Blood transfusion is a safe method of therapy under certain conditions, violation of which provokes complications and post-transfusion reactions. The following errors lead to them: non-observance of the rules of blood preservation, incorrect determination of the blood group, incorrect technique, failure to take into account contraindications for transfusion. Thus, in order to prevent complications and reactions during blood transfusion, a certain set of rules should be strictly observed.
Indications for blood transfusion
Indications for this manipulation are determined by the goal that must be achieved: increasing blood coagulation activity with its losses, replenishing the missing volume of circulating blood. Vital indications include:
- shock;
- acute bleeding;
- severe anemia;
- traumatic surgery.
Other indications include:
- intoxication;
- blood pathology;
- purulent-inflammatory processes.
Contraindications
Among the contraindications are the following ailments:
- septic endocarditis;
- hypertension of the third stage;
- pulmonary edema;
- acute glomerulonephritis;
- violation of cardiac activity;
- general amyloidosis;
- bronchial asthma;
- cerebrovascular accident;
- allergy;
- severe renal failure;
- thromboembolic disease.
When analyzing contraindications, special attention should be paid to an allergic and transfusiological history. However, with vital (absolute) indications for transfusion, blood is transfused, despite the presence of contraindications.
Transfusion Procedure Algorithm
In order to avoid mistakes and complications during blood transfusion, the following sequence of actions should be followed during this procedure:
- Preparing the patient for it consists in determining the blood group and Rh factor, as well as identifying contraindications.
- For two days they take a general blood test.
- Immediately prior to transfusion, the individual should urinate and empty the intestines.
- Perform the procedure on an empty stomach or after a light breakfast.
- A transfusion method and a transfusion medium are chosen.
- The suitability of blood and its components is determined. Check the expiration date, the integrity of the packaging, storage conditions.
- Make a determination of the blood group of the donor and recipient, which is called the control.
- Conduct a compatibility check.
- If necessary, determine the compatibility of the Rh factor.
- A disposable transfusion system is being prepared.
- Transfusion is carried out, after administration of 20 ml, the transfusion is stopped and a biocompatibility sample is taken.
- Watch the transfusion.
- After the procedure is completed, an entry is made in medical documents.
Classification of complications of blood transfusion
According to the systematization developed by the Institute of Hematology and Blood Transfusion, all complications are divided into groups, depending on the factors that provoked them:
- blood transfusion incompatible with Rh factor and group;
- massive blood transfusions;
- errors in the transfusion technique;
- transmission of pathogens of infection;
- post-transfusion metabolic disorders;
- transfusion of low-quality blood and its components.
Classification of post-transfusion complications
Among the post-transfusion complications associated with blood transfusion, the following are distinguished:
- Blood transfusion shock caused by transfusion of inappropriate blood. This is a very dangerous complication and in terms of severity is mild, moderate, severe. Of decisive importance is the rate of administration and the amount of transfused incompatible blood.
- Post-transfusion shock - occurs when transfusion of group-compatible blood.
- Transfer of infection along with the blood of a donor.
- Complications arising from errors made in the blood transfusion technique.
At present, the risk of developing blood transfusion and post-transfusion shock is almost nullified. This was achieved by the correct organization of the process during transfusion.
Symptoms of post-transfusion shock
Symptoms of complications after a blood transfusion appear after administration of 30-50 ml. The clinical picture is as follows:
- tinnitus;
- pressure reduction;
- discomfort in the lumbar region;
- chest tightness;
- headache;
- dyspnea;
- severe pain in the abdomen and increasing pain in the lumbar spine;
- the patient screams in pain;
- loss of consciousness with involuntary bowel movements and urination;
- lip cyanosis;
- heart rate
- sharp redness, and then blanching of the face.
In rare cases, ten to twenty minutes after a blood transfusion with a complication of this nature can be fatal. Often the pain subsides, the work of cardiac activity improves, consciousness returns. In the next period of shock is observed:
- leukopenia, which is replaced by leukocytosis;
- jaundice is poorly expressed, may be absent;
- temperature increase to 40 and above degrees;
- hemoglobinemia;
- impaired renal function, which is progressing;
- oliguria is replaced by anuria and in the absence of timely measures, death occurs.
This period is characterized by slowly arising oliguria and pronounced changes in urine - the appearance of protein, an increase in specific gravity, cylinder and red blood cells. A mild degree of post-transfusion shock from the previous ones is characterized by a slow course and a rather late manifestation of symptoms.
Therapy at the first sign of blood transfusion shock
With this complication of blood transfusion, it is recommended to immediately interrupt the procedure and urgently begin intensive therapy using the following means:
- cardiovascular - “Oubain”, “Korglikon”;
- "Norepinephrine" to increase pressure;
- antihistamines - "Suprastin" or "Diphenhydramine", of corticosteroids it is preferable to "Hydrocortisone" or "Prednisolone".
The above funds slow down the reaction rate of antigen antibodies and stimulate vascular activity. The movement of blood through the vessels, as well as microcirculation, is restored with blood substitutes, saline solutions, Reopoliglyukin.
With the help of the preparations "Sodium lactate" or "Sodium bicarbonate" the products of the destruction of red blood cells are removed. Diuresis is supported by Furosemide, Mannitol. In order to relieve spasm of the renal vessels, a perinephral bilateral blockade "Novocaine" is performed. In case of respiratory failure, an individual is connected to a ventilator.
In the absence of the effect of the pharmacotherapy of acute renal failure, as well as an increase in autointoxication (uremia), hemosorption (removal of toxic substances from the bloodstream), hemodialysis are indicated.
Bacterial toxic shock
Such a complication of blood transfusion and blood substitutes is quite rare. His provocateur is blood infected during the process of harvesting and storage. A complication occurs during the transfusion period or thirty to sixty minutes after it. Symptoms
- severe chills;
- a sharp jump in pressure down;
- excitation;
- temperature rise;
- loss of consciousness;
- filamentous pulse;
- fecal and urine incontinence.
Blood that has not been transfused is sent for bacteriological examination, and the diagnosis is confirmed, therapy is started. For this, drugs that have detoxification, anti-shock and antibacterial effects are used. In addition, cephalosporin and aminoglycoside antibacterial agents, blood substitutes, electrolytes, analgesics, detoxifiers, anticoagulants and vasoconstrictor drugs are used.
Thromboembolism
Such a complication after a blood transfusion is provoked by blood clots that break away from the affected vein as a result of a transfusion or by blood clots that arose during its improper storage. Blood clots, clogging blood vessels, provoke a pulmonary infarction (ischemia). The individual appears:
- chest pain;
- a dry cough of a type later turns into a wet cough with bloody sputum.
An x-ray shows focal pneumonia. When the initial signs appear:
- the procedure is stopped;
- connect oxygen;
- enter cardiovascular drugs, fibrinolytics: Streptokinase, Fibrinolysin, anticoagulants Heparin.
Massive blood transfusion
If in a short period (less than 24 hours) blood is poured in a volume of two or three liters, then this manipulation is called massive blood transfusion. In this case, blood from different donors is used, which together with its long storage period provokes the occurrence of a massive blood transfusion syndrome. In addition, the occurrence of such a serious complication during blood transfusion is influenced by other reasons:
- the ingress of sodium nitrate and blood decay products in large quantities;
- negative effects of chilled blood;
- a large amount of fluid entering the bloodstream overloads the cardiovascular system.
Acute heart expansion
Contributes to the emergence of such a condition is the rather rapid intake of a large volume of canned blood during jet injection or by pressure buildup. Symptoms of this complication during blood transfusion are manifested:
- the appearance of pain in the right hypochondrium;
- cyanosis;
- shortness of breath
- increased heart rate;
- a decrease in arterial numbers and an increase in venous pressure.
When the above symptoms appear, stop the procedure. Bleed in an amount of not more than 300 ml. Next, the introduction of medicines of the group of cardiac glycosides begins: "Strofantin", "Korglikon", vasoconstrictor drugs and "Sodium chloride".
Potassium and nitrate intoxication
When transfused canned blood, which has been stored for more than ten days, in a rather large volume, severe potassium intoxication may develop, leading to cardiac arrest. For the prevention of complications of blood transfusion, it is recommended to use one that has been stored for no more than five days, and also use red blood cells washed and thawed.
The state of nitrate intoxication occurs during massive transfusion. A dose of 0.3 g / kg is considered toxic. Severe poisoning develops as a result of the accumulation of sodium nitrate in the recipient and its chemical reaction with calcium ions in the blood. Intoxication is manifested by the following symptoms:
- low pressure;
- cramps
- increased heart rate;
- arrhythmia;
- trembling.
In a serious condition, the edema of the brain and lungs is added to the above symptoms, and pupils dilate. Prevention of complications of blood transfusion is as follows. During the period of blood transfusion, it is necessary to introduce a drug called “Calcium Chloride”. For these purposes, apply a 5% solution based on for every 500 ml of blood 5 ml of the drug.
Air embolism
There is such a complication with:
- violation of the technique of blood transfusion;
- incorrect filling of the medical device for transfusion, as a result, air is present in it;
- premature completion of a blood transfusion under pressure.
Air bubbles, once in a vein, then penetrate into the right half of the heart muscle and then clog the trunk or branches of the pulmonary artery. The flow of two or three cubic centimeters of air into a vein is quite enough to cause embolism. Clinical manifestations:
- the pressure drops;
- shortness of breath appears;
- the upper half of the body becomes bluish;
- sharp pain is felt in the sternum;
- there is a cough;
- increased heart rate;
- there is fear, anxiety.
In most cases, the prognosis is poor. When these symptoms appear, you should stop the procedure and begin resuscitation procedures, including artificial respiration and the introduction of medications.
Homologous blood syndrome
With massive blood transfusion, the development of such a condition is possible. During the procedure, the blood of different donors is used, compatible by group and Rh factor. Some recipients, due to individual intolerance to plasma proteins, develop a complication in the form of a homologous blood syndrome. It manifests itself with the following symptoms:
- shortness of breath
- wet wheezing;
- cold to the touch dermis;
- pallor and even cyanosis of the skin;
- a decrease in arterial numbers and an increase in venous pressure;
- weak and frequent heart contractions;
- pulmonary edema.
With the growth of the latter, the individual has wet rales and seething breath. The hematocrit falls, compensation for blood loss from the outside cannot stop a sharp decrease in the BCC in the body. In addition, the coagulation process is slowed down. The cause of the syndrome lies in microscopic blood clots, immobility of red blood cells, in the accumulation of blood and malfunctions of microcirculation. Prevention and treatment of complications of blood transfusion is reduced to the following manipulations:
- It is necessary to infuse donated blood and blood substitutes, i.e., to carry out combination therapy. As a result, blood viscosity will decrease, and microcirculation and fluidity will improve.
- Replenish the lack of blood and its components, given the circulating volume.
- Do not try to completely replenish the level of hemoglobin during massive transfusion, since its content of about 80 g / l is quite enough to support the transport function of oxygen. The missing blood volume is recommended to be replaced with blood substitutes.
- Transfuse an absolutely compatible transfusion medium, washed and thawed red blood cells.
Infectious complications of blood transfusion
During transfusion, various pathogens of infectious diseases can be carried along with blood. Often this phenomenon is associated with the imperfection of laboratory methods and the hidden course of the existing pathology. The greatest danger is viral hepatitis, which affects the individual two to four months after transfusion. Transmission of cytomegalovirus infection occurs along with white blood cells of peripheral blood, so that this does not happen, it is necessary to use special filters that will delay them, and only platelets and red blood cells will be transfused.
This measure will significantly reduce the risk of infection in the patient. In addition, HIV infection is a dangerous complication. Due to the fact that the period during which antibodies are formed is from 6 to 12 weeks, it is impossible to completely exclude the risk of transmission of this infection. Thus, to avoid complications during transfusion of blood and its components, this procedure should be performed solely for health reasons and with comprehensive screening of donors for viral infections.