Doctrine about Blood. Test before hemo-transfusion

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

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

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

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

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

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

8. ІІ stage - (1925-1941) - problem of donor blood, delivery of the blood,
transporting of blood, indications and contra-indications to transfusion, its
efficiency at different diseases.
ІІІ stage is the period of the second World war, is development and
improvement of organization of service of blood, components of the blood
and blood substitutions.
ІV stage – since 1945 to our days.
The second period can be divided into 4 stages:
І stage – (1901-1925) – determination of
blood types, substantiation the method and
technique of blood transfusion taking into
account the law of isohaemagglutination.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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