V. Table of contents of teaching

Basic concepts at antigens properties of blood, blood type, Rh-factor and their practical value.

Blood type - genetically conditioned biological sigh which is characterized by the set of antigens which are contained in the uniform elements of blood (red corpuscles, leucocytes, thrombocytes) and squirrels of plasma of the given individual. Notion about blood types which use in clinical practice includes the red corpuscles antigens of the system ABO and Rh-factor, so as they active and come forward the most frequent reason of incompatibility at hemotransfusion. Landshteyner (1901) took to I groups of people at which a whey agglutinin the ІІ and ІІІ groups with red corpuscles, and red corpuscles in the whey of other groups not agglutination; in the ІІ group a whey agglutination the ІІІ groups with red corpuscles, and the red corpuscles of the ІІ group agglutination with a whey I and the ІІ groups. However it appeared that separate people as though have not submitted to this law. So Jansky (1907) was opened the ІV group in which whey of not agglutination with the red corpuscles of other groups, and red corpuscles cause agglutination with the whey of people of three other groups.

The above-mentioned blood types are strictly incorporated in the sole system which named the system A, B, O. In Europe 42-44% people have a blood type A (ІІ); a group 0 (І) is the second on frequency and makes 38-39%, group B (ІІІ) there is that group AB (ІV) in 4-6% in 12-14%. Every blood type is characterized by separate antigens (agglutinogens) and agglutinins.

Antigens (agglutinogens A also B and antigen 0, which is a weak antigen in red corpuscles I group and does not give the reaction of agglutination) are termolabile organic compounds. They are found in red corpuscles, as well as in all other fabrics of organism except for a brain. Have the practical value agglutinogen, located on the surface of uniform elements of blood, they are the reason of izoimmunization and with them unite antibodies, causing agglutination and hemolisis.

Agglutinin ( or ) - termolabile globulins of plasma of blood; they are found also in a lymph, exudate and transudate. Group to the agglutinin blood present by itself the molecules of gamut-globulins which differ from other globulins by power specifically to unite with the of the same name antigens of blood.

Complete denotations of blood types :

I group – 0 (І)  ,

ІІ group – A (ІІ) ,

ІІІ group – B (ІІІ) ,

ІV group – AB (ІV)

Earlier it was adhered to a law Otenberg, according to which the red corpuscles of the poured donor blood agglutination only, and no recipient. It was considered, that agglutinin donor blood divorce in the blood of recipient and are not able agglutination his red corpuscles. This circumstance allowed at a level with same group of blood to pour the blood of other group, the whey of which not agglutinate the red corpuscles of recipient. Donors with a 0(І) blood type quite often are named “universal donors”, and recipients with the AB (ІV) group - “universal recipients”. In the last few years it is led to, that there are a few sub-groups of agglutinogen. From the sub-groups of agglutinogen A most essential A1 and A2. A1 – strong antigen, find him approximately in 88% people with And (ІІ) blood type, and the reaction of agglutination runs across is quickly and sharply expressed. A2 – weak antigen, he is found in 12% people; the reaction of agglutination runs across poorly and is heavily noticeable (Antigens A3, A4, A0 and in.). Agglutinogen B also has a few sub-groups. Their difference only quantitative and to attention they are not adopted. In our time it is settled to pour only an same group of blood to the patients.

Opened Rh-factor (Rh) in 1940 C.Landshteyner and A.Viner. It is a strong antigen which was inherited. He is found in red corpuscles, leucocytes, thrombocyte different organs and in liquids, around fetus waters. If a blood with a positive Rh-factor gets to the man with Rh-negative blood, specific antibodies appear – anti-Rh -agglutinins; they can appear at Rh-negative pregnant from Rh-positive fetus. It is led to, that approximately 85% people of Rh-positive, other 15% - Rh -negative. The practical value is had by 6 antigens of the system Rh-Hr (D, C, E, d, c, e). At blood transfusion it follows strictly to hold to principle of the use of blood of homogeneous for Rh-factor. Before blood transfusion it follows to set Rh belonging of donor and recipient and to conduct a test on Rh-compatibility.

Determination to the Rh-factor is based on the use of a 50% mixture of red corpuscles in an own whey. Mixture of red corpuscles that whey of anti-Rh inflict on a cup Petri, which later place on water bath-house at a temperature 45-48 S on 10 minutes. On ending of term rock a cup and read a result on a presence or absence of agglutination of red corpuscles.

Monoclonal reagents (antibodies) are intended for the exposure of separate antigens of the system Rh on the red corpuscles of man. They can be applied in place of izoimmunity serum or parallel with them. The reaction with monoclonal anti-Rh test-reagents can be put in test tubes, on a plane and in the microplats. The reaction of agglutination on a plane is most accepted in practice.

At presence of absolute shows to blood transfusion knowing a blood type and Rh-factor to the patient of more frequent from the station blood transfusion deliver preparations of blood. in our time it is possible to pour same group and blood same Rh. On every transfusion of preparations of blood proceedings of transfusion is filled, where before transfusion a pulse, arterial pressure, temperature of body, general blood test, is determined, general analysis of urine. These researches are conducted after blood transfusion. At first before transfusion macroestimation of preparations of blood is conducted. in red corpuscles mass must not be clots. She has the small volume of plasma above the layer of formation red corpuscles. Red corpuscles mass is got from a canned blood by the separation of plasma. The Transfusion environment contains not less than 70% red corpuscles and is optimum in medical treatment of anemic syndrome.

The washed red corpuscles are got from a whole blood (after the selection of plasma). Red corpuscles mass either the frozen red corpuscles wash in 0.9% solution of NaCl or in the special wash environments. In the process of washing the squirrels of plasma, leucocytes, thrombocyte, microagregants of cages and stroma of lost at saving cellular elements, are selected. The washed red corpuscles – this areactogenic transfusion environment and is shown to the patients, at which in anamnesis were to the posttransfusion reaction and also patients which by the sensibilisation antigens of albumens. In communication with absence in the washed red corpuscles of stability of blood and products of metabolism of cellular elements which result in toxic action, them transfusion is shown in therapy of heavy anemia at patients with hepatic and kidney insufficiency and at „syndrome of massive hemotransfusion”. The less risk of infection by viral hepatitis and AIDS is advantage of application of the washed red corpuscles. The washed red corpuscles at a temperature are saved +4^оС – 24 hours from the moment of their making.

Native plasma or fresh-frozen at preparation is to be yellow, transparent. If plasma rose or turbid, with flakes, such blood useless for transfusion. A small bottle with preparations of blood is to be hermetically closed, on a label the noted date of taking away of blood, blood type and Rh-factor (stamp of dark blue color – Rh positive, red – Rh negative). Label with to the small bottle is taken off and registered in protocol of transfusion. After macroestimation of blood (if she suitable for transfusion) puncture is conducted to the small bottle and again determined blood type in a small bottle. If blood type of donor and recipient coincide, before transfusion 3 tests are conducted on compatibility.

At transfusion of preparations of blood during anesthesia the will be falling of arterial pressure and rise of frequency of pulse can testify about the reactions and complications. In such case transfusion of preparations of blood it is necessary to stop. A surgeon must decide a question about the reason of hemodynamic violations and if except for hemotransfusion other reasons are not present, it follows fully to halt transfusion. After transfusion the container or bottle with tailings of hemotransfusion environment are saved in a refrigerator 48 hours. A recipient after transfusion during 2 hours is found abed and a treating doctor looks after his state. Temperature of body, arterial pressure, pulse and indexes, is hourly taken write down in proceedings of transfusion of preparations of blood. The control of selection of urine and its color is conducted. On a next day the clinical blood test and urine is necessarily conducted. A doctor is under an obligation to write down in proceedings of blood transfusion or in a hospital chart the following data:

• shows to hemotransfusion

• passport data from every bottle or container (the last name of donor, blood type, to the Rh -factor, date of prepare and number of bottle or container)

• results of final check of blood type of recipient on the system ABO

• results of final check of blood type of donor on the system ABO, taken from a bottle or container

• results of test on Rh-compatibility

• results of test on biological compatibility

• method and way of introduction of blood.

Action of the poured blood on an organism:

1. Substitute (at sharp and massive loss of blood).

2. Stimulant action of blood due to plasma albumens (pressure rises, gets better breathing and in.).

3. Haemostatic action (direct transfusion 100-200 ml. blood or plasma).

4. Immunobiological action at medical treatment of infectious diseases, septic states.

5. Dezintoxication action (disinfecting action) is the globulins of blood.

Shows to blood transfusion.

There are the absolute and relative shows.

Absolute:

1. Main show to blood transfusion is sharp loss of blood (hemorrhagic shock). Reduction of hemoglobin on a fourth and falling of arterial pressure below 80 mm. of rt. to the item immediate blood transfusion is required. At chronic loss of blood is poured in less doses finely (relative show).

2. Shocks (burn or traumatic).

3. Operations of large volume

All other shows to transfusion are relative.

Contra-indication to blood transfusion.

1. Heavy functional violations of liver and buds, sharp cardiac insufficiency and disease is related to stagnation in the small circle of circulation of blood; absolute contra-indication is the edema of lights.

2. Thrombophlebitis, thrombosis, embolism heart attacks, traumas of cerebrum of eclampsia, rheumatism

3. Allergic states and diseases (sharp eczema, bronchial asthma)

4. Active tuberculosis (process in the stage of infiltration)

Methods and tests before blood transfusion.

Distinguish direct, indirect, reverse, exchange and extracorporeal methods of transfusion.

Direct transfusion is executed directly from a donor to the recipient. Shows: afibrinemia, heavy after delivery bleeding, violation of the coagulation system of blood.

Indirect transfusion - the canned is used, the stabilized blood. Transfusion can be intravenous, endarterial, in spongy fabric of bone. Pressure is the show for endarterial blood transfusion below 70 mm. of rt. st.; in bone blood transfusion is used in the exceptional case (burns, at impossibility to execute puncture of vein).

Autotransfusion - prepare of autohemoculture and plasma by the method of plasmapharesis.

Reinfusion - his blood transfusion to the patient, which was outpoured in cavities (pectoral, abdominal).

Exchange blood transfusion - is executed at poisoning. It is let out parts of blood and simultaneously overflowed blood with some exceeding of volume.