Primož Rožman

2006

UVOD V TRANSFUZIJSKO UVOD V TRANSFUZIJSKO MEDICINOMEDICINO

22

VsebinaVsebina

Kratka zgodovina transfuzije1

Transfuzijska medicina v Sloveniji2

3 Organizacija transfuzijske dejavnosti

4 Transfuzija kod veda, znanost

5

6

7

Prihodnost transfuzije

Mednarodna združenja

K-skladna transfuzija

33

“Blut ist ein ganz besonderer Saft”

Johann Wolfgang von Goethe, FAUST

1749-1832

44

Kri je edini tekoči organVsebuje številne vrste celicBrez krvi ni življenjaOskrbuje vsako človeško celico:

– Hranivo– Kisik– Energija– Toplota– Izmenjava snovi

Ima sposobnost hemostazeVsebuje informacije o drugih organihAli je že na razpolago umetna kri?

To drži, kajti:

55

66

Huang Di Nei Jing - Yellow Emperor’s Classic

of Medicine, China, Warring States period,

475-221 B. C.

“The flow of blood . . never stops . . . . . it is moving eternally . . . . in a closed circle . “

Chi Poh, Court doctor

Huang Di (2698 - 2589 B.C.)

77

1492:First reported historical attempt at a blood transfusion:

the Pope Innocent VIII sank into a coma, at the suggestion of a Jewish physician, the blood of three boys was infused into his veins. They were ten years old, and had been promised a ducat each. All three died.

88

1628: William Harvey

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1667 Jean-Baptiste Denis, a physician to Louis XIV : the first transfusion from a sheep to a madman. The patient died, Denis accused of murder,Blood transfusion banned by for 150 years.

1666 Richard Lower:

direct transfusion dog-dog: “The dog came back from the dead, as though the life force had filled it up again."

1010

Kratka zgodovina transfuzije

Jean-Baptiste Denis1640 - 1704

Transfuzijaprepovedana

Pariška medicinska fakulteta

1688

transfuzija živalske krvi človeku 1667

James Blundell*1770-1878

Transfuzija krvi s človeka na človeka

2000

Karl Landsteiner1868-1943

Odkrije ABO in (skupaj z Levinom)Rh sistem

PREPOVED VELJA 130 LET!

Prvo uspešno ABO –skladno transfuzijo -V bolnišnici Mt. Sinaiizvede Dr. Reuben

Ottenberg

19071818

*Sklicuje se na Leacockovo delo na Karibih

1111

Dr.James Blundell, a British obstetrician:the first successful transfusion human-patient for the treatment of postpartum hemorrhage. He used the patient's husband as a donor, extracted 4 ounces of blood from his arm to transfuse into his wife.

1825 – 1830: he performed 10 transfusions, 5 beneficial and published

1818

1212

Uvod dr. James Blundell, 1825Uvod dr. James Blundell, 1825--18301830

performed 10 transfusions, 5 beneficial and published

1313

MILESTONES OF TM IN 20th cent.

1900 : Landsteiner AB0 blood groups1909: Ottenberg - crossmatch1914: Albert Hustin, BE, non-direct transfusion with Na-citrate1916: Royal Army Medical Corps: cooled stored blood 1925: blood transfusion institute, Alexander Bogdanov - Moscow1940: Landsteiner, Wiener - Rh blood groups 1945: Coombs et al. - antiglobulin test (Moreschi 1908)1964: Terasaki - microcytotoxicity test, HLA typing1990s: - molecular typing2000s: - cellular therapies

1414

1901: Institute of Pathology and Anatomy, Vienna.Prof. Dr. Anton Weichselbaum. Assist. Dr. Karel Landsteiner

Tabelle 1. betrettend das Blut sechs anscheinend gesunder Manner

Sera/RBCs Blood group

Dr. Stork - + + + + - CDr. Plečnik - - + + - - BDr. Sturli - + - - + - ADr. Erdheim - + - - + - Alab. Carič - - + + - - BDr. Landst. - + + + + - C

Odkritje krvnih skupin ABOOdkritje krvnih skupin ABO

1515

dr.Karl Landsteinerdr.Karl Landsteiner

1616

Janez Plečnik Janez Plečnik (1875 (1875 -- 1940)1940)

1717

Predtransfuzijske preiskave - laboratorij

1818

Predtransfuzijske preiskave

1933 dr.F. Oehlecker: „biološki preiskus”

= in vivo crossmatch

1919

2020

direktna transfuzijadirektna transfuzija

2121

Predtransfuzijske preiskave

1909: v bolnišnici Mount SinaiHospital, New York - izvede dr. Reuben Ottenberg prvo uspešno ABO – skladno transfuzijonavzkrižni preiskus

1882-1959

2222

PretransfusionPretransfusion TestingTesting

● 1939/40: RhD kompatibilnost

● 1946 → antiglobulinski (Coombsov test)

2323

2424

2525

Slovenska transfuzijska medicina

1926: prva transfuzija krvi v Mariboru, dr. A.Ramšak1945: Oddelek za transfuzijo krvi v Centralni vojni bolnici -organizacija krvodajalstva, odvzemanje in konzerviranje krvi, 1946: Zavod za transfuzijo krvi MF v Ljubljani1956: Zavod RS za transfuzijo krvi1949 – 1959: transfuzijski oddelki v CE, MB, Izoli, MS, Ptuju, SG, NG, NM in Trbovljah

2626

TRANSFUZIJSKA VERIGA

DAJALEC

KRVNA BANKA

BOLNIK

ODVZEM

PREDELAVA

TESTIRANJE

APLIKACIJA

2727

5 Collection Issuing & crossmatching Processing Testing

2 4

8,980

41,029

312

11,414

4,457

4,240

4,179

2,914

2,776

1,409

4,769

Trbovlje

Ptuj

Ljubljana

Organization of Blood transfusion service in Slovenia - 2004

2828

Blood Donors Structure in Slovenia

Sex:female male

Age:

Frequency of blood donation

4 x2 %

3 x7 %

2 x29 %

1 x62 %

per yearblood donors

2929

94,9351070 sessions

83 694 units33 951 units

1 394 units27 991 litres

blood donors (4.75% of population)(323 at the field collection sites)red blood cellsplatelets (recovered from whole blood)platelets (platelet apheresis)plasma (recovered from whole blood + collected by plasmapheresis)

Statistics for the Year 2004

Percentage of collected whole blood

3030

TRANSFUZIJSKA MEDICINA KOT MEDICINSKA VEDA

združuje klinične in temeljne medicinske vedePodročja:

biologija krvi, fiziologija, imunologija,imunohematologija in imunogenetika,celične terapijamedicinska biotehnologija, itd.

3131

TRANSFUZIJSKA MEDICINA KOT STROKA

1. preskrba s krvjo – krvodajalstvo, blood banking2. zdravljenje s krvjo in krvnimi pripravki - klinična TM3. transplantacija, histokompatibilnost4. zdravljenje z drugimi postopki – biotehnologija, celična TH5. laboratorijske preiskave, ki podpirajo TM6. spremljevalne aktivnosti:

nacionalni register krvodajalcev, bolnikov, dajalcev kostnega mozgabiobankarazvoj transfuzijske informacijske tehnologijeprenatalna zaščita

3232

TM KOT ZNANOST

Influence of 3D carriers on differentiation capabilities of chondrocytesL7-7598

The use of cultivated skin supplements for the treatment of chronic and acute woundsL7-7457

Development of tissue engineered bone for use in periodontology, traumatology and orthopaedic surgeryL4-6325

Isolation, characterisation and differentiation of human stem cell as a basis for cellular therapyL3-6011

Prion diseases and their diagnosticsL3-6006

The use of cultivated autologous chondrocytes for ttreatment of vesico-uretheral refluxL3-6265

Prion diseases and their diagnosticsL3-3435

Immunomodulation in solid malignant tumors refractory to standard treatmentL3-3368

Human Monocyte Derived Dendritic Cells - The Activators and Modulators of Specific Immune ResponsesL1-6295

The production of human recombinant metalloproteinase inhibitor TIMP-1 and development of specificimmunodiagnostic reagents for determination of the native TIMP-1 in biological samples.L1-3372

Pharmakogenetics of thiopurines- diagnostics and individualized therapyJ3-7406

Healing of poorly healing fractures of long bone with the use of platelet rich plasmaJ3-6290

Genetic background of chronic diseases in children and adolescentsJ3-6072

Genetic mechanisms of human diseasesJ3-4532

Molecular-genetic basis of chronic disorders in children and adolescentsJ3-3096

Chemical and biological monitoring of neonicotinoids and their impact assessment in the environmentJ1-6001

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TM V IZOBRAŽEVANJU

Dodiplomski programi:• Medicinska fakulteta

•Katedra za ginekologijo/porodništvo V letnik •Katedra za interno medicino VI letnik

• Visoka šola za zdravstvo - Program za VMS – 2.letnik• Fakulteta za farmacijo: Laboratorijska biomedicina, Visoki študij 3+2. Predmet: Hematologija s transfuzijsko medicino, 2.letnik

Podiplomski programi:• Medicinska fakulteta

•Smer Biomedicina, izbirni predmet: Transfuzijska medicina, transplantacija in celična terapija

• Fakulteta za farmacijo: Predmet Laboratorijska transfuzijska medicina in transplantacija, Magistrski študij (+2)

[1] Directive 2002/98/EC of the European Parliament and of the Council of 27 January 2003 setting standards of quality and safety for the collection, testing, processing, storage and distribution of human blood and blood components and amending Directive 2001/83/EC

[2] Directive 2004/23/EC Of The European Parliament and of the Council of 31 March 2004 on setting standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells. Official Journal of the European Union 7.4.2004 L 102/48

Zakonodaja

3535

GENETICS: HUGO 2001

PRIHODNOST TM 2006

CLASSICAL TRANSFUSION

MEDICINEStem cell

engineering

Cellular therapies& engineering

Gene therapy Recombinant technologies

PROTEOMICS and microarray technology

Viral inactivation

Blood substitutes

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3838

European School of Transfusion Medicinewith Prof. Dr. Umberto Rossi

European Federation of Immunogenetics

Bristol School of Transfusion and Transplantation Sciences

4040

Mednarodne organizacije

European Commission: http://europa.eu.int/comm/health/

Council of Europe http://www.coe.int/

WHO: http://www.who.int/bloodsafety/en/

URL: http://www.ztm.si/e-Pošta:primoz.rozman@ztm.si

Telefon: +386 (0)1 5438100Faks: +386 (0)1 5438186

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