Implementation of a patient blood management program based on a low-income country-adapted clinical decision support system

ABSTRACT Introduction: Patient blood management (PBM) programs are associated with better patient outcomes, a reduced number of transfusions and cost-savings The Clinical Decision Support (CDS) systems are valuable tools in this process, but their availability is limited in developing countries This study assesses the feasibility and effectiveness of an adapted CDS system for low-income countries. Methods: This was a prospective study of the PBM program implementation, in a 200-bed tertiary hospital, between February 2019 and May 2020. Outcome measures were red blood cell (RBC), fresh frozen plasma (FFP) and platelet unit transfusions, the transfusion of a single unit of red blood cells and an RBC adequacy index (RAI). Results: Comparing the post-PBM program era with the pre-PBM system era, there was a decrease in red blood cell transfusions (p = 0.05), with an increase in single unit red blood cell transfusions (p = 0.005) and RAI (p < 0.001). Conclusions: The PBM programs, including electronic transfusion guidelines with pre-transfusion medical auditing, was associated with improved transfusion practices and reduced product acquisition-related costs.

Crise hemolitica aguda seguida por insuficiencia hepatica fulminante com evolucao fatal, como primeira manifestacao clinica da doenca de Wilson / Acute hemolytic anemia followed by a fulminant hepatic failure with lethal evolution as a first clinical manifestation of Wilson's disease

Descreveremos neste trabalho o caso clinico de paciente do sexo feminino, de 21 anos, portadora de doenca de Wilson, cuja primeira manifestacao clinica da doenca ocorreu como crise hemolitica aguda seguida por insuficiencia hepatica fulminante, com evolucao para o obito apos 26 dias de internacao. O diagnostico definitivo foi obtido apenas com a medida quantitativa do cobre hepatico em material de necropsia...