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2011, vol. 27, br. 4, str. 356-361
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Terapija labilnim krvnim komponentama u pedijatriji
Blood component therapy in children
Sažetak
Pedijatrijska populacija, posebno u novorođenačkom uzrastu, zbog svojih fizioloških karakteristika (sklonost ka infekciji, anemiji i hipovolemiji) veoma često su kandidati za suportivnu terapiju labinim krvnim komponentama i derivatima krvi. Dobra klinička procena i laboratorijsko ispitivanje neophodni su u identifikovanju osnovnog poremećaja, kako bi se primenio optimalni krvni produkt, na odgovarajući način i u dovoljnoj dozi. Nove tehnološke procedure u pripremi i obradi krvnih komponenti, pridržavanje principa dobre proizvođačke i laboratorijske prakse, kao i stalna kontrola kvaliteta krvnih produkata čine transfuziju krvnim komponentama bezbednijom i efikasnijom. U pedijatrijskoj praksi danas su na raspolaganju produkti dobijeni iz jedinice cele krvi, a to su: koncentrati eritrocita, trombocita, sveže smrznuta plazma i krioprecipitat i to u dozama male zapremine koje odgovaraju telesnoj masi bolesnika (pedijatrijske doze). Prema našim rezultatima najčešći razlog za transfuziološko zbrinjavanja pedijatrijskih bolesnika bila je korekcija anemije, dijagnostikovana ili na prijemu ili tokom lečenja, koja je zahtevala transfuzije koncentratima eritrocita. Da bi se izbeglo nepotrebno davanje krvnih produkata, neophodno je da se pored pridržavanja preporuka Nacionalnih vodiča za primenu labilnih krvnih komponenti, multidisciplinarnim pristupom omogući pravovremena dijagnostika poremećaja i stanja koja zahtevaju transfuziološko zbrinjavanje i tako učini ovaj vid lečenja pedijatrijskih bolesnika efikasnim i bezbednim.
Abstract
Pediatric population, particularly in neonatal age, because of their physiological characteristics (propensity to infection, anaemia and hypovolemia) are often candidates for supportive therapy with labile blood components and blood derivate. Good clinical assessment and laboratory testing are essential in identifying the primary disorder, in order to implement the optimal blood product, with an appropriate manner and in sufficient doses. New technological procedures in the preparation and processing of blood components, adherence to the principles of good manufacturing and laboratory practices, as well as permanent quality control of labile blood components, make transfusion with blood products safe and more efficient. In pediatric practice are now available the products obtained from whole blood units, which are concentrates of red cells, platelets, fresh frozen plasma and cryoprecipitate. All doses are adjusted to the body mass of the patients (small volume doses). According to our results, the most common reason for transfusion care for pediatric patients was anaemia. In spite the reason of hospitalization (different diagnoses), during diagnostic procedures the diagnosis of anaemia was established. This condition required the supportive therapy with small volume concentrated erythrocytes. To avoid giving unnecessary blood products, it is necessary to comply with recommendations by national guidelines for the application of labile blood components. Multi-disciplinary approach should provide right time diagnosis of disorders and conditions with right time transfusion care. Because of that, treatment of pediatric patients was efficient and safe.
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