Blood Transfusion


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blood transfusion,

transfer of blood from one person to another, or from one animal to another of the same species. Transfusions are performed to replace a substantial loss of blood and as supportive treatment in certain diseases and blood disorders. When whole blood is not needed, or when it is not available, plasma, the fluid of the blood without the blood cells, can be given. Alternately, such components of the blood as red cells, white cells, or platelets may be given for particular deficiencies. Blood substitutesblood substitute,
substance that mimics the function of blood. Blood substitutes typically concentrate only on reproducing the function of hemoglobin, the molecule that carries oxygen through the body, and do not attempt to replicate the blood's other functions.
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, which are under development, are expected ultimately to ease the chronic short supply of blood and to alleviate certain storage and compatibility problems.

In whole-blood transfusions, the blood of the donor must be compatible with that of the recipient. Blood is incompatible when certain factors in red blood cells and plasma differ in donor and recipient; when that occurs, agglutinins (i.e., antibodies) in the recipient's blood will clump with the red blood cells of the donor's blood. The most frequent blood transfusion reactions are caused by substances of the ABO blood groupblood groups,
differentiation of blood by type, classified according to immunological (antigenic) properties, which are determined by specific substances on the surface of red blood cells.
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 system and the Rh factorRh factor,
protein substance present in the red blood cells of most people, capable of inducing intense antigenic reactions. The Rh, or rhesus, factor was discovered in 1940 by K. Landsteiner and A. S.
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 system. In the ABO system, group AB individuals are known as universal recipients, because they can accept A, B, AB, or O donor blood. Persons with O blood are sometimes called universal donors, since their red cells are unlikely to be agglutinated by the blood of any other group. In the Rh factor system, agglutinins are not produced spontaneously in an individual but only in response to previous exposure to Rh antigens, as in some earlier transfusion. Transfusion reactions involving incompatibility eventually cause hemolysis, or disruption of donor cells. The resulting liberation of hemoglobin into the circulatory system, causing jaundice and kidney damage, can be lethal.

In addition to providing for the compatibility of blood groups in transfusion, it is necessary to determine that the donor's blood is free of organisms that might cause syphilissyphilis
, contagious sexually transmitted disease caused by the spirochete Treponema pallidum (described by Fritz Schaudinn and Erich Hoffmann in 1905). Syphilis was not widely recognized until an epidemic in Europe at the end of the 15th cent.
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, malariamalaria,
infectious parasitic disease that can be either acute or chronic and is frequently recurrent. Malaria is common in Africa, Central and South America, the Mediterranean countries, Asia, and many of the Pacific islands.
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, serum hepatitishepatitis
, inflammation of the liver. There are many types of hepatitis. Causes include viruses, toxic chemicals, alcohol consumption, parasites and bacteria, and certain drugs.
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, or HIVHIV,
human immunodeficiency virus, either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States.
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, the virus believed to cause AIDSAIDS
or acquired immunodeficiency syndrome,
fatal disease caused by a rapidly mutating retrovirus that attacks the immune system and leaves the victim vulnerable to infections, malignancies, and neurological disorders. It was first recognized as a disease in 1981.
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. Allergic reactions to transfusions may occur in cases where allergic antibodies have been transmitted from the donor's blood, possibly because of some type of food recently ingested by the donor. These problems have increased the popularity of autologous transfusions, transfusions using a person's own blood, which has been donated ahead of time. See blood bankblood bank,
site or mobile unit for collecting, processing, typing, and storing whole blood, blood plasma and other blood constituents. Most hospitals maintain their own blood reserves, and the American Red Cross provides a nationwide collection and distribution service.
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.

Blood Transfusion

 

the branch of hematology concerned with the transfusion of blood and its component elements.

The use of blood for therapeutic purposes began with attempts in antiquity and the Middle Ages to transfuse the blood of animals to human beings. In 1667 the French scientist J. Denis successfully transfused the blood of a lamb to an anemic patient. Subsequent attempts to transfuse animal blood to sick human beings proved fatal and the procedure was banned in a number of countries. In 1819 the English obstetrician J. Blundell was the first to transfuse the blood of one person to another. In 1832 in Russia the obstetrician G. S. Vol’f transfused human blood and saved the life of a woman dying of uterine hemorrhage. A. M. Filomafitskii’s Treatise on Blood Transfusion (As the Only Means in Many Cases of Saving an Expiring Life) in Its Historical, Physiological, and Surgical Aspects (1848) was the first basic work on blood transfusion in Russia. It was not until the establishment of blood groups in 1901 by the Austrian scientist K. Landsteiner and in 1907 by the Czech physician J. Jansky and the introduction in 1914 of sodium citrate as a means of preserving blood that transfusion became safe and was brought into wide use. The discovery of the rhesus (Rh) factor by the American scientist A. Wiener made the procedure even safer. In 1919 in Soviet Russia, V. N. Shamov was the first to transfuse blood taking group compatibility into account. In 1921, N. N. Elanskii prepared standard sera to determine blood group. In 1926 in Moscow, A. A. Bogdanov founded the world’s first scientific institute of blood transfusion; A. A. Bogomolets, I. R. Petrov, S. I. Spasokukotskii, M. P. Konchalovskii, and Kh. Kh. Vlados began to develop the science of blood transfusion. By 1932 three large scientific methodological and organizational centers for blood transfusion (in Moscow, Leningrad, and Kharkov) had been organized. The network of scientific institutions dealing with the most urgent matters in blood transfusion and hematology was subsequently enlarged. In addition to the specialized institutes, many blood transfusion stations are concerned with the study of blood transfusion. S. D. Balakhovskii, D. N. Belen’kii, A. D. Beliakov, P. S. Vasil’ev, F. R. Vinograd-Finkel’, S. E. Severin, A. E. Kiselev, A. N. Filatov, and others conducted research on one of the fundamental problems of transfusion—the preservation of blood and its components (red and white blood cells, plasma, and so on). As a result of this research it became possible to extend the storage time of whole blood and its preparations by freezing and flash freezing. Considerable progress was also made in the preservation of bone marrow (A. G. Fedotenkov, S. S. Lavrik, N. G. Kartashevskii, and others).

An important aspect of the science of blood transfusion is fractionation (the separation of blood proteins). The protein preparations obtained by fractionation (protein, albumin, fibrinogen, fibrinolysin, thrombin, and gamma globulin) are used for therapeutic purposes. The use of plasmapheresis, which involves the separation of blood obtained from a donor into plasma and formed elements and returning the red blood cells to the donor, makes it possible to obtain 6 to 7 liters of plasma per year from a single donor without impairing his health. The investigations of S. I. Spasokukotskii, P. L. Sel’tsovskii, V. I. Kazanskii, A. V. Guliaiev, B. V. Petrovskii, and D. M. Grozdov have been devoted to the surgical aspects of blood transfusion. Hemotherapy was brought into use in the clinical aspects of internal and infectious diseases, obstetrics, and gynecology thanks to the work of A. A. Bagdasarov, P. M. Al’perin, and M. S. Dul’tsin. The serological studies of N. I. Blinov, N. V. Popov, and M. A. Umnova on blood groups, the formation of group factors, and the capacity of the sick to produce antibodies have taken a major place in the science of blood transfusion. V. N. Shamov and S. S. Iudin worked on the pressing problems of the procurement and preservation of cadaveric blood.

The first International Congress on Blood Transfusion was held in Rome in 1935 and the International Society of Blood Transfusion was founded. Soviet scientists are active participants in its work as well as in their own scientific society.

REFERENCES

Gavrilov, O. K. Ocherki istorii razvitiia i primeneniia perelivaniia krovi. Leningrad, 1968.
Rukovodstvo po perelivaniiu krovi i krovozamenitelei. [Leningrad] 1965.

A. M. POLIANSKAIA


Blood Transfusion

 

the introduction of a donor’s whole blood or blood components into a recipient’s bloodstream. Blood transfusions are performed to replace red blood cells, to partially replace plasma proteins, and to halt bleeding. Detoxicants, including Neocompensan, and blood substitutes are transfused to treat poisonings and to restore the volume and osmotic pressure of circulating blood. Blood transfusion is indicated in many conditions, including traumatic shock, operations that involve considerable blood loss and internal bleeding, for example, operations on the stomach and lungs, and chronic posthemorrhagic anemia. Other conditions that require blood transfusions include aplastic anemia, chronic suppurative processes, burns, severe infections, and severe poisonings.

In order to replace erythrocytes, packed red blood cells can be transfused. The therapeutic effect of packed red blood cell transfusion is long lasting, since donor erythrocytes circulate in the patient’s blood for up to three months. A concentrate of fresh leukocytes can be transfused to correct leukocyte deficiencies. Plasma proteins do not become active in metabolism before three to four weeks after transfusion, and thus, plasma-protein transfusion is not a method of parenteral feeding. For hemostasis, 70–100 ml of fresh blood is introduced. Antihemophilic plasma, which is a concentrate of freshly frozen plasma, is administered to hemophiliacs.

Blood can be transfused directly from donor to recipient or indirectly, in which case whole blood is first collected in a flask that contains a preservative. With both direct and indirect transfusions, the blood is introduced drop by drop into a peripheral vein, usually the ulnar, or into a large vein, for example, the subclavian; such a transfusion is a form of drip treatment. In acute massive bleeding, the intra-arterial jet method is used, while transfusion for newborns makes use of the umbilical vein, cerebral sinus, and cranial veins.

Prior to every transfusion, the blood group, Rh (Rhesus) status, and individual compatibility of the donor’s and recipient’s blood are checked. In addition, a test is run during which the patient’s condition is observed for ten to 15 minutes after an injection of 20–25 ml of the new blood. Observance of these procedures helps to prevent complications. Usually, the blood group of the donor matches that of the recipient.

If the recipient lacks the Rh factor, only Rh-negative blood can be transfused. The first Rh-negative blood group is compatible with all patients, regardless of their native blood group. Blood is transfused by a physician under aseptic conditions. If side effects develop, for example, chills, lower back pain, nausea, or hives, the patient is covered and given hot liquids and injections of caffeine, Fargan and sedatives.

Whole blood is obtained, prepared, and distributed to hospitals and clinics by blood banks.

A. N. SMIRNOV

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