Correlation Analysis of Hemolytic Transfusion Reaction Induced by Low Titer Antibody / 中国实验血液学杂志

OBJECTIVE@#To establish the diagnostic process of low titer blood group antibody in the occurrence of adverse reactions of hemolytic transfusion.@*METHODS@#Acid elusion test, enzyme method and PEG method were used for antibody identification. Combined with the patient's clinical symptoms and relevant inspection indexes, the irregular antibodies leading to hemolysis were detected.@*RESULTS@#The patient's irregular antibody screening was positive, and it was determined that there was anti-Lea antibody in the serum. After the transfusion reaction, the low titer anti-E antibody was detected by enhanced test. The patient's Rh typing was Ccee, while the transfused red blood cells were ccEE. The new and old samples of the patient were matched with the transfused red blood cells by PEG method, and the major were incompatible. The evidence of hemolytic transfusion reaction was found.@*CONCLUSION@#Antibodies with low titer in serum are not easy to be detected, which often lead to severe hemolytic transfusion reaction.

Transfusão de hemácias em neonatos pelo cateter central de inserção periférica: revisão integrativa / Red blood cell transfusions in newborn infants through peripherally inserted central catheter: an integrative review / Transfusión de glóbulos rojos en neonatos a través de catéter central de inserción periférica: revisión integradora

Objetivo: identificar na literatura as implicações relacionadas à transfusão de hemácias, por meio do Cateter Central de Inserção Periférica, em neonatos. Métodos: revisão integrativa realizada nas bases de dados Web of Science, Scopus, Biblioteca Virtual em Saúde e PUBMED. Incluíram-se publicações em inglês, espanhol e português, disponíveis na íntegra, sem data limite. Resultados: selecionaram-se quatro (100,0%) pesquisas que abordaram hemólise das hemácias e dois deles (50,0%), também, versaram sobre obstrução do cateter durante a transfusão. Os estudos evidenciaram ocorrência de hemólise relacionada à velocidade de infusão e ao tempo de armazenamento das hemácias, porém sem relevância clínica. Referente à obstrução, observou-se ocorrência em apenas um cateter de 38 acompanhados em um estudo; no outro, não houve obstrução, sendo as transfusões consideradas tecnicamente viáveis. Conclusão: urgem estudos clínicos primários que avaliem as consequências clínicas das transfusões de hemácias por esse tipo de cateter, em neonatos.

Objective: this study aimed to identify in literature the implications related to red blood cell (RBC) transfusions, through Peripherally Inserted Central Catheter, in neonates. Methods: this is an integrative review conducted in the Web of Science, Scopus, Virtual Health Library, and PubMed databases. Publications in English, Spanish and Portuguese, available in full, without date limit, were included. Results: four (100.0%) studies that addressed hemolysis of RBCs were selected, of which two (50.0%) also addressed catheter obstruction during transfusion. Studies revealed the occurrence of hemolysis related to infusion rate and storage time of RBCs, however without clinical relevance. Regarding obstruction, it was verified in only one catheter out of 38 followed-up in a study; in the other, there was no obstruction and transfusions were considered technically feasible. Conclusion:there is urgent need for primary clinical studies to assess clinical consequences of red blood cell transfusions through this type of catheter in neonates.

Objetivo: identificar en la literatura las implicaciones relacionadas con la transfusión de glóbulos rojos, por Catéter Central de Inserción Periférica, en neonatos. Métodos: revisión integrativa, en las bases de datos Web of Science, Scopus, Biblioteca Virtual en Salud y PUBMED. Se incluyeron publicaciones en inglés, español y portugués, disponibles en totalidad, sin fecha límite. Resultados: seleccionaron cuatro (100,0%) estudios que abordaban la hemólisis de glóbulos rojos y dos de ellos (50,0%) la obstrucción del catéter durante la transfusión. Los estudios señalaron ocurrencia de hemólisis relacionada con velocidad de infusión y tiempo de almacenamiento de los glóbulos rojos, pero sin relevancia clínica. Sobre la obstrucción, se observó en catéter de 38 seguidos en un estudio; en otro, no hubo obstrucción, y las transfusiones se consideraron técnicamente factibles. Conclusión:se necesitan estudios clínicos primarios para evaluar las consecuencias clínicas de las transfusiones de glóbulos rojos a través de este tipo de catéter en los recién nacidos.

The Efficacy of Rh Phenotype Matched Blood Transfusion / 中国实验血液学杂志

OBJECTIVE@#To analyze and evaluate the efficacy of Rh phenotype matched blood transfusion.@*METHODS@#The increasing of hemoglobin (Hb) and hemolysis tests in the patients treated by Rh matched red blood cells or not, as well as the first time unmatched transfusions and the unmatched transfusions happened again after a period (≥10 d) were retrospectively analyzed.@*RESULTS@#A total of 674 times transfusions in 120 patients were evaluated. The increasing of Hb in each unit was higher in the patients treated by Rh matched blood transfusion (vs unmatched) [(33.397±1.475) g/U vs (29.951±1.304) g/U, P=0.033], while the increasing of Hb at first time unmatched transfusion and the second time unmatched transfusion was not statistically different[ (28.942±2.083) g/U vs (30.686±1.737) g/U, P=0.589]. The level of lactate dehydrogenase were related to erythrocyte washing, irradiation, period of validity and the second time unmatched transtusion (all P<0.05); the levels of total bilirubin (TBil), direct bilirubin (DBil) and indirect bilirubin (IBil) between the first time unmatched transfusion and the second time unmatched transfusion were statistically different (all P<0.05).@*CONCLUSION@#For the patients need multiple blood transfusions, Rh phenotype matched blood transfusion can reduce the exposure to Rh allogenic antigens, improve the efficacy and ensure the safety of blood transfusion.

Recambio de Hematíes en gestante con Anemia de Células Falciformes: reporte de un caso en el Hospital Regional de Talca / Red blood cell exchange in pregnant women with Sickle Cell Anemia: report of a case in the Regional Hospital of Talca

Sickle cell anemia or sickle cell disease is an autosomal recessive disease, caused by a mutation in the hemoglobin gene, where glutamic acid is substituted for valine at position 6 of the beta chain of hemoglobin, resulting in hemoglobin S The diagnosis is made with electrophoresis. The clinical manifestations are varied, the most frequent being the vaso-occlusive crisis, which can increase in pregnancy, during which sickle cell disease also increases the risk of maternal-fetal complications, caused by pre-eclampsia infections, intrauterine growth restriction, and premature delivery. and miscarriage. The usual treatment for the management of seizures is hydroxyurea, a drug that is teratogenic, so its use is contraindicated during pregnancy. Other treatment alternatives are red blood cell transfusion and red blood cell exchange. Next, the first case of red blood cell exchange or exchange transfusion in a pregnant patient with sickle cell anemia at the Hospital Regional de Talca is presented.

Protocolo de ayuno peritransfusional en enterocolitis necrotizante, en recién nacidos colombianos / Implementation of a peri-transfusion fasting protocol in necrotizing enterocolitis, in Colombian newborns

Objetivo: Determinar la diferencia de incidencia de enterocolitis necrotizante asociada a transfusión en recién nacidos pretérmino con y sin implementación de un protocolo de ayuno peritransfusional. Métodos: Estudio observacional retrospectivo. Se incluyeron todos los recién nacidos pretérmino que fueron transfundidos con unidad de glóbulos rojos entre julio 2015 y octubre 2016 en la unidad de recién nacidos un centro de tercer nivel de Colombia. El protocolo de ayuno peritransfusional se inició a partir de abril 2016. La enterocolitis necrotizante asociada a transfusión se definió como enterocolitis necrotizante presentada dentro de las 48 horas posteriores a la transfusión. Se analizaron variables demográficas, alimentación, número de transfusiones y variables asociadas a enterocolitis necrotizante. Resultados: Durante el tiempo de estudio, 148 recién nacidos prematuros necesitaron al menos una transfusión de glóbulos rojos que representaron 385 eventos de transfusión. Se informaron siete casos de enterocolitis necrotizante asociada a transfusión. La incidencia acumulada global fue 4,7 por ciento (3,6 por ciento con protocolo de ayuno peritransfusional y 6,3 por ciento sin protocolo), la tasa de incidencia global de enterocolitis necrotizante asociada a transfusión fue 18/1000 personas-transfusión (IC95 por ciento 7-37/1000 personas-transfusión), mayor en el grupo sin protocolo (28/1000 personas-transfusión) que en el grupo con protocolo (12/1000 personas-transfusión), pero sin significación estadística. Conclusiones: La implementación del protocolo de ayuno peritransfusional podría disminuir la incidencia y gravedad de la enterocolitis necrotizante asociada a transfusión. Se requieren estudios prospectivos para establecer la relación entre la alimentación enteral durante la transfusión y la enterocolitis necrotizante(AU)

Objective: Determine the difference in incidence of transfusion-associated necrotizing enterocolitis in preterm newborns with and without implementation of a peri-transfusion fasting protocol. Methods: Retrospective observational study. All preterm newborns that were transfused with red blood cell units during the period from July 2015 to October 2016 in the newborns´ unit at a third level of care center in Colombia were included. The peri-transfusion fasting protocol started on April 2016. Transfusion-associated necrotizing enterocolitis was defined as necrotizing enterocolitis presented within 48 hours after the transfusion. Demographic variables, feeding, number of transfusions and variables associated with necrotizing enterocolitis were analyzed. Results: During the study time, 148 premature newborns needed at least one transfusion of red blood cells that accounted for 385 transfusion events. Seven cases of transfusion-associated necrotizing enterocolitis were reported. The overall cumulative incidence was 4.7 percent (3.6 percent with peri-transfusion fasting protocol and 6.3 percent without protocol), the overall incidence rate of transfusion-associated necrotizing enterocolitis was 18/1000 people-transfusion (IC 95 percent 7-37/1000 people-transfusion); it was higher in the group without protocol (28/1000 people-transfusion) than in the group with protocol (12/1000 people-transfusion), but without statistical significance. Conclusions: Implementation of the peri-transfusion fasting protocol may decrease the incidence and severity of necrotizing enterocolitis associated with transfusion. Prospective studies are required to establish the relationship between enteral feeding during transfusion and necrotizing enterocolitis(AU)

Manejo de la hemorragia digestiva alta en pacientes con infección por SARS-CoV-2 en un hospital de Lima, Perú / Management of upper gastrointestinal bleeding in patients with SARS-COV-2 infection in a hospital in Lima-Peru

Resumen Introducción: la pandemia por SARS-CoV-2 ha conllevado la reestructuración de las unidades de endoscopía digestiva en el mundo, lo cual ha limitado los procedimientos endoscópicos y priorizado indicaciones de emergencia como la hemorragia digestiva alta (HDA). No obstante, existe escasa evidencia respecto a su impacto en la evolución y resultados. Objetivo: evaluar el manejo de la HDA en el contexto de la pandemia del coronavirus por SARS-CoV-2. Materiales y métodos: estudio observacional, descriptivo, retrospectivo de marzo a agosto de 2020 en pacientes con diagnóstico de HDA e infección por SARS-CoV-2. Resultados: de 4320 pacientes con infección por SARS-CoV-2, 51 presentaron HDA al ingreso. La mediana de edad fue de 70 años. El 58,8 % era de sexo masculino. El 56,9 % tenía una puntuación de Glasgow-Blatchford (SGB) ≥12. El 21,6 % requirió soporte de oxígeno. Solo 34 pacientes (66,7 %) recibieron tratamiento médico; asimismo, 17 (33,3 %) recibieron tratamiento médico más endoscopia digestiva alta (EDA); de estos, a 6 (35,3 %) se les realizó endoscopia terapéutica. La enfermedad ulcerosa péptica fue el hallazgo más frecuente. Al comparar el tipo de tratamiento recibido, no hubo diferencias significativas entre el número de transfusiones de glóbulos rojos, resangrado, reingreso por HDA, estancia hospitalaria ni mortalidad secundaria a la HDA. La mortalidad global fue del 25,4 % (13 pacientes) y se debió, principalmente, al compromiso respiratorio por SARS-CoV-2. Conclusiones: se observa una reducción en el número de EDA de emergencia por HDA en la pandemia actual, así como un tiempo mayor al estándar para su realización. Más del 80 % de los pacientes que recibieron solo tratamiento médico evolucionaron favorablemente, y solo un tercio de los pacientes a quienes se les realizó una EDA requirió terapéutica endoscópica.

Abstract Introduction: The SARS-CoV-2 pandemic has led to the restructuring of digestive endoscopy units around the world, limiting endoscopic procedures and prioritizing emergency indications such as upper gastrointestinal hemorrhage (UGH). However, there is little evidence regarding its impact on evolution and outcomes. Objective: To evaluate the management of UGH in the context of the SARS-CoV-2 coronavirus pandemic. Materials and methods: Observational, descriptive, retrospective study carried out between March and August 2020 in patients with diagnosis of UGH and SARS-CoV-2 infection. Results: Of 4 320 patients with SARS-CoV-2 infection, 51 had UGH on admission. The median age of the population was 70 years and 58.8% were male. Glasgow-Blatchford Bleeding Score (GBS) of ≥12 was obtained in 56.9%. Oxygen support was required by 21.6%. 34 (66.7%) patients received medical treatment only, while 17 (33.3%) received medical treatment plus upper gastrointestinal endoscopy (UGE), of which 6 (35.3%) underwent therapeutic endoscopy. Peptic ulcer disease was the most frequent finding. When comparing the type of treatment received, there were no significant differences between the number of red blood cell transfusions, rebleeding, re-admission due to UGH, hospital stay, or mortality secondary to UGH. Overall mortality was 25.4% (13 patients), mainly due to respiratory failure due to SARS-CoV-2. Conclusions: A reduction in the number of emergency upper gastrointestinal endoscopies for UGH was observed during the current pandemic, as well as a longer than standard time for their performance. More than 80% of patients who received medical treatment alone evolved favorably and only one third of the patients who underwent UGE required endoscopic therapy.

Implications of perioperative allogeneic red blood cell transfusion on the immune-inflammatory response

ABSTRACT Background: The allogeneic transfusion-related immunomodulation (TRIM) may be responsible for an increase in survival of renal transplants but in contrast it could increase the rate of bacterial infections or the recurrence rate of tumors post-operatively. Objective: This review focuses in the implications of perioperative allogeneic transfusions on the immune-inflammatory response of surgical transfused patients. Results: ABTs modify immune functions in recipients including decrease of the number of lymphocytes; decrease the CD4 cells; decrease the CD4/CD8 T-cell ratio; decrease NK cells; and decrease the lymphocyte response to mitogens. TRIM effects may be mediated by allogeneic white cells present in blood products; soluble peptides present in transfused plasma; and/or biologic mediators released into the supernatant of blood units. A recent systematic review and meta-analysis including 36 clinical observational studies (n = 174,036) concluded that perioperative ABTs not only decreased overall survival and reduced colorectal cancer-specific survival. Furthermore ABTs increased the rate of infectious, cardiac, pulmonary and anastomotic complications in colorectal cancer patients undergoing surgery. Conclusions: It has been demonstrated by laboratory tests that TRIM is associated with transfusion recipient immune alterations but its influence in colorectal cancer recurrence after resection remains controversial though may exist. Surgical techniques reducing intraoperative blood loss have limited the number of ABTs perioperatively, however increase in mortality continues to be reported in literature after ABT in colorectal cancer surgery. Poor survival associated to TRIM in colorectal cancer might be due to higher number of allogeneic transfused units and/or prolonged length of blood storage.

Impacto da transfusão de eritrócitos no transporte e no metabolismo de oxigênio em pacientes com sepse e choque séptico: uma revisão sistemática e metanálise / Impact of red blood cell transfusion on oxygen transport and metabolism in patients with sepsis and septic shock: a systematic review and meta-analysis

RESUMO Considera-se que a transfusão de eritrócitos melhora a respiração celular durante o choque séptico. Contudo, seu impacto agudo no transporte e no metabolismo de oxigênio nessa condição ainda é amplamente debatido. O objetivo deste estudo foi avaliar o impacto da transfusão de eritrócitos na microcirculação e no metabolismo do oxigênio em pacientes com sepse e choque séptico. Conduzimos um levantamento nas bases de dados MEDLINE®, Elsevier e Scopus. Incluímos estudos realizados com seres humanos adultos com sepse e choque séptico. Realizamos uma revisão sistemática e metanálise com utilização do modelo de efeitos aleatórios de DerSimonian e Laird. Consideramos significante valor de p < 0,05. Incluíram-se na análise 19 manuscritos, correspondentes a 428 pacientes. As transfusões de eritrócitos se associaram com aumento de 3,7% na média combinada de saturação venosa mista de oxigênio (p < 0,001), diminuição de razão de extração de oxigênio de -6,98 (p < 0,001) e nenhum efeito significante no índice cardíaco (0,02 L/minuto; p = 0,96). Obtiveram-se resultados similares em estudos que incluíram mensurações simultâneas de saturação venosa mista de oxigênio, razão de extração de oxigênio e índice cardíaco. As transfusões de eritrócitos levaram a aumento significante na proporção de pequenos vasos perfundidos (2,85%; p = 0,553), enquanto os parâmetros de oxigenação tissular revelaram aumento significante no índice de hemoglobina tissular (1,66; p = 0,018). Estudos individuais relataram melhoras significantes na oxigenação tissular e nos parâmetros microcirculatórios sublinguais em pacientes com microcirculação alterada na avaliação inicial. A transfusão de eritrócitos pareceu melhorar o metabolismo sistêmico de oxigênio com aparente independência de variações no débito cardíaco. Observaram-se alguns efeitos benéficos para a oxigenação tissular e parâmetros microcirculatórios, em particular em pacientes com alterações iniciais mais graves. São necessários mais estudos para avaliar seu impacto clínico e individualizar as decisões relativas à transfusão.

ABSTRACT Red blood cell transfusion is thought to improve cell respiration during septic shock. Nevertheless, its acute impact on oxygen transport and metabolism in this condition remains highly debatable. The objective of this study was to evaluate the impact of red blood cell transfusion on microcirculation and oxygen metabolism in patients with sepsis and septic shock. We conducted a search in the MEDLINE®, Elsevier and Scopus databases. We included studies conducted in adult humans with sepsis and septic shock. A systematic review and meta-analysis were performed using the DerSimonian and Laird random-effects model. A p value < 0.05 was considered significant. Nineteen manuscripts with 428 patients were included in the analysis. Red blood cell transfusions were associated with an increase in the pooled mean venous oxygen saturation of 3.7% (p < 0.001), a decrease in oxygen extraction ratio of -6.98 (p < 0.001) and had no significant effect on the cardiac index (0.02L/minute; p = 0,96). Similar results were obtained in studies including simultaneous measurements of venous oxygen saturation, oxygen extraction ratio, and cardiac index. Red blood cell transfusions led to a significant increase in the proportion of perfused small vessels (2.85%; p = 0.553), while tissue oxygenation parameters revealed a significant increase in the tissue hemoglobin index (1.66; p = 0.018). Individual studies reported significant improvements in tissue oxygenation and sublingual microcirculatory parameters in patients with deranged microcirculation at baseline. Red blood cell transfusions seemed to improve systemic oxygen metabolism with apparent independence from cardiac index variations. Some beneficial effects have been observed for tissue oxygenation and microcirculation parameters, particularly in patients with more severe alterations at baseline. More studies are necessary to evaluate their clinical impact and to individualize transfusion decisions.

Recambio por aféresis de glóbulos rojos. Primer registro de un hospital pediátrico en Quito-Ecuador / Red blood cell exchange. First report in a pediatric Hospital in Quito-Ecuador

Introducción: La anemia falciforme es la hemoglobinopatía estructural más frecuente en todo el mundo y es causada por la producción de hemoglobina S (HbS) a consecuencia de una mutación puntual en el gen de la beta globina.Objetivo: Mostrar los beneficios del recambio de glóbulos rojos por aféresis en la presentación del síndrome torácico agu-do, causado por la anemia drepanocítica.Presentación del caso: Se describe el manejo de una paciente de trece años de edad, con anemia drepanocítica que, al momento de su ingreso al hospital, presentó crisis vaso- oclusiva secundaria a su patología de base. Al segundo día presen-tó síndrome de tórax agudo, por lo que se solicitó al Servicio de Medicina Transfusional, el recambio eritrocitario. Analizado el caso, se realizó el cálculo de la volemia total de la paciente, se prepararon concentrados de glóbulos rojos (CGRs) com-patibles con la paciente: se filtraron; y se les cuantificó el hematocrito. El procedimiento se realizó con el equipo de aféresis COM.TEC. en el que se recambió 1.200 mililitros de eritrocitos totales. Discusión: El recambio eritrocitario por aféresis aportó una notable y visible mejoría clínica y laboratorial. Por lo que en nuestra experiencia consideramos que el procedimiento fue eficiente. Conclusiones: El recambio de eritrocitos por aféresis en el síndrome torácico agudo en crisis drepanocítica es un procedi-miento que se puede utilizar en pacientes que no responden a otras terapias por su mínima alteración de la viscosidad y volumen sanguíneo en el paciente, y disminuir la concentración de hemoglobina S.

Introduction: Sickle-cell anemia is the most common structural hemoglobinopathy worldwide and is caused by the pro-duction of hemoglobin S (HbS) as a result of a point mutation in the beta globin gene.Objective: Show the benefits of red blood cell replacement by apheresis in the presentation of acute chest syndrome, cau-sed by sickle-cell anemia.Case Presentation: We describe the management of a thirteen-year-old patient with sickle-cell anemia, who presented, at admission to the hospital, an occlusive vessel crisis, secondary to her underlying pathology. On the second day of admission, she presented acute chest syndrome. Erythrocyte replacement was requested to the hospital blood service. After analyzing the case, the total blood volume of the patient was calculated, red blood cell concentrates (RBCs) compatible with the pa-tient were prepared, all RBCs were filtered, and the hematocrit was quantified in all RBCs. The procedure was performed with the apheresis equipment COM.TEC. in which a total of 1,200 milliliters of erythrocytes was replaced. Discussion: The erythrocyte replacement by apheresis contributed a remarkable and visible clinical and laboratory impro-vement. In our view, we consider that the procedure was efficient.Conclusions: The replacement of erythrocytes by apheresis in the acute thoracic syndrome in sickle cell crisis is a procedure that may be used in patients who do not respond to other therapies, benefiting from minimal alteration of the viscosity and blood volume in the patient, as well as concomitant decrease of hemoglobin S concentration.

Aspectos esenciales sobre el uso de hemocomponentes en el paciente hospitalizado: revisión narrativa de literatura / Essential aspects for the administration of blood components in hospitalized patients: a narrative literature review

Introducción La medicina transfusional desarrolla y difunde pautas que rigen las condiciones óptimas para transfundir. El objetivo de este artículo es revisar la evidencia que existe actualmente en relación con el uso de hemocomponentes. Los temas abordados son fisiopatología, transfusión de glóbulos rojos, corrección profiláctica de las coagulopatías, reversión del efecto de coumadínicos y desencadenantes fisiológicos de la transfusión. Métodos Se utilizaron los portales web y bases de datos de PubMed, Scholar Google, ScienceDirect, SciELO y Cochrane, además de documentos oficiales publicados en la Sociedad Chilena de Hematología. Se incluyeron artículos de los últimos 10 años, de los cuales, 42 respondieron a los objetivos planteados para esta revisión narrativa de literatura. Conclusión En primer lugar, existe controversia entre dos tipos de estrategias al momento de abordar la práctica transfusional de glóbulos rojos: una estrategia liberal y una estrategia restrictiva. En segundo lugar, para el manejo de las coagulopatías, los tiempos de la coagulación no reflejan la verdadera capacidad de coagular de los pacientes. En tercer lugar, para revertir el efecto de coumadínicos, bastaría con la administración de vitamina K por sobre el uso de plasma fresco congelado. En cuarto lugar, el uso de desencadenantes fisiológicos evaluaría el momento óptimo para poder transfundir.

Introduction Transfusion medicine develops and disseminates guidelines that govern the optimal conditions for transfusion. The purpose of this article is to review the current evidence on the use of blood components. Methods We searched PubMed, Scholar Google, ScienceDirect, SciELO and Cochrane web portals, as well as official documents published in the Chilean Society of Hematology. Articles from the last ten years were included, of which 42 were appropriate for this narrative literature review. Conclusion First of all, there is a controversy between two types of strategies regarding the practice of red blood cell transfusion: a liberal strategy and a restrictive strategy. Second, for the management of coagulopathies, clotting times do not reflect the true ability of patients to clot. Third, to reverse the effect of coumadin, the administration of vitamin K would suffice over the use of fresh frozen plasma. Fourth, the use of physiological triggers could help define the best time for a transfusion.

Hemoterapia en el paciente gravemente enfermo / Hemotherapy in the seriously ill patients

Introducción: Para mejorar la estabilidad hemodinámica, trastornos de la coagulación, perfusión hística, capacidad de transporte de oxígeno, entre otros, en el paciente crítico se hace necesario la transfusión de sangre y derivados. Objetivo: Caracterizar la población de pacientes graves que recibieron tratamiento con sangre y hemoderivados. Métodos: Se realizó un estudio descriptivo y transversal en 199 pacientes ingresados en la unidad de cuidados intensivos del Hospital General Orlando Pantoja Tamayo del municipio Contramaestre, provincia Santiago de Cuba, desde enero de 2016 hasta abril de 2019. Las variables analizadas fueron: edad, sexo, causas de hemoterapia, tipo de componente sanguíneo empleado, frecuencia de administración, reacciones adversas y estado al egreso. Se utilizó el porcentaje para resumir la información, así como el test chi cuadrado para identificar asociación estadística. Resultados: Predominaron el sexo femenino (56,7 por ciento) y la edad comprendida entre 65 años y más, con el diagnóstico de politraumatizados, sangrado digestivo alto y sepsis. El concentrado de hematíes fue el más empleado y la frecuencia de administración, en una ocasión, fue en la categoría que más reacciones adversas se encontró (56,6 por ciento); el empleo en cuatro o más ocasiones incrementó la mortalidad. Conclusiones: El concentrado de hematíes fue el hemoderivado más administrado, la administración en una ocasión fue la que más reacciones adversas provocó y la mayoría fueron del tipo inmediatas inmunológicas(AU)

Introduction: To improve hemodynamic stability, coagulation disorders, tissue perfusion, oxygen transport capacity, among others, the transfusion of blood and plasma derivatives is necessary in the critically-ill patient. Objective: To characterize the population of seriously-ill patients who received treatment with blood and hemoderivatives. Methods: A descriptive and cross-sectional study was carried out with 199 patients admitted to the intensive care unit of Orlando Pantoja Tamayo General Hospital in Contramaestre Municipality, Santiago de Cuba Province, from January 2016 to April 2019. The variables analyzed were age, sex, causes for hemotherapy, type of blood component used, frequency of administration, adverse reactions, and discharge status. Percentage was used to summarize the information. Also, the chi-square test was used to identify statistical association. Results: There was a predominance of the female sex (56.7%) and of the age 65 years and older, with diagnosis of polytrauma, high digestive bleeding, and sepsis. The red blood cell concentrate was the most used and the frequency of administration, on one occasion, occurred in the category with the highest amount of adverse reactions (56.6%). Administration on four or more occasions increased mortality. Conclusions: The red blood cell concentrate was the most administered hemoderivative. Administration on one occasion that caused the most adverse reactions and most were immediate immunological ones(AU)

Impacto del volumen de sangre extraído por flebotomía sobre el requerimiento transfusional en prematuros menores de 1500 g. Estudio cuasiexperimental / Impact of the volume of blood collected by phlebotomy on transfusion requirements in preterm infants with birth weight of less than 1500 g. A quasi-experimental study

Introducción. La anemia es una complicación para los recién nacidos de muy bajo peso al nacer, y los exámenes de laboratorio son un factor de riesgo preponderante. Más del 50 % recibe, al menos, una transfusión de glóbulos rojos. Estas se han asociado a mayor riesgo de infecciones, hemorragia intracraneal, enterocolitis necrotizante y displasia broncopulmonar. En 2012, se implementó, en el Hospital Italiano de Buenos Aires, una estrategia de menor volumen de extracción de sangre por flebotomía. El objetivo del presente estudio fue evaluar su asociación con el número detransfusiones.Métodos. Estudio cuasiexperimental del tipo antes/después. Se comparó el número de transfusiones entre dos grupos de prematuros de muy bajo peso con diferente volumen de extracción. Se evaluó la correlación entre el volumen extraído y el número de transfusiones estimando el coeficiente de Spearman. Para ajustar por confundidores, se realizó un modelo de regresión logística.Resultados. Se incluyeron en el estudio 178 pacientes con edad gestacional media de 29,4 semanas (desvío estándar: 2,7) y peso al nacer de 1145 gramos (875-1345). El perfil de la serie roja inicial fue similar entre ambos grupos. El número de transfusiones (p = 0,017) y el volumen transfundido (p = 0,048) disminuyeron significativamente. El coeficiente de correlación resultó de 0,83. En el análisis multivariado, volumen de extracción y peso al nacer se asociaron a un requerimiento mayor de 3 transfusiones.Conclusión. Un menor volumen de extracción de sangre en prematuros de muy bajo peso está asociado de manera independiente a menor requerimiento transfusional.

Introduction. Anemia is a complication in very low birth weight (VLBW) infants, and lab tests are a predominant risk factor. At least one red blood cell transfusion is given in more than 50 % of cases. Transfusions are associated with a higher risk for infections, intracranial hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia. In 2012, Hospital Italiano de Buenos Aires implemented a strategy to collect a lower blood volume by phlebotomy. The objective of this study was to assess its association with the number of transfusions.Methods. Before-and-after, quasi-experimental study. The number of transfusions was compared between two groups of VLBW preterm infants with different blood collection volumes. The correlation between the collection volume and the number of transfusions was assessed estimating Spearman's coefficient. A logistic regression model was used to adjust for confounders.Results. The study included 178 patients with a mean gestational age of 29.4 weeks (standard deviation: 2.7) and a birth weight of 1145 g (875-1345). The baseline red series profile was similar between both groups. The number of transfusions (p = 0.017) and the transfusion volume (p = 0.048) decreased significantly. The correlation coefficient was 0.83. In the multivariate analysis, collection volume and birth weight were associated with a requirement of more than three transfusions.Conclusion. A lower blood collection volume in VLBW preterm infants is independently associated with fewer transfusion requirements.

Obstrução do cateter central de inserção periférica nas transfusões de concentrado de hemácias em neonatos / Obstruction of the peripherally inserted central catheter in transfusions of packed red blood cells in neonates

Introdução: O Cateter Central de Inserção Periférica (PICC) é uma tecnologia dura amplamente utilizada em Unidade de Terapia Intensiva Neonatal. Quando o neonato necessita de transfusão de concentrado de hemácias, esse cateter é uma alternativa útil para essa terapêutica. Contudo, torna-se necessário conhecer as causas de uma possível ocorrência de obstrução. Objetivos: avaliar a ocorrência de obstrução do cateter central de inserção periférica após a transfusão de concentrado de hemácias realizada em neonatos e estimar a incidência e o tempo livre de obstrução do cateter nas 24 horas após a transfusão. Método: pesquisa com delineamento do tipo coorte prospectiva, com abordagem quantitativa, desenvolvida na Unidade de Terapia Intensiva Neonatal de um hospital de ensino de Curitiba, Paraná. A amostra foi por conveniência e abrangeu os recém-nascidos que necessitaram de transfusão de concentrado de hemácias durante a utilização do PICC no período de janeiro a julho de 2019. A coleta de dados ocorreu mediante observação direta da transfusão, e da busca e registro de informações contidas nos prontuários dos recém-nascidos até 24 horas após a transfusão. O instrumento de coleta de dados abrangeu variáveis relacionadas aos recém-nascidos, aos PICC e ao desfecho. Resultados: Foram realizadas 46 transfusões de concentrado de hemácias em 24 recém-nascidos por meio de 31 PICC. Predominaram recém-nascidos do sexo masculino (70,8%), prematuros abaixo de 32 semanas (66,7%) e com peso inferior a 1500g (62,5%). Todos os cateteres eram mono lúmens, inseridos em sua maioria (35,4%) nos membros inferiores e 80,6% encontravam-se em posição central no momento da transfusão. Todos os cateteres estavam pérvios no momento da transfusão. Em pouco mais da metade (52,2%) dos PICC estava sendo infundidas três soluções e em 74,2% deles houve apenas uma transfusão de Concentrado de Hemácias. Em 100% dos cateteres foi realizado flushing intermitente. Nesta pesquisa, dentre os 31 acompanhados, um PICC obstruiu 15 minutos após o término da transfusão. A incidência de obstrução foi de 2,2% dos eventos de transfusão, e a probabilidade do PICC livre de obstrução foi de 97,8% 24 horas após a transfusão de concentrado de hemácias. Conclusões: os resultados permitem concluir que a hemotransfusão não foi a variável que contribuiu para a obstrução do PICC, e que este pode ser utilizado com segurança no que diz respeito à obstrução do cateter.

Introduction: The Peripherally Inserted Central Catheter (PICC) is a hard technology widely used in Neonatal Intensive Care Units. When the neonate needs red blood cell transfusion, this catheter is a useful alternative for this therapy. However, it is necessary to know the causes of a possible occurrence of obstruction. Objectives: To evaluate the occurrence of Peripherally Inserted Central Catheter obstruction after transfusion of red blood cells done in newborn babies, and to estimate the incidence and the time free of obstruction of the catheter in the 24 hours after the transfusion. Method: This is a research with prospective cohort outline, with a quantitative approach, developed in a Neonatal Intensive Care Unit of a teaching hospital in Curitiba, Parana. The sample was taken by convenience, and it encompassed newborns babies that needed red blood cells transfusion during the use of the PICC in the period of January-July 2019. Data collection was done through direct observation of the transfusion, and through search and registry of information collected from the patient records of new-borns until 24 hours after transfusion. The data collection instrument encompassed the variables related to the new-borns, that of the PICC, and that of the outcomes. Results: 46 red blood cells transfusion were performed on 24 newborns through 31 PICC. Male sex new-borns (70.8%), premature babies under 32 weeks (66.7%), and with weight under 1500g (62.5%) were predominant. All catheters were mono-lumen, most were inserted in the lower limbs (35.4%), and 80.6% were in central position at the moment of transfusion. All catheters were pervious at the moment of transfusion. In barely more than half (52.2%) of the PICC there were three solutions being infused, and in 74.2% there was only one transfusion done. An intermittent flushing was done in 100% of the PICC. In this research, among the 31 subjects, a single PICC was obstructed 15 minutes after the end of transfusion. The incidence of obstruction was that of 2.2%, and the probability of a PICC free of obstruction was that of 97.8% 24 hours after red blood cells transfusion. Conclusions: The results allow the conclusion that blood transfusion was not the variable that contributed for the obstruction of the PICC, and that may be used safely regarding the obstruction of the catheter.

Chronic transfusion therapy effectiveness as primary stroke prophylaxis in sickle cell disease patients

Abstract Introduction About 10% of sickle cell anemia patients will have ischemic stroke. Adams showed stroke incidence reduction in children receiving monthly erythrocyte transfusions by reducing transcranial Doppler (TCD) velocities. Since then, chronic transfusion is recommended as primary stroke prophylaxis. This study aims to assess the effectiveness of chronic transfusions as stroke prophylaxis. Method Retrospective study, reviewing medical records from 15 sickle cell anemia patients undergoing chronic transfusion. Data collected were age, sex, adverse reactions, stroke, hemoglobin, reticulocytes, ferritin, HbS and TCD values (baseline, after 12 and 24 months of treatment). Results The mean age was 118.67 ± 41.40 months; six patients experienced allergic reactions. No stroke was recorded. One patient had alloimmunization. There was a decrease in the HbS rate and an increase in hemoglobin values in the first 12 months. Values were maintained after 24 months, but with no improvement of data. Before treatment, the mean HbS rate was 75.18%±11.69; after 12 months, 41.63 ± 14.99 and after 24 months, 43.78 ± 10.6. Thirteen patients initiated chelation after 12 months from the beginning of chronic transfusions and ferritin decline after 24 months. Pre-transfusional TCD velocities were 204.28 ± 9.41 cm/s (right) and 198.85 ± 33.37 cm/s (left). After a 12-month treatment, these values were 158.5 ± 28.89 cm/s and 157.62 ± 34.43 cm/s, respectively, and this reduction was statistically significant (p = 0.002 right and p = 0.02 left). After 24 months, these values were 149.63 ± 26.95 cm/s (right) and 143.7 ± 32.27 cm/s (left). Conclusion Significant reduction of TCD velocity occurred after treatment with chronic transfusion in sickle cell anemia patients, leading to a normal or conditional test and reducing stroke risk in all but one patient.

Proposta de escala colorimétrica para inspeção visual do grau de hemólise em bolsas de concentrado de hemácias / Colorimetric scale proposal for visual inspection of the hemolysis degree in red cells concentrate bags

Objetivo: Os concentrados de hemácias não estão livres de lesões de estoque, sendo a mais comum a lise das hemácias. Criar uma escala colorimétrica para inspeção visual do grau de hemólise de concentrados de hemácias. Métodos: Foram utilizadas 102 bolsas de concentrados de hemácias (n=36), concentrados de hemácias pobres em leucócitos (n=36) ou de concentrados de hemácias desleucotizadas (n=36), com até 28 dias da produção, em condições padrões de armazenamento e da rotina da Fundação Hemopa. Os valores de hemoglobina e hematócrito foram lidos em contador automatizado. O grau de hemólise foi realizado em amostras de 5 mL do segmento das bolsas, com leitura em espectrofotômetro. O teste de hemólise foi realizado com três gotas de amostras do segmento das bolsas, em tubo seco, adição de 4 mL de solução fisiológica, centrifugação e inspeção visual do sobrenadante (estudo duplo-cego). Para a confecção da escala colorimétrica foram utilizados os resultados de grau de hemólise e teste de hemólise (n=36) e registro fotográfico dos vários níveis de grau de hemólise das bolsas. Para a validação da escala colorimétrica foram realizados grau de hemólise e teste de hemólise para as bolsas restantes (n=66), e com os resultados comparados com a escala proposta (estudo duplo-cego). Resultados: Apenas 7,5% (5/66) das bolsas testadas foram negativas para o teste de hemólise clássico (visual), e positivas quando reavaliadas na escala colorimétrica proposta. Conclusão: A escala colorimétrica proposta mostrou-se simples e reproduzível para definição de teste de hemólise e o grau de hemólise para concentrados de hemácias.

Objective: Red blood cell (RBC) concentrates are not free of stock lesions, the most common of which is lysis of RBC. Create a colorimetric scale for visual inspection of the degree of hemolysis of bag red blood cells. Methods: Eighty-two bags of RBC concentrates (n = 36), RBC concentrates poor in leukocytes (n = 36) or RBC concentrates desleucotizadas (n = 36) were used with up to 28 days of production, under standard storage conditions of the Hemopa Foundation routine. Hemoglobin and hematocrit values were read in automated counter. The degree of hemolysis performed in 5ml samples from the bag segment, with spectrophotometer reading. The hemolysis test was performed with three drops of bag segment samples, in a dry tube, addition of 4 mL of physiological solution, centrifugation and visual inspection of the supernatant (double-blind study). To prepare the colorimetric scale used was the degree of hemolysis and hemolysis test results (n = 36) and photographic records of multiple levels of degree of hemolysis of bags. For the validation of the Colorimetric scale, hemolysis degree and hemolysis test were performed for the remaining bags (n = 66), and the results were compared with the proposed scale (double-blind study). Results: Only 7.5% (5/66) of the tested bags were negative for the classical (visual) hemolysis test, and positive when reevaluated on the proposed colorimetric scale. Conclusion: The proposed colorimetric scale was simple and reproducible for the definition of hemolysis test and the degree of hemolysis for RBC concentrates.

Prescription of red cell concentrates by emergency physicians

SUMMARY OBJECTIVE To evaluate the adequacy of the prescription of red cell concentrates by emergency physicians. METHODS A cross-sectional study based on the survey of transfusion requests records completed by emergency physicians, from May/2018 to April/2019, in an emergency hospital. Adequacy in the indication, volume, and subtype (filtered, irradiated, and washed) of prescribed erythrocytes were evaluated. To compare the qualitative data, we used the χ2 test. The significance level adopted was 5%. RESULTS One thousand and twenty-two transfusions were evaluated. The indication, volume, and subtypes were correct in 72.7%, 45.9%, and 81.6% respectively. Transfusion in symptomatic patients presented superior adequacy when compared to asymptomatic individuals with significant statistical difference (indication: 79,6% vs 67.2%, p <0.001; Volume: 63.5% vs 31.7%, p <0.001; subtype: 85.3% vs 78.7%, p 0.006). Among clinical situations, there were more errors in sepsis (39.7%) and pneumonia (36.3%). More than half of the prescriptions presented excessive volume, raising the risk of circulatory overload, observing that the mean age was 60.6 years. The specific analysis of the prescribed subtypes showed adequacy of 17.9% in the filtered, 1.7% in the irradiated, and none in the washed. Thirty transfusions should have been filtered, but the prescriber did not request the subtype. CONCLUSION One hypothesis for the observed inaccuracies is inadequate medical training on the subject, both in undergraduate and medical residency, associated with a lack of continuing education on transfusion protocols. The transfusion Committee received the results of this study with a proposal for continuing education measures on transfusion hemotherapy.

RESUMO OBJETIVO Avaliar a adequação da prescrição de concentrados de hemácias por médicos emergencistas. MÉTODOS Estudo transversal por levantamento de fichas de requisição de transfusões preenchidas por médicos emergencistas, no período de maio de 2018 a abril de 2019, em um hospital de emergências. Foram avaliadas as adequações na indicação, volume e subtipo (filtradas, irradiadas e lavadas) de hemácias prescritas. Para comparação dos dados qualitativos, utilizamos o teste de χ2. O nível de significância adotado foi de 5%. RESULTADOS Foram avaliadas 1.022 transfusões. A indicação, o volume e os subtipos estavam corretos em 72,7%, 45,9% e 81,6%, respectivamente. A transfusão prescrita em pacientes sintomáticos apresentou adequação superior quando comparada aos assintomáticos, com diferença estatística significativa (indicação: 79,6% vs 67,2% - p<0,001; volume: 63,5% vs 31,7% - p<0,001; subtipo: 85,3% vs 78,7% - p 0,006). Entre as situações clínicas, ocorreram mais erros na sepse (39,7%) e pneumonia (36,3%). Mais da metade das prescrições apresentavam volume excessivo, elevando o risco de sobrecarga circulatória, observando-se que a média da idade foi 60,6 anos. A análise específica dos subtipos prescritos apresentou adequação de 17,9% nas filtradas, 1,7% nas irradiadas e nenhuma das lavadas. Trinta transfusões deveriam ter sido filtradas, porém o prescritor não solicitou o subtipo. CONCLUSÃO Uma hipótese para as incorreções observadas é a formação médica inadequada sobre o assunto, tanto na graduação como na residência médica, associada à falta de atualização nos protocolos transfusionais. O comitê transfusional recebeu os resultados deste estudo com proposta de medidas de educação permanente sobre hemoterapia transfusional.

Red blood cell prescription and recognition of transfusion reactions by pediatricians / Prescrição de hemácias e reconhecimento de reações transfusionais por pediatras

ABSTRACT Objective To assess the level of knowledge of emergency pediatricians on red blood cell transfusions and their reactions. Methods Written survey with emergency pediatricians from a pediatric hospital. Results Less than 20% of pediatricians showed appropriate knowledge on prescribing red blood cells and recognition of transfusion reactions. There was no significant statistical regarding time since graduation and blood transfusion classes in undergraduate studies or during medical residency. Conclusion Pediatricians have insufficient knowledge about red blood cell transfusions and recognition of transfusion reactions.

RESUMO Objetivo Avaliar o conhecimento de pediatras emergencistas sobre transfusão de concentrados de hemácias e reações transfusionais. Métodos Aplicação de formulário para pediatras emergencistas de um hospital pediátrico. Resultados Menos de 20% dos participantes demonstraram conhecimento adequado sobre prescrição de concentrados de hemácias e reconhecimento de reações transfusionais. Não houve diferença estatística significativa quando avaliados o tempo de formação profissional e o fato de ter recebido aula de hemoterapia na graduação ou na residência médica. Conclusão Os pediatras têm conhecimento insuficiente sobre prescrição de concentrados de hemácias e reconhecimento de reações transfusionais.

Prevalence of red blood cell alloimmunization in multiply transfused patients

Introduction: To analyze the prevalence of alloantibodies in multiply transfused patients. Methods: This study was a retrospective, exploratory and descriptive study with a quantitative approach. The study sample comprised 185 patients transfused at a referral service in the city of Passo Fundo, Rio Grande do Sul, from January 2016 to February 2018. Results: Overall, the antibodies identified were as follows: anti-E in 47 patients (18%), anti-D and anti-K in 28 patients each (11%), anti-C in 21 patients (8.1%), and inconclusive antibody results in 23 patients (8.9%). Females were a majority (55.7%), mean age was 48.8 years and mean quantity of blood transfused was 7.2 bags. Cardiovascular disorders were the most common comorbidities, in 39 patients (21.2%), followed by oncological disorders, in 38 patients (18.4%). Conclusion: Alloimmunization is an important and frequent clinical condition that increases the risk of hemolytic reactions and is associated with significant patient morbidity and mortality. (AU)