RU2464031C2 - Method for assessing patient's state following packed red blood cell transfusion in critical conditions - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely transfusiology and surgery, and concerns the assessment of the patient's state following packed red blood cell transfusion in critical conditions. For this purpose packed red blood cell transfusion is followed by blood sampling and preparing of a patient's blood serum sample for wedge degradation test. If observing a tongue-like structure in a fascia edge, the further progression of the patient's state is stated to be favourable, while the absence shows the unfavourable state up to lethal outcome.

EFFECT: method provides obtaining reliable information on the patient's state with no other laboratory studies required.

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Description

The invention relates to medicine, namely to laboratory diagnostics, and can be used in disaster medicine, emergency and emergency care, emergency anesthesiology and intensive care, transfusiology, surgery to assess the outcome of a critical condition after massive blood loss and a blood transfusion in connection with this.

A known method for predicting and assessing the health status of a human body (RF Patent 02339045, IPC G01N 33/62, publ. 2008), which evaluates the entire metabolism as a whole in the analysis of biochemical parameters of blood serum characterizing the type of metabolism, the intensity of synthesis and decay substances, the depth of catabolic shifts, the depth of pathological and physiological disorders.

However, this method is time-consuming and expensive due to the significant use of consumables. In addition, a comparison of a number of biochemical parameters with respect to the depth of the ongoing metabolic shifts is subjective, especially when it comes to critical conditions.

A known diagnostic method used in the assessment of critical conditions (RF Patent 02312357, IPC G01N 33/68, publ. 2007) according to the systemic inflammatory response of the body, in which the concentration of the main cationic protein of blood plasma eosinophils is determined by the immunochemiluminescent method.

However, this method is limited, since it can only be used for persons who do not have a history of allergic diseases. However, the admission of patients in critical condition as a result of injuries in various, for example, car accidents, terrorist attacks excludes the use of this method.

Closest to the proposed method is a method for assessing the patient’s condition (RF Patent 2103692, IPC G01N 33/53, publ. 1998), including a study of the dynamics of the activity of alanine aminotransferase and aspartate aminotransferase in blood serum taken from a patient during an acute process. A blood serum sample is placed in the medium at the temperature of the refrigerator, and subsequent dynamic studies of enzyme activity are carried out in samples taken directly from this sample, and the patient's condition is assessed indirectly from the data obtained.

The disadvantage of this method is the mandatory use of biochemical analyzers and special sets of reagents, which significantly reduces the possibility of its widespread use in laboratory practice.

The task of the invention is to remedy these disadvantages. We set out to find a single clear sign that would objectively signal the state of the body and evaluate the further course of the pathological process. Moreover, obtaining such a feature would be distinguished by technical simplicity, the absence of the use of any special devices and chemical reagents.

We have studied the features of the morphological picture of the serum facies in postoperative patients with severe concomitant pathology who received red blood cells during or after the operation during massive blood loss. Further monitoring of these patients and the outcome of the critical condition gave us reason to interpret the revealed morphological features of the blood serum facies as evaluative.

For this, in the method for assessing the patient’s condition after transfusion of the erythrocyte mass in critical conditions, including a study of the patient’s blood serum, it is proposed to take blood from the patient after transfusion of the red blood cell mass. Moreover, for the study, a patient’s blood serum sample is prepared by the method of wedge-shaped dehydration and, if a “tongue” type structure is detected in the marginal zone of the facies, the further dynamics of the process of restoring homeostasis is assessed as favorable, and in their absence, as unfavorable, even fatal.

An explanation of the manifestation of the prognostic phenomenon described above is that a donor erythrocyte mass is poured into the body of a severe patient, while a small part of the red blood cells is necessarily hemolized. When a foreign protein (antigen) enters the bloodstream into a human body that can withstand the action of an irritating factor, it stimulates the immune system with the formation of antibodies. The active reaction of the immune system to a foreign agent characterizes a fairly high ability of the body to restore homeostasis and, as a result, the body gets out of a critical state. The absence of an immune response in response to the injected red blood cell mass indicates a complete suppression of the immunological activity of the body and, possibly, their vital systems, and, as a result, the death of the patient with the complete exhaustion of reserve capabilities and the inability of the body to emerge from a critical state, i.e. about an unfavorable prognosis.

Figure 1 shows a fragment of the patient's blood serum facies after transfusion of a red blood cell mass, in the edge zone of which structures of the "tongue" type are visible; figure 2 is a fragment of the facies of the blood serum of another patient also after transfusion of red blood cells, however, in the edge zone of the structure of the type of "language" are missing.

The implementation of the method shown in specific clinical examples.

Example 1

Patient R., 65 years old. Suffers from complex somatic pathology (systemic atherosclerosis, hypertension, nephrolithiasis). Operated on gastric resection. During the operation, due to massive blood loss, a red blood cell mass was transferred to him.

Immediately after the operation, blood was taken and the picture was evaluated by the proposed method.

Blood was taken from the ulnar vein, serum was obtained by settling in a test tube (possibly centrifugation), a drop of blood serum was applied in an amount of 0.01-0.02 ml on the surface of a glass slide, dried at a temperature of 24-25 ° C and after 18 hours ( the time of the test is maintained from 18 to 24 hours), the picture of the facies under microscopy was evaluated. In the marginal zone of the blood serum facies, structures of the tongue type were clearly revealed (Fig. 1).

Conclusion: the condition of the body is compensated, the prognosis is favorable.

The postoperative period at the patient R. passed without complications.

Example 2

Patient P., 67 years old. Suffers from complex somatic pathology (systemic atherosclerosis, coronary heart disease, prostate adenoma). Held cholecystectomy. During the operation, due to massive blood loss, a red blood cell mass was transferred to him.

Immediately after the operation, blood was taken and the picture was evaluated by the specified method. In the marginal zone of the facies of blood serum structures of the type "language" are absent (figure 2).

Conclusion: the state of the body is decompensated, the prognosis is poor.

The postoperative period in patient P. proceeded with the development of severe complications, and on the 7th day after the operation, a fatal outcome occurred.

The use of this method in 37 patients of the intensive care unit showed a 100% coincidence of the result of assessing the state of a favorable and unfavorable outcome of the state of the body after massive blood loss.

The specified method has the following advantages over the known:

- limited to one sign (excludes subjectivity);

- simple to execute;

- highly economical

- highly reliable.

Claims (1)

A method for predicting a patient’s condition after a red blood cell transfusion, including a blood serum test, characterized in that the patient’s blood sampling is carried out after a red blood cell transfusion, a patient’s blood serum is prepared for examination by wedge-shaped dehydration and if a tongue-like structure is detected in the edge zone "Evaluate the further dynamics of the patient’s condition as favorable, and in their absence, as unfavorable, up to a fatal outcome.

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