Blood Banking and Transfusion

.: PREFACE
ÖN SÖZ
PREFACE
Prof. Dr. Nurgül CERAN
Sağlık Bilimleri Üniversitesi Haydarpaşa Numune Eğitim ve Araştırma Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji ABD, İstanbul, Türkiye
Article Language: TR
Kan, çağlar boyu insanlar için gizemli bir madde olmuştur. Yapısının ne olduğu bilinmediği dönemlerde bile hayati öneme sahip olduğu düşünülmekteydi. 1901 yılında ABO kan gruplarının keşfinden beri yapısı hakkında çok şey öğrenilmiş olmakla birlikte, dokulara oksijen taşınması, koagülasyon ve pıhtılaşma fonksiyonları için hâlen, kanın pratik bir alternatifi bulunmamaktadır. Toplamı yaklaşık beş litre olan total kan hacminin %30'dan fazlasının kaybı yerine konmazsa, hayati risk taşımaktadır. Kan bankacılığında kanın temini amacıyla; bağışçının seçimi, kan alınması, enfeksiyon testlerinin çalışılması, kan komponentlerinin hazırlanması, kan gruplarının çalışılması, hastaya kan ürünü ihtiyacının belirlenmesi, uygun ürün isteği yapılması, uygunluk testlerinin çalışılması, hastaya kullanım amacıyla çıkış işlemleri, hastada transfüzyonun takibi ve kayıtların tutulması olarak özetlenebilecek bir döngü mevcuttur. Bu döngüde bağışçı, laboratuvar sorumlusu/çalışanları, klinik doktoru/ personeli ve hastaların ayrı önemi vardır. Kan bankacılığında stok yönetimi, mikrobiyoloji, enfeksiyon hastalıkları, immünoloji ve hematolojiyle ilgili konular mevcuttur. Kan bankacılığı oldukça komplike ve spesifik bir çalışma alanıdır. Ülkemizde hâlen bir uzmanlık alanı değildir. Bu konuda ülkemizde lisans ve ön lisans düzeyinde eğitim de yetersizdir. 2001 yılından itibaren sertifikalı eğitim verilen alanlardan biridir. Kan Bankası ile ilgili son yasal düzenlemeler 1983 yılında hayata geçirilen 'Kan ve Kan Ürünleri Kanunu' ile başlamıştır. Günümüzde kanın temini Türk Kızılayının sorumluluğundadır.

Kan transfüzyonunun hayati desteğinin olmasının yanında, birtakım riskler de taşımaktadır. Kan ürünü ile enfeksiyon bulaşı, immünmodülasyon, alloantikor gelişimi ilk akla gelenlerdir. Transfüzyon anından itibaren hayatı tehdit edebilen reaksiyonlar ve komplikasyonlar gelişebilmektedir. Basit bir dikkatsizlik gibi görülen etiketleme hataları ölümcül sonuçlara neden olabilmektedir. Kan bankacılığı sonuçları, açısından sıfır hata ile çalışmanın gerekli olduğu bir alandır. Günümüzde çıkarılan yasal mevzuatlar, ürünlerin tek kurumca temini, enfeksiyon tarama testleri, uluslararası kan bankası ağına (ISBT) bağlı ürün oluşturmak, alınan kanın son halkaya kadar izlenebilmesi ve hataların önüne geçilmesi amacıyla hemovijilans ağının kurulmasının ortak amacı kanın güvenliğinin artırılmasıdır. Biyolojik bir madde olan ve hücre içeren kan ürünlerinin belirli bir miadı vardır. Bu süre 5 ve 42 gündür. Bu süre içinde kullanılması gerekmekte, aksi taktirde imha edilmektedir. Yani ihtiyaç süreklidir. Sürekli olarak güvenli kan ürünü temin edilmelidir. Kan ürünlerinin hastalarda kullanımı ayrı bir konudur ve hasta başı kan güvenliği, klinik çalışanlarının sorumluluğundadır. Kanın kullanım kararı, kan ürününün güvenli nakli de klinik doktor ve hemşirelerinin bilgisi ve bilinçli yaklaşımıyla mümkündür. Hasta başı kan güvenliği için klinik çalışanlarının da eğitimi gerekmektedir.

Bu kadar emekle üretilen kan ürünleri nakli, aslında bir doku naklidir. Günlük yoğun tempoda, bir doku olduğu unutulmakta, hak ettiği özen çoğu kez verilmemektedir. Kan bankacılığında yukarıda sayılan ve her birinin ayrı işleyişi olan birkaç dişli çark mevcut olup; bağışçının, ürünün, sağlık personelinin, hastanın güvenliği açısından bunların uyum içinde çalışması gerekmektedir.

Kan Bankacılığında bugüne kadar gönüllü hizmet veren kuruluşlardan; Türkiye Kan Merkezleri ve Transfüzyon Derneği, Türk Kan Vakfı, 'Sağlık Bakanlığı, Avrupa Birliği Kan Tedarik Sisteminin Güçlendirilmesi Teknik Destek Projesi' projelerini yürüten birim çalışanlarının, kan bankacılığı eğitimi ve bilimsel gelişimine yaptıkları katkılar büyüktür. Ben de kan bankacılığına gönül vermiş biri olarak şimdiye kadar tüm emeği geçenlere teşekkür ediyorum.

Kan bankacılığında önemli ilerlemeler sağlanmış olmakla birlikte henüz yolun başında olduğumuzu unutmamamız gerekmektedir. Bağışçı kazanım programları, kanın işlenmesi, güvenli kana erişim, kanın uygun kullanımı ve hasta kan yönetimi programları artarak devam etmelidir.

Türkiye Klinikleri'nin bu kitabının, kan bankacılığı ve transfüzyon tıbbı ile ilgilenen sağlık çalışanlarına katkı sunmasını diliyorum.

Prof. Dr. Nurgül CERAN
Editör
Blood has been a mysterious substance to humans for ages. It was thought to be of vital importance even in times when its structure was unknown. Although much has been learned about the structure of blood since the discovery of ABO blood groups in 1901, there is still no alternative for oxygen transport to tissues, coagulation and clotting functions. Total blood volume is about five liters and loss of more than 30% of it is life-threatening if not replaced. The workflow in blood banking can be summarized as donor selection, blood collection, tests for infection, preparation of blood components, study of blood groups, determination of blood product need for the patient, requesting appropriate products, compatibility tests, supply procedures for patient use, monitoring of transfusion in the patient, and keeping records. In this cycle, the donor, laboratory supervisor/employees, clinic doctor/staff and patients have special importance. There are subjects related to stock management, microbiology, infectious diseases, immunology and hematology in blood banking. Blood banking is a very complex and specific field of study, but still not an area of expertise in our country. In this regard, education at undergraduate and associate degree levels is also insufficient. It is one of the fields where certified trainings have been given since 2001. The legal regulations regarding blood banking started with the 'Blood and Blood Products Law' in 1983. Turkish Red Crescent is responsible for blood supply.

Although blood transfusion is a vital support for patients, it also carries some risks. Transmission of infection with blood product, immunomodulation, development of alloantibody are among the top of the list. Life-threatening reactions and complications may develop from the moment of transfusion. Labeling mistakes, which is an outcome of simple carelessness, can lead to fatal results. Blood banking is an area where it is necessary to work with zero error due to the potential consequences. The legal regulations, the supply of blood products by a single institution, infection screening tests, creation of products connected to the International Society of Blood Transfusion (ISBT) network, tracing the blood from the donor to recipient, and establishment of the hemovigilance network to prevent errors serve to the common pur pose, which is to increase the safety of blood. Blood products, which are biological substances and contain cells, have a certain expiration date. This period is between 5 and 42 days. Blood products must be used within this period, otherwise they must be destroyed. For this reason the need for blood product is constant. Safe blood products should be provided continuously. The use of blood products in patients is a different topic and blood safety is the responsibility of clinic staff. The decision to use the blood and safe transfer of blood product is possible with the knowledge and conscious approach of clinic doctors and nurses. Clinic staff should also be trained for bedside blood safety.

Transplantation of blood products produced with such effort is actually a tissue transplant. In the intense daily workload, it is forgotten that it is a texture, and the attention it deserves is often not given. There are several mechanisms listed above in blood banking, each of which has a separate function, and they must work in harmony for the safety of the donor, the product, the health personnel and the patient.

Among the organizations that have provided voluntary service in blood banking, Blood Banks and Transfusion Society of Turkey, Turkish Blood Foundation, and the employees who carried out the Ministry of Health, Strengthening the Blood Supply System Project of the European Union contributed greatly to blood banking education and scientific development. As a person who has been working in blood banking, I would like to thank all those who have contributed so far.

Although significant progress has been made in blood banking, we should not forget that we are only at the beginning. Donor acquisition programs, blood processing, access to safe blood, appropriate use of blood, and patient blood management programs should continue at an increasing rate.

I hope this book of Türkiye Klinikleri will contribute to healthcare professionals interested in blood banking and transfusion medicine.

Prof. Dr. Nurgül CERAN
Editor

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