Much modern preparations of blood are known Much modern preparations of blood are known sufficiently today.sufficiently today.

1. 1. ArithromassArithromass – canned blood, from which is – canned blood, from which is removed plasma. Its reasonable use at removed plasma. Its reasonable use at anemia.anemia.

2. 2. Washed erythrocytesWashed erythrocytes – same arithromass, in – same arithromass, in which plasma are absenting.which plasma are absenting.

3. 3. ArithroweighArithroweigh – the blood, which is pour – the blood, which is pour plasmas, which change physiological solution, plasmas, which change physiological solution, with the accompaniment of levometicine, with the accompaniment of levometicine, rivanole and glucoses.rivanole and glucoses.

4. 4. Leycitar-trombocitar Leycitar-trombocitar mass or weigh is got mass or weigh is got after centrifuging of blood and branches of after centrifuging of blood and branches of leukocytes and erythrocytes. leukocytes and erythrocytes.

5. 5. Native plasma Native plasma – fluid part of blood without – fluid part of blood without form elements. It is getting after centrifuging form elements. It is getting after centrifuging of canned blood. Keep also, either as a blood, of canned blood. Keep also, either as a blood, not more than 72 hours. Enter with not more than 72 hours. Enter with observance group accessories. The ways of observance group accessories. The ways of introduction such either as for preserves. introduction such either as for preserves.

6. 6. FibrinogenumFibrinogenum. Stands out from native . Stands out from native plasma, is kept in vials on 1 gram. Group plasma, is kept in vials on 1 gram. Group specificity has not. Before using is divorce by specificity has not. Before using is divorce by water or physiological solution and is enter water or physiological solution and is enter intravenous.intravenous.

7. 7. Whey – a plasma, pour fibrinogenum, is keep Whey – a plasma, pour fibrinogenum, is keep and enter as native plasma. Sometimes in she and enter as native plasma. Sometimes in she enters calcium, vitamins, alcohol.enters calcium, vitamins, alcohol.

8. 8. FibrinolisinFibrinolisin – a ferment, chosen from the – a ferment, chosen from the plasma, is kept in vials in the manner of dry plasma, is kept in vials in the manner of dry powder. Possesses a possibility to dissolve powder. Possesses a possibility to dissolve tombs.tombs.

9. 9. Albumin and proteinAlbumin and protein. Stand out from the . Stand out from the plasma 20 or 25% dissolve, specificity have plasma 20 or 25% dissolve, specificity have not, is enter intravenous.not, is enter intravenous.

10. 10. Specific immunoglobulins Specific immunoglobulins (antistafrilococcus, antitetanus, (antistafrilococcus, antitetanus, countercoroar, antiinfluence), stands out from countercoroar, antiinfluence), stands out from the plasma of persons, which illed by the plasma of persons, which illed by corresponding diseases or immunized weaken corresponding diseases or immunized weaken by the toxin. Group accessories has not, are by the toxin. Group accessories has not, are enter intramuscular.enter intramuscular.

11. 11. Blood substistutions Blood substistutions (plasma substitutes). (plasma substitutes). Separate functions of blood are to be a Separate functions of blood are to be a change by different preparations, biological or change by different preparations, biological or chemical derived.chemical derived.

Plasma substitutes Plasma substitutes plasma substitutes of hemodynamic plasma substitutes of hemodynamic

actionaction desintoxicative solutionsdesintoxicative solutions plasma substitutes for parenteral plasma substitutes for parenteral

nutritionnutrition regulators of water-salt exchange regulators of water-salt exchange

and acid-base balanceand acid-base balance oxygen transmitters.oxygen transmitters.

Anti-shock plasma Anti-shock plasma substitutes substitutes

preparations originating from preparations originating from dextrane;dextrane;

preparations of gelatine;preparations of gelatine; preparations on the base of preparations on the base of

oxyethylstarch.oxyethylstarch.

(1) Preparations originating from (1) Preparations originating from dextranedextrane

Depending on their molecular mass Depending on their molecular mass solutions of this group are:solutions of this group are:

medium-molecular (polyglucin, polyfer, medium-molecular (polyglucin, polyfer, rondex, macrodex, intradex, dextrane, rondex, macrodex, intradex, dextrane, plasmodex, chemodex, oncovertine);plasmodex, chemodex, oncovertine);

low-molecular (rheopoluglucin, low-molecular (rheopoluglucin, rheogluman, rheomacrodex, lomodex, rheogluman, rheomacrodex, lomodex, dextrane-40, hemodex).dextrane-40, hemodex).

The main medium-molecular preparation The main medium-molecular preparation of dextrane is polyglucin, low-molecular is of dextrane is polyglucin, low-molecular is rheopoluglucin.rheopoluglucin.

PolyglucinPolyglucin is 6% solution of medium-molecular is 6% solution of medium-molecular dextrane fraction (molecular mass is 60 000 –dextrane fraction (molecular mass is 60 000 –80 000) in isotonic solution of sodium. During 80 000) in isotonic solution of sodium. During intravenous injection it rapidly increases the intravenous injection it rapidly increases the volume of circulating blood, increases and volume of circulating blood, increases and keeps arterial pressure. Polyglucin increases keeps arterial pressure. Polyglucin increases the volume of circulating blood on the quantity the volume of circulating blood on the quantity more than volume of injected preparation; it is more than volume of injected preparation; it is due to its high colloid-osmotic pressure. It due to its high colloid-osmotic pressure. It circulates in the organism from 3 to 7 days; circulates in the organism from 3 to 7 days; during first day 45-55% of solution is excreted, during first day 45-55% of solution is excreted, the main way of excretion is through kidneys. the main way of excretion is through kidneys. Injection of polyglucin increases oxidative-Injection of polyglucin increases oxidative-reductive processes in the organism and reductive processes in the organism and utilization of oxygen from flowing blood by utilization of oxygen from flowing blood by tissues. Flow injection of the preparation tissues. Flow injection of the preparation increases vessel tone.increases vessel tone.

RheopolyglucinRheopolyglucin is 10% solution of low- is 10% solution of low-molecular dextrane (molecular mass is 20 molecular dextrane (molecular mass is 20 000 – 40 000) in isotonic solution of 000 – 40 000) in isotonic solution of sodium chloride or 5% solution of sodium chloride or 5% solution of glucose. Like polyglucin, it is glucose. Like polyglucin, it is hyperonkotic colloid solution and during hyperonkotic colloid solution and during intravenous injection it considerably intravenous injection it considerably increases the volume of circulating fluid.increases the volume of circulating fluid.

Every gram of preparation connects 20-Every gram of preparation connects 20-25 ml of water in blood. It explains its 25 ml of water in blood. It explains its hemodynamic action. Rheopolyglucin hemodynamic action. Rheopolyglucin circulates in the organism during 2-3 circulates in the organism during 2-3 days, 70% of the preparation is excreted days, 70% of the preparation is excreted for the first day with the urine.for the first day with the urine.

(2) Preparations of gelatin(2) Preparations of gelatin..

They are gelatinole, modegel, They are gelatinole, modegel, hemodel, gelofusin, plasmogel. hemodel, gelofusin, plasmogel. Originator of this group and the Originator of this group and the most vide-spread preparation is most vide-spread preparation is gelatinol.gelatinol.

GelatinolGelatinol is 8% solution of partly decomposed is 8% solution of partly decomposed food gelatin in isotonic solution of sodium food gelatin in isotonic solution of sodium chloride (molecular mass is 15 000-25 000). chloride (molecular mass is 15 000-25 000). Gelatinol is protein, which contains some Gelatinol is protein, which contains some aminoacids: glycin, proline etc. Treating aminoacids: glycin, proline etc. Treating action is mainly connected with its high action is mainly connected with its high colloid-osmotic pressure, which provides fast colloid-osmotic pressure, which provides fast coming of interstitial fluid into blood flow. As coming of interstitial fluid into blood flow. As hemodynamic preparations gelatinol and its hemodynamic preparations gelatinol and its analogs are less effective than dextranes. analogs are less effective than dextranes. They leave the blood flow faster and localize They leave the blood flow faster and localize in interstitium. Gelatinol is nontoxic, in interstitium. Gelatinol is nontoxic, apyrogenic, does not cause antigenic apyrogenic, does not cause antigenic reactions. Kidneys excrete main part of the reactions. Kidneys excrete main part of the preparation. Indications for usage are acute preparation. Indications for usage are acute hypovolemia, different kinds of shock, and hypovolemia, different kinds of shock, and intoxication. Preparation is contraindicated in intoxication. Preparation is contraindicated in acute kidney diseases and lipid embolia.acute kidney diseases and lipid embolia.

(3) Preparations on the base (3) Preparations on the base of oxyethylstarchof oxyethylstarch..

Last years in USA, Germany, Japan the Last years in USA, Germany, Japan the solutions of oxyethylated starch found their solutions of oxyethylated starch found their usage. These are plasmosteryl, plasmotonin, usage. These are plasmosteryl, plasmotonin, rolex, and NAES-steryl.rolex, and NAES-steryl.

Structurally these preparations are close to Structurally these preparations are close to glycogen of animal tissues and are able to glycogen of animal tissues and are able to decompose in blood by amylolytic enzymes. decompose in blood by amylolytic enzymes. Solutions on the base of oxyethylstarch have Solutions on the base of oxyethylstarch have good hemodynamic action, which are not good hemodynamic action, which are not followed side effects.followed side effects.

2. Desintoxicative solutions.2. Desintoxicative solutions.

Plasma substitutions of desintoxicative Plasma substitutions of desintoxicative action provide desintoxication of the action provide desintoxication of the organism by connecting, neutralization organism by connecting, neutralization and excretion of toxic substances. They and excretion of toxic substances. They are preparations of polyvinylpyrolidone are preparations of polyvinylpyrolidone (hemodes, neohemodes, periston-N, (hemodes, neohemodes, periston-N, neocompensan, plasmodan, colidone) neocompensan, plasmodan, colidone) and solution of low-molecular polyvinyl and solution of low-molecular polyvinyl alcohol - polydes. Desintoxicative action alcohol - polydes. Desintoxicative action of those preparations is based on high of those preparations is based on high ability of polymer to complex-formation ability of polymer to complex-formation with toxin.with toxin.

HemodesHemodes – is 6% solution of low-molecular – is 6% solution of low-molecular polyvinylpyrolidon with molecular mass of 12 polyvinylpyrolidon with molecular mass of 12 000 – 27 000. Most its part is excreted by 000 – 27 000. Most its part is excreted by kidneys in 6-8 hours after intravenous kidneys in 6-8 hours after intravenous injection. It is active to many toxins, excluding injection. It is active to many toxins, excluding diphteria, and tetanus, and toxins formed diphteria, and tetanus, and toxins formed during radiation disease. It also stops stasis of during radiation disease. It also stops stasis of erythrocytes in capillaries during acute erythrocytes in capillaries during acute bleeding, shock, burn disease, and other bleeding, shock, burn disease, and other pathological processes. Depending on the pathological processes. Depending on the level of intoxication adults are injected with level of intoxication adults are injected with 200 – 400 ml a day, and children get 15 ml for 200 – 400 ml a day, and children get 15 ml for every kg of body weight. Contraindications every kg of body weight. Contraindications are bronchial asthma, acute nephritis, are bronchial asthma, acute nephritis, hemorrhage into brain.hemorrhage into brain.

NeohemodesNeohemodes is 6% solution of low- is 6% solution of low-molecular polyrinylpyrolidon with molecular polyrinylpyrolidon with molecular mass 6000 – 10000 with molecular mass 6000 – 10000 with addition of sodium, potassium, calcium addition of sodium, potassium, calcium ions. Detoxicative effect of neohemodes ions. Detoxicative effect of neohemodes is higher than of hemodes.is higher than of hemodes.

Indications are the same as hemodes has. Indications are the same as hemodes has. Besides, neohemodes has noticeable Besides, neohemodes has noticeable treating action in thyrotoxicosis, ray treating action in thyrotoxicosis, ray disease (radiation disease), different disease (radiation disease), different diseases of liver and other pathologies. diseases of liver and other pathologies. Preparation is injected intravenously with Preparation is injected intravenously with speed of 20 – 40 drops per minute, speed of 20 – 40 drops per minute, maximum single dose for adults is 400 maximum single dose for adults is 400 ml, for children this is 5 – 10 ml / kg.ml, for children this is 5 – 10 ml / kg.

PolydesPolydes is 3% solution of polyvinyl alcohol is 3% solution of polyvinyl alcohol in isotonic of sodium of chloride. in isotonic of sodium of chloride. Molecular mass is 10000 – 20000. It is Molecular mass is 10000 – 20000. It is fully excreted by kidneys during 24 hours. fully excreted by kidneys during 24 hours. Polydes is used intravenously drop by Polydes is used intravenously drop by drop for treating of intoxication caused by drop for treating of intoxication caused by peritonitis, acute pancreatitis, acute peritonitis, acute pancreatitis, acute cholecystitis, acute purulent infection, cholecystitis, acute purulent infection, burn disease, liver injury etc. Adults are burn disease, liver injury etc. Adults are injected with 200 – 500 ml / day, children injected with 200 – 500 ml / day, children – 5 – 10 ml / kg of body weight. In fast – 5 – 10 ml / kg of body weight. In fast injection of preparation there may occur injection of preparation there may occur dizziness and nausea.dizziness and nausea.

3. Plasma substitutes for 3. Plasma substitutes for parenteral feedingparenteral feeding

They are indicated in cases of full or portional They are indicated in cases of full or portional exclusion of natural nutrition of the patient, as exclusion of natural nutrition of the patient, as a result of some diseases and after operation a result of some diseases and after operation on the organs of alimentary tract, during on the organs of alimentary tract, during purulent septic injuries, traumatic, ray and purulent septic injuries, traumatic, ray and thermic injuries, severe complications of thermic injuries, severe complications of postoperative period (peritonitis, abscesses postoperative period (peritonitis, abscesses and intestinal anastomoses), and also in and intestinal anastomoses), and also in hypoproteinemia of any origin. Parenteral hypoproteinemia of any origin. Parenteral nutrition is provided with protein nutrition is provided with protein preparations, lipid emulsions and preparations, lipid emulsions and carbohydrates. First help the aminoacids go carbohydrates. First help the aminoacids go into the organism, and lipid emulsions and into the organism, and lipid emulsions and carbohydrates provide him with energy for carbohydrates provide him with energy for protein digestion.protein digestion.

(1) Protein Preparations(1) Protein Preparations Among protein preparations are Among protein preparations are

hydrolysates of proteins and mixtures of hydrolysates of proteins and mixtures of aminoacids.aminoacids.

The sources of protein hydrolysates are The sources of protein hydrolysates are casein, proteins of cattle’s blood, muscle casein, proteins of cattle’s blood, muscle proteins, and also erythrocytes and thrombs proteins, and also erythrocytes and thrombs of donor blood. When getting protein of donor blood. When getting protein hydrolysates, enzymes or acid hydrolyses hydrolysates, enzymes or acid hydrolyses the products. The most widely used are the products. The most widely used are hydrolysate of casein, hydrolysin, hydrolysate of casein, hydrolysin, aminocrovin, amicin, aminopeptide, aminocrovin, amicin, aminopeptide, fibrinosol, aminozol, aminone, amigen fibrinosol, aminozol, aminone, amigen etc.etc.

Separate group contains solutions of aminoacids, Separate group contains solutions of aminoacids, which are easily digested by the organism, which are easily digested by the organism, because there’s no need to decompose because there’s no need to decompose peptides. The advantage of mixtures of peptides. The advantage of mixtures of crystallic aminoacids is easier technology of crystallic aminoacids is easier technology of preparation, high concentration of aminoacids, preparation, high concentration of aminoacids, possibility to create the preparation with any possibility to create the preparation with any correlation of aminoacids and adding into the correlation of aminoacids and adding into the mixture electrolytes, vitamins and energy mixture electrolytes, vitamins and energy substances. The main preparations are: substances. The main preparations are: polyamine, infusamine, vamine, polyamine, infusamine, vamine, moramine, freaminemoramine, freamine etc. Aminoacid mixtures etc. Aminoacid mixtures are injected intravenously drop-by-drop, 20 – 30 are injected intravenously drop-by-drop, 20 – 30 drops / minute in full parenteral feeding in dose drops / minute in full parenteral feeding in dose 800 – 1200 ml every day. They can be injected 800 – 1200 ml every day. They can be injected through the tube into the stomach or through the tube into the stomach or duodenum.duodenum.

(2) Lipid emulsions(2) Lipid emulsions..Inclusion of lipid emulsions into the complex of Inclusion of lipid emulsions into the complex of

parenteral nutrition improves the energetics parenteral nutrition improves the energetics of patient’s organism has considerable of patient’s organism has considerable nitrogen-keeping action, corrects the lipid nitrogen-keeping action, corrects the lipid content of plasma and structures of cell content of plasma and structures of cell membranes. Lipids provide the organism with membranes. Lipids provide the organism with essential fatty acids (linolic, linolenic, essential fatty acids (linolic, linolenic, arachidonic), fat-soluble vitamins (A, K, D), arachidonic), fat-soluble vitamins (A, K, D), phospholipids. In clinical practice they use phospholipids. In clinical practice they use lipid emulsions (emulgated lipids do not cause lipid emulsions (emulgated lipids do not cause lipid embolia). The most popular are lipid embolia). The most popular are intralipid, lipiphysian, infusolipid, intralipid, lipiphysian, infusolipid, lipofundin, lipomool, infonutrol, fatgen lipofundin, lipomool, infonutrol, fatgen etc.etc.

(3) Carbohydrates.(3) Carbohydrates. Carbohydrates are used in parenteral Carbohydrates are used in parenteral

nutrition for providing with energy needs, and nutrition for providing with energy needs, and also energetic addition to protein also energetic addition to protein hydrolysates. Injected carbohydrates hydrolysates. Injected carbohydrates stimulate the decomposition of protein stimulate the decomposition of protein hydrolysates and formation of own proteins hydrolysates and formation of own proteins from aminoacids.from aminoacids.

The most widely used are solutions of The most widely used are solutions of glucoseglucose (5%, 10%, 20%, 40%). (5%, 10%, 20%, 40%). Contraindication is diabetes mellitus.Contraindication is diabetes mellitus.

From the other carbohydrates fructose and From the other carbohydrates fructose and carbohydrate alcohols (carbohydrate alcohols (xylite, sorbite, xylite, sorbite, mannitemannite) are used. The digestion of those ) are used. The digestion of those preparations is not connected with insulin and preparations is not connected with insulin and may be possible in patients with diabetes may be possible in patients with diabetes mellitus.mellitus.

4. Regulators of water – salt 4. Regulators of water – salt exchange and acid – base balance.exchange and acid – base balance.

These are crystalloid (polyion) These are crystalloid (polyion) solutions and osmotic diuretics.solutions and osmotic diuretics.

(1) Crystalloid solutions(1) Crystalloid solutions.. The most widely used are:The most widely used are: physiologic (isotonic) solutionphysiologic (isotonic) solution

sodium chloridesodium chloride 0,9% solution0,9% solution Ringer’s solution

sodium chloride 8,0 gmpotassium chloride 0,075 gmcalcium chloride 0,1 gmsodium bicarbonate 0,1 gmdistilled water to 1 liter

Ringer – Lock’s solutionRinger – Lock’s solution

sodium chloridesodium chloride 9,0 gm9,0 gm

sodium bicarbonatesodium bicarbonate 0,2 gm0,2 gm

calcium chloridecalcium chloride 0,2 gm0,2 gm

glucoseglucose 1,0 gm1,0 gm

bidistilled waterbidistilled water to 1 literto 1 liter

LactasoleLactasole

sodium chloridesodium chloride 6,2 gm6,2 gm

potassium chloridepotassium chloride 0,3 gm0,3 gm

calcium chloridecalcium chloride 0,16 gm0,16 gm

magnesium chloridemagnesium chloride 0,1 gm0,1 gm

sodium bicarbonatesodium bicarbonate 0,3 gm0,3 gm

sodium lactatesodium lactate 3,36 gm3,36 gm

distilled waterdistilled water to 1 literto 1 liter

In clinical practice these solutions are In clinical practice these solutions are used for correction of water-salt used for correction of water-salt balance, they contain the most balance, they contain the most adequate set of ions to blood adequate set of ions to blood content. Ringer – Lock’s solution and content. Ringer – Lock’s solution and lactasole contain also anti-acidotic lactasole contain also anti-acidotic components like bicarbonate or components like bicarbonate or lactate of sodium. For acidosis lactate of sodium. For acidosis correction they provide intravenous correction they provide intravenous injection of injection of 4 – 5% solution of 4 – 5% solution of sodium bicarbonate.sodium bicarbonate.

(2) Osmodiuretics(2) Osmodiuretics These are multiatomic alcohols: sorbite These are multiatomic alcohols: sorbite

and mannite.and mannite. MannitoleMannitole is 15% solution of mannite in is 15% solution of mannite in

isotonic solution.isotonic solution. SorbitoleSorbitole is 20% solution of sorbite in is 20% solution of sorbite in

isotonic solution.isotonic solution. The mechanism of diuretic action of these The mechanism of diuretic action of these

preparations is connected with increased preparations is connected with increased plasma osmotic level and going of plasma osmotic level and going of interstitial fluid into blood flow, which interstitial fluid into blood flow, which increases the volume of circulating blood increases the volume of circulating blood and venal blood flow.and venal blood flow.

Indications for osmodiuretics usage are Indications for osmodiuretics usage are early stage of acute renal insufficiency, early stage of acute renal insufficiency, hemolytic shock, heart insufficiency, hemolytic shock, heart insufficiency, brain edema, paresis of intestine brain edema, paresis of intestine (stimulate the peristalsis), liver diseases (stimulate the peristalsis), liver diseases and diseases of bile-excreting tracts etc. and diseases of bile-excreting tracts etc. Contraindications to their usage are Contraindications to their usage are disorder of filtration in kidneys, heart disorder of filtration in kidneys, heart insufficiency with evident anasarka and insufficiency with evident anasarka and other states of extra cellular other states of extra cellular hyperhydratation, intracranial hyperhydratation, intracranial hematomas.hematomas.

5. Oxygen Transmotters.5. Oxygen Transmotters. Creation of plasma substitutes, which provide Creation of plasma substitutes, which provide

such function as oxygen transmission to the such function as oxygen transmission to the tissues of the organism, so called “artificial tissues of the organism, so called “artificial blood”, is difficult, but very important task.blood”, is difficult, but very important task.

Nowadays there are created oxygen-Nowadays there are created oxygen-transmitting preparations (transmitting preparations (perftoran, perftoran, perfucole, flusol-Daperfucole, flusol-Da) and soluble ) and soluble hemoglobin (hemoglobin (erygem, conjugated erygem, conjugated hemoglobinhemoglobin), but they have a little oxygen ), but they have a little oxygen capacity and have some toxicity. The capacity and have some toxicity. The questions of their decomposition and questions of their decomposition and excretion from the organism are studied not excretion from the organism are studied not enough.enough.

Till this time the problem of Till this time the problem of sterilization and cheeping of their sterilization and cheeping of their making is not solved. That’s why in making is not solved. That’s why in clinical practice oxygen transmitters clinical practice oxygen transmitters are almost not used.are almost not used.

Usage of plasma substitutes solutions Usage of plasma substitutes solutions in some cases causes allergic, in some cases causes allergic, pyrogenic and toxic reactions, but their pyrogenic and toxic reactions, but their frequency and severity are frequency and severity are considerably less than those in considerably less than those in transfusion of blood and its transfusion of blood and its components components