Prof. S.D.KhimichProf. S.D.KhimichVinnitsa National Medical Vinnitsa National Medical

UniversityUniversity

LECTURELECTURE BLOOD BLOOD

TRANSFUSIONTRANSFUSION

IntroductionIntroduction The treatment of blood disorders and The treatment of blood disorders and

the management of bleedings during the management of bleedings during surgical manipulations is traditionally surgical manipulations is traditionally relied on techniques involving the relied on techniques involving the transfusion of donor blood and blood transfusion of donor blood and blood products.products.

Blood is fluid tissue of organism with Blood is fluid tissue of organism with its own specific cells, which executes its own specific cells, which executes

the most important functions. The the most important functions. The treatment of human with blood treatment of human with blood

products is broadly used and high products is broadly used and high resulting in clinic.resulting in clinic.

Historical AspectsHistorical Aspects

The idea of replacement of lost The idea of replacement of lost blood appeared in XIV-XV century. blood appeared in XIV-XV century. But, as Harvey described the But, as Harvey described the anatomy-physiological bases of anatomy-physiological bases of circulation only in 1728, therefore circulation only in 1728, therefore transfusion of blood could not be transfusion of blood could not be carried out before this time.carried out before this time.

In 1666, Richard Lower published the In 1666, Richard Lower published the results of experiments on transfusion results of experiments on transfusion

of blood to animals. of blood to animals.

In 1697 Merklin and in 1682 In 1697 Merklin and in 1682 Attenmuller reported the results of the Attenmuller reported the results of the

observation, according to which at observation, according to which at mixing blood of two individuals mixing blood of two individuals

agglutination sometimes occurred. agglutination sometimes occurred. That specifies incompatibility of blood. That specifies incompatibility of blood.

Despite of obscurity of this Despite of obscurity of this phenomenon, in 1820, Blandel phenomenon, in 1820, Blandel

(England) successfully carried out (England) successfully carried out transfusion of blood from man to man.transfusion of blood from man to man.

However, after transfusion of such However, after transfusion of such blood there were a lot of blood there were a lot of

complications, therefore the complications, therefore the method was not widely used.method was not widely used.

After opening blood groups by After opening blood groups by K.Landsteiner and Y.Yansky (1901-K.Landsteiner and Y.Yansky (1901-

1907) these obstacles were 1907) these obstacles were eliminated. eliminated.

Hustin in Brussels carried out the first Hustin in Brussels carried out the first successful use of sodium citrate as an successful use of sodium citrate as an anticoagulant for stored blood in 1914 anticoagulant for stored blood in 1914

at St. Jean Hospital. Thus, the at St. Jean Hospital. Thus, the elements were in place for the elements were in place for the development of blood bank, development of blood bank,

anticoagulation, cold storage, and the anticoagulation, cold storage, and the addition of sugar to prolong the life of addition of sugar to prolong the life of

the red cell.the red cell.

From a moment of blood From a moment of blood transfusions and before our days transfusions and before our days

hemotrunsfusiology passed hemotrunsfusiology passed complex, time tragic, way. This is complex, time tragic, way. This is

stipulated by an absence of stipulated by an absence of knowledge on that length of time-knowledge on that length of time-

knowledge in anatomy, knowledge in anatomy, physiology, knowledge about the physiology, knowledge about the role of blood in the organism of role of blood in the organism of

person.person.

Blood type -Blood type -

is is genetically outlined type of genetically outlined type of antigens set and their combination antigens set and their combination in each person. We can count in each person. We can count thousands blood types because of thousands blood types because of hundreds of combined antigens. hundreds of combined antigens.

As far back as 1901 years LanshteyAs far back as 1901 years Lanshteynerner - had opened such phenomena as - had opened such phenomena as

agglutination, having separated people agglutination, having separated people on 3 groups, he had installed that on 3 groups, he had installed that under the first blood type a serum under the first blood type a serum

agglutinating with erythrocytes of II agglutinating with erythrocytes of II and III groups. In II blood type a serum and III groups. In II blood type a serum

is agglutinating erythrocytes of III is agglutinating erythrocytes of III groups, but III group agglutinating groups, but III group agglutinating

erythrocytes of II group.erythrocytes of II group.

Later Yanskiy had opened IVth Later Yanskiy had opened IVth group. Such a phenomena was group. Such a phenomena was

explained by existence of explained by existence of system AB0, in other words – a system AB0, in other words – a

kit of agglutinogens and kit of agglutinogens and agglutinins within one agglutinins within one

individual. individual.

Some epidemiologySome epidemiology On statistical Europe On statistical Europe

data data 42-44% 42-44% A(II)A(II) 38-39% 38-39% 0(I)0(I) 12-14% 12-14% B(III)B(III) 4-6% 4-6% AB(0)AB(0)

Note that these values Note that these values are different for are different for

different continentsdifferent continents

O Positive O Positive 38%38% A Positive A Positive 34%34% B Positive B Positive 9%9% O Negative O Negative 7%7% A Negative A Negative 6%6% AB Positive AB Positive 3%3% B Negative B Negative 2%2% AB Negative AB Negative 1%1%

Blood type…Blood type… Each blood type defines a Each blood type defines a

combination of agglutinins and combination of agglutinins and agglutinogens. agglutinogens.

So, in the first group there are So, in the first group there are agglutinins agglutinins and and and agglutinogen and agglutinogen 0; in second accordingly - A and 0; in second accordingly - A and ; in ; in third- B and third- B and ; and in fourth AB0.; and in fourth AB0.

Indication of blood type is Indication of blood type is accepted on presence of accepted on presence of

agglutinogen: agglutinogen: 0(I); A(II); B(III); AB(IV).0(I); A(II); B(III); AB(IV).

AgglutinogensAgglutinogens A and B - are A and B - are termolabile organic substancetermolabile organic substance..

They base on They base on erythrocytes and erythrocytes and cause a formation cause a formation an antibody. an antibody.

Agglutinins Agglutinins and and are are termolabile globulins termolabile globulins

They base in the They base in the plasma, also in plasma, also in liquid tissue. liquid tissue. Accumulation them Accumulation them in the plasma go in the plasma go gradually, reaching gradually, reaching that level (titre) that level (titre) when when theythey are able are able to cause a reaction to cause a reaction of agglutination of agglutination

TiterTiter of agglutinins is usually of agglutinins is usually composed in adult from 1:32 to 1:128; composed in adult from 1:32 to 1:128;

- 1:16, 1:64. - 1:16, 1:64.

Than is above titer, that is big Than is above titer, that is big possibility for reaction of possibility for reaction of agglutination under meeting of the agglutination under meeting of the same agglutinogens of erythrocytes.same agglutinogens of erythrocytes.

Otenberg’s rules were held Otenberg’s rules were held under hemotransfusion under hemotransfusion ::

-- during blood transfusion during blood transfusion agglutinating introduced agglutinating introduced erythrocytes (agglutinogens) erythrocytes (agglutinogens) because the incorporated plasma because the incorporated plasma (agglutinins) are diluting in general (agglutinins) are diluting in general volume of liquid and their titre volume of liquid and their titre becomes to be insufficient for becomes to be insufficient for agglutination of patient's agglutination of patient's erythrocytes erythrocytes

Render that there are several subgroups of Render that there are several subgroups of agglutinogens. agglutinogens. SoSo A1, A2, A3, A4; AO, Ah, Az A1, A2, A3, A4; AO, Ah, Az

and others are discovered. and others are discovered. The most strong antigen – AThe most strong antigen – A11, it meet, it meetss

approximately beside 88% people with the approximately beside 88% people with the second blood type. It causes a quick reaction second blood type. It causes a quick reaction of agglutination. Several more weak actions of agglutination. Several more weak actions A2, it meetA2, it meetss approximatelly in 12% people approximatelly in 12% people

with the second blood type. with the second blood type.

Agglutinogen B also has Agglutinogen B also has several subgroups (B1, B2, B3), several subgroups (B1, B2, B3),

but their titer and antigen but their titer and antigen action are small, so in the action are small, so in the

clinic there do not take into clinic there do not take into consideration.consideration.

At the blood transfusion is take At the blood transfusion is take into account not only system into account not only system

AB0, but and system a Rhesus AB0, but and system a Rhesus of factor.of factor.

What is it?What is it?

At 1940 years LandshteinAt 1940 years Landshteinerer and Vinner, and Vinner, entering erythrocytes of manlike monkeys to entering erythrocytes of manlike monkeys to the rabbit had found that beside it is worked the rabbit had found that beside it is worked

out antibodies, capable to agglutinate out antibodies, capable to agglutinate erythrocyteserythrocytes

Render that in blood of human in Render that in blood of human in erythrocytes, but at last years and in fluid erythrocytes, but at last years and in fluid its part, inheres a factor, capable to cause its part, inheres a factor, capable to cause antibodies, and named antibodies, and named rhrh factor. factor.

The blood of 85% of the people contains an The blood of 85% of the people contains an antigenic Rhesus factor (a rh-positive). antigenic Rhesus factor (a rh-positive). About 15% of the people are rh-negative About 15% of the people are rh-negative

Consequently, transfusing Consequently, transfusing blood, always we had a danger blood, always we had a danger

a a RRh-conflict, or under the h-conflict, or under the recurrent transfusion a rh-recurrent transfusion a rh-negative patient the negative patient the RRh-h-

positive blood, or during the positive blood, or during the transfusion a transfusion a RRh-negative h-negative

blood, containing antibodies, blood, containing antibodies, RRh-positive sick. h-positive sick.

Determination of blood Determination of blood type:type:

with the help of standard serums with the help of standard serums (known agglutinin);(known agglutinin);

with the help of the standard with the help of the standard erythrocytes (known agglutinogen);erythrocytes (known agglutinogen);

and modern method, which falls and modern method, which falls into the life, this use monoclonal into the life, this use monoclonal antibodies anti-A and anti-B.antibodies anti-A and anti-B.

The determination of blood types The determination of blood types with the help of standard serums;with the help of standard serums;

As rule, serums of first, second and third As rule, serums of first, second and third groups are taken. Serum of fourth group is groups are taken. Serum of fourth group is used seldom.used seldom.

Always use serums of two titrums, so Always use serums of two titrums, so to the cup inflict on two dripped to the cup inflict on two dripped standard whey, each of three groups. standard whey, each of three groups.

The testing blood is adding there, The testing blood is adding there, moreover it’s taken in 5-10 once moreover it’s taken in 5-10 once less; serums mix and take an less; serums mix and take an answer account into reactions of answer account into reactions of agglutination. agglutination. - If testing blood of first group, - If testing blood of first group, agglutination absent. agglutination absent. - If second - there is agglutination in - If second - there is agglutination in the whey of first and third group. the whey of first and third group. - If third – there is agglutination - If third – there is agglutination present with first and second serums. present with first and second serums. -And if agglutination is in all three -And if agglutination is in all three ways – this is fourth group.ways – this is fourth group.

At the account of reactions possible to At the account of reactions possible to find agglutination where it practically find agglutination where it practically

is absent and reason to this is absent and reason to this phenomena (pseudoagglutination) are phenomena (pseudoagglutination) are

toto bebe:: low temperaturelow temperature indoorsindoors,, this below 15° this below 15°

C;C; account to reactions later 5 minutes;account to reactions later 5 minutes; concentrate (is sub narrow) standard concentrate (is sub narrow) standard

way;way; at presence infesting blood the immune at presence infesting blood the immune

antibody, if patient suffers a sepsis, antibody, if patient suffers a sepsis, system disease of blood.system disease of blood.

Sometimes agglutination is Sometimes agglutination is impossible to notice, this can be at impossible to notice, this can be at

number of conditions:number of conditions:

Determination of blood types is lead Determination of blood types is lead at temperature over 25-30at temperature over 25-30C;C;

If it is take reaction less than 5 If it is take reaction less than 5 minutes into account;minutes into account;

If low titer of agglutinins (below If low titer of agglutinins (below 1:32), in other words, you define 1:32), in other words, you define blood type by one series of serum;blood type by one series of serum;

The most reliable method of The most reliable method of determination of blood types is a determination of blood types is a using using ColiclonsColiclons anti-A and anti-B anti-A and anti-B

Coliclons are not the products of human's Coliclons are not the products of human's cells; cells;

this is ascetical divorced liquid of this is ascetical divorced liquid of mousses; mousses;

which are kept in specific immunoglobulins which are kept in specific immunoglobulins class M, which are directed against class M, which are directed against antigens A or B of the person. antigens A or B of the person.

Determination of blood type Determination of blood type On the tablet or plate, in conditions On the tablet or plate, in conditions

of temperature indoors +15 - +25of temperature indoors +15 - +25C, C, inflict on one drop (0,1 ml) coliclons inflict on one drop (0,1 ml) coliclons

anti-A and B, anti-A and B, then inflict testing blood (drop its then inflict testing blood (drop its

must be in 10 once less), must be in 10 once less), mix 3 minutes, mix 3 minutes, observe a reaction observe a reaction

Determination group of blood Determination group of blood with coliclonswith coliclons anti-A and anti-B anti-A and anti-B

The The blood typeblood type:: If there is no agglutination in both If there is no agglutination in both

coliclons - a first group; coliclons - a first group; if agglutination with colicions anti-A – if agglutination with colicions anti-A –

second;second; if with anti-B – third; if with anti-B – third; and, if agglutination in both coliclons and, if agglutination in both coliclons

- a fourth group.- a fourth group.

Determination of rh- Determination of rh- factorfactor

Several methods are exists to install the Several methods are exists to install the presence rh-factor in blood of human. In presence rh-factor in blood of human. In emergency situations can be used an emergency situations can be used an express-method.express-method.

The investigated blood are adding to the The investigated blood are adding to the standard anti-rh serum (containing standard anti-rh serum (containing antibodies) on cups Petry, and take a antibodies) on cups Petry, and take a reaction account into 3-5 minutes.reaction account into 3-5 minutes.

Presence of agglutination means presence Presence of agglutination means presence of rh-factor. This method is possible in of rh-factor. This method is possible in specifically emergency situations.specifically emergency situations.

Problems with rh- Problems with rh- factor…factor…

The Sources of getting The Sources of getting bloodblood

Main source of blood is Main source of blood is sound people - donors. sound people - donors. Rarefied to take a blood Rarefied to take a blood beside persons, reached beside persons, reached adult, which didn’t suffer adult, which didn’t suffer from tuberculosis, syphilis, from tuberculosis, syphilis, malaria, aren’t base in a malaria, aren’t base in a period of recovery after period of recovery after carrying infectious carrying infectious diseases, virus hepatitis.diseases, virus hepatitis.

Blood, which were taken from the Blood, which were taken from the donor, must be preserved at donor, must be preserved at particular conditionsparticular conditions At present, blood is preserving by the At present, blood is preserving by the

solution of glugicir from the solution of glugicir from the calculation 25 ml on 100 ml of blood.calculation 25 ml on 100 ml of blood.

Earlier were used preservatives of Earlier were used preservatives of different composition COLIPK. different composition COLIPK.

Blood, prepared by such Blood, prepared by such method…method…

is keeping in sterile vials at the is keeping in sterile vials at the temperature +4 - +6 degrees in temperature +4 - +6 degrees in the refrigerator. Shelf times the refrigerator. Shelf times before 10-11 days, but optimum before 10-11 days, but optimum term is 7 days.term is 7 days.

By accompaniments 50-60 mg of By accompaniments 50-60 mg of heparins on 1 liter blood is heparins on 1 liter blood is possible to preserve. This blood possible to preserve. This blood is used in devices of artificial is used in devices of artificial circulation of the blood; shelf circulation of the blood; shelf time 24 hours. time 24 hours.

Exist and other sources of Exist and other sources of getting blood:getting blood:

Utilate Blood (phlebotomy);Utilate Blood (phlebotomy); Auto blood (blood …. during Auto blood (blood …. during

operations);operations); Umbilical cord-placental blood;Umbilical cord-placental blood; The Shamov's work had shown that The Shamov's work had shown that

after 10-12 hours after the death a after 10-12 hours after the death a blood saves their own qualities.blood saves their own qualities.

Mechanism of transfused Mechanism of transfused blood actionblood action

The effect of transfused blood The effect of transfused blood depends on amounts, method, depends on amounts, method, velocities of transfusion. velocities of transfusion. Incorporated blood renders replacing Incorporated blood renders replacing and haemostatic action, intensifies and haemostatic action, intensifies an exchange of materials, possesses an exchange of materials, possesses by immunobiological, desintoxical by immunobiological, desintoxical and nourishing action.and nourishing action.

In the surgical practice the In the surgical practice the most significant is a most significant is a replacement action replacement action

Haemostatic effect Haemostatic effect

Together with donor blood are Together with donor blood are entering antibodies, globulins, entering antibodies, globulins, which take place in immune which take place in immune correcting of patient’s correcting of patient’s organismorganism

Desintoxicating actionDesintoxicating action

The indications and The indications and contraindications to the blood contraindications to the blood

transfusiontransfusion Coming from the mechanism of action Coming from the mechanism of action

transfuse blood, are determined absolute transfuse blood, are determined absolute and relative contraindications to and relative contraindications to hemotransfusion. hemotransfusion.

At first, no contraindications to the At first, no contraindications to the account do not undertake when we account do not undertake when we talking about the blood transfusion talking about the blood transfusion (bleeding) under the evident threat life of (bleeding) under the evident threat life of sick.sick.

The showing (indications) to The showing (indications) to haemotransfusionhaemotransfusion

The commonest indication for blood The commonest indication for blood transfusion is transfusion is profuse hemorrhageprofuse hemorrhage;;

It is indicated during certain It is indicated during certain major major operationsoperations, where a large amount of , where a large amount of blood loss is inevitable;blood loss is inevitable;

In case of deep In case of deep burns blood burns blood transfusiontransfusion is indicated; is indicated;

Preoperatively blood transfusionPreoperatively blood transfusion is is required when This is particularly needed required when This is particularly needed before operations for malignant before operations for malignant diseasesdiseases;;

Contraindications to Contraindications to hemotransfusion are:hemotransfusion are:

Sharp violation a function livers, Sharp violation a function livers, kidneys, heart;kidneys, heart;

Inflammatory diseases of vessels Inflammatory diseases of vessels (tromboflebitis, phlebitis, embolisms);(tromboflebitis, phlebitis, embolisms);

Allergic conditions;Allergic conditions; Active tuberculoses process, also Active tuberculoses process, also

inflammation disease pulmonary inflammation disease pulmonary tissues.tissues.

Methods and technology of Methods and technology of blood transfusionblood transfusion

Direct transfusionDirect transfusion - a direct using donor’s - a direct using donor’s blood, which is take now and immediately blood, which is take now and immediately transfused to recipient, avoiding stage of transfused to recipient, avoiding stage of preservations, and such blood is the most preservations, and such blood is the most valuable. However it hides in itself danger valuable. However it hides in itself danger of infecting sick beside disease, which can of infecting sick beside disease, which can suffer a donor, time not being aware of suffer a donor, time not being aware of this.this.

All this procedures is conduct in sterile All this procedures is conduct in sterile conditions. conditions.

Indirect methodIndirect method.. Blood withdrew from the donor, mix with Blood withdrew from the donor, mix with

the preservative, and is kept under certain the preservative, and is kept under certain conditions and, after 5-10 days, possible conditions and, after 5-10 days, possible use for the transfusion.use for the transfusion.

Disposable systems for the indirect Disposable systems for the indirect transfusion are used. transfusion are used.

When blood is entering intra-arterial, we When blood is entering intra-arterial, we used bladder and manometer in the used bladder and manometer in the system, which allows creating a pressure system, which allows creating a pressure in the system. Pressure in the system in the system. Pressure in the system must be within I80-200 mm Hg.must be within I80-200 mm Hg.

The following researches are The following researches are necessary for carrying out before necessary for carrying out before

a hemotransfusion:a hemotransfusion: determination of blood group of the donor;determination of blood group of the donor; determination of blood group of the determination of blood group of the

recipient;recipient; determination of group compatibility of determination of group compatibility of

donor and recipient;donor and recipient; determination of rhesus compatibility of determination of rhesus compatibility of

donor and recipient;donor and recipient; biological test (see next picture).biological test (see next picture).

Coming from different a showing Coming from different a showing possible topossible to use the following ways use the following ways

of introduction the blood:of introduction the blood: Intravenous;Intravenous; Intraarterious;Intraarterious; Intrabones;Intrabones; Intramuscular;Intramuscular; Subdermal;Subdermal; Through corpus cavernosus.Through corpus cavernosus.

Test questions:Test questions: Types of blood groups.Types of blood groups. Rh-factor.Rh-factor. Methods of determination of blood Methods of determination of blood

groups.groups. Determination of Rh-factor.Determination of Rh-factor. Sources of getting blood.Sources of getting blood. Indication and contraindications to blood Indication and contraindications to blood

transfusion.transfusion. Ways of blood introduction.Ways of blood introduction.

Спасибо за вниманиеСпасибо за внимание

Thank for attentionThank for attention