Sometimes cancer patients require blood transfusions. If the doctor said that he plans to prescribe a blood transfusion, the patient usually has a lot of questions. Why is the procedure needed? Did something terrible happen? How safe is blood transfusion? Can you get HIV and other dangerous infections from a donor? How will the body react to someone else's blood? Will there be any complications? Is it possible to refuse the procedure or replace it with something else?
Below you will find answers to many questions.
- What you need to know about blood?
- In what cases do cancer patients need blood transfusions?
- What are the types of blood transfusion?
- Red blood cell transfusion
- Plasma transfusion
- Platelet transfusion
- Cryoprecipitate transfusion
- Leukocyte transfusion
- How is the blood transfusion procedure performed?
- From whom can a blood transfusion be given?
- How is donor blood tested?
- Are there any alternatives?
- How safe is it?
- Is it possible to refuse a blood transfusion?
- Price
What you need to know about blood?
Doctors and scientists often refer to blood as the body's internal environment. It washes all organs. Blood performs many important functions: it carries oxygen, nutrients and hormones, removes waste products of metabolism, provides immune protection, and helps regulate body temperature.
Blood consists of two main parts:
- The liquid part is plasma. It is a solution of salts, ions, proteins and other substances.
- Blood cells. Erythrocytes (red blood cells) contain hemoglobin and transport oxygen. Leukocytes (white blood cells) provide nonspecific and immune protection. Platelets (blood platelets) form a clot when bleeding needs to be stopped.
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In what cases do cancer patients need blood transfusions?
The cause may be the malignant tumor itself or side effects of antitumor treatment.
Some types of cancer, especially tumors of the gastrointestinal tract and tumors of the female genital area (vagina, cervix, uterus), can cause internal bleeding.
With a long course of cancer, various disorders occur in the body, which cause the so-called anemia of a chronic disease.
Some malignant tumors affect the red bone marrow (the main organ of hematopoiesis), or organs that are necessary to maintain a normal number of blood cells (spleen, kidneys). These types of cancer may also require blood transfusions.
Donor blood is needed by patients after complex operations that are accompanied by large blood loss.
Chemotherapy and radiation therapy affect not only tumor cells, but also other rapidly dividing cells in the body. Sometimes they cause quite a lot of damage to the red bone marrow. It disrupts the production of blood cells, which threatens anemia, bleeding, and severe infections against the background of decreased immunity. Blood transfusion helps normalize the patient's condition and prevent complications.
1.What is blood transfusion and when is it necessary?
A blood transfusion is a medical operation in which blood lost during surgery, injury or illness is replaced with donor blood. Blood is transferred from a special container into your vein through a catheter.
When is a blood transfusion required?
Blood transfusion may be needed in the following cases:
- Blood loss from injury or major surgery;
- Blood loss caused by illness - for example, a bleeding ulcer;
- Diseases that affect blood cells (hemolytic anemia or thrombocytopenia);
- Diseases of the bone marrow - one of the main hematopoietic organs.
A must read! Help with treatment and hospitalization!
Red blood cell transfusion
The main function of erythrocytes (red blood cells) is the delivery of oxygen to tissues and the return transport of carbon dioxide to the lungs. A condition in which the number of red blood cells in the blood decreases is called anemia. Actually, this is an indication for red blood cell transfusion. The doctor makes a decision depending on how quickly the anemia increases:
- With chronic anemia, which increases gradually, there is no need to rush. The doctor monitors the patient’s condition, controls the level of red blood cells and hemoglobin. If these indicators decrease significantly, or the patient’s condition worsens, red blood cells are transfused. For heart and lung diseases that impede oxygen delivery to tissues, transfusions may be required even if there is a relatively small decrease in hemoglobin levels.
- Acute blood loss requires immediate action. This usually happens during surgery. If the doctor is planning a complex operation during which the patient will lose a lot of blood, blood transfusion may be performed in advance.
Indications
The most common indication for transfusion is blood loss. Acute loss is defined as the patient losing more than 30% of their blood volume within a couple of hours. In addition, absolute indications for blood transfusion include shock, incessant bleeding, severe anemia, and surgical interventions.
Frequent indications for transfusion of blood components are anemia, hematological diseases, purulent-septic diseases, severe toxicosis, acute intoxication.
Plasma transfusion
Plasma, the liquid part of blood, appears as a clear, yellowish liquid. It contains blood clotting factors - substances that are necessary for the formation of a blood clot and stop bleeding. Plasma also contains substances that protect the body from infection.
Plasma can be stored frozen for up to 12 months. When necessary, it is thawed and the resulting fresh frozen plasma is transfused into the patient.
The main indication for plasma transfusion in cancer patients is increased bleeding. The procedure is also necessary for DIC syndrome (disseminated intravascular coagulation syndrome) - a serious condition in which blood clots form in small vessels, ultimately depleting the entire supply of platelets and coagulation factors, and there is a risk of severe bleeding.
Contraindications
Blood transfusion was and remains an extremely risky procedure. Blood transfusion can cause serious disruption of vital processes, therefore, even if there are indications for this procedure, doctors always consider the presence or absence of contraindications, including heart failure due to defects, myocarditis, cardiosclerosis, purulent inflammation of the inner lining of the heart, third stage hypertension, impaired blood flow brain, general disorder of protein metabolism, allergic conditions and other diseases.
By the way
There is such a thing as “blood doping,” otherwise known as autohemotransfusion. In this procedure, the recipient is transfused with his own blood. This is a fairly common technique in sports, but official structures equate it to the use of doping. “Blood doping” accelerates the delivery of oxygen to the muscles, increasing their performance. Information about previous transfusions, if any, plays a big role. Also at risk are women who have experienced difficult childbirth, miscarriages or the birth of children with jaundice, and patients with cancer, blood pathologies, and prolonged septic processes.
Often, when there are absolute indications for blood transfusion, the procedure is performed despite contraindications, but at the same time preventive measures are organized, for example, to prevent an allergic reaction. Sometimes, during surgical operations, the patient's own blood is used in advance.
Platelet transfusion
Platelets, or blood platelets, take part in the formation of a blood clot and stop bleeding. Their levels may drop due to chemotherapy, radiation therapy, or if the tumor has replaced normal red bone marrow tissue. Platelet transfusions are usually required for cancer patients in one of three cases:
- if the level of platelets in the blood has fallen below a critical value;
- if there is increased bleeding, risk of bleeding;
- if you are undergoing surgery during which significant blood loss is expected.
How is the blood transfusion procedure performed?
Although blood transfusion is formally equated to surgical interventions, this procedure is not at all scary and is practically painless. Blood transfusion is carried out through a needle that is inserted into a vein. It is no more painful than a regular intravenous injection. If the patient already has a central venous catheter, donor blood can be administered through it.
The procedure can take different times, depending on which blood components are transfused: from 30-60 minutes (platelet transfusion) to 2-4 hours (red blood cell transfusion).
Interesting Facts
Article on the topic
Extend youth and avoid stroke. An expert on the benefits of donation In 1926, the world's first blood transfusion institute was organized in Moscow (today it is the Hematological Research Center of the Russian Academy of Medical Sciences), and a special blood service was created.
Direct blood transfusion, directly from a donor to a patient, is currently practically prohibited due to the danger of contracting AIDS and hepatitis and is carried out only in particularly extreme situations.
In addition, the transfusion of donor blood and its components that have not been tested for AIDS, hepatitis B surface antigen and syphilis is completely prohibited.
And contrary to popular belief, ambulances never give blood transfusions.
How is donor blood tested?
A person who donates blood for the first time must fill out a questionnaire, undergo an examination by a therapist, a dermatovenerologist, and take tests for blood type, Rh factor, and infections: HIV, viral hepatitis B and C, syphilis, cytomegalovirus. Sometimes the examination program can be expanded.
If signs of a particular infection are found in the donor’s blood, it is discarded and not used in the future.
The compatibility of the blood of the donor and the recipient is checked using a special test - a cross-blood compatibility test.
Are there any alternatives?
Sometimes blood disorders can be corrected with medications. For example, colony-stimulating factors are used to increase the number of white blood cells.
However, in cases where blood transfusion is necessary, there are no alternatives. There are no blood substitutes that can provide similar effects. That is why donation is constantly promoted in all countries of the world, including Russia, and donor days are held periodically. It is important. This helps save the lives of many people.
How safe is it?
Can you get an infection from donated blood? Donated blood goes through rigorous testing, but there are still risks, even though they are negligible. Thus, the likelihood of becoming infected with HIV through donated blood is lower than the likelihood of being struck by lightning during a person’s lifetime. The risk of contracting hepatitis C is 1 in 2,000,000. Doctors and scientists are constantly working to reduce the risks to zero.
Can incompatible blood be transfused? Before blood transfusion, the recipient's blood type and Rh factor must be determined; the doctor must make sure that the blood of the donor and recipient are compatible.
But the blood of different people can differ not only in group A0 and Rh factor. It is very difficult to take into account all the nuances. Therefore there is a slight risk of an allergic reaction. Most often it manifests itself in the form of fever, chills, and rash. Such complications are rarely life-threatening. In order to provide assistance to the patient, if necessary, a medical professional is constantly monitoring his condition during the procedure.
An allergic reaction can occur not only immediately during the transfusion, but also within 48 hours after it. You should immediately tell your doctor if your body temperature rises above 38°C, chills, rash, itching, redness of the skin, shortness of breath, difficulty breathing, nausea, lower back pain, blood in the urine, weakness. The most dangerous symptom is chest pain, which requires immediate attention. If you are at home, you should immediately call an ambulance.
Algorithm for blood transfusion
ABO system The main antigens of the ABO system are 2-A and B. As separate specificities, 2 more antigens are distinguished in it - A, B and A1. The absence of these 4 antigens on red blood cells is designated O. Anti-A and anti-B antibodies are of natural origin. They are designated by the Greek α and β. There are 4 blood groups formed by combinations of antigens A and B with isohemagglutinins α and β. On red blood cells of the first group O (I), antigens A and B are absent, the plasma contains antibodies α and β. In the second blood group A (II), the erythrocytes have antigen A, and the plasma contains β antibodies. The third group B (III) contains the B antigen and α antibodies. In the fourth group AB (IV), antigens A and B are present; isohhemamaglutinins α and β are absent in the blood serum.
Rh factor
Rh factor is an antigen found in the red blood cells of 85% of people, as well as in Macaus rhesus monkeys. The blood of people whose red blood cells contain Rh is called positive. There are several different antigens of the Rh system, including the Hr group, which forms a common system with Rh. Rh-Hr Including -3 varieties of Rh agglutinogen (C, D, E) -3 varieties of Hr agglutinogen (c, d, f) and other rarer species. Agglutinogen Hr is found in the red blood cells of 83% of people. The Rh factor is inherited as a dominant trait and does not change throughout life. The transfusion of blood components has the right to be carried out by: - The attending physician or the doctor on duty. -During the operation, the surgeon or anesthesiologist (not involved in the operation or anesthesia). -Doctor of the blood transfusion department or room. -Transfusiologist.
Determination of blood group according to the ABO system (Using coliclones) - 2 drops (0.1 ml) of the reagent and next to one drop of red blood cell sediment (0.02 - 0.03 ml) - Serum and red blood cells are mixed with a glass rod - The plate is periodically shaken, observing the progress of the reaction for 5 minutes (allows you to identify the weak agglutinogen A2) - interpret the results
Difficult to determine blood types
Blood subgroups. Antigen A, contained in erythrocytes of groups A (II) and AB (IV), can be represented by two variants (subgroups) - A_1 and A_2. Antigen B has no such differences. Nonspecific agglutination of erythrocytes. It is judged on the basis of the ability of erythrocytes to agglutinate with sera of all groups, including AB (IV). Nonspecific agglutination is observed in autoimmune hemolytic anemia and other autoimmune diseases accompanied by the adsorption of autoantibodies on erythrocytes, in hemolytic disease of newborns, whose erythrocytes are loaded with maternal alloantibodies.
Blood chimeras. Blood chimeras are the simultaneous presence in the bloodstream of two populations of red blood cells that differ in blood type and other antigens. Transfusion chimeras arise as a result of repeated transfusion of red blood cells or suspension of group 0 (I) to recipients of another group. True chimeras occur in heterozygous twins, as well as after allogeneic bone marrow transplantation. Other features. Determining the AB0 blood group and Rhesus affiliation can be difficult in patients due to changes in the properties of red blood cells in various pathological conditions (in patients with liver cirrhosis, burns, sepsis). Determination of Rh-belonging
Apply a large drop (about 0.1 ml) of reagent to the plate. A small drop (0.02-0.03 ml) of the red blood cells being tested is placed nearby. Mix the reagent with red blood cells thoroughly using a glass rod. Rock the record gently. The reaction results are taken into account 3 minutes after mixing. If agglutination is present, the blood being tested is labeled as Rh positive; if not, it is marked as Rh negative.
Compatibility test on a plane at room temperature
To conduct tests for individual compatibility, the patient’s blood (serum) is used, taken before transfusion or no more than 24 hours before, provided it is stored at a temperature of +4+2°C.
Apply 2-3 drops of the recipient's serum to the plate and add a small amount of red blood cells so that the ratio of red blood cells to serum is 1:10. Next, the red blood cells are mixed with the serum, and the plate is gently rocked for 5 minutes. Compatibility test using 33% polyglucin
Add 2 drops (0.1 ml) of recipient serum, 1 drop (0.05) ml of donor erythrocytes into the test tube and add 1 drop (0.1 ml) of 33% polyglucin.
The test tube is tilted to a horizontal position, shaking slightly, then slowly rotated so that its contents spread over the walls in a thin layer. Contact of erythrocytes with the patient’s serum while rotating the tube should continue for at least 3 minutes.
After 3-5 minutes, add 2-3 ml of physiological solution to the test tube and mix the contents by inverting the test tube 2-3 times without shaking.
The result is taken into account by viewing the test tubes with the naked eye or through a magnifying glass. Agglutination of red blood cells indicates that the blood of the recipient and the donor are incompatible; the absence of agglutination is an indicator of the compatibility of the blood of the donor and recipient.
Technical errors
Incorrect order of reagents. Temperature conditions (blood group determination is carried out at a temperature not lower than 15°C and not higher than 25°C) The ratio of reagents and red blood cells being studied. Duration of observation. (allows us to identify weak agglutinogen A_2, characterized by delayed agglutination)
Biological sample
The biological test is carried out regardless of the volume of the blood transfusion medium and the speed of its administration.
If it is necessary to transfuse several doses of blood components, a biological test is carried out before the start of the transfusion of each new dose. Technique for conducting a biological test: 10 ml of blood transfusion medium is transfused once at a rate of 2 - 3 ml (40 - 60 drops) per minute
observe the recipient for 3 minutes, monitoring his pulse, breathing, blood pressure, general condition, skin color, and measure body temperature
This procedure is repeated twice more. The appearance during this period of even one of the clinical symptoms such as chills, lower back pain, a feeling of heat and tightness in the chest, headache, nausea or vomiting requires immediate cessation of the transfusion and refusal to transfuse this transfusion medium.
The urgency of transfusion of blood components does not exempt one from performing a biological test!!!
The doctor performing the transfusion of blood components is obliged to:
1. Determine the indications for blood transfusion therapy, taking into account contraindications.
2. Obtain informed voluntary consent of the recipient or his legal representative to conduct blood transfusion therapy in the prescribed form.
3. Conduct an initial determination of the patient’s blood group according to the ABO system.
IT IS STRICTLY PROHIBITED TO USE DATA ABOUT GROUP MEMBERSHIP FOR THE ABO AND RHESUS SYSTEMS FROM THE PASSPORT, PREVIOUS ILLNESS HISTORY AND OTHER DOCUMENTS.
4. Include in the referral to the clinical diagnostic laboratory (form No. 207/u) information about the result of determining the blood group according to the ABO system, a series of diagnostic tests, transfusion and obstetric-gynecological history. Sign the direction
5. Familiarize yourself with the conclusion of the clinical diagnostic laboratory. Transfer data about the group and Rh affiliation of the patient to the front part of the inpatient medical card, indicating the date of the analysis and your last name.
6. Prepare a pre-transfusion epicrisis.
7. Conduct a macroscopic assessment of laboratory gelatin and diagnosticums.
8. Conduct a macroscopic assessment of each dose of blood transfusion medium.
9. Immediately before transfusion, determine the recipient’s blood group according to the ABO system.
10. Determine the blood group according to the ABO system with erythrocyte-containing medium.
11. Check the compliance of passport data.
12. Conduct a compatibility test between the recipient’s blood and the donor’s blood (transfusion medium) according to the ABO and Rh systems.
13. Record the results of isoserological studies in the protocol of the blood transfusion operation.
TESTS FOR INDIVIDUAL COMPATIBILITY ACCORDING TO THE ABO AND RHESUS SYSTEM DO NOT REPLACE EACH OTHER.
ARE CARRIED OUT IN ALL CASES WITH BLOOD SAMPLES FROM EACH CONTAINER.
MANDATORY EVEN IF THE ERYTHROCYTE MASS OR SUSPENSION IS SELECTED FOR THE RECIPIENT INDIVIDUALLY IN A SPECIALIZED LABORATORY.
14. Conduct a biological test. Record its result in the protocol of the blood transfusion operation.
15. Monitor the condition of the recipient, the rate of administration of the transfusion medium.
16. If the patient’s condition changes, first of all, exclude a post-transfusion complication.
17. Assess blood pressure, pulse, thermometry results.
18. Register blood transfusion:
•in the observation diary of the medical record of an inpatient;
• in the register of registration of blood transfusions and its components (form No. 009/u);
•fill out the blood transfusion protocol
19. Conduct a macro-assessment of the first portion of urine.
20. Prescribe clinical blood and urine tests the next day after blood transfusion.
21. Assess daily diuresis, water balance, results of urine and blood tests.
22. Observe the patient and reflect the observation results in the medical history diary. If clinical symptoms and laboratory parameters change before the patient is discharged from the hospital, first of all exclude a post-transfusion complication.
Complications - Immune complications (acute hemolysis, hyperthermic non-hemolytic reaction, anaphylactic shock, non-cardiogenic pulmonary edema)
-Non-immune complications (acute hemolysis, bacterial shock, OSHF, pulmonary edema)
- Immediate complications (alloimmunization with antigens of erythrocytes, leukocytes, platelets or plasma proteins, hemolysis, graft-versus-host disease, post-transfusion purpura)
Long-term complications
-Immune (hemolysis, Graft-versus-host disease, Post-transfusion purpura, Alloimmunization with antigens of erythrocytes, leukocytes, platelets or plasma proteins
Literature:
A. G. Rumyantsev, V. A. Agranenko. Clinical transfusiology-M.: GEOTAR MEDICINE, 1997.
E. B. Zhiburt. Transfusiology-S.: PETER, 2002.
Regulations and audit of blood transfusion. Guide for doctors. -M. , RANS, 2010.
Ragimov A. A. Transfusiology . National leadership-M.: GEOTAR Media, 2012.
S. I. Donskov, V. A. Morokov. Human blood groups: Guide to immunoserology - M.: IP Skorokhodov V. A., 2013.
Zhiburt E. B. Patient blood management//Healthcare. -2014.
Algorithms for studying erythrocyte antigens and anti-erythrocyte antibodies in difficult to diagnose cases. Methodological recommendations N 99/181 (approved by the Ministry of Health of Russia on May 17, 2000)
Order of the Ministry of Health of Russia dated November 25, 2002 N363 “On approval of the Instructions for the use of blood components”
Order of the Ministry of Health of Russia dated 04/02/2013 N183н “On approval of the rules for the clinical use of donor blood and (or) its components”
Is it possible to refuse a blood transfusion?
The patient always has the right to refuse prescribed treatment, be it chemotherapy, surgery or blood transfusion. But you need to remember some points:
- A doctor will not prescribe a procedure, especially one as serious as a blood transfusion, just like that. If the doctor decides to perform a blood transfusion, then there are good reasons for this, and first of all it is in the interests of the patient.
- Large blood loss during surgery and significant blood disorders can lead to death or serious complications and impair the effectiveness of antitumor treatment.
- There are some risks during blood transfusion, but they are negligible, and the procedure often helps save the patient's life.
Euroonko clinics officially cooperate with the largest blood banks in the country. We operate on the basis of a license for “transfusiology in outpatient and inpatient settings” issued by the health departments of Moscow and St. Petersburg.
Contraindications to blood transfusion
Blood transfusion is the introduction of foreign cells into the human body, and this increases the load on the heart, kidneys and liver. After a transfusion, all metabolic processes are activated, which leads to an exacerbation of chronic diseases.
Therefore, before the procedure, it is necessary to carefully collect an anamnesis of the patient’s life and illness.
Information about allergies and previous transfusions is especially important. Based on the results of the clarified circumstances, recipients of the risk group are identified.
These include:
- women with a burdened obstetric history - miscarriages, birth of children with hemolytic disease;
- patients suffering from diseases of the hematopoietic system or with oncology in the stage of tumor disintegration;
- recipients who have already undergone transfusion.
Absolute contraindications:
- acute heart failure, which is accompanied by pulmonary edema;
- myocardial infarction.
In conditions that threaten the patient's life, blood is transfused, despite contraindications.
Relative contraindications:
- acute cerebrovascular accident;
- heart defects;
- septic endocarditis;
- tuberculosis;
- liver and kidney failure;
- severe forms of allergies.
You may be interested in reading: How a heart transplant is performed.
Price
- Consultation with a transfusiologist - 4,500 rubles.
- Complete blood count (CITO) - RUB 1,800.
- Compatibility test before blood transfusion - 2,300 rubles.
- Erythrocyte suspension, depleted of leukocytes (filtered) - RUB 21,760.
- Transfusion of blood components - 3,900 rub.
- The cost of fresh frozen plasma (1 dose 250 ml) is 20,100 rubles.
- Platelet concentrate (1 dose) - 68,000 rub.
In accordance with the legislation of the Russian Federation (Law of the Russian Federation of June 9, 1993 N 5142-I “On the donation of blood and its components”), the procurement of blood, the receipt of blood components and their storage are carried out exclusively by state budgetary institutions. Blood transfusions to our patients are carried out on the basis of licenses for “transfusiology in outpatient and inpatient settings”.
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Types of blood transfusion
There are 4 types of blood transfusion:
Direct blood transfusion
Transfusion of whole blood directly from a donor to a recipient. Before the procedure, the donor undergoes a standard examination.
It is carried out both using a device and using a syringe.
Indirect blood transfusion
The blood is pre-collected, divided into components, preserved and stored under appropriate conditions until use.
This blood transfusion is the most common type of transfusion. It is performed using a sterile intravenous system. In this way, fresh frozen plasma, red blood cells, platelets and leukocytes are administered.
Exchange transfusion
Replacement of the recipient's own blood with donor blood in sufficient volume. The recipient's blood is simultaneously removed from the vessels partially or completely.
Autohemotransfusion
For transfusion, the recipient's own blood, prepared in advance, is used. This method eliminates blood incompatibility, as well as the introduction of infected material.
Routes of administration into the vascular bed:
- Intravenously is the main method of transfusion, when the drug is injected directly into a vein - venipuncture, or through a central venous catheter into the subclavian vein - venesection. The central venous catheter is installed for a long time and requires careful care. Only a doctor can place a CVC.
- Intra-arterial and intra-aortic blood transfusion - they are used in exceptional cases: clinical death caused by massive blood loss. With this method, the cardiovascular system is reflexively stimulated and blood flow is restored.
- Intraosseous transfusion - blood is injected into bones with a large amount of spongy substance: the sternum, calcaneus, wings of the ilium. The method is used when it is impossible to find accessible veins; it is often used in pediatrics.
- Intracardiac transfusion is the injection of blood into the left ventricle of the heart. It is used extremely rarely.
