Much modern preparations of blood are known
sufficiently today.
1. Arithromass – canned blood, from which is
removed plasma. Its reasonable use at
anemia.
2. Washed erythrocytes – same arithromass,
in which plasma are absenting.
3. Arithroweigh – the blood, which is pour
plasmas, which change physiological solution,
with the accompaniment of levometicine,
rivanole and glucoses.
4. Leycitar-trombocitar mass or weigh is got
after centrifuging of blood and branches of
leukocytes and erythrocytes.
5. Native plasma – fluid part of blood without
form elements. It is getting after centrifuging
of canned blood. Keep also, either as a blood,
not more than 72 hours. Enter with
observance group accessories. The ways of
introduction such either as for preserves.
6. Fibrinogenum. Stands out from native
plasma, is kept in vials on 1 gram. Group
specificity has not. Before using is divorce by
water or physiological solution and is enter
intravenous.
7. Whey – a plasma, pour fibrinogenum, is keep
and enter as native plasma. Sometimes in she
enters calcium, vitamins, alcohol.
8. Fibrinolisin – a ferment, chosen from the
plasma, is kept in vials in the manner of dry
powder. Possesses a possibility to dissolve
tombs.
9. Albumin and protein. Stand out from the
plasma 20 or 25% dissolve, specificity have
not, is enter intravenous.
10. Specific immunoglobulins
(antistafrilococcus, antitetanus, countercoroar,
antiinfluence), stands out from the plasma of
persons, which illed by corresponding
diseases or immunized weaken by the toxin.
Group accessories has not, are enter
intramuscular.
11. Blood substistutions (plasma substitutes).
Separate functions of blood are to be a
change by different preparations, biological or
chemical derived.
Plasma substitutes
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plasma substitutes of hemodynamic
action
desintoxicative solutions
plasma substitutes for parenteral
nutrition
regulators of water-salt exchange
and acid-base balance
oxygen transmitters.
Anti-shock plasma
substitutes
preparations originating from
dextrane;
 preparations of gelatine;
 preparations on the base of
oxyethylstarch.
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(1) Preparations originating from
dextrane
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Depending on their molecular mass
solutions of this group are:
medium-molecular (polyglucin, polyfer,
rondex, macrodex, intradex, dextrane,
plasmodex, chemodex, oncovertine);
low-molecular (rheopoluglucin,
rheogluman, rheomacrodex, lomodex,
dextrane-40, hemodex).
The main medium-molecular preparation
of dextrane is polyglucin, low-molecular
is rheopoluglucin.
Polyglucin is 6% solution of medium-molecular
dextrane fraction (molecular mass is 60 000 –
80 000) in isotonic solution of sodium. During
intravenous injection it rapidly increases the
volume of circulating blood, increases and
keeps arterial pressure. Polyglucin increases
the volume of circulating blood on the quantity
more than volume of injected preparation; it is
due to its high colloid-osmotic pressure. It
circulates in the organism from 3 to 7 days;
during first day 45-55% of solution is excreted,
the main way of excretion is through kidneys.
Injection of polyglucin increases oxidativereductive processes in the organism and
utilization of oxygen from flowing blood by
tissues. Flow injection of the preparation
increases vessel tone.
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Rheopolyglucin is 10% solution of lowmolecular dextrane (molecular mass is 20
000 – 40 000) in isotonic solution of
sodium chloride or 5% solution of
glucose. Like polyglucin, it is
hyperonkotic colloid solution and during
intravenous injection it considerably
increases the volume of circulating fluid.
Every gram of preparation connects 2025 ml of water in blood. It explains its
hemodynamic action. Rheopolyglucin
circulates in the organism during 2-3
days, 70% of the preparation is excreted
for the first day with the urine.
(2) Preparations of gelatin.
They are gelatinole, modegel,
hemodel, gelofusin, plasmogel.
Originator of this group and the
most vide-spread preparation is
gelatinol.
Gelatinol is 8% solution of partly decomposed
food gelatin in isotonic solution of sodium
chloride (molecular mass is 15 000-25 000).
Gelatinol is protein, which contains some
aminoacids: glycin, proline etc. Treating
action is mainly connected with its high
colloid-osmotic pressure, which provides fast
coming of interstitial fluid into blood flow. As
hemodynamic preparations gelatinol and its
analogs are less effective than dextranes.
They leave the blood flow faster and localize
in interstitium. Gelatinol is nontoxic,
apyrogenic, does not cause antigenic
reactions. Kidneys excrete main part of the
preparation. Indications for usage are acute
hypovolemia, different kinds of shock, and
intoxication. Preparation is contraindicated in
acute kidney diseases and lipid embolia.
(3) Preparations on the base
of oxyethylstarch.
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Last years in USA, Germany, Japan the
solutions of oxyethylated starch found their
usage. These are plasmosteryl, plasmotonin,
rolex, and NAES-steryl.
Structurally these preparations are close to
glycogen of animal tissues and are able to
decompose in blood by amylolytic enzymes.
Solutions on the base of oxyethylstarch
have good hemodynamic action, which are
not followed side effects.
2. Desintoxicative solutions.
Plasma substitutions of desintoxicative
action provide desintoxication of the
organism by connecting, neutralization
and excretion of toxic substances. They
are preparations of polyvinylpyrolidone
(hemodes, neohemodes, periston-N,
neocompensan, plasmodan, colidone)
and solution of low-molecular polyvinyl
alcohol - polydes. Desintoxicative action
of those preparations is based on high
ability of polymer to complex-formation
with toxin.
Hemodes – is 6% solution of low-molecular
polyvinylpyrolidon with molecular mass of 12
000 – 27 000. Most its part is excreted by
kidneys in 6-8 hours after intravenous
injection. It is active to many toxins,
excluding diphteria, and tetanus, and toxins
formed during radiation disease. It also stops
stasis of erythrocytes in capillaries during
acute bleeding, shock, burn disease, and
other pathological processes. Depending on
the level of intoxication adults are injected
with 200 – 400 ml a day, and children get 15
ml for every kg of body weight.
Contraindications are bronchial asthma, acute
nephritis, hemorrhage into brain.
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Neohemodes is 6% solution of lowmolecular polyrinylpyrolidon with
molecular mass 6000 – 10000 with
addition of sodium, potassium, calcium
ions. Detoxicative effect of neohemodes
is higher than of hemodes.
Indications are the same as hemodes
has. Besides, neohemodes has noticeable
treating action in thyrotoxicosis, ray
disease (radiation disease), different
diseases of liver and other pathologies.
Preparation is injected intravenously with
speed of 20 – 40 drops per minute,
maximum single dose for adults is 400
ml, for children this is 5 – 10 ml / kg.
Polydes is 3% solution of polyvinyl alcohol
in isotonic of sodium of chloride.
Molecular mass is 10000 – 20000. It is
fully excreted by kidneys during 24
hours. Polydes is used intravenously drop
by drop for treating of intoxication caused
by peritonitis, acute pancreatitis, acute
cholecystitis, acute purulent infection,
burn disease, liver injury etc. Adults are
injected with 200 – 500 ml / day, children
– 5 – 10 ml / kg of body weight. In fast
injection of preparation there may occur
dizziness and nausea.
3. Plasma substitutes for
parenteral feeding
They are indicated in cases of full or portional
exclusion of natural nutrition of the patient,
as a result of some diseases and after
operation on the organs of alimentary tract,
during purulent septic injuries, traumatic, ray
and thermic injuries, severe complications of
postoperative period (peritonitis, abscesses
and intestinal anastomoses), and also in
hypoproteinemia of any origin. Parenteral
nutrition is provided with protein
preparations, lipid emulsions and
carbohydrates. First help the aminoacids go
into the organism, and lipid emulsions and
carbohydrates provide him with energy for
protein digestion.
(1) Protein Preparations
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Among protein preparations are
hydrolysates of proteins and mixtures of
aminoacids.
The sources of protein hydrolysates are
casein, proteins of cattle’s blood, muscle
proteins, and also erythrocytes and thrombs
of donor blood. When getting protein
hydrolysates, enzymes or acid hydrolyses
the products. The most widely used are
hydrolysate of casein, hydrolysin,
aminocrovin, amicin, aminopeptide,
fibrinosol, aminozol, aminone, amigen
etc.
Separate group contains solutions of aminoacids,
which are easily digested by the organism,
because there’s no need to decompose
peptides. The advantage of mixtures of
crystallic aminoacids is easier technology of
preparation, high concentration of aminoacids,
possibility to create the preparation with any
correlation of aminoacids and adding into the
mixture electrolytes, vitamins and energy
substances. The main preparations are:
polyamine, infusamine, vamine,
moramine, freamine etc. Aminoacid mixtures
are injected intravenously drop-by-drop, 20 –
30 drops / minute in full parenteral feeding in
dose 800 – 1200 ml every day. They can be
injected through the tube into the stomach or
duodenum.
(2) Lipid emulsions.
Inclusion of lipid emulsions into the complex of
parenteral nutrition improves the energetics
of patient’s organism has considerable
nitrogen-keeping action, corrects the lipid
content of plasma and structures of cell
membranes. Lipids provide the organism with
essential fatty acids (linolic, linolenic,
arachidonic), fat-soluble vitamins (A, K, D),
phospholipids. In clinical practice they use
lipid emulsions (emulgated lipids do not cause
lipid embolia). The most popular are
intralipid, lipiphysian, infusolipid,
lipofundin, lipomool, infonutrol, fatgen
etc.
(3) Carbohydrates.
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Carbohydrates are used in parenteral
nutrition for providing with energy needs, and
also energetic addition to protein
hydrolysates. Injected carbohydrates
stimulate the decomposition of protein
hydrolysates and formation of own proteins
from aminoacids.
The most widely used are solutions of
glucose (5%, 10%, 20%, 40%).
Contraindication is diabetes mellitus.
From the other carbohydrates fructose and
carbohydrate alcohols (xylite, sorbite,
mannite) are used. The digestion of those
preparations is not connected with insulin and
may be possible in patients with diabetes
mellitus.
4. Regulators of water – salt
exchange and acid – base balance.
These are crystalloid (polyion)
solutions and osmotic diuretics.
(1) Crystalloid solutions.
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The most widely used are:
physiologic (isotonic) solution
sodium chloride
0,9% solution
Ringer’s solution
sodium chloride 8,0 gm
potassium chloride
0,075 gm
calcium chloride 0,1 gm
sodium bicarbonate 0,1 gm
distilled water
to 1 liter
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Ringer – Lock’s solution
sodium chloride 9,0 gm
sodium bicarbonate 0,2 gm
calcium chloride 0,2 gm
glucose 1,0 gm
bidistilled water to 1 liter
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Lactasole
sodium chloride 6,2 gm
potassium chloride
0,3 gm
calcium chloride 0,16 gm
magnesium chloride 0,1 gm
sodium bicarbonate 0,3 gm
sodium lactate
3,36 gm
distilled water
to 1 liter
In clinical practice these solutions are
used for correction of water-salt
balance, they contain the most
adequate set of ions to blood
content. Ringer – Lock’s solution and
lactasole contain also anti-acidotic
components like bicarbonate or
lactate of sodium. For acidosis
correction they provide intravenous
injection of 4 – 5% solution of
sodium bicarbonate.
(2) Osmodiuretics
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These are multiatomic alcohols: sorbite
and mannite.
Mannitole is 15% solution of mannite in
isotonic solution.
Sorbitole is 20% solution of sorbite in
isotonic solution.
The mechanism of diuretic action of these
preparations is connected with increased
plasma osmotic level and going of
interstitial fluid into blood flow, which
increases the volume of circulating blood
and venal blood flow.
Indications for osmodiuretics usage are
early stage of acute renal insufficiency,
hemolytic shock, heart insufficiency, brain
edema, paresis of intestine (stimulate the
peristalsis), liver diseases and diseases of
bile-excreting tracts etc.
Contraindications to their usage are
disorder of filtration in kidneys, heart
insufficiency with evident anasarka and
other states of extra cellular
hyperhydratation, intracranial
hematomas.
5. Oxygen Transmotters.
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Creation of plasma substitutes, which provide
such function as oxygen transmission to the
tissues of the organism, so called “artificial
blood”, is difficult, but very important task.
Nowadays there are created oxygentransmitting preparations (perftoran,
perfucole, flusol-Da) and soluble
hemoglobin (erygem, conjugated
hemoglobin), but they have a little oxygen
capacity and have some toxicity. The
questions of their decomposition and
excretion from the organism are studied not
enough.
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Till this time the problem of
sterilization and cheeping of their
making is not solved. That’s why in
clinical practice oxygen transmitters
are almost not used.
Usage of plasma substitutes solutions
in some cases causes allergic,
pyrogenic and toxic reactions, but their
frequency and severity are
considerably less than those in
transfusion of blood and its
components