Donation as the basis of transfusiology
The primary and most demanded resource for blood transfusion is blood obtained from living humans. In the Russian Federation, this process is based exclusively on voluntary principles. Any citizen whose physical condition meets strict medical criteria has the right to become a donor.
Before the biological material donation procedure, a person undergoes a mandatory comprehensive examination. This includes not only a general assessment of well-being, but also specific laboratory tests. Screening for dangerous infections is strictly mandatory:
- Wassermann reaction to exclude syphilis.
- Testing for carriage of viral hepatitis markers.
- Testing for human immunodeficiency virus (HIV).
All work on collection, preservation, and subsequent fractionation—separation into erythrocytes, plasma, and other components—falls upon blood transfusion stations or specialized hospital departments. High-tech separation, lyophilization, and freezing units are used for these purposes.
Salvaged blood: use of placenta
Salvaged blood refers to blood that could initially be considered a byproduct or biological waste in medical practice. Placental blood is of primary practical importance in this group.
It is collected in delivery rooms immediately after the baby is born and the umbilical cord is clamped. Following strict aseptic rules, physicians collect the fluid from the umbilical vessels into special containers containing a preservative. A relatively small volume—up to 200 milliliters—can be obtained from a single placenta. The most important rule: the biological material from each parturient woman is packaged and stored in a separate vial; mixing in a common container is unacceptable.
Historically, salvaged sources also included blood obtained from therapeutic phlebotomy (e.g., in relieving hypertensive crises or severe eclampsia), but this method has lost its relevance in modern clinical practice. Today, the collected placental material is most often sent for deep processing to isolate valuable protein preparations, such as protein, fibrinogen, and thrombin.
Cadaveric blood: a physiological phenomenon
The use of blood from suddenly deceased individuals is a technique whose concept was introduced by V.N. Shamov, and its wide clinical application was ensured by S.S. Yudin. Only those individuals whose death occurred rapidly, without a preceding prolonged agony, are considered as donors. Common causes in such cases are acute myocardial infarction, acute heart failure, blunt trauma, electrocution, or massive cerebral hemorrhages.
The main physiological feature of this source lies in the phenomenon of postmortem fibrinolysis. In the interval from one to four hours after cardiac arrest, fibrin precipitates from the bloodstream, as a result of which the fluid becomes defibrinated and completely loses its ability to clot.
The collection procedure is strictly regulated:
- Timing: the manipulation must be performed no later than 6 hours from the moment of death.
- Technique: collection occurs by gravity from large venous trunks into sterile containers with full observance of asepsis rules.
- Volume: an impressive amount of material—from 1 to 4 liters—can be obtained from a single body.
The harvested fluid undergoes thorough control. Blood group according to the ABO system and Rh factor are determined, and testing for HIV and hepatitis is performed. At the final stage, labeling is applied indicating the volume, date of collection, and characteristics. Collection is strictly prohibited if the deceased has oncological pathology, systemic blood diseases, active infections (syphilis, tuberculosis, AIDS), and severe poisonings (except for acute alcohol intoxication).
Autogenous blood (autologous blood)
The safest option for the patient is the use of their own biological resources. The use of autogenous blood minimizes rejection reactions since it does not require individual cross-matching tests. In surgery, this approach is implemented in two ways.
The first method is autotransfusion. It implies the planned collection of a certain volume of blood from the patient during the preparation stage for an upcoming surgical intervention. The collected material is preserved and stored securely to be transfused back to the same person during surgery.
The second method is reinfusion. This technique is used in internal organ trauma or diseases accompanied by massive bleeding. The essence lies in using blood that has spilled into closed serous cavities (abdominal or pleural). After collection, it is returned back into the patient's bloodstream.
Briefly: answers to topical questions
What are the contraindications for blood reinfusion?
Contraindications for blood reinfusion are the risk of infection, oncological diseases, and changes in the properties of the blood itself. Absolute contraindications include:
- Blood contamination — contact with pus, intestinal, or gastric contents.
- Damage to hollow organs — large bronchi, esophagus, stomach, intestines, gallbladder, and urinary bladder.
- Malignant neoplasms — presence of a tumor process.
- Bleeding during uterine ruptures — a specific obstetric contraindication.
- Prolonged presence of blood — residing in the abdominal cavity for more than 24 hours (in gynecology, more than 12 hours).
- Alteration of blood properties — hemolysis or a positive Petrov test.
What preservative solutions are used in the harvesting of donor blood?
During the harvesting of donor blood, preservative solutions containing a stabilizer and substances to maintain erythrocyte viability are used.
The sources indicate:
- "Glugicir" — blood storage period of 21 days.
- "Ciglufad" — blood storage period of 35 days.
The composition of preservative solutions includes:
- sodium citrate — a stabilizer that binds calcium ions and prevents clotting;
- dextrose, sucrose, and other substances — for erythrocyte nutrition.
Antibiotics are also added when preparing conserved blood.
What are the storage periods and temperature conditions for red blood cell mass?
Red blood cell mass is stored in vials or plastic bags at a temperature of 4–6 °C. The exact storage periods for red blood cell mass specifically are not indicated in the sources, but for a related medium—red blood cell suspension—the storage period is 8–15 days at a similar temperature. In general, for conserved blood and its components, it is most appropriate to use media with a storage period of no more than 5–7 days, since its extension reduces positive properties due to biochemical and morphological changes.
What blood components are isolated during the fractionation of donor blood?
During the fractionation of donor blood, the following components are isolated:
- Red blood cell mass — a component with a high concentration of erythrocytes.
- Red blood cell suspension — a mixture of red blood cell mass and a preservative solution.
- Leukocyte mass — a medium with a high leukocyte content.
- Platelet mass.
- Blood plasma — liquid, frozen, or dry.
Albumin is obtained from blood plasma by fractionation. Sources also indicate fibrinogen and cryoprecipitate as transfusion agents for hemostasis disorders.
DUTA: Donor, Salvaged, Cadaveric, Autogenous — the four main sources of obtaining blood in surgery.
Class and exam questions
Why does cadaveric blood not clot upon collection?
In individuals who died suddenly without prolonged agony, fibrinolysis occurs within the first 1–4 hours after death. Due to fibrin precipitation, the blood becomes defibrinated and loses its ability to clot.
What is the main advantage of reinfusion?
Reinfusion involves returning the patient's own blood that has spilled into body cavities. This eliminates the need for cross-matching tests and causes significantly fewer post-transfusion reactions.
Which diseases are contraindications for cadaveric blood collection?
Blood is not taken from those who died from infectious diseases (tuberculosis, syphilis, AIDS), oncology, blood diseases, as well as in cases of poisoning (the only exception is acute alcohol intoxication).
What else to study on this topic
- Equipment for blood transfusion stations
- Fractionation process and blood components
- Medicinal products derived from placental blood
- Physiological mechanisms of post-mortem fibrinolysis
- Indications and contraindications for reinfusion
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