a need for repeated injections of blood products.

Complications

Manipulation is considered relatively safe, especially if all the rules and regulations for its implementation are observed. However, there is a risk of some complications, among which there are such.

1. Embolic and thrombotic processes due to a violation of the transfusion technique.
2. Post-transfusion reactions as a consequence of the ingestion of a foreign protein into the human body.

Among the post-transfusion complications, the most life-threatening are hemotransfusion shock, which manifests itself already in the first minutes of transfusion, as well as massive hemotransfusion syndrome, due to the rapid and large amount of drug administration.

The first is manifested by cyanosis, pallor of the skin, severe hypotension with palpitations, pain in the abdomen and lumbar region. The situation is urgent, therefore, requires immediate medical attention.

The second is caused by nitrate or citrate intoxication. These substances are used to preserve drugs. It also requires urgent medical attention.
Much less often there are various bacterial or infectious processes. Despite the fact that drugs go through several stages of testing, such complications cannot be ruled out either.

In medical practice, the most widespread are transfusions
erythrocyte mass (suspension), fresh frozen plasma, con -
platelet centrate.

TRANSFUSION OF ERYTHROCYTE MASS.

Erythrocyte mass (EM) is the main component of the blood, which
its composition, functional properties and therapeutic efficacy
in anemic conditions superior to whole blood transfusion.
A smaller volume of EM contains the same number of erythrocytes, but
less citrate, cell breakdown products, cellular and protein
antigens and antibodies than in whole blood.
leading place in hemotherapy aimed at replenishing the deficiency
red cells in anemic conditions. The main indication for
changes in erythrocyte mass is a significant decrease in the number
erythrocytes and, as a result, the oxygen capacity of the blood, us-
blunting due to acute or chronic blood loss or
inadequate erythropoiesis with hemolysis, narrowing of the blood base
creations in various hematological and oncological diseases
niyah, cytostatic or radiation therapy.
Red blood cell transfusions are indicated for anemic conditions
different genesis:
- acute post-hemorrhagic anemia (injuries accompanied by
blood loss, gastrointestinal bleeding, blood loss with chi-
surgical operations, childbirth, etc.);
- severe forms of iron deficiency anemia, especially in the elderly
persons, in the presence of pronounced changes in hemodynamics, as well as in the order
preparation for urgent surgical interventions with
due to large blood loss or in preparation for childbirth;
- anemia accompanying chronic diseases of the gastrointestinal
-intestinal tract and other organs and systems, intoxication with reflection
phenomena, burns, purulent infection, etc.;
- anemia accompanying depression of erythropoiesis (acute and chronic
nic leukemia, aplastic syndrome, multiple myeloma, etc.).
Since adaptation to a decrease in the number of erythrocytes and hemoglobin in
blood varies widely in different patients (elderly
tolerate anemic syndrome worse, young people, especially women,
better), and erythrocyte transfusion is far from indifferent
operation, when prescribing transfusions, along with the degree of anemia
tion should be guided not only by indicators of red blood
(the number of erythrocytes, hemoglobin, hematocrit), and the appearance of circ-
cululatory disorders, as the most important criterion that makes the indication
nym transfusion of erythrocyte mass. With acute blood loss, even
massive, the level of hemoglobin (hematocrit) itself is not
being the basis for resolving the issue of prescribing a transfusion, tk.
it can remain at satisfactory numbers for a day
with an extremely dangerous decrease in circulating blood volume. However, according to
the phenomenon of shortness of breath, palpitations against the background of pale skin and mucous membranes
is a good reason for a transfusion. On the other hand, when
chronic blood loss, hematopoiesis insufficiency in most
In most cases, only a drop in hemoglobin below 80 g / liter, hematocrit
- below 0.25 is the basis for erythrocyte transfusion, but always
Yes strictly individually.
Erythrocyte mass is obtained from canned blood by separating
plasma. EM looks different from donated blood
a smaller volume of plasma above the layer of settled cells, an indicator
hematocrit. In terms of cellular composition, it contains mainly erythro-
cytes and only a small number of platelets and leukocytes,
which makes it less reactive. In medical practice
several types of erythrocyte mass can be used, depending on
ty from the method of harvesting and indications for hemotherapy: 1) erythrocyte
weight (native) with hematocrit 0.65-0.8; 2) erythrocyte suspension
- erythrocyte mass in a resuspending, preservative solution
(the ratio of erythrocytes and solution determines its hematocrit, and
the composition of the solution - the duration of storage); 3) erythrocyte mass,
depleted in leukocytes and platelets; 4) red blood cell mass
frozen and washed.
EM can be used in combination with plasma substitutes and drug-
mi plasma. Its combination with plasma substitutes and fresh frozen
plasma is more effective than whole blood because
in EO the content of citrate, ammonia, extracellular potassium is reduced, and
also microaggregates from destroyed cells and denatured proteins
kov plasma, which is especially important for the prevention of the "syndrome of massive
transfusions".
EM is stored at a temperature of +4 degrees.
with the composition of a preservative solution for blood or resuspendable
stock solution for EM: EM obtained from blood preserved on
Glyugitsir or Citroglucophosphate solution is stored up to 21 days; from the blood
harvested on a solution of Cyglufad - up to 35 days; EM, resuspended
bath in Eritronaf solution, store up to 35 days. In the process of storage
EM, there is a reversible loss of the transfer function by erythrocytes and
delivery of oxygen to body tissues. Partially lost in the process
storage of erythrocyte functions are restored within 12-24 hours
owls of their circulation in the body of the recipient. It follows from this that
logical conclusion - for the relief of massive acute post-hemorrhagic
some anemia with severe manifestations of hypoxia, in which it is necessary
we need an urgent restoration of the oxygen capacity of the blood, it should
use EM predominantly of short shelf life, and with a decrease in
blood loss, chronic anemia, it is possible to use EM more
longer periods of storage.
In the presence of a pronounced anemic syndrome of absolute
there are no indications for transfusion of EM. Relative contraindications
are: acute and subacute septic endocarditis, progressive
developing diffuse glomerulonephritis, chronic renal
naya, chronic and acute liver failure, decompensated
circulatory system, heart defects in the stage of decompensation, myocardial
dit and myocardiosclerosis with impaired general circulation P-Sh
degree, stage III hypertension, severe atherosclerosis
cerebral vessels, cerebral hemorrhages, severe disorders
cerebral circulation, nephrosclerosis, thromboembolic
disease, pulmonary edema, severe general amyloidosis, acute current and
disseminated tuberculosis, acute rheumatism, especially with rheumatism
Czech purple. In the presence of vital indications, these diseases
and pathological conditions are not contraindications. With os-
caution, EO transfusions should be used for thrombophlebic
and thromboembolic conditions, acute renal and hepatic
insufficiency, when it is more expedient to transfuse washed erythro-
quotes.
In order to reduce the viscosity of EO in the indicated cases (patients with
rheological and microcirculatory disorders) directly
before transfusion, 50-100 ml of sterile
0.9% isotonic sodium chloride solution.
WASHED RED CELLS (OE) are obtained from whole blood (after removal
plasma), EM or frozen erythrocytes by washing them in
isotonic solution or in special washing media. In pro-
during the washing process, plasma proteins, leukocytes, platelets, micro-
roaggregates of cells and stroma of cell complexes destroyed during storage
components.
The washed erythrocytes represent an areactogenic transfusion
environment and are shown to patients who have a history of post-transfusion
zionnye reactions of non-hemolytic type, as well as patients, sensitization
zated to plasma protein antigens, tissue antigens and
antigens of leukocytes and platelets. Due to the absence of sta-
blood bilizers and metabolic products of cellular components,
having a toxic effect, their transfusions are shown in tera-
pia of deep anemia in patients with hepatic and renal insufficiency
styu and at "a syndrome of massive transfusions". The advantage
of OE is also a lower risk of infection with viral hepatitis
volume.
The shelf life of OE at a temperature of +4 degrees C is 24 hours from the moment
their preparations.

TRANSFUSION OF THE PLATELET MASS.

Modern replacement therapy for thrombocytopenic hemorrhoids
hygienic syndrome of amegakaryocytic etiology is impossible without
transfusion of donor platelets obtained, as a rule, during
therapeutic dose from one donor. The minimum therapeutic
dose required to stop spontaneous thrombocytopenic
hemorrhages or to prevent their development during surgical
interventions, including cavitary, performed in patients with
deep (less than 40 x 10 to the power of 9 per liter) amegakaryocytic
thrombocytopenia is 2.8 -3.0 x 10 to the degree of 11 platelets.
General principles for prescribing platelet transfusions (TM)
are manifestations of thrombocytopenic bleeding, caused by
lazy:
a) insufficient formation of platelets - amegakaryocytes -
naya thrombocytopenia (leukemia, aplastic anemia, depression co-
cerebral hematopoiesis as a result of radiation or cytostatic
coy therapy, acute radiation sickness);
b) increased consumption of platelets (syndrome of intravascular
that coagulation in the phase of hypocoagulation);
c) increased consumption of platelets (disseminated
intravascular coagulation in the phase of glucoagulation);
d) functional inferiority of platelets (various
thrombocytopathy - Bernard-Soulier syndrome, Wiskott-Aldrich syndrome, thrombo-
Glantsman's cystasthenia, Fanconi's anemia).
Specific indications for transfusion of TM are established by the attending
by a doctor based on the dynamics of the clinical picture, analysis of the causes
thrombocytopenia and its severity.
In the absence of bleeding or hemorrhage, cytostatic
therapy, in cases where patients are not expected to have any
planned surgical interventions, in itself a low level
platelets (20 x 10 to the power of 9/l or less) is not an indication
for platelet transfusions.
Against the background of deep (5-15 x 10 to the degree of 9 / l) thrombocytopenia, absolute
Another indication for TM transfusion is the occurrence of hemorrhages
(petechiae, ecchymosis) on the skin of the face, upper half of the body, local
bleeding (gastrointestinal tract, nose, uterus, urinary
bubble). An indication for emergency transfusion of TM is the appearance
hemorrhages in the fundus, indicating the danger of developing cerebral
ral bleeding (in severe thrombocytopenia, it is advisable
systematic examination of the fundus).
TM transfusion is not indicated for immune (thrombocytic) thrombosis.
bocytopenia (increased destruction of platelets). Therefore, in those
when there is only thrombocytopenia without anemia and
leukopenia, a bone marrow examination is necessary. Normal or
an increased number of megakaryocytes in the bone marrow
favor the thrombocytolytic nature of thrombocytopenia. So sick
therapy with steroid hormones is necessary, but not transfusion of thrombo-
quotes.
The effectiveness of platelet transfusions is largely determined by the amount of
with the help of fused cells, their functional usefulness and survival
capacity, methods of their isolation and storage, as well as the state of
pienta. The most important indicator of the therapeutic effectiveness of transfusion
TM, along with clinical data on the cessation of spontaneous bleeding
bleeding or bleeding is an increase in the number of platelets in
1 µl. 1 hour and 18-24 hours after transfusion.
To ensure a hemostatic effect, the number of platelets in patients
leg with thrombocytopenic bleeding in the 1st hour after trans-
TM fusion should be increased to 50-60 x 10 to the power of 9/l,
which is achieved by transfusion of 0.5-0.7 x 10 to the degree of 11 platelets
for every 10 kg of weight or 2.0-2.5.x 10 to the power of 11 per 1 sq. meter
body surface.
Received at the request of the attending physician from the blood transfusion department
ve and from the blood transfusion station TM must have the same brand
rovka, as well as other transfusion media (whole blood, erythrocyte-
mass). In addition, the passport part must indicate
the number of platelets in this container, counted after
the end of their receipt. The selection of a pair of "donor - recipient" is carried out
lyatsya according to the ABO system and Rhesus. Immediately before transfusion
the doctor carefully checks the labeling of the container, its tightness,
checking the identity of blood groups of the donor and recipient by systems
ABO and Rhesus. A biological test is not carried out. With repeated
transfusions of TM, some patients may experience a problem of ref -
susceptibility to repeated platelet transfusions associated with
development of a state of alloimmunization.
Alloimmunization is caused by sensitization of the recipient of the alloantigen
us donor (s), is characterized by the appearance of antiplatelet and
anti-HLA antibodies. In these cases, dark
peratural reactions, the lack of a proper increase in platelets and hepatic
bridge effect. To remove sensitization and receive treatment
benefit from TM transfusions, therapeutic plasma can be applied -
mapheresis and selection of a pair of "donor - recipient" taking into account the antigens of the system -
HLA topics.
In TM, the presence of an admixture of immunocompetent and immunoaggregating is not excluded.
strong T and B lymphocytes, therefore, for the prevention of GVHD (reactions
graft versus host) in immunocompromised patients with
bone marrow transplantation, HM irradiation at a dose of
1500 rad. With immunodeficiency due to cytostatic or lu-
chevy therapy, in the presence of appropriate conditions, irradiation of the same
laterally.
When using TM transfusions in normal (uncomplicated) practice
the following tactics are recommended: patients who do not have a burdened
transfusion history, requiring long-term support -
schey therapy, receive a transfusion of platelets of the same name
ABO blood groups and Rh factor. In case of manifestation of clinical
and immunological data on refractoriness subsequent transfusions
carried out by a special selection of compatible platelets
by antigens of the HLA system, while it is recommended as donors
use close (blood) relatives of the patient.

TRANSFUSION OF LEUKOCYTE MASS.

The appearance in the modern transfusion service of special
separators of blood cells made it possible to receive therapeutically
effective number of leukocytes from one donor (of which there are no
less than 50% of granulocytes) for transfusion to patients in order to compensate
they have a deficiency of leukocytes with myelotoxic depression of the hemopoietic
rhenium.
Depth and duration of granulocytopenia are critical
for the occurrence and development of infectious complications, necrotic
which enteropathy, septimecia. Transfusion of leukocyte mass (LM) into
therapeutically effective doses avoids or reduces
intensity of infectious complications in the period before recovery
own bone marrow hematopoiesis.
the use of LM is advisable during the period of intensive care
with hemoblastosis. Specific indications for the appointment of a transfusion
LM is the absence of the effect of intense antibacterial
rapies of an infectious complication (sepsis, pneumonia, necrotic
enteropathy, etc.) against the background of myelotoxic agranulocytosis (uro-
the vein of granulocytes is less than 0.75 x 10 to the degree of 9 / l).
A therapeutically effective dose is considered to be a transfusion of 10-15 x 10
to the degree of 9 leukocytes containing at least 50% granulocytes, and
received from one donor. The best way to get this
number of leukocytes - using a blood cell separator. Several
a smaller number of leukocytes can be obtained with the help of ref-
reactor centrifuge and plastic containers. Other Methods
obtaining leukocytes do not allow transfusion of therapeutically effective
active numbers of cells.
As well as TM, LM before transfusion in patients with severe immuno-
depression, during bone marrow transplantation, it is desirable to undergo
to pre-irradiation at a dose of 15 grays (1500).
The selection of a pair of "donor-recipient" is carried out according to the ABO system, Rhesus.
Dramatically increases the effectiveness of leukocyte replacement therapy
their selection according to histoleukocyte antigens.
Both prophylactic and therapeutic use of LM transfusions
effective with a frequency of transfusions of at least three times a week.
LM transfusion is not indicated in the immune etiology of agranulocytosis.
The requirements for labeling a container with leukocytes are the same as for
TM - an indication of the number of leukocytes in the container and
% granulocytes. Immediately before the transfusion, the doctor, producing
carrying it out, checks the labeling of the container with the LM with the passport data
recipient, a biological test is not carried out.

PLASMA TRANSFUSION

Plasma is the liquid part of the blood, which contains a large amount of
number of biologically active substances: proteins, lipids, carbohydrates,
enzymes, vitamins, hormones, etc. The most effective application
PLASMA FRESH FROZEN (PSZ) due to the almost complete preservation of
ty biological functions. Other types of plasma - native (liquid),
lyophilized (dry), antihemophilic - to a large extent
lose their medicinal properties during their manufacture and clinical
their use is not very effective and should be limited.
In addition, the presence of several plasma dosage forms is disorienting
doctor and reduces the quality of treatment.
PSZ is obtained by plasmapheresis or centrifugation of whole
blood no later than 0.1-1 hour from the moment it was taken from the donor. Plasma
freeze immediately and store at -20°C.
At this temperature, PSZ can be stored for up to one year. During
this time, labile factors of the hemo-
stasis. Immediately before transfusion, PSZ is thawed in water at
temperature +37 - +38 degrees C. In the thawed plasma,
fibrin flakes, which does not prevent transfusion through the station
darny plastic systems with filters. The appearance of a significant
turbidity, massive clots, indicates poor quality
plasma veins and should not be transfused. PSZ should be one
groups with patients according to the ABO system. In emergency cases, in the absence of
In the case of single-group plasma, transfusion of plasma of group A (P) is allowed
to the patient of group 0(1), plasma of group B(III) - to the patient of group 0(1) and
plasma group AB(IV) - to a patient of any group. When transfusing PSZ
group compatibility test is not carried out. defrosted
plasma before transfusion can be stored for no more than 1 hour. Repeated
its freezing is unacceptable.
The possibility of long-term storage of PSZ allows you to accumulate it from
one donor in order to implement the principle of "one donor - one patient"
Noah".
Indications for transfusion of PSZ is the need to correct the
volume of circulating blood in case of massive bleeding, normalization
hemodynamic parameters. With a blood loss of more than 25% of the volume of the
PSS transfusion should also be combined with RBC transfusion.
masses (better - washed erythrocytes).
Transfuzim and PSZ are indicated: in case of burn disease in all clinical
phases; purulent-septic process; massive external and internal
them bleeding, especially in obstetric practice; with coagulopa-
ties with a deficiency of P, V, Vp and XIII coagulation factors; with hemo
philia A and B in acute bleeding and hemorrhage of any locale
lysis (dose of at least 300 ml 3-4 times a day with an interval of 6-8 hours
owls until the bleeding stops completely); with thrombotic processes
sah against the background of heparin therapy, disseminated intracom-
vascular coagulation. In case of microcirculation disorders, PSZ is not
poured with rheologically active drugs (reopoliglyukin, etc.).
PSZ is transfused intravenously, depending on the condition of the patient
drip or jet, with severe DIC - predominantly
but slick.
It is forbidden to transfuse PSZ to several patients from one plastic
container or bottle, plasma must not be left for subsequent
transfusions after depressurization of the container or vial.
Transfusion of PSZ is contraindicated in patients sensitized to pa-
enteral administration of protein. For the prevention of reactions, it is necessary to
conduct a biological sample, as in a whole blood transfusion.

TECHNIQUE OF BLOOD TRANSFUSION AND ITS COMPONENTS.

Indications for transfusion of any transfusion medium, and
also its dosage and the choice of transfusion method are determined by the attending
doctor on the basis of clinical and laboratory data. At the same time, not
may be a standard approach for the same pathology or
syndrome. In each case, the decision on the program
and method of transfusion therapy should be based not only on
clinical and laboratory features of a particular treatment
situation, but also on general provisions on the use of blood and its components
ntov set forth in this manual. Frequently Asked Questions
various methods of blood transfusion are set out in the relevant methods
wild recommendations.

INDIRECT TRANSFUSION OF BLOOD AND ITS COMPONENTS.

The most common method of transfusion of whole blood, its
components - erythrocyte mass, platelet mass, leukocyte
mass, fresh frozen plasma is an intravenous injection with
using disposable filter systems, which are not -
a bottle or polymer container is connected directly with
transfusion environment.
In medical practice, for indications, other methods are also used.
ty introduction of blood and erythrocyte mass: intra-arterial, intra-
aortic, intraosseous. Intravenous route of administration, especially when
the use of central veins and their catheterization, allows you to achieve
a variety of transfusion rates (drip, jet),
varying the volume and rate of transfusion depending on the dynamics of the clinical
Czech painting.
Technique for filling a disposable intravenous system
set out in the manufacturer's instructions.
A feature of the transfusion of donor platelets and leukocytes is
there is a fairly fast pace of their introduction - within 30 - 40 minutes
at a rate of 50 - 60 drops per minute.
In the treatment of DIC syndrome, of fundamental importance is the rapid
under the control of hemodynamics and CVP for no more than 30
minutes of transfusion of large (up to 1 liter) volumes of freshly frozen
plasma.

DIRECT BLOOD TRANSFUSION.

The method of blood transfusion directly to the patient from a donor without a hundred
dii stabilization or conservation of blood is called the direct method
transfusion. Only whole blood can be transfused in this way.
administration - only intravenous. Technology of application of this method
does not provide for the use of filters during transfusion,
which significantly increases the risk of getting into the bloodstream of the recipient
enta of small blood clots that inevitably form in the transfusion system
ion, which is fraught with the development of thromboembolism of small branches of the pulmonary
arteries.
This circumstance, taking into account the identified shortcomings of transfusion
whole blood and the benefits of using blood components, making
There is no need to strictly limit the indications for the direct method of transfusion.
blood circulation, considering it as a forced medical measure
tie in an extreme situation with the development of a sudden massive
in the loss and absence of large amounts of erythrocytes in the doctor's arsenal
commodities, fresh frozen plasma, cryoprecipitate. As a rule, instead of
direct blood transfusion, you can resort to transfusion
freshly prepared "warm" blood.

EXCHANGE TRANSFUSION.

Exchange transfusion - partial or complete removal of blood
from the bloodstream of the recipient with simultaneous replacement of its
adequate or exceeding the volume of donated blood. The main goal
this operation - the removal of various poisons along with the blood (with reflection
phenomena, endogenous intoxications), decay products, hemolysis and
antibodies (for hemolytic disease of the newborn, blood transfusion
onnom shock, severe toxicosis, acute renal failure and
etc.).
The action of this operation consists in a combination of substitution and des-
intoxication effect.
Exchange transfusion of blood has been successfully replaced by intensive
sive therapeutic plasmapheresis with withdrawal per procedure up to 2 liters.
plasma and its replacement with rheological plasma substitutes and fresh
frozen plasma.

AUTOHEMOTRANSFUSION.

Autohemotransfusion - transfusion of the patient's own blood. Osu-
It is carried out in two ways: TRANSFUSION of one’s own blood, harvested
in a preservative solution in advance of the operation and
REINFUSION of blood collected from serous cavities, surgical wounds
with massive bleeding.
For autotransfusions, a step-by-step method can be used
accumulation of significant (800 ml or more) blood volumes. By th-
exfusion and transfusion of previously harvested autologous blood
it is possible to obtain large quantities of freshly prepared canned
noah blood. The method of cryopreservation of autoerythrocytes and plasma is
also allows you to accumulate them for surgical interventions.
evidence.
Advantages of the method of autohemotransfusion over transfusion of donor-
blood the following: the risk of complications associated with
with incompatibility, with the transfer of infectious and viral diseases
ny (hepatitis, AIDS, etc.), with the risk of alloimmunization, the development of syn-
the drome of massive transfusions, while providing better function
onal activity and survival of erythrocytes in the vascular bed
le sick.
The use of the method of autohemotransfusion is indicated in patients with red-
some blood group and the impossibility of selecting a donor, with operative
interventions in patients with expected large blood loss with
the presence of liver and kidney dysfunctions, a significant increase
reducing the risk of possible post-transfusion complications during transfusion
research of donor blood or erythrocytes. Recently, autohemo-
transfusions have become more widely used and with relatively small
the volume of blood loss during operations in order to reduce the thrombogenic risk
ty as a result of hemodilution occurring after exfusion of blood.
The use of the method of autohemotransfusion is contraindicated in case of expressed
ny inflammatory processes, sepsis, severe liver damage
and kidneys, as well as pancytopenia. Absolutely contraindicated
use of the method of autohemotransfusion in pediatric practice.

BLOOD REINFUSION.

Blood reinfusion is a type of autohemotransfusion and concluding
is a transfusion to the patient of his blood, poured out into the wound or
serous cavities (abdominal, thoracic) and no more than
12 hours (with a longer period, the risk of infection increases).
The application of the method is indicated for ectopic pregnancy, ruptures
spleen, wounds of the chest, traumatic operations.
For its implementation, a system consisting of a sterile
containers and a set of tubes for collecting blood using an electric suction and
subsequent transfusion.
Standard hemopreservatives are used as a stabilizer
or heparin (10 mg in 50 ml isotonic sodium chloride solution
per 450 ml of blood). The collected blood is diluted with iso-
with tonic sodium chloride solution in a ratio of 1: 1 and add
1000 ml of blood.
Transfusion is carried out through an infusion system with a filter,
it is preferable to transfuse through a system with a special
al microfilter.

PLASMAPHERESIS.

Therapeutic plasmapheresis is one of the main transfusiological
operations to provide effective medical care
patients, often in critical condition.
but with the withdrawal of plasma during therapeutic plasmapheresis,
decrease in the taken volume by transfusion of erythrocytes, freshly frozen
noah plasma, rheological plasma substitutes.
The therapeutic effect of plasmapheresis is based both on the mechanical removal of
plasma studies of toxic metabolites, antibodies, immune complexes
owls, vasoactive substances, etc., and to compensate for the missing
important components of the internal environment of the body, as well as on the active
macrophage system, improving microcirculation, deblocking
organs of "cleansing" (liver, spleen, kidneys).
Therapeutic plasmapheresis can be performed by one of the following methods:
dov: using a blood cell separator in a continuous flow method,
using centrifuges (usually refrigerated) and polymer containers
nerov intermittent method, as well as the filtration method.
The volume of plasma removed, the rhythm of the procedures, the plasma program
substitution depends on the goals set before the procedure, initially
of the patient's condition, the nature of the disease or post-transfusion
th complication. Therapeutic breadth of plasmapheresis application
(its appointment is indicated for the syndrome of increased viscosity, disease
vaniya immunocomplex etiology, various intoxications, DIC-
- syndrome, vasculitis, sepsis and chronic renal and hepatic
insufficiency, etc.) can significantly improve the efficiency
the effectiveness of therapy for a wide variety of diseases in therapeutic, surgical
medical and neurological clinics.

ERRORS IN THE TECHNIQUE OF BLOOD TRANSFUSION AND ITS COMPONENTS

AIR EMBOLISM occurs when the system is not properly filled,
as a result of which air bubbles enter the patient's vein. That's why
It is strictly forbidden to use any injection appa-
procedures for transfusion of blood and its components. When
air embolism, patients have shortness of breath, shortness of breath
ka, pain and feeling of pressure behind the sternum, cyanosis of the face, tachycardia.
Massive air embolism with the development of clinical death requires
carrying out immediate resuscitation measures - indirect mass
heart soot, mouth-to-mouth artificial respiration, resuscitation call
noah brigade.
Prevention of this complication lies in the exact observance of all
transfusion rules, installation of systems and equipment.
but fill with transfusion medium all tubes and parts of the equipment,
following the removal of air bubbles from the tubes. Observation
for the patient during transfusion should be constant until its completion
Chania.
THROMBOEMBOLISM - embolism with blood clots that occurs when ingested
into the patient's vein of various sizes of clots formed in the
poured blood (erythrocyte mass) or, which is less common,
washed with blood flow from the thrombosed veins of the patient. Cause of embolism
there may be an incorrect transfusion technique when they enter the vein
clots present in the transfused blood, or emboli become
blood clots formed in the patient's vein near the tip of the needle. Educational
The formation of microclots in canned blood starts from the first
days of storage. The resulting microaggregates, getting into the blood,
linger in the pulmonary capillaries and, as a rule, undergo
lysis. When a large number of blood clots enter, it develops
clinical picture of thromboembolism of the branches of the pulmonary artery: sudden
pain in the chest, a sharp increase or the occurrence of shortness of breath
ki, the appearance of a cough, sometimes hemoptysis, pallor of the skin
cyanosis, in some cases, a collapse develops - cold sweat, pa-
decrease in blood pressure, frequent pulse.
diagram, there are signs of a load on the right atrium, and
you can shift the electrical axis to the right.
Treatment of this complication requires the use of fibrinolytic activators.
for - streptase (streptodecase, urokinase), which is administered through
catheter, it is better if there are conditions for its installation, in the pulmonary
arteries. With a local effect on a thrombus in a daily dose
150,000 IU (50,000 IU 3 times). With intravenous administration, daily
naya dose of streptase is 500.000-750.000 IU. Shown unpre-
intermittent intravenous administration of heparin (24.000-40.000 units per day),
immediate jet injection of at least 600 ml of fresh frozen
plasma under the control of coagulogram.
Prevention of pulmonary embolism lies in the correct
noah technique of harvesting and transfusion of blood, in which are excluded
ingress of blood clots into the patient's vein, use in hemo-
transfusion of filters and microfilters, especially with massive and
jet transfusions. In case of needle thrombosis, repeated puncture is necessary.
excision of the vein with another needle, in no case trying in various ways
to restore the patency of the thrombosed needle.

REACTIONS AND COMPLICATIONS DURING BLOOD AND ITS TRANSFUSION
COMPONENTS.

In case of violation of the established rules for blood transfusion and components
goods, fuzzy establishment of indications or contraindications for
the significance of a particular transfusiological operation, incorrect
assessment of the recipient's condition during or after transfusion
the end, the development of blood transfusion reactions or complications is possible
neny. Unfortunately, the latter can be observed regardless of
whether there were any irregularities during the transfusion.
It should be noted that the transition to a component replenishment of the deficit
that cells or plasma in a patient dramatically reduces the number of reactions and
lies. There are practically no complications during the transfusion of washed
frozen erythrocytes. Significantly reduces the number of complications
ny while observing the principle of "one donor - one patient" (especially
the risk of transmission of viral hepatitis is reduced). Reactions are not accompanied by
are serious and long-term dysfunctions of organs and systems
Complications are characterized by severe clinical manifestations,
endangering the patient's life.
Depending on the severity of the clinical course, body temperature and
duration of violations distinguish post-transfusion reactions of three
degrees: mild, moderate and severe.
LIGHT REACTIONS are accompanied by an increase in body temperature within the
lax 1 degree, pain in the muscles of the limbs, headache,
boom and malaise. These effects are short-lived and usually disappear.
without any special treatment.
REACTIONS OF INTERMEDIATE SEVERITY are manifested by an increase in body temperature by
1.5-2 degrees, increasing chills, increased heart rate and respiration,
sometimes - urticaria.
IN SEVERE REACTIONS, body temperature rises by more than 2
degrees, there are stunning chills, cyanosis of the lips, vomiting, severe
headache, back and bone pain, shortness of breath, hives, or
angioedema, leukocytosis.
Patients with post-transfusion reactions need mandatory
medical supervision and timely treatment. Depending on the
causes of occurrence and clinical course are pyrogenic, an-
tigenic (non-hemolytic), allergic and anaphylactic reactions
tions.

PYROGENIC REACTIONS AND COMPLICATIONS (NOT RELATED TO
IMMUNOLOGICAL INCOMPATIBILITY).

The main source of pyrogenic reactions is the entry of endoxin into the trans-
fusion environment. These reactions and complications are associated with
use for preservation of blood or its components
thieves, not devoid of pyrogenic properties, insufficiently processed
(in accordance with the requirements of the instructions) systems and equipment
for transfusion; these reactions may be the result of penetration
microbial flora into the blood at the time of its preparation and during storage
neniya.With the use of disposable plastic containers for cutting
blood and blood components, disposable transfusion systems
the frequency of such reactions and complications is significantly reduced.
The principles of therapy are the same as for the development of non-hemolytic
post-transfusion reactions and complications.

COMPLICATIONS IN THE TRANSFUSION OF BLOOD, ITS COMPONENTS.

REASONS: immunological incompatibility; post-transfusion meta-
pain disorders; massive blood transfusions; poor quality -
the nature of the transfused blood or its components; errors in the methodology
transfusion; transfer of infectious diseases from donor to recipient
entu; underestimation of indications and contraindications for blood transfusion.

COMPLICATIONS CAUSED BY BLOOD TRANSFUSION, EM,
INCOMPATIBLE IN THE GROUP FACTORS OF THE ABO SYSTEM.

The cause of such complications in the vast majority of cases is
there is a failure to comply with the rules stipulated by the technical instructions
blood transfusions, according to the method of determining ABO blood groups and checking
testing for compatibility.
PATHOGENESIS: massive intravascular destruction of transfused erythro-
cells with natural agglutinins of the recipient with release into plasma
stroma of destroyed erythrocytes and free hemoglobin, possessing
thromboplastin activity, includes the development of dys-
seminal intravascular coagulation with severe impairment
changes in the system of hemostasis and microcirculation, followed by
changes in central hemodynamics and the development of blood transfusion
shock.
The initial clinical signs of hemotransfusion shock in this case
types of complications may appear directly during hemotrans
sfusion or shortly after it and are characterized by a short-term
awakening, pain in the chest, abdomen, lower back. In the future, gradually
but circulatory disturbances characteristic of shock are increasing.
standing (tachycardia, hypotension), a picture of massive
intravascular hemolysis (hemoglobinemia, hemoglobinuria, biliary
rubinemia, jaundice) and acute impairment of kidney and liver function.
If shock develops during surgery under general
anesthesia, then its clinical signs can be expressed
bleeding from the surgical wound, persistent hypotension, and with
the presence of a urinary catheter - the appearance of dark cherry or black urine
color.
The severity of the clinical course of shock largely depends on
volume of transfused incompatible erythrocytes, while a significant
the nature of the underlying disease and the patient's condition play a role
before blood transfusion.
TREATMENT: stop transfusion of blood, erythrocyte mass, causing
neck hemolysis; in a complex of therapeutic measures simultaneously with the removal
shock shows a massive (about 2-2.5 l) plasma
mapheresis to remove free hemoglobin, products of degra-
fibrinogen dation, with the replacement of the removed volumes with the corresponding
the amount of fresh frozen plasma or in combination with colloidal
plasma substitutes; to reduce the deposition of hemolytic products
for in the distal tubules of the nephron it is necessary to maintain diuresis
patient at least 75-100 ml / hour with a 20% mannitol solution
(15-50g) and furosemide (100 mg once, up to 1000 per day) corrected
blood acid-base balance with 4% sodium bicarbonate solution; in order to maintain
volume of circulating blood and stabilization of blood pressure, rheological
solutions (rheopolyglucin, albumin); if necessary, correct
deep (not less than 60 g / l) anemia - transfusion individually
selected washed erythrocytes; desensitizing therapy - en-
tihistamines, corticosteroids, cardiovascular
stva. The volume of transfusion-infusion therapy should be adequate
ten diuresis. The control is the normal level of central
venous pressure (CVD). The dose of administered corticosteroids is adjusted
adjusted according to hemodynamic stability, but should not
be less than 30 mg per 10 kg of body weight per day.
It should be noted that osmotically active plasma expanders should
apply until anuria occurs. With anuria, their purpose is the womb
the development of pulmonary or cerebral edema.
On the first day of the development of post-transfusion acute intravascular
In addition, hemolysis shows the appointment of heparin (intravenously, up to 20 thousand
U per day under the control of clotting time).
In cases where complex conservative therapy does not prevent
rotates the development of acute renal failure and uremia, progressing
sirovaniya creatinemia and hyperkalemia, requires the use of hemodia-
analysis in specialized institutions. Question about transportation
the doctor of this institution decides.
COMPLICATIONS CAUSED BY BLOOD TRANSFUSION, ERYTHROCYTE
NOY OF MASS INCOMPATIBLE BY RH FACTOR AND OTHER SI-
STEMAM OF ERYTHROCYTE ANTIGENS.

REASONS: these complications occur in patients sensitized to
relation to the Rh factor.
Immunization with the Rh antigen can occur under the following conditions
1) upon repeated administration to Rh-negative recipients, Rh-by
positive blood; 2) during pregnancy of an Rh-negative woman
Rh-positive fetus, from which the Rh factor enters
mother's blood, causing the formation of immune
antibodies against the Rh factor. The cause of such complications is overwhelmingly
In most cases, there is an underestimation of obstetric and transfusion
anamnesis, as well as non-compliance or violation of other rules,
warning of Rh incompatibility.
PATHOGENESIS: massive intravascular hemolysis of transfused erythrocytes
comov immune antibodies (anti-D, anti-C, anti-E, etc.), forming-
in the process of previous sensitization of the recipient, repeated
nymny pregnancies or transfusions of antigenic incompatible
erythrocyte systems (Rhesus, Kell, Duffy, Kidd, Lewis, etc.).
CLINICAL MANIFESTATIONS: This type of complication differs from
the previous one with a later onset, less rapid course, slowed down
ny or delayed hemolysis, which depends on the type of immune anti-
bodies and their titers.
The principles of therapy are the same as in the treatment of post-transfusion shock.
caused by transfusion of blood (erythrocytes) incompatible in group
new factors of the ABO system.
In addition to the group factors of the ABO system and the Rh factor Rh (D), the causes
complications during blood transfusion, although less often, may be
other antigens of the Rh system: rh (C), rh (E), hr (c), hr (e), as well as
the same antigens of Duffy, Kell, Kidd and other systems. It should be indicated
that the degree of their antigenicity, therefore, the value for practice
blood transfusions are significantly lower than the Rh factor Rh 0 (D). However
such complications occur. They occur as in Rh-negative
nyh, and in Rh-positive individuals immunized as a result
those of pregnancy or repeated blood transfusions.
The main measures to prevent transfusion
complications associated with these antigens are accounting for obstetric
th and transfusion history of the patient, as well as the implementation of all
other requirements. It should be emphasized that especially sensitive
a compatibility test to detect antibodies, and,
therefore, the incompatibility of the blood of the donor and the recipient is
This is an indirect Coombs test. Therefore, an indirect Coombs test is recommended
it is possible to produce when selecting donor blood for patients, in anam-
which had post-transfusion reactions, as well as sensitization
zirovanny persons, characterized by increased sensitivity to the introduction of
red blood cells, even if they are ABO compatible and
Rh factor. Test for isoantigenic compatibility of transfused
blood as well as a test for compatibility by Rh factor -
Rh 0 (D) is produced separately with a test for compatibility by group
memory of ABO blood and in no way replaces it.
The clinical manifestations of these complications are similar to those described above.
when transfusing Rh-incompatible blood, although there are much
to less frequently. The principles of therapy are the same.

POST-TRANSFUSION REACTIONS AND COMPLICATIONS OF NON-HEMOLITI-
CZECH TYPE

Causes: sensitization of the recipient to leukocyte antigens, thrombo-
cytes during transfusion of whole blood and plasma proteins as a result of
previous repeated blood transfusions and pregnancies.
CLINICAL MANIFESTATIONS usually develop after 20-30 minutes after
after the end of the blood transfusion, sometimes earlier or even during the transfusion
bleeding and are characterized by chills, hyperthermia, headache,
back pain, urticaria, skin itching, shortness of breath, suffocation,
development of Quincke's edema.
Treatment: desensitizing therapy - adrenaline intravenously in
amount of 0.5 - 1.0 ml., antihistamines, corticoste -
roids, chloride or calcium gluconate, if necessary - cardio-
vascular drugs, narcotic analgesics, detoxification
nye and antishock solutions.
PREVENTION of this kind of reactions and complications is
careful collection of transfusion history, use of washed
erythrocytes, individual selection of the donor-recipient pair.

POST-TRANSFUSION REACTIONS AND COMPLICATIONS RELATED TO
BLOOD PRESERVATION AND STORAGE, ERYTHRO-
CYTE MASS.

They arise as a result of the body's reaction to stabilizing
solutions used in the preservation of blood and its components,
on the metabolic products of blood cells resulting from its
storage, on the temperature of the transfused transfusion medium.
HYPOCALCEMIA develops with transfusion of large doses of whole blood
vi or plasma, especially at a high transfusion rate,
len using sodium citrate, which, by binding in the blood
nasal bed free calcium, causes the phenomenon of hypocalcemia.
Transfusion of blood or plasma prepared with citrate
sodium, at a rate of 150 ml / min. reduces the level of free calcium
tion up to a maximum of 0.6 mmol / liter, and at a rate of 50 ml / min. co-
the content of free calcium in the plasma of the recipient changes insignificantly
significantly. The level of ionized calcium returns to normal immediately
after the cessation of transfusion, which is explained by the rapid mobilization
her calcium from endogenous depot and the metabolism of citrate in the liver.
In the absence of any clinical manifestations of temporary hypo-
calcium, the standard prescription of calcium preparations (for "neutral
lysing" citrate) is unjustified, because it can cause the appearance
arrhythmias in patients with cardiac pathology. It is necessary to remember about
categories of patients who have true hypocalcemia or about
the possibility of its occurrence during various medical
procedures (therapeutic plasmapheresis with compensation of exfusable
plasma volume), as well as during surgical interventions. Oso -
combat attention should be shown to patients with the following concomitant
pathology: hypoparathyroidism, D-avitaminosis, chronic renal
insufficiency, liver cirrhosis and active hepatitis, congenital hypo-
calcium in children, toxic-infectious shock, thrombolytic
conditions, post-resuscitation conditions, long-term therapy
corticosteroid hormones and cytostatics.
CLINIC, PREVENTION AND TREATMENT OF HYPOCALCEMIA: lowering the level
free calcium in the blood leads to arterial hypotension,
increased pressure in the pulmonary artery and central venous pressure
leniya, prolongation of the interval O - T on the ECG, the appearance of convulsive
twitching of the muscles of the lower leg, face, violation of the rhythm of breathing with transition
home in apnea with a high degree of hypocalcemia. Subjectively
patients perceive hypocalcemia at first as unpleasant
sensations behind the sternum that interfere with inhalation, an unpleasant sensation appears in the mouth
taste of metal, convulsive twitching of the muscles of the tongue and
lips, with a further increase in hypocalcemia - the appearance of tonic
convulsions, impaired breathing up to its stop, impaired
heart rate - bradycardia, up to asystole.
PREVENTION is to identify patients with potential hypo-
calcium (tendency to convulsions), the introduction of plasma at a rate
not higher than 40-60 ml / min., prophylactic administration of a 10% solution of gluco-
calcium konate - 10 ml. for every 0.5 l. plasma.
When clinical symptoms of hypocalcemia appear, it is necessary to pre-
shorten the introduction of plasma, intravenously inject 10-20 ml. gluconate
calcium or 10 ml. calcium chloride, ECG monitoring.
HYPERKALAEMIA in the recipient may occur with rapid transfusion
(about 120 ml / min.) Long-term stored canned
blood or erythrocyte mass (with a shelf life of more than 14 days
Potassium levels in these transfusion media can be as high as 32
mmol/L). The main clinical manifestation of hyperkalemia is
the development of bradycardia.
PREVENTION: when using blood or erythrocyte mass,
more than 15 days of storage, transfusion should be performed drip (50-
-70 ml/min.), it is better to use washed erythrocytes.

MASSIVE TRANSFUSION SYNDROME.

This complication occurs with the introduction of a short period in the blood
vein of the recipient up to 3 liters of whole blood from many to
burrows (more than 40-50% of the volume of circulating blood). negative
the impact of massive whole blood transfusions is expressed in the development
disseminated intravascular coagulation syndrome. On the
autopsy reveals small hemorrhages in organs associated with
with microthrombi, which consist of aggregates of erythrocytes and thrombi
quotes. Hemodynamic disorders occur in a large and small circle
blood circulation, as well as at the level of capillary, organ blood flow
ka.
Massive transfusion syndrome, with the exception of traumatic hemorrhage
losses, usually as a result of whole blood transfusions
already begun DIC, when, first of all, it is necessary to
pouring large amounts of fresh frozen plasma (1-2 liters and more
lee) with jet or frequent drops of its introduction, but where overflow-
consumption of red blood cells (rather than whole blood) should be limited
vital indications.
Transfusions should be avoided to prevent this complication.
whole blood in large quantities. It is necessary to strive to
replenishment of massive blood loss prepared in advance from one -
- two donors with cryopreserved erythrocytes, freshly frozen;
plasma on the principle of "one donor - one patient", build
transfusion tactics on strict indications for transfusion before
Nordic blood, widely using blood components and preparations
(erythrocyte mass, fresh frozen plasma), low molecular weight
dextran solutions (rheopolyglucin, gelatinol), achieving hemodilu-
tions. An effective method for the prevention of massive transfusion syndrome
ziya is the use of autologous blood of the patient, harvested by
the cryopreservation of erythrocytes before a planned operation. So-
it is also necessary to introduce more widely the use of autologous blood collected during
operations from cavities (method of reinfusion).
Treatment of DIC - a syndrome caused by massive blood transfusion,
based on a set of measures aimed at normalizing
systems of hemostasis and elimination of other leading manifestations of the syndrome,
primarily shock, capillary stasis, acid-base disorders
leg, electrolyte and water balance, damage to the lungs, kidneys,
adrenal glands, anemia. It is advisable to use heparin (medium
dose 24,000 units. per day with continuous administration). The most important method
home therapy is plasmapheresis (removal of at least 1 liter of plasma) with
replacement with fresh frozen donor plasma in a volume of at least
600 ml. Blockade of microcirculation by aggregates of blood cells and spasm
vessels are eliminated with antiplatelet agents and other drugs (rheopolyglu-
kin, intravenously, chimes 4-6 ml. 0.5% solution, eufillin 10 ml.
2.4% solution, trental 5 ml.). Protein inhibitors are also used
az - trasilol, counterkal in large doses - 80-100 thousand units each. on the
one intravenous injection. The need and amount of transfusion
therapy is dictated by the severity of hemodynamic disorders. Next-
remember to use whole blood for DIC
it is impossible, and the washed erythrocyte mass should be transfused with a decrease in the level
hemoglobin up to 70 g/l.

Blood transfusion (hemotransfusion) is a therapeutic method consisting in the introduction into the bloodstream of a patient (recipient) of whole blood or its components prepared from a donor or from the recipient himself (autohemotransfusion), as well as blood that has poured into the body cavity during injuries and operations (reinfusion ).

In medical practice, the most widespread is the transfusion of erythrocyte mass (suspension of erythrocytes), fresh frozen plasma, platelet concentrate, leukocyte mass. Red blood cell transfusions are indicated for various anemic conditions. Erythrocyte mass can be used in combination with plasma substitutes and plasma preparations. When transfusing erythrocyte mass, there are practically no complications.

Plasma transfusions are indicated if it is necessary to correct the volume of circulating blood in case of massive bleeding (especially in obstetric practice), burn disease, purulent-septic processes, hemophilia, etc. In order to maximize the preservation of the structure of plasma proteins and their biological activity, the plasma obtained after fractionation is subjected to rapid freezing at -45°C). At the same time, the volume-replacing effect of plasma administration is short-lived and inferior to the effect of albumin and plasma substitutes.

Platelet transfusion is indicated for thrombocytopenic bleeding. The leukocyte mass is transfused to patients with a decrease in the ability to produce their own leukocytes. The most common method of transfusion of whole blood or its components is intravenous administration using a disposable system with a filter. Other ways of introducing blood and its components are also used: intra-arterial, intra-aortic, intraosseous.

The method of transfusing whole blood directly from a donor to a patient without a stage of blood preservation is called direct. Since the technology of this method does not provide for the use of filters during transfusion, the risk of small thrombi entering the recipient's bloodstream, which inevitably form in the transfusion system, is significantly increased, which is fraught with the development of thromboembolism of small branches of the pulmonary artery. Exchange transfusion - partial or complete removal of blood from the recipient's bloodstream with simultaneous replacement with an adequate or exceeding volume of donor blood - is used to remove various poisons (for poisoning, endogenous intoxication), decay products, hemolysis and antibodies (for hemolytic disease of the newborn, blood transfusion shock, severe toxicosis, acute renal failure). Therapeutic plasmapheresis is one of the main transfusiological operations, while simultaneously with the removal of plasma, the volume taken is replenished by transfusion of erythrocytes, fresh frozen plasma, rheological plasma substitutes. The therapeutic effect of plasmapheresis is based both on the mechanical removal of toxic metabolites with plasma, and on the replacement of the missing vital components of the internal environment of the body, as well as on the deblocking of organs (“cleansing” of the liver, spleen, kidneys).

Blood transfusion rules

Blood transfusion rules

Blood transfusion rules

Indications for transfusion of any transfusion medium, as well as its dosage and choice of transfusion method, are determined by the attending physician based on clinical and laboratory data. The doctor performing the transfusion is obliged, regardless of previous studies and available records, to personally conduct the following control studies: 1) determine the recipient's blood type according to the AB0 system and compare the result with the data of the medical history; 2) determine the group affiliation of the donor's erythrocytes and compare the result with the data on the label of the container or bottle; 3) conduct tests for compatibility in relation to blood groups of the donor and recipient according to the AB0 system and the Rh factor; 4) conduct a biological test.

Selection of blood and its components for transfusion. Before transfusion it is necessary to carry out the following transfusion measures:

1) Obtain a citizen's prior voluntary consent for the transfusion of blood and its components. If the patient is unconscious, then the need for transfusion to save the patient's life substantiates the indications of doctors. Blood transfusions for children are carried out with the written permission of the parents.

2) Check the patient's blood group according to the AB0 system, compare the result with the data of the medical history.

3) Recheck the blood group according to the AB0 system of the donor container with the data on the label of the container.

4) Compare the blood type and Rh affiliation indicated on the container with the results of the study previously entered in the medical history and just received.

5) Carry out tests for individual compatibility according to the ABO system and Rh of erythrocytes of donors and serum of the recipient.

6) Clarify the patient's last name, first name, patronymic, year of birth and compare them with those indicated on the title page of the medical history. The data must match and the patient must confirm them if possible (except when the transfusion is performed under anesthesia or in an unconscious state).

7) Conduct a biological test.

Visually, the doctor performing the transfusion checks the tightness of the package, the correctness of certification, and evaluates the quality of the transfusion medium. It is necessary to determine the suitability of the hemotransfusion medium with sufficient lighting directly at the place of storage, shaking is not allowed. The eligibility criteria for transfusion are: for whole blood - plasma transparency, uniformity of the upper layer of erythrocytes, the presence of a clear boundary between erythrocytes and plasma, and for fresh frozen plasma - transparency at room temperature. It is forbidden to transfuse blood and its components, not previously tested for HIV, hepatitis B and C, syphilis.

Test for individual compatibility of the donor and recipient according to the ABO system.

2-3 drops of the recipient's serum are applied to the plate and a small amount of erythrocytes are added so that the ratio of erythrocytes and serum is 1:10 (for convenience, it is recommended to first release a few drops of erythrocytes through the needle from the container to the edge of the plate, then transfer a small amount of erythrocytes from there with a glass rod). a drop of erythrocytes into serum). Next, the erythrocytes are mixed with serum, the plate is slightly shaken for 5 minutes, observing the course of the reaction. After the specified time has elapsed, 1-2 drops of saline can be added to the reaction mixture to remove possible non-specific aggregation of erythrocytes. Accounting for results. The presence of erythrocyte agglutination means that the donor's blood is incompatible with the recipient's blood and should not be transfused. If after 5 minutes there is no erythrocyte agglutination, this means that the donor's blood is compatible with the recipient's blood in terms of group agglutinogens.

Indirect Coombs test. 1 drop (0.02 ml) of the sediment of three times washed donor erythrocytes is added to the tube, for which a small drop of erythrocytes is squeezed out of the pipette and it touches the bottom of the tube and 4 drops (0.2 ml) of the recipient's serum are added. The contents of the test tubes are mixed by shaking, after which they are placed for 45 minutes in a thermostat at a temperature of +37ºС. After the specified time, the erythrocytes are again washed three times and a 5% suspension in saline is prepared. Next, 1 drop (0.05 ml) of erythrocyte suspension on a porcelain plate, add 1 drop (0.05 ml) of antiglobulin serum, mix with a glass rod. The plate is periodically shaken for 5 minutes. The results are recorded with the naked eye or through a magnifying glass. Agglutination of erythrocytes indicates that the blood of the recipient and the donor are incompatible, the absence of agglutination is an indicator of the compatibility of the blood of the donor and the recipient.

To determine the individual compatibility of blood according to the Rhesus system, a test using 10% gelatin and 33% polyglucin is used.

Compatibility test using 10% gelatin. One small drop (0.02 ml) of donor erythrocytes is added to the test tube, for which a small drop of erythrocytes is squeezed out of the pipette and touched to the bottom of the tube. Add 2 drops (0.1 ml) of gelatin and 2 drops (0.1 ml) of the recipient's serum. The contents of the tubes are mixed by shaking, after which they are placed in a water bath for 15 minutes or a thermostat for 30 minutes at a temperature of +46-48ºС. After the specified time has elapsed, 5-8 ml of physiological saline is added to the tubes and the contents are mixed by turning the tubes 1-2 times. The result is taken into account by examining the tubes in the light. Agglutination of erythrocytes indicates that the blood of the recipient and the donor are not compatible, the absence of aggregation is an indicator of the compatibility of the blood of the donor and the recipient.

Test for compatibility with the use of 33% polyglucin. 2 drops (0.1 ml) of the recipient's serum, 1 drop (0.05 ml) of the donor's erythrocytes are added to the tube, and 1 drop (0.1 ml) of 33% polyglucin is added. The test tube is tilted to a horizontal position, slightly shaking, then slowly rotated so that its contents spread over the walls in a thin layer. This spreading of the content makes the reaction more pronounced. The contact of erythrocytes with the patient's serum during the rotation of the test tube should be continued for at least 3 minutes. After 3-5 minutes, add 2-3 ml of physiological saline to the tube and mix the contents by 2-3 times inverting the tube without shaking. The results are recorded with the naked eye or through a magnifying glass. Agglutination of erythrocytes indicates that the blood of the recipient and the donor are incompatible, the absence of agglutination is an indicator of the compatibility of the blood of the donor and the recipient.

biological test. Before use, the container with the transfusion medium (erythrocyte mass or suspension, fresh frozen plasma, whole blood) is removed from the refrigerator and kept at room temperature for 30 minutes, and in emergency cases it is warmed in a water bath at a temperature of 37ºС under the control of a thermometer. The test technique is as follows: simultaneously pour 10 ml of the transfusion medium at a rate of 2-3 ml (40-60 drops per minute), then stop the transfusion and observe the recipient for 3 minutes, controlling his pulse, blood pressure, general condition , skin color, measure body temperature. This procedure is repeated twice more. The appearance of chills, back pain, fever, chest tightness, headache, nausea or vomiting indicates biological incompatibility, requires immediate termination of the transfusion and refusal to transfuse this transfusion medium. When transfusing blood or its components in patients under anesthesia, the reaction or incipient complications are judged by an unmotivated increase in bleeding in the surgical wound, a decrease in blood pressure, an increase in heart rate, a change in the color of urine during bladder catheterization, and also by the results of a test to detect early hemolysis . In such cases, the transfusion of the transfusion medium is stopped, the surgeon and anesthesiologist, together with the transfusiologist, are obliged to find out the cause of hemodynamic disturbances. If they were caused by transfusion, then this medium is not transfused, and the patient is treated depending on the available clinical and laboratory data.

Blood transfusion (post-transfusion) reactions and complications. In some patients, shortly after P. to., hemotransfusion reactions are noted, which are not accompanied by serious long-term dysfunction of organs and systems and do not pose an immediate danger to the patient's life. Depending on the severity of clinical manifestations, blood transfusion reactions of three degrees are distinguished: mild, moderate and severe. Light blood transfusion reactions are characterized by an increase in body temperature within 1 °, pain in the muscles of the extremities, headache, chilling and malaise. These phenomena are short-lived; usually for their relief does not require any special therapeutic measures. Reactions of moderate severity are manifested by an increase in body temperature by 1.5-2 °, increasing chills, increased heart rate and respiration, and sometimes urticaria. In severe reactions, body temperature rises by more than 2 °, severe chills, cyanosis of the lips, vomiting, severe headache, pain in the lower back and bones, shortness of breath, urticaria and Quincke's edema are observed.

Depending on the cause and clinical course, pyrogenic, allergic, anaphylactic reactions are distinguished. They appear in 20-30 min after transfusion (sometimes during it) and last from several minutes to several hours. Pyrogenic reactions may be the result of the introduction of pyrogens together with preserved blood and erythrocyte mass into the bloodstream of the recipient. They are manifested by general malaise, fever, chills, headache; in some cases, circulatory disorders are possible. Allergic reactions occur as a result of the recipient's sensitization to antigens of plasma proteins, various immunoglobulins, as well as to antigens of leukocytes, platelets during transfusion of whole blood, plasma. They are manifested by fever, shortness of breath, suffocation, nausea, vomiting. Anaphylactic reactions are caused by isosensitization, more often to class A immunoglobulins. The main role in their pathogenesis is played by the antigen-antibody reaction. These reactions are accompanied by the release of biologically active substances that cause damage to the vascular wall with the formation of edema, spasm of the muscles of the bronchi and a sharp decrease in blood pressure. Clinically, they are characterized by acute vasomotor disorders.

For the treatment of pyrogenic reactions, antipyretic, desensitizing and symptomatic agents are used; to eliminate allergic reactions, antihistamines and desensitizing agents (diphenhydramine, suprastin, calcium chloride, corticosteroids), cardiovascular drugs, promedol are prescribed. The treatment of anaphylactic reactions is complex and includes resuscitation methods (if indicated), since the outcome depends on the speed and effectiveness of emergency care. Intravenously slowly injected 60-90 mg prednisolone or 16-32 mg dexamethasone at 20 ml 40% glucose solution. If there is no effect within 15-20 min administration of glucocorticoids is repeated. In severe collapse, rheopolyglucin transfusion is indicated. If necessary, cardiac glycosides are used: injected into a vein slowly (for 5 min) 0,5-1ml 0.05% solution of strophanthin or 1 ml 0.06% solution of corglycone in 20 ml 5, 20 or 40% glucose solution or isotonic sodium chloride solution, as well as antihistamines (2-3 ml 1% diphenhydramine solution, 1-2 ml 2% suprastin solution or 2 ml 2.5% diprazine solution).

Prevention of blood transfusion reactions includes strict compliance with all conditions and requirements for the procurement and transfusion of canned blood and its components; correct preparation and processing of systems and equipment for transfusions, use of systems for P. to. disposable; taking into account the state of the recipient before blood transfusion, the nature of his disease, individual characteristics and reactivity of the organism, detection of hypersensitivity to administered proteins, sensitization by pregnancy, repeated transfusions with the formation of anti-leukocyte, anti-platelet antibodies, antibodies to plasma proteins, etc.

Clinically, a complication caused by transfusion of blood or erythrocyte mass that is incompatible according to the group factors of the AB0 system is manifested by hemotransfusion shock that occurs at the time of transfusion or more often in the near future after it. Characterized by short-term excitation of the patient, pain in the chest, abdomen, lower back. In the future, tachycardia, arterial hypotension are noted, a picture of massive intravascular hemolysis develops (hemoglobinemia, hemoglobinuria, bilirubinemia, jaundice) and acute impairment of kidney and liver function. If shock develops during surgery, which occurs under anesthesia, severe bleeding appears.

The clinical manifestations of complications caused by the transfusion of blood or red blood cells incompatible with the Rh factor are in most cases the same as after transfusion of whole blood or red blood cells incompatible with the AB0 group factors, but they usually occur somewhat later, proceed less expression.

With the development of hemotransfusion shock, first of all, immediately stop P. to. and proceed to intensive care. The main therapeutic measures should be aimed at restoring and maintaining the function of vital organs, stopping the hemorrhagic syndrome, preventing acute kidney failure.

To stop hemodynamic and microcirculation disorders, it is necessary to administer plasma-substituting solutions of rheological action (rheopolyglucin), heparin, fresh frozen plasma, 10-20% serum albumin solution, isotonic sodium chloride solution or Ringer-Locke solution. When carrying out these activities within 2-6 h after transfusion of incompatible blood, it is usually possible to remove patients from the state of hemotransfusion shock and prevent the development of acute renal failure.

Therapeutic measures are carried out in the following order. Produce injections of cardiovascular (0.5-1 ml corglicon at 20 ml 40% glucose solution), antispasmodic (2 ml 2% papaverine solution), antihistamines (2-3 ml 1% diphenhydramine solution, 1-2 ml 2% suprastin solution or 2 ml 2.5% diprazine solution) agents and corticosteroid drugs (intravenously 50-150 mg prednisolone hemisuccinate). If necessary, the introduction of corticosteroid drugs is repeated, in the next 2-3 days their dose is gradually reduced. In addition, rheopolyglucin is infused (400-800 ml), hemodez (400 ml), 10-20% serum albumin solution (200-300 ml), alkaline solutions (200-250 ml 5% sodium bicarbonate solution, lactosol), as well as isotonic sodium chloride solution or Ringer-Locke solution (1000 ml). In addition, furosemide (Lasix) is administered intravenously (80-100 mg), then intramuscularly after 2-4 h 40 each mg(furosemide is recommended to be combined with a 2.4% solution of eufillin, which is administered in 10 ml 2 times through 1 h, then 5 ml after 2 h), mannitol in the form of a 15% solution intravenously, 200 ml, after 2 h- 200 more ml. In the absence of effect and the development of anuria, further administration of mannitol and lasix is ​​stopped, because. it is dangerous due to the threat of the development of hyperhydration of the extracellular space as a result of hypervolemia, pulmonary edema. Therefore, early hemodialysis is extremely important (indications for it appear after 12 h after a fixed erroneous P. to. in the absence of the effect of intensive therapy).

Prevention of hemotransfusion shock is based on the careful implementation by the doctor transfusing blood or erythrocyte mass of the rules of the instructions for P. to. Immediately before P. to. or erythrocyte mass, the doctor must: blood groups on the vial; determine the group affiliation of the donor's blood taken from the vial and compare the result with the record on this vial; conduct tests for compatibility by blood groups AB0 and Rh factor

AVO system

The doctrine of blood groups arose from the needs of clinical medicine. When transfusing blood from animals to humans or from humans to humans, doctors often observed severe complications, sometimes ending in the death of the recipient (the person receiving the blood transfusion).

With the discovery of blood groups by the Viennese doctor K. Landsteiner (1901), it became clear why in some cases blood transfusions are successful, while in others they end tragically for the patient. K. Landsteiner first discovered that the plasma, or serum, of some people is able to agglutinate (stick together) the red blood cells of other people. This phenomenon has been named isohemagglutination. It is based on the presence of antigens in erythrocytes, called agglutinogens and denoted by the letters A and B, and in plasma - natural antibodies, or agglutinins, called α and β . Agglutination of erythrocytes is observed only if agglutinogen and agglutinin of the same name are found: A and α , In and β.

It has been established that agglutinins, being natural antibodies (AT), have two binding centers, and therefore one molecule of agglutinin is able to form a bridge between two erythrocytes. In this case, each of the erythrocytes, with the participation of agglutinins, can contact the neighboring one, due to which a conglomerate (agglutinate) of erythrocytes arises.

In the blood of the same person, there cannot be agglutinogens and agglutinins of the same name, since otherwise mass agglutination of erythrocytes would occur, which is incompatible with life. Only four combinations are possible in which agglutinogens and agglutinins of the same name do not occur, or four blood groups: I- αβ, II- Aβ, III-B α ,IV-AB.

In addition to agglutinins, plasma or serum contains hemolysins: there are also two types of them and they are designated, like agglutinins, by the letters α and β . When the agglutinogen and hemolysin of the same name meet, hemolysis of erythrocytes occurs. The action of hemolysins is manifested at a temperature of 37-40 ο FROM. That is why, when transfusing incompatible blood in a person, already after 30-40 s. erythrocyte hemolysis occurs. At room temperature, if agglutinogens and agglutinins of the same name occur, agglutination occurs, but hemolysis is not observed.

In the plasma of people with II, III, IV blood groups, there are antiagglutinogens that have left the erythrocyte and tissues. They are designated, like agglutinogens, by the letters A and B (Table 6.4).

Table 6.4. Serological composition of the main blood groups (ABO system)

As can be seen from the table below, blood group I does not have agglutinogens, and therefore, according to the international classification, it is designated as group 0, II- is called A, III-B, IV-AB.

To resolve the issue of compatibility of blood groups, the following rule is used: the environment of the recipient must be suitable for the life of the erythrocytes of the donor (the person who donates blood). Plasma is such a medium, therefore, the recipient should take into account the agglutinins and hemolysins in the plasma, and the donor should take into account the agglutinogens contained in the erythrocytes.

Blood transfusion rules

Indications for transfusion of any transfusion medium, as well as its dosage and choice of transfusion method, are determined by the attending physician based on clinical and laboratory data. The doctor performing the transfusion is obliged, regardless of previous studies and available records, to personally conduct the following control studies:

1) determine the recipient's blood group according to the AB0 system and compare the result with the data of the medical history;

2) determine the group affiliation of the donor's erythrocytes and compare the result with the data on the label of the container or bottle;

3) conduct tests for compatibility in relation to blood groups of the donor and recipient according to the AB0 system and the Rh factor;

4) conduct a biological test.

It is forbidden to transfuse donor blood and its components that have not been tested for AIDS, hepatitis B surface antigen and syphilis. Transfusion of blood and its components is carried out in compliance with the rules of asepsis using disposable plastic systems. Blood received from a donor (usually in a volume of 450 ml) after adding a preservative solution can be stored in a refrigerator at a temperature of 4-8°C for no more than 21 days. Frozen at the temperature of liquid nitrogen (-196°C), erythrocytes can be stored for years.

It is allowed to transfuse whole blood and its components only of the group and Rh affiliation that the recipient has. In exceptional cases, it is allowed to transfuse Rh-negative blood of group O (I) (“universal donor”) to a recipient with any blood type in an amount up to 500 ml (except for children). The blood of Rh-negative donors A (II) or B (III) can be transfused not only to recipients matching the group, but also to a recipient with an AB (IV) group, regardless of his Rh affiliation. A patient with AB (IV) group Rh-positive blood can be considered a "universal recipient".

In addition, in the absence of single-group blood, blood (erythrocyte mass) of the 0 (I) Rh-positive group can be transfused to a Rh-positive recipient of any group according to the AB0 system. Blood group A (II) or B (III) Rh-positive can be transfused to a Rh-positive recipient with group AB (IV). In all cases, a compatibility test is absolutely mandatory. In the presence of antibodies of rare specificity, an individual selection of donor blood and additional tests for compatibility are required.

After transfusion of incompatible blood, the following complications may occur: hemotransfusion shock, dysfunction of the kidneys and liver, metabolic processes, activity of the gastrointestinal tract, cardiovascular and central nervous systems, respiration, hematopoiesis. Organ dysfunction occurs as a result of acute intravascular hemolysis (erythrocyte breakdown). As a rule, as a result of these complications, anemia develops, which can last up to 2-3 months or more. If the established rules for blood transfusion are violated or indications are unclear, non-hemolytic post-transfusion reactions may also occur: pyrogenic, antigenic, allergic and anaphylactic. All post-transfusion complications require immediate treatment.

11. Rh antigenic system of the blood. Definition method. Types of Rh immunization and their mechanisms.

6.3.2. Rhesus system (Rh-hr) and others

K. Landsteiner and A. Wiener (1940) found in the erythrocytes of the macaque monkey Rhesus AG, which they called Rh factor. Later it turned out that approximately 85% of people of the white race also have this hypertension. Such people are called Rh-positive (Rh +). About 15% of people do not have this hypertension and are called Rh-negative (Rh).

It is known that the Rh factor is a complex system that includes more than 40 antigens, denoted by numbers, letters and symbols. The most common types of Rh antigens are D (85%), C (70%), E (30%), e (80%) - they also have the most pronounced antigenicity. The Rh system does not normally have agglutinins of the same name, but they can appear if an Rh-negative person is transfused with Rh-positive blood.

The Rh factor is inherited. If a woman is Rh, a man is Rh +, then the fetus will inherit the Rh factor from the father in 50-100% of cases, and then the mother and fetus will be incompatible with the Rh factor. It has been established that during such a pregnancy, the placenta has an increased permeability to fetal erythrocytes. The latter, penetrating into the mother's blood, lead to the formation of antibodies (anti-Rhesus agglutinins). Penetrating into the blood of the fetus, antibodies cause agglutination and hemolysis of its erythrocytes.

The most severe complications arising from transfusion of incompatible blood and Rh conflict are caused not only by the formation of erythrocyte conglomerates and their hemolysis, but also by intense intravascular coagulation, since erythrocytes contain a set of factors that cause platelet aggregation and the formation of fibrin clots. In this case, all organs suffer, but the kidneys are especially severely damaged, since the clots clog the "wonderful network" of the kidney glomerulus, preventing the formation of urine, which may be incompatible with life.

According to modern concepts, the erythrocyte membrane is considered as a set of the most diverse AGs, of which there are more than 500. More than 400 million combinations, or group signs of blood, can be made from these AGs alone. If we take into account all the other AGs found in the blood, then the number of combinations will reach 700 billion, i.e., much more than people on the globe. Of course, not all AHs are important for clinical practice. However, when transfusing blood with relatively rare hypertension, severe blood transfusion complications and even death of the patient can occur.

Quite often, serious complications occur during pregnancy, including severe anemia, which can be explained by the incompatibility of blood groups according to the systems of poorly studied maternal and fetal antigens. At the same time, not only the pregnant woman suffers, but the unborn child is also in unfavorable conditions. Blood type incompatibility between mother and fetus can cause miscarriages and premature births.

Hematologists identify the most important antigenic systems: ABO, Rh, MNSs, P, Lutheran (Lu), Kell-Kellano (Kk), Lewis (Le), Duffy (Fy) and Kid (Jk). These antigen systems are used in forensic science to establish paternity and sometimes in organ and tissue transplants.

Currently, whole blood transfusion is relatively rare, since they use transfusion of various blood components, that is, they transfuse what the body needs most: plasma or serum, erythrocyte, leukocyte or platelet mass. In this situation, fewer antigens are administered, which reduces the risk of post-transfusion complications.

Hemagglutination reaction - one of the main methods by which erythrocyte antigens are determined. RBC agglutination is mediated by antibodies. The speed and severity of this process depend on the number of erythrocytes, the concentration of antibodies, pH, temperature and ionic strength of the solution. Agglutination occurs when the binding forces exceed the repulsive forces due to the negative charge on the erythrocyte cell surface. IgMs carrying 10 binding sites cause erythrocyte agglutination even in saline. IgG cannot cause agglutination until the negative charge of erythrocytes is reduced with the help of some macromolecular substance (for example, bovine albumin) or removal of sialic acids (for this, erythrocytes are treated with proteases: ficin, papain, bromelain or trypsin).

Agglutination also depends on the availability, i.e., the number and location of antigen molecules on the surface of the erythrocyte. The antigens of the AB0 system (erythrocyte antigens A and B) are located on the outer surface of the cell membrane and therefore easily bind to antibodies, and the antigens of the Rh system are in its thickness. The availability of such antigens is enhanced by the treatment of erythrocytes with enzymes.