Complicações transfusionais em pacientes idosos hospitalizados: revisão integrativa da literatura / Complicaciones transfusionales en ancianos hospitalizados: revisión integrativa de la literatura / Transfusion complications in hospitalized elderly patients: integrative literature review

Objetivo: identificar as principais complicações ocasionadas pela transfusão sanguínea à saúde do idoso hospitalizado através da análise das evidências científicas. Método: revisão integrativa realizada com estudos em inglês provenientes de bases de dados nacionais e internacionais publicados no período de 2017 a 2021. Os principais descritores foram "Blood Transfusion", "Transfusion Reaction", "Aged" e "Hospitalization", combinados por meio dos operadores booleanos "AND" e "OR". Resultados: foram incluídos 23 estudos que retratavam as principais complicações da transfusão sanguínea para a pessoa idosa hospitalizada. As doze diferentes complicações foram alocadas em duas categorias: relacionadas a cirurgias ou complicações não-cirúrgicas. Maior tempo de permanência hospitalar, mortalidade, reações transfusionais, lesão renal aguda pós-operatória e delirium pós-operatório fizeram parte dos principais achados. Conclusão: os mecanismos pelos quais as complicações se desenvolvem ainda não estão totalmente esclarecidos, evidenciando a importância do estímulo à realização de novas pesquisas que envolvam esta temática.

Objective: to identify the main complications caused by blood transfusion to the health of the hospitalized elderly through the analysis of scientific evidence. Method: integrative review conducted with studies in English from national and international databases published in the period from 2017 to 2021. The main descriptors were "BloodTransfusion", "Transfusion Reaction", "Aged" and "Hospitalization", combined by means of the Boolean operators "AND" and "OR". Results: 23 studies were included that depicted the main complications of blood transfusion for the hospitalized elderly person. The twelve different complications were allocated into two categories: surgery-related or non-surgical complications. Longer hospital stay, mortality, transfusion reactions, postoperative acute kidney injury and postoperative delirium were among the mainachievements. Conclusion: the mechanisms by which complications develop are not yet fully understood, highlighting the importance of encouraging further research on this topic.

Objetivo: identificar las principales complicaciones ocasionadas por la transfusión sanguínea a la salud del idoso hospitalizado a través del análisis de las evidencias científicas. Método: revisión integradora realizada con estudios en inglés de bases de datos nacionales e internacionales publicados en el período 2017 a 2021. Los descriptores principales fueron "BloodTransfusion", "Transfusion Reaction", "Aged" y "Hospitalization", combinados mediante los operadores booleanos "AND" y "OR". Resultados:se incluyeron 23 estudios que retrataban las principales complicaciones de la transfusión sanguínea en el anciano hospitalizado. Las doce complicaciones diferentes se asignaron a dos categorías: complicaciones relacionadas con la cirugía o complicaciones no relacionadas con la cirugía. La prolongación de la estancia hospitalaria, la mortalidad, las reacciones transfusionales, la lesión renal aguda postoperatoria y el delirio postoperatorio formaron parte de las principales. Conclusión: los mecanismos por los que se desarrollan las complicaciones aún no se comprenden del todo, lo que pone de relieve la importancia de fomentar la investigación sobre este tema.

Efficacy of different doses and timing of tranexamic acid in major orthopedic surgeries: a randomized trial / Eficácia de diferentes doses e esquemas de administração de ácido tranexâmico em cirurgias ortopédicas de grande porte: estudo randomizado

Abstract Background: Tranexamic acid was studied in four different dosage regimens and their efficacy was compared for perioperative blood loss reduction, blood transfusion requirements and deep vein thrombosis (DVT) complication. Methods: Two hundred patients undergoing major orthopedic procedures were divided into five groups containing 40 patients each: Placebo, low dose (bolus 10 mg kg-1), low dose + maintenance (bolus 10 mg kg-1 + maintenance 1 mg kg-1 hr-1), high dose (bolus 30 mg kg-1) and high dose + maintenance (bolus 30 mg kg-1 + maintenance 3 mg kg-1 hr-1). Surgical blood loss was measured intraoperatively and drains collection in the first 24 hours postoperatively. Blood transfusion was done when hematocrit falls less than 25%. DVT screening was done in the postoperative period. Results: The intraoperative blood loss was 440 ± 207.54 mL in the placebo group, 412.5 ± 208.21 mL in the low dose group, 290 ± 149.6 ml in the low dose plus maintenance group, 332.5 ± 162.33 mL in the high dose group and 240.7 ± 88.15 mL in the high dose maintenance group (p < 0.001). The reduction in postoperative blood loss in the drain for first 24 hours was 80 ± 44.44 mL in the placebo group, 89.88 ± 44.87 mL in the low dose group, 56.7 ± 29.12 mL in the low dose plus maintenance group, 77.9 ± 35.74 mL in the high dose group and 46.7 ± 19.9 mL in the high dose maintenance group (p < 0.001). DVT was not encountered in any patient. Conclusion: Tranexamic acid was most effective in reducing surgical blood loss and blood transfusion requirements in a low dose + maintenance group.

Resumo Justificativa: O ácido tranexâmico foi avaliado em quatro esquemas com diferentes posologias, comparando-se a eficácia de cada esquema quanto a redução na perda sanguínea perioperatória, necessidade de transfusão sanguínea e ocorrência de Trombose Venosa Profunda (TVP). Método: Duzentos pacientes submetidos a procedimentos ortopédicos de grande porte foram divididos em cinco grupos de 40 pacientes de acordo com o esquema de administração de ácido tranexâmico: grupo placebo, grupo baixa dose (bolus de 10 mg.kg-1, grupo baixa dose e manutenção (bolus de 10 mg.kg-1 + manutenção de 1 mg.kg-1.h-1), grupo alta dose (bolus de 30 mg.kg-1), e grupo alta dose e manutenção (bolus de 30 mg.kg-1 + manutenção de 3 mg.kg-1.h-1). A perda sanguínea cirúrgica foi medida no intraoperatório. Além disso, nas primeiras 24 horas pós-operatórias, foi medido o volume de sangue coletado no dreno. Era realizada transfusão de sangue se o valor do hematócrito fosse inferior a 25%. Foi realizada avaliação quanto à ocorrência de TVP no pós-operatório. Resultados: A perda sanguínea intraoperatória foi de 440 ± 207,54 mL no grupo placebo, 412,5 ± 208,21 mL no grupo baixa dose, 290 ± 149,6 mL no grupo baixa dose e manutenção, 332,5 ± 162,33 mL no grupo alta dose, e 240,7 ± 88,15 mL no grupo alta dose e manutenção (p < 0,001). A redução na perda sanguínea pós-operatória pelo dreno nas primeiras 24 horas foi de 80 ± 44,44 mL no grupo placebo; 89,88 ± 44,87 mL no grupo baixa dose, 56,7 ± 29,12 mL no grupo baixa dose e dose de manutenção, 77,9 ± 35,74 mL no grupo alta dose e 46,7 ± 19,9 mL no grupo alta dose e manutenção (p < 0,001). TVP não foi observada em nenhum paciente. Conclusão: O ácido tranexâmico administrado em baixa dose combinado à manutenção foi mais eficaz em reduzir a perda sanguínea cirúrgica e a necessidade de transfusão de sangue.

Role of acute hemodilution in blood transfusion rate in patients submitted to scoliosis surgery: observational retrospective study / Papel da hemodiluição aguda na taxa de transfusão sanguínea em pacientes submetidos a tratamento cirúrgico de escoliose: estudo observacional retrospectivo

Abstract Background and objectives: The study assessed the role of acute hemodilution in the blood transfusion rate in patients submitted to surgical treatment of scoliosis. Methods: Retrospective observational study performed at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC-FMRP-USP). Medical charts of patients submitted to elective correction of scoliosis between January 1996 and December 2016 were analyzed. Variables assessed were: age, weight, sex, presence of comorbidities, data regarding anesthesia and surgery, lab data, adverse events and blood transfusion rate. The final sample consisted of 33 procedures performed by the same anesthesiologist and same surgeon, divided into two groups: Hemodilution Group (n = 16) and Control Group (n = 17). Indication of acute normovolemic hemodilution was determined by patient refusal of blood transfusion for religious reasons. Results: The sample was statistically homogeneous and the groups were compared in terms of the attributes analyzed. The volume of homologous blood used by the Hemodilution Group was significantly lower than the Control Group (p = 0.0016). The percentage of patients who required transfusion was 12.5% in the Hemodilution Group, while it was 70.69% (p = 0.0013) in the Control Group. Upon hospital discharge, mean values of hemoglobin and hematocrit between groups did not present significant differences (p = 0.0679; p = 0.1027, respectively). Conclusions: Acute normovolemic hemodilution, in scoliosis correction surgeries, reduces blood transfusion rates, meeting patient needs without increasing adverse events or infection rates.

Resumo Justificativa e objetivos: Este estudo avaliou o papel da hemodiluição aguda na taxa de transfusão sanguínea em pacientes submetidos a tratamento cirúrgico de escoliose. Método: Estudo observacional retrospectivo realizado no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HCFMRP/USP). Analisados prontuários de pacientes submetidos à correção de escoliose no período entre janeiro de 1996 a dezembro de 2016, em regime eletivo. As variáveis avaliadas foram: idade, peso, sexo, presença de doenças concomitantes, dados referentes à anestesia e à cirurgia, dados laboratoriais, eventos adversos e taxa de transfusão sanguínea. A amostra final foi composta por 33 procedimentos realizados pelo mesmo médico anestesiologista e pelo mesmo cirurgião, divididos em dois grupos: Grupo Hemodiluição (n = 16) e Grupo Controle (n = 17). A indicação de hemodiluição normovolêmica aguda foi determinada pela recusa à transfusão sanguínea pelos pacientes, por motivos religiosos. Resultados: A amostra foi estatisticamente homogênea e os grupos foram comparados considerando os atributos analisados. O volume de sangue homólogo utilizado pelo Grupo Hemodiluição foi significativamente menor que no Grupo Controle (p = 0,0016). A porcentagem de pacientes que necessitou transfusão foi de 12,5% no grupo Hemodiluição, enquanto no Grupo Controle foi de 70,69% (p = 0,0013). Na alta hospitalar, os valores médios de hemoglobina e hematócrito entre os grupos não apresentaram diferenças significantes (p = 0,0679; p = 0,1027, respectivamente). Conclusões: A hemodiluição normovolêmica aguda, em cirurgias para correção de escoliose, reduz a taxa de transfusão sanguínea, satisfazendo as necessidades dos pacientes sem aumentar as taxas de eventos adversos e de infecção.

Adverse Events and Risk Factors of Blood Transfusion in Cardiovascular Surgery: A Prospective Cohort Study

Abstract Background: Hemodilution, transoperative bleeding and cardiopulmonary bypass (CPB) are some of the factors associated with high transfusion rates in cardiac surgery. Objective: To analyze the incidence of blood transfusion and early postoperative outcomes in cardiac surgery patients. Methods: Cohort study of patients undergoing cardiac surgery in a university hospital, consecutively enrolled from May 2015 to February 2017. Data were prospectively collected and comparisons were made between two patients' groups: transfused and not transfused. Student's t-test, chi-square test, and logistic regression were used, and a p-value < 0.05 was considered significant. Results: Among the 271 patients evaluated, 100 (37%) required transfusion in the transoperative (32.1%) and/or postoperative periods (19.5%). The following predictors of transfusion were identified by multivariate analysis: EuroScore II (OR 1.2); chronic kidney disease (CKD) (OR 3.2); transoperative bleeding ≥ 500 mL (OR 6.7); baseline hemoglobin (Hb) ≤ 10 g/dL (OR 11.5); activated partial thromboplastin time (aPTT) (OR 1.1) and CPB duration (OR 1.03). Transfusion was associated with prolonged mechanical ventilation (≥ 24h) (2.4% vs. 23%), delirium (5.9% vs. 18%), bronchopneumonia (1.2% vs. 16%), acute renal failure (3.5% vs. 25%), acute on CKD (0.6% vs. 8%), stroke or transient ischemic attack (1.8% vs. 8%), intensive care unit stay ≥ 72 h (36% vs. 57%), longer hospital stay (8 ± 4 days vs. 16 ± 15 days), as well as increased early mortality (1.75% vs. 15%). Conclusion: EuroScore II, CKD, major transoperative bleeding, preoperative Hb and aPTT values and CPB time were independent predictors of transfusion, which was associated with a higher rate of adverse outcomes, including early mortality.

Blood transfusion and increased perioperative risk in coronary artery bypass grafts

Abstract Objective: To correlate blood transfusions and clinical outcomes during hospitalization in coronary artery bypass grafting surgery (CABG). Methods: Transfusion, clinical and hematological data were collected for 1,378 patients undergoing isolated or combined CABG between January 2011 and December 2012. The effect of blood transfusions was evaluated through multivariate analysis to predict three co-primary outcomes: composite ischemic events, composite infectious complications and hospital mortality. Because higher risk patients receive more transfusions, the hospital mortality outcome was also tested on a stratum of low-risk patients to isolate the effect of preoperative risk on the results. Results: The transfusion rate was 63.9%. The use of blood products was associated with a higher incidence of the three coprimary outcomes: composite infectious complications (OR 2.67, 95% CI 1.70 to 4.19; P<0.001), composite ischemic events (OR 2.42, 95% CI 1.70 to 3.46; P<0.001) and hospital mortality (OR 3.07, 95% CI 1.53 to 6.13; P<0.001). When only patients with logistic EuroSCORE ≤ 2% were evaluated, i.e., low-risk individuals, the mortality rate and the incidence of ischemic events and infectious complications composites remained higher among the transfused patients [6% vs. 0.4% (P<0.001), 11.7% vs. 24,3% (P<0.001) and 6.5% vs. 12.7% (P=0.002), respectively]. Conclusion: The use of blood components in patients undergoing CABG was associated with ischemic events, infectious complications and hospital mortality, even in low-risk patients.

Factores asociados a mal pronóstico en pacientes con sangrado digestivo bajo en un hospital público / Poor outcome factors associated to patients with lower digestive bleeding in a public hospital

Introducción: El sangrado digestivo bajo (SDB) es una entidad cuyas tasas de complicaciones y mortalidad se han incrementado en las últimas décadas. Si bien se han identificado algunos factores relacionados a mal pronóstico, aún quedan variables por evaluar. Objetivo: Identificar factores de mal pronóstico en pacientes que presentaron SDB en el Hospital Nacional Edgardo Rebagliati Martins de Lima, Perú. Materiales y métodos: Se realizó un estudio observacional analítico de tipo cohorte retrospectivo. Se realizó un censo de todos los pacientes que presentaron SDB agudo entre enero 2010 y diciembre 2013. Las variables principales a evaluar fueron frecuencia cardiaca ≥100/min, presión arterial sistólica <100 mmHg y hematocrito bajo (≤35%) al ingreso. Se definió mal pronóstico como cualquiera de los siguientes criterios: muerte durante la hospitalización, sangrado que requiera transfusión de ≥4 unidades de sangre, reingreso dentro del primer mes, o necesidad de cirugía de hemostasia. Resultados: Se incluyó un total de 341 pacientes con SDB, de los cuales el 27% tuvo mal pronóstico y 2% fallecieron. Se encontró como variables asociadas a mal pronóstico: frecuencia cardiaca ≥100/min al ingreso (RR: 1,75, IC 95% 1,23-2,50), presión arterial sistólica <100 mmHg al ingreso (RR: 2,18, IC 95% 1,49-3,19), hematocrito ≤35% al ingreso (RR: 1,98, IC 95% 1,23-3,18) y sangrado de origen no determinado (RR: 2,74, IC 95% 1,73-4,36). Conclusiones: Frecuencia cardiaca elevada al ingreso, hipotensión sistólica al ingreso, hematocrito bajo al ingreso y presentar un sangrado en el cual no se encuentra el punto de origen son factores que incrementan el riesgo de presentar mal pronóstico, por lo que se recomienda un monitoreo más estricto en estos pacientes

Background: Lower gastrointestinal bleeding (LGIB) is an event that has shown an increase in complications and mortality rates in the last decades. Although some factors associated with poor outcome have been identified, there are several yet to be evaluated. Objective: To identify risk factors for poor outcome in patients with LGIB in the Hospital Edgardo Rebagliati Martins of Lima, Peru. Material and methods: A prospective analytic observational cohort study was made, and a census was conducted with all patients with acute LGIB between January 2010 and December 2013. The main variables were heart rate ≥100/min, systolic blood pressure <100 mmHg and low hematocrit (≤35%) at admission. Poor outcome was defined as any of the following: death during hospital stay, bleeding requiring transfusion of ≥4 blood packs, readmission within one month of hospital discharge, or the need for hemostatic surgery. Results: A total of 341 patients with LGIB were included, of which 27% developed poor outcome and 2% died. Variables found to be statistically related to poor outcome were: heart rate ≥ 100/min at admission (RR: 1.75, IC 95% 1.23-2.50), systolic blood pressure <100 mmHg at admission (RR: 2.18, IC 95% 1.49-3.19), hematocrit ≤35% at admission (RR: 1.98, IC 95% 1.23-3.18) and LGIB of unknown origin (RR: 2.74, IC 95% 1.73-4.36). Conclusions: Elevated heart rate at admission, systolic hypotension at admission, low hematocrit at admission and having a LGIB of unknown origin are factors that increase the risk of developing poor outcome, and these patients should be monitored closely due to their higher risk of complications

Use of tranexamic acid in primary total knee replacement: effects on perioperative blood loss / Uso do ácido tranexâmico em artroplastia total primária de joelho: repercussões na perda sanguínea perioperatória

ABSTRACT BACKGROUND AND OBJECTIVES: The use of tranexamic acid in primary total knee replacement surgeries has been the subject of constant study. The strategies to reduce bleeding are aimed at reducing the need for blood transfusion due to the risks involved. In this study we evaluated the use of tranexamic acid in reducing bleeding, need for blood transfusion, and prevalence of postoperative deep vein thrombosis in primary total knee replacement. METHOD: 62 patients undergoing primary total knee replacement were enrolled in the study, from June 2012 to May 2013, and randomized to receive a single dose of 2.5 g of intravenous tranexamic acid (Group TA) or saline (Group GP), 5 min before opening the pneumatic tourniquet, respectively. Hemoglobin, hematocrit, and blood loss were recorded 24 h after surgery. Deep vein thrombosis was investigated during patient's hospitalization and 15 and 30 days after surgery in review visits. RESULTS: There was no demographic difference between groups. Group TA had 13.89% decreased hematocrit (p = 0.925) compared to placebo. Group TA had a decrease of 12.28% (p = 0.898) in hemoglobin compared to Group GP. Group TA had a mean decrease of 187.35 mL in blood loss (25.32%) compared to group GP (p = 0.027). The number of blood transfusions was higher in Group GP (p = 0.078). Thromboembolic events were not seen in this study. CONCLUSION: Tranexamic acid reduced postoperative bleeding without promoting thromboembolic events.

RESUMO JUSTIFICATIVA E OBJETIVOS: O uso do ácido tranexâmico, em cirurgias de artroplastia total primária de joelho, tem sido objeto de constante estudo. As estratégias para redução de sangramento visam à redução da necessidade de transfusão de sangue devido aos riscos que apresentam. Neste estudo, propomos a avaliação do uso do ácido tranexâmico na redução do sangramento, na necessidade de transfusão de sangue e na prevalência de trombose venosa profunda (TVP) pós-operatória em artroplastia total primária de joelho. MÉTODO: Foram estudados 62 pacientes submetidos à artroplastia primária total de joelho, de junho de 2012 a maio de 2013, randomizados para receber ácido tranexâmico 2,5 g endovenoso (grupo AT), em dose única, ou soro fisiológico (grupo GP), cinco minutos antes da abertura do torniquete pneumático, respectivamente. Foram feitas dosagens de hemoglobina e hematócrito e medida a perda sanguínea 24 horas após a cirurgia. A TVP foi pesquisada durante a internação do paciente, 15 e 30 dias após a cirurgia nas consultas de revisão. RESULTADOS: Não houve diferenças demográficas entre os grupos estudados. O grupo GT apresentou queda do hematócrito 13,89% (p = 0,925) comparado com o grupo placebo. O grupo GT apresentou diminuição de 12,28% (p = 0,898) da hemoglobina comparado com o grupo GP. O grupo GT apresentou uma diminuição média de 187,35 ml nas perdas sanguíneas (25,32%) quando comparado com o grupo GP (p = 0,027). O número de transfusões sanguíneas foi maior no grupo GP (p = 0,078). Eventos tromboembólicos não foram evidenciados neste estudo. CONCLUSÕES: O ácido tranexâmico diminuiu o sangramento pós-operatório sem promover eventos tromboembólicos.

Two-year experience with cell salvage in total hip arthroplasty / Dois anos de experiência com recuperação intraoperatória de sangue em artroplastia total do quadril

ABSTRACT BACKGROUND AND OBJECTIVE: The aim of this study was to determine the efficacy of the cell salvage system in total hip arthroplasty surgeries and whether the cell salvage system can reduce the allogeneic blood transfusion requirement in total hip arthroplasty patients. METHODS: We reviewed retrospectively the medical records of patients who underwent hip arthroplasty surgeries between 2010 and 2012 in a university hospital. A total of 181 arthroplasty patients were enrolled in our study. RESULTS: In the cell salvage group, the mean perioperative rate of allogeneic blood transfusion was significantly lower (92.53 ± 111.88 mL) than that in the control group (170.14 ± 116.79 mL; p < 0.001). When the mean postoperative transfusion rates were compared, the cell salvage group had lower values (125.37 ± 193.33 mL) than the control group (152.22 ± 208.37 mL), although the difference was not statistically significant. The number of patients receiving allogeneic blood transfusion in the CS group (n = 29; 43.2%) was also significantly lower than control group (n = 56; 73.6%; p < 0.05). In the logistic regression analysis, perioperative amount of transfusion, odds ratio (OR) -4.257 (95% CI -0.502 to 0.184) and operation time, OR: 2.720 (95% CI 0.001-0.004) were independent risk factors for the usage of cell salvage system. CONCLUSION: Cell salvage is an effective strategy for reducing the need for allogeneic blood transfusion in the perioperative setting; it provides support to patient blood management interventions. Thus, we recommend the cell salvage system for use in total hip arthroplasty surgeries to reduce the need for allogeneic blood transfusion, if possible.

RESUMO JUSTIFICATIVA E OBJETIVO: Determinar a eficácia do sistema de recuperação intraoperatória de sangue em artroplastia total de quadril e se o sistema de recuperação intraoperatória de sangue pode reduzir a necessidade de transfusão de sangue alogênico em pacientes submetidos à artroplastia total de quadril. MÉTODOS: Análise retrospectiva dos prontuários de pacientes submetidos a cirurgias de artroplastia de quadril entre 2010 e 2012 em um hospital universitário. Foram inscritos no estudo 181 pacientes submetidos à artroplastia. RESULTADOS: A média da taxa de transfusão de sangue alogênico no período perioperatório foi significativamente inferior no grupo de recuperação intraoperatória de sangue (92,53 ± 111,88 mL) do que no grupo controle (170,14 ± 116,79 mL; p < 0,001). Quando as médias das taxas de transfusão no pós-operatório foram comparadas, o grupo de recuperação intraoperatória de sangue apresentou valores inferiores (125,37 ± 193,33 mL) aos do grupo controle (152,22 ± 208,37 mL), embora a diferença não tenha sido estatisticamente significativa. O número de pacientes que recebeu transfusão de sangue alogênico no grupo RC (n = 29; 43,2%) também foi significativamente inferior ao do grupo controle (n = 56; 73,6%; p < 0,05). Na análise de regressão logística, a quantidade de transfusão no período perioperatório, a razão de chance (OR) -4,257 (95% CI -0,502-0,184) e o tempo cirúrgico OR: 2,720 (IC 95% 0,001-0,004) foram fatores de risco independentes para o uso de sistema de recuperação intraoperatória de sangue. CONCLUSÃO: A recuperação intraoperatória de sangue é uma estratégia eficaz para reduzir a necessidade de transfusão de sangue alogênico no período perioperatório, que auxilia no manejo sanguíneo durante as intervenções. Portanto, recomendamos o sistema de recuperação intraoperatória de sangue para uso em artroplastia total de quadril para diminuir a necessidade de transfusão de sangue alogênico, quando possível.

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.

Clinical applications of retrograde autologous priming in cardiopulmonary bypass in pediatric cardiac surgery

Retrograde autologous priming (RAP) has been routinely applied in cardiac pediatric cardiopulmonary bypass (CPB). However, this technique is performed in pediatric patients weighing more than 20 kg, and research about its application in pediatric patients weighing less than 20 kg is still scarce. This study explored the clinical application of RAP in CPB in pediatric patients undergoing cardiac surgery. Sixty pediatric patients scheduled for cardiac surgery were randomly divided into control and experimental groups. The experimental group was treated with CPB using RAP, while the control group was treated with conventional CPB (priming with suspended red blood cells, plasma and albumin). The hematocrit (Hct) and lactate (Lac) levels at different perioperative time-points, mechanical ventilation time, hospitalization duration, and intraoperative and postoperative blood usage were recorded. Results showed that Hct levels at 15 min after CPB beginning (T2) and at CPB end (T3), and number of intraoperative blood transfusions were significantly lower in the experimental group (P<0.05). There were no significant differences in CPB time, aortic blocking time, T2-Lac value or T3-Lac between the two groups (P>0.05). Postoperatively, there were no significant differences in Hct (2 h after surgery), mechanical ventilation time, intensive care unit time, or postoperative blood transfusion between two groups (P>0.05). RAP can effectively reduce the hemodilution when using less or not using any banked blood, while meeting the intraoperative perfusion conditions, and decreasing the perioperative blood transfusion volume in pediatric patients.

Sickle cell anemia in Brazil: personal, medical and endodontic patterns

Abstract Sickle cell anemia (SCA) is the most prevalent genetic disease worldwide. Recurrent vaso-occlusive infarcts predispose SCA patients to infections, which are the primary causes of morbidly and mortality. This study aimed to evaluate the relationship between SCA and endodontic diseases. Personal information, medical data (hematological indices, virologic testing, blood transfusions, medications received, splenectomy) and information on the need for endodontic treatment were obtained from SCA patients who were registered and followed up by the Fundação Hemominas, Minas Gerais, Brazil.These data were compared with the need for root canal treatment in SCA patients. One hundred eight patients comprised the studied population, and the rate of the need for endodontic therapy was 10.2%. Among the medical data, a significant difference was observed for eosinophil (p = 0.045) counts and atypical lymphocyte counts (p = 0.036) when the groups (with and without the need for endodontic treatment) were compared. Statistical relevance was observed when comparing the patients with and without the need for root canal therapy concerned eosinophil counts and atypical lymphocyte counts. The differences in statistical medical data, observed between the groups suggest that both parameters are naturally connected to the stimulation of the immune system that can occur in the presence of root canal infections and that can be harmful to SCA individuals.

Indicaciones, eficacia y complicaciones en el uso de productos sanguíneos, Hospital General San felipe, Honduras / Indications, efficacy and complications of blood products, Hospital General San Felipe, Honduras

Los hemoderivados son productos valiosos cuya utilización puede salvar vidas, pero pueden dañar aquien los recibe. El país no dispone de información publicada sobre la utilización de productossanguíneos a nivel hospitalario, sus indicaciones, eficacia y complicaciones. Objetivo: Determinar las indicaciones, eficacia y complicaciones en el usode productos sanguíneos en el Hospital General San Felipe. Material y Métodos: se realizó un estudio descriptivo de tipo transversal en 166 pacientes mayores de 18 años, hospitalizados, que precisaban productos sanguíneos en el periodo comprendido entre el 18 de marzo 2013 al 4 de marzo 2014. Parala recolección de datos se utilizó un cuestionario con preguntas abierta y cerradas; la información para el análisis se extrajo de las boletas de requisiciónde productos sanguíneos recibidas en el Banco de Sangre, del expediente clínico y del instrumento de trabajo. Los pacientes fueron evaluados antes,durante y después de la transfusión. Resultados: 166 pacientes fueron transfundidos, 107(64.5%) mujeres y 59(35.5%) hombres. 138(83.1%) pacientes adolecían alguna enfermedad neoplásica. De 174 transfusionesrealizadas, los productos indicados fueron 154(88.5%) glóbulos rojos empacados, 8(4.8%) plaquetas y 6(3.4%) plasma. 104(62.6%) de los 166 pacientes transfundidos refirieron mejoría subjetiva, 26(15.7%)mejoraron su rendimiento físico, medido por la escala del Eastern Collaborative Oncology Group. Se encontró diversas complicaciones clínicas en 87(57.6%) de pacientes transfundidos con glóbulosrojos empacados. Conclusión: Más del 60% de los pacientes transfundidos experimentaron una sensación de bienestar, sin embargo la frecuencia decomplicaciones es considerable...(AU)

Should oncological cases of upper urinary system be excluded at the beginning of the laparoscopic learning curve?

ABSTRACTPurpose:The place of oncological cases of upper urinary system in the laparoscopic learning curve was investigated.Materials and Methods:A total of 139 patients from two different centers underwent laparoscopic operations and were included in this retrospective study.Results:Mean operative times for oncological, and non-oncological cases were 101.3 (range 60-450), and 102.7 (45-490) minutes respectively. Fourty-two (31.3 %) patients were oncological cases. In 4 oncological cases, the surgeons switched to open surgery because of massive bleeding and six (14.2 %) oncological cases required blood transfusions during peri/postoperative periods. Pulmonary embolism was observed in one oncological case. In one non-oncological case, the surgeon switched to open surgery because of intestinal perforation and 10 (9.7 %) non-oncological cases needed blood transfusions during peri/postoperative periods. In addition, some complications such as intestinal perforation (n=1), mechanical ileus (n=1), and pulmonary embolism (n=1) were observed during postoperative period. Intestinal perforation was repaired using laparoscopic (n=1) method. Mechanical ileus was approached with open surgical technique. Mean hospital stay of the patients in the oncological and non-oncological series were 4.5 (3-23) and 4.5 (3-30) days respectively.Conclusion:We think that renal oncological cases should be included in the spectrum of laparoscopic indications even at the beginning of the learning curve. Certainly, we still share the opinion that cancer cases which require highly challenging surgeries like radical cystectomy, and prostatectomy should be postponed till to gaining of higher level of experience.

Value of CT angiography in reducing the risk of hemorrhage associated with mini-percutaneous nephrolithotomy

ABSTRACTPurpose:To evaluate the clinical value of computed tomography angiography (CTA) in reducing the risk of hemorrhage associated with mini-percutaneous nephrolithotomy (PCNL).Materials and Methods:A total of 158 patients with renal or ureter stones who had undergone mini-percutaneous nephrolithotomy were retrospectively enrolled into this study from May of 2011 to April of 2014. Group 1 (65 patients) underwent computed tomography angiography, and Group 2 (93 patients) underwent non-contrast CT. The clinical characteristics of the patients and hemorrhagic complications were recorded. The hematologic complications (transfusion rate, and preoperative and postoperative hemoglobin values) were assessed.Results:There were no statistically significant differences in age, body mass index(BMI), stone diameter, operative time, stone-free rate, and hospital stay between the 2 groups. In group 2, 1 patient (1.1%) developed a renal arteriovenous fistula and was treated with embolus therapy. In addition, Group 2 showed significantly drop in hemoglobin (3.6 g/dL vs. 2.4 g/dL, respectively; P <0.001) and more transfusions (9.7% vs. 1.5%, respectively; P <0.05) compared with Group 1.Conclusion:The study showed that patients who underwent computed tomography angiography prior to percutaneous nephrolithotomy had lower drop of hemoglobin and needed less transfusions. These findings may suggest that the use of computed tomography angiography may reduce the risk of bleeding during percutaneous nephrolithotomy.

Comparison beetwen open and laparoscopic radical cistectomy in a latin american reference center: perioperative and oncological results

ABSTRACTObjectives:To evaluate the differences of peri-operatory and oncological outcomes between Laparoscopic Radical Cystectomy and Open Radical Cystectomy in our center.Materials and Methods:Overall, 50 patients were included in this non randomized match-pair analysis: 25 patients who had undergone Laparoscopic Radical Cystectomy for invasive bladder cancer (Group-1) and 25 patients with similar characteristics who had undergone Open Radical Cystectomy (Group-2). The patients were operated from January 2005 to December 2012 in a single Institution.Results:Mean operative time for groups 1 and 2 were 350 and 280 minutes (p=0.03) respectively. Mean blood loss was 330 mL for group 1 and 580 mL for group 2 (p=0.04). Intraoperative transfusion rate was 0% and 36% for groups 1 and 2 respectively (p=0.005). Perioperative complication rate was similar between groups. Mean time to oral intake was 2 days for group 1 and 3 days for group 2 (p=0.08). Median hospital stay was 7 days for group 1 and 13 for group 2 (p=0.04). There were no differences in positive surgical margins and overall survival, between groups.Conclusions:In a reference center with pelvic laparoscopic expertise, Laparoscopic Radical Cystectomy may be considered a safe procedure with similar complication rate of Open Radical Cystectomy. Laparoscopic Radical Cystectomy is more time consuming, with reduced bleeding and transfusion rate. Hospital stay seems to be shorter. Oncologically no difference was observed in our mid-term follow-up.

Cardiopulmonary bypass increases the risk of vasoplegic syndrome after coronary artery bypass grafting in patients with dialysis-dependent chronic renal failure / O uso da circulação extracorpórea aumenta o risco de síndrome vasoplégica em pacientes com insuficiência renal crônica hemodialítica submetidos à revascularização cirúrgica do miocárdio

AbstractObjective:Coronary artery bypass grafting is currently the best treatment for dialysis patients with multivessel coronary artery involvement. Vasoplegic syndrome of inflammatory etiology constitutes an important postoperative complication, with highly negative impact on prognosis. Considering that these patients have an intrinsic inflammatory response exacerbation, our goal was to evaluate the incidence and mortality of vasoplegic syndrome after myocardial revascularization in this group.Methods:A retrospective, single-center study of 50 consecutive and non-selected dialysis patients who underwent myocardial revascularization in a tertiary university hospital, from 2007 to 2012. The patients were divided into 2 groups, according to the use of cardiopulmonary bypass or not (off-pump coronary artery bypass). The incidence and mortality of vasoplegic syndrome were analyzed. The subgroup of vasoplegic patients was studied separately.Results:There were no preoperative demographic differences between the cardiopulmonary bypass (n=20) and off-pump coronary artery bypass (n=30) group. Intraoperative data showed a greater number of distal coronary arteries anastomosis (2.8 vs. 1.8, P<0.0001) and higher transfusion rates (65% vs. 23%, P=0.008) in the cardiopulmonary bypass group. Vasoplegia incidence was statistically higher (P=0.0124) in the cardiopulmonary bypass group (30%) compared to the off-pump coronary artery bypass group (3%). Vasoplegia mortality was 50% in the cardiopulmonary bypass group and 0% in the off-pump coronary artery bypass group. The vasoplegic subgroup analysis showed no statistically significant clinical differences.Conclusion:Cardiopulmonary bypass increased the risk for developing postoperative vasoplegic syndrome after coronary artery bypass grafting in patients with dialysis-dependent chronic renal failure.

ResumoObjetivo:O melhor tratamento atual para os pacientes dialíticos com acometimento coronariano multiarterial é a revascularização cirúrgica do miocárdio. Dentre as complicações pós-operatórias, a síndrome vasoplégica de etiopatogenia inflamatória torna-se importante pelo impacto altamente negativo no prognóstico. Considerando que esses pacientes possuem uma exacerbação intrínseca da resposta inflamatória, nosso objetivo foi avaliar a incidência e a mortalidade da síndrome vasoplégica no pós-operatório de revascularização miocárdica nesse grupo.Métodos:Estudo retrospectivo, unicêntrico, de 50 pacientes dialíticos consecutivos e não selecionados, submetidos à revascularização miocárdica, em um hospital terciário universitário, no período de 2007 a 2012. Esses pacientes foram divididos em 2 grupos, de acordo com o emprego ou não da circulação extracorpórea. A incidência e a mortalidade da vasoplegia foram analisadas nos grupos. Após a identificação dos pacientes quanto à presença de vasoplegia, este subgrupo foi estudado separadamente.Resultados:Não houve diferenças demográficas pré-operatórias entre os grupos com circulação extracorpórea (n=20) e sem circulação extracorpórea (n=30). Dados intraoperatórios demonstraram maior número de artérias coronárias revascularizadas (2,8 vs. 1,8; P<0,0001) e maior necessidade de transfusão (65% vs. 23%; P=0,008) no grupo circulação extracorpórea. A incidência de vasoplegia foi estatisticamente maior (P=0,0124) no grupo circulação extracorpórea (30%) em comparação ao grupo sem circulação extracorpórea (3%). A mortalidade dos pacientes com vasoplegia foi 50% no grupo circulação extracorpórea e 0% no grupo sem circulação extracorpórea. A análise do subgrupo vasoplégico não demonstrou diferenças clínicas estatisticamente significantes.Conclusão:O emprego da circulação extracorpórea na revascularização cirúrgica do miocárdio em pacientes com insuficiência renal crônica dialítica aumentou o risco para desenvolvimento de síndrome vasoplégica pós-operatória.

Estudio comparativo de los eventos adversos entre el abordaje posterolateral y lateral directo para artroplastía primaria de cadera no cementada en pacientes mayores de 65 años con fracturas del cuello femoral / Comparative study of adverse events between a posterolateral and a direct lateral approach for uncemented primary hip arthroplasty in patients over 65 years of age with femoral neck fractures

Introducción: Las fracturas del cuello del fémur, constituyen un capítulo muy importante en la práctica de la Traumatología, debido a su alta incidencia principalmente en los pacientes mayores de 65 años, suponiendo cerca de 65% de las intervenciones en Traumatología. Es de vital importancia la funcionalidad temprana de un paciente con fractura del cuello de la cadera, ya que la supervivencia disminuye en los primeros 12 meses. El objetivo de este trabajo fue comparar la evolución trans- y postquirúrgica de los pacientes sometidos a cirugía articular primaria de cadera con el abordaje lateral de Hardinge y el posterolateral de Moore. Material y métodos: Se seleccionaron 79 pacientes mayores de 65 años, con fracturas del cuello del fémur y se dividieron en dos grupos según el estudio. Representando al abordaje lateral de Hardinge (32 pacientes) y abordaje posterolateral de Moore (47 pacientes) en el período de Marzo de 2011 a Abril 2013. Resultados: Tomando en consideración las variables estudiadas se observó una diferencia estadísticamente significativa (p < 0.005) en el número de paquetes transfundidos por pacientes manejados mediante el abordaje lateral directo de Hardinge. Conclusiones: Coincidimos con la literatura en que hay diferencia significativa en la evolución trans- y postquirúrgica de los pacientes con fracturas del cuello del fémur manejado mediante abordaje lateral de Hardinge. Se demostró una diferencia estadísticamente significativa en el número de paquetes transfundidos por paciente, lo cual en nuestro medio representa una mejor utilización de los recursos.

Introduction: Femoral neck fractures represent an important chapter in the practice of Traumatology, due to their high incidence, mainly among patients over 65 years of age; they account for around 65% of surgeries in Traumatology. Early function of patients who sustained a femoral neck fracture is of the utmost importance, as survival decreases within the first 12 months. The purpose of this paper is to compare the intra- and postoperative course of patients who underwent primary hip surgery using Hardinge's direct lateral approach versus Moore's posterolateral approach. Material and methods: 79 patients over 65 years of age with femur fractures were selected and divided into 2 groups according to the approach used. Hardinge's direct lateral approach was used in 32 patients and Moore's posterolateral approach in 47 patients, from March 2011 to April 2013. Results: Considering the variables studied, a statistically significant difference (p < 0.005) was seen in the number of blood units transfused to patients in whom Hardinge's direct lateral approach was used. Conclusions: We agree with the literature in that there is a significant difference in the intra- and post-operative course of patients with femur neck fractures managed using Hardinge's direct lateral approach. A statistically significant difference was seen in the number of blood units transfused per patient, something that in our setting represents better resource utilization.

Transfusional profile in different types of intensive care units / Perfil transfusional em diferentes tipos de unidades de terapia intensiva / Perfil transfusional en diferentes tipos de unidades de cuidados intensivos

Background and objectives: anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units. Methods: prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusional profile were collected, a univariate analysis was done, and the results were considered significant at p = 0.05. Results: 408 transfusions were analyzed in 71 patients. The mean hemoglobin concentration on admission was 9.7 ± 2.3 g/dL and the pre-transfusional concentration was 6.9 ± 1.1 g/dL. The main indications for transfusion were hemoglobin concentration (49%) and active bleeding (32%). The median number of units transfused per episode was 2 (1-2) and the median storage time was 14 (7-21) days. The number of patients transfused with hemoglobin levels greater than 7 g/dL and the number of bags transfused per episode were significantly different among intensive care units. Patients who received three or more transfusions had longer mechanical ventilation time and intensive care unit stay and higher mortality after 60 days. There was an association of mortality with disease severity but not with transfusional characteristics. Conclusions: the practice of blood products transfusion was partially in agreement with the guidelines recommended, although there are differences in behavior between the different profiles of intensive care units. Transfused patients evolved with unfavorable outcomes. Despite the scarcity of blood in blood banks, the mean storage time of the bags was high. .

Justificativa e objetivos: Anemia é um achado clínico frequente nas UTIs. A transfusão de hemácias é a principal forma de tratamento, apesar dos riscos a ela associados. Dessa forma, propusemos avaliar o perfil transfusional dos pacientes em diferentes UTIs. Métodos: Análise prospectiva dos pacientes internados nas UTIs de um hospital universitário terciário com indicação de transfusão de concentrado de hemácias. Foram coletados características demográficas e o perfil transfusional, foi feita análise univariada e foram considerados significativos resultados com p = 0,05. Resultados: Foram analisadas 408 transfusões em 71 pacientes. A concentração média de hemoglobina na internação foi 9,7 ± 2,3 g/dL e a concentração pré-transfusional 6,9 ± 1,1 g/dL. As principais indicações de transfusão foram a concentração de hemoglobina (49%) e o sangramento ativo (32%). O número mediano de unidades transfundidas por episódio foi 2 (1-2) e a mediana do tempo de estocagem foi 14 (7-21) dias. O número de pacientes transfundidos com hemoglobina acima de 7 g/dL e o número de bolsas transfundidas por episódio foram significativamente diferentes entre as UTIs. Pacientes que receberam três ou mais transfusões tiveram maior tempo de ventilação mecânica e de permanência na UTI e maior mortalidade em 60 dias. Houve associação da mortalidade com gravidade da doença, mas não com as características transfusionais. Conclusões: A prática transfusional de hemocomponentes esteve parcialmente de acordo com as diretrizes preconizadas, embora haja diferença de conduta entre os diferentes perfis de UTIs. Pacientes transfundidos evoluíram com desfechos desfavoráveis. Apesar da escassez de sangue ...

Justificación y objetivos: la anemia es un hallazgo clínico común en las UCI. La transfusión de hematíes es la principal forma de tratamiento, a pesar de los riesgos que están asociados a ella. Así, nos propusimos evaluar el perfil transfusional de los pacientes en diferentes UCI. Métodos: análisis prospectivo de los pacientes ingresados en las UCI de un hospital universitario terciario con indicación de transfusión de concentrado de hematíes. Se recolectaron características demográficas y el perfil transfusional, haciéndose el análisis univariado considerando como significativos los resultados con p = 0,05. Resultados: se analizaron 408 transfusiones en 71 pacientes. La concentración promedio de hemoglobina en el ingreso fue de 9,7 ± 2,3 g/dL y la concentración pretransfusional de 6,9 ± 1,1 g/dL. Las principales indicaciones de transfusión fueron la concentración de hemoglobina (49%) y el sangrado activo (32%). El número intermedio de unidades transfundidas por episodio fue 2 (1-2) y la mediana del tiempo de almacenaje fue de 14 (7-21) días. El número de pacientes transfundidos con hemoglobina por encima de 7 g/dL y el número de bolsas transfundidas por episodio fueron significativamente diferentes entre las UCI. Los pacientes que recibieron 3 o más transfusiones tuvieron más tiempo de ventilación mecánica y de permanencia en la UCI y una mayor mortalidad en 60 días. Hubo una asociación de la mortalidad con la gravedad de la enfermedad, pero no así con las características transfusionales. Conclusiones: la práctica transfusional de hemocomponentes estuvo parcialmente a tono con las directrices preconizadas, aunque exista una diferencia de conducta entre los diferentes perfiles de UCI. Pacientes transfundidos evolucionaron con resultados desfavorables. ...

Blood use in neurosurgical cases at the University Hospital of the West Indies / El uso de la sangre en los casos de neurocirugía en el Hospital Universitario de West Indies

OBJECTIVE: Many neurosurgical cases are done without the need for blood transfusion, yet blood is unnecessarily cross-matched, resulting in wasted resources. This study was undertaken to document and compare the number of units of blood components requested, cross-matched and transfused in neurosurgical cases at the University Hospital of the West Indies (UHWI). METHODS: A prospective, observational study was undertaken over one year. Data collected for each patient included demographic information, relevant perioperative data, and blood banking data including blood components requested, cross-matched and transfused. Data were analysed using SPSS version 16. RESULTS: Data were analysed on 152 patients, 71 females (46.7%) and 81 males (53.3%). The mean age was 48.7 ± 19.6 years and 100 of the procedures were done electively (65.8%). Blood components were ordered in 114 (75%) cases, red cells more commonly in 113 (74.3%) patients, and plasma in 19 (12.5%) patients. Overall, 20 patients (13.2%) were transfused. Most patients (90.9%) needed one to two units of blood. Of the 236 units of blood components that were cross-matched or prepared, only 62 were transfused. The cross-match/preparation to transfusion ratio (CTR/PTR) was 6.00 for red cells and 1.31 for plasma. Preoperative haemoglobin < 10.0 g/dL (p = 0.001), estimated blood loss of > 1 litre (p < 0.001), higher American Society of Anesthesiologists (ASA) physical status score (p < 0.03) and a resident as lead surgeon (p < 0.05), were significant predictors of blood transfusion. CONCLUSION: The transfusion rate was low with a high cross-match to transfusion ratio, suggesting that less cross-matching is needed. A new approach to blood ordering for neurosurgical cases is recommended.

OBJETIVO: Muchos casos neuroquirurgicos se realizan sin necesidad de transfusion de sangre. Sin embargo, la sangre es innecesariamente sometida a pruebas cruzadas, lo cual resulta en un malgasto de recursos. Este estudio fue emprendido con el proposito de documentar y comparar el numero de unidades de los componentes sanguineos requeridos, cotejados, y transfundidos en los casos de neurocirugia en el Hospital Universitario de West Indies (HUWI). MÉTODOS: Se realizo un estudio prospectivo observacional por espacio de mas de un ano. Los datos recopilados de cada paciente incluian informacion demografica, datos relevantes perioperatorios, y datos de bancos de sangre, incluyendo los componentes sanguineos solicitados, cotejados, y transfundidos. Los datos fueron analizados utilizando SPSS version 16. RESULTADOS: Los datos se analizaron en 152 pacientes: 71 mujeres (46.7%) y 81 varones (53.3%). La edad promedio fue de 48.7 ± 19.6 anos y 100 de los procedimientos se realizaron de manera electiva (65.8%). Se ordenaron componentes de la sangre en 114 casos (75%), siendo los globulos rojos los mas comunmente requeridos en 113 pacientes (74,3%) y el plasma en 19 pacientes (12.5%). En general, 20 pacientes (13.2%) fueron transfundidos. La mayoria de los pacientes (90.9%) necesito una o dos unidades de sangre. De las 236 unidades de componentes sanguineos que fueron preparados o sometidos a pruebas cruzadas, solo 62 fueron transfundidos. La proporcion de la preparacion/prueba cruzada en relacion con la transfusion (CTR/PTR por sus siglas en ingles) fue 6.00 para los globulos rojos y 1.31 para el plasma. La hemoglobina preoperatoria < 10.0 g/dL (p = 0.001), la perdida estimada de sangre de > 1 litro (p < 0.001), la mayor puntuacion del estado fisico (p < 0.03) segun los criterios de la Sociedad Americana de Anestesiologos (ASA), y un residente como principal cirujano (p < 0.05), fueron predictores significativos de la transfusion de sangre. CONCLUSIÓN: La tasa de transfusion fue baja, con una alta proporcion de la prueba cruzada frente a la transfusion, sugiriendo que se necesitan menos pruebas cruzadas. Se recomienda un nuevo enfoque a la hora de hacer pedidos de sangre para los casos neuroquirurgicos.

Severe Bleeding and Perforation Are Rare Complications of Endoscopic Ultrasound-Guided Fine Needle Aspiration for Pancreatic Masses: An Analysis of 3,090 Patients from 212 Hospitals

BACKGROUND/AIMS: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful for the pathological diagnosis of pancreatic masses, but patients are susceptible to severe bleeding and perforation. Because the incidence and severity of these complications have not been fully evaluated. METHODS: We aimed to evaluate severe bleeding and perforation after EUS-FNA for pancreatic masses using large-scale data derived from a Japanese nationwide administrative database. RESULTS: In total, 3,090 consecutive patients from 212 low- to high-volume hospitals were analyzed. Severe bleeding requiring transfusion or endoscopic treatment occurred in seven patients (0.23%), and no perforation was observed. No patient mortality was recorded within 30 days of EUS-FNA. The rate of severe bleeding in low-volume hospitals was significantly higher than that in medium- and high-volume hospitals (0.48% vs 0.10%, p=0.045). CONCLUSIONS: Severe bleeding and perforation following EUS-FNA for pancreatic masses are rare, and the procedure is safe.