Septicemia

Septicemia is a life-threatening infection; where there is bacteria in the blood. This is a form of blood poisoning and the fatality rate is nearly 50%. It is also called a systemic inflammatory response syndrome or SIRS where the whole body is inflamed due to suspected infection. Severe sepsis leads to organ failure. Infections in the lungs, urinary tract or abdomen can lead to sepsis. Other conditions that can lead to septicemia are endocarditis, meningitis and osteomyelitis. Symptoms of sepsis begin with chills, high fever and rapid breathing. The condition worsens rapidly with hypothermia and low blood pressure setting in. There is very low urine output. Blood test for platelet count, CBC, blood gases and PTT are done. CSF culture is also done to diagnose sepsis. Treatment of septicemia involves hospitalization. IV fluids and medications are administered. Plasma is often given when clotting factors are affected. Dialysis and mechanical ventilation might be required to support the kidney and lung function.

Gangrene

Gangrene refers to the death of the tissue in any particular area of the body caused by the loss of blood supply. Though gangrene can occur in any part of the body, it normally affects toes, fingers, feet and hands. Infections, vascular disease, diabetes, injury and weakened immunity are some of the causes of gangrene.

Types of gangrene

Dry gangrene: Dry gangrene involves lack of blood supply due to cell death and necrosis. This condition is not associated with infection and develops gradually over a period of time. Patients with diabetes, atherosclerosis and other blood vessel diseases are most likely to develop dry gangrene. Those suffering from injuries, burns, frostbite and any other arterial trauma are also prone to dry gangrene.

Symptoms of dry gangrene

• Affected area feels numb and cold.
  
• Does not show any signs of healing due to interrupted blood supply and necrosis (un programmed cell death).
  
• Patients may or may not have pain.
  
• Color changes gradually from red to brownish red and eventually becomes black.
  
• Skin becomes dry, scaly, shriveled and finally falls off the body if not treated in time.
  
• On very rare occasions, the onset of dry gangrene may be sudden which may be caused by an immediate loss of arterial blood supply. In such a case, the affected area turns pale or bluish and then starts withering away.

Wet gangrene: Bacterial infection, loss of blood supply due to swollen tissues and gas production are some of the causes of wet gangrene. Wet gangrene spreads very quickly and in no time turns into sepsis. It restricts the white blood cells from reaching affected area, allowing the bacteria to feed on the surrounding muscles. Hence wet gangrene is a medical emergency and requires immediate treatment.

There are few variations to wet gangrene and one of them is gas gangrene. The bacterial organism called Clostridium perfringens causes gas gangrene. The bacteria present in the site releases toxins and produces gas bubbles in the dead tissues affecting not only the local site, but adjoining tissues and muscles. Though gangrene normally occurs on external parts of the body like hands, toes and legs, it can also attack internal organs like gallbladder, intestines and appendix. This condition is called internal gangrene. Internal organs may develop hernia, get strangulated and as a result do not receive sufficient blood supply causing gangrene.

Fournier gangrene is the gangrene that occurs in the male genital area due to an infection or urinary tract infection. Red skin, swelling, tenderness associated with pain are some of the symptoms of Fournier gangrene.

Necrotizing fasciitis is a type of wet gangrene that is caused by bacterial infection, affecting the deep layers of skin. It progresses rapidly and starts eating up the flesh in the body.

Symptoms of wet gangrene

• The site at which gangrene has occurred becomes swollen and painful. The skin in that area gets discolored.
  
• Pus, oozing of fluid and foul smell in the affected area.
  
• Fever indicating sepsis.
  
• If it is a gas gangrene, along with above mentioned symptoms, patient may experience increased heartbeat and vigorous breathing as toxins enter the blood stream. When the wound is pressed, there will be a slight crackling noise as there is a gas beneath the skin.

Causes of gangrene

The first and the primary cause of gangrene is complete loss or insufficient supply of blood to the tissue. When there is no blood supply, the required oxygen does not reach the cells allowing them to decay and die. Bacterial infections, trauma, damaged blood vessels, and blood vessel disease like atherosclerosis are some of the causes that restrict the blood supply leading to gangrene. Surgery wounds, frost bites, severe burns are typical breeding sites for bacteria causing infection and gangrene.

Diagnosing gangrene

Doctor will conduct a thorough physical examination and look for the symptoms like discoloration, pus, shrinking of skin, odor to determine the type of gangrene. If it is a wet gangrene, further tests like blood test, blood culture and tissue cultures are carried on to find out about the white blood cell count and the kind of bacteria causing the issue. This helps the doctors to decide on the right course of antibiotics. Imaging studies like X-ray, MRI and CT scan are done to determine the spread of gangrene.

Gangrene Treatment

Treatment approach varies depending upon the type of gangrene. However, whatever be the type of gangrene; it should be brought to the notice of the medical practitioner at the earliest to prevent it from spreading. In case of dry gangrene, firstly, doctor will remove the dead tissues from the affected area surgically. Next, he will try to correct the destroyed blood vessels to smoothen the blood flow. Patient will be administered antibiotics to curtail the spread and will also be given some anti blood clotting drugs.

Wet gangrene is a medical emergency and once diagnosed, treatment should start as quickly as possible. Debridement procedure is normally adopted to treat wet gangrene. Debridement refers to the removal of dead and decaying tissues from the affected site. Antibiotics are administered to control the infection and pain killers are given to relieve the patient from pain. In worst cases surgeon may have to amputate, where the affected limb will be separated from the body to prevent further deterioration. Gas gangrene is a deadly disease. Though it is treated in the same way as mentioned above, it necessitates swift action when compared to all other gangrenes. The infection can spread and enter the blood stream very quickly causing organ failures.

There is also an alternate therapy called hyperbaric oxygen therapy that is gaining momentum to treat gas gangrene. This process involves exposing the patient to 100% oxygen at inflated pressure for 90 to 120 minutes, three times a day for 2 days. Then the frequency will be brought down as per the patient's requirements. This therapy stimulates the cell growth, enhances the white blood cell count thereby regulating the infection and increasing the blood flow to areas affected by the arterial blocks.

Preventing gangrene

• Seek prompt treatment for any kind of external wound, cut or injury before the site is attacked by infection.
  
• Diabetics should keep their sugar levels under control as they are at higher risk. Those with vascular diseases and low immunity levels should be extremely cautious and vigilant about the signs of infection like pus, oozing, discoloration, swelling and pain. They should take good care of their fingers, toes and feet and go for frequent health checkups to rule out any adverse health condition.

Dry gangrene is easily treatable provided there is no infection associated with it. Chances of recurrence are higher in diabetes patients. The outlook for wet gangrene is poor and patients with severe infection and sepsis may also lose their life, if treatment is not initiated in time. It requires an aggressive treatment and patients with wet gangrene may end up with amputation.

Blood Transfusion

Blood transfusion is one of the important procedures administered in healthcare centers to meet surgical and trauma needs. This procedure is categorized under transfusion medicine section. Blood transfusion is a high-risk procedure as it involves multiple protocols and guidelines for safe and effective transfusion.

Guidelines and Procedure

Transfusion medicine has high significance as it involves the transfusion of blood and blood products depending upon the patient needs. Blood required for the transfusion is obtained from blood banks, which are established either by the government or privately following NCCLS standards for the blood banks. The standards are evaluated by organizations such as WHO to set a uniform and global protocol for safe transfusion. Blood transfusion is predominantly done to increase the percentage of hemoglobin in anemic patients and also to replace vital components such as platelets and serum proteins in some medical conditions. Other reasons for blood transfusion is to replace the amount of blood lost during surgery or trauma. Patients suffering thrombocytopenia (any disorder in which there is an abnormally low amount of platelets) might be in need of platelet transfusion.

Blood banks are authorized by the government to collect blood of different groups. Some of the rare groups include B negative, O negative and Bombay blood group. In these situations, the names and the address of these respective rare blood types are noted to ensure timely availability in case of a transfusion request. Cancer patients also require transfusion in case of conditions such as leukemia and malignant carcinomas associated with spleen or bone marrow. Leukocyte reduction procedure is followed in some transfusion centers in order to minimize the incidence of transfusion-associated allergic reactions. All donors are checked for a three-month gap before the subsequent transfusion to facilitate fresh blood collection from the donors containing viable red blood cells.

Different types of Blood transfusions:

Fresh Whole Blood: This is mostly needed during cardiac surgery or massive hemorrhage. Fresh Whole blood has RBC, plasma and fresh platelets.

Packed RBC: This is mostly needed to raise the hematocrit (the proportion of total blood volume that is composed of red blood cells).

Frozen packed RBC: Stored for nearly 3 years, frozen packed RBC is sparingly used. It is often used for rare blood groups. Patients suffering severe leukoagglutinin reactions or anaphylactic reactions might need this.

Leukocyte-Poor Blood: Patients who suffer severe leukoagglutinin reactions might need this. It is an expensive process as WBC are removed by centrifugation.

Precautions and risks

Transfusion is a very important procedure and hence primary analysis of the donor blood is done in order to avoid blood borne sepsis, transfusion allergies and organ damage. The donor blood is always cross-matched with the recipient's in order to check the compatibility of the blood. All procedures are documented to ensure safety and tracking of a transfusion procedure, as it is associated with medico-legal protocols. The A and B antigens are the first check before transfusion. In emergencies, type O/Rh-negative blood can be given to any recipient and usually packed cells are given. The Rh factor has also to be tested. Blood from the donor is also investigated for infections such as HIV 1&2, HBV, HCV, and VDRL to ensure safe transfusion.

Blood is collected from the healthy donor in a blood bank by administering venipuncture procedure from the brachial region. The obtained blood is transported for immediate need in surgeries or stored for few days in case of a scheduled surgery having the requirement for the particular blood group. The transfusion requirement is clearly stated in the surgical form and the blood bank technicians provide number of units required on the given date. Some of the common side effects associated with blood transfusions are infections of both viral and bacterial origin obtained from an infected donor. Receipt of blood contaminated with gram-negative bacteria often causes septic shock, Disseminated intravascular coagulation or DIA (a large amount of procoagulant enters the blood stream over a short period of time, overwhelming the body’s ability to replenish coagulation factors and causing bleeding) and acute kidney injury. Receipt of blood with gram-positive bacteria causes fever and Bacteremia (presence of bacteria in blood) but rarely causes sepsis.