Desafíos en el manejo del sarcoma de Ewing en una paciente testigo de Jehová / Challenges in the care of Ewing's sarcoma in a Jehovah's Witness patient

El sarcoma de Ewing es una neoplasia de hueso y tejidos blandos, cuyo manejo se relaciona con toxicidad hematológica. Este aspecto representa un desafío médico y ético en los pacientes testigos de Jehová quienes, por sus creencias religiosas, rechazan la aplicación de hemoderivados, con riesgo de que se descontinúe la quimioterapia o de que se utilicen dosis subóptimas. Se presenta el caso de una mujer colombiana de 34 años, testigo de Jehová, con diagnóstico de sarcoma de Ewing con estadificación clínica IIB (T1N0M0) en las regiones maxilar y mandibular izquierdas, tratada con quimioterapia, quien presentó un valor mínimo de hemoglobina de hasta 4,5 g/dl y tuvo indicación quirúrgica como parte del tratamiento. En estos pacientes, la decisión de practicar una transfusión comprende implicaciones éticas que requieren alternativas terapéuticas y un abordaje multidisciplinario.

Ewing's sarcoma is a bone and soft tissue neoplasm, whose management is related to hematological toxicity. This aspect represents a medical and ethical challenge in Jehovah's Witnesses patients, who, due to their religious beliefs, reject the blood component transfusion, with the risk of discontinuing chemotherapy or using suboptimal doses. We present the case of a 34-year-old Colombian woman, Jehovah's Witness, diagnosed with Ewing's sarcoma with clinical stage IIB (T1N0M0) in the left maxillary and mandibular regions, treated with chemotherapy, who presented a hemoglobin nadir of up to 4.5 g/dL, and surgical indication as part of the treatment. In these patients, the transfusion decision has ethical implications that require therapeutic alternatives and a multidisciplinary approach.

Construction and validity of checklist for patient safety during the transfusion process / Construcción y validación de una lista de verificación para la seguridad del paciente durante el proceso de transfusión / Construção e validação de checklist para segurança do paciente no ato transfusional

ABSTRACT Objective: to construct and validate a checklist for patient safety during transfusion. Method: this is a methodological study whose development took place, between February 2020 and January 2021, at a teaching hospital in Santa Maria, RS, Brazil. The design was based on the survey of items in an integrative literature review, and validity, with 17 health specialists and 8 hemotherapy experts. Pre-test was carried out with 36 professionals from the target population. For data analysis, the Content Validity Index was calculated. Results: the checklist was composed of 29 items and 90 sub-items, distributed in three domains, corresponding to the transfusion act stages: Pre-transfusion (Medical prescription, Compatibility and Bedside identification); Transfusion (Blood component installation); and Post-transfusion (Monitoring). The items obtained a Content Validity Index predominantly > 0.80 in all stages. After reformulations suggested by participants, a Content Validity Index of 0.98 was obtained in its final version. Conclusion: the checklist demonstrated evidence of content validity and can be a reliable instrument to promote patient safety during transfusion.

RESUMEN Objetivo: construir y validar una lista de verificación para la seguridad del paciente durante la transfusión. Método: estudio metodológico cuyo desarrollo tuvo lugar entre febrero de 2020 y enero de 2021 en un hospital universitario de Santa María, RS, Brasil. El diseño se basó en el levantamiento de ítems en una revisión integrativa de la literatura, validación con 17 especialistas de la salud y 8 expertos en hemoterapia. La preprueba se realizó con 36 profesionales de la población objetivo. Para el análisis de los datos, se calculó el Índice de Validez de Contenido. Resultados: la lista de verificación estuvo compuesta por 29 ítems y 90 subítems, distribuidos en tres dominios, correspondientes a las etapas del acto transfusional: Pre-transfusión (Prescripción médica, Compatibilidad e Identificación al pie de la cama); Transfusión (Instalación del componente sanguíneo); y Post-transfusión (Monitoreo). Los ítems obtuvieron un Índice de Validez de Contenido predominantemente > 0,80 en todas las etapas. Luego de reformulaciones sugeridas por los participantes, se obtuvo un Índice de Validez de Contenido de 0,98 en su versión final. Conclusión: la lista de verificación demostró evidencia de validez de contenido y puede ser una herramienta confiable para promover la seguridad del paciente durante la transfusión.

RESUMO Objetivo: construir e validar um checklist para segurança do paciente no ato transfusional. Método: estudo metodológico cujo desenvolvimento ocorreu entre fevereiro de 2020 e janeiro de 2021, em um hospital de ensino de Santa Maria, RS, Brasil. A concepção se deu pelo levantamento dos itens em revisão integrativa da literatura, validação com 17 especialistas da saúde e 8 experts em hemoterapia. O pré-teste foi realizado com 36 profissionais da população-alvo. Para análise dos dados, procedeu-se ao cálculo do Índice de Validade de Conteúdo. Resultados: o checklist ficou composto de 29 itens e 90 subitens, distribuídos em três domínios, correspondentes às etapas do ato transfusional: Pré-transfusão (Prescrição médica, Compatibilização e Identificação Beira-leito); Transfusão (Instalação do hemocomponente); e Pós-transfusão (Monitoramento). Os itens obtiveram Índice de Validade de Conteúdo predominantemente >0,80 em todas as etapas. Após realizadas reformulações sugeridas pelos participantes, obteve-se Índice de Validade de Conteúdo de 0,98 na sua versão final. Conclusão: o checklist demonstrou evidências de validade de conteúdo, podendo ser uma ferramenta confiável para promover a segurança do paciente no ato transfusional.

Analysis of blood component transfusion and some adverse reactions in myelodysplastic syndroms patients / 中国输血杂志

【Objective】 To analyze the blood transfusion and adverse reactions in myelodysplastic syndroms (MDS) patients, so as to improve transfusion management in MDS patients. 【Methods】 The diagnosis and treatment information of MDS patients with blood transfusion in our hospital from January 2003 to December 2022 were collected, and the component transfusion and adverse reactions were investigated. 【Results】 The average infusion volume of red blood cells(RBCs) and platelets were respectively (27.46±43.11 ) and (16.41±24.81 ) in 799 MDS patients, which had no correlation with gender and blood type. The incidence of adverse reactions was 18.27% (146/799), with the most common adverse reactions as delayed serologic transfusion reaction (DSTR) (9.01%, 72/799), followed by non hemolytic fever reaction (4.76%, 38/799) and allergic reaction (4.38%, 35/799). Compared with all patients with transfusion, DSTR was more common in females (P<0.05), with elder age and had more RBCs consumption (all P<0.01). 86.11%(62/72) were Rh system, and 40.28% (29/72) had 2 or more antibodies. The occurrence time of DSTR in some patients was not related to the volume of RBCs trans infusion. 【Conclusion】 MDS patients, with more average transfusion volume and higher incidence of adverse reactions especially DSTR, were recommended a strictly limited transfusion schedule and Rh phenotype matching RBC products. The investigation of immune status of MDS patients at different periods is helpful to provide new aspects and therapeutic measures for the pathogenesis of DSTR, and the antibody screening time may adjusted appropriately.

Profile of hemotherapy care and the safety of the transfusion process

SUMMARY OBJECTIVE: This study aimed to evaluate the safety of the transfusion process in a public teaching hospital and to outline the profile of the hemotherapy care provided. METHODS: This was an exploratory, descriptive, and prospective study with a quantitative approach and grounded in field research. Data were obtained from medical and nursing records and active search. RESULTS: Concentrated red blood cells were the most transfused blood component. Inadequate indications of blood components were detected in 15% of Concentrated red blood cells transfusions, 20% of fresh plasma, 29.2% of platelet concentrates, and 36.4% of cryoprecipitates. Filling out the blood component request forms, the nursing checklist and the entry book were inadequate in 88.3, 92.8, and 69.5% of the procedures, respectively. CONCLUSIONS: Faults were identified throughout the transfusion process, revealing inadequate compliance with current standards and legislation, essential in minimizing the occurrence of errors and maximizing the safety of transfusion. Studies of this nature reinforce the need for continued research in this field.

Adverse reactions to blood transfusion: A retrospective analysis of 814 cases in Qingdao area from 2020 to 2021 / 中国输血杂志

【Objective】 To investigate the incidence and composition of adverse reactions to blood transfusion(ARBT) in Qingdao hospitals in recent years. 【Methods】 The "Statistical Table of Adverse Reactions to Blood Transfusion in Medical Institutions" issued by Qingdao Quality Control Center of Blood Transfusion throughout 2020 to 2021, involving 96 hospitals in the region, were collected and analyzed, including the number, proportion and types of ARBT, as well as the types of blood components transfused. 【Results】 From 2020 to 2021, 296 676 cases of blood transfusion in 96 hospitals occurred, and the incidence of ARBT was 0.27% (814/296 676), of which the incidence of ARBT involving plasma transfusion was 0.17% [accounting for 39.07% (318/814) of all transfusion reactions], involving platelet transfusion was 0.68% [31.08% (259/814)], involving erythrocyte transfusion was 0.11% [27.64% (225/814)] and cryoprecipitation transfusion 0.03% [1.47% (12/814)]. The types of ARBT were anaphylaxis 77.64% (632/814), fever 19.78% (161/814), transfusion-related dyspnea 1.47% (12/814), transfusion-related circulatory overload 0.37% (3/814), purpura 0.25% (2/814) and transfusion-related hypotension 0.25% (2/814), delayed hemolysis 0.12%(1/814) and acute hemolysis 0.12%(1/814), respectively. 【Conclusion】 In recent years, the incidence of ARBT in local medical institutions is lower than that of domestic general level, and the main reactions are anaphylaxis and fever following the transfusion of plasma or (and) platelets.The monitoring and control of ARBT should be strengthened in each hospital with accurate and timely report, and active preventive measures should be taken to control or reduce the incidence of ARBT effectively.

Clinical blood use in Tibet Autonomous Region People′s Hospital: A respective study of 2014~2018 / 中国输血杂志

【Objective】 To retrospectively investigate the clinical transfusion status in Tibet Autonomous Region People′s Hospital, in order to provide data basis for further improvement of the rational and scientific blood use in our hospital. 【Methods】 Medical records of transfusion recipients in our hospital from 2014 to 2018 were investigated via HIS system, and such indicators as total clinical blood use, usage of whole blood and blood components, blood transfusion per capita, usage of blood components with different types. and the usage of red blood cells and plasma in each clinical department were retrospectively analyzed. 【Results】 The total clinical blood usage of our hospital increased from 3 930.5 U in 2014 to 4 949 U in 2018, with an annual growth rate of 5.93%. The average blood use per capita in 2014 and 2018 was 0.205 U vs 0.218 U, and incidence of blood component transfusion was 47.18% vs 99.02% The proportion of blood component (red blood cell and plasma) usage was 36.0%, 35.9%, 20.7% and 7.4% for blood type O, A, B and AB, respectively. The usage of total blood, red blood cell and plasma in internal and surgical departments were 13 883.8 U vs 7 080.8 U, 4 963.3 U vs 3 647.3 U and 6 055 U vs 1 170 U, respectively. 【Conclusion】 The total clinical blood usage and the proportion of blood component transfusion in our hospital is increasing year by year. Therefore, rational and scientific blood use should be further improved.

Role of blood and blood components transfusion in obstetric emergencies

Background: Common obstetric emergencies require blood and blood components transfusion. The use of blood and its components has become a lifesaving strategy in management of obstetric haemorrhage. This study was aimed to know the prevalence, indications and adverse reactions of blood and its components transfusion.Methods: A review of 405 patients of obstetric emergencies requiring blood and its component transfusion was done.Results: Prevalence of blood and blood components transfusion in obstetric emergencies in one-year period was 18.4%. Mostly women who received blood transfusions were multiparous (50.12%) and belonged to rural areas (62%). Anemia is a risk factor for obstetric emergencies and the mean pre transfusion hemoglobin ±SD was 8.04±1.38 (g/dl). Obstetric hemorrhage (68.6%) was the most common indication for transfusion and packed red cells were most commonly (54.07%) transfused. The overall percentage of adverse reactions seen during transfusion was 1.95%.Conclusions: The present study reinforces the importance of appropriate use of blood and its components in obstetric emergencies. Appropriate use of blood components avoids many of the hazards associated with use of whole blood. All blood components should be made available at peripheral hospitals as most of the patients require specific blood component and they are referred to tertiary care centre in emergencies which can be avoided.

Hemovigilance and patient safety: analysis of immediate transfusion reactions in elderly / Hemovigilancia y seguridad del paciente: análisis de reacciones de transfusión inmediata en ancianos / Hemovigilância e segurança do paciente: análise de reações transfusionais imediatas em idosos

ABSTRACT Objective: To identify immediate transfusion reactions in elders hospitalized in a public hospital in the Federal District. Methods: This is an observational, retrospective, documental, and analytical research, with a quantitative analysis of 516 transfusions of packed red blood cells in elders hospitalized in the largest public hospital, who required blood components, from June to December 2017, through descriptive statistics. Results: The sample corresponded to 46.36% of the total number of transfusions in elders in the period. The mean age was 70 years old. There were adverse effects (reactions to the transfusion) in 12 (2.3%) transfusions. Respiratory alterations (33.3%) and fever (23.8%) were the most common events. Conclusion: The incidence of reactions to the transfusion is below national and international rates, indicating probable undernotification, which could be associated to a lack of knowledge regarding its clinical manifestations and the lack of systematic monitoring of the transfusion.

RESUMEN Objetivo: Identificar reacciones transfusionales inmediatas en pacientes ancianos ingresados en un hospital público del Distrito Federal. Métodos: Investigación observacional, retrospectiva, documental y analítica, con análisis cuantitativo de 516 transfusiones de hematíes en pacientes ancianos ingresados en el mayor hospital público que requirió hemocomponentes, de junio a diciembre de 2017, utilizando estadística descriptiva. Resultados: La muestra correspondió al 46,36% del total de transfusiones en ancianos en el período. La mediana de edad fue de 70 años. Hubo manifestaciones adversas (reacciones transfusionales) en 12 (2,3%) transfusiones. Los cambios respiratorios (33,3%) y la fiebre (23,8%) fueron las condiciones más frecuentes. Conclusión: La incidencia de reacción a la transfusión se encuentra por debajo de los parámetros nacionales e internacionales, lo que revela un probable subregistro posiblemente relacionado con el desconocimiento de las manifestaciones clínicas y la falta de seguimiento sistemático de la transfusión.

RESUMO Objetivo: Identificar reações transfusionais imediatas em idosos internados em hospital público do Distrito Federal. Métodos: Pesquisa observacional, retrospectiva, documental e analítica, com análise quantitativa de 516 transfusões de concentrado de hemácias em idosos internados no maior hospital público demandante de hemocomponentes, de junho a dezembro de 2017, por meio de estatística descritiva. Resultados: A amostra correspondeu a 46,36% do total de transfusões em idosos no período. A mediana de idade foi de 70 anos. Houve manifestações adversas (reações transfusionais) em 12 (2,3%) transfusões. Alterações respiratórias (33,3%) e febre (23,8%) foram os quadros mais comuns. Conclusão: A incidência de reação transfusional está abaixo dos parâmetros nacionais e internacionais, revelando provável subnotificação possivelmente relacionada ao desconhecimento das manifestações clínicas e à falta de acompanhamento sistemático da transfusão.

Hemocomponentes en urgencias: tratamiento vital para los pacientes politraumatizados / Blood products in the emergency room: vital treatment for polytraumatized patients

Introducción: La principal causa de mortalidad temprana en pacientes politraumatizados es la hipovolemia secundaria a hemorragia masiva. La terapia con hemocomponentes y cristaloides constituye un mecanismo esencial y salvavidas en estas situaciones como medida de reemplazo de volumen. De la misma manera los pacientes con lesiones traumáticas graves tienen una disminución aguda significativa en el recuento de plaquetas circulantes que los hace candidatos a la transfusión de componentes plaquetarios; sin embargo, el uso de estos componentes sanguíneos puede traer consigo desenlaces no deseados como aumento en la mortalidad. Si bien muchos estudios revelan un aumento de la mortalidad como desenlace asociado al uso de hemocomponentes, otros establecen su uso como una medida reductora de este desenlace. Objetivo: Exponer las principales indicaciones de hemocomponentes en los pacientes politraumatizados, así como relacionar los eventos adversos asociados a su uso que influyen sobre la mortalidad y el tiempo de hospitalización de estos pacientes. Desarrollo: La mortalidad asociada al uso de hemocomponentes aún es un tema controvertido. En la hemorragia masiva el apoyo transfusional rápido y eficiente es esencial en el tratamiento y la atención de politraumatismos, de ahí que sea necesario contar con protocolos de transfusión que mejoren los resultados y disminuyan las complicaciones. Además, se identificó la necesidad de nuevos estudios sobre el tema para mejorar estos protocolos y reducir las complicaciones.(AU)

Introduction: The main cause of early mortality in polytrauma patients is hypovolemia secondary to massive hemorrhage. Hemocomponent and crystalloid therapy is an essential and life-saving mechanism in these situations as a measure of volume replacement. In the same way, patients with severe traumatic injuries have a significant acute decrease in circulating platelet counts that makes them candidates for transfusion of platelet components; However, the use of these blood components can lead to unwanted outcomes such as increased mortality. Although many studies reveal an increase in mortality as an outcome associated with the use of blood components, others establish its use as a reducing measure of this outcome. Objective: to present the main indications of blood components in polytrauma patients, as well as to relate the adverse events associated with their use that influence the mortality and hospitalization time of these patients. Devlopment: Mortality associated with the use of blood components is still a controversial issue. In massive hemorrhage, rapid and efficient transfusion support is essential in the treatment and care of polytrauma, hence it is necessary to have transfusion protocols that improve results and reduce complications. In addition, the need for new studies on the subject to improve these protocols and reduce complications was identified(AU)

Valoración de la calidad de prescripción de transfusión sanguínea en un hospital de alta complejidad en la región Lambayeque / Evaluation of the quality of blood transfusion prescriptions in a high-complexity hospital in Lambayeque region

Objetivo: Valorar la calidad de la prescripción en las transfusiones sanguíneas realizadas y conocer los principales diagnósticos por los que se prescribió una transfusión sanguínea en un hospital de Alta Complejidad de la región Lambayeque. Materiales y Métodos: Estudio transversal. Se evaluaron 298 prescripciones de transfusiones sanguíneas efectivizadas, que fueron seleccionadas mediante aleatorización estratificada por departamento hospitalario. Se valoró la calidad de la prescripción en base al cumplimiento de la Guía de Indicaciones Adecuadas de Componentes Sanguíneos del Hospital Edgardo Rebagliati Martins. Se revisó las historias clínicas para obtener información necesaria para el llenado de la ficha de recolección y mediante estadística descriptiva se obtuvieron frecuencias y porcentajes acerca de la calidad de prescripción de transfusión sanguínea. Resultados: El 26,5% de las prescripciones sanguíneas en general se valoraron como inadecuadas [IC95%: 21,7 - 31,3]. El hemocomponente con mayor valoración de calidad inadecuada fue el plasma fresco congelado (52,6% [IC95%: 35,4% - 69,8%]), mientras que se encontró una menor proporción de calidad inadecuada en las solicitudes de crioprecipitado (20,0% [IC95%: 0,5%-71,6%]). Según departamento hospitalario, el departamento de Medicina obtuvo la mayor proporción de prescripciones inadecuadas (36,0%), seguido del departamento de Anestesiología (29,4%) y de Gineco-obstetricia (27,3%). Conclusiones: La calidad de prescripción de transfusión sanguínea se valoró como inadecuada en el 26,5%, siendo mayor en el Departamento de Medicina, y en las solicitudes de plasma fresco congelado.

Objective: To assess the quality of blood transfusion prescriptions and to verify the main diagnoses for prescribing blood transfusions in a high complexity hospital in Lambayeque region. Materials and Methods: This is a cross-sectional study. We assessed 298 blood transfusion prescriptions, which were selected using stratified randomization by hospital areas. Prescription quality was assessed based on compliance with the Guide for Appropriate Indications of Blood Components from Edgardo Rebagliati-Martins Hospital. Clinical records were reviewed aiming to obtain the information required for filling the data collection form. Descriptive statistics was used for obtaining rate regarding quality of blood transfusion prescriptions. Results: Roughly one-quarter (26.5%) of blood transfusion prescriptions were deemed as inadequate [95% CI: 21.7-31.3]. The blood product with the highest inadequate quality rate was frozen plasma (52.6% [95% CI: 35.4% - 69.8%]), while cryoprecipitate requests had the lowest rate of inadequate quality in its prescriptions (20.0% [95% IC: 0.5% -71.6%]). When different hospital areas were assessed, the general medicine department had the highest rate of inadequate quality of blood transfusion prescriptions (36.0%), followed by anesthesiology (29.4%) and gynecology & obstetrics (27.3%) departments. Conclusions: The quality of blood transfusion prescriptions was found to be inadequate in 26.5% of all cases, and the highest inadequacy rates were found in the general medicine department and in frozen plasma requests.

Adequação das atividades da intervenção "administração de hemoderivados" da classificação das intervenções de enfermagem para pacientes adultos / Adequacy of the activities in "blood products administration", of the nursing interventions classification, for adult patients / Adecuación de las actividades de la intervención "administración de hemoderivados" de la clasificación de intervenciones de enfermería para pacientes adultos

Introdução: a prevenção e/ou identificação precoce de reações transfusionais dependem de vigilância e cuidados diretos realizados pelos enfermeiros de forma segura e baseada em evidências. A Administração de Hemoderivados, uma intervenção na Classificação de Intervenções de Enfermagem, compreende 27 atividades que não foram validadas anteriormente. Objetivo: avaliar a adequação das atividades da intervenção da Classificação das Intervenções de Enfermagem Administração de Hemoderivados para pacientes adultos. Métodos: a adequação das atividades da Administração de Hemoderivados para pacientes adultos foi avaliada por 73 enfermeiros intensivistas de um hospital particular no Brasil. Atividades com médias ponderadas <0,80 e >0,50 foram classificadas como secundárias. Atividades com médias ponderadas ≥0,80 foram classificadas como principais. Atividades com razões ponderadas <0,50 foram consideradas não essenciais. Além disso, as atividades, dentro de suas classificações como principais ou secundárias, foram tipificadas pelos pesquisadores em seis subgrupos: cuidado basal; cuidado durante transfusão; cuidado após transfusão; cuidados durante e após transfusão; cuidados basal, durante e após transfusão; e cuidado após reação. Resultados: 22 atividades foram classificadas como principais, quatro foram classificadas como secundárias (dois cuidados basais, um cuidado durante e um cuidado após transfusão) e uma foi considerada não essencial (obter amostra do sangue e amostra da primeira urina após a reação à transfusão). Conclusões: na opinião dos enfermeiros intensivistas, a adequação da maioria das atividades da intervenção NIC Administração de Hemoderivados foi apoiada. Algumas mudanças na redação de algumas atividades podem melhorar a clareza e a precisão. Nossos resultados podem contribuir para futuros estudos de validação de conteúdo com maiores amostras de enfermeiros de diferentes especialidades que realizam transfusões rotineiramente, como enfermeiros oncologistas.(AU)

Introduction: prevention and/or early identification of transfusion-associated reactions rely on safe, evidence-based vigilance and direct care by nurses. Blood Products Administration, an intervention in the Nursing Interventions classification (NIC), comprises 27 activities that have not been previously validated. Objective: to evaluate the adequacy of the activities in the NIC intervention Blood Products Administration for adult patients. Methods: the adequacy of Blood Products Administration activities for adult patients was evaluated by 73 critical care nurses of a private hospital. Activities with weighted ratios (WR) <0.80 but >0.50 were labeled as minor. Activities with WR ≥0.80 were classified as major. Activities with WR <0.50 were discarded. Additionally, the activities within their classifications as major or minor were typified by the researchers in six subgroups: Baseline care; Care throughout transfusion; Care...(AU)

Introducción: la prevención y / o identificación temprana de las reacciones a la transfusión dependen de la vigilancia y de la atención segura de enfermería, en base a evidecias. La administración de hemoderivados, una intervención en la Clasificación de intervenciones de enfermería, comprende 27 actividades que no han sido validadas antes. Objetivo: evaluar la idoneidad de las actividades de intervención de la Clasificación de Intervenciones de Enfermería Administración de Hemoderivados para pacientes adultos. Métodos: 73 enfermeras de cuidados intensivos de un hospital privado de Brasil evaluaron la idoneidad de las actividades de administración de hemoderivados para pacientes adultos. Las actividades con promedios ponderados <0,80 y> 0,50 se clasificaron como secundarias. Las actividades con promedios ponderados ≥0,80 se clasificaron como principales. Las actividades con relaciones ponderadas <0,50 se consideraron no esenciales. Además, las actividades dentro de sus clasificaciones como principales o secundarias fueron tipificadas por los investigadores en seis subgrupos: atención basal; precaución durante la transfusión; cuidado después de la transfusión; cuidado durante y después de la transfusión; cuidado basal durante y después de la transfusión; y cuidado después de la reacción. Resultados: 22 actividades se clasificaron como principales, cuatro se clasificaron como secundarias (dos cuidados iniciales, uno durante y uno después de la transfusión) y uno se consideró no esencial (obtención de muestra de sangre y muestra de la primera orina después de la reacción a la transfusión). Conclusiones: los enfermeros de cuidados intensivos apoyan la idoneidad de la mayoría de las actividades de intervención NIC Administración de hemoderivados. Ciertas alteraciones en la redacción de algunas actividades podrían mejorar la claridad y la precisión. Nuestros hallazgos podrían contribuir a futuros estudios de validación de contenido con muestras más amplias de enfermeros de diferentes especialidades que realizan transfusiones de forma rutinaria, tales como los enfermeros oncológicos. (AU)

Effect of exchange transfusion therapy on complications and prognosis in newborns with bilirubin encephalopathy / 中国基层医药

Objective To study the influence of exchange transfusion therapy on the complications and prognosis in newborns with bilirubin encephalopathy.Methods From June 2013 to June 2016,76 children with bilirubin encephalopathy in Feicheng People's Hospital were selected and divided into study group(n =41) and control group(n =35) according to whether or not accepted the exchange transfusion treatment.The levels of total bilirubin (TBIL),indirect bilirubin(IBIL),direct bilirubin(DBIL) and the ratio of total bilirubin to plasma albumin(B/A)were detected and compared between the two groups.The complications and prognosis of the two groups were recorded.Results After exchange transfusion,the TBIL,IBIL,DBIL and B/A values in the study group were (209.49 ± 48.82) μmol/L,(201.81 ± 39.62) μmoL/L,(21.92 ± 19.47) μmoL/L and (5.15 ± 1.89),respectively,which were significantly lower than those before exchange transfusion [(492.35 ± 42.41) μmol/L,(439.44 ± 52.56) μmol/L,(69.38 ± 21.56) μmol/L and (13.28 ± 0.40)] (t =28.007,23.117,10.461,26.947,all P ＜ 0.05).The incidence rates of anemia,sinus bradycardia and electrolyte disturbances in the study group were 48.78％,48.78,60.98％,respectively,which were significantly higher than those in the control group(17.14％,14.29％,14.29％) (x2 =8.397,10.178,17.228,all P ＜ 0.05).The incidence rates of death,hearing impairment and brain damage in the study group were 7.32％,70.73％ and 12.20％,respectively,which in the control group were 11.43％,71.43％ and 14.29％,respectively,there were no statistically significant differences between the two groups (x2 =0.382,0.004,0.072,all P ＞ 0.05).Conclusion Exchange transfusion can significantly reduce the levels of bilirubin and B/A in the treatment of newborns with bilirubin encephalopathy,but it can increase the incidence rate of anemia,sinus bradycardia and electrolyte disturbances,which has no significant influence on the prognosis of patients.

Effects of component blood transfusion and whole blood transfusion on the incidence of non-hemolytic fever / 中国基层医药

Objective@#To analyze the effects of component blood transfusion and whole blood transfusion on the incidence of nonhemolytic fever(FNHTR).@*Methods@#A total of 384 patients who needed blood transfusion were treated from January 2015 to January 2017 in The Third People's Hospital of Datong.The patients were randomly divided into control group (n=192) and observation group(n=192) according to the digital table.The control group was treated with whole blood transfusion, and the observation group was treated with blood component therapy.The incidence of FNHTR was compared between the two groups.@*Results@#The incidence rates of FNHTR in the control group and the observation group with blood transfusion 1 time were 6.85% and 0.67%, respectively, which were significantly lower than those of the blood transfusion ≥2 times (23.91% and 7.14%), there were statistically significant differences between the two groups(χ2=10.455, 6.746, all P<0.05). The total incidence rate of FNHTR in the observation group was 2.08%, which was significantly lower than that in the control group(10.94%), the difference between the two groups was statistically significant(χ2=12.365, P<0.05).@*Conclusion@#The use of component blood transfusion in the course of clinical treatment can effectively reduce the incidence of FNHTR, effectively inhibit the incidence of blood transfusion related diseases, improve the safety of clinical treatment, the effect is remarkable, and is worthy of clinical promotion.

Effects of component blood transfusion and whole blood transfusion on the incidence of non-hemolytic fever / 中国基层医药

Objective To analyze the effects of component blood transfusion and whole blood transfusion on the incidence of nonhemolytic fever(FNHTR).Methods A total of 384 patients who needed blood transfusion were treated from January 2015 to January 2017 in The Third People's Hospital of Datong.The patients were randomly divided into control group (n =192) and observation group(n =192) according to the digital table.The control group was treated with whole blood transfusion,and the observation group was treated with blood component therapy.The incidence of FNHTR was compared between the two groups.Results The incidence rates of FNHTR in the control group and the observation group with blood transfusion 1 time were 6.85％ and 0.67％,respectively,which were significantly lower than those of the blood transfusion ≥ 2 times (23.91％ and 7.14％),there were statistically significant differences between the two groups (x2 =10.455,6.746,all P ＜ 0.05).The total incidence rate of FNHTR in the observation group was 2.08％,which was significantly lower than that in the control group (10.94％),the difference between the two groups was statistically significant (x2 =12.365,P ＜ 0.05).Conclusion The use of component blood transfusion in the course of clinical treatment can effectively reduce the incidence of FNHTR,effectively inhibit the incidence of blood transfusion related diseases,improve the safety of clinical treatment,the effect is remarkable,and is worthy of clinical promotion.

Treatment of hemorrhagic transformation in patients with ischemic stroke / 国际脑血管病杂志

10% to 15% of patients with ischemic stroke may have hemorrhagic transformation.Its treatment is more complex,mainly includes blood pressure management,reversing coagulopathy,and treatment of complications (including increased intracranial pressure).The current research is mainly to find the therapeutic regimen of hemorrhagic transformation after anticoagulation and thrombolytic therapy in order to improve the prognosis in patients with stroke.

New Insights into Restrictive Transfusion Strategy in Gastrointestinal Bleeding / 胃肠病学

Gastrointestinal bleeding is a common acute and critical illness that may result in hemorrhagic shock.In conventional concept, sufficient blood transfusion to ensure volume resuscitation was necessary for this emergency condition.With the propose and application of restrictive transfusion strategy in clinical practice, the new concept has been applied in patients with gastrointestinal bleeding.Restrictive transfusion strategy could maintain the perfusion of vital organs with a minimized blood transfusion, and avoiding the coagulopathy and acidosis caused by massive transfusion.This article reviewed the advances in study on gastrointestinal bleeding and restrictive transfusion strategy.

Prognostic effect of different blood transfusion ratios in trauma patients with massive transfusion / 中华创伤杂志

Objective To evaluate the prognostic effect of different ratios of fresh frozen plasma (FFP) to packed red blood cells (PRBC) in massively transfused trauma patients.Methods A retrospective cohort study was conducted for 210 trauma patients who received more than 10 units of PRBC during the initial 24 hours from January 2007 to June 2015.The patients were divided into four groups:Group A(PRBC:FFP ≤1,n=41),GroupB (1 ＜PRBC:FFP≤1.5,n=63),GroupC(1.5＜PRBC:FFP≤2,n=30) and Group D (PRBC:FFP ＞2,n =76).At 24 hours after admission,blood transfusion amount,blood transfusion ratios,post-transfusion adverse reactions (allergy,non-hemolytic febrile transfusion reaction,hemolysis,congestive heart failure,pulmonary edema,etc) and coagulation changes [hemoglobin (Hb),platelet count (PC),prothrombin time(PT),activated partial thromboplastin time(APTT),international normalized ratio (INR),etc] were compared among groups.Prognostic markers including sequential organ failure assessment(SOFA),hospital stay,ICU stay,30-day mortality and causes of death were also evaluated.Results Use of PRBC was decreased significantly in Group A than in other groups (P ＜ 0.01),and there were no differences in blood transfusion adverse reactions among all groups (P ＞ 0.05).The coagulation indices (PT,APTT and INR) in Groups A and B were significantly decreased compared to Group D after transfusion (P ＜ 0.05).There were no differences in length of hospital stay and ICU stay among all groups (P ＞ 0.05).Group D was associated with higher SOFA and higher 30-day mortality than other groups(P ＜0.01),but no differences were found in Group A,B and C (P ＞0.05).Meanwhile,ratio of patients died of massive hemorrhage in Group D was also higher than other groups (P ＜0.01).Kaplan-Meier survival analysis showed the survival interval was the shortest in Group D,while the longest in Group B and C.Conclusions Modest transfusion ratios (1.5 ＜ PRBC:FFP ≤2)within 24 hours can substantially improve outcomes in trauma patients.Aggressive ratios may improve coagulation indices and reduce use of PRBC,with no more benefit to the outcomes.

Pilares del ahorro transfusional / Pillars in the blood conservation

Las transfusiones sanguíneas alogénicas han tenido un rol central en el desarrollo de la medicina, principalmente como terapia de soporte en pacientes críticos, cirugía mayor, trauma y trastornos hematopoyéticos. Sin embargo, su utilización no está exenta de importantes efectos adversos y de altos costos asociados. Además, los productos sanguíneos son un recurso limitado que no debe ser desperdiciado. Por otro lado, la cirugía en pacientes que rehúsan la utilización de hemoderivados ha mostrado igual o mejores resultados que los pacientes que aceptan transfusiones. Esto ha llevado a buscar un manejo apropiado de la sangre en todos nuestros pacientes, evitando los riesgos y costos innecesarios de las transfusiones, pero permitiéndolos cuando se cree que los beneficios serán mayores que los riesgos. En este trabajo se presentan 3 pilares esenciales. El primero es el diagnóstico y manejo apropiado de la anemia preoperatoria, disminuyendo los riesgos perioperatorios, ya que la anemia por sí sola es un factor de morbimortalidad. El segundo pilar está constituido por diversas técnicas, que están disponibles en la actualidad, para minimizar el sangrado perioperatorio. Finalmente, el tercer pilar es mejorar la tolerancia a la anemia. El uso en conjunto de diversas técnicas descritas en este trabajo ha mostrado ser efectivo en disminuir el sangrado perioperatorio, la necesidad de transfusiones alogénicas y las unidades de sangre utilizadas, lo cual podría permitir mejores resultados clínicos en nuestros pacientes.

Allogeneic blood transfusions have played a central role in the development of medicine, mainly as a support therapy in critically ill patients, major surgery, trauma and hematopoietic disorders. However, their use is not without significant adverse effects and associated high costs. Moreover, blood products are a limited resource that should not be wasted. Furthermore, surgery in patients who refuse the use of blood products has shown equal or better results than patients who accept transfusions. This has led to seek an appropriate blood management in all our patients, avoiding unnecessary costs and risks of transfusions, but allowing them when they believe the benefits outweigh the risks. In this paper three essential pillars are presented. The first is the appropriate diagnosis and management of pre-operative anaemia decreasing perioperative risk, since anaemia itself is a factor of morbidity and mortality. The second pillar is formed by various techniques that are available today to minimize bleeding perioperative. Finally, the third pillar is to improve tolerance to anaemia. The joint use of various techniques described in this paper has proven effective in decreasing perioperative bleeding, the need for allogeneic transfusions and blood units used, which may allow better clinical outcomes in our patients.

Técnicas y medidas tendientes a disminuir el sangrado y el consumo de hemocomponentes en trasplante hepático. Evaluación de los primeros dos años de la Unidad Bi-Institucional de Trasplante Hepático en la especialidad Medicina Transfusional y Hemoterapia / Techniques and measures geared to reducing bleeding and the consumption of hemocomponents in liver transplant. Evaluation of the first two years at the Bi-Institutional Transplant Unit in the Transfusion Medicine and Hemotherapy specialization. Results of the participation of the Transfusion Medicine Department on the indicatio of deplasmatized bloodduring heart surgery preoperative period

Introducción: el trasplante hepático (TH) es el único tratamiento definitivo para la enfermedad hepática terminal crónica y patologías que no cuentan con otra alternativa terapéutica. El sangrado y el consumo de hemocomponentes se ha vinculado al descenso de la sobrevida del injerto y del paciente. Objetivo: evaluar los resultados en el consumo de hemocomponentes con la utilización de medidas y técnicas tendientes a minimizar el sangrado. Estimar la sobrevida. Material y método: se realiza un estudio descriptivo, observacional, retrospectivo de los primeros 31 pacientes sometidos a TH. Para la búsqueda de asociación entre variables de tipo cualitativo se utilizó test de chi cuadrado para un nivel de significación ?= 0,05, para el análisis de sobrevida fue utilizado Kaplan-Meyer. Resultados: se diseñó un score para analizar el consumo de hemocomponentes; en cinco pacientes (16,1%) no se transfundieron unidades de sangre desplasmatizada (u SD) y en 58,1% se consumieron de 1 a 4 u SD, con un promedio de 3,7 ± 0,6. Un solo paciente (3,2%) se trasplantó sin transfusión de hemocomponentes. A los seis meses la sobrevida corresponde a 81,3%, con un total de cinco eventos, permaneciendo vivos al final del estudio 26 pacientes. Conclusiones: las medidas para disminuir el sangrado y los requerimientos transfusionales fueron efectivos. Los resultados fueron aceptables, cercanos a los publicados a nivel internacional.

Abstract Introduction: liver transplant is the only final treatment for chronic terminal liver disease and other conditions that have no alternative therapies. Bleeding and the hemocomponents consumption has been associated to reduction of graft survival and patient. Objective: to evaluate results in hemocomponents consumption with the application of measures and techniques that aim to minimize bleeding. To estimate survival time. Method: descriptive, observational, retrospective study of the first 31 patients who had undergone liver transplant. A chi square test was used to find the qualitative variables association, significance level ? = 0.05, the Kaplan Meyer test was used to analyse survival. Results: a score was designed to analyse hemocomponent consumption, no deplasmatized blood units were transfused in 5 patients (16.1%), and 1 to 4 deplasmatized blood units were consumed in 58.1%, with a 3.7 ± 0.6 average. A single patient (3.2%) was transplanted with no hemocomponent transfusion. Upon six months, survival represents 81.3%, with a total of five events, 26 patients being alive towards the end of the study. Conclusions: measures to diminish bleeding and transfusion requirements were effective. Results were acceptable, similar to those published globally.

Resumo Introdução: o transplante hepático (TH) é o único tratamento definitivo para a doença hepática terminal crônica e outras patologias que não contam com alternativas terapêuticas. O sangramento e o consumo de hemocomponentes foram vinculados à diminuição da sobrevida do enxerto e do paciente. Objetivo: avaliar o consumo de hemocomponentes utilizando medidas e técnicas que buscam minimizar o sangramento. Estimar a sobrevida. Material e método: estudo descritivo, observacional, retrospectivo dos primeiros 31 pacientes submetidos à TH. Para buscar a associação entre variáveis de tipo qualitativo foi utilizado o teste do , com um nível de significância ? = 0,05; para a análise de sobrevida foi utilizado o teste de Kaplan Meyer. Resultados: foi elaborado um índice para analisar o consumo de hemocomponentes; cinco pacientes (16,1%) não receberam unidades de sangue desplasmatizada (u SD) e 58,1% consumiram de 1 a 4 u SD, com uma média de 3,7 ± 0,6. Somente um (3,2%) foi transplantado sem transfusão de hemocomponentes. A sobrevida aos seis meses foi de 81,3%, com um total de cinco eventos, permanecendo vivos ao final do estudo 26 pacientes. Conclusões: as medidas para diminuir o sangramento e os requerimentos transfusionais foram eletivas. Os resultados foram aceitáveis, próximos aos valores publicados a nível internacional.

Transfusion monitoring: care practice analysis in a public teaching hospital / Monitorização transfusional: análise da prática assistencial em um hospital público de ensino

ABSTRACT Objective To analyze the process of recording transfusion monitoring at a public teaching hospital. Methods A descriptive and retrospective study with a quantitative approach, analyzing the instruments to record transfusion monitoring at a public hospital in a city in the State of Minas Gerais (MG). Data were collected on the correct completion of the instrument, time elapsed from transfusions, records of vital signs, type of blood component more frequently transfused, and hospital unit where transfusion was performed. Results A total of 1,012 records were analyzed, and 53.4% of them had errors in filling in the instruments, 6% of transfusions started after the recommended time, and 9.3% of patients had no vital signs registered. Conclusion Failures were identified in the process of recording transfusion monitoring, and they could result in more adverse events related to the administration of blood components. Planning and implementing strategies to enhance recording and to improve care delivered are challenging.

RESUMO Objetivo Analisar o processo de registro de monitorização do ato transfusional em um hospital público de ensino. Métodos Estudo descritivo, retrospectivo, de abordagem quantitativa. Foram analisados os instrumentos de registro de monitorização do ato transfusional em um hospital público do interior de Minas Gerais (MG). Foram coletados dados relativos a correto preenchimento do instrumento, tempo decorrido das transfusões, registros dos sinais vitais, tipo de hemocomponente mais frequentemente transfundido e setor de ocorrência da transfusão. Resultados Foram analisados 1.012 instrumentos, dos quais 53,4% apresentaram falhas no preenchimento, 6% das infusões foram iniciadas após o tempo preconizado e 9,3% dos pacientes não tiveram os sinais vitais registrados. Conclusão Foram identificadas falhas no processo de registro da monitorização transfusional, que podem gerar maior ocorrência de eventos adversos relacionados à administração de hemocomponentes. É um desafio elaborar e implementar estratégias que possibilitem aprimorar os registros, assim como a assistência prestada.