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

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

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

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

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

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Definition of Patient Blood Management

Abstract Managing the patient's blood and hematopoietic system is like managing any of the other organs and organ systems during patient care. Specialists control the heart, kidneys, endocrine system, etc. and the patient's blood requires similar clinical treatment. The hematopoietic system and its circulatory products are fundamental for the healthy functioning of the human body. In simple terms, Patient Blood Management (PBM) is an organized, patient-centered approach in which the entire healthcare team coordinates efforts to improve outcomes by managing and preserving the patient's own blood. By reducing dependence on blood transfusions, PBM seeks to improve clinical outcomes, reduce the risks and costs associated with transfusions, and improve the safety and quality of patient care. Essentially, the concept of PBM is about the holistic management and preservation of the patient's own blood in the medical and surgical context.

Nursing technicians' proxemic behaviors during transfusions in hospitalized clients / Comportamientos proxémicos de técnicos de enfermería durante transfusiones en clientes internados / Comportamentos proxêmicos de técnicos de enfermagem durante o ato transfusional em clientes hospitalizados

ABSTRACT Objective: to describe nursing technicians' proxemic behaviors during transfusions in hospitalized clients. Method: a qualitative, descriptive and exploratory study based on non-participant observation, recorded in an instrument prepared from the Theory of Proxemic Behavior. The participants were 18 nursing technicians from a reference hospital for Hematology and Hemotherapy in the Brazilian Southeast Region, from April to December 2022. Data analysis prioritized thematic content. Results: the following stood out: eye contact; instrumental touch; normal tone of voice; and intimate and personal distances. These indicate welcoming, attention and technical vigilance when carrying out the transfusions. Conclusion: there is a need to raise nursing technicians' awareness regarding proxemic behaviors when welcoming clients. That is: expanding listening, bonding and effective interpersonal coexistence, and favoring the reach of comprehensive health care in Hematology and Hemotherapy.

RESUMEN Objetivo: describir los comportamientos proxémicos de técnicos de Enfermería durante transfusiones en clientes internados. Método: estudio cualitativo, descriptivo y exploratorio, basado en la observación no participante y registrado en un instrumento elaborado a partir de la Teoría del Comportamiento Proxémico. Los participantes fueron 18 técnicos de Enfermería de un hospital que es referencia en Hematología y Hemoterapia de la Región Sudeste de Brasil, entre abril y diciembre de 2022. En el análisis de los datos se priorizó el contenido temático. Resultados: se destacó lo siguiente: contacto visual; toque instrumental; tono de voz normal; y distancias íntima y personal; los cuales indican buen recibimiento, atención y vigilancia técnica al realizar las transfusiones. Conclusión: es necesario generar conciencia en los técnicos de Enfermería con respecto a los comportamientos proxémicos al recibir a los clientes. Eso implica: prestar más atención al escuchar y ampliar los vínculos y la convivencia interpersonal efectiva, además de favorecer el alcance de las medidas de atención en integrales en Hematología y Hemoterapia.

RESUMO Objetivo: descrever os comportamentos proxêmicos de técnicos de enfermagem durante o ato transfusional em clientes hospitalizados. Método: estudo qualitativo, descritivo e exploratório, pautado em observação não participante, registrado em instrumento elaborado a partir da teoria do comportamento proxêmico. Participaram 18 técnicos de enfermagem de um hospital referência em hematologia e hemoterapia da Região Sudeste do Brasil, de abril a dezembro de 2022. A análise de dados priorizou o conteúdo temático. Resultados: destacaram-se o contato visual; o toque instrumental; o tom de voz normal e as distâncias íntima e pessoal. Estes, indicativos de acolhimento, atenção e vigilância técnica à realização do ato transfusional. Conclusão: há necessidade de despertar a consciência dos técnicos de enfermagem em relação aos comportamentos proxêmicos durante o acolhimento aos clientes. Isto é: ampliar a escuta, o vínculo, a efetiva convivência interpessoal e favorecer o alcance dos cuidados em saúde integral na hematologia e hemoterapia.

Marcadores infecciosos asociados a factores demográficos en donantes de sangre peruanos

Introducción: Las características de los donantes de sangre pueden variar entre centros de hemoterapia y pueden relacionarse con la seropositividad de marcadores infecciosos. Objetivo: Relacionar la seropositividad de marcadores infecciosos con los factores demográficos de los donantes de sangre peruanos. Métodos: Estudio observacional en los bancos de sangre del hospital nacional Cayetano Heredia y el Instituto Nacional Materno Perinatal durante el año 2019. La población la conformaron los 11 936 donantes que fueron tamizados para 7 agentes infecciosos según el Programa Nacional de Hemoterapia y Banco de Sangre. Se usó la prueba de correlación de Pearson para determinar la asociación entre las variables demográficas con los marcadores infecciosos. Resultados: Del total 8449 (70,8 %) fueron varones y el grupo etario de 35 a 55 años fue el más frecuente en ambos hospitales (~ 44,5 %). La mayoría de donantes procedían de la costa (4944; 41,4 %), aunque en el Hospital Nacional Cayetano Heredia hubo 734 (8,9 %) de la selva. La seropositividad fue de 507 (4,25 %) donaciones; los más frecuentes fueron el antígeno del core del virus de Hepatitis B, los anticuerpos contra el virus linfotrópico de células T humanas 1-2, y sífilis, con 51,2 %, 16,8 % y 14,9 %, respectivamente. La seropositividad de los marcadores infecciosos se asoció con factores demográficos como la edad, sexo y lugar de procedencia (p< 0,05). Conclusiones: Existe relación entre los factores demográficos con la seropositividad de los marcadores infecciosos en donantes peruanos.

Introduction: The characteristics of blood donors may vary between hemotherapy centers and may be related to the seropositivity of infectious markers. Objective: To related the seropositivity of infectious markers with the demographic factors of Peruvian blood donors. Methods: Observational in the blood banks of the Hospital Nacional Cayetano Heredia and the Instituto Nacional Materno Perinatal during 2019. The population consisted of 11,936 donors who were screened for the seven infectious agents according to the National Hemotherapy and Blood Bank Program. Pearson's correlation test was used to determine the association between demographic variables and infectious markers. Results: Of the total, 8,449 (70.8%) were male and the age group from 35 to 55 years was the most frequent in both hospitals (~ 44.5%). Most donors came from the coast (4,944; 41.4 %), although at the Cayetano Heredia National Hospital, there were 734 (8.9%) from the jungle. Seropositivity was 507 (4.25%) donations, then most frequent was Hepatitis B virus core antigen, antibodies against human T-cell lymphotropic virus 1-2, and syphilis, with 51.2%, 16.8%, and 14.9%, respectively. Seropositivity of infectious markers was associated with demographic factors such as age, gender, and place of origin (p< 0.05). Conclusions: There is a relationship between demographic factors with the seropositivity of infectious markers in Peruvian donors.

Development of blood transfusion external quality assessment program at national scale

Introduction: External quality assessment is a crucial component in ensuring the quality of blood transfusion testing laboratories. Objectives: To develop a procedure for generating external quality assessment items for blood transfusion testing to evaluate participants' performance. Methods: Experimental research was conducted at Quality Control Center for Medical laboratory- University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam. Three items, including red blood cell, serum, and atypical antibody serum samples, were assessed for homogeneity and stability; 5 assessment areas, including ABO grouping, Rh grouping, compatible cross matches, Coombs test, and screening of atypical antibodies, were utilized to evaluate the performance of 38 participants in the 2020-2021 period. Results: Red blood cell and serum samples maintained quality for a specific period at controlled temperatures, while serum samples with atypical antibodies showed stability at different temperatures. The participants demonstrated high satisfactory performance in ABO grouping, Rh grouping, Coombs test, and screening for atypical antibodies. However, the most unsatisfactory performance was reported in crossmatching, with 15% of participants unsatisfactory results. Conclusion: The procedure of production of proficiency testing items has been successfully developed, and its application at the national level is suggested to improve the quality of blood transfusion laboratories.

Introducción: La evaluación externa de calidad es esencial para asegurar la calidad de los laboratorios de pruebas de transfusión sanguínea. Objetivos: Desarrollar un procedimiento para generar elementos de evaluación externa de calidad y evaluar el rendimiento de los participantes en pruebas de transfusión sanguínea. Métodos: Estudio experimental realizado en el Centro de Control de Calidad para Laboratorios Médicos de la Universidad de Medicina y Farmacia en la Ciudad de Ho Chi Minh, Vietnam. Se evaluaron muestras de glóbulos rojos, suero y suero con anticuerpos atípicos para homogeneidad y estabilidad. Se utilizaron 5 áreas de evaluación, incluida la agrupación ABO, la agrupación Rh, las coincidencias cruzadas compatibles, la prueba de Coombs y la detección de anticuerpos atípicos, para evaluar el desempeño de 38 participantes, en el período 2020-2021. Resultados: Las muestras de glóbulos rojos y suero mantuvieron la calidad durante un período específico a temperaturas controladas, mientras que las muestras de suero con anticuerpos atípicos mostraron estabilidad a diferentes temperaturas. Los participantes obtuvieron un alto rendimiento en algunas áreas, como la agrupación ABO y Rh, la prueba de Coombs y la detección de anticuerpos atípicos. Sin embargo, las pruebas de compatibilidad reportaron un rendimiento insatisfactorio en un 15% de los participantes. Conclusión: El procedimiento desarrollado cumple con los criterios de calidad, y se sugiere su aplicación a nivel nacional para mejorar la calidad de los laboratorios de transfusión sanguínea.

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

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

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

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

Statistical Analysis of Monocyte Monolayer Assay Validation in Brazilian Blood Donors

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Implementación de tromboelastografia para evitar la transfusión de plasmas fresco congelado en neonatos / Implementation of thrombelastography to avoid transfusion of fresh frozen plasma in neonates

Introducción: actualmente, la indicación principal para la transfusión de FFP es corregir la deficiencia de los factores de coagulación en pacientes con hemorragia activa o sugestión de esta, sin embargo, la práctica clínica ha demostrado que un porcentaje grande de las transfusiones de FFP en neonatología no siguen las recomendaciones de las guías actuales y, en su mayoría, son innecesarias. Objetivo: ampliar el conocimiento que se tiene sobre la transfusión de FFP en neonatología y la implementación de la tromboelastografía para evitar realizar estas intervenciones. Metodología: se realizó una revisión de la literatura en la base de datos PubMed y Elsevier, usando palabras clave como tromboelastografía, transfusión de plasma en neonatos, hemostasia neonatal. Conclusión: se evidenció que los tiempos de coagulación de los neonatos y prematuros sanos son más prolongados en comparación a los adultos, por ello facilita su errada cuando se habla de transfusión de FFP, de ahí que la TEG sea una buena herramienta para evaluar el estado coagulante de los neonatos de manera integral, sin abrir paso a errores de interpretación y facilitando la decisión de tratamientos en los pacientes en UCIN, antes de requerir transfusiones de FFP.

Introduction: Currently the main indication for FFP transfusion is to correct coagulation factor deficiency in patients with active bleeding or its suggestion, however, clinical practice has shown that a large percentage of FFP transfusions in neonatology do not they follow current guideline recommendations and are mostly unnecessary. Objective: To expand the knowledge about these transfusions in neonatology and the implementation of thrombelastography to avoid performing these interventions. Methodology: A review of the literature was carried out in the PubMed and Elsevier databases, using keywords such as "thrombelastography", "plasma transfusion in neonates", "neonatal hemostasis". Conclusion: It was evidenced that the coagulation times of healthy neonates and premature infants are longer compared to adults, thus facilitating their misinterpretation and limiting their use when talking about FFP transfusion, therefore TEG is a good tool. to evaluate the coagulation interpretación y limita su utilización status of neonates in a comprehensive manner, without giving way to interpretation errors and facilitating treatment decisions in patients in the NICU before requiring FFP transfusions.

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

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

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

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

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

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

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

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

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

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