Autohemotransfusion support of pulmonary operations is a traditional area of research conducted at the department, the main results of which were summarized in the monograph by I. Kolesnikova et al. (1979), which was essentially the first major domestic work devoted to this problem. At the same time, the achievements of the last two decades in the field of canning and blood fractionation have significantly expanded the possibilities of this method of filling up blood loss .
The advantages of autohemotransfusions are known: tangible savings in donor blood and the exclusion of post-transfusion complications due to immunological incompatibility or transfer of pathogens of viral and infectious diseases. Autologous blood is less deposited, has good replacement and rheological effects, provides relative stability of circulating erythrone, does not inhibit erythropoiesis . However, each of the currently available options for autotransfusion has certain disadvantages.
In particular, the widespread use of re-infusion of blood from the pleural cavity during surgery is hampered by the danger of dissemination of the tumor process. The risk of getting into the bloodstream of cancer cells persists even after repeated washing of reinfused red blood cells. . Therefore, in patients with lung cancer, blood infusion is rarely carried out only with an unexpected massive blood loss, which represents an immediate danger to the patient’s life. Another option for autotransfusion is acute normovolemic hemodilution. This method allows you to replenish autoblood blood loss to 25—% bcc, and with a larger volume additional transfusions of donor erythrocytes are required. This method can be attributed to its complexity and its invasiveness, the increased risk of hypervolemia of the pulmonary circulation, possible allergic reactions to the introduction of large amounts of hemodilutants, the need for more strict patient selection than with other methods of transfusion therapy. Many contraindications limit the use of this method in patients operated on the lungs.
In clinical practice, autologous blood or its components harvested before the operation are used more widely. The choice of a specific method of reservation is determined by the characteristics of each of them, but the primary requirement for autotransfusions is always of paramount importance — ensuring that it is possible to effectively compensate for blood loss when treating autologous blood in a safe volume for the patient (Kolesnikov IS, 1979, Surgen LM, 1990). Safety is usually achieved by careful assessment of indications and contraindications for hemoexfusion, determination of the maximum allowable dose of autologous autologous blood and the time intervals before surgery. Blood reservation is contraindicated in anemia, hypovolemia, hypo- and dysproteinemia, leukocytopenia and thrombocytopenia, marked disorders homeostasis (hypoxia, acidosis, hyperosmia, etc.), as well as in patients older than 70 years. The existence of numerous contraindications is due to the fact that hemoexfusion, being essentially dosed blood loss, has an undoubted negative effect on the patient’s body: after blood preparation, no organ, no system, performs better than before. In addition, it must be borne in mind that during storage, the autoblood of the patient undergoes the same and even more significant changes than the blood of a healthy donor. Its gas transmission and transportation are deteriorating. morphofunctional characteristics, platelets and leukocytes contained in it undergo irreversible changes and lysis, completely disappearing by the 7th day of storage. In the process of degradation of cells in canned blood, biologically active substances are released, which contributes to the formation of microgus, which is one of the causes of posttransfusion disorders of pulmonary gas exchange. Transfusion of such blood during or after lung surgery always increases the blood supply to the pulmonary circulation and disrupts the ventilation-perfusion ratio. Therefore, the indications for autoblood transfusion, in our opinion, can only be vital and be determined on the basis of the criteria used in the transfusion of donor blood. This approach, however, poses the problem of unnecessary exfusions,which, combined with numerous contraindications and lack of effectiveness, significantly hinders the spread of this method of autotransfusion.