Transfusion shock emergency care algorithm. What to do with blood transfusion shock, its causes and signs

The most common cause of blood transfusion complications is transfusion of blood that is incompatible with the AB0 system and the Rh factor (approximately 60%). Less common are incompatibility for other antigenic systems and transfusion of poor-quality blood.

The main and most severe complication in this group, and indeed among all blood transfusion complications, is blood transfusion shock.

Transfusion shock

When transfusing blood that is not compatible according to the AB0 system, a complication develops, called "hemotransfusion shock".

Cause The development of complications in most cases becomes a violation of the rules provided for by the instructions for the technique of blood transfusion, the methodology for determining the blood group according to the AB0 system and conducting tests for compatibility. When transfusing blood or erythrocyte mass that is incompatible with the group factors of the AB0 system, massive intravascular hemolysis occurs due to the destruction of the donor's erythrocytes under the influence of the recipient's agglutinins.

In pathogenesis transfusion shock, the main damaging factors are free hemoglobin, biogenic amines, thromboplastin and other products of hemolysis. Under the influence of high concentrations of these biologically active substances, a pronounced spasm of peripheral vessels occurs, quickly replaced by their paretic expansion, which leads to impaired microcirculation and oxygen starvation of tissues. An increase in the permeability of the vascular wall and blood viscosity worsens the rheological properties of the blood, which further disrupts microcirculation. The consequence of prolonged hypoxia and the accumulation of acid metabolites are functional and morphological changes in various organs and systems, that is, a complete clinical picture of shock unfolds.

A distinctive feature of transfusion shock is the occurrence of DIC with significant changes in the system of hemostasis and microcirculation, gross violations of central hemodynamics. It is DIC that plays a leading role in the pathogenesis of damage to the lungs, liver, endocrine glands and other internal organs. The starting point in the development of shock is the massive influx of thromboplastin from destroyed erythrocytes into the bloodstream.

Characteristic changes occur in the kidneys: hematin hydrochloride (a metabolite of free hemoglobin) and the remains of destroyed erythrocytes accumulate in the renal tubules, which, along with spasm of the renal vessels, leads to a decrease in renal blood flow and glomerular filtration. The described changes are the cause of the development of acute renal failure.

clinical picture.

During the complication of transfusion of blood that is not compatible according to the AB0 system, there are three periods:

• hemotransfusion shock;
• acute renal failure;
• convalescence.

Hemotransfusion shock occurs directly during transfusion or after it, lasts from several minutes to several hours.

Clinical manifestations are first characterized by general anxiety, short-term agitation, chills, pain in the chest, abdomen, lower back, shortness of breath, shortness of breath, cyanosis. Pain in the lumbar region is considered the most characteristic symptom of this complication. In the future, circulatory disturbances characteristic of a state of shock gradually increase (tachycardia, a decrease in blood pressure, sometimes a violation of the rhythm of cardiac activity with symptoms of acute cardiovascular insufficiency). Quite often, a change in complexion (redness, followed by pallor), nausea, vomiting, fever, marbling of the skin, convulsions, involuntary urination and defecation are noted.

Along with the symptoms of shock, acute intravascular hemolysis becomes one of the early and permanent signs of hemotransfusion shock. The main indicators of increased breakdown of red blood cells: hemoglobinemia, hemoglobinuria, hyperbilirubinemia, jaundice, liver enlargement. The appearance of brown urine is characteristic (in the general analysis - leached erythrocytes, protein).

A violation of hemocoagulation develops, clinically manifested by increased bleeding. Hemorrhagic diathesis occurs as a result of DIC, the severity of which depends on the degree and duration of the hemolytic process.

When transfusing incompatible blood during surgery under anesthesia, as well as against the background of hormonal or radiation therapy, reactive manifestations can be erased, symptoms of shock are most often absent or slightly expressed.

The severity of the clinical course of shock is largely due to the volume of incompatible erythrocytes transfused, the nature of the underlying disease and the general condition of the patient before hemotransfusion.

Depending on the magnitude of blood pressure, there are three degrees of hemotransfusion shock:

• I degree - systolic blood pressure above 90 mm Hg;
• II degree - systolic blood pressure 71-90 mm Hg;
• III degree - systolic blood pressure below 70 mm Hg.

The severity of the clinical course of shock and its duration determine the outcome of the pathological process. In most cases, therapeutic measures can eliminate circulatory disorders and bring the patient out of shock. However, some time after the transfusion, the body temperature may rise, a gradually increasing yellowness of the sclera and skin appears, and the headache intensifies. In the future, impaired renal function comes to the fore: acute renal failure develops.

Acute renal failure

Acute renal failure occurs in the form of three successive phases: anuria (oliguria), polyuria and restoration of kidney function.

Against the background of stable hemodynamic parameters, daily diuresis sharply decreases, hyperhydration of the body is noted, and the content of creatinine, urea and plasma potassium increases. Subsequently, diuresis is restored and increased (sometimes up to 5-6 liters

per day), while high creatininemia may persist, as well as hyperkalemia (polyuric phase of renal failure).

With a favorable course of complications, timely and proper treatment, kidney function is gradually restored, the patient's condition improves.

convalescence period

The period of convalescence is characterized by the restoration of the functions of all internal organs, the homeostasis system and water and electrolyte balance.

PRINCIPLES OF TREATMENT OF HEMOTRANSFUSION SHOCK.

- immediate cessation of blood transfusion and erythrocyte mass;

- the introduction of cardiovascular, antispasmodic, antihistamines;

- IVL in the absence of spontaneous breathing, severe hypoventilation, pathological rhythms

- massive plasmapheresis (about 2-2.5 liters) to remove free hemoglobin, products

fibrinogen degradation. The removed volume is replaced with the same amount.

fresh frozen plasma or fresh frozen plasma in combination with colloidal

blood substitutes;

- intravenous drip of heparin;

- maintaining diuresis of at least 75-100 ml / h;

- correction of the acid-base state with 4% sodium bicarbonate solution;

- elimination of severe anemia (hemoglobin level of at least 60 g / l) by transfusion

individually selected washed erythrocytes;

- conservative treatment of acute hepatorenal insufficiency: restriction of fluid intake,

salt-free diet with protein restriction, vitamin therapy, antibiotic therapy regulation of water

electrolyte balance and acid-base status;

- in cases of ineffectiveness of conservative treatment of renal failure and uremia in patients

requires hemodialysis in specialized departments.

Post-transfusion complications of the hemolytic type can occur in people who are immunized as a result of pregnancy or repeated blood and packed red cell transfusions.

For their prevention, it is necessary to take into account the obstetric and transfusion history of recipients. If patients have a history of post-transfusion reactions or hypersensitivity to the administration of even ABO- and Rh-compatible erythrocytes, then an indirect Coombs test is necessary to select a compatible erythrocyte-containing transfusion medium.

Transfusion complications of non-hemolytic type.

Post-transfusion non-hemolytic reactions are due to the interaction between highly immunogenic antigens of leukocytes, platelets and plasma proteins and antibodies directed to them. As a rule, these reactions occur in cases of alloimmunization of the recipient to HLA antigens of leukocytes and platelets of patients who have previously undergone transfusions of blood, its components, or in repeated pregnancies.

Immediately after the start of the transfusion, facial flushing occurs, and after 40-50 minutes there is a high temperature rise, chills, headache, pruritus, urticaria, back pain, shortness of breath, restless behavior of the patient. Sometimes develops bronchospasm, acute respiratory failure, angioedema.

The frequency of antigenic reactions is especially high in hematological patients who received repeated blood transfusions.

Transfusion of blood, red blood cells, platelet concentrates containing leukocytes also contributes to the occurrence of immunosuppression and can create favorable conditions for the transmission of infections, such as cytomegalovirus.

To prevent transfusion complications of a non-hemolytic type, especially in people with a history of blood transfusions, it is recommended to use blood components after washing and filtering them to reduce the content of leukocytes (to less than 0.5x10.6) and platelets, as well as individual selection of a donor, taking into account established conditions. the patient's antibodies to group antigens of leukocytes, platelets and plasma proteins. IV. Allergic reactions.

They are caused by sensitization of the body to various immunoglobulins. The formation of antibodies to immunoglobulins occurs after transfusion of blood, plasma and cryoprecipitate. Sometimes these antibodies exist in the blood of people who have not tolerated blood transfusions and have not had pregnancies. To eliminate allergic reactions (hyperemia, chills, suffocation, nausea, vomiting, urticaria), desensitizing agents (diphenhydramine, suprastin, calcium chloride, corticosteroids), cardiovascular and narcotic drugs are used according to indications.

Prevention of allergic reactions includes the use of washed thawed erythrocytes, blood, platelet and leukocyte concentrates, selected taking into account the nature of the antibodies in the recipient.

Anaphylactic reactions.

May occur during transfusion of blood, plasma, serum. The blood groups of plasma proteins are linked by allogeneic variants of immunoglobulins, which can cause sensitization in repeated plasma transfusions and induce unwanted immune responses.

The clinical picture of an anaphylactic reaction includes acute vasomotor disorders: anxiety, reddening of the skin of the face, cyanosis, asthma attacks, shortness of breath, increased heart rate, decreased blood pressure, erythematous rash.

These symptoms can develop both immediately after the transfusion, and after 2-6 days. Late reactions are manifested by fever, urticaria, joint pain.

Patients become restless, complain of difficulty in breathing. On examination, attention is drawn to hyperemia of the skin, cyanosis of the mucous membranes, acrocyanosis, cold sweat, wheezing, thready and frequent pulse, pulmonary edema. Patients in a state of anaphylactic shock need urgent help.

Prevention of anaphylactic reactions consists in a careful history taking in order to identify sensitization during vaccination and serotherapy, as well as after the administration of protein preparations.

Transfusion complications associated with the conservation and storage of blood.

Post-transfusion reactions and complications can be caused by preservative solutions, metabolic products of cells resulting from blood storage, and the temperature of the transfusion medium.

Hypocalcemia occurs with the rapid introduction of large doses of whole blood and plasma, prepared on citrate-containing preservative solutions, to the patient. When this complication occurs, patients note discomfort behind the sternum that makes breathing difficult, a metallic taste in the mouth, and convulsive twitching of the muscles of the tongue and lips can be noticed.

Prevention of hypocalcemia consists in identifying patients with initial hypocalcemia or persons in whom its occurrence may be associated with a medical procedure or surgical intervention. These are patients with hypoparathyroidism, D-avitaminosis, chronic renal failure, cirrhosis of the liver and active hepatitis, congenital hypocalcemia, pancreatitis, infectious-toxic shock, thrombophilic conditions, post-resuscitation disease, who received corticosteroid hormones and cytostatics for a long time.

Hyperkalemia can occur with rapid transfusion (about 120 ml / min) of long-term stored canned blood or erythrocyte mass and is accompanied by bradycardia, arrhythmia, myocardial atony of the flesh to asystole.

Prevention of complications consists in the use of freshly prepared canned blood or erythrocyte mass.

Transfusion shock can develop directly during blood transfusion or within an hour after the end of the procedure. It is important to diagnose a dangerous condition in time and provide medical assistance as soon as possible.

The mechanism of development of hemotransfusion shock

Transfusion shock is a state of the body that occurs in response to mistakes that have been made.

When incompatible blood is added to the body, the agglutinins of the recipient (recipient) destroy the erythrocytes of the donor, which leads to the appearance of free hemoglobin. As a result, blood flow is disturbed and DIC (disseminated intravascular coagulation) is observed, which causes oxygen starvation and malfunctions in the functioning of all organs. Shock develops, requiring immediate medical attention.

Blood transfusion rules - video

The reasons

All possible causes of the condition can be divided into 2 groups:

1. Immune:
   • antigenic AB0 and Rh factor;
   • plasma incompatibility.
2. Non-immune:
   • penetration into the blood of pyrogenic (increasing body temperature) substances;
   • transfusion of poor quality or infected blood;
   • violation of the acid-base balance of the blood;
   • disruptions in hemodynamics (blood circulation);
   • non-compliance with the transfusion technique.

Symptoms and signs

Transfusion shock may be accompanied by:

• feeling of pain in the sternum, abdomen and lower back;
• muscle pain;
• feeling cold and feverish;
• rise in temperature;
• difficulty breathing and shortness of breath;
• redness, blueness, or blanching of the skin;
• frequent and weak pulse;
• reduced pressure;
• violation of the heart rhythm;
• nausea and vomiting;
• involuntary urination and defecation;
• oligoanuria - a sharp decrease in urine production.

Symptoms vary depending on the stage:

1. At the beginning of the pathological condition, the patient becomes agitated. He has pain in his chest and lower back.
2. Over time:
   • the skin becomes pale;
   • a sharp drop in blood pressure;
   • tachycardia appears;
   • the body is covered with cold sweat.
3. At the last stage, hemoglobinemia (increased content of free hemoglobin in the blood), hemolytic jaundice, kidney and liver failure are detected.

All the most important about increased hemoglobin in children and adults:

If shock develops during surgery, then:

• greatly reduced blood pressure;
• increased wound bleeding;
• urine acquires the color of "meat slops."

The intensity of manifestation of symptoms is influenced by the volume of transfused blood, the primary disease, age, general condition of the patient before the blood transfusion, as well as the anesthesia used. The degree of shock is determined by the magnitude of the pressure.

Determination of the degree of shock - table

Diagnostics

Be sure to conduct instrumental and laboratory studies:

1. Phlebotonometry - using a phlebotonometer, the pressure exerted by venous blood in the right atrium is measured.
2. Colorimetry - determine the content of free hemoglobin in plasma by the color intensity of the solution.
3. Goryaev's method of counting - blood is placed in a chamber of a certain volume and the number of erythrocytes and platelets is counted using a microscope, after which they are recalculated by 1 microliter.
4. Rutberg's gravimetric method - fibrin formed after plasma clotting is dried and weighed to determine the concentration of fibrinogen in the blood.
5. Blood centrifugation - after a strictly defined number of revolutions of the centrifuge, using a special scale, hematocrit is calculated - the ratio of blood cells to plasma.
6. Determination of diuresis - count the amount of urine that is produced over a certain time period.

If necessary, measure the acid-base state of the blood and the content of gases in it, make an electrocardiogram.

Treatment

Antishock therapy is aimed at eliminating symptoms, restoring and maintaining the normal functioning of the body, eliminating the consequences, and preventing the further development of the pathological process.

Treatment consists of several stages:

• providing emergency care;
• infusion therapy;
• blood purification;
• state stabilization.

Emergency help: algorithm of actions

When the first signs of shock appear, you must:

• stop the blood transfusion to prevent further complications;
• to replace the infusion system for anti-shock therapy;
• measure blood pressure and count the pulse;
• provide fresh air to prevent hypoxia;
• make a bilateral novocaine blockade to relieve spasms of the kidney vessels;
• inhalation with humidified oxygen;
• install a catheter on the bladder to monitor the functioning of the kidneys and collect urine for analysis;
• if necessary, carry out forced diuresis - accelerate urine formation with the help of diuretics.

After the end of anti-shock therapy, blood pressure and pulse are re-measured to determine the effectiveness of treatment.

Infusion therapy

To restore blood circulation, an infusion of blood-substituting solutions (Rheopoliglyukin, Polyglukin, Albumin, gelatin preparations) and solutions of glucose, bicarbonate or sodium lactate is done.

To stabilize diuresis and remove decay products, diuretics are dripped (Hemodez, Mannitol).

Medical therapy

Traditional drugs that help to remove the body from a state of shock are Eufillin, Prednisolone and Lasix.

Also appointed:

• narcotic analgesics (Promedol);
• antihistamines (Diphenhydramine, Suprastin, Tavegil, Diprazine);
• corticosteroid hormonal drugs (hydrocortisone);
• antiplatelet agents (Complamin, Curantil, Trental, Aspirin, Aspizol, nicotinic acid);
• heparin;
• cardiovascular drugs (Korglikon, Strofantin).

Classical triad for the treatment of transfusion shock - gallery

Blood purification

Plasmapheresis is used to remove toxic substances and free hemoglobin from the body. At the same time, blood is withdrawn in parts, purified and returned back to the bloodstream.

Body stabilization

After eliminating the violations that have arisen, it is necessary to stabilize the body's performance:

• if hypoventilation of the lungs is diagnosed, then artificial ventilation is done;
• in case of detection of acute renal failure, the water-electrolyte balance is corrected, an "artificial kidney" is connected;
• for anemia, washed erythrocytes are administered, selected individually;
• if there is a progression of uremia, then the blood is purified by hemodialysis or hemosorption.

What is a biological transfusion test and why is this test needed:

Prevention

To prevent the development of hemotransfusion shock, it is necessary:

• strictly observe the rules of transfusion;
• adhere to asepsis and antiseptics when preparing and storing blood products;
• carefully examine donors and remove them from donating blood if an infection is detected.

In the event of transfusion shock, emergency measures should be taken immediately. The health and life of the patient depends on the timely conduct of anti-shock therapy and rehabilitation measures.

Blood transfusion is a safe method of therapy under certain conditions, violation of them provokes complications and post-transfusion reactions. The following errors lead to them: non-compliance with the rules of blood preservation, incorrect determination of the blood group, incorrect technique, disregard for contraindications to transfusion. Thus, in order to prevent complications and reactions during blood transfusion, a certain set of rules should be strictly followed.

Indications for blood transfusion

Indications for this manipulation are determined by the goal to be achieved: increasing the activity of blood coagulation in case of its loss, replenishing the missing. Vital indications include:

• 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;
• glomerulonephritis in acute form;
• violation of cardiac activity;
• general amyloidosis;
• bronchial asthma;
• violation of cerebral circulation;
• allergy;
• severe renal failure;
• thromboembolic disease.

When analyzing contraindications, special attention should be paid to 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 errors and complications during blood transfusion, the following sequence of actions should be observed 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 take a general blood test.
• Immediately before the transfusion, the individual should urinate and have a bowel movement.
• Carry out the procedure on an empty stomach or after a poor breakfast.
• Choose the method of transfusion and transfusion medium.
• Determine the suitability of blood and its components. Check the expiration date, the integrity of the packaging, storage conditions.
• They make a determination of the blood group of the donor and recipient, which is called the control.
• Check for compatibility.
• If necessary, determine compatibility by Rh factor.
• Prepare a disposable system for transfusion.
• Transfusion is carried out, after the introduction of 20 ml, the transfusion is stopped and a sample is taken for biological compatibility.
• Watch for the transfusion.
• After the procedure is completed, an entry is made in the medical records.

Classification of complications in 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:

• transfusion of blood incompatible with the Rh factor and group;
• massive blood transfusions;
• errors in transfusion technique;
• transfer of infectious agents;
• 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:

• Transfusion shock caused by inappropriate blood transfusion. This is a very dangerous complication and the 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 a blood group is compatible with a transfusion.
• Transfer of infection along with the blood of a donor.
• Complications arising from errors made in the technique of blood transfusion.

Currently, the risk of developing hemotransfusion and posttransfusion shock is almost reduced to zero. This was achieved by the correct organization of the process during transfusion.

Symptoms of post-transfusion shock

Symptoms of complications after blood transfusion appear after the introduction 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 cries out in pain;
• loss of consciousness with involuntary defecation and urination;
• cyanosis of the lips;
• frequent pulse;
• a sharp reddening, and further blanching of the face.

In rare cases, ten to twenty minutes after a blood transfusion, with a complication of this nature, a fatal outcome may occur. Often the pain subsides, the work of the heart improves, consciousness returns. In the next period of shock, there is:

• leukopenia, which is replaced by leukocytosis;
• jaundice is little expressed, may be absent;
• an increase in temperature to 40 and above degrees;
• hemoglobinemia;
• kidney dysfunction that progresses;
• oliguria is replaced by anuria, and in the absence of timely measures, death occurs.

This period is characterized by slowly emerging oliguria and pronounced changes in urine - the appearance of protein, an increase in specific gravity, a cylinder and erythrocytes. A mild degree of post-transfusion shock differs from the previous ones in a slow course and a rather late onset of symptoms.

Therapy at the first sign of transfusion shock

• cardiovascular - "Uabain", "Korglikon";
• "Norepinephrine" to increase pressure;
• antihistamines - "Suprastin" or "Diphenhydramine", from corticosteroids "Hydrocortisone" or "Prednisolone" is preferable.

The above means 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, and Reopoliglyukin.

With the help of drugs "Sodium lactate" or "Sodium bicarbonate" remove the products of destruction of red blood cells. Diuresis is supported by Furosemide, Mannitol. In order to relieve spasm of the renal vessels, a pararenal bilateral blockade with Novocaine is performed. In case of respiratory failure, the individual is connected to a ventilator.

In the absence of the effect of the ongoing pharmacotherapy of acute renal failure, as well as an increase in autointoxication (uremia), hemosorption (removal of toxic substances from the bloodstream), hemodialysis is indicated.

Bacterial toxic shock

Such a complication of blood transfusion and blood substitutes is quite rare. Its provocateur is the blood infected in the process of harvesting and storage. A complication appears 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;
• thready pulse;
• incontinence of feces and urine.

The blood that did not have time to be transfused is sent for bacteriological examination, and when the diagnosis is confirmed, therapy is started. To do this, use drugs that have a detoxifying, anti-shock and antibacterial effect. In addition, cephalosporin and aminoglycoside antibacterial agents, blood substitutes, electrolytes, analgesics, detoxifiers, anticoagulants and vasoconstrictors are used.

Thromboembolism

Such a complication after a blood transfusion is provoked by blood clots that have come off from the affected vein as a result of a transfusion or blood clots that have arisen during its improper storage. Blood clots, clogging blood vessels, provoke a heart attack (ischemia) of the lung. The individual has:

• chest pain;
• a dry type of cough later turns into a wet one with the release of bloody sputum.

An x-ray shows focal inflammation of the lungs. When initial symptoms appear:

• the procedure is stopped;
• connect oxygen;
• administer cardiovascular drugs, fibrinolytics: "Streptokinase", "Fibrinolysin", anticoagulants "Heparin".

Massive blood transfusion

If for a short period (less than 24 hours) blood is poured in a volume of two or three liters, then such 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 massive blood transfusion syndrome. In addition, other reasons also influence the occurrence of such a serious complication during blood transfusion:

• ingestion of sodium nitrate and blood decay products in large quantities;
• negative impact of chilled blood;
• a large volume of fluid entering the bloodstream overloads the cardiovascular system.

Acute dilatation of the heart

Contributes to the emergence of such a condition is a fairly rapid flow of a large volume of canned blood with a jet injection or by pressurizing. Symptoms of this complication during blood transfusion are manifested:

• the appearance of pain in the right hypochondrium;
• cyanosis;
• shortness of breath;
• increase in heart rate;
• a decrease in arterial and an increase in venous pressure.

When the above symptoms appear, the procedure is stopped. Bloodletting is carried out in an amount of not more than 300 ml. Next, the introduction of medicines from the group of cardiac glycosides begins: "Strophanthin", "Korglikon", vasoconstrictor drugs and "Sodium chloride".

Potassium and nitrate intoxication

When transfusing canned blood, which has been stored for more than ten days, in a fairly large volume, potassium intoxication of a severe form may develop, leading to cardiac arrest. To prevent complications during blood transfusion, it is recommended to use the one that was stored for no more than five days, as well as to use red blood cells, washed and thawed.

The state of nitrate intoxication occurs during a massive transfusion. The dose of 0.3 g/kg is recognized as toxic. Severe poisoning develops as a result of the accumulation of sodium nitrate in the recipient and its entry into a chemical reaction with calcium ions in the blood. Intoxication is manifested by the following symptoms:

• low pressure;
• convulsions;
• increase in heart rate;
• arrhythmia;
• jitter.

In severe condition, the above symptoms are accompanied by swelling of the brain and lungs, dilated pupils are observed. Prevention of complications during blood transfusion is as follows. During the period of blood transfusion, it is necessary to inject a drug called "Calcium Chloride". For these purposes, a 5% solution is used at the rate of 5 ml of the drug for every 500 ml of blood.

Air embolism

This complication occurs when:

• violation of the technique of blood transfusion;
• incorrect filling of the medical device for transfusion, as a result, air is present in it;
• premature termination of a blood pressure transfusion.

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 the vein is enough to cause an embolism. Clinical manifestations:

• pressure drops;
• shortness of breath appears;
• the upper half of the body becomes bluish;
• a sharp pain is felt in the sternum;
• there is a cough;
• increase in heart rate;
• there is fear and anxiety.

In most cases, the prognosis is poor. If these symptoms appear, you should stop the procedure and start resuscitation, including artificial respiration and the administration of medications.

homologous blood syndrome

With massive blood transfusion, the development of such a condition is possible. During the procedure, blood from different donors is used, compatible in group and Rh factor. Some recipients develop a complication in the form of a homologous blood syndrome due to individual intolerance to plasma proteins. It manifests itself with the following symptoms:

• shortness of breath;
• moist rales;
• cold to the touch dermis;
• pallor and even cyanosis of the skin;
• decrease in arterial and increase in venous pressure;
• weak and frequent heartbeats;
• pulmonary edema.

With an increase in the latter, the individual has moist rales and turbulent breathing. Hematocrit falls, compensation for blood loss from the outside cannot stop a sharp decrease in BCC in the body. In addition, the process of blood clotting is slowed down. The cause of the syndrome lies in microscopic thrombi, immobility of red blood cells, accumulation of blood and microcirculation failures. Prevention and treatment of complications during blood transfusion is reduced to the following manipulations:

• It is necessary to infuse donor blood and blood substitutes, i.e., carry out combined therapy. As a result, blood viscosity will decrease, and microcirculation and fluidity will improve.
• Compensate for the lack of blood and its components, taking into account the circulating volume.
• You should 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 volume of blood is recommended to be filled with blood substitutes.
• To transfuse the individual with absolutely compatible transfusion media, washed and thawed red blood cells.

Infectious complications during blood transfusion

During transfusion, various pathogens of infectious diseases can be transferred along with the blood. Often this phenomenon is associated with the imperfection of laboratory methods and the latent course of the existing pathology. The greatest danger is viral hepatitis, which an individual becomes ill in two to four months after transfusion. The transmission of cytomegalovirus infection occurs along with the white blood cells of the peripheral blood, so that this does not happen, special filters must be used that will delay them, and only platelets and erythrocytes will be transfused.

Such a measure will significantly reduce the risk of infection in the patient. In addition, a dangerous complication is HIV infection. Due to the fact that the period during which antibodies are formed is from 6 to 12 weeks, it is impossible to completely eliminate the risk of transmission of this infection. Thus, in order to exclude complications during the transfusion of blood and its components, this procedure should be performed exclusively for health reasons and with a comprehensive screening of donors for viral infections.

Transfusion shock develops only after blood transfusion

Transfusion shock is the name of a pathological condition that develops after transfusion of incompatible blood groups. Also, the main causes of development include incompatibility of the Rh factor, violation of manipulations for conducting blood samples, its components, and violations of storage conditions. Emergency care for transfusion shock is characterized only by medical manipulations and the actions of nursing staff.

Blood transfusion is a complex procedure that is carried out only in a hospital. The development of shock at home is impossible

Blood transfusion is a narrow medical manipulation that is performed only in a hospital. Recently, a new position has been introduced in many medical institutions - a transfusiologist, which involves additional training and obtaining an appropriate certificate.

Transfusion shock develops against the background of blood incompatibility directly at the time of transfusion, when the patient is in the clinic. That is why at home the development of this pathology is impossible.

If relatives notice a violation in the condition of a person who has recently had a blood transfusion, then first of all it is necessary to call an ambulance. No action is recommended, other than ensuring a comfortable position. Households may mistakenly assume that transfusion shock is developing, but the problem is most likely different.

Symptoms of pathology

Any symptom in transfusion shock should be a signal to stop the blood transfusion.

The symptoms of shock can be both pronounced and confused. The approximate time for the first signs of incompatibility to appear is up to 2 hours from the moment of transfusion.

The most obvious symptoms are:

• periodic excited state of the patient;
• violation of breathing - heaviness, intermittency, shortness of breath;
• blue tint of the skin and mucous membranes;
• chills;
• pain in the back (lower back).

The transfusiologist asks the patient about pain in the back area from the moment the blood transfusion starts to the end. Kidney dysfunction is the first sign of transfusion shock.

The development of pathology depends on the patient's condition before the procedure and the immune system. Changes can begin rapidly with a sharp drop in blood pressure and kidney damage, which requires emergency care for blood transfusion shock.

In other cases, the condition worsens gradually, giving a vague clinical picture.

Assistance Algorithm

The list of medical actions in the development of hemotransfusion shock:

Action	Description
	Immediate cessation of blood transfusion - at the first suspicion of incompatibility, the doctor stops the procedure.
	Replacement of the transfusion system - existing equipment is sent for disinfection and disposal if it is disposable. The patient is connected to a new system, but the procedure is not resumed until the order of the doctor.
	Oxygen supply to the patient through a mask to exclude oxygen starvation and the development of comorbidities. This is a mandatory item in the emergency care algorithm.
	Monitoring diuresis - is carried out to assess the performance of the kidneys. The excretory system in hemotransfusion shock suffers first of all.
	In parallel with all actions, a laboratory assistant is called to take blood and determine its composition. The blood group, Rh factor and fluid components are determined again: leukocytes, erythrocytes, hemoglobin. A comparison is made with the transfusion specimen and any incompatibility is found.
	The urine sample is also sent to the laboratory.
	ECG to determine the work of the cardiovascular system.

After finding out the cause of the development of hemotransfusion shock, the procedure is resumed under the strict control of the transfusiologist. First aid for errors and complications of blood transfusion consists in the instant termination of the manipulation and the identification of the causes.

Subsequent medical actions

Rehabilitation therapy is no less important than emergency care

After the transfusion procedure and the elimination of the consequences of shock, the patient is prescribed rehabilitation therapy:

• infusion injections - through the drip infusion system, the patient receives a solution of polyglucin, which stabilizes the circulatory system;
• drug therapy - the introduction of drugs refers to the first aid for hemotransfusion shock. Doctors use prednisolone, aminophylline, or lasix to relieve shock;
• extracorporeal method - the elimination of free hemoglobin in the blood, toxins and other enzymes that interfere with the stabilization of the hematopoietic system is carried out.

In addition, general strengthening therapy is used to support the kidneys and immunity.

The video in this article tells more about blood transfusion.

Emergency care for transfusion shock is a standard set of measures aimed at removing the patient from the pathological state in the shortest possible time. The procedure is typical only for a hospital and develops directly at the time of blood transfusion. After discharge from the clinic, the development of shock is impossible, as is the provision of assistance to people without medical education.

Transfusion shock is the result of errors made by medical personnel when transfusing blood or its components. Transfusion from the Latin transfusio - transfusion. Hemo - blood. So blood transfusion is a blood transfusion.

The procedure of transfusion (blood transfusion) is performed only in a hospital by trained doctors (in large centers there is a separate doctor - a transfusiologist). The preparation and conduct of the transfusion procedure requires a separate explanation.

In this article, we will focus only on the consequences of the mistakes made. It is believed that blood transfusion complications in the form of blood transfusion shock in 60 percent of cases occur precisely because of an error.

Transfusion shock is a consequence of immune and non-immune causes.

Immune causes include:

• Incompatibility of blood plasma;
• Incompatibility of the group and the Rh factor.

Non-immune causes are as follows:

• The entry into the blood of substances that increase body temperature;
• Transfusion of infected blood;
• Disruptions in blood circulation;
• Non-compliance with the rules of transfusion.

For reference. The main and most common cause of this complication is non-compliance with the technique of blood transfusion. The most common medical errors are incorrect blood typing and violations during compatibility tests.

How transfusion shock develops

Hemotransfusion shock is one of the most life-threatening condition of the victim, which manifests itself during or after blood transfusion.

After the donor's incompatible blood enters the recipient's body, an irreversible process of hemolysis begins, which manifests itself in the form of the destruction of red blood cells - erythrocytes.

Ultimately, this leads to the appearance of free hemoglobin, resulting in impaired circulation, thrombohemorrhagic syndrome is observed, and the level of blood pressure is significantly reduced. Multiple dysfunctions of internal organs and oxygen starvation develop.

For reference. In a state of shock, the number of hemolysis components increases, which cause a pronounced spasm of the walls of the vessels, and also cause an increase in the permeability of the vascular walls. Then the spasm turns into paretic expansion. Such a difference in the states of the circulatory system is the main cause of the development of hypoxia.

In the kidneys, the concentration of decay products of free hemoglobin and formed elements increases, which, together with the contraction of the walls of blood vessels, leads to the ontogenesis of renal failure.

As an indicator of the degree of shock, the level of blood pressure is used, which begins to fall as shock develops. It is believed that during the development of shock there are three degrees:

• first. Mild degree, at which the pressure drops to the level of 81 - 90 mm. rt. Art.
• second. The average degree at which the indicators reach 71 - 80 mm.
• third. Severe degree, in which the pressure drops below 70 mm.

The manifestation of a blood transfusion complication can also be divided into the following stages:

• The onset of a shock post-transfusion state;
• The occurrence of acute renal failure;
• Stabilization of the patient's condition.

Symptoms

• Short-term emotional arousal;
• Difficulty breathing, shortness of breath;
• The manifestation of cyanosis in the skin and mucous membranes;
• Fever due to chill;
• Muscular, lumbar and chest pains.

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Spasms in the lower back primarily signal the beginning of transformations in the kidneys. Ongoing changes in blood circulation are manifested in the form of a noticeable arrhythmia, blanching of the skin, sweating and a steady decrease in blood pressure levels.

If, at the first symptoms of hemotransfusion shock, the patient was not provided with medical assistance, then the following symptoms occur:

• Due to the uncontrolled growth of free hemoglobin, signs of hemolytic jaundice are born, characterized by yellowing of the skin and whites of the eyes;
• Actually, hemoglobinemia;
• The occurrence of acute renal failure.

Not so often, experts noticed the manifestation of such signs of hemotransfusion shock as hyperthermia, vomiting, numbness, uncontrolled muscle contraction in the limbs and involuntary bowel movements.

If a blood transfusion is performed to a recipient who is under anesthesia, then hemotransfusion shock is diagnosed by the following signs:

• Decreased blood pressure;
• Uncontrolled bleeding in the operated wound;
• Dark brown flakes are seen in the urinary catheter.

Important! A patient who is under the influence of anesthesia cannot report his state of health, therefore, the responsibility for the timely diagnosis of shock lies entirely with the medical staff.

First aid for shock

In order to avoid the development of oxygen starvation, it is necessary to adjust the supply of humidified oxygen using a mask. The doctor should begin monitoring the volume of urine formed, and also urgently call laboratory assistants to take blood and urine for an early complete analysis, as a result of which the values ​​\u200b\u200bof the content will be known. erythrocytes , free hemoglobin, fibrinogen.

For reference. If there are no reagents in the laboratory at the time of diagnosing post-transfusion shock to establish compatibility, then the proven Baxter method, which has been used in field hospital settings, can be used. It is necessary to inject 75 ml of donor material into the victim, and after 10 minutes to take blood from any other vein.

The test tube must be placed in a centrifuge, which, using centrifugal force, will separate the material into plasma and shaped elements. When incompatible, the plasma acquires a pink tint, while in the normal state it is a colorless liquid.

It is also desirable to immediately measure the central venous pressure, acid-base balance and electrolyte levels, as well as conduct electrocardiography.

Operative anti-shock measures in most cases lead to an improvement in the patient's condition.

Treatment

Once the emergency response to shock has been taken, there is an urgent need to restore the main blood indicators.