Transfusiology (transfusio - transfusion,logos - doctrine) - the science of transfusion of blood, its components and preparations, blood substitutes for therapeutic purposes by affecting the composition of blood, body fluids.

Blood transfusion- A powerful tool for treating a wide variety of diseases, and in a number of pathological conditions (bleeding, anemia, shock, major surgeries, etc.) - the only and yet irreplaceable means of saving the lives of patients. Blood, its components and preparations obtained from blood, are widely used not only by surgeons, traumatologists, obstetricians, gynecologists, but also by therapists, pediatricians, infectious disease specialists, and doctors of other specialties.

The interest of doctors in blood transfusion for the treatment of patients has long been known - Celsus, Homer, Pliny, and others mention such attempts.

In Ancient Egypt, 2000-3000 BC they tried to transfuse the blood of healthy people with the sick, and these attempts were sometimes curious, sometimes tragic in nature. Of great interest was the transfusion of blood of young animals, often lambs, to a sick or infirm old man. The blood of animals was preferred for the reasons that they are not subject to human vices - passions, excesses in food, and drink.

Three periods can be distinguished in the history of blood transfusion, which sharply differ in time: the 1st period lasted several millennia - from ancient times to 1628, when the 2nd period began with the opening of blood circulation by Harvey. Finally, the 3rd - the shortest, but most significant period, is associated with the name of K. Landsteiner, who discovered the law of isohemagglutination in 1901.

The second period in the history of blood transfusion was characterized by an improvement in the technique of blood transfusion: blood was transfused from a vein into a vein using silver tubes, and they also used the syringe method; the volume of transfused blood was determined by the decreasing weight of the lamb. Based on the teachings of Harvey, the French scientist Jean Denis in 1666 first made a blood transfusion to a person, although unsuccessfully. The empirical approach to blood transfusion has nevertheless allowed to accumulate a certain experience. So, the appearance of anxiety, redness of the skin, chills, trembling was regarded as incompatibility of blood, and blood transfusion was immediately stopped. The number of successful blood transfusions was small: by 1875, 347 cases of transfusion of human blood and 129 cases of animal blood were described. In Russia, the first successful blood transfusion after bleeding during childbirth was carried out in 1832 by G. Wolf in St. Petersburg.

About the great prospect of blood transfusions in 1845 I.V. wrote Buyalsky, believing that over time they will occupy a worthy place among operations in emergency surgery.

In 1847, A.M. Filomafitsky's “A treatise on blood transfusion as the only means in many cases to save a dying life”, in which, from the standpoint of the science of that time, testimonies, a mechanism of action, and blood transfusion methods were set forth. Naturally, both the described mechanism and practical recommendations were based mainly on empirical research methods and did not ensure the safety of blood transfusion. From 1832 until the end of the 19th century, only 60 blood transfusions were performed, of which 22 - S.P. Kolomnin, a contemporary of N.I. Pirogov.

The modern period in the study of blood transfusion begins in 1901 - the time when K. Landsteiner discovered blood groups. Having revealed various isoagglutination properties of human blood, he established three varieties (groups) of blood. Y. Yansky in 1907, the fourth blood group was isolated. In 1940, K. Landsteiner and A.S. Wiener discovered the Rh factor (Rh factor).

Blood groups are divided taking into account the presence of antigens (agglutinogens A and B) in human red blood cells and, accordingly, antibodies (agglutinins α and β) in the blood serum. With the contact of the same agglutinogens and agglutinins, the agglutination (gluing) of red blood cells occurs, followed by their destruction (hemolysis). In the blood of each person can be only unlike agglutinogen and agglutinin. According to Jansky, four blood groups are distinguished, in clinical practice they use the concept of “blood group according to the AB0 system”.

An important stage in blood transfusion is the property of sodium citrate (sodium citrate) discovered by A. Justin (Hustin A, 1914) to prevent blood coagulation. This served as the main prerequisite for the development of indirect blood transfusion, as it was possible to procure blood for future use, store it and use it as needed. Sodium citrate, as the main part of blood preservatives, has been used to this day.

Much attention was paid to blood transfusion issues in our country - the contribution of 19th century surgeons G. Wolf, S.P. Kolomnina, I.V. Buyalsky, A.M. Filomafitsky, as well as those living in Soviet times V.N. Shamova, S.S. Yudina, A.A. Bagdasarova et al. The scientific development of blood transfusion issues and the practical application of the method began in our country after the first publications of V.N. Shamova (1921). In 1926, the Institute of Blood Transfusion was organized in Moscow. In 1930 in Kharkov and in 1931 in Leningrad, similar institutes began to work, now such institutes are also available in other cities. In regional centers, methodological and organizational work is performed by regional blood transfusion stations. A special contribution to the development and implementation of cadaveric blood transfusion method in practice was made by V.N. Shamov and S.S. Yudin.

Currently, transfusiology has taken shape in an independent science (the doctrine of blood transfusion) and has become a separate medical specialty.

Infusion (infusio) - infusion, transfusion (transfiisio) - transfusion, blood transfusion (heamotransfusio) - blood transfusion.

Donor - giving blood, recipient - receiving blood.

There are a number of surgical diseases and conditions of the body in which infusion therapy is the only treatment, and in some cases mandatory along with other methods (acute blood loss, peritonitis, sepsis, intestinal obstruction, cholecystitis and pancreatitis, all types of shock, poisoning, etc. )

The most common routes for parenteral administration of transfusion media are:

•   intravenous;
•   intraarterial;
•   intraosseous;
•   rectal.

Blood transfusion

In infusion therapy, transfusion of blood, its components and preparations is of great importance.

Blood transfusion may be direct  (from vein to vein) and indirect  (blood is collected, canned, stored, transfused).

If you use your own blood, this method is called autohemotransfusion. Its collection is carried out in advance of the operation, and transfusion is performed as necessary during the operation or in the early period after the operation.

Transfusion during a blood operation collected from serous cavities is called reinfusion.  It is used for massive bleeding, rupture of the spleen, ectopic pregnancy, chest wounds. The collected blood is filtered through 4-8 layers of gauze. As a stabilizer, standard blood preservatives or heparin are used.

The idea of \u200b\u200bblood transfusion originated in ancient times, but this became possible after the discovery of blood groups. The beginning of the study of blood groups dates back to 1900, when Professor Shotoka noticed the phenomenon of agglutination. A year later, K. Landsteiner called this phenomenon isoagglutination and explained it. He divided all people by group into 3 groups. After 6 years (1907) I AM.  Jansky discovered the fourth (IV) blood group. The letter designation of blood groups was introduced in 1928. In 1940, K. Landsteiner established the presence of a specific protein in the blood of monkeys and called it a Rh factor. He found this protein in 85% of people and called them Rh-positive, and people who do not have it - Rh-negative.

Blood groups mean a different combination of antigenic properties of erythrocytes called agglutininogens (AH) and antibodies (AT) with respect to them - agglutinins of human blood plasma.

Antigen  (AH) - a substance that can stimulate the immune response. It can be a protein, a tumor cell, a toxin, a virus, etc. In relation to blood groups, AH are polypeptides; they appear in red blood cells during the first three months of life and are able to stimulate the immune response (cause the formation of antibodies).

Antibody  (AT) - specific proteins synthesized in response to the appearance of an antigen are bound by gamma and beta globulins in blood plasma and appear during the first year of life.

There are two group agglutininogens - A and B and two group antibodies - air.

Agglutination reaction -  the interaction of the same AG and AT; this reaction is considered as an immunity reaction. If the donor has A, and the recipient has a, then when mixing the blood, a reaction occurs - the blood is incompatible.

Only red blood cells are agglutinated by the serum of the recipient, and not vice versa.

The main difference between the Rhesus system and the ABO system is that only agglutininogens of this system are contained in the blood of people, and antibodies to them like the ABO system are not normal.

Antibodies can only form:

• during transfusion to a Rh-negative recipient of a Rh-positive donated blood. The first transfusion is usually successful, but difficulties arise in determining the Rhesus affiliation in the subsequent, repeated transfusions end in anaphylactic shock;
•   during pregnancy, a Rh-negative woman is a Rh-positive fetus. The consequence of this sensitization is hemolytic disease of the newborn or fetal death.

Indications for blood transfusion are currently sharply narrowed, as there are many solutions that replace blood functions. Almost the only indication for blood transfusion is acute blood loss of more than 25% - 30% of the BCC.

Contraindications to blood transfusion:

•   severe violations of the liver, kidneys;
•   allergic diseases and conditions;
•   active tuberculosis;
•   thrombosis, embolism;
•   malignant plethora.

Blood transfusion rules:

•   be sure to compare the record of blood group and Rhesus affiliation in the recipient’s medical history and on the donor bottle;
•   check the suitability of transfused blood;
•   regardless of the verification of documentation, the following tests are performed:
• - to group affiliation;
• - for individual compatibility;
• - for Rhesus compatibility;
• - for biocompatibility.

Compatibility tests by groups of the ABO system and Rh accessories are carried out separately and cannot replace one another.

If blood is transfused from different bottles of the same donor, an individual, Rh compatibility and a biological test are carried out with blood from each bottle.

Repeated blood transfusion requires re-checking the patient's blood group.

With blood transfusions, only the same blood group is transfused.

Preparing a patient for a blood transfusion includes:

•   determination of a general analysis of blood and urine on the eve of a transfusion;
•   determination of blood group, Rh blood affiliation of the patient;
•   measurement of blood pressure, heart rate, temperature;
•   a blood compatibility test;
•   bladder emptying.

After a blood transfusion, it is necessary:

•   patient compliance with bed rest for 4 hours;
•   three times, at intervals of 1 hour, measurement of blood pressure, heart rate, temperature;
•   urine test one day after transfusion.

The determination of blood groups is possible by standard sera, standard red blood cells or monoclonal reagents.

Standard Serum Requirements:

•   agglutination should begin after 15-20 s and be expressed by 2 min;
•   do not give a reaction with the I blood group;
•   have a title of at least 1: 32;
•   meet expiration dates;
• the time and place of preparation, blood type, titer, expiration date must be indicated on the label.

Serum is stored at room temperature for 4 months. Their shelf life is determined by the control red blood cells. Opened vials are stored at a temperature of 4-8 ° C, closed with stoppers.

Serum titer  - maximum dilution at which agglutination reaction is still possible.

In human blood, agglutininogens are found one or two. In the table. 1 shows a digital image of blood groups.

Table 1.  The combination of agglutinogens and agglutinins in various blood groups

The blood group is determined using two series of standard sera (to avoid errors and errors) of each group and is recorded by the doctor in the medical history, then checked by the laboratory assistant. Rhesus affiliation is determined by a laboratory doctor.

The determination of the blood group is carried out in good light and at room temperature (15-20 ° C).

Equipment:

•   white plates with a wettable surface;
•   standard serums in two series;
•   a tripod with two rows of nests for serum;
•   pipettes for each vial of each series;
•   physiological saline vial;
•   hourglass;
•   glass sticks or glass slides;
•   needles.

The technique for determining blood types using standard serums.  Blood is drawn from the finger, cells with the numbers of blood groups are signed on the plate from left to right. The initials and surname of the person whose blood group is determined are written. In each cell, a large drop of the corresponding serum is applied in two series with a pipette, which is immediately placed in the bottle from which it was taken. Blood for examination is taken from the tip of the nail phalanx of the 3 ^ 1st finger (Fig. 3), in newborns - from the 1st toe. An injection is made with a sterile disposable needle after treating a finger with an antiseptic, and next to each applied to

Fig. 3.

Fig. 4.

small droplets (10 times less than a drop of serum) of the test blood are applied to a saucer with a drop of standard serum.

A glass plate, each time new, the blood and serum are mixed (Fig. 4). The plate is left for 1-2 minutes at rest, and then periodically sways.

By the time the agglutination occurs, but not earlier than the third minute, a drop of physiological sodium chloride solution is added to the cells with the agglutination that has begun, and the plate is periodically shaken until 5 minutes have elapsed.

In the absence of agglutination in all cells, the test blood belongs to the I (0) group (Fig. 5, i); with agglutination in

• 1st and 3rd cells - to II (Fig. 5, b); with agglutination in the 1st and
• 2nd cell - to III (Fig. 5, at);  with agglutination in all three cells - to IV (Fig. 5, d).

However, to exclude nonspecific agglutinability of the studied red blood cells, it is necessary to conduct a control blood test with standard serum of group IV. Only in the absence of agglutination, blood corresponds to group IV.

Determination of group affiliation of the patient using monoclonal reagents.   Monoclonal Rea

Fig. 5.and  - no agglutination; b  - agglutination with sera in the 1st and 3rd cells; at  - agglutination with sera in the 1st and 2nd cells; g  - agglutination with sera in all

three cells

gents are made in three groups, each of which is painted in a different color:

•   anti-A is blue;
•   anti - red;
•   anti-AB is colorless.

Storage temperature: +2 ... + 8 ° С.

The technique for determining blood groups using monoclonal reagents.  Anti-A, anti- and anti-AB reagents are applied dropwise on a plate with individual pipettes under the appropriate inscriptions. Next to drops of reagents, one small drop of test blood is applied. The drops are mixed with a glass rod and, shaking the plate, the reaction is monitored for 5 minutes.

A positive result is expressed in the agglutination of red blood cells that quickly stick together in large flakes. With a negative reaction, the drop remains uniformly colored without signs of agglutination.

With a positive result of the agglutination reaction with all reagents, it is necessary to exclude spontaneous non-specific agglutination of the studied red blood cells. For this, it is necessary to mix one drop of physiological solution on the plate with one drop of the studied red blood cells. Blood can be attributed to group AB (IV) only in the absence of red blood cell agglutination in physiological saline.

Evaluation of the results of the agglutination reaction with anti-A and anti monoclones is given in table. 2.

Table 2.  Agglutination of red blood cells with monoclones depending

from blood types

If there is no agglutination with anti-A monoclones and anti- blood group I; in the presence of agglutination only with anti-A - blood group II; with agglutination only with anti - blood type III; if agglintination with both reagents - blood group IV.

Individual compatibility.  Compatibility tests are performed with serum (not plasma!) Of the recipient’s blood.

To obtain serum take 5 ml of blood without a stabilizer in a test tube, which is immediately signed (name, group, date) and centrifuged. Serum can also be obtained by sedimentation of blood taken. After 1-2 minutes, the tube with blood is shaken vigorously. To separate the blood clot from the walls, it is surrounded with a glass rod (the liquid part is serum).

Donor blood is taken from the vial through a needle and a large drop is placed on board the plate, the plate is immediately signed. Then a small drop of blood with a glass rod is mixed with the recipient's serum in a ratio of 1:10. The reaction is carried out at room temperature. The result is determined after 5 minutes. Saline is not used in this test.

Rhesus compatibility.  When determining the Rh compatibility, a test tube should be signed: name and surname of the recipient's blood group, donor vial number. Then add 2 drops of recipient serum, 1 drop of donor blood and 1 drop of 33% polyglucin solution to the bottom of the tube with a Pasteur pipette. Stirring of the mixture obtained in the test tube is carried out by tilting the test tube (without shaking), turning it so that the contents spread over the wall in its lower third.

After 5 minutes, 2-3 ml of an isotonic 0.9% sodium chloride solution is added to the tube and mixed by 2-3 fold inversion of the tube.

Uniform staining of the contents of the tube without signs of agglutination indicates the compatibility of the blood of the donor and the blood of the patient.

Rhesus compatibility can be determined in another way: apply 1 drop of recipient serum to a Petri dish, mix with 1/10 drop of donor blood from the vial. Put in a water bath at a temperature of 46 ^ 18 ° C for 10 minutes. In the presence of agglutination, Rh factor blood is incompatible.

Biological sample.  Blood (plasma, etc.) is injected intravenously in a dose of 10-15 ml at 3-minute intervals. Three repetitions of the sample without reaction gives the right to continue transfusion.

A biological sample eliminates the possible incompatibility of blood in other (except for the ABO system and the Rhesus system) systems and groups of antigens.

Transfusiology- The science of the rational use of blood components and preparations, taking into account the characteristics of the course of the disease and the properties of the medium used.

Transfusion- the treatment method, which consists in introducing into the bloodstream of the patient the blood components obtained from the donor or the recipient (autologous donation).

Donor- a person from whom blood components are transfused.

Recipient- a person who receives blood components.

Immunological basis of transfusiology

A mandatory requirement for blood transfusion therapy is its safety, primarily immunological. Transfusion of blood components is, in fact, a tissue transplant, and is possible only after assessing the compatibility of the blood of the donor and recipient.

The classification of blood groups is based on the presence or absence of group antigens and antibodies in the plasma and cellular elements of the blood. Currently, more than 200 group blood antigens are known, which are combined into several group antigenic systems. Group antigens are inherited, do not change throughout life, their set is individual for each person.

There are group antigenic systems of red blood cells, white blood cells, platelets and plasma proteins.

Red blood cell system

More than 20 antigenic systems of red blood cells are known, of which for clinical practice the most important are ABO and Rhesus systems. Compatibility for these two systems is mandatory taken into account at each transfusion.

ABO system

This is the first red blood cell system of antigens, discovered in 1900. Viennese scientist Karl Landsteiner. He discovered and studied three antigens. In 1907 Yang Jansky concluded that there are four blood types. From this time to the present day, the determination of blood groups according to this system is based on the presence of group-specific antigens (O, A, B) in red blood cells, and anti-A (α) and anti-B (β) antibodies in serum.

Group-specific antigens (O, A, B) are genetically determined.

Antibodies against antigens of the ABO system - isohemagglutinins belonging to the IgM class. The ability to develop them is inherited.

There are four blood types. They have an alphanumeric designation:

O (I) - red blood cells do not contain antigens, but in plasma 2 agglutinin (α and β)

43% in the European population.

A (II) - agglutinogen A and agglutinin β

42% in the European population.

In (III) - agglutinogen B and agglutinin α

11% in the European population.

AB (IV) - agglutinogens A and B, no agglutinins

4% in the European population.

The cause of the immunological conflict in the ABO system is the meeting of the same agglutinins and agglutininogens: A-α or B-β.

Rhesus group system

After AVO antigens, the Rhesus antigen system is of greatest importance in clinical practice. The presence of antigen is indicated by a “+” sign, and its absence is indicated by a “-” sign. Rhesus affiliation of red blood cells is determined by the presence of the Rh antigen in the phenotype. People in the red blood cells of which this antigen is present are classified as Rh-positive, in its absence - Rh-negative. The frequency of Rh-positive individuals in Europeans is 85%.

Antibodies against rhesus antigens, in contrast to group antibodies, are immune, resulting from isosensitization. Their specificity is due to antigens. When Rh-positive red blood cells are transfused, persons with antitussive antibodies experience post-transfusion hemolytic type reactions. This occurs in the following cases:

With repeated transfusion of a Rh-positive blood to a Rh-negative recipient. At the first blood transfusion, anti-Rhesus antibodies are formed in the human body. When a Rh-positive blood transfusion is repeated, previously developed antibodies cause erythrocyte hemagglutination.

During pregnancy, if the mother has Rh-negative blood and the fetus is Rh-positive. Rhesus agglutinogens penetrate the placental barrier, where anti-Rhesus antibodies are produced. They penetrate the fetus, where they cause a hemagglutination reaction. The fetus develops severe hemolytic anemia. Anti-Rhesus antibodies persist throughout life, each subsequent pregnancy is more dangerous.

Transfusiology in surgery

Transfusiology -the science of transfusion of blood, its components and preparations, blood substitutes for therapeutic purposes by affecting the composition of blood, body fluids.

Basic transfusion agents:

• - blood and its components (transfusion - blood transfusion)
• - blood substitutes

Transfusiolgia also studies myelotransplantation (bone marrow transplant).

Individual Transfusion Compatibility Test

Tests for individual compatibility are carried out in preparation for blood transfusion. They put two reactions: a test for individual compatibility according to the ABO system and according to the Rh factor. Preliminarily, blood is taken from a vein to formulate reactions in a recipient, which is divided into a clot and serum (by sedimentation or centrifugation).

• a) Test for individual compatibility according to the ABO system On a white surface (plate, plate), apply a large drop (0.1 ml) of recipient blood serum and a small drop (0.01 ml) of donor blood from the vial and mix them together, periodically shaking plate (plate). The reaction is carried out at a temperature of 15-25 ° C. the results are evaluated after 5 minutes: the absence of agglutination of donor erythrocytes indicates the compatibility of the blood of the donor and the recipient according to the ABO system. The appearance of agglutination indicates their incompatibility - this patient can not be transfused with such blood.
• 6) Sample for individual Rh compatibility

After the compatibility of the blood of the donor and the recipient according to the ABO system. it is necessary to establish compatibility with respect to the Rh factor. Rh factor compatibility test can be performed in one of two options:

* sample using 33% polyglucin,

¦ sample using 10% gelatin.

In clinical practice, the most widely used test with polyglucin.

Sample using 33% polyglucin. The reaction is carried out in a centrifuge tube without heating for 5 minutes. At the bottom of the tube make 2 drops of recipient serum, 1 drop of donor blood and 1 drop of 33% polyglucin solution. After that, the contents are mixed by tilting the tube and rotating it around the axis, distributing the contents along the walls with an even layer.

The tube is rotated for 5 minutes, after which 3-4 ml of physiological saline are added and gently mixed, 2-3 times tipping the tube to a horizontal plane (without shaking!). After that, the result is evaluated: the presence of red blood cell agglutination indicates the incompatibility of the blood of the donor and recipient by the Rh factor, such blood cannot be transfused.

Uniform staining of the contents in a test tube, the absence of an agglutination reaction indicates the compatibility of the blood of the donor and recipient by the Rh factor. Sample using 10% gelatin At the bottom of the tube, 1 drop of donor erythrocytes, previously washed with a ten-fold volume of physiological saline, is placed, then 2 drops of a 10% gelatin solution preheated to dilute and 2 drops of recipient serum are added.

The contents of the tube are mixed and placed in a water bath at a temperature of 46-48 C for 10 minutes. After that, 6-8 ml of physiological solution is added to the test tube, the contents are mixed, turning the test tube 1-2 times and the result is evaluated: the presence of agglutination indicates the incompatibility of the blood of the donor and the recipient, its transfusion is unacceptable. If the contents of the tube remain uniformly colored and there is no agglutination reaction in it, the blood of the donor is compatible with the blood of the recipient by the Rh factor.

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Video: Blood transfusion is a terrifying truth that everyone needs to know!

Blood transfusion in children began to be used only in the last 15-25 years, and it very quickly became widespread (Vyshegorodskaya, Surin, Greenbaum and Ternovsky, Sokolova-Ponomareva and Ryseva, etc.).
Children, even the smallest, tolerate blood transfusions. When studying the material on blood transfusion for children in a surgical clinic, we were able to establish that the greatest number of transfusions was made for children under 3 years of age. From this we can conclude that almost young children especially need to use this method.
Blood transfusion in some cases is performed once, in others several times. The number of transfusions is determined by the nature of the disease and the condition of the sick child. Indications for repeated transfusions should always be set taking into account the analysis of blood and urine.
Blood transfusion in children is carried out with a number of surgical diseases, which are very difficult to list. However, three groups of them can be established. The main indications for blood transfusion in pediatric surgery will be: 1) blood loss and shock; 2) chronic and subacute purulent diseases; 3) blood diseases.
Blood loss and shock should be understood in a broad sense. This group includes severe cases of trauma, burns, postoperative shock, blood loss, etc. Blood transfusion for this group of patients is. effective method and often saves the patient's life.
With shock and to prevent it. it is necessary to administer sufficient doses of blood, repeating the transfusion, if the state of shock does not go away. Of course, rational shock therapy should be comprehensive, and not limited to blood transfusion.
As we indicated above, blood transfusion is a healing agent for toxicosis, in particular for purulent infection, burns, after anesthesia (barbiturates).
In order to stimulate the body, a blood transfusion, sometimes repeated, is used mainly in patients with subacute and chronic purulent diseases who develop secondary anemia and exhaustion. An example of such diseases is osteomyelitis, infected burns, etc.
In the group of blood diseases, hemophilia should be mentioned first. Children with this suffering are constantly, and sometimes re-admitted to the surgical department due to heavy blood loss. Blood transfusion for these patients is not only a replacement therapy, but also one of the main therapeutic factors. When large hemorrhage develops with hemophilia, timely transfusion of a sufficient amount of blood (100-500 ml) stops bleeding, and patients who previously died in such cases recover. In addition to hemophilia, there are other blood diseases in which blood transfusion also gives a good therapeutic effect and allows further surgery if necessary.
Of course, this scheme does not exhaust all the indications for blood transfusion in surgical diseases in children. There may be individual cases in which a blood transfusion should be performed on the basis of the general provisions developed for it. For example, during heavy operations, a massive blood transfusion is systematically performed as a prevention of shock and to compensate for blood loss. Doses in these cases are determined by the surgeon individually for each patient and often exceed the usual therapeutic standards.
Technically, blood transfusions in children are carried out in compliance with general rules. The main method is indirect transfusion of canned or fresh citrated blood. As a rule, children are injected with blood by venipuncture in the ulnar vein, vein of the rear of the hand, foot or vein of the head. Venesection is performed only in individual cases, and it should be noted that, as experience is gained, the doctor less and less uses this method. In the absence of veins of sufficient size, small children have recently been injected with blood into the red bone marrow, for which they use the upper metaphysis of the tibia, calcaneus, sternum or ilium scallop.
It is most convenient to use the upper metaphysis of the tibia. The needle is inserted under local anesthesia from the medial side of the tibia, 2-3 cm below the distal edge of the patella, to a depth of 1.5-2 cm so that its end is in the center of the spongy bone tissue. Blood is injected with a syringe under a slight pressure of 5-10 ml per minute. The needle must be inserted with a mandrin to avoid blockage of the lumen with a piece of bone tissue when it penetrates into the bone. Intraosseous administration allows you to transfuse blood by the drip method, which is not always possible to organize in children with intravenous administration of blood. The introduction of blood into the sinus is not without danger, and therefore, recently, most authors left.
With threatening bleeding and severe shock, a blood transfusion is performed intraarterially (K.V. Konstantinova).
The blood group of the patient is determined in advance, immediately before transfusion, a reaction to compatibility is made and then a biological sample is required. As a rule, the blood of the group of the same name is administered, but the blood of a universal donor (the first group) can also be used with success. We did not observe the complications caused by the use of blood of the universal group - with the right technique, children tolerate transfusion well. The amount of transfused blood is determined by the age of the patient and the nature of the disease. Infants receive blood at the rate of 10-15 ml per 1 kg of weight. In children under 3 years old, according to our materials, the average dose was 85 ml, fluctuating in some cases from 50 to 100 ml. In children older than 3 years, the amount of transfused blood ranges from 75-250 ml. In case of blood loss and shock, the dose should be increased - in order to stimulate the body, smaller doses (50-75 ml) are used.
In the vast majority of cases, blood transfusion in children does not give complications. Sometimes there is an increase in temperature, less often - a general reaction with chills. Patients who are prone to general reactions, with repeated transfusions, it is recommended to first inject 4-8 ml of a 0.25% solution of novocaine into a vein. This event often removes an unpleasant reaction for the patient.
In case of hemolytic shock resulting from an erroneous transfusion of in-group blood, a second transfusion of single-group blood is immediately produced, as suggested by A. N. Filatov in similar cases in adults. Such repeated transfusion gives a quick effect and often saves the patient. In addition, if during repeated blood transfusions an increasing general reaction with chills is observed, it is necessary to remember about the possibility of Rh-negative blood.
It is known that in 15% of people the Rh factor in the blood is absent. In these cases, it is urgent to examine the baby's blood for the Rh factor. If it turns out to be Rh negative, the child needs to transfuse only Rh negative blood.
Indications for blood transfusion have expanded significantly in recent years, and it has now been proven that with some diseases that were previously considered contraindications for blood transfusion, it can be used with success. The main contraindications to blood transfusion in children remain decompensation of cardiac activity and acute damage to the kidneys and liver. Chronic compensated suffering of the kidneys and liver is not an obstacle to a careful transfusion of blood in small doses.
So, A. N. Filatov indicates that blood transfusion can be performed in case of chronic nephrosis, nephritis and amyloidosis, as well as in anemia associated with hepatic and hepatolienal diseases.
Our significant experience in surgical treatment (removal of the spleen) of splenomegaly with the Banti symptom complex, in which we usually transfuse blood, confirms the latter position.
Any acute and subacute hepatitis is a contraindication to blood transfusion, as it can cause an exacerbation of the inflammatory process in the liver.
In addition to canned blood, in children, as in adults, we use the introduction of plasma, red blood cell mass.
Last year, for some diseases that cause a decrease in nutrition and a lack of protein, we experienced the introduction of species-specific serum proposed by N. G. Belenky. The administration of this serum is well tolerated by children; no complications are observed.