Donor blood: a place in therapy
Despite the well-founded propagation of component hemotherapy, the use of whole blood has its own, although limited indications: with massive blood loss with pronounced hypovolemic shock and anemic hypoxia, reduced bcc (erythrocytes and plasma), massive exchange transfusions (hemolytic disease of newborns, acute hemolysis, toxicosis , chronic renal failure), especially in military field conditions, catastrophes, when it is not possible to immediately obtain a sufficient number of blood components. In peacetime, especially in planned surgery, with indications for blood transfusion, it is necessary to strictly adhere to the concept of component hemotherapy - to pour out the essential components of donor blood.
The duration of the substitution effect of blood transfusion depends largely on the initial state of the organism. With fever, a high level of catabolism for burns, extensive surgical interventions, sepsis, hemolysis and blood coagulation disorders, it is reduced. In the process of transfusion and the next 2-3 days after it, donor blood causes a volemic effect only if the volume of transfused blood does not exceed 20-30% of the BCC and there are no microcirculatory shifts. Blood transfusion, exceeding 30-50% of BCC, leads to worsening of blood circulation, disturbance of hemodynamics stability, pathological deposition of blood.
The method of autotransfusion should be used in all cases when transfusion of blood components is shown to compensate for blood loss and there are no contraindications to blood exfusion in this patient.
A more pronounced effect of autotransfusions compared with the use of homologous blood can be reduced to the following points:
- higher replacement (anti-anemic) effect;
- more rapid postoperative blood recovery due to hemopoiesis stimulation by a second preoperative blood supply;
- absence of immunosuppressive effect of transfusion;
- economic effect - the reserves of donor homologous blood are preserved.
It is recommended to adhere to two basic rules when deciding the issue of blood transfusion for patients who have been autografted:
- It is better not to use pre-operative autograft (or its components) than to transfuse it to a patient without evidence;
- if necessary, blood transfusions of large doses of blood components first of all, autologous blood must be poured.
The last blood lead should be carried out at least 3-4 days before surgery.
It is possible to recommend a patient to autonomy if two basic conditions are met: compensated functions of organs (cardiovascular, pulmonary, metabolic, hematopoietic) and the exclusion of acute generalized infection, in particular bacteremia / sepsis.
Autocraft canned, filtered. If blood transfusion or auto-erythrocytic mass is necessary within a time period exceeding 2-3 days after the preparation, it is recommended to filter the blood through leuco filters. The removal of leukocytes is the prevention of isensensibilization to leukocyte antigens, hemotransmissive virus infections (cytomegaloviruses-CMV), anaphylactic, allergic reactions caused by leuko-responsins. For leukofiltration, the most optimal is the use of systems for the collection of donor blood, consisting of several interconnected containers with a built-in filter (closed systems).
Preoperative hemodilution - part of the BCC after the patient's blood exfusion is replaced by blood substitutes to a hematocrit level of 32-35%. The collected donor blood is used to compensate perioperative bleeding.
Intraoperative hemodilution - blood exfusion directly in the operating room after an initial anesthesia with reimbursement of plasma substitutes to a level of hematocrit not lower than 30% (in exceptional cases up to 21-22%).
Autograft cavity, canned, filtered for reinfusion (intraoperative autotransfusion, autologous reinfusion) is most effective where the predicted blood loss can be more than 20% of the BCC. With blood loss exceeding 25-30% of BCC, reinfusion should be combined with other methods of autohemotransfusion.
Postoperative autotransfusion is the return to the patient of blood that has been isolated from the drainage in the nearest postoperative period. Safe for blood reinfusion (without washing red blood cells) is hemolysis, which does not exceed 2.5 g / l (250 mg /%) of free hemoglobin. Focusing on the level of free hemoglobin (should not exceed 2.5 g / l), the number of washing procedures is determined - 1, 2 or 3 times, until a colorless supernatant is obtained. In Cell Saver devices, washing is performed automatically in a rotor-bell by physiological solution.
At the same time, it should be borne in mind that in stationary conditions with the correct organization of a transfusiologic benefit in all of the indications listed above, the use of blood hemocomponents is more appropriate and justified from the medical and rational point of view to the use of donor blood and autoblood. Transfusions of whole canned blood in a multidisciplinary hospital, especially in patients with planned surgery, should be considered as a result of the unsatisfactory work of the department of transfusiology and blood service.
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