38. Infusion-transfusion therapy of acute massive blood loss in obstetrics and gynecology

Acute blood loss of 30% or more of the BCC within 1-2 hours is considered massive and requires intensive infusion-transfusion therapy, since the protective compensatory mechanisms of the body are untenable. First of all, the heart, lungs, brain, liver, kidneys are provided with oxygen. The activity of the secretory glands of the gastrointestinal tract is suppressed, hence a number of symptoms arise: dry mouth, a practical stop of intestinal motility, a decrease in urination, a collapse of the vessels of the skin and muscles (peripheral vasoconstriction). Along with the listed compensatory reactions, there is an increase in the supply of oxygen to the tissues and an increase in its use.

Lymph, interstitial fluid, moves into the bloodstream, blood is diluted - hemodilution. The level of hemoglobin for several hours may remain close to the original, despite heavy bleeding and severe pallor of the skin. Red blood cells enter the bloodstream. There is an autotransfusion of blood components and maximum centralization of blood circulation. DIC is characterized by two phases: hypercoagulation and hypocoagulation. Pathogenetically, they are due to self-limitation of thrombus formation, since the fibrin precipitated in the thrombus undergoes enzymatic decomposition, and the decay products (degradation) of fibrin (PDF), in turn, themselves

have fibrinolytic properties. In this regard, with massive thrombus formation in the hypercoagulable phase of the DIC syndrome, if measures are not taken to eliminate the cause of massive thrombus formation or the process is not stopped by the administration of heparin, a large amount of PDP will soon appear in the blood, which actively dissolve disseminated blood clots. In the opposition of coagulation factors and fibrinolysis, fibrinolysis often predominates due to the depletion of coagulation factors due to the fact that they are used at a high rate in the blood clots that have appeared.

Hypercoagulation syndrome is a state of increased readiness of the blood coagulation system for thrombosis resulting from platelet activation due to intoxication, infections, damage to the vascular wall, hyperthrombocytosis, and increased blood viscosity. The latent hypercoagulable syndrome does not manifest itself clinically, but there may be a rapid thrombosing of the catheter or needle located in the vein. The severity of manifestation of hypercoagulable syndrome does not always depend on the volume of acute blood loss. Sometimes even a small volume of acute blood loss (10-15% of BCC) in women with increased blood clotting can lead to the development of disseminated thrombosis with a rapid transition to the hypocoagulable phase of the DIC syndrome. In acute massive blood loss associated with vascular damage, there is a sharp activation of the primary platelet link of hemostasis, changes in plasma hemostasis and in the fibrinolysis system. Disbalance in these systems leads to the development of the DIC syndrome.

Author: Ivanov A.I.

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