Blood transfusion complications. Blood transfusion shock

Transfusion shock is a fairly rare but serious complication that develops during transfusion of blood and its components.

Occurs during the procedure or immediately after it.

Requires immediate emergency anti-shock therapy.

Read more about this condition below.

• blood group incompatibility according to the ABO system;
• incompatibility according to RH (Rhesus) factor;
• incompatibility with antigens of other serological systems.

Occurs due to violation of the rules of blood transfusion at any stage, incorrect determination of the blood group and Rh factor, errors during the compatibility test.

Features and changes in organs

The basis of all pathological changes is the destruction of red blood cells of incompatible donor blood in the recipient’s vascular bed, as a result of which the following enters the blood:

• Free hemoglobin - normally free hemoglobin is located inside red blood cells, its direct content in the bloodstream is insignificant (from 1 to 5%). Free hemoglobin is bound in the blood by haptaglobin, the resulting complex is destroyed in the liver and spleen and does not enter the kidneys. The release of a large amount of free hemoglobin into the blood leads to hemoglobinuria, i.e. all hemoglobin is not able to bind and begins to be filtered into renal tubules.
• Active thromboplastin, an activator of blood coagulation and the formation of a thrombus (blood clot), is not normally present in the blood.
• Intraerythrocyte coagulation factors also promote clotting.

The release of these components leads to the following violations:

DIC syndrome, or disseminated intravascular coagulation syndrome - develops as a result of the release of coagulation activators into the blood.

Has several stages:

• hypercoagulation – multiple microthrombi are formed in the capillary bed, which clog small vessels, resulting in multiple organ failure;
• consumptive coagulopathy – at this stage, coagulation factors are consumed to form multiple blood clots. At the same time, the anticoagulation system of the blood is activated;
• hypocoagulation – at the third stage, the blood loses its ability to clot (since main factor coagulation - fibrinogen - is no longer present), resulting in massive bleeding.

Oxygen deficiency – Free hemoglobin loses its connection with oxygen, and hypoxia occurs in tissues and organs.

Microcirculation disturbance- as a result of spasm of small vessels, which is then replaced by pathological expansion.

Hemoglobinuria and renal hemosiderosis– develops as a result of the release of a large amount of free hemoglobin into the blood, which, when filtered in the renal tubules, leads to the formation of hemosiderin (salt hematin - a breakdown product of hemoglobin).

Hemosiderosis in combination with vasospasm, it leads to disruption of the filtration process in the kidneys and accumulation of nitrogenous substances and creatinine in the blood, thus developing acute renal failure.

In addition, impaired microcirculation and hypoxia lead to disruption of the functioning of many organs and systems: liver, brain, lungs, endocrine system and etc.

Symptoms and signs

The first signs of transfusion shock may appear already during a blood transfusion or in the first few hours after the procedure.

• the patient is agitated and behaves restlessly;
• pain in the chest area, a feeling of tightness behind the sternum;
• breathing is difficult, shortness of breath appears;
• the complexion changes: more often it turns red, but it can be pale, cyanotic (blue) or with a marbled tint;
• lower back pain - characteristic symptom shock, indicates pathological changes in the kidneys;
• tachycardia - rapid heart rate;
• decreased blood pressure;
• Sometimes there may be nausea or vomiting.

After a few hours, the symptoms subside and the patient feels better. But this is a period of imaginary well-being, after which the following symptoms appear:

• Icterus (jaundice) of the eye sclera, mucous membranes and skin (hemolytic jaundice).
• Increased body temperature.
• Renewal and intensification of pain.
• Kidney and liver failure develops.

When receiving a blood transfusion under anesthesia, signs of shock may include:

• Fall in blood pressure.
• Increased bleeding from the surgical wound.
• The urinary catheter produces urine that is cherry-black or the color of “meat slop,” and there may be oligo- or anuria (decreased amount of urine or its absence).
• Changes in urinary excretion are a manifestation of increasing renal failure.

Course of the pathology

There are 3 degrees of transfusion shock depending on the level of decrease in systolic blood pressure:

1. up to 90 mm Hg;
2. up to 80-70 mm;
3. below 70 mm. rt. Art.

There are also periods of shock characterized by a clinical picture:

• Shock itself is the first period in which hypotension (a drop in blood pressure) and DIC occur.
• The period of oliguria (anuria) – the impairment of kidney function progresses.
• The stage of diuresis restoration is the restoration of the filtering function of the kidneys. Occurs when provided in a timely manner medical care.
• Convalescence (recovery) – restoration of the functioning of the blood coagulation system, normalization of hemoglobin, red blood cells, etc.

Anaphylactic shock is a rapid and dangerous reaction of the body to an external irritant, which requires immediate medical attention. Following the link, we will consider the mechanism of development of this condition.

Types of treatment procedures

All therapeutic measures for blood transfusion shock are divided into 3 stages:

Emergency anti-shock therapy - to restore normal blood flow and prevent serious consequences. It includes:

• infusion therapy;
• intravenous administration antishock drugs;
• extracorporeal methods of blood purification (plasmapheresis);
• correction of the function of systems and organs;
• correction of hemostasis (blood clotting);
• treatment of acute renal failure.

Symptomatic therapy – carried out after stabilization of the patient’s condition during the recovery period (recovery).

Preventive measures - identifying the cause of the development of shock and eliminating similar errors in the future, strict adherence to the sequence of transfusion procedures, conducting compatibility tests, etc.

First aid

If signs of transfusion shock or corresponding complaints from the recipient appear, it is necessary to urgently stop further blood transfusion without removing the needle from the vein, since anti-shock drugs will be administered intravenously and time cannot be wasted on new catheterization of the vein.

Emergency treatment includes:

Infusion therapy:

• blood replacement solutions (reopolyglucin) - to stabilize hemodynamics, normalize BCC (circulating blood volume);
• alkaline preparations (4% sodium bicarbonate solution) - to prevent the formation of hemosiderin in the kidneys;
• polyionic saline solutions (Trisol, Ringer-Locke solution) - to remove free hemoglobin from the blood and preserve fibrinogen (i.e., to prevent stage 3 of DIC, in which bleeding begins).

Drug antishock therapy:

• prednisolone – 90-120 mg;
• aminophylline – 2.4% solution in a dosage of 10 ml;
• lasix – 120 mg.

This is a classic triad for preventing shock, helping to increase blood pressure, relieve spasm of small vessels and stimulate kidney function. All drugs are administered intravenously. Also used:

• antihistamines (diphenhydramine and others) - for expansion renal arteries and restoration of blood flow through them;
• narcotic analgesics (for example, promedol) - to relieve severe pain.

An extracorporeal treatment method – plasmapheresis – involves taking blood, purifying it of free hemoglobin and fibrinogen breakdown products, then returning the blood to the patient’s bloodstream.

Correction of functions of systems and organs:

• transfer of the patient to mechanical ventilation (artificial ventilation) in case of a serious condition of the patient;
• transfusion of washed red blood cells - carried out when there is a sharp drop in hemoglobin levels (less than 60 g/l).

Correction of hemostasis:

• heparin therapy – 50-70 IU/kg;
• anti-enzyme drugs (contrical) - prevents pathological fibrinolysis, leading to bleeding in shock.

Treatment of acute renal failure:

• hemodialysis and hemosorption are procedures for purifying blood outside the kidneys, carried out when oligo- or anuria develops and previous measures are ineffective.

Principles and methods of treatment procedures

The basic principle of treating transfusion shock is emergency intensive care. It is important to start treatment as early as possible, only then can we hope for a favorable outcome.

Treatment methods differ fundamentally depending on diuresis indicators:

• Diuresis is preserved and is more than 30 ml/h - active infusion therapy is carried out with a large volume of infused liquid and forced diuresis, before which it is necessary to pre-administer sodium bicarbonate (to alkalinize urine and prevent the formation of hydrochloric acid hematin);
• Diuresis less than 30 ml/h (oligoanuria stage) – strict limitation of fluid intake during infusion therapy. Forced diuresis is contraindicated. At this stage, hemosorption and hemodialysis are usually used, since renal failure is severe.

Forecasts

The patient's prognosis directly depends on the early provision of anti-shock measures and the completeness of treatment. Therapy in the first few hours (5-6 hours) ends with a favorable outcome in 2/3 of cases, i.e. patients recover completely.

In 1/3 of patients, irreversible complications remain, developing into chronic pathologies of systems and organs.

Most often this happens with the development of severe renal failure, thrombosis of vital vessels (brain, heart).

If emergency care is not provided in a timely or adequate manner, the outcome for the patient can be fatal.

Blood transfusion is a very important required procedure, which treats and saves many people, but in order for donor blood to bring benefit to the patient and not harm, it is necessary to carefully follow all the rules for its transfusion.

This is done by specially trained people who work in blood transfusion departments or stations. They carefully select donors; after blood collection, blood goes through all stages of preparation, safety testing, etc.

Blood transfusion, like preparation, is a carefully controlled process, carried out only by trained professionals. It is thanks to the work of these people that today this process is quite safe, the risk of complications is low, and the number of people saved is very large.

Video on the topic

Post-transfusion reactions:

Allergic;

Pyrogenic;

Antigenic (non-hemolytic);

Blood transfusion complications

All complications after blood transfusion can be divided into 3 groups.

1. Mechanical errors

Air embolism

Thromboembolism

Thrombophlebitis

Circulatory overload

2. Reactive complications

2.1Blood transfusion shock as a result of:

Incompatibility of components according to the AB0 system

Incompatibilities of components according to the Rh system

Incompatibility of components with respect to antigens of other serological systems

2.2. Post-transfusion shock due to transfusion of poor-quality medium

Bacterial contamination

Overheating, hypothermia, hemolysis

Expiration of shelf life

Violation of storage temperature conditions

2.3. Anaphylactic shock

2.4. Citrate shock (with the simultaneous transfusion of a large amount of canned blood).

2.5. Massive transfusion syndrome

2.6. Acute pulmonary failure syndrome

3. Transmission of infectious diseases

3.1. Syphilis infection

3.2. Malaria infection

3.3. Viral hepatitis infection

3.4. HIV infection

3.5. Infection with herpes viral infections

Blood transfusion reactions

In addition to complications after blood transfusion, a person may experience hemotransfusion reactions , which, unlike complications, do not pose a threat to life. These include:

A) pyrogenic reactions

B) allergic reactions.

Pyrogenic reactions arise due to the ingress of pyrogens along with blood components. Pyrogens are produced by many bacteria, as well as as a result of poor asepsis when collecting blood. The reaction is manifested by increased body temperature, chills, and headache.

Allergic reactions appear a few minutes after the start of transfusion, due to sensitization to plasma proteins and various immunoglobulins. Manifested by shortness of breath, suffocation, skin rashes, swelling of the face, and urticaria. Occur more often during plasma and albumin transfusions.

Antigenic (non-hemolytic reactions) as a result of sensitization of the recipient with antigens during repeated transfusion, during pregnancy.

Manifested by chills, vomiting, lower back pain, shortness of breath, urticaria, temperature 39-40, in severe cases there may be bronchospasm, acute respiratory failure, loss of consciousness.

Prevention: compliance with the rules of asepsis and antisepsis when collecting and storing blood.

Careful collection of transfusion history.

The use of blood components with less pronounced reactive properties.

Individual selection of blood transfusion media.

Treatment.

Stop the transfusion without leaving the vein, add antihistamines, glucocorticosteroids, adrenaline, anti-shock solutions, blood substitutes, cardiac glycosides, fight against hyperthermia.

Mechanical errors

1. Air embolism

An air embolism occurs when the system is not filled correctly, due to air entering the patient’s vein along with blood during transfusion.

1.as a result of improper filling of the system

2. as a result of untimely stop of transfusion during blood transfusion under pressure.

Clinic: difficulty breathing, shortness of breath, pain and a feeling of pressure behind the sternum, cyanosis of the face, tachycardia.

Treatment: massive air embolism with the development of clinical death requires immediate resuscitation measures - indirect massage heart, mouth-to-mouth artificial respiration, calling a resuscitation team.

Prevention consists in strict compliance with all technical rules of transfusion, installation of systems and equipment. It is necessary to carefully fill all tubes and parts of the equipment with the transfusion medium, ensuring that air bubbles are removed from the tubes. Monitoring of the patient during the transfusion should be constant until its completion.

2. Thromboembolism- embolism with blood clots in the pulmonary arteries.

Causes: separation of a blood clot from varicose veins lower limbs, separation of blood clots forming in the vein near the tip of the needle, entry of blood clots formed in the transfused blood.

Pulmonary embolism clinic: sudden pain in chest, a sharp increase or occurrence of shortness of breath, the appearance of cough, sometimes hemoptysis, pallor of the skin, cyanosis, in some cases, patients develop collapse - cold sweat, drop in blood pressure, rapid pulse.

Treatment activators of fibrinolysis - streptases (streptodecases, urokinases),

Continuous intravenous administration of heparin (25,000-40,000 units per day), immediate jet administration of at least 600 ml of fresh frozen plasma under the control of a coagulogram, euphyllin, cardiac glycosides and other therapeutic measures are indicated.

Prevention correct preparation, stabilization of blood, use of disposable systems for transfusion using filters. In case of needle thrombosis, repeated puncture of the vein with another needle is necessary; in no case should you try to restore the patency of the thrombosed needle in various ways.

3. Thrombophlebitis— the formation of blood clots in the inflamed vein.

Cause: violation of aseptic rules, multiple infusion punctures.

Clinic: pain along the vein, redness, swelling, upon palpation - painful compaction along the vein.

Treatment: dressings with heparin ointment, alcohol compresses.

4. Circulatory overload SHF manifests itself and develops more often in patients with myocardial damage.

Cause: the introduction of a large amount of fluid in a short period of time and, as a result, expansion and cardiac arrest.

Clinic: difficulty breathing, chest tightness, facial cyanosis, decreased blood pressure, tachycardia, arrhythmias, increased central venous pressure.

Help: stop infusion, intravenous cardiac glycosides, diuretics, vasopressor amines (mesaton).

Reactive complications:

Blood transfusion shock

Causes:

Develops as a result of blood transfusion:

1. incompatible according to the ABO system (during a biological test or during a blood transfusion);

Rh incompatibility – (spasm after blood transfusion or after 6-12 hours the course is less violent).

Clinically, transfusion shock manifests itself:

• Short-term excitement;
• Pain in the chest, abdomen, lower back;
• Tachycardia occurs;
• Blood pressure decreases;

• The skin is first hyperemic, then suddenly becomes pale. If a person is under anesthesia, then signs of developing shock are severe bleeding from the surgical wound, persistent low blood pressure, and in the presence of a urinary catheter, the appearance of cherry or black urine.
• After 1-2 days, urine the color of “meat slop” appears;
• The amount of urine “oliguria” decreases;

Urine production stops (anuria).

Algorithm of the nurse's action

Actions	Target
1. stop intravenous infusion of donor blood	- prevention of worsening transfusion shock
2. maintain contact with the vein	— for infusion antishock therapy (as prescribed by a doctor)
3. call a doctor	— assessing the recipient’s condition, giving prescriptions
4. measure A/D and count pulse	— monitoring the recipient’s condition
5. provide a flow of fresh air	— prevention of hypoxia
6. Perform bladder catheterization (as prescribed by a doctor)	- monitoring kidney function and urine collection clinical analysis(detection of red blood cell hemolysis)
7. fulfillment of doctor’s medication prescriptions solution of promedol 1% 1 ml mezaton 2 ml or ephedrine 5% 2 ml or norepinephrine 0.2% 1 ml, Prednisolone solution 30-60 mg or hydrokartisone 125 mg; diphenhydramine 1% 2 ml or pipolfen 2.5% 2 ml or tavegil 2.5%, calcium chloride 10% 10ml, aminophylline 2.4% 10ml diuretics: 20% mannitol (15-50 g) lasix 100 mg once, up to 1000 per day antishock solution (polyglucin, gelatinol, 4% sodium bicarbonate solution. According to indications, the patient is connected to hemodialysis.	for pain relief to increase blood pressure to relieve spasm from the renal arteries to reduce the deposition of hemolysis products in the distal tubules of the nephron to maintain blood volume and stabilize blood pressure Correction of acid-base balance Removal from the body of substances that led to the development of shock
8. repeated A/D measurement and pulse counting	— monitoring the effectiveness of measures to eliminate blood transfusion shock

Citrate shock


Occurs as a result of transfusion of large quantities of blood prepared with sodium citrate, which binds calcium, causing hypocalcemia.

Clinic: a metallic taste in the mouth, pain behind the sternum, interfering with inhalation, a drop in blood pressure, bradycardia and convulsions (twitching of the muscles of the lips, tongue, lower leg, in severe cases - respiratory failure up to stoppage and asystole.

For prevention development of citrate shock during transfusion of large doses of blood and plasma, after each transfusion 500 ml of blood must be injected into a vein with 10%-10 ml of calcium chloride or calcium gluconate. Introduce the medium at a rate of 40-60 drops/min.

Treatment: stop administration, 10 ml of calcium chloride or 10-20 ml of calcium gluconate must be injected into the vein and monitor the ECG.

Hypocalcemia may occur during rapid transfusion of long-term stored blood (more than 14 days);

Clinic: bradycardia.

Prevention: Slow, drip administration (50-70 ml/min.)

The use of washed red blood cells,

Massive transfusion syndrome

It occurs when up to 3 liters of whole blood from many donors are introduced into the recipient’s bloodstream in a short period of time.

Clinic: bradycardia, ventricular fibrillation, asystole, wound bleeding, acidosis, anemia, development of hepatic renal failure.

Help: The use of fresh frozen plasma, rheopolyglucin, heparin, cardiac glycosides, aminophylline, protease inhibitors, plasmapheresis.

Prevention: Avoid transfusion of whole blood in large quantities.

Transfusions only for strict indications

Use of blood components and products.

The use of the patient's autologous blood (prepared before a planned operation) or taken from the patient's body cavities.

Acute pulmonary failure syndrome


After 3-7 days of storage, microclots form in the blood and aggregation of formed elements occurs. The lungs are the first filter on the path of transfused blood. The capillaries of the lungs retain microclots, which leads to thromboembolism of the pulmonary capillaries, and subsequently to the development of acute pulmonary failure.

Clinic: shortness of breath, cyanosis, tachycardia, moist rales, increased breathing of auxiliary muscles.

Prevention: use for transfusion of disposable systems using filters, blood transfusion with a shelf life of less than 7-10 days.

Septic shock


Occurs when transfusion of poor quality blood occurs,

Clinic: characterized by a sharp increase in temperature to 39-41ºС, chills, drop in blood pressure, abdominal pain, cramps, vomiting

Symptoms of multiple organ failure: anuria, enlarged liver, yellowness of the skin, dullness of heart sounds.

Prevention: visual macroscopic assessment of transfused blood. Blood transfusion with a valid expiration date.

Treatment: cessation of transfusion, administration of large doses of antibiotics, detoxification therapy, antishock therapy, corticosteroids, cardiac glycosides, plasmapheresis.

BLOOD TRANSFUSION COMPLICATIONS

Blood transfusion complications are the most life-threatening for the patient. Most common cause hemotransfusion complications is the transfusion of blood that is incompatible according to the ABO system and the Rh factor (approximately 60%). The main and most severe transfusion complication is transfusion shock.

a) Complications from transfusion of blood incompatible with the ABO system. Blood transfusion shock

The reason for the development of complications in most cases is a violation of the rules provided for in the instructions for blood transfusion techniques, methods for determining ABO blood groups and conducting compatibility tests. When transfusion of blood or EVs that are incompatible with the group factors of the ABO system, massive intravascular hemolysis occurs due to the destruction of the donor's red blood cells under the influence of the recipient's agglutinins.

In the pathogenesis of hemotransfusion shock, the main damaging factors are free hemoglobin, biogenic amines, thromboplastin and other hemolysis products. Under the influence of high concentrations of these biologically active substances, a pronounced spasm of peripheral vessels occurs, quickly giving way to 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 acidic metabolites are functional and morphological changes various organs and systems, that is, a complete clinical picture shock.

A distinctive feature of blood transfusion shock is the occurrence of disseminated intravascular coagulation syndrome with significant changes in the hemostasis and microcirculation system, and gross disturbances in central hemodynamics. It is DIC syndrome that plays a leading role in the pathogenesis of damage to the lungs, liver, endocrine glands and others. internal organs. The starting point in its development is the massive entry of thromboplastin into the bloodstream from destroyed red blood cells.
Characteristic changes occur in the kidneys: hematin hydrochloride (a metabolite of free hemoglobin) and the remains of destroyed red blood cells 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 complications during blood transfusion that is incompatible according to the ABO system, three periods are distinguished:
■ blood transfusion shock,
■ acute renal failure,
■ convalescence.

Transfusion shock occurs immediately during or after transfusion and lasts from several minutes to several hours. In some cases it is not clinically manifested, in others it occurs with severe symptoms leading to the death of the patient.

Clinical manifestations at first they are characterized by general anxiety, short-term agitation, chills, pain in the chest, abdomen, lower back, difficulty breathing, shortness of breath, cyanosis. Pain in the lumbar region is considered a pathognomonic sign for this type of complication. Subsequently, circulatory disorders characteristic of a state of shock gradually increase (tachycardia, decreased blood pressure, sometimes cardiac arrhythmia with symptoms of acute cardiovascular failure). Quite often there are changes in facial color (redness followed by pallor), nausea, vomiting, increased body temperature, marbling of the skin, convulsions, involuntary urination and defecation.

Along with symptoms of shock, one of the early and persistent signs of transfusion shock is acute intravascular hemolysis. The main indicators of increased breakdown of red blood cells are hemoglobinemia, hemoglobinuria, hyperbilirubinemia, jaundice, and liver enlargement. Characteristic is the appearance of brown urine (in the general analysis - leached red blood cells, increased protein content).

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

When incompatible blood is transfused during surgery under anesthesia, as well as against the background of hormonal or radiation therapy reactive manifestations may be erased and symptoms of shock are most often absent or mildly expressed.

The severity of the clinical course of shock is largely determined by the volume of incompatible red blood cells transfused, the nature of the underlying disease and the general condition of the patient before blood transfusion. Depending on the level of blood pressure, there are three degrees of transfusion shock:
I degree - systolic blood pressure above 90 mm Hg. Art.
II degree - systolic blood pressure 71-90 mm Hg. Art.
III degree - systolic blood pressure below 70 mm Hg. Art.

The severity of the clinical course of shock and its duration determine the outcome pathological process. In most cases, therapeutic measures can eliminate circulatory disorders and bring the patient out of shock. However, some time after the transfusion, body temperature may rise, gradually increasing yellowness of the sclera and skin appears, and intensification headache. Subsequently, renal dysfunction comes to the fore, and acute renal failure develops.
Acute renal failure occurs in three alternating phases: anuria (oliguria), polyuria and restoration of renal function. Against the background of stable hemodynamic parameters, daily diuresis sharply decreases, hyperhydration of the body is noted, and the level of creatinine, urea and plasma potassium increases. Subsequently, diuresis is restored and sometimes increases to 5-6 liters per day, while high creatininemia and hyperkalemia may persist (polyuric phase of renal failure).

Treatment. When the first signs of transfusion shock appear, the blood transfusion is stopped, the transfusion system is disconnected and a system with saline solution is connected. Under no circumstances should the needle be removed from the vein so as not to lose ready venous access.
The main treatment is aimed at removing the patient from a state of shock, restoring and maintaining the function of vital organs, relieving hemorrhagic syndrome, and preventing the development of acute renal failure.

Principles of treatment of blood transfusion shock. Infusion therapy. To maintain blood volume and stabilize hemodynamics and microcirculation, transfusions of blood-substituting solutions are performed (the drug of choice is rheopolyglucin, it is possible to use polyglucin and gelatin preparations). It is also necessary to start administering a soda solution (4% sodium bicarbonate solution) or lactasol as early as possible to obtain an alkaline urine reaction, which prevents the formation of hematin hydrochloride. Subsequently, polyionic solutions are transfused to remove free hemoglobin and to prevent fibrinogen degradation. The volume of infusion therapy should correspond to diuresis and be controlled by the value of central venous pressure.

First-line medications. Classic drugs for the treatment of transfusion shock are prednisolone (90-120 mg), aminophylline (10.0 ml of 2.4% solution) and lasix (100 mg) - the so-called classic anti-shock triad. In addition, antihistamines (diphenhydramine, tavegil) and narcotic analgesics (promedol) are used.

Extracorporeal methods. A highly effective method is massive plasmapheresis (exfusion of about 2 liters of plasma with replacement of PSZ and colloidal solutions) to remove free hemoglobin and fibrinogen degradation products.

Correction of the function of organs and systems. According to indications, cardiac glycosides, cardiotonic drugs, etc. are used. In case of severe anemia (HB below 60 g/l), washed red blood cells of the same blood group as the recipient are transfused. With the development of hypoventilation, transfer to artificial ventilation is possible.
Correction of the hemostatic system. Heparin is used (50-70 IU/kg body weight), PSZ is transfused, and anti-enzyme drugs (contrical) are used.
When recovering from shock and the onset of acute renal failure, treatment should be aimed at improving renal function (aminophylline, Lasix and osmodiuretics), correcting the water and electrolyte balance. In cases where therapy does not prevent the development of uremia, progression of creatininemia and hyperkalemia, hemodialysis is required. In this regard, it is advisable to treat patients with acute renal failure in a specialized department equipped with an “artificial kidney” apparatus.

During the period of convalescence, symptomatic therapy is carried out.
Prevention consists of strict adherence to the rules for performing blood transfusion (careful implementation of all sequential procedures, especially reactions to the compatibility of transfused blood).

b) Complications during blood transfusion that is incompatible with the Rh factor and other erythrocyte antigen systems

Complications caused by incompatibility of transfused blood with respect to the Rh factor occur in patients who are sensitized to the Rh factor. This may occur when inserted Rh positive blood Rh-negative recipients sensitized by previous blood transfusion with Rh-positive blood (or in women, pregnancy with an Rh-positive fetus).

The cause of complications in most cases is an insufficiently complete study of the obstetric and transfusion history, as well as failure to comply with or violation of other rules preventing incompatibility for the Rh factor (primarily tests for individual compatibility for the Rh factor).
In addition to the Rh factor Rh0(D), complications during blood transfusion can be caused by other antigens of the Rh system: rh" (C), rh" (E), hr"(c), hr" (e), as well as antigens of the Lewis systems , Duffy, Kell, Kidd, Cellano. The degree of their immunogenicity and significance for the practice of blood transfusion is much lower.

The developing immunological conflict leads to massive intravascular hemolysis of transfused donor red blood cells by immune antibodies (anti-D, anti-C, anti-E) formed during the previous sensitization of the recipient. Next, the mechanism for the development of blood transfusion shock is triggered, similar to ABO incompatibility.

It should be noted that similar changes in the body (except for immune conflict) are observed when a large amount of hemolyzed blood is transfused.
Clinical picture. Clinical manifestations differ from complications of ABO incompatibility in that they have a later onset, a less violent course, slow and delayed hemolysis, which depends on the type of immune antibodies and their titer; When transfusion of blood incompatible with the Rh factor, symptoms appear 30-40 minutes, sometimes 1-2 hours and even 12 hours after the blood transfusion. In this case, the shock phase itself is less pronounced, and its picture is often blurred. Subsequently, a phase of acute renal failure also begins, but its course is usually more favorable.
Treatment is carried out according to the same principles as for ABO incompatibility.
Prevention consists of carefully collecting a transfusiological history and following the rules of blood transfusion.

Transfusion shock can develop directly during a 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.

Mechanism of development of blood transfusion shock

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

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

Blood transfusion rules - video

Causes

All possible reasons states can be divided into 2 groups:

1. Immune:
   • antigenic AB0 and Rh factor Rh;
   • blood plasma incompatibility.
2. Non-immune:
   • penetration of pyrogenic (raising body temperature) substances into the blood;
   • transfusion of low-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 fever;
• increased temperature;
• difficulty breathing and shortness of breath;
• redness, blueness or paleness of the skin;
• frequent and weak pulse;
• low blood pressure;
• heart rhythm disturbances;
• 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 problems painful sensations in the chest and lower back.
2. Over time:
   • the skin becomes pale;
   • blood pressure drops significantly;
   • tachycardia appears;
   • the body becomes covered in cold sweat.
3. On last stage hemoglobinemia (increased content of free hemoglobin in the blood), hemolytic jaundice, renal and liver failure are detected.

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

If shock develops during surgical intervention, That:

• blood pressure drops significantly;
• wound bleeding increases;
• urine takes on the color of “meat slop.”

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

Determination of the degree of shock - table

Diagnostics

Instrumental and laboratory tests must be carried out:

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 red blood cells and platelets is counted using a microscope, after which they are recalculated per 1 microliter.
4. Rutberg's gravimetric method - fibrin formed after plasma coagulation 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, the hematocrit is calculated using a special scale - the ratio of blood cells to plasma.
6. Determination of diuresis - calculate 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, and do an electrocardiogram.

Treatment

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

Treatment consists of several stages:

• provision of emergency assistance;
• infusion therapy;
• blood purification;
• stabilization of the condition.

Emergency care: algorithm of actions

When the first signs of shock appear, you must:

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

After completion of antishock 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 (Reopoliglucin, Polyglucin, Albumin, gelatin preparations) and solutions of glucose, bicarbonate or sodium lactate is done.

To stabilize diuresis and remove breakdown products, diuretics (Hemodez, Mannitol) are administered by drip.

Drug therapy

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

Also prescribed:

• narcotic analgesics (Promedol);
• antihistamines (Diphenhydramine, Suprastin, Tavegil, Diprazin);
• corticosteroids hormonal drugs(Hydrocortisone);
• disaggregants (Complamin, Curantyl, Trental, Aspirin, Aspizol, nicotinic acid);
• heparin;
• cardiovascular medications (Korglikon, Strophanthin).

Classic triad for the treatment of transfusion shock - gallery

Blood purification

Plasmapheresis is used to remove toxic substances and free hemoglobin from the body. In this case, the blood is removed in parts, purified and returned back into the bloodstream.

Stabilization of the body

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 performed;
• if acute renal failure is detected, correct water-electrolyte balance, connect an “artificial kidney”;
• for anemia, washed red blood cells selected individually are administered;
• if progression of uremia is observed, then blood purification is carried out using hemodialysis or hemosorption.

What is a biological sample during transfusion and why is this check needed:

Prevention

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

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

If transfusion shock develops, emergency measures should be taken immediately. The patient’s health and life depend on the timely implementation of anti-shock therapy and rehabilitation measures.

Complications of a blood transfusion nature, such as the most severe - blood transfusion shock, are rightfully considered more dangerous for the patient. Doctors call the most common cause of complications and reactions of a blood transfusion nature a disrupted blood transfusion process that is incompatible with the Rh factor or inappropriate with the ABO system (about 60% of all cases).

Causes, features and changes in organs

The main factors causing complications, in more cases, are violations of the provisions of the rules of blood transfusion, inconsistency with the methods by which blood type is determined, and incorrect sampling when checking for compatibility. During the process of blood transfusion, which turns out to be incompatible according to the group's indications, massive hemolysis occurs inside the vessels, which is caused by the destruction of the donor's red blood cells, which occurs under the influence of agglutinins in the patient.

The pathogenesis of the shock state is characterized by such damaging agents as the main components of hemolysis (amines of biogenic origin, free hemoglobin, thromboplastin). Large concentrations of the listed substances provoke the occurrence of pronounced vasospasm, which is replaced by paretic dilation. Such a difference is main reason resulting oxygen starvation of tissues and microcirculation disorders.

At the same time, the permeability of the vessel walls increases, the viscosity of the blood increases, which significantly worsens its rheological qualities, and further reduces the level of microcirculation. Due to hypoxia for a long time, and the simultaneous concentration of acidic metabolites, dysfunctions of organs and systems, as well as their morphological changes, appear. The stage of shock begins, at which immediate, urgent Care.

The difference that characterizes blood transfusion shock is disseminated intravascular coagulation syndrome, which is accompanied by significant changes in hemostasis and microcirculatory process. All hemodynamic parameters change sharply. The syndrome is considered the main factor in the pathogenetic picture of disorders in the lungs, endocrine glands and liver. The main provocation of its development - the highest point of the clinical picture - is the full penetration of thromboplastin into the bloodstream from destroyed red blood cells - erythrocytes.

The kidneys at this time undergo characteristic changes associated with the concentration in the renal tubules of hematin hydrochloride (a metabolite of free hemoglobin) and the remnants of destroyed red blood cells. In combination with simultaneous spasm of the renal vessels, these changes cause a decrease in renal blood flow and a decrease in glomerular filtration. This combined clinical picture of disorders reveals the main reason why acute renal failure develops.

During the clinical picture of complications encountered during blood transfusion, there are 3 main periods:

• the actual onset of shock;
• the occurrence of acute renal failure;
• disappearance process clinical signs shock - convalescence.

Shock of a blood transfusion nature occurs specifically during the transfusion process, and/or immediately after it. It can last for a few minutes or for several hours. In some cases, shock does not manifest itself in a clear clinical picture, and is sometimes accompanied by pronounced manifestations that can be fatal.

Symptom Clinic

Signs of the onset of shock are:

• general anxiety;
• sudden excitement for a short period;
• feeling of cold, chills;
• painful sensations in the abdomen, chest, lower back;
• heavy breathing and shortness of breath;
• the appearance of a bluish tint of the skin and mucous membranes, signs of cyanosis.

Doctors call the appearance of pain in the lumbar region a “marker” symptom, or a pathognostic (pathognomonic) manifestation that characterizes this pathological condition.

It is accompanied by a gradual (or sharp) increase in disturbances of circulatory origin, signs of a state of shock (the appearance of tachycardia, a decrease in blood pressure, a failure of the heart rhythm with manifestations of acute cardiovascular failure).

Such manifestations as:

• change in facial skin color - redness, pallor;
• vomit;
• the appearance of temperature;
• “marbling” of the skin;
• convulsions;
• involuntary defecation and urination.

Doctors consider persistent hemolysis of blood vessels to be one of the symptoms of the early manifestation of a state of shock, with indicators of the breakdown of red blood cells - signs of hemoglobinemia or hemoglobinuria, hyperbilirubinemia, jaundice (enlarged liver). The urine turns brown, tests show a high protein content and destruction of red blood cells. The development of disturbances in the hemocoagulation process also begins sharply, the clinical picture of which is manifested by profuse bleeding. The severity and level of hemorrhagic diathesis depend on the same factors of the hemolytic process.

Doctors should be sure to monitor the blood transfusion process during operations performed under anesthesia, as symptoms may be mild or not appear at all.

Course of the pathology

The extent of the condition largely depends on the volume of incompatible red blood cells transfused, the type of primary disease and the condition of the patient before the blood transfusion procedure.

The level of pressure determines to what degree experts classify transfusion shock:

• 1st degree shock occurs with systolic blood pressure over 90 mm Hg. Art.
• Stage 2 is characterized by pressure in the range of 71 mm Hg. Art. up to 90 mm Hg Art.
• Stage 3 is diagnosed when systolic blood pressure is less than 70 mm Hg. Art.

In most cases, assistance was provided on time and carried out properly healing procedures make it possible to stop the circulatory disorder, bring the patient out of shock, and eliminate its consequences.

Although characteristic is considered to be an increase in temperature some time after the transfusion, the appearance of yellowness of the sclera and skin, with a gradual increase, and increased headache. After a certain period of time may begin functional disorders in the kidney area, and develop acute renal failure. This pathology continues through alternating stages: anuria-polyuria-recovery period.

When hemodynamic factors are stable, the following occurs:

• a sharp decrease in daily diuresis;
• state of overhydration of the body;
• increased levels of creatinine, plasma potassium and urea.

Principles and methods of treatment procedures

At the first manifestation of symptoms of shock of a blood transfusion nature, the blood transfusion process is immediately stopped, the drip for transfusion is disconnected, and infusions begin saline solution. In this case, it is strictly forbidden to remove the needle from the vein, since you may lose ready-made access to the vein.

The main focus of recovery from shock is to restore all functions of the body, maintain them, relieve the syndrome, and eliminate the consequences in order to prevent further development of disorders.

Types of treatment procedures

• Infusion therapeutic methods. To stabilize hemodynamics and restore microcirculation, blood replacement solutions are transfused - rheopolyglucin is considered the best option (polyglucin and gelatin preparations are also used).

In addition, a 4% solution of sodium bicarbonate (soda solution) or lactasol is started to be administered as early as possible in order to initiate an alkaline reaction in the urine, which is an obstacle to the formation of hematin hydrochloride. In the future, it is advisable to transfuse solutions of polyions, which promote the excretion of free hemoglobin and also prevent the degradation of fibrinogens. The volume of the infusion procedure is controlled by the value of central venous pressure.

Forecasts

The patient’s future condition, and often life, depends on how timely and competently the rehabilitation therapy is carried out and all the appropriate measures are taken. If all procedures are carried out correctly in the first period (4-6 hours), doctors’ forecasts are positive, as is the patient’s complete return to a full-fledged lifestyle. Moreover, timely assistance in 75% of cases prevents severe organ dysfunction.