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Complications during blood transfusion can be caused by errors in technique or arise as a consequence of so-called post-transfusion reactions. Complications of the first kind include: a) vascular embolism with blood clots and air; b) formation of extensive hematomas in the puncture area blood vessel. Towards total number complications they make up a small percentage and are rare.
Much more often we have to deal with various post-transfusion reactions. Nonspecific reactions may be associated with the properties of the transfused blood itself (exogenous factors) or depend on individual characteristics reactivity of the recipient's body (endogenous factors). Their severity may vary. In mild cases, 15-30 minutes after the transfusion, the wounded person begins to complain of chills, his temperature rises slightly, and subjective disorders are expressed in a feeling of slight malaise.
When reacting moderate severity the chills are much more pronounced, the temperature rises to 39°, the wounded person complains of a feeling of weakness and headache. A severe reaction manifests itself in stunning chills, a rise in temperature to 39° and above, vomiting and a drop in cardiac activity. Sometimes reactions can manifest as allergic symptoms such as a slight increase in temperature, the appearance of urticarial skin rash (urticaria) and swelling of the eyelids.
Frequent causes of post-transfusion reactions are technical errors in blood collection (insufficient processing of dishes, poor distillation of water, improper preparation of a preservative solution, etc.), as well as the effects on the blood of various external factors, leading to labilization, instability, and ease of flocculation of blood proteins.
You should also be aware that when very large doses of canned blood are administered, toxic effect citrate in the form of the so-called “nitrate shock”. To prevent this complication, after transfusion of massive doses of blood, a solution of calcium chloride is injected intravenously (3-5 ml of a 10% solution after each ampoule of preserved blood).
Mild to moderate reactions are usually transient and do not require special treatment. However, when chills appear, the patient must be warmed well (covered with blankets, covered with heating pads), and if the reaction intensifies, resort to symptomatic remedies(camphor and caffeine, promedol, intravenously - 40% glucose solution in an amount of up to 50 ml). For allergic phenomena, a 10% solution of calcium chloride in an amount of 10 ml and a 2% solution of diphenhydramine are administered intravenously in an amount of 2-3 ml.
The most severe complication is transfusion shock, which develops as a result of transfusion of incompatible and hemolyzed blood. One should keep in mind the possibility of developing transfusion shock from transfusion of Rh-incompatible blood. Therefore, in the conditions of field military medical institutions, if the wounded have a history of significant post-transfusion reactions, one should refrain from blood transfusions and instead administer various plasma-substituting solutions. In hospitals, in such cases, the Rh status of the recipient’s blood is determined or a transfusion of Rh-negative blood is performed.
A characteristic symptom of hemotransfusion shock is the appearance of sharp pain in the lower back. In the wounded it decreases blood pressure, the pulse becomes small and frequent, shortness of breath occurs, the face becomes pale and then cyanotic. IN severe cases Vomiting may begin, the wounded person loses consciousness, and involuntary passage of feces and urine occurs.
After some time, the symptoms of shock subside, blood pressure is restored, and breathing improves. Then the condition worsens again - symptoms associated with dysfunction appear internal organs(hemoglobinuria, jaundice, oliguria, high fever lasts a long time).
With persistent dysfunction of the night and accumulation of nitrogenous products and urea in the blood, it is possible to remove patients from the state of intoxication by using hemodialysis using the so-called artificial night or by peritoneal dialysis. Of course, these rather complex procedures can only be performed in specially equipped front-line or rear hospitals.
In the treatment of transfusion shock, all therapeutic measures in the acute stage should be aimed at restoring blood pressure and cardiac activity.
Along with the introduction of the above symptomatic drugs, it is necessary to bleed 300-400 ml of blood, followed by the injection of compatible blood or plasma to the wounded person. It is also advisable to administer anti-shock solutions intravenously by drip. Due to the fact that during hemotransfusion shock the function of the kidneys is sharply impaired as a result of the onset of spasm of their vessels, a bilateral perinephric novocannon blockade according to Vishnevsky with the introduction of a 0.25% solution of novocaine, 100-150 ml on each side, is highly recommended.
With persistent, systematic and timely implementation of the listed measures, it is often possible to bring the patient out of a threatening state, even in very severe cases.
Blood transfusion shock is quite rare, but severe complication, which develops during transfusion of blood and its components.
Occurs during the procedure or immediately after it.
Requires immediate emergency anti-shock therapy.
Read more about this condition below.
- blood group incompatibility according to the ABO system;
- incompatibility according to RH (Rhesus) factor;
- incompatibility with antigens of other serological systems.
Occurs due to violation of the rules of blood transfusion at any stage, incorrect determination of the blood group and Rh factor, errors during the compatibility test.
Features and changes in organs
The basis of all pathological changes is the destruction of red blood cells of incompatible donor blood in the recipient’s vascular bed, as a result of which the following enters the blood:
- Free hemoglobin - normally free hemoglobin is located inside red blood cells, its direct content in the bloodstream is insignificant (from 1 to 5%). Free hemoglobin is bound in the blood by haptaglobin, the resulting complex is destroyed in the liver and spleen and does not enter the kidneys. Release into the blood large quantity free hemoglobin leads to hemoglobinuria, i.e. all hemoglobin is not able to bind and begins to be filtered in the renal tubules.
- Active thromboplastin is an activator of blood clotting and blood clot formation ( blood clot), is not normally present in the blood.
- Intraerythrocyte coagulation factors also promote clotting.
The release of these components leads to the following violations:
DIC syndrome, or disseminated intravascular coagulation syndrome - develops as a result of the release of coagulation activators into the blood.
Has several stages:
- hypercoagulation – multiple microthrombi are formed in the capillary bed, which clog small vessels, resulting in multiple organ failure;
- consumptive coagulopathy – at this stage, coagulation factors are consumed to form multiple blood clots. At the same time, the anticoagulation system of the blood is activated;
- hypocoagulation - at the third stage, the blood loses its ability to clot (since the main coagulation factor - fibrinogen - is no longer present), resulting in massive bleeding.
Oxygen deficiency – Free hemoglobin loses its connection with oxygen, and hypoxia occurs in tissues and organs.
Microcirculation disturbance- as a result of spasm of small vessels, which is then replaced by pathological expansion.
Hemoglobinuria and renal hemosiderosis- develops as a result of the release of a large amount of free hemoglobin into the blood, which, when filtered in the renal tubules, leads to the formation of hemosiderin (salt hematin - a breakdown product of hemoglobin).
Hemosiderosis in combination with vasospasm, it leads to disruption of the filtration process in the kidneys and accumulation of nitrogenous substances and creatinine in the blood, thus developing acute renal failure.
In addition, impaired microcirculation and hypoxia lead to disruption of the functioning of many organs and systems: liver, brain, lungs, endocrine system and etc.
Symptoms and signs
The first signs of transfusion shock may appear already during a blood transfusion or in the first few hours after the procedure.
- the patient is agitated and behaves restlessly;
- pain in the chest area, a feeling of tightness behind the sternum;
- breathing is difficult, shortness of breath appears;
- the complexion changes: more often it turns red, but it can be pale, cyanotic (blue) or with a marbled tint;
- lower back pain - characteristic symptom shock, indicates pathological changes in the kidneys;
- tachycardia - rapid heart rate;
- decreased blood pressure;
- Sometimes there may be nausea or vomiting.
After a few hours, the symptoms subside and the patient feels better. But this is a period of imaginary well-being, after which the following symptoms appear:
- Icterus (jaundice) of the eye sclera, mucous membranes and skin (hemolytic jaundice).
- Increased body temperature.
- Renewal and intensification of pain.
- Kidney and liver failure develops.
When receiving a blood transfusion under anesthesia, signs of shock may include:
- Fall in blood pressure.
- Increased bleeding from the surgical wound.
- By urinary catheter urine is cherry-black or the color of “meat slop”; there may be oligo- or anuria (decreased amount of urine or its absence).
- Changes in urinary excretion are a manifestation of increasing renal failure.
Course of the pathology
There are 3 degrees of transfusion shock depending on the level of decrease in systolic blood pressure:
- up to 90 mm Hg;
- up to 80-70 mm;
- below 70 mm. rt. Art.
There are also periods of shock characterized by a clinical picture:
- Shock itself is the first period in which hypotension (a drop in blood pressure) and DIC occur.
- The period of oliguria (anuria) – the impairment of kidney function progresses.
- The stage of diuresis restoration is the restoration of the filtering function of the kidneys. Occurs with timely provision of medical care.
- Convalescence (recovery) – restoration of the functioning of the blood coagulation system, normalization of hemoglobin, red blood cells, etc.
Anaphylactic shock is a rapid and dangerous reaction of the body to an external irritant, which requires immediate medical attention. Following the link, we will consider the mechanism of development of this condition.
Types of treatment procedures
All therapeutic measures for blood transfusion shock are divided into 3 stages:
Emergency anti-shock therapy - to restore normal blood flow and prevent serious consequences. It includes:
- infusion therapy;
- intravenous administration of antishock drugs;
- extracorporeal methods of blood purification (plasmapheresis);
- correction of the function of systems and organs;
- correction of hemostasis (blood clotting);
- treatment of acute renal failure.
Symptomatic therapy – carried out after stabilization of the patient’s condition during the recovery period (recovery).
Preventive measures - identifying the cause of the development of shock and eliminating similar errors in the future, strict adherence to the sequence of transfusion procedures, conducting compatibility tests, etc.
First aid
If signs of transfusion shock or corresponding complaints from the recipient appear, it is necessary to urgently stop further blood transfusion without removing the needle from the vein, since anti-shock drugs will be administered intravenously and time cannot be wasted on new catheterization of the vein.
Emergency treatment includes:
Infusion therapy:
- blood replacement solutions (reopolyglucin) - to stabilize hemodynamics, normalize BCC (circulating blood volume);
- alkaline preparations (4% sodium bicarbonate solution) - to prevent the formation of hemosiderin in the kidneys;
- polyionic saline solutions(Trisol, Ringer-Locke solution) - to remove free hemoglobin from the blood and preserve fibrinogen (i.e., to prevent stage 3 of DIC, in which bleeding begins).
Drug antishock therapy:
- prednisolone – 90-120 mg;
- aminophylline – 2.4% solution in a dosage of 10 ml;
- lasix – 120 mg.
This is a classic triad for preventing shock, helping to increase blood pressure, relieve spasm of small vessels and stimulate kidney function. All drugs are administered intravenously. Also used:
- antihistamines(diphenhydramine and others) - to dilate the renal arteries and restore blood flow through them;
- narcotic analgesics (for example, promedol) - to relieve severe pain.
An extracorporeal treatment method – plasmapheresis – involves taking blood, purifying it of free hemoglobin and fibrinogen breakdown products, then returning the blood to the patient’s bloodstream.
Correction of functions of systems and organs:
- transfer of the patient to mechanical ventilation (artificial ventilation) in case of a serious condition of the patient;
- transfusion of washed red blood cells - carried out when there is a sharp drop in hemoglobin levels (less than 60 g/l).
Correction of hemostasis:
- heparin therapy – 50-70 IU/kg;
- anti-enzyme drugs (contrical) - prevents pathological fibrinolysis, leading to bleeding in shock.
Treatment of acute renal failure:
- hemodialysis and hemosorption are procedures for purifying blood outside the kidneys, carried out when oligo- or anuria develops and previous measures are ineffective.
Principles and methods of treatment procedures
The main principle of treatment for transfusion shock is emergency intensive care. It is important to start treatment as early as possible, only then can we hope for a favorable outcome.
Treatment methods differ fundamentally depending on diuresis indicators:
- Diuresis is preserved and is more than 30 ml/h - active infusion therapy is carried out with a large volume of infused liquid and forced diuresis, before which it is necessary to pre-administer sodium bicarbonate (to alkalinize urine and prevent the formation of hydrochloric acid hematin);
- Diuresis less than 30 ml/h (oligoanuria stage) – strict restriction administered fluid during infusion therapy. Forced diuresis is contraindicated. At this stage, hemosorption and hemodialysis are usually used, since renal failure is severe.
Forecasts
The patient's prognosis directly depends on the early provision of anti-shock measures and the completeness of treatment. Therapy in the first few hours (5-6 hours) ends with a favorable outcome in 2/3 of cases, i.e. patients recover completely.
In 1/3 of patients, irreversible complications remain, developing into chronic pathologies of systems and organs.
Most often this happens with the development of severe renal failure, thrombosis of vital vessels (brain, heart).
If emergency care is not provided in a timely or adequate manner, the outcome for the patient can be fatal.
Blood transfusion is a very important and necessary procedure that heals and saves many people, but in order for donor blood to bring benefit and not harm to the patient, it is necessary to carefully follow all the rules for its transfusion.
This is done by specially trained people who work in blood transfusion departments or stations. They carefully select donors; after blood collection, blood goes through all stages of preparation, safety testing, etc.
Blood transfusion, like preparation, is a carefully controlled process, carried out only by trained professionals. It is thanks to the work of these people that today this process is quite safe, the risk of complications is low, and the number of people saved is very large.
Video on the topic
Blood transfusion is often the only method of saving patients with massive blood loss, hematopoietic diseases, poisoning, and purulent-inflammatory pathologies. Hemotransfusion shock, which occurs when blood is incompatible, is an extremely serious condition that can be fatal. With a competent approach to the feasibility of carrying out the procedure, taking into account contraindications for the patient, careful prevention, proper treatment and active monitoring of the patient, such a complication does not arise.
What is transfusion shock
Transfusion shock refers to pathological conditions extremely severe - life-threatening - disorder of all body functions that occurs during blood transfusion.
The term blood transfusion comes from the Greek “haem” - blood and Latin word"transfusion", which means transfusion.
Blood transfusion shock is a dangerous and difficult to treat complication, manifesting itself in the form of a rapidly developing powerful inflammatory-anaphylactic reaction affecting all organs and systems.
Transfusion shock is a life-threatening complication of blood transfusion.By medical statistics This condition occurs in almost 2% of all blood transfusions.
Transfusion shock occurs either during the transfusion process or immediately after the procedure and lasts from 10–15 minutes to several hours. Thus, the first signs of infusion of blood of the wrong type occur when only 20–40 ml enters the patient’s body. It happens that a full-blown reaction is registered after 2–4 days.
In rare cases, pathology does not give clear clinical signs, especially when general anesthesia, but more often it is accompanied by pronounced manifestations, which without intensive and emergency treatment lead to the death of the patient.
The danger of blood transfusion shock is a serious disruption of the heart, brain, insufficiency of liver and kidney function up to their failure, hemorrhagic syndrome (increased bleeding) with hemorrhages and bleeding that aggravate the condition of patients, intravascular thrombosis that threatens a drop in blood pressure.
Causes
Experts consider the most common cause of acute hemotransfusion complications to be the use of blood that is incompatible with the Rh factor Rh (a special protein present or absent on the surface of red blood cells - erythrocytes), which does not correspond to the group according to the ABO system (60% of all cases). Less commonly, a complication occurs when blood is incompatible with individual antigens.
Blood group compatibility - table
| Blood type | Can donate blood to groups | Can accept blood groups |
| I | I, II, III, IV | I |
| II | II, IV | I, II |
| III | III, IV | I, III |
| IV | IV | I, II, III, IV |
The blood transfusion procedure is a medical procedure, therefore leading causal factors are:
- violation of blood transfusion technique;
- inconsistency with the methodology and errors in determining the blood group and Rh factor;
- incorrect execution of samples when checking for compatibility.
Risk factors that aggravate the condition include:
- use of bacteria-infected or poor-quality blood due to a disorder temperature regime and shelf life;
- a large amount of incompatible blood transfused to the patient;
- the type and severity of the primary disease that required blood transfusion;
- condition and age of the patient;
- allergic predisposition.
Clinical aspects of transfusion shock - video
Symptoms and signs
The clinical picture of shock is accompanied by characteristic manifestations, but experts always take into account that erased symptoms also occur. Moreover, the brief improvement that occurs in many patients is suddenly replaced by a state with obvious and acute manifestations severe renal-hepatic damage, which in 99% of cases is the main cause of death.
Therefore, both during and after blood transfusion, the patient must be under continuous monitoring.
Symptoms of transfusion shock - table
| By time of manifestation | Symptoms |
| Initial |
Lower back pain is a defining sign of the onset of shock during and after blood transfusion. It serves as a signal of catastrophic damage to the kidney tissue. |
| As the condition progresses |
|
| Late | In the absence of medical assistance:
|
Features of manifestations of the disease during general anesthesia
When incompatible blood is transfused into a patient who is under anesthesia during surgical operations, signs of shock are weak or absent.
The patient does not feel anything, does not complain, so early diagnosis of the development of pathology falls entirely on the doctors performing the operation.
Manifestations of jaundice during blood transfusion indicate the development of pathological processes in the liver
An abnormal blood transfusion reaction is indicated by:
- an increase or, conversely, a drop in blood pressure below normal levels;
- increased heart rate;
- a sharp rise in temperature;
- paleness, cyanosis (blue discoloration) of the skin and mucous membranes;
- a noticeable increase in tissue bleeding in the area of the surgical wound;
- discharge of brown urine with inclusions resembling meat flakes in structure.
During surgical blood transfusion, it is necessary to insert a catheter into the bladder: in this case, you can visually track the color and type of urine released.
The degree of shock reaction is determined by the doctor based on blood pressure readings.
Degrees of transfusion shock - table
Diagnostics
Diagnosis is carried out based on the analysis of the patient’s subjective feelings, Special attention address lower back pain - specific symptom. Of the objective signs, importance is attached to sharp fall pressure, redness of urine, decreased diuresis, increased temperature and increased heart rate.
The analysis is difficult because in some cases the only sign of a complication is an increase in the patient’s temperature, so changes in this indicator are monitored for 2 hours after the transfusion.
Since treatment for shock must be immediate, and it takes time to obtain test results, experienced specialists resort to the old method of determining the incompatibility of transfused blood, which was widely used in military hospitals in combat conditions - the Baxter test.
Baxter's test: after administering about 70–75 ml of donor blood to the patient, 10 minutes later a 10 ml sample is drawn from another vein into a test tube. Then centrifugation is carried out to separate the liquid part - plasma, which is normally colorless. Pink color indicates a high probability of developing transfusion shock as a result of incompatibility.
Laboratory tests reveal:
- Signs of hemolysis (destruction of red blood cells), which include:
- the appearance of free hemoglobin in the serum (hemoglobinemia reaches 2 grams per liter) already in the first hours;
- detection of free hemoglobin in the urine (hemoglobinuria) within 6–12 hours after the procedure;
- high content of indirect bilirubin (hyperbilirubinemia), which persists for up to 5 days, along with the appearance of urobilin in the urine and an increase in the content of stool stercobilin.
- A positive reaction with a direct antiglobulin test (Coombs test), meaning the presence of antibodies to the Rh factor and specific globulin antibodies that are fixed on red blood cells.
- Detection of agglutination (sticking together) of red blood cells when examining blood under a microscope (a sign of the presence of an antigen or antibody).
- Decrease in hematocrit (the volume of the red blood cell fraction in the blood).
- Reduction or absence of haptoglobin (a protein that transports hemoglobin) in the blood serum.
- Oliguria (decreased amount of urine excreted) or anuria (urinary retention), indicating kidney dysfunction and the development of failure.
Difficulties differential diagnosis associated with the frequent absence or erasure of clinical symptoms of a reaction to blood transfusion. When studies determining the development of acute hemolysis are insufficient, additional serological tests are used.
Hemolysis - destruction of red blood cells and release of free hemoglobin - is the main laboratory indicator of incompatibility of blood transfused to a patient
Treatment
Treatment for transfusion shock is carried out in the intensive care unit and includes a set of measures.
Emergency care algorithm
Emergency medical actions in case of blood transfusion complications are aimed at preventing coma, hemorrhagic syndrome and kidney failure.
Emergency help in case of shock during blood transfusion, it is aimed at stabilizing cardiac activity and vascular tone
At the first signs of shock:
- The transfusion procedure is immediately stopped and, without removing the needle from the vein, the dropper is closed with a clamp. Next, massive infusions will be administered through the left needle.
- Change the disposable transfusion system to a sterile one.
- Adrenaline is administered subcutaneously (or intravenously). If blood pressure does not stabilize after 10–15 minutes, the procedure is repeated.
- Heparin administration is started (intravenously, intramuscularly, subcutaneously) to prevent the development of disseminated intravascular coagulation syndrome, which is characterized by massive thrombus formation and bleeding.
- Infusion therapy is carried out to stabilize blood pressure to the minimum normal level of 90 mmHg. Art. (systolic).
- A solution of calcium chloride is injected intravenously (reduces the permeability of the vascular wall and relieves the allergic reaction).
- Perinephric (perinephric) blockade is carried out - introduction of Novocaine solution into the perinephric tissue according to A.V. Vishnevsky to relieve vasospasm, edema, maintain blood circulation in tissues and relieve pain.
- Infused into a vein:
- means for maintaining heart function - Cordiamine, Korglykon with glucose solution;
- antishock drugs (Kontrikal, Trasylol);
- Morphine, Atropine.
With the development of hemorrhagic syndrome:
- begin to transfuse the patient with freshly collected blood (same group), plasma, platelet and erythrocyte mass, cryoprecipitate, which have an effective anti-shock effect, preventing kidney damage;
- epsilon-aminocaproic acid is administered intravenously as a hemostatic agent for bleeding associated with increased fibrinolysis (thromt dissolution processes).
At the same time, instrumental measurements of blood pressure are taken and catheterization is performed. Bladder to monitor kidney function and collect urine for hemolysis.
Drug treatment
If blood pressure can be stabilized, active drug therapy is carried out.
Use:
- diuretics intravenously (then intramuscularly for 2–3 days) to remove free hemoglobin and reduce the risk of developing acute failure kidneys, liver or reducing its severity: Lasix, Mannitol. In this case, Furosemide (Lasix) is combined with Eufillin according to the scheme.
Important! If during infusion of Mannitol healing effect is absent, its administration is stopped due to the threat of developing pulmonary and cerebral edema and simultaneous tissue dehydration.
- antihistamines (antiallergic) agents to suppress the reaction of rejection of foreign blood components: Diphenhydramine, Suprastin, Diprazine;
- corticosteroids to stabilize the walls of blood vessels, relieve inflammatory edema, prevent acute pulmonary failure: Prednisolone, Dexamethasone, Hydrocortisone with gradual dose reduction;
- as a means of improving microcirculation, preventing oxygen starvation cells that have a hemostatic (hemostatic) effect:
Troxevasin, Cyto-Mac, ascorbic acid, Etamsylate; - disaggregants that prevent the formation of blood clots: Pentoxifylline, Xanthinol nicotinate, Complamin;
- to relieve spasms of the bronchi and blood vessels: No-shpa, Eufillin, Baralgin (allowed only for stable blood pressure);
- analgesic and narcotic drugs for severe pain: Ketonal, Promedol, Omnopon.
- for bacterial contamination of the blood - broad-spectrum antimicrobial drugs.
Drugs for the treatment of blood transfusion shock - photo gallery
Suprastin refers to antihistamines 
Prednisolone - hormonal drug 
Etamsylate is used for increased bleeding 
Eufillin dilates the lumen of blood vessels 
Ketonal is an effective pain reliever
Important! Do not prescribe antibiotics with nephrotoxic side effects, including sulfonamides, cephalosporins, tetracyclines, streptomycin.
Infusion therapy
The treatment regimen, choice of medications and dosage are determined by the amount of diuresis (the volume of urine collected per unit of time).
Infusion therapy for the development of intravascular hemolysis - table
| Diuresis in ml per hour | |
| More than 30 | Less than 30 or anuria (lack of urination) |
| at least 5–6 liters of solutions are administered over 4–6 hours | the amount of fluid administered is reduced to a volume calculated using the formula 600 ml + volume of urine excreted |
|
|
| Stimulation of diuresis with infusion solutions begins only after the administration of drugs to alkalize urine in order to avoid damage to the renal tubules. | |
| Mannitol, Lasix to maintain diuresis rates of 100 ml/hour or more | Lasix. Mannitol is discontinued because its use against the background of anuria causes overhydration, which can lead to edema of the lungs and brain. |
| Diuresis is forced until the urine clears and free hemoglobin in the blood and urine is eliminated | If urine output does not increase within 20–40 minutes from the onset of hemolysis, disruption of renal blood flow may begin with the development of renal ischemia and nephronecrosis (death of organ cells). To remove toxins and free hemoglobin from the blood, plasmapheresis is performed and the question of the need for hemodialysis is raised, which can be performed only after the signs of hemolysis have been eliminated. |
| If a violation of the level of electrolytes is detected, solutions of potassium and sodium are added. | |
| Treatment of DIC or acute coagulopathy ( dangerous condition severe violation of blood clotting, leading to the development of massive bleeding), if necessary, blood transfusion is performed in the amount of blood loss. | |
Blood purification
If possible, and especially with the development of anuria, indicating acute destructive processes in the kidneys, blood purification is carried out outside the patient's body - plasmapheresis.
The procedure involves taking a certain amount of blood and removing the liquid part from it - plasma containing free hemoglobin, toxins, and decay products. This purification of the blood occurs when its liquid part passes through special filters and is subsequently infused into another vein.
Plasmapheresis provides a rapid therapeutic effect due to the active removal of aggressive antibodies, hemolysis products, and toxins. It is performed using a device, completely eliminating the possibility of infection of the patient, and lasts about 1–1.5 hours.
Stabilization of organ function
To prevent the destruction of kidney, liver, and brain tissue during blood transfusion shock, measures are necessary to maintain their functioning.
Rapid progression respiratory failure, hypoxia (decreased oxygen in the blood) and hypercapnia (increased amount of carbon dioxide) requires an emergency transfer of the patient to artificial respiration.
If symptoms of severe kidney failure appear (anuria, brown urine, lower back pain), the patient is transferred to hemodialysis - a method based on the extrarenal purification of the blood from toxins, allergens, and hemolysis products using an “artificial kidney” device. It is prescribed if renal failure does not respond to drug treatment and threatens the death of the patient.
Prevention
Prevention of transfusion shock consists of observing the principle: the medical approach to the blood transfusion procedure should be as responsible as for organ transplantation, including limiting the indications for transfusion, competently conducting tests and preliminary tests in accordance with the instructions.
Main indications for blood transfusion:
- Absolute indications for blood transfusion:
- acute blood loss(more than 21% of the circulating blood volume);
- traumatic shock grade 2–3;
- Relative indications for blood transfusion:
- anemia (hemoglobin level in the blood less than 80 g/l);
- diseases inflammatory in nature with severe intoxication;
- continued bleeding;
- blood coagulation disorder;
- decline immune status body;
- long-term chronic inflammatory process(sepsis);
- some poisoning (snake venom, etc.).
To prevent the development of transfusion complications it is necessary:
- eliminate errors when determining a patient’s blood group and conducting compatibility tests;
- carry out a control re-determination of the patient’s blood group immediately before the blood transfusion procedure;
- eliminate the possibility of developing an Rh conflict, for which it is necessary to examine the patient’s Rh status and antibody titer, and perform compatibility tests;
- exclude the possibility of blood incompatibility due to rare serological factors using Coombs tests;
- use only disposable blood transfusion systems;
- visually assess the type and volume of urine excreted by the patient during and immediately after transfusion (volume, color);
- monitor and analyze symptoms of transfusion shock and hemolysis;
- carefully monitor the patient for 3 hours after blood transfusion (measure temperature, pressure, pulse rate every hour).
The prognosis for transfusion shock depends on the timeliness of emergency care and further therapy. If active full treatment of pathology with manifestations of hemolysis, acute renal and respiratory failure, hemorrhagic syndrome is carried out in the first 6 hours after the onset of the disease, 75 patients out of 100 experience full recovery. In 25–30% of patients with severe complications, renal-hepatic dysfunction of the heart, brain, and pulmonary vessels develops.
To date medical practice It is impossible to imagine without blood transfusions. There are many indications for this procedure, the main goal is to restore the lost blood volume to the patient, which is necessary for the normal functioning of the body. Despite the fact that it belongs to the category of vital manipulations, doctors try not to resort to it for as long as possible. The reason is that complications during transfusion of blood and its components are common, the consequences of which for the body can be very serious.
The main indication for blood transfusion is acute blood loss - a condition when the patient loses more than 30% of his blood volume in a few hours. This procedure is also used if there is unstoppable bleeding, a state of shock, anemia, hematological, purulent-septic diseases, or massive surgical interventions.
The blood infusion stabilizes the patient, and the recovery process after a blood transfusion is much faster.
Post-transfusion complications
Post-transfusion complications during transfusion of blood and its components are common; this procedure is very risky and requires careful preparation. Side effects arise due to non-compliance with the rules of blood transfusion, as well as individual intolerance.
All complications are divided into two groups. The first includes a pyrogenic reaction, citrate and potassium intoxication, anaphylaxis, bacterial shock, and allergies. The second includes pathologies caused by incompatibility between the donor and recipient groups, such as blood transfusion shock, respiratory distress syndrome, renal failure, and coagulopathy.
Allergic reaction
Allergic reactions are the most common after blood transfusion. They are characterized by the following symptoms:
- skin rash;
- attacks of suffocation;
- Quincke's edema;
- nausea;
- vomit.
Allergies are provoked by individual intolerance to one of the components or sensitization to plasma proteins infused earlier.
Pyrogenic reactions
A pyrogenic reaction may occur within half an hour after infusion of the drugs. The recipient develops general weakness, fever, chills, headache, myalgia.
The cause of this complication is the ingress of pyrogenic substances along with transfused media; they appear due to improper preparation of systems for transfusion. The use of disposable kits significantly reduces these reactions.
Citrate and potassium intoxication
Citrate intoxication occurs due to exposure of the body to sodium citrate, which is a preservative for hematological drugs. Most often it manifests itself during jet injection. Symptoms of this pathology are a decrease in blood pressure, changes in the electrocardiogram, clonic convulsions, respiratory failure, even apnea.
Potassium intoxication occurs when a large volume of drugs is administered that have been stored for more than two weeks. During storage, potassium levels in transfusion media increase significantly. This condition is characterized by lethargy, possible nausea with vomiting, bradycardia with arrhythmia, up to cardiac arrest.
To prevent these complications, before massive blood transfusion, the patient needs to be administered a 10% calcium chloride solution. It is recommended to pour in ingredients that were prepared no more than ten days ago.
Blood transfusion shock
Blood transfusion shock - acute reaction for blood transfusion, which appears due to incompatibility of the donor and recipient groups. Clinical symptoms of shock may occur immediately or within 10-20 minutes after the start of the infusion.
This condition is characterized arterial hypotension, tachycardia, shortness of breath, agitation, redness of the skin, lower back pain. Post-transfusion complications during blood transfusion also affect organs of cardio-vascular system: acute expansion of the heart, myocardial infarction develops, cardiac arrest. Long-term consequences of such an infusion are renal failure, disseminated intravascular coagulation syndrome, jaundice, hepatomegaly, splenomegaly, and coagulopathy.
There are three degrees of shock as complications after blood transfusion:
- mild is characterized low blood pressure up to 90 mm Hg st;
- average: systolic pressure decreases to 80 mmHg. st;
- severe - blood pressure drops to 70 mm Hg. Art.
At the first signs of transfusion shock, the infusion should be stopped immediately and medical assistance should be provided.
Respiratory distress syndrome
The development of post-transfusion complications and their severity can be unpredictable, even life-threatening patient. One of the most dangerous is the development respiratory distress syndrome. This condition is characterized by acute impairment of respiratory function.
The cause of the pathology may be the administration of incompatible drugs or non-compliance with the red blood cell infusion technique. As a result, the recipient's blood clotting is impaired; it begins to penetrate the walls of blood vessels, filling the cavities of the lungs and other parenchymal organs.
Symptomatically: the patient feels shortness of breath, the heart rate increases, pulmonary shock develops, and oxygen starvation develops. During the examination, the doctor cannot listen to the affected part of the organ; on an x-ray, the pathology looks like a dark spot.
Coagulopathy
Among all the complications that appear after blood transfusion, coagulopathy is not the least important. This condition is characterized by a coagulation disorder, resulting in massive blood loss syndrome with severe complications for the body.
The reason lies in the rapid increase in acute intravascular hemolysis, which occurs as a result of non-compliance with the rules for infusion of red blood cells or transfusion of different types of blood. With a volumetric infusion of red cells alone, the ratio of platelets responsible for coagulation is significantly reduced. As a result, the blood does not clot, and the walls of the blood vessels become thinner and more penetrating.
Kidney failure
One of the most severe complications after blood transfusion is acute renal failure syndrome, clinical symptoms which can be divided into three degrees: mild, moderate and severe.
The first signs pointing to it are strong pain in the lumbar region, hyperthermia, chills. Next, the patient begins
red urine is released, which indicates the presence of blood, then oliguria appears. Later, the state of “shock kidney” occurs; it is characterized by the complete absence of urine in the patient. IN biochemical research such a patient will have a sharp increase in urea levels.
Anaphylactic shock
Anaphylactic shock is the most severe condition among allergic diseases. The cause of the appearance is the products included in the canned blood.
The first symptoms appear instantly, and immediately after the start of the infusion. Anaphylaxis is characterized by shortness of breath, suffocation, rapid pulse, drop in blood pressure, weakness, dizziness, myocardial infarction, and cardiac arrest. The condition never occurs with high blood pressure.
Along with pyrogenic and allergic reactions, shock is life-threatening for the patient. Failure to provide assistance in a timely manner can lead to death.
Transfusion of incompatible blood
The most dangerous consequences for the patient’s life are the consequences of transfused blood of different types. The first signs indicating the onset of a reaction are weakness, dizziness, increased temperature, decreased blood pressure, shortness of breath, rapid heartbeat, and lower back pain.
In the future, the patient may develop myocardial infarction, renal and respiratory failure, hemorrhagic syndrome followed by massive bleeding. All these conditions require immediate response from medical staff and assistance. Otherwise, the patient may die.
Treatment of post-transfusion complications
After the first signs of post-transfusion complications appear, it is necessary to stop blood transfusion. Health care and treatment is individual for each pathology, it all depends on which organs and systems are involved. Blood transfusion, anaphylactic shock, acute respiratory and renal failure require hospitalization of the patient in the intensive care unit.
For various allergic reactions, antihistamines are used for treatment, in particular:
- Suprastin;
- Tavegil;
- Diphenhydramine.
Calcium chloride solution, glucose with insulin, sodium chloride - these drugs are the first aid for potassium and citrate intoxication.
As for cardiovascular drugs, Strofanthin, Korglykon, Norepinephrine, Furosemide are used. In case of renal failure, an emergency hemodialysis session is performed.
Impaired respiratory function requires provision of oxygen supply, administration of euphilin, and in severe cases, connection to a ventilator.
Prevention of complications during blood transfusion
Prevention of post-transfusion complications consists of strict compliance with all norms. The transfusion procedure must be carried out by a transfusiologist.
Concerning general rules, this includes compliance with all standards for the preparation, storage, and transportation of drugs. It is imperative to conduct an analysis to detect severe viral infections transmitted by hematological routes.
The most difficult complications that threaten the patient’s life are those caused by incompatibility of the transfused blood. To avoid such situations, you need to adhere to the preparation plan for the procedure.
The first thing the doctor does is determine the patient’s group affiliation and order the right drug. Upon receipt, you must carefully inspect the packaging for damage and the label, which indicates the date of preparation, shelf life, and patient information. If the packaging does not raise suspicions, the next step should be to determine the group and rhesus of the donor; this is necessary for reinsurance, since it is possible misdiagnosis at the fence stage.
After this, an individual compatibility test is carried out. To do this, the patient's serum is mixed with the donor's blood. If all checks have passed positively, they begin the transfusion procedure itself, making sure to conduct a biological test with each individual bottle of blood.
In case of massive blood transfusions, it is impossible to resort to jet infusion methods; it is advisable to use drugs that are stored for no more than 10 days; it is necessary to alternate the administration of red blood cells with plasma. If the technique is violated, complications are possible. If all standards are followed, the blood transfusion will be successful and the patient’s condition will improve significantly.
Post-transfusion reactions during blood transfusion, their prevention and treatment.
Blood products, indications for their use
Blood components, indications for their use.
Erythrocyte mass (red blood cells and a small amount of preservative and stabilizer);
Erythrocyte suspension (erythrocyte mass in a resuspending solution - erythronaf or erythrocyphonitis);
Thawed and washed red blood cells;
Plasma (native, dry, fresh frozen);
Platelet mass;
Leukocyte mass.
Increased oncotic blood pressure;
2. Increase in BCC;
3. Increase in protein content in the blood;
4. Detoxification effect;
5. Stimulation of diuresis.
In order to prevent pyrogenic and allergic reactions in patients with isosensitivity to HLA antigens, leukocyte or platelet antigens, it is necessary to use washed donor red blood cells, platelet concentrates, and leukocyte mass, selected taking into account the specificity of the antibodies in the recipient. Patients sensitized by multiple blood transfusions are recommended to undergo medicinal antihistamine premedication with drugs that prevent the manifestation of allergic reactions before transfusion.
Prevention of blood transfusion reactions includes:
Before transfusion:
1) strict compliance with all requirements and conditions for the procurement, storage and transfusion of canned blood, its components and preparations;
2) use of disposable systems;
3) careful collection of transfusion and obstetric history:
Number of previous transfusions;
The interval between them;
Portability;
Type of transfusion solution;
How long after the transfusion did the reaction occur and its nature (increase in temperature by 0.5-2.0 ° C, muscle pain, suffocation, swelling, skin rash, shortness of breath);
Signs of post-transfusion hemolytic complications (yellowness of the skin and mucous membranes, dark color urine, pain in the lower back, abdomen, behind the sternum);
Number of pregnancies, births, early miscarriages, antenatal fetal death, hemolytic disease of the newborn;
4) determination of group and Rh affiliation by a doctor and in the laboratory. Antibody screening in the laboratory;
5) determination of indications for the use of donor blood and its components;
6) conducting control studies of the patient’s and donor’s blood groups. Testing for compatibility.
During transfusion:.
1) transfusions (except for emergencies) should be carried out using the drip method or at a rate of 500 ml/h;
2) biological sample;
3) during blood transfusion, the patient is monitored by a doctor or nursing staff for the timely detection of clinical manifestations of post-transfusion reactions or complications.
After transfusion:.
1) monitoring the patient for 24 hours after transfusion:
During the first 2 hours after the end of the transfusion, body temperature and blood pressure are recorded;
Every hour: volume, color of the first portion of urine, daily diuresis. The doctor records any post-transfusion reaction or complication in the medical/delivery history;
2) a bag or bottle with the remainder (at least 10 ml) of a blood transfusion medium with a label is stored for 48 hours, and a test tube with the patient’s blood taken before transfusion is stored for 7 days in the refrigerator at +2-6 °C;
3) each transfusion is recorded in:
Journal of registration of transfusion of transfusion media, form 009/u (order of the USSR Ministry of Health No. 1030 dated 10/04/80);
Medical history/birth history in the form of a protocol or in the transfusion media transfusion registration sheet, form 005/u (order of the USSR Ministry of Health No. 1030 dated 10/04/80).
Post-transfusion reactions. Transfusion therapy in the vast majority of cases is not accompanied by reactions. However, some patients develop reactive manifestations during or shortly after transfusion, which, unlike complications, are not accompanied by serious and long-term dysfunction of organs and systems; they occur in 1-3% of patients. If reactions and complications occur, the doctor performing the blood transfusion must immediately stop the transfusion without removing the needle from the vein.
Patients who experience post-transfusion reactions must be observed by a doctor and paramedic and treated promptly. Depending on the cause and clinical manifestations, pyrogenic, allergic and anaphylactic reactions are distinguished.
Pyrogenic reactions. Such reactions usually begin 20 to 30 minutes after transfusion and last from several minutes to several hours. They are manifested mainly by general malaise, fever and chills. In severe reactions, body temperature rises by more than 2 °C, stunning chills, cyanosis of the lips, and severe headache appear.
Mild reactions usually go away without treatment. In case of moderate and severe reactions, the patient must be warmed up by covering him with a warm blanket, putting a heating pad under his feet, and giving him a strong drink. hot tea or coffee. In case of high hyperthermia, hyposensitizing, antipyretic drugs, lytic mixtures, and promedol are administered.
Allergic reactions. These reactions appear a few minutes after the start of the transfusion. The clinical picture is dominated by allergic symptoms: shortness of breath, suffocation, nausea, vomiting. Skin itching, urticaria, and Quincke's edema appear. Leukocytosis with eosinophilia is detected in the blood. Symptoms mentioned can be combined with common features feverish condition.
For treatment, antihistamines, hyposensitizing agents are used, and, if necessary, promedol, glucocorticoids, and cardiovascular drugs.
Anaphylactic reactions. In rare cases, blood transfusions can cause anaphylactic reactions. The clinical picture is characterized by acute vasomotor disorders: patient anxiety, facial redness, cyanosis, suffocation, erythematous rash; pulse quickens, blood pressure decreases. Often reactive manifestations quickly stop.
Sometimes a serious complication can develop - anaphylactic shock, requiring immediate intensive care. The course of anaphylactic shock is acute. It develops during transfusion or in the first minutes after it. Patients are restless and complain of difficulty breathing. Skin usually hyperemic. Cyanosis of the mucous membranes, acrocyanosis, and cold sweat appear. Breathing is noisy, wheezing, audible at a distance (bronchospasm). Arterial pressure very low or not determined by auscultation, the heart sounds are muffled, and the sounds of the lungs are heard during percussion, a boxy tone of the percussion tone is heard, and during auscultation - whistling dry rales. Pulmonary edema may develop with bubbling breathing, coughing with the release of foamy pink sputum. In this case, moist rales of various sizes are heard over the entire surface of the lungs.
Complete antishock therapy is carried out. Intravenous corticosteroids, rheopolyglucin, cardiovascular, and antihistamines are used to relieve broncho- and laryngospasm. Acute laryngeal edema with asphyxia is an indication for urgent tracheostomy. As the process increases and respiratory failure progresses, the patient is transferred to artificial pulmonary ventilation (ALV). For seizures, anticonvulsant therapy is administered. Correct water and electrolyte disturbances and stimulate diuresis. If necessary, carry out resuscitation measures in full.
Post-transfusion complications. In contrast to post-transfusion reactions, post-transfusion complications pose a danger to the patient’s life, since vital activity is disrupted. important organs and systems. Complications may be associated with incompatibility according to the AB0 system or the Rh factor, poor quality of transfused blood components, the state of the recipient's body, unaccounted contraindications for blood transfusion, and technical errors when performing blood transfusion. In the prevention of post-transfusion complications, the leading role belongs to organizational measures and careful compliance with relevant instructions and orders.
Complications associated with transfusion incompatible components blood. Most often, the first and most serious sign of a complication is blood transfusion shock. It can develop already during a biological test, during a transfusion, or in the next minutes and hours after it. The earliest and most characteristic sign of transfusion shock is an acute circulatory and respiratory disorder. In contrast to ABO incompatibility, Rhesus incompatibility is characterized by late onset of symptoms and weariness clinical picture shock. Also, reactive manifestations and symptoms of shock are mildly expressed when incompatible blood is transfused to patients under anesthesia, receiving glucocorticoid hormones or radiation therapy.
The duration of shock in most cases exceeds 1 hour. Often in the first hours or even days after transfusion, the only symptom of incompatibility of transfused blood is acute intravascular hemolysis, which manifests itself as symptoms of hemolytic jaundice and lasts on average 1 - 2 days, in severe cases up to 3 -6 days . the degree of hemolysis increases with increasing dose of transfused incompatible blood.
Hemolysis is especially pronounced during transfusion of Rh-incompatible blood.
Along with symptoms of shock and acute hemolysis, characteristic features Blood transfusion complications include a serious disorder in the blood coagulation system - disseminated intravascular coagulation syndrome.
Shock, acute hemolysis, and renal ischemia resulting from transfusion of incompatible blood lead to the development of acute renal failure. If the phenomena of blood transfusion shock are stopped, after a short period of relatively calm state In the patient, from the 1st to 2nd day of the disease, renal dysfunction is already detected. The oliguric and then the anuric period of acute renal failure begins. The duration of the oligoanuric period varies from 3 to 30 days or more, most often 9-15 days. Then, within 2 - 3 weeks, diuresis is restored.
Treatment of transfusion shock begins immediately after diagnosis. It should be aimed at solving two problems: 1) therapy of blood transfusion shock; 2) therapy and prevention of organ damage, primarily kidneys and DIC syndrome.
The infusion system is completely changed. Procedure of administration, selection and dosage medicines depend on the severity of the shock and are described in special guidelines.
Emergency plasmapheresis is very effective, removing at least 1.3-1.8 liters of plasma containing pathological substances. If necessary, plasmapheresis is repeated after 8-12 hours. Replacement of the volume of removed plasma is carried out by transfusions of albumin, fresh frozen plasma and crystalloid solutions.
Prevention and treatment of blood clotting disorders and acute renal failure are carried out.
Post-transfusion complications caused by poor quality of transfused blood. Bacterial contamination. Infection of a blood component can occur at any stage of the technological process, as well as in medical institution in case of violation of aseptic and antiseptic requirements.
When an infected blood component is transfused, bacterial shock develops with rapid fatal. In other cases, phenomena of severe toxicosis are observed. Bacterial shock is manifested by the development of severe chills in the patient, high temperature, tachycardia, severe hypotension, cyanosis, seizures. Excitement, blackouts, vomiting, and involuntary bowel movements are noted.
This complication is possible only in case of gross violations of the organization of blood transfusion in the department and the rules for storing blood components. All patients develop shock and acute intravascular hemolysis. Subsequently, toxic hepatitis and acute renal failure occur.
Violation of the temperature regime for storing blood components. Transfusion of overheated blood components occurs most often as a result of the use of wrong methods warming blood components before transfusion, thawing plasma, as well as in case of non-compliance with the temperature regime for storing blood components. In this case, protein denaturation and hemolysis of red blood cells are observed. Shock develops with symptoms of severe intoxication, development of disseminated intravascular coagulation syndrome and acute renal failure.
Transfusion of “frozen” red blood cells can occur if there is a gross violation of the storage temperature regime. When frozen, hemolysis of red blood cells occurs. The patient develops acute intravascular hemolysis, disseminated intravascular coagulation syndrome and acute renal failure.
Complications associated with technical errors when performing blood transfusion. Air embolism. As a result of air (2-3 ml is enough) entering the patient’s vein due to technical errors in performing blood transfusion, an air embolism occurs. Air entering the central veins through a catheter is especially dangerous. The reasons for this may be improper filling of the transfusion system with blood, a defect in the system (leaks leading to “leakage” of air into the line), or the entry of air at the end of the transfusion due to untimely shutdown of the system.
Thromboembolism. Due to the detachment of a venous thrombus and its entry into the arterial bed (brain, lungs, kidneys), thromboembolism occurs. Blood clots can enter a patient's vein due to transfusion through an unfiltered system. Acute cardiac disorders. With rapid infusion of large volumes of fluids against the background of cardiac weakness, symptoms may appear. acute disorders cardiac activity. They are evidenced by symptoms of acute heart failure - cardiac asthma, pulmonary edema, myocardial infarction.
Potassium and citrate intoxication. When transfusing large volumes of whole canned blood stabilized with nitrate hemopreservatives, potassium and citrate intoxication occurs. For prevention, it is enough to administer 10 ml of 10% CaC12 solution for every 500 ml of preserved blood.
