It is tense to relieve the blood: It is as important as reducing expenditure to increase income
In the past two years, a lot of city emerging blood of the whole country is in short supply, pay close attention to the focus as the society. In the propaganda activity of unpaid blood donation of 2011 years which six ministries and commissions launched of December of last year, cure Ministry of Public Health the intersection of policy and department, trust, health newspaper office and the intersection of Shanghai and Municipal Health Bureau hold guarantee blood safety and strengthen reasonable to cut the forum with blood vessel jointly in Shanghai. The expert participating in the conference proposes, ensure blood supplt, guarantee the blood safety and use the blood scientifically and rationally, it is significant to relieving the blood intensely. Staff reporter Sun Meng Ministry of Public Health cures Shen ZiYu, division chief of Blood Management Office of policy department: It is tense main reason of the blood at present that the clinical demand for blood increases fast, increase " catch up with " in blood supplt of our country The increase of the clinical demand for blood, this is that " bottleneck " appears in the services of blood collecting and supplying Main reason,last contradiction only, be could break by " the bottlenecked " . This needs to promote unpaid blood donation in a more cost-effective manner, and it is clinical and rational to do well and pay attention to the blood vessel. Since " law of blood donating " was issued in 1998, the service of blood collecting and supplying of our country has made very great progress. In blood supplt, succeed in, realize, donate blood to transition of unpaid blood donation with compensation already, now, unpaid blood donation rate is up to 99%, blood supplt can basically satisfy the clinical need. The situation of the blood safety of our country is more steady too, in the AIDS patient that sends newly in 2009, 2010, have not found that pass the blood disseminator. However, the blood works but also face a lot of challenges. A most central question is, though the annual amount of blood supply of our country is increased progressively at the speed of 12.6%, but still can't totally meet the medical demand, this brings enormous presure to free blood donation, the contradiction when opposite to blood deliverability insufficiently in constant increase of the demand of blood used in clinic is stressed in the key city, the sustainable development of service of this pair of blood collecting and supplying is challenged. After the medical reform is started, medical treatment ensures the system to build and obtain very good achievement, the people have money to see the doctor, this makes its demand of medical care released out. Compared with 2009 in 2010, the skill person of my national champion will increase by 18.6%, and adopt oligemic only 7.7% of growth, have caused the intension of blood supplt directly. It is a question that can't be avoided either that the working foundation of blood collecting and supplying is weak. Of our country the blood used in clinic comes from unpaid blood donation above 99%, close with the level of developed country. But only 8.7% of donating blood rate of people of our country. ,45.4% less than world high-income countries. With 10.1% of the middle-income countries. ,Also lower than 30% of Hong Kong of our country. With 23% of Macao. ,Leave 10% that World Health Organization recommended. Also there is certain disparity. Our country will really form the long-efficiency mechanism of the free blood donation, there are ways not shorting will go. In the face of the challenge, our country should advocate increasing income and reducing expenditure and regarding as equally important. In increasing income, blood collecting and supplying of our country work, should set up, improve the intersection of government and leading factor, many department, cooperate coordinating mechanism actively, revise the relevant laws and regulations, promote unpaid blood donation in a more cost-effective manner, implement the duty of health authority at the same time, strengthen the self-building of blood station. In reducing expenditure, will advocate using the idea of the blood clinically scientifically and rationally in a more cost-effective manner. The medical organization should strengthen management, examine and approve with the blood strictly, and study and popularize the ripe one, since blood such as the blood transfusion of body protect technology, Ministry of Public Health would release the new medical organization to pay attention to the method clinically with the blood vessel, would also organize supervising and guiding checking to supervise to implement specially in 2012. Deputy Bureau Director of Shanghai Municipal Health Bureau Ju JieMing: The medical portfolio that should insist on giving play to the role of group's unpaid blood donation in Shanghai rises very fast, at present, the medical portfolio in the whole city is close to 200 million persons, more than 30 large-scale tertiary hospitals of the whole city accept to the patients from all parts of the country. Though the blood used in clinic faces the pressure greatly, still can guarantee the basic equilibrium of supply and demand. Blood of Shanghai gather, work, insist on, based on group's unpaid blood donation, donate blood as support in the street all the time, this kind of system arranges to have unique advantage, to guaranteeing the equilibrium of supply and demand of blood plays a good role. In recent years, Shanghai has undertaken some work of the World Expo, world swimming championships and Olympic Games, accumulated certain experience in guaranteeing blood supplt. Had some seasons, like around winter, summer and the Spring Festival, the seasonal one will often happen ischemically, in these cases, group's unpaid blood donation can relieve blood shortage quickly, well regulate the plan of blood collecting and supplying of the whole year, the ones that guaranteed blood used in clinic are in order nature. The blood director of management office Zhu YueGuo in Shanghai: " planned management " Guaranteeing the blood of Shanghai of equilibrium of supply and demand of blood manages and realizes the separation of function of blood collecting and supplying and supervisory function, done and responsible for donating blood, collects blood, the everyday control of the blood supply and medical blood used in clinic by the blood vessel; The blood center is responsible for the blood to gather, measure, prepare, store and supply etc.. A the same one very with the intersection of the whole country and other city, blood of Shanghai gather, work, insist on, based on group's unpaid blood donation, donate blood as support in the street all the time. Group's unpaid blood donation can optimize the structure of blood donating. Uncertainty exists in flexible street blood collecting, blood group one is partial type and inevitable. Take Shanghai as examples, the ones that basically will find blood of A type and O type 6 months every 3 months are partial type, and group's unpaid blood donation can be corrected in time. In addition, when the accident happens to need to recruit the blood donor promptly, group's unpaid blood donation can play an irreplaceable role too. In raising the efficiency of blood collecting and supplying, the experience of Shanghai is to popularize third amino acid amino transferase of serum to measure fast actively. According to " first launch a pilot project, and then popularize " Principle,Shanghai at present is at preexamination blood donors non- been at all of the whole cities already implement serum third amino acid transferase amino to measure fast. Assess the result according to the pilot project, the condernmation facte of blood can be dropped from 10% original to under 3%. Before making the plan for the use of blood, Shanghai has carried on the investigation to key indexes such as the organization door emergency call quantity, number, berth counting, surgery quantity in hospital in recent years of medical blood used in clinic at all levels of the whole city,etc., plan for the use of blood detailed to turn monthly plan every medical year such as unit, set up the intersection of fixed hospital and the intersection of blood and the intersection of stock and the intersection of daily and system during important activity, tournament, know dynamically that uses the blood tendency. Shanghai has also set up early warning mechanism, tells the stock situation to the medical organizations at all levels in time, can adjust and use the blood structure to let clinically in time. Last year, the blood supply of Shanghai had not obviously increased, but the clinical order was more steady, until the intersection of body and energetical development of blood transfusion there are very great relations since this. Counted some tertiary sample investigation of medical organization last year according to Shanghai, the total example of blood transfusion of the body of since city these is counted and increased by 130% on the basis of 2010, the quantity of answering for blood transfusion is from 1191525 ml (shares of about 5958 people) in 2010 Rise to 1325449 Ml( Shares of about 6627 people) ,Growth rate is 11.23%; Combined for year and used blood volume, blood transfusion of body in since 2010 rate is 6.6%, it was 8.9% in 2011, increased by 2.3 percentage points. Deputy Director of Shandong blood center Liu JinLing: Strengthen the beginning of December 2011 years such as function until blood work such as government, Shandong convenes the blood transfusion services at all levels to hold the forum, the personnel present get out of, promote the blood to work and develop continuously in an all-round way and must strengthen the government on the function among them. The personnel present propose, issue the file in the name of provincial government, define duties of related departments such as the finance, education, urban construction, traffic, garden of the governments at all levels,etc., for energetical support in the respect of propagating construction,etc. that launching, group donates blood, fixes the blood donating room, donates blood and clicks of unpaid blood donation; Strengthen the ability construction of blood collecting and supplying of blood station at all levels, increase the strengths of blood station at all levels, increase the input in funds; Propose the department of propagating, educating etc. includes the free blood donation in the scientific education of school and examination category of the construction of spiritual civilization, make the free blood donation really become the component with inalienable socialist spiritual civilization. None of specialized agencies fulfil the duty instead of the government, the task is very difficult to implement. The personnel present propose, should set up with taking the lead in, free blood donation coordinating mechanism which every department participates in of provincial government, give full play to the role of blood donation office. The department of public health of Shandong issued the rules of management of clinical blood transfusion of the hospital and basic standard of the blood transfusion dept. of the new hospital in October of 2011, the purpose is rational to the hospital standardized with the blood, launch from new technology of failing etc. of going back of the blood of body in a more cost-effective manner at the same time. At present, Linyi has already had hospitalled that has launched this technology, others' large hospital is expected to launch rapidly too, will make contributions to saving the blood. Treasure Professor Hua of the money of head of the department of blood transfusion of the second army medical university Changhai hospital: Strengthen sections of blood vessel, cut with new the intersection of technical application and the intersection of Changhai and the intersection of hospital and annual the intersection of operation and quantity reaching 40300 more than, have occupied the first place in every large hospital of Shanghai for 3 years in succession. In recent years, it is clinical and rational for the our academy to pay attention to the blood vessel through strengthening, employ the new technology to protect the blood at the same time, save and reach more than 1 million ml clinically with blood volume every year on average. General Board, main clinical person in charge of relevant department take the post as the committee member's clinical blood transfusion committee of hospital after the our academy has established and appointed president as, it is clinical by paying attention to and technology regular guidance and supervision of blood vessel to responsible for the hospital, have made the overall relevant system of blood used in clinic, if pay attention to method and implementing regulation clinically with the blood vessel, since management of blood transfusion of body and system to assess, composition blood transfusion system and system to assess, blood protect management and system to assess etc.. The hospital successively purchased the retrieving machine of 10 sets of blood, allocated one's own blood transfusion attenbant for 24 hours, set up blood sampling room,etc.. Our academy insist on, hold reasonable to continue educating with blood, tell basic conception and requirement every year, require each clinician to read and study and sign and confirm, at the same time science, it is rational to include in the education training content of entering hospital's medical personnel newly with the blood. Rational relevant system, examination index with the blood of our academy distribute into every clinical relevant function departments and organs and manage the department, examine and implement to each one and mainly examine group's professor, check and rate in quarter, and and reward and get in touch with medical quality. For example, implementing differentiated control to the blood used in clinic, the attending physician is above qualified to apply to use the blood, 5 units of the above must be examined and sign by the personnel of high title with blood, 10 units of the above must be reported to medical matters for approval with blood, need, hold a consultation by the intersection of blood transfusion dept. and doctor with blood while being above-mentioned. The clinical department standardizes the implementation and implements the moon and notifies the system with the rationality of the blood, blood used in clinic, charged to medical quality and checked and rated the score finally. The our academy launches from the blood transfusion of body actively, erythropoietin with the intersection of iron and application, hypotension of controlling etc., use protect and styptic medicine, raise the intersection of operation and skill and employ latest skill type measure rationally of pharmaceutical, launch the all-round blood protection work. At present, blood transfusion of body of since the hospital rate is more than 22%, use this technology to launch more than 1700 operations every year. Director of Shanghai blood center Zhu YongMing: Set up nuclear acid as soon as possible and measure the standardized system of the whole course in the field of blood testing, because the sour technology of the core be able to find earlier the virus is infected and paid close attention to as being in the industry. Began since last October, the blood center of Shanghai was under the financial project funds subsidy of the city, the nuclear acid is measured after launching hepatitis B, third liver and HIV in blood conventionally. Because the blood center of the city has already measured the blood focis to the blood station of the whole city, this mean Shanghai become domestic to go on province where the nuclear acid find conventionally to blood while being first ' Market) . Shanghai had already measured and verified the nuclear acid 10 years ago, and appealed for the factor adopting the nuclear acid to measure from the norm. Up until now, verification and domestic and foreign experience of more than 200,000 samples in Shanghai show, the influence factor of the sour detection method of the core is numerous, so need to set up overall quality control and standard system as soon as possible, guarantee to measure quality. Compared with current amynologic method, the nuclear acid measures higher sensitivity, on average, can hepatitis B, third liver and detection " window one " of HIV Shorten by 40%, 89% and 50% separately. In addition, core sour technology still can detect amynologic method powerless immunity mourn in silence infection, the intersection of hepatitis B and invisible infection, virus make a variation one infect etc. still, can further ensure the blood safety. However, the nuclear acid has its limitation to measure. For example, the sample of quantity is difficult detection in low virus year, " window one " The residual risk remains as before. Have already been reached quite high security by the blood that the amynologic method measured, the nuclear acid is measured " Give an added grace to what is already beautiful " ,Its meaning and beginning immunology while measuring in 1993 " Provide timely help " It is not totally the same. Count for the example with the residual risk of HIV, immunology, as about 2/1000000 while measuring, increase nuclear acid, lower millionth zero about five point to measure. Measure, have one try hard overall as to nuclear acid objective understanding, carry on the intersection of core and sour laboratory and technology adopted that measure conventionally have entry procedures planning. It is that the nuclear acid measures the special problem of comparison faced to pollute in the suspected laboratory or sample. It is red in 1999, U.S.A. will laboratory measure in initial stage of test run in carrying on by acids nuclear, it was all false positive incidents that can't be removed to once measure results. Certainly, with the technological progress (if has already had full-automatic platformed that has come out now) The accumulation with the experience, the risk happening in this kind of incident will be reduced. But consider the differences of different platforms used at home, the difference between ability of the laboratory and management level, have to cause and watch out for. So, besides entry ,In the course of technology popularization, need to set up overall quality control and standard system as soon as possible, guarantee to measure quality. Advise operating and strengthening the standardized construction of the sour detection technique of cores with quality control a plurality of from the country, reagent enterprise, technical regulation, blood station. Sift and consult reagent as the blood, the country should criticize and criticizing examining sour reagent of core, so as to ensure exactness and blood safety of the survey report; Reagent enterprises should guarantee standardization such as the transportation, installation. When suspected pollution or other problems take place, causing the nuclear acid can't go on normally while measuring, the sample measures and waits for how to go on, should define the regulation as soon as possible. In addition, the country should also make the nuclear acid of blood station and measure the technical specification and technological instruction of the laboratory as soon as possible, set up to the hardware, workflow, staff training and operational procedure,etc. for regulatory guidance. It becomes the boundary that the Deputy Director of blood center of Jiangsu Province is yellow: Popularize the nuclear acid to measure while still needing and concurrently repair at present, our country has been already in a plurality of provinces (market) Launch the intersection of blood station and nuclear acid measure pilot project, Jiangsu Province to launch the intersection of blood and the intersection of core and sour the intersection of monitoring and pilot the intersection of time and early and the intersection of range and wide province one of. In June of 2010, the blood center of Jiangsu Province has already launched the pilot project with the blood station of city center of Changzhou. Since last year, blood transfusion services such as the blood center of Nanjing and blood station of city center of Yancheng,etc. participated in the pilot project voluntarily. Jiangsu Province advances the nuclear acid of blood station to measure the pilot project actively, has established the nuclear acid of blood transfusion service of the province to measure the leading group of pilot work, responsible for organizing, coordinating, supervising and guiding, implementing the pilot work of the whole province, and the expert panel of pilot work is established, measure and carry on the technological guidance and assessment to the nuclear acid of blood transfusion service. The whole province is while improving the nuclear acid and measuring the construction of laboratory, according to relevant standard, norm strictly, to finishing upgrading the unit laboratory organization of the pilot project of the transformation to confirm, and require the pilot blood station and establish the quality system of impractical laboratory of cores. Already 26 people have obtained the nuclear acid and measured the qualification card in the whole province. Pass the pilot project, our understanding that how the blood station do the impractical blood of core well to sift and check work is clearer. Quality and level of laboratory the intersection of blood station and the intersection of core and sour key of monitoring, so arrangement and standardized management of the laboratory are particularly important, especially the antipollution measure in the laboratory must be implemented completely, this needed to strengthen the management of laboratory personnel, and the one that did workflow of the laboratory well was given a new lease of life to. We combine pilot work, summarize the following three points: First, the nuclear acid measures deficiency and defect of remedying immune serology and testing, help to shorten " The window one " ,Improve blood security. But can only pay attention to the sour detection technique of the core, but ignore regular serology (enzyme exempts) Detection. In 2003, U.S.A. and Italy reported it caused the case which the receptor HIV infected as the negative blood donor that AIDS antibody and nuclear acid were measured. It means, the nuclear acid can't find all early HIV-positives to measure, still need to strengthen the blood donor and seek the opinion of links, the person who gets rid of high-risk behaviour donates blood. Second, should pay close attention to the fact that measure with the blood transfusion safe problem in HIV-2 type. In 1986, scientific research personnel were from HIV (HIV) in west African Infect and separate to and differ by bigger HIV-2 with HIV-1 gene sequence in crowds. Our country found scattered the infeted in Shanghai, Hunan, Ningxia, Guangzhou after Fujian Province found the infeted of the first HIV-2 in 2000, they are mostly that HIV-1/2 mix and infect. Clinic incubation period when HIV-2 infects the individual is relatively long, seldom cause AIDS to have illness coming on. Model HIV-2 the infeted quantity is low year such as virus such as blood plasma ' 100 -fold lower than HIV-1 the infeted) ,Can't even measure the virus in a lot of the infeted blood. Antibody of the infeted of the Model HIV-2 relatively appears early, and the antibody is competent. At present, Luo's COBASs201 system can find the virus core of Model HIV-2 sour only. From the view point of guaranteeing the blood safety in the future, or should notice the HIV-2 type measuring the question. Third, should also pay close attention to the fact that measure the false positive blood donor's shielding and question of rejoining the unit. Serology (EIA) Measure and mainly keep with the sample and can not deal with well the false positive reason, haemolysis, bacterium pollute, the quality of measuring reagent box does not pass, the technical staff's detection level is not high, and the instrument is involved in environmental factor,etc.. Nuclear acid measure, appear false and positive, mainly until laboratory pollute and pollution at some operation link have something to do. In addition, different detection systems and detection modes have influenced the false positive rate measured. The single sample is measured(ID-NAT) False positive to if you can't lead, higher than mixing by kinds of acids nuclear measure(MP-NAT) Mode. However, these two kinds of modes can only reduce and measure the false positive rate from technology to the maximum extent, can't absolutely avoid producing false. Shield, eliminate, will cause the loss of the blood donor to measuring the false positive blood donor, the blood donating dispute will even take place. Our country does not have relevant standard and norm at present, require " measures the false positive blood donor to shield and eliminate " ,Also issued the concrete rule that the blood donor rejoined the unit. What American FDA2010 issues in annual May <
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