Umbral crítico de administración en pacientes con trauma severo y reanimación endovascular: ¿Un concepto útil? / Critical Administration Threshold in severe trauma patients and endovascular resuscitation: A useful concept?

Introducción. Se describe la utilidad del umbral crítico de administración (CAT por su denominación en inglés) como herramienta para la reanimación hemostática en pacientes con trauma severo y oclusión endovascular aórtica. Métodos. Revisión retrospectiva de pacientes adultos con hemorragia por trauma, con o sin oclusión endovascular aórtica (REBOA), atendidos entre enero de 2015 y junio de 2020, en un centro de trauma nivel I en Cali, Colombia. Se registraron variables demográficas, severidad del trauma, estado clínico, requerimiento transfusional, tiempo hasta CAT+ y CAT alcanzado (1, 2 ó 3). Resultados. Se incluyeron 93 pacientes, se utilizó REBOA en 36 y manejo tradicional en 57. El grupo REBOA presentó mayor volumen de sangrado (mediana de 3000 ml, RIC: 1950-3625 ml) frente al grupo control (mediana de1500 ml, RIC: 700-2975ml) (p<0,001) y mayor cantidad de glóbulos rojos transfundidos en las primeras 6 horas (mediana de 5, RIC:4-9); p=0,015 y en las primeras 24 horas (mediana de 6, RIC: 4-11); p=0,005. No hubo diferencias estadísticamente significativas en número de pacientes CAT+ entre grupos o tiempo hasta alcanzarlo. Sin embargo, el estado CAT+ durante los primeros 30 minutos de la cirugía fue mayor en grupo REBOA (24/36, 66,7 %) frente al grupo control (17/57, 29,8 %; p=0,001), teniendo este mayor tasa de mortalidad intrahospitalaria frente a los pacientes CAT-. Conclusión. El umbral crítico de administración es una herramienta útil en la reanimación hemostática de pacientes con trauma y REBOA, que podría predecir mortalidad precoz.

Introduction. The objective is to describe the utility of the Critical Administration Threshold (CAT) as a tool in hemostatic resuscitation in patients with severe trauma and REBOA. Methods. Retrospective review between January 2015 and June 2020 of adult patients with hemorrhage secondary to trauma with or without REBOA in a level I trauma center in Cali, Colombia. Demographic variables, trauma severity, clinical status, transfusion needs, time to CAT+ and number of CAT achieved (1, 2 or 3) were recorded. Results. Ninety-three patients were included, in which REBOA was used in 36 and traditional management in 57. The REBOA group had a higher bleeding volume (3000 ml), IQR: 1950-3625 ml vs the control group (1500 ml, IQR: 700-2975 ml) (p<0.001) and a higher rate of PRBC units transfused in the first 6 hours (median 5, IQR: 4-9); p=0.015 and in the first 24 hours (median 6, IQR: 4-11); p=0.005. There were no statistically significant differences in the number of CAT+ patients between groups or time to CAT+. However, CAT+ status during the first 30 minutes of surgery was higher in the REBOA Group (24/36, 66.7%) vs. the control group (17/57, 29.8%; p=0.001), having this group a higher in-hospital mortality rate vs. CAT- patients. Conclusion. CAT is a useful tool in the hemostatic resuscitation of patients with trauma and REBOA that could predict early mortality.

Predicting the Need for Blood Transfusions in Cardiac Surgery: A Comparison between Machine Learning Algorithms and Established Risk Scores in the Brazilian Population

ABSTRACT Introduction: Blood transfusion is a common practice in cardiac surgery, despite its well-known negative effects. To mitigate blood transfusion-associated risks, identifying patients who are at higher risk of needing this procedure is crucial. Widely used risk scores to predict the need for blood transfusions have yielded unsatisfactory results when validated for the Brazilian population. Methods: In this retrospective study, machine learning (ML) algorithms were compared to predict the need for blood transfusions in a cohort of 495 cardiac surgery patients treated at a Brazilian reference service between 2019 and 2021. The performance of the models was evaluated using various metrics, including the area under the curve (AUC), and compared to the commonly used Transfusion Risk and Clinical Knowledge (TRACK) and Transfusion Risk Understanding Scoring Tool (TRUST) scoring systems. Results: The study found that the model had the highest performance, achieving an AUC of 0.7350 (confidence interval [CI]: 0.7203 to 0.7497). Importantly, all ML algorithms performed significantly better than the commonly used TRACK and TRUST scoring systems. TRACK had an AUC of 0.6757 (CI: 0.6609 to 0.6906), while TRUST had an AUC of 0.6622 (CI: 0.6473 to 0.6906). Conclusion: The findings of this study suggest that ML algorithms may offer a more accurate prediction of the need for blood transfusions than the traditional scoring systems and could enhance the accuracy of predicting blood transfusion requirements in cardiac surgery patients. Further research could focus on optimizing and refining ML algorithms to improve their accuracy and make them more suitable for clinical use.

Targeting patient blood management's first pillar: A multicentric retrospective study on preoperative anemia

ABSTRACT Introduction: Anemia is a common issue in surgical patients and has been associated with worse clinical outcomes, such as a higher probability of transfusions and longer hospital stay. Therefore, Patient Blood Management programs are actively aiming to achieve early identification and treatment of anemia, previous to the surgery. Methods and materials: In this study, preoperative hemoglobin within the Blood Order Schedule (BOS) at 16 blood centers in several Brazilian regions were retrospectively evaluated. Data regarding hemoglobin, age, gender and Brazilian regions were further analyzed. Results: From the 20,201 BOSs evaluated, the mean age was 55.65 ± 23.52 years old, with an overall prevalence of preoperative anemia of 60.9%. Women had a lower mean preoperative hemoglobin (11.74 ± 2.84 for women and 12.27 ± 3.06 for men) and higher prevalence of anemia than men (66% of females and 52.2% of males). The individuals over 65 years old and under 18 were the most affected by preoperative anemia. All regions had a high prevalence of preoperative anemia, without any direct association with the Human Development Index. Conclusion: In summary, upon evaluating the BOS, our study showed a high prevalence of preoperative anemia in all Brazilian regions, regardless of the gender and age group, but that women and individuals less than 18 or over 65 years old have an even higher prevalence of preoperative anemia. This information can identify the institutions in which preoperative anemia is a critical issue and in which new strategies, such as preoperative screening clinics, might be helpful.

Analysis of requests for reservation of blood concentrates in patients referred to urgent surgeries in a teaching hospital

Introduction: The rates of request and use of blood concentrates are still poorly reported in the literature. This study aimed to analyze the rates of requests for blood concentrates and their use in patients undergoing emergency surgery in a teaching hospital. Methods: A retrospective, quantitative and descriptive study was conducted in 359 medical records of patients in urgent surgery scheduled with a request for a reserve of blood concentrate. The ratios between crossmatched and transfused units (C/T), transfusion index (TI), and probability (TP) were calculated, and the times between request and delivery at the transfusion agency (TA) and patient admission to the surgical center (SC). Results: The mean age was 58.5 ± 22.2 years, with the majority being male (53.1%). There was an average of 27.5 monthly requests (min 12, max 44). Ninety-seven units of blood concentrates were transfused into 44 patients (C/T ratio 7.59; TI 0.27; TP 12.3%). Only seven patients had their requests made after admission to the OR. The median time between the request and arrival at the TA was 1h15min, while that between the request and the patient's arrival at the SC was 5h23min. There was greater transfusion in major surgery (major 37, 14.8% vs. medium 7, 6.5%; p = 0.027) and non-orthopedic surgery (orthopedic 9, 4.0% vs. non-orthopedic 35, 26.9%; p < 0.001). Conclusion: there was a significant discrepancy between the number of requests for blood reservation and its real use and an increased time between reservation requests and their arrival at the TA.

Statistical Analysis of Monocyte Monolayer Assay Validation in Brazilian Blood Donors

Aims: To validate the monocyte monolayer assay (MMA) technique concerning its suitability for blood donor screening and its cost per test performed. The MMA is an in vitro simulation of the behavior of the antibodies, demonstrating the reactions that would occur in the endothelial reticulum system after a transfusion of incompatible red blood cells, indicating the risk of a hemolytic transfusion reaction and therefore of the clinical significance of the antibodies. Study Design: Blood samples of alloimmunized patients, selected at random from a blood donation bank, were submitted to validation tests recommended by the Brazilian National Health Surveillance Agency for the approval of new testing procedures. Place and Duration of Study: The following Brazilian institutions were involved between June 2009 and July 2010: Immunohematology laboratory of the Hematology and Hemotherapy Center of Santa Catarina state in Florianópolis, Department of Medicine (Medical Unit IV) and Department of Radiology of the Institute of Medical Sciences, Hospital Lahore in São Paulo. Methodology: Ninety samples of alloimmunized patients treated by the Santa Catarina blood donors were used. The validation tests evaluated the selectivity, linearity, precision, and accuracy of the MMA method and determined the limits of detection and quantification. External validation of the method was performed by comparing these results with those of an independent laboratory in São Paulo, while making sure that the latter was blind to the results of the former. The coefficient of variation was used to express the MMA testing precision of 5 replicates across 5 different concentration levels. Type I error for evaluating statistical significance was set at 5%. Results: Selectivity assessment of the impact of multiple alloantibodies on the MMA test result showed no statistically significant difference (P>0.05) across the titers of 64, 256, and 2048, each with three replications, thus confirming the test specificity. Homoscedasticity of the monocyte index (MI) data was not refuted by Levine's test with the F-value of 0.746, much below the value of 3.056 needed to achieve a statistical significance level of P<0.05. MI linearity against the logarithm of the alloantibody concentration was shown in a simple linear regression where the latter predicted 83% of the variation in the former, and the regression slope of 0.4 (95% confidence interval 0.32, 0.48). The limits of detection and quantification on the logarithm scale were 0.28 and 0.84, respectively. External validation found no statistically significant difference between the MMA test results from the two independent laboratories. The coefficient of variation of <15% indicated good MMA testing precision under routine laboratory conditions. Conclusion: The assay met all validation criteria and was therefore effective in assessing the clinical significance of alloantibodies.

Fetal hemoglobin, blood transfusion, and retinopathy of prematurity in preterm infants: An observational, prospective study

Purpose: The objective of this study was to identify the association between fetal hemoglobin (HbF) concentration, blood transfusion, and retinopathy of prematurity (ROP) in preterm infants. Methods: This was an observational, prospective study. A total of 410 preterm infants born with <36 weeks gestational age and <2.0 kg birth weight in a tertiary care center of central India for a period of 1 year were included in this study. Clinical data were obtained from case notes. HbF of infants was measured in the blood sample using high?performance liquid chromatography at the first visit and after 1 month follow?up and was analyzed statistically. Dilated fundus examination was done as per ROP screening guidelines, and ROP was classified as per the International Classification of Retinopathy of Prematurity (ICROP), 2021. The study subjects were divided into two groups based on the status of ROP. The relationship among HbF, blood transfusion, and ROP was evaluated in both the groups. The relationship between other clinical characteristics and various neonatal risk factors was also studied between the groups. Results: A total of 410 preterm infants were included in this study, of which 110 infants had ROP (26.8%). Blood transfusion was found to be significantly associated with the development of ROP. Higher fraction of HbF (%) was associated with a lower prevalence of ROP. HbF was also inversely related with the severity of ROP. Conclusion: Replacing HbF by adult hemoglobin during blood transfusion may promote the development of ROP. Conversely, maintaining a higher percentage of HbF may be a protective factor against ROP.

Desenlaces maternos según el tipo de placenta previa en un hospital de alta complejidad en Cali, Colombia. Estudio de cohorte retrospectivo / Maternal outcomes according to the type of placenta previa in a high complexity hospital in Cali, Colombia. Retrospective cohort study

Objetivos: Describir la frecuencia de complicaciones maternas en mujeres gestantes con placenta previa (PP) mayor o menor y evaluar una posible asociación entre tipo de PP y la presencia de hemorragia materna severa y otros resultados maternos asociados. Materiales y métodos: Cohorte retrospectiva, descriptiva. Se incluyeron gestantes con 20 semanas o más de embarazo, con diagnóstico confirmado de placenta previa, quienes fueron atendidas en un hospital de alto nivel de complejidad localizado en Cali (Colombia), entre enero de 2011 y diciembre de 2020. Se excluyeron las gestantes con diagnóstico de placenta previa y acretismo placentario concomitante. Las variables recolectadas fueron: edad materna, índice de masa corporal, tabaquismo, obesidad, paridad, presencia de sangrado, hemorragia posparto, manejo de la hemorragia posparto, transfusión y admisión a UCI de la gestante. Se realizó análisis descriptivo. El protocolo fue aprobado por el comité de ética de la Fundación Valle de Lili. Resultados: 146 pacientes cumplieron con los criterios de inclusión. La población estuvo constituida por mujeres con una mediana de edad de 32 años, sin antecedente quirúrgico, con diagnóstico prenatal de placenta previa a la semana 22. En el 70,5 % de los casos se trató de pacientes con placenta previa mayor. Las complicaciones más frecuentes fueron hemorragia posparto (37,9 % vs. 16,3 % para pacientes con placenta previa mayor y menor, respectivamente), requerimiento de transfusión (23,3 y 9,3 %, respectivamente) y el ingreso materno a la UCI (40,8 % vs. 18,6 %, respectivamente). No se registraron muertes maternas. Conclusiones: Las mujeres con placenta previa experimentan una frecuencia elevada de complicaciones; probablemente, dicha frecuencia es más alta cuando se documenta placenta previa mayor. Se requieren más estudios que comparen la frecuencia de complicaciones maternas según el tipo de placenta previa.

Objectives: To describe the frequency of maternal complications in pregnant women with major or minor placenta previa (PP), and to assess a potential association between PP type and the presence of severe maternal bleeding and other associated outcomes. Material and methods: Retrospective descriptive cohort. The study included pregnant women with 20 weeks of gestation or more and a confirmed diagnosis of placenta previa who were seen in a high complexity hospital in Cali (Colombia), between January 2011 and December 2020. Women with a diagnosis of placenta previa and concomitant placenta accreta were excluded. The collected variables were maternal age, body mass index, smoking, obesity, parity, presence of bleeding, postpartum hemorrhage, management of postpartum hemorrhage, transfusion, and maternal ICU admission. A descriptive analysis was performed. The protocol was approved by the ethics committee of Fundaciónn Valle de Lili. Results: A total of 146 patients met the inclusion criteria. The population consisted of women with a mean age of 32 years, with no history of prior surgery, with a prenatal diagnosis of placente previa at week 22; 70% were major placenta previa cases. The most frequent complications were postpartum hemorrhage (37.9 % vs. 16.3 % for patients with major and minor placenta previa, respectively), transfusion requirement (23.3 and 9.3 %, respectively), and maternal ICU admission (40.8 % vs. 18.6 %, respectively). There were no cases of maternal death. Conclusions: There is a high frequency of complications in women with placenta previa, and it is probably higher in cases of major placenta previa. Further studies are needed to compare the frequency of maternal complications according to the type of placenta previa.

La formación y especialización médica en medicina transfusional / Medical training and specialization in transfusion medicine

Introducción: Para una práctica transfusional segura se requiere una formación en medicina transfusional. Objetivo: Determinar la manera en que se integran los contenidos y las habilidades de medicina transfusional en la formación y la especialización médica en Cuba. Métodos: Se hizo un estudio educacional, analítico, de corte transversal en la Universidad de Ciencias Médicas de Camagüey, desde marzo de 2020 hasta julio de 2021. Se realizó un análisis documental para precisar cómo se integraban los contenidos y las habilidades de medicina transfusional al currículo para la formación de médicos, a los programas de estudio del internado vertical en 26 especialidades médicas, y a 29 planes de estudio y programas de especialización en Cuba. Resultados: El currículo para la formación de médicos en Cuba no incluye medicina transfusional. La asignatura que más contribuye a la formación en esta área del saber es Sangre y Sistema inmune. Los contenidos y las habilidades de medicina transfusional solo se incluyen expresamente en nueve programas de estudio del internado vertical y en 12 planes de estudio y programas de especialización. Conclusiones: Existe una insuficiente integración de los contenidos y las habilidades de medicina transfusional en el currículo de la carrera de medicina en Cuba, situación que se manifiesta también en los programas de estudios de los internados verticales y en la mayoría de los programas de las especialidades médicas.

Introduction: Safe transfusion practice requires training in transfusion medicine. Objective: To determine the way in which transfusion medicine contents and skills are integrated into medical training and specialization in Cuba. Methods: An educational, analytical and cross-sectional study was carried out at Universidad de Ciencias Médicas de Camagüey, from March 2020 to July 2021. A documentary analysis was conducted to determine how transfusion medicine contents and skills were integrated into the curriculum for the training of physicians, into the study programs of the vertical internship in 26 medical specialties, as well as into 29 study plans and specialization programs in Cuba. Results: The curriculum for the training of physicians in Cuba does not include transfusion medicine. The subject that most contributes to training in this area of knowledge is Blood and Immune System. Transfusion medicine contents and skills are only expressly included in nine vertical internship study programs and in twelve study plans and specialization programs. Conclusions: There is insufficient integration of transfusion medicine contents and skills in the Cuban medical major curriculum, a situation that is also manifested in the study programs of vertical internships and in most of the medical specialties programs.

Clinical outcomes of MANTA vs suture-based vascular closure devices after transcatheter aortic valve replacement: An updated meta-analysis

Objective: A recently published randomized control trial showed different results with suture-based vascular closure device (VCD) than plug-based VCD in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). The learning curve for MANTA device is steep, while the learning curve for suture based VCD is shallow as the devices are quite different. In this meta-analysis, we have compared suture-based (ProGlide and Prostar XL) vs plug-based VCDs (MANTA). Methods: We performed a meta-analysis of all published studies (using PubMed/Medline and Cochrane databases) reporting the clinical outcome of plug-based vs suture-based VCDs in transfemoral TAVR patients. Results: We included nine studies with a total of 2865 patients (plug-based n ¼ 1631, suture-based n ¼ 1234). There was no significant difference in primary outcome of all bleeding when using plugbased as opposed to suture-based VCDs (RR 1.14 [0.62e2.06] I2 ¼ 72%). There was no significant difference in the incidence of secondary outcomes between two groups including major life threatening bleeding (RR 1.16 [0.38e3.58] I2 ¼ 65%), major vascular complications (RR 0.84 [0.35e2.00] I2 ¼ 55%), minor vascular complications (RR 1.05 [0.56e1.95] I2 ¼ 42%), pseudo aneurysm (RR 1.84 [0.11e29.98] I 2 ¼ 44%), stenosis-dissection (RR 0.98 [0.66e1.47] I2 ¼ 0%), VCD failure (RR 1.71 [0.96e3.04] I2 ¼ 0%), and blood transfusion (RR 1.01 [0.38e2.71], I2 ¼ 61%). Conclusion: Large bore arteriotomy closure with plug-based VCD was not superior to suture-based VCDs in this transfemoral TAVR population. There was very frequent use of secondary VCDs in suture-based VCD group which is not practical when using MANTA. Additional high-powered studies are required to determine the safety and efficacy of MANTA device.

Factors associated with blood product requirements during the transoperative period in pediatric patients / Factores asociados a los requerimientos de productos sanguíneos durante el transoperatorio en pacientes pediátricos

Abstract Background: The efficiency of blood products (BP) requisition in elective non-cardiac surgeries is inherently complex. Moreover, it is aggravated in the pediatric population. This study aimed to identify the factors associated with using less than the requested BP during the transoperative period in pediatric patients undergoing elective non-cardiac surgery. Methods: We conducted a cross-sectional comparative study including 320 patients undergoing elective non-cardiac surgery for whom BPs were requested. Low requirements were considered when less than 50% of the requested amount or no BPs were used, and high requirements when more than the requested amount was used. The Mann-Whitney's U test was applied for comparative analysis, and multiple logistic regression was used to adjust for factors associated with lower requirements. Results: The median age of the patients was 3 years. From 320 patients, 68.1% (n = 218) received less than the requested amount of BP, while only 1.25% (n = 4) received more than the requested amount of BP. Factors associated with transfusion of less than the requested BPs were prolonged clotting time (odds ratio (OR) = 2.66) and anemia (OR = 0.43). Conclusions: Factors associated with lower than requested BP transfusion were prolonged clotting time and anemia.

Resumen Introducción: La eficiencia de la solicitud de productos sanguíneos (PS) en las cirugías electivas no cardiacas es, de por sí, compleja. No obstante, se agrava para la población pediátrica. El objetivo de este estudio fue identificar los factores asociados con la utilización de una cantidad de PS menor a la solicitada durante el transoperatorio en pacientes pediátricos sometidos a cirugía electiva no cardiaca. Métodos: Se realizó un estudio transversal comparativo donde se incluyeron 320 pacientes sometidos a cirugía electiva no cardiaca para quienes se solicitaron PS. Los requerimientos de hemoderivados se consideraron como menores cuando no se utilizaron o se utilizó menos del 50% de lo solicitado y como mayores cuando se utilizó una cantidad mayor a la solicitada. Se aplicó la prueba U de Mann-Whitney para el análisis comparativo y regresión logística múltiple para ajustar los factores asociados a la presencia de menores requerimientos. Resultados: La mediana para la edad de los pacientes fue de 3 años. Se transfundió una cantidad de PS menor a la solicitada en el 68.1% (n = 218) de los pacientes, mientras que se transfundió una cantidad mayor a la solicitada solo en el 1.25% de los pacientes (n = 4). Los factores asociados con la transfusión de una cantidad de PS menor a la solicitada fueron tiempos de coagulación alargados (TCA) (razón de momios (RM) = 2.66) y anemia (RM = 0.43). Conclusiones: Los factores asociados a una transfusión de PS inferior a la solicitada fueron el tiempo de coagulación prolongado y la anemia.

Turnaround time for the issuing of packed red cells: A retrospective study in a tertiary care hospita

Introduction: Turnaround time (TAT) is one of the most crucial performance indicators for blood transfusion and laboratory services. It is especially crucial in transfusion services due to its seminal role as a determining factor in patient care outcomes. We examined our institution’s TAT for issuing blood units. Materials and Methods: The Department of Immunohematology and Blood Transfusion, MGM Medical College and Hospital in Navi Mumbai, Maharashtra, India, undertook this retrospective noninterventional study over 12 months from January 01, 2020 to December 31, 2020. TAT was determined using a random audit of 10% of all monthly requests at the blood center. All requests for packed red cells (PRCs) received in the blood center during the study period were included in the evaluation. All requests for other blood components such as fresh-frozen plasma, random donor platelets, and cryoprecipitates were excluded along with all reservations for PRCs. A team of investigators tracked 369 requests for packed red cells over the year, noting the turnaround time. The standard TAT was set depending on the nature of the clinical case. Any significant deviation from institutionally established TAT was investigated, and root cause analysis was done. Results: The majority of transfusion requests were routine (72%) followed by emergency (23%) and lifesaving (5%). For routine cases, the average TAT was observed at 104 minutes. For emergency cases, the average TAT was observed at 39 minutes. For lifesaving cases, the average TAT was observed at 12 minutes. The highest number of cases were categorized under routine, followed by emergency cases and lifesaving categories. Conclusion: It was observed that there were no significant variations in turnaround time in routine, emergency, or lifesaving cases. Overall, as per our blood center standards, TAT for the issue of packed red cells was observed to fall under the normal range for routine, emergency, and lifesaving. Any outliers observed during the duration of the study were mainly due to inadequate samples or patient details received at the blood center or the presence of irregular antibodies encountered during the crossmatch.

O uso da transfusão sanguínea autóloga na cirurgia do aparelho digestivo: uma revisão de literatura / The use of autologous blood transfusion in digestive tract surgery: a literature review

ABSTRACT Background: The use of autologous blood transfusion in digestive tract surgeries, whether after preoperative blood collection or intraoperative blood salvage, is an alternative to allogeneic blood, which brings with it certain risks and shortage, due to the lack of donors. Studies have shown lower mortality and longer survival associated with autologous blood, however the theoretical possibility of spreading metastatic disease is still one of the limiting factors of its use. Objective: To evaluate the application of autologous transfusion in digestive tract surgeries, noting the benefits, damages and effects on the spread of metastatic disease. Methods: This is an integrative review of the literature available in the PubMed, Virtual Health Library and SciELO databases, by searching for "Autologous Blood Transfusion AND Gastrointestinal Surgical Procedures". Observational and experimental studies and guidelines published in the last five years in Portuguese, English or Spanish were included. Results: Not all patients benefit from blood collection before elective procedures, with the time of surgery and hemoglobin levels some of the factors that may indicate the need for preoperative storage. Regarding the intraoperative salvaged blood, it was observed that there is no increased risk of tumor recurrence, but the importance of using leukocyte filters and blood irradiation is highlighted. There was no consensus among the studies whether there is a maintenance or reduction of complication rates compared to allogeneic blood. The cost related to the use of autologous blood may be higher, and the less stringent selection criteria prevent it from being added to the general donation pool. Conclusion: There were no objective and concordant answers among the studies, but the strong evidence of less recurrence of digestive tumors, the possibility of changes in morbidity and mortality, and the reduction of costs with patients suggest that the practice of autologous blood transfusion should be encouraged in digestive tract surgeries. It is necessary to note if the deleterious effects would stand out amidst the possible benefits to the patient and to health care systems.

RESUMO Contexto: O emprego da transfusão sanguínea autóloga nas cirurgias do aparelho digestivo, seja através da coleta de sangue no pré-operatório ou da recuperação de sangue no intraoperatório, é uma alternativa ao sangue alogênico, que traz consigo determinados riscos e a escassez, pela falta de doadores. Estudos têm demonstrado menor mortalidade e maior sobrevida associadas ao sangue autólogo, no entanto a possibilidade teórica de propagação de doença metastática ainda é um dos fatores limitantes do seu uso. Objetivo: Avaliar a aplicação da transfusão autóloga em cirurgias do aparelho digestivo, observando os benefícios, prejuízos e efeitos sobre a propagação de doenças metastáticas. Métodos: Trata-se de uma revisão integrativa da literatura disponível nas bases de dados PubMed, Biblioteca Virtual em Saúde e SciELO, através da busca por "Autologous Blood Transfusion AND Gastrointestinal Surgical Procedures". Foram incluídos estudos observacionais e experimentais e guidelines publicados nos últimos 5 anos, nos idiomas português, inglês ou espanhol. Resultados: Nem todos os pacientes beneficiam-se da coleta de sangue antes de procedimentos eletivos, sendo o tempo de cirurgia e os níveis de hemoglobina alguns dos fatores que podem indicar a necessidade do armazenamento pré-operatório. Em relação ao sangue recuperado no intraoperatório, observou-se que não há maior risco de recorrência de tumores, mas destaca-se a importância do uso de filtros leucocitários e irradiação sanguínea. Não houve consenso entre os estudos se há uma manutenção ou redução das taxas de complicação, em comparação com o sangue alogênico. O custo relacionado ao uso de sangue autólogo pode ser maior, além de os critérios de seleção menos rigorosos impedirem que seja adicionado ao pool geral de doações. Conclusão: Não houve respostas objetivas e concordantes entre os estudos, mas os fortes indícios da menor recorrência de tumores digestivos, a possibilidade de alterações na morbimortalidade e a redução dos custos com os pacientes sugerem que a prática da transfusão sanguínea autóloga seja fomentada nas cirurgias do aparelho digestivo. É necessário observar se os efeitos deletérios se destacariam em meio aos possíveis benefícios ao paciente e aos sistemas de saúde.

External quality control program in infectious diseases screening at laboratories and blood banks in Latin America: an analysis of the past 5 years / Programa de control externo de la calidad en el tamizaje de enfermedades infecciosas en laboratorios y bancos de sangre de América Latina: análisis de los últimos 5 años / Programa externo de controle de qualidade na triagem de doenças infecciosas em laboratórios e bancos de sangue da América Latina: análise dos últimos 5 anos

ABSTRACT Objective. To evaluate the screening of blood samples for infectious disease markers at laboratories and blood banks in Latin America per the findings of an External Quality Assessment Program (EQAP). Methods. This qualitative analysis used data from the EQAP coordinated by the Fundação Pro Sangue Hemocentro de São Paulo with the support of the Pan American Health Organization to assess the performance of blood screening for infectious diseases from 2014 to 2018 in Latin America. Each participating laboratory or blood bank received an identical blind panel with 24 blood samples with variable reactivity for all the screening parameters. Panels were processed at each participating facility and results were returned to the Fundação Pro Sangue Hemocentro de São Paulo for individual and joint analyses. Two types of discrepant results were potential failures: false positive results (FPRs) and false nonreactive results (FNRRs). Results. A total of 23 136 samples were evaluated. Global rates of FPR, FNRR, and concordant results were 0.3%, 1.0% and 98.7%, respectively. Seven FNRRs were found for HBsAg (1.0%), 12 for syphilis (2.6%), and 21 for Chagas disease (2.9%). No FNRRs were found for the HIV, HCV, and HTLV viruses. The average accuracy of all the laboratories and blood banks participating in the EQAP during the study period was 99.5% (standard deviation, 0.5%). Conclusion. The findings of this qualitative analysis are positive for blood safety in Latin America, with an average accuracy of 99.5% among the participating laboratories and blood banks. This report reflects an important improvement in blood bank serological screening EQAP-PAHO report since the 2003.

RESUMEN Objetivo. Evaluar el tamizaje de muestras de sangre en las que se analizan marcadores de enfermedades infecciosas en laboratorios y bancos de sangre de América Latina según los resultados de un programa de evaluación externa de la calidad (EQAP, por su sigla en inglés). Métodos. Este análisis cualitativo utilizó datos del EQAP —coordinado por la Fundação Pro Sangue Hemocentro de São Paulo con el apoyo de la Organización Panamericana de la Salud— para evaluar la eficacia del tamizaje sanguíneo para la detección de enfermedades infecciosas que se realizó entre el 2014 y el 2018 en América Latina. Cada laboratorio o banco de sangre participante recibió un panel idéntico para análisis a ciegas compuesto por 24 muestras de sangre con reactividad variable para todos los parámetros del tamizaje. Los paneles se procesaron en cada establecimiento participante y los resultados se enviaron a la Fundação Pro Sangue Hemocentro de São Paulo donde se realizaron análisis individuales y conjuntos. Había dos tipos de resultados discrepantes que eran posibles fallas del tamizaje: los positivos falsos (PF) y los negativos falsos (NF). Resultados. En total se evaluaron 23 136 muestras. Las tasas generales de PF, NF y resultados concordantes fueron, respectivamente, del 0,3%, 1,0% y 98,7%. Se obtuvieron siete NF en casos de HBsAg (1,0%), 12 en casos de sífilis (2,6%) y 21 en casos de enfermedad de Chagas (2,9%). No se obtuvieron NF en casos de infección por virus del VIH, el VHC o el VLTH. La precisión promedio de todos los laboratorios y bancos de sangre participantes en el EQAP durante el periodo de estudio fue del 99,5% (desviación típica: 0,5%). Conclusión. Los resultados de este análisis cualitativo son positivos en lo referente a la seguridad sanguínea en América Latina, con una precisión promedio del 99,5% entre los laboratorios y bancos de sangre participantes. Este informe refleja la considerable mejora del tamizaje serológico que se realiza en los bancos de sangre, en comparación con los resultados del informe del EQAP que contó con el apoyo de la OPS y se publicó en el 2003.

RESUMO Objetivo. Avaliar a triagem de marcadores de doenças infecciosas em amostras de sangue realizada em laboratórios e bancos de sangue da América Latina de acordo com os resultados de um Programa Externo de Avaliação de Qualidade (EQAP, na sigla em inglês). Métodos. Esta análise qualitativa usou dados do EQAP coordenado pela Fundação Pró-Sangue Hemocentro de São Paulo, com o apoio da Organização Pan-Americana da Saúde, para avaliar o desempenho da triagem de sangue quanto a doenças infecciosas no período de 2014 a 2018 na América Latina. Cada laboratório ou banco de sangue participante recebeu um painel cego idêntico com 24 amostras de sangue de reatividade variável para todos os parâmetros de triagem. Os painéis foram processados em cada estabelecimento participante e os resultados foram devolvidos à Fundação Pró-Sangue Hemocentro de São Paulo para análises individuais e conjuntas. Dois tipos de resultados discrepantes representavam falhas em potencial: resultados falso-positivos e resultados falso-negativos (não reativos). Resultados. Foram avaliadas 23.136 amostras. As taxas globais de resultados falso-positivos, falso-negativos e concordantes foram de 0,3%, 1,0% e 98,7%, respectivamente. Foram encontrados sete resultados falso-negativos para HBsAg (1,0%), 12 para sífilis (2,6%) e 21 para doença de Chagas (2,9%). Não houve resultados falso-negativos para os vírus HIV, HCV e HTLV. A acurácia média de todos os laboratórios e bancos de sangue que participaram do EQAP durante o período do estudo foi de 99,5% (desvio padrão de 0,5%). Conclusões. Os resultados desta análise qualitativa são positivos para a segurança do sangue na América Latina, com uma acurácia média de 99,5% entre os laboratórios e bancos de sangue participantes. Este relatório reflete uma melhoria importante na triagem sorológica dos bancos de sangue em relação aos resultados do relatório do EQAP apoiado pela OPAS que foi publicado em 2003.

George W. Crile (1864-1943); excepcional cirurgião americano / George W. Crile (1864-1943); excepcional cirujano estadounidense / George W. Crile (1864-1943); exceptional American surgeon

George W. Crile (1864-1943); excepcional cirurgião americano, que serviu no Corpo Médico do Exército durante a Guerra Hispano-Americana. Durante a Primeira Guerra Mundial, foi diretor cirúrgico do American Ambulance Hospital em Neuilly, na França. Ajudou fundar o American College of Surgeons em 1913, foi membro e diretor não apenas dessa organização, mas também da American Medical Association, da American Surgical Association, da Royal Academy of Surgeons e da Royal Academy of Medicine (Reino Unido). Em 1921, foi cofundador da Cleveland Clinic em Cleveland, Ohio, EUA. Foi um importante médico cujas pesquisas e escritos incluíam choque cirúrgico, função glandular, pressão arterial e transfusões, neurose de guerra e os efeitos da cirurgia em tempos de guerra. Ele também foi um cirurgião extraordinário e prolífico que introduziu inovações no tratamento cirúrgico de muitas patologias. Embora sua pesquisa tenha sido publicada há muito tempo, suas contribuições para a medicina continuam sendo fundamentais para a prática clínica nas salas de cirurgia e unidades de terapia intensiva atuais.

George W. Crile (1864-1943) fue un excepcional cirujano estadounidense que sirvió en el Cuerpo Médico del Ejército durante la Guerra Hispanoamericana. Durante la Primera Guerra Mundial fue director quirúrgico del American Ambulance Hospital de Neuilly (Francia). Ayudó a fundar el Colegio Americano de Cirujanos en 1913 y fue miembro y director no sólo de esta organización, sino también de la Asociación Médica Americana, la Asociación Quirúrgica Americana, la Real Academia de Cirujanos y la Real Academia de Medicina (Reino Unido). En 1921 fue cofundador de la Cleveland Clinic de Cleveland (Ohio, EE.UU.). Fue un importante médico cuyas investigaciones y escritos abarcaron el shock quirúrgico, la función glandular, la presión arterial y las transfusiones, la neurosis de guerra y los efectos de la cirugía en tiempos de guerra. También fue un cirujano extraordinario y prolífico que introdujo innovaciones en el tratamiento quirúrgico de muchas patologías. Aunque sus investigaciones se publicaron hace mucho tiempo, sus aportaciones a la medicina siguen siendo fundamentales para la práctica clínica en los quirófanos y unidades de cuidados intensivos actuales.

George W. Crile (1864-1943) was an exceptional American surgeon who served in the Army Medical Corps during the Spanish-American War. During the First World War, he was surgical director of the American Ambulance Hospital in Neuilly, France. He helped found the American College of Surgeons in 1913 and was a member and director not only of this organization, but also of the American Medical Association, the American Surgical Association, the Royal Academy of Surgeons and the Royal Academy of Medicine (UK). In 1921, he co-founded the Cleveland Clinic in Cleveland, Ohio, USA. He was an important physician whose research and writings included surgical shock, glandular function, blood pressure and transfusions, war neurosis and the effects of wartime surgery. He was also an extraordinary and prolific surgeon who introduced innovations in the surgical treatment of many pathologies. Although his research was published long ago, his contributions to medicine remain fundamental to clinical practice in today's operating rooms and intensive care units.

Uso de componentes sanguíneos en el Hospital Docente Provincial Oncológico María Curie en Camagüey / Use of blood components at the Oncologica l University Hospital Marie Curie of Camagüey

Introducción: La comunidad médica en muchas partes del mundo está preocupada porque se indica realizar más transfusiones que lo recomendado. La transfusión de sangre alogénica se ha considerado erróneamente un procedimiento exento de peligros y con beneficios indiscutibles; además, no es una forma totalmente segura para tratar la anemia asociada al cáncer. Objetivo: Analizar el consumo de componentes sanguíneos en el Hospital Docente Provincial Oncológico María Curie en Camagüey. Métodos: Estudio descriptivo, longitudinal, retrospectivo, sustentado en el análisis del consumo hospitalario de componentes sanguíneos en el período enero 2018 a diciembre 2021. Las variables analizadas fueron: cantidad mensual de unidades transfundidas de componentes sanguíneos, celulares y plasmáticos; el total de pacientes ingresados y transfundidos y la tasa de hemoterapia por cada 1000 ingresos hospitalarios. Resultados: El concentrado de eritrocitos fue el componente sanguíneo más solicitado en el período desde 2018 hasta 2021 (excepto en tres meses). La tasa de hemoterapia se mantuvo por encima de 245 hemocomponentes transfundidos por cada 1000 pacientes ingresados. Conclusiones: El consumo de hemocomponentes, según el cumplimiento de la tasa de hemoterapia, fue evaluado de mal en los años desde 2018 hasta 2021. Se sugiere mejorar la seguridad del paciente y la calidad de la asistencia médica con la aplicación imprescindible del método clínico, la preparación en medicina transfusional, el establecimiento de los consensos de criterios que sirvan de guía para el tratamiento de la anemia asociada a cáncer y la atención centrada en el paciente (tratamientos personalizados).

Introduction: Around the world, the Medical Community concerned with blood transfusions being recommended more than it is indicated. Allogenic blood transfusions have been erroneously considered as a safe procedure with unquestionable benefits; as well as it is not completely safe for cancer anemia treatment. Objective: To analyse the use of blood components at the Oncological Hospital Marie Curie of Camagüey Method: Longitudinal, descriptive study, retrospectively sustained in the analysis of the consumption of blood components at the hospital from January 2018 to December 2021. Analysed variables were the monthly quantity of transfused units, cellular and plasma, blood products, total of admitted patients, total transfused patients and haemotherapy rate for each 1000 patients admitted at the hospital. Results: Red blood cells were the most requested components during the study period. From 2018 to 2021 (except three months). Haemotherapy rate stayed above 245 blood component transfused by each 1000 admitted patients. Conclusions: According to compliance with the haemotherapy rate, the use of blood components was evaluated unfavorably in analyzed period. With the indispensable application of the clinical method, education in transfusion medical practice, the consensus criteria as a guide for anemia cancer treatment, and patient-centered attention (personalized treatments), will improve the patient's safety and the quality of the medical treatment.

Assessment of the need for routine intraoperative cell salvage in liver transplantation

Purpose: This study aimed to assess the necessity of routine intraoperative cell salvage in liver transplantations. Methods: A total of 327 liver transplants performed between 2014 and 2016 was included in the analysis. Patient data, including pre-transplant examinations, intraoperative red blood cell transfusions, and procedural information, were collected. Results: The median age of the patients was 54 years old, with 67% (219) being male. The most prevalent ABO blood type was O, accounting for 48% (155) of cases. The leading causes of liver disease were hepatitis C (113 cases, 34.6%) and alcohol-related liver disease (97 cases, 29.7%). Out of the 327 liver transplants, allogeneic red blood cell transfusions were administered in 110 cases (34%) with a median of two units of red blood cells per case. Cell salvage was employed in 237 transplants (73%), and successful blood recovery was achieved in 221 cases (93%). Among the group that recovered more than 200 mL of blood, the median volume of recovered blood was 417 mL, with no transfusion of allogeneic blood required. A total of 90 transplants was performed without utilizing cell salvage, and, among these cases, 19 required blood transfusions, with a median of zero units transfused. Conclusions: This study suggests that routine cell salvage is unnecessary for all liver transplantations. The most suitable indication for its use is in patients presenting with portal vein thrombosis and abnormal creatinine levels.

Risk Factors of Thrombocytopenia After Cardiac Surgery with Cardiopulmonary Bypass

ABSTRACT Introduction: Postoperative thrombocytopenia is common in cardiac surgery with cardiopulmonary bypass, and its risk factors are unclear. Methods: This retrospective study enrolled 3,175 adult patients undergoing valve surgeries with cardiopulmonary bypass from January 1, 2017 to December 30, 2018 in our institute. Postoperative thrombocytopenia was defined as the first postoperative platelet count below the 10th quantile in all the enrolled patients. Outcomes between patients with and without postoperative thrombocytopenia were compared. The primary outcome was in-hospital mortality. Risk factors of postoperative thrombocytopenia were assessed by logistic regression analysis. Results: The 10th quantile of all enrolled patients (75×109/L) was defined as the threshold for postoperative thrombocytopenia. In-hospital mortality was comparable between thrombocytopenia and non-thrombocytopenia groups (0.9% vs. 0.6%, P=0.434). Patients in the thrombocytopenia group had higher rate of postoperative blood transfusion (5.9% vs. 3.2%, P=0.014), more chest drainage volume (735 [550-1080] vs. 560 [430-730] ml, P<0.001), and higher incidence of acute kidney injury (12.3% vs. 4.2%, P<0.001). Age > 60 years (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.345-3.765, P=0.002], preoperative thrombocytopenia (OR 18.671, 95% CI 13.649-25.542, P<0.001), and cardiopulmonary bypass time (OR 1.088, 95% CI 1.059-1.117, P<0.001) were positively independently associated with postoperative thrombocytopenia. Body surface area (BSA) (OR 0.247, 95% CI 0.114-0.538, P<0.001) and isolated mitral valve surgery (OR 0.475, 95% CI 0.294-0.77) were negatively independently associated with postoperative thrombocytopenia. Conclusion: Positive predictors for thrombocytopenia after valve surgery included age > 60 years, small BSA, preoperative thrombocytopenia, and cardiopulmonary bypass time. BSA and isolated mitral valve surgery were negative predictors.

Incidentes transfusionais imediatos notificados em crianças e adolescentes / Reacciones transfusionales inmediatas notificadas en niños y adolescentes / Immediate transfusion incidents reported in children and adolescents

Resumo Objetivo Analisar o perfil dos incidentes transfusionais imediatos notificados em crianças e adolescentes internados em hospital geral de alta complexidade. Métodos Estudo documental retrospectivo, com análise de 287 Fichas de Notificação, reportando reações transfusionais em crianças e adolescentes de zero a 18 anos de idade, ocorridas no período de janeiro de 2007 e maio de 2021, em um serviço de hemovigilância de um Hospital Universitário, de caráter filantrópico, de alta complexidade, localizado na cidade de São Paulo. Resultados Das 287 fichas avaliadas, 42,5% das reações foram observadas em adolescentes (entre 12 e 18 anos), 83,6% ocorreram na primeira transfusão. Manifestações clínicas mais comuns foram lesões de pele e hipertermia. Cerca de 50% das reações ocorreram em pacientes com leucemia ou anemias e o hemocomponente associado foi o concentrado de hemácias. Incidentes mais comuns foram: reação febril não hemolítica e reações alérgicas, em sua maioria leves e moderadas. Outras reações foram 9,8% moderadas/graves. Conclusão O estudo favoreceu maior conhecimento sobre os incidentes transfusionais ocorridos em crianças e adolescentes e traz contribuições para reforçar a segurança do paciente e dos serviços de hemoterapia pediátrica.

Resumen Objetivo Analizar el perfil de las reacciones transfusionales inmediatas notificadas en niños y adolescentes internados en un hospital de alta complejidad. Métodos Estudio documental retrospectivo, con análisis de 287 Fichas de Notificación, donde se reportaron reacciones transfusionales en niños y adolescentes de cero a 18 años, ocurridas en el período de enero de 2007 a mayo de 2021, en un servicio de hemovigilancia de un hospital universitario de carácter filantrópico, de alta complejidad, ubicado en la ciudad de São Paulo. Resultados De las 287 fichas analizadas, el 42,5 % de las reacciones fue observada en adolescentes (entre 12 y 18 años) y el 83,6 % sucedió en la primera transfusión. Las manifestaciones clínicas más comunes fueron lesiones en la piel e hipertermia. Cerca del 50 % de las reacciones ocurrió en pacientes con leucemia o anemia, y el componente sanguíneo asociado fue el concentrado de eritrocitos. Los incidentes más comunes fueron: reacción febril no hemolítica y reacciones alérgicas, en su mayoría leves y moderadas. Otras reacciones fueron 9,8 % moderadas/graves. Conclusión El estudio ayudó a tener mayores conocimientos sobre los incidentes transfusionales ocurridos en niños y adolescentes y contribuye para reforzar la seguridad del paciente y de los servicios de hemoterapia pediátrica.

Abstract Objective To analyze the profile of immediate transfusion incidents reported in children and adolescents hospitalized in a high complexity general hospital. Methods This is a documentary and retrospective study that analyzed 287 notification records, reporting transfusion reactions in children and adolescents from zero to 18 years of age, occurred from January 2007 to May 2021, in a hemovigilance service of a high-complexity philanthropic university hospital in the city of São Paulo. Results Of the 287 records assessed, 42.5% of reactions were observed in adolescents (between 12 and 18 years), and 83.6% occurred in the first transfusion. Most common clinical manifestations were skin lesions and hyperthermia. About 50% of reactions occurred in patients with leukemia or anemia and the associated blood component was red blood cell concentrate. Most common incidents were nonhemolytic febrile reaction and mostly mild and moderate allergic reactions. Other reactions were 9.8% moderate/severe. Conclusion The study favored greater knowledge about transfusion incidents in children and adolescents and brings contributions to enhance patient safety and pediatric hemotherapy services.

Validation of Blood Transfusion Risk Scores (TRACK and TRUST) in a Cardiac Surgery Service in Brazil

ABSTRACT Introduction: Transfusion of red blood cells is recurrent in cardiac surgery despite the well-established deleterious effects. Identifying patients with higher chances of requiring blood transfusion is essential to apply strategic preventive measures to reduce such chances, considering the restricted availability of this product. The most used risk scores to predict blood transfusion are the Transfusion Risk and Clinical Knowledge (TRACK) and Transfusion Risk Understanding Scoring Tool (TRUST). However, these scores were not validated for the Brazilian population. The objective of this study was to assess the accuracy of TRACK and TRUST scores in estimating the need for postoperative transfusion of red blood cell concentrates (TRBCC) after cardiac surgery. Methods: A clinical retrospective study was conducted using the database of a Brazilian reference service composed of patients operated between November 2019 and September 2021. Scores were compared using Mann-Whitney U test. Hosmer-Lemeshow goodness of fit test assessed calibration of the scores. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC). All analyses considered a level of significance of 5%. The study was approved by the research ethics committee (CAAE 55577421.4.0000.5201). Results: This study assessed 498 patients. Only the TRACK score presented good calibration (P=0.238; TRUST P=0.034). AUC of TRACK was 0.678 (95% confidence interval 0.63 to 0.73; P<0.001), showing a significant accuracy. Conclusion: Between the scores analyzed, only the TRACK score showed a good calibration, but low accuracy, to predict postoperative TRBCC after cardiac surgery.

Pediatric patient safety in the administration of blood components / Seguridad de pacientes pediátricos al administrar hemocomponentes / Segurança do paciente pediátrico na administração de hemocomponentes

ABSTRACT Objective: to analyze pediatric patient safety in the administration of blood components. Method: a documentary and retrospective study, developed at a hospital in the Brazilian Midwest region. Data collection took place through medical records and 234 transfusions were identified, performed in 90 patients aged from zero to twelve years old, hospitalized between July and December 2020. An instrument based on good practice guidelines about blood components was used. Descriptive and inferential statistics were used for data analysis. Results: the transfusions were predominantly performed in breastfeeding infants (71.1%). Blood transfusions in critical sectors stood out (86.3%), as well as with indication of a clinical order (87.2%) and prescription of packed red blood cells (75.3%). The Nursing reports identified adverse events (n=05) and incidents (n=13) that were associated with inadequacies between the prescribed and infused volumes and the request and administration time (p<0.001), although no notification was formalized in the institution during the period. Conclusion: the administration of blood components presented nonconformities, which results in risk situations for pediatric patients.

RESUMEN Objetivo: analizar la seguridad de pacientes pediátricos al administrar hemocomponentes. Método: estudio documental y retrospectivo, desarrollado en un hospital de la región Centro-Oeste de Brasil. Los datos se recolectaron a través de historias clínicas y se identificaron 234 transfusiones, realizadas en 90 pacientes de cero a doce años de edad, internados entre los meses de julio y diciembre de 2020. Se empleó un instrumento basado en directrices de buenas prácticas de hemocomponentes. Para el análisis se utilizó estadística descriptiva e inferencial. Resultados: las transfusiones se realizaron predominantemente en lactantes (71,1%). Hubo predominio de transfusiones sanguíneas en sectores críticos (86,3%), con indicación de orden clínico (87,2%) y prescripción de concentrado de glóbulos rojos (75,3%). En los informes de Enfermería se identificaron eventos adversos (n=05) e incidentes (n=13) que estuvieron asociados a inconsistencias entre los volúmenes prescripto e infundido y al tiempo de solicitud y administración (p<0,001), aunque no se formalizó ninguna notificación en la institución durante el período investigado. Conclusión: la administración de hemocomponentes presentó inconformidades, lo que deriva en situaciones de riesgo para los pacientes pediátricos.

RESUMO Objetivo: Analisar a segurança do paciente pediátrico na administração de hemocomponentes. Método: Estudo documental, retrospectivo, desenvolvido em um hospital da região Centro-Oeste do Brasil. A coleta de dados ocorreu através de prontuários e foram identificadas 234 transfusões, realizadas em 90 pacientes de zero a doze anos, internados entre os meses de julho a dezembro de 2020. Utilizou-se instrumento baseado em diretrizes de boas práticas de hemocomponentes. Para a análise foi utilizada estatística descritiva e inferencial. Resultados: As transfusões ocorreram predominantemente em lactentes (71,1%). Sobressaíram hemotransfusões em setores críticos (86,3%), com indicação de ordem clínica (87,2%) e a prescrição de concentrado de hemácias (75,3%). Identificou-se no relatório de enfermagem eventos adversos (n=05) e incidentes (n=13) que se associaram a inadequações entre volume prescrito e infundido e ao tempo de solicitação e administração (p<0,001), embora nenhuma notificação foi formalizada na instituição durante o período. Conclusão: A administração de hemocomponentes apresentou inconformidades, o que resulta em situações de risco ao paciente pediátrico.