Blood transfusion

Blood transfusion is the process of transferring blood or blood-based products from one person to another's circulatory system. In some cases, such that due to excessive bleeding due to injury, blood transfusion can be life-saving, or it can be used to supply loss of blood during surgery. Blood transfusions can also be used to treat severe bleeding caused by blood related disease or deficiency of deficiency (a reduction in the number of platelets in the blood). The person affected by hemophiliac or crescendent red blood cellular disease may need blood transfusions most often. Initial blood transfusions used whole blood, but modern medical systems usually only use blood components.

History Initial effort

The first historical effort in relation to blood transfusion was first described by the 17th Century historian Stefano Infessura. Infagesa discusses that, in 1492, when Pope Innocent VIII went into deep unconscious (coma), the blood of three boys was poured into the body of the Pope (bishop) on the suggestion of a physician (from the mouth, because of circulation The concepts and methods of intravenous admission did not exist at the time). The boys were ten years old and each of them was promised a gold coin. However, not only did the Pope die, but his three children also died. Some authors have accused Infagesura of being anti-Papal, and its description is not correct. Shot of World War II for direct inter-human blood transfusion.

Starting with Harvey's blood circulation experiments, sophisticated research into blood transfusion began in the 17th century, in which successful transfusion of blood between animals was used. However, the result of gradual endeavors to humans remained fatal.

The first fully documented human blood transfusion was done on June 15, 1967 by Dr. Jean Baptist Dennis, renowned physician of France, Emperor Louis XIV. He did a blood transfusion in a 15 year old boy who survived after blood transfusion. Dennis also performed a blood transfusion, and he also survived. Both examples were probably due to small amounts of blood, which in reality these blood transfusions were done. It allowed them to withstand allergic reactions. Dennis's third patient who passed through blood transfusion was the Swedish businessman Baron Bond. They received two transmissions Bond died after the second transfusion. In the winter of 1667, Dennis had transmitted several times with the blood of Antoine Moroy's calf, who died for the third time. There are many controversies surrounding his death. Moroy's wife strongly asserted that Dennis was responsible for her husband's death. But Moroy's wife was accused of his death. Although it was later determined that in reality Moroy died from Arsenic poisoning, Dennis's experiments with animal blood created a hot controversy in France. Finally, in 1670, this process was banned. At the right time, the British Parliament and even the Pope did the same. Blood transfusion went into oblivion for the next 150 years. First successful transfusion

Richard Lower tested the effects of changes in blood volume of the circulation work and developed methods of cross-circulatory study in animals, removing clots by closed arterioles. Ultimately, real blood transfusion was possible from their newly created devices.

"Many of his colleagues were present. By the end of February 1665 [when he] selected a medium sized dog, he opened his vein and took out his blood until his strength became almost depleted, then, this dog To compensate for the loss of the blood to be supplied by another blood, the blood from the cervical artery of the relatively large mestif, tied next to that first animal, used it, The latter animal showed that it was overwhelmed by the inherent blood. " "Later, after sealing the throat of the throat," animals were without any troubles or bad signs. "

Lower made the first blood transfusion between animals. Then he was requested to "introduce the Royal Society to the whole of the process of using the Royal" by the Honorable [Robert] Boyle, which he did in the philosophical work of the Society in December 1665. On June 15, 1667, at that time, a professor in Paris, Denis claimed to have executed the first transition between humans and received the credit of this technique, but the priority of lower can not be challenged.

Six months later in London, Lower made the first human transmissions in Britain, where he used to perform various times of some ounces of sheep's blood in [patient's] arm without any inconvenience at the Royal Society meeting. "The recipient" was a patient of harmless insanity "Arthur Koga." The blood of sheep was used due to speculation regarding the importance of blood transfusion among species. It was suggested that the blood taken from a gentle lamb can calm the stormy feeling of an agitated person and can be made out of the person who is embarrassed by the blood taken from more affable living organisms. He wanted to be treated, but his patients refused. No other transfusion was done. Shortly before, there came to Lower London, where his growing profession helped him The led to abandonment. Initial success

The science of blood transfusion is old until the first decade of the 19th century when the pattern of mixing some blood from the blood donor and blood recipient before the transfusion (the earliest form of mutual-matching), as a result of different blood types.

In 1818, British obstetrician Dr. James Blundell edited the first successful blood transfusion of human blood to treat post-traumatic bleeding. He used the husband's husband as a donor and his wife took four ounces of blood from his arm to transfusion. During the years 1825 and 1830, Dr. Blundell edited 10 transcripts, five of which were beneficial and they published their results. He also invented many instruments for blood transfusion. With his effort, he earned a large amount of rupees, which was about 50 million (about 2 million in 1827) the actual dollar (adjusted for inflation).

In 1840, with the help of Dr. Blundell in St. George's Medical School, London, Samuel Armstrong Lane edited the first complete blood transfusion to treat epilepsy.

In Bram Stoker's novel "Dracula", various incidents of blood transfusion were deliberately made. This book was published in 1897.

George Washington Crile is credited with editing blood surgery directly in the Cleveland Clinic.

By 1901, many patients had died, when Karl Landsteiner of Austria discovered human blood groups, so blood transfusion was safe. A mixture of blood of two persons can produce blood clotting or attachment. The collected red cells can crack and they can cause toxic reactions that may have fatal consequences. Karl Landsteiner observed that the collection of blood is a immune system that occurs when the recipient of blood transfusions contains antibodies (both A, B, A and B, or none) against the donor blood cells. Karl Landsteiner's work made possible the determination of blood groups (A, B, AB, O) and thus paved the way for the execution of blood transfusions safely. For this discovery, he was awarded the Nobel Prize for Physiology and Medicine in 1930. Development of Blood Collection Main article: Blood collection

While the first transfusion was done directly before the donor in the recipient, it was discovered in 1910 that it was possible to mix it with anticoagulants and freeze it for a few days, due to blood banks. The route opened. The first non-direct transfusion was edited on 27 March 1914 by Belgian physician Albert Hastin, who used sodium citrate in the form of anti-scarring. Using the blood collected and cooled blood, the first blood transfusion was edited on 1 January 1916. A medical researcher and US Army officer Oswald Hope Robertson is generally credited with establishing the first blood bank while serving France during World War I.

The first educational institution dedicated to the science of blood transfusion was established in Moscow by Alexander Bogdanov in 1925. Bogdanov was inspired to some extent by looking for an everlasting puberty, and after receiving 11 transfusions of whole blood, after commenting satisfactorily in his vision, preventing baldness, and other positive symptoms, he commented satisfactorily.

In fact, after the death of Vladimir Lenin, with the aim of reviving the dead Bolshevik leader, Bogdanov was assigned the task of Lenin's brain study. As a result of one of his experiments, Bogdanov died in 1928 when a blood transfusion of a student suffering from malaria and tuberculosis was inserted into his body. Some scholars (such as Lauren Graham) speculated that their death could be a suicide, while others call it the reason for the inconvenience of the blood group, which was not fully understood at that time. Modern Era

Following the Bogdanov sample, the Soviet Union established a national system of blood banks in the 1930s. The news of the Soviet experience reached the United States where in 1937 Bernard Fantes, director of the Medical Council of Cook County Hospital in Chicago founded the first hospital blood bank in the United States. At the time of establishing a hospital laboratory that preserves and deposits the donor's blood, Phantos introduced the term "blood bank". Within a few years, hospitals and community blood banks were established throughout the United States.

In the late 1930s and early 1940s, Dr. Charles R. Drew's research gave birth to this discovery that blood can be divided into blood plasma and red blood cells and plasma can be stored separately. The blood deposited in this way lasted longer and the likelihood of its contamination was very low.

There was another significant breakthrough in 1939-40 when Carl Landsteiner, Alex Wiener, Philip Levine, and R.E. Stetson discovered the Rhesus blood group system, which until then was considered the cause of the majority of the transfusion reactions. Three years later, J.F. Lootitt and Patrick L. The behavior of acid-citrate-dextrose (ACD) solutions that reduce the anticoagulant volume by Molison has allowed greater amount of blood transfusion and long-term storage.

Carl Walter and W. P. Murphy, Jr. began the practice of plastic bags in 1950 for blood collection. The behavior of durable plastic bags in place of brittle glass bottles allowed the development of a collection system capable of safe and simple preparation of multi blood components from a whole unit of blood.

Completion of heavy loss of blood in the field of cancer-related surgery became a major problem. The rate of heart rate was very high. Dr C. Paul Boyn and William Holland found that the rate of blood temperature and transfusion greatly affected the survival rate and more soft blood was born. ( : 1. Boyan CP, Holland W. S. Cardiac Arrest and Temperatures of Bank Blood .Jama. 1963 January 5, 183: 58-60. 2. Editor Rupert J, Van Leiberg MJ, Erdman W. Anesthesia: Essays On It's History. Springer-Verlag, Berlin, 1985, pp. 99-101 ..)

An anti-antibody preservative, which was expanding in the period of the preservation of the stored blood, was CPDA-1, which started in 1979, which increased blood supply and exchange of resources between the blood banks Made Easy.

Since 2006, the blood products offered in the United States each year was approximately 15 million units. Precautions Compatibility (compatibility)

The main importance of the Rh group is its role in fetal and hemolytic disease of the newborn. When an Rh negative negative mother holds a positive embryo, she may be immune to Rh antigen (antigin). It is usually not important during pregnancy, but in subsequent pregnancies it can develop an immune response to Rh antigen (antigin). The mother's immune system can attack the infant's red cells by placenta. Light cases of HDFN can cause disability, but some serious cases can be fatal. Rh-D is the most commonly included red cell antigen in HDFN, but other red cell enzymes can also cause this condition. The listened blood types include "positive" or "negative" such as "O positive" Rh-D antigen. Transfusion transmitted infection

Many infectious diseases (such as HIV, Syphilis, Hepatitis B and Hepatitis C in other diseases) can transmit from the donor to the recipient.

Diseases transmitted through transfusion include:

When the need for a person's transfusion is anticipated, as is done in the prescribed surgery, to protect against the transmission of the disease and to remove the problem of blood type compatibility (compatibility) for the same Organizational donations can be used. Donation from donors known to the recipient during the initial years of HIV was a common practice. This type of donation is still common in developing countries. Processing of blood products before transfusion

After collection, the blood donated is usually processed, so that it can be made suitable for use in specific patient population. Examples include: Some quality control related topics such as disease or contamination investigations Neonatal transfusion

To ensure the safety of blood transfusion in patients with pediatric patients, hospitals are taking additional precautions to avoid infection and they prefer to use specially tested units which are declared negative for cytomegalovirus. has been carried out. Most guidelines recommend the use of CMV-negative blood components not only for white blood cell deficiency (leukoridous components) for infants or under-weight babies, in which the immune system has not been fully developed. These specific requirements impose extra restrictions on those blood donors who can donate for newborn use.

Generally, newborn transfusion occurs in any one of the following categories: Blood transfusion pre-compatibility test Main article: Cross-matching

Typ and screen words are used to check which (1) determines blood group (ABO compatibility) and (2) those who are naturally occurring diseases against the external tissue of the same species - Checks the opponents. It takes about 45 minutes to complete (depending on the method used). To know the pre-identified antibodies of the patient, blood bank technologists also examine the special needs and history of the patient.

A positive probe justifies the panel / exploration of an antibiotic. In a antibody panel, commercially prepared groups of donor blood are O red cell sealings, which are commonly and clinically significant forms which are contrary to the external tissue of individuals of the same species. The formation is done against the antibodies that arise in the form. Donor cells do not have any expression of homozygotic (such as K + K-), heterozygous (K + K +) expression or various antigens (K-k +). The samples of all the donor cells to be tested are shown in a chart. Using the growth method, the patient's serum is examined against various donor cells, such as gel or lias. Depending on the reaction of the patient's serum against donor cells, a method will emerge to confirm the presence of one or more antibodies. All antibodies are not clinically important (i.e. generate transfusion reactions, HDN etc.). Once the diagnostically important anti-antibody has developed within the patient, it is necessary that the patient receive the antigen negative sampling red blood cells so that there is no transfusion reaction in the future. A direct globulin resistance test (DAT) is also done as a part of antibody-related investigations.

Once the type and type screen is complete, the potential donor units will be compatibility with the patient's blood group, special requirements (such as CMV negative, or irradiated or washed) and antigen negative (a disease-resistant condition) Will be selected on the basis of). If no antibodies are present or there is no possibility, then immediate spin or CAC (computer-assisted cross-marking) method can be used.

In the immediate spin method, two drops of patient serum are examined against one drop of suspension of 3-5% of donor cells in an exam tube and rotated in a serophygue. Blood collection or blood fusion in the test tube is a positive reaction and the unit should not be taken.

If an antibody is suspected, then potential donor units should be tested and tested for a corresponding antigen. Then, to simplify the responsiveness and to examine the probe, antigen-negative units are tested against the patient's plasma at 37 ° C using globulin-induced / indirect cross-smatch technology.

If there is no time, the blood is called "no cross-matched blood". Without cross-matched blood, O is positive or O negative. Generally O negative is used for children and children of childbearing age. It is better for the lab to get a pre-transfusion sample in these cases so that to determine the actual blood group of the patient and examine the naturally occurring antibodies against the external tissue of the same species. The type and screen process can be adopted for this. process

Blood transfusion can be divided into two main types depending on their source:

To prevent cellular related growth, the donor blood units should be kept refrigerated to slow cellular metabolism. The transfusion should start within 30 minutes of taking the unit out of controlled storage.

The blood can only be given intravenously. Therefore it is necessary to insert a cannula with appropriate capacity.

Before donating blood to minimize the risks of transfusion reactions, the patient's personal details are matched with blood transfusion. Clerical error is an important source of transfusion reactions and attempts have been made to create redundancy in the matching process that occurs in the bedside.

Usually a unit of blood (up to 500 ml) is given for a period of 4 hours. In patients at risk of congestive heart failure, many physicians give urological vaccine to prevent overloading of fluid, in which case the circulatory overload or TACO of transfusion is called. To prevent other types of reactions, sometimes pharmaceuticals such as disafenhydramine are given to sterilize the effects of acetaminophen and / or a histamine before transfusion. Blood donation Main article: Blood donation

The blood donation is most commonly collected by placing a catheter in the form of whole blood in the vein and it is stored in a plastic bag (by mixing anticoagulants) through gravity. The stored blood is then divided into components so that it can be best used. In addition to red blood cells, plasma and platelets, the resulting blood component products include albumin protein, the formation of clotting agents, precipitates when soluble in the soluble substance, fibrinogen concentration, and immunoglobulin (antibodies). A more complex process of red cells, plasma and platelets can also be donated individually through apheresis.

In developed countries, donations are usually anonymous for the recipient, but the product in any blood bank is always personally detected through donation of whole cycle of charity, testing, separation in components, storage, and giving to the recipient Are eligible. This enables the management and investigation of transmission of a suspected transfusion disease or transfusion reaction. Donors in developing countries are sometimes appointed specifically by the recipient or recipient, usually a member of the family, and donated just before the transfusion. Risk to recipient Main article: Blood transfusion reaction

There are risks associated with receiving blood transfusions and they should be balanced against the estimated profit. The most common adverse reaction to blood transfusion is the febrile non-hemolytic reaction, in which there is fever which is cured of itself and does not produce any lasting problems or side effects.

Hemorrhoidic reactions include chills, headache, back pain, breathlessness, nervousness, chest pain, cardiac arrest (abnormal increase in heart rate) and low blood pressure.

Blood products can hardly be contaminated with bacteria; Since 2002, 1 in 50,000 platelet transfusions, and 1 in 50,000 blood cell transfusions, is estimated to have serious bacterial infections and blood vessel risk.

There is a risk that the blood transfusion will transmit viral infection to its recipient. Since 2006, the risk of having hepatitis B through blood transfusion in the United States is 1 in 250,000 units, and the risk of having HIV or hepatitis C in the United States through blood transfusion is 1, 2,000,000 (2 million) is. These risks were bigger before the advent of second and third generation tests of transfusion diseases. In the early 2000s, the implementation of nucleic acid probation or "NAT" has increased the risks further, and it has confirmed that in the developed world, viral infection by blood transfusion is extremely rare.

The transfusion acute hemophagic wound (TRAI) is a fast growing adverse event related to blood transfusion. TRALI is a syndrome of acute respiratory distress, which is often associated with fever, non-cardiac pulmonary edema (swelling of water), and hypoglycemia, which can occur in 1 in 2000 diabetes. Symptoms can be mildly deadly, but most patients are fully healed within 96 hours, and mortality from this condition is less than 10%. Although due to TRALI is not very clear, it is constantly associated with HLA antibody. Because the HLA-resistant pregnant women are deeply linked, many transfusion organizations (Blood and Tissue Bank of Cantabria, Spain, National Health Service in Britain) have decided to use plasma only for men for transfusion.

Other risks associated with obtaining blood transfusion include volume overload, iron overload (including multi-red blood cell transfusion), condom-related anti-nerve-vascular disease, anaphylactic reactions (in people with IgA deficiency) , And acute hemolytic reactions (more commonly due to the use of mismatched blood types).

Whether the risk of transfusion increases through storage time, concerns are also emerging, although the consensus has not yet been reached regarding the significance of the blood age. In relation to this, questions have been raised regarding the uncertain and inconsistent capacity of the transfusion for some highly susceptible patient groups such as the seriously ill, even though studies do not consider age as the only decisive factor. At this time $ 17 billion is much higher than the combined cost of purchasing, testing / treatment, and blood transfusion of estimated, unexpected transfusion costs dealing with ineffectiveness.

Scientists working in the University of Copenhagen explored the findings of enzymes in the journal Nature Biotechnology in April 2007, which could potentially convert blood from group A, B and AB to O group. is. These enzymes do not affect the RH group of blood. Objections regarding blood transfusion

Objections in relation to blood transfusions may arise from personal, medical, or religious reasons. For example, Jehovah's Witnesses mainly oppose blood transfusions for religious reasons - they believe that blood is sacred, although they have highlighted the potential complications associated with the transfusion. Non-MN blood transfusion

Veterinarians also use transfusion in other animals. To ensure a consistent match, different species require different levels of testing. For example, there are 3 known types of cat, 11 animals of cattle, 12 dogs, 16 pigs and 34 blood types of horses. However, in many species (especially in horses and dogs), cross matching is not required before the first transfusion because antibodies against non-self-cell antigens are not expressly expressed. - That is, the animal should be sensitive to adopt an antibody reaction against the blood (transposed) blood.

The rare and experimental methodology of inter-species blood transfusions is a form of heterogeneity. Substitution of blood transfusion Main article: Replacement of blood transfusions

Since 2009, there are no widely used oxygen-carrying blood substitutes for humans, although non-blood volume expansions and other blood-saving techniques are widely available. These therapist and surgeon avoid the risk of transmitting disease and immune suppression, discuss the lack of chronic blood donor and pay attention to the concerns of Jehovah's Witnesses and other people whose transfusion (blood offered) There are religious objections to getting.

There are currently many substitute blood related clinical evaluation steps. Most efforts to find a suitable alternative to blood have so far focused on ways to solve cell-free hemoglobin. Blood substitutes can be made available in emergency medicine and pre-hospital EMS care more easily. Upon successful, such substances in the blood can save many lives, especially if there is excessive bleeding in case of trauma. Hemopure, hemoglobin based medicine is valid for use in South Africa. Also see them read ahead

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