Humanity has been convinced of the miraculous power of blood since ancient times. Even Homer described the sixth adventure of Odysseus, who, trying to return the consciousness and speechlessness to the deceased prophet Tiresias, gave his shadow to drink the blood of sacrificial animals. Hippocrates was convinced of the effectiveness of the treatment of the mentally ill with the blood of healthy people.
In the writings of Pliny and Celsus, there are stories that the elderly took the blood of dying gladiators for the purpose of rejuvenation. There is a known case when the decrepit Pope Innocent VIII tried in vain to regain strength and youth by drinking a drink made from the blood of three ten-year-old boys.
Blood was used for medicinal purposes during the wars. For example, the Egyptian troops were always followed by herds of sheep, whose blood was used to heal the wounded. The ancient Greek king Constantine, who suffered from leprosy, used the blood to take medicinal baths. For many centuries it was believed that drunk blood can replace a person that he lost as a result of injury or illness.
The circulatory system in the human body was described in 1628 by the English scientist William Harvey. He discovered the law of blood circulation, deduced the basic principles of the movement of blood in the body, which after a while allowed him to start developing a method of blood transfusion.
Modern fears of medicine are perhaps an echo of the early days of blood transfusion. The methods of two or three centuries ago were really exotic. In the 60s of the 17th century, at the dawn of experiments with blood, Europeans feared that blood transfusion could cause a change in biological species.
Although at first things went pretty smoothly: William Harvey discovered blood circulation, then surgeons in London and Paris began experimenting with blood transfusions from calves and sheep to dogs, from dogs to cows, from goats to horses and from sheep to people. The first recipient was Arthur Koga, a student from Cambridge. Samuel Pepys (English naval officer, author of the famous diary about the daily life of Londoners during the Stuart Restoration period, 17th century) wrote in his diary that this young man "did not get along with his head", and, according to the logic of the time, his blood should have been cooled a little … The experiment was successful, Koga did not die. It is possible that the imperfection of the equipment saved him: at that time goose feathers and silver tubes were used for blood transfusions, and in the end, apparently, he got little.
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By 1667, the London surgeons were surpassed by the French. The greatest success was achieved by Jean-Baptiste Denis, who conducted a massive demonstration of blood transfusion on the banks of the Seine. Denis transfused the blood of a lamb to a sick sixteen-year-old boy, then from a calf to a madman Antoine Moreau, formerly an irreplaceable lackey of the Marquis de Sevigne.
Denis wrote about the transfusion of blood from animals to humans: “Animals do not spoil their health either by excess in food and drink, or by strong passions; violence can be used against animals, which cannot and is dangerous to do with people; animals can be prepared for this operation with selected food, and if the milk and meat of animals are nutritious food for sick and healthy people, why not use their blood?"
Less cold-blooded doctors of the time were trying to figure out whether a blood transfusion could cause the recipient to inherit some of the donor's traits. For example, Robert Boyle asked: "Will the color of the coat or feathers of the recipient animal change to match the color of the donor?"
Numerous experiments have brought a number of failures along with successful results. This led to the fact that in France in 1670 a law was passed to prohibit transfusion. This was followed by the ban of the Vatican (1675).
The first blood transfusion from person to person was carried out in 1818 by the Englishman James Blundell. The peculiarity of the technique used by D. Blundell was that the blood was heated in a specially designed apparatus and thus its coagulation slowed down. In addition, he suggested that blood should be injected slowly, observing the patient's condition. If any reaction appeared, he recommended stopping the blood transfusion from this donor and taking blood from another person.
A real breakthrough in the practice of blood transfusion was the experiments of the British obstetrician James Blundell, who in 1818 saved the life of one of his patients by transfusing her husband's blood. Working extensively on the problems of transfusiology, Blundell invented the first convenient instruments for the collection and transfusion of blood. Blundell performed 10 transfusions between 1825 and 1830, five of which saved the lives of his patients. In 1830-1831, James Blundell published the results of his research.
The first mention of blood transfusion in Russian literature belongs to S. F. Hotovitsky (1796-1885) and refers to 1830. He recommended "blood transfusion as the only means to save life in cases of severe blood loss in women in labor."
This proposal was carried out by the St. Petersburg obstetrician G. Wolf, who in 1832 made the first blood transfusion in Russia to a postpartum woman who was dying from bleeding. The woman who was fatally drained of blood during childbirth was saved. He subsequently received six more blood transfusions.
Using the instruments invented by Blundell and his technique, the Russian obstetrician Andrei Wolf was able to save a woman in labor with severe postpartum hemorrhage. In 1840, under the leadership of Blundell, English physician Samuel Armstrong Lane first used blood transfusion to treat hemophilia.
In 1847, an employee of Moscow University I. M. Sokolov made the first transfusion of blood serum to a person for therapeutic purposes. The transfusion was done for cholera and was successful. In the West, this procedure was repeated only in the 30s of the XX century.
In total, about 60 therapeutic blood transfusions were performed in Russia in the 19th century. The development of this method was hampered by ignorance of the laws of blood compatibility and the inability to prevent its coagulation.
Only in 1901, the Viennese scientist Karl Landsteiner discovered three blood groups in humans (for which he was awarded the Nobel Prize in 1930). A year later, his employees Decostello and Sturley supplemented it with a dedicated fourth group. A few years after that, blood transfusion became a mass procedure, and the First World War became the main impetus for the development of the procedure.
In 1902, Karl Landsteiner's colleagues Alfred de Castello and Adriano Sturli added a fourth blood group to the list - AB.
All these discoveries gave a powerful impetus to research in the field of cross-compatibility of blood, and already in 1907 in New York, the first blood transfusion was made to a patient from a healthy person, with a preliminary screening of the donor and recipient's blood for compatibility. The doctor who performed this transfusion, Ruben Ottenberg, over time drew attention to the universal suitability of the first blood group.
The following years were marked by major research in the prevention of blood clotting, both surgically and chemically, and in the preservation and storage of blood.
Another important discovery was made by American doctors Roger Lee and Dudley White. They have empirically proved that blood of the first group can be transfused to patients with any group, and patients with the fourth blood group are suitable for any other blood group. This is how the concepts of "universal donor" and "universal recipient" appeared.
The following years were marked by research in the field of combating blood clotting - both surgically and chemically, as well as in the field of blood preservation.
The use of a solution of sodium citrate and glucose made it possible to store blood for several days after donation, and thus create a certain supply in case of the need for numerous transfusions. Mass blood transfusions were first used during the First World War in England.
In our country, the practice of blood transfusion was widely used only in the 20s of the last century. The first scientifically grounded blood transfusion, taking into account its group affiliation in the Soviet Union, was made on June 20, 1919 by a prominent Russian and Soviet surgeon Vladimir Shamov.
This was preceded by extensive preparatory work on the creation of domestic standard sera for determining the blood group. Simultaneously with the introduction of the clinical practice of blood transfusion, the issues of the development of the institution of donation became relevant.
Wikipedia says:
Transfusiology (from Lat. Transfusio "transfusion" and -logy from Old Greek. Λέγω "I say, I inform, I tell") is a branch of medicine that studies the issues of transfusion (mixing) of biological and replacing them fluids of organisms, in particular blood and its components, blood groups and group antigens (studied in blood transfusiology), lymph, as well as problems of compatibility and incompatibility, post-transfusion reactions, their prevention and treatment.
Types of blood transfusion
Intraoperative reinfusion
Intraoperative reinfusion is a method based on the collection of blood poured into the cavity (abdominal, chest, pelvic cavity) during the operation, and the subsequent washing of erythrocytes and their return to the bloodstream.
Autohemotransfusion
Autohemotransfusion is a method in which the patient is both a donor and a recipient of blood and its components.
Homologous blood transfusion
Direct blood transfusion
Direct blood transfusion is a direct blood transfusion from donor to recipient without stabilization or preservation.
Indirect blood transfusion
Indirect blood transfusion is the main method of blood transfusion. With this method, stabilizers and preservatives are used (citrate, citrate-glucose, citrate-glucose-phosphate preservatives, adenine, inosine, pyruvate, heparin, ion-exchange resins, etc.), which makes it possible to prepare blood components in large quantities, as well as store it for a long time. time.
Exchange transfusion
In exchange transfusion, donor blood is infused simultaneously with the recipient's blood sampling. Most often, this method is used for hemolytic jaundice of newborns, with massive intravascular hemolysis and with severe poisoning.
Blood preparations
Blood components
Erythrocyte mass is a blood component consisting of erythrocytes (70-80%) and plasma (20-30%) with an admixture of leukocytes and platelets.
Erythrocyte suspension is a filtered erythrocyte mass (the admixture of leukocytes and platelets is lower than in the erythrocyte mass) in a resuspension solution.
Erythrocyte mass, washed from leukocytes and platelets (EMOLT) - erythrocytes washed three times or more. The shelf life is no more than 1 day.
Thawed washed erythrocytes are erythrocytes that have undergone cryopreservation in glycerin at a temperature of -195 ° C or -80 ° C. In a frozen state, the shelf life is not limited (according to regulatory documents - 10 years), after defrosting - no more than 1 day (repeated cryopreservation is not allowed).
Granulocytes is a transfusion medium with a high content of leukocytes. The shelf life is 24 hours.
Platelet concentrate is a suspension (suspension) of viable and hemostatically active platelets in plasma. It is obtained from fresh blood by thrombocytopheresis. Shelf life - 5 days on condition of continuous stirring.
Plasma is a liquid component of blood, obtained by centrifuging and settling it. Apply native (liquid), dry and fresh frozen plasma. When transfusing fresh frozen plasma, the Rh factor and blood group are taken into account according to the ABO system (order No. 363, order No. 183n).
Complex action blood preparations
Complex action drugs include plasma and albumin solutions; they simultaneously have a hemodynamic, anti-shock effect. The greatest effect is caused by fresh frozen plasma due to the almost complete preservation of its functions. Other types of plasma - native (liquid), lyophilized (dry) - largely lose their medicinal properties during the manufacturing process, and their clinical use is less effective. Fresh frozen plasma is obtained by the method of plasmapheresis (see Plasmapheresis, cytapheresis) or centrifugation of whole blood with rapid subsequent freezing (in the first 1-2 hours after taking blood from the donor). It can be stored for up to 1 year at 1 ° -25 ° and below. During this time, all factors of blood coagulation, anticoagulants, components of the fibrinolysis system are preserved in it. Immediately before transfusion, the freshly frozen one is thawed in water at t ° 35-37 ° (to accelerate the thawing of the plasma, the plastic bag in which it is frozen can be kneaded in warm water by hand). Plasma should be transfused immediately after rewarming for the first hour in accordance with the attached instructions for use. Flakes of fibrin may appear in thawed plasma, which does not prevent it from being transfused through standard plasticate systems with filters. Significant turbidity, the presence of massive clots indicate the poor quality of the plasma: in this case, it cannot be transfused. Plasma should be transfused immediately after rewarming for the first hour in accordance with the attached instructions for use. Flakes of fibrin may appear in thawed plasma, which does not prevent it from being transfused through standard plasticate systems with filters. Significant turbidity, the presence of massive clots indicate the poor quality of the plasma: in this case, it cannot be transfused. Plasma should be transfused immediately after rewarming for the first hour in accordance with the attached instructions for use. Flakes of fibrin may appear in thawed plasma, which does not prevent its transfusion through standard plasticate systems with filters. Significant turbidity, the presence of massive clots indicate the poor quality of the plasma: in this case, it cannot be transfused.
Hemodynamic drugs
These drugs are used to replenish the circulating blood volume (BCC), have a persistent volemic effect, and retain water in the vascular bed due to osmotic pressure. Volumetric effect 100-140% (1000 ml of the injected solution replenishes the BCC by 1000-1400 ml), volumetric effect from three hours to two days.
There are 4 groups:
albumin (5%, 10%, 20%)
preparations based on gelatin (Gelatinol, Gelofusin)
dextrans (Polyglyukin, Reopoliglyukin)
hydroxyethyl starches (Stabizol, Hemohes, Refortan, Infukol, Voluven)
Crystalloids
They differ in their electrolyte content. The volumetric effect is 20-30% (1000 ml of the injected solution replenishes the BCC by 200-300 ml), the volumetric effect is 20-30 minutes. The most famous crystalloids are saline, Ringer's solution, Ringer-Locke's solution, Trisol, Acesol, Chlosol, Ionosteril.
Blood substitutes of detoxification action. Preparations based on polyvinylpyralidone (Gemodez, Neohemodez, Periston, Neocompensan). Oxygen carriers.
Complications of blood transfusion:
Tissue incompatibility syndrome
The syndrome of tissue incompatibility develops when the blood of the donor and recipient is incompatible in one of the immune systems as a result of the reaction of the recipient's body to the injected foreign protein.
Homologous blood syndrome Homologous blood syndrome is characterized by impaired microcirculation and transcapillary metabolism as a result of an increase in blood viscosity and blockage of the capillary bed by microaggregates of platelets and erythrocytes.
Massive blood transfusion syndrome Massive blood transfusion syndrome occurs when the volume of blood transfused exceeds 50% of the BCC.
Transmission syndrome Transmission syndrome is characterized by the transfer of disease-causing factors from donor to recipient.