Notas acerca de la transfusión sanguínea en México / Notes about blood transfusion in Mexico

Resumen: La historia de la transfusión sanguínea es apasionante. En México, esta práctica se inició en el siglo XIX y a partir de entonces los avances y contribuciones de investigadores y clínicos fueron decisivos para su desarrollo e implementación en la práctica clínica. El objetivo de este trabajo es hacer una breve revisión histórica de la transfusión sanguínea en México.

Abstract: The history of blood transfusions is exciting. In Mexico this practice began in the XIX century and from this time the advances and contributions of researchers and clinicians were decisive for its development and implementation in the clinical practice. The aim of this paper is to make a brief review of the history of blood transfusion in Mexico.

Liver transplantation in Jehovah's Witnesses: a case series / Experiencia en trasplante hepático para testigos de Jehová: serie de casos

Abstract Introduction: Orthotopic liver transplantation (OLT) is a procedure characterized by high bleeding rates and a significant likelihood of exposure to blood products. Objectives: This case series shows the experience at a referral center for Jehovah's Witnesses (JW) with end-stage liver disease, undergoing OLT. Materials and methods: A search was conducted in our database of JW undergoing OLT between July 2007 and August 2012. The information about their pre-operative condition and progress up to 30 days post-transplantation. Results: Four subjects were identified (3F/1M) with an average age of 42 years (range 22-55). All of them received a multidisciplinary management which included pre-operative optimization of red cell mass, antifibrinolytic prophylaxis, and cell salvage (mean volume of 344mL [range 113-520]). The average intraoperative bleeding volume was of 625mL (range 300-1000). One of the patients presented with a primary graft dysfunction and died, while the rest had a normal postoperative course. Conclusion: It is possible to offer OLT to patients who refuse to receive allogeneic blood transfusions, through a comprehensive approach that includes perioperative hematologic optimization and the use of blood conservation measures, without a significant impact on the outcomes.

Resumen Introducción: El trasplante hepático ortotópico (THO) es un procedimiento caracterizado por índices significativos de sangrado y alta probabilidad de exposición a hemocomponentes. Objetivos: Esta serie de casos muestra la experiencia de un centro de referencia en la atención de testigos de Jehová (TJ) con enfermedad hepática terminal llevados a THO. Materiales y métodos: Se realizó una búsqueda en nuestra base de datos de TJ que hubiesen sido llevados a THO entre julio de 2007 y agosto de 2012. Se registraron datos correspondientes a su estado preoperatorio, manejo perioperatorio y evolución hasta los 30 días postrasplante. Resultados: Se encontraron cuatro sujetos (3M/1H) con una edad promedio de 42 años (rango de 22-55). Todos recibieron un manejo multidisciplinario que incluyó la optimización preoperatoria de su masa eritrocitaria, profilaxis antifibrinolítica y salvamento celular [volumen promedio de 344 ml (rango de 113-520)]. El volumen promedio de sangrado intraoperatorio fue de 625 ml (rango de 300-1000). Uno de los pacientes presentó disfunción primaria del injerto y muerte, mientras que los demás tuvieron un curso posoperatorio convencional. Conclusiones: Es posible ofrecer la posibilidad de THO para sujetos que se niegan a recibir transfusiones alogénicas, por medio de un abordaje integral que incluya la optimización hematológica perioperatoria y la utilización de medidas de conservación sanguínea, sin que esto afecte significativamente los resultados.

Disminución de transfusiones con uso de Ácido Tranexámico en artroplastias de cadera y rodilla / Decreased use of blood transfusions using Tranexamic Acid in hip and knee arthroplasties

Introducción: se ha demostrado que el uso de Ácido Tranexámico (AT) en diferentes procedimientos quirúrgicos puede disminuir la necesidad de transfusiones sanguíneas. Objetivo: Determinar si disminuye la necesidad de transfusiones sanguíneas con el uso de AT en artroplastias de cadera y rodilla. Métodos: Estudio descriptivo y retrospectivo desarrollado con información de 230 pacientes operados en los hospitales Herrera Llerandi y Multimédica en los períodos de 2015, 2016 y 2017. Resultados: Utilizando la distribución binomial para dos poblaciones se obtuvo que existe una disminución de la necesidad de transfusiones sanguíneas del 97.7% al utilizar AT. Los pacientes que no reciben AT tienen una probabilidad de 83.4% de necesitar una transfusión sanguínea. Conclusión: Se logró determinar que con la utilización de Ácido Tranexámico disminuye la necesidad de transfusiones sanguíneas en artroplastias de cadera y rodilla en un 97.7% con el 95% de confianza

Introduction: It has been demonstrated that blood transfusions need is reduced when tranexamic acid (TA) is used during different surgical procedures. Objective: To determine if blood transfusions need is reduced by using TA during total knee and hip arthroplasty. Methods: Descriptive and retrospective study about 230 patients operated in Herrera Llerandi and Multimédica hospitals from 2015 through 2017. Binomial distribution was used for two populations to find out that the probability of reducing the need of blood transfusions Results: The use of blood transfusions was reduced in 97.7% when using TA. The probability of needing a blood transfusion is 83.4% when TA is not used. Conclusion: The need of blood transfusions during total knee and hip arthroplasty is reduced when using tranexamic acid in 97.7% with 95% confidence level.

Clinical significance of Rh antigen typing detection for patients who require blood transfusions repeatedly / 中国免疫学杂志

Objective:The Rh antigen typing and antibody identification results of the patients whose irregular antibody screening positive were analyzed,to explore the clinical significance of detecting the Rh antigens typing before the first blood transfusion of the patients who require multiple blood transfusions.Methods:The Rh antigenic typing of 128 irregular antibody screening positive patients were tested by test tube method.The monospecific antibody were identified by microcolumn gel method.Results: Of the 128 patients with irregular antibody screening positive,there were 77 cases in Rh system,including 72 cases of anti-E and 5 cases of anti-c. There were 14 cases of MNSs system,including 10 cases of anti-M and 4 cases of anti-Mur.There were 15 cases of anti-Leain Lewis system.There were 4 cases of anti-P1in P system and 18 cases of other nonspecific antibodies.The distribution of Rh antigen detection was DCCee(74 cases)> DCcEe(34 cases)> DCcee(10 cases)> DccEE(5 cases)> DccEe(2 cases)> DCcEE(1 case),dCcee(1 case),dccee(1 case).The majority phenotype of Rh system antibodies in patients were DCCee.The patients were mainly distributed in the wards who require repeated blood transfusions such as the department of blood internal medicine(26 cases),digestive internal medicine(11 cases),ICU(4 cases).Conclusion:Before the first blood transfusion,we detect the Rh antigenic typing and choose the same antigen phenotype of Rh system for the patients who require blood transfusions repeatedly,which can avoid producing the irregular antibodies in this system,and then to ensure the safety and effective of the blood transfusion.

Cause analysis and preventive measures for blood sample errors / 中国基层医药

Objective To study the reason and preventive measures of inconformity of the extraction appeared in the process of transfusion blood specimens with the patient's blood type.Methods The reasons of transfusion errors why extracting required blood type was not consistent with the patient's blood type examplesa in Zhengzhou transfusion of hospital from 2008 to 2012 were retrospectively analyzed.Results The experimental results showed that blood specimen inconformity was 49.60%,the error rate of blood extraction and blood infusion was 31.20%,infusion error only was 15.20%,blood type change after stem cell transfusion was 4.00%.Reasons of blood type change after stem cell transplantation to extract blood samples mainly included the blood center or blood did not accord with logo type blood stations provided (16.13%),blood use application form to fill in error(20.97%),check the wrong blood type (6.45%),blood samples taken(29.03%),the blood sample tag(27.42%).Conclusion In order to ensure the safety for clinical use must adopt measures to prevent resolutely put an end to a blood transfusion errors.

Correlation between serum ferritin level and liver function tests in thalassemic patients receiving multiple blood transfusions.

Background: Multiple blood transfusions are the mainstay of thalassemic patients in order to combat the severe anemia. These frequent blood transfusions result in the excessive iron deposition, leading to multiple injuries to a variety of organs in the body. In response to these injuries, the levels of various enzymes are disturbed. The whole phenomena usually involve the interrelation of one parameter with some other. The present study aimed to estimate the levels of serum ferritin and hepatic enzymes and to find out any possible correlation between them in thalassemic patients receiving multiple blood transfusions. Methods: A total number of 90 thalassemic patients of both sexes ranging from 10-15 years, receiving multiple blood transfusions were included in the present study. Blood samples from all the patients were withdrawn and analyzed for the values of serum ferritin, hemoglobin and hepatic enzymes (serum alanine transaminase, serum aspartate transaminase, serum alkaline phosphatase). Pearson correlation coefficient was applied to observe correlation between serum ferritin level and hepatic enzymes. A P value of ≤0.05 was considered statistically significant. Results: The overall values of serum ferritin, and hepatic enzymes (serum Alanine Transaminase, serum Aspartate Transaminase, serum Alkaline Phosphatase) were remarkably increased than their normal values. However, hemoglobin level was considerably decreased in thalassemic patients. A weak positive insignificant correlation was observed between serum ferritin with hepatic enzymes and hemoglobin in thalassemic patients. Conclusion: Multiple blood transfusions cause iron overload in the body, which in turn, lead to increased serum ferritin levels in thalassemic patients. High levels of hepatic enzymes are somewhat correlated to serum ferritin concentration. However, the exact reason of elevated levels is still unclear. Further detailed studies should be conducted in order to identify the exact mechanism behind this and to search for the promising correlations of various parameters in thalassemic patients receiving multiple blood transfusions.

Incidencia y mortalidad por anemia en pacientes gravemente enfermos / Incidence and mortality due to anemia in acutely ill patients

Introducción: la anemia es una de las enfermedades más conocidas y evaluadas en la práctica médica diaria. Objetivo: determinar la morbilidad y mortalidad de pacientes graves con anemia. Métodos: se realizó un estudio prospectivo de 118 pacientes ingresados en la Unidad de Terapia Intensiva del Hospital General Universitario "Vladimir Ilich Lenin" de Holguín, desde agosto hasta diciembre de 2010. Las variables discretas fueron comparadas mediante el test de £i al cuadrado y el de Fisher, y las continuas, por medio de las pruebas de T-Student y Mann-Whitney (la hemoglobina media), para á=0,05. Resultados: la anemia afectó 79,6 % de los integrantes de la serie y aumentó evolutivamente, con el consecuente empeoramiento de estos, de los cuales fallecieron 34,0 %, quienes tenían mayor edad (p=0,0004), necesitaron más transfusiones sanguíneas (p=0,005) y presentaron el trastorno de la hemoglobina más tardíamente (5,1 días). De los pacientes con anemia grave (hemoglobina:<85 g/L), 50,0 % falleció, no obstante, las administraciones de glóbulos rojos no parecieron asociarse con la disminución de la mortalidad (p>0,05). Conclusiones: la anemia en los pacientes graves se relacionó con una mayor mortalidad, estadía, necesidad de transfusiones de glóbulos rojos y causas médicas (neurológicas), en tanto, la edad avanzada y la gravedad de la anemia de aparición tardía se asociaron fundamentalmente a la mortalidad.

Introduction: anemia is one of the well-known and evaluated diseases in the daily medical practice. Objective: to determine the morbidity and mortality of acutely ill patients with anemia. Methods: a prospective study of 118 patients admitted in the Intensive Therapy Unit of "Vladimir Ilich Lenin" General University Hospital in Holguín was carried out from August to December, 2010. Discrete variables were compared by means of the X² and Fisher tests, and the continuous variables, by means of the T-Student and Mann-Whitney tests (the mean hemoglobin), for á =0.05. Results: anemia affected 79.6% of the members of the series and it increased progressively, with the consequent worsening of them, out of which 34.0% died, those older in age (p=0.0004), those who needed more blood transfusions (p=0.005) and who presented the hemoglobin dysfunction later (5.1 days). Of the patients with severe anemia (hemoglobin: <85 g/L), 50.0% died; nevertheless, red blood cell supplies didn't seem to associate with the decrease of mortality (p > 0.05). Conclusions: anemia in acutely ill patients was related to a higher mortality, hospital stay, necessity of red blood cell transfusions and medical causes (neurological), while, the advanced age and anemia severity of late occurrence were associated fundamentally to mortality.

Necesidades transfusionales en una unidad de terapia intensiva polivalente de adultos / Transfusion requirements in a polyvalent intensive care unit for adults

Introducción: Las transfusiones sanguíneas son una práctica frecuente en las unidades de terapia intensiva. Objetivo: Determinar las necesidades transfusionales de 382 pacientes hospitalizados en este servicio en estado crítico. Métodos: Se realizó un estudio descriptivo y retrospectivo de los integrantes de esa casuística que se esperaba que no fallecieran en las primeras 24 horas de ingresados en la Unidad de Terapia Intensiva Polivalente del Hospital General Universitario "Vladímir Ilich Lenin" de Holguín, durante el 2010. Las variables clinicoepidemiológicas fueron analizadas mediante las pruebas de Ji al cuadrado y t-Student (á=0,05). Resultados: Del total de la serie, la mayoría eran hombres (51,6 %), la edad media fue de 54±21 años, los fallecimientos constituyeron 35,1 % y la estadía hospitalaria media resultó ser de 7,2±8,4 días. La transfusión con glóbulos rojos se aplicó a 23,3 % y con plasma fresco, plaquetas y crioprecipitado, a 12,6 %; 4,5 y 5,2 %, respectivamente. Se administraron 3,3±3,9 transfusiones por paciente, si bien las de glóbulos rojos y plasma fresco devinieron superiores, así como inferiores los niveles de hemoglobina pretransfusionales en los fallecidos. Entre las principales complicaciones se presentaron las infecciones hospitalarias y la insuficiencia renal aguda, con predominio en los pacientes transfundidos, en los cuales se prolongó la estadía.

Introduction: Blood transfusion is a common practice in intensive care units. Objective: To determine the transfusion need of 382 critically ill patients hospitalized in this service. Methods: A descriptive and retrospective study was carried out in these cases that were not expected to die in the first 24 hours of being admitted to "Vladímir Ilich Lenin" Polyvalent Intensive Care Unit in Holguín during 2010. Clinical epidemiological variables were analyzed by means of the chi-square and Student's t tests (alpha=0.05). Results: Of all the series the majority were men (51.6%), the mean age was 54±21 years, and deaths constituted 35.1% and mean hospital stay was found to be 7.2±8.4 days. Red cell transfusion was applied to 23.3%, and fresh plasma, platelets and cryoprecipitate to 12.6%; 4.5 and 5.2% respectively. Each patient received 3.3±3.9 transfusions, although those of red blood cells and fresh plasma became higher and lower levels of pretransfusion hemoglobin in those who died. Among the major complications were hospital infections and acute renal failure with prevalence in transfused patients, who had longer stays.

Conocimiento de la ley general de salud respecto de las transfusiones sanguíneas en médicos y pacientes Testigos de Jehová del Hospital Dr. Darío Contreras de República Dominicana / Knowledge of general health law with respect to blood transfusions by physicians and patients Jeovah Witnesses in Hospital Dr. Dario Contreras of Dominican Replubic / Conhecimento da lei geral de saúde - respeito às transfusões sanguíneas em médicos e pacientes Testemunhas de Jeová do Hospital Dr. Darío Contreras da República Dominicana

Este estudio evalúa hasta qué grado el cuerpo médico del Hospital Dr. Darío Contreras de República Dominicana conoce, respeta, informa y aplica la Ley General de Salud, con relación al derecho del paciente Testigo de Jehová de negarse a ser transfundido (respeto a su autonomía). También si los Testigos de Jehová conocen la Ley General de Salud y hasta qué grado se han beneficiado con la puesta en marcha de la misma. El estudio reveló que ni médicos ni Testigos de Jehová conocen suficientemente dicha ley.

This study evaluates up to which degree physicians of Hospital Dr. Dario Contreras of Dominican Republic know, respect, inform and apply the General Health Law in relation to the right of Jehovah witness patients to refuse being blood transfused (respect to their autonomy). It also evaluates whether Jehovah witnesses know General Health Law and in which degree they have been benefited by putting it into practice. The study reveals that Jehovah Witnesses do not know the law.

Este estudo avalia quanto o corpo médico do Hospital Dr. Darío Contreras de República Dominicana conhece, respeita, informa e aplica a Lei Geral de Saúde em relação aos direitos do paciente Testemunha de Jeová de negar-se a ser transfundido (respeito a sua autonomia); também se os Testemunhas de Jeová conhecem a Lei Geral de Saúde e até que ponto têm se beneficiado diante dessa proposição. O estudo revelou que nem médicos, nem Testemunhas de Jeová conhecem de fato essa lei.

Effect of wheat grass tablets on the frequency of blood transfusions in thalassemia major.

Forty patients of Thalassemia Major children were treated with wheat grass tablets (WGT). The mean hemoglobin in the pre WGT was 8.54 +/- 0.33 g% whereas in WGT period was 9.13 +/- 0.14 g% (p < 0.001). The mean blood transfused as packed cells in pre WGT period was 326.82 +/- 74.10ml/kg/year whereas during WGT period it was 256.39 +/- 45.47 ml/kg/ year. The percentage difference in the amount of packed cells transfused in pre WGT and WGT period was 18.02 +/- 22.96 (p < 0.001). The decrease in the blood transfusion requirements was by 25% or more in 20 (60.6%) cases. The mean interval between the consecutive blood transfusions in Pre WGT period was 18.78 ± 4.48 days whereas in WGT period was 24.16 ± 4.78 days (p < 0.001). Wheat grass has the potential to increase the Hb levels, increase the interval between blood transfusions and decrease the amount of total blood transfused in Thalassemia Major patients.

Telangiectasia hemorrágica hereditaria: tratamiento farmacológico / Pharmacological treatment of hereditary haemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) of Rendu-Osler-Weber disease is a multi system vascular dysplasia characterized by the presence of multiple telangiectasias, mainly affecting mucosal tissue and arterial-venous connections. It commonly affects lungs, liver and central nervous system. Bleeding is the most common symptom and its treatment can be surgical or pharmacological. We herein review the systemic therapy that attempts to minimize bleeding as well as blood transfusion therapy. Blood therapy and fibrinolytic treatment especially aminocaproic acid and tranexamic acid are discussed. Danazol, hormone therapy and other less common drugs used in the treatment of HHT are also reviewed.

Effect of intravenous deferoxamine in multiply transfused patients / 소아과

PURPOSE: Multiple transfusions in patients with chronic anemia can result in excessive iron deposition in tissues and organs. Effective iron chelation therapy in chronically transfused patients can only be achieved when iron chelators remove sufficient amounts of iron equivalent to those accumulated in the body from transfusions, thus leading to maintain body iron load at a non-toxic level. This study was retrospectively carried out to investigate the effect of intravenous iron chelation therapy with deferoxamine in patients who have received multiple transfusions. METHODS: From March 2005 to January 2007, 15 patients who have received multiple transfusions were included in this study. Transfusion dependent patients were defined as those receiving >1 packed red blood cell (RBC) units/month for at least 6 months. They received intravenous deferoxamine for 7 days (10-30 mg/kg/day, 24 hour continuous infusions). Before and after deferoxamine infusions and 3 months later, we compared serum iron, TIBC, and ferritin in transfusion dependent patients and transfusion independent patients. RESULTS: There were 6 males and 9 females and their age range was 5.6-21.3 (median 8.3) years. Transfusion dependent patients were 7 and 8 were transfusion independent states after stem cell transplantation or chemotherapy. There was no significant change in ferritin level after deferoxamine treatment for the transfusion dependent patients but significant falling of ferritin level was observed for the transfusion independent patients 3 months later compared with baseline ferritin level (P=0.046). Some adverse events were observed but symptoms were mild and tolerable. CONCLUSION: Seven days of intravenous deferoxamine was safe and effective in transfusion independent patients. In transfusion dependent patients, chelation therapy should be maintained, in order to minimize or prevent iron accumulation and storage in the tissues.