A furuncle is an acute purulent-necrotic inflammation of the hair follicle and sebaceous gland, occasionally affecting nearby tissue. Boils can be located anywhere there are hair follicles (that is, excluding the palmar and plantar areas), but the most common locations are the back, buttocks, face, neck, and forearms. Furunculosis is the occurrence of multiple boils in any area of the body. Blood transfusion for furunculosis is often the only effective treatment method.
In what cases is blood transfusion performed?
Whole blood cannot be transfused; it is possible to use only its components, such as fresh frozen red blood cells and platelet concentrate. One of the main indications for blood transfusion is a hemoglobin level of less than 70 g/l and a decrease in saturation (oxygen saturation of the blood) to 80%. The procedure is necessary for the disintegration of massive tumors; the disintegration process is accompanied by chronic blood loss. Usually these are tumors of the uterus, vagina, and cervix. And such an oncological problem as melanoma has a depressing effect on the red blood cell, in this case, in order to carry out chemotherapy, it is necessary to restore the normal level of red blood cells and hemoglobin, so a blood transfusion is performed.
The need for a transfusion of fresh frozen plasma is due to profuse edema and the presence of a state of suppressed hematopoiesis; this transfusion is also carried out to prevent the development of disseminated intravascular coagulation syndrome with a sharp inhibition of blood clotting.
Diagnostic methods
Diagnosis of a simple unbranched single-channel fistula is not difficult - it is enough to feel a cord in the local seal, from which contents can leak when pressed.
All external exits of the fistula are examined with a button probe, this is how the localization of the passages is determined. The probe is inserted from the side of the skin, carefully pushing it all the way; if a rectal fistula is being examined, then the passage of the probe inside the rectum is determined with the index finger.
Next, a test is carried out with a dye - methylene blue, which is injected into the outer hole with a syringe. In case of rectal fistula, a cotton swab is inserted into the intestine before the test, and the exact location of the internal opening is determined by the dye marks on it.
For any fistula, the paint output can be recorded during endoscopy: anoscopy, rectoscopy, colonoscopy, cystoscopy, colposcopy, and so on. Endoscopic examination is one of the leading ones and is performed repeatedly in the process of diagnosis and treatment.
In some cases, fistulography is performed - an x-ray of the anatomical area before and after the injection of a contrast agent into the fistula. The procedure is not required only for simple and short rectal fistulas without exacerbation of inflammation.
Imaging methods - CT and MRI also make it possible to clarify the localization of tracts and leaks, branching and the root cause of the disease.
When the rectum is involved, ultrasonography (ultrasound) with a special rectal sensor is informative, when a computer program allows you to see the pathology in a three-dimensional image. When planning the operation, the function of the anal sphincter is additionally determined.
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Blood transfusion procedure
Upon admission to the hospital, each patient's blood group according to the ABO system and antigens are checked. If a patient has a negative KO (Kell system), then he is allowed to use only blood with similar characteristics for transfusion. If this rule is not followed, hemolysis will occur and the red blood cells will be destroyed by the patient's own antibodies.
Also, before each blood transfusion procedure, the blood group according to the ABO system and the Rh factor, a compatibility test between the patient and the donor, and a biological test must be carried out (20-25 ml of blood is administered and the patient is monitored for 15 minutes). If the Rh factors, blood group match, the compatibility test is positive and there are no abnormalities in the biological test, further blood transfusion is carried out.
It is possible to individually select various blood components for patients with existing Rh conflict, hemolytic anemia and multiple previous transfusions. For such patients, a gel test is performed in a specially equipped blood bank laboratory.
Causes
Furuncle is an acute purulent-necrotic inflammation of the hair follicle and sebaceous gland, occasionally affecting nearby tissue. They can be located anywhere on the body where there are hair follicles (that is, with the exception of the palmar and plantar areas), but the most common location is the back, buttocks, face, neck, and forearms.
Among the causes of furunculosis, Staphylococcus aureus is the leader (rarely other microorganisms). It penetrates the hair follicle and causes purulent inflammation, beginning to actively multiply and secrete waste products. Necrosis of the follicle occurs, which affects neighboring tissues, increasing the affected area. This process often occurs in people with immunodeficiencies.
What does transfusion help with?
Solid tumors lead to significant changes in the hematopoietic system. Under their influence, anemia and abnormalities in the blood clotting system can develop.
The disintegration of tumors leads to depletion of the bloodstream and blood reserve of the body. Surgical treatment also leads to massive bleeding. All of the above factors lead to the fact that the body’s own reserve is depleted and it requires a blood transfusion from a donor. Due to insufficient blood volume, treatment may be delayed because In case of anemia and thrombocytopenia, chemotherapy cannot be administered.
Chemotherapy drugs can have side effects on blood germs and worsen thrombocytopenia. That is why constant monitoring of red and white blood indicators and coagulation properties is necessary. If any deviations from the norm are noted, blood transfusion is prescribed according to all rules.
Sepsis. Septic shock
Introduction
Just as local immunity reacts to a splinter - with a rush of blood, a local increase in temperature, activation of immune factors, and an attack of macrophages on bacteria brought in with dirt - general immunity tries to cope with the pathogenic microorganism and its toxins if they penetrate the systemic bloodstream and spread throughout all tissues and organs.
In this case, an acute infectious-inflammatory process flares up on the scale of the entire organism, and, figuratively speaking, something like a total atomic war begins, where the enemy can be destroyed only at the cost of self-destruction. According to rough WHO estimates, sepsis affects over 30 million people every year, of whom at least one in five die from this cause. The epidemiological situation is especially unfavorable in underdeveloped regions, but in much more prosperous countries there is sepsis, including iatrogenic, i.e. associated with the provision of medical care remains a formidable and pressing problem, especially considering that the cause is often hospital microflora, habitual and resistant to almost any antibiotics.
There are many terminological definitions of the concept of “sepsis”. Previously, the presence of a pathogenic organism in the circulatory system was indicated as an obligate, obligatory sign, then the “systemic inflammatory reaction” (septicemia) was emphasized. Recently, however, in medicine there has been a desire for more and more precise formulations and a clear delineation of concepts. It was found, for example, that not every bacteremia (the presence of bacteria in the blood) leads to sepsis, and vice versa: a condition that is extremely close in essence and clinically to septic shock can develop in the absence of bacteremia (see the material “Infectious-toxic shock” ). Today, many theoretical and methodological positions have been revised; In 2016, new guidelines on sepsis were presented by the Society of Intensive Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). The definition of the concept no longer focuses on a “systemic reaction to infection,” but on life-threatening multiple organ dysfunction due to impaired regulation of the immune response (such a regulatory disorder can be compared, again, with the order “Beat everyone, your own and others, with whatever you like, as it turns out.” by any force"). The concept of “severe sepsis” has been excluded from the guidelines as unnecessary and tautological. And then to say: if this is really sepsis, the situation is in any case quite serious.
Also in 2016, a study was conducted in the United States on the cost of medical care provided in an intensive short-term mode. Among the conditions requiring the most expensive emergency response, sepsis was in first place (osteoarthritis in second, perinatal pathology in third, implantation complications in fourth, myocardial infarction in fifth).
In 2022 , it was proven that the introduction of new intensive care protocols for sepsis significantly reduces mortality. However, it remains high and is estimated at 20-35%, and in septic shock (the most severe, extreme form of sepsis) varies in the range of 30-70%.
Since 2008, in St. Petersburg, the country’s only Center for the treatment of severe sepsis has been operating at the Research Institute of Emergency Medicine named after. Dzhanelidze. Its director, Professor S.A. Shlyapnikov, repeatedly drew the attention of the medical community to the fact that domestic sepsis statistics do not fully reflect reality; that this diagnosis, especially if it is established posthumously as a postoperative diagnosis, is very disliked “at the top”; that in fact, almost all patients who die after complex surgical interventions on the third or fourth day die precisely from sepsis, and not from the “main diagnosis.”
Since 2015, the multidisciplinary Society of Sepsis Specialists has been actively working in St. Petersburg.
September 13 is World Sepsis Day.
In August 2022, under the auspices of the Global Alliance against Sepsis, the Second World Congress on Sepsis was held, and it was held entirely online, thereby uniting and connecting interested specialists from various countries. All this suggests that even today, in the era of asepsis and antiseptics, the problem of “blood poisoning” has not disappeared.
How long does the effect last after a blood transfusion?
Everyone knows that blood transfusion is a medical procedure that saves the life of many patients in extreme and difficult situations and prolongs it for cancer patients. But the blood transfusion system is not at all simple. At the first stage, 250-300 ml of red blood cells are administered and the vital signs of the body are monitored. If red blood cells and hemoglobin have returned to normal, the next blood transfusion is carried out no earlier than 18-30 days later, provided that the red blood cell has not recovered during this period of time.
In a situation where, due to the constant destruction of pathological tissues of the neoplasm, daily blood loss occurs, transfusion is performed in the amount of 2-3 doses of red blood cells every 5-7 days. This situation is typical for cervical or vaginal cancer. The procedure will be repeated until conditions are created that are suitable for embolization of the vessels feeding the tumor, or for surgical treatment or chemotherapy.
Symptoms of appearance
The process of fistula formation is difficult to track; it can take several days, as happens with acute pancreatitis, or several months, as with post-radiation tissue changes.
Manifestations at the initial stage of fistula formation are due to its root cause, as a rule, a local inflammatory process resulting in purulent melting of tissue with pain and infiltration, often intoxication and fever.
Without an exacerbation of the inflammatory reaction, the fistula can be felt as a cord. The size of the compaction around the fistula tract is due to inflammatory infiltration and branching of the fistula tracts themselves, cicatricial changes in the surrounding tissues, previously involved in the inflammatory conglomerate.
A formed fistula has an entrance and, sometimes, an exit, the tissues around it are compacted, and discharge can be squeezed out of the hole: pus, bile, pancreatic juice, and so on. With a fistula, feces may leak from the intestine into the vagina from the genital organs; when there is an anastomosis of the intestine with the bladder, urine leaks from the anus. The discharge from the intestinal fistula has a fecal smell, and the purulent secretion from the vagina also has a specific smell. The smell of a discharged fistula, leading from the zone of disintegration of a malignant tumor, seems especially heavy to others.
Inflammation causes pain ranging from slight discomfort to unbearable pain. Tumor fistulas do not hurt because they form inside a disintegrating tumor.
When the infection activates with the formation of streaks of purulent contents, a general reaction occurs: intoxication, high temperature, sweating and pallor, palpitations and rapid breathing.
