Blood components requests at an orthopedic hospital: a critical survey

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

Blood components requests at an orthopedic hospital: a critical survey.

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

Oxidized tissue proteins after intestinal reperfusion injury in rats

OBJETIVO: Analisar se a mensuração da proteína carbonilada pode ser validada como método capaz de permitir a identificação de um estresse oxidativo intestinal causado por lesões decorrentes da isquemia e reperfusão. MÉTODOS: Vinte e cinco ratos machos da linhagem Wistar, pesando entre 200 e 250g, foram divididos em três grupos. Grupo I – controle (n = 10). Grupo II – simulação (n = 5) e grupo III (n = 10) submetido a 60 minutos de isquemia intestinal e igual intervalo para reperfusão. Para este fim clampeou-se a artéria mesentérica superior no seu terço distal. Alterações histológicas e os níveis de proteínas carboniladas foram determinados em amostras obtidas em todos os grupos. No grupo III foram estudados segmentos ileais reperfundidos e normais. RESULTADOS: Em todos os segmentos reperfundidos houve edema da mucosa e submucosa, além de infiltrado inflamatório da lâmina própria. Os níveis de proteína carbonilada aumentaram no grupo III, inclusive nos segmentos não isquemiados. A sensibilidade e a especificidade da proteína carbonilada no tecido foram, respectivamente, de 94% e 88%. CONCLUSÃO: O procedimento da proteína carbonilada é útil como marcador biológico do estresse oxidativo após isquemia e reperfusão intestinal em ratos. Também foi relevante o efeito do estresse oxidativo, observado à distância do lócus da lesão primária.

Oxidized tissue proteins after intestinal reperfusion injury in rats.

PURPOSE: To analyse if the carbonyl proteins measurement could be validated as a method that allows the identification of an intestinal oxidative stress after ischemia and reperfusion injury. METHODS: Twenty-five male Wistar rats (n = 21) weighting 200 to 250 g were divided into three groups. Group I--control (n = 10). Group II--sham (n = 5) and Group III (n = 10) subjected to 60 minutes of intestinal ischemia and equal period of reperfusion. For this purpose it was clamped the superior mesenteric artery in its distal third. Histological changes and carbonyl protein levels were determined in the samples of all groups. In group III, samples of both normal and reperfused ileal segment were studied. RESULTS: All the reperfused segments showed mucosal and submucosal swelling and inflammatory infiltrate of the lamina propria. Levels of carbonyl protein rose in group III, including in the non-ischemic segments. The sensitivity and specificity of the carbonyl protein tissue levels were respectively 94% and 88%. CONCLUSION: The carbonyl protein method is a useful biologic marker of oxidative stress after the phenomenon of intestinal ischemia and reperfusion in rats. It was also noteworthy that the effects of oxidative stress could be seen far from the locus of the primary injury.