Plasma (native). Autogenous colloidal solutions

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PLASMA

Plasma is the liquid part of the blood, devoid of cellular elements. Normal plasma volume is about 4% of total body weight (40-45 ml/kg). Plasma components maintain normal circulating blood volume and fluidity. Plasma proteins determine its colloid-oncotic pressure and balance with hydrostatic pressure; they also support the systems of blood coagulation and fibrinolysis in an equilibrium state. In addition, plasma ensures the balance of electrolytes and the acid-base balance of the blood.

AT medical practice fresh frozen plasma, native plasma, cryoprecipitate and plasma preparations are used: albumin, gamma globulins, blood coagulation factors, physiological anticoagulants (antithrombin III, protein C and S), components of the fibrinolytic system.

PLASMA FRESH FROZEN

Under fresh frozen plasma refers to plasma that is separated from erythrocytes by centrifugation or apheresis within 4-6 hours after blood exfusion and placed in a low-temperature refrigerator that provides complete freezing to a temperature of -30°C per hour. This mode of plasma preparation ensures its long-term (up to a year) storage. In fresh frozen plasma, labile (V and VIII) and stable (I, II, VII, IX) coagulation factors are preserved in the optimal ratio.

It is desirable that fresh frozen plasma comply with the following standard quality criteria: the amount of protein is not less than 60 g / l, the amount of hemoglobin is less than 0.05 g / l, the level of potassium is less than 5 mmol / l. The level of transaminases should be within the normal range. The results of tests for markers of syphilis, hepatitis B and C, HIV are negative.

Fresh frozen plasma volume, obtained by centrifugation from a single dose of blood, is 200-250 ml. When performing double donor plasmapheresis, the plasma output can be 400-500 ml, hardware plasmapheresis- no more than 600 ml.

Xhurt at a temperature - 20°WITH. At this temperature, PSZ can be stored up to 1 year. During this time, labile factors of the hemostasis system remain in it. Immediately before transfusion, PSZ is thawed in water at a temperature +37 - +38°WITH. In thawed plasma, fibrin flakes may appear, which does not prevent transfusion through standard plastic systems with filters. The appearance of significant turbidity, massive clots indicate poor quality plasma and should not be transfused.

Thawed plasma prior to transfusion may be preserved no more than 1 hour. Re-freezing it is unacceptable.

Transfused fresh frozen plasma should be of the same group with the recipient according to the AB 0 system. Rh compatibility is not mandatory, since fresh frozen plasma is a cell-free medium, however, with bulk transfusions of fresh frozen plasma (more than 1 liter), Rh compatibility is required. Compatibility for minor erythrocyte antigens is not required. When transfusing PSZ, a group compatibility test is not carried out. (?)

In emergency cases, in the absence of single-group fresh frozen plasma, transfusion of plasma of group AB (IV) to a recipient with any blood type is allowed.

Indications and contraindications for transfusion of fresh frozen plasma:

Acute disseminated intravascular coagulation (DIC) syndrome complicating the course of shocks various genesis(septic, hemorrhagic, hemolytic) or caused by other causes (amniotic fluid embolism, crush syndrome, severe trauma with tissue crushing, extensive surgical operations, especially on the lungs, vessels, brain, prostate), massive transfusion syndrome;

Acute massive blood loss (more than 30% of the circulating blood volume) with the development hemorrhagic shock and DIC;

Liver diseases accompanied by a decrease in production plasma factors coagulation and, accordingly, their deficiency in circulation (acute fulminant hepatitis, cirrhosis of the liver);

Overdose of anticoagulants indirect action(dicoumarin and others);

When performing therapeutic plasmapheresis in patients with thrombotic thrombocytopenic purpura (Moshkowitz's disease), severe poisoning, sepsis, acute DIC;

Coagulopathy due to deficiency of plasma physiological anticoagulants.

With burn disease in all clinical phases;

With purulent-septic processes;

Not recommended transfuse fresh frozen plasma for volume replenishment (safer and more economical means are available) or for parenteral nutrition purposes. With caution, transfusion of fresh frozen plasma should be prescribed in individuals with a burdened transfusion history, in the presence of congestive heart failure.

Features of transfusion of fresh frozen plasma. Transfusion of fresh frozen plasma is carried out through a standard blood transfusion system with a filter, depending on clinical indications- jet or drip, with acute DIC with severe hemorrhagic syndrome - jet. It is forbidden to transfuse fresh frozen plasma to several patients from one container or bottle.

When transfusing fresh frozen plasma, it is necessary to perform a biological test (similar to the transfusion of blood gas carriers). The first few minutes after the start of fresh frozen plasma infusion, when a small amount of transfused volume has entered the recipient's circulation, are decisive for the occurrence of possible anaphylactic, allergic and other reactions. plasma fresh frozen native cryoprecipitate

Transfused volumeFFP depends on clinical indications. For bleeding associated with DIC shows the introduction of at least 1000 ml of fresh frozen plasma simultaneously under the control of hemodynamic parameters and central venous pressure. Often it is necessary to re-introduce the same volumes of fresh frozen plasma under the dynamic control of the coagulogram and clinical picture. In this state, the introduction of small amounts (300-400 ml) of plasma is ineffective.

With acute massive blood loss(more than 30% of the volume of circulating blood, for adults - more than 1500 ml), accompanied by the development of acute DIC, the amount of transfused fresh frozen plasma should be at least 25-30% of the total volume of transfusion media prescribed to replenish blood loss, i.e. not less than 800-1000 ml.

With chronic DIC, as a rule, combine the transfusion of fresh frozen plasma with the appointment of direct anticoagulants and antiplatelet agents (coagulological control is necessary, which is a criterion for the adequacy of the therapy). In this clinical situation, the volume of transfused fresh frozen plasma is not less than 600 ml.

For severe liver disease accompanied by sharp decline the level of plasma coagulation factors and developed bleeding or the threat of bleeding during surgery, transfusion of fresh frozen plasma at the rate of 15 ml / kg of body weight is indicated, followed, after 4-8 hours, by repeated transfusion of plasma in a smaller volume (5-10 ml / kg).

The possibility of long-term storage of fresh-frozen plasma makes it possible to accumulate it from one donor in order to implement the principle of "one donor - one recipient", which makes it possible to drastically reduce the antigenic load on the recipient.

Reactions during transfusion of fresh frozen plasma. The most severe risk when transfusing fresh frozen plasma is the possibility transmission of viral and bacterial infections . That is why today much attention is paid to methods of viral inactivation of fresh frozen plasma (plasma quarantine for 3-6 months, detergent treatment, etc.).

In addition, there are potential immunological reactions associated with the presence of antibodies in the plasma of the donor and recipient. The heaviest of them is anaphylactic shock, clinically manifested by chills, hypotension, bronchospasm, retrosternal pain. As a rule, such a reaction is due to IgA deficiency in the recipient. In these cases, the cessation of plasma transfusion, the introduction of adrenaline and prednisolone is required. If it is vital to continue therapy with a transfusion of fresh frozen plasma, it is possible to prescribe antihistamines and corticosteroids 1 hour before the start of the infusion and re-administer them during the transfusion.

Absolute contraindications for FFP transfusions:

* hypercoagulation;

* sensitization to parenteral protein administration. It must be remembered that plasma is the main carrier of infectious disease markers.

Technique for obtaining and preparing plasma. Plasma harvesting can be carried out by several methods:

centrifugation of a dose of canned blood and isolation of native plasma from it;

Plasmapheresis method - repeated taking of a dose of blood from one donor, its centrifugation, plasma isolation and return of the erythrocyte mass to the donor;

by the method of automatic plasmapheresis - the separation of plasma from a continuous flow of blood from a donor entering an automatic separator

Currently, blood service establishments can procure several types of plasma:

Native plasma - isolated from donated canned blood during allowable time its storage;

fresh frozen plasma (FFP);

Plasma depleted in factor VIII (plasma remaining after the release of cryoprecipitate);

Plasma depleted of cells (remaining after the harvesting of QDs and CLs from LTS).

From 500 ml. canned blood receive 250-300 ml. native plasma. Containers with red blood cells and plasma are aseptically separated, sealed and labeled. Plasma is sent: for processing to medications; frozen or used for transfusion to patients.

Obtaining blood components using plasmacytopheresis techniques by qualified, specially trained personnel is safe procedure. The operation of plasmapheresis consists of a number of stages: preparation of equipment, equipment and polymer double containers; taking blood from a donor into a polymer container; centrifuging a polymer container with blood; plasma separation; reinfusion to a donor of autologous erythrocytes. After the donor's own red blood cells are returned, the single plasmapheresis procedure is terminated. The prepared plasma should be transferred to the clinic for transfusion within the first 3 hours after the end of plasmapheresis or no later than 4 hours, after which the plasma should be frozen.

Automatic hardware plasmapheresis is carried out by the system for obtaining plasma of the apparatus of the "Gemanetic" type, which is fully automated and computerized. She receives whole blood from a donor; mixes it with an anticoagulant, separates the plasma from the globular mass and returns unused cellular elements to the donor.

The prepared plasma is collected in plastic containers. Most of it is frozen, and some is sent for clinical use.

NATIVE PLASMA

Native plasma is obtained under sterile conditions from whole donated blood after centrifugation.

After separation from the plasma of water, the concentration of total protein in it, plasma coagulation factors, in particular, IX, increases significantly - such plasma is called plAzma native concentrated.

Concentrated native plasma (PNK) contains all the main components of freshly prepared plasma (except for a reduced content factor VIII), but 2.5-4 times smaller volume (80 ± 20 ml). The concentration of total protein is higher than in native plasma and must be at least 10% (100 g/l). Possesses increased hemostatic and oncotic properties due to an increase in the content of plasma proteins and coagulation factors (except for factor VIII).

Indications for use. PNK is intended for the treatment of patients with severe deficiency of various procoagulants, hypo- and afibrinogenemia; as a dehydrating and detoxifying agent; for the treatment of diseases accompanied by protein deficiency, the development of edematous-ascitic and hemorrhagic syndromes.

Dosage and administration. In case of bleeding due to congenital or acquired deficiency of procoagulants, PNA is administered at a dose of 5-10 ml/kg per day until the bleeding stops completely.

With protein deficiency with the development of ascitic syndrome, it is possible to use the drug at a dose of 125-150 ml per day at intervals of 2-3 days, on average, 5-6 transfusions per course.

Contraindications. PNA should not be used in severely impaired renal function with anuria. After administration of the drug, it is possible to develop allergic reactions, which are stopped by the introduction antihistamines.

Storage conditions. The drug is stored frozen. Shelf life - 3 months at a temperature of -30 ° C.

CRYOPRECIPITATE

If cryoprecipitate is removed from the plasma during fractionation, then the remaining part of the plasma is the supernatant plasma fraction (cryosupernatant), which has its own indications for use.

Recently cryoprecipitate, being medicine obtained from donor blood is considered not so much as a transfusion medium for the treatment of patients with hemophilia A, von Willebrand's disease, but as a feedstock for further fractionation in order to obtain purified factor VIII concentrates.

For hemostasis, it is necessary to maintain the level of factor VIII up to 50% during operations and up to 30% in postoperative period. One unit of factor VIII corresponds to 1 ml of fresh frozen plasma. Cryoprecipitate obtained from a single blood unit must contain at least 100 units of factor VIII.

Demand calculation in transfusion of cryoprecipitate is performed as follows:

Body weight (kg) x 70 ml/kg = blood volume (ml).

Blood volume (ml) x (1.0 - hematocrit) = plasma volume (ml)

Plasma volume (mL) x (required factor VIII level - present factor VIII level) = required amount factor VIII for transfusion (u).

Required amount of factor VIII (U): 100 U = number of doses of cryoprecipitate needed for a single transfusion.

The half-life of transfused factor VIII in the recipient's circulation is 8-12 hours, so repeated transfusions of cryoprecipitate are usually necessary to maintain therapeutic levels.

In general, the amount of cryoprecipitate transfused depends on the severity of hemophilia A and the severity of bleeding. Hemophilia is regarded as severe at a level of factor VIII less than 1%, moderate - at a level in the range of 1-5%, mild - at a level of 6-30%.

The therapeutic effect of cryoprecipitate transfusions depends on the degree of distribution of the factor between the intravascular and extravascular spaces. On average, a quarter of the transfused factor VIII contained in the cryoprecipitate passes into the extravascular space during therapy.

The duration of therapy with cryoprecipitate transfusions depends on the severity and location of bleeding, the clinical response of the patient. At large surgical operations or extraction of teeth, it is necessary to maintain the level of factor VIII at least 30% for 10-14 days.

If due to some circumstances it is not possible to determine the level of factor VIII in the recipient, then indirectly it is possible to judge the adequacy of therapy by activated partial thromboplastin time. If it is within the normal range (30-40 s), then factor VIII is usually above 10%.

Another indication for the appointment of cryoprecipitate is hypofibrinogenemia, which is extremely rarely observed in isolation, more often being a sign of acute DIC. One dose of cryoprecipitate contains, on average, 250 mg of fibrinogen. However, large doses of cryoprecipitate can cause hyperfibrinogenemia, which is fraught with thrombotic complications and increased erythrocyte sedimentation.

The cryoprecipitate must be compatible according to the AB 0 system. The volume of each dose is small, but the transfusion of many doses at once is fraught with volemic disorders, which is especially important to consider in children with a smaller blood volume than adults. Anaphylaxis, allergic reactions to plasma proteins, and volemic overload may occur during cryoprecipitate transfusion. The transfusiologist must constantly be aware of the risk of their development and, if they appear, conduct appropriate therapy (stop transfusion, prescribe prednisolone, antihistamines, adrenaline).

PLASMA PRODUCTS

Antihemophilic plasma- plasma from freshly citrated blood of a donor, obtained 30 minutes after its collection. Contains unchanged antihemophilic globulin and other easily inactivated coagulation factors. Dried antihemophilic plasma can be stored at room temperature for up to a year.

Fibrinogen-specific plasma protein takes part in blood clotting. Receive it from plasma (1 g from 1 l of plasma). Used to stop bleeding caused by afibrinogenemia and fibrinolysis. Antihemophilic globulin - factor VIII concentrate (dry or cryoprecipitate); 20 ml of cryoprecipitate corresponds to 250 ml of antihemophilic plasma. Used for hemophilia (hemophilia A) as a hemostatic agent. Stored for 6 months at a temperature of - 30 °C.

Clotting Factor Concentrate (PPSB)- prothrombin, proconvertin, Stewart factor and antihemophilic factor B. Used for hemorrhagic diathesis due to the lack of these factors.

fibrinolysin- a plasma enzyme preparation with high thrombolytic activity. Dry powder before use is dissolved in isotonic solution sodium chloride and administered intravenously in combination with heparin for several hours. Used for thrombosis and vascular embolism. Streptase, cabikinase, streptodecase have a higher efficiency.

Protein - protein preparation, obtained from hemolyzed blood, contains 75-80% albumin and 20-25% globulins. The protein concentration in the preparation is about 4.5-6%. It has a hemodynamic and detoxifying effect due to rapid rise BCC, dilution and binding of toxins. It is used for traumatic, hemorrhagic, dehydration and other types of shock, as well as sepsis, hypoproteinemia of various origins. Enter intravenously drip (from 250 to 1000 ml). It is stored for about 3 years at a temperature of 4 "C.

Albumen 5, 10, 20% is obtained by ethanol fractionation of donor plasma. Shelf life - 3 years at a temperature of 4-8 °C. Has a pronounced therapeutic effect with shock, blood loss, hypoproteinemia, cerebral edema, hepatic-renal insufficiency etc. Quickly increases blood pressure. Introduced by drip. A single dose of a 10% solution is about 100-300 ml.

IMMUNE PLASMA

The most demanded at present is PI of the following specificity: antistaphylococcal plasma, antipseudomonal plasma, antiproteus plasma. At the same time, when using modern diagnostic kits, it is possible to obtain PI of a different specificity (antiescherichiosis, etc.).

The main stages of obtaining (production) IP are:

* selection and acquisition of donors of immune plasma;

* examination of blood samples of donors for the presence of antibodies to opportunistic pathogens and determination of their titer;

* Documenting the results of the study in the Registration Book laboratory research? and? Donor card? ;

* selection of plasma samples containing antibacterial antibodies (ABA) in therapeutic titers and suitable for transfusion;

* labeling of selected samples of donor plasma labeling corresponding to the established specificity of ABA with indication of the titer;

* registration (documentation) of receiving IP in? Journal of registration of blood procurement and its components? and transfer to storage;

* release of IP suitable for transfusion.

For the study of natural ABA, labeled donor serum samples are used, remaining after the completion of immunohematological studies, stored at a temperature of +2 °C ... +6 °C in the absence of signs of poor quality (infection, hemolysis, etc.). The timing of the screening should not exceed 3 days after taking blood from donors. If long-term storage is required, donor serum can be frozen at -20°C or lower in special sealed plastic tubes.

Plasma antistaphylococcal human and plasma antipseudomonal human. TSA transfusions or ASGP are indicated for the treatment or prevention of purulent-septic complications caused by the corresponding bacterial agent (sepsis, wound infection, burn disease, abscess pneumonia, hemoblastoses, etc.).

Plasma administered intravenously drip daily or every other day - depending on the severity of the disease - 200-300 ml or 3-5 ml / kg of body weight (at least 18 IU). Course: 3-5 times or more in accordance with the severity of the disease and therapeutic effect. Children of the period newborns, including premature, transfusion of antistaphylococcal plasma is performed at the rate of 10 ml / kg of body weight (at least 60 IU). For each type of plasma, the indications for transfusion will be different.

Antistaphylococcal hyperimmune plasma. Currently, anti-staphylococcal plasma is obtained at blood transfusion stations from donors immunized with staphylococcal toxoid. After the immunization (1.0-1.0-2 ml) and the appearance of specific antibodies in the blood in a titer of 6.0-10 IU/l, plasmapheresis is performed on donors. It should be emphasized that one of the conditions for obtaining immune plasma is the use of the plasmapheresis method.

When conducting treatment with this immune preparation, it must be taken into account that the significantly greater clinical effect is achieved not with a single injection, but with a course of treatment, which consists of 3-5 intravenous infusions of antistaphylococcal hyperimmune plasma, 150-200 ml per day.

Sources

1. http://ksmu.org.ru/library/surgery/536.html.

2. http://arenmed.org/ob10006.php.

3. http://spbgspk.ru/index.php?option=com_content&view=article&id=178&Itemid=21.

4. Receipt and clinical application immune plasma in military medical institutions. Guidelines.

5. http://www.medskop.ru/antistafilokokkovaya_plazma/.

6. http://meduniver.com/Medical/Xirurgia/1024.html.

7. http://www.vrachebnye-manipulyacii.ru/vm/18.html.

8. http://www.transfusion.ru/doc/3638.htm.

9. Instructions for the use of blood components (approved by order of the Ministry of Health of the Russian Federation of November 25, 2002 N 363).

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Plasma - the liquid part of the blood, containing about 90% water, 7-8% protein, 1.1% organic matter non-protein and 0.9% inorganic compounds. It contains biological active ingredients Key words: lipoproteins, carbohydrates, metalloproteins, enzymes, vitamins, hormones, antibodies, alpha-globulins, beta-globulins, gamma-globulins. In addition, all blood coagulation factors are stable: factor I, II, IX, XI, XII, XIII and labile V, VII, VIII - the latter are destroyed within 12-24 hours.

native plasma

Native plasma is prepared from canned blood, which settles for 2 days in a refrigerator at a temperature of +4 0 to +6 0 C by draining or aspirating it. Such plasma is stored at a temperature of +4 0 to +6 0 C and used within one day. Predominantly native plasma in that all biologically active components are preserved. When transfusing native plasma, a biological test is carried out: drip 10 ml and a break of 3 minutes, observing the patient's condition, then repeat twice.

Fresh frozen plasma

Plasma is prepared 4-6 hours after blood sampling by centrifugation and freezing at -30 0 C. This mode of plasma preparation ensures its storage for a year. Plasma retains both stable and labile clotting factors.

After thawing at a temperature of + 37 0 C, the plasma should be used within an hour, re-freezing is not performed.

Indications for transfusion are:

DIC of various etiologies;

Acute massive blood loss;

Liver disease with a decrease in the production of plasma coagulation factors;

Overdoses of anticoagulants of indirect action;

Coagulopathy.

When transfusing fresh frozen plasma, a biological test is performed.

When transfusing fresh frozen plasma, infection with the hepatitis virus can be excluded by quarantine of the plasma for 3-6 months.

Antihemophilic plasma

Transfusion medium having a high level of factor VIII. To obtain antihemophilic plasma, donors are selected from men under 40 years of age, who have the highest level of antihemophilic globulin in the blood (up to 170%). Plasma, as a rule, is harvested by plasmapheresis and used in the near future or frozen at a temperature of -25 0 - 35 0 C. Antihemophilic plasma is characterized by a substitution mechanism of action. To stop hemophilic bleeding, the required plasma dose is from 400 to 800 ml and depends on the initial level of AHG in plasma.

Antihemophilic plasma is transfused intravenously and at a fast pace.

Anti-staphylococcal plasma

This plasma contains specific antibodies to staphylococcal toxin. Obtained from the blood of a donor immunized with staphylococcal toxoid. Antistaphylococcal plasma is used in native, frozen and dried state for massive immunotherapy of patients suffering from various diseases caused by staphylococci.

Dry plasma

Dry plasma prepared by lyophilization at room temperature or freeze-dried under vacuum has a shelf life of 5 years. The main indication for the use of plasma is hypoproteinemia, shock, bleeding. The effectiveness of plasma infusion is explained by the fact that the molecular weight of its proteins is quite high and corresponds to molecular weight recipient's blood.

Due to this, the permeability of plasma proteins through endothelial membranes blood vessels are small, so the plasma long time stays in the patient's bloodstream. When transfusing dry plasma, a biological test is carried out; 15-20 drops, then 10 ml and 20 ml with an interval of 3 minutes.

Native concentrated plasma

In this plasma, the concentration of total protein is higher than in native plasma and should be at least 100% (100 g/l). both native and frozen are produced, the shelf life is 6 months when stored at 25 0 C. Native concentrated plasma has increased hemostatic, osmotic and dehydration properties, due to high content plasma proteins, including blood clotting factors. The use is indicated for the treatment of patients with severe deficiency of various blood coagulation factors, hypoproteinemia, hypo- and afibrinogenemia, etc.

Dosage form

Pharmacotherapeutic group

Pharmacological properties

Indications for use Concentrated native plasma

Contraindications

Method of application and dosage Plasma native concentrated

Storage conditions

Native plasma refers to unstable preparations, the shelf life of which is limited to several days (up to three days). In this regard, native plasma is prepared by blood transfusion stations on the orders of medical institutions and transfused on the day of receipt.

In extreme cases, it can be transfused on the second day after receipt, then it is stored in the refrigerator at a temperature of +6 °.

Native plasma should be transported only in isothermal containers, since temperature changes adversely affect its properties. Transportation of plasma over long distances is not recommended due to its instability, therefore it is issued, as a rule, only medical institutions located near blood transfusion stations.

When evaluating the suitability of the drug, attention is paid to the integrity of the container (bottle), its capping, the correct filling of the label and the date of preparation. Violation of the integrity of the vial or its sealing, as well as a damaged label, are an indication of the unsuitability of the plasma for use.

Native plasma should be clear, straw-yellow in color and free of any suspended matter.- flakes, threads, grains. The presence of suspension and loss of transparency indicate that the plasma is becoming unusable.

In some cases, a whitish film appears on the surface of native plasma, which may be caused by bacterial contamination or chileness. For differentiation, the bottle is placed for 30 minutes in a water bath or a thermostat at a temperature of +38°C. The film caused by bacterial contamination remains unchanged in all cases, while the chylous one dissolves.