Y HOC VIET NAM THANG 12 - S O D A C BIET/2011
XAY DlAJG Lire LlTQfNG HIEN MAU Dlf Bj
THITC CHAT, HIEU QUA VA BEN VUNG TAI CONG OONG
Nguyen Anh Tri***' Ngo Manh Quan * \ Nguyen Van Nhii-**', Nguyen Diic Thuan * *
dugc biet trudc (ve nhan than, sire khde, nhdm mau, xet nghiem sang lgc trudc HM...); va khi benh vien can la se mdi tdi de HM. Tieng Anh thudng su dyng tir Walk-in - den khdng ben trudc.
b. Ngudi HM du bj (Walk-in Donor) La nhirng ngudi khde manh, dang ky vdi CO sd y te va san sang HM mau bat eii liic nao. Hg duge tuyen chgn va quan ly dya tren nhihig tieu chuan cu the (quy djnh theo timg qudc gia, khu vyc). Thdng thudng, tieu chuan co ban cho ngudi HMDB la:
- Khde manh, dii tieu chuan HM va da timg HM.
- Bilt trudc nhdm mau ciia minh (cd khu vyc chi tuyen ngudi nhdm mau O).
- Lam viec, cu trii dn djnh va lau dai tai dja phuong.
- Dugc quan ly, theo ddi siic khde, hanli vi nguy co va xet nghiem vi riit truyen qua dudng mau.
Cam kit sin sang HM bat cii liic nao va chi HM khi dugc yeu eau.
Ngudi HMDB thudng cd tinh rdng bupc tuong ddi vdi cac co sd tiep nhan mau do cd cam kit chi HM khi dugc yeu cdu. Phan biet vdi ngudi HM nhdc Igi, ciing dugc mdi den HM nhung theo Ijch hen trudc vdi cac co sd truyin mau (call-responsive donor), hg khdng chju bdt cii rang budc va cam kit nao vdi cac CO sd truyen mau, hg cd the tuy chgn thdi dilm HM thich hgp vdi ban than minh.
c. Ngdn hdng mdu song (Walking
T O M TAT
Hien mau dy bi (HMDB) la mdt bien phap dam bao cd dii nguon ngydi hien mau (HM) trong trydng hdp khan cap, dac biet d nhu'ng khu vyc thudc vung niii, viing sau, vung xa, hai dao. Tuy nhien, d nydc ta, nhu'ng kien thiTc, cd sd khoa hgc ve ndi dung nay cdn kha phan tan va chya dygc chu trgng. Chuyen luan nay nham he thdng hda nhCTng dinh nghTa, kien thirc chung nham hydng tdi xay diing lyc lUdng HMDB thyc chat, hieu qua va ben vu'ng.
Tit khoa: hien mau, hien mau dy bj, ngan hang mau song
SUMMARY
Walk-In blood donation is one of the important methods to ensure blood supply in emergency, especially in rural and remote area. In fact, scientific knowledge and base relating to walking blood donation is not fully collected in Vietnam. This monograph aims to systematize the awareness in order to establish Walking Blood Bank and how to activate it substantially, effectively and stably.
Key words: blood donation, walk-in blood donation, emergency blood bank
I. MOT S6 KHAI NIEM
a. Hiin mdu du: bi (Walk-in Donation, Emergency Donation):
Hiin mdu du bi \k viec tilp nhan mau trong hoan canh cdp cim, tir nhimg ngudi khde manh da dugc xac dinh truoc, klidng cd hen trudc, trong thdri gian ngdn. 6 day cd yeu cdu rdt quan trgng la nhung ngudi nay da
^'> Vien Huyit hoc - Truyin mdu TW, ' Hdi CTD Viet Nam
HOI NGH! KHOA HQC TOAN QU6c LAN THL/ N H A T vi VAN D O N G HI^'N M A U TJNH NGUYgN
Blood Bank)
Hay cdn ggi Id Lye lugng HMDB- la viee td ehire lyc lugng nhirng ngucVi HMDB thanh cac td ehirc (dgi/nbdm/cau lac bg).
thudng do cac co scV ed .su dyng niiiu quan ly hoac kel hgp \di eiie Id elure nhu Chir thiip dd, quan dgi, Doan thanh nien cung quiin ly.
Tiiy vao nhu eau, tinh ebiit dae thu eiia don vj y te ma \iee td chuc lye lugng nay ed khac nhau.
O cac viing dja ly thuge vung sau, vung xa, bien gidi, hai dao: Ngan bang mau sdng dya vao lyc lugng HMDB la ngudi dan d xung quanh khu vyc cd eo sd y le cd nbu cau truyen mau va/hoac lyc lugng quan dgi tai dja phuong. Nhd viec quan ly tdt lyc lugng nay, viee HM se dugc dam bao nhanh chdng, hieu qua va an toan.
Ve ban chat, "ngan hang" nay cd dac diem:
- La "ngan hang" ao: luu giii danh sach, dii lieu ve nhirng ngudri dang ky HMDB.
- Td chiic cac boat ddng de duy tri mdi lien he vdi ngudi HMDB, bd xung lien tyc neu thieu hyt.
- Mdi ggi, huy ddng lyc lugng ngudi den HM khi can thiet.
Khi can mau, ngan hang mau sdng s6 dugc "khdi ddng" (activate) voi vi?c mdi ggi ngudi HM theo nhu cdu. Day la hinh thirc td chiic phd bien va hi?u qua cho nhQng co sd truyen mau d viing sau, viing xa, hai dao, cac don vj y te thudc quan dgi ma thudng xuyen di chuyin, tryc chien... Lugng mau thu dugc la mau tuoi, khdng can bao quan, khdng can san xuat- dam bao tdt chirc nang van chuyin d xy va ddng mau, phuc vy kjp thdri cho cdp ciiu va dieu tri.
II. VAI TRO cCiA Ll/C LUpNG HMDB TRONG O A M Sko MAU
Theo 16 chirc Y tl the gidri, neu moi nude dat 2% dan sd HM, lugng mau thu dugc day du, kjp thdi va dn djnh tbi mdi co the dap irng duge nhu eau mau tdi thieu. Tuy nhien, ngay ca d nhirng nude ma nguon ngucVi HM dat tdi tren 3% dan sd HM, thi vice dam bao mau day du va dn djnh van co the bi iinh budng do:
Tinh thdri diem: cd nhirng quang thdi gian ma lugng mau bj thyt giam sg vdi miic trung binh nhu djp Noel, Tet, nghi he, nghi ddng, nghi le...Tinh trang nay thudng dugc ticn lugng trudre va thudng nang ne d nhirng noi dang cd tinh trang thieu mau.
Nhu cau vugt qua kha nang dy trii hoac cung cap: khi xay ra tai nan, tham hoa, chien tranh.. can truyen mau vdi sd lugng Idn, hay d viing sau, viing xa, hai dao... hoSc can truyen mau thudc nhdm mau hiem...
cac tham hga thien nhien thudng khdng gay tang nhu cau mau cao nhung iam can tro viec td chirc huy ddng ngudn ngudi HM, tiep nhan N'ii cung cap mau nen cd the gay thieu mau. 6 hau bet cac nude, noi cd dja hinh da dang (cd hai dao, vimg sau, viing xa -remote and rural area) hoae cd co sd > te thudc quan dgi cd truyen mau (nhung khdng thudng xuyen), thudng xay dung dugc chuang trinh ddm bdo cung cdp mdu khdn cdp. 0 Uc co '"Chuang trinh Luc luang cho mdu khdn cap'' (Emergency Donor Panels EDP), o Anh co ''Chuang trinh qudn ly HM khdn cap'' (Emergency Blood Donation Management EBDM), nhieu nuoc khac nhu My, Nhat...
cung xay dyng lyc lugng HMDB.
Mau cho dieu tri thudng dugc huy dong theo 4 bien phap:
Y HOC VIET NAM T H A N G 12 - S O D A C BIET/2011
- Du trir mdu tgi cdc ca sa y ti: dy trir khoang 10 don vi mau d l dy phdng cho trudng hgp cdp ciiu, thudng xuyen ddi mau vdi cac trung tam truyin mau Idn ban;
- Cung cdp mdu khdn cdp: bdng cac phuong tien nhu tryc thang, tau cao tdc...
nhung bien phap nay khd dugc dam bao khi xay ra tham hga thien nhien, bao..
- Van chuyen benh nhdn tdi benb vien Idn hon de dugc cap cuu va truyen mau.
- Xdy dung ngdn hdng mdu sdng. cd the ket hgp voi cac bien phap ndi tren.
Theo tinh toan, khi xay ra tham hga, mdt nan nhan cd the can tdi 50 don vj mau cho cap ciiu. O cac khu vyc noi xay ra tham hga, truyen mau cd the it, nhung khi ma tdt ca cac ngudn cimg cap khac khdng kjp thdi hoac khdng kha thi, thi viec huy ddng lyc lugng tai cho - cd chuan bj la mdt bien phap hiiu hieu. Day la each thiic dugc nhieu nude ap dyng nham cd dugc ngudn ngudi HM dy bj an toan, sEn sang cd mat de HM khi cd thdng bao khan cap.
III. TINH HINH XAY DUNG LUC LUONG HIEN MAU D U BI 6 MOT Sd NUdC TREN
• • •
THE GIdl VA 6 NUdc TA
a. Mgt so mo hinh td chiec lire lugng HMDB tren thi gidi:
• (J Uc: mdi ca sa y te thupc viing sdu, vung xa, bien gidi, hdi dao thuang xdy dung mpt luc lucmg HMDB hogt dpng khd hieu qud:
- Sd lugng: gdm tdi thilu 10 ngudi, uu tien tuyin chgn ngudi tre tudi, khde manh, cd nhdm mau O. Khdng cd so lugng tdi da cho lyc lugng nay, tuy nhien thudng mdt dia ban cd quy md la LOOO dan thi cdn cd 10 ngudi HMDB nhdm O.
- Nguoi dang ky HMDB dugc lam xet nghiem nhdm mau he ABO, Rh(D), xet nghiem sang lgc HIV, HCV, HBV dinh ky 3
thdng/ldn (mau dugc lay va giri ve TTTM de xet nghiem). Trong trudrng hgp khan cap, nhiing ngudi HMDB nay dugc huy ddng den de lay mau va truyen eho ngudi benh ma khdng can lam xdt nghiem sang lgc HIV, HBV. HCV lai bdng ky thuat ELISA ma chi can lam cac xet nghiem nay bang thir nghiem nhanh;
- Khi da lay mau bao nhieu ngudi HMDB de truyen eho ngudi benh thi se phai tuyen chgn tiep tyc de bd sung cho dii co sd tdi thieu la 10 ngudi ed nhdm O ngay tai thdi diem dd de duy tri dii lye lugng HMDB.
••• Trong qudn dpi (Mi, Ca na da) ciing cd nhieu md hinh khdc nhau:
- Lyc lugng dac nhiem quan ddi MT:
lay mau tat ea quan nhan trong don vj, test va thir cheo cho nhau de xay dyng danh sach, trong dd chi rd khi ngudi nay can truyen mau, ai trong don vj cd the truyen cho hg.
- Hoac td chirc theo md hinh phd bien hon dd la tap hgp quan nhan d nhung don vj gan nhau, hoac tai chd, dugc tuyen chgn, xet nghiem va quan ly bdi dcm vj y te.
Cdc md hinh thuang khd da dgng a cdc nude khdc nhau. O mpt sd nude, viec xet nghiem dinh ky cho ngudi HMDB. dugc tien hdnh mdi 6 thdng/ldn. Cd nude xet nghiem cd HIV, HCV vd HBV; cd nude khdng xet nghiem HIV cho ngudi HMDB.
b. dnir&cta:
Nhilu tinh/thanh pho da xay dyng dugc lyc lugng HMDB va ddng gdp vai trd quan trgng cho dam bao mau nhu d huyen dao Cdn Dao, Huyen dao Phii Qudc, d Binh Djnh, TP Hd Chi Minh, Ha Ndi, Da Ndng.. .Dac diem chung la:
Lap dugc danh sach ngudi dang ky HMDB, cd thi la ngudi da HM hoac chua HM.
Chu yeu do Hdi chii thap dd, Doan thanh nien quan ly va phy trach. Khi cdn
HQI NGH! KHOA HQC TOAN QUOC LAN THL/ NHAT VJ VAN D O N G HlgN MAU TINH NGUYgN
mau, ciic benh \ ieii lii'ii he (elni yeu l;i ggi dien) thdng qua hai dan \ i nin .
Hinh lluie id ehirc kha phd bien hi eiiu lac be) IIMDR. liien tai Irung ucmg lldi chir thap clo Viel Nam quim ly 1 ciiu k.ic hg HMDB, cr nhieu dia phucmg do hi ciic CLB cap thimh phd, quan/hu> eii/thj xii.
- Da ihiinh lap duge Ciiu lae bg nhdm mau hiem a 3 mien, dii\ eiing la mgl loai hinh td ehire lye lugng HMDB.
Mdt .so dia pbircrng da lien hanh lap hd so .sire khde xii khimi sue khoe djnh ky eho ngucri hien miui {lni\en Phu Qui)e (Kien Giang), huNcn Tjnh Bien (An Ciiang) vcVi sy ho trg ciia Vien Hu\el bgc Tiii>en mau TW.
Tuy nhien, ca cdu, sd lugng cho lire lugng HMDB dang dugc xem xet vd linh todn cho phii hgp vdi dieu kien cua tirng dia phuang, dan vi.
IV. YEU CAU CUA VIEC XAY DUNG LUC
• • •
LUONG HIEN M A U DU 61
• • •
a) Thuc chat:
La viec ngudi dang ky HMDB mdt each ty nguyen va khi can tbi hg chdc chdn tham gia HM. De viec xay dyng lyc lugng HMDB thyc chat, can luu y:
Tu van ky cho ngudi dan, dl hg thyc sy hieu dugc vai trd, y nghTa xa sy cdn thiit ciia HMDB, tieu chudn ciia ngudi HMDB, quy trinh tham gia HM khdn cdp... trudc khi dang ky HMDB.
- Nen van ddng nhirng ngudi dii timg HM tham gia lyc lugng HMDB.
can cd sy cam ket ciia ngudi tham gia HMDB. Neu dang ky theo tap till, nen cd cam ket cua lanh dao don vj cd ngudi HMDB.
- Quan ly chat che va duy tri lien lac vdi ngudi HM, tranh dl viec dang ky HMDB la boat ddng phong trao, vi thanh tich va dd hudng ling cac chiin djch.
Co boat ddng thir thach, vi du bao dgng thir, de bg ed trai nghiem vdi viec HM trong hoiin eiinh dae biet, ke ea khi thdi tilt, ihiri gian khdng thuan lgi...
h) Hieu qud
La viee mdi ggi hieu qua ngudi HM, mdi hi hg den, den la HM dugc, mau cd the sir dung an toan. Viee duy tri hieu qua lire lugng HMDB ddi khi bj anh hudng bdi:
Thdi diem dugc huy dgng khdng phii hgp v'(7i lich ca nhim cua ngudi HM: di cdng lae, di du lich.. hay iihting eude ggi vao thdi gian khdng ibuiin tien nhu nira dem, trong nhung ngiiy nghi tet, nghi le, gia dinh cd viec...
Ngudi HM nan, khdng chd dgi diroc do ehi mdi kham, xet nghiem ma khdng dugc mdi HM. 1 Ig se tir bd lyc lugng HMDB hoac tham gia HM kbi bg ihieh.
- Ngudi HM nhiem benh, hoac cd hanh vi nguy co.
Chinh vi the, can lam tdt viec quan ly, giam sat va lien he thudng Nu\en vcii ngudi HMDB. Ddng thdri, can theo ddi hieu qua ciia viec mdi ggi ngudi 1 IM.
Sau day la mdt sd chi sd giam sat hieu qua viee mdi ggi ngudri HMDB:
Sd ca cap cim can ggi mdi nam.
Sd ngudri can hu> ddng HM.
Sd ngudi HM trung binh can huy ddng cho mdi ea.
r> le sd cugc ggi thanh cdng.
- T> 1? ngudi den HM/sd ngudi dugc goi.
- Ty 1^ HM thanh cdng.
- Sd don \ j mau trung binh sir dung/
mdi ea cap ciru.
c) Ben vimg
La viec duy tri dugc thudng xuyen lire lugng HMDB, dam bao duy tri dn djnh vl so lugng va chat lugng. Cd tai lieu cho rang, ty le rdi bd/khdng tham gia lyc lugng HMDB khong dugc qua 20% tdng sd ngudi dugc quan ly.
Y HQC VIET NAM THANG 12 - S O D A C BIET/2011 Nhu v$y, viec duy tri bin vung ngan
bang mau sdng bao gdm:
- Ngudri HM cd cam kit HMDB. cam kit dugc xem lai it nhdt 1 idn/nam.
- Kit hgp vcri viee kham, tu vdn va kilm tra sire khde djnh ky bdng nam, d l phat hien va loai trir nhiing ngirdi khdng phu hgp;
bd sung them bang sd bj loai.
- Duy tri dn djnh sd ngutri dang ky; kjp thdi thay the, bd sung khi:
• Cd tren 20% sd ngudi thudc nhdm mau nao dd (O. A, B) vira dugc buy ddng de HM khan cap trong vdng 3 thang.
• Cd ngudi thdi. tir bd lire lugng HMDB do chuyen noi sdng/cdng tac, phu nii cd thai va nghi sinh, phat hien benb tat mdi.
xuat hien hanli vi nguy eo cao...
- c a n tinh den ty le nhat djnh ngudi cd nhdm mau hiem trong lyc luong HMDB.
Theo khao sat cua Nguyen Anh Tri va cdng sy nam 2008 tai dao Binh Ba (Khanh Hda) de tien hanh xay diing lyc lugng HMDB, da phat hien 02 trudng hgp nhdm mau Rh (-) khi dang ky tham gia HMDB.
Lyc lugng HMDB da va dang ddng vai trd quan trgng trong viee dam bao mau trong trudng hgp cap ciin d nuoc ta ciing nhu nhieu nude tren the gidi. Nham xay dyng dugc lyc lugng HMDB thyc chat, bieu qua, ben viing, can tiep tyc dau tu nghien eiiu, hoan thien Iy luan, ddng thdri xay dyng md hinh hgp ly vdi timg khu vyc, nhdt la vimg sau, vimg xa, bien gioi, hai dao.
TAI LIEU THAM KHAO
1. Nguyen Dire Phat*, Nguyen Van Diing*, Nguyen Thj Loan*, Ngo Manh Quan**, Nguyen Anh Tri**, Nghien ciru kit qua cdng tac dam bao an toan truyen mau tai benh vien da khoa huyen phii qudc 5 nam 2007-2011,
2. Ngo Manh Quan, Nguyen Van Nhir, Nguyen Dii'c Thuan, Nguyen Xuan Thai, Nguyen Duy Ngoc, Trieu Thi Bien, Nguyen Anh Tri (2010), Nhan thirc, thai do va hanh vi ve HM tinh nguyen d ngudi dang ky HM dir bj tai mc)l so vimg dao, Y hoc Viet Nam, thangO,s6 2/2010, 422-427.
3. Nguyen Anh Tri, Biii Thj Mai An, Pham Quang Vinh, Pham Tuan Duong, Ngo Manh Quim (2010), Khao sat nhom mau he ABO, Rh(D) cua ngirdi dan tai mot so huyen dao de xay dyng luc lugng HM dir bi, Y hoc
Viel Nam. tliang 9, sd 2/2010, 400-404.
4. Abdalla, F., O.W. Mwanda and F. Rana (2005). Comparing walk-in and call-responsive donors in a national and a private hospital in Nairobi. East Afr. Med. J., 82: 531-535, abstract
available at littp://www.ncbi.nim.nih.gov/pubmed/16450682
5. Ausralia Blood Service (2007), Draft Principles For The Provision Of Blood To Rural And Remote Communities Via Emergency Donor Panels, 2007.
6. California Blood Bank Society, Questions about a 'Walking Blood Donor Program' in
remote geographic areas, http://www.cbbsweb.org/enf/2003/walking_d
onor.html, 2003.
7. Canaday Agency for Drug and Technology in Heahh, Walking Blood Donor Programs http://www.cadth.ca/inedia/pdf/kOI69_walki ng_blood_donor_programs_htis-Ll-5.pdf 8. Hrezo RJ, Clark J. (2003), The walking
blood bank: an alternative blood supply in military mass casuaUies, Disaster Manag Response. 2003 ,lan-Mar; 1(1): 19-22.
9. Malsby R 3rd, Frizzi J, Ray P, Raff J., Walking donor transfusion in a far forward environment., South Med J. 2005 Aug; 98 (8): 809-10.
10. Walking Blood Bank created for Task Force 1-08, available at:
http://www.armee.gc.ca/land-terre/news- nouvelles/story-reportage-eng.asp?id=2581.
