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Introduction: Anemia is a highly prevalent disorder. Preoperative anemia is associated with higher mortality, more complications, longer hospital stays, and higher healthcare costs. Red blood cell transfusion (RBC) does not improve these outcomes. The World Health Organization recommends implementing Patient Blood Management (PBM) programmes, as they can improve these clinical outcomes, reduce unnecessary RBC transfusions, and save costs. Despite compelling evidence, the implementation of these measures has yet to be effectively achieved. The objective of this study is to conduct a situational analysis to raise awareness about this issue and encourage the implementation of these measures. Methodology: An observational, longitudinal, retrospective cohort study was conducted at a single center. All patients undergoing elective surgery from 01/01/2022 to 01/04/2022 at the Hospital de Clínicas were included. Exclusion criteria: absence of a complete blood count in the three months prior to surgery and refusal to participate in the study. Results: A total of 329 surgeries were analyzed. 52 out of 100 procedures were performed on patients with anemia. A statistically significant association was found between preoperative anemia and receiving RBC transfusion during hospitalization. OR 11.746 (4.518 - 30.540). Anemia and RBC transfusions significantly prolonged hospital stay. Length of hospitalization based on patient condition: No anemia: 10.1 ± 1.1 days, with anemia: 27.2 ± 2.3 days. Value of p < 0.001. Non-transfused: 14.5 ± 1.3 days, transfused: 41.8 ± 4.4 days. Value of p < 0.001. Only 49 (28.6%) of the 171 patients with anemia had iron metabolism assessed before surgery. Among the 140 patients with Hb < 12 g/dL undergoing surgeries with non-insignificant bleeding, only 4 received specific treatment to optimize Hb. A total of 185 units of red blood cells (RBC) were administered during hospitalization. 49 to unstable patients (intraoperative or acute hemorrhage) and 136 to stable patients. From the analysis of the latter group, 42.5% of the patients received 3 or more RBC units. The average pre-transfusion hemoglobin was 7.0 ± 0.1. A statistically significant association was found between receiving RBC units and dying during hospitalization. OR 17.182 (3.360 - 87.872). Conclusiones: A situational analysis was conducted, revealing a high prevalence of preoperative anemia, scarce study and treatment of anemia before surgeries, and an excessive amount of blood transfusions received by some patients. This work establishes the need to implement Patient Blood Management programs to reduce the prevalence of preoperative anemia and improve our transfusion practices. It also sets a comparative framework to evaluate the progress of these measures and indicates possible indicators to assess the benefits of their implementation.
Introdução : A anemia é um distúrbio altamente prevalente. A anemia pré-operatória está associada a maior mortalidade, mais complicações, tempo prolongado de internação e maiores custos de saúde. A transfusão de glóbulos vermelhos (TGV) não melhora esses resultados. A Organização Mundial da Saúde recomenda a implementação de medidas de Gerenciamento de Sangue do Paciente (GSP), pois permitem melhorar esses resultados clínicos, reduzir TGV desnecessárias e economizar custos. Apesar da evidência contundente, a implementação dessas medidas ainda está aquém de ser efetivada. O objetivo deste trabalho é realizar uma análise da situação para conscientizar sobre o problema e incentivar a implementação dessas medidas. Metodologia: Foi realizado um estudo observacional, longitudinal, retrospectivo de coorte histórica, unicêntrico. Foram incluídos todos os pacientes submetidos a cirurgias de coordenação de 01/01/2022 a 01/04/2022 no Hospital de Clínicas. Critérios de exclusão: ausência de hemograma nos três meses anteriores à cirurgia e recusa em participar do estudo. Resultados: Foram analisadas um total de 329 cirurgias. 52 a cada 100 procedimentos foram realizados em pacientes com anemia. Foi encontrada uma associação estatisticamente significativa entre a anemia pré-operatória e a recepção de TGR durante a internação. OR 11,746 (4,518 - 30,540). A anemia e as TGR prolongaram significativamente a internação hospitalar. Dias de internação em função da condição do paciente: Sem anemia: 10,1 ± 1,1 dias, com anemia: 27,2 ± 2,3 dias. Valor p < 0,001. Não transfundidos: 14,5 ± 1,3 dias, transfundidos: 41,8 ± 4,4 dias. Valor p < 0,001. Apenas 49 (28,6%) dos 171 pacientes com anemia tinham metabolismo do ferro antes da cirurgia. Dos 140 pacientes com Hb < 12 mg/dL submetidos a cirurgias com sangramento não insignificante, 4 receberam tratamento específico para otimizar a Hb. Foram administradas um total de 185 unidades de glóbulos vermelhos (UGV) durante a internação. 49 em pacientes instáveis (intraoperatório ou hemorragia aguda) e 136 em pacientes estáveis. Da análise desses últimos, 42,5% dos pacientes receberam 3 ou mais UGV. A hemoglobina pré-transfusional média foi de 7,0 ± 0,1. Foi encontrada uma associação estatisticamente significativa entre receber UGV e falecer durante a internação. OR 17,182 (3,360 - 87,872). Conclusões: Foi realizado uma análise da situação na qual foi observada uma elevada prevalência de anemia pré-operatória, um estudo e tratamento escasso da anemia antes das cirurgias e uma quantidade excessiva de UGV recebidas por alguns pacientes. Este trabalho estabelece a necessidade de implementar programas de Gerenciamento de Sangue do Paciente para reduzir a prevalência de anemia pré-operatória e melhorar nossas práticas transfusionais. Além disso, estabelece um quadro comparativo para avaliar o progresso dessas medidas e aponta possíveis indicadores para avaliar os benefícios de sua implementação.
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Background: Blood transfusion holds utmost importance in comprehensive obstetric care and Gynaecology. The present study has been done to evaluate the indications of blood transfusion in the Obstetrics and Gynaecology Department. Methods: The retrospective observational study was conducted between April 2023 to April 2024 in Department of Obstetrics and Gynaecology, Government Medical College, Saharanpur. Results: A total of 257 units of Blood was transfused between April 2023 to April 2024 in Obstetrics and Gynaecology Department. 60.6% transfusion were in age group 21-30 years. 48.26% transfusion were in hemoglobin 7-9 gm/dl. Most common blood group transfused was B positive 40.79% and 85.2% transfusion were packed red blood cell, 84.07% had single unit blood transfusion, 57.25% had transfusion for anemia in pregnancy, 36.84% transfusion were for abnormal uterine bleeding. Conclusions: Prevalence of anemia in reproductive age group is an important reason for blood transfusion in obstetrics and gynaecology. Hence emphasis should be to treat anemia through drugs to reduce unnecessary transfusion especially single unit transfusion.
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The Bombay blood group is a rare blood type, predominantly found in regions with a high prevalence of consanguineous marriages due to its autosomal recessive inheritance pattern. This blood group is unique because individuals lack the H antigen, a precursor to the A and B antigens found in other blood types, making their blood type exceptionally rare. Managing antenatal patients with the Bombay blood group presents significant challenges, especially in cases of anaemia or any instance of blood loss. The primary difficulty arises from the scarcity of compatible blood for transfusion, as individuals with the Bombay blood group can only receive blood from other Bombay group donors. This rarity complicates the management of potential complications during pregnancy, labour, and delivery. To address these challenges, minimizing blood loss is essential during all stages of pregnancy, particularly during labour, Caesarean sections, and in the prevention of postpartum haemorrhage. Effective management requires a multidisciplinary approach, involving obstetricians, haematologists, and blood bank services. One potential strategy to mitigate the risk of blood shortages is autologous blood transfusion. This option can be particularly valuable during pregnancy; however, it requires careful consideration of the potential risks and benefits. The procedure should be conducted under the guidance of healthcare professionals experienced in managing such cases, ensuring the safety and well-being of both the mother and the foetus. In our case report, we present an antenatal patient with anaemia and the challenges encountered during the antenatal and postnatal periods. This case highlights the complexities of managing pregnancies involving the Bombay blood group. It underscores the importance of a well-coordinated, multidisciplinary approach to optimize outcomes for both mother and child.
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Background: Neonatal hyperbilirubinemia continues to be the most common cause of hospital admissions and readmissions in the neonatal population worldwide and this pattern continues despite attempts to identify neonates at risk of pathological hyperbilirubinemia. The aim of the study was to determine the clinical profile and etiology in neonates who were treated with double volume exchange transfusion (DVET).Methods: This was a hospital based prospective observational study in neonates ?35 weeks of gestation who were treated with DVET for severe hyperbilirubinemia in a tertiary care centre over a period of six months.Results: In our study 110 neonates with severe hyperbilirubinemia were treated with DVET. Majority of the neonates were males (59.1%). Lower segment caesarean section (LSCS) was the common mode of delivery observed in 66.4% of the study subjects. Rh incompatibility (36.4%) was the commonest cause of exchange transfusion followed by ABO incompatibility (20%). The mean age of neonates at admission and mean age at DVET in days were 4.03�46 and 4.25�44 respectively. The mean birth weight of neonates treated with DVET was found to be 2.81�57. The mean total serum bilirubin at pre-exchange and post exchange were 26.13�58 mg/dl and 11.63�24 mg/dl respectively.Conclusions: Rh incompatibility was the most common cause in neonates with severe hyperbilirubinemia requiring double volume exchange transfusion.
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Background: Thalassemia, a prevalent genetic disorder, necessitates recurrent blood transfusions for life, precipitating iron overload and premature death. In ?-thalassemia major (BTM), hypothyroidism prevalence fluctuates (6-30%) globally, influenced by diverse chelation regimens. The objective of this study is to evaluate the thyroid hormone levels in pediatric patients diagnosed with transfusion-dependent thalassemia (TDT).Methods: A hospital-based cross-sectional study was conducted at the paediatrics department of Sir Salimullah medical college Mitford hospital, Dhaka, focusing on TDT patients aged 4 to 18 years. Exclusions comprised known cases of hypothyroidism, children receiving hormonal therapy, those with a family history of hypothyroidism, and individuals with fewer than 10 blood transfusions. Serum separation involved centrifugation at 3000 rpm for 5 minutes, with subsequent aliquoting into two screw-capped dry clean vials: 1 ml each for FT4/TSH and serum ferritin estimation. Data were analyzed using SPSS version 24.0.Results: Eighty-seven transfusion dependent thalassemia children aged between 4 to 18 years were chosen in this study. The hypothyroidism was seen in 7 (8%) patients. Of these, 4 (4.6%) participants were compensated hypothyroid and 3 (3.4%) participants were uncompensated hypothyroid. Most of the participants were hypothyroidism with Hb E-? thalassemia. The mean serum ferritin level was 2578.49�85.06 ng/ml. Positive correlation of TSH with duration of disease (in years), total number of blood transfusion times and serum ferritin were statistically significant (p<0.05).Conclusions: The present study demonstrates that 8% of the children with TDT have hypothyroidism. Hypothyroidism is more frequent among Hb E ?-thalassemic children as compared to ?-thalassemic children.
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Although blood is the essence of life, and is one of the most precious donations; blood transfusion services are facing shortage of blood all over the world. A significant percentage of people have false beliefs about blood donation. Increase in the level of knowledge and correction of false beliefs should be the top most priority. Therefore, studying factors contributing to their knowledge, attitude and practice of blood donation is essential. There are studies that investigated the effectiveness of interventions or procedure changes in blood donation settings on outcomes including donor deferral, disclosure of risk factors, and rates of errors and omissions. Researchers also identified several interventions to improve donor compliance that have been tested in blood donation settings and provided evidence for the effectiveness of computerized interviews in improving detection of risk factors. Interventions can utilize the processes of change (POC) measure to guide stage matched interventions to encourage use of relevant experiential and behavioral strategies to increase blood donation. Interventions to recruit and retain blood donors in the general population have been classified into five approaches: motivational, reminders/asking, measurement of cognitions, incentives, and preventing vasovagal reactions. Effective recruitment and retention are two different processes and may require different approaches. For example, retention may be influenced more by interventions that focus on actions during or after donation rather than interventions prior to the blood donation appointment.
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Background: Blood transfusion is a routine lifesaving medical intervention which is generally regarded as safe when done properly. However, at the same time it also bears considerable risk. The aim of the study was to assess the serum IgE levels in patients experiencing transfusion-related allergic reactions after receiving fresh frozen plasma. Methods: This cross-sectional observational study was conducted at the Department of Transfusion Medicine, BSMMU, from March 2019 to August 2021, focusing on patients aged 5 to 60 years receiving fresh frozen plasma. Patients were included after obtaining informed consent from themselves or their legal guardians in the case of minors, according to the eligibility criteria. Data were analyzed using SPSS version 26, with statistical significance set at p<0.05, employing Chi-square tests and Pearson抯 correlation coefficient for variable comparisons. Results: Raised IgE level was significantly related with transfusion related allergic reaction after receiving fresh frozen plasma (p<0.05). The mean IgE was 521.4�4.6 in patients with reaction and 67.8�.2 in patients without reaction. Significant positive correlation was observed in serum IgE level with age in years. Conclusions: Patients with transfusion related allergic reaction receiving fresh frozen plasma had higher mean IgE levels as compared to those without reaction.
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Hydrops fetalis is a presenting illness with various immune and non-immune etiologies. It involves fluid accumulation in body cavities, and symptoms specific to its underlying cause. In this case, we report on a preterm neonate with a history of bad obstetrics who presented with hydrops fetalis due to fetal anemia related to RH incompatibility. The patient received an intrauterine transfusion for severe fetal anemia and subsequently required NICU admission. Routine preterm care was provided, along with specific management for jaundice resulting from isoimmune hemolytic anemia.
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Objective: This study was conducted to assess the knowledge, attitude and application of hemovigilance by postgraduates and interns in a tertiary care hospital.Methods: A pre-validated questionnaire is used in this cross-sectional investigation. Postgraduates’ and interns’ Knowledge, Attitude and Practice (KAP) about hemovigilance, potential reasons for under-reporting, and strategies for enhancing transfusion reaction reporting were all intended to be evaluated in this study. The study was carried out over a period of 2 mo and included all the clinical PGs and interns who willingly gave consent.Results: The questionnaire was completed by 243 individuals in total. A mean of 94% of postgraduate students and 92% of interns were familiar with transfusion reactions. Merely 68% of the respondents possessed knowledge of India's Hemovigilance initiative. A total of 90% of participants concurred that it is essential to report adverse transfusion reactions. The idea of hemovigilance should be taught in UG curricula, according to 92% of participants overall. The majority of participants exhibited a favourable attitude towards the idea of hemovigilance. All the participants were willing to report unfavourable transfusion reactions.Conclusion: Although most participants have a good attitude towards reporting transfusion reactions, there is a lack of information about the hemovigilance program and the reporting process. For this reason, our research recommends that reporting procedures be included in undergraduate curricula and that seminars like training programs be held for postgraduates and practitioners.
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Background: Total knee replacement is one of the common orthopaedic procedures performed worldwide. Blood transfusion is one of the major requirements in TKR procedure due to the amount of blood loss during and after the procedure. We carried out a prospective study to determine the efficacy of tranexamic acid in controlling blood loss during TKR procedure. Methods: Study was conducted at a tertiary care centre, involving cases operated by a single surgeon. Study included 140 patients undergoing primary TKR for advance degenerative disease of knee and were divided into two groups of 70 each, one group that received tranexamic acid before surgery and another group that did not receive tranexamic acid before surgery. Patient with allergy to the drug, hepato/renal dysfunction, DVT, abnormal PT and INR were not included. Tranexamic acid was given intravenously as well as intra-articular. Results: Pre-operative haemoglobin ranged from 10.2 gm% to 14.4 gm% in the group getting tranexamic acid and from 10% to 14 % in the group not getting tranexamic acid. Post operatively haemoglobin varied from 8.4 gm% to 12.8 gm% in Group 1 and from 7.8 gm% to 12 gm% in Group 2. Difference of mean post-operative Hb (p=0.0045) and PCV (p=0.0024) in two groups was statistically significant. Conclusions: We concluded that administration of tranexamic acid reduces the blood loss as well as need of blood transfusion in a patient undergoing total knee replacement.
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Background: Aim of the study were to identify the changing trends in labor management in terms of rate of cesarean section (C-section), rate of trial of labor after C-section (TOLAC), rate of primary and repeat C-section, rate of episiotomy in primi and multi-gravida and percentage contribution of red cell concentrate (RCC) to total blood transfusion.Methods: The data was collected retrospectively for every year at SSG hospital, Baroda from 1st January 2014 to 31st December 2022. C-section rate was calculated per annum in percentage, which was again split into primary and repeat C-section rate. Leading indications for primary C-section were identified. Rate of total episiotomy, in primigravida and multigravida, trends of RCC transfusion rates and its contribution to total blood products were estimated. Appropriate statistical tests were applied to check level of significance.Results: C-section rate contributing to total confinements increased from 30.76% in 2014 to 37.6% in 2022, which was statistically significant. Contribution by primary C-section has decreased but repeat C-section has increased over these years. Common indications for primary C-section included fetal distress, MSL, breech presentation, non-progression of labor etc. Overall rate of episiotomy has increased from 41% in 2104 to 54.4% in 2022, with decrease in primigravida and increase in multigravida over these years but these rates are not significantly changed. Contribution of RCC to total transfusion significantly decreased from 76.1% in 2014 to 66% in 2022.Conclusions: Rate of total and for repeat C-section are increasing with time, so TOLAC and other strategies to reduce primary C-section should be focused upon. Episiotomy must not be routine and should be given when indicated only. Interventions to reduce requirement of blood transfusion must be strengthened. New oral and parenteral iron preparations should be accepted based on evidences.
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Anemia is frequent in preterm infants. Red blood cell transfusion practices vary between different centers. The objective of this study was to review red blood cell transfusion practices in preterm infants between 2020 and 2021. This was a narrative review that included studies published on PubMed (Medline) and Web of Science between October 2020 and October 2021. Ten studies were included finally. Red blood cell transfusion frequency was variable. Some neonatal units did not report transfusion protocols. Most studies reported volumes of 10-15 ml/kg per transfusion. The implementation of an anemia care bundle and adoption of restrictive transfusion resulted in a reduction in the number of transfusions, the volume transfused, and a reduction in the rate of multiple transfusions. We suggest that neonatal units that care for preterm infants should have a transfusion protocol based on the best evidence available and this issue may improve.
A anemia é frequente nos bebês prematuros. As práticas de transfusão de glóbulos vermelhos variam entre os diferentes hospitais. O objetivo deste estudo foi revisar as práticas de transfusão de glóbulos vermelhos em bebês prematuros entre 2020 e 2021. Esta foi uma revisão narrativa que incluiu estudos publicados no PubMed (Medline) e Web of Science entre outubro de 2020 e outubro de 2021. Dez estudos foram definitivamente incluídos. A frequência de transfusão de glóbulos vermelhos foi variável. Algumas unidades neonatais não relataram protocolos de transfusão. A maioria dos estudos relatou volumes de 10-15 ml/kg por transfusão. A implantação de um conjunto de cuidados para anemia e a adoção de transfusão restritiva resultaram em uma redução do número de transfusões, do volume transfundido e uma redução na taxa de transfusões múltiplas. Sugerimos que as unidades neonatais que prestam cuidados a bebês prematuros devem ter um protocolo de transfusão baseado em evidências para que todo esse problema melhore.
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Humanos , Recém-Nascido , Recém-Nascido Prematuro , Transfusão de Eritrócitos , AnemiaRESUMO
Background: Jaundice is one of the most common problems occurring in newborns. Severe neonatal hyperbilirubinemia is a common cause of sensory neural hearing loss. It is important to identify and treat the jaundice early, to prevent complications like encephalopathy leading to hearing loss. Early detection of hearing loss is important for early intervention. The aim of the study was to evaluate the prevalence of sensorineural hearing loss (SNHL) in children with hyperbilirubinemia and to correlate the degree of hearing loss with degree of hyperbilirubinemia. Methods: The 50 cases including newborn and young children (<12 years of age) having history of hyperbilirubinemia and exchange transfusion were included in this study. After the approval and clearance from institutional ethical committee, this study was conducted from April 2021 to March 2022 in the department of ENT, govt. medical college Amritsar in co-ordination with department of pediatrics. Results: On comparing brain stem evoked response audiometry (BERA) and otoacoustic emissions (OAE) results, it was found that out of 50 patients BERA was abnormal in 8 patients while 42 had normal BERA. 18% (9) patients had abnormal OAE results out of which 7 had bilateral REFER result while 2 had unilateral REFER result. On comparing the OAE and BERA for sensitivity and specificity, the sensitivity was 92.9% in right ear while specificity was 62.5%, whereas in left ear sensitivity was 95.2% while specificity was 75%. Conclusions: According to our study the prevalence of sensorineural hearing impairment comes out to be 16% as per BERA. BERA is more sensitive and specific as compared to OAE. But still OAE can be used as screening test considering the cost factor and ease of conducting OAE test while BERA is a confirmatory test for SNHL.
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Background: The etio-pathogenesis of growth failure in transfusion dependent thalassemia major (TDTM) children is mainly because of chronic anemia, iron overload and endocrine complications. Aim was to determine the association between anthropometric measurements with pre-transfusion haemoglobin in TDTM children.Methods: Present cross-sectional study included total 55 children between 5-18 years of age who were diagnosed as TDTM. Mean pre transfusion hemoglobin of last 1 year was obtained from previous medical records. Anthropometric measurements like weight in kg and height in cm measured while body mass index (BMI) was calculated using standard formula in each patient. Weight for age, height for age, and BMI were plotted on WHO 2006 and Indian academy of paediatrics 2015 combined growth charts in terms of percentile. Data was analysed statistically.Results: Total 55 children of TDTM between 5-18 years of age were studied. The mean age was 10.42(4.07) years. The mean weight (kg), height (cm) and BMI was 23.76 (7.5), 123.94 (18.13) and 15.24 (1.76) respectively. Fifty-one (92.73%) children were having BMI less than 3rd centile (Underweight). Forty (93.02%) and 11 (91.66%) children between age group of 5-10 years and more than 10 years were underweight and was statistically significant (p<0.05). Total 50 (94.33%) children were having mean pre transfusion hemoglobin below 9 gm/dl who were underweight which was statistically significant.Conclusions: Low pre-transfusion hemoglobin is one of the risk factors for growth failure in children with TDTM and it should be maintained above 9 gm/dl may for normal growth in children with TDTM.
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Background: The Bombay blood group, a rare type often confused with 慜�, poses a critical transfusion risk, requiring specific compatibility with Bombay (Oh) blood. With a lack of data in Bangladesh, this study aimed to establish a comprehensive database for the rare Bombay phenotype, crucial for transfusion safety. Objective was to determine the frequency prevalence of Bombay phenotype among 慜� blood group individuals. Methods: A cross-sectional study conducted at Bangabandhu Sheikh Mujib Medical University from January 2020 to June 2021 involved, aseptic collection of 3 ml venous blood sample, with forward and reverse blood grouping revealing a 慜� phenotype. Utilizing anti-H lectin resolved discrepancies and confirmed the absence of 慔� antigen in individuals with Bombay blood groups. Blood samples of Bombay phenotype individuals showed the following reactions: anti-A (-), anti-B (-), anti-AB (-), anti-H (-), A cells 4+, B cells 4+, O cells 4+. Results: Among 10,000 individuals with apparent blood group 慜�, 99.97% were identified as 慜� blood type, while only 0.03% exhibited the rare Bombay blood group. ABO and Rh-D blood group frequencies varied over the study period, with B +ve at the highest (28.31%) and AB -ve at the lowest (0.21% to 0.23%). Overall, O +ve had the highest frequency (97.29%), and Bombay blood group was rare, with 慜� dominating at 99.97%. Conclusions: The study identified a 0.03% prevalence of the Bombay phenotype. Due to its potential confusion with 慜� blood group, transfusing 慜� blood to Bombay individuals carries a substantial risk of severe hemolytic reactions, including fatal consequences.
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Resumen: Introducción: La transfusión conlleva complicaciones y mortalidad en cirugía cardíaca, con incidencia de 40-90%. Existen escalas que predicen riesgo transfusional; sin embargo, difieren en el número y tipo de variables; además, pocas han sido comparadas en la población mexicana. Objetivo: Evaluar las escalas Transfusion Risk Understanding Scoring Tool (TRUST) y Transfusion Risk and Clinical Knowledge (TRACK) para riesgo de transfusión en cirugía cardiovascular en población mexicana. Material y métodos: Estudio observacional, retrospectivo, comparativo. Incluyó 300 pacientes sometidos a cirugía cardiovascular electiva mayores de 18 años. Se evaluó mediante curva ROC el área bajo la curva (AUC) de los puntajes TRACK y TRUST y su relación con la variable hemotransfusión. La estadística inferencial fue mediante t de Student y χ2. Resultados: Fueron 83 mujeres (27.7%) y 217 hombres (72.3%). Se transfundieron 227 pacientes (75.7%); la mayoría con hematocrito > 35% (82.2%). La sensibilidad, especificidad y AUC para identificar pacientes de riesgo alto y muy alto de la escala TRACK fueron: 76%, 50% y 0.702, respectivamente; para la escala TRUST fueron: 68%, 57% y 0.69, respectivamente. Conclusiones: Las escalas TRACK y TRUST son útiles para la estratificación de riesgo de transfusión en cirugía cardíaca electiva en nuestra población.
Abstract: Introduction: Transfusion leads to complications and mortality in cardiac surgery, with an incidence of 40-90%. There are scales that predict transfusion risk, however, they differ in the number and type of variables; furthermore, few have been compared in Mexican population. Objective: To evaluate the Transfusion Risk Understanding Scoring Tool (TRUST) and Transfusion Risk and Clinical Knowledge (TRACK) scales for risk of transfusion in cardiovascular surgery in the Mexican population. Material and methods: Observational, retrospective, comparative study. It included 300 patients older than 18 years who underwent elective cardiovascular surgery. The area under the curve (AUC) of the TRACK and TRUST scores and their relationship with the transfusion variable were evaluated using the ROC curve. The inferential statistics implemented were Student's t and χ2. Results: There were 83 women (27.7%) and 217 men (72.3%). 227 Patients (75.7%) were transfused; the majority with hematocrit > 35% (82.2%). Sensitivity, specificity, and AUC to identify high and very high risk patients of the TRACK scale were: 76%, 50% and 0.702, respectively; for the TRUST scale were: 68%, 57% and 0.69, respectively. Conclusions: The TRACK and TRUST scales are useful for transfusion risk stratification in elective cardiac surgery in our population.
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Background: Adverse reactions due to transfusion of blood and blood products should be reported for the betterment of patients health and to minimize such effects in the future. A Program was initiated to report and reduce incidence of adverse reactions to blood products which is hemovigilance program of India. Aim was to evaluate the knowledge, attitude and practice of haemovigilance among postgraduates and interns. Methods: This was a cross-sectional questionnaire-based study conducted among 159 participants of a tertiary care hospital for a period of 1 month. Results: Results obtained were analysed using descriptive and qualitative statistics. About 83.6% of the participants were aware about the concept of Haemovigilance. Only 23 out of the 159 had reported transfusion reactions in the past but the attitude towards this concept was satisfactory. Conclusions: Overall the participants had a less satisfactory overview of this concept and hence educational interventions can aid in serving the purpose.
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Background: Blood transfusion is a life-saving intervention. Blood should be accepted from non-remunerated and healthy donors. Proper donor screening procedure minimizes the risk of transfusion transmitted Infections and also wastage of blood and blood products and thus screening of donors is a prerequisite for blood donation. Methods: This is a retrospective study conducted in blood bank center in the Department of Pathology in a Government teaching hospital, Shivamogga from January 2022 to June 2022. All the voluntary and replacement donors were evaluated by the standard questionnaire and medical examination including demographic profile, anthropometry, blood group, vital signs and hemoglobin estimated by cyanmethemoglobin method were collected from the donation requisition forms and online deferred list. The data were represented in the form of percentage, descriptive statistics and analysed. Results: Out of 3,449 blood donors, 252 were deferred. The deferral rate was 7.31%. Among the ineligible donors, males 245 (97.22%) outnumbered females 7 (2.8%). 242 donors (96.03%) were temporarily rejected among which high blood pressure constituted to 23.02% followed by alcohol consumption (11.11%) whereas 10 donors (3.96%) were deferred permanently. 9 donors (3.57%) had low haemoglobin level. Conclusions: Temporary deferrals are more than permanent deferrals thus temporarily deferred donors should be instructed to return for blood donation after their period of deferral days to retain the pool of blood donors.
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Introducción: la terapia transfusional es un procedimiento terapéutico que ha contribuido a disminuir la mortalidad, y mejorar la calidad de vida de pacientes con diversas patologías. La utilización de guías en la práctica transfusional, contribuye a la utilización racional de las mismas. Objetivo: describir las características de los niños de 1 mes a 14 años 11 meses hospitalizados en el Centro Hospitalario Pereira Rossell durante el 2019 que recibieron transfusión de sangre desplasmatizada. Metodología: estudio descriptivo retrospectivo. Se incluyeron los niños entre 1 mes y 14 años 11 meses asistidos en emergencia, unidad de reanimación, cuidados moderados, intermedios e intensivos del Centro Hospitalario Pereira Rossell. Variables: edad, sexo, área de asistencia, motivo de ingreso, indicación de transfusión, cifras de Hb pre y post-transfusión, clasificación de la anemia, dosis. Resultados: se incluyeron 160 transfusiones correspondientes a 97 pacientes, 56% eran de sexo masculino. Media de edad 3 años, 52% < 1 año. El motivo de ingreso más frecuente fue patología respiratoria infecciosa 37%. El 79% fueron transfundidos en unidad de cuidados intermedios e intensivos. Media Hb pre-transfusión 7,45 g/dL y post-transfusión de 10,1 g/dL. Predominó la anemia moderada, normocítica-normocrómica, pura. La dosis media de sangre desplasmatizada transfundida fue 12 cc/kg. Conclusiones: en esta serie predominaron los pacientes de sexo masculino y menores a un año que ingresaron principalmente por patología respiratoria infecciosa. La mayoría de los pacientes transfundidos estaban en cuidados intensivos. Futuros estudios, de diseño prospectivo, que incluyan pacientes de todos los escenarios asistenciales y de otros prestadores de salud, contribuirán a continuar el estudio de los pacientes transfundidos y a la elaboración de recomendaciones o protocolos locales.
Introduction: Transfusion therapy is a therapeutic procedure that has contributed to reducing mortality and improving the quality of life of patients with various pathologies. The use of guides in transfusion practice contributes to their rational use. Objective: To describe the characteristics of children from 1 month to 14 years 11 months who were hospitalized in the Centro Hospitalario Pereira Rossell during 2019 who received a red blood cell transfusion. Methodology: Retrospective descriptive study. Children aged 1 month to 14 years and 11 months assisted in the emergency, moderate, intermediate and intensive care of the Centro Hospitalario Pereira Rossell were included in the study. Variables: age, sex, area of care, reason for admission, indication for transfusion, Hb figures before and after transfusion, classification of anaemia, dose. The study protocol was approved by the Institutional Ethics Committee. Results:160 transfusions corresponding to 97 patients were included, 56% were male. Mean age 3 years, 52% <1 year. The most frequent reason for admission was infectious respiratory disease 37%. 79% were transfused in the intermediate and intensive care unit. Mean Hb pre-transfusion 7.45 g/dL and post- transfusion of 10.1 g/dL. Moderate, normocytic-normochromic, pure anaemia predominated. The mean dose of deplasmatized blood transfused was 12 cc/kg. Conclusions: In this series, male patients less than one year of age predominated, admitted mainly for infectious respiratory disease. Most of the transfused patients were in intensive care. Future studies of prospective design that include patients from all healthcare settings and from other healthcare providers, will contribute to continuing the study of transfused patients and to the development of local recommendations or protocols.
Introdução: a terapia transfusional é um procedimento terapêutico que tem contribuído para reduzir a mortalidade e melhorar a qualidade de vida de pacientes com diversas patologias. A utilização de diretrizes na prática transfusional contribui para o seu uso racional. Objetivo: descrever as características das crianças de 1 mês a 14 anos e 11 meses internadas no Centro Hospitalario Pereira Rossell durante o ano de 2019 que receberam transfusão de sangue desplasmatizado. Metodologia: estudo descritivo retrospectivo. Foram incluídas crianças com idade entre 1 mês e 14 anos e 11 meses atendidas na emergência, unidade de reanimação, cuidados moderados, intermediários e intensivos do Centro Hospitalario Pereira Rossell. Variáveis: idade, sexo, área de atendimento, motivo da admissão, indicação de transfusão, valores de Hb pré e pós-transfusão, classificação da anemia, dose. Resultados: foram incluídas 160 transfusões correspondentes a 97 pacientes, 56% eram do sexo masculino. A idade média foi de 3 anos, 52% < 1 ano. O motivo mais frequente de admissão foi pato- logia respiratória infecciosa (37%). 79% foram transfundidos na unidade de tratamento intermediário e intensivo. Hb média pré-transfusional de 7,45 g/dL e Hb pós-transfusional de 10,1 g/dL. Predominou a anemia moderada, normocítica-normocrômica e pura. A dose média de sangue desplasmatizado transfundida foi de 12 cc/kg. Conclusões: nesta série, houve uma predominância de pacientes do sexo masculino com menos de um ano de idade que foram admitidos principalmente por patologia respiratória infecciosa. A maioria dos pacientes transfundidos estava em tratamento intensivo. Estudos prospectivos futuros incluindo pacientes de todos os ambientes de atendimento e outros presta- dores de serviços de saúde, contribuirão para um estudo mais aprofundado dos pacientes transfundidos e para o desenvolvimento de recomendações ou protocolos locais.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Reação Transfusional , Anemia/terapia , Estudos Retrospectivos , Distribuição por Idade e SexoRESUMO
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.