Lecture: “ DOCTRINE ABOUT BLOOD. TESTS BEFORE HAEMOTRANSFUSION”.

Marrow is one of most organs of body, achieving sizes and mass of liver. The cellular elements of blood are leucocytes, red corpuscles and platelets are contained as suspension in plasma. The general volume of blood in a norm is 8% from mass of body (5600 мl at men by mass 70 kg). Plasma makes of about 55% this volume. Red corpuscles, most leucocytes and platelets appear in marrow. In a norm 75% of cages of brain is represented by a myeloid sprout, from which leucocytes develop (time of life of leucocytes is short) and only 25% make red corpuscles

The proteins of plasma consist of fractions of albumens, globulins and fibrinogen. A capillary wall is some impenetrable for the albumens of plasma, it predetermines osmotic pressure about 25 mm.m.с. An albumen serves as a transmitter for metals, ions, fat acids, amino acid, enzymes and medications. Haemotransfusion takes leading place in surgical practice. Haemotransfusion is the method of fight against hypoxia, anemia, hypoproteinemia, at traumatic shock and acute bleeding, at preparation of patients to operation, before and after operation. Liquid part of blood (plasma) is solution, which contains the some amount of ions, inorganic and organic molecules, that are transported to different areas of body or taken part in transporting of other matters. In a norm the volume of plasma makes 5% from mass of body. The serum of blood is formed after coagulating of fibrinogen and ІІ, V, VIII factors.

Definition: Autogenic transplantation: donor and recipient is the same person. Allogenic transplantation: donor and recipient belong to one kind (for example, transplantation from a man to man).. Introduction into vascular way of patient the blood of donor or its components with the medical purpose is haemotransfusion Blood transfusion is operation of transplantation of allogenic or autogenic tissue. Blood transfusion – introductions of fresh blood to the patient, cellular components and proteins preparations.

Autotransfusion is an old method of restoring the patient's blood volume by transfusing his or her own blood who is excessively losing blood by injury such as ruptured spleen or ruptured liver or in ruptured ectopic gestation. The blood is collected from the * peritoneal cavity and put into a sterile container. This blood is now filtrated through a few layers of sterile gauge into a container which already contained anticoagulant CPD solution. This blood is now immediately transfused into the patient. This method is particularly used when stored blood is not available.

History of blood transfusion Development of studies about blood transfusion can be divided into 2 main periods. The first period divides into two stages. I stage – from ancient times to opening of circulation of blood by Harvey (1628). ІІ stage – proceeds from 1628 to opening of blood types by K.Landsteiner (1901р.) and Y.Yansky(1907р.).

ІІ stage - ( ) - problem of donor blood, delivery of the blood, transporting of blood, indications and contra-indications to transfusion, its efficiency at different diseases. ІІІ stage is the period of the second World war, is development and improvement of organization of service of blood, components of the blood and blood substitutions. ІV stage – since 1945 to our days. The second period can be divided into 4 stages: І stage – ( ) – determination of blood types, substantiation the method and technique of blood transfusion taking into account the law of isohaemagglutination.

Blood groups In 1901 the Austrian immunologist K.Landsteiner noticed about isoagglutinable possibility of blood of normal people. It is marked, that serum contains agglutinins. Reaction between a serum and red corpuscles of the same type of animals, with agglutination of red corpuscles is named isoheamaggluination.

The red cells contain agglutinogens named A and B and the serum contains agglutinins named anti-A and anti-B. For transfusion, the red cells of the donor are matched against the serum of the recipient. As agglutinins, present in the recipient, are in high-titre, can act the agglutinogens in the red cells of the donor's blood to produce agglutination and haemolysis. To the contrary, the small amount of agglutinins, present in donor's serum, is not sufficient to cause agglutination of the recipient's cells as its titre falls on being diluted in the huge blood volume of the recipient. According to the presence or absence of the two agglutinogens A and B, there are 4 blood groups : (i) Group A is one, whose red cells contain A agglutinogen and the serum contains anti-B agglutinin; (ii) Group B is one, whose red cells contain B agglutinogen and the serum contains anti-A agglutinin; (iii) Group AB is one, whose red cells contain both A and B agglutinogens and the serum contains neither anti-A nor anti-B agglutinin; (iv) Group O is one, whose red cells contain neither A nor B agglutinogen and the serum contains both anti-A and anti-B agglutinins. The persons with group AB can receive blood from any group (universal recipient). The persons with group O blood can give blood to anybody as it has got no agglutinogen in the red cells (universal donor).

In 1907 Y.Yansky opened IV blood type - serum does not agglutinate the erythrocytes of any groups. I group – serum agglutinates the erythrocytes of II and III groups. II group – serum agglutinates the erythrocytes of III groups. III group - serum agglutinates the erythrocytes of II groups.

I group - Оαβ III group - Вα II group - Аβ ІV група - АВо In persons I blood groups - red corpuscles do not contain agglutinogens and market О(І), is present aggluinins α and β. Serological formula of blood group

In Europe: О(І) 39% - // - A(II) 44% - // - В(ІІІ) 12% - // - АВ(ІV) 5% - // - Blood type – is genetic stipulate sign and showing by the combination of antigens, which basing in forming elements and plasma of blood.

Is observed that II and IV groups have А1 and А2 (12%)

Method of determination of blood types. Determination of blood type is simple, but responsible procedure. It is need to define a presence of agglutinogen for determination of blood type. The standard serum of different groups are used for this purpose with known set of agglutinins. it is possible to use standard serum

Requirements to the serum: transparent, without decay, a group, title, terms of storage, place and time of preparation must be marked. Use two series of serum. The results of one series must answer the results of other.

Technique of blood grouping. On a glass slide, one drop of stock of anti-A serum and one drop of anti-B serum, are placed side by side. The person, who is to be grouped, is pricked his finger tip and a drop of blood is added to each of these drops of serum placed on the slide. After 5 minutes, the slide is examined under the microscope. If agglutination is observed with serum of group A, the person belongs to group A. If agglutination occurs in the serum of group B, the person belongs to group B. If agglutination is seen in both, the person belongs to group AB and if agglutination is not seen in either of the two, the person belongs to group O.

Rhesus factor In 1940 Landshtein and Vinner investigatived a new antigen factor in the red unites of people and marmosets (Macasus shesus). About 85% people have this rhesus factor (rh-positive), and 15% - have not it (rh- negative). Obviously persons with Rh positive blood do not posses Rh anti-body in the serum. When Rh positive cells are injected into Rh-negative persons, the anti-body Rh develops. The first j transfusion may escape to produce any symptom but further transfusion will definitely produce serious reactions. A similar condition happens when a Rh-negative woman carries Rh-positive foetus. The red cells of the foetus when come in contact with the mother's serum, will form anti-Rh. The anti-Rh will pass into foetal circulation and destroy the red cells of the foetus producing haemolytic reaction. Introduction of rh-positive blood to the patients with a rh-negative blood leads to making specific antibodies (antirhesusagglutinins). During the repeated transfusions their amount gradually grows and there is a rhesus-conflict, posthaemotransfusion reaction which can dive a death.

Determination of blood on a group compaibility and rhesus-compatibility. two drops of serum of recipient + half-drop blood of donor drops are mixed in a cup, placed in water-bath at 10 minutes at 46-48º. The presence of agglutination notices about incompatibility of blood

DETERMINATION OF Rh For this purpose it is necessary to have a antirhesus-serum (specially prepared by immunization of Rh-donors by a Rh+blood); 10% of gelatin; explored blood. 1)1 drop of explored suspension of red unites is placed in a test tube + 2 drop of antiRh-serum 2) put it on an water-bath on 10 minutes at the temperature 46-48º 3) estimation in a test tube is visual at light. At presence of agglutination a rhesus-factor is positive, and in default of agglutination – rhesus-factor is negative

MEASURES BEFORE INTRADUSING OF BLOOD - Determination of indications and contra- indications to blood transfusion. - Determination of group and rhesus-factor for patient and donor. - Tests on individual and rhesus compatibility - Biological test. Macroverification of ampoule of blood (a blood has three layers: down is layer of red corpuscles, above it is thin layer of leucocytes and above is transparent layer of plasma).

Indications to transfusion. 1. Acute anemia. 2. Shock Festering intoxication. 4. Severe operations. Contra-indications to transfusion 1. acute hepatitis 2. a cute nephroso-nephritis 3. decompensation pulmonary-cardiac activity. 4. increased coagulation (thrombosis, heart attack, stroke, thromboembolism). 5. acute hepatitis. 6. allergic condition (bronchial asthma). 7. tuberculosis in stage of infiltration.

Methods of blood transfusion. Direct and indirect. Direct – direct using of donor’s blood to recipient without preservation. Such blood is the most valuable.

Indirect method – get blood from donor, mix with preservative and keep under certain conditions.

Technology of blood transfusion. Into vein: а) by stream (big bleeding, shok) b) dropping. Into artery (decrease blood preasure). Into bone (burn, in children). Into aorta (during abdominal and thorax operations)

Types of transfusions  Autohaemotransfusion – take a blood from man before and keeping  Reinfusion – during parenchimatose bleeding  Utilade blood – after blood letting (during hypertonic crisis)  Usage cord-placentar blood.

Effect of transfused blood:  haemostatic  replacing  intensifies an exchange of materials  desintoxical  immunobyological  nourishing Komponents of blood:  Red cell blood  Platelet mass  Leucocytes mass  Plasma  Albumine  Proteins  fibrinolisin  Haemostatic sponge

Complications during blood transfusion:  Mecanical (circulatory overload, ear embolism, thromboembolism, thrombosis)  Reactive (pyrogenic reactions, allergic reactions, syndrom of big volume transfusions, haemolytic shok, citrate intoxycation, hyperkalemia)  Infection (hepatitis, AIDS, syphilis)

Blood substitutions are medical solutions for substitutions of lost blood functions or normalization of disorder blood functions : 1.Plasma substitutes of haemodinamic action 2.Desintoxicative solutions 3.Plasma substitutes for parenteral nutrition 4.Regulators of water-salt exchange and acid-base balance 5.Oxygen transmitters