Lecture 6.
“Blood service. Blood donation. Blood components and blood products,
blood substitutes.”
The blood service is a network of special organizations called to supply
medical establishments by blood and it's preparations. The blood service in Ukraine
was created in middle of 20th years.
A structure of blood service .
The first link - Institutes of hematology and blood transfusion. First in Ukraine
Institute of hematology and blood transfusion was created in Kharkov in 1930. Now
it is Research institute of general and urgent surgery.
The second link is Station of transfusion of blood (republican, regional, urban).
The stations conduct preparation of blood, it's approbation, receive from blood it's
components (red corpuscles, platelets, plasma etc.), supplyes with plasma factors
which perform it's processing, provide medical establishments with blood and it's
components.
The third link - factoryes executing industrial preparations of various drugs
from plasma (fibrinogen, albumin, thrombin, gamma globulin, other immune
preparations).
The fourth link - departments of blood transfusion transfusion in hospitals and large
clinical centres. They prepare fresh donor blood, organize transfusion therapy in the
given medical establishment. The advantage preparation of blood is brought near to
the patient.
The donor is persone giving blood, it's components, bone marrow and other
organs for the medical purposes.
Classification of the donors:
- Donors of blood is persons giving blood for preparation of conserved blood or for
direct transfusions;
- Donors of rare groups of blood;
- The donors of standard RBC - persons, whose red corpuscles have well investigated
antigen structure;
- Donors of plasma;
- The donors of immune plasma are persons, who give plasma or blood previously
subjected special immunization or whose plasma contains the specific antibodies of
certain concentration after the transferred infections;
- The donors of cells of blood are persons, who give separate cell-like elements of
blood;
- Donors of bone marrow;
- Donors on duty give blood in case of emergency;
- Donors for direct transfusion of blood.
Dosage of given blood and it's influence on organism.
The single doze of blood should not exceed 450 ml of whole blood (1 unit). At
the donors up to 20 years or older than 55 years the doze of the first taking of blood is
should not exceed 300 ml.
Within one year the donors can give blood irrespective of doze no more than 5
times with an interval between giving of blood not less than 60 days. After 5 giving
of blood makes an interraption for 3 months.
Influence of taking of blood to an organism of the donor.
Each blood loss in quantity 200-500 ml calls a number of changes in an
organism of the donor: decreases quantity of red corpuscles, level of hemoglobin.
The full recovery of initial parameters of red blood is observed to 15-30 days. As the
parameter of compensation function of hematogenesis since 3 day is increased
quantity of reticulocytes: their maximum quantity is observed on 13-15 day,
becomes normal to 27-30 day.
On type of regeneration of red blood donors are distinquished on three groups.
Hyperregeneration type: the parameters of hemoglobin and red corpuscles after
giving of blood exceed initial figures.
Regeneration type: the parameters of hemoglobin and red corpuscles after
giving of blood do not vary.
Hyporregeneration type: the contents of red corpuscles and of hemoglobin under
influence of giving of blood is descended.
The speed of regeneration of red blood is slowed down at persons more young
20 and is more higher than 55 years. At persons giving blood multiply, the recovery
of parameters of peripheral blood happens earlier, than at the primary donors.
Changes in leukogram after taking 200-500ml of blood: in the beginning is observed
decreasing of quantity of leucocyites with relative increase of lymphocytes, then their
increasing with increase of segmented neutrophils.
Reactions on taking of blood is exhibited by small hypoalbuminemia, increase
of sugar, potassium, changes of nitrous metabolism between blood and tissues. These
changes are normalized within 7-10 days. After taking of blood also are observed
changes in coagulating system of blood. Immediately after taking of blood at the
donors the changes in hemodynamic parameters is marked: the pulse becomes
frequent, ABP decreases. Normalization of cardiovascular activity comes during 3060 min. In this period the donors is recommended to rest.
In reply to blood loss there is some energization more expressed at the primary
donors (cheerful, elevated mood, increase of appetite, ease in making decision,
desire to move and to be among the people). The response on taking of blood is too
individual.
The taking of blood up to 300 ml does not disturb work capacity of the donor.
At some persons giving of 400-500 ml of blood, cause some drop of muscular force,
increase freqency of errors is observed at the solving the tests. Therefore it is not
recommended to the donors, which activity requires precisiouly and fast reactions,
to do it immediately after giving the blood.
The repeated taking of blood is favorable influences on CNS, metabolism in
an organism. Among constant donors the smallest percent of persons with clinics of
atherosclerosis is observed.
The examination of the donors actuates: general inspection, determination of
pulse, arterial pressure, palpitation of limphatic nodes, anamnesis detection
(syphilis, hepatitis, infectious diseases).
Blood of the donors is investigated on syphilis, hepatitis B, C, brucellosis,
HIV, determines level of bilirubin.
Conserving of blood
Conserving of blood - it's a process, which makes conditions for it long
duration storage in condition suitable for transfusion. There are two methods of
storage of blood in liquid condition at temperatures above 0 and in the frozen rigid
condition at temperature from -150 up to -196 C.
Stabilizers of blood.
The blood deprived of ability to coagulation, is named stabilized. The
stabilization of blood in liquid condition is reached by linkage or destruction of one
from components of coagulating system of blood. In clinical practice are applied
stabilizers which eliminats ions of calcium. As is known, linkage of calcium
suppresses the first phase of blood coagulation - formation of thrombin. Most
frequently from stabilizers of blood of the given group applyes sodium citric acid or
citrate. In blood sodium citrate dissociates, liberating citric acid, which contacts with
cations of calcium, derivating complex undissociated connections remaining in
solution.
After 30-40 min of transfusion of citrated blood not less than 90 % entered
citrate is coming from an organism. At large transfusion evacuation of citric acid is
decelerated, that can result to citric shock (hypocalcemia). Toxic sodium citrate doze
is 0,2-0,3 g on 1 kg of weight of the patient. Therefore after fast transfusion of
citrated blood in dozes exceeding 500 ml, it is necessary to give to the patient
intravenously 10 ml of 5% solution (0,5 g) of calcium chloride or gluconate for
equalization of deficit of calcium.
Representative of enother group of stabilizers overwhelming action of
thrombin, is heparin. Adding 50-60 mg of heparin on 1 l of blood provides good it's
stabilization. However this stabilizer does not allow long duration storage of blood.
Biochemical changes in red corpuscles in process of preserving.
In time of blood storage in red corpuscles continue processes of metabolism of
substances, that results in accumulation of lactic acid, drop рН of blood and
deterioration of the biochemical status of cells. Before certain time red corpuscles can
compensate this process and to synthesize necessary quantity of ATF. To 21day of
storage in red corpuscles 70 % ATF is on average saved, that correlates with 70 %
RBC get acclimatized in recipient's organism. This size of acclimatization of red
corpuscles is an international criterion of suitability for transfusion.
In accordance with increase of terms of storage of blood happens decreasing of
oxygen-transport function of red corpuscles, therefore they do not realize this
function on level of microcirculation.
Morphological changes in conserving process.
Happens gradual changes of their form discoid on thorn-like, then in spherical.
In accordance with increase of terms of storage the quantity of thorn-like and
spherical forms is increased. As a result is decreasing of rigidity of a diaphragm,
there is a propensity to it's rupture. The loss by spherocytes of flexibility and ability
to deformation hampers their passing through capillary tubes with smaller diameter,
than at spherocyte; under pressure of circulatting blood in capillary tubes they are
subjected fragmentations or rupture. It is accepted to consider the spherical form of
RBC appropriate to hemolythic stage.
Preserving of blood in and liquid condition.
Solutions intended for storage of blood at positive temperatures, should for the
long time support viability of cells and their functional full value. Therefore, apart
from stabilizers, in a structure of preserving solutions enters substances, which
penetrats in red corpuscles and participat in it's metabolism (glucose, inorganic
phosphate etc.)
In clinical practice is used preservative glugicir - acidum glucosecitric solution
(sodium citrate 2,0g, glucose without water 3,0g, bidistilled water up to 100 ml, pH
of solution 5,0).
Working life of blood prepared on these preservativs, under the data of
acclimatization of red corpuscles of transfused of blood (not less than 70 %) 21 days.
It is expedient to use it for transfusion within 10 days from the moment of conserving
in connection with adrop of red corpuscles oxygen-transport function at large terms
of storage.
Cryoconserving of RBC.
The long-term storage of blood is possible only at full suppression of
methabolism in cells at their freezing (anabiosis).
Nowadays for preserving of RBC of the person are applyed 2 methods of
freezing.
- Very fast cooling (250 ml during 2 min up to -196 C and storage in liquid nitrogen
(at temperature -196 C);
Such technique does not require large concentration of cryoprotectors;
- The slow cooling, at which freezing lasts some hours at moderate low temperatures
(from -25 up to -100C) with application of large concentration (from 30 up to 50 %)
cryoprotectors (in basic glycerine).
After defrosting viability and the functional full value is saved at 90-80 %
RBC, subjected to freezing. The storage within 10 years and more in the frozen
condition does not influence almost a degree of their structural safety.
Components and preparations of blood
Components of blood and their clinical application.
Depending on deficit of those or other cell-like elements of blood or
albuminous factors of plasma, the patient should get transfusions of those
components of blood or albuminous preparations of plasma, which insufficiency
should be filled.
In practical medicine approach to transfusion of blood or it's components
should be based on substitution effect of their action. Only circulation in vessels,
acclimatization or functional selective action of transfused cells of blood saving
biological full value, can render necessary medical effect.
The rational use of whole blood provides it's simultaneous separation on a
number of components. This separation is made by a differential centrifuging or
method of 24-hour spontaneous sedimentation. Thus above red corpuscles layerwise
settle leucocites as a grey film of altitude 0,5sm and small fuzzy layer platelets. The
plasma takes all stayed above volume of a liquid part of blood.
RBC mass represents a concentrate of RBC with hematocrite 65-80%. Term of
storage 21 days.
The control of suitability for transfusion of RBC mass: a transparency of a
layer of plasma above red corpuscles (absence of dregs, flakes, threads of fibrin),
uniform erithrocytic layer (absence of clots), obligatory safety of unit, air-tightness of
there corking presence of the documentation.
RBC suspension is RBC mass in resuspension solution. Term of storage is 815 days. Acclimatization of RBC is lower.
Washed RBC mass is from native defreezed RBC mass with removed cell-like
elements: leucocites, platelets and proteins of plasma. Washed red corpuscles for
transfusion it is expedient to use per the first day after their washing up.
Platelet mass is applied at thrombocytopenia to stop hemorrhagies. Use platelet
concentrait, stored no more than 24 hours at temperature 4 C.
Leucocyites mass (leucoconcentrait) is component fo transfusion with the high
contents of leucocyites, with an additive of red corpuscles, blood platelet and plasma.
A maximum storage time at temperature 4-6 C is 24 hours.
At трансфузии take into account group and Rh-fittings of the donor and recipient,
on occassion - compatibility of blood on antigenes of system HLA.
Apply leucocyites mass under the strict indications, at pathological condition
accompanied expressed leucopenia, with threat of development of complications, or
at explicatings infectious complications.
Plasma of blood. The plasma is and liquid part of blood containing about 90 %
a water, 7-8 % of protein, 1,1 % of organic substances and 0,9 % of inorganic
substances.
Plasma native (liquid, frozen). The plasma native is used per day of
manufacturing. The frozen plasma can be stored, at temperature -25 C within 90
days, at temperature –10C, maximum term of storage 30 days.
Dry plasma. Is kept for 5 years. Specific biological activity of labil protein
components, first of all of coagulating factors of blood, is sharply reduced or is
absent.
Preparations of blood
Preparations of a complex action.
Albumin. 5, 10, 20 % solution. Albumin has high oncotic activity, supports
oncotic pressure in circulatting blood, that stipulates hemodynamic operation.
Albumin executes also transport function is carrying products of metabolism,
nutritious, medicinal substances, participates in nitrous metabolism. The indications
to application: blood loss, traumatic shock, hypoalbuminemia, burn desease etc.
Cryoprecipitate. Contains not less than 200 ЕД of the factor VIII
(antihemophilic globulin), and also, fibrinogen and small additive of other proteins,
including fibrinstabilazing factor (factor XIII). Apply to treatment and preventive
maintenance of bleedings at the patients with hemophilia A and angiohemophilia, and
also at bleedings other aetiology when is observed a deficit of the factor VIII in blood
of the patient.
Fibrinogen. Contains about 60 % of fibrinogen and 40 % of other proteins.
Manufactured as dry porous mass of white or cream colour. Is applied at bleedings,
when there is an increase of fibrinolytic activity (hypo- or afibrinogenamia). Is
introduced intravenously in a doze 2-8-12 g/d.
Trombin. Contains trombin, small quantity of tromboplastine and calcium
chloride, additive of fibers entering into Cone's fraction III. Manufactured in small
bottles or ampoules containing not less one doze of preparation, making 125ЕД of
specific activity. Is applied locally to stop capillary bleedings from various organs
and tissues, at operations on parenchymal organs.
Fibrinolysin. It's protein preparation obtained from plasma of donor blood or
serum of placental blood. At dissolution in 100 ml of preparation, apart from
fibrinolysin, is contained also 50 mg of tripsine and up to 0,8 г sodium chloride.
Manufactured as a white hygroscopic powder in small bottles on 20000, 30000 and
40000 ЕД.
Is applied at arterial and venous thromboses of vessels, heart attack of
myocardium, vascular operations. After dissolution the preparation fast loses activity
therefore it is necessary to introduce it at once after dissolution. To a solution of
fibrinolysin add 10 000-15 000 ЕД of heparine (at the rate of 10000 ЕД of heparine
on 20000 ЕД of fibrinolysin).
Preparations of immunological operation.
Gamma-globulin. The preparation represents a solution of gammaglobulin
fraction of plasma proteins. Manufactured in ampoules on 1,5 ml (one doze) and 3 ml
(2 dozes) of 10 % solution. A main active component of preparation is (IgG). Assign
gamma globulin with the purposes of increase resistance of an organism to infections,
for preventive maintenance of measles, infectious hepatitis etc.
Antistaphylococcus gamma-globulin. In 1 ml of preparation is contained not
less than 20 (or 50 ME) antistaphylococcus anti-a-toxic antibodies. For one medical
doze receive volume of 10% solution containing 100 ME. Accordingly one ampoule,
should be contained minimum 100 ME of antistaphylococcus antitoxin.
Manufactured in steril kind in ampoules. Apply to specific preventive maintenance
and treatment of various diseases (staphylococcus sepsis, osteomyelitis, pneumonia
etc.).
Antitetanic gamma-globulin. The preparation represents a solution of gammaglobulin containing antitetanic antibodies. Manufactured in steril kind in ampoules on
3 ml. For one preventive doze receive 3 ml with general activity not less than 450 ME
(150 ME /ml).
Apply to treatment and preventive maintenance of tetanus at children and adults.
Blood substitutes
Blood substitutes are preparations, which can at intravenous introduction in an
organism of the patient in and certain measure substitute medical operation of donor's
blood. They are applied to therapy of various pathological conditions.
Select following main medical functions of blood substitutes:
1) Filling blood channels ensuring recovery up to normal level and maintenance
constant ABP broken in an outcome of blood loss or shock;
2) Release of an organism from toxins in case of poisoning by toxic substances;
3) Maintenance of delivery of nutritious protein substances to all organs and tissues
of an organism.
Blood substitute fluids should answer the following requirements:
1) To be similar on physico-chemical properties with plasma of blood;
2) To be injected completely from an organism or be metabolized by enzymic
systems;
3) To not call sensitization of an organism at repeated introductions;
4} To not render toxic operation on organs and tissues;
5) To maintain sterilization by autoclaving, during long duration term to save the
physico-chemical and biological properties.
Depending on directivity of operation blood substitute fluids classifys as
follows:
I. Hemodynamic (antishock).
1. Low molecular dextrans (reopolyglucin).
2. Moderate molecular dextrans (polyglucin).
3. Gelatin preparations (gelatinol).
II. Detoxicating.
1. Low molecular polyvinylpyrrolidone (hemodes).
2. Low molecular polyvinyl spirit (polydes).
III. Preparations for parentheral feeding.
1. Albuminous and casein hydrolysates (casein hydrolysate,
aminipeptide,
aminocrovin, aminosol, hydrolysine).
2. Amino acids solutions (polyamine, mariamine, friamine).
3. Emulsions of fats (intralipid, lipofundin).
4. Sugar and polyatomic spirits (glucose, sorbitole, fructose).
IV. Regulators of water-salt and acidic-alcaline state.
1. Salt solutions (isotonic solution of sodium chloride, Ringer's solution, lactasol,
solution of sodium hydrocarbonate, trisamine)
Blood substitutes of hemodynamic operation. Blood substitutes of high molecular
mass in basic are hemodilutants, promote increase of VCB and by that to recovery of
level of blood pressure. They are capable to circulate in blood channel for a long time
and to attract in vessels intercell-like fluid. These properties are used at shock, blood
loss. Low molecular blood substitutes improve capillary perfusion, less long duration
circulate in blood, are extracted by kidneys, faster carrying away redundant fluid.
These properties are used at treatment of disturbances of capillary perfusion, for
dehydration of an organism and struggle with intoxication due to removing of toxins
through kidneys.
Albuminous hydrolysates. Them apply to fulfilment of nutritious function of
blood. The preparations represent solutions of products of hydrolysis of proteins
(hydrolysates), contain interchangeable and irreplaceable aminoacid and low
molecular peptides.