Levan Avalishvili MD

1
?????????? ????????????????? ? ????????

• Levan Avalishvili MD
• Jo Ann Medical Center
• Tbilisi, Georgia

2
??????

• ??????????? ?????????? ???
• ???????????? ????????? ?????
• ?????????? ???????????

3
??????

• ???????? ??????????? ??? ???????????
• ???????????? ??????????? ???????????? ? ????????
• ???????????? ????????? ? ????????????????

4
??????

• ???????????? ????????? ? ?????????????
  ???????????
• ???????????? ???????? ???????? ? ??????,
  ????????? ? ???????????? ??????????? ?????

5
?????????? ??? ??????????? ?????

• ?????????? ????? ?????? ?????????? ?
  ?????????????? ?????
• ????????? ? ????? ????? ?????? ???? ?????????
  ???????????????? ?? ?????? ???????????
• ?????????? ????? ?????? ??????????? ?????
  ???????, ??????????????? ??? ???????? ???????? ?
  ?????????

6
???????????? ????????? ?????

• ??????? ????? ?????? ?????? ???? ????????? ??
• ABO
• Rh

7
???????????? ????????? ?????

• ?????????? ??????
• HIV 1/2 antibody
• Hepatitis C antibody (anti-HCV)
• Human T-cell lymphotropic virus (anti-HTLV-I/II)
• Hepatitis B surface antigen (HBsAg)
• Hepatitis B core antibody (anti-HBc)
• HCV RNA (NAT testing)
• HIV-1 RNA (NAT testing)
• WNV- West Nile Virus

8
???????????? ????????? ?????

• ???????????? ??????
• ?? ?? ?????, ??? ??? ?????????? ???????, ????
  ??????? ????? ?????????????? ??? ??????????
  ??????????
• ???????????? ?? ?????????, ???? ???????
  ???????????? ?????? ???????????

9
?????????? ????? ? ???????????

• ??????????
• ???????? ??????????
• ????? ?????????
• ?????????? ? ?????????????
• ?????
• ?????????? ?????? ? ????
• ????????????? ????? ??? ??????????

10
?????????? ????? ? ???????????

• ????????, ?????, ??????????????? ?????, ?????
  ???????? ????? ?????
• ???? ????????
• ????????????????? ????? ???????

11
?????????? ????? ? ???????????

• ????????? ??????
• ABO ? Rh
• ?????????? ? ??????????? ????????
• ?????????? ????????????? ??????????, ?????????? ?
  ????? ????????.

12
?????????? ???????????
13
?????????? ?? ISBT
????????????????? ????? ??????
ABO/Rh
??? ????????
???? ????????
14
?????????? ??? ??????????? ?????

• ??????? ????????? ??? ???????? ?????? ???????
  ????????? ? ????? ??? ?????? ? ?????? ???
  ????????????, ?? ??????????? 0,9 ?????? ???????
• ??????? ??????? ??????? ??? ?????? ????????,
  ?????????? ??????? ?? ? ???? ?????? ?? ??????
  ???? ????????? ? ????? ??? ?????? ? ?????? ???
  ????????????, ??????????? ??????

15
?????????? ??? ??????????? ?????

• ????? ? ?????????? ?????? ???? ?????????
  ??????????????? ????? ??????????????

16
?????????? ??? ??????????? ?????

• ????? ??? ?????????? ?? ?????? ?????????????? ???
  ???????????, ????
• ??? ?????????? ???????, ????????? ?? ???????? ???
  ???????? ??????????? (??????? ????????)
• ??????? ???????????? ????????? ????? ? ?????
  ????? ?? ????????? ? ??????? ?????????, ????????
  ??????? ???, ??? ?????? ????????

17
?????????? ??? ??????????? ?????

• ???? ????????? ?????????? ? ???????? ???????, ???
  ???? ???????? 4 ???? ??? ????????? ???????????
  (20-24C), ??? 24 ???? ??? (1-6C)

18
?????????? ??? ??????????? ?????

• ?????????? ????? ????? ???????, ???? ???????????
  ???????? ???????, ????????? ??? ??????????
  ???????????
• ????????? ?????????? ????? ??????? ?????
  ????????? ????? ??????? ????? ??????? ?????.
  ??????? ???????? ??????? ?????? ???? ???????
  ?????????. ????????????? ?????????? ? ??????
  ????????? ??????????? ?????? ??????????? ?? ?????
  ? ????? ???????????

19
?????????? ??? ??????????? ?????

• ??? ?????????????? ???????, ??????????? ??????
  ???? ?????????? ??????????, ? ???????????????
  ??????? ??????
• ??????????? ?????? ???? ????????? ? ??????? 4
  ?????, ? ?? ????????? ????? ??????????

20
?????????? ??? ??????????? ?????

• ??? ??????????????? ???????, ????????? ?
  ????????????, ? ??? ????? ????????? ?????????????
  ??????????? ??????????? ????? ??? ??????????
  ???????? ???????????, ?????? ???? ???????? ??
  ???????? ?????? ??????????? ? ???????????? ?
  ?????????? ???????????

21
RBC

• ???????
• ?????????? ?????????? ????????? ?????????????
  ???????????
• ?????????
• ??????? ????????????????? ????????
  ??????????????? ?????????

22
RBC

• ????????????????
• ?? ?????? ???? ???????????? ??? ??????? ??????,
  ??????? ????? ???? ?????????? ? ??????? ????????
• ?? ?????? ?????????????? ? ???????? ??????????
  ??????

23
RBC

• ?????? ?????????? ? ????
• ???? ??????? ??????? ????? ??? ??????? ??????
  ????? ?????? ??????? ?????????? ???????? ?? 1 ? /
  ?? ? ?????????? ?? 3

24
RBC

• ?????? ?????????? ? ????
• ABO ?????? RBC ?????? ???? ?????????? ? ABO
  ?????????? ??????????
• ?? ??????????? ?????????? ????? ?????????,
  ?????????????? ????? ?? ABO / Rh, ??????? ???????
  ? crossmatching ?????? ???? ????????? ??
  ???????????

25
RBC

• ?????????? ???????? ?????????? ? ?????? ?
  ???????? ????????? ????????? ??? ??????????
  ?????????
• ??????, ??????? ??????? ????? ???????? 450 mL
  (?10) ???? 500 mL (?10)

26
RBC
27
RBC

• ??????????? ??????????
• 38
• ???? ????????
• ???????????? ? ??????????? ?? ?????????????-??????
  ?????

28
RBC

• Anticoag/Preserv.
• ACD-A
• CPD
• CP2D
• CPDA-1

• ???? ????????
• 21 ????
• 21 ????
• 21 ????
• 35 ????

29
RBC

• ?????????????? ????? ???????? ????????
  ??????????? ????? ???????? ??????
• ??????????
• 65-80 (??? (AS)
• 55-65 (? (AS)
• ?????
• 225-350 mL

30
RBC (AS)

• ????????? ?????????????????? ??????? ????? ?
  ???????????? ??????????? ??????, ? ??????? ??????
  100-110 ?? ??????????? ????????

31
RBC (AS)

• ?????????? ??????? (AS)
• ????????
• ??????
• ?????????
• ?????? ??????
• ???????????? ?????? ?????? ??? ????????

32
RBC (AS)

• ??????????
• 55-65
• ???? ????????
• 42 ??? ??? 1-6C

33
RBC ?????????????????????

• Made by adding glycerol to red cells
• Glycerol acts as a cryoprotective agent before
  freezing, and must be removed before infusion

34
RBC ?????????????????????

• Contains 80 or more of red cells in the original
  unit
• Glycerol is removed by washing with lowering
  concentrations of 0.9 Sodium Chloride
• Hemoglobin in the supernatant should not exceed
  500 mOSM

35
RBC ?????????????????????

• May be useful for transfusion to patients with
  IgA antibodies or IgA deficiency
• Carries risk of intravascular hemolysis if
  deglycerolization is inadequate

36
RBC ???????????

• May be prepared from red cells stored in CPD,
  CPDA-1, and AS up to 3 days after expiration
• Rejuvenation solution is used to restore 2,3-DPG

37
RBC ???????????

• Must be washed before infusion to remove inosine
• May be washed and transfused within 24 hours or
  prepared for frozen storage by glycerolization

38
RBC ?????????

• Collected by aphersis using an automated
  collection method
• Contains approximately 60 grams of hemoglobin

39
FFP

• ???????? ?? ??????? ??????? ????? ??? ?????
  ???????
• ?????????????? ???-18C ??? ???? ? ??????? 8 ?.
  ???? ??????????? ? CPD, CP2D ??? CPDA-1, ?
  ??????? 6 ?. ???? ??????????? ? ACD

40
FFP
41
FFP

• ?????????
• ?????????? ???????????????? ????????? ???
  ????????? ? ????????????? , ??????? ?????????
  ????????? ???????? ??????????
• ???????? ? ????????? ???????????? ? ??????????
  ???????? ????????? ??????????

42
FFP

• ?????????
• ???????? ?? ?????????, ? ????????????? ???
  ??????????? ? ?????????? ??????????
• ?????????? ??? ??????????? ? ????????? ? TTP

43
FFP

• ?????????
• ??????? ????????? ? ?????????? ??????????
  ???????? ???????????, ??????????? ???
  ??????????????, ????? ??? ? ??????? ???????????
  ????????????

44
FFP

• ?????????
• ??????? ??????? ? ??????? ?????????? ?????? ??????

45
FFP

• ????????????????
• ?? ??????? ????????????, ???? ???????????? ?????
  ???? ?????????? ????? ?????????? ? ???????????
  ????????????? ??????? ??? ????????? K,
  ????????????????, ??? ???????? VIII

46
FFP

• ????????????????
• ?? ?????? ?????????????? ? ???????? ??????????
  ??????

47
FFP

• ?????? ?????????? ? ????
• ???????????? ?? ????????????? ?? ????????????
  ????? ????????
• ?????? ?????? ???? ??? ?????????? ? ????????????
  ??????????

48
FFP

• ?????? ?????????? ? ????
• ????? ??????????? ??????? ?? ???????????
  ????????, ??????? (????) ????????, ? ????????????
  ???????? ??????? ??????????

49
FFP

• ?????? ?????????? ? ????
• ?????????? ??????????? ? ??????? ???? ?????
  30-37C ??? ?????? ????????
• ????? ?????? ????? ????????? ??? ??????????? 1-6?
  ?? 24 ?????

50
FFP

• ???????? ??? ??????? ??????????? ?????, ???????
  ????????? ??????? V ? VIII

51
????? ??????

• ??????????? ?? FFP
• ?????????????? ??? 30-37C
• ???????? ??? 1-6C 1-5 ????
• ???????? ??????????? ?????????? ?????????
  ???????? V ? VIII

52
?????? ??????

• ???????? ?? ??????? ????? ?? ??????? ??? ????? 5
  ???? ????? ????????? ????? ??????? ?????
• ???????? ??? 1-6 ?

53
?????????????? ??????

• ???????? ?? FFP, ????? ???????? ?????????????,
  ????? ?????????????? ? ?????????????????
• ??????? ??????????????, ?????? VIII, ?????? ???
  ???????????, ??????????, ????????????, ?
  ???????????

54
?????????????? ??????

• ?????????
• ???????? ?????? ??????, ????? ???????????,
  ??????? VIII, ??????? XIII, ? ???????????
• ???????????? ??? ??????????? ??? ???????????? ?
  ??????? ???
• ???????? ??????? ???????????, ????? ???????? I,
  VIII, XIII, ? ???????????

55
??????????????

• ????? ????????? ??? ??????????????? ?????? (AHF)
• ???????????? ????? ?????????? FFP ??? 1-6C,
  ??????????????? ??????, ? ????????????? ?????? ?
  ??????? 1 ????

56
??????????????
57
??????????????

• ?????? ??????? ????????
• ? 80 IU Factor VIII
• ? 150 mg ???????????
• ?????????????? 15 mL ??????

58
??????????????

• ?????????
• ??????? ?????? ????? ??? ??????? ??????????? ?
  ????????? A
• ?????? ?????????????? ?????? ????
  ?????-???????????????? ?????????? ??????? VIII
  ??? ????????? ?????????????? ???????? ?? ????????

59
??????????????

• ?????????
• ???????????? ? ?????????? ????????????,
  ?????????? ? ????????? ???????????
• ???????? ????????????

60
??????????????

• ?????? ?????????? ? ????
• ???? ?? ????????????? ?? ?????
• ???????????????? ??????????? ABO ???????????
• Rh ?? ????? ????????

61
??????????????

• ?????? ?????????? ? ????
• ?????????? ??? t 30-37C
• ???????? ??? ????????? ??????????? ?? 6 ????? ???
  ????, 4 ???? ? ????.

62
??????????????

• ?????? ?????????? ? ????
• ??????? ????????? A
• ??????? ???????? ??????? VIII ? ????????????
  ?????????
• ??????? ??????????????????

63
??????????????

• ?????? ???? ???????????????
• ????????? ?????????? ?????? ???????????????
• ???????? ?????????? ?????? ??????? VIII () x
  ????? ?????? ???????? (? mL)/ ??????? ??????????
  ?????? ??????? VIII ? ??????????????? (??????? 80)

64
??????????

• ????????????
• ??????? ??????????? ???????????? ????? ??????????
  ?????????? ?? ????? ??????? ??????? ?????
• ?????? ????????? ?? ????? 5.5 x 1010 ???????????
  ? 40-70 ?? ??????

65
??????????
66
??????????

• ????????????
• ??????? ??????????? ????? ????????? ????????????
  ?????????? ?????????? ? ???? ???????????
• ??? ?????????? ??????????? ?????? ???? ?????????
  ?? ????????????? ???????????

67
??????????

• ???????
• ????????? ??? ??????????? ?????????
• ??????????? ??????? ???????? ? ???????
  ???????????, ????????? ? ??????????? ?????????
  ??????????? ??????, ??? ???????? ? ??????????????
  ??? ??????????? ????????????

68
??????????

• ?????????
• ??????? ????????????, ????????? ???????????
  ????????? ????????????? ??????????? ???
  ????????????? ???????????? ???????????
• ???????????????? ??????? ????????? ? ??????
  ??????????? ?????? ??????????? ? ????? ? ?????,
  ???????? ???????? ?????, ??? ?????????????

69
??????????

• ????????????????
• ?? ?????? ???? ????????????, ???? ???????????? ??
  ????? ????????? ? ???????? ?????, ???
  ????????????? ???????????????? ???????????
• ???????? ? ??? ??? ???, ?? ???????????
  ????????????, ?????????? ?????

70
??????????

• ?????? ?????????? ? ????
• ???? ?? ????????????? ?? ????? ? ??? ????????
  ????????????
• ????????? ?????? ?????? ???? ?????????? ? ???
  ??????????? ??????????, ????? ?????????
  ???????????? ?????, ??? ????? ????????????
  ??????? ??????

71
??????????

• ?????? ?????????? ? ????
• ???? ??? ???????? 4-8 ??????
• ???? ??????? ??????????? ?????? ?????????
  ?????????? ??????????? 70-?? ????????? ??
  5-10,000/?L
• ???????????????? ??????? ???????? (CCI) ????????
  ??????????? ????? ?????? ??????????? ??
  ??????????? ???????????

72
??????????

• ??????????? CCI (Corrected count increment)
• CCI (post-count-pre-count) x BSA/ platelets
  transfused
• Post and pre-count are platelet counts (?/L)
• BSA patient body surface area (meter2)

73
??????????

• ???????? ??????? ? ?????????
• ????????????? ???????????
• ??????????????? ???????????
• sensitization to HLA antigens
• ??????????????? ??????? ??????

74
??????????

• ???????? ??????? ? ?????????
• ???????? ????? ??????? HLA ???????? ? ?????
  ????????????? ? ???????????
• Rh Immune Globulin ?????? Rh negative ????????
  ??????????? ???????? ??? ??????????? Rh positive
  ???????????

75
??????????

• ?????????? ???????????
• ??????????
• ???????? ?? ??????? ??????? ?????
• ????????????? ??????????
• ??????? ???????????? ? ????
• ???? ???????? 4 ????

76
??????????

• ????????? ??????????
• ????????? ??????? ???????
• ?????? ????????? ? 3 x 1011 ???????????
• ????????????? - ACD-A
• HLA ???????????? ???????????? ??? ???????
  ?????????????? ????????? ? ??????????? ??
  ?????????????? ???????
• ???? ?? RBC ????????????? ??????????? ????
  ????????? ???????? ? 2 mL RBC
• ???? ???????? - 5 - 7 ????)

77
????????? ??????????
78
??????????

• Leukocyte Reduced ??????????
• ???????????? ? ?????????????? ?????-????????.
• ?????????? ?????????? ?????????? ? 8.0 x 105 ???
  ? 5 x 106
• ?????????? ? 3 x 1011

79
??????????

• Leukocyte Reduced ??????????
• ?????????
• ????????????, ????? ????????? ??????? ?????????
  ??????????, ???????????????? ??????? ??
  ??????????? ?????
• ???????? HLA ???????????????
• ?????????? ???-????????

80
Leukocyte Reduced ??????????

• ????? ?????-????????, ?????????? ??????????
  ??????????
• ? 5 x 106 ? RBC
• ? 8.3 x 105 ? leukoreduced platelet pheresis

81
Leukocyte Reduced ??????????

• ?????????
• ????????????, ????? ????????? ??????? ?????????
  ??????????, ???????????????? ??????? ??
  ??????????? ?????
• ???????? HLA ???????????????
• ?????????? ???-????????

82
Leukocyte Reduced ??????????

• ????????????????
• ?? ????????????? GVHD
• ?????-??????? ?? ?????? ????????????? ???
  ?????????? ????????????

83
CMV ?????????????? ?????????? ?????

• ???????? CMV ??????? ? ?????????? ??????????
  ?????
• FFP, ?????????????? ? ?????? ?????????? ?? ??????
  ??????, ?? ??????? ???????????? ????????????

84
CMV ?????????????? ?????????? ?????

• ?????????
• CMV ?????????????? ?????????? ? ?????? ???????
  CMV ????????
• ?????????? ??????? ? ?????
• ????????????? ? ?????? ?????

85
CMV ?????????????? ?????????? ?????

• ?????????
• ?????????????? ???????
• ?????????????? ???????? ?????
• ?????????? ? ?????? ??????????? ???????????
• HIV ??????????????

86
??????????????? ?????????? ?????

• ?????????? ?????, ??????? ???????? ??????????????
  ?????????, ????? ???? ???????? ??? ??????????????
  ???????????? ?-??????????, ??? ????????
  ???????????????? ???????? GVHD
• ??????????? ????
• 2500 cGY ?????????? ? ????? ??????????

87
??????????????? ?????????? ?????

• ?????????
• ???????? ? ?????? GVHD
• ????? ??? ?????????????? ???????????
• ?????????? ? ??????????? ???????????

88
??????????????? ?????????? ?????

• ?????????
• ?????????? ????????? ??????????? ????? ??
  ??????? ?????????????
• ?????????? ?????? ???????????????? ?? ?? ??? ??
• ?????????? HLA ??????????? ????????? ???????????

89
??????????????? ?????????? ?????

• ?????????
• ?????????? ?????????? ???????? RBC
• ???????? ??????? ?????
• ????????? ???? ???????? ?????????? ??????????? ??
  28 ????

90
??????? ?????????? ?????

• ?????? ????????? ? ?????????????? 0.9 Sodium
  Chloride
• ????????? ??????? ????????????? ????? ??????, ?
  ??? ????? ????????
• ?????? ??????????? ? ???????????

91
??????? ?????????? ?????

• ???? ????????
• 1-6C ?? ????? 24 ?.
• 20-24C ?? ????? 4 ?.

92
??????? ?????????? ?????

• ?????????
• ??????? ????????????? ??????, ???????
  ??????????????? ????????? ? ???????????? ???????,
  ???????? IgA-?????????? ???????????, ???
  ??????????? ??????? ?????????? ????????????????
  ??????? ?? ?????????? ??????

93
??????? ?????

• ??? ?????????? ????? ?????? ??????????? ?????
  ??????? ??? ???????? ????????? ????????, ???????
  ????????????? ??? ????????
• ??????????? ??????
• 70-170 um

94
??????? ?????

• ??????? ??? ?????????????
• ?????? ????????? ?????????? ?????????? ?
  ??????????? ??? ??????????? ?? lt 5x106
• ?????????????????? ???????
• ????????????? ??? ??????????? ??????????? ???
  ???????????
• 20-40 ??????
• ??????? ?????????????? ???????????, ?????????? ?
  ????? ???????
• ?? ?????? ???? ???????????? ??? ???????????
  ????????????

95
??????????

• Circular of Information, American Society of
  Blood Banks, Americas Blood Centers, American
  Red Cross.
• Harmening, D.M. Modern Blood Banking and
  Transfusion Practice. 5th ed.

96
??????? ?? ????????