Transfusion of blood gas carriers (packed red blood cells). Red blood cell suspension is the Shelf life of red blood cells law
The introduction of donor blood gas carriers is aimed at replenishing the volume of circulating red blood cells and maintaining normal oxygen transport function of the blood in anemia. Indications for transfusion of blood gas carriers in acute anemia due to massive blood loss, there is a loss of 25–30% of the circulating blood volume, accompanied by a decrease in hemoglobin levels below 70–80 g/l and hematocrit below 25% and the occurrence of circulatory disorders. The effectiveness of transfusion of blood gas carriers, which can be judged by a decrease in shortness of breath, tachycardia, and an increase in hemoglobin levels, depends on the initial condition of the patient, the hemoglobin level, as well as on the hematocrit level of the transfusion medium and its shelf life. Transfusion of one unit of red blood cells (i.e., the number of red blood cells from one 450 ml blood supply) generally increases the hemoglobin level by approximately 10 g/l and the hematocrit level by 3% (in the absence of ongoing active bleeding).
Red blood cell mass- the main blood transfusion medium, the hematocrit of which is not higher than 80%. Red blood cells are obtained from preserved blood by separating the plasma. Compared to whole blood, red blood cells contain a smaller volume of the same number of red blood cells, but significantly less citrates of cell breakdown products, cellular and protein antigens and antibodies. Patients with heart failure and elderly people do not tolerate a sharp increase in blood volume, so transfusion of red blood cells when the oxygen capacity of the blood is reduced is most appropriate for them, because with a minimal increase in blood volume due to an increase in the number of circulating red blood cells, oxygen delivery to tissues is significantly improved. In addition, non-hemolytic transfusion reactions with red blood cell transfusion are observed much less frequently than with whole blood transfusion.
Erythrocyte suspension It is practically a deplasmated erythrocyte concentrate, the protein level of which does not exceed 1.5 g/l. Transfusion of red blood cell suspension is indicated for persons with a history of severe allergies in order to prevent anaphylactic reactions.
Red blood cell mass, thawed and washed contains fewer leukocytes, platelets and plasma compared to other red blood cell-containing transfusion media. It is an ideal form for storing rare blood groups, for long-term (years) storage of blood components for the purpose of autotransfusion. Red blood cell mass, thawed and washed, must be used within 24 hours after thawing. Transfusion of thawed, washed erythrocytes is especially indicated for patients with a burdened transfusion history when anti-leukocyte and anti-platelet antibodies are detected in them.
Erythrocyte suspension with saline solution obtained from whole blood after removal of plasma or from red blood cells by washing three times in an isotonic solution or in special washing media. During the washing process, plasma proteins, leukocytes, platelets, cell microaggregates and stroma of cellular components destroyed during storage are removed. An erythrocyte suspension with physiological solution is a reactogenic medium, the transfusion of which is indicated for patients with a history of post-transfusion reactions of the non-hemolytic type, as well as for persons sensitized to leukocyte and platelet antigens, and plasma proteins. The shelf life of erythrocyte suspension with physiological solution at a temperature of +4°C is 24 hours from the moment of preparation.
Standard red blood cell mass is stored at a temperature of +4 +2°C. Storage periods are determined by the composition of the blood preservative solution or resuspension solution. Red blood cell mass obtained from blood prepared in Glugitsir or Citroglucophosphate solution is stored for 21 days. Red blood cells resuspended in Erythronaf solution can be stored for up to 35 days.
Transfusion of plasma-coagulation hemostasis correctors
Plasma is the liquid part of the blood, devoid of cellular elements. Normal plasma volume is about 4% of total body weight (40-45 ml/kg). Plasma components maintain normal circulating blood volume and its fluid state. Plasma proteins determine its colloid-oncotic pressure and balance with hydrostatic pressure; They also maintain balance in the blood coagulation and fibrinolysis systems. In addition, plasma ensures the balance of electrolytes and the acid-base balance of the blood.
In medical practice, fresh frozen plasma, native plasma, cryoprecipitate and plasma preparations are used: albumin, gamma globulins, blood coagulation factors, physiological anticoagulants (antithrombin III, protein C and S), components of the fibrinolytic system.
Under fresh frozen plasma refers to plasma that, within 4-6 hours after blood exfusion, is separated from red blood cells by centrifugation or apheresis and placed in a low-temperature refrigerator, ensuring complete freezing to a temperature of -30°C in an hour. This mode of plasma procurement ensures its long-term (up to a year) storage. In fresh frozen plasma, labile (V and VIII) and stable (I, II, VII, IX) coagulation factors are preserved in an optimal ratio.
Indications for prescribing fresh frozen plasma transfusions are:
Acute disseminated intravascular coagulation (DIC), complicating the course of shocks of various origins (septic, hemorrhagic, hemolytic) or caused by other reasons (amniotic fluid embolism, crash syndrome, severe injuries with crushing tissue, extensive surgical operations, especially on the lungs, blood vessels, brain, prostate), massive transfusion syndrome.
Acute massive blood loss (more than 30% of circulating blood volume) with the development of hemorrhagic shock and disseminated intravascular coagulation syndrome,
Liver diseases accompanied by a decrease in the production of plasma coagulation factors and, accordingly, their deficiency in the circulation (acute fulminant hepatitis, cirrhosis of the liver),
Overdose of indirect anticoagulants (dicoumarin, etc.),
When performing therapeutic plasmapheresis in patients with thrombotic thrombocytopenic purpura, severe poisoning, sepsis,
Coagulopathies caused by a deficiency of plasma physiological anticoagulants.
The transfused fresh frozen plasma must be of the same group as the recipient according to the AB0 system. Compatibility according to the Rh system is not mandatory, since plasma is a cell-free medium, however, for volume transfusions (more than 1 liter), Rh compatibility is required. In emergency cases, in the absence of single-group fresh frozen plasma, transfusion of group AB(IV) plasma to a recipient with any blood group is allowed. When transfusing fresh frozen plasma, a biological test must be performed.
Immediately before transfusion, fresh frozen plasma is thawed in a water bath at a temperature of 37°C. Thawed plasma may contain fibrin flakes, which does not prevent its use using standard intravenous transfusion devices with a filter. After thawing, plasma must be used within an hour; plasma cannot be re-frozen.
The possibility of long-term storage of fresh frozen plasma allows it to be accumulated from one donor in order to implement the principle of “one donor - one recipient,” which sharply reduces the antigenic load on the recipient.
The most serious risk when transfusing fresh frozen plasma is the possibility of transmission of viral and bacterial infections. That is why today much attention is paid to methods of viral inactivation of fresh frozen plasma (plasma quarantine for 3-6 months, detergent treatment, etc.).
A 6% sodium citrate solution is used as a stabilizing solution in a ratio of 1:10 to blood. Such blood is used immediately after collection or within the next few hours.
Heparinized blood
Heparinized blood is used to fill artificial blood circulation machines. Sodium heparin with dextrose and chloramphenicol is used as a stabilizer and preservative. Heparinized blood is stored at 4°C. Shelf life - 1 day.
Blood components
In modern conditions, blood components (individual components) are mainly used. Whole blood transfusions are performed less and less frequently due to possible post-transfusion reactions and complications caused by the large number of antigenic factors present in whole blood. In addition, the therapeutic effect of component transfusions is higher, since this involves a targeted effect on the body. There are certain readings to component transfusion: in case of anemia, blood loss, bleeding, transfusions of red blood cells are indicated; for leukopenia, agranulocytosis, immunodeficiency state - leukocyte mass; for thrombocytopenia - platelet mass; with hypodysproteinemia, coagulation system disorders, deficiency of bcc - blood plasma, albumin, protein.
Component blood transfusion therapy allows one to obtain a good therapeutic effect with less blood consumption, which is of great economic importance.
Red blood cell mass
Red blood cell mass is obtained from whole blood, from which 60-65% of the plasma has been removed by sedimentation or centrifugation. It differs from donor blood in having a smaller volume of plasma and a high concentration of red blood cells (hematocrit number 0.65-0.80). Available in bottles or plastic bags. Store at a temperature of 4-6 °C.
Erythrocyte suspension
Erythrocyte suspension is a mixture of red blood cells and a preservative solution in a 1:1 ratio. Stabilizer - sodium citrate. Store at a temperature of 4-6 °C. Shelf life - 8-15 days.
Indications for transfusion of red blood cells and suspension include bleeding, acute blood loss, shock, diseases of the blood system, and anemia.
Frozen red blood cells
Frozen red blood cells are obtained by removing leukocytes, platelets and plasma proteins from the blood, for which the blood is washed 3-5 times with special solutions and centrifuged. Freezing of red blood cells can be slow - in electric refrigerators at temperatures from -70 to -80 ° C, or fast - using liquid nitrogen (temperature -196 ° C). Frozen red blood cells are stored for 8-10 years. To defrost red blood cells, the container is immersed in a water bath at a temperature of 45 ° C and then washed from the enclosing solution. After thawing, red blood cells are stored at 4 °C for no more than 1 day.
The advantage of thawed red blood cells is the absence or low content of sensitizing factors (plasma proteins, leukocytes, platelets), coagulation factors, free hemoglobin, potassium, serotonin. This determines the indications for their transfusion: allergic diseases, post-transfusion reactions, patient sensitization, cardiac, renal failure, thrombosis, embolism. You can use blood from a universal donor and avoid massive transfusion syndrome. Washed native or thawed red blood cells are transfused to patients in the presence of incompatibility with leukocyte antigens of the HLA system or those sensitized to plasma proteins.
ERYTHROCYTE MASS(Greek erythros red + kytos container, here - cell; synonym: red blood cell mass, erythroconcentrate) - the main component of preserved donor blood, consisting of red blood cells, plasma and an admixture of leukocytes and platelets.
Red blood cells are obtained from preserved donor blood by removing most of the plasma. Depending on the remaining plasma volume, the dilution and therefore the hematocrit number of the packed red blood cells can be 65-95% (see Hematocrit number).
For therapeutic purposes, several types of red blood cells are prepared: native red blood cells with a hematocrit number of 65-80%; erythrocyte suspension (it is obtained from whole blood by removing most or all of the plasma and adding a preservative, resuspending or plasma-substituting solution instead to the remaining erythrocytes); washed red blood cells depleted of leukocytes and platelets; defrosted and washed red blood cells.
To separate plasma from canned blood and prepare red blood cells, the method of spontaneous sedimentation of canned blood red blood cells (within 1-2 days of storage at +°4°) is used, followed by aspiration of the plasma through a special system into a sterile vial or polymer container in compliance with strict aseptic measures and a method of centrifuging canned blood at 980 g for 25 minutes, followed by plasma separation. A layer of plasma (about 10 mm high) is left above the red blood cells, with the hematocrit number being 65-80%. It is also possible to completely remove the plasma along with the buffy platelet layer located above the red blood cells, thereby obtaining a red blood cell mass with a hematocrit number of 85-95%. Due to its high viscosity, such red blood cell mass is used for transfusion in the form of an erythrocyte suspension, adding the plasma-substituting solution TsOLIPK-8 (see Blood transfusion) or the resuspending and preserving solution “Erythronaf” with adenine and nicotinamide. The shelf life of erythrocyte suspension at t° 4° in TsOLIPK-8 solution is up to 15 days, in Erythronaf solution (in polymer containers) - up to 35 days. The shelf life of native red blood cells at t° 4° is up to 21 days.
The method of cryopreservation of red blood cells (freezing together with cryophylactic solutions) allows you to preserve it for a long time (years). After defrosting (thawing) and washing, this type of red blood cell mass has the same morphofunctional properties and therapeutic effectiveness as freshly prepared (see Blood Preservation).
The criteria for the suitability of red blood cells for transfusion are the transparency of the plasma above the red blood cells (absence of turbidity, flakes, fibrin threads), uniform red blood cell layer (absence of clots), integrity of the bottle or polymer container and documentation data. Pink coloration of plasma (minor hemolysis) is not a contraindication for clinical use, since the concentration of free hemoglobin in a small volume of red blood cell plasma, calculated as whole blood, does not exceed the permissible level.
Red blood cell mass, depleted of leukocytes and platelets (more than 70-80% of these cells have been removed from the red blood cell mass from their initial content in whole canned blood), is prepared by repeated (3-5 times) washing, followed by serial centrifugation in a sterile isotonic sodium chloride solution or by the method of accelerated sedimentation of erythrocytes by diluting in large volumes of glucose or sucrose or by adding colloidal precipitants (gelatin, hydroxyethyl starch) with subsequent removal of the supernatant along with plasma and the buffy platelet layer, as well as by filtering the erythrocyte mass (after removing the plasma and buffy platelet layer) through special filters (nylon, danulon, etc.) or by cryopreservation of red blood cells followed by washing after thawing. The most complete removal of leukocytes and platelets from the red blood cell mass is achieved by cryopreservation.
Transfusion of red blood cells for acute and chronic anemia of various origins has a number of advantages compared to the transfusion of regular blood: red blood cells are contained there in a smaller volume, which reduces the risk of circulatory overloads; the red blood cell mass contains significantly fewer citrate, potassium, ammonium, lactate ions, as well as antigens and antibodies, which causes reduced post-transfusion reactivity and a lower risk of isoimmunization.
Red blood cell mass depleted of leukocytes and platelets has additional advantages; it is the least reactive blood transfusion medium, especially for sensitized patients who are prone to reactions to repeated blood transfusions or red blood cells; causes isosensitization to a much lesser extent; red blood cells have a reduced aggregation ability, which makes it possible to carry out hemotherapy in patients with impaired rheological properties of blood and impaired microcirculation; there is no risk of citrate intoxication or hyperkalemia during massive transfusions; There seems to be a wider possibility of using red blood cells from a universal donor. The listed advantages of red blood cells have led to a significant reduction in the indications for the use of whole preserved blood in medical practice.
Indications for red blood cell transfusion are chronic anemia (see) of various origins; replenishment of blood loss (see) associated with injury, surgery, childbirth (in combination with saline solutions, blood substitute fluids, components and blood products); correction of anemia in patients with increased reactivity and sensitization, the presence of anti-leukocyte, anti-platelet and anti-erythrocyte antibodies (paroxysmal nocturnal hemoglobinuria, thalassemia, immune hemolytic anemia, etc.); anemia due to hypertension, cardiopulmonary, renal and liver failure.
Transfusions of red blood cells are indicated for patients with chronic posthemorrhagic iron deficiency anemia and B12-(folate) deficiency anemia with severe anemia, fraught with the risk of developing anemic coma.
In surgical and obstetric-gynecological practice, the use of red blood cells (in combination with saline solutions and blood substitutes) is advisable for the elimination of acute circulatory disorders and hypoxia caused by blood loss, traumatic and surgical shock, complications during childbirth, in preparing patients with severe anemia for surgery, during II and III periods of burn disease, as well as during heart surgery under artificial circulation, which makes it possible to replenish blood loss, stop anemia and avoid homologous blood syndrome (see Perfusion).
Before transfusion of red blood cells, the doctor is obliged to verify its quality (visual control) and carry out the necessary compatibility tests taking into account the blood type and Rh factor (see Blood groups, Rh factor). The dosage of red blood cells is individual (from 100-200 ml to 500 ml or more) and depends on the patient’s condition. Transfusions are usually performed using the drip method. If rapid administration is necessary, especially in acute circulatory disorders (shock, acute blood loss), it is preferable to use an erythrocyte suspension; when using red blood cells, 50-100 ml of sterile isotonic sodium chloride solution is added to each dose immediately before transfusion.
When transfusion of red blood cells, in some cases, blood transfusion reactions (for example, pyrogenic, allergic) can be observed. In this case, the transfusion of red blood cells is immediately stopped, and cardiovascular, sedative and hyposensitizing agents are used to eliminate blood transfusion reactions.
Complications are possible (in case of transfusion of red blood cells that are incompatible, infected, or overheated). Therapeutic measures are aimed at restoring the volume of circulating blood, improving the rheological properties of blood and microcirculation (see Blood transfusion).
Bibliography: Agranenko V. A. and Obshivalova N. N. Method of restoration (rejuvenation) of canned red blood cells with shelf life limits, Sov. med., No. 8, p. 66, 1976; Agranenko V. A. and Skachilova N. N. Hemotransfusion reactions and complications, M., 1979; Agranenko V. A. and Fedorova L. I. Frozen blood and its clinical use, M., 1983; Agranenko V. A. et al. New resuspending and preserving solution for red blood cells, Probl. hematol. and overflow, blood, vol. 27, No. 10, p. 19, 1982; Guide to general and clinical transfusiology, ed. B.V. Petrovsky, p. 62, M., 1979; Handbook of blood transfusion and blood substitutes, ed. O. K. Gavrilova, p. 42, 61, M., 1982; N b g m a n S. F. a. O. Red blood cell reservation in protein-poor media, I. Leu-ocyte enzymes as a cause of hemolysis, Transfusion, v. 18, p. 233, 1978; Lovric V. A., Prince B. a. Bryant J. Packed red cell transfusions - improved survival, quality and storage, Vox Sang., v. 33, p. 346, 1977; Valeri C. R. Blood banking and the use of frozen blood products, Cleveland, 1976.
V. A. Agranenko.
The hematocrit of the erythrocyte suspension does not exceed 0.70, which ensures the safety of erythrocytes and good rheological properties of the component. The erythrocyte suspension is transfused without prior dilution with physiological solution. All hemoglobin in donor blood is completely contained in the erythrocyte suspension.
The unique biochemical composition of the weighing solution ensures the preservation of the functional properties of red blood cells. The shelf life of erythrocyte suspension is 42 days.
When producing erythrocyte suspension, in addition to measures that guarantee the quality of whole donor blood, additional measures are carried out as indicated in the table.
Quality control of erythrocyte suspension
If necessary, the Blood Center of the Russian Ministry of Health provides transportation of red blood cell suspension with a guarantee of compliance with the temperature regime and proper storage conditions.
Isolating an erythrocyte suspension makes it possible to obtain, to the maximum extent possible, other important therapeutic components of donor blood - plasma and platelets. We invite you, all healthy people aged 18 to 60 years, to become blood donors.
Erythrocyte suspension is indicated for the correction of deficiency in the gas transport function of the blood during blood loss and for the treatment of anemia.
Erythrocyte suspension and other blood transfusion media can be ordered and available around the clock:
tel. Expedition - 24 hours a day, tel. (additional, only at night)
Pre-order and consultation by phone:
Lyudmila Georgievna Kalinchenko
Donor selection and individual selection of red blood cell suspension:
Valentina Ivanovna Popova
Nina Grigorievna Tikhonova
Vladlena Anatolyevna Belorusova
Address: Moscow, st. Shchukinskaya, 6, building 2
Erythrocyte suspension
Erythrocyte suspension with physiological solution is a reactogenic transfusion medium, which is obtained from whole blood after removal of plasma or from erythrocyte mass by washing three times in an isotonic solution. Washing removes plasma proteins, leukocytes, platelets, microaggregates of cells and stroma of destroyed cellular components.
Erythrocyte suspension with physiological solution is stored for 24 hours at a temperature of +4°C.
Indications for transfusion of red blood cell suspension
- Blood transfusions for patients with a history of post-transfusion reactions of a non-hemolytic type.
Erythrocyte suspension is
More stringent centrifugation of donor canned blood when dividing it into components makes it possible to obtain a medium with a hematocrit of%. One dose of EC (200 ± 20 ml) contains almost the same number of red blood cells as one dose of blood. The component of donor blood called erythroconcentrate is absent in OK KKChiK.
To improve the rheological properties of erythrocyte mass (or EC), immediately before transfusion, it is possible to add 50-100 ml of 0.9% sodium chloride solution to the container, which actually turns it into an erythrocyte suspension with physiological solution (see OK KKChiK).
Erythrocyte suspension
By resuspending the red blood cell mass in a special solution (0.9% sodium chloride solution, modelel, etc.), you can obtain a red blood cell suspension (ES). At the same time, EV, acquiring higher fluidity and, accordingly, higher rheological properties, simultaneously has a lower hematocrit number (40-50%).
It is not recommended to use glucose solutions and solutions containing calcium ions for preparing EVs. The use of a 5% glucose solution or its analogues causes gluing and hemolysis of red blood cells. Solutions containing calcium ions cause coagulation and clot formation.
Indications for the use of EV are the same as for EM. In practice, EOs are often diluted with 30-50 ml of isotonic sodium chloride solution immediately before administration in order to increase the fluidity of the solution to speed up the rate of administration.
Transfusion of erythrocyte suspension can be done drip or stream.
The advisability of using erythrocyte-containing media in combination with blood substitutes is undoubted. The use of a solution of EO in rheopolyglucin in a ratio of 1:1 or 1:0.5 reliably preserves the bcc, reduces aggregation and sequestration of formed elements during the operation and on the next day.
The use of an erythrocyte suspension in a solution of modelel (decalcified gelatinol), which is an original blood component - an erythrocyte transfusate, not only replenishes blood loss and restores the oxygen transport function of the blood, but also has a hemodynamic disaggregating effect with a fairly pronounced volemic effect.
Unreasonable or excessive administration of EOs or EVs can lead to hemoconcentration, which reduces cardiac output and thereby worsens hemodynamics in general.
Storage conditions for erythrocyte suspension. The shelf life of EVs is limited to 24-72 hours (depending on the preservative solution) at a temperature of +4 °C.
Indications for use. Indications for EV transfusion are similar to those for EM use.
Transfusions of EOs and EVs can be done by drip or stream.
Contraindications to the use of EM and EV.
Thromboembolism of various origins;
Acquired non-hemolytic anemia. Excessive administration of EO or EV can lead to hemoconcentration, which reduces cardiac output and thereby worsens hemodynamics in general.
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Topic 10. Transfusion of blood and its components. 1. a) erythrocyte mass; b) erythrocyte suspension; c) washed frozen or native red blood cells
1. a) erythrocyte mass; b) erythrocyte suspension; c) washed frozen or native red blood cells.
2. a) a correctly executed passport of the blood component (label); b) the integrity of the container or vial with the blood component; c) visual inspection of the blood component for the presence of impurities, flakes, clots, uniformity of mass and color.
3. a) using standard isohemagglutinating serums; b) using monoclonal antibodies (coliclones); c) using standard washed erythrocytes with known group affiliation.
4. Doctor (attending or on duty).
5. Acute blood loss (deficiency of gas carriers).
1. a) components of “red” blood (gas carriers); b) blood plasma.
2. a) native plasma; b) fresh frozen plasma.
3. Immediately before transfusion, fresh frozen plasma is thawed in a water bath at a temperature of 37°C.
4. a) a correctly executed passport of the blood component (label); b) the integrity of the container or vial with the blood component; c) visual inspection of the blood component for the presence of impurities, flakes, clots, films, and changes in color to grayish-brown.
5. Biological sample.
1. Washed frozen or native red blood cells.
2. a) tests for individual and Rh-factor compatibility; b) biological sample.
3. Doctor (attending or on duty).
4. ml of donor blood is injected intravenously three times with breaks of 2-3 minutes. The test is carried out to identify symptoms of transfusion shock.
5.drops per minute.
1. If the recipient experiences any reactions or complications after the transfusion, this blood can be used to determine the cause of their occurrence.
2. Within 48 hours.
3. a) a blood transfusion protocol of the established form is drawn up in the medical history; b) all information is duplicated in a special register for registering the transfusion of blood components.
4. a) bed rest for 3-4 hours after blood transfusion;
b) 3-hour thermometry of the recipient’s body; c) monitoring the general condition of the patient, his behavior, skin color, respiratory rate, heart rate, blood pressure, the first portion of urine after blood transfusion is visually assessed.
5. a) general blood test; b) general urine analysis.
4. Blood from the abdominal cavity is removed with a sterile scoop or using suction and filtered through 8 layers of gauze, washed, then a stabilizer is added and transfused no later than 6 hours after collection. According to the order of the Ministry of Health of the Russian Federation No. 363 of November 25, 2002, filtering spilled blood through several layers of gauze is currently unacceptable. Special devices have been created for intraoperative collection and washing of blood lost during surgery. Reinfusion is permissible only if this equipment is available in the medical institution.
5. a) damage to the hollow organs of the abdominal or thoracic cavities; b) the presence of malignant tumors in the patient; c) if blood is in the serous cavity for more than 24 hours.
2. a) antihemophilic globulin (factor VIII); b) fibrin-stabilizing factor (factor XII); c) fibrinogen.
3. a) a correctly executed passport of the blood component (label); b) the integrity of the container or vial with the blood component; c) visual inspection of the blood component.
4. Biological sample.
5. Severe allergic diseases.
2. a) erythrocyte mass; b) albumin.
3. a) assess the suitability of blood components; b) determine the blood group and Rh factor of the recipient and donor red blood cells; c) conduct a test for group (individual) compatibility; d) carry out a compatibility test for the Rh factor; e) conduct a biological test.
4. At room temperature, 2-3 drops of the recipient’s serum are applied to the plate and a small amount of red blood cells is added so that the ratio of red blood cells to serum is 1:10. Next, the red blood cells are mixed with the serum, the plate is gently rocked for 5 minutes, observing the progress of the reaction. After the specified time, 1-2 drops of physiological solution can be added to the reaction mixture to remove possible nonspecific aggregation of red blood cells.
5. 33% polyglucin solution.
1. Hidden bleeding.
2. Absolute (acute blood loss).
3. The blood type and compatibility tests are determined by the doctor, who also conducts the blood transfusion; a biocompatibility test was not carried out.
4. Blood transfusion shock.
5. Termination of blood transfusion, transfusion of single-group compatible plasma, anti-shock measures.
2. Add 2 drops of recipient serum, 1 drop of donor erythrocytes into the test tube and add 1 drop of 33% polyglucin solution. The test tube is tilted to a horizontal position, shaking slightly, then slowly rotated so that its contents spread over the walls in a thin layer. Contact of erythrocytes with the patient’s serum while rotating the tube should continue for at least 3 minutes. After 3-5 minutes, add 2-3 ml of physiological solution to the test tube and mix the contents by inverting the test tube 2-3 times without shaking. The results are assessed by the presence or absence of an agglutination reaction in the test tube.
3. Citrate shock.
4. Intravenous administration of calcium chloride or calcium gluconate, cardiac agents, hormonal and antihistamines.
5. Intravenous administration of 10 ml of calcium chloride for every 500 ml of preserved blood.
1. Pyrogenic reaction (non-hemolytic febrile reaction).
2. Pyrogenic reactions are a consequence of the presence in the recipient’s blood plasma of cytotoxic or agglutinating antibodies that react with antigens located on the membrane of transfused lymphocytes, granulocytes or platelets contained in the erythrocyte mass.
3. Transfusion of red blood cells depleted of leukocytes and platelets significantly reduces the incidence of pyrogenic reactions. The use of leukocyte filters in systems for transfusion of blood components significantly increases the safety of transfusion therapy.
4. Symptomatic (antipyretics).
5. Non-hemolytic febrile reactions are more common with repeated transfusions or in women who have had multiple pregnancies.
6. An increase in body temperature associated with transfusion may often be the first sign of more dangerous complications such as acute hemolysis or bacterial contamination.
Topic 11. Fluid and electrolyte disturbances in surgical patients and principles of infusion therapy
1. K-norm, hypernatremia, hypochloremia. Decompensated acidosis.
2. 4% sodium bicarbonate solution.
1. K-norm, hyponatremia, hypochloremia, subcompensated acidosis.
2. 5% glucose, Ringer's solution.
1. Hyperglycemia, glycosuria, hyperosmolarity, hypernatremia.
2. Phys. solution. Ringer's solution.
1. Burn disease.
3. Hypoproteinemia, hyperkalemia, hyponatremia.
4. Phys. solution, calcium gluconate, diuretics.
1. Burn disease.
2. Hypochloremia, subcompensated alkalosis.
3. Saline solution, Ringer's solution, 5% glucose.
small output syndrome
2. Laboratory changes:
3. Rehydration in the form of infusion of glucose-saline solutions.
4. Identification and elimination of hypoproteinemia and protein deficiency - transfusion of colloidal solutions.
· If it is impossible to establish full enteral feeding within 2-3 days, start parenteral nutrition.
· Therapy of the underlying disease (antibacterial therapy, enteroprotectors, elimination of vitamin deficiency, enzymes).
· water-electrolyte imbalance (isotonic dehydration)
· subcompensated metabolic acidosis with respiratory alkalosis.
2. Laboratory changes:
Subcompensated metabolic acidosis
3. Infusion therapy with crystalloid solutions.
4. Correction of dehydration and hypovolemia by infusion of glucose-saline solutions. Correction of protein deficiency - colloid infusion.
5. Treatment of burn disease according to the basic principles - surgical methods, maintenance of daily caloric intake, antibacterial therapy, immunotherapy, improvement of tissue perfusion, antiplatelet agents.
subcompensated metabolic alkalosis
2. Laboratory changes:
Subcompensated metabolic alkalosis
3. Pain relief, infusion therapy
4. Infusion therapy taking into account the acid-base and water-electrolyte state (crystalloids, colloids)
· Therapy of the underlying disease
ongoing gastrointestinal bleeding
subcompensated normochromic anemia
local changes in the stomach wall
2. Laboratory changes:
Decompensated metabolic acidosis
3. Cold on the stomach, oral administration of aminocaproic acid, etamsylate, infusion antishock therapy under blood pressure control (increased pressure is dangerous due to resumption of bleeding).
· Stopping bleeding using surgical methods.
· Correction of anemia - blood transfusion.
endocrine pancreatic insufficiency
2. Laboratory changes:
Neutrophilic leukocytosis with a shift to the left
decompensated metabolic acidosis
3. Infusion therapy with crystalloids.
· Correction of hyperglycemia: insulin therapy - 0.1 U/kg/hour micro-jet under glucose control.
· Normalization of microcirculation: trental, chimes.
· Hepatoprotectors: Essentiale, Heptral.
· Prevention and treatment of infectious complications: antibacterial therapy.
· When the pH decreases to less than 7.0, metabolic acidosis is corrected with sodium bicarbonate.
Topic 12. Critical disability
in surgical patients
1. Acute respiratory failure syndrome.
2. X-ray of the chest organs.
3. Spontaneous pneumothorax.
4. Puncture of the pleural cavity on the right; relief of pain syndrome.
1. Acute renal failure syndrome (postrenal form).
2. Prostate adenoma.
3. BH urine analysis (urea); Ultrasound of the genitourinary system.
4. Ensure the outflow of urine by catheterizing the bladder; carrying out adequate intravenous infusion therapy.
5. Preventive treatment of diseases of the genitourinary system that can cause disruption of the outflow of urine.
1. Acute liver failure syndrome.
2. Cirrhosis of the liver.
3. HD blood test (increased levels of bilirubin, transaminases); Ultrasound of the digestive system (enlarged liver, spleen, fluid in the abdominal cavity - ascites), FGDS - varicose veins.
4. Prescription of hepatoprotectors (Heptral, Essentiale), glucocorticoids (prednisolone).
2. Coronary heart disease; acute myocardial infarction.
3. ECG, chest x-ray.
4. Applications of nitroglycerin; pain relief; correction of rhythm disturbances; inhalation of oxygen passed through an antifoam agent; administration of diuretics.
1. Acute respiratory failure syndrome; acute left ventricular heart failure syndrome.
2. Acute myocardial infarction, pulmonary embolism.
3. ECG, chest x-ray, ultrasound of the heart.
4. Provide adequate pain relief; anticoagulant therapy; maintaining normal blood pressure; decrease in pressure in the pulmonary circulation (antispasmodics, diuretics).
2. Hemopericardium. Cardiac tamponade.
3. Performing a thoracotomy for health reasons. Elimination of cardiac tamponade, stopping bleeding.
4. Reinfusion of blood, transfusion of blood and its components, transfusion of blood substitutes.
1. Multiple organ failure syndrome.
2. Peritonitis with severe abdominal sepsis.
3. Liver failure, renal failure, central nervous system failure.
4. Infusion, detoxification therapy.
5. Laparotomy, appendectomy, sanitation, drainage of the abdominal cavity.
1. Acute renal failure.
2. Release of myoglobin from crushed muscles (crush syndrome).
3. Infusion therapy, detoxification therapy, pain relief, diuretics.
4. Excision of non-viable tissue after obtaining sufficient urine.
1. It is caused by the lack of intrasecretory function of the kidneys - the production of erythropoietin.
2. Administration of erythropoietin or its analogues, in their absence - transfusion of red blood cells.
3. Infectious complication – acute hepatitis B.
5. The patient is indicated to continue extracorporeal detoxification and pharmacotherapy for hepatitis B.
1. Asphyxia due to drowning.
2. In sea water, since salt water has a higher osmolarity compared to plasma, which leads to pulmonary edema.
3. Free the airways from mucus, algae, etc., allow the patient to breathe oxygen.
4. Opioids (promedol, morphine).
5. Loop diuretic, for example furosemide (Lasix), nitroglycerin.
Red blood cell mass
Erythrocyte mass (EM) is a blood component that consists of red blood cells (70-80%) and plasma (20-30%) with an admixture of leukocytes and platelets (hematocrit%). In terms of erythrocyte content, one dose of erythrocyte mass (270 ± 20 ml) is equivalent to one dose (510 ml) of blood.
There are 6 types of erythrocyte mass (erythrocyte mass, filtered; erythrocyte mass, gamma-irradiated; erythrocyte mass, depleted of leukocytes and platelets; erythrocyte mass with removed leukothrombolayer; erythrocyte mass with removed leukothrombolayer, filtered; erythrocyte mass with removed leukocytes cotrombolayer, gamma-irradiated) and several types of auto-erythrocyte mass (auto-EM; auto-EM, filtered; auto-EM, gamma-irradiated, etc.).
Erythrocyte suspension (ES) is a mass of red blood cells resuspended in a special solution of sodium chloride and a hemopreservative containing gelatin preparations and some other components. As a rule, the ratio of erythrocyte suspension and solution is 1: 1. The erythrocyte suspension, acquiring higher fluidity and, accordingly, higher rheological properties, simultaneously has a lower hematocrit number (40-50%).
There are 5 types of erythrocyte suspension (erythrocyte suspension with saline solution, erythrocyte suspension with resuspending solution, erythrocyte suspension with resuspending solution, filtered, erythrocyte suspension with resuspending solution, gamma-irradiated, erythrocyte suspension, defrosted and washed).
Red blood cell mass depleted of leukocytes and platelets (washed red blood cells - (WE) is a red blood cell mass deprived of plasma, as well as leukocytes and platelets by 1-5 times repeated addition of saline and removal of the supernatant after centrifugation. Washed red blood cells are stored until use in a weighed physiological solution with a hematocrit of 0.7-0.8 (70-80%).
To remove leukocytes from whole canned blood or red blood cells, special filters are actively used, which make it possible to remove more than 99% of leukocytes, which can dramatically reduce the number of post-transfusion reactions of the non-hemolytic type and thereby increase the effect of treatment procedures.
Erythrocyte suspension, defrosted and washed, is a method of freezing and storing red blood cells at low temperatures (up to 10 years) that allows you to obtain functionally complete red blood cells after thawing and washing from the cryoprotectant (glycerol). Red blood cells can remain frozen for up to 10 years.
Just as with donor blood, it is more expedient from both medical and economic points of view to procure its components instead of whole canned autologous blood - autologous (autogenic) hemocomponents: red blood cells, fresh frozen plasma (FFP), and in some cases platelet concentrate. With adequate medical preparation of the patient (iron supplements, vitamin therapy, erythropoietin), up to 00 ml of auto-FFP, ml of auto-EM can be prepared 2-3 weeks before surgery.
In some cases, autoEV with saline solution or, with additional filtration, autoEV with resuspension solution, filtered, are obtained from autoEM.
Red blood cell mass: place in therapy
Red blood cell mass is prescribed to relieve anemia and enhance the oxygenating function of the blood. Unlike canned blood, the use of EM significantly reduces the likelihood of immunization of the patient with plasma proteins, leukocytes and platelets from donor blood.
In patients with normal initial values of hemoglobin, hematocrit and plasma proteins with blood loss within 10-15% of the blood volume, there is no need to use EM. Maintain stable hemodynamics and replace blood loss with sufficient blood substitutes.
With blood loss of more than 15-20% of the bcc, as a rule, the first signs of a violation of the oxygen transport function of the blood are observed, which requires adequate replenishment of the red blood cell deficiency, i.e. applications of EM. Transfusions of EOs and EVs can be done drip or stream.
It is not possible and hardly advisable to establish any absolute laboratory criteria for prescribing EM. First of all, it is necessary to take into account the clinical condition of the patient, concomitant pathology, the degree and location of injury, the cause of anemia, bleeding time and many other factors. Thus, it is known that patients with chronic anemia are more adapted to low hemoglobin levels. At the same time, patients with arterial hypotension, with severe cardiopulmonary insufficiency, with infectious diseases, etc. require EM transfusion even at higher values of red blood parameters.
In case of chronic blood loss or insufficiency of hematopoiesis, the basis for infusion of red blood cells in most cases is a drop in the blood hemoglobin level below 80 g/l and hematocrit below 25% (0.25 l/l). To improve the rheological properties of EV (or EC), immediately before transfusion, it is possible to add 0.9% sodium chloride solution to the container, which actually turns it into EV with saline solution. Indications for transfusion of EV, OE, and thawed OE are similar to the prescription of red blood cells:
- traumatic and surgical shock complicated by blood loss;
- anemic hypoxia in normo-hypovolemic conditions;
- posthemorrhagic anemia;
- during the preparation of patients with critically low hemogram values for extensive surgical interventions;
- postthermal (with burn disease) anemia.
Washed red blood cells are used in patients sensitized by previous blood transfusions to plasma factors or antigens of leukocytes and platelets. The cause of most transfusion reactions of the non-hemolytic type in patients with a history of multiple transfusions of blood components, as well as in women who have had pregnancies, are isoantibodies to leukocyte antigens (in particular, HLA), which undoubtedly reduce the effect of not only the transfused component, but also the entire medical procedure. Washing of red blood cells almost completely eliminates plasma and elements of destroyed peripheral blood cells, platelets and sharply reduces the content of leukocytes (200 mg%) is a contraindication for blood transfusion. This red blood cell mass is washed before blood transfusion.
Tolerability and side effects
If the rules for procurement, processing, storage and use of donor red blood cells are adequate to the clinical condition of the patient, the risk of reactions and complications is minimized.
Warming blood components reduces the risk of hypothermia during massive transfusions of refrigerated blood components. The minimum recommended temperature of transfused blood and its components is +35° C. When transfusion of unheated blood or its components, ventricular arrhythmias can sometimes be observed (usually they do not develop until the body temperature drops below +28° C).
There are pyrogenic, allergic, anaphylactic, febrile (non-hemolytic) types of blood transfusion reactions.
Post-transfusion reactions, as a rule, are not accompanied by serious and long-term dysfunction of organs and systems and do not pose an immediate danger to the patient’s life. They manifest, as a rule, a minute after the start of blood transfusion, in some cases they are noted after the end of blood transfusion and, depending on the severity, can last from several minutes to several hours.
Pyrogenic reactions (hyperthermia) occur as a result of infusion of pyrogens into the recipient’s bloodstream along with canned blood or its components. Pyrogens are nonspecific proteins, waste products of microorganisms. Post-transfusion pyrogenic reactions can also occur in patients isosensitized by repeated blood transfusions or in women who have had a history of repeated pregnancies in the presence of anti-leukocyte, anti-platelet or anti-protein antibodies. Filtration of blood through leukofilters and washing can dramatically reduce the risk of isosensitization of patients with multiple blood transfusions.
If pyrogenic reactions occur, chills appear, the temperature rises to +39 or 40 ° C, usually 1-2 hours after blood transfusion, less often during it. Fever is accompanied by headache, myalgia, chest discomfort, and pain in the lumbar region. The clinical picture may have varying degrees of severity. Blood transfusions quite often occur with low-grade fever, which usually passes soon. The prognosis for pyrogenic reactions is favorable. Clinical signs disappear after a few hours.
Allergic reactions of varying severity are observed in 3-5% of cases of blood transfusion. As a rule, they are recorded in patients sensitized by previous blood transfusions or who have had a history of repeated pregnancies with antibodies to antigens of plasma proteins, leukocytes, platelets and even Ig. In some patients, allergic reactions are observed already during the first transfusion of hemocomponents and are not associated with previous isosensitization. It is believed that in such cases these reactions are due to the presence of "spontaneous" antibodies to Ig and the IgE response of the recipient's mast cells to the transfused specific donor antigen, which is often associated with platelets or plasma proteins.
Allergic reactions can occur both during the transfusion of blood or its components, and delayed, 1-2 hours after the end of the procedure. A characteristic sign of an allergic post-transfusion reaction is an allergic rash, often accompanied by itching. With a more severe reaction - chills, headaches, fever, joint pain, diarrhea. It should be borne in mind that an allergic reaction can occur with anaphylactic symptoms - respiratory failure, cyanosis, and sometimes with the rapid development of pulmonary edema. One of the most dangerous complications of blood transfusion is an anaphylactic reaction, sometimes developing at lightning speed to anaphylactic shock.
Based on the severity of the clinical course (body temperature and duration of manifestation), three degrees of post-transfusion reactions are distinguished: mild, moderate, severe.
Mild reactions are characterized by a slight increase in temperature, headache, slight chills and malaise, pain in the muscles of the extremities. These phenomena are usually short-term. Usually, their relief does not require any special treatment measures.
Moderately severe reactions - there is an increase in pulse and breathing, an increase in temperature by 1.5-2 ° C, increasing chills, and sometimes urticaria appears. In most cases, drug therapy is not required.
Severe reactions - cyanosis of the lips, vomiting, severe headache, pain in the lower back and bones, shortness of breath, urticaria or edema (Quincke type), body temperature rises by more than 2 ° C, stunning chills, leukocytosis are observed. It is necessary to begin medical correction of the blood transfusion complication as soon as possible.
Since the autocomponents are immunoidentical to the patient’s blood, there are no reactions or complications associated with the transfusion of donor blood components, provided that all blood transfusion rules are followed.
Interaction
It is not recommended to use glucose solutions for preparing EVs (5% glucose solution or its analogues cause gluing and hemolysis of red blood cells) and solutions containing calcium ions (cause blood clotting and the formation of clots).
Red blood cells are diluted with saline solution. The use of a solution of EO in a low molecular weight dextran solution in a ratio of 1:1 or 1:0.5 reliably preserves the bcc, reduces aggregation and sequestration of formed elements during the operation and on the next day.
Red blood cell mass in a solution of 8% gelatin with citrate, sodium chloride and bicarbonate is essentially an original blood component - an erythrocyte transfusate, which not only replenishes blood loss and restores the oxygen transport function of the blood, but also has a hemodynamic disaggregating effect with a fairly pronounced volemic effect. The use of 8% gelatin with citrate, chloride and sodium bicarbonate as a preservative allows the shelf life of OE to be extended to 72 hours.
Cautions
The red blood cell mass is stored (depending on the preservative solution) at a temperature of +4° C. Ready-to-use EV, thawed and washed, should have a hematocrit in the range of 0.7-0.8 (70-80%). The shelf life of washed EOs before use due to the risk of bacterial contamination can be no more than 24 hours at +1-6° C.
The administration of excessive quantities of EOs or EVs can lead to hemoconcentration, which reduces CO and thereby worsens hemodynamics in general.
Medical Expert Editor
Portnov Alexey Alexandrovich
Education: Kyiv National Medical University named after. A.A. Bogomolets, specialty - “General Medicine”
Attention!
To make information easier to understand, these instructions for use of the drug “Red blood cell mass” have been translated and presented in a special form based on the official instructions for medical use of the drug. Before use, read the leaflet included directly with the medication.
The description is provided for informational purposes and is not a guide to self-medication. The need to use this drug, the prescription of the treatment regimen, methods and doses of the drug are determined solely by the attending physician. Self-medication is dangerous for your health.
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