Much modern preparations of blood are known sufficiently today.

1. Much modern preparations of blood are known sufficiently today. 1. Arithromass – canned blood, from which is removed plasma. Its reasonable use at anemia. 2. Washed erythrocytes – same arithromass, in which plasma are absenting. 3. Arithroweigh – the blood, which is pour plasmas, which change physiological solution, with the accompaniment of levometicine, rivanole and glucoses. 4. Leycitar-trombocitar mass or weigh is got after centrifuging of blood and branches of leukocytes and erythrocytes.

2. 5. Native plasma – fluid part of blood without form elements. It is getting after centrifuging of canned blood. Keep also, either as a blood, not more than 72 hours. Enter with observance group accessories. The ways of introduction such either as for preserves. 6. Fibrinogenum. Stands out from native plasma, is kept in vials on 1 gram. Group specificity has not. Before using is divorce by water or physiological solution and is enter intravenous. 7. Whey – a plasma, pour fibrinogenum, is keep and enter as native plasma. Sometimes in she enters calcium, vitamins, alcohol. 8. Fibrinolisin – a ferment, chosen from the plasma, is kept in vials in the manner of dry powder. Possesses a possibility to dissolve tombs.

3. 9. Albumin and protein. Stand out from the plasma 20 or 25% dissolve, specificity have not, is enter intravenous. 10. Specific immunoglobulins (antistafrilococcus, antitetanus, countercoroar, antiinfluence), stands out from the plasma of persons, which illed by corresponding diseases or immunized weaken by the toxin. Group accessories has not, are enter intramuscular. 11. Blood substistutions (plasma substitutes). Separate functions of blood are to be a change by different preparations, biological or chemical derived.

4. Plasma substitutes • plasma substitutes of hemodynamic action • desintoxicative solutions • plasma substitutes for parenteral nutrition • regulators of water-salt exchange and acid-base balance • oxygen transmitters.

5. Anti-shock plasma substitutes • preparations originating from dextrane; • preparations of gelatine; • preparations on the base of oxyethylstarch.

6. (1) Preparations originating from dextrane • Depending on their molecular mass solutions of this group are: • medium-molecular (polyglucin, polyfer, rondex, macrodex, intradex, dextrane, plasmodex, chemodex, oncovertine); • low-molecular (rheopoluglucin, rheogluman, rheomacrodex, lomodex, dextrane-40, hemodex). • The main medium-molecular preparation of dextrane is polyglucin, low-molecular is rheopoluglucin.

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

8. Rheopolyglucin is 10% solution of low-molecular dextrane (molecular mass is 20 000 – 40 000) in isotonic solution of sodium chloride or 5% solution of glucose. Like polyglucin, it is hyperonkotic colloid solution and during intravenous injection it considerably increases the volume of circulating fluid. • Every gram of preparation connects 20-25 ml of water in blood. It explains its hemodynamic action. Rheopolyglucin circulates in the organism during 2-3 days, 70% of the preparation is excreted for the first day with the urine.

9. (2) Preparations of gelatin. They are gelatinole, modegel, hemodel, gelofusin, plasmogel. Originator of this group and the most vide-spread preparation is gelatinol.

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

11. (3) Preparations on the base of oxyethylstarch. • Last years in USA, Germany, Japan the solutions of oxyethylated starch found their usage. These are plasmosteryl, plasmotonin, rolex, and NAES-steryl. • Structurally these preparations are close to glycogen of animal tissues and are able to decompose in blood by amylolytic enzymes. Solutions on the base of oxyethylstarch have good hemodynamic action, which are not followed side effects.

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

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

14. Neohemodes is 6% solution of low-molecular polyrinylpyrolidon with molecular mass 6000 – 10000 with addition of sodium, potassium, calcium ions. Detoxicative effect of neohemodes is higher than of hemodes. • Indications are the same as hemodes has. Besides, neohemodes has noticeable treating action in thyrotoxicosis, ray disease (radiation disease), different diseases of liver and other pathologies. Preparation is injected intravenously with speed of 20 – 40 drops per minute, maximum single dose for adults is 400 ml, for children this is 5 – 10 ml / kg.

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

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

17. (1) Protein Preparations • Among protein preparations are hydrolysates of proteins and mixtures of aminoacids. • The sources of protein hydrolysates are casein, proteins of cattle’s blood, muscle proteins, and also erythrocytes and thrombs of donor blood. When getting protein hydrolysates, enzymes or acid hydrolyses the products. The most widely used are hydrolysate of casein, hydrolysin, aminocrovin, amicin, aminopeptide, fibrinosol, aminozol, aminone, amigen etc.

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

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

20. (3) Carbohydrates. • Carbohydrates are used in parenteral nutrition for providing with energy needs, and also energetic addition to protein hydrolysates. Injected carbohydrates stimulate the decomposition of protein hydrolysates and formation of own proteins from aminoacids. • The most widely used are solutions of glucose (5%, 10%, 20%, 40%). Contraindication is diabetes mellitus. • From the other carbohydrates fructose and carbohydrate alcohols (xylite, sorbite, mannite) are used. The digestion of those preparations is not connected with insulin and may be possible in patients with diabetes mellitus.

21. 4. Regulators of water – salt exchange and acid – base balance. These are crystalloid (polyion) solutions and osmotic diuretics.

22. (1) Crystalloid solutions. • The most widely used are: • physiologic (isotonic) solution sodium chloride 0,9% solution • Ringer’s solution sodium chloride 8,0 gm potassium chloride 0,075 gm calcium chloride 0,1 gm sodium bicarbonate 0,1 gm distilled water to 1 liter

23. Ringer – Lock’s solution sodium chloride 9,0 gm sodium bicarbonate 0,2 gm calcium chloride 0,2 gm glucose 1,0 gm bidistilled water to 1 liter

24. Lactasole sodium chloride 6,2 gm potassium chloride 0,3 gm calcium chloride 0,16 gm magnesium chloride 0,1 gm sodium bicarbonate 0,3 gm sodium lactate 3,36 gm distilled water to 1 liter

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

26. (2) Osmodiuretics • These are multiatomic alcohols: sorbite and mannite. • Mannitole is 15% solution of mannite in isotonic solution. • Sorbitole is 20% solution of sorbite in isotonic solution. • The mechanism of diuretic action of these preparations is connected with increased plasma osmotic level and going of interstitial fluid into blood flow, which increases the volume of circulating blood and venal blood flow.

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

28. 5. Oxygen Transmotters. • Creation of plasma substitutes, which provide such function as oxygen transmission to the tissues of the organism, so called “artificial blood”, is difficult, but very important task. • Nowadays there are created oxygen-transmitting preparations (perftoran, perfucole, flusol-Da) and soluble hemoglobin (erygem, conjugated hemoglobin), but they have a little oxygen capacity and have some toxicity. The questions of their decomposition and excretion from the organism are studied not enough.

29. Till this time the problem of sterilization and cheeping of their making is not solved. That’s why in clinical practice oxygen transmitters are almost not used. • Usage of plasma substitutes solutions in some cases causes allergic, pyrogenic and toxic reactions, but their frequency and severity are considerably less than those in transfusion of blood and its components