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ISBT синхронизирани работни групи на Българската асоциация по трансфузионна медицина

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ISBT синхронизираните работни групи на Българската асоциация по трансфузионна медицина обсъждат и координират проекти на национално ниво, които се популяризират чрез или асоциират към проектите на престижните работни групи на International Society of Blood Transfusion.

В момента, съществуват общо 15 работни групи на International Society of Blood Transfusion, а някои от тях работят в тясно сътрудничество. Идентичните работни групи на Българската асоциация по трансфузионна медицина имат или ще имат формална структура, координирана от един или двама председатели.

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1. Apheresis
discuss current and future apheresis techniques and develop apheresis in less experienced countries
Apheresis involves the removal of whole blood from a patient or donor. Whole blood is separated by a centrifugation or filtration process into the various blood components either plasma (plasmapheresis), platelets (plateletpheresis) or leukocytes (leukapheresis). The remaining blood component(s) are transfused back into the donor/patient. Apart from the collection of donor blood components, apheresis is used for treatment of certain (autoimmune) disorders (e.g. thrombotic thrombocytopenic purpura, sickle cell disease and Multiple Sclerosis). This is done to remove existing harmful substances or cells (e.g. antibodies, cytokines or diseased blood cells) when immunosuppressive or cytotoxic drugs suppress their production.

2. Blood Supply Management
optimise the use of donated blood and blood component wastage along the whole chain
The blood supply chain starts with the blood donor and an end with the patient, but ultimately it is the requirement for blood by the patient that drives the chain and hence the number of blood donations required. Various factors affect the blood supply chain; the number of donors who are willing to donate regularly, seasonal factors affecting donation e.g. public holidays, the blood services ability to adequately predict the number of units of blood required throughout the year and to ensure that they do not overstock and therefore increase wastage, the clinicians awareness of appropriate blood ordering and transfusion and the hospital laboratories ability to ensure sufficient stock yet have minimal wastage. It is essential that all staff working in each area of the blood supply chain is aware of their responsibilities to ensure minimal wastage of this freely given resource. Therefore education and training and data collection are important elements of the blood supply chain.

3. Cellular Therapies
raise awareness of cellular therapies and support their improvement globally within Transfusion Medicine
Cellular Therapy involves utilization of cells for treatment including haematopoietic stem cell transplantation (HSCT). HSCT may enable stem and progenitor cells to be engrafted, replacing the bone marrow of the recipient completely. Other examples include bone marrow-derived mesenchymal stromal cells, embryonic or induced pluripotent stem cells (iPs) and specific T-lymphocytic cell lines which can differentiate into a variety of cells. In the future this might also include the ex-vivo expansion of cord blood into red blood cells, platelets and their progenitors. Novel blood-derived therapeutics include platelet lysates, amniopatch and serum eye drops.

4. Clinical Transfusion
promote good clinical transfusion practice globally through education, audits and scientific studies
Clinical transfusion comprises all clinical aspects of blood transfusion and promotes safe practice and appropriate use of blood (components). This includes both the risks and benefits of transfusion as well as close monitoring of patients. Patients should only be transfused when there is evidence for potential benefit. Occasionally, transfusion alternatives might be considered. In order to optimize patient care in need for blood transfusion, it is crucial to follow an evidence-based, multidisciplinary approach. Patient Blood Management (PBM) comprises patient evaluation and clinical management surrounding this decision-making process. This includes application of appropriate indications, minimization of blood loss and optimization of patient red cells. PBM can reduce allogeneic blood transfusions and health-care costs, while ensuring that blood components are available for patients.

5. Donors and Donation
monitor trends and emerging new practices related to blood donors and donation and facilitate training in resource-limited countries
The blood supply chain begins with the blood donor and blood services strive for 100% voluntary non-remunerated blood donation (VNRBD). For a robust blood supply, selection, assessment and retention of donors is important. The study of demographics and psychology of blood donation is carried out by many blood services and Academic institutes so that they can better understand trends in blood donation to ensure an adequate supply. The health of the donor is important both pre- and post-donation, therefore, health and personal questionnaires are key. Because some donors donate very regularly they may become susceptible to iron depletion and anaemia, and should therefore be monitored regularly. To raise awareness of the importance of safe blood and to thank all blood donors, annually, on June 14, World Blood Donor Day is celebrated globally.

6. Global Blood Safety
foster and support global improvements in blood safety and availability
One of the key elements of blood transfusion is the availability to safe blood (products). A sustainable national blood programme assists in ensuring a safe and adequate blood supply. Globally, half of the annual blood donations are collected in high-income countries from various types of donors (voluntary unpaid, family/replacement and paid. Although, national blood supplies are >99.9% based on voluntary unpaid blood donations, 40 countries, however, collect only <25% from voluntary unpaid blood donors. In general, there are also wide differences in the efficiency of blood collection across countries and income groups. In a number of low-income countries, especially in the Sub Saharan African region, 20% of blood donations are not tested for transfusion-transmissible infections (HIV, hepatitis B, hepatitis C and syphilis) and some of the tests used are not reliable, while this region is heavily affected by HIV. The minority of whole blood is separated into blood components in these countries also, which therefore limit their capacity to provide patients with the different blood components. And importantly, only a small number of low-income countries have a national haemovigilance system to monitor and improve the safety of the transfusion process.

7. Granulocyte Immunobiology
enable collaborations in granulocyte immunobiology by bringing together members working in a (diagnostic) laboratory, research and/or clinical setting
Neurophils are part of the granulocyte family and play an important role in innate immunity. Neutrophils or polymorphonuclear neutrophils (PMNs) make up the largest proportion of circulating leukocytes. Patients with low PMN counts (neutropenia) or functional defects in PMN are more likely to be overwhelmed by infection. Granulocyte-reactive antibodies have been shown to play a key role in the pathophysiology of several immune-mediated neutropenias, transfusion-related acute lung injury (TRALI), auto-immune neutropenia after bone marrow transplantation and febrile transfusion reactions. Post-transfusion, in TRALI, the donor-derived antibodies can cause inappropriate activation of neutrophils leading to damage of the pulmonary microvasculature with severe clinical consequences. Thus, these disorders demand rapid and precise diagnosis using reliable neutrophil serology.

8. Haemovigilance
improve safety for blood donors and transfusion recipients through promoting and supporting haemovigilance systems
Haemovigilance (HV) comprises surveillance procedures covering the whole transfusion chain from collection of blood (components) to follow-up of its recipients. It assesses information on undesirable transfusion effects to prevent their occurrence. This includes local venepuncture accidents, iron depletion, graft vs. host disease and mild to severe transfusion reactions. The HV definitions aim to standardize and report all these events in order to improve blood safety.

9. Immunohaematology
promote best practice and facilitate improvements in immunohaematology through education, exchange of ideas/resources and support red cell serology, molecular testing, antigen/allele matching and transfusion recommendations
Immunohaematology studies the reactions that take place between antigens present on blood cells and antibodies present in plasma. Patients undergoing transfusion therapy are tested for their ABO and RhD blood groups and the presence of any antibodies that may cause a reaction between their plasma and donor red cells. A range of tests are available to use to detect and identify antibodies in the patient's plasma from simple tube and gel tests to more complex absorption and elution techniques as well as advanced molecular techniques. These same tests will also identify if the antigen is present on the patient's red cells. For patients with haematological conditions such as auto immune haemolytic anaemia, a wide range of immune-haematological techniques are used to identify and resolve the diagnostic problems in these patients. Molecular techniques are increasingly used in immunohaematology to determine the antigen profile of patients, resolve complex problems and large scale red cell typing.

10. Information Technology
exchange ideas and information related to Information Technology for use in Transfusion Medicine
Information Technology (IT) is a critical part of Transfusion Medicine and Cellular Therapy which comprises recruitment, collection, testing, processing, distribution, transfusion/transplantation and quality. IT supports fast and easy access to process data generated in the blood supply chain, including manufacturing, labelling and inventory, facilitating and improving compliance with Good Manufacturing Practice (GMP). At blood centres, different tags are needed for blood bags, containers, locations, personal identification and/or tubes. A 'license plate', in which a unique tag identification code (UID) is linked with a unique donation number ⁄ product code in the host computer, is used for tracking and information. A data carrier held on the label in barcodes and paper is also used. Radio Frequency IDentification (RFID) is a method of uniquely identifying items that uses electromagnetic radio waves (wireless air interface) to interact and exchange data between tags and readers.

11. Platelet Immunobiology
collaborate to improve the quality of platelet antigen and antibody diagnostics and promote research
Platelet Immunobiology studies the pathogenic immune mechanisms responsible for autoimmune (e.g. Immune thrombocytopenia or ITP) and alloimmune (e.g. transfusion-induced) platelet disorders. In ITP, platelets are destructed by platelet-specific antibodies leading to bleeding in these patients. To date, platelet alloantigens are characterized by molecular biology techniques (e.g. PCR) since a single nucleotide polymorphisms in the platelet membrane proteins can result in specific platelet antigenicity. Anti-platelet antibodies are measured by various serology techniques (e.g. monoclonal antibody-specific immobilization of platelet antigens or MAIPA).

12. Quality Management
defining quality systems in blood transfusion medicine and promoting education and training in Quality Management
Quality management in blood transfusion consists of continuous improvement of the quality of all processes and products related to blood transfusion: donation, production of blood components and the transfusion itself. The efficacy, safety and efficiency of these processes require the use of Good Manufacturing Practice Guidelines and Standard Operating Procedures. Quality management in blood transfusion covers all elements of the blood supply chain from blood collection to the transfusion of the patient. For all processes in blood collection, quality indicators should be defined, monitored, collated, analysed, reported and finally implemented.

13. Rare Donors
enhance international collaboration to enable provision of rare blood to patients
In general, the majority of the population has one of the ABO blood groups and is Rh positive or negative. There are >200 minor blood groups and >600 known antigens besides A, B and Rh. Because blood groups are distributed differently in different ethnic groups, finding a blood donor with the exact same blood type is a huge challenge. A rare blood donor phenotype occurs 1/1000 and includes high-frequency-antigen-negative and multiple-common-antigen-negative blood groups. Examples of rare blood types include Rhnull, Bombay (Oh) and Junior (Jr) a-. To prevent shortages of rare donor blood units, red cell donations can be frozen for future use. Therefore, it is of high importance to have an accurate international database of rare blood donors to ensure that patients who require lifesaving rare blood units are able to receive them.

14. Red Cell Immunogenetics and Blood Group Terminology
develop and maintain guidelines for blood group antigen and allele nomenclature for use in Transfusion Medicine and related sciences
The red cell membrane contains many anchored surface proteins and proteins that cross the lipid bilayer. Many of these surface proteins are polymorphic and carry the different blood groups. Most blood group antigens are glycoproteins and their specificity is mostly determined either by the oligosaccharide (e.g. ABO) or amino acid sequence (e.g. MN, Kell, Duffy, Kidd, Diego). Each blood group system represents either a single gene or a cluster of closely linked homologous genes. The 30 human blood group system genes have been identified and sequenced and all the polymorphisms are now known. Most blood group polymorphisms result from single nucleotide polymorphisms (SNPs) encoding amino acid substitutions in either a glycosyltransferase or extracellular domain of a red cell membrane protein. A blood group system consists of one or more antigens controlled at a single gene locus, or by two or more very closely linked homologous genes with little or no observable recombination between them. Currently recognized antigens within blood group systems are shown in the table and fall into one of four classifications:
- systems
- collections (200 series)
- low incidence antigens (700 series)
- high incidence antigens (901 series).

15. Transfusion Transmitted Infectious Diseases
evaluate and advance safety of blood transfusion by analysing Transfusion Transmitted Infectious Diseases, coordinating international studies and publishing scientific reports
Following blood transfusion, there is a risk of transfusion-transmitted infectious diseases (TTID), despite current advanced screening technologies. Infectious agents involved are very diverse and include hepatitis B (HBV), hepatitis C (HCV), human immunodeficiency (HIV-1/2), human T-cell lymphotropic (HTLV-I/II), Cytomegalo- (CMV), Parvo- B19, West Nile (WNV) and Dengue viruses. Trypanosomiasis, malaria, and Transmissible Spongiform Encephalopathy (TSE) also belong to TTID. TTID can be reduced by donor exclusion, screening for serological infection markers or nucleic acid testing (NAT) by viral gene amplification. Despite this, blood-borne infectious agents are transmitted through transfusion of infected blood donated by apparently healthy and asymptomatic blood donors.


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