Classification and clinical presentation
Side effects during the administration of blood substitutes are generally divided into three main groups: allergic, pyrogenic, and toxic.
1. Allergic reactions
Most often they are triggered by the administration of protein hydrolysates. In the case of dextran (with a mean molecular weight of 50,000–70,000), the complication rate is about 0.1% and is associated with individual hypersensitivity of the body.
The high-risk group includes:
- Patients with severe purulent processes.
- Patients with extensive burns (due to autosensitization processes).
- Individuals with a burdened allergic history.
Symptoms: dyspnea, cyanosis, rapid heart rate (tachycardia), pruritus and rashes, as well as eyelid and facial swelling (angioedema).
2. Pyrogenic reactions
Characterized by a sharp increase in body temperature and severe chills. These symptoms usually appear towards the end of the transfusion or some time after its completion. The basis for the prevention of such conditions is the use of strictly single-use infusion sets, mandatory replacement of the set during prolonged (more than 24 hours) infusions, and strict adherence to the temperature regimes for storing preparations.
3. Toxic reactions
The main etiological factor is the elevated content of protein breakdown products in the hydrolysate used. Symptoms: severe headache, tachycardia, lower back pain, pathological changes in urine, and hepatomegaly. It is important to remember that it is strictly forbidden to transfuse fluids that show any signs of unsuitability or have an expired shelf life.
Emergency care for developing complications
If during the infusion the patient shows signs of any of the reactions described above, it is necessary to act according to a strict algorithm:
- Immediately stop the transfusion or slow down the rate of intravenous administration of the drug as much as possible.
- Initiate drug therapy. The following drugs are administered intravenously:
- 10% calcium chloride solution (10 ml);
- Antihistamines (diphenhydramine or chloropyramine);
- 40% dextrose solution (20 ml);
- 0.2% platyphylline solution (1 ml);
- 1% trimeperidine solution (1 ml).
- In case of a sharp drop in blood pressure (BP), the regimen is supplemented with vasopressors and cardiac drugs, administration of crystalloid solutions, as well as glucocorticosteroids.
Prevention principles
To minimize the risk of adverse reactions, medical personnel are obliged to follow a number of rules:
- Thorough history taking. Details of the transfusion and allergic history must be clarified.
- Control of rate and dosage. It is unacceptable to exceed the established daily dose. The administration rate of protein preparations must strictly be 20–40 drops per minute.
- Performing a biological test. This step is mandatory when transfusing protein blood substitutes, dextran [mean MW 50,000–70,000], and fat emulsions.
- Premedication. If there is reason to suspect the possibility of a reaction, antihistamines (promethazine, chloropyramine, or diphenhydramine) and calcium chloride are prophylactically administered to the patient 10–15 minutes before the start of the infusion.
Briefly: answers to topical questions
What technical complications can occur during infusion therapy?
During infusion therapy, technical complications associated with the entry of emboli of various origins into the bloodstream may occur. Such complications include:
- Air embolism — entry of atmospheric air into the vascular bed;
- Foreign body embolism — entry of fragments or medical catheters into the bloodstream;
- Thromboembolism — occlusion of vessels by blood clots from the patient's vein during phlebitis or thrombosis at the infusion site, as well as clots formed during storage.
What are the absolute contraindications to the transfusion of fat emulsions?
According to the source, contraindications for fat emulsions include:
- shock;
- early postoperative period;
- severe liver disease;
- fat embolism;
- thrombophlebitis and thromboembolism;
- pronounced atherosclerosis;
- uncompensated diabetes mellitus;
- lipid metabolism disorders.
To remember the three types of reactions, use the abbreviation PAT: Pyrogenic, Allergic, Toxic.
Class and exam questions
For which drugs is the biological test mandatory?
The biological test is strictly mandatory before transfusing protein blood substitutes, fat emulsions, and dextran solutions with a mean molecular weight of 50,000–70,000.
What is the very first action to take when a complication is suspected?
First of all, it is necessary to immediately stop the transfusion or slow down the solution administration rate as much as possible.
Why is the risk of allergic reactions to infusion increased in burns?
In patients with extensive burns, autosensitization processes occur (formation of antibodies to their own damaged tissues), which makes their organism hyperreactive to administered protein preparations.
What else to study on this topic
- Methodology for performing a biological test during blood substitute transfusion
- Mechanisms of autosensitization in burn patients
- Pharmacodynamics of antihistamines in emergency therapy
- Differential diagnosis of toxic and allergic reactions
Master the entire topic in the "General Surgery" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on the topic "Complications of Infusion Therapy" and another 3,335 pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 70 video lessons on the subject
Other topics of "CHAPTER 7. BLOOD SUBSTITUTES"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.