Blood transfusion: complications, indications, preparation
Blood transfusion is a blood transfusion procedure that has certain indications, can give complications, and therefore requires preliminary preparation.
The first attempts to transfuse blood to a person were made long before the birth of Christ. At that time, they tried to inject the blood of animals into man: lambs, dogs, pigs, which, of course, did not end with success. Then, experimentally, it was found that only human blood is suitable for a person. People only learned about blood compatibility in 1901, when scientist Karl Landsteiner discovered the antigenic blood system ABO (blood groups). It was a real breakthrough in medicine, which made it possible to carry out blood transfusions from person to person without more or less dangerous health consequences. Another 40 years later, the Rhesus system was discovered, which made this procedure even more accessible.
Content:
- What is blood transfusion?
- Methods and methods of blood transfusion
- Preparing for a blood transfusion
- Indications and contraindications for blood transfusion
- Blood for transfusion and its components
- Blood transfusion for a newborn baby
- Complications from blood transfusion
What is blood transfusion?
Blood for transfusion is collected from people voluntarily. This is done in hospitals, blood banks and blood transfusion stations. Blood taken from a donor is stored in containers so that it does not deteriorate; special preservatives and stabilizers are added to it. Without fail, blood is tested for various infectious diseases, such as HIV, gonorrhea, hepatitis. Also, various components are extracted from the blood: erythrocytes, plasma, platelets. Medicines are made from blood: gamma globulin, albumin, cryoprecipitate, etc.
The blood transfusion procedure is similar to the procedure for transplanting tissue from one person to another. It is simply impossible to find blood that is ideally suited for all parameters, therefore whole blood is very rarely transfused. This only happens when the patient requires an emergency direct blood transfusion. In order for the body to give a minimum of side effects, the blood is broken down into components. Most often, they are erythrocytes and plasma.
In order to prevent a person from becoming infected with dangerous infectious diseases, such as HIV or hepatitis, the blood taken from the donor is sent to quarantine, where it is stored for 6 months. Ordinary refrigerators are not suitable for this, since under such conditions the blood will lose its beneficial properties. So, platelets are stored for 6 hours, red blood cells can exist for no more than 3 weeks in the refrigerator, but after freezing they are destroyed. Therefore, the blood obtained from the donor is divided into red blood cells, which can be frozen at a temperature of -196 ° C using nitrogen. Also, ultra-low temperatures can withstand blood plasma. The process of storing blood is very complex and requires a selective approach.
Most people who, by virtue of their professional activities, are not associated with medicine, know only about the most common method of blood transfusion. In this case, blood from a container (bottle or gemakon - a bag of blood and a preservative) is fed through a puncture in a vein into the patient's bloodstream. A preliminary study of the patient's blood is carried out to determine its group and Rh factor, if this is not known. Then he is given the blood that suits a person in all respects.
If earlier it was believed that any blood is suitable for a person, the main thing is that it should be obtained from a person, then modern medicine does not share this point of view. A compatibility test is required first.
Blood can be transfused from donor to recipient for the following purposes:
- The function of replacing one's own blood.
- Hemostatic function.
- Stimulating function.
- Removal of intoxication.
- Nutritional function.
Carrying out blood transfusion requires a careful attitude on the part of the doctor. The procedure should be performed only if there are certain indications for it. Unjustified blood transfusion threatens with serious health problems, because only identical twins can have 100% blood compatibility. In other people, even though they are blood relatives, the blood differs in a number of individual indicators. Therefore, there is no guarantee that the body will not begin to reject it.
Methods and methods of blood transfusion
There are several methods of blood transfusion, each of which is designed to meet specific goals and objectives.
Among those:
- Indirect transfusion, when a patient is transfused with donor blood stored in certain containers.
- Direct blood transfusion, when the patient receives blood transfusion directly from the vein of the donor. This procedure is carried out using special equipment. The device makes it possible to perform continuous blood transfusion, and an intermittent transfusion is performed with a syringe.
- Exchange blood transfusion, when a patient's blood is transfused after his blood has been partially or completely removed.
- Autohemotransfusion. In this case, the patient is transfused with the donor's blood prepared in advance during the operation. In this case, the donor and the patient are one and the same person.
- Reinfusion. In this case, a person's own blood, which was poured out during an accident or during an operation, is collected and then transfused to the person himself.
Blood is transfused by drip, jet or jet-drip. The doctor should decide on the speed of the transfusion.
Blood transfusion is a complex procedure that is compared to surgery, so its implementation is in the competence of the doctor, and not the nursing staff.
Methods for supplying blood to the recipient:
- Intravenous infusion is the basic method of blood transfusion. Venepuncture is a standard blood transfusion, and venesection is a method of blood transfusion through a catheter inserted into the subclavian vein. The device can be in this place for a long time, but at the same time, the catheter must be properly maintained.
- Intra-arterial blood transfusion is performed very rarely when a person has cardiac arrest.
- It is possible to perform intraosseous blood transfusion. For this purpose, the bones of the sternum and ilium are most often used. Less commonly, blood is injected into the calcaneus, into the condyles of the femur, and into the tuberosity of the tibia.
- Intracardial blood transfusion is carried out into the left ventricle. This method of blood transfusion is rarely implemented in practice when other methods are not available.
- Intra-aortic transfusion can be performed when there are only a few seconds to save a person's life. The indications are: unexpected clinical death, massive blood loss during surgery in the sternum.
It is important to distinguish between autohemotransfusion and autohemotherapy, since these are two radically different procedures. With autohemotransfusion, a person is given a full-fledged transfusion of his own blood, which was previously prepared. With autohemotherapy, the patient's own blood is transfused from a vein into the buttock. This procedure is aimed at eliminating cosmetic defects, for example, youthful acne, pustular skin lesions, etc.
Preparing for a blood transfusion
Blood transfusion requires careful preparation of the person. First of all, this concerns the high-quality collection of anamnesis, as well as the study of the patient's allergic tension.
Therefore, the doctor must ask the patient the following questions:
- Has he received a blood transfusion before? If so, how did he manage this procedure?
- Does the person suffer from allergies?
- The woman is asked how many births she had, whether they all ended successfully. If the patient has a burdened history, then she is shown preliminary additional examinations, including: the Kumbas test, which allows detecting immune antibodies.
- It is imperative to find out what diseases the patient suffered earlier, and from what pathologies he suffers at a given time.
In general, the doctor is faced with the task of qualitatively examining the patient and finding out if he is in the risk group of people for whom blood transfusion is contraindicated.
Depending on the purpose of the transfusion, the doctor may administer certain blood components to the patient. I rarely use whole blood.
Preliminary preparation comes down to the following steps:
- Determination of the patient's blood group and blood Rh factor, if he does not have a written certificate with a seal on his hands, confirming these indicators.
- Determination of the blood group and Rh factor of the donor, despite the fact that such a mark is already on the vial with blood.
- Performing a biological test for the compatibility of the donor's and recipient's blood.
Sometimes an emergency blood transfusion is required, in which case all preparatory steps are at the discretion of the doctor. If the surgical intervention is planned, then the patient should adhere to a diet for several days, cutting back on protein foods in his diet. Only a light breakfast is allowed on the day of surgery. If the intervention is scheduled for the morning, then the patient's intestines and bladder should be empty.
Indications and contraindications for blood transfusion
Even though the preparation for the blood transfusion process is carried out according to all the rules, this procedure still provokes sensitization of the body. Moreover, there is always a risk of immunizing the body with antigens that modern medicine does not yet know about. Therefore, there are practically no indications for performing a whole blood transfusion.
Only the following situations can act as an exception:
- Acute blood loss in humans, when its total volume is about 15% of the total circulating blood volume.
- Bleeding against the background of a violation of the hemostasis system. If possible, the patient is not given whole blood, but the necessary elements.
- Shock state.
- Severe anemia.
- Trauma or complex surgery that involves massive blood loss.
Whole blood transfusion has much more contraindications than indications. The main contraindication is a wide variety of diseases of the cardiovascular system. However, when it comes to transfusion of erythrocyte mass or other individual blood elements, absolute contraindications often turn into relative ones.
So, the absolute contraindications for whole blood transfusion include:
- Septic endocarditis in the subacute and acute stages.
- Thrombosis and embolism.
- Cerebral circulation disorders of pronounced intensity.
- Lung edema.
- Myocarditis and myocardiosclerosis.
- The third stage of arterial hypertension.
- The third and 2B degree of circulatory disorders.
- Atherosclerosis of the vessels of the brain.
- Nephrosclerosis.
- Retinal hemorrhage.
- Rheumatism in the acute stage, rheumatic fever.
- Renal and hepatic failure in acute and chronic stages.
Relative contraindications:
- Amyloidosis.
- Disseminated pulmonary tuberculosis.
- Hypersensitivity to proteins and protein preparations.
- Allergy.
If a situation is created that poses a direct threat to a person's life, then they do not pay attention to absolute contraindications. After all, there are times when a person will simply die without a prompt blood transfusion. However, even then it is highly desirable to give the patient not whole blood, but its individual components, for example, erythrocyte mass. Also, doctors try to replace blood with special solutions as much as possible. In parallel, the patient is shown the introduction of antiallergenic drugs.
Blood for transfusion and its components
Human blood consists of blood cells and plasma. Various preparations are prepared from these components, although this process cannot be called easy in terms of technology.
The most common blood components obtained from whole blood are white blood cells, plasma, platelets, and red blood cells.
Erythrocytes
Red blood cells are transfused when there is a shortage of red blood cells. The indications for the procedure are the hematocrit level below 0.25 and hemoglobin below 70 g / l.
This can happen under the following conditions:
- Anemia that develops in the early postpartum period, or in the early postoperative period.
- Severe iron deficiency anemia, which develops in older people with heart or respiratory failure, or in young women during pregnancy. The procedure in this case can be carried out before the onset of labor or before the forthcoming operation.
- Anemia against the background of various diseases of the digestive system.
- Intoxication of the body against the background of severe burns, poisoning, purulent processes. Erythrocytes from the donor's blood help rid the patient's body of toxic substances.
- Erythropoiesis that caused anemia.
If the patient has symptoms that indicate a violation of blood microcirculation, then he is given an erythrocyte suspension. It is a diluted mass of red blood cells.
To minimize the risk of developing unwanted reactions from the body, it is necessary to use three or five times washed erythrocytes for transfusion. With the help of physiological solution, platelets, leukocytes, preservatives, electrolytes, microaggregates and other substances are removed from them, which the body of a sick person does not need. If the erythrocyte mass has been subjected to the procedure for removing leukocytes and platelets from it, then it is called EMOLT.
Blood, which is currently used for transfusion, is frozen after collection from the donor. Therefore, they wash the erythrocytary mass on the day when they are going to perform its transfusion.
EMOLT is administered to patients for the following indications:
- If the patient has previously experienced complications caused by blood transfusion.
- The presence of isoimmune or autoimmune antibodies in the patient's blood. A similar situation is often observed with hemolytic anemia.
- Washing of erythrocytes is required in the case when it is necessary to perform a large amount of blood transfusion, which reduces the risks of developing massive blood transfusion syndrome.
- Increased blood clotting.
- The patient has renal or hepatic impairment.
Thus, it becomes obvious that EMOLT makes it possible to help a person who has absolute contraindications to performing whole blood transfusion.
Plasma
Plasma contains a large amount of protein components, vitamins, antibodies, hormones and other useful substances that are required by patients in a wide variety of situations. Therefore, plasma is a constituent of blood, which is very much in demand for transfusion. It can also be used in combination with other blood components.
Plasma is transfused in the following cases: a decrease in the total volume of circulating blood, bleeding, immunodeficiency, exhaustion and other serious health problems.
Platelets
Platelets are plates that take part in the process of hematopoiesis. They form white blood clots, which are necessary to stop capillary bleeding. The fewer platelets in the human body, the higher the risk of bleeding. If their level drops to a critical zero mark, then the likelihood of cerebral hemorrhage increases.
Storing and harvesting platelets is a very complex process. Platelet mass cannot be prepared in advance at all, since it is stored for a very short time, and also requires constant stirring. Therefore, platelets are transfused only on the day of collection from the donor. Before this, the blood is urgently checked for infections.
Most often, the donor is a person who is a relative of the victim. Alloimmunization develops in those patients who are often transfused with platelet mass. Also, this condition is a frequent companion of women who have undergone a difficult abortion or childbirth, as a result of which they needed a donor's blood.
For blood platelet transfusion to be successful, it is highly desirable to conduct an analysis for the selection of platelets for the antigens of the leukocyte system HLA. This analysis is very financially costly and also very time consuming.
In addition, platelet transfusions carry the risk of developing another reaction called graft versus host. This happens when aggressive T and B cells are present in the donor's platelets. Therefore, platelet transfusion is a rather difficult task.
Indications for platelet transfusion:
- Thrombocytopathies, which are accompanied by increased bleeding. This pathology can be either acquired or congenital. If the platelet level reaches 60.0 * 10 9 / L, but there is no hemorrhagic syndrome, then this is not an indication for blood transfusion. The platelet mass is transfused when the platelet level reaches 40 * 10 9 / l.
- Operative intervention.
- Preparation for treatment with cytostatics.
Leukocytes
Leukocyte transfusion is an even more difficult task than platelet transfusion. This procedure is used to treat leukopenia and is also indicated for patients who have received radiation or chemotherapy.
Often they refuse this procedure, since it is very difficult to obtain a high-quality leukocyte mass. It is extracted only using a separator. After removal from the donor's body, leukocytes die very quickly. In addition, leukocyte transfusion is associated with complications such as chills, shortness of breath, tachycardia, fever, and a drop in blood pressure.
Blood transfusion for a newborn baby
The indications for blood transfusion for a newborn child are similar to those for blood transfusion for an adult. The selection of a blood dose is carried out on an individual basis. Doctors should be especially attentive to children who were born with hemolytic disease of the newborn.
In case of hemolytic jaundice, the child undergoes replacement blood transfusion using EMOLT of group 0 (I), with the obligatory coincidence of the Rh factor.
Transfusing blood to a newborn baby is a complex process that requires caution and utmost attention from the doctor.
Complications from blood transfusion
Complications during blood transfusion most often develop due to the fact that medical personnel made mistakes in storing, collecting blood or during the procedure.
The basic reasons that can lead to complications include:
- Blood group incompatibility between the donor and the patient. In this case, blood transfusion shock develops.
- Allergy of the patient to immunoglobulins contained in the blood of the donor.
- Poor quality donor blood. In this case, the development of potassium intoxication, bacterial-toxic shock, pyrogenic reactions is possible.
- Mass blood transfusion, which can provoke homologous blood syndrome, acute enlarged heart, massive transfusion syndrome, citrate intoxication.
- Transmission of infection with donor blood. Although its long-term storage reduces this complication to a minimum.
Destruction (hemolysis) of foreign erythrocytes:
If a patient develops one or another negative reaction, the doctor must take emergency measures. Symptoms of such complications will be obvious: a person's body temperature rises, chills increase, and suffocation may develop. The skin turns blue, blood pressure drops sharply. Every minute the person's condition will worsen, up to the development of acute renal failure, pulmonary embolism, pulmonary infarction, etc.
Any mistake of medical personnel that was made in the process of blood transfusion can cost a person his life, therefore, the procedure must be approached as responsibly as possible. It is unacceptable that blood transfusion is performed by a person who does not have enough knowledge about this procedure. In addition, blood transfusions must be carried out for extremely strict indications.
Report on blood donation and transfusion:
The author of the article: Shutov Maxim Evgenievich | Hematologist
Education: In 2013 he graduated from the Kursk State Medical University and received a diploma "General Medicine". After 2 years, completed residency in the specialty "Oncology". In 2016 completed postgraduate studies at the National Medical and Surgical Center named after N. I. Pirogov.
