Routes of administration of transfusion media
The method for delivering blood components or plasma substitutes into the body depends on the severity of the patient's condition and the expected duration of treatment.
- Main method: medications are administered intravenously by drip, most commonly via puncture of superficial veins.
- Massive or prolonged therapy: requires more reliable access. In such cases, catheterization of large veins is used, such as the external jugular or subclavian vein.
- Emergency situations: when immediate hemodynamic restoration is required, intraarterial administration may be used.
Tactics in acute blood loss
The replenishment algorithm depends directly on the volume of blood lost. With a deficit of up to 15% of the total circulating blood volume (CBV), transfusion of blood components is not performed, as administration of standard volume-substituting fluids is sufficient for the body.
Indications for starting a blood transfusion are laboratory changes: a drop in hemoglobin levels below 80 g/L and a decrease in hematocrit to values below 30.
- Loss of 15–30% of CBV: requires the administration of packed red blood cells, albumin solutions, and plasma substitutes.
- Loss of more than 30% of CBV: dictates the need for a comprehensive approach. The patient is indicated for the administration of whole blood, packed red blood cells, fresh frozen plasma, albumin, and plasma substitutes.
- In critical loss within the range of 35–40% of CBV, plasma transfusions in combination with packed red blood cells or whole blood are mandatory.
Therapy for hemostasis and blood composition disorders
Depending on the specific cellular or plasma deficit, a specific component is selected:
- Anemia: the basis of treatment is packed red blood cells along with the use of plasma substitutes.
- Thrombocytopenia: requires isolated administration of platelet concentrate.
- Leukopenia: is compensated by leukocyte concentrate; cryoprecipitate, fibrinogen, and volume-substituting solutions may also be indicated.
- Hemophilia: is managed by administering clotting factors—cryoprecipitate and fibrinogen.
- Ongoing bleeding: requires replenishment with whole blood, plasma, and plasma substitutes.
Infections, shock, and protein deficiency
Transfusiology addresses not only the problems of blood cell loss but also combats systemic shifts.
- Shock states: administration of packed red blood cells, plasma, albumin, and volume-substituting fluids is indicated to stabilize hemodynamics.
- Hypoproteinemia and dysproteinemia: protein disorders are corrected with infusions of plasma and albumin and supported by plasma substitutes.
- Purulent-inflammatory diseases: in severe infectious processes, the treatment regimen includes plasma, albumin, specific immunoglobulins, and plasma substitutes to support immunity and oncotic pressure.
Briefly: answers to topical questions
What are the indications for a fresh frozen plasma transfusion?
Indications for fresh frozen plasma transfusion include emergency reversal of vitamin K antagonist effects and correction of hemorrhagic syndrome when prothrombin time or aPTT is increased by more than 1.5 times compared to normal. It is also transfused for volume replacement during plasmapheresis, for hypofibrinogenemia less than 1 g/L, in the perioperative period, or in massive bleeding if the fibrinogen level is less than 1.5 g/L.
Which volume-substituting solutions belong to the hemodynamic group?
Hemodynamic plasma substitutes include medium-molecular-weight dextrans with an average molecular weight of 50,000–70,000, gelatin preparations, and hydroxyethyl starch-based preparations, such as hydroxyethyl starch.
Class and exam questions
Why is donor blood not transfused with a loss of up to 15% of CBV?
With this volume of loss, the body is able to compensate for oxygen deprivation on its own. It is sufficient to administer volume-substituting fluids to restore volume in order to avoid unjustified risks associated with blood transfusion.
What are the laboratory indications for red blood cell transfusion?
Absolute triggers for transfusion are considered to be a drop in blood hemoglobin levels below 80 g/L and a decrease in the hematocrit level to less than 30.
When is it necessary to catheterize the subclavian vein?
Catheterization of large central veins, such as the subclavian or jugular vein, is indicated in cases where massive or prolonged infusion-transfusion therapy is planned.
What else to study on this topic
- Mechanisms of action of volume-substituting fluids
- Complications of massive transfusion
- Rules of blood group and Rh factor compatibility
- Indications for the use of fresh frozen plasma
- Features of transfusions in shock states
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Other topics in the section "CHAPTER 6. BLOOD TRANSFUSION"
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