Hemotransfusionic shock
Contents:
Description:
Hemotransfusionic shock belongs to the 11th type of anaphylactic reactions - cytotoxic. Destruction of erythrocytes is provided with system of a complement. From erythrocytes thromboplastin, ADF, potassium, free hemoglobin, erythrocyte factors of coagulation, BAV come to a blood stream. The metabolic acidosis develops, the IDCS is started, OPN develops, the oxygen capacity of blood decreases, the content of bilirubin, urea, creatinine, potassium increases.
Symptoms of Hemotransfusionic shock:
Signs of hemotransfusionic shock:
1) excitement of patients;
2) stethalgias;
3) back pains.
Then develop:
4) pallor of integuments;
5) tachycardia;
6) cold sweat;
7) permanent falling of the ABP.
Develop in later terms:
8) haemoglobinaemia;
9) hemolitic jaundice;
10) OPN;
11) acute liver failure.
If shock develops in operation time, under anesthetic, that its signs are:
1) permanent falling of the ABP,
2) the raised bleeding from an operational wound,
3) emergence of urine of color of "meat slops" (therefore in hemotransfusion cases during operation bladder catheterization is obligatory).
Degrees of hemotransfusionic shock:
1 degree - decrease in systolic arterial pressure to 90 mm of mercury.; The 2nd degree - to 80-70 mm of mercury.; The 3rd degree - is lower than 70 mm of mercury.
Periods of hemotransfusionic shock:
1) actually hemotransfusionic shock;
2) period of an oliguria and anury;
3) period of recovery of a diuresis;
4) recovery period.
Clinical symptoms of shock
The patient shows concern, the fever complains of pains and feeling of constraint behind a breast, a back pain, muscles, sometimes, an asthma, breath difficulty is observed; the person is hyperemic, sometimes pale or cyanochroic. Nausea, vomiting, an involuntary urination and defecation are possible. Pulse is frequent, weak filling, arterial pressure decreases.
Clinic under anesthetic:
At incompatible blood transfusion during operation under anesthetic manifestations of shock are absent more often or are poorly expressed. On incompatibility of blood specify increase or falling of arterial pressure, cyanosis of an integument and visible mucous membranes in such cases, raised, sometimes it is considerable, bleeding of fabrics in an operational wound.
Hemotransfusionic reactions and complications are classified:
I. Immune:
- incompatibility on AVO, Rh, HLA - hemolitic reactions;
- febrile - HLA;
- anaphylactic - IgA;
- allergic - proteins of plasma;
- syndrome of massive hemotransfusions.
II. Not immune:
- substandard blood;
- the infected blood;
- errors in technology of transfusion;
- condition of the recipient.
Reasons of Hemotransfusionic shock:
Hemotransfusionic shock arises at hemotransfusion, a packed red cells, incompatible on the AVO group system. It is shown in time or in the next hour after a hemotransfusion in the form of falling of arterial pressure, emergence of urine of dark-brown color and an oligoanuriya, a fever, pains in a waist, an asthma, jaundice.
The reason - in most cases failure to follow rules of hemotransfusion at one of stages. Pathogeny: intravascular destruction of erythrocytes of donor blood leads to an exit in blood of free hemoglobin, active thromboplastin that leads to DVS - a syndrome, disturbance of microcirculation, TsNS, shock.
Treatment of Hemotransfusionic shock:
At emergence of signs of hemotransfusionic shock it is necessary to stop hemotransfusion at once, to begin antishock therapy - Polyglucinum, narcotic analgetics, heparin, antihistaminic drugs, corticosteroid hormones. Then carrying out an artificial diuresis, plasma exchange, according to indications - a hemodialysis is necessary, at anemia - transfusion of individually picked up washed erythrocytes.
