Reactive complications are the most serious, dangerous and common complications of blood transfusion. Their development is due to the incompatibility of transfused donor blood or the body's reaction to the transfusion medium.
Among the complications of a reactive nature, reactions and actual blood transfusion complications are distinguished. Reactions are not accompanied by serious and prolonged violations of the functions of organs and systems. Complications are characterized by severe clinical manifestations that pose a danger to the life of the patient.
(1) TRANSFUSION REACTIONS
According to the severity of the clinical course, reactions of three degrees are distinguished: mild, moderate and severe.
Mild reactions are accompanied by an increase in body temperature within 1 ° C, pain in the muscles, limbs, headache, chills and malaise. These phenomena are short-lived and do not require treatment.
Reactions of moderate severity are manifested by a rise in body temperature by 1.5-2 ° C, increasing chills, increased heart rate and respiration, and sometimes a skin rash.
In severe reactions, body temperature rises by more than 2 ° C, there are stunning chills, cyanosis of the lips, vomiting, severe headache, muscle and bone pain, shortness of breath, urticaria or Quincke's edema.
Depending on the cause of occurrence and clinical course, the following types of reactions are distinguished:
pyrogenic,
antigenic (non-hemolytic),
allergic.
a) Pyrogenic reactions
The reasons for the development of pyrogenic reactions are not associated with immunobiological incompatibility and are the result of the formation of pyrogenic substances in the transfusion medium - the decay products of donor blood proteins or the vital activity of microorganisms that enter the blood during its preparation, storage, or in violation of asepsis rules at the time of transfusion.
The clinical picture is an increase in body temperature, a feeling of heat, chills. Headache, tachycardia and other secondary manifestations are possible.
Treatment. With a mild reaction, no special measures are required. With the development of a severe or moderate reaction, it is necessary to stop the blood transfusion, introduce antipyretics (analgin, reopyrin), narcotic analgesics (promedol), antihistamines (diphenhydramine, tavegil).
Prevention consists in observing the rules for the preparation, storage and transfusion of blood. With the use of disposable plastic containers for the collection of blood and its components and disposable transfusion systems, the frequency of such reactions is significantly reduced.
b) Antigenic (non-hemolytic) reactions
The causes of these reactions are not associated with bacterial pyrogens, but are due to sensitization by antigens of leukocytes, platelets and plasma proteins as a result of previous blood transfusions and pregnancies. In 50% of cases, the development of reactions is associated with antileukocyte antibodies.
The clinical picture of the reaction appears 20-30 minutes after the end of the blood transfusion (chills, fever, development of bradycardia, headache and back pain). These symptoms are a consequence of the release of pyrogenic, vasoactive and complement-activating substances during the mass death of leukocytes.
Treatment. The occurrence of post-transfusion reactions of a non-hemolytic type requires vigorous therapy with the use of antihistamines, cardiovascular drugs, narcotic analgesics, detoxification and anti-shock solutions.
Prevention consists in a careful history taking and, if indicated, in the use of individual selection of a donor. To prevent the development of post-transfusion reactions in the serological laboratory, a lymphocytotoxic test and a leukoagglutination test of the patient's serum and donor leukocytes are performed. Persons with a history of multiple blood transfusions or repeated pregnancies are recommended to treat anemia with transfusions of EMOLT, devoid of leukocyte, platelet and other plasma and cellular immunoaggressive factors.
c) Allergic reactions
Causes. Allergic reactions are caused by sensitization of the body to various immunoglobulins. The formation of antibodies to immunoglobulins occurs after transfusion of blood, plasma and cryoprecipitate. Sometimes these antibodies exist in the blood of people who have not tolerated blood transfusions and have not had a pregnancy.
clinical picture. The severity of allergic reactions can be different - from mild to the development of anaphylactic shock. In case of allergic reactions, the development of urticaria, Quincke's edema, bronchospasm is possible. In the pathogenesis of anaphylactic shock, the main role is played by the reaction "antigen - antibody" in which biologically active substances are released that damage the vascular wall with the formation of edema and a sharp drop in blood pressure, there is also a spasm of the smooth muscles of the bronchi. Patients become restless, complain of difficulty in breathing. On examination, there is hyperemia of the skin, cyanosis of the mucous membranes, acrocyanosis, cold sweat, wheezing, deafness of tones.
heart, pulmonary edema.
Treatment. To eliminate allergic reactions, desensitizing agents are used, and, according to indications, corticosteroids, cardiovascular and narcotic drugs.
Patients in a state of anaphylactic shock require immediate anti-shock therapy. The complex of therapeutic measures should include jet or drip administration of volume-replacing solutions, corticosteroids, antihistamines, bronchodilators, cardiac and sedative drugs.
Prevention of allergic reactions consists in a thorough history taking in order to identify previous sensitization, the use of washed erythrocytes, individual selection of a donor, preliminary administration of antihistamines to patients with a predisposition to allergic reactions.
(2) TRANSFUSION COMPLICATIONS
Blood transfusion complications are the most dangerous for the life of the patient. The most common cause of blood transfusion complications is transfusion of blood that is incompatible according to the ABO system and the Rh factor (approximately 60%). Less often - with incompatibility for other antigenic systems, transfusion of poor-quality blood.
The main and most severe in this group, and indeed among all hemotransfusion complications, is hemotransfusion shock.
a) Complications in transfusion of blood that is incompatible according to the ABO system. Transfusion shock
When transfusing blood that is incompatible according to the ABO system, a clinical picture of shock develops, called "transfusion shock".
The reason for the development of complications in most cases is a violation of the rules stipulated by the instructions for the technique of blood transfusion, the methodology for determining ABO blood groups and conducting compatibility tests. When transfusing blood or EO, incompatible with the group factors of the ABO system, massive intravascular hemolysis occurs due to the destruction of the donor's erythrocytes under the influence of the recipient's agglutinins.
In the pathogenesis of transfusion shock, the main damaging factors are free hemoglobin, biogenic amines, thromboplastin and other products of hemolysis. Under the influence of high concentrations of these biologically active substances there is a pronounced spasm of peripheral vessels, quickly replaced by their paretic expansion, which leads to disruption of microcirculation and oxygen starvation of tissues. An increase in the permeability of the vascular wall and blood viscosity worsen the rheological properties of the blood, which further disrupts microcirculation. The consequence of prolonged hypoxia and the accumulation of acid metabolites are functional and morphological changes in various organs and systems, that is, a complete clinical picture of shock unfolds.
hallmark transfusion shock is the occurrence of DIC with significant changes in the system of hemostasis and microcirculation, gross violations of central hemodynamics. It is DIC that plays a leading role in the pathogenesis of damage to the lungs, liver, endocrine glands and other diseases. internal organs. The starting point in its development is the massive influx of thromboplastin from destroyed erythrocytes into the bloodstream.
Characteristic changes occur in the kidneys: hematin hydrochloride (a metabolite of free hemoglobin) and the remains of destroyed erythrocytes accumulate in the renal tubules, which, along with spasm of the renal vessels, leads to a decrease in renal blood flow and glomerular filtration. The described changes are the cause of the development of acute renal failure.
clinical picture. During the complications of transfusion of blood that is incompatible according to the ABO system, there are three periods:
transfusion shock,
acute renal failure,
convalescence.
Hemotransfusion shock occurs directly during transfusion or after it, lasts from several minutes to several hours. In some cases, it is not clinically manifested, in others it proceeds with severe symptoms, leading to the death of the patient.
Clinical manifestations are initially characterized by general anxiety, short-term agitation, chills, pain in the chest, abdomen, lower back, shortness of breath, shortness of breath, cyanosis. Pain in the lumbar region is considered pathognomonic for this type of complication. In the future, circulatory disorders characteristic of a state of shock gradually increase (tachycardia, lowering blood pressure, sometimes a violation of the rhythm of cardiac activity with symptoms of acute cardiovascular insufficiency). Quite often there is a change in the color of the face (redness, followed by pallor), nausea, vomiting, fever, marbling of the skin, convulsions, involuntary urination And defecation.
Along with the symptoms of shock, one of the early and permanent signs of transfusion shock is acute intravascular hemolysis. The main indicators of increased breakdown of erythrocytes are hemoglobinemia, hemoglobinuria, hyperbilirubinemia, jaundice, liver enlargement. Characteristic is the appearance of brown urine (in general analysis- leached erythrocytes, increased protein content).
A violation of hemocoagulation develops, which is clinically manifested by increased bleeding. Hemorrhagic diathesis occurs as a result of DIC, the severity of which depends on the degree And the duration of the hemolytic process.
When transfusing incompatible blood during surgery under anesthesia, as well as against the background of hormonal or radiation therapy, reactive manifestations can be erased and symptoms of shock are most often absent or mildly expressed.
The severity of the clinical course of shock is largely determined by the volume of transfused incompatible erythrocytes, the nature of the underlying disease, and the general condition of the patient before hemotransfusion. Depending on the level of blood pressure, there are three degrees of hemotransfusion shock:
/ degree -
systolic blood pressure above 90 mm Hg. Art. II degree -
systolic blood pressure 71-90 mm Hg. Art. /77 degree -
systolic blood pressure below 70 mm Hg. Art.
The severity of the clinical course of shock, its duration determine the outcome of the pathological process. In most cases, therapeutic measures can eliminate circulatory disorders And bring the patient out of shock. However, some time after the transfusion, the body temperature may rise, a gradually increasing yellowness of the sclera and skin appears, and the headache intensifies. In the future, impaired renal function comes to the fore, acute renal failure develops.
Acute renal failure occurs in the form of three successive phases: anuria (oliguria), polyuria and recovery of function. tions kidneys.
Against the background of stable hemodynamic parameters, daily diuresis sharply decreases, hyperhydration of the body is noted, melts creatinine, urea And plasma potassium. Subsequently, diuresis is restored and sometimes increases up to 5-6 liters per day. ki, while high creatininemia, hyperkalemia (polyuric phase of renal failure) may persist.
With a favorable course of complications, timely and proper treatment, kidney function is gradually restored and the patient's condition improves.
The period of convalescence is characterized by the restoration of the function of all internal organs, the homeostasis system and water and electrolyte balance.
Treatment. When the first signs of transfusion shock appear, the blood transfusion is stopped, the transfusion system is disconnected and the saline system is connected. In no case should the needle be removed from the vein, so as not to lose the ready venous access.
Hemotransfusion shock requires immediate emergency medical care, intensive care. The main treatment is aimed at removing the patient from the state of shock, restoring and maintaining the function of vital organs, stopping the hemorrhagic syndrome, and preventing the development of acute renal failure.
The time factor is of decisive importance - the earlier the patient is helped, the more favorable the outcome.
Principles of treatment of transfusion shock infusion therapy. To maintain the bcc and stabilize hemodynamics and microcirculation, blood-substituting solutions are transfused (the drug of choice is rheopolyglucin, it is possible to use polyglucin and gelatin preparations). It is also necessary to start the administration of a soda solution (4% sodium bicarbonate solution) or lactasol as early as possible to obtain an alkaline urine reaction, which prevents the formation of hematin hydrochloride.
Subsequently, polyionic solutions are transfused to remove free hemoglobin and to prevent degradation of fibrinogen.
The volume of infusion therapy should correspond to diuresis and be controlled by the value of central venous pressure.
First line drugs. The classic drugs in the treatment of transfusion shock are prednisolone (90-120 mg), aminophylline (10.0 ml of a 2.4% solution) and lasix (100 mg) - the so-called classic anti-shock triad. In addition, antihistamines (diphenhydramine, tavegil) and narcotic analgesics (promedol) are used.
extracorporeal methods. A highly effective method is massive plasmapheresis (exfusion of about 2 liters of plasma with replacement of PSZ and colloidal solutions) to remove free hemoglobin and fibrinogen degradation products.
Correction of the function of organs and systems. According to the indications, cardiac glycosides, cardiotonic drugs, etc. are used. In case of severe anemia (Hb below 60 g / l), washed erythrocytes of the same name in relation to the recipient of the blood group are transfused. With the development of hypoventilation, it is possible to transfer to artificial ventilation of the lungs.
Correction of the hemostasis system. Apply heparin (50-70 IU/kg of body weight), transfuse PSZ, use anti-enzymatic drugs (kontrykal).
With the withdrawal from shock and the onset of the phase of acute renal failure, treatment should be aimed at improving kidney function (eufillin, lasix and osmodiuretics), correction of water and electrolyte balance. In cases where therapy does not prevent the development of uremia, the progression of creatininemia and hyperkalemia, the use of hemodialysis is required. In this regard, it is advisable to treat patients with acute renal failure in a specialized department equipped with a "artificial kidney".
In the period of convalescence, symptomatic therapy is carried out.
Prevention consists in strict adherence to the rules for performing hemotransfusion (careful implementation of all sequential procedures, especially reactions to the compatibility of transfused blood).
b) Complications in the transfusion of blood incompatible with the Rh factor and other systems of erythrocyte antigens
Complications due to the incompatibility of the transfused blood according to the Rh factor occur in patients who are sensitized to the Rh factor. This can occur when administering Rh-positive blood to Rh-negative recipients who have been sensitized by a previous blood transfusion with Rh-positive blood (or, in women, by pregnancy with an Rh-positive fetus).
The cause of complications in most cases is an insufficiently complete study of the obstetric and transfusion history, as well as non-compliance or violation of other rules that prevent incompatibility by the Rh factor (primarily tests for individual compatibility by the Rh factor).
In addition to the Rh factor Rh 0 (D), other antigens of the Rh system can cause complications during blood transfusion: rh "(C), rh" (E), hr "(c), hr" (e), as well as antigens of the Rh systems Lewis, Duffy, Kell, Kidd, Cellano, etc. The degree of their immunogenicity and importance for the practice of blood transfusion is much lower.
The developing immunological conflict leads to massive intravascular hemolysis of transfused donor erythrocytes by immune antibodies (anti-D, anti-C, anti-E, etc.) formed during the previous sensitization of the recipient. Next, the mechanism for the development of hemotransfusion shock is triggered, like incompatibility according to the ABO system.
It should be noted that similar changes in the body (except for the immune conflict) are observed when a large amount of hemolyzed blood is transfused.
clinical picture. Clinical manifestations differ from complications in case of incompatibility according to the ABO system by a later onset, less rapid course, slow and delayed hemolysis, which depends on the type of immune antibodies and their titer; When transfusing Rh-incompatible blood, symptoms appear after 30-40 minutes, sometimes 1-2 hours, and even 12 hours after blood transfusion. At the same time, the phase of the shock itself is expressed to a lesser extent, its erased picture is often observed. In the future, the phase of acute renal failure also occurs, but its more favorable course is usually noted.
Treatment is carried out according to the same principles as in case of incompatibility according to the ABO system.
Prevention consists in a careful collection of transfusiological anamnesis and compliance with the rules of blood transfusion.
c) Massive blood transfusion syndrome
Causes. A complication occurs when more than 40-50% of the circulating blood volume is injected into the recipient's bloodstream against the background of acute blood loss in a short period. Its development is explained by immunobiological processes associated with the rejection of foreign donor tissue (most likely, the main role here belongs to immunologically aggressive plasma proteins, in particular immunoglobulins), as well as the imbalance of the spontaneous hemostasis system (blood transfusion of different storage periods) and the toxic effect of preservatives.
clinical picture. When the syndrome of massive blood transfusion occurs in the body, a whole complex of severe changes occurs: pathological redistribution of blood, increased hemolysis, impaired myocardial contractility, functional changes in the hemostasis system, impaired microcirculation, blood protein composition and water metabolism. Small hemorrhages are formed in the organs, microthrombi are detected, consisting of aggregates of erythrocytes and platelets.
The most common clinical manifestation of massive blood transfusion syndrome is the symptomatology of DIC. Clinically, instead of the expected improvement in the patient's condition due to compensation for blood loss, it worsens.
Treatment of DIC caused by massive blood transfusion includes measures aimed at normalizing the hemostasis system, eliminating capillary stasis, disorders of acid-base, electrolyte and water balances, correcting lesions of the lungs, kidneys, adrenal glands and anemia. For these purposes, it is recommended to use heparin (up to 24,000 IU per day with continuous administration), plasmapheresis (removal of at least 1 liter of plasma with a replacement of 600 ml of PSZ), antiplatelet agents (rheopolyglucin, curantil, trental, etc.) "protease inhibitors (trasilol, contrykal). In case of severe anemia (hemoglobin level below 80 g / l), washed red blood cells are transfused (whole blood transfusion in DIC is unacceptable).
Prevention of massive blood transfusion syndrome consists in refusing to transfuse whole blood from many donors to one patient. It is expedient to compensate for massive blood loss with cryopreserved erythrocytes and PSZ prepared in advance from one or two donors according to the principle "one donor - one patient", crystalline and colloidal blood substitutes, creating controlled hemodilution, as well as the widespread use of autohemotransfusion and blood reinfusion in surgical interventions.
d) Citrate intoxication
Cause. It develops during the transfusion of large doses of blood prepared using sodium citrate as a stabilizer, especially at a high transfusion rate. Sodium citrate binds free calcium in the bloodstream, causing the phenomenon of hypocalcemia. The level of ionized calcium returns to normal immediately after the cessation of the transfusion, which is explained by the rapid mobilization of calcium from endogenous depots and the metabolism of citrate in the liver.
clinical picture. With a decrease in the level of free calcium in the blood, unpleasant sensations behind the sternum, convulsive twitching of the muscles of the lower leg, face, respiratory rhythm disturbances with a transition to apnea with a high degree of hypocalcemia appear. It is possible to reduce blood pressure, increase heart failure, the ECG shows a prolongation of the Q-T interval, heart rhythm disturbance: bradycardia, up to asystole. The development of the fullness of these changes is called "citrate shock".
Treatment. With the appearance of clinical signs of hypocalcemia, it is necessary to stop the introduction of whole canned blood, intravenously inject 10-20 ml of calcium gluconate or 10 ml of a 10% solution of calcium chloride.
Prevention consists in identifying patients with initial hypocalcemia, slow blood injection, prophylactic administration of a 10% solution of calcium chloride (gluconate) - 10 ml for every 0.5 l of transfused blood.
e) Potassium intoxication
Causes. Hyperkalemia can occur when transfusing long-term stored canned blood or EM (there is a destruction of formed elements with the release of potassium into the plasma).
The clinical picture is characterized by bradycardia, arrhythmia, myocardial atony, up to asystole. In the biochemical blood test, hyperkalemia is confirmed.
Labile type - a psychotype, a characteristic personality pattern. Sometimes - accentuation of character.
The labile type is most fully described under various names "emotionally labile" (Schneider, 1923), "reactively labile" (P. B. Gannushkin, 1933) or "emotively labile" (Leongard, 1964, 1968), etc. In the classification of N.I. Kozlov, this is a Mood Man.
Brief description of the psychotype
The main feature of the labile type is extreme mood variability, fast and little predictable switching of the emotional state ...
Rich sensory sphere, high sensitivity to signs of attention. Severe mental pain with emotional rejection from loved ones, loss of loved ones and separation from those to whom they are attached. Sociability, good nature, sincere affection, social responsiveness. They are interested in communication, reach out to their peers, are content with the role of a ward.
Labile type and external evaluation
Labile adolescents are very sensitive to all kinds of signs of attention, gratitude, praise and encouragement - all this gives them sincere joy, but does not at all induce arrogance or conceit. Reproaches, condemnations, reprimands, lectures are deeply experienced and are capable of invading into hopeless despondency.
More about the labile type
Portrait of a labile type according to N.N. Kozlov
We all come from childhood. The man of mood, however, differs from the rest in that he remained in his childhood. His is the soul of a child, she is bright, sincere, spontaneous and naive. Look
Doctors call a reactive state a disorder that occurs as a response of the body to the influence of an adverse factor. This term is used in both somatic medicine and psychiatry. Harmful conditions can cause both disruption of the internal organs (liver, pancreas), and damage to mental health.
In the first case, the cause of deviations is bodily ailments, and in the second - serious mental trauma. Such pathologies are usually temporary. Next, the main types of negative reactions from the organs and systems of the body (liver, pancreas and psyche), as well as the causes, symptoms and treatment of these disorders, will be considered.
What is reactive hepatitis
The reactive state of the liver proceeds in the form of hepatitis. However, in this case, the pathology is not caused by a virus, but by diseases of other organs. This is the liver's response to harmful influences. Reactive hepatitis is milder and has a better prognosis than infectious lesions. The disease does not progress. Symptoms are mild, and sometimes the disorder proceeds without painful manifestations and is detected only during a medical examination. Deviations in the activity of liver enzymes and the level of bilirubin are insignificant. If the cause of the reactive state of the liver is cured, then all violations are completely stopped.
Causes of reactive hepatitis
This disease is always secondary. The following pathologies can provoke its development:
- gastrointestinal ailments: ulcerative processes, inflammation of the pancreas, nonspecific colitis;
- autoimmune rheumatic lesions: systemic lupus erythematosus, scleroderma, rheumatoid arthritis, dermatomyositis, rheumatism, periarthritis nodosa;
- disruption of the endocrine system: diabetes mellitus, hypo- and hyperthyroidism;
- burns of a large area of the body;
- infectious diseases;
- malignant tumors;
- surgical interventions;
- poisoning;
- long-term use of drugs with a hepatotoxic effect.
The pathological process most often affects only the parenchymal tissue and is reversible.
Reactive hepatitis is more common in adults. This is due to the fact that children are less likely to suffer from chronic diseases. But if the child still has this pathology, then it proceeds with severe symptoms. In children, diseases of the gastrointestinal tract, as well as helminthic invasion, most often become the cause of reactive changes in the liver.
Symptoms and treatment of reactive hepatitis
In adulthood, the reactive state is very often asymptomatic, which makes diagnosis difficult. The following discomforts are sometimes observed:
- general malaise;
- feeling tired;
- subfebrile temperature;
- weakness;
- discomfort and pain under the ribs on the right side;
- slightly yellowish skin tone.
The patient does not always associate these signs with impaired liver function. It is very important to identify these deviations in time. During a medical examination, slight pain is possible when probing. The liver is slightly enlarged. Assign a blood test for biochemistry. The results of the study determined a slight increase in bilirubin, liver enzymes and a decrease in protein. It is important to separate reactive inflammation from viral hepatitis. To do this, conduct blood tests for the presence of infection.
With timely treatment, the reactive state has a favorable outcome. All violations are functional. For successful therapy, it is necessary to find out the cause of the disorders that have arisen and cure the underlying disease. In addition, hepatoprotectors are prescribed, the patient is recommended to follow a sparing diet. If the pathology is caused by poisoning or prolonged use of hepatotoxic drugs, then enterosorbents must be taken.
This condition is not dangerous, but it is unacceptable to delay contacting a doctor and self-medicate. Without therapy, disorders can become persistent and complicate the course of existing diseases.
What is reactive pancreatitis
The pancreas is closely related to the digestive system. Therefore, many pathologies of the gastrointestinal tract negatively affect the work of this organ. The gland produces pancreatic juice, which then mixes with bile and enters the intestine through the ducts. However, various diseases disrupt this process, and then there is a reactive state of the pancreas (reactive pancreatitis).
Enzymes of pancreatic juice begin to work after entering the intestine. In the pancreas, they are in an inactive form. Special intestinal fluids put these enzymes into action. This is how the digestive process works in a healthy person. But with diseases of the gastrointestinal tract, intestinal fluid can be thrown into the bile ducts. In this case, the pancreatic juice becomes active, being in the pancreas, and the enzymes begin to negatively affect this endocrine organ. Inflammation occurs - reactive pancreatitis.
Causes of reactive pancreatic pathology
The provoking factors in the development of a reactive state of the pancreas are the following diseases and disorders:
- pathologies of the stomach and intestines: gastritis, peptic ulcer, gastroduodenitis, infections and injuries of the digestive system;
- liver disease: gallstones, cirrhosis, biliary dyskinesia;
- operations on the gastrointestinal tract and gallbladder;
- autoimmune pathological processes;
- poisoning;
- alcohol abuse;
- inadequate and malnutrition.
In children, this disease often develops as a complication of ascariasis. With a strong invasion, helminths clog the bile ducts, which leads to congestion and inflammation of the pancreas.
Symptoms and treatment of reactive pancreatitis
Symptoms of reactive inflammation of the pancreas are usually pronounced. At the initial stage, the patient has the following symptoms:
- There is severe pain in the abdomen and under the ribs, discomfort intensifies after eating.
- Often there is vomiting, which does not bring relief.
- The patient suffers from heartburn and belching.
- In the intestines, an increased amount of gases is formed, bloating is determined.
- There is diarrhea up to several times a day.
Then comes a strong intoxication of the body. The patient's skin turns pale, the limbs become cold, heart palpitations appear, and blood pressure drops. The general condition is rapidly deteriorating. In severe forms of reactive pancreatitis, immediate hospitalization is required.
The clinical picture also depends on the cause of the pathology. If the reactive state has arisen due to diseases of the liver and gallbladder, then patients complain of pain in the solar plexus. If pancreatitis was provoked by lesions of the gastrointestinal tract, then discomfort is localized in the upper abdomen.
The symptomatology of the reactive state of the pancreas in a child has its own characteristics. In addition to the above manifestations, children have heat, plaque on the tongue, dry mouth, diarrhea is replaced by constipation. In the blood test, the level of sugar rises. In infancy, the disease often occurs without pronounced symptoms, but lethargy and reduced appetite in infants can be noticed.
Diagnosis of the disease is carried out using ultrasound. In this case, not only the pancreas is examined, but also all the digestive organs. This is necessary to establish the cause of reactive inflammation. In addition, a urine test for pancreatic enzymes, a blood test for leukocytes and ESR, as well as endoscopy of the duodenum are prescribed.
The underlying disease that caused reactive pancreatitis is being treated. They also prescribe anti-inflammatory drugs, analgesics and antispasmodics. This helps relieve pain. A diet with a restriction of spicy and fatty foods is necessary.
Reactive pancreatitis has a favorable prognosis. Timely therapy leads to complete recovery. If left untreated, the inflammatory process can become chronic, in addition, patients often have an increase in blood sugar levels.
Reactive mental disorders
In psychiatry, reactive states are temporary mental disorders that develop after emotional upheavals. Violations are reversible and disappear after treatment. Such a pathology can occur in any person after difficult experiences, for example, after the death or serious illness of a loved one, family breakup and other sad events. However, an unfavorable and protracted course of these disorders is observed in people suffering from psychopathy or vascular diseases.
Reactive states are the body's response to mental trauma. Two main subtypes of such disorders can be distinguished:
- reactive neuroses;
- reactive psychoses.
Neurosis usually occurs during a long traumatic situation. Psychoses appear as a reaction to acute emotional experiences and stress.
The following forms of reactive states of a neurotic nature can be distinguished:
- neurasthenia;
- obsessive-compulsive disorder;
- hysteria.
There are also several types of reactive psychoses:
- depression of psychogenic etiology;
- paranoid disorders;
- psychogenic hallucinosis;
- puerilism;
- delusional fantasies;
- stupor;
- syndrome of "running wild";
- imaginary dementia.
The symptoms of such disorders are always pronounced. The duration of the course of reactive mental disorders depends on the presence of concomitant vascular pathologies and the type of patient's personality. In vulnerable people with a fine mental organization, as well as in patients with atherosclerosis, such disorders can continue for a long time.
Symptoms of reactive mental disorders
The clinical picture of reactive disorders is extremely diverse. Symptoms of the disease depend on the form of the disorder.
The main symptoms observed in various forms of psychogenic neurotic states should be considered:
- Neurasthenia. The patient is mentally and physically exhausted. The patient gets tired easily, feels constant fatigue, headaches, sleep is sharply disturbed. Decreased performance. The person becomes excitable, irritable, anxious. At the same time, the mood is constantly lowered.
- Obsessional neurosis. Such a deviation after a psychotrauma is observed infrequently. The patient constantly performs the same actions, for example, counting objects or touching them. Sometimes a person makes different movements. For the patient, this takes on the character of protective rituals. Disturbed by obsessive thoughts, memories, fears that arise against the will of the patient.
- Hysteria. There is a strong crying with screams and motor excitation. In some cases, a person cannot stand and walk with a completely healthy musculoskeletal system. These phenomena are accompanied by vegetative disorders: sensation of a lump in the throat, suffocation, nausea.
In reactive psychoses, more severe disorders are noted:
- Psychogenic depression. Patients experience a persistent decrease in mood. The severity of this symptom can vary from mild depression to severe depression. Often patients blame themselves, for example, for death and illness. loved one. Movement and facial expressions are sharply inhibited.
- paranoid disorders. Against the background of a dreary mood and increased anxiety, delusions of persecution or external influence arise. Patients become fearful, restless or aggressive. The content of delusional ideas is usually associated with psychotrauma.
- psychogenic hallucinosis. The patient has auditory hallucinations. He hears voices discussing him. In this case, the patient feels intense fear. Optical deceptions are possible when the patient takes the surrounding objects for people. The content of hallucinations is associated with experienced stress.
- Puerilism. The patient imitates the behavior of a small child. Patients talk in a childish voice, act up, cry.
- Delusional fantasies. The patient periodically has ideas of greatness or imaginary wealth. Unlike paranoid delusions, these disturbances are not persistent and permanent. One idea quickly replaces another. With treatment, fantasies disappear.
- Stupor. The patient becomes extremely lethargic, stops moving, eating and talking.
- Syndrome "wildness". This type of reactive mental state is extremely rare. In the behavior of the patient, features characteristic of the habits of animals are noted. Patients moo, bark, crawl on all fours, become aggressive.
- Imaginary dementia. There are signs of dementia. Patients have impaired memory, they cannot give the correct answer to simple questions or perform habitual actions. However, unlike true dementia, this condition is easily cured and has a good prognosis.
Diagnosis of reactive psychoses is often difficult. These conditions must be distinguished from schizophrenia and bipolar disorder. The psychiatrist should conduct a conversation with the patient and his relatives to identify the presence of a stressful situation. Chronic mental illness develop independently of psychotrauma, and reactive disorders are always the result of moral upheavals.
Reactive mental disorders in childhood
A reactive state in children occurs after suffering a fright and other traumatic factors. It is most often seen in infancy and preschool age. There are two types of reactions of the child's psyche to trauma. The child either becomes restless (rushing about, crying, screaming), or freezes in place and stops talking. This is accompanied by vegetative disorders: sweating, redness of the skin, tremors, involuntary urination and defecation.
Then the child becomes lethargic, whiny, he is worried about fears. In behavior, traits characteristic of children are more likely to appear. younger age. For example, a child of 5 - 6 years old begins to behave like a baby of 1.5 years old. Reactive mental states in children require immediate treatment. All changes are reversible.
Therapy of reactive mental disorders
In the treatment of neurotic disorders, sedatives are used. If the symptoms are mild, then you can prescribe herbal remedies (valerian, motherwort) or the medicine "Afobazol". For more severe disorders, tranquilizers are indicated. Not only medicines are used, but also psychotherapeutic methods.
Treatment of reactive psychoses is more challenging. In a dreary mood with ideas of self-blame, antidepressants are used. If the patient has delusions and hallucinations of psychogenic origin, then neuroleptics and sedative drugs are used.
Forensic medical examination for reactive mental disorders
In the forensic psychiatric assessment of reactive states, the form of the disorder should be taken into account. With neuroses, patients are usually recognized as sane. They may be held responsible for the offenses committed.
As for reactive psychoses, it is necessary to take into account the degree of their severity. With mild violations, a person usually gives an account of his actions. In severe delusional disorders and hallucinations, the patient may be declared insane. It is also important to remember that depressed patients with ideas of self-blame often slander themselves and sometimes confess to offenses they did not commit.
Acute reactive states with delusions and hallucinations are considered as mental pathologies that are temporary. During the period of painful manifestations, a person may be recognized as incapacitated. In this case, all civil legal acts (transactions, wills, etc.) committed by him during a mental disorder are recognized as invalid.
Psychology can provide almost all answers to questions about human behavior. This science can explain why some people become leaders, while others try to avoid attention all their lives. An important role in characterizing the personality is played by the type of temperament, which is influenced by such a concept as reactivity. This is often taken in psychology as the determining factor in the individual's reaction to various external stimuli.
Temperament in the view of philosophers and scientists of antiquity
Even ancient philosophers argued that a person has a number of features given to him at birth, which are further formed into a set of traits or a so-called character. It is impossible to significantly change these features, they can only be easily adjusted under the influence of society and upbringing.
On what temperament or character depends, the scientists of that time could not imagine, but they made attempts to substantiate their numerous theories in proportion to knowledge in medicine and psychology. The founder was Hippocrates, he first defined each of the types that are used to this day. That's just the famous doctor explained temperament by the predominance of one or another liquid in the human body.
Years later, European scientists tried to put forward their own typology based on the physical characteristics of people. This version was subjected to great criticism in the scientific world and is now practically not used.
Temperament through the eyes of Hippocrates and Claudius Galen
Hippocrates defined the temperaments of the individual, and his student and follower Claudius Galen wrote a large scientific treatise, where he described each type in detail and in detail, specifying the liquid that is contained in the maximum amount in human organs.
Based on the theory of Galen, there were the following types of human temperament:
- sanguine - in this person there was a large amount of blood, which influenced his actions and emotions;
- phlegmatic - he was the result of the predominance of phlegm;
- choleric - had an increased content of bile;
- melancholic - suffered from an abundance of black bile in the body, corroding his internal organs.
Almost until the eighteenth century, this theory was perceived as the only true one. And only the diligent work of modern scientists dispelled the fantastic assumptions of Hippocrates, although the names and characteristics of temperaments have remained unchanged and are actively used.
Division into temperaments in modern psychology
He made a great contribution to the development of psychology. As a result of research, he found out that a person from birth has his own, which determines his behavior. Moreover, this theory is equally effective for animals and humans. Later, Pavlov's research became the basis for the work of Soviet and European psychologists. As a result, a scientifically based typology of human temperaments appeared:
- Sanguine. People of similar temperament easily adapt to new conditions, are active and efficient. For the most part, they are friendly and have high. They are sensitive to the mood of others and are extroverts.
- Choleric. This temperament characterizes irritable and quick-tempered people. They are very quickly distracted from the case, it is difficult to concentrate. The expression of emotions in choleric people is violent and short, they can also be considered extroverts.
- Phlegmatic person. Such people are very efficient, but it is difficult to switch from one thing to another. They are a little emotional and able to remain calm in any situation. All their movements are slightly slowed down, the same applies to facial expressions. Phlegmatic people are classified as introverts.
- Melancholic. Melancholics are very sensitive, but not too active. They are touchy, but timid and inhibited. Such people have low labor productivity and find it difficult to converge with new people. The slightest trouble causes them violent emotions that paralyze any activity.
To determine the temperament of a person, it is necessary to consider it in relation to a number of properties. Psychology has a productive system that allows you to analyze the type nervous system and classify it.
Basic properties of temperament
The definition of temperament is impossible without eight aspects that characterize it:
- sensitivity;
- activity;
- the ratio of reactivity and activity;
- plasticity and rigidity;
- reaction rate;
- extraversion or introversion.
An experienced psychologist assesses the personality for each aspect and displays the type of temperament. The most important parameters are reactivity and activity. It is worth talking about them in more detail.
Reactivity in psychology: definition
It is difficult to say when psychology emerged as a serious science and began to consider a person's personality, taking into account all aspects of temperament. But the scientific community believes that Wolf Solomonovich Merlin was the first to introduce such a concept as reactivity in psychology. This gave impetus to further research into the psycho-emotional differences of individuals, which eventually resulted in a fundamental scientific theory.
At the moment, it can be argued that reactivity in psychology is the uncontrolled reactions of an individual to any stimuli of an external and internal nature. The intensity and duration of these reactions largely determine. Later, psychologists came to the conclusion that it is emotional reactivity that is responsible for the performance and productivity of labor. In psychology, this has acquired a special meaning; many large corporations in the West use the concept of reactivity when selecting new personnel.
Reactivity and speed of decision-making: is there a relationship?
According to the results of numerous studies and tests, psychologists have found that the speed of decision-making and reactions to various life situations depends on reactivity.
People with high reactivity often make decisions under the influence of emotions and the moment, many of their conclusions and reactions are incorrect. But in a critical situation, they are able to save the life of not only one person, but many others. What cannot be said about individuals with low reactivity. They think over each decision for a long time and are not able to make it at a particular moment under the influence of stimuli from the outside world.
Reaction Intensity Formula in Emotional Reactivity
Since reactivity in psychology is a reaction to an external stimulus, it would be natural to assume that it has a certain force. IN modern world there is even a formula according to which you can determine the degree and saturation of the reaction.
In people with low reactivity, the intensity is in direct interaction with the strength of the impact. The more pressure you put on such a person, the more intense is his reaction.
Otherwise, everything happens to people who are excitable. The intensity of their reaction is absolutely independent of the strength of the impact. Even slight pressure serves as an impetus for an intense reaction of the individual. This makes highly reactive people unpredictable and difficult to manage.
Reactivity in psychology: examples of manifestation in everyday life
In order to have a complete understanding of reactivity, let's take a simple real-life example. Suppose you are daydreaming about a vacation after a hard year of work. Your friends are also going to relax, but one goes to the mountains, and the other dreams of a lazy beach holiday in a warm country. Both of them call you with them, but after much thought, you decide on a trip to the sea and the sun. At the moment when you are ready to voice your decision to a friend, he begins to argue that you should go with him and have no right to do otherwise. Here great importance has your reactivity. What will you do? Will you start to resist the pressure and refuse the already planned and much-desired vacation on the beach by going to the mountains as a protest? Or stick with the original plan, no matter the pressure you're under?
People who are able to harm themselves are highly reactive and often draw the wrong conclusions from the situation. Moreover, the personality of the opponent does not play a role in making a decision, it can be a close friend or an unfamiliar person. The tendency to make hasty and wrong decisions is revealed in those people who have an increased reactivity. In psychology, this is considered to be a constant, from which they start in determining the temperament of a person.
Reactivity and activity: features of the relationship
It has long been proven that the productivity of any human activity determines the ratio of reactivity and activity. In psychology, this has been expressed in several formulas that have appeared as a result of special and long studies. Highly reactive individuals have little activity, as they cannot work with concentration and are constantly distracted by the slightest external stimuli. In addition, this type is also affected by internal stimuli - thoughts, emotions, memories. All this significantly reduces labor productivity.
Individuals with low reactivity usually have the highest activity. They are able to solve one problem until the result is achieved, without being distracted by anything in the world around them. Such people are able to work for weeks and months until they get what they want. Scientists who gave the world great discoveries are often referred to this type.
The psychological reactions of many people cannot be controlled, but, having certain knowledge, one can predict a person’s behavior and draw conclusions about his capabilities on the way to the top of his career.
People can be divided in different ways, but there is one principle of division that distinguishes them by their actions. The division of people into proactive and reactive types is based on their different attitudes to different issues, it is this difference that defines them radically. different behavior V different situation. And this, in turn, becomes for these people the reason for more or less success.
There are many differences in the views and attitudes of proactive and reactive people, but we have tried to highlight the most significant ones, those that most of all determine the distinctive actions of people and, therefore, in our opinion, most of all help or hinder a person from achieving the intended goal, the desired success.
The biggest difference between proactive and reactive people is precisely their different attitudes towards success. For proactive people, success is expressed not in money, property and authority, but in a sense of social benefit created with their help. They feel, see, appreciate the benefits that are created as a result of their work, and this is what gives them a feeling of special success. Everything else that follows this success is less important to them.
Hence their different attitude to life. For a proactive person, the main goal of life is to have time to create the maximum benefit. They try to act this way, think this way, and work in such a way as to create the maximum benefit over the course of their lives. They know perfectly well that exactly how much you do, and how useful it is, depends on what and how much you get in return. And the greater the social benefit you create, the more freely you can choose the form of bestowal. Get it in the form of money, respect, or any combination of them.
This leads to their different relationship to time. For proactive people, time is the main, most valuable resource. They perfectly understand that the one who is better able to use this most important resource will have more time. They plan and change their plans, but never go with the flow, they set themselves clear goals in time, and always try to achieve them. They fall asleep earlier and get up early in order to do more and better the work planned for that day. Every day for them is another step towards the intended goal, even when they devote this day to rest. Because they know that they rest in order to work better later, and not vice versa - to work in order to have a good rest later.
The attitudes of proactive people to their work differ. They believe that the thing they do is a tool for self-expression, creativity, creating more. They are constantly trying to improve the methods, approaches and tools used in order to do more and better in time. For them, perfection in business is the main condition for achieving the goal. They try not to waste time on what they can’t do, can’t, and doesn’t give pleasure, because they know that perfection can be achieved only in the business that you like, it turns out, where you use the maximum of your abilities and properties, where you feel like fish in the water. It is by finding such a thing, doing a lot, and getting better and better, that they try to achieve the goal of life - to do the maximum of what they can. That is why proactive people, as soon as they see that they are doing what they do not like, quit their jobs, but where they understand that they are doing the right thing, they fight to the end in order to create the best working conditions. Unlike reactive people, who also feel that they are wasting time, but get used to such work, they themselves do nothing to improve working conditions, and try to dispel the discomfort caused by the feeling of wasted time, mainly by complaining to relatives about managers, employees, work, however no result.
A different attitude to the matter also comes from the different attitudes of proactive and reactive people to the environment. Business for proactive people is an opportunity to take care of the environment, relatives, colleagues, society as a whole. Any business they do is permeated with concern for others. Since proactive people are well aware that caring is the most important motive and desire that drives a person to do special, worthwhile things. Caring helps a person find both the strength and the idea to take better care of those he loves and who are important to him. Whereas for reactive people it is much more important that others take care of them, take into account their interests, mood, otherwise they feel in an unfair environment. They do things to a greater extent in order to prove to themselves and others their advantage, abilities, capabilities, and to earn respect for this, rather than to bring anyone any benefit.
The existing difference in relation to the matter determines the different attitudes of proactive and reactive people to learning. If reactive people study in order to get a title, diploma, or the right to do something, after which they consider that the book and study are just a waste of time for them, and now it's time to enjoy due to the fact that they suffered while studying, for proactive people learning is a constant, continuous process that is the main opportunity to achieve excellence in what they do. To do more and better, which enables them to achieve the purpose of life. Accordingly, proactive people never stop learning, every day they try to spend at least half an hour reading a book that is interesting for them, listening to a lecture, or thinking for themselves, working on a question that will make it possible to find something new, interesting, worthwhile.
Just the attitude to learning is one of the main things that causes different attitudes of proactive and reactive people towards other people. Proactive people know that everyone around them is better in some way. They look for the best in them, appreciate and respect them because of this difference, and try to learn, adopt this best from others. Whereas, reactive people, on the contrary, look for the worst in people in order to feel their superiority and enjoy it. Accordingly, their attitude towards people is more arrogant, more secretive and mocking. As a result, relationships with reactive people are more complex and pressured, while relationships with proactive people are enjoyable and interesting.
The attitudes of proactive and reactive people towards subordinates are extremely different. Reactive people perceive subordinates as low-ranking employees in relation to themselves, who are mainly used to do menial work. They try not to entrust them with anything that will help them prove themselves, and that will cause them to increase their self-esteem. Because they think, or subconsciously believe that in this case they may have a competitor who will have a claim to their place. Accordingly, they block the best ideas coming from employees, or, having slightly altered them, they attribute them to themselves. They always try to present to the leaders in such a way that their subordinate employees are mostly ignoramuses, idlers, unmotivated, and they have to do everything themselves. This way they feel more secure.
Whereas for proactive people, subordinates are first of all full members of their team. They are well aware that if they want to do and do more, this can only be achieved with the right team, where the more will be done, the more the creative abilities of each person are included, where people will open up to the end, try hard, ideas will appear, and until the end they will fight for the realization of their ideas in life. Proactive people know that creating such an environment in a team is a prerequisite for doing things more and faster than anyone else, which is why they try to create conditions for employees where they will give their best, increase self-esteem, learn more, and receive, and create more value. Since the main benefit of the team leader is not in the authorship or implementation of any specific idea, but in the leadership of the team that produces and executes the best ideas, and this helps them both in achieving their own life goals and in getting a better assessment from the leaders and the environment.
And finally, the biggest difference between proactive and reactive people is still in relation to their own successes or failures. Proactive people believe that the main reason for their success is luck, their employees, friends, family members, to which fortunate circumstances were added, and in the end all this led to success. Whereas, during a failure, they believe that they missed out on huge chances, misjudged the situation, made the wrong decisions, did not give people the opportunity to help in time and correctly. This approach helps proactive people to learn more from any failure, to analyze well what changes need to be made in their behavior and attitude in order to avoid similar mistakes. And success causes less complacency. As a result, proactive people are never satisfied with what they have achieved. They always strive to achieve more, and openly express gratitude to everyone around them for helping them achieve this, and this helps them achieve even greater success.
Whereas reactive people believe that success is the result of their special abilities and diligence, respectively, they themselves deserve both fame and greatness from this success, and failure is due to the situation and people around them, and they always look outside themselves for the culprit in unachieved goals, unsolved tasks, wrong steps. This attitude creates less motivation in them to seek opportunities for their own improvement, makes them more easily satisfied with what they have achieved, makes it difficult and stressful for others to work with them, and daily relationships with them, which causes even greater failure.
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Proactive and reactive people are distinguished only by their attitude to different issues, however, it is these attitudes that determine their different behavior in specific situations, which, in turn, also often causes different results. We are not saying that proactive people are better than reactive people, however, they can usually achieve more in life, and this is precisely the result of such relationships. Being proactive is not at all difficult, the main thing is to understand the difference, and make the appropriate choice.
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