RU2387452C1 - Method of infusion medication of spinal surgery in children - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: to ensure optimal preparation of children to spinal operation is ensured by the preclinical analysis of iron metabolism parametres, detection of the latent iron deficiency to be corrected, and also making an individual autodonation program included acute normovolemic hemodilution. Two days before the first donation, iron preparations are introduced in a dose 1/2 of a daily dose to be continued with a complete dose during the whole preoperative and thereafter postoperative period. After donation, the exfused autoblood volume is compensated in the equivalent volume with a plasma substitute solutions: crystalloids - 6-10 ml/kg and colloid of hydroxyethylated starch - 5 ml/kg. On the second days following the donation, epocrine is administered in a single dose 150 units/kg; it is followed with the nutritional supplementation with using enteral mixtures, for cause, parenteral support of protein exchange is applied. On the third day after the first donation, the biochemical analysis of blood serum, the hemostasis system analysis and the complete blood count and clinical urine analysis are used to control the case. The hemoglobin level 110 g/l, and packed cell volume 33% and decreased hemoglobin by 15 g/l and less of the reference level enables to perform the second blood donation. If the reference hemoglobin has decreased by 15 g/l and more, autodonation represents autoplasma giving. On the operation day, the acute normovolemic hemodilution is performed. ^ EFFECT: method provides the short-term preparation of autoblood components, including the cases of potential latent iron deficiency in the patient, not leading to the failure of adaptive reserves of an organism. ^ 3 ex

Description

The invention relates to medicine, namely to transfusiology, and can be used to ensure optimal preparation of the patient for surgical treatment of scoliotic disease.

Known methods for preoperative harvesting of autologous blood, suggesting a long period of blood collection, which leads to a delay in surgical intervention and a significant increase in the length of hospital stay. In addition, long-term storage of blood components is accompanied by the development of degenerative changes in canned blood, which entails a violation of the oxygen-transport function of the blood, as well as the formation of cellular microaggregates, which can cause damage to the microcirculation system (M.M. Petrov et al. “Application of autohemotransfusion in a multidisciplinary hospital "// Materials of the international scientific-practical conference" Bloodless surgery on the threshold of the XXI century "- M. - 2000. - P.85-87; Björn Lysander." Comparative assessment of p different methods of blood preservation in surgery "// Appendix to the journal Anesthesiol. and reanimation." Alternatives to blood transfusion in surgery. "- M. - 1999. - P.81-93; Aria Shander, MD" Anesthetic management and pharmacological agents to limit perioperative blood loss ”// Appendix to the journal Anesthesiol. and reanimation.“ Alternatives to blood transfusion in surgery. ”- M. - 1999. - P.68-80; Jean-Francois Baron.“ Pharmacological methods for stimulating erythropoiesis - erythropoietin in combination with methods blood savings ”// Appendix to the journal Anesteziol. and reanim. "Alternatives to blood transfusion in surgery." - M. - 1999. - P.68-80).

Closest to the claimed is a method of preoperative harvesting of autologous blood during orthopedic operations in children (Lebedeva M.N., Ovcharenko A.I. et al. Patent RU No. 22328315).

The method is carried out by harvesting 4 doses of autologous blood components (double exfusion of whole autologous blood with subsequent fractionation and obtaining two doses of red blood cells and two doses of freshly frozen plasma) with an interval of 3 days against the background of complex drug preparation, including the appointment of partial parenteral nutrition for all patients during autodonation ( crystalline amino acids intravenously, 10% glucose intravenously), crystalloids, epocrine, ferrumlec, sorbifer, B vitamins, ascorbic acid lots, folic acid Retabolilum holding nutritional support using a mixture of enteric "Berlamin modular".

This method has the following disadvantages:

- when planning the preparation of autologous blood, the possible presence of a latent iron deficiency in the patient is not taken into account, which affects the dynamics of the restoration of hematological parameters during the preparation of autologous blood and its effectiveness;

- the appointment of parenteral nutritional support (administration of AMA) is carried out for all patients, regardless of the characteristics of protein metabolism;

- the use of replacement infusion therapy with crystalloids does not exclude the likelihood of developing vasovagal reactions to temporary blood loss;

- autologous blood is harvested in advance (preoperatively) without acute normovolemic hemodilution (ONG).

The objective of the invention is to develop a method for the preparation and conduct of surgical treatment of children with spinal deformities by harvesting the optimal amount of autologous blood with minimal risk to the patient.

The solution of this problem allows us to adapt the body to blood loss during autologous blood harvesting, which qualitatively improves the recovery postoperative period and reduces its time. Correction of latent iron deficiency prepares the patient for effective auto-donation. Infusion-drug therapy ensures the stability of hemodynamics during blood sampling, the effectiveness of erythropoiesis in the perioperative period. This method of carrying out and the infusion-drug supply of autohemotransfusions allows you to rationally compose and implement a program for procurement of components of autologous blood, taking into account the individual characteristics of the patient, to procure autocomponents in sufficient quantities in a short time (6-10 days), without disrupting the adaptive reserves of the body, ensuring satisfactory the well-being of patients at the preoperative stage, avoids complications associated with the process of harvesting autologous blood and the use of m allogeneic hemocomponents.

The technical result is achieved due to the intensive infusion-medication support at all stages of autologous blood procurement, which allows preparing the required number of autocomponents in a short period of time (6-10 days) with minimal risk for patients. The autologous blood preparation program includes acute normovolemic hemodilution (ONG), the only source of fresh whole blood in which the functions of red blood cells, platelets, white blood cells and plasma coagulation factors are preserved. In addition, ONG reduces blood viscosity, improves its rheological properties and microcirculation, positively affects cardiac output and increases oxygen delivery to tissues.

The problem is solved due to the fact that at the prehospital stage, the parameters of iron metabolism are examined, the presence of latent iron deficiency is detected, it is corrected, at the hospital stage, an additional ultrasound of the heart, kidneys and liver, spirography are performed, an individual autodonation program is included with the inclusion of acute normovolemic hemodilution; two days before the first donation, iron preparations are prescribed in a dose ^of _1/2 daily dose and continue in full dose for the entire preoperative and postoperative period, after donation the exfused volume of autologous blood is replaced with an equivalent volume of plasma-replacing solutions: crystalloids - 6-10 ml / kg and colloids on the basis of hydroxyethylated starch - 5 ml / kg, epocrine - 150 units / kg intravenously once, nutritional support is prescribed using enteral mixtures, paraenteral support for protein metabolism is carried out as shown pits; on the third day after the first donation control is carried out: biochemical analysis of blood serum, analysis of the hemostatic system, general analysis of blood and urine; with a minimum level of hemoglobin of 110 g / l and hematocrit of 33% and with a decrease in hemoglobin not more than 15 g / l from the original, a second donation of blood is performed, with a decrease in the initial hemoglobin by more than 15 g / l, autodonation is carried out in the form of an autoplasma, per day operations carry out acute normovolemic hemodilution.

The method is as follows. At the prehospital stage, the parameters of iron metabolism are examined, the presence of latent iron deficiency is detected and its correction is carried out. At the hospital stage, all patients undergo a full clinical and paraclinical examination before the planned autodonation: anthropometry, biochemical analysis of blood serum (concentration of bilirubin, total protein, urea, glucose and electrolytes), analysis of the hemostasis system (prothrombin index (IPT), fibrinogen concentration, clotting time blood count, duration of bleeding, platelet count), complete blood count (OAK), general urinalysis (OAM). Of the functional tests required are: ECG, chest x-ray. Additional examinations include ultrasound examination of the heart, kidneys, liver, and spirography.

Based on the results of the examination and in the absence of contraindications to auto donation, an individual auto donation program is drawn up.

At the initial parameters of the exchange of iron, total protein, red blood parameters (erythrocytes, hemoglobin, hematocrit, color index (CP)), within the age norm, the first donation of autologous blood is carried out with subsequent fractionation (erythrocyte mass, freshly frozen plasma (FFP)). Two days prior to exfusion, the drug and drug supply is carried out with ferrum-lecom (sorbifer) in a dosage ^of _1/2 of the calculated daily dose (depending on the age of 50-100 mg once a day for two days).

Autologous blood is infused from a cubital vein in a volume of 8–10 ml / kg, which is 9–13% of BCC, into a polymer container of the Gemakon type with a preservative, observing the rules for blood collection. Storage of the obtained components of autologous blood (erythrocyte mass, SZP) is carried out in the military industrial complex at appropriate temperature conditions. Infusion-medication support consists in reimbursing the exfused volume of autologous blood with an equivalent volume of plasma-replacing solutions: crystalloids (Ringer's solution, physiological saline) in the amount of 6-10 ml / kg, colloids (rephtan, voluven, gelofusin) in the amount of 5 ml / kg. Ferrum-lek (sorbifer) 100 mg twice daily per os daily, on the second day after exfusion, epocrine (eprex) 150 units / kg intravenously, once. Prescribed nutritional support using the protein module to the mixture “Berlamin Modular” 50 g 2 times a day daily.

On the 3rd day after the first exfusion of blood, laboratory monitoring is carried out according to the scheme: biochemical analysis of blood serum (total protein concentration), analysis of the hemostasis system (IPT, fibrinogen concentration, platelet count), general blood test, general urinalysis. The minimum allowable hemoglobin level before the second blood exfusion is - 110 g / l; hematocrit - 33%.

When blood hemoglobin is reduced by no more than 15 g / l from the initial one, a second exfusion of autologous blood is performed (no later than 72 hours before the operation): from a cubital vein in a volume of 8-10 ml / kg into a polymer container of the Gemakon type with a preservative, observing the rules blood preparation. Autoblood is fractionated into red blood cells and FFP. Storage of the obtained components of autologous blood is carried out in the OPK at appropriate temperature conditions.

Infusion-drug compensation of the exfused volume of autologous blood is carried out with an equivalent volume of plasma-replacing solutions with crystalloids (Ringer's solution, physiological saline) in a volume of 6-10 ml / kg and colloids (reformed, voluven, gelofusin) in a volume of 5 ml / kg. Ferrum-lek (sorbifer) 100 mg twice a day, per os daily, nutritional support is continued using the protein module to the mixture “Berlamin Modular” 50 g 2 times a day, daily.

With a decrease in blood hemoglobin by more than 15 g / l, the second donation is carried out in the form of an autoplasma delivery, autologous blood exfusion is performed from a cubital vein in a volume of 8-10 ml / kg into a Gemacon-type polymer container with a preservative, observing the rules for blood collection. Autoblood is fractionated into red blood cells and FFP. Autoerythrocyte mass is returned. Infusion-medication support of this stage is carried out with colloids (gelofusin, voluven, reftan) 5 ml / kg, ferrum-leuk 100 mg twice a day / m daily, nutritional support using the protein module to the Berlamin Modular mixture 50 g 2 once a day daily.

On the day of surgery (according to the results of control parameters of red blood) - acute normovolemic hemodilution. Immediately before the procedure - control of blood pressure, heart rate. Autologous blood exfusion is carried out from a cubital vein in a volume of 8-10 ml / kg into a polymer container of the Gemakon type with a preservative (post-hemodilution hemoglobin level not lower than 90-100 g / l, hematocrit not less than 28%). Compensation - crystalloids (Ringer's solution, physiological saline) in a volume of 3 ml for each ml of seized autologous blood. Autoblood reinfusion is performed within 6 hours after exfusion, intraoperatively.

At the initial values of the total protein at the lower normal limit in a patient with a body weight deficit, physical development retardation, nutritional support includes parenteral nutrition: the infusion-drug supply of the exfused autologous volume is carried out with 5 ml / kg crystalloid (Ringer's solution, physiological saline), infezol-40 250 ml iv / drop, once, 10% glucose solution 10 ml / kg, retabolil 50 mg / m once. In the postoperative period, all patients who received autologous blood preparations, iron preparations (ferrum-lek, sorbifer) 100 mg once a day daily.

Clinical Examples

1. Patient C.

Age 17 years old.

The medical history No. 13807.

Diagnosis: Scheuermann-Mau disease, stage 3, pain form. Rigid hyperkyphosis of the thoracic spine (69 °) with a right thoracolumbar scoliotic component (17 °). Secondary degenerative changes in the thoracic spine.

Pre-hospital examination:

OAK - decrease in CP (color index) - 0.79, the amount of hemoglobin, erythrocytes - within the age norm.

Ferrokinetics: reduction of the reserve and transport pool - latent iron deficiency (LF - 7.7 μmol / L; OZHSS - 75.8 μmol / L; SF - 8.4 ng / ml). Correction of latent iron deficiency by ferrodrugs within 6 weeks was carried out.

Upon admission, a complete clinical and paraclinical examination was performed.

Survey Results:

Ultrasound of the heart: an abnormality of the chordal apparatus (additional chord of the cavity of the left ventricle).

ECG: sinus rhythm 68-85 per minute. Incomplete blockade of the right bundle branch block. The predominance of bioelectric activity of the left ventricle.

Ultrasound of the abdominal cavity: without pathological changes.

OAK: red blood cells - 4.6 · 10 ¹² / l; hemoglobin - 138 g / l; hematocrit - 39%; color indicator - 0.9; platelets 274 · 10 ⁹ / l - within the age norm.

Biochemical analysis of blood: total serum protein 70 g / l (within the age norm).

OAM, studies of the hemostatic system: without deviations from the physiological norm.

Ferrokinetics indicators: within the physiological norm, restoration of the reserve and transport fund of iron.

Radiography of the chest and spine.

Surgical treatment, autologous blood preparation are indicated.

According to the results of a preoperative examination, contraindications to auto donation were not revealed.

An individual autologous donation program has been drawn up, suggesting a double preoperative autologous blood harvest and ONG on the day of surgery.

Anthropometric data: height - 167 cm; weight - 63 kg.

The approximate estimated bcc is 4000-4100 ml.

Iron preparations were prescribed according to an individual program during the preoperative period.

The first exfusion of whole autologous blood followed by fractionation in a volume of 400 ml: an erythrocyte mass of 220 ml was obtained, SZP - 280 ml. Infusion-medication support according to an individual program. Hemodynamics is stable. The state of health is satisfactory. The day after the first autodonation, epocrine 10,000 I / O, once. Nutritional support with a protein module daily.

On the third day after the first exfusion, control analyzes:

OAK: red blood cells - 4.7 · 10 ¹² / l; hemoglobin - 140 g / l; hematocrit - 38%; color indicator - 0.89; platelets 287 · 10 ⁹ / l - within normal limits.

Biochemical analysis of blood: total serum protein - 71 g / l.

Studies of the hemostatic system, OAM: without deviations from the physiological norm.

Ferrokinetics: a slight decrease in SJ and SF, a moderate increase in SJSS.

Conducted infusion-drug therapy ensured the stability of hemodynamics, the effectiveness of erythropoiesis, the possibility of further preparation of autohemocomponents.

The second exfusion of whole autologous blood in a volume of 400 ml, followed by fractionation into an erythrocyte mass of 200 ml and an SZP of 300 ml. Infusion-medication support according to an individual program. Hemodynamics is stable. The state of health is satisfactory. The patient continues to take iron supplements (200 mg per day), a protein module (50 g 2 times a day).

On the day of surgery, a normovolemic hemodilution is performed.

OAK: red blood cells - 4.3 · 10 ¹² / l, hemoglobin - 130 g / l; hematocrit - 37%; color indicator - 0.91; platelets 285 · 10 ⁹ / l - in the range of the physiological norm.

Ferrokinetics: SJ and SF - a slight decrease; OZHSS - a slight increase.

400 ml of whole autologous blood is infused. Infusion support - according to the formula. Hemodynamics is stable.

The total volume of harvested whole blood was 1200 ml, the number of harvested blood components: two doses of autoerythrocyte mass, two doses of autoplasm freshly frozen, a dose of whole autologous blood.

The patient underwent a four-stage planned intervention. Total blood loss (intraoperative and postoperative drainage) - 1650 ml, which is 40% of the BCC. Correction of blood loss intraoperatively and in the postoperative period was carried out only by autohemocomponents.

Donor blood components were not used.

In the postoperative period, the patient received iron preparations.

On the 6th day after the operation:

OAK: red blood cells - 2.9 · 10 ¹² / l; hemoglobin - 95 g / l; hematocrit - 27%; color indicator - 0.98; platelets 389 · 10 ⁹ / l - posthemorrhagic anemia, mild severity.

Biochemical analysis of blood, studies of the hemostatic system, OAM: without deviations from the physiological norm.

Conclusion: intensive infusion-medication support of autodonation gives the hemodynamic stability of patients, excluding the development of adverse reactions to blood sampling; the appointment of iron preparations ensures the maintenance of ferrokinetics parameters at a level sufficient for effective erythropoiesis, and the correction of latent iron deficiency allows implementing the autologous blood harvesting program in the planned volume, avoiding transfusion of allogeneic hemocomponents and complications associated with their use. The appointment of iron preparations in the postoperative period corresponds to increased erythropoiesis, aimed at stopping posthemorrhagic anemia, and is also aimed at replenishing the reserve and transport pool of iron (decrease in SF during autodonation).

2. Patient I.

Age 16 years old.

Medical history No. 8303a.

Diagnosis: Scheuermann-Mau disease, stage 3, pain form. Rigid hyperkyphosis of the thoracic spine (65 °). Secondary degenerative changes in the thoracic spine.

At the prehospital stage, a survey was conducted:

OAK: red blood cells - 5.5 · 10 ¹² / l; hemoglobin - 136 g / l; hematocrit - 43%; color indicator - 0.78; platelets 226 · 10 ⁹ / l - within the physiological norm.

Ferrokinetics: SJ - 7.5 μmol / L; OZHSS - 77.7 mmol / l; SF - 8.3 ng / ml - latent iron deficiency (decrease in the reserve and transport stock of iron).

No correction was made.

Upon admission, a complete clinical and paraclinical examination was performed.

Survey Results:

Ultrasound of the heart: mitral valve prolapse 1 tbsp.

ECG: sinus rhythm of 80 per minute. Minor myocardial changes.

Ultrasound of the abdominal cavity: without pathological changes.

OAK: red blood cells - 5.5 · 10 ¹² / l; hemoglobin - 136 g / l; hematocrit - 42%; color indicator - 0.78; platelets 230 · 10 ⁹ / l.

Biochemical analysis of blood: total serum protein - 69 g / l (within the physiological norm).

OAM: without pathology, studies of hemostasis (within the physiological norm).

Radiography of the chest and spine.

Ferrokinetics: latent iron deficiency

Surgical treatment, autologous blood preparation are indicated.

According to the results of a preoperative examination, contraindications to auto donation were not revealed.

An individual autologous donation program has been drawn up, suggesting a double preoperative autologous blood harvest and ONG on the day of surgery.

Anthropometric data: height - 175 cm; weight - 65 kg.

The approximate estimated bcc was 4,500 ml.

Iron preparations were prescribed according to the program during the preoperative period.

The first exfusion of whole autologous blood followed by fractionation in a volume of 400 ml: a red blood cell mass of 230 ml was obtained, SZP - 270 ml. Infusion-medication support according to the individual program. Hemodynamics is stable. The state of health is satisfactory. The day after the first autodonation, epocrine 10,000 IU, once. Nutritional support with a protein module daily.

On the third day after the first exfusion, control analyzes:

OAK: red blood cells - 4.84 · 10 ¹² / l; hemoglobin - 119 g / l; hematocrit - 37.6%; color indicator - 0.77; platelets 218 · 10 ⁹ / l - a significant decrease in hemogram values.

Biochemical analysis of blood, studies of the hemostatic system, OAM: without deviations from the physiological norm.

Ferrokinetics: SJ - 7.1 μmol / l; OZHSS - 93.3 mmol / l; SF - 8.5 ng / ml - latent iron deficiency without further reduction in ferrokinetics.

The ongoing infusion-drug therapy ensured hemodynamic stability, a sufficient supply of exogenous iron necessary for erythropoiesis, and the possibility of further preparation of autohemocomponents. Given the existing iron deficiency state, a decrease in hemogram values (hemoglobin decrease of more than 15 g / l), the second exfusion in a smaller volume is 350 ml.

The second exfusion of whole autologous blood in a volume of 350 ml, obtained: erythrocyte mass of 170 ml and SZP 230 ml. Infusion-medication support according to the program. Hemodynamics is stable. The state of health is satisfactory. The patient continues to take iron supplements, a protein module.

On the day of surgery, a normovolemic hemodilution is performed.

OAK: red blood cells - 4.76 · 10 ¹² / l; hemoglobin - 117 g / l; hematocrit - 36.9%; color indicator - 0.75; platelets 219 · 10 ⁹ / L.

Ferrokinetics indicators: maintaining the transport and reserve fund of iron at the same level.

350 ml of whole autologous blood is infused. Infusion support according to the program. Hemodynamics is stable.

The total volume of harvested whole blood was 1100 ml, the number of harvested blood components: two doses of autoerythrocyte mass, two doses of autoplasm freshly frozen, a dose of whole autologous blood.

The patient underwent a four-stage planned intervention. Total blood loss (intraoperative and postoperative drainage) - 2500 ml, which is 55% of the BCC. Correction of blood loss intraoperatively and in the postoperative period was carried out only by autohemocomponents.

Donor blood components were not used.

In the postoperative period, the patient received iron preparations (200 mg per day - taking into account the existing iron deficiency state).

On the 6th day after the operation:

OAK: red blood cells - 2.6 · 10 ¹² / l; hemoglobin - 85 g / l; hematocrit - 26%; color indicator - 0.77; platelets 235 · 10 ⁹ / l - anemia of moderate severity.

RBC morphology - hypochromia.

Biochemical analysis of blood, studies of the hemostatic system, OAM: without deviations from the physiological norm

Conclusion: this clinical example demonstrates that the intake of exogenous iron (ferrodrugs) contributed to maintaining the reserve pool of iron in the body, maintaining the ferrokinetics parameters at a level sufficient for erythropoiesis, however, the latent deficiency of iron did not allow the program to procure autologous blood in the planned volume, determining a less effective erythropoiesis, and the second exfusion of whole autologous blood led to an even greater decrease in hemogram indices before surgery and a longer To restore the red blood parameters in the postoperative period. This once again shows the relevance of the study of the parameters of ferrokinetics at the prehospital stage, the identification and correction of iron deficiency states.

3. Patient M.

Age 15 years.

Case history No. 16564.

Diagnosis: Idiopathic progressive uncomplicated subcompensated mobile right-sided thoracic scoliosis 4 tbsp. (56 °) with lumbar anti-curvature (48 °). Rear right-side rib hump.

At the prehospital stage, a survey was conducted:

OAK: within the physiological norm.

Ferrokinetics indicators: latent iron deficiency (decrease in the reserve and transport stock of iron).

No correction was made.

Upon admission, a complete clinical and paraclinical examination was performed.

Survey Results:

Ultrasound of the heart: an abnormality of the chordal apparatus (additional chord of the cavity of the left ventricle). Mitral valve prolapse 1 tbsp.

ECG: sinus rhythm 61-75 per minute. The predominance of bioelectric activity of the left ventricle. Violation of the processes of repolarization of the anterior septal apical region.

Ultrasound of the abdominal cavity: without pathological changes.

04/29/07, OAK: red blood cells - 5.0 · 10 ¹² / l; hemoglobin - 138 g / l; hematocrit - 42%; color indicator - 0.83; platelets 180 · 10 ⁹ / l - within the physiological norm.

Biochemical blood test: total serum protein - 70 g / l (within normal limits).

OAM, studies of the hemostatic system - without pathological abnormalities.

Radiography of the chest and spine.

Ferrokinetics indicators: latent iron deficiency - SG, SF decreased.

Surgical treatment, autologous blood preparation are indicated.

According to the results of a preoperative examination, contraindications to auto donation were not revealed.

An individual autologous donation program has been drawn up, suggesting a double preoperative autologous blood harvest and ONG on the day of surgery.

Anthropometric data: height - 162 cm; weight - 54 kg.

The approximate estimated bcc was 3700-3800 ml.

Iron preparations were prescribed according to the formula during the preoperative period.

The first exfusion of whole autologous blood followed by fractionation in a volume of 400 ml: a red blood cell mass of 230 ml was obtained, SZP - 270 ml. Infusion-medication support according to the program. Hemodynamics is stable. The state of health is satisfactory. The day after the first autodonation, epocrine 10,000 IU, once. Nutritional support with a protein module daily.

On the third day after the first exfusion, control analyzes:

OAK: red blood cells - 4.2 · 10 ¹² / l; hemoglobin - 116 g / l; hematocrit - 36%; color indicator - 0.83; platelets 201 · 10 ⁹ / l - a significant decrease in hemogram values.

Biochemical analysis of blood, studies of the hemostatic system, OAM: without deviations from the physiological norm.

Ferrokinetics: maintained at the same level.

Conducted infusion-drug therapy ensured hemodynamic stability, satisfactory well-being of the patient, a sufficient supply of exogenous iron necessary for erythropoiesis, and stability of ferrokinetics. The existing iron deficiency determined a significant decrease in hemogram parameters (hemoglobin more than 15 g / l) and a longer time for their recovery. With these features in mind, the second donation was performed as an autoplasma delivery.

The second exfusion of whole autologous blood in a volume of 400 ml, followed by fractionation into an erythrocyte mass of 190 ml and an SZP of 310 ml. Autoerythrocyte mass returned to the patient, the compensation of the exfused autoplasma volume with an equivalent volume of colloids. Hemodynamics is stable. The patient continues to take iron supplements, a protein module.

On the day of surgery, a normovolemic hemodilution is performed.

OAK: red blood cells - 4.7 · 10 ¹² / l; hemoglobin - 130 g / l; hematocrit - 39%; color indicator - 0.83; platelets 230 · 10 ⁹ / l - within normal limits, in dynamics with recovery.

Ferrokinetics: SJ - at the lower boundary of the age norm, SF - with a tendency to increase.

400 ml of whole autologous blood is infused. Infusion support according to the program. Hemodynamics is stable.

The total number of prepared hemocomponents: a dose of autoerythrocyte mass, two doses of autoplasm freshly frozen, a dose of whole autologous blood.

The patient underwent a two-stage planned intervention. Total blood loss (intraoperative and postoperative drainage) - 1350 ml, which is 36% of the BCC. Correction of blood loss intraoperatively and in the postoperative period was carried out only by autohemocomponents.

Donor blood components were not used.

In the postoperative period, the patient received iron preparations (200 mg per day).

On the 6th day after the operation:

OAK: mild anemia.

Biochemical blood test: moderate hypoproteinemia.

Studies of the hemostatic system, OAM: without deviations from the physiological norm

Conclusion: thus, the second donation, taking into account the individual characteristics of erythropoiesis and ferrokinetics, in the form of autoplasma delivery allowed to continue the preparation of autohemocomponents without further lowering the hemogram parameters and gave time for their recovery to the final stage of the implementation of the auto donation program (normovolemic hemodilution), the appointment of perioperative ferrodrug contributed erythropoiesis and restoration of the transport and reserve pool of iron.

Claims (1)

The method of infusion-medication support of operations on the spine in children through clinical examination and preoperative planning of blood loss, infusion-medication support, characterized in that at the prehospital stage, the parameters of iron metabolism are examined, the presence of latent iron deficiency is examined, it is corrected, an individual auto-donation program is made with the inclusion of acute normovolemic hemodilution; two days before the first donation, iron preparations are administered in a dose of 1/2 daily dose and continue in full dose for the entire preoperative and postoperative period, after donation the exfused volume of autologous blood is replaced with an equivalent volume of plasma-replacing solutions: crystalloids - 6-10 ml / kg and colloids based on hydroxyethylated starch - 5 ml / kg, on the second day after exfusion, epocrine is administered - 150 units / kg intravenously once, nutritional support is carried out using enteral mixtures, parenteral support of proteins the second exchange is carried out according to indications; on the third day after the first donation control is carried out: biochemical analysis of blood serum, analysis of the hemostatic system, general analysis of blood and urine; at a hemoglobin level of 110 g / l and a hematocrit of 33% and with a decrease in hemoglobin of not more than 15 g / l from the source, a second donation of blood is performed, with a decrease in the initial level of hemoglobin by more than 15 g / l, autodonation is carried out in the form of an autoplasma, on the day of surgery carry out acute normovolemic hemodilution.