Whole blood. Solid canned donor blood
how many blood take plasma donation? More often people need plasma or solid blood? And got the best answer
Answer from Alexander [Guru]
The standard dose of the closed plasma is 600 ml.
With your complex, most likely, not at all take. The minimum weight for the donor is 50 kg (and this is for a donor of solid blood, and only donors are allowed in some plasma donation in some poured donors - with weight from 60-65 kg).
Answer from 2 response[guru]
Hey! Here is a selection of topics with answers to your question: how much blood take plasma donation? More often people need plasma or solid blood?
Answer from Doctor_112.[guru]
no, you can not pass. The minimum weight of the donor is 50 kg in my opinion. We have at least in Cheboksary.
Answer from ЎLenk @[guru]
there seems to be taken 300-400 grams. The fence occurs so, blood is divided into 2 components of plasma and red blood cells. The latter returns you back. They say That the blood is to take the opposite is useful. This can be done once every 2 weeks.
Answer from Katyushka[guru]
I merge 1l blood. Then unscrew the plasma (on the centrifuge) and overflow it into a separate package. Approximately 500ml.
Then the remaining mass is diluted with saline and poured again in you.
You have the same blood remains the same as it was. They took only proteins.
Plasma needs patients more often than blood.
The plasma is poured to each second patient, and blood only during bleeding.
Blood can be handed over once every two months (i.e. 6 times per year.),
and plasma every two weeks (i.e. 24 times a year.).
Avitaminosis will not start, the hair will not fall out!
I rent a plasma for 10 years and nothing ...
Definition method Mass spectrometry with inductively bound argon plasma (EC-MS).
The material under study One-piece Blood (Lithium Heparin)
Available Departure to the house
The vital (essential) trace element.
See also Separate studies: Another biomaterial is also taken to study this trace element in profiles:
- (zinc study is carried out on serum)
Literature
- Tietz Clinical Guide to Laboratory Tests. 4-th ed. ED. WU a.n.b.- USA, W.B Sounders Company, 2006. 1798 p.
- Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4 ED. ED. Burtis C.A., Ashwood E.R., BRUNS D.E. Elsevier. New Delhi. 2006. 2412 p.
Before blood flow
Thank you for decided to become a donor! This is important and necessary. Blood donors and its components save human life!
You can be a donor if you are healthy, over 18 years old, and your weight exceeds 50 kg. There are a number of medical and social contraindications to donation. We advise you to carefully read the section where they are described in detail. Blood donation in the modern clinic is absolutely safe for healthy people process. And yet it requires the observance of a number of simple, but very important rules that we suggest you read before you go to the station or to the blood transfusion.
Decide in advance that you will take: solid blood or its components. The process of the Donation depends on what kind of blood pressure you choose. Decide with the place where you will donate blood. On this page there is a detailed list of stations and blood transfusions of Moscow. A - B. different regions Russia. We ask to pay attention to the fact that in different departments and at different stations of blood transfusion there are various requirements for registration of donors. We advise you to clarify these requirements immediately before donation by SEC or OPK. Going to donate blood, be sure to take a passport with you!
Procedure of blood flow
A visit to the station or in the separation of blood transfusion always begins with the filing of the questionnaire. If you pass the blood address for a particular patient, you need to call it the surname and number of the hospital in which it is located. Sometimes you may ask the direction written by the doctor.
If you came to pass one-piece blood, you will have blood from the finger to the express analysis to determine the group, rees-factor and the kelle factor, as well as the level of hemoglobin. If you are going to donate blood components, you will take blood from the vein to determine the group, rees-factor, some indicators of clinical and biochemical analysis Blood, as well as to eliminate HIV, syphilis and hepatitis.
The results of express analysis of blood from the finger are ready in a few minutes, and if the level of hemoglobin turns out to be sufficient for the bloodstand, the future donor goes to the doctor. Blood analysis results from veins, which pre-rendered by the blood component donor, at some stations (separations) of blood transfusion becomes known within an hour, and in other institutions - every other day. In the latter case, you must find out themselves by calling in SEC or OPK, and then sign up for blood components. On some SEC (or OPK), blood components can only pass frame donors.
Immediately before the bloodstream donor receives a doctor - examines it and asks questions about well-being and suffered diseases. Frankly answer the doctor's questions and do not hide information about drugs accepted and transferred diseases. If the doctor does not find contraindications, you are allowed to surrender blood.
The procedure for the donation of whole blood takes about 10 minutes, during which you will take 450 ml from the vein. The donation of blood components occurs by the apheresis - procedures, during which the special device takes the blood from the vein of the donor, selects the necessary component from it, and all other components return it back. Thrombocitherasez takes from an hour to one and a half, erythrocytaferesis and plasmapheresis - about half an hour.
All items and materials directly contact with the blood of the donor are disposable, so it is impossible to infect anything during the donation.
To prevent blood coagulation during appearance in the blood of the donor is added sodium citrate. Sometimes he can cause unpleasant feelings: chills, dizziness, weakness. They need to immediately inform the doctor, on duty in the donor hall. The doctor will introduce you calcium gluconate, tightens the blanket, and you will be better.
After blood flow
Please read in the "Basics of Safety Safety" on how to behave after the bloodstand, to feel well. It is very important! And now let's talk about the compensation and benefits of the donor and benefits - a free donor can count on them. After the blood or its components, you will definitely receive a coupon for lunch or cash compensation for food, as well as a certificate of donation. This reference gives you the right to two extra holidays: the day of blood and any other day.
If, after putting one-piece blood, you want to learn about the results of your analyzes, contact where the blood donated. Employees of the SEC or OPK are obliged to inform if you have everything in order, and if there are problems, then what it is.
DONOR, RETURN!
Dear donors, surrendered solid blood! We are very pleased after six months after the bloodux again come and pass the blood there, where you have already passed it.
The fact is that solid blood taken from the donor (in the form, in which it is taken) it is not overflowing anyone. Blood is divided into components: erythrocyte mass, platelets and plasma. The erythrocyte mass and platelets are overflowing shortly after blood. The reason is that the "lifetime" of these blood components is limited: platelets need to be pouring within a few days, red blood cells - within a few weeks. But the blood plasma, subject to the necessary conditions, can be stored for a long time. At the same time, if there are dangerous viruses in the blood of the donor, they are detected in plasma.
And in order to further reduce the likelihood of infection with a patient through blood transfusion, the donor plasma is sent for half a year to quarantine. As a result of the plasma, it will be transferred to people in need of it only after the donor surrendered her again will come to SEC or in the OPK and passed solid blood, one of the blood components or simply analyzes for HIV, syphilis and viral hepatitis. That is why the re-visit of solid blood donors is very important.
Dear donors! Huge human thank you!
To eliminate the harmful effects of the sodium citrate of canned blood on the recipient's body, it was proposed to defibring donor blood, as well as stabilization by applying ion exchange resins (A. A. Bagdasarov, 1956, etc.).
In recent years, a group of employees of the Belarusian Research Institute of Blood Transfusion, together with the Academy of Sciences of the BSSR (E. D. Buglov, I. N. Yermolenko et al., 1967), a blood workpiece method was developed without administering to a preservative solution of chemical stabilizers.
Calcium ions involved in education blood bunch, Sorbitize the method of canning on a special filter, through which the blood of the donor passes along the path from Vienna to the vial.
As a rule, blood is bought in 250 ml bottles. Typically, the vial contains 200 ml of blood of the donor and 50 ml of the conservative of TSOLIPK-76. Accounting for the number of blood purity is carried out in total, i.e. with a preservative. There are labels on the bottle with blood, on which the surname and initials of the donor, blood type, number, date of the workpiece and the name of the doctor who made preservation are labeled.
Labels have a color labeling: Group 0 (i) - White strip, Group A (II) - Blue, Group in (III) - Red, Ab (IV) - Yellowee. The color designation is accepted to create an additional possibility to eliminate the transfusion of the information.
In addition to the listed designations, the label must be stamped with a rubbish belonging: "Blood Rh-positive" or "Blood Rh-negative". If there is no such designation, the blood needs to be considered rhesus-positive and overflow only rhesus-positive persons.
"Seminars on blood transfusion",
L.V.Ivanov, I.P. Danilov, B.A. Shuvaeva
In medical practice, the transfusion of blood components is carried out with a substitution goal, and therefore indications for transfusion of solid blood are significantly narrowed and practically absent.
1. Transfusion of solid blood.
Whole blood for transfusion is blood taken from the donor using sterile and apirogenic anticoagulants and containers. Fresh-lying whole blood retains all its properties for a limited period of time. The rapid decay of factor VIII, leukocytes and platelets makes one-piece blood unsuitable for the treatment of hemostasis disorders after storing it more than 24 hours.
Indications for use.
Whole blood should be considered as a source for the preparation of blood components and only in an extremely limited number of cases can use the transfusion directly. In the absence of plasma proceeds and blood components, it is permissible to use solid blood in cases of the simultaneous deficiency of red cells and the volume of circulating blood.
Storage and stability.
Donor blood prepared for transfusion in solid form should be stored at 2-6 0 C. The storage period depends on the composition of the hemokonservant used. For CPDA-1, the shelf life is 35 days. During storage, there is a gradual decrease in the concentration of labile coagulation factors V and VIII, an increase in potassium concentration and a change in pH in the direction of increasing acidity. The ability of oxygen transportation is reduced due to a gradual decrease in the level of 2.3 bifosphoglycerate (2.3 BFG, it used to be 2.3 DFG). After 10 days of storage in the CPDA-1, the level of 2.3 BFG drops, but is restored to the bloodstream recipient after blood transfusion.
Side effects When using solid blood:
circulatory overload;
non-magliatic post-transfusion reactions;
alloimmunization against HLA antigens and erythrocyte antigens;
rarely, but the transfer of Protozoa (for example, malaria);
post Transfusion Purple.
2. Transfusion of the erythrocytic mass (erythroconcentrate).
Receipt of rapidity
The erythrocytic mass (EM) is the main component of the blood, which in its composition, functional properties and therapeutic efficacy under anemics is superior to the transfusion of solid blood. Its combination with plasma-proof and freshly frozen plasma is more efficient than the use of solid blood (in particular, when conducting exchange transfusions in newborns), since the content of citrate, ammonia, extracellular potassium, as well as microaggregates from destroyed cells and microgenirates is reduced compared to one-piece blood. denatured plasma proteins. This is especially important for the prevention of "massive transfusion syndrome". The erythrocytic mass is obtained from canned blood by separating plasma. The erythrocytic weight hematocrit is 0.65-0.75; Each dose must contain a minimum of 45 g of hemoglobin. The dose contains all red blood cells, which were in the original dose of blood (500 ml), most leukocytes (about 2.5-3.0x10 9 cells) and a different number of platelets, depending on the centrifugation method.
Indications for the use of erythrocytic mass
EM transfusion occupy a leading place in hemotherapy aimed at replenishing the deficiency of red cells under anemics. The main indication to the use of the erythrocyty mass is a significant decrease in the number of erythrocytes and, as a result, the oxygen capacity of the blood, which occurs as a result of acute or chronic blood loss or inadequate erythropoese, with hemolysis, a narrowing of a fluid of blood formation for various hematological and oncological diseases, cytostatic and radiation therapy.
Erythrocytic mass transfusion is shown for use with a substitution goal with anemic states of different genes:
acute postgemorrhagic anemia (injuries accompanied by blood loss, gastrointestinal bleeding, blood loss surgical operations, in childbirth, etc.);
heavy forms of iron deficiency anemia, especially in the elderly, in the presence of severe changes of hemodynamics;
anemia accompanying chronic diseases of the gastrointestinal tract and other organs and systems, intoxication in poisoning, burns, purulent infection, etc.;
anemia, accompanying erythropoese depression (acute and chronic leukemia, aplastic syndrome, myeloma disease, etc.).
Since adaptation to the blood loss and the decrease in the number of erythrocytes and hemoglobin in the blood is widely varied in different patients (the elder's faces are worse than the anemic syndrome), and the transfusion of red blood cells refers to a far from a safe operation, when prescribed transfusions, along with a degree of anemization, not only On the indicators of red blood, but also on the appearance of circulatory disorders, as the most important criterion, determining, along with others, the testimony for the transfusion of the erythrocyty mass. For acute blood lossEven the massive, in itself the hemoglobin level (70 g / l) is not a reason for solving the issue of appointing transfusion. However, the appearance of sickness of shortness of breath, tachycardia against the background of the background of the skin and mucous membranes is a serious basis for conducting hemotransphus. On the other hand, in most cases, the hemoglobin drop is below 80 g / liter, hematocrit is below 0.25, is the basis for erythrocyte transfusion, but always strictly individually.
Precautions when using uh
If there is a pronounced anemic syndrome of absolute contraindications for transfusion, the EM is not. Relative contraindications are: acute and subacute septic endocarditis, progressive development of diffuse glomerulonephritis, chronic renal, chronic and acute hepatic insufficiency, decompensation of blood circulation, heart defects in the decompensation stage, myocarditis and myocardioosclerosis with a violation of general blood circulation II-III degree hypertonic disease III stage, pronounced atherosclerosis of brain vessels, brain hemorrhage, heavy brain circulation disorders, nephrosclerosis, thromboembolic disease, pulmonary edema, pronounced general amyloidosis, acutely current and disseminated tuberculosis of light, acute rheumatism, etc. In the presence of life testimony, these diseases and pathological States do not relate to contraindications. With thrombophilic and thromboembolic conditions, acute renal and liver failure, it is advisable to transfix the washed erythrocytes.
It is not recommended to apply the erythrocyt mass with different types Remainlessness of plasma, incompatibility due to alloimmunization by leukocyte antigens, with paroxysmal night hemoglobinuria. The erythrocytic mass is used for exchange transfusion in newborns, subject to the addition of freshly frozen plasma. Premature children and recipients at risk of overload with iron, the red blood cell mass is overflowing with no more than 5 days, harvested on the anticoagulant "GLYUGICIR", CPD and 10 days - on the CPDA-1 anticoagulant.
In a container with erythrocytic mass, Ca 2+ or glucose solutions should not be added.
In order to reduce the viscosity of the EM in the cases shown (patients with rheological and microcirculatory disorders), 50-100 ml of sterile 0.9% isotonic sodium chloride solution are added to each dose of EM.
Side Effects when using erythrocytic mass
When overflowing the erythrocyty mass, reactions may occur and complications:
hemolytic post-transfusion reactions;
alloimmunization against NLA and erythrocyte antigens;
syphilis can be transferred if the erythrocytes were stored less than 96 hours at 4 0 s;
possible transfer of viruses (hepatitis, HIV, etc.) Contrary to careful control of donor blood;
septic shock due to bacterial pollution;
biochemical imbalance with massive overflow, for example, hypercalemia;
post Transfusion Purple.
Storage and stability of the erythrocytic mass
The EM is stored at a temperature of +2 - +4 0 C. The storage time is determined by the composition of the preservative solution for the blood or resuspending solution for the EM: EM, obtained from blood canned on solutions of gluggicir, CPD, is stored until 21 days; from the blood harvested on solutions ciglufad, CPDA-1 - up to 35 days; EM, resuspended in additional solutions, stored up to 35-42 days. In the process of storage, the EM is reversible with erythrocytes, the function of the transfer and returns of oxygen tissues of the body occurs. Partially lost in the process of storage of the erythrocyte functions are restored for 12-24 hours of circulation them in the recipient body. It follows from this practical conclusion - to relieve massive acute postghemorgic anemia with pronounced manifestations of hypoxia, in which the urgent replenishment of the oxygen capacity of the blood is necessary, the UM should be used primarily small storage time, and with moderate blood loss, chronic anemia It is possible to use EM longer storage time.
In medical practice, the erythrocytic mass of several species can be used, depending on the method of workpiece and testimony to gemotherapy:
erythrocytic mass (native) with hematocrit 0.65-0.75;
erythrocyte suspension - the erythrocytic mass in the resuspendent, preservative solution (the ratio of red blood cells and the solution determines its hematocrit, and the composition of the solution is the duration of storage);
the erythrocytic weight depleted with leukocytes and platelets;
erythropocytic mass is frostated and washed.
3. Transfusion of the erythrocytic mass in the resuspendent preservative solution.
Preparation of the erythrocytic mass in the resuspendent preservative solution.
This blood component is isolated from a complete dose of blood to centrifugation and plasma removal, followed by adding a preservative solution to the erythrocytes in a volume of 80-100 ml, providing energy metabolism in red blood cells and, therefore, a longer shelf life.
The erythrocytic weight hematocrit is 0.65-0.75 or 0.5-0.6, depending on the centrifugation method and the amount of the remaining plasma. Each dose must contain a minimum of 45 g of hemoglobin. The dose contains all erythrocytes from the initial blood dose, most of the leukocytes (about 2.5-3.0x10 9 cells) and a different number of platelets depending on the centrifugation method.
Indications and Contraindications for use, side effects
Indications and contraindications to the use of erythrocytic mass in the resuspendent preservative solution, as well as side effects in its application - the same as for the erythrocyty mass.
Depending on the composition of the hemoconservant and the resuspendent solution, the erythrocytic mass can be stored up to 42 days. The storage period should be specified on the container label (bottle) with the erythrocytic mass.
4. Transfusion of the erythrocytic mass depleted with leukocytes and platelets (with a remote leukecottaric layer).
Obtaining an EM with a remote leukecotter layer
The component is obtained from a blood dose after centrifuging or spontaneous sedimentation by removing the plasma and 40-60 ml of the leukotrombocyte layer in a closed system of polymer containers. The plasma is returned to the erythrocyte container in an amount sufficient to ensure hematocrit 0.65 - 0.75. Each dose of the component must contain a minimum of 43 g of hemoglobin. The leukocyte content should be less than 1.2x10 9 cells in a dose, platelets - less than 10x10 9.
Indications and contraindicationsto the use of the component, side effects are the same as for the erythrocytic mass.
It should be noted that post-transfusion reactions of non-combatant type are much less common than when overflowing the usual erythrocytic mass. This circumstance preferred the use of EM with a remote leukelombocitar layer for the treatment of patients who have a history of post-transfusion reactions of a non-combatant type.
The erythrocytic mass with a remote leukecottar layer and filtering through anti-golocitary filters have lower immunogenicity and the possibility of transferring cytomegalovirus. In such a dose of EM, depleted with leukocytes, the level of less than 1.0x10 9 leukocytes is achieved, each dose of the component must contain at least 40 g of hemoglobin.
Storage and stability EM with remote leukocyte layer
The erythrocytic mass depleted with leukocytes and platelets should be stored no more than 24 hours at a temperature of from +2 to +6 0 C if filtration was used when preparing it was prepared. When applying open systems, it should be used immediately.
5. Transfusion of the washed of the erythrocyty mass.
Getting washed red blood cells
Mixed red blood cells (OE) are obtained from solid blood (after plasma removal), EM or frozen red blood cells by laundering in an isotonic solution of sodium chloride or in special laundering environments. During the laundering process, plasma proteins, leukocytes, platelets, microgenirates of cells and stromes destroyed during the storage of cellular components are removed. The detergent EM should contain at least 40 g of hemoglobin in a dose.
Indications for the use of MM washed
Mixed erythrocytes are shown in patients who have a history of post-transfusion reactions of non-polyithic type, as well as patients sensitized to plasma protein antigens, tissue antigens and leukocyte antigens and platelets.
Due to the absence of blood stabilizers and metabolic products of cellular components that have toxic effects, their transfusion is shown for deep anemia in patients with hepatic and hepatic and renal failure and with "massive transfusion syndrome." The use of laminated red blood cells is recommended for reimbursement of blood loss in patients with plasma antibodies to IgA, as well as in acute complement-dependent hemolysis, in particular, with paroxysmal night hemoglobinuria.
Side effects:
hemolytic post-transfusion reactions;
syphilis can be transferred if the erythrocytes were stored 96 hours at 4 0 s;
it is possible to transfer viruses (hepatitis, HIV, etc.) Contrary to careful control;
rarely, but it is possible to transfer solozoa (eg malaria);
biochemical imbalance with massive overflow, for example, hypercalemia;
post Transfusion Purple.
The shelf life of the OE at a temperature of +4 0 ± 2 0 C - no more than 24 hours from the moment of their billet.
6. Transfusion of cryopreserved erythrocytic mass.
Obtaining and use of the component
Erythrocytes are used, frozen in the first 7 days from the moment of blood harvesting with the use of a cryoprotector and stored at temperatures below
minus 80 0 C. Before transfusion, the cells are defrosting, washed and poured with a resuspending solution. The reduced dose of cryopreserved erythrocytes practically does not contain plasma proteins, granulocytes and platelets. Each reduced dose should contain at least 36 g of hemoglobin.
Indications for use
Cryconsved erythrocytes are designed to replenish erythrocyte deficit at the recipient. Due to the high cost of this component, it should be used in special cases:
for transfusion to patients with a rare blood group and multiple antibodies;
in the absence of a washed and depleted EM leukocytes, if it is impossible to prepare an EM, which does not contain cytomegalovirus;
for isoimunization, if frozen red blood cells were stored for more than 6 months;
for autotransfusion.
Side effects:
it is possible to transfer viruses (hepatitis, HIV, etc.) Contrary to careful control;
alloimmunization to erythrocyte antigens;
septic shock due to bacterial dish.
Shelf life - no more than 24 hours after defrosting.
7. Transfusion of platelet concentrate (CT)
In clinical practice, platelets obtained from one dose of canned blood or thrombocyteresis are applied.
Preparation of canned blood thromboconcentrate
The component obtained from the dose of freshly prepared blood contains most of the platelets in therapeutically active form. Depending on the preparation method, the platelet content may vary from 45 to 85x10 9 (on average 60x10 9) in 50-70 ml of plasma. A small amount of red cells remain in the dose, the number of leukocytes varies from 0.05 to 1.0x10 9.
Side effects when applying CT:
non-mahemolytic post-transfusion reactions (mainly chills, fever, urticaria);
alloimmunization of NLA antigens. If leukocytes are removed, the risk decreases;
syphilis can be transferred if the erythrocytes were stored less than 96 hours at 4 0 s;
possible transfer of viruses (hepatitis, HIV, etc.) Contrary to careful control in the selection of donors and laboratory screening. If leukocytes are removed, the risk of transfers of the cytomegalovirus is reduced;
rarely, but it is possible to transfer Protozoa (eg malaria);
septic shock due to bacterial dissemination;
post Transfusion Purple.
CT storage and stability
If platelets have to be stored for more than 24 hours, for their preparations use closed system Plastic containers. Polymer containers must have good gas permeability. Storage temperature + 22 ± 2 0 S. platelets should be stored in thromboomycer, which:
provides both satisfactory mixing in the container and gas exchange through its walls;
does not give when stirring folds on the container;
it has a speed switch to prevent foaming.
The storage period of platelets must be specified on the label. Depending on the conditions of workpiece and quality of containers, the shelf life can range from 24 hours to 5 days.
Preparation of platelet concentrate by thrombocitheresis
This blood component is obtained using automatic blood cell separators from one donor. Depending on the method and used machines, the platelet content can range from 200 to 800x10 9. The content of erythrocytes and leukocytes can also fluctuate depending on the method. The method of obtaining provides the ability to harvest platelets from selected donors, reducing the risk of alcohimmunization, and allows you to effectively treat already alloimmunized patients. The risk of virus transfer decreases, if used for transfusion platelet from one donor in the medical dose.
With thrombocytapherase, with the help of machines for apheresis, platelets are isolated from solid blood donor, and the remaining components of the blood return donor. To reduce leukocyte impurities, you can carry out additional centrifugation or filtering.
When using thrombocitheléesis, the amount of platelets equivalent to obtained from 3-8 doses of solid blood can be obtained in one procedure.
Side effects with the use, storage and stability of the component are the same as for platelet concentrate obtained from the dose of canned blood.
Application of platelet concentrate in clinical practice
Modern replacement therapy of thrombocytopenic hemorrhagic syndrome of amgacariocyte etiology is impossible without transfusion of donor platelets obtained, as a rule, in the therapeutic dose from one donor. Mining therapeutic dosenecessary to stop spontaneous thrombocytopenic hemorrhages or to prevent their development when operational interventionsah, including stripes performed in patients with deep (less than 40x10 9 / l) amgacariocyte thrombocytopenia, is 2.8-3.0x10 11 platelets.
Common principles The purpose of transfusion of platelet concentrate is the manifestations of thrombocytopenic bleeding due to:
the insufficient formation of platelets (leukemia, aplastic anemia, bone-brain hematopopic depression as a result of radiation or cytostatic therapy, sharp radiation disease);
increased consumption of platelets (disseminated intravascular coagulation syndrome in the hypocoagulation phase);
functional inferiority of platelets (various thrombocytathopathy - Bernard-Sulie syndrome, Viscott-Oldrich, thrombaster of Glanzman).
Specific testimony for PT transfusions are established by the attending physician based on the dynamics. clinical picture, analysis of the causes of thrombocytopenia and the degree of severity.
In the absence of bleeding or bleeding, cytostatic therapy, in the case when patients do not assume any planned operational interventions, the low platelet level itself (20x10 9 / l and less) is not an indication for the purpose of transfusions of the CT.
Against the background of deep (5-15x10 9 / l) thrombocytopenia absolute indications KT transfusion is the emergence of hemorrhage (petechia, ekkimosis) on the skin of the face, the upper half of the body, local bleeding (gastrointestinal tract, nose, uterus, bladder). The appearance of hemorrhages on the eye, indicating the danger of the development of cerebral bleeding (with severe thrombocytopenia, the emergence of cerebral bleeding (with severe thrombocytopenia, a systematic study of the eye-catching bottom) is appropriate.
The transfusion of CT is not shown in immune (thrombocytolytic) thrombocytopenia (increased fragmentation of platelets). Therefore, in cases where only thrombocytopenia is observed without anemia and leukopenia, it is necessary to study the bone marrow. A normal or increased amount of megacariocytes in the bone marrow speaks in favor of thrombocytolytic nature of thrombocytopenia. Such patients need therapy with steroid hormones, but not overflowing platelets.
The effectiveness of platelet transfusions is largely determined by the amount of overflow cells, their functional usefulness and accessibility, methods for their allocation and storage, as well as the state of the recipient. The most important indicator of therapeutic efficiency of transfusion CT, along with clinical data, during the cessation of spontaneous bleeding or bleeding, is an increase in the number of platelets in 1 μl after 1 hour and 18-24 hours after transfusion.
To ensure the hemostatic effect, the number of platelets in a patient with thrombocytopenic bleeding in 1st hour after transfusion CT should be increased to 50-60x10 9 / l, which is reached with a transfusion of 0.5-0.7x10 11 platelets for every 10 kg of body weight or 2 0-2.5x10 11 per 1 m 2 body surfaces.
The initial physician obtained from the OPK or SEC CT should have a label, in the passport part of which indicates the number of platelets in this container, calculated after the end of obtaining CT.
Selection of a "donor recipient" pair is carried out on the AVO and Res System. Immediately before the transfusion of platelets, the doctor thoroughly checks the container label, its tightness, the identity of blood donor and recipient groups and recycling. Biological test is not carried out.
With multiple transfusions of CT, some patients may have a problem of refractoriness to re-transfusions of platelets, associated with the development of the state of alloimmunization.
Alloimmunization is caused by the sensitization of the recipient by alloantigen donor (s), is characterized by the appearance of antitrombocyte and anti-HLA antibodies. In these cases, after transfusion, temperature reactions are observed, the lack of proper thrombocyte growth and hemostatic effect. For removing sensitization and receipt therapeutic effect The medical plasmapheres and selection of the donor recipient pair of the HLA antigens can be applied from the CT transfusion.
In CT, the presence of impurities of immunocompetent and immunoagnet-silica t- and in lymphocytes is not excluded, therefore, for the prevention of RTPH (the "transplant against host" reaction in patients with immunodeficiency in bone marrow transplantation, it is necessary to irradiate CT in a dose of 25 Gray. In case of immunodeficiency due to cytostatic or radiation therapy, if there is relevant irradiation conditions, it is recommended.
8. Transfusion of granulocytes.
Obtaining and use of granulocytes
With the help of special blood cell separators, it was possible to obtain a therapeutically effective amount of granulocytes from one donor (10x10 9 in a dose) for transfusion with patients with the purpose of reimbursement of leukocyte deficiency in myelotoxic depression.
The depth and duration of granulocyptopenia are essential for the occurrence and development of infectious complications, necrotic enteropathy, septicemia. The transfusion of donor granulocytes in therapeutically effective doses allows to avoid or reduce the intensity of infectious complications in the period before the restoration of its own bone marrowing. The prophylactic use of granulocytes is advisable during the period of intensive cytostatic therapy during hemoblastosis. Specific indications for the purpose of transfusion of granulocytes are the absence of intensive effect. antibacterial therapy infectious complication (sepsis, pneumonia, necrotic enteropathy, etc.) against the background of myelotoxic agranulocytosis (level of granulocytes less than 0.75x10 9 / l).
The therapeutically effective dose is the transfusion of 10-15x10 9 granulocytes obtained from one donor. The optimal method for obtaining such a number of leukocytes is using a blood cell separator. Other methods of obtaining leukocytes do not allow to overflow therapeutically effective amounts of cells.
Just like CT, granulocytes before overflow in patients with severe immunosuppression, when transplantation of bone marrow, it is desirable to subjected to preliminary irradiation at a dose of 25 Gray.
Selection of a "donor recipient" pair is carried out on the AVO system, Res. Radically increases efficiency replacement therapy leukocytes selection of their histocompatibility antigens.
The transfusion of granulocytes is not shown in the immune etiology of agranulocytosis. Requirements for labeling container with leukocytes are the same as for CT - be sure to indicate the number of granulocytes in the container. Immediately before the transfusion, the doctor coars the marking of the container with granulocytes with the passport data of the recipient. A significant admixture of erythrocytes in a dose requires a sample for compatibility and biological sample.
Storage and stability
This component cannot be stored and need to be transfused as quickly as possible. If it is impossible, it must be stored not more than 24 hours at a temperature of +22 0 C.
9. Transfusion of fresh frozen plasma
Obtaining fresh frozen plasma (SZP)
This is a component obtained from one donor by plasmapheresis or from canned blood through its centrifugation and frozen 1-6 hours after venopunction.
SPP has a normal content of stable coagulation factors, albumin and immunoglobulins. It should contain at least 70% of the initial number of factor VIII and, at least, the same amounts of other labile coagulation factors and natural inhibitors. SPP is the main raw material for the preparation of plasma fractionation products.
Indications for the use of SPP
Since all factors of blood coagulating system are maintained in the SPP, it is mainly used to replenish their recipient plasma deficiency:
SZP is shown for use in order to stop bleeding in patients with acquired shortage of various coagulation factors (in case of liver disease, vitamin C and for the overdose of anticoagulants - derivatives of kumarin, DVS-syndrome, coagulopathy, due to massive hemotransphus or hemodilization, etc.).
SPP is used for transfusion patients with hereditary deficits of coagulation factors in the absence of concentrates of these factors (factors VIII, IX, V, VII, XI, etc.)
the transfusion of the SZP is shown for the treatment of thrombotic thrombocytopenic purple and hemolytic-uremic syndrome.
SZP is the main means of replacing the plasma withdrawn during the treatment of plasmapheresis.
The amount of IPP entered is determined depending on clinical flow Diseases. It is believed that 1 ml of SPP contains approximately 1 unit of the activity of coagulating factors. In order to replenish their deficiency in the blood of the patient nzp, they are prescribed at a dose of 10-15 ml per 1 kg of weight (3-6 doses of 250.0 ml for adults). Such a dose is capable of increasing the level of deficient coagulation factors by 20% immediately after transfusion.
SPP should be a single group with a patient over the AVO system. In emergency cases, in the absence of a single-group plasma, the plasma is allowed to transfusion of the group A (II) of the patient group 0 (I), the plasma of the group B (III) - the patient of group 0 (I) and the plasma of the AB (IV) group - the patient of any group. The transfusion of the SZP patients is allowed without taking into account the compatibility with the exception of the rhesus-negative women of childbearing age. When overflowing a sample sample on group compatibility is not carried out, a biological sample should be carried out for the prevention of reactions, as when overflowing the erythrocyty mass. Freated plasma before transfusion can be maintained no more than 1 hour. Her freezing is unacceptable.
The SPP is transfused intravenously, depending on the condition of the patient - drip or inkjet, with a pronounced DVS syndrome - mainly inkjet.
Contraindications for the use of SPP
SZP should not be used to replenish the volume of circulating blood, since the risk of transmissible infections exceeds the effectiveness of the application of plasma for this purpose. It has been proven and no doubt the safety and feasibility of application for the correction of hemodynamic disorders in the organism of the patient albumin (protein), colloid and crystalloid solutions.
It is also not shown the use of fresh frozen plasma as a protein source for parenteral nutrition patients. In the absence of amino acid mixtures, albumin can serve as a selection.
Side effects when overflowing SPP:
citrate intoxication is possible with a rapid overflow of large volumes;
non-mahemolytic post-transfusion reactions (mainly chills, fever, urticaria);
transferring viruses (hepatitis, HIV, etc.) Contrary to careful control in the selection of donors and laboratory screening;
septic shock due to bacterial contamination.
STORAGE AND STABILITY OF SPP
The shelf life of fresh frozen plasma depends on the storage temperature:
24 months at temperature -40 0 C or lower;
12 months at temperatures from -30 0 to -40 0 s;
6 months at temperatures from -25 0 to -30 0 s;
3 months at temperatures from -18 0 to -25 0 S.
Before overflowing the fresh frozen plasma is thawed on a water bath or in a special device at a temperature not higher than +30 - +37 0 С with periodic swaying container. The flamement of plasma should be transparent, straw-yellow, without muta, flakes, fibrin filaments, signs of hemolysis and overclit for 1 hour after defrosting.
10. The use of a hyperimmune antistaphococcal plasma
Obtaining antistaphococcal plasma (ASP)
ASP is obtained from the blood of donors immunized by adsorbed staphylococcal anatoxin. ASPs are harvested using the production of freshly frozen plasma. In 1 ml of anti-staphylococcal plasma (after thawing), no less than 6 meters of antistaphylotoxin should be contained.
Indications for the use of asp
ASP is designed to treat various diseases Staphylococcal etiology in children and adults under the condition of bacteriological confirmation of the presence of the pathogen in the patient. ASP is used in complex therapy patients in combination with etiopathogenetic medical treatment Diseases (antibiotics, etc.).
The use and dose of asp
ASP is introduced to patients intravenously at the calculation of the therapeutic dose of 3-5 ml per 1 kg of body weight of the patient. Children of the period of newborn, incl. Premature, the transfusion of ASP is produced at a rate of 10-15 ml per 1 kg of body weight. Plasma transfusion is carried out once a day, with an interval between transfusions 1, 2, 3 days, for treatment - 3-6 transfusions and more, depending on the severity of the pathological process and therapeutic effect.
Side effects when overflowing the ASP are the same as when overflowing the SPP.
Storage conditions for the same as for SPP.
11. Transfusion of a hyperimmous freshly frozen plasma of directional specificity (antsynegenic, anti-cycle, anti-bossiele and other)
Obtaining a hyperimmune samp of directional specificity
The nzp of the directional specificity (anti-synthetic, anti-whisk, anti-housing, etc.) is a human plasma, enriched with antibodies against the pathogens of one of the above infections and intended for neutralizing their adverse effects. The content of specific antibodies in the SPP of the directional specificity should be at least 1: 320. The specified titer of natural antibodies is determined by screening of donor blood sera.
Indications for the use of the SPP of the directional specificity
Used for passive immunotherapy of patients suffering from one of the types of infection, against which plasma antibodies are directed (sepsis, septicopemia, pnegumonia, peritonitis, abscess, phlegmon, etc.).
Method of application and dose.
The transfusis of the SPP of the directional specificity is produced 1 time per day, with intervals between transfusions of 2-3 days. Depending on the severity of the disease and the therapeutic effect on the course of treatment, 2-4 transfusion and more are prescribed. The plasma is injected with patients intravenously at the calculation of the total specific activity of the therapeutic dose of 3-5 ml per 1 kg of mass body of the patient. Newborn, incl. Premature children, plasma transfusion is produced at a rate of 10-15 ml per 1 kg of body weight of the patient.
Side Effects When overflowing the SZP of the directional specificity and the conditions for its storage are the same as when overflowing and storing the SPP.