Blood components requests at an orthopedic hospital: a critical survey

Abstract Introduction The correct completion of the blood components request form is the starting point to ensure good transfusion care. Many guidelines have been developed to search for hemoglobin values that trigger the need for transfusion and show the importance of Patient Blood Management, a scientific evidence-based approach in processes where transfusion is a possibility, such as in elective surgeries. Objective The cross-sectional study aimed to analyze the transfusion requests at a complex orthopedic hospital over a one-year period. Method The completion quality was classified as Good, Regular, Bad or Very Bad, according to the information given by the physician. Transfusion medicine professionals analyzed the transfusion indication reported on the request form and classified it as Correct, Not based on Patient Blood Management (PBM), in accordance or not with the institutional Maximum Surgical Blood Order Schedule, Impossible to evaluate due to lack of information on the form, and Incorrect. Results The study categorized the completion quality of 2011 requests as Good (8.80%), Regular (9.30%), Bad (72.75%) and Very Bad (9.15%). Analysis of the indications revealed that 54.90% of the requests were in accordance with the current blood transfusion recommendations, and on 23.12% of the forms this field had not been filled out. Conclusion The majority of blood components (63%) requests are in tune with current blood transfusion recommendations, despite the great number of incorrectly completed forms; nevertheless, it is mandatory to reach much better appropriateness rates.

Cenário mundial do fracionamento industrial de plasma e da produção de hemoderivados / World scenario of industrial plasma fractioning and blood derivates production

A produção de hemoderivados no mundo se iniciou nos anos 40, depois que o químico americano Edwin Cohn desenvolveu uma técnica de precipitação das proteínas plasmáticas pelo álcool. Desde então, a indústria tem passado por diversas fases, das quaisa primeira foi o boom da produção de albumina em pequenos laboratórios. Depois, surgiram os fatores de coagulação liofilizados para o tratamento da hemofilia e as imunoglo-bulinas intravenosas. O aparecimento da AIDS e a comprovação de que ela era transmitida pelos hemoderivados, nos anos 80, trouxeram no seu bojo uma transformação radical, com a introdução de métodos de inativação viral e a obrigação de a indústria cumprir compadrões de qualidade cada vez mais rígidos. O surgimento dos fatores de coagulação recombinantes modificou preços e estratégia dos centros de fracionamento de plasma, hoje focados principalmente na produção de imunoglobulina. A tendência da indústria de hemoderivados tem sido o de consolidações e fusões, criando grandes grupos econômicos que controlam o setor e que dependem cada vez mais do plasma em centros de doação remunerada, disseminados nos Estados Unidos. O Brasil entrou recentemente para o rol dos países com indústrias de hemoderivados, com a criação da Hemobrás, empresa estatalpertencente ao governo federal, cujo objetivo central é aproveitar o plasma disponível no país e reduzir a dependência externa por hemoderivados.

The hemoderivative production started in the 1940s, after the American chemistEdwin Cohn developed a alcohol–based plasmatic–protein precipitation technique. Since then, industry has gone through many phases, being the boom of albumin production in small labs the first one. After that, lyophilized coagulation factors appeared for the treatment of hemophilia and intravenous immunoglobulin. AIDS appearing and the verification that it was transmitted by hemoderivatives, in the 1980s, made present a radical transformation that introduced viral inactivation methods and the industry’s obligation of complying with higher quality standards. The appearance of recombinant coagulation factors modified both prices and strategies of plasma fractionation centers, focused nowadays in imunnoglobulin production. Hemoderivative industry is following a consolidation and fusion tendency, creating big economical groupswhich control the sector and depend more and more on plasma from paid donation center, popular in The United States. Brazil has recently entered to the list of countries with hemoderivative industries after the creation of Hemobrás, whose main goal is to use the plasma available in the country to reduce the dependance on imported hemoderivatives.