International Congress of Transfusion Medicine Abstracts

Congres International de Medicina
Transfuzionala;
Volum de rezumate
Oradea, 22 25 martie 2012

Abstracts Book;
International Congress of Transfusion
Medicine
Oradea, 2012, March 22 25

Olivia Ligia BURTA, Andrei ROSIN, Gheorghe BUMBU,
Jean GEROTA

Editor sef: Bogdan LEAHU
Editori: Radu IOVAN, Catalin NICOLAE

Colectia: Centrul de Cercetari in Medicina de Inalta Performanta
volum 23
ISBN 978-606-10-0782-0
Editura Universitatii din Oradea
2

Cuprins/Table of Contents
Pr 01. Implicarea medicinii primare in promovarea donarii de sange, la diferite categorii populationale,
Zsuzsanna Farkas-Pall1, Olivia Ligia Burta1,2, Eugenia Voica Pop1 ......................................................... 8
Pr 01. The Role of General Practitioners in Blood Donation Promotion, in Different Population
Categories, Zsuzsanna Farkas-Pall1, Olivia Ligia Burta1,2, Eugenia Voica Pop1 ...................................... 9
Pr 02. Prezentarea brosurii: Statusul current si viitor al strategiilor din domeniul Securitatii
Transfuzionale in Medicina de Urgenta si Circumstante Speciale, Marie-Emmanuelle Behr-Gross1,
Valentina Hafner2, Fatima Nascimento3, Snezhana Chichevaliev3, Olivia Ligia Burta4, Gilles Follea5 . 10
Pr 02 The Booklet South-Eastern Europe Health Network Current Status and Future Strategies in Safe
Blood and Blood Components Transnational Availability for Medical Emergencies and Special
Circumstances, in South Eastern Europe Presentation, Marie-Emmanuelle Behr-Gross1, Valentina
Hafner2, Fatima Nascimento3, SnezhanaChichevaliev3, Olivia Ligia Burta4, Gilles Follea5 .................. 12
Pr 03. Catalogul produselor sanguine furnizate la nivelul centrelor de transfuzie sanguine; perspective,
Olivia Ligia Burta1, Andrei Rosin2 ............................................................................................................ 14
Pr 03. The Catalog of Blood Components, Issued by Romanian Transfusion Service; Future Trends,
Olivia Ligia Burta1, Andrei Rosin2 ............................................................................................................ 15
Pr 04. Rolul colectei mobile in asigurarea auto-suficientei in terapia transfuzionala, Mariana Maier1,
Paraschiva Dobos1, Olivia Ligia Burta1, 2 , Radu Iovan2 ......................................................................... 16
Pr 04. The Role of Mobile Collection in Self-SufficiencyiIn Transfusion Therapy, Mariana Maier1,
Paraschiva Dobos1, Olivia Ligia Burta1, 2, Radu Iovan2 .......................................................................... 17
Pr 05. Evaluarea activitatii retelei nationale de transfuzie din Romania, pe anul 2011, Andrei Rosin ...... 18
Pr 05. The Activity Evaluation of The Romanian National Transfusion Network, in 2011, Andrei Rosin 19
Pr 06. Evaluarea unitatilor de transfuzie sanguina din spitale (UTS) in conformitate cu Ord. Msp nr.
1224/2006 la nivelul judetului Bihor in anul 2011, Alietta Florian1, Zoia Bitea2 ..................................... 20
Pr 06. The Evaluation of Hospital Transfusion Units (HTU) according to Mh Order 1224/2006, In 2011
at Bihor County Level, Alietta Florian1, Zoia Bitea2 ................................................................................. 21
Pr 07. Educatia medicala continua - atu al dezvoltarii profesionale in domeniul medicine transfuzionale,
Max Constantinescu
1
, Leila Curtamet
2
..................................................................................................... 22
Pr 07. Continuous Medical Education Milestone in Professional Development in Transfusion Medicine
(E-Learning Model), Max Constantinescu 1, Leila Curtamet 2 .................................................................. 23
Pr 08. Monitorizarea la nivelul medicinei primare a donatorului depistat cu markeri microbiologici
(virusologici, bacteriologici), Mariana Fericean1, Olivia Ligia Burta2 ..................................................... 24
Pr 08. The Category of Blood Donors with Positive Microbial Markers (Viruses, Bacteria) Monitorized
By The General Practitioner, Mariana Fericean1, Olivia Ligia Burta2 ...................................................... 25
Pr 09. Implementarea sistemului de calitate in centrele de transfuzie din Republica Moldova, Svetlana
Cebotari ....................................................................................................................................................... 26
3

Pr 09. The Status of Quality System Implementation in Blood Transfusion Establishments in Republic of
Moldova, Svetlana Cebotari ........................................................................................................................ 27
Pr 10. WNV si securitatea transfuzionala: concluzii ale anului 2011, propuneri pentru anul 2012, G
Folla, R Lieshout , P Hewitt, Wr Mayr (EBA) ......................................................................................... 28
Pr 10. West Nile Virus and blood safety: lessons learnt from 2011 proposals for 2012, G Folla, R
Lieshout , P Hewitt, Wr Mayr (EBA) ......................................................................................................... 30
Pr 11. Terapia transfuzionala in anemia hemolitica autoimuna: experienta spitalului Universitar Bucuresti,
Corina Posea, Anca Ursachi........................................................................................................................ 31
Pr 11. Transfusion Therapy in Autoimmune Hemolytic Anemia: Bucharest University Hospital Experience,
Corina Posea, Anca Ursachi ........................................................................................................................ 32
Pr 12. Dificultati in implementarea sistemului de hemovigilenta in Spitalul Universitar De Urgenta
Bucuresti, Corina Posea, Anca Ursachi ...................................................................................................... 33
Pr 12. Difficulties in Implementing the Hemovigillance System in the University Hospital Of Bucharest,
Corina Posea, Anca Ursachi ........................................................................................................................ 34
Pr 13. Monitorizarea la nivelul medicinii primare a pacientului care a beneficiat de terapie transfuzionala,
Corina Posea, Anca Ursachi........................................................................................................................ 35
Pr 13. Monitoring of Transfused Patient in Primary Care Medicine, Corina Posea, Anca Ursachi ........... 36
Pr 14. Utilizarea tehnicii conventionale si a tehnicii de aglutinare in coloana pentru efectuarea testelor
pre-transfuzionale in unitatile de transfuzie sanguina din spitale, Gabriela Miricescu............................... 37
Pr 14. The Use of Conventional and Column Agglutination Techniques for Pre-Transfusion Testing in
Blood Transfusion Units of the Hospitals, Gabriela Miricescu .................................................................. 39
Pr 15. Principii generale ale recoltarii prin afereza a celulelor stem periferice. Recoltarea celulelor stem
periferice cu automatul MCS + HAEMONETICS, Gabriela Miricescu ..................................................... 41
Pr 15. selePcn rPrlareneGo s rePrelePcn lnPP ere aennG aPnnearrPlGb s selePeGrG . le selePeGrG
aPnnearrPlo s rePrelePcn lnPP ere aennG errl eae + EsHeOTHae sEOesH , Gabriela
Miricescu .................................................................................................................................................... 43
Pr 16. Raportul anual de activitate a unitatilor de transfuzie sanguina din cadrul spitalelor, Simona Parvu
.................................................................................................................................................................... 45
Pr 16. Annual Activity Report of the Hospitals Blood Transfusion Units, Simona Parvu ............................ 46
Pr 17. Standarde i criterii europene comune pentru inspectia unitatilor de transfuzii sanguine, Simona
Parvu ........................................................................................................................................................... 47
Pr 17. Common European Standards and Criteria for the Inspection of Blood Establishments, Simona
Parvu ........................................................................................................................................................... 49
Pr 18. Strategia Ministerului Sanatatii privind sistemul transfuzional din Romania, Ministru, Dr. Ritli
Ladislau ....................................................................................................................................................... 51
4

Pr 18. The Strategy of The Ministry of Health for the Transfusion System in Romania, Minister, Dr. Ritli
Ladislau ....................................................................................................................................................... 53
Pr 19. Implementarea Ord. M.F.P 946/2005 cu modificarile si completarile ulterioare, privind controlul
intern/managerial in Centrele de Transfuzie Sanguina, Sevastiana Bran
1
, Cristina Stoian
2
...................... 55
Pr 19. Implementation of Ord. Mfp 946/2005 as Amnended and Supplemented, on Internal Control /
Management in Blood, Sevastiana Bran
1
, Cristina Stoian
2
......................................................................... 57
Pr 20. Controlul intern de calitate in laboratorul de imunohematologie (CTS I unitati de transfuzie din
spital), Victoria Halmagi
1
, Cristina Bichis
2
.................................................................................................. 59
Pr 20. Internal Quality Control in Immune-Hematology Lab (BTC and Hospital Transfusion Units),
Victoria Halmagi
1
, Cristina Bichis
2
.............................................................................................................. 60
Pr 21. Formularele aferente activitatii centrelor de transfuzie sanguina i interfata cu spitalele, Victoria
Halmagi
1
, Cristina Bichis
2
........................................................................................................................... 61
Pr 21. Reporting Documents of BTCS and the Interface With Hospitals, Victoria Halmagi
1
, Cristina Bichis
2
.................................................................................................................................................................... 63
Pr 22. Iradierea produselor sanguine labile, pentru prevenirea riscului post-transfuzional al maladiei
grefonului contra gazdei (PT-GVHD, engl.) La pacientii imuno-deprimati, Jean Gerota ............................ 65
Pr 22. Irradiation of Blood Products: Prevention of the Risk of Post-Transfusion Graft-Versus-Host
Disease (Pt-Gvhd) in Immuno-Depressed Patients , Jean Gerota ............................................................... 67
Pr 23. Modele de raportare (formulare) a reactiilor/incidentelor severe transfuzionale (cf OMS 1228);
prezentarea definitiilor de caz, gradelor de severitate, nivelului de imputabilitate; ancheta
transfuzionala, Diana Pelea
1
, Patricia Marusca
2
, Ovidiu Burta
2
.................................................................. 69
Pr 23. Reporting models (documents) for severe transfusion reactions/incidences (cf OMS 1228); cases
definitions, severity degrees, level of imputability; transfusion investigation, Diana Pelea
1
, Patricia
Marusca
2
, Ovidiu Burta
2
.............................................................................................................................. 70
Pr 24. Formulare aferente activitatii Unitatilor de transfuzie sanguina (UTS), Diana Pelea
1
, Patricia
Marusca
2
, Corina Posea
3
, Olivia Ligia Burta
4
............................................................................................... 71
Pr 24. Documents corresponding to hospital transfusion unit (HTU) activity , Diana Pelea
1
, Patricia
Marusca
2
, Corina Posea
3
4
............................................................................................... 72
Pr 25. Legislatia aferenta organizarii si functionarii Comisiei de Transfuzie si Hemovigilenta (CTH) si
Unitatii de Transfuzie Sanguina (UTS), Diana Pelea
1
, Patricia Marusca
2
, Simona Parvu
3
........................... 73
Pr 25. Current legislation about transfusion and hemovigilance comission (THC) and hospital transfusion
unit (HTU), Diana Pelea
1
, Patricia Marusca
2
, Simona Parvu
3
...................................................................... 74
Pr 26. Alianta europeana a sangelui: prezentare, realizari in 2011, proiecte pentru 2012, Gilles Folla,
Olivia Ligia Burta, Andrei Rosin ................................................................................................................... 76
Pr 26. European Blood Alliance: Presentation, Achievements in 2011, Projects for 2012, Gilles Folla,
Olivia Ligia Burta, Andrei Rosin ................................................................................................................... 77
5

Pr 27. Interconditionarea: fisa postului program de instruire a cadrelor sanitare medii evaluarea anuala
a performantelor profesionale, Romulus Roman
1
1,2
, Radu Iovan
2
, Patricia Marusca
2
78
Pr 27. Interrelation: individual professional responsibility sheet medical staff training program annual
evaluation of professional skills, Romulus Roman
1
1,2
, Radu Iovan
2
, Patricia Marusca
2
.................................................................................................................................................................... 79
Po 01. Tulburari posttransfuzionale ale potasiului si echilibrului acido-bazic, Mir, Hira1, 3, Mir, Hajra2,
3, Ovidiu Burta3, Olivia Ligia Burta3, 4 .................................................................................................... 81
Po 01. Post-Transfusion Potassium- and Acid-Base- Imbalance, Mir, Hira
1, 3
, Mir, Hajra
2, 3
, Ovidiu Burta
3
,
Olivia Ligia Burta
3, 4
................................................................................................................................... 82
Po 02. Hipocalcemia post-transfuzionala, Mir Hira1, 3, Mir Hajra2, 3, Patricia Marusca3,4, Ovidiu
Burta3,4 ....................................................................................................................................................... 83
Po 02. Post-Transfusion Citrate Toxicity, Mir Hira
1, 3
, Mir Hajra
2, 3
,

Patricia Marusca
3,4
, Ovidiu Burta
3,4
84
Po 03. Reactia hemolitica acuta si intarziata post-transfuzionala, Ioana Zaha1,2, Olivia Ligia Burta2 ..... 85
Po 03. Acute and Delayed Hemolytic Reactions, Ioana Zaha
1,2
2
................................. 86
Po 04. Supraincarcarea circulatorie posttransfuzionala, Andrei Tarsoly
1, 2
, Romina Crisan
1, 2
, Olivia Ligia
Burta
2
, Diana Pelea
2
.................................................................................................................................... 87
Po 04. Posttransfusion circulatory overload, Andrei Tarsoly
1, 2
, Romina Crisan
1, 2
2
,
Diana Pelea
2
................................................................................................................................................ 88
Po 05. Insuficienta respiratorie acuta post-transfuzionala, Carina, Dudas (Petricau)
1, 2
2
.................................................................................................................................................................... 89
Po 05. Transfusion Related Acute Lung Injury (Trali), Carina, Dudas (Petricau)
1, 2
2
. 90
Po 06. Boala grefon contra gazda post-transfuzionala, Lavinia Florentina Rad
1,2
2
..... 91
Po 06. Transfusion-Associated Graft Versus Host Disease (TA-GVHD), Lavinia Florentina Rad1,2,
Olivia Ligia Burta2 ..................................................................................................................................... 92
Po 07. Reactie alergica usoara (urticarie) in relatie cu terapia transfuzionala, Roxana Burta
1
, Carina Dudas
(Petricau)
1
, Sebastian Stanciu
1
2
, Stefan Reikli
2
........................................................... 93
Po 07. Mild Allergic Reaction Transfusion-Related, Roxana Burta
1
, Carina Dudas (Petricau)
1
, Sebastian
Stanciu
1
2
, Stefan Reikli
2
............................................................................................... 94
Po 08. Hemoliza acuta post-transfuzionala mediata non-imun, Paula Dejeu
1
, Adela Vicas
1
, Danut Dejeu
2
,
Razvan Vicas
3
4
............................................................................................................. 95
Po 08. Acute Non-Immune Hemolytic Transfusion Reaction, Paula Dejeu
1
, Adela Vicas
1
, Danut Dejeu
2
,
Razvan Vicas
3
4
............................................................................................................. 96
Po 09. Reactiafebrila post-transfuzionala, non-hemolitica, Horatiu Burta
1
, Teo Rif
1
, Sebastian Heredea
1
,
Bogdan Leahu
1
, Catalin Nicolae
1
, R. Iovan
2
.............................................................................................. 97
Po 09. Non-haemolytic immune transfusion reactions (NHTR), Horatiu Burta
1
, Teo Rif
1
, Sebastian
Heredea
1
, Bogdan Leahu
1
, Catalin Nicolae
1
, R. Iovan
2
............................................................................. 98
6

Po 10. Contaminarea bacteriana, Ioana Szanto
1
, Ramona Budau
1
2
............................. 99
Po 10. Bacterial Contamination, Ioana Szanto
1
, Ramona Budau
1
1, 2
......................... 100
Po 11. Trombocitopenia posttransfuzionala (TPT), Adela Vicas
1
, Paula Dejeu
1
2
..... 101
Po 11. Posttransfusion Purpura (PTP), Adela Vicas
1
, Paula Dejeu
1
2
......................... 102
Po 12. Reactie alergica severa-soc anafilactic, Nicoleta Marcut
1,2
, Mirela Florescu
3
, Catalin Florescu
2
,
Patricia Marusca
2
...................................................................................................................................... 103
Po 12. Posttransfuzional Severe Allergic Reaction- Anaphylactic Shock, Nicoleta Marcut
1,2
, Mirela
Florescu
3
, Catalin Florescu
2
, Patricia Marusca
2
........................................................................................ 104
po 13. Coagulopatia intravasculara diseminata (CID) post transfuzionala, Romina Crisan1,3, Ingrid Veres2
.................................................................................................................................................................. 105
po 13. Transfusion-Related Disseminated Intravascular Coagulation, Romina Crisan1,3, Ingrid Veres2 106
Po 14. Contaminarea microbiana; agenti infectiosi cu potential de transmitere transfuzionala, Radu
Iovan1, Olivia Ligia Burta2, Bogdan Leahu1,3, Catalin Nicolae1,3 ............................................................ 107
Po 14. Microbial Contamination, Infectious Agents with Potential Transfusion Transmission, Radu
Iovan1, Olivia Ligia Burta2, Bogdan Leahu1,3, Catalin Nicolae1,3 ............................................................ 108
7

Sesiune prezentari
Presentations Session
8

Pr 01. Implicarea medicinii primare in promovarea donarii de sange, la
diferite categorii populationale
Zsuzsanna Farkas-Pall1, Olivia Ligia Burta1,2, Eugenia Voica Pop1

1
Centrul de Cercetari in Medicina de Inalta Performanta/FMF/UOradea, Romania
2
Centrul de Transfuzie Sanguina Oradea, Romania

Introducere. Furnizorii de asistenta medicala primara au un rol important in promovarea
comportamentului responsabil fata de sanatate si in reducerea inegalitatilor in sanatate. Ei pot
avea un rol esential in educatia, selectia si retentia/fidelizarea donatorilor de sange.
Programele de promovare a sanatatii si de educatie sanitara s-au dovedit a fi durabile si eficiente
atunci cand interventiile sunt accesibile, au continuitate, sunt centrate pe client si adaptate la
nevoile comunitatii.
Obiective. Identificarea de modele de buna practica adaptate la asistenta medicala primara
pentru dezvoltarea de parteneriat si colaborare eficace si eficienta intre diferiti furnizori de
servicii de sanatate si comunitati in vederea recrutarii si retentiei/fidelizarii donatorilor de sange.
Metode. Am efectuat o analiza SWOT cu privire la promovarea donarii de sange in asistenta
medicala primara cu un grup format din medici de familie, asistenti medicali, profesori si
specialisti din domeniu. Diferite studii de caz au inclus zone cu acces adecvat la servicii, zone
cu resurse limitate, grupuri de tineri, model de lucru in echipa cu alti furnizori.
Rezultate. Am identificat criteriile de buna practica centrate pe comunitate in promovarea
donarii de sange. Accesibilitatea serviciilor, un comportament pro-activ, continuitate, colaborare
inter-profesionala, participarea comunitatii, sunt printre caracteristicile cele mai importante.
Totodata, formarea profesionala a cadrelor sanitare, dezvoltarea de materiale de educatie pentru
donatori, monitorizarea calitatii, adaptarea serviciilor la cerintele locale, au de asemenea un rol
cheie.
Concluzii. Strategii comprehensive active de incluziune a activitatilor de promovare a donarii
de sange in asistenta medicala primara rezulta intr-o mai buna intelegere a donarii voluntare, in
atragerea atentiei in comunitate, schimbarea in atitudini si comportamente, in siguranta
pacientilor si de siguranta donatorului.

Cuvinte cheie. Asistenta medicala primara, educatie, donarea de sange, comportament de
sanatate responsabil si constient
9

Pr 01. The Role of General Practitioners in Blood Donation Promotion, in
Different Population Categories
Zsuzsanna Farkas-Pall1, Olivia Ligia Burta1,2, Eugenia Voica Pop1

1
High Performance Medical Research Center, Faculty of Medicine and Pharmacy, University of
Oradea, Romania
2
Blood Transfusion Center Oradea, Romania

Introduction. Primary care providers have an important role in promoting responsible health
behaviour choices and in reducing health inequalities. They can play a crucial role in donor
education, selection and retention. Health promotion and education programmes are proved to be
sustainable and effective when the interventions are accessible, continuous, patient centered and
adapted to community needs.
Objectives. To identify best practices adapted to primary care for building effective and efficient
partnership and collaboration between different health service providers and communities aimed
to recruit and retain safe blood donors.
Methods. We conducted a SWOT analysis about promoting blood donation in primary care in a
group formed of general practitioners, practice nurses, teachers and specialists responsible for
blood donation. Different case studies included areas with good accessibility to the service,
resource poor settings, youth groups, working in teams with other care providers.
Results. We had identified the criteria for the best practice in community centered promotion of
blood donation. Availability of the service, pro-activeness, continuity, inter-professional
collaboration, community participation are amongst the most important features. However,
training of the health care professionals, development of donor education materials, quality
monitoring, adapting of the services to local requirements are also proved to have a key role.
Conclusions. Comprehensive active inclusion strategies of the promotion of blood donation in
primary care will result in improved understanding of voluntary donation, raised community
awareness, change in attitudes and behaviours, patient safety and donor safety.
Keywords. Primary Care, Education, Blood Donation, Responsible and Self Conscious, Healthy
Behaviour

10

Pr 02. Prezentarea brosurii: Statusul current si viitor al strategiilor din
domeniul Securitatii Transfuzionale in Medicina de Urgenta si Circumstante
Speciale,
Marie-Emmanuelle Behr-Gross1, Valentina Hafner2, Fatima Nascimento3,
Snezhana Chichevaliev3, Olivia Ligia Burta4, Gilles Follea5

1
European Directorate for Quality of MedicineDQM- CoE
2
WHO Regional Office for Europe
3
Reteaua de Sanatate pentru Sud-Estul Europei; presedinte al departamentului pentru integrare
europeana proiect securitatea sangelui (SEEHN BS)
4
Reteaua de Sanatate pentru Sud-Estul Europei Manager Regional pe proiectul Securitatea
Sangelui
5
Alianta Europeana a Sangelui
Introducere. Situatiile definite ca si situatii de urgenta in serviciile transfuzionale, sunt din ce in
ce mai frecvente, datorate cresterii frecventei patologiei induse de situatii critice imprevizibile
(cauze naturale, accidente, arma biologica) care pot afecta negativ procedurile operationale
prespital si spital, ale terapiei transfuzionale (legate de infrastructura, personal, echipamente,
facilitati).
Scop. Capacitatea unei institutii medicale, de a raspunde eficient in situatii de urgenta si
circumstante speciale, impune dezvoltarea unui sistem coordonat de activitati specifice,
secventiale ale fiecarei verigi implicate in terapia transfuzionala. Planurile nationale de
contingenta trebuiesc concepute si validate, in asa maniera incat elementul surpriza sa fie
minimal.
Material si metoda. In cadrul Retelei de Sanatate pe Sud-Estul Europei, s-a identificat
necesitatea acordarii importantei cuvenite securitatii transfuzionale, astfel ca in cadrul proiectului
destinat acestui obiectiv, s-a derulat activitatea Cresterea disponibilitatii de sange si produse
sanguine securizate in urgente medicale si circumstante speciale (Increasing the transnational
availability of safe blood for medical emergencies and special circumstances) in cursul lunii
iunie 2011, la Oradea. Activitatea a fost sustinuta atat financiar cat si profesional de structuri
internationale (CoE, OMS, Slovenia) si de expertii lor in domeniu. Echipele multidisciplinare de
specialisti din cele 9 tari partenere, au s-au implicat activ in dezvoltarea unui cadru comun, de la
care sa se dezvolte programe nationale, cu targetul final: autosuficienta cu sange si produse
sanguine securizate, in situatii speciale.
11

Concluzii. Pe baza completarii chestionarelor personalizate de evaluare si a rapoartelor nationale
(draft conceput cu ocazia derularii activitatii) s-a identificat specificul fiecarei natiuni, cu
punctele slabe si puntele tari, toate stand la baza dezvoltarii strategiei viitoare pentru atingerea
obiectivului propus. Punctul final al activitatii, il constituie tiparirea unei brosuri, ca si material
de referinta, cu titlul Statusul curent si viitor al strategiilor din domeniul Securitatii
Transfuzionale in Medicina de Urgenta si Circumstante Speciale, care prezinta intr-o maniera
profesionista, datele obtinute in cadrul acestei activitati.
Cuvinte cheie. Situatii de urgenta, circumstante speciale, securitate transfuzionala, planuri de
contingenta
12

Pr 02 The Booklet South-Eastern Europe Health Network Current Status
and Future Strategies in Safe Blood and Blood Components
Transnational Availability for Medical Emergencies and Special
Circumstances, in South Eastern Europe Presentation,
Marie-Emmanuelle Behr-Gross1, Valentina Hafner2, Fatima
Nascimento3, SnezhanaChichevaliev3, Olivia Ligia Burta4, Gilles Follea5

1
European Directorate for Quality of MedicineDQM- CoE
2
WHO Regional Office for Europe
3
South Eastern Europe Health Network (SEEHN), Chair Head, Department for European
Integration

4
SEEHN BS Regional Manager of Blood Safety Project
5
European Blood Alliance (EBA)

Introduction. The defined conditions as medical emergencies, and special circumstances are
increasing in frequency, due to higher incidence of pathologies caused by unpredictable
situations (such as natural causes, accidents, biological weapons) being able to affect in a
negative way the pre-hospital and hospital operational procedures of transfusion therapy (eg
infrastructure, staff, equipment, other facilities).
Aim. The capacity of a medical institution to act in an efficient manner in emergency situations
and special circumstances, imposes the development of a coordinated system of specific
activities, sequentially for each ring of the transfusion therapy chain.the national contingency
plans, should be elaborated and validated in due time, in order to avoind as much as possible the
surprise reaction.
Material and method. As part of SEEHN project, was identified the necessity to pay attention
to transfusion safety, thus as part of the entire project, was developed and ruled the entitled
Increasing the transnational availability of safe blood for medical emergencies and special
circumstances last June, in Oradea. The activity was supported financial by European
Organizations (CoE, WHO, Slovenian Authorities), and professional with experts in transfusion
domain. The multidisciplinary teams from the 9 countries, were actively involved in developing
a common frame, as reference for national programs, having as final target: self-sufficiency with
safety blood and blood products in certain condition.
13

Conclusions. Based on data reported on personalized questionnaire, and national report (drafted
during June activity) completion, was identificed the specificity of each nation, with afferent
weak and strong points, all these representing references for future strategies, in order to get to
the main objective. The final moment of the last June activity is the publish of a booklet entitled
South-Eastern Europe Health Network Current status and future strategies in Safe Blood and
Blood Components Transnational Availability for Medical Emergencies and Special
Circumstances, in South Eastern Europe where are presented in a professional manner, all
collected and interpreted data.
Key words. Emergency Situations, Special Circumstances, Transfusion safety, Contingence
Plans

14

Pr 03. Catalogul produselor sanguine furnizate la nivelul centrelor de
transfuzie sanguine; perspective
Olivia Ligia Burta1, Andrei Rosin2
1

Institutul National de Hematologie Transfuzionala,Bucuresti, Romania

Introducere. Unul dintre obiectivele primordiale ale activitatii centrelor de transfuzie, este
livrarea unui produs de calitate biologica maxima si cu risc rezidual infectios minim.
Scop. Prezentarea produselor destinate terapeuiei transfuzionale (atat labile cat si stabile), cu
propunerea configurarii unei brosuri personalizate (catalog) intr-o maniera atractiva.
Material si metode. Pe langa un scurt istoric al evolutiei tipurilor de produse terapeutice
furnizate pentru terapia transfuzionala de-a lungul ultimilor 20 de ani, se vor prezenta secvential
fiecare tip, cu proprietatile aferente si cu indicatiile terapeutice specifice fiecaruia. De asemenea
se vor trece in revista si alte produse, care inca nu au intrat pe piata terapeutica romaneasca sau
utilizarea este redusa din cauza incapacitatii de prelucrare sau a costurilor mari, cu propunerea
unor solutii practice de perspectiva, pentru alinierea la standardele europene.
Concluzie. Necesitatea editarii catalogului de produse, care sa fie accesibil atat in forma
electronica cat si pe suport de hartie, la nivelul institutiilor medicale implicate in terapia
transfuzionala.
Cuvinte cheie. Produse sanguine, catalog, standarde europene
15

Pr 03. The Catalog of Blood Components, Issued by Romanian Transfusion
Service; Future Trends
Olivia Ligia Burta1, Andrei Rosin2
1
Blood Transfusion Center, Oradea, Romania
National Institute of Transfusion Medicine, Bucharest, Romania

Introduction. One of the major objective of blood transfusion establishments, is to issue a
therapeutic product with a higher biologic quality and lowest infectious residual risk.
Aim. Will be presented the products (both labile and stable) with transfusion administration
purpose, along a proposal about the configuration in a very friendly way of a personalized
catalog (booklet).
Material and methods. Shortly will be presented the history of blood products panel, during the
last 2 decades, then sequentially each product, with afferent indications and biological proprieties
. Will be mentioned other therapeutical products, lacking/or limited used on Romanian market,
due either the technical incapacity, or high financial involvement, but with future practical
solutions for our transfusion therapeutic market, for alliniation with European standards.
Conclusion. Is imposed by practical and eficacy reasons, to be configurated and issued (both
electronic and paper support) then distributed to any medical institution involved in transfusion
therapy.
Key words. Blood Products, catalog, European Standards
16

Pr 04. Rolul colectei mobile in asigurarea auto-suficientei in terapia
transfuzionala
Mariana Maier1, Paraschiva Dobos1, Olivia Ligia Burta1, 2 , Radu Iovan2
1
2
Centrul de Cercetari in Medicina de Inalta Performanta/FMF/UOradea, Romania
Introducere. Colecta mobila a sangelui si produselor sanguine, poate constitui o activitate cu un
impact favorabil asupra auto-suficientei in medicina transfuzionala.
Scop. Prin prezentarea de fata se doreste detalierea aspectelor specifice ale colectei mobile cat si
maniera in care aceasta activitate, motiveaza includerea ei in politica si strategia Centrului de
Transfuzie Sanguina din Oradea.
Material si metoda. S-au utilizat datele inregistrate in formularele de raportare a activitatii
medicale, in intervalul 2007-2011. Ca si referinte populationale la nivelul judetului Bihor, au fost
consultate informatiile puse la dispozitie de catre Directia de Statistica judeteana. Colecta mobila
a fost evaluata in functie de dispozitia geografica, numarul donatorilor, repartitia pe sexe, varsta
si categoria de donatori.
Rezultate. Analiza secventiala a activitatii de colecta mobila, pe seama criteriilor mentionate, a
aratat ca trend-ul este similar cu cel al colectei fixe (de la nivelul Centrului de Trannsfuzie
Sanguina din Oradea) si anume scaderea progresiva varstei medii a donatorilor, evolutii variabile
ale numarului donatorilor noi, cu raport favorabil sexului masculin. Relatia dintre colecta fiza si
mobila, desi prezinta variatii anuale, continua sa repezinte un procent suficient de mare, pentru a
participa intr-o maniera semnificativa la atingerea nivelului de auto-suficienta..
Concluzii. Existenta unei politici de promovare atat la nivel de centru cat si la nivel de teritoriu a
actului donarii, responsabilizarea si devotamentul cadrelor medicale implicate in aceasta
activitate, flexibilitatea managementului de varf, avand capacitatea corectarii evolutiilor
nefavorabile, dovedeste ca una dintre solutiile fiabile ale auto-suficientei este colecta mobila.
Cuvinte cheie. Colecta mobila, strategie, politici, criterii de evaluare, autosuficienta
17

Pr 04. The Role of Mobile Collection in Self-SufficiencyiIn Transfusion
Therapy
Mariana Maier1, Paraschiva Dobos1, Olivia Ligia Burta1, 2, Radu Iovan2
1
2
Oradea, Romania
Introduction. Blood and blood products mobile collection, can be a relevant activity, with
favorable impact upon self-sufficiency in transfusion medicine.
Aim. The current presentation is configurated to detail the specific respects of mobile collection
activity, and the motivation to be part of the politics and strategy of Blood Transfusion Center of
Oradea.
Material and method. Were used the recorded data from the reporting sheets of the medical
activity, during 2007-2011. For population the references for Bihor county, the information was
got from County Statistical Agency. According to selected criteria, the mobile collection was
assessed according to geographical distribution, the number of blood donors, gender, age and
blood donors categories.
Results. The sequential analyze of mobile collection activity, base don already presented criteria,
showed that the trend is similar with that of fixed collection activity (performed at Blood
Transfusion Center Oradea) meaning: progressive decrease of blood donors age average, the
rate of new blood donors category was variable, but mainly representated by males. The ratio
fixed collection vs mobile collection, shows a ondulant evolution along the studied period.
Conclusions. The existence of blood donation promotion policy (both in the main city, and
different regions of the county) the responsibility and devotion of medical staff, involved in
blood collection activity, a flexible top-managent able to correct any unfavorable evolution.
prove that one of the most reliable self-sufficiency status, is mobile collection.
Key words. Mobile Collection, Strategy, Policies, Evaluation Criteria, Self-sufficiency
18

Pr 05. Evaluarea activitatii retelei nationale de transfuzie din Romania, pe
anul 2011
Andrei Rosin

Institutul National de Hematologia Transfuzionala, Bucuresti, Romania

Introducere. Evaluarea activitatii, este un criteriu major al strategiei viitoare a retelei de
transfuzie din Romania si este prezentata atat din punct de vedere cantitativ i calitativ.
Scop. Evaluarea anuala ofera conditiile monitorizarii activitatii specifice a centrelor de
transfuzie, cu structurarea prioritatilor activitatilor viitoare (promovare/activitate/corectoare).
Material si metoda. Utilizandu-se formularul raportului de activitate medicala, furnizat de
Institutul National de Hematologie Transfuzionala, sunt prezentate si discutate secvential datele
raportate de fiecare centru de transfuzie, cu raportare lor la nivel national si in context european.
Rezultate. Din punct de vedere cantitativ, se observa o diminuare cu circa un sfert de procent
fata de anul 2010, tinand seama Insa i de faptul ca unele centre, din motive obiective, au trebuit
sa-i limiteze activitatea. Diminuarea este prezenta Indeosebi la nivelul centrelor mari i este
cauzata, In principal, de lipsa unei ponderi adecvate a colectei mobile. O alta cauza a diminuarii
consta In numarul mare de donatori noi, respectiv o cretere a numarului de rebuturi. Din punct
de vedere calitativ, se constata o neconcordanta Intre consumul de reactivi specifici i numarul
de unitati recoltate.
Concluzii. Din aceasta reiese faptul ca nu sunt respectate Intocmai protocoalele de donare; de
exemplu In locul hemoglobinemiei pre-donare se prefera efectuarea unei hemoleucograme
complete, ceea ce face ca repetabilitatea testului sa nu fie posibila la nivelul altor centre. In mod
similar, nu Intotdeauna exista o corelare a cantitatii de reactivi consumati pentru markerii virali
i numarul de prize efectuate. O cretere evidenta a calitatii produselor de sange o reprezinta
gradul mult mai Inalt de separare fata de anul 2010. Se vor implementa masuri pentru creterea
eficacitatii colectei, pentru creterea calitatii produselor i pentru implementarea unor protocoale
unitare de lucru.
Cuvinte cheie. Evaluare, cantitativ, calitativ, protocoale unitare de lucru

19

Pr 05. The Activity Evaluation of The Romanian National Transfusion
Network, in 2011
Andrei Rosin

National Institute of Transfusion Medicine, Bucharest, Romania

Introduction. The evaluation of activity, is a major criterion for future strategy of the Romanian
National Transfusion Network, being presented from both quantitative and qualitative respects.
Aim. Annual evaluation gives a professional opportunity to monitor the specific activity of blood
transfusion centers, and to structure the future activities (promotion, action, correction),
according to certain National/European priorities.
Material and method. Based on the standardized reporting document (about the medical
activity) issued by National Institute of Transfusion Medicine, are sequentially presented and
discussed the reported data about each blood transfusion activity, projected to national level, but
taking in consideration the European context, as well.
Results. From the quantitative point of view, is noticed a diminish (about 25%) in comparison to
2010, but had be taken into account certain objective conditions which limited the activitiy. The
main diminish is noticed al the level of larger blood centers, partly motivated by the insufficient
mobile collection activity, partly by the increased number of new blood donors, implicit the
higher number of rejected blood units. From qualitative point of view, is reported a non-
concordance between reagents consumption and the total number of collected blood and blood
products units.
Conclusions. Based on these data, was noticed that the standard protocols for blood donations,
are not entirely respected, for example sometime is preferred a total blood count, instead of only
Hb level to be performed, this leads to impossibility the blood check to be repeted in other blood
transfusion centers. Similarly, not always can be proven the corelation between reagents usage
for viral markers and the number of collected blood and blood products units. A very important
positive respect, is the increase of blood products quality, due to much higher separation rate,
than in 2010. Is obvious the necessity to implement certain measures in order to increase the
collection efficacy, the blood products quality and unitary working protocols.
Key words. Evaluation, Qualitative, Quantitative, Unitary Working Protocols
20

Pr 06. Evaluarea unitatilor de transfuzie sanguina din spitale (UTS) in
conformitate cu Ord. Msp nr. 1224/2006 la nivelul judetului Bihor in anul
2011
Alietta Florian1, Zoia Bitea2

1
Serviciul de Control in Sanatate Publica Bihor, Directia de Sanatate Publica Bihor, Romania
2
Directia de Sanatate Publica Bihor, Romania

Introducere. Administrarea terapeutica a sangelui sau a componentelor sanguine este o
interventie medicala indicata si prescrisa de catre medic. Actvitatea de transfuzie sanguina se
efectueaza cu responsabilitate si sub supraveghere medicala, numai in unitati medicale care
corespund legislatiei sanitare in vigoare si detin autorizatie sanitara in domeniu. In judetul Bihor,
in anul 2011 si-au desfasurat activitatea 8 unitati de transfuzie sanguina in 7 spitale.
Scop. Evaluarea UTS din spitalele judetului Bihor prin aprecierea conformitatii la prevederile
legislatiei sanitare in vigoare privind organizarea activitatii de transfuzie sanguina si asigurarea
calitatii si securitatii sanitare in vederea utilizarii terapeutice a sangelui si componentelor
sanguine de origine umana.
Material si Metoda. S-a evaluat activitatea desfasurata in anii 2009- 2011 in unitatile de
transfuzie sanguina. Evaluarea s-a desfasuarat anual, in baza metodologiei de control a
MS, utilizandu-se grila de verificare a UTS, cu: date despre spital, volumul activitatii de
transfuzie, generalitati (autorizatie sanitara de functionare), locatie (amplasare, numar incaperi,
echipamente proprii omologate, finisaje), sistem de calitate, instruirea personalului, controlul
stocului de reactivi, autocontrolul, echipamentul, protectia muncii, gestionarea erorilor si
activitatea propriu-zisa din UTS. S-a aplicat procedura generala de control conform prevederilor
MS nr.824/2006.
Rezultate. Activitatea in UTS este permanenta si necesara. Evaluarea UTS din spitalele judetului
Bihor a evidentiat aspecte pozitive ca: preocuparea unor coordonatori UTS pentru dotarea cu
echipamente critice omologate si implementarea de strategii si proceduri de lucru , asigurarea de
spatii/conditii corespunzatoare desfasurarii activitatii UTS, iar ca aspecte negative: lipsa
autorizatiei sanitare de functionare, locatii subdimensionate, dotare incompleta cu echipamente
critice omologate, lipsa procedurilor de lucru, personal sanitar de specialitate insuficient (lipsa
schema organizatorie proprie).
Concluzii. Datorita schimbarii structurii organizatorice a spitalelor, a descentralizarii si a
schimbarii managementului, activitatea UTS s-a desfasurat mai performant sau mai putin
performant si functie de intelegerea de catre decidenti a importantei acestei activitati si a
sprijinului acordat specialistilor. Activitatea de evaluare periodica a UTS , de catre structuri de
inspectie este necesara. Rezolvarea in timp optim a neconformitatilor semnalate reduce riscul
aparitiei incidentelor si accidentelor in activitatea de transfuzie sanguina. Este necesara alinierea
21

legislatiei sanitare privind autorizarea UTS din spitale la realitatea actuala, conform directivelor
europene.
Cuvinte cheie. UTS, inspectie, autorizare
Pr 06. The Evaluation of Hospital Transfusion Units (HTU) according to Mh
Order 1224/2006, In 2011 at Bihor County Level
Alietta Florian1, Zoia Bitea2

1
Serviciul de Control in Sanatate Publica, Public Health Agency Bihor, Romania
2
Public Health Agency Bihor, Romania

Introduction. Therapeutic administration of blood or blood products is a medical act, indicated
by the physician. The transfusion activity is done under the medical responsability and
surveillance, in certain medical institutions, organized in concordance with current legislation,
having a certificate of authorization in transfusion domain. In Bihor county, along 2011, 8 HTUs
ruled the activity, being organized in 7 hospitals.
Aim. The HTU evaluation, according to current legislation regarding transfusion activity
organization and quality and blood safety criteria.
Material and method. Was evaluated the activity ruled during 2009-2011 in HTUs. The
evaluation procedure was done annually, based on Ministry of Health control methodology,
using a HTU personalized check-list, regarding: hospital identification data, the volume of
transfusion activity, general respects (certificate of authorization) place (the personalized space,
number of rooms, agreed equipment) quality system, training of personal, reagents stocks, self-
control, equipment, work protection, errors management, and practical activity of HTU, the
procedure being stipulated in MH Order 824/2006.
Results. The HTU activity is continuous and necessary. The evaluation procedure in Bihor
county, highlighted certain positive respects, such as: the interest of some HTU coordinators for
achieving critical equipment, to implement the quality system (strategies, procedures), to
organize the area for HTU in accordance with legal requirements; but on the other hand, were
reported some negative respects, regarding the lack of the certificate of authorization, limited
area for HTU activity, the critical equipment partly achieved, lack of specific procedures in
quality system, insufficient number of professionals in transfusion domain (lack of HTU
organization chart).
Conclusions. Due to hospitals re-organization, to un-centralized system and management
change, the HTU activity rules on a better or less efficient manner, according to decidents way of
understanding the importance of transfusion activity, and to the level of involvement of the
specialists. The periodical evaluation, done by health authority is very important and necessary;
the ability to solve in due time the non-conformities, tremendous reduces the risk of
incidents/accidents in transfusion medicine. Is also important the alliniation of sanitary
legislation, regarding HTU authorization to Romanian reality, but in conformity with European
Directives.
Key words. HTU, Inspection, Authorization
22

Pr 07. Educatia medicala continua - atu al dezvoltarii profesionale in
domeniul medicine transfuzionale
Max Constantinescu
1
, Leila Curtamet
2

1
Redactor sef Revista Medic.ro
2
Product Division Manager, Versa Puls Media

Introducere. Profesionistii din sistemul sanitar au nevoie constanta de informatie de ultima ora,
de calitate, din surse sigure.
Scop. In acelasi timp, educatia medicala continua constituie nu numai o necesitate dar si o
obligatie a medicului pentru a oferi, la randul sau, servicii de cea mai buna calitate.

Material si metode. Cercetarile cantitative realizate In 2009 prin intermediul chestionarelor pe
un esantion de 3.500 de medici de familie au aratat ca medici de familie au nevoie de informatii
medicale stiintifice specializate si de actualitate pentru dezvoltarea lor profesionala. De
asemenea, potrivit unui studiu de cercetare cantitativa realizat cu ajutorul unor companii
specializate prin metoda telemarketing pe un esantion de 750 de medici de familie In cursul lunii
octombrie 2009, s-a constat ca peste 52,3% din medici de familie sunt interesati de initierea unui
program de educatie medicala continua la distanta oferit de o revista medicala de specialitate.
Rezultate. Drept urmare, in anii 2010 si 2011, prin revista Medic.ro s-au desfasurat cursuri de
pregatire profesionala continua la distanta. Acestea au fost evaluate ulterior ca metoda de
pregatire continua profesionala. De asemenea, au fost implementate ulterior si cursurile medicale
de tip e-learning pentru celelate specialitati medicale.
Concluzii. Cercetarile desfasurate in vederea evaluarii cursurilor au aratat ca medicii le-au
apreciat si, mai ales, le-au considerat foarte utile pentru practica clinica. Aceasta este premisa
pentru care propunem implementarea unor cursuri de educatie medicala continua in domeniul
medicinei transfuzionale.
Cuvinte cheie. Educatie medicala la distanta, cercetare de piata
23

Pr 07. Continuous Medical Education Milestone in Professional
Development in Transfusion Medicine (E-Learning Model)
Max Constantinescu 1, Leila Curtamet 2

1
Editor-in-chief Medic.ro
2
Product Division Manager, Versa Puls Media

Introduction. Healthcare professionals need constant cutting edge quality information from
reliable sources.
Aim. At the same time, continuing medical education is not only a necessity but an obligation for
the physician to provide, in turn, best quality services.
Material and method. Quantitative research conducted in 2009 through questionnaires on a
sample of 3,500 family physicians showed that family physicians need specialized and up-to-
date medical information for their professional development. Also, according to a quantitative
research study conducted by specialized telemarketing companies on a sample of 750 family
physicians in October 2009, it was found that over 52.3% of family physicians are interested in
starting a continuing medical education program offered by a remote specialist medical journal.
Results. As a result, in 2010 and 2011, the magazine Medic.ro promoted continuing professional
education courses at a distance. These courses were subsequently evaluated as a method of
continuous professional training. Also, were subsequently implemented medical courses e-
learning for the other medical specialties.
Conclusions: The research conducted to evaluate the courses, have shown that physicians have
appreciated it. Also, they considered these courses especially useful for clinical practice. This is
the premise for which we propose the implementation of continuing medical education courses
in transfusion medicine.
Keywords. Continuing Medical Education, Market Research
24

Pr 08. Monitorizarea la nivelul medicinei primare a donatorului depistat cu
markeri microbiologici (virusologici, bacteriologici)
Mariana Fericean1, Olivia Ligia Burta2

1
Directia de Sanatate Publica Bihor, Romania
2
Centrul de Transfuzie Sanguina, Centrul de Cercetari in Medicina de Inalta
Performanta/FMF/UOradea, Romania
Introducere. Recunoscut fiind riscul rezidual infectios al terapiei transfuzionale, fiecare tara si-
a stabilit un sistem de supraveghere al transfuziilor, care se adreseaza intregului lant: de la
donatorul pana la primitorul de sange. Primii 3 agenti infectiosi, cu implicatii in securitatea
transfuzionala, de ordin social, economic si etic pe care le antreneaza, sunt virusul hepatic B, C si
virusul HIV asupra carora vom insista in prezentarea de fata.
Scop. Prevalenta i incidenta crescuta a hepatitei virale B In Romania (si in judetul Bihor)
precum i creterea incidentei hepatitei C i HIV/SIDA indica o data in plus, necesitatea
prevenirii transmiterii acestor boli prin actul transfuzional, in primul rand prin eligibilitatea
biologica a donatorului de sange, cat si validarea produselor sanguine administrate. Rolul
monitorizarii integrate a donatorului de sange este atat la nivelul centrelor de transfuzie, la
nivelul medicinei primare, cat si al Compartimentului de Epidemiologie din cadrul DSP, cu rol
de liant si coordonator al sistemului de supraveghere ce se doreste cat mai performant.
Material si metoda. Este prezentat modelul sistemului de supraveghere si de monitorizare a
donatorilor, care functioneaza la nivelul judetului Bihor, formularele utilizate, sistemul
informational, cu datele aferente perioadei 2007 2011 si anume, indicatorii de evaluare anuali:
numar total donatori monitorizati, numar donatori pe tip de donare, numar si rata de donatori
diagnosticati cu hepatita B, C, HIV, pe tip de donare, numar si rata de donatori pozitivi anuntati
medicului de familie, numarul de persoane imunizate impotriva hepatitei B la nivelul DSP din
randul contactilor cazurilor de hepatita cronica B, numar total de purtatori HIV pozitivi care intra
in sistemul de evaluare si tratament HIV/ SIDA.
Concluzie. Monitorizarea donatorilor de sange, la nivelul retelei de medicina primara este una
dintre masurile de scadere a morbiditatii hepatitei B, C, HIV/SIDA, lues, pe de alta parte,
donatorii diagnosticati intra In sistemele de supraveghere i tratament specifice fiecareia dintre
aceste patologii, fiind necesare sesiuni periodice de instruire pe aceste domenii de interes. In
plus, este necesara standardizarea la nivel national a sistemelor de monitorizare pentru printr-o
evaluare eficienta si implicarea intr-o maniera cat mai activa a medicului de familie.
Cuvinte cheie. Risc rezidual infectios, sistem de supraveghere, medic de familie

25

Pr 08. The Category of Blood Donors with Positive Microbial Markers
(Viruses, Bacteria) Monitorized By The General Practitioner
Mariana Fericean1, Olivia Ligia Burta2

1
Public Health Agency Bihor, Romania
2
Blood Transfusion Center, High Performance Medical Research Center, Faculty of Medicine
and Pharmacy, University of Oradea, Romania
Introduction. Being recognized the residual infectious risk of transfusion therapy, each country
developed a surveillance system of transfusion activity, adressed to the entire chain: starting with
the blood donor and ending with the recipient. The first 3 infectious agents, involved in blood
safety, with important social, economic and ethic impact, are represented by: hepatitis virus type
B, C and HIV, the presentation being targeted on these.
Aim. The high prevalence and incidence of B hepatitis in Romania (also in Bihor county) as well
as the higher incidence of C hepatitis and HIV/AIDS, underline again, the necessity to prevent
transfusion transmission of the mentioned viral agents, mainly due to blood donor biologic
eligibility and blood product validation criteria. The role of integrated monitorization of blood
donors, belongs to medical staff of blood transfusion center, to general practitioner and to
Epidemiology Dept. of Public Health Agency, the last as a link and coordinator for all interested
parts to develop an efficient surveillance system.
Material and method. Sequentially is presented the blood donor surveillance system which
functions in Bihor county, also the documents, the IT system; there are reported the collected
annual data during 2007-2011, such as: the total number of monitorized blood donors, according
to blood donor category, the number and rate of blood donors diagnosed with B, C hepatitis, HIV
sero-positive, the number and rate of diagnosed blood donors reported to the general practitioner,
the number of contact individuals immunized against B hepatitis, the total number of the carriers
HIV positive, as part of the HIV/AIDS evaluation and treatment.
Conclusion. The monitorization of blood donors by general practitioner, is one of the most
important measure to decrease the morbidity of B, C hepatitis, HIV/AIDS, lues, on the other
hand the diagnosed blood donors are admitted in specific surveillance and treatment for each
pathology, thus is necessary to be organized training sessions about the domains of interest. Also
is important to exist a national standardization of the monitoring system, for an efficient
evaluation and a more active involvement of the general practitioner.
Key words. Infectious Residual Risk, Surveillance System, General Practitioner
26

Pr 09. Implementarea sistemului de calitate in centrele de transfuzie din
Republica Moldova
Svetlana Cebotari
Centrul National de Transfuzie a Sangelui Chisinau, Republica Moldova
Introducere. Managementul calitatii reprezinta un ansamblu de activitati avand ca
scop realizarea activitatilor coordonate, desfasurate pentru asigurarea controlului
calitatii la toate nivelurile in institutiile de transfuzie sanguina. Acest ansamblu
cuprinde activitati de planificare, coordonare, organizare, control si asigurare a
calitatii.
Scop. Serviciul de transfuzie a sangelui din Republica Molodva incepind cu anul
2007 si-a propus o serie de "obiective strategice" care se realizeaza prin
intermediul unor "obiective operationale". Acestea din urma ar fi obtinerea unui
produs sanguin potrivit in situatia clinica potrivita.
Rezultate. Elementele esentiale in implementarea si asigurarea managementului
calitatii in Centrele de Transfuzuie a Sangelui constate in ultimii 5 ani au fost si
ramin in permanenta:
angajarea totala (hotararea ferma) si coordonarea nemijlocita din partea
conducerii centrelor;
buna comunicare in institutie;
alocarea corecta a resurselor administrative si financiare;
instruirea corespunzatoare a personalului institutiei;
implicarea constienta si continua a intregului personal;
stabilitate manageriala si organizationala a institutiei;
monitorizarea programului de implementare a sistemului calitatii.
Concluzie. Adoptarea unui sistem de management al calitatii in Centrele de
Transfuzie a Sangelui din Republica Moldova este in primul rind o decizie
strategica a conducerii institutiei. Proiectarea, implementarea si asigurarea unui
sistem de management al calitatii este influentata de obiectivele specifice, de
volumul si nomenclatorul produselor sanguine pe care le furnizeaza, de procesele
utilizate si de marimea si structura institutiei.
27

Cuvinte cheie. Management, strategie, obiective operationale
Pr 09. The Status of Quality System Implementation in Blood Transfusion
Establishments in Republic of Moldova
Svetlana Cebotari

National Center of Blood Transfusion, Chisinau, Republic of Moldovia
Introduction. The quality management represents the panel of activities having as
common purpose, to complete the coordinated activities, ruled in order to assure
the quality control, at any level of transfusion establishments. The assembly is
represented by planned, coordinated, organized, control and quality assurance
activities.
Aim. The Blood Transfusion Service in Republic of Moldavia, since 2007,
identified as major interest to identify a series of strategic objectives which can
be fulfilled using operational objectives. The last category, means to be able to
obtain a blood product fitted to its clinical purpose.
Results. The essential criteria in order to implement and assure the quality
management in BTCs, noticed during the last 5 years, have permanent caracter,
and are listed below:
total engagement (firm attitude) and coordination from the side of top-
management
institutional well communication system
proper repartition of administrative and financial resources
staff training schedule
the continuous and conscious involvement of the staff
managerial and organization stability of the institution
the implementation of quality system needs to be monitored
Conclusion. The adoption of a quality management system in Moldavian BTCs, is
mainly a strategic decision of the top-management. The project, the
implementation and the maintenance of the quality management, are influenced by
28

the specific objectives, by the volume of issued blood products, by used processes,
by the institution size and structure.
Key words. Management, Strategic Objectives, Operational Objectives
Pr 10. WNV si securitatea transfuzionala: concluzii ale anului 2011, propuneri
pentru anul 2012
G Folla, R Lieshout , P Hewitt, Wr Mayr (EBA)

Introducere. Unul dintre domeniile de interes ale EBA, este monitorizarea etiologiilor
infectioase care amprenteaza medicina transfuzionala.
Scopul. Unul dintre agentii infectiosi cu relevanta in politicile de securitate transfuzionala, este
Virusul West Nile; prezentarea de fata insista asupra elementelor majore a acestei patologii, in
ceea ce priveste schimbul informatiilor, testele performante de laborator, aspect legate de
evolutia sezoniera. Toate aceste date, au la baza lectiile invatate anterior (cu anumite aspect ce
trebuiesc reconsiderate) si obiectivele pentru anul 2012, in ceea ce priveste orientarea si luarea
deciziilor corecte, armonizarea in decizii, cu ajutorul nemijlocit al expertilor EBAEID Monitor.
Material si metode. In ciuda utilizarii unpr metode specific, cum sunt : hartile saptamanale,
liste de distributie, tabele de raportare, toate conditionate de momentul raportarii (in timp si
simultan) s-a dovedit persistenta confuziei, neclaritati legate de efectuarea/implementarea NAT
(Nucleic Acid Amplification Technique) cat si date inregistrate variat, de la nivelul celor 28 de
tari raportoare.
Concluzii. Este necesar sa se clarifice atat definitiile (de exemplu a ariei afectate, a ariei in care
continua transmiterea virusului WN la oameni) sa se moduleze evaluarile riscului cu scopul de a
atinge beneficiile previzionate, recunoscandu-se importanta lor in securitatea transfuzionala atat
a donatorului cat si la primitorului de sange. Toate aceste aspect impun existent unei colaborari
profesioniste intre institutiile medicale, bazata pe interdisciplinaritate (o echipa complexa
interdisciplinara, compusa din: epidemiolog, infectionist, microbiology, transfuziolog).
Cuvinte cheie. Virus WN, lectii invatate, luarea deciziilor, armonizare

29

30

Pr 10. West Nile Virus and blood safety: lessons learnt from 2011
proposals for 2012
G Folla, R Lieshout , P Hewitt, Wr Mayr (EBA)

European Blood Alliance
Introduction. One of the domain of interest of EBA, is to monitor infectious-transfusion related
etiologies.
Aim. One the infectious agents, which fingerprints the blood safety policies, is WNV; the
presentation insists on main respects of this pathology, regarding information exchange,
performant lab tests to be performed, seasonal reasons. All these are based on learnt lessons
(with some respects which should be reconsider) and future objectives for the WNV 2012
guidance, regarding decision making and harmonization in decisions, with the help of EBAEID
Monitor experts.
Material and methods. Despite of using specific tools, such as weekly maps, distribution lists,
reporting table, conditioned by the manner of working (time and simultaneous) were still noticed
confusions, un-clarity in NAT implementation, and variable reported data from the 28 countries
surveyed and assessed.
Conclusions. Is necessary to clarify the definitions (such as affected area, area with ongoing
transmission of WNV to humans) to modulate the risk assessment, in order to get the expected
benefits, being recognized in both donor and recipient safety, by preventing a potential threat on
blood supply. All these impose the professional collaboration between medical institutions,
based on interdisciplinary approach (a complex team of experts, composed of epidemiologist,
infectionist, microbiologist, clinician, transfusiologist).
Key words. WNV, Learnt Lessons, Decision Making, Harmony

31

Pr 11. Terapia transfuzionala in anemia hemolitica autoimuna: experienta
spitalului Universitar Bucuresti
Corina Posea, Anca Ursachi

Spitalul Universitar de Urgenta Bucuresti (SUUB)

Introducere: Investigarea imunoserologica in anemiile hemolitice autoimmune (AHAI) este
laborioasa si reprezinta o sarcina dificila pentru medic/biolog. Protocolul de teste vizeaza pe de
o parte diagnosticul de laborator al acestui tip de patologie si pe de alta parte selectia de sange
compatibil. Anumiti pacienti se prezinta cu anemie severa iar tratamentul transfuzional trebuie
administrat de urgenta.
Scop: In SUUB selectia de sange pentru pacientii cu AHAI se face conform unui algoritm
prestabilit care consta in efectuarea urmatoarelor teste: testul Coombs direct (TCD), testul
Coombs indirect, fenotip, aglutinine la rece cu amplitudine termica, elutie, teste de adsorbtie
(auto- si alo-) sau teste de dilutie, identificarea aloanticorpilor, testul Donath- Landsteiner.
Dilutia se foloseste cu precadere in situatiile de urgenta, pentru evidentierea prezentei
aloanticorpilor, fiind mult mai rapid si mai simplu in comparatie cu testele de adsorbtie. In
perioada 2006- 2012 au fost diagnosticati 206 pacienti cu AHAI dintre care: 179 cazuri AHAI
la cald, 21 cazuri AHAI la rece, 4 cazuri AHAI mixt, 2 cazuri AHAI la medicament. In 9 cazuri
(4,3%) au fost identificati aloanticorpi cu diferite specificitati: anti-E (4), anti-J
ka
(2), anti-F
yb

(1), anti-C
W
+ antiKell (1), anti-E + antiK
pa
(1). Prezenta aglutininelor la rece cu amplitudine
termica a fost identificata in 4 cazuri. 84 de pacienti (40,8%) au necesitat transfuzie fiind
compatibilizate si administrate 167 unitati MER in fenotip. Nu au fost inregistrate reactii
adverse transfuzionale si aloimunizari prin aplicarea acestui protocol.
Concluzii: Investigarea in AHAI se face pas cu pas, in functie de rezultatele etapei anterioare.
Elaborarea unui algoritm optim pentru selectia de sange este esentiala pentru mangementul
acestor pacienti.
Cuvinte cheie. AHAI, autoanticorpi, aloanticorpi, transfuzie

32

Pr 11. Transfusion Therapy in Autoimmune Hemolytic Anemia:
Bucharest University Hospital Experience

Emergency University Hospital Bucharest (UHB)

Introduction: Immunoserological investigation in autoimmune hemolytic anemia (AIHA) is
laborious and represents a difficult task for physician/biologist. Tests are aimed to diagnose the
type of AIHA as well as the selection of compatible blood. Some patients present severe anemia
and transfusion treatment should be given in emergency.
Aim: In UHB selection of blood for AIHA patients is made according to a predetermined
algorithm consisting of performing the following tests: direct and indirect antiglobulin test,
phenotype, cold agglutinins and thermal amplitude, elution, adsorbtion (auto- and alo-),
dilution, alloantibodies identification, Donath-Landsteiner test. For alloantibodies detection, in
urgent situation, we use dilution technique instead of adsorbtion procedure, as it is easier and
faster. During 2006-2012 we diagnosed 206 AIHA patients, of which: 179 warm AIHA, 21 cold
AIHA, 4 mixed AIHA and 2 drug induced IHA. 9 patients (4,3%) were identified with
different alloantibodies specificities: anti-E (4), anti-J
ka
(2), anti-F
yb
(1), anti-C
W
+ anti-Kell (1),
anti-E + anti-Kpa (1). In 4 cases cold agglutinins with thermal amplitude were identified. 84
patients required transfusion and 167 phenotyped compatible RBC units were selected for them.
There were no adverse transfusion reactions and alloimmunisation by applying this protocol.
Conclusion: The investigative process in AHAI is step-driven, based on previous findings.
Developing an algorithm for blood selection is essential for the management of these patients.
Key words: AIHA, Autoantibodies, Aloantibodies, Transfusion

33

Pr 12. Dificultati in implementarea sistemului de hemovigilenta in Spitalul
Universitar De Urgenta Bucuresti

Spitalul Universitar de Urgenta Bucuresti (SUUB)

Introducere. Implementarea sistemului de hemovigilenta (SHV) la nivelul spitalului reprezinta
un instrument util de supraveghere pentru a preveni aparitia si repetarea reactiilor si incidentelor
transfuzionale. In conformitatate cu Ordinul MS 1228/2006, toate reactiile si incidentele adverse
severe trebuie raportate Centrelor de transfuzie si autoritatii competente intr-o prima etapa,
urmand ca dupa centralizare acestea sa fie raportate Comisiei Europene.
Scop. In SUUB, o imbunatatire semnificativa a SHV existent s-a facut prin procesul de
certificare ISO 9001 a spitalului, in anul 2010. Astfel au fost elaborate mai multe tipuri de
documente: formular de notificare a reactiei transfuzionale, procedurile de operare standard
referitoare la trasabilitate, monitorizarea pacientului transfuzat, la raportarea reactiilor
transfuzionale si un ghid cu definitiile de caz ale reactiilor adverse severe, asa cum sunt definite
in Ordinul MS 1228/2006. Toate documentele au fost revizuite si aprobate de Comisia de
transfuzie si hemovigilenta din spital.
Dupa implementarea SHV numarul reactiilor transfuzionale raportate in 2010 a crescut
comparativ cu cel raportat in 2009 si 2008. De asemenea am constatat o implicare mult mai
activa a medicilor prescriptori in activitatea transfuzionala.
Concluzii. Principalele dificultati intampinate in implementarea SHV au constat in: numar
scazut al personalului format in sistemul de management al calitatii pentru elaborarea
procedurilor, necunosterea de catre medicii prescriptori a legislatiei in domeniul transfuziei,
dificultatea organizarii cursurilor cu medicii prescriptori, inexistenta unei abordari comune, la
nivel national a documentatiei referitoare la SHV.
Cuvinte cheie. hemovigilenta, proceduri de operare, ISO

34

Pr 12. Difficulties in Implementing the Hemovigillance System in the
University Hospital Of Bucharest

Emergency University Hospital Bucharest (UHB)

Introduction. The implementation of the hemovigilance system (HVS) in a hospital setting
represents a useful instrument for surveillance in order to prevent the appearance and recurrence
of serious adverse incidents (SAI) and serious adverse reactions (SAR). According to the
1228/2006 Ministry of Health Order, all SAI and SAR must be reported to the Blood
Establishments and Competent authorities and afterwards the centralized data to the European
Commission.
Aim. In the University Hospital of Bucharest, a significant improvement of the existing HVS
was recorded in 2010, due to the ISO 9001 certification process. Many documents were
compiled including the form for the notification of transfusion reaction, standard operating
procedures referring to traceability, monitoring of transfused patient, reporting system of
transfusion reactions and a guide with common case definitions for transfusion reactions. All the
documents were revised and approved by the hospital Hemovigillance and Transfusion
Commission.
After the HVS implementation, the number of reported transfusion reactions in 2010 raised
compared to 2008 and 2009. Furthermore, it came out that physicians in charge with transfusion
prescription became more implied in the overall transfusion activity.
Conclusion. The main difficulties encountered in the implementation of the HVS were: the low
number of trained personnel in quality management for issuing of standard operating procedures,
the insufficient knowledge of transfusion legislation within the doctors, difficulties in organizing
courses for physicians and lack of a national common approach for hemovigillance documents.
Key words. Hemovigilence, Operating procedures, ISO

35

Pr 13. Monitorizarea la nivelul medicinii primare a pacientului care a
beneficiat de terapie transfuzionala

Spitalul Universitar de Urgenta Bucuresti

Introducere. Pacientul transfuzat in unitatile de ingijire tertiara se poate prezenta la medicul de
familie pentru una din complicatiile tardive ale transfuziei: reactia hemolitica post-transfuzionala
tardiva, purpura post-transfuzionala, boala grefa-contra-gazda, supraincarcarea cu fier, infectii
transmise prin transfuzie. Reactiile transfuzionale trebuie recunoscute, investigate si tratate cu
promptitudine.
Scop. Documentarea si raportarea complicatiilor transfuziei presupune existenta unor relatii
interinstitutionale prestabilite. Medicul de familie trebuie sa consemneze in dosarul pacientului
aspecte legate tratamentul transfuzional primit conform inscrisurilor de pe biletul de externare. In
cazul suspiciunii unei complicatii transfuzionale, medicul de familie trebuie sa indrume pacientul
si sa raporteze reactia medicului specialist si unitatii de transfuzie din spital urmand ca prin
reteaua de hemovigilenta sa fie demarata ancheta transfuzionala pentru confirmarea acesteia.
Prevenirea aparitiei acestor complicatii este importanta si consta in folosirea in practica
transfuzionala a unor metode sensibile de depistare/identificare a alo-anticorpilor anti-erirocitari
(LISS, PEG, aglutinare in faza solida), a iradierii produselor celulare sanguine in cazul gazdelor
imunocompromise, a folosirii de chelatori de fier in cazul pacientilor transfuzati cronic si a
testelor cu sensibilitate si specificitate crescuta pentru diagnosticul maladiilor infectioase.
Concluzii. Deoarece o reactie transfuzionala intarziata poate apare dupa saptamani sau luni de la
transfuzie, asocierea cu aceasta poate fi ignorata. De aceea este esential sa se inregistreze cu
acuratete toate transfuziile in dosarul medical al pacientului si sa fie luate in consideratie pentru
diagnosticul diferential.
Cuvinte cheie: medic de familie, tranfuzie, reactii transfuzionale tardive
36

Pr 13. Monitoring of Transfused Patient in Primary Care Medicine

Emergency University Hospital Bucharest

Introduction. Patients transfused in a hospital setting could be presented to the general
practitioner (GP) for one of the following delayed transfusion complication: delayed hemolytic
transfusion reaction, post-transfusion purpura, transfusion associated graft-versus-host disease,
iron overload, transfusion transmitted infectious diseases. Transfusion reactions require
immediate recognition, laboratory investigation, and clinical management.
Aim. Documenting and reporting transfusion complications involve the existence of inter-
institutional relationships. GP must record in the patients file issues regarding the received
transfusion therapy, according to medical discharge documents. If a suspected transfusion
complication occurs, GP should refer the patient and report the reaction to the physician and
hospital blood bank. After confirmation the reaction will be reported through hemovigilance
network. Preventing the occurrence of this complication is important and consist in the use in
transfusion practice of sensitive methods for detection/identification of alloantibodies (LISS,
PEG technique, solid-phase agglutination), irradiation of cellular blood components for
immunodeficient hosts, iron chelation therapy for chronically transfused patients and tests with
high sensitivity and specificity for diagnosis of infectious diseases.
Conclusion. Since a delayed transfusion reaction can occur weeks and month after the
transfusion, the association with it can be ignored. It is therefor essential to accurately records all
transfusion in patients medical file and to be taken into consideration for differential diagnosis.
Key words. General Practitioner, Transfusion, Delayed Transfusion Reactions

37

Pr 14. Utilizarea tehnicii conventionale si a tehnicii de aglutinare in coloana
pentru efectuarea testelor pre-transfuzionale in unitatile de transfuzie
sanguina din spitale
Gabriela Miricescu

Hemarom, Bucuresti
Introducere. Scopul testarii pre-transfuzionale este de a asigura compatibilitatea ABO Intre
donator si primitor si de a determina anticorpii imuni antieritrocitari cu semnificatie clinica
potentiala, anticorpi care prin interactiunea cu eritrocitele transfuzate pot declansa reactii post-
transfuzionale hemolitice de tip imun. Anticorpii naturali Anti-A si Anti-B sunt considerati
intotdeauna importanti din punct de vedere ai semnificatiei clinice. Exceptand anumite cazuri,
anticorpii antieritrocitari cu semnificatie clinica potentiala, sunt anticorpii care reactioneaza la
37C In Test Coombs Indirect, In mod obisnuit anticorpi imuni de tip IgG.
Scop. Testarea pre- transfuzionala din Unitatile de Transfuzie Sanguina din Spitale presupune
determinarea la primitor, prin teste de aglutinare directa si indirecta, In tehnica conventionala
si/sau In tehnica de aglutinare In coloana de gel, a urmatoarelor elemente:
- grup sanguin ABO (proba globulara si proba serica) si Rh D
- fenotip Rhesus and Kell
- depistarea anticorpilor iregulari: testarea serului pacientului fata de eritrocite test pentru
determinarea anticorpilor imuni anti eritrocitari cu semnificatie clinica potentiala
- proba de compatibilitate majora: testarea serului primitorului fata de eritrocitele donatorului
pentru a depista potentiale incompatibilitati.
Depistarea anticorpilor iregulari este mai sensibila si mai fiabila decat proba de compatibilitate
majora. Din aceasta cauza In practica imuno -hematolologica internationala, se recomanda
efectuarea depistarii anticorpilor iregulari pentru toti primitorii. Datorita sensibilitatii si
specificitatii ,Testul Coombs Indirect (TCI) cu eritrocite diluate In solutie LISS, este considerat a
fi mai adecvat pentru depistarea anticorpilor cu semnificatie clinica potentiala, In conditiile In
care tehnica de aglutinare In coloana s-a demonstrat a fi o tehnica simpla, rapida si fiabila. Testul
enzimatic In doua etape poate fi utilizat ca un test complementar. Includerea In procedurile de
38

testare pre-transfuzionala a TCI efectuat In tehnica de aglutinare In coloana de gel, este
considerata cea mai importanta componenta de securitate pentru depistarea anticorpilor iregulari,
dar mai ales pentru proba de compatibilitate majora.
Tehnicile alternative, In special tehnica de aglutinare In coloana de gel, Incearca sa controleze
efectele indezirabie ale etapei de spalare dinTCI, modul individual de citire a reactiilor, nivelul
de expertiza necesar pentru efectuarea testarii cu acuratete , instabilitatea rezultatului, optimizand
In acelasi timp pH -ul, forta ionica, raportul ser/celule si alte variabile ale aglutinarii
conventionale.
Prin controlul acestor variabile, In tehnica de aglutinare In coloana de gel testarea devine mai
simpla, avand o mai buna reproductibilitate si fiabilitate a rezultatelor. Exista un raport mai bun
Intre sensibilitate si specificitate si confera multiple avantaje legate de absenta etapei de spalare
din TCI, standardizarea dilutiilor eritrocitare si a volumelor de pipetare. Rezultatele sunt usor de
citit si interpretat, fiind stabile cel putin 24 de ore.
Concluzie. Este necesara stabilirea unui protocol standard pentru testarea pre-transfuzionala de
rutina In Unitatile de Transfuzie Sanguina din Spitale, care sa defineasca elementele obligatorii
ale testarii si procedurile ce trebuie adoptate pentru realizarea lor, precizand testele de aglutinare
directa si indirecta necesare pentru fiecare element de testare si reactivii adecvati, si In acelasi
timp tehnicile de aglutinare ce pot fi utilizate In practica de rutina: conventionala , In coloana de
gel sau alte categorii.
Cuvinte cheie. Compatibilitate, Testarea pre- transfuzionala, Tehnici de Aglutinare
39

Pr 14. The Use of Conventional and Column Agglutination Techniques for
Pre-Transfusion Testing in Blood Transfusion Units of the Hospitals
Gabriela Miricescu

Hemarom, Bucharest
Introduction. The goal of pre-transfusion testing is to ensure ABO compatibility between the
donor and the recipient and should detect the most clinically significant red cell antibodies that
will react with donor's red cells causing hemolytic post-transfusion reactions. Natural antibodies
Anti-A and Anti-B are always regarded to be of clinical significance. With few exceptions, red
cell antibodies potentially clinically significant, are those which are reactive in the indirect anti-
globulin test (IAT), performed at 37C, habitually immune IgG antibodies.
Purpose. Pre-transfusion testing in the Blood Transfusion Units of the Hospitals presume
determination to the recipient, by direct and indirect agglutination tests, usually in conventional
or gel column agglutination technique, of the following elements:
- the ABO (forward and reverse testing) and Rh (D) blood group
- the Rhesus and Kell phenotype
- the antibody screening: testing the patients serum against test red cells, for detection of red
cell immune antibodies, clinically significant
- the major cross-match - testing the recipients serum against donors red cells, to detect
potential incompatibilities.
The antibody screening may be more sensitive and reliable than major cross-match. Therefore in
the international immune hematologic practice is recommended that antibody screening to be
performed in all pre- transfusion testing. Indirect anti-globulin test (IAT) using red cells
suspended in LISS solution is considered to be more suitable for the detection of clinically
significant antibodies, because of its sensibility and specificity. Column agglutination technique
has been shown to be simple, speedy and reliable. Additional tests, such as two-stage enzyme,
may be used. The inclusion of an IAT performed in gel column agglutination technique is
considered to be the most important feature of safety in pre-transfusion testing, in antibody
screening and particularly in the major cross-match.
40

Alternative techniques, like gel column agglutination technique, attempt to control the
undesirable effects of the washing step, individual reading mode of the reactions, the level of
expertise needed for accurately testing, the unstable endpoint, as well as to optimize pH, ionic
strength, the serum-to-cell ratio and others variables of the conventional technique. By
controlling these variables, in gel column agglutination technique, the testing become easier,
having a better reproducibility and reliability of test results. The gel column agglutination
technique has a better balance of both specificity and sensibility and confers many advantages
related to no need for washing step in IAT, standardization of erythrocytes dilutions and
pipetting volumes. It provides a clear, easy to read and stable endpoint of reaction and gel cards
can be read with accuracy for at least 24 hours after testing.
Conclusion. A guideline for standard pre-transfusions testing in the Blood Transfusion Units of
the Hospitals should be established, in order to define the mandatory elements of pre-transfusion
testing, the procedures that should be adopted for running them, recommended tests of direct or
indirect agglutination for each element of testing and the suitable reagents, alongside the
recommended techniques of agglutination to be use: conventional, column agglutination or
others.
Key words. Compatibility, Pre-transfusion Testing, Agglutination Techniques
41

Pr 15. Principii generale ale recoltarii prin afereza a celulelor stem
periferice. Recoltarea celulelor stem periferice cu automatul MCS +
HAEMONETICS
Gabriela Miricescu

Hemarom, Bucuresti
Introducere. Grefarea de celule stem periferice (CSP) la pacientii care au primit tratament
mieloablativ, antreneaza o reconstituire hematologica optima si mai rapida decat grefarea de
maduva osoasa, cu mai putine zile de neutropenie si trombocitopenie. Recoltarea CSP se face
prin afereza si poate fi de tip autolog la pacient sau allogenic la donatorul sanatos.
pocS. O crrlePec nlnr iPesPl e aer esrarelr rePceenrra , renrac P PcrnrscPe PenGrrc c aennnenPP
Gre rl cndc PGPcGc Gr P erPPnPire ceadcrc e ePPiPccPe Gr esearncPe c aPnearer .
Mobilizarea se poate face prin chimioterapie si/sau factori de crestere a hematopoezei. Pentru
donatorii sanatosi Gnlr nrrnrscrr lncr factori de crestere , crlrGrPcrr l P nsncn rre e 5
srne . relrPn ePPaenPrne de tip autolog (pacient), aPcrlcPecchimioterapiei cu factori de crestere,
eGre aec cr esrarelrc Gr sPeadelr nrrnrscrc erPc . rcPcerPnn nsncn sPnPGrr eelrPn c edcnnc
Pelrnn Perr e ePPiPccPe c ePPaenPrnPP e PeaPnrcPe c aer , eGre lncPnn e aennnenPP
aC 43 + rl Gcliene eePrsePra , erePrlcr ePrl snPd - arrPerPre , srrl rPrPcrc nl ecPcerPn
ePerarrd eelrPn Pclcelrnn rPrcn cn aPnearer e aer . El lncP e rlr 01 celule
CD34+/microlitru este recomandat pentru a Incepe procedura de colecta. In colecta standard se
proceseaza 10 -12 litri de sange In 3- 4 ore si pentru a recolta un numar adecvat de CSP pot fi
necesare 1- 4 proceduri de acest fel pentru a obtine doza tinta definita de clinician; frecvent
aceasta doza este stabilita la 2,5 x10
6
CD34+ cells/kg. eaPnrcPec aer ePcre sr Pecnrscrc Pencrrd
nGPP , an cr nn re rrenPr e cnrPcre e csePesc ePeselre ee ercrc , cnrPcre ae cn nl ePPrPaPn
eracr e PeaPnrcPe c aer . rPPaenPc e aPnearc eGre P nenacsePesc acPe PeaPnrecsc esrarelr
aennnene PlPlnanecPe Gr ePcre sr Pecnrscrc ePrl snno aPlrrlnn ( Pnc ccPPnPr delPcG e ) Gcn
rGaPlrrlnn ( nl GrlinP ccPP delPG . ecliene PeaPnrcr Gr clrraPcinncr eGre aelrPrsnicr Gr
Gerelrecsc l GrPcrnPr rGrrlare , acPe l PPrlec aPeGacrPcPe c elGrrcrrr Gnlr : encGc ,
rPPcParrene , PlParrene , nrsParrene , iPclnnParrene ceGreacre eGrn n e nnr an ePrrPParrene Gr
GrPcrnn ePrlarecn ePrrPParrcP . relrPn c PeaPnrc aer , acPe cn P PPsPnPire cGeclcrPcPe an c
nrsParrenPP , cnrPcrnn e csePesc rPecnre Gc sre aceccrn Gc PeaPnrese l sPlc rlrPe GrPcrnn
iPclnnParrcP Gr GrPcrnn rPPcParrcP . relr Pn ePPaenPrne cnnPielrae e PeaPnrcPe c aer nc PlcrPPr
GclcrPGr , Ge ePcre ePcarrac ePPaenPc e aPnearc GrclcP ePrl csePesc rGaPlrrlnc an cnrPcrnn
e csePesc eae + EcePlerraG . rPPrPaPnnn eelrPn PeaPnrcPec aer eGre an nl GrlinP ccPP delPG
42

Gr eGre cc scr ee rellPnPirc cPnnnnr e aelrPnsnicPe ecrlc . reacPe ePPaenPc cPe nl lncP
acnanncr Gr ePPiPccr e arannPr ; sreacPe arann cPe P ercec e aPnearc c aennnenPP PlPlnanecre
GeecPcre ePrl aelrPrsnicPec Gcliennr rPrcn clrraPcinncr Gr P ercec e PernP ePr l acPe Gnlr PernPlcre
PlcrPPnnnr encGc cPicrc l rPPcParre Gr ePrrPParrene . CnPcrc nler ePPaenPr e PeaPnrcPe Gr
lncPnn leaeGcP e ePPaenPr acPe rPecnre esearncre , eerle e lncPnn e aennne aC 43 + /
microlitru si de doza tinta stabilita pentru colecta.
Concluzie. Stabilirea unui protocol de mobilizare reusita a CSP din maduva osoasa si
selectionarea unei proceduri eficiente de recoltare prin afereza a CSP, reprezinta parametrii
foarte importanti care contribuie la cresterea calitatii si eficientei terapeutice a procedurii de
grefare a CSP.
eieucC oiCuC. aennne ere rePrsePrae , eraliliboM , azMoMib
43

Pr 15. sCcCPcn rPucouSnCGo a rCPuSiCPc n oncce pC eCnnG ecnnCouccG b
sSiCPCGuG . niC sSiCPCGuG ecnnCoucco a rCPuSiCPcn oncce pC eCnnG ui
ep + As EEMEnUep sInEsnE
Gabriela Miricescu

Hemarom, Bucharest
UcPceioucc. P ePrelePcn cnPP Gre aennG ( rlea ) eliPcsr rP rle ecrrelrG dlP lcde Peaerde
senPccncrrde rlePces , rldPnde c optimal and a faster hematological reconstitution rlcl cPPPd
iPcsr , drr l sedeP csG Ps lenrPPeelrc cl rlPPcPasrPeelrc . le aPnnearrPl Ps rlea rG
eePsPPe cs celePeGrG cl cs ce cnrPnPiPnG ( ecrrelr ) PP cnnPielra ( lecnrls PlPP .)
Purpose. O crcrlrli rlea PegnrPeG csuccessful PcrnrscrrPl Ps Gre aennG sPP cPPPd rlrP
eePre lePcn cnPP cl c essrarelr erlPPnPis sPP ePPicrli cl eePsPPrli rle aPnnearrPl .
alePrlePces cl / PP iPPdrl scarPPG cPe nGe sPP Gre aennG PcrnrscrrPl . PP lecnrls cnnPielera
PlPPG cPe nGe Plns iPPdrl scarPPG , nGncnns sPP 5 csG . PP cnrPnPinG ePP aenPeG ( ecrrelrG ) , rle
aPcrlcrrPl Ps alePrlePces cl iPPdrl scarPPG rG rle PGr essearrde cl aPPlns eenPse
ecl Ps Pcrnrsrli rlea . le cnPP aC 43 + aennG aPnlr cs snPd - asrPerPs rG ePerarrde sPP rle
rPrcn sren Ps ePPielrrPPG cl nGncnns rG nGe rP erePrle dlel celePeGrG ePPaenPe acl ce
ePPice . s rlrn pre-count of 01 aC 43 + aennG per micro-liter is recommended for
starting the procedure. l c GrclcP aPnnearrPl , 01 rP 01 nrrePG Ps cnPP cPe nGncnns ePPaeGGe rl 4
rP 3 lPnPG cl Ple rP sPnP Gnal ePPaenPeG cs ce PegnrPe rP aPnnear c ePeesrle rcPier sren ,
Gnal cG 1,5 o 01
6
aC 43 + aennG / gi of body weight . aPnnearrPl Ps rlea rG Pecrns caaPenrGle
drrl rssePelr celePeGrG rlGrPnelrG ePeGelrG rl rle cPger . le aPnnearrPl ePPaenPe rG c
nengc elePeGrG rlcr essrarelrns aPnnearG PlPlnanecP aennG , dlral cs ce eePsPPe cs celePeGrG
rlcontinuous snno ( rdP cPG ePPaenPe ) PP rl discontinuous snno ( Ple cP ePPaenPe .) le
clrraPcinncre dlPne cnPP aPnneare cs celePeGrG rG Gnceare rP aelrPrsnicn sPPae cl rr
GerelrG rlrP rGrrlar ncsePG . les cPe rl PPeP Ps rlaPecGrli elGrrs : encGc , encrenerG ,
PlPasreG , nselPasreG , iPclnnPasreG iPecrns rlreProe drrl Pe aennG cl rlel crlns Pe
aennG . P aPnnear rlea , dlral ePGGeGG c nselPasre - nrge PPe lPnPis , rle celePeGrG rlGrPnelr
GlPnn lcPdeGr rl rle sPle cerdeel rle iPclnnPasre ncseP cl rle encrener ncseP . PP cnnPielra
rlea PlPPG , cs ce nGe c GrclcP aPnnearrPl cs rGaPlrrlnPnG celePeGrG ePPaenPe ,
eePsPPe drrl eae + , rle EcePlerraG cnrPc re . eae + lcG c eracre ePPrPaPn sPP aPnnearrli
rlea cs Ple cP ePPaenPe cl rr rG ccGe Pl ecrlc cPdn reallPnPis . Hcal ePPaenPe lcG c
ePPiPce lnceP Ps asaneG ; ecal asane lcG c aPnnearrPl elcGe Ps mononuclear cells Pcrcrle
44

csreP aelrPrsnicrrPl Ps clrraPcinncre dlPne cnPP cl c PernPl elcGe nPrli dlral , rle encrener
Pral encGc cl rle Pe aennG Pecrlrli rl rle cPdn , cPe PernPle rP rle PlPP . le nPcrrPl Ps
Ple ePPaenPe cl rle lnceP Ps leee ePPaenPeG , eeelG Ps rle PlPP ' G lnceP Ps aC 43 +
aennGper micro-liter and the ePeesrle rcPier sren Ps aPnnearrPl .
Conclusion. Establishing a protocol for a successful stem cells mobilization sPP cPPPd rlrP
eePrelePcn cnPP cl rle GenearrPl Ps c essrarelr erlPPnPis sPP ePPiPcrli cl eePsPPr li
rle aPnnearrPl cs celePeGrG , cPe aPlGrePe dePs rePPrclr ecPcerePG dlral aPlrPrcnre rP c
lrileP gncnrrs cl rlePceenrracn essrarelas Ps rlea iPcsr .
Key words. rePrelePcn ere aennG , ePcrnrscrrPl , selePeGrG

45

Pr 16. Raportul anual de activitate a unitatilor de transfuzie sanguina
din cadrul spitalelor
Simona Parvu
Ministerul Sanatatii, Romania
Introducere. Unul din obiectivele principale pentru atingerea unui nivel ridicat de performanta
al sistem transfuzional este de a asigurarea autosuficienta In sange i componente sanguine
umane. Acesta poate fi atins prin mai multe directii de actiune printre care se numara i utilizarea
eficienta de sange i produse sanguine umane prin asigurarea unei bune colaborari Intre centrele
de transfuzie sanguina teritoriale i unitatile de transfuzie sanguina din cadrul spitalelor dar i
prin administarea corecta a acestora.
Scop. In calitate de Stat Membru al Uniunii Europene, Romania are obligatia de a raporta anual
situatia reactiilor adverse i a incidentelor posttransfuzionale pentru anul anterior. Raportarile din
anii trecuti nu au putut releva situatia reala la nivel national, In lipsa unor proceduri i a unui
sistem de raportare anuala a activitatii unitatilor de transfuzie sanguina din spitale. Pana In
prezent notificarea In cadrul sistemului de hemovigilenta nu putut functiona corect la nivelul
tuturor institutiilor din sistemului transfuzional, nefiind stabilita o procedura de raportare.Pe de
alta parte art. 13 (1) i Anexa II din Directiva 2002/98/EC, reglementeaza obligativitatea i
modalitatea de raportare a activitatii centrelor de transfuzie sanguina, iar Legea nr. 282/2005
privind organizarea activitatii de transfuzie sanguina, donarea de sange i componente sanguine
de origine umana, precum i asigurarea calitatii i securitatii sanitare, In vederea utilizarii lor
terapeutice, prevede elaborarea periodica de rapoarte privind date statistice i epidemiologice.
Astfel, Incepand cu anul 2011 la initiativa Ministerului Sanatatii, unitatile de transfuzie din
spitale raporteaza activitatea anului precedent dupa un model conceput de expertii din domeniu.
Implementarea raportarii anuale a unitatilor de transfuzie din spitale a urmarit:
- inregistrarea unitara a datelor la nivelul acestor structuri,
- armonizarea activitatii i a utilizarii terapeutice a sangelui i componentelor sanguine,
- posibilitatea elaborarii unei baze de date care poate sa furnizeze informatii statistice i
epidemiologice utilizate pentru diverse raportari catre Comisia Europeana,
- posibiltatea elaborarii unui raport anual de activitate la nivel national care sa cuprinda
toate institutiile din sistemul de transfuzie sanguina.
Concluzii. Raportul anual de activitate a unitatilor de transfuzie sanguina din cadrul spitalelor
este o parte componenta importanta In elaborarea de catre Institutul Nationla de Hematologie
Transfuzionala a raportului anual de activitate a retelei nationale de transfuzie sanguina i o sursa
de date pentru evaluarile Comisiei Europene. Rapoartele de activitate reprezinta o sursa
46

valoroasa de informatii analiza acestora avand drept scop eficientizarii activitatii unitatilor de
transfuzie sanguina i corelarea cu activitatea centrelor de transfuzie sanguina teritoriale.
Cuvinte cheie. Autosuficienta, raport anual de activitate, eficienta
Pr 16. Annual Activity Report of the Hospitals Blood Transfusion Units
Simona Parvu
Ministry of Health, Romania
Introduction. One of the major objectives to achieve a high level of performance in the
transfusion system is to ensure self-sufficiency in blood and blood components. This can be
achieved by several lines of action, including an efficient use of blood and blood components, as
a result of a good cooperation between territorial blood establishments and hospital blood
transfusion units and the correct administration of these.
Purpose. As a Member State of the European Union, Romania has the annual obligation to
report adverse reactions and the after transfusion incidents for the previous year. Romania last
reports could not reveal a real situation at the national level, in the absence of procedures and a
reporting system set out for the hospital blood transfusion units. Up now the notification within
the framework of the system of haemovigilence could not function properly at levels in the
transfusion system, because there is now reporting procedure established. On the other hand
article 13 (1) and Annex II of Directive 2002/98/EC, provides the reporting activity compulsory
for the blood establishments and the Law no. 282/2005 on organization of the work of blood-
transfusion, donation of blood and blood components of human origin, as well as quality
assurance and safety health, with a view to their therapeutic use, requires the periodic
development of reports on statistical and epidemiological data. So, starting from 2011 on
Ministry of Health initiative, the hospitals blood transfusion units are reporting their activities on
previous year, after a model designed by experts in the field. Annual deployment of the hospitals
blood transfusion units followed:
- The same registration of data at the level of these structures,
- Harmonization of therapeutic activity and the use of blood and blood components,
- The possibility of a drawing up a database which may provide statistical and
epidemiological information that can be used for various reports to the European
Commission,
- Drawing up an complete annual report of activity at the national level that will include all
the institutions of the transfusion system.
Conclusions. The activity reports are a valuable source of information, the aim of their analysis
will be a more efficiently run for the units and a good correlation with the blood establishments
activities. The annual activity report of the hospital blood transfusion units is an important
component of the annual report for the activities of national network of blood transfusion,
developed by the National Institute of Blood Transfusion and a source of data for the European
Commission evaluations.
47

Key words. Self-sufficiency, Annual Report of Activity, Efficacy

Pr 17. Standarde i criterii europene comune pentru inspectia unitatilor
de transfuzii sanguine
Simona Parvu

Introducere. Un obiectiv major In cadrul actiunilor din domeniul sanatatii publice la nivel
national i european este asigurarea faptului ca "pacientii din Uniunea Europeana care au
indicatie de tratament transfuzional sa primeasca sange In conditii de securitate.Intrarea In
vigoare a legislatiei Uniunii Europene In domeniul sangelui, pornind de la Directiva 2002/98/CE
i a cerintele tehnice ale acesteia, a fost urmata de un progres remarcabil In directia asigurarii
furnizarii de sange i componente sanguine In mod sistematic In conditii de securitate la nivelul
Intregii Europe. Cu toate acestea, extinderea semnificativa a Uniunii Europene a impus ca atentia
responsabililor sa se concentreze asupra necesitatii unor standarde i criterii pan-europene pentru
inspectia centrelor de transfuzii sanguine un element esential In punerea In aplicare a bunei
practici.
Scop. In cadrul proiectului European Blood Inspection System (EuBIS), finantat de Comisia
Europeana In baza Cererii de Oferte din anul 2006, i al Programului acesteia de Sanatate
Publica (2003-2008) privind calitatea i securitatea sangelui, a fost elaborat i implementat un
manual (Manualul EuBIS) care cuprinde standarde i criterii pan-europene pentru inspectia
centrelor de transfuzii sanguine. Acesta este rezultatul unui efort de colaborare a reprezentantilor
institutiilor guvernamentale, centrelor de transfuzii sanguine i autoritatilor competente din 19
state membre, printre care se numara i Romania. Astfel, manualul stabilete:
criterii i standarde comune pentru inspectia centrelor de transfuzii sanguine
cerinte privind punerea In aplicare sau extinderea sistemelor de management al calitatii
care urmeaza a fi inspectate
liste de verificare pentru inspectie care respecta cu strictete Directiva 2002/98/CE i
cerintele tehnice ale acesteia i
criterii de evaluare pentru inspectii i un sistem de referinta pentru abateri i ameliorari.
Cerintele elaborate sunt destinate utilizarii nu doar de catre responsabilii centrelor de transfuzii
sanguine, ci i de catre cei responsabili cu inspectia acestora, conform legislatiei aplicabile
apartinand Uniunii Europene (UE). Manualul este completat i de un Ghid de instruire
48

audit/inspectie cu privire la aspectele relevante care trebuie avute In vedere In timpul procesului
de inspectie, incluzand referinte Incruciate pentru standardele i criteriile europene comune
referitoare la sistemele de management al calitatii din cadrul centrelor de transfuzii sanguine,
definite In legislatia comunitara. De aceea, manualul va sta la baza unui program de instruire atat
pentru auditorii interni ai centrelor de transfuzii sanguine cat i pentru inspectorii sanitari ai
Ministerului Sanatatii, acest lucru asigurand aplicarea unitara a standardelor i criteriilor
europene comune.
Concluzii. Manualul EuBIS ofera asistenta Statelor Membre UE In implementarea cerintelor de
reglementare prevazute de Directivele 2002/98/CE, 2004/33/CE 2005/61/CE i 2005/62/CE,
prin:
-optimizarea sistemului de calitate, inclusiv In cadrul procesului de audit intern al centrelor de
transfuzie sanguina
-eficientizarea actiunilor de control i remediere, prin asigurarea unor grile de verificare unitare,
folosite de catre autoritatile competente pentru inspectiile externe.
Cuvinte cheie. Eubis, cerinte de reglementare, grile de verificare unitare

49

Pr 17. Common European Standards and Criteria for the Inspection of
Blood Establishments
Simona Parvu

Introduction. Ensuring that patients who receive blood transfusion in the European Union are
given safe blood is a major objective within the framework of public health on the national and
European level. The entry into force of European Union legislation on blood, based on Directive
2002/98/EC and its technical requirements, has been accompanied by noteworthy progress
towards ensuring the provision of consistently safe blood and blood components across Europe.
The significant expansion of the European Union, however, focused attention on the need to
have common pan- European standards and criteria for the inspection of blood establishments a
key element in the implementation of good practice.
Goal. Within the European Blood Inspection System (EuBIS) project funded by the European
Commission under its 2006 Call for Proposals and in the framework of its Public Health
Program (2003-2008) addressing the quality and safety of blood, the manual (EuBis Manual) of
pan-European standards and criteria for the inspection of blood establishments was developed
and implemented. It is the result of a collaborative effort of representatives from governmental
institutions, blood establishments and competent authorities of 19 member states, including
Romnaia. The manual sets out:
common criteria and standards for the inspection of blood establishments
requirements for the implementation or expansion of quality management systems to be
inspected
inspection checklists which closely follow Directive 2002/98/EC and its technical
requirements, and
evaluation criteria for inspections and a benchmark system for deviations and
improvements.
These requirements are intended for use not only by those responsible for the operation of blood
establishments but by those in charge of inspecting them, in compliance with relevant European
Union (EU) legislation. The manual is accompanied by an audit / inspection training guide to
assist the inspection process, including master templates of key documents used during the
inspection. These documents give examples for the implementation of good practice (GP) as
defined by the EU blood directives. That is why it will also serve as the basis of a training
50

programmes for inspectors of blood establishments and will help to ensure common application
of the European standards and criteria.
Conclusion. The EuBIS manual aims to provide assistance to EU Member States in their
implementation of regulatory requirements set out in Directives 2002/98/EC, 2004/33/EC,
2005/61/EC and 2005/62/EC for:
blood establishments in need to optimize their quality system and self-inspection process
related to the EU blood directive and to prepare for regulatory inspections by competent
authorities, and
competent authorities, which wish to use the manual and training guide as a reference for the
implementation process of the European blood legislation related to regulatory inspections.
Key words. Eubis, Reglementation Requirements, Unitary Checking Procedures

51

Pr 18. Strategia Ministerului Sanatatii privind sistemul transfuzional din
Romania
Ministru, Dr. Ritli Ladislau
Introducere. Sistemul national de transfuzie constituie un domeniu strategic national,
impunandu-se recunoterea lui ca parte a sistemului medical de urgenta. Siguranta terapiei
transfuzionale este esential legata de asigurarea unui grad echivalent de calitate i securitate In
fiecare etapa a lantului transfuzional, inclusiv la nivelul spitalului, respectiv In unitatile de
transfuzie i serviciile clinice.
Scop. Cadrul general de organizare i cerintele de baza privind calitatea i securitatea In
domeniul transfuziei sanguine au fost reglementate prin Legea nr. 282/2005 privind organizarea
activitatii de transfuzie sanguina, donarea de sange i componente sanguine de origine umana,
precum i asigurarea calitatii i securitatii sanitare, In vederea utilizarii lor terapeutice, care
transpune cerintele Directivei 2002/98/CE i partial cerintele Directivei 2004/33/CE. Alte acte
legislative secundare au transpuns prevederile Directivei 2005/61/CE, ale Directivei 2005/62/CE
i restul reglementarilor din Directiva 2004/33/CE. Romania nu dispune In prezent de o viziune
strategica pe termen mediu i lung In domeniul transfuziei sanguine pentru asigurarea atingerii
paramaterilor de performanta din celelalte state ale Uniunii Europene i pentru integrarea acestor
preocupari In strategiile nationale. In acest context obiectivele principale ale Ministerului
Sanatatii In domeniul transfuziei sanguine sunt:
I. Asigurarea autosuficientei In sange i componente sanguine umane avand ca obiective
specifice:
1. Stimularea colectei prin creterea numarului de donatori atat prin dezvoltarea colectei
mobile cat i prin creterea ponderii componentei de promovare, informare, comunicare
i educare pentru donarea benevola.
2. Valorificarea eficienta i eficace a Intregului potential de donare a plasmei prin
fractionarea acesteia In vederea obtinerii diferitelor produse utilizate In terapia
bolnavilor. Avand In vedere cantitatea mare de plasma produsa la nivel national este
necesara dezvoltarea capacitatii de fractionare a plasmei prin implementarea acestui
proces sau prin contractarea de servicii avand ca rezultat scaderea costului produselor
obtinute, In beneficiul pacientilor.
3. Utilizarea eficienta de sange i produse sanguine umane i administarea corecta a
acestora prin asigurarea unei bune colaborari Intre centrele de transfuzie sanguina
teritoriale i unitatile de transfuzie sanguina din cadrul spitalelor.
II. Creterea nivelului de siguranta i securitate transfuzionala prin:
52

1. Aplicarea sau extinderea sistemelor de management al calitatii In centrele de transfuzie
sanguina teritoriale i In unitatile de transfuzie sanguina din spital.
2. Dezvoltarea i modernizarea infrastructurii In concordanta cu noua organizare a activitatii
de transfuzie sanguina.
3. Dotarea cu echipamente de testare, stocare, etc. de ultima generatie cum ar fi tehnologia
NAT, utila atat In procesul de fractionare a plasmei cat i In aplicarea masurilor specifice
In situatii speciale (ex. epidemia cu virusul West Nile).
4. Eficientizarea activitatii unitatilor implicate In sistemul national de transfuzie sanguina,
prin implementarea unui sistem unitar informatic de Inregistrare i dezvoltarea unei baze
de date unice.
5. Initierea procesului de autorizare a institutiilor din sistemul transfuzional conform
cerintelor comunitare.
6. Intarirea capacitatii de control prin organizarea de programe de instruire pentru
inspectorii sanitari de stat precum i prin elaborarea de norme i proceduri pentru
desfaurarea inspectiei In domeniul transfuzional.
Realizarea ambelor obiective presupune formarea de personal i dimensionarea corecta a
resurselor umane din reteaua de transfuzie sanguina, care In prezent functioneaza sub
normativele legale In vigoare.
De aceea, este absolut necesar implementarea unui sistem clar reglementat i organizat de
formare profesionala initiala i continua, prin elaborarea unui program national de instruire In
domeniul transfuziei sanguine pentru personalul medical cu studii superioare, cadre medicale
medii precum i a altor categorii, care Ii desfaoara activitatea In domeniul transfuziei sanguine,
cu recunoaterea competentei In medicina transfuzionala.
Concluzii. In sprijinul aplicarii acestor obiective trebuie sa existe Insa un cadru legislativ cu
norme clare, aplicabile i In concordanta cu cerintele comunitare, fiind necesara revizuirea i
reglementarea In regim de urgenta a mai multor acte normative din domeniu. Astfel, Ministerul
Sanatatii a initiat i elaborat mai mult proiecte legislative care se afla deja pe circuitul de avizare
interna In vederea dezbaterii acestora, precum:
1. Hotararea de Guvern care stabilete organizarea i functionarea Sistemului national de
transfuzie sanguina
2. Revizuirea Ordinului MS nr. 1225/2006 pentru aprobarea normelor privind autorizarea
Institutului National de Transfuzie Sanguina, a centrelor de transfuzie sanguina regionale,
judetene si al municipiului Bucuresti, precum si a unitatilor de transfuzie din spitale
3. Revizuirea Ordinului MS nr. 1228/2006 privind sistemul de hemovigilenta,
precum i alte proiecte de modificare de ordine de ministru cu scopul transpunerii conforme a
cerintelor directivelor.
Cuvinte cheie. Autosuficienta, cadru legislativ, cerinte directive

53

Pr 18. The Strategy of The Ministry of Health for the Transfusion System
in Romania
Minister, Dr. Ritli Ladislau
Introduction . The national transfusion system is a strategic sector requiring the Recognition as
part of the emergency medical care system. Ensuring an equivalent level for quality and security
at every stage of the transfusion chain, including the hospital and clinical services is essential in
transfusion therapy.
Purpose. The general framework of the blood transfusion organization and its basic
requirements addressing to the quality and safety of blood are regulated by Law no. 282/2005 on
organization of the work of blood-transfusion, donation of blood and blood components of
human origin, as well as quality assurance and safety health, with a view to their therapeutic
use, transposing Directive 2002/98/EC requirements and partially the Directive 2004/33/EC
requirements. Provisions of Directive 2005/61/EC, Directive 2005/62/EC, and the remaining
requirements of Directive 2004/33/EC are transposed in other legislative acts. Currently
Romania doesnt have a strategic vision in the field, for medium and long term, to ensure
achieving the performance level of other member states of the European Union in the field of
blood transfusion and integrate these concerns into the national strategies. In this context the
Ministry of Health main objectives in the blood transfusion field are:
I. To ensure self-sufficiency in blood and blood components through following specific
objectives:
1. Stimulating the blood collection by increasing the number of donors, both through the mobile
collection development and the increase of promotion, information, communication and
education for voluntary blood donation.
2. An efficient and effective capitalization of the entire potential of plasmas donation using
fractionation in order to obtain various products used in patients therapy.
Having regard to the amount of plasma produced at national level, it is necessary develop the
capacity for plasma fractionation, by implementing this process or by contracting services with e
result of reduced cost for the obtained products, in the patients benefit.
54

3. Ensuring an efficient use of blood and blood components through a good cooperation between
territorial blood establishments and the hospitals blood transfusion units and the correct
administration of these.
II. Increasing the safety and security level for blood transfusion through:
1. Applying or extending the quality management systems in blood establishments and hospital
blood transfusion units
2. A developed and modernized infrastructure in accordance with the new organization in the
blood transfusion system, such as NAT technology useful both in the fractionation process of
plasmas as well as in special situations when specific measures are applied (e.g. epidemic with
West Nile Virus).
4. The implementation of a recording data system and the development of a unique database
shall provide an efficiently work in all units involved in the national blood transfusion system.
5. Initiating the authorization process of blood establishments in accordance with Community
requirements.
6. Strengthening the control ability by developing rules and procedures for inspections activities
in the blood transfusion field, as well as through the organization of training programs for
inspectors.
III. Achieving both objectives involves a trained personnel and a correct dimensioning of human
resources in the blood transfusion network, which currently operates under legal settings.
Therefore, it is necessary to implement an organized and clearly governed training system
through the development of a national program of training for medical personnel with higher
education and nurses, working in the blood transfusion field with the competence recognition in
transfusion medicine.
Conclusions. An applicable legislative framework, with clear rules and in accordance with the
European Union requirements must support the implementation of these objectives therefore it is
absolutely necessary to revise in a matter of urgency national legal acts in the blood transfusion
field. Thus, the Ministry of Health has initiated and developed some legislative projects that are
already in the approval procedure and for their internal debate, such as:
1. A Government Decision which establishes the organization and operation of the national
blood transfusion system
2. A review of the Health Ministry Order no. 1225/2006 for the approval of the rules concerning
the National Institute of Blood Transfusion, the regional and counties blood establishments, as
well as of the hospitals transfusion units authorization,
55

3. A review of the Health Ministry Order no. 1228/2006 concerning the haemovigilance system,
as well as other projects in order to change some ministry of health legal acts for a correct
transposition of the directives requirements.
Key words. Self-sufficiency, Legislation Frame, Requirements, Directives
Pr 19. Implementarea Ord. M.F.P 946/2005 cu modificarile si
completarile ulterioare, privind controlul intern/managerial in Centrele
de Transfuzie Sanguina
Sevastiana Bran
1
, Cristina Stoian
2

1
Centrul Regional de Transfuzie Sanguina Craiova, Romania
2
Centrul Judetean de Transfuzie Sanguina Slobozia, Romania

Introducere. Conceptul de Control Intern. Etimologia cuvantului control provine din
latininescul contra rolus , ceea ce inseamna verificarea unui act duplicat realizat dupa unul
original. Controlul in acceptiunea lui semantica este o analiza permanenta sau periodica a unei
activitati, a unei situatii, pentru a urmari mersul ei si pentru a lua masuri de imbunatatire.
Scop. Controlul intern este un proces integral realizat de catre conducere si personalul unei
entitati pentru identificarea riscurilor si furnizarea unei asigurari rezonabile ca misiunea entitatii
si obiectivele generale au fost indeplinite.
Metoda. In legislatia din Romania, controlul intern este definit ca reprezentand ansamblul
formelor de control exercitate la nivelul entitatii publice, inclusiv auditul intern, stabilite de
conducere in concordanta cu obiectivele acesteia si cu reglementarile legale, in vederea asigurarii
administrarii fondurilor publice in mod economic, eficient si eficace; acesta include de asemnea
structurile organizatorice, metodele si procedurile.
Componentele controlului intern
Controlul intern este format din cinci componente intercorelate : mediul de control, evaluarea
riscurilor, activitatile de control, informarea si comunicarea, monitorizarea.
Etapele de implementare a controlului intern
56

1 Constituirea comisiei de monitorizare, corelarea si indrumarea metodologica a dezvoltarii
sistemului de control intern managerial.
2 Stabilirea regulamentului de organizare si functionare al comisiei de monitorizare, coordonare
si indrumare metodologica a dezvoltarii sistemului de control intern managerial.
3 Instituirea comisiei de monitorizare, coordonarea si indrumarea metodologica a dezvoltarii
sistemului de control intern managerial cu privire la cerintele OMFP 946/ 2005 cu modificarile si
completarile ulterioare.
4 Stabilirea regulamentului de autoevaluare a sistemului de control intern managerial.
5 Stabilirea ROF, ROI, organigrama, legislatia aplicabila in domeniu
6 Implementarea standardelor de control intern managerial
7 Elaborarea Programului de dezvoltare a sistemului de control intern managerial al calitatii
8 Stabilirea obiectivelor generale si specifice ale entitatii si structurilor organizatorice
9 Stabilirea activitatilor si actiunilor necesare pentru realizarea obiectivelor pentru fiecare
structura organizatorica a entitatii
10 Identificarea riscurilor si activitatilor de control
11 Elaborarea Registrului de Riscuri
12 Elaborarea procedurilor operationale de lucru formatizate pe activitati
13 Elaborarea Programului de pregatire profesionala in domeniul controlului managerial
14 Audit intern
Concluzii. Controlul intern este un instrument utilizat de conducere si legat direct de obiectivele
entitatii. Conducerea reprezinta un element important al controlului intern, dar si restul
personalului institutiei joaca roluri la fel de importante in realizarea acestuia.
Cuvinte cheie. Obiective generale, control intern managerial al calitatii, audit intern

57

Pr 19. Implementation of Ord. Mfp 946/2005 as Amnended and
Supplemented, on Internal Control / Management in Blood
Sevastiana Bran
1
, Cristina Stoian
2

1
Craiova Regional Blood Center, Romania
2
Slobozia Blood Center, Romania

Introduction: The Concept of Control The word "control" comes from the latin "against role",
which means checking an act done by a duplicate original. Control the acceptance of semantics is
a constant or periodic review of activities, a situation to track her progress and to take measures
for improvement.
Purpose. Internal control is a process done entirely by an entity's management and staff to
identify risks and provide reasonable assurance that the entity's mission and overall objectives
were met.
Method. In the legislation of Romania, internal control is defined as all forms of control
exercised in the public entity, including internal audit, established by management in accordance
with its objectives and legal regulations, to ensure the administration of public funds in
economic, efficiently and effectively, this includes also cover organizational structures, methods
and procedures.
Internal control components
Internal control consists of five interrelated components: control environment, risk assessment,
control activities, information and communication monitoring.
Stages of implementation of internal control
1 Establishment of Commission monitoring, correlation and methodological guidance of the
internal control system development management.
2 Establishing rules of organization and functioning of the Monitoring Committee, coordination
and methodological guidance of the internal control system development management.
3 Establishment of the monitoring, coordination and methodological guidance of the internal
control system development on requirements management OMFP 946/2005 with subsequent
amendments.
4 Establishment of self-regulation of the internal control system management.
5 Establishment ROF, ROI, organizational, applicable law in the field
6 Implementation of internal control standards management
7 Development Program to develop internal control system of quality management
8 Establish specific objectives and requirements, and organizational structures
58

9 Determination of activities and actions necessary to achieve the objectives for each
organizational structure of the entity
10 Identification of risks and control activities
11 Development of Risk Register
12 Develop operational procedures adapted to work / activities
13 Develop training programs in the field of management control
14 Internal Audit
Conclusion. Internal control is a tool of management and directly related to the entity's
objectives. Leadership is an important element of internal control, and other staff of the
institution plays as important role in its implementation.
Key words. General Objectives, Internal Managerial Control, Internal Audit

59

Pr 20. Controlul intern de calitate in laboratorul de imunohematologie
(CTS I unitati de transfuzie din spital)
Victoria Halmagi
1
, Cristina Bichis
2

1
CTS Deva , Romania
2
CTS Hunedoara, Romania
Introducere. Managementul calitatii este un sistem integrat al asigurarii calitatii cu influenta
individuala i colectiva , fiecare constituind o componenta pentru garantarea calitatii. Bunele
practici de laborator , controlul calitatii i auditurile programate sunt legate de managementul
erorilor i accidentelor. Riscul hemolizei imunologice rezulta din incompatibilitatea prin
anticorpi antieritrocitari prezenti la receptor i este cel mai frecvent i mai grav. Prevenirea
acestui risc i securitatea transfuzionala necesita teste de imunohematologie : determinare de
grup sanguin ABO , Rh , RAI , test Coombs direct i indirect , compatibilitate directa.
Scop. Controlul intern de calitate In laboratorul de imunohematologie permite decelarea
anomaliilor i erorilor ce trebuie remediate imediat. El cuprinde masurile destinate verificarii
tuturor fazelor de activitate i e compus din:
-controlul echipamentelor
-controlul reactivilor
-controlul tehnicii
Elementele ce intervin In obtinerea unor rezultate fiabile , de calitate , a acestor analize sunt :
-selectia reactivilor i validarea lor In tehnicile utilizate
-validarea receptionarii lor
controlul reactivilor preparati secundar(hematii test)
-controalele cotidiene interne
Aceste controale de calitate interne se efectueaza zilnic. Ele sunt eantioane asemanatoare cu
probele din seria de lucru , standardizate i livrate de firme specializate sau efectuate In
laborator. Aceste controale interne au ca scop decelarea anomaliilor datorate tehnicii , reactivilor
sau dificultatilor de determinare de grup ABO Rh i allo i autoanticorpi la pacienti. Sunt
prezentate In lucrare principalele dificultati de determinare de grup ABO/Rh.
60

Concluzii. Controlul intern de calitate face parte integranta din sistemul de hemovigilenta i
securitate transfuzionala.
Cuvinte cheie. Anomalii, remediere, control de calitate
Pr 20. Internal Quality Control in Immune-Hematology Lab (BTC and
Hospital Transfusion Units)
Victoria Halmagi
1
, Cristina Bichis
2

1
BTC Deva , Romania
2
BTC Hunedoara, Romania
Introduction. Quality management is an integrated system of quality assurance to influence
individual and collective, each representing a component for quality assurance. Good laboratory
practice, quality control and audits management program is about errors and accidents. Risk
resulting from hemolysis immunological incompatibility anti-eritrocitary antibody present in the
recipient and is the most common and serious. Prevent risk and transfusion safety requires
immunohematology tests: determination of ABO blood group, Rh, RAI, direct and indirect
Coombs test, direct compatibility.
Purpose. Internal quality control laboratory to detect anomalies and errors immunohematology
be rectified immediately. It includes measures to verify all phases of activity and is composed of:
-Control equipment
-Control reagents
-Control technique
Elements involved in obtaining reliable results, the quality of this analysis are:
-Selection of reagents and their validation techniques
-Validation of their reception
-Prepared secondary-control reagents (red test)
-Internal-controls daily
These internal quality checks are made daily. They are samples from the series similar work
samples, standardized and delivered by specialized companies or performed in the laboratory.
These internal controls are designed to detect anomalies due to equipment, reagents and
difficulties of determining the ABO group and Rh, allo and autoantibodies in patients. The paper
presents the main difficulty in determining the ABO Rh group.
Conclusion. Internal quality control system is part of haemovigilance and transfusion safety.
Key words. Anomalies, Remediate, Quality Control
61

Pr 21. Formularele aferente activitatii centrelor de transfuzie sanguina
i interfata cu spitalele
Victoria Halmagi
1
, Cristina Bichis
2

1
CTS Deva , Romania
2
CTS Hunedoara, Romania
Introducere. Organizarea activitatii de transfuzie sanguina In spitale este conditionata de:
a) crearea unitatii de transfuzie sanguina din spital (UTS)
b) numirea Comisiei de transfuzie i hemovigilenta a unitatii sanitare
Comisia de transfuzie i hemovigilenta din spital
monitorizeaza nivelul de asigurare a securitatii transfuzionale la nivelul spitalului
este responsabila de organizarea i monitorizarea functionarii sistemului de
hemovigilenta la nivelul spitalului i colaborarea cu Centrul de transfuzie teritorial In
analiza reactiilor i incidentelor adverese posttransfuzionale
Intre CTS i UTS exista o conventie pe baza careia CTS-ul livreaza PSL-uri validate
catre spital.
Scop. Urmarim toate etapele de parcurs pentru administrarea unei transfuzii de sange de la
comanda PSL pana la finalizarea transfuziei.
Prescriptia medicala
Identificarea pacientului: numele , CNP, sexul.
Identificarea i semnatura medicului.
Diagnosticul.
Primirea de produse din sange
La sosirea unui component sanguin, se verifica imperativ:
daca produsul comandat este i cel primit .
concordanta dintre datele de pe formularul insotitor cu datele de pe produsul sanguin
concordanta dintre identitatea pacientului i cea Inregistrata pe formularul de distributie.
Concordanta Intre grupul de grup efectuat la patul bolnavului i cel al pacientului.
Produs: aspect, integritate, produs pastrat la temperatura corespunzatoare i data expirarii.
62

Verifica de pe avizul de expeditie:
Locul de plecare
Destinatie i destinatar
continutul de produse i numarul,
Conditii de depozitare;
Verifica daca exista concordanta Intre comanda, PSL-urile existente i cele scrise pe avizul de
expeditie
Transfuziile salveaza vieti, dar pot, de asemenea, ucide. Neglijenta poate avea consecinte grave.
Dupa transfuzie:
documentele sunt pastrate un exemplar in Foaia de observatie a pacientului , iar celalalt se
returneaza la Unitatea de transfuzie sanguina a spitalului
Trasabilitatea Finalizarea documentelor
Completati cu atentie Formularul de transfuzie , datele pacientului, fara a omite nici o eventuala
reactie posttransfuzionala.
Completeaza formularul de feedback pentru Unitatea de transfuzie din spital si trimite-l
Concluzii. Elementele-cheie pentru siguranta transfuziei sunt:
-O indicatie relevanta;
-Prescriptie corecta;
-Monitorizarea pacientului;
- Raportarea de incidente posttransfuzionale;
-Follow-up (urmarirea pacientului Inainte , In timpul i dupa transfuzie, urmarirea trasabilitatii).
Cuvinte cheie. Trasabilitatea, feed-back, monitorizare

63

Pr 21. Reporting Documents of BTCS and the Interface With Hospitals
Victoria Halmagi
1
, Cristina Bichis
2

1
BTC Deva , Romania
2
BTC Hunedoara, Romania
Introduction
Organization of blood in hospitals depends on:
a) creation unit of the hospital blood
b) appointment of transfusion and haemovigilance health unit
Commission hospital transfusion and haemovigilance
level monitoring to ensure safety in the hospital transfusion
is responsible for organizing and monitoring the functioning haemovigilance system and
working with the hospital transfusion center territorial adverese transfusion reactions and
analysis
Between BTC and UTS there is agreement on which BTC delivers the BLP's (Blood Labile
Products) validated at the hospital.
Purpose
-We follow all the next steps for taking a blood transfusion from BLP command until the
transfusion.
-Prescription
Identification of patient name, identification number, sex.
Identification and signature of doctor.
Diagnosis.
-Receipt of blood products
Upon arrival of a blood component, check imperatively:
if the product ordered is the one received.
consistency of data on the form accompanying the data on blood product
consistency of patient identity and distribution recorded on the form.
Consistency between the group performed at the bedside group and the patient.
Product appearance, integrity, product and store appropriate expiration date.
Check the delivery note:
Point of departure
Destination and consignee
64

content of products and number,
Storage conditions;
Check if there is consistency between the control, BLPs existing and written notice of shipment
Transfusions save lives but can also kill. Neglect can have serious consequences.
-After the transfusion:
documents are kept a copy in pacientuli observation sheet and the other unit is returned to the
hospital transfusion
-Complete traceability documents
Complete the form carefully transfusion, patient data, without omitting any possible transfusion
reaction.
Fill out the feedback form to the hospital transfusion unit and send it
Conclusion
Key elements for transfusion safety
A relevant indication;
-Prescription correct;
-Monitoring of the patient;
- Reporting incidents transfusion
-Follow-up (follow the patient before, during and after transfusion, follow traceability).
Key words. Traceability, Feed-Back, Monitor

65

Pr 22. Iradierea produselor sanguine labile, pentru prevenirea riscului
post-transfuzional al maladiei grefonului contra gazdei (PT-GVHD, engl.)
La pacientii imuno-deprimati
Jean Gerota

Hpital Saint-Louis, Paris

Introducere. Transfuzia de produse sanguine labile (sange total, masa eritrocitara, trombocite
sau granulocite concentrate) transmite, Impreuna cu celulele terapeutic active, celule limfocitare
imuno-competente (ICC) periculoase, care sunt In mod normal respinse de pacientii cu o stare
imunitara intacta. La unii pacienti grav imuno-compromisi, aceste limfocite pot fi activate i apoi
prolifereaza. O astfel de grefa involuntara de ICC este responsabila pentru o varianta (post-
transfuzionala) de GVHD, de asemenea cunoscuta ca o complicatie majora a alogrefei de celule
stem medulare.
Scop. Rata de mortalitate extrem de mare datorate aceastei complicatii, creterea constanta a
indicatiilor i a pacientilor cu risc, indica necesitatea de prevenire a acestei boli In mod eficient,
cu mijloace uor de utilizat, accesibile la orice moment. Centrele de Transfuzie, care ofera
produse sofisticate de sange pentru unitatile clinice moderne de Hematologie, trebuie sa
garanteze absenta oricaror ICC mitotical active, care pot fi prezente printre celulele terapeutice
dorite. Doua variabile intervin In special In declanarea: cantitatea de ICC din produsul sanguin
labil i stadiul de imunosupresie a primitorului.
Metode. Trecem In revista metodele de prevenire a PT-GVHD, In special iradierea produselor
din sange, luand In considerare dozele optime de iradiere pentru: i) inhibarea capacitatii
proliferative ICC, la minim 5 Gy ; ii) pastrarea calitatilor functionale i eficacitatea terapeutica a
celulelor sanguine, la dozele: granulocite sub 50 Gy; trombocite sub 25 Gy pentru concentratele
proaspat preparate i 15 Gy pentru cele conservate 48 h; eritrocite sub 200 Gy; produse
plasmatice labile, la cele mai Inalte limite admise. Reglementarile SUA mentioneaza doze
cuprinse Intre 15 - central 25 - 50 Gy, legislatia franceza indica 25-45 Gy, Consiliul Europei
(2008), BCSH (1996, 2010) i ANZSBT (2003, 2011) indica o doza minima de iradiere In camp
de 25 Gy, cu nici o zona a campului care sa primeasca mai mult de 50 Gy. Pentru tehnica de
iradiere, exista doua posibilitati alternative: i) la Sectia de Radioterapie, folosind aparate cu surse
de
60
Cobalt, sau acceleratorii de particule; ii) la Centrele de Transfuzie sau Clinici de Hemato-
Oncologie, utilizand un iradiator autonom cu surse Inchise de
60
Cobalt sau
137
Cesium, special
66

conceput pentru acest tip de tratament. Optiunea tehnicii se bazeaza pe evaluarea necesitatilor:
iradierea a doar catorva pungi se poate face Intr-un Departament de Radioterapie, dimpotriva, o
cretere a cererilor va fi logic satisfacuta de un irradiator autonom autoprotejat, situat In CTS sau
Clinici.
Concluzie. Expunerea la anumite doze de radiatii ionizante este cel mai eficient mod de a
preveni maladia post-transfuzionala a grefonului contra gazdei. Doza minima absorbita In
campul de iradiere va fi de 25 Gy, cu nici o zona care sa primeasca mai mult de 50 Gy.
Cuvinte cheie. Iradierea produselor sanguine, ICC mytotical active, PT-GVHD
67

Pr 22. Irradiation of Blood Products: Prevention of the Risk of Post-
Transfusion Graft-Versus-Host Disease (Pt-Gvhd) in Immuno-Depressed
Patients
Jean Gerota

Hpital Saint-Louis, Paris

Introduction. Transfusion of labile blood products (whole blood, packed red cells, platelets or
granulocytes concentrates) provides, along with the therapeutically active cells, dangerous
lymphocytes called immune-competent (ICC) cells, which are normally rejected in recipients
with unimpaired immunity. In some severely immune-compromised patients, these lymphocytes
may be activated and then proliferate. Such an involuntary graft of ICC is responsible for a
variant of Graft-versus-Host Disease (GVHD), also known as a major complication of bone
marrow allograft.
Aim. The extremely high mortality rate of this complication and the constant increase of
indication and of patients at risk, indicate the need for the prevention of this disease by efficient,
easy to use means, accessible at any time. Blood Transfusion Centers, providing sophisticated
blood products for modern hematology care units, must guarantee the absence of all mitotically
active ICC which may be present among the therapeutically desired cells. Two variables
intervene especially in triggering a PT-GVHD: the quantity of ICC injected and the stage of the
recipients immunosuppression.
Methods. We discuss the methods of prevention of PT-GVHD, particularly the irradiation of
blood products taking into account the optimal irradiation doses for: i) the inhibition of ICC
proliferative capacity, at minimum 5 Gy; ii) the preservation of functional qualities and
therapeutic effectiveness of blood cells: granulocytes under 50 Gy; platelets under 25 Gy for
fresh prepared concentrates and 15 Gy for stored at 48 h; red cells up 200 Gy; labile plasma
products at the highest limits allowed. The U.S. regulation mention doses between 15-central 25-
50 Gy, French legislation indicates 25-45 Gy, Council of Europe (2008), the BCSH (1996, 2010)
and ANZSBT (2003, 2011) mandate a minimum dose in the irradiation field of 25 Gy, with no
part receiving greater than 50 Gy. For irradiation technique there are two alternatives: i) at
Radiotherapy Department, using
60
Cobalt sources or particle accelerators; ii) at Blood
Transfusion Centers, utilizing a self-contained irradiator using
60
Cobalt or
137
Cesium sources,
especially designed for this type of treatment. The decision to choose between, is based on the
68

evaluation of needs: the irradiation of a few bags can be done in a Radiotherapy Department, on
the contrary, an increasing demand will be done better by a self-contained irradiator.
Conclusion. Exposure to certain doses of ionizing radiations is the most efficient way to prevent
Post-Transfusion Graft-versus-Host Disease. The minimum dose achieved in the entire
irradiation field should be 25 Gy, with no part receiving greater than 50 Gy.
Key words. Irradiated Blood Products, ICC mytotical active, PT-GVHD

69

Pr 23. Modele de raportare (formulare) a reactiilor/incidentelor severe
transfuzionale (cf OMS 1228); prezentarea definitiilor de caz, gradelor
de severitate, nivelului de imputabilitate; ancheta transfuzionala,
Diana Pelea
1
, Patricia Marusca
2
, Ovidiu Burta
2

1
Spital Clinic Pelican Oradea, Centrul de Cercetari in Medicina de Inalta
2
Spital Clinic Municipal Oradea, Centrul de Cercetari in Medicina de Inalta

Introducere. Prin Ordinul Nr. 1228/ 2006 se aduce in prim plan asigurarea trasabilitatii, dar si
Regulamentul privind sistemul de inregistrare si raportare in cazul aparitiei de incidente si
reactii adverse severe legate de colecta si administrarea de sange si de componente sanguine
umane. In conformitate cu legislatia actuala, UTS sunt obligate sa raporteze catre Centrul de
Transfuzie Sanguina si Directia de Sanatate Public ajudeteana toate reactiile/efectele nedorite
posttransfuzionale, incepand cu reactiile minore, pana la incidentele severe, in paralel cu
aplicarea primelor masuri terapeutice/corectoare care se impun.
Scop. Autorii isi propun prezentarea si sustinerea importantei supravegherii pacientului atat in
timpul transfuziei cat si in primele ore posttransfuzional, pentru a creste sansa de a se interveni in
timp real in cazul aparitiei reactiilor sau incidentelor legate de administrarea de sange sau
produse din sange.
Metode. Sunt analizate independent toate etapele in care ar putea sa apara astfel de evenimente,
precum si obligatiile personalului implicat in actul transfuzional, cu exemplificarea lor, pe grade
de severitate.
Concluzie. Pentru recunoasterea acestor reactii/incidente legate de actul transfuzional,
personalul trebuie instruit periodic pe baza unor proceduri si instructiuni de lucru cu privire la
masurile care se vor lua in astfel de situatii cand pe baza inregistrarilor efectuate anterior si a
contraprobelor pastrate in UTS, se declanseaza o ancheta interna pentru investigarea cauzei si
stabilirea nivelului de imputabilitate.
Cuvinte cheie. Incidente, reactii adverse, act transfuzional
70

Pr 23. Reporting models (documents) for severe transfusion
reactions/incidences (cf OMS 1228); cases definitions, severity degrees,
level of imputability; transfusion investigation
Diana Pelea
1
, Patricia Marusca
2
, Ovidiu Burta
2

1
Pelican Clinic Hospital Oradea, High Performance Medical Research Center, Faculty of
Medicine and Pharmacy, University of Oradea, Romania
2
Municipal Clinic Hospital Oradea, High Performance Medical Research Center, Faculty of

Introduction. Based on MH Order 1228/2006 the traceability assurance is detailed, but also the
regulations regarding the registration and reporting system of severe transfusion adverse
reactions, related to blood and blood products collection and administration. According to
current legislation, the HTU are obliged to report to Blood Transfusion Center (as supplier) and
to Public Health Agency, all unexpected posttransfusion reactions/effects, from the minor ones to
severe incidences, in parallel with appropiate therapeutic/corective measures.
Aim. The authors present and insist on the importance of patients surveillance both during the
transfusion therapy and during the first hours portransfusion, having the motivation to increase
the chance of therapeutic support in due time, in case of any reactions/incidents occurence,
related to blood and blood products administration.
Material and method. Independently, are analyzed all the phases which could be part of such
events occurrence, along with the medical staff responsabilities regarding the transfusion
therapy; in order to be more useful there are presented examples, divided according to their
severity.
Conclusion. For recognition of these reactions/incidents related to blood and blood products
administration, the staff should be periodically trained specifically, based on certain work sheet
and procedures; these are devoted to the measures imposed to be followed in such conditions,
using lab data and recorded results (from both patient and transfused samples); the chain
continues with internal investigation to identify the cause and to be established the imputability
level.
71

Key words. Incidents, Adverse Reactions, Transfusion Therapy

Pr 24. Formulare aferente activitatii Unitatilor de transfuzie sanguina
(UTS)
Diana Pelea
1
, Patricia Marusca
2
, Corina Posea
3
4

1
2
3
Spital Universitar de Urgenta Bucuresti, Romania
4
Centrul de Transfuzie Sanguina Oradea, Centrul de Cercetari in Medicina de Inalta

Introducere. In conformitate cu legislatia in vigoare trebuie sa existe o trasabilitate a produselor
din sange si derivate, din primul moment: screeningului predonare, pana la final: cand produsul
ajunge la utilizator (beneficiar al produsului sanguin). In spitale, trasabilitatea acestor produse se
asigura si se documenteaza la nivelul UTS.
Scop. Autorii isi propun sa prezinte un model pentru un sistem de inregistrari specifice UTS,
astfel incat fiecare etapa sa fie monitorizata, incepand cu documentarea necesitatii terapiei
transfuzionale pentru un pacient pana la momentul posttransfuzional, intr-o maniera usor de
identificat de-a lungul lantului de actiuni, pe baza inregistrarilor efectuate de catre personalul
echipei implicate in transfuzie.
Material si metoda. Este identificat initial sirul al activitatilor din UTS, dupa care sunt
prezentate intr-o succesiune logica si fireasca modele pentru formularele ce pot fi utilizate pentru
inregistrarea tuturor datelor, in acord cu legislatia in vigoare.
Concluzie. Implementarea la nivel de utilizatori finali (UTS) a documentatiei complete pentru
asigurarea trasabilitatii unitatilor de sange si derivate de sange, este azi nu numai o necesitate
legislativa, dar si una de importanta practica majora, ca parte a sistemului de calitate in domeniul
securitatii transfuzionale.
72

Cuvinte cheie. Legislatie, trasabilitate, formulare, securitate transfuzionala

Pr 24. Documents corresponding to hospital transfusion unit (HTU)
activity
Diana Pelea
1
, Patricia Marusca
2
, Corina Posea
3
4

1
2

3
Emergency Universitar Hospital Bucharest, Romania
4
Blood Transfusion Center Oradea, High Performance Medical Research Center, Faculty of
Introduction. According to current legislation, is compulsory to exist the traceability of blood
and blood products, starting with the first moment: blood donors screening procedure, till the
end: when the therapeutic product is administered (gets to the beneficiar). In hospitals the
traceability is assured and is documented as well, at the level of HTU.
Aim. The authors propose a certain model for specific records al HTU level, in such a manner
that each phase can be monitor, starting with documents based on the needs of transfusion
therapy for the patient, till the postransfusion phase; the monitorization should be done in a very
efficient and logical way along the chain of activities, according to registered data, by the
members of the team involved in transfusion therapy.
Material and mothod. Initially is identified the chain of HTU activities, then are presented in a
logical sequence the models for certain documents, which could be used for all required data
records, in accordance to current legislation.
Conclusion. The implememtation of complete documentation at the level of the beneficiars
(HTU) in order to assure the traceability of the blood and blood products, is nowadays not only
under the legislation umbrella, but tremendous important in practice, as part of the quality system
in transfusion safety domain.
Key words. Legislation, Traceability, Documents, Transfusion Safety
73

Pr 25. Legislatia aferenta organizarii si functionarii Comisiei de
Transfuzie si Hemovigilenta (CTH) si Unitatii de Transfuzie Sanguina
(UTS)
Diana Pelea
1
, Patricia Marusca
2
, Simona Parvu
3

1
2
3
Ministerul Sanatatii Romania Departamentul de Sanatate Publica si Control

Introducere. Ultimii cinci ani au adus o reorganizare semnificativa a Sistemului National de
transfuzii si hemovigilenta; anul 1996 ramane ca referinta pentru plusul legislativ in activitatea
transfuzionala atat la nivelul retelei nationale a centrelor de transfuzie, cat si la nivelul utilizator
final: UTS; astfel, intr-o singura zi (9 octombrie 1996) s-au emis 5 (cinci) Ordine MS cu privire
la organizarea si functionarea activitatii transfuzionale.
Scop. Autorii propun trecerea in revista a principalelor Ordine MS cu impact asupra activitatii
transfuzionale in spitale.
Material si metoda. Sunt prezentate pe scurt cerintele acestor ordine complementare. Primul
Ordin (nr. 1224/ 9 octombrie 1996), reglementeaza activitatea de transfuzie din spitale, fiind
urmat de un altul care enunta conditiile pentru autorizarea UTS (nr. 1225/9 octombrie 1996).
Ordinul MS Nr. 1228/ 9 octombrie 1996 este cel mai complex: reglementeaza organizarea
sistemului de hemovigilenta, pentru dovedirea trasabilitatii, enuntand in acelai timp
Regulamentul privind sistemul de inregistrare si raportare in cazul aparitiei de incidente si
reactii adverse; anul urmator, Ordinul MS nr. 1167/2 iulie 2007 aduce completari la Ordinul MS
nr. 1228/ 9 octombrie 1996.
Concluzie. Legislatia actuala reuete sa acopere principalele probleme legate de actul
transfuzional. Ordinul MS nr. 1132 din 27 iunie 2007 jaloneaza standardele si specificatiile
referitoare la sistemul de calitate in activitatea transfuzionala, sistem de calitate care trebuie
74

implementat si care armonizeaza activitatile, procesele si documentatia intr-un tot unitar capabil
sa demonstreze in permanenta trasabilitatea produselor sanguine.
Cuvinte cheie. Legislatie, comisia de transfuzie si hemovigilenta, unitatea de transfuzie sanguina
Pr 25. Current legislation about transfusion and hemovigilance
comission (THC) and hospital transfusion unit (HTU),
Diana Pelea
1
, Patricia Marusca
2
, Simona Parvu
3

1
2

3
Romanian Ministry of Health Public Health and health Control Dept

Introduction. During the last 5 years, was noticed a significant re-organization of National
Network according to Transfusion Activity and Hemovigilance System; 1996 represents a
reference in legislative domain on both blood transfusion centers activity (as supplier) and the
HTU (as beneficiar), due to 5 Ministerial Orders, issued in a single day (October 9
th
).
Aim. The authors intention is to present sequentially the main Ministerial Orders, with
significant fingerprint upon transfusion activity at hospital level.
Material and method. There are briefly presented the requirements of the complementary
orders. The 1st one (1224/1996, October 9th) establish the hospital transfusion activity, being
followed by another one where are stated the conditions for HTU authorization (1225/1996,
October 9th). The most complex one is 1228/1996, October 9th, which deals with hemovigilance
system organization, in order to support traceability, along with regulations for
recording/reporting the posttransfusion incidences and adverse reactions; in 1997, July 2nd, was
issued the MH Order nr. 1167, to complete the MH Order 1228/1996, October 9th.
Conclusion. The current legislation succeds to cover the major problems related to transfusion
activity. The MH Order 1132/2007 July, 27th, is focused on quality system, aiming the
activities/processes/documentation harmonization, in such a manner to exist the possibility for
permanent tracing of blood products.
Key words. Legislation, Transfusion and Hemovigilance Comission, Hospital Transfusion Unit
75

76

Pr 26. Alianta europeana a sangelui: prezentare, realizari in 2011,
proiecte pentru 2012
Gilles Folla, Olivia Ligia Burta, Andrei Rosin

Introducere. Alianta Europeana a Sangelui (EBA) este constituita dintr-o retea de organizatii
nationale cu interes in domeniul sangelui creata in 1998, avand rolul de a facilita colectarea
informatiilor si schimbul de cunostinte, la nivelul Statelor Uniunii Europene si alte state
europene nemembre, avand de asemenea si parteneri inafara Europei.
Scop. Prezentarea este structurata pe detalierea: misiunii si scopului EBA, obiectivelor strategice,
calitatea de membru, structura organizatorica, activitatile curente si proiectele viitoare.
Rezultate. Misiunile primordiale ale Aliantei Europene a Sangelui sunt de a contribui la
securitatea si furnizarii unui produs sanguin, celule sau tesuturi eficiente din punct de vedere
terapeutic, de a promova donarea de sange voluntara si ne-remunerata cat si performanta
profesionala, toate acestea fiind sustinute de reteaua activa de unitati medicale implicate in
terapia transfuzionala (din cele 25 de state membre).Profesionalismul Aliantei Europene a
Sangelui are la baza modul de luarea a deciziilor: intr-o maniera de consens, cu rezultate pe
masura, reflectate la nivelul unui panel larg de proiecte (derulate/in curs de
derulare/previzionate) de exemplu: benchmarking-ul (atingerea unor standard de referinta, pe
baza evaluarilor comparative) achizitie complementara, validarea colaborativa, domeniile
celulelor si tesuturilor, programe de educatie si instruire, servicii de furnizare de audituri (care
este un proiect pilot) donarea de sange remunerate vs. ne-remunerata, incidenta patologiei
infectioase. Lista lunga a realizarilor aliantei, dovedeste strategia logica in domeniul transfuziei,
cu intentia ca actiunile sa fie complementare cu prioritatile identificate si agreate.
Concluzie. Alianta Europeana a Sangelui ofera oportunitatea de a face pasi in directia
armonizarii anumitor standarde referitoare la sange si componentele sanguine, la nivel mondial,
cu implicarea nemijlocita a activitatilor colaborative ale EBA (ABO) in beneficiul donatorului,
primitorului de sange si nu numai.
Cuvinte cheie. Retea, schimb de cunostinte, luarea deciziilor, prioritati agreate

77

Pr 26. European Blood Alliance: Presentation, Achievements in 2011,
Projects for 2012
Gilles Folla, Olivia Ligia Burta, Andrei Rosin

European Blood Alliance (EBA)
Introduction. The European Blood Alliance (EBA) is the network of national blood
organizations, created in 1998, which facilitates information collection and knowledge exchange
in the European Union Member States and some other European countries, having global
partners, as well.
Aim. The presentation skeleton is composed of: Mission and Scope, Strategic Objectives,
Membership, Organizing Structure, Current Activities and Future Projects.
Results. The main missions of the European Blood Alliance (EBA) is to contribute to the safety
and efficiency of the supply of blood products, cells and tissues, to promote Voluntary and non-
remunerated donation, and Performance, as well, due to its active network of blood
establishments in Europe (25 countries). EBA professional is supported by The decision making:
based on consensus, with important outcomes, reflected on the large panel of projects
(ruled/ongoing/foreseen) such as: Benchmarking, Joint procurement, Collaborative validation,
Tissues and Cells, Education and training, Coll. Supplier audits (pilot), VNRD versus paid
donations, Emerging Infectious Disease. The list of the main achievements proves the logical
strategy in transfusion domain, in order to act complementary on agreed priorities.
Conclusion. EBA supplies the opportunity to make steps toward harmonizing certain standards
for blood and blood components worldwide, being necessary a deeper involvement in the
EBA (ABO) collaborative activities, for the benefit of patients and donors, and beyond.
Key words. Network, Knowledge Exchange, Decision Making, Agreed Priorities
78

Pr 27. Interconditionarea: fisa postului program de instruire a cadrelor
sanitare medii evaluarea anuala a performantelor profesionale,
Romulus Roman
1
1,2
, Radu Iovan
2
, Patricia Marusca
2

1
Centrul de Transfuzie Sanguina Oradea
2
Centrul de Cercetari in Medicina de Inalta Performanta/FMF/UOradea

Introducere. Pornind de la Ord. Nr. 1229/01.08.2011, este prezentat si comentat fiecare criteriu
de evaluare, in paralel cu subcriteriile identificate si definite la nivelul Centrului de Transfuzie
Sanguina Oradea.
Scopul. Lucrarea prezinta o abordare originala si specifica a activitatii unui centru de transfuzie,
urmarind adaptarea la cerintele de evaluare anuala a personalului angajat, in conformitate cu
legislatia in vigoare.
Material si metoda. Bazat pe documentul oficial, se insista asupra originalitatii dezvoltarii unui
sistem de evaluare propriu ancorat la realitate, consta in prezentarea unor momente istorice
critice, fiecare caracterizat din punct de vedere al sistemului social, motivatiei si tipologiei
individului. Urmarindu-se atat elementele comune cat si cele specifice momentului raportat, a
fost proiectat un model logic de instruire, conditionat de obiectivul principal, acela de ridicare a
nivelului calitatii actului medical a activitatii transfuzionale prespitalicesti. Curricula de instruire,
alaturi de motivatia ei in cadrul criteriilor de evaluare anuala, este prezentata secvential, pentru
fiecare compartiment de lucru, cu o derulare de subiecte teoretice si practice, de la simplu la
complex, cu monitorizarea evolutiei individuale; structura programului a fost proiectata si
dezvoltata in ultimii 3 ani, din momentul in care s-a recunoscut necesitatea ridicarii la un nivel
superior a calitatii actului medical, intr-un colectiv subdimensionat, in care atat volumul de
munca, cat si complexitatea actului medical creste progresiv.
Concluzii. Sistemul de calitate in medicina transfuzionala este conditie esentiala in asigurarea
securitatii transfuzionale, in conditiile unui management performant. Pornindu-se de la realitatea
romaneasca, se impune gasirea de solutii adaptate la situatia actuala, menite sa dezvolte atat
cunoastintele si abilitatile practice ale personalului unui centru de transfuzie sanguina, cat si
gradul de constientizare a importantei actului medical specific, toate acestea putand fi
cuantificate si monitorizate periodic la nivelul managementului de varf. De asemenea este
imperios necesara configurarea unei scheme la nivel national de instruire a personalului, cu
dezvoltarea unei bibliografii specifice, adaptata fiecarei categorii profesionale.
Cuvinte cheie. Criterii de evaluare, instruire, management performant
79

Pr 27. Interrelation: individual professional responsibility sheet medical
staff training program annual evaluation of professional skills,
Romulus Roman
1
1,2
, Radu Iovan
2
, Patricia Marusca
2

1
Blood Transfusion Center Oradea , Romania
2
High Performance Medical Research Center/Faculty of Medicine and Pharmacy/University of
Oradea , Romania

Introduction. The reference document is the Romanian Ministry of Health Order, nr.
1229/01.08.2011; each criterion, part of the order, is discussed and divided in subcriteria,
identified and defined in accordance to Oradea Blood Transfusion Center activity.
Aim. The paper presents an original and specific approach of a blood transfusion center activity,
having the purpose to adapt it to annually evaluation criteria of medical staff, according to
current Romanian legislation.
Material and method. Based on the official document, was built The original part of the
evaluation, expressed by the interrelation with current reality, but having as guidelines, the
features of few historic critical moments, from the individual point of view (according to social
system, human motivation and typology). Both common and specific elements were reported
taking into account the certain moment, and based on these, was projected a logical training
schedule, following the main objective, identified as continuous increase of medical act quality
in pre-hospital transfusion activity. Sequentially, is presented the training curricula, along with
the motivation of annually evaluation criteria, according to each department for theoretical and
practical professional achievements, progressively from simple to complex approach, with
periodical monitor of individual evolution, as well. The entire structure of training program, was
developed during last 3 years, the start moment being motivated by obvious necessity to augment
the quality of medical act, in a certain reduced medical collectivity, being characterized by
progressive higher quantity of work and complexity of medical act, as well.
Conclusions. The quality system in transfusion medicine is an essential condition for transfusion
safety assurance, part of a high performance management. Based on Romanian reality, is
tremendous important to search and find specific answers and solutions, having the aims the
development of both knowledge and skills specific to a blood transfusion center medical staff,
and the level of awareness of the importance of medical act, all of these respects being
periodically quantified and monitored, by the top management system. Also, was proved the
necessity to build a national scheme of training sessions adapted on purposes, along with up-to-
date specific bibliography, according to certain professional categories.
80

Key words. Evaluation Criteria, Trening Schedule, Performant Management

Sesiunea postere
tineri medici /studenti
Proiectul:
Reactii transfuzionale
(mecanisme imunologice/non-imunologice)

Young Doctors/Students
Project:
Transfusion - Related Reactions
(immunologic/non-immunologic
mechanisms)

81

Po 01. Tulburari posttransfuzionale ale potasiului si echilibrului acido-bazic
Mir, Hira1, 3, Mir, Hajra2, 3, Ovidiu Burta3, Olivia Ligia Burta3, 4

1
Student, Facultatea de Medicina si Farmacie Oradea, Romania
2
Medic rezident Medicina Interna, Spitalul Clinic Municipal Gavril Curteanu, Oradea,
Romania
3
4

Introducere. Transfuzia masiva (TM) de sange (administrarea de mai mult decat 10 unitati)
poate afecta atat pH-ul cat si kaliemia recipientului. Acidoza metabolica si hiperkaliemia sunt
modificari tranzitorii si rare, putandu-se dezvolta dupa administrarea rapida de cantitati mari de
sange, care in decursul conservarii pretransfuzie si-au modificat pH-ul (devenind acidic) si
potasiul (devenind hiperkaliemic). Persistenta acidozei si hiperkaliemiei, se datoreaza fie unei
insuficiente hepatice preexistente sau a unei hipoperfuzii tisulare a recipientului, ducand la
acidoza lactica, cu scaderea excretiei renale a potasiului si cu eliberarea potasiului de la nivelul
celulelor anoxice. Pe de alta parte, alcaloza metabolica si hipokaliemia sunt mult mai frecvente,
datorate citratului din sangele conservat, care dupa administrare va fi metabolizat si va fi
convertit in bicarbonat.
Scop. Lucrarea prezinta succint mecanismele fiziopatologice care duc la tulburari ale potasiului
si echilibrului acido-bazic, in conditiile unei transfuzii masive de sange si a atrage atentia asupra
prevenirii, ameliorarii/tratarii acestor complicatii.
Materiale i metode. Aceste mecanisme sunt ilustrate prin diagrame diferite i un caz clinic,
selectat pentru a fi cat mai sugestiv acest domeniu de patologie posttransfuzionala.
Concluzie. Tulburarile de potasiu si ale echilibrului acido-bazic pot fi fatale. Fiecare conditie
patologica asociata, exacerbeaza dezechilibrele, ca intr-un ciclu vicios. Este imposibil de a
preveni sau minimaliza aceste dezechilibre, fiind binestiut ca TM se indica In situatii de maxima
urgenta, iar preventia impune utilizarea produselor sanguine spalate. Rezulta importanta
anamnezei corecte pentru a identifica patologiile asociate, In plus, ori de cate ori se indica TM,
ritmul de administrare trebuie sa fie lent, cu monitorizarea extrem de atenta a simptomelor
pacientului, ECG, tensiunii arteriale, i ionograma care pot ajuta la recunoasterea, tratarea, dar
mai ales preventia dezvoltarii acestei patologii.
Cuvinte cheie. Complicatii transfuzie, hiperpotasemie, acidoza metabolica, hipokaliemie,
alcaloza metabolica

82

Po 01. Post-Transfusion Potassium- and Acid-Base- Imbalance
Mir, Hira
1, 3
, Mir, Hajra
2, 3
, Ovidiu Burta
3
3, 4

1
Student, Faculty of Medicine and Pharmacy, Oradea, Romania
2
Internal Medicine Resident, Clinical Municipal Hospital, Oradea, Romania
3
High Performance Medical Research Center/ Faculty of Medicine and Pharmacy/ University of
Oradea
4

Introduction. Massive blood transfusion (MT), i.e. more than 10 units, can cause pH and serum
potassium abnormalities. Metabolic acidosis and hyperkalemia are transient and rare, occurring
after a fast transfusion with blood that has become acidic and hyperkalemic during storage.
Persistent acidosis and hyperkalemia, however, occur either due to underlying liver failure or
tissue hypoperfusion, leading to lactic acidosis, diminished renal excretion of Potassium, and
release of Potassium from damaged anoxic cells. On the other hand, metabolic alkalosis and
hypokalemia are more frequent, as citrate from stored blood is metabolized into bicarbonate.
Objective: The purpose of this presentation is to examine the pathophysiological mechanisms
leading to Potassium and Acid-Base disturbances after massive blood transfusions, aiming to
prevent, minimize, and treat these complications.
Materials and Methods. These mechanisms are illustrated using various diagrams and a clinical
case presentation, in order to underline the main aspects to be known by all medical categories
involved in transfusion therapy.
Conclusion. Potassium and acid-base disturbances can be fatal. Each condition exacerbates the
other, often leading to vicious cycle. It is impossible to prevent minimize these reactions by
washing blood products because the vast majority of MTs are conducted in emergency situations.
Good history taking to identify underlying conditions in addition using slower rates of
transfusion and fresher blood while monitoring patient symptoms, ECG, blood pressure, and
electrolyte values can help identify affected individuals for early rectification.
Keywords. Transfusion Complications, Hyperkalemia, Metabolic Acidosis, Hypokalemia,
Metabolic Alkalosis

83

Po 02. Hipocalcemia post-transfuzionala
Mir Hira1, 3, Mir Hajra2, 3, Patricia Marusca3,4, Ovidiu Burta3,4

1
2
Medic rezident Medicina Interna, Spitalul Clinic Municipal Gavril Curteanu, Oradea,
Romania
3
Centrul de Cercetari in Medicina de Inalta Performanta/FMF/Uoradea
4
Spital Clinic

Introducere. Solutia de citrat avand abilitatea de chelare a ionilor de calciu, are efect anti-
coagulant. In situatii obisnuite, este bine tolerata atat dupa administrarea de sange sau produse
sanguine, cat si dupa procedura de afereza. Cu toate acestea, uneori pot apare efecte adverse, de
exemplu o hipocalcemie severa, care in cazul procedurilor de afereza sunt raportate cu o
frecventa de 0.38%, in conformitate cu Crocco, et al (1997).
Scop. Lucrarea de fata explica etiologia toxicitatii cu solutie de citrate, prezinta din punct de
vedere clinic aceasta patologie, cat si tratamentul (atat postransfuzional cat si postafereza).
Material si metode. Informatiile au fost colectate si coroborate dintr-o varietate de studii, iar
mecanismele fiziopatologice, clinical si diagnosticul sunt ilustrate in imagini si diagrame, intr-o
maniera atractiva, usor de inteles. Cazul clinic vine sa sustina importanta recunoasterii precoce a
patologiei, pentru instituirea terapiei corectoare in timp util.
Concluzie. Dei dezvoltarea toxicitatii post-transfuzionala cu citrat este rara cu forme clinice
in general usoare, atunci cand este prezenta, nu poate fi ignorata, impunandu-se corectarea
metabolica rapida.
Cuvinte cheie: citrat de toxicitate, hipocalcemie, corectare metabolica

84

Po 02. Post-Transfusion Citrate Toxicity
Mir Hira
1, 3
, Mir Hajra
2, 3
,

Patricia Marusca
3,4
, Ovidiu Burta
3,4

1
2
Internal Medicine Resident, Clinic Municipal Hospital, Oradea, Romania
3
High Performance Medical Research Center/ Faculty of Medicine and Pharmacy/ University of
Oradea
4
Clinic Municipal Hospital, Oradea, Romania

Introduction. Citrate functions as an anti-coagulant by chelating calcium ions. Normally, it is
well tolerated after blood transfusions and apheresis and metabolized in the body but it may have
adverse effects e.g. severe hypocalcemia, in up to 38% of apheresis procedures, according to
Crocco, et. al (1997).
Objective. The aim of this presentation is to explain the causes of citrate toxicity, its clinical
presentation, and its treatment.
Materials and methods: Data was collected from a variety of studies, All patho-physiological
mechanisms are illustrated using diagrams and pictures. A clinical case is included to show the
importance of citrate toxicity.
Conclusion. Although post-transfusional citrate toxicity is rare and mild when present, its
existence can not be entirely ignored, as dignosis requires a high index of suspicion.
Key words: Citrate Toxicity, Hypocalcemia, Metabolic Correction

85

Po 03. Reactia hemolitica acuta si intarziata post-transfuzionala
Ioana Zaha1,2, Olivia Ligia Burta2

1
2

Introducere. Reactiile hemolitice post-transfuzionale (HTRs) sunt reactii in care eritrocitele
donatorului de sange sunt distruse de catre anticorpii din organismul gazda (recipient).
Distrugerea poate sa se dezvolte intr-un interval foarte scurt sau la un anumit interval de timp,
dupa administrarea terapeutica a sangelui sau produselor sanguine.
Scop. Acest articol are scopul de a ilustra intr-o maniera schematica si logica mecanismul de
producere al acestor reactii, si in acest context sa se sublinieze importanta preventiei, cat si
tratamentul aplicabil.
Material si metoda. Sunt prezentate secvential: etiologia, mecanismul fiziopatologic, semnele
clinice si simptome in primele 24 de ore, diagnostic si tratament, masuri de preventie; selectia
unui caz clinic sugestiv ajuta la intelegerea patologiei prezentate, a mecanismului de aparitie si
identificarea in timp util a patologiei.
Concluzie. Tinand cont de cele 2 mari categorii, putem spune ca in cazul reactiilor acute, acestea
se datoreaza in general erorilor umane, fiind frecvente cazurile in care grupul de sange O este
transfuzat pacientilor cu grup A,B sau AB, o categorie susceptibila aparte fiind pacientii care
primesc maduva sau celule stem incompatibile. In cea de-a doua categorie, a reactiilor intarziate,
acestea pot trece nedetectate, pacientii sunt de regula cei care au avut transfuzii in antecedente
sau sarcini multiple, dar la momentul respectiv anticorpii au fost intr-un titru scazut, iar reactia
greu detectabila.
Cuvinte cheie. Reactii hemolitice, anticorpi anti-A, anti-B, anti-Jk, antigen Rh

86

Po 03. Acute and Delayed Hemolytic Reactions
Ioana Zaha
1,2
2

1
Student, Faculty of Medicine and Pharmacy Oradea, Romania
2
Oradea

Introduction. Hemolytic transfusion reactions (HTRs) are reactions in which the donor RBCs
are destroyed by antibodies in the recipients` circulation. These can be destroyed in a acute or
delayed manner, after transfusion therapy.
Purpose. This article shows in a schematic and logical manner the mechanism of production in
these reactions, and by this to offer a clear image of the way the treatment works, and prevention
importance.
Materials and Methods. There are sequentially presented: the etiology, pathophysiological
mechanism, clinical signs and symptoms within 24 h, diagnosis and treatment, measures of
prevention, a typical clinical case presentation of the pathology for a much better understanding
of the mechanism and the fast recognition of the pathology.
Conclusion. Taking into account the 2 main types, we can consider that acute reactions are
caused by human errors, frequently in case that group O is given to patients with group A,B or
AB, and also a susceptible category is the patients who receive bone marrow or stem cells that
are incompatible.
The second type, delayed reactions can occur undetected, regularly there are patients that have
had transfusions in the past, or pregnancy, but at the time the titer of the antibodies is too low,
and the reaction was to weak to be detected.
Key words: Hemolytic Reactions, Anti-A antibodies, Anti-B antibodies, Anti-Jk antibodies, Rh
antigen.
87

Po 04. Supraincarcarea circulatorie posttransfuzionala
Andrei Tarsoly
1, 2
, Romina Crisan
1, 2
2
, Diana Pelea
2

1
2

Introducere. Lucrarea de fata, prezinta unul dintre efectele nefavorabile, relativ comun ale
terapiei transfuzionale si anume supraincarcarea circulatorie.
Scop. In practica medicala exista situatii diverse care pot duce la supraincarcarea circulatorie,
transfuzia in exces fiind una dintre ele, fapt care a motivat interesul nostru pentru acest subiect.
Material si metoda Urmand cursul logic al unei expuneri, am incercat intr-un mod cat mai
schematic si atractiv, sa prezentam aspectele fiziopatologice, clinica, diagnosticul si atitudinea
terapeutica in aceasta situatie, cu sublinierea importantei prevenirii ei. Cazul clinic vine sa
sustina importanta recunoasterii in timp util a supraincarcarii circulatorii (urmarirea si
monitorizarea semnelor vitale) si respectarea criteriilor de administrare a sangelui si produselor
de sange, in context clinic individual.
Concluzii: Scurt si la obiect, proiectul doreste sa atraga interesul unei plaje largi de categorii
profesionale medicale, de la medici la studenti prin paradoxul simplitatii sale ce, in acelasi timp,
nu scapa deloc informatii vitale.
Cuvinte cheie: supraincarcare, terapie transfuzionala, context clinic

88

Po 04. Posttransfusion circulatory overload
Andrei Tarsoly
1, 2
, Romina Crisan
1, 2
2
, Diana Pelea
2

1
2
High Performance Medical Research Center/ of Medicine and Pharmacy /University of Oradea

Introduction. The presentation is targeted on one of the most common unfavorable effects of
transfusion therapy, known as circulatory over-load.
Aim. In medical practice, there are different situations when circulatory over-load occurs. One of
these, is represented by transfusion in excess, our interest being motivated by this condition.
Material and method Following a logical frame, we tried to express in a very schematic and
attractive manner the patho-physiologic, clinical respects, the diagnosis and therapeutic attitude,
stretching the importance of prevention this medical condition. The case study, supports the
recognition in due time of this pathology (to follow and monitor the vital signs), but mainly the
correct prescription of blood and blood products, according to individual clinic context.
Conclusions. Briefly and pointed, the presentation main purpose is to attract the interest of a
wide range of professional categories, from physicians to medical students; even could be
consider a paradox the simplicity of the topic, it does not lack substance, even vital information.
Key words: Over-load, Transfusion Therapy, Clinic Context
89

Po 05. Insuficienta respiratorie acuta post-transfuzionala
Carina, Dudas (Petricau)
1, 2
2

1
2

Introducere. In conformitate cu UK SHOT (1996-2007) si US FDA (2005-2007), insuficienta
respiratorie acuta post-transfuzionala (TRALI) este principala cauza de deces raportata
sistemului de hemovigilenta.
Scop: Scopul acestei cercetari a fost de a identifica si de a intelege mecanismele imunologice a
reactiei TRALI si bazat pe acestea, sa gasim care sunt aspectele specifice medicinei
transfuzionale care ar putea fi imbunatatite in scopul de a reduce probabilitatea reactiei cu
evolutie potential fatala.
Material si metoda. Importanta recunoasterii in timp util a TRALI, precum si mecanismele
fiziopatologice ale ei, cunoscandu-se ca este o reactie post-transfuzional bazata pe doua
mecanisme imunologice complicate, care duc la edem pulmonar acut non-cardiogen, rezida din
potentialul fatal, in special in cazul in care beneficiarul de sange are o patologie pulmonara pre-
existenta. Prezentarea schematica intr-o ordine logica a evenimentelor clinice/paraclinice (in
special imunologice) a diagnosticului si terapiei specifice, ajuta la intelegerea patologiei, putand
fi identificata ca si referinta pentru orice cadru medical implicat in terapia transfuzionala. Cazul
clinic selectat, sustine necesitatea cunoasterii aspectelor medicale, pentru o conduita terapeutica
corecta si eficienta.
Concluzie. Deoarece mecanismele de TRALI au la baza lor prezenta anticorpilor anti-HLA in
plasma donatorului, aceasta reactie post-transfuzionala ar putea fi redusa prin spalarea produselor
sanguine, prin scaderea cantitati de plasma administrata, prin evitarea folosiri plasmei de la
femei multipare pentru persoanele cu o patologie pulmonara pre-existenta, si desigur
indentificarea corecta a reactie si tratarea acesteia.
Cuvinte cheie. reactii de transfuzie, HLA, edem pulmonar, imunologie

90

Po 05. Transfusion Related Acute Lung Injury (Trali)
Carina, Dudas (Petricau)
1, 2
2

1
2

Introduction. According to UK SHOT (1996-2007) and US FDA (2005-2007), Transfusion
Related Acute Lung Injury (TRALI) is the leading cause of death reported to the hemovigilance
system. TRALI is a post-transfusion reaction based on two intricate immunological mechanisms
leading to non-cardiogenic edema which could be fatal especially if the blood recipient has a pre-
existing lung pathology.
Purpose. The purpose of this research was to identify and understand the immunological
mechanisms of TRALI reaction and by this draws conclusions on which aspects of Transfusion
Medicine might be improved in order to decrease this possibly fatal reaction.
Conclusion. Because TRALI mechanisms have at their base the presence of anti-HLA in the
donor plasma, this post-transfusion reaction could be minimized by washing blood products,
decreasing amounts of plasma administered, avoid multiparous women donors for individuals
with pre-existing pathology and most importantly: identify the reaction and treat as soon as
possible.
Key words. Transfusion Reactions, Human Leukocyte Antigen, Pulmonary Edema, Immunology
91

Po 06. Boala grefon contra gazda post-transfuzionala
Lavinia Florentina Rad
1,2
2

1
2
Introducere. Dei boala post-transfuzionala grefa-contra-gazda (TA-GVHD) este raportata rar
in ultimii ani, prognosticul extrem de nefavorabil subliniaza importanta cunoasterii tuturor
aspectelor legate de aceasta afectiune.
Scop. Scopul acestei cercetari este descrierea mecanismului care permite dezvoltarea acestei
patologii (TA-GVHD), cunoaterea categoriei pacientilor cu risc, cunoaterea simptomelor si
complicatiilor si de a insista asupra rolului iradierii produsului sanguin in preventia TA-GVHD.
Material si metoda. Mecanismul fizio-patologic/imunologic al aparitiei TA-GVHD are la baza
limfocitele donorului care initiaza un raspuns de rejectie a tesutului gazdei. Simptomele apar
pana la 30 de zile de la transfuzie, facand uneori dificila asocierea simptomelor cu terapia
transfuzionala. Amanarea diagnosticului agraveaza prognosticul care este oricum extrem de
nefavorabil, putand cauza moartea (complicatii ale pancitopeniei) din cauza inexistentei unui
tratament eficient. Cazul clinic selectat si prezentat subliniaza importanta intelegerii patologiei,
recunoasterii preococe, dar mai ales a preventei apartiei..
Concluzie. TA-GVHD in general nu raspunde la tratamentele folosite pentru GVHD in
transplanturile de maduva osoasa, rolul crucial detinandu-l preventia (identificarea pacientilor cu
risc si utilizarea pentru terapie transfuzionala a produselor sanguine (care contin limfocite T
viabile imuno competente) doar iradiate gamma
Cuvinte cheie. reactii posttransfuzionale tardive, iradierea produselor sanguine, imunologic

92

Po 06. Transfusion-Associated Graft Versus Host Disease (TA-GVHD)
Lavinia Florentina Rad1,2, Olivia Ligia Burta2

1
2
Oradea
Introduction. Although graft-versus-host disease (TA-GVHD) has a relatively low incidence in
recent years, the extremely severe prognosis underlines the importance of being familiar with
specific aspects of presented pathology.
Purpose. The purpose of the presentation is to describe the mechanism that allows transfusion-
associated graft versus host disease (TA-GVHD) to occur, the category of patients at risk, the
symptoms/complications and to insist on the tremendous role of irradiated blood components for
preventing TA-GVHD.
Materials and Methods. The patho-physiologic/immunologic mechanism of TA-GVHD is
represented by donor lymphocytes able to initiate a rejection response of the host tissue. The
symptoms can occur up to 30 days after transfusion therapy, making difficult sometimes to
associate them to prior transfusion. The delayed diagnosis aggravates already extremely
unfavorable prognosis till death (due to complications of pancytopenia) not existing any effective
treatment. The selected clinical case underlines the importance of understanding, early
recognition, but mainly pathology prevention.
Conclusion: TA-GVHD generally fails to respond to treatments used for GVHD following bone
marrow transplants, thus the most effective mean is its prevention by using only irradiated
gamma blood (due to viable, immune competent T lymphocytes presence).
Key words. Delayed Transfusion Reactions, Blood Irradiation, Immunology
93

Po 07. Reactie alergica usoara (urticarie) in relatie cu terapia transfuzionala
Roxana Burta
1
1
, Sebastian Stanciu
1
2
,
Stefan Reikli
2

1
2
Introducere. Reactiile alergice sunt intalnite relativ frecvent, fiind recunoscute ca si complicatii
ale terapiei transfuzionale. Gama de manifestari clinice este redusa: fie eruptii cutanate (urticaria
si angioedemul) fie dispnee, sau o combinatie intre acestea.
Scopul. Prezentarea de fata este motivata de interesul de a arata ca reactiile alergice usoare, pot
apare fie prin mecanism imunologic (cu implicarea IgE sau altor clase de imunoglobuline) sau
non-imunologic. Sunt explicate diferite mecanisme de aparitie, de exemplu: 1. pe de o parte
relationate cu terapia transfuzionala din cauza prezentei de anticorpi fata de celule sanguine
transfuzate (de ex. anti-HLA, anti-plachete) sau prezenta anumitor proteine (IgA, ale sistemului
Complement) in plasma primitorului, sau in cazul existentei diferentelor alotipice intre donator si
primitor 9de exemplu alotipuri IgE, Complement C4d, haptoglobina) 2. pe de alta parte
independente de transfuzie, de exemplu alergia la latex, sau indusa medicamentos (aspirina).
Material si metoda. Intr-o maniera sugestiva, usor de inteles, prin utilizarea de imagini, scheme
explicative logice, am reusit sa figuram cele mai importante caracteristici etiologice, de
diagnostic, imunologice, ale uneia dintre cele mai comune complicatii induse de terapia
transfuzionala, sustinuti de un caz clinic reprezentativ.
Concluzii. Chiar in conditiile in care personalul medical responsabil de terapia transfuzionala
efectueaza un istoric detailat al pacientului, determina parametrii biologici sanguini (de exemplu
proteine din sistemul Complement) aceasta complicatie poate sa apara; de aceea este foarte
importanta constientizarea personalului asupra riscului de aparitie, impunandu-se monitorizarea
stricta a pacientului in cursul terapiei transfuzionale, iar dezvoltarea alergiilor usoare impun
oprirea transfuziei, cu terapie medicamentoasa corectoare.
Cuvinte cheie. Reactii alergice, dependenta de terapia transfuzionala, intreruperea transfuziei

94

Po 07. Mild Allergic Reaction Transfusion-Related
Roxana Burta
1
1
, Sebastian Stanciu
1
2
,
Stefan Reikli
2

1
2
Oradea
Introduction. Allergic reactions are not infrequent post-transfusion complication, and may
include local cutaneous reactions (urticaria or agio-oedema) or wheeze, or combination thereof.
Aim. The presentation is motivated by the interest to show that the mild allergic reactions may
be either immunologically based (with IgE or other Igs involvement) or non-immunological.
There are explained different mechanisms of occurence, such as 1. transfusional like: due to the
presence of antibodies to transfused blood cells (eg anti-HLA, anti-platelets) or certain protein
structures (IgA, Complement) in recipients plasma or recipient/donor allotypic differences (eg
IgE allotypes, Complement C4d, haptoglobin) and 2. other causes: latex allergy, or drug-
associated (eg aspirin).
Material and method. In an friendly manner, easy to be understood, using pictures, logical
explanatory schemes, we reached our goal to display the most important features regarding:
etiology, diagnosis, immunology of one of the most common post-transfusion complication,
helped by a relevant case report.
Conclusions. Eventhough the medical staff responsible for transfusion therapy do a full clinical
history, with blood testing for Complement proteins) this condition may occur; therefore is
important the clinician to be awared about it, to monitor strictly the patient during transfusion
therapy, and in case of urticaria occurrence, it imposes the discontinuity of the transfusion
therapy, with corrective medication.
Key words. Allergic reactions, Transfusional-like, Transfusion Discontinuity
95

Po 08. Hemoliza acuta post-transfuzionala mediata non-imun
Paula Dejeu
1
, Adela Vicas
1
, Danut Dejeu
2
, Razvan Vicas
3
4

1
Medic rezident Laborator Clinic, Centrul de Transfuzie Sanguina Oradea, Romania
2
Medic specialist Chirurgie Generala, Spitalul Clinic Judetean de Urgenta, Oradea, Romania
3
Medic rezident Ortopedie, Spitalul Clinic Judetean de Urgenta, Oradea, Romania
4
Centrul de Cercetari in Medicina de Inalta Performanta/FMF/UOradea, Centrul de Transfuzie
Sanguina Oradea

Introducere. Hemoliza acuta post-transfuzionala mediata non-imun apare in urma unei
transfuzii de masa eritrocitara continand eritrocite hemolizate compatibile serologic.
Scop. Prezentarea este centrata pe intelegerea proceselor fiziopatologice, pe aspectele clinice,
de laborator si tratament ale hemolizei acute post-transfuzionale mediata non-imun, cu
sublinierea aspectelor de preventie a acestei patologii.
Material si metoda. Maniera de prezentare schematica, faciliteaza intelegerea mecanismelor de
aparitie, de diagnostic si suport terapeutic. Selectarea unui caz clinic sugestiv, subliniaza atat
aspectele comune cat si cele care impun suspicionarea patologiei, in conditii de nerespectare a
standardelor de calitate, de-a lungul terapiei transfuzionale.
Concluzii. In cazul unei reactii hemolitice acute post-transfuzionale mediata non-imun,
investigatiile de laborator nu evidentiaza anomalii serologice, ci, in majoritatea cazurilor, o
manipulare inadecvata a sangelui transfuzat, o depozitare improprie a acestuia sau un proces
transfuzional necorespunzator. Acest tip de reactii, trebuie suspectat in prezenta unei
hemoglobinurii inexplicabile aparute in urma unei transfuzii de masa eritrocitara, fara a mai
asocia alte semne si simptome ale unei reactii hemolitice acute post-transfuzionale.
Cuvinte cheie. Manipulare inadecvata sangelui si produselor sanguine, compatibilitate
serologica, eritrocite hemolizate, hemoglobinurie

96

Po 08. Acute Non-Immune Hemolytic Transfusion Reaction
Paula Dejeu
1
, Adela Vicas
1
, Danut Dejeu
2
, Razvan Vicas
3
4

1
Clinical Laboratory Resident, Blood Transfusion Center, Oradea, Romania
2
General Surgion, Specialist, Country Clinical Hospital, Oradea, Romania
3
Orthopedic Surgeon Rezident, Country Clinical Hospital, Oradea, Romania
4
High Performance Medical Research Center/ of Medicine and Pharmacy /University of Oradea,

Introduction. Acute non-immune Hemolytic Transfusion Reaction occurs whenever are
transfused hemolysed red cells, even in compatibility condition.
Objective. The aim of this study is to understand the pathophysiological processes, clinical and
paraclinical data of the acute non-immune hemolytic transfusion reactions, in order to insist on
ways to treat it appropiate, but mainly to prevent it.
Materials and Methods. It is briefly described the pathophysiological mechanisms, clinical and
laboratory aspects, diagnosis and specific treatment of the acute non-immune transfusion
reaction. A clinical case study will be related as an example to help understand and easily
recognize it in due time, to rise the suspicion in conditions of non-respected quality standards,
along the transfusion therapy.
Conclusions. For an acute non-immune hemolytic transfusion reaction, the investigation does
not reveal serologic abnormalities, but rather, in most cases, a handling, storage or transfusion
error. Non-immune hemolytic transfusion reactions should be suspected in the presence of
unexplained hemoglobinuria that is temporally related to red cell transfusion, but not associated
with other signs and symptoms of an acute hemolytic transfusion reaction.
Key words. Improper Handling of Blood and Blood Products, Serological Compatibility,
Hemolysed Red Cells, Hemoglobinuria.
97

Po 09. Reactiafebrila post-transfuzionala, non-hemolitica
Horatiu Burta
1
, Teo Rif
1
, Sebastian Heredea
1
, Bogdan Leahu
1
, Catalin Nicolae
1
,
R. Iovan
2

1
2

Introducere. Reactia febrile non-hemolitica transfuzionala, are un mecanism
imunologic prin reactionarea anticorpilor din plasma primitorului cu anumiti
structuri antigenice continute de sangele donatorului, cel mai frecvent cu
leucocitele, pachetele continute sau protei ne plasmatice, cu eliberarea pirogenilor
endogeni, responsabili de reactia febrila.
Scop. Prezentarea doreste sa prezinte aspecte specifice acestei reactii imune, cu
insistarea asupra semnelor clinice (definitoriu: ascensionarea temperaturii cu
minimum 1
0
C, in relatie cu terapia transfuzionala), care pot orienta spre o atitutine
terapeutica corecta in timp util.
Material si metoda. Utilizandu-se surse bibliografic recente, au fost selectate cele
mai reprezentative scheme fiziopatologice, imunologice (cei mai frecventi anticorpi
implicati fiind cei anti -leucocitari) clinice (multiparitate, politransfuzati) si de
diagnostic, alaturi managementul patologiei si de indicele de prognostic aferent.
Concluzie. Utilizarea produselor sanguine selectate, pentru categorii de pacienti
identificati cu risc de anticorpi plasmatici (multipare, politransfuzati) duc la
scaderea semnificativa, chiar preventia devoltarii reactiei febrile non-hemolitice.
Produsele sanguine selectate sunt: concentrate eritrocitare sarace in leuc ocite
(preparate fie prin filtrare, fie centrifugate), cu limitarea indicatiei (atat pe criteriu
de frecventa scazut, cat si financiar) de utilizare a produselor, doar la pacientii care
au dezvoltat cel putin 2 reactii febrile transfuzionale, respectand categoriile de
pacienti, mentionate.
Cuvinte cheie. Reactie febrila transfuzionala non-hemolitica, produse sanguine
selectate, preventie

98

Po 09. Non-haemolytic immune transfusion reactions (NHTR)
Horatiu Burta
1
, Teo Rif
1
, Sebastian Heredea
1
, Bogdan Leahu
1
, Catalin Nicolae
1
,
R. Iovan
2

1
2
Oradea
Introduction. Non-haemolytic Immune Transfusion Reaction (NHTR), is provoked
by an immune conflict between the antibodies contained by recipient plasma, and
certain antigenic structures from donors blood; the most frequent antigens are
represented by leucocytes, platelets or plasmatic proteins; the conflict will lead to
endogenous pyrogens release.
Aim. The presentation shows the specific conditions of this immune reaction,
underlying the clinical signs (the marker being the temperature rise, with minimum
1
0
C transfusion-related) which can guide to a correct and in due time of therapeutic
attitude.
Material and methods. Using recent bibliographic articles, were selected the most
representative patho-physiologic, immunologic (the most frequent antibodies
involved in this reaction are represented by anti-leucocytic) clinical (history of
pregnancies, poli-transfused patients) diagnosis schemes, along with the condition
management, and afferent prognosis index.

Concluzie. Utilizarea produselor sanguine selectate, pentru categorii de pacienti
identificati cu risc de anticorpi plasmatici (multipare, politransfuzati) duc la
scaderea semnificativa, chiar preventia devoltarii reactiei febrile non-hemolitice.
Produsele sanguine selectate sunt: concentrate eritrocitare sarace in leucocite
(preparate fie prin filtrare, fie centrifugate), cu limitarea indicatiei (atat pe criteriu
de frecventa scazut, cat si financiar) de utilizare a produselor, doar la pacientii care
au dezvoltat cel putin 2 reactii febrile transfuzionale, respectand categoriile de
pacienti, mentionate.
Conclusions. Using selected blood products, for identified categories of patients as
being at risk of having plasmatic antibodies (history of pregnancies, politransfused)
can decrease, even prevent the NHTR occurrence. Types of selected blood products,
are: Leucocyte depleted red cell concentrates (obtained by filtration or
centrifugation). Even so, the selected blood products administration is limited (duet
o low frequence of NHTR occurence, and financial aspects, as well) mainly
99

indicated to pacients with history of at least 2 febrile episods transfusion-related in
certain patients categories.
Key words. NHTR, Selected Blood Products, Prevention
Po 10. Contaminarea bacteriana
Ioana Szanto
1
, Ramona Budau
1
2

1
2
Sanguina Oradea

Introducere. Socul septic asociat terapiei transfuzionale, are o incidenta foarte scazuta si este
considerat o complicatie cu potential evolutiv fatal, datorat contaminarii bacteriene a produselor
sanguine administrate.
Scop. Aceasta prezentare are rolul ca intr-o maniera explicita, sa sublinieze importanta
diagnosticarii precoce a acestei patologii cat mai ales preventia ei.
Material si metoda. Descrierea mecanismului fiziopatologic, a semnelor clinice si paraclinice,
diagnosticului si tratamentului specific sepsisului, ajuta la orientarea si intelegerea acestei
patologii. Descrierea unui caz clinic de referinta, orienteaza pe orice practician interesat in
medicina transfuzionala, subliniind totodata importanta asigurarii unui produs sanguin de o
calitate maxima din punct de vedere al securitatii transfuzionale. Pe de alta parte, monitorizarea
atenta pe tot parcursul si dupa terminarea terapiei transfuzionale, asigura un diagnostic corect si
instituirea conduitei terapeutice adecvate in cel mai scurt timp.
Concluzie. Datorita faptului ca la baza aparitiei socului septic posttransfuzional este implicat
produsul sanguin contaminat bacterian, rezida importanta asigurarii calitatii actului
donarii/validarii (microbiologice si macroscopice) a fiecarei unitati de produs sanguin ce
urmeaza a fi utilizat in terapia transfuzionala.
Cuvinte cheie. Soc septic, produs sanguin contaminat bacterian, complicatie posttransfuzionala

100

Po 10. Bacterial Contamination
Ioana Szanto
1
, Ramona Budau
1
1, 2

1
Clinical Laboratory resident, Blood Transfusion Center, Oradea, Romania
2

Introduction. Transfusion-associated septic shock is a rare but potentially fatal complication
caused by transfusion of bacterially contaminated blood components.
Objective. The purpose of this research is to present in an explicit manner, to underline the
importance of early recognition of this condition, but mainly the importance of its prevention
Material and method. The brief description of patho-physiologic mechanism, of clinical and
paraclinical signs, the diagnosis and specific treatment of sepsis, helps in understanding this
pathology. The case report, guides any interested practitioner in transfusion medicine, and insists
once again in transfusion safety, based on a high quality blood product. On the other side, a strict
survey along the transfusion procedure, and after it, assures a correct diagnosis and an adequate
therapeutic support, in due time.
Conclusion. Due to the fact that posttransfusion sepsis is caused by bacterial contaminated blood
product administration, is obvious the importance of quality assurance along donation/validation
(microbiologic and macroscopic) procedures to each unit of blood product, supposed to be
transfused.
Key words. Septic Shock, Blood Product Bacterial Contamination, Posttransfusion
Complication.

101

Po 11. Trombocitopenia posttransfuzionala (TPT)
Adela Vicas
1
, Paula Dejeu
1
2

1
2
Sanguina Oradea

Introducere. Trombocitopenia sau purpura posttransfuzionala este o forma rara dar grava de
trombocitopenie mediata de alloanticorpi, care apare in urma transfuziilor de sange sau masa
trombocitara.
Scop. Acest studiu a urmarit depistarea si intelegerea proceselor fiziopatologice si imunologice,
precum si efectele clinice ale trombocitopeniei posttransfuzionale, in vederea identificarii unor
metode de preventie sau a depistarii precoce a acestei patologii.
Material si metoda. Intr-o maniera schematica dar sugestiva este descris mecanismul
fiziopatologic, semnele clinice si datele paraclinice, diagnosticul si tratamentul specific al TPT.
Prezentarea unui caz clinic de referinta, sustine intelegerea si recunoasterea cu usurinta a acestei
patologii, de catre personalul medical implicat in actul trasfuzional si nu numai.
Concluzie. Datorita faptului ca in mecanismul fiziopatologic de producere al trombocitopeniei
posttransfuzionale sunt implicate antigenele HPA-1a, administrate odata cu transfuzia de sange
sau masa trombocitara la un pacient HPA-1a negativ, este esentiala identificarea acestor pacienti
si preventia TPT prin transfuzii de sange HPA-1a negativ. Pe de alta parte, daca un pacient
prezinta trombocitopenie in urma unei transfuzii trebuie considerata posibilitatea unei dezvoltarii
TPT, targetul fiind un diagnostic corect si instituirea conduitei terapeutice adecvate.
Cuvinte cheie. Antigen HPA-1a, alloanticorpi, complexe imune, hemoragie.

102

Po 11. Posttransfusion Purpura (PTP)
Adela Vicas
1
, Paula Dejeu
1
2

1
Clinical Laboratory Resident, Blood Transfusion Center Oradea, Romania
2

Introduction. Thrombocytopenia or posttransfusion purpura is a rare but severe pathology
mediated by alloantibodies, consequent on blood or platelets transfusions.
Objective. The aim of the study is to understand the pathophysiological processes,
immunological and clinical data of posttransfusion thrombocytopenia, in order to identify
methods of prevention or early exposure of this pathology.
Materials and Methods. Outline description of the pathophysiological mechanisms, clinical and
laboratory aspects, diagnosis and specific treatment PTP. Describing a clinical case study and
reference, particularly as an example to help understanding and easily recognize this pathology
by the medical staff involved in transfusion therapy and beyond.
Conclusion: Due to the fact that pathophysiological mechanism of production of posttransfusion
thrombocytopenia involves HPA-1a antigens, administered along with blood or platelets
transfusion to a patients negative HPA-1a, the identification of these patients is essential as well
as the prevention of blood transfusion PTP HPA-1a. On the other hand, if a patient develops
thrombocytopenia following transfusion one should take into account the possibility of PTP, in
order to discover in time the correct diagnosis and to establish the appropriate therapeutic
support.
Key words: HPA-1a antigen, Alloantibodies, Immune Complexes, Bleeding
103

Po 12. Reactie alergica severa-soc anafilactic
Nicoleta Marcut
1,2
, Mirela Florescu
3
, Catalin Florescu
2
, Patricia Marusca
2

1
2
3
Introducere. Desi reactia anafilactica datorata administrarii produselor din sange are incidenta
scazuta, severitatea clinica motiveaza interesul prezentarii ei.
Scop. Scopul acestei lucrari este de a explica mecanismul imunologic al ATR (Anaphylactic
Transfusion Reaction), etiologia sa si de a intelege importanta prevenirii aparitiei, folosind fie
produse din sange deficiente in IgA, fie hematii sau trombocite ``ultra-spalate`` ori de cate ori
se impune.
Material si Metoda. Debutul rapid al reactiei anafilaxice, manifestat prin soc, hipotensiune,
angioedem si disfunctie respiratorie, necesita recunoasterea cat mai precoce, cu atitudine
terapeutica rapida si eficienta. O reactie anafilactica posttransfuzionala poate aparea de la cateva
secunde pana la cateva minute dupa administrarea unei varietati de produse sanguine, cum sunt:
plasma proaspata congelata, concentrat eritrocitar, trombocite standard sau concentrat,
granulocite, crioprecipitat sau gamaglobuline. Cazul clinic prezentat, sta la baza intelegerii
mecanismul fiziopatologic, insistand asupra tratamentului, dar mai ales asupra preventiei
aparitiei reactiei.
Concluzie. Reactiile transfuzionale se datoreaza adesea erorilor inocente``, cu o plaja larga de
manifestare clinica, de la simple la urgente amenintatoare de viata. Recunoasterea precoce,
intreruperea tratamentului si instituirea terapiei de suport, stau la baza amendarii reactiei.
Raportarea reactiilor postransfuzionale ajuta la imbunatatirea practicii transfuzionale si la
reducerea eventualelor evenimente nedorite.
Cuvinte cheie. Anafilaxie, produse sanguine, practica transfuzionala

104

Po 12. Posttransfuzional Severe Allergic Reaction- Anaphylactic Shock
Nicoleta Marcut
1,2
, Mirela Florescu
3
, Catalin Florescu
2
, Patricia Marusca
2

1
2
3

Introduction. Although anaphylactic reaction to blood products is rare, its severity motivates
our interest in presenting the main respects.
Purpose. The purpose of the presentation is to point the immunological mechanism of
Anaphylactic Transfusion Reaction (ATR), its etiology and the importance of prevention (using
either IgA-deficient blood products or "ultra-washed" red cell or platelet products) is necessary.
Materials and Methods. Rapid onset of anaphylaxis, manifested by shock, hypotension,
angioedema, and respiratory distress, in a transfusion recipient requires early recognition and
concomitant specific action since it is a life-threatening condition. An anaphylactic transfusion
reaction (ATR) may occur within a few seconds to a few minutes following the initiation of a
transfusion that contains frozen plasma, red cells concentrate, standard or concentrated platelets,
granulocytes, cryoprecipitate, or gamma globulin. Based on the clinical case and on the patho-
physiological mechanism with all the clinical manifestations it can be point out that practitioners
have to be aware of prevention and rapid treatment of this acute reaction.
Conclusion: Transfusion reactions are mostly due to clerical errors and can range from benign
reactions to life threatening emergencies. Early detection, discontinuation of transfusion and
instituting supportive care are keys of management. Reporting of all reactions helps to improve
transfusion practices and reduce future potential occurrences.
Key word. Anaphylaxis, Blood Products, Transfusion Practice
105

po 13. Coagulopatia intravasculara diseminata (CID) post transfuzionala
Romina Crisan1,3, Ingrid Veres2

1
2
Medic rezident Hematologie, Centrul de Transfuzie Sanguina Oradea, Romania
3
Centrul de Cercetari in Medicina de Inalta Performanta/FMF/Uoradea

Introducere. Coagularea intravasculara diseminata este o complicatie potentiala, grava aparuta
la pacienti in urma reactiilor acute, initiale, post-trasfuzionale. Mortalitatea depinde direct de
cantitatea de sange transfuzat.
Scop. Scopul lucrarii este de prezenta si indica semenele si simptomele reactiilor transfuzionale,
necesitatea unei recunoasteri imediate si a investigatiilor de laborator si control clinic.
Material si metoda. Importanta identificarii manifestarilor clinice din reactiile hemolitice
transfuzionale, cum este coagularea intravasculara diseminata, este data de aspectul reactiilor
violente de incompatibilitate a anticorpilor din sangele donatorului,cu cei ai primitorului , care
duc la deces, daca nu are loc interventia prompta, inainte ca unitatea de sange sa fie complet
transfuzata. Lucrarea va fi expusa prin descrierea si prezentarea schematica a mecanismului
fiziopatologic, diagnosticului clinic/paraclinic si immunologic, alaturi de cazuistica.
Concluzii. Deoarece reactiile trasfuzionale hemolitice sunt printre cauzele CID, fiind rezultatul
reactiei anticorpilor din plasma primitorului directionati impotriva eritrocitelor donorului, se
impune respectarea stricta a calitatii actului transfuzional.
Cuvinte cheie. Reactii acute trasfuzionale, manifestari clinice, anticorpi, deces

106

po 13. Transfusion-Related Disseminated Intravascular Coagulation
Romina Crisan1,3, Ingrid Veres2

1
2
Resident of Hematology, Blood Transfusion Center Oradea, Romania
3

Introduction. Disseminated intravascular coagulation is a potential and severe complication,
occurred in patients after acute, initial, post-trasfusionale reactions. Mortality depends directly on
the amount of transfused blood.
Aim. The studys aim is to present and show signs and symptoms of transfusion reactions, the
need for immediate recognition and for laboratory investigations, along with clinical
surveillance.
Materials and methods. The importance of identifying clinical signs of hemolytic transfusion
reactions, such as disseminated intravascular coagulation, is given by the violent reactions of
incompatibility of blood donor antibodies with those of recipient, leading to death, if there is no
prompt intervention, before the blood unit is completely transfused. The study will be ruled
through description and schematic presentation of the pathophysiological mechanism, clinical
and paraclinical (immunologic) diagnosis, along with a case study.
Conclusions. Because transfusion hemolytic reactions are among the causes DIC, being the
result of antibodies in recipients plasma directed against the donors erythrocytes, the
transfusion act requires the standards of quality to be strictly respected.
Key words. Transfusion Acute Reactions, Clinical Manifestations, Antibodies, Mortality
107

Po 14. Contaminarea microbiana; agenti infectiosi cu potential de
transmitere transfuzionala
Radu Iovan1, Olivia Ligia Burta2, Bogdan Leahu1,3, Catalin Nicolae1,3

1
2
3
Student Facultatea de Medicina si Farmacie/UOradea
Introducere. Este recunoscuta importanta reducerii la maximum a potentialului rezidual
infectios, conditie de baza a asigurarii calitatii biologice a oricarui produs terapeutic sanguin.
Scop. Se va prezenta succint, etiologia microbiana (bacterii, virusuri, paraziti) cu potential de
transmitere transfuzionala.
Material si metode. Schemele si diagramele vor incerca sa puncteze intr-o maniera care tine
cont de incidenta/prevalenta varietatii microbiene, de aspectele epidemiologice, cat si infectioase
ale fiecarui agent in parte. Se vor prezenta de asemenea protocoalele specifice stabilirii statusului
de contaminare microbiana, insistandu-se asupra acelora care implicavalidarea microbiologica a
sangelui si produselor sanguine.
Concluzie. Importanta cunoasterii, constientizarii si vizualizarii celor mai frecvente etiologii,
pentru intelegerea mecanismului de transmitere si preventia acesteia, criteriu definitoriu al
calitatii terapiei transfuzionale.
Cuvinte cheie. Potential rezidual infectios, calitatea terapiei transfuzionale
108

Po 14. Microbial Contamination, Infectious Agents with Potential
Transfusion Transmission
Radu Iovan1, Olivia Ligia Burta2, Bogdan Leahu1,3, Catalin Nicolae1,3

1
High Performance Medical Research Center /FMF/UOradea
2
Blood Transfusion Establishment Oradea, Romania
3
Student Faculty of Medicine and Pharmacy/UOradea
Introduction. Is recognized the importance of maximum reduction of infectious residual risk of
any transfusion therapeutic product.
Aim. Will be presented the microbial etiology (bacteria, viruses, parasites) from etiology, to
microbial characteristics, clinics, diagnosis of those with potential transfusion transmission.
Material and methods. The selected schemes and diagrams try to underline the manner of being
infectious of the large variety of microbs, according to their incidence, prevalence, and clinics as
well. Will be presented the specific protocols in establishing the status of bacterial
contamination, insisting on those involved in microbiologic validation of blood and blood
praducts.
Conclusion. Is important to be known, awared and visualized the most frequent etiologies, in
order to understand the transmission route, and mainly the prevention measures, as major
criterion of transfusion therapy quality.
Key words. Infectious Residual Risk, Transfusion Therapy Quality
109

Index autori /Index of Authors
A
Alietta Florian1, 20, 21
Andrei Rosin, 18, 19, 74, 75
Andrei Tarsoly, 86, 87
B
Bogdan Leahu, 107
C
Carina, Dudas (Petricau), 88, 89,92
Catalin Nicolae, 107
Corina Posea, 71
Cristina Bichis, 58,62
Cristina Stoian, 56
D
Diana Pelea, 69, 71, 73, 86, 87
F
Fatima Nascimento, 10
G
Gilles Follea, 10,28,74
I
Ioana Zaha, 84, 85
J
Jean Gerota, 66
L
Lavinia Florentina Rad, 90, 91
Leila Curtamet, 22, 23
M
Mariana Maier, 16
Marie-Emmanuelle Behr-Gross, 10
Max Constantinescu, 22, 23
Mir Hajra,80, 81, 82, 83
Mir, Hira1, 80, 81
O
Olivia Ligia Burta, 10, 14, 71, 77, 80, 81, 84, 85, 86
Olivia Ligia Burta, 24, 25, 84, 85, 86, 87, 88, 89, 90, 91, 92,
93, 98, 100, 101
Ovidiu Burta,3, 69, 81, 82, 83
P
P Hewitt, 28, 29
Patricia Marusca, 69, 71, 77, 82, 83
R
R Lieshout, 28, 29
Radu Iovan, 16, 77, 97, 107
Ritli Ladislau, 52
Romina Crisan, 86, 87
Romulus Roman, 77
Roxana Burta, 92
S
Sebastian Stanciu,92, 93, 96, 97
Sevastiana Bran, 56
Simona Parvu, 44, 45, 46, 48
Snezhana Chichevaliev, 10
Stefan Reikli, 92
V
Valentina Hafner, 10
Victoria Halmagi
1
, 58, 62
W
Wr Mayr, 28, 29
Z
Zoia Bitea2, 20, 21

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