bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.25837/HAT.2019.62.39.006bloodjour-115Research ArticleРЕКОМЕНДАЦИИRЕCOMMENDATIONSКЛИНИЧЕСКОЕ ИСПОЛЬЗОВАНИЕ ЭРИТРОЦИТСОДЕРЖАЩИХ КОМПОНЕНТОВ ДОНОРСКОЙ КРОВИCLINICAL GUIDELINES FOR RED BLOOD CELL TRANSFUSIONhttps://orcid.org/0000-0002-4434-3123АксельродБ. А.AkselrodB. A.

Аксельрод Борис Альбертович (Boris Akselrod), д. м. н., заведующий отделением анестезиологии-реанимации II, врач анестезиолог-реаниматолог высшей аттестационной категории

https://orcid.org/0000-0002-3741-0770БалашоваЕ. Н.BalashovaE. N.

Балашова Екатерина Николаевна (Ekaterina Balashova), к. м. н., врач анестезиолог-реаниматолог, неонатолог, педиатр отделения реанимации и интенсивной терапии имени профессора А.  Г.  Антонова

https://orcid.org/0000-0001-5031-7637БаутинА. Е.BautinA. E.

Баутин Андрей Евгеньевич (Andrey Bautin), д. м. н., заведующий НИЛ анестезиологии и реаниматологии, профессор кафедры анестезиологии и реаниматологии, доцент, врач высшей категории

https://orcid.org/0000-0001-7813-2028БаховадиновБ. Б.BakhovadinovB. B.

Баховадинов Бурхонидин Баховадинович (Burkhonidin Bakhovadinov), д. м. н., профессор кафедры гематологии, трансфузиологии, трансплантологии факультета последипломного обучения

https://orcid.org/0000-0003-1098-8406БирюковаЛ. С.BiryukovaL. S.

Бирюкова Людмила Семеновна (Lyudmila Biryukova), заведующая отделением гемодиализа и полиорганной патологии, врач-нефролог, профессор

https://orcid.org/0000-0001-6999-8145БулановА. Ю.BulanovA. Yu.

Буланов Андрей Юльевич (Andrey Bulanov), д. м. н., руководитель консультативной трансфузиологической бригады, профессор

https://orcid.org/0000-0001-7472-4683БыстрыхО. А.BystrykhO. A.

Быстрых Оксана Анатольевна (Oksana Bystrykh), к.  м.  н., заведующая отделением трансфузионной иммунологии и заготовки компонентов крови, врач-трансфузиолог

https://orcid.org/0000-0003-2651-1442ВиноградоваМ. А.VinogradovaM. A.

Виноградова Мария Алексеевна (Maria Vinogradova), к.  м.  н., заведующая отделением репродуктивной гематологии и клинической гемостазиологии, врач-гематолог

https://orcid.org/0000-0001-8818-8949ГалстянГ. М.GalstyanG. M.

Галстян Геннадий Мартинович (Gennadii Galstyan), д.  м.  н., заведующий отделением реанимации и интенсивной терапии, врач анестезиолог-реаниматолог

https://orcid.org/0000-0002-9684-5045ГапоноваТ. В.GaponovaT. V.

Гапонова Татьяна Владимировна, кандидат медицинских наук, заместитель генерального директора по трансфузиологии

заведующая отделом процессинга клеток крови и криоконсервирования, главный внештатный специалист-трансфузиолог Минздрава России

Tat’yana V. Gaponova, MD, PhD deputy director, head of transfusion service

gaponova.tatj@yandex.ruhttps://orcid.org/0000-0002-9423-2640ГоловкинаЛ. Л.GolovkinaL. L.

Головкина Лариса Леонидовна (Larisa Golovkina), д. м. н., заведующая лабораторией трансфузиологической иммуногематологии, врач-иммуногематолог клинической лабораторной диагностики

https://orcid.org/0000-0002-1858-314XГороховскийВ. С.GorokhovskiyV. S.

Гороховский Вадим Семенович (Vadim Gorokhovskiy), к. м. н., доцент, заведующий кафедрой анестезиологии-реаниматологии, трансфузиологии и скорой медицинской помощи

https://orcid.org/0000-0001-5809-8563ЕременкоА. А.EremenkoA. A.

Еременко Александр Анатольевич (Aleksandr Eremenko), д. м. н., заведующий отделением кардиореанимации, профессор, член-кор. РАН

https://orcid.org/0000-0002-7943-6266ЖибуртЕ. Б.ZhiburtE. B.

Жибурт Евгений Борисович (Evgeniy Zhiburt), д. м. н., заведующий кафедрой трансфузиологии и проблем переливания крови

профессор, врач-трансфузиолог высшей категории

https://orcid.org/0000-0002-9992-9260ЖуравельС. В.ZhuravelS. V.

Журавель Сергей Владимирович (Sergey Zhuravel), д. м. н., профессор кафедры анестезиологии, реаниматологии и неотложной медицины, заведующий научным отделом анестезиологии и реаниматологии для трансплантации органов

https://orcid.org/0000-0003-0261-5941КохноА. В.KokhnoA. V.

Кохно Алина Владимировна (Alina Kokhno), к. м. н., врач-гематолог отделения интенсивной высокодозной химиотерапии гемобластозов и депрессий кроветворения с круглосуточным и дневным стационаром

https://orcid.org/0000-0001-6201-6276КузьминаЛ. А.KuzminaL. A.

Кузьмина Лариса Анатольевна (Larisa Kuzmina), к.  м.  н., заведующая отделением интенсивной высокодозной химиотерапии и трансплантации костного мозга с круглосуточным и дневным стационаром, врач-гематолог

https://orcid.org/0000-0003-1769-7038КулабуховВ. В.KulabukhovV. V.

Кулабухов Владимир Витальевич (Vladimir Kulabukhov), к. м. н., руководитель отдела анестезиологии-реанимации

https://orcid.org/0000-0001-7673-4762КупряшовА. А.KupryashovA. A.

Купряшов Алексей Анатольевич (Alexey Kupryashov), д.  м.  н., заведующий отделением переливания крови

https://orcid.org/0000-0003-2595-5877ЛубнинА. Ю.LubninA. Yu.

Лубнин Андрей Юрьевич (Andrei Lubnin), д. м. н., проф., заведующий отделением анестезиологии-реанимации, врач анестезиолог-реаниматолог

https://orcid.org/0000-0003-3917-0771МазурокВ. А.MazurokV. A.

Мазурок Вадим Альбертович (Vadim Mazurok), д. м. н., заведующий кафедрой анестезиологии и реаниматологии, профессор

https://orcid.org/0000-0002-5088-951XМеньшугинИ. Н.MenshuginI. N.

Меньшугин Иван Николаевич (Ivan Menshugin), врач анестезиолог-реаниматолог

https://orcid.org/0000-0001-7137-8877МинееваН. В.MineevaN. V.

Минеева Наталья Витальевна (Natalia Mineeva), д.  б.  н., профессор, руководитель лаборатории изосерологии

https://orcid.org/0000-0003-1074-8963МихайловаЕ. А.MihailovaE. A.

Михайлова Елена Алексеевна (Elena Mihailova), д. м. н., профессор, ведущий научный сотрудник отдела интенсивной высокодозной химиотерапии гемобластозов и депрессий кроветворения с круглосуточным и дневным стационаром

https://orcid.org/0000-0002-2490-1263НикитинЕ. А.NikitinE. A.

Никитин Евгений Александрович (Evgeniy Nikitin), д. м. н., заведующий дневным стационаром гематологии (гематологии, химиотерапии и онкологии)

https://orcid.org/0000-0003-0876-5414ОловниковаН. И.OlovnikovaN. I.

Оловникова Наталья Ивановна (Natalia Olovnikova), к. б. н., ведущий научный сотрудник, биолог-биохимик, лаборатория физиологии кроветворения

https://orcid.org/0000-0002-3674-252XОшоровА. В.OshorovA. V.

Ошоров Андрей Васильевич (Andrey Oshorov), д. м. н., врач анестезиолог-реаниматолог, отдел анестезиологии-реанимации и интенсивной терапии с отделениями (отделение реанимации и интенсивной терапии)

https://orcid.org/0000-0001-9240-2768ПевцовД. Э.PevtsovD. E.

Певцов Дмитрий Эдуардович (Dmitrii Pevtsov), руководитель отделения переливания крови

https://orcid.org/0000-0003-2910-9571ПопцовВ. Н.PoptsovV. N.

Попцов Виталий Николаевич (Vitaliy Poptsov), д.  м.  н., профессор, заместитель директора по реализации высокотехнологичных программ

https://orcid.org/0000-0001-9847-5765РогачевскийО. В.RogachevskiyO. V.

Рогачевский Олег Владимирович (Oleg Rogachevskiy), д. м. н., трансфузиолог, акушер-гинеколог, заведующий отделением экстракорпоральных методов лечения и детоксикации

https://orcid.org/0000-0003-3329-5434СалимовЭ. Л.SalimovE. L.

Салимов Эмин Львович (Emin Salimov), врач-трансфузиолог, доцент, заведующий отделом заготовки крови и ее компонентов

https://orcid.org/0000-0003-4431-3343ТитковК. В.TitkovK. V.

Титков Константин Валентинович (Konstantin Titkov), к. м. н., врач анестезиолог-реаниматолог, неонатолог отделения хирургии новорожденных

https://orcid.org/0000-0002-0231-1617ТрахтманП. Е.TrakhtmanP. E.

Трахтман Павел Евгеньевич (Pavel Trakhtman), д. м. н., заведующий отделением трансфузиологии, заготовки и процессинга гемопоэтических стволовых клеток, врач-трансфузиолог, профессор

https://orcid.org/0000-0002-4827-8947ТроицкаяВ. В.TroitskayaV. V.

Троицкая Вера Витальевна (Vera Troitskaya), к. м. н., заведующая отделением интенсивной высокодозной химиотерапии гемобластозов и депрессий кроветворения с круглосуточным и дневным стационаром, врач-гематолог

https://orcid.org/0000-0001-6714-6344ФедороваТ. А.FedorovaT. A.

Федорова Татьяна Анатольевна (Tatiana Fedorova), д. м. н., руководитель отдела трансфузиологии и экстракорпоральной гемокоррекции, профессор

https://orcid.org/0000-0003-0934-6094ФидароваЗ. Т.FidarovaZ. T.

Фидарова Залина Таймуразовна (Zalina Fidarova), к.  м.  н., заведующая отделением химиотерапии гемобластозов и депрессий кроветворения с дневным стационаром

https://orcid.org/0000-0002-0977-215XЦветаеваН. В.TsvetaevaN. V.

Цветаева Нина Валентиновна (Nina Tsvetaeva), к.  м.  н., ведущий научный сотрудник, врач-гематолог отделения орфанных заболеваний

https://orcid.org/0000-0002-0204-8337ЧжаоА. В.ChzhaoA. V.

Чжао Алексей Владимирович (Alexey Chzhao), д. м. н., руководитель центра абдоминальной хирургии

https://orcid.org/0000-0003-1214-4493ШестаковЕ. Ф.ShestakovE. F.

Шестаков Евгений Андреевич (Evgeniy Shestakov), д. м. н., заведующий отделением переливания крови, врач-трансфузиолог высшей категории, профессор, доцент

ФГБНУ «РНЦХ им. акад. Б. В. Петровского»РоссияPetrovsky National Research Centre of SurgeryRussian FederationФГБУ «НМИЦ АГП им. В. И. Кулакова» Минздрава РоссииРоссияV. I. Kulakov Research Center of Obstetrics, Gynecology, and PerinatologyRussian FederationФГБУ «НМИЦ им. В. А. Алмазова» Минздрава РоссииРоссияAlmazov National Medical Research CentreRussian FederationФГБОУ ВО ПСПбГМУ им. И. П. Павлова Минздрава РоссииРоссияPavlov First Saint Petersburg State Medical UniversityRussian FederationФГБУ «НМИЦ гематологии» Минздрава РоссииРоссияNational Research Center for HematologyRussian FederationГБУЗ «Городская клиническая больница № 52 ДЗМ»РоссияCity municipal hospital 52Russian FederationФГБОУ ВО «Дальневосточный государственный медицинский университет» Минздрава РоссииРоссияFar-Eastern State Medical UniversityRussian FederationФГБУ «НМХЦ им. Н. И. Пирогова» Минздрава РоссииРоссияPirogov National Medical and Surgical CenterRussian FederationГБУЗ «НИИ СП им. Н. В. Склифосовского ДЗМ»РоссияN. V. Sklifosovsky Research Institute of Emergency MedicineRussian FederationФГБУ «НМИЦ хирургии им. А. В. Вишневского» Минздрава РоссииРоссияA. V. Vishnevsky National Medical Research Center of SurgeryRussian FederationФГБУ «НМИЦ ССХ им. А. Н. Бакулева» Минздрава РоссииРоссияBakulev Scientific Center for Cardiovascular SurgeryRussian FederationФГАУ «НМИЦ нейрохирургии им. акад. Н. Н. Бурденко» Минздрава РоссииРоссияBurdenko Neurosurgery InstituteRussian FederationФГБУ Рос НИИГТ ФМБА РоссииРоссияRussian Research Institute of Hematology and Transfusiology of St PetersburgRussian FederationГБУЗ «ГКБ им. С. П. Боткина ДЗМ»РоссияS. P. Botkin City Clinical HospitalRussian FederationФГБУ «НМИЦ ТИО им. акад. В. И. Шумакова» Минздрава РоссииРоссияV. I. Shumakov Federal Research Center of Transplantology and Artificial OrgansRussian FederationФГАОУ ВО Первый МГМУ им. И. М. Сеченова Минздрава России (Сеченовский университет)РоссияI. M. Sechenov First Moscow State Medical UniversityRussian FederationФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава РоссииРоссияDmitry Rogachev National Research Center of Pediatric Hematology, Oncology and ImmunologyRussian Federation201825062019634372435Copyright © Аксельрод Б.А., Балашова Е.Н., Баутин А.Е., Баховадинов Б.Б., Бирюкова Л.С., Буланов А.Ю., Быстрых О.А., Виноградова М.А., Галстян Г.М., Гапонова Т.В., Головкина Л.Л., Гороховский В.С., Еременко А.А., Жибурт Е.Б., Журавель С.В., Кохно А.В., Кузьмина Л.А., Кулабухов В.В., Купряшов А.А., Лубнин А.Ю., Мазурок В.А., Меньшугин И.Н., Минеева Н.В., Михайлова Е.А., Никитин Е.А., Оловникова Н.И., Ошоров А.В., Певцов Д.Э., Попцов В.Н., Рогачевский О.В., Салимов Э.Л., Титков К.В., Трахтман П.Е., Троицкая В.В., Федорова Т.А., Фидарова З.Т., Цветаева Н.В., Чжао А.В., Шестаков Е.Ф., 20192019Аксельрод Б.А., Балашова Е.Н., Баутин А.Е., Баховадинов Б.Б., Бирюкова Л.С., Буланов А.Ю., Быстрых О.А., Виноградова М.А., Галстян Г.М., Гапонова Т.В., Головкина Л.Л., Гороховский В.С., Еременко А.А., Жибурт Е.Б., Журавель С.В., Кохно А.В., Кузьмина Л.А., Кулабухов В.В., Купряшов А.А., Лубнин А.Ю., Мазурок В.А., Меньшугин И.Н., Минеева Н.В., Михайлова Е.А., Никитин Е.А., Оловникова Н.И., Ошоров А.В., Певцов Д.Э., Попцов В.Н., Рогачевский О.В., Салимов Э.Л., Титков К.В., Трахтман П.Е., Троицкая В.В., Федорова Т.А., Фидарова З.Т., Цветаева Н.В., Чжао А.В., Шестаков Е.Ф.Akselrod B.A., Balashova E.N., Bautin A.E., Bakhovadinov B.B., Biryukova L.S., Bulanov A.Y., Bystrykh O.A., Vinogradova M.A., Galstyan G.M., Gaponova T.V., Golovkina L.L., Gorokhovskiy V.S., Eremenko A.A., Zhiburt E.B., Zhuravel S.V., Kokhno A.V., Kuzmina L.A., Kulabukhov V.V., Kupryashov A.A., Lubnin A.Y., Mazurok V.A., Menshugin I.N., Mineeva N.V., Mihailova E.A., Nikitin E.A., Olovnikova N.I., Oshorov A.V., Pevtsov D.E., Poptsov V.N., Rogachevskiy O.V., Salimov E.L., Titkov K.V., Trakhtman P.E., Troitskaya V.V., Fedorova T.A., Fidarova Z.T., Tsvetaeva N.V., Chzhao A.V., Shestakov E.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/115

Принимая во внимание возможные посттрансфузионные реакции и осложнения, необходимо придерживаться строгих показаний к переливанию эритроцитсодержащих компонентов крови (ЭСК). Цель настоящих рекомендаций  — представить основные виды ЭСК и показания к их применению у различных категорий больных. Методы. Методические подходы основываются на мнении ведущих российских экспертов, данных опубликованных в литературе рандомизированных исследований, изучавших сроки хранения, порог концентрации гемоглобина и клинические показания для трансфузии ЭСК. Результаты. Проект клинических рекомендаций рассмотрен 1  октября 2018  г. на Первом конгрессе российских трансфузиологов (г.  Владивосток). В рекомендациях представлены основные типы ЭСК, сроки их хранения, условия транспортировки, показания к трансфузии ЭСК у различных категорий больных (в акушерстве, неонатологии, гематологии, кардиологии, кардиохирургии, нейрохирургии, нефрологии, при острой массивной кровопотере, при сепсисе, септическом шоке, при трансплантации гемопоэтических стволовых клеток и солидных органов). Заключение. Рекомендации предназначены для врачей различных специальностей, администраторов здравоохранения, студентов медицинских учебных заведений.

Adherence to proper indications for red blood cells (RBC) transfusion is essential because of its potential adverse effects and costs of therapy. Aim of these recommendations is to summarize typed of RBC concentrates and indications for RBC transfusions among different categories of the patients. Methods. The methodological approaches are based on the recommendations of the Russian expert council (leading specialists of the Russian Federation) and literature search for randomized clinical trials evaluating RBC storage duration, hemoglobin thresholds and clinical indications for RBC transfusion without language restrictions. Results. The draft clinical guidelines were reviewed on February 1, 2018 at First Russian Transfusiology Congress of the (Vladivostok). The main types of RBC concentrates, storage duration, transport conditions and indications for RBC transfusions are presented. The indications for RBC transfusions are analyzed for various clinical conditions (in obstetrics, neonatology, hematology, cardiology, neurosurgery, nephrology, in patients with sepsis and septic shock, patients with acute blood loss, in patients after hematopoietic stem cell and organ transplantation). Conclusion. The recommendations are intended for doctors of various specialties, health administrators, medical students.

анемияэритроцитсодержащие компоненты донорской кровиэритроцитная массаэритроцитная взвесьэритроцитная взвесь лейкоредуцированнаяотмытые эритроцитыоблученные эритроцитыэритроцитная взвесь размороженнаяотмытаяanemiaRBC componentsRBC concentrateRBC suspensionleukoreduced RBCwashed RBC сoncentratesapheresis RBCirradiated RBC concentratescryopreserved RBC concentratesReferencesПостановление Правительства РФ от 26 января 2010 г. №29 «Об утверждении технического регламента о требованиях безопасности крови, ее продуктов, кровезамещающих растворов и технических средств, используемых в трансфузионно-инфузионной терапии».Постановление Правительства РФ от 26 января 2010 г. №29 «Об утверждении технического регламента о требованиях безопасности крови, ее продуктов, кровезамещающих растворов и технических средств, используемых в трансфузионно-инфузионной терапии».Жибурт ЕБ, Протопопова ЕБ, Губанова МН, Каюмова ЛИ, Кузьмин НС, Танкаева ХС. 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Adverse reactions and complications after red blood cell transfusions (etiology, diagnosis, treatment) Вид реакций и осложнений Type of reactions and complications Причина Cause Лечебные мероприятия Treatment Обязательные и дополнительные лабораторные и инструментальные исследования реципиента Mandatory and additional laboratory and instrumental tests Септический шок Septic shock Трансфузия (переливание) инфицированного ЭСК Transfusion of bacterial contaminated RBC Терапия антибиотиками широкого спектра действия и противошоковая терапия Broad-spectrum antibiotic therapy and anti-shock therapy Обязательные исследования: бактериологическое исследование крови больного и ЭСК Mandatory tests: blood culture Перегрузка железом — гемохроматоз Iron overload — hemochromatosis Многократные переливания эритроцитов Multiple red blood cell transfusions Препараты группы комплексообразующих средств (деферазирокс 15—20 мг/кг или другой препарат с аналогичным действием) Iron chelators (deferasirox 15—20 mg/kg) Обязательные исследования: ферритин сыворотки более 1000 нг/мл Mandatory tests: ferritin measurement (reference: over 1000 ng/ml)Baek JH, D’Agnillo F, Vallelian F, Pereira CP, Williams MC, Jia Y et al. Hemoglobin-driven pathophysiology is an in vivo consequence of the red blood cell storage lesion that can be attenuated in guinea pigs by haptoglobin therapy. J Clin Invest. 2012;122:1444—58. Таблица 4 (окончание). Реакции и осложнения, возникающие у реципиентов при переливании ЭСК (этиология, диагностика, лечение) Table 4 (ending). Adverse reactions and complications after red blood cell transfusions (etiology, diagnosis, treatment) Вид реакций и осложнений Type of reactions and complications Причина Cause Лечебные мероприятия Treatment Обязательные и дополнительные лабораторные и инструментальные исследования реципиента Mandatory and additional laboratory and instrumental tests Септический шок Septic shock Трансфузия (переливание) инфицированного ЭСК Transfusion of bacterial contaminated RBC Терапия антибиотиками широкого спектра действия и противошоковая терапия Broad-spectrum antibiotic therapy and anti-shock therapy Обязательные исследования: бактериологическое исследование крови больного и ЭСК Mandatory tests: blood culture Перегрузка железом — гемохроматоз Iron overload — hemochromatosis Многократные переливания эритроцитов Multiple red blood cell transfusions Препараты группы комплексообразующих средств (деферазирокс 15—20 мг/кг или другой препарат с аналогичным действием) Iron chelators (deferasirox 15—20 mg/kg) Обязательные исследования: ферритин сыворотки более 1000 нг/мл Mandatory tests: ferritin measurement (reference: over 1000 ng/ml)Kriebardis AG, Antonelou MH, Stamoulis KE, Economou-Petersen E, Margaritis LH, Papassideri IS. 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The authors declare that there are no conflicts of interest present.