Evaluación de las indicaciones de plasma fresco congelado en el Hospital General Enrique Cabrera de la ciudad de La Habana / Assessment on fresh frozen plasma prescription at Enrique Cabrera Hospital, Habana City

La transfusión de sangre y sus componentes es una práctica común en la actividad médica diaria, no exenta de riesgos, por lo que todo empleo de sangre y sus componentes deberá estar plenamente justificado. Actualmente las indicaciones de PFC (Plasma Fresco Congelado) se han reducido considerablemente debido a la existencia en el mercado farmacéutico de concentrados de proteínas plasmáticas que ofrecen una mayor garantía terapéutica y un riesgo biológico mínimo. Teniendo en cuenta esta situación, se analizaron 878 indicaciones de PFC efectuadas a 389 pacientes en el Hospital General "Enrique Cabrera" y se encuestó al azar a 18 médicos pertenecientes a los servicios con mayor número de indicaciones incorrectas. Las indicaciones de PFC fueron diversas en dependencia del servicio; únicamente en 65 pacientes (16,7 por ciento) se justificaba la transfusión de este componente de la sangre; ninguno de los otros casos cumplió estos criterios. Resalta el uso inapropiado y casi extendido del PFC como expansor de volumen, en las hipoproteinemias, en pacientes sépticos, posoperados y con síndrome de oclusión intestinal. En 27 casos no fue posible determinar el motivo de la indicación. Existe desconocimiento del personal médico que labora en el hospital de las indicaciones del PFC y de las repercusiones negativas en la evolución de los pacientes cuando éste es usado en forma inadecuada; desconocemos la magnitud de este problema en nuestro país y por consiguiente nos proponemos elaborar una estrategia de trabajo para garantizar la educación de nuestro personal y el cumplimiento de los lineamientos establecidos para el uso de este componente sanguíneo. (AU)

Recent advances in the development and use of plasma concentrates.

The consequences of blood donations infected with human immunodeficiency virus, the rapid advances in protein fractionation and the introduction of recombinant DNA technology have revolutionized the range of plasma products available to the clinician. This article reviews these developments and describes recent recommendations on their use.

[Recent circumstances in the supply and demand of various blood products in Japan, and appropriate use of blood components or plasma protein derivatives].

In Japan, as in the United States and several other advanced countries, the use of fresh frozen plasma (FFP) and albumin has increased dramatically over the past 10 years. Especially in Japan the increase has been at least tenfold, and half of this usage has been for surgery. Most reviews of albumin usage acknowledge that there is a high ratio of wastage, or use in clinical circumstances without a firm scientific basis. Recently Japan has imported an enormous volume of various plasma fraction products such as albumin, Factor VIII etc., or plasma as raw material from foreign countries, especially the United States. As a result, Japan has come to monopolized a quarter of the albumin manufactured in the world, and has therefore received much internal and external criticism from or ethical standpoint. As countermeasures against shortage of these blood products, it will be necessary for doctors to use these blood products more sparingly and to increase the yield of volunteer donor's blood, especially plasma. More red blood cell concentrate should be utilized for hemorrhage in routine surgical operations. Because whole blood transfusion is rarely used except in cases of massive bleeding that cannot be stopped immediately, exchange transfusion has been performed in the United States and European countries recently. Transfusion of FFP is appropriately used only for replacement of coagulation factor deficiencies, massive transfusion etc. in the United States. It should be particularly noted that these carry the risk of transmission of diseases such as hepatitis and possibly AIDS. Albumin is an effective oncotic agent in the treatment of acute shock and in the maintenance of intravascular volume and cardiac output. However, albumin and FFP have no demonstrable effect in the general supportive management of chronic hypoproteinemia and undernutrition.

Medical resources after nuclear war. Availability v need.

In defining capacity to "survive" a massive nuclear exchange, it is important to assess the medical resources that will be available in the post-nuclear war world. Approximately 80% of these resources--hospital beds and personnel, blood, drugs, and medical supplies--will have been destroyed, since they are located in or near the densely populated areas that constitute primary targets of attack. Casualty estimates published by federal agencies, together with data from the Hiroshima-Nagasaki experience, suggest the numbers and types of injuries that will afflict the US population. With a probable 48,000 surviving physicians to treat 32 million casualties, there will be one physician for every 663 patients. Of the trauma and burn victims, approximately 55% will require hospitalization; this will mean 64 patients for each available hospital bed. Data from recent wars have been utilized to determine the trauma-related blood requirements in the post-nuclear war world. Of the 64 million units of whole blood needed, only 14,000 will be available. Other medical resources will be in equally short supply. This disparity between need and availability indicates the difficulty of developing a meaningful medical response for the surviving injured.

KIE: A quantitative analysis is presented of the likely impact of a massive nuclear attack on the U.S. in terms of (1) the numbers and types of casualties that would afflict the population and (2) the numbers and types of health personnel, hospital beds, blood and body fluids, and medical supplies that would be available to treat these casualties. A significant disparity between need and the availability of resources is calculated, suggesting the difficulty of developing a meaningful medical response to nuclear war.

[The demand for blood in open-heart surgery (author's transl)]. / La domanda di sangue in chirurgia cardiaca.

Because of the continous increase of utilization of open heart surgery, whenever possible a more conservative use of blood is desirable. During 1977, 262 consecutive patients were operated upon using the hemodilution technique of cardiopulmonary bypass. Thirtyone operative deaths occurred (11.8%) and were not related to lack of blood administration. Mean hematocrit values were 32.4% two hours after surgery and between 31 and 32.5% in the following postoperative course. Hemoglobin concentration averaged from 9.9 to 10.4 g/100 ml during the first postoperative week. The estimated amount of blood transfused averaged 872 +/- 66 ml (+/- SE) per patient. Sixtyone patients (23%) didn't receive any transfusion. A conservative attitude towards blood administration is justified by transfusion related many risks and by the current shortage of blood.

Artificial blood and the National Blood Policy.

Artificial blood will become important to the extent that it is safer, more effective, more economical, and more readily available than natural substances. If physicians would accept blood substitutes, their use might help to eliminate prevailing shortages of blood and increasing needs for plasma. The high demand for albumin, one of the safest biologics known, is pushing the requirement for plasma to higher levels every year. The albumin situation illustrates both the value placed on hemotherapeutic agents of proven safety and the problem of mobilizing sufficient blood resources for their production. The solutions to this problem and others addressed by the National Blood Policy will involve both scientific efforts and improvements in the operation and organization of blood service systems. Thus, the search for blood and plasma substitutes must be viewed as just one of a set of management and scientific approaches to meeting the need for safe, effective hemotherapuetic agents.