The procedure of hemotransfusion (transfusion of blood, plasma) cannot be taken lightly. In order for the manipulation to bring the expected therapeutic benefit, it is important to choose the right donor material and prepare the recipient.
The success of this manipulation depends on a number of irreplaceable factors. A significant role is played by the thoroughness of the preliminary assessment of indications for hemotransfusion, the correct phasing of the operation. Despite the development of modern transfusiology, it is impossible to exclude with absolute certainty the risk of such a consequence of blood plasma transfusion as a fatal outcome.
A brief history of manipulation
In Moscow, since 1926, the National Research Center for Hematology, the leading scientific center of Russia, has been operating. It turns out that the first attempts of blood transfusion were recorded in the Middle Ages. Most of them were not successful. The reason for this can be called the almost complete lack of scientific knowledge in the field of transfusiology and the impossibility of establishing group and Rh affiliation.
The transfusion of blood plasma in case of incompatibility of antigens is doomed to death of the recipient, therefore today doctors have abandoned the practice of introducing whole blood in favor of implanting its individual components. This method is considered safer and more efficient.
Risks for the recipient
Even if a blood transfusion is somewhat similar to the introduction of saline or medicines by drip, this procedure is more complicated. Hemotransfusion is a manipulation equivalent to the transplantation of biological living tissue. Implantable materials, including blood, contain many heterogeneous cellular components that carry foreign antigens, proteins, and molecules. A perfectly matched tissue will under no circumstances be identical with the patient's tissues, so the risk of rejection is always present. And in this sense, the responsibility for the consequences of blood plasma transfusion lies solely on the shoulders of a specialist.
Any intervention carries risks that do not depend on the qualifications of the doctor or on the preliminary preparation for the procedure. At the same time, at any stage of plasma transfusion (sample or direct infusion), the superficial attitude of the medical staff to work, rush or lack of a sufficient level of qualification is unacceptable. First of all, the doctor must make sure that this manipulation is indispensable. If there is an indication for plasma transfusion, the doctor must be sure that all alternative therapies have been exhausted.
Who needs blood transfusion
This manipulation has clear goals. In most casesthe infusion of donor material is due to the need to replenish the lost blood in case of extensive bleeding. Also, blood transfusion may be the only way to increase platelet levels to improve clotting parameters. Based on this, the indications for blood plasma transfusion are:
- deadly blood loss;
- shock condition;
- severe anemia;
- preparation for a planned surgical intervention, allegedly accompanied by impressive blood loss and carried out using artificial circulation devices (heart, vascular surgery).
These readings are absolute. In addition to them, sepsis, blood diseases, chemical poisoning of the body can serve as a reason for blood transfusion.
Transfusion for children
There are no age restrictions for blood transfusion. If it is objectively necessary, manipulation can also be prescribed to a newborn. Plasma transfusion at an early age has similar indications. In addition, when choosing a method of treatment, the decision in favor of blood transfusion is made in the case of rapid progression of the disease. In infants, blood transfusions can be caused by jaundice, an enlarged liver or spleen, or an increase in red blood cells.
The main argument in favor of this manipulation is the bilirubin index. For example, if in a newborn it exceeds 50 µmol / l (material for research is takenfrom umbilical cord blood), they begin to closely monitor the condition of the baby, since this violation signals the need for the introduction of donor blood in the near future. Doctors monitor not only the indicators of bilirubin, but also the rate of its accumulation. If it significantly exceeds the norm, the child is prescribed a blood transfusion.
Contraindications
Identification of contraindications is an equally important step in the process of preparing for the procedure. According to the rules of blood plasma transfusion, the main obstacles to this manipulation include:
- heart failure;
- recent myocardial infarction;
- ischemic heart disease;
- congenital heart defects;
- bacterial endocarditis;
- hypertensive crisis;
- acute cerebrovascular accident;
- thromboembolic syndrome;
- pulmonary edema;
- glomerulonephritis at the stage of exacerbation;
- liver and kidney failure;
- Tendency to be allergic to many irritants;
- bronchial asthma.
In some cases, when transfusion is the only way to save the patient's life, individual contraindications may be ignored. At the same time, the tissues of the recipient and the donor must undergo many tests in order to confirm compatibility. Plasma transfusion should also be preceded by a comprehensive diagnosis.
Donor blood for allergy sufferers
For a person suffering from allergic reactions, different rules apply for plasma transfusion. Immediately beforemanipulation, the patient must undergo a course of desensitizing therapy. For this, calcium chloride is administered intravenously, as well as antihistamines Suprastin, Pipolfen, and hormonal preparations. To reduce the risk of an allergic response to a foreign biomaterial, the recipient is injected with the minimum required amount of blood. Here the emphasis is not on quantitative, but on its qualitative indicators. Only those components that the patient lacks are left in the plasma for transfusion. At the same time, the volume of fluid is replenished with blood substitutes.
Biomaterial for transfusion
As a transfusion fluid can be used:
- whole blood donation, which is extremely rare;
- erythrocyte mass containing a meager amount of leukocytes and platelets;
- platelet mass, which can be stored for no more than three days;
- fresh frozen plasma (transfusion is used in case of complicated staphylococcal, tetanus infection, burns);
- components to improve clotting performance.
Introduction of whole blood is often impractical due to the high consumption of biomaterial and the highest risk of rejection. In addition, the patient, as a rule, needs specifically missing components, there is no point in “loading” him with additional foreign cells. Whole blood is transfused mainly during open heart surgery, as well as in emergency cases with life-threatening blood loss. The introduction of the transfusion medium can be carried out in several ways:
- Intravenous replenishment of missing blood components.
- Exchange transfusion - part of the recipient's blood is replaced with donor liquid tissue. This method is relevant for intoxication, diseases accompanied by hemolysis, acute renal failure. The most common transfusion is fresh frozen plasma.
- Autohemotransfusion. It involves the infusion of the patient's own blood. Such a liquid is collected during bleeding, after which the material is cleaned and preserved. This type of blood transfusion is relevant for patients with a rare group in which there are difficulties in finding a donor.
About compatibility
Transfusion of plasma or whole blood involves the use of materials of the same group, matching the Rh affiliation. But, as you know, every rule has an exception. If there is no suitable donor tissue, in an emergency, patients with group IV are allowed to inject blood (plasma) of any group. In this case, it is important to observe only the compatibility of Rh factors. Another interesting feature concerns the blood of group I: for patients who need to replenish the volume of erythrocytes, 0.5 l of this liquid tissue can replace 1 liter of washed erythrocytes.
Before the start of the procedure, personnel must ensure the suitability of the transfusion medium, check the expiration date of the material, its storage conditions, and the tightness of the container. It is also important to evaluate the appearance of blood (plasma). If flakes are present in the liquid,strange impurities, convolutions, a film on the surface, it is impossible to inject it into the recipient. Before the direct manipulation, the specialist must once again clarify the group and Rh factor of the blood of the donor and the patient.
Preparing for transfusion
The procedure begins with formalities. First of all, the patient must familiarize himself with the likely risks of this manipulation and sign all the necessary documents.
The next step is to conduct an initial study of blood group and Rh factor according to the ABO system using coliclones. The information received is recorded in a special registration journal of the medical institution. Then the removed tissue sample is sent to the laboratory for clarification of blood phenotypes by antigens. The results of the study are indicated on the title page of the medical history. For patients with a history of complications of transfusion of plasma or other blood components, as well as pregnant women and newborns, the transfusion medium is selected individually in the laboratory.
On the day of the manipulation, blood is taken from the recipient from a vein (10 ml). Half is placed in a tube with an anticoagulant, and the rest is sent to a container for a series of tests and biological samples. When transfusing plasma or any other blood components, in addition to checking according to the ABO system, the material is tested for individual compatibility using one of the methods:
- conglutination with polyglucin;
- conglutination with gelatin;
- indirect Coombs reaction;
- reactions on the plane at room temperature.
These are the maintypes of samples that are carried out during the transfusion of plasma, whole blood or its individual components. Other tests are assigned to the patient at the discretion of the doctor.
In the morning you can not eat anything for both participants in the procedure. Blood transfusion, plasma is performed in the first half of the day. The recipient is advised to cleanse the bladder and intestines.
How the procedure works
The operation itself is not a complex intervention requiring serious technical equipment. For exchange transfusion, subcutaneous vessels on the hands are punctured. If there is a long transfusion, large arteries are used - the jugular or subclavian.
Before proceeding with the direct infusion of blood, the doctor should not have the slightest doubt about the quality and suitability of the implanted components. Be sure to carry out a detailed inspection of the container and its tightness, the correctness of the accompanying documents.
The first step in transfusion of blood plasma is a single injection of 10 ml of transfusion medium. The liquid is injected into the recipient's bloodstream slowly, at an optimal rate of 40-60 drops per minute. After infusion of test 10 ml of donor blood, the patient's condition is monitored for 5-10 minutes. The biological sample is repeated twice.
Dangerous signs that indicate the incompatibility of the biomaterials of the donor and the recipient are sudden shortness of breath, increased heart rate, severe reddening of the skin of the face, lowering blood pressure, suffocation. In the event that suchsymptoms stop the manipulation and immediately provide the patient with the necessary medical assistance.
If no negative changes have occurred, proceed to the main part of the blood transfusion. Simultaneously with the intake of blood components into the human body, it is necessary to monitor the temperature of his body, carry out dynamic cardiorespiratory monitoring, and control diuresis. The rate of administration of blood or its individual components depends on the indications. In principle, jet and drip administration is allowed at a rate of about 60 drops every minute.
During a blood transfusion, a blood clot can stop the needle. In this case, you can not push the clot into the vein. The procedure is suspended, the thrombosed needle is removed from the blood vessel and replaced with a new one, which is already inserted into another vein and the flow of liquid tissue is restored.
After transfusion
When all the necessary amount of donated blood enters the patient's body, some blood (plasma) is left in the container and stored for two to three days in the refrigerator. This is necessary in case the patient suddenly develops post-transfusion complications. The drug will reveal their cause.
Basic information about the manipulation is recorded in the medical history. The documents indicate the volume of injected blood (its components), composition, the result of preliminary tests, the exact time of manipulation, a description of the patient's well-being.
After the procedure, the patient should not get up immediately. The next few hours will have to be spent lying down. Perduring this time, the medical staff should carefully monitor the heartbeat, temperature indicators. A day after the infusion, the recipient takes urine and blood tests.
The slightest deviation in well-being can indicate unforeseen negative reactions of the body, rejection of donor tissue. With an increase in heart rate, a sharp decrease in pressure and soreness in the chest, the patient is transferred to the intensive care unit or intensive care unit. If, within the next four hours after transfusion of plasma or other blood components, the recipient's body temperature does not rise, and the pressure and pulse indicators are within normal limits, we can talk about successful manipulation.
What could be the complications
Subject to the correct algorithm and rules of blood transfusion, the procedure is absolutely safe for humans. The slightest error can cost a human life. So, for example, when air enters through the lumen of blood vessels, embolism or thrombosis may develop, which are manifested by respiratory disorders, cyanosis of the skin, and a sharp drop in blood pressure. Such conditions require emergency resuscitation, as they are deadly for the patient.
The post-transfusion complications mentioned above are extremely rarely life-threatening and often represent an allergic reaction to donor tissue components. Antihistamines help to cope with these.
A more dangerous complication with fatal consequences,is the incompatibility of blood by group and Rh, as a result of which the destruction of red blood cells occurs, multiple organ failure occurs and the death of the patient.
Bacterial or viral infection during the procedure is a relatively rare complication, but still its possibility cannot be completely ruled out. If the transfusion medium was not stored under quarantine conditions, and all the rules of sterility were not observed during its preparation, there is still a minimal risk of infection with hepatitis or HIV.
