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Железодефицитная анемия — полиэтиологичное заболевание, развитие которого связано с дефицитом железа в организме из-за нарушения поступления, усвоения или повышенных потерь данного микроэлемента, характеризующееся микроцитозом и гипохромной анемией. В практическом руководстве подробно описывается этиология, лабораторная и инструментальная диагностика, тактика ведения пациентов в различных клинических ситуациях. Практическое руководство предназначено для специалистов практического здравоохранения, оказывающих первичную медико-санитарную помощь, в том числе врачей-терапевтов, врачей общей практики (семейной медицины), кардиологов, гастроэнтерологов и других специалистов, оказывающих помощь пациентам с железодефицитной анемией.

The work of the Samara Regional Clinical Blood Transfusion Station, the collection and delivery of platelet concentrates in 2018, 2019 and in the first 6 months of 2020 was assessed. The annual demand for platelet concentrates in 2019 increased by 22.9%, and in the first half of 2020 the issue of platelet concentrate decreased by 12.1%, which is associated with a change in treatment work during the period of infection COVID‑19. The proportion of platelets isolated from whole blood in the first half of 2020 decreased from 24.7% (the end of 2019) to 17.4%, (p

The blood donorship is an integral part of modern medicine. Nowadays, it is very important to develop gratuitous and regular donorship and formation in population, especially in the youth, deliberate attitude to donorship and revival of noble traditions of charity, humanism and moral values. The article presents analysis of regional characteristics of dynamics of blood donorship in the Republic of Kazakhstan. The condition of annually increasing need in blood and its preparations creates a necessity in studying means of incoming of blood to the blood service. The analysis of reports concerning functioning of blood service in the regions of the Republic of Kazakhstan demonstrated that during 2012-2015 percentage of gratuitous donations increased from 47.7% to 54.9%. The percentage of donations of donors-relatives decreased from 36.4% to 34.5% and paid donations decreased from 15.9% to 10.8% as well. The obtained data testifies that in regions of the country nowadays a main impulsive cause for participating in blood donorship is gratuitous support of patients.

The article presents analysis of screening of markers of infections in donors using the nucleic amplification technique (NAT) within 4 years. The comparison is made with similar international indices and evaluation was applied to efficiency of the given technique in Kazakhstan. The study established that productivity of NAT technique in Kazakhstan significantly exceeds average international values. The implementation of the given technique permitted to prevent transfusion of infected blood.

There were compared the results of 520 platelets transfusions in 8 centers. In the surveyed organizations part of prophylactic platelet transfusions ranged from 10% to 91%. On average platelet transfusions for the prevention of bleeding in 3,6 times more often than to stop the bleeding. 67,5% ofrecipients ofplatelets have oncology diseases. Target platelet concentrations for preventive transfusions seems high compared to modern evidence-based value - 10 @. 10⁰/l. 25% ofprophylactic transfusions included in the study were performed in patients with platelet count of 30 @. 10⁰l or more. In 76,7% of transfusions used platelet concentrates prepared by apheresis. Single whole blood- derived-units are used at 3,7 times more often than pooled platelets.

The effect of postoperative wound drainage on the frequency of red blood cells transfusion after primary hip arthroplasty was assessed. Prospective comparative study included 632 patients. The patients were divided into 2 groups depending on whether the postoperative drainage was performed (1st group) or not (2nd group). Duration of surgery, volume of intraoperative blood loss, the level of hemoglobin before surgery and during the first postoperative day, frequency and volume of red blood cells transfusion during the whole period of hospital treatment was evaluated. In group 1 donor red blood cells transfusion was required in 1.3%, in group 2 - in 0.8% of cases (p>0.05). No data on the effect of postoperative wound drainage upon the frequency of red blood cells transfusion after primary hip arthroplasty was obtained.

Aim. Characteristics of thrombocytopenia and finding ways of predicting platelet transfusions at autologous hematopoietic stem cell transplantation in patients with hematologic and autoimmune diseases. Methods. Thrombocytopenia period after autologous hematopoietic stem cell transplantation in patients with autoimmune (group I, n=87) and hematological (group II, n=82) diseases was evaluated. Results. It was revealed that in patients with hematological oncologic diseases platelet count before the transplantation and on the first day after it is connected with the length of thrombocytopenia and the number of transfused platelets units. In patients with autoimmune diseases, low platelet count on the first day after transplantation might be used as a predictor for the transfusion risk. Day of thrombocytopenia onset is predictive of its duration and the need for blood components. In patients with hematological oncologic diseases, severe thrombocytopenia at day 14 before the transfusion is associated with further transfusion of 3 or more units of platelets. Platelet count at the first day after the transfusion is related to the number of platelet units transfused and thrombocytopenia duration. Onset of thrombocytopenia with platelet count lower than 20 and 10×109/L is predictive of its duration and the need for blood components. In patients with hematological oncologic diseases, early onset of thrombocytopenia is associated with further transfusion of larger doses of platelets. Conclusion. The revealed differences may be used as the criteria for predicting platelet transfusions in patients after autologous hematopoietic stem cell transplantation.

Aim. To compare the prevalence of HLA-system antigens genetic variants in potential hematopoietic stem cells donors in Kazakhstan and worldwide.Methods. Prevalence of HLA-antigens genetic variants in blood samples of potential hematopoietic stem cells donors included in hematopoietic stem cells donors register of Kazakhstan was analyzed and compared to a «Allele frequencies in Worldwide populations» database developed by the Royal Liverpool University Hospital.Results. The biggest overlap of Kazakhstan and World registers was seen in the distribution of 31-01 allele: 68 (4.5%) in Kazakhstan register, 1678 (4.63%) worldwide; odds ratio (OR) = 0.97 (0.76 to 1.24), F=0.851441, χ2=0.06. The biggest difference between the two registers was found in the distribution of locus A antigens: A 02-01 (χ2=24.59), A 02-07 (χ2=24.42), A 32-01 (χ2=27.1), A 02-37 (χ2=23.96), A 11-38 (χ2=3.96). In locus B alleles, the biggest overlap between the two comparison groups was in В 14:02 allele: Kazakhstan register - 31 (2.05%), worldwide register - 757 (2.01%) [OR=1.02 (0.71 to 1.47), F=0.851990, χ2=0.01], followed by 38:02 (χ2=0.02), 44:05 (χ2=0.03), in 27:07 (χ2=0.04), 54:01 (χ2=0.07). The biggest difference between the two registers was in 13:02 (χ2=256.9), 08:01 (χ2=26.92) locus B alleles. Distribution of locus C alleles was discovered to have the biggest statistical similarity of two registers provided by C 07:01 (χ2=0.07), 08:02 (χ2=0.15), 15:02 (χ2=0.23) 12:03 (χ2=0.76). The biggest difference in the distribution of locus C alleles between the two registers was in 06:02 (χ2=125.78) and C 03:02 (χ2=103.64).Conclusion. The overlap of HLA-antigens genetic variants distribution in Kazakhstan and global registers varies from 41 to 52% by loci (locus A - 50%, B - 52%, C - 48%, DRB1 - 51%, DQB1 - 41%, mean 48.4%, median 50%). Kazakhstan register contains information on unique HLA-antigens genetic variants not included in the general database, manifesting the need for national register development and its integration into the «Allele frequencies in Worldwide populations» register.

Aim. To develop the system of regional management of platelets bank based on the analysis of platelet concentrate supplies to Irkutsk region healthcare facilities.Methods. Irkutsk Regional Blood Transfusion Center expedition service reporting forms, branch statistical reports, accounting records of blood supply service facilities of Irkutsk Region for 2014 were analyzed.Results. To ensure the proper supply of Irkutsk region healthcare facilities with platelet concentrate, the main activities for stock management were determined: (1) key customers interaction management - by exploring the need for platelets and developing a mechanism for request planning for the next 7-9 days; (2) advance request execution - by donor acquisition, platelet concentrate production management, interaction with other institutions of the blood supply service; (3) platelet donation campaign. Regional management system for platelet stock was developed.Conclusion. Regional management system for platelet stock consists of 7 elements: (1) constant interaction with key customers: daily monitoring of healthcare facilities’ needs for platelet concentrate and planned advance requests for platelet concentrates; (2) anticipatory appointments for donors for platelet apheresis; (3) formation of platelet donors registry; (4) providing pediatric dosages of platelet concentrates for pediatric healthcare facilities; (5) combination of different ways of platelet concentrates preparation (production of platelet concentrates recovered from regular blood donors blood allows to create a «safety net» for emergencies); (6) arranging the planned production of platelet concentrates for Irkutsk at the branches of Irkutsk Regional Blood Transfusion Center, as well as in other Irkutsk Region regional blood supply service facilities; (7) promotion of platelet donation in blood supply service facilities.

The historical concentration of thrombocytes is an average of three subsequent concentrations of thrombocytes before donation (during two years) in blood of donors. The evaluation was applied to characteristics of historical concentration of thrombocytes concerning concentration of thrombocytes in blood of 99 regular donors before every donation of apheresis thrombocytes. It is established that less than 20% dispersion between historical concentration of thrombocytes and value obtained in day of donation is observed in 96% of regular donors. The average concentration of thrombocytes before three subsequent donations of apparatus apheresis in males is statistically higher than in females: 235,2±6,7 and 222,1±11,0 (× 109 cells/l) correspondingly (p0,05). The concentration of thrombocytes has no relationship with intervals between donations. There is no statistically significant differences between historical concentration of thrombocytes and concentration of thrombocytes before fourth donation and in general and between separate donations both in males and females. It is appropriate to analyze quality of concentrates of thrombocytes received through program accounting historical concentration of thrombocytes.

Aim. To evaluate features of the evolution of blood donation in Kazakhstan, including motivation and types of donations.Methods. Statistical data of blood donations in the Republic of Kazakhstan for 2010-2014 were studied.Results. In 2014, 51.8% of all blood donations in Kazakhstan were done by voluntary donors, 35.5% - by recipient’s relatives. The median proportion of paid donations in 2012-2014 years dropped by twice: 15.3; 10.5 and 7.6%, respectively. The number of platelet donations in 2010-2014 years increased by 717.3, of which 77% came from the cities of Astana and Almaty, where high-tech medical care is mainly provided. The number of plasma donations in 2014 compared to 2010 year has decreased by 35.7%, while its share in total number of donations dropped by 40.2%. Preparations are underway to contract plasma fractionation, becomes an actual the problem of determining blood donor reserves for plasma donations.Conclusion. Voluntary blood donations (51.8%) prevail in Republic of Kazakhstan; the the number of platelet donations increased by 717.3% in 2010-2014, the number of plasma donations dropped by 40.2%, which reveals the potential for implementing contract fractionation.

The prevalence and incidence of the infections among Russian blood donors in 2010-2012 was determined. The estimated residual risk of the transfusion infection was as follows: for HIV - 16.2, HCV - 33.7; HBV - 97.1 per 1 million donations. In the information system of the blood service AIST data should be divided based on the posi- tive results of screening and confirmatory tests for markers of the infection. High risk of the transfusion infection with HIV, hepatitis B and C stimulates the active implementation of the measures for increasing the safety of blood: the selection of donors, increasing the sensitivity of infections screening methods, inactivation of patho- gens in blood components, and transfusion management appointment at the clinic.

H. W. Reesink, J. Lee, A. Keller, P. Dennington, J. Pink, R. Holdsworth, H. Schennach, M. Goldman, T. Petraszko, J. Sun, Y. Meng, K. Qian, V. Rehacek, P. Turek, T. Krusius, E. Juvonen, P. Tiberghien, D. Legrand, G. Semana, J. Y. Muller, J. Bux, A. Reil, C. K. Lin, H. Daly, E. McSweeney, L. Porretti, N. Greppi, P. Rebulla, H. Okazaki, S. A. Sanchez-Guerrero, H. A. Baptista-Gonzalez, C. Martinez-Murillo, A. Guerra-Marquez, H. Rodriguez-Moyado, R. A. Middelburg, J. C. Wiersum-Osselton, A. Brand, C. van Tilburg, D. Dinesh, J. Dagger, P. Dunn, E. Brojer, M. Letowska, K. Maslanka, E. Lachert, M. Uhrynowska, E. Zhiburt, M. Palfi, G. Berlin, B. M. Frey, L. Puig Rovira, E. Muniz-Diaz, E. Castro, C. Chapman, A. Green, E. Massey, N. Win, L. Williamson, C. C. Silliman, D. J. Chaffin, D. R. Ambruso, N. Blumberg, P. Tomasulo, K. J. Land, P. J. Norris, O. C. Illoh, R. J. Davey, R. J. Benjamin, A. F. Eder, L. McLaughlin, S. Kleinman & S. Panzer

Since the first successful haematopoietic stem cell transplantation (HSCT) using cord blood from a sibling in 1988 and the establishment of the first public umbilical cord blood bank in New York Blood Center in 1992, umbilical cord blood banks have been instituted in many countries. Funding was received from regular blood banks, health councils, charity funds or commercial investments. The international medical society is indebted to the New York Blood Center for publishing their procedures and EuroCord for fighting a patent on cord blood processing. Although it is unknown how many cord blood samples are currently banked and have been transplanted worldwide, the figures of the international registration of World Marrow Donor Association (WHDA) show an increase of cord blood use, in addition to other sources of unrelated HSCT (Fig. 1). Cord blood for HSCT is, in addition to national/regional use, exchanged worldwide. Donor counselling, human leucocyte antigen (HLA)-typing, tests for transmittable diseases and product quality control requirements to comply with (inter)national [AABB, Paul-Ehrlich-Institut, NetCord/ Foundation for the Accreditation of Cellular Therapy (FACT)] standards are expensive, making storage of cord blood for unrelated allogeneic haematopoietic transplantation currently a loss-making activity, not particularly attractive for private enterprise. In the last years, hopes have been fueled that other stem cells in cord blood may be used for future repair of metabolic or degenerative diseases. Autologous or personal cord blood banking appeals to individual initiatives and private funding; money is desperately needed by allogeneic cord blood banks, and it would be much better if it could

The prevalence and incidence of infections among 28,248 blood donors in Astana in 2012 was determined. The estimated residual risk of the transfusion infection was as follows: for HIV--1,2, HCV--137,7, HBV--125,4 per 1 million donations. High risk of transfusion infection with HIV, hepatitis B, and C stimulates the active implementation of the measures for increasing the safety of blood: the selection of donors, increasing the sensitivity of infections screening methods, inactivation of pathogens in blood components and transfusion management appointment at the clinic.

The article presents the results of changes of concentration of DNA of viral hepatitis B under conservation in frozen conditions. The optimal scheme of preparing and delivering samples of donor blood stored up in institutions of blood service of the Irkutskaia oblast for molecular biological testing was elaborated.

The article deals with the results of work of Krasnoyarsk kray blood center immune hematologic laboratory concerning selection of erythrocytes in 2003-2010. In Krasnoyarsk kray, the portion of transfusions of individually selected erythrocytes increases and reached 31.9%. The setting up of register of donors typed by Ab0 and Rhesus systems makes it possible to implement effectively the individual selection of erythrocytes in optimal time-frame and in amount needed in clinics.

The authors studied materials of 17 complications due to transfusion of erythrocytes incompatible by AB0 phenotype, developed during 25 years in clinics of the Stavropol krai. All complications were associated with concrete defects in the work of blood service: wrong organization of blood service management in the clinic, poor special training of the personnel, low technological equipment of blood service, errors in laboratory investigations, laboratory investigations made not by specialists of laboratory diagnostics. In 40% of cases of posttransfusion complications transfusion was not indicated.

The cost-effectiveness of prescreening for alanine aminotransferase (ALT) activity was evaluated in blood donors before donation. Since September 15, 2006, the Krasnodar Territory blood transfusion station has examined more than 32 thousand donors in this fashion. A Reflotron Plus biochemical analyzer (Roche Diagnostics, Switzerland) was used. In 2008, 1230 subjects with increased ALT activity were withdrawn from donation. A total of 17,096 persons were examined. Their examination cost 1,219,457.8 rubles. Non-productive outlays of 7,773,919.8 rubles were prevented. The savings amounted to 6,554,462.12 rubles. Prescreening for ALT was found to be cost-effective if the rate of positive results in the donor population was 1.13% or more.

The authors have analyzed distinctions of transfusion correction of massive blood loss in Russia and abroad. National protocols of massive transfusions suppose using plasma volumes 3-4 times greater than similar protocols in other developed countries. Russian standards of quality of blood components do not correspond to the tasks of modem transfusion therapy.

An analysis of questionnaires used in the institutions of blood service has shown the absence of standards in maintenance of safety of the personnel storing up blood. Most frequent cases of contamination of the personnel with donors' blood was noted when venepunctions were being made, during filling the test-tubes from a tube, utilization of waste products, cutting the tubes and opening the test tubes. Introduction of a system of higher occupational safety of the personnel and successive action of using innovations, up-to-date configuration of hemocontainers with vacuum sampling of the first portion of blood for laboratory investigations and fixed closing the needle allows reduce occupational traumatism in blood service.

Transfusion-transmitted viral infection in Russia is most commonly due to plasma transfusion. Methylene blue treatment (Macotronic) is the most practical technology for plasma viral inactivation. It was shown to provide the maximal level of inactivation of both enveloped and non-enveloped viruses. It is preferable to perform inactivation of single plasma units, which can be done at any healthcare facility. The first experience in methylene blue plasma virus inactivation revealed good clinical results and social satisfaction.

To prevent bacterial contamination of blood transfusion media, the following three types of rooms in blood service institutions should meet especially high requirements for cleanness: 1. Box and its foreroom (or room equipped with laminar cabinet) for open-air preparation of washed red blood cells or other blood components. 2. Box (laminar cabinet) in bacteriological laboratory. 3. Two areas of gene diagnosis laboratory: a) for RNA detection (HIV and HCV diagnosis) to prevent sample contamination with extraneous RNAases; b) for preparation of in-house test kits. Required cleanness of rooms in blood service institutions can be attained using the following equipment available from Laminarnye Sistemy, Ltd. (Miass, Chelyabinsk Region, Russia): clean chamber equipment; abacterial air environment box for working with agents and microorganisms; box for working with DNA samples.

The incidence of viral hepatitis was compared in donors (n = 184532) with the increased or normal activity of alanine aminotransferase (ALT) without the specific markers of hepatitis - HbsAg and anti-HCV. The activity of ALT was found to retain its diagnostic values in preventing blood-transmitted diseases only with the insufficient sensitivity of the specific markers of viral hepatitis in donors. A prospective case-control study of the specific markers of the infections may be recommended to assess the quality of work of diagnostic laboratories.

Ultraviolet irradiation of peripheral blood in therapeutic doses corrects the immuno-suppressive effect of staphylococcal toxin. The main immunoregulatory effect of ultraviolet irradiation is associated with the production of endogenous immune transmitters by blood cells such as interleukin-1 and tumor necrosis factor. Ultraviolet irradiation increases the content of CD3+ and CD4+ lymphocytes and restores the natural killer activity. The last parameter is proposed as a convenient criterion of the efficiency of quantum hemotherapy.

6,744 persons were examined for the presence of antibodies to hepatitis C virus (HCV) before blood donation (4,219 persons in Moscow and 2,525 persons in St. Petersburg). The serum samples found to contain antibodies to HCV were additionally studied by the immunoblot techniques. The positive results of antibody screening were registered in 78 persons: 26 persons in Moscow (0.62%) and 52 in St. Petersburg (2.05%). In both cities the positive results of screening were confirmed in 62% of cases. Different occurrence of the profile with the presence of antibodies to all fragments of the virus: 52% in Moscow, 12% in St. Petersburg (chi2 = 12.11; p0.001). Considerable differences were also registered in the spread of individual antibodies.

Costs of electric power used for storage of freshly frozen plasma (FFP) were compared for refrigerators most widely used in Russian medical facilities. The minimal costs (2763.43 R) are those obtained for storage of 5000 FFP units in 12 plasma freezers, MDF-U536 (Sanyo, Japan). When 30,000 plasma units are stored the cost efficiency of power consumption is higher for the TELEDOOR freezer (Germany) versus MDF-U536. It can be assumed that, as the electric power cost increases, it will be more attractive to store FFP in liquid nitrogen vapor (MABAG, Germany). The above technology is registered in Russia; however, its application is still problematic due to economic reasons.

A conclusion is made, on the basis of independent research results and published data, on the need to verify, compulsorily, the screening finding of donor blood for hepatitis virus by immunoblot and, in extra complicated cases, by PCR.

Inactivation or elimination of (possibly) contaminated viruses from a pool of prepared several hundreds or thousands of donor-blood samples are an obligatory stage in the donor-blood preparation process. Virus-inactivation is verified through contaminating the basic material with viruses. The quality control of blood preparations, according to the Russian compulsory regulations, must include the testing of ready blood-based drugs for a lack of antibodies to HIV, hepatitis C virus and hepatitis B virus by using the test systems, which could not be exactly designed for the above purpose. Therefore, the below tasks are vital for the Russian Blood Service: 1) cancellation of the norm (belonging to the regulations of the quality control of blood preparations) to test the blood preparations for a lack of antibodies to HIV, hepatitis C virus and to the surface antigen of hepatitis B virus because it is biologically inexpedient and has no analogues in the world practice; 2) introduction of the virus-inactivation methods into the practice of plasma processing; 3) establishment of a special center that would evaluate the efficiency of the virus-inactivation methods used by producers of blood-based preparations; and 4) introduction of the methods of genetic testing of HIV, hepatitis B and C viruses into monitoring the quality of donor-sera pools that are later used in preparations' manufacturing.

It is important to well balance the loads of the opposite cups with plastic blood containers in order to correctly separate the donor blood into its components through centrifugation. A new balancer for centrifugation cups (USC5-01, manufacturer--Biophysical Instruments Ltd., Moscow) was tested at the Blood Center of Russia's Health Ministry. The original weights of all cups placed on the device weight sensors differed in all cases by readings of the light-emitting diode scale, which necessitated an appropriate balancing. The weight differences varied from 4 to 20 g, i.e. from 1 to 5 green lamps). The testing of the device verified its simplicity, convenience, and a shorter time spent on each balancing procedure; the device response lag to balancing made only 2-3 sec. The minimal out-of-balance index did not exceed 4 g, which ensures the obtaining of components meeting the requirements applied to them.

Cryopreservation is the method of choice in solution of the problem of the done in good time reservation of the components of blood and bone marrow for autotransfusion in patients referred to the contingent of particular risk. Freezing of autologous hemocomponents increases the infection safety and efficiency of therapy with hemocomponents. The wide introduction of using autologous hemocomponents into the everyday surgical practice and in the arsenal of means and methods of the medicine of extreme situations is an indispensable condition for increasing the effects of curative and medico-evacuational measures.

About 20% of accident and disaster victims need the hemotransfusion therapy. At present the method of erythrocyte long-term storage in the blood banks with glycerin high concentration is the most acceptable one. There are special medical teams (SMT) in the districts. They include the transfusiologic group with appropriate reserve of hemotransfusion materials. Most of them must be stored as untouchable reserve in the institutions of blood service and large hospitals on which the SMTs are based.

A new device for preparing washed red cell components was proposed by the Sintez Co., Kurgan. The disposable containers were evaluated at the Center of Blood and Tissues, Military Medical Academy. The new system was found to be more effective, time-saving, cost-effective and decreased the risk of infectious complications as compared to the traditional methods for washing red cell components. Thus, the new device can be recommended for wide use in transfusion medicine.

The first Russian solution Krimolit designed for cryopreservation of platelet concentrates down -196 degrees C was clinically tested. The therapeutical efficacy of the cryopreserved platelets was evaluated on the basis of clinical and laboratory monitoring of transfusions in 20 cancer hematological patients. They were found to have the same therapeutical action as fresh cells. The introduction of cryopreserved platelets into clinical practice allows one to form stores and to transfuse autological cells. Krimolit is recommended for clinical application.

Modern arms in combat tend to increase sanitary losses, change their structure and make combat traumas more severe. Blood transfusion therapy became a necessity in the wounds treatment. The recent armed conflicts made military medics move the blood transfusion service to the front lines. The authors present some data obtained in Afghanistan and Chechnya.

Marrow stroma was investigated in 20 patients with chronic lymphocytic leukemia (CLL). Such morphological and functional features as adipose tissue reduction, sinusoid pattern obliteration and increased number of reticular cells were identified as typical of marrow stroma in such patients. Foci of fibrosis, nuclear bodies in stromal cell nuclei and heightened proliferation of stromal precursors in organ cultures were recorded in the subendostal and perivascular areas in 60% of patients with diffuse lesions of bone marrow. Bone marrow stroma was shown to suffer morphological and functional changes which were particularly pronounced in diffuse lesions of the bone marrow. Such changes may be traced both to the malignant clone of lymphoid cells and stromal lesions.