Sources of transfusion components
To perform a transfusion procedure, medical specialists use components that can be obtained from three main sources. The choice of a specific source depends on the clinical situation, the patient's condition, and the nature of the surgery or trauma.
- Donor harvest. This is the classic and most common method, where components are obtained from a healthy individual.
- Autologous donation. In this case, components are harvested from the recipient themselves. The patient donates their own blood in advance so that doctors can transfuse it back into their bloodstream later if needed. This completely eliminates incompatibility risks.
- Reinfusion. A specific method used in massive hemorrhages, where the patient's own blood—shed into body cavities as a result of severe trauma or extensive surgical procedures—is returned to their bloodstream.
Transfused media (components)
In modern medical practice, the therapeutic method of transfusion involves the administration of strictly defined transfused media rather than whole blood. Each of them performs a specific physiological task in the recipient's body:
- Erythrocyte-containing media. The main task of these components is to act as blood gas carriers, ensuring adequate gas exchange.
- Platelet-containing media and plasma correctors. These components are used for the targeted correction of hemostasis (stopping bleeding) and fibrinolysis processes.
- Leukocyte-containing media and plasma products. This group of transfused components is used when the patient requires specialized immune correction.
Consequences of incompatible blood transfusion
The transfusion procedure requires absolute precision in determining blood group compatibility. If blood that is group-incompatible enters the recipient's bloodstream, it immediately triggers a cascade of severe, life-threatening pathological reactions.
Complications develop in the following sequence:
- Erythrocyte agglutination (clumping) occurs.
- Following agglutination, hemolysis begins—the massive destruction of incompatible erythrocytes.
- As a result of hemolysis, the internal contents of the cells are released, which manifests as free hemoglobin in both the patient's blood and urine.
- Severe vascular shock develops rapidly.
- The toxic effect of free hemoglobin and the shock state lead to acute renal dysfunction.
- In the most severe cases, if the pathological process cannot be halted, the recipient dies.
Briefly: answers to topical questions
What renal pathology develops upon transfusion of incompatible blood?
Transfusion of incompatible blood leads to acute kidney injury (AKI), including oliguric and anuric phases. Incompatible blood transfusion results in free hemoglobin in the urine and impaired renal function.
What methods are used to determine blood type and Rh factor before transfusion?
Blood type and Rh factor are determined using the following methods:
- Using synthetic antibodies (tsoliklons) anti-A, anti-B, anti-AB, anti-D (for Rh factor), and anti-Kell.
- Using standard isohemagglutinating sera of known groups.
- Using standard washed erythrocytes of known groups (I, II, III).
How is the biological compatibility test correctly performed before a transfusion?
The biological test during the transfusion of blood or its components is performed at the beginning of the transfusion. It is indicated for the transfusion of blood and its components: packed red blood cells, suspensions, and plasma. The source indicates that the test starts with the first 15–20 ml of administration.
Which specific Ministry of Health regulations govern transfusion rules?
Transfusion rules and issues in the cited sources are related to the following regulations of the Russian Ministry of Health:
- Order of the Russian Ministry of Health No. 1170n dated October 28, 2020 — Procedure for the provision of medical care to the population in the field of "Transfusiology".
- Order of the Russian Ministry of Health No. 1148n dated October 26, 2020 — Requirements for the organization of the safety system for activities involving donor blood circulation.
- Order of the Russian Ministry of Health No. 1128n dated October 20, 2020 — Procedure for submitting information on reactions and complications in recipients associated with the transfusion of donor blood and/or its components.
- Order of the Russian Ministry of Health No. 1134n dated October 20, 2020 — Medical examination of the recipient, individual compatibility tests, and biological test during the transfusion of blood and its components.
To memorize the consequences of incompatibility, use the acronym A-H-H-S-K-D: Agglutination — Hemolysis — Hemoglobin (in urine/blood) — Shock — Kidneys (dysfunction) — Death.
Class and exam questions
What is autologous donation?
Autologous donation is a process in which blood components are harvested from the recipient themselves in order to later transfuse them back to the same patient.
For what purpose are erythrocyte-containing media transfused?
Erythrocyte-containing components are administered into the recipient's bloodstream because they perform the vital function of carrying blood gases.
What is the term for returning blood shed during trauma to the patient?
This therapeutic method is called reinfusion. It is used when blood is shed into body cavities during trauma and surgery.
Why does the excretory system suffer during incompatible blood transfusion?
Incompatibility causes erythrocyte hemolysis, leading to free hemoglobin in the blood and urine. Along with vascular shock, this results in severe renal dysfunction.
What else to study on this topic
- Normative documents of the Russian Ministry of Health and Social Development regulating transfusion
- Mechanisms of erythrocyte agglutination and hemolysis
- Pathogenesis of vascular shock in blood transfusion complications
- Mechanisms of renal dysfunction upon the appearance of free hemoglobin
- Principles of operation of hemostasis and fibrinolysis plasma correctors
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