Patient blood management: recommendations rrom the 2018 Frankfurt consensus conference

What is the current evidence base for patient blood management (PBM) in adults, and what international clinical recommendations can be derived for preoperative anemia, red blood cell transfusion thresholds, and PBM implementation strategies? Diagnosis and management of preoperative anemia is crucial, and iron-deficient anemia should be treated with iron supplementation. Red blood cell transfusion thresholds for critically ill, clinically stable patients (hemoglobin concentration <7 g/dL), patients undergoing cardiac surgery (hemoglobin concentration <7.5 g/dL), patients with hip fractures and cardiovascular disease or risk factors (hemoglobin concentration <8 g/dL), and hemodynamically stable patients with acute gastrointestinal bleeding (hemoglobin concentration 7-8 g/dL) are relatively well defined, although the quality of evidence is moderate to low. Further high-quality research to support PBM is required for a range of clinical scenarios and implementation of PBM programs.

Transfusioonravi juhend (I osa): Äge verejooks ja transfusioonravi; operatsioonile eelnev patsiendi ambulatoorne ja perioperatiivne käsitlus / Guidelines for transfusion therapy (Part I): acute bleeding and transfusion therapy; outpatient and perioperative management of the patient before surgery

The need to prepare a treatment manual In 2005, "Medicinal preparations made from human blood" was published in Estonia the Estonian guide to the use" (1), the purpose of which was to provide the first a more comprehensive overview in Estonian of the state-of-the-art in the use of blood preparations principles. This guide has helped create a theoretical foundation for all patients to ensure a consistent quality of transfusion therapy, but as the guideline authors point out, the point of departure for this guide is the remedy, not the condition. Bearing in mind that in other parts of the world, the patient's blood has started to be followed more and more there is a need to prepare the concept of patient blood management a new treatment guide introducing the use of transfusion therapy from the patient and based on his medical conditions. The concept of the patient's blood is based on the evidence of modern transfusiology a multidisciplinary concept that seeks to optimize the need for blood transfusion patient treatment. When making a treatment decision, the patient, whose conserving one's own blood is paramount, and a clinical outcome is sought without unnecessary transfusion of blood components. To date, the patient's blood perception program implemented in many countries, e.g. Australia, Great Britain, in the United States, Germany, etc. The guideline aims to emphasize the importance of preoperative assessment and performing analyzes and, if necessary, correcting the patient's treatment so that reduce the number of patients receiving blood transfusions. Anemia, acute bleeding and blood transfusion are three independent risk factors affecting the patient treatment outcome unfavorably. The mortality rate of patients receiving blood transfusions is higher and morbidity (including occurrence of cardiac, renal, respiratory and wound complications) more frequent, the duration of hospitalization is longer, and the need for intensive care and treatment costs are higher higher than in patients who did not receive a blood transfusion in the same condition. The updated treatment manual provides an opportunity to evaluate the practice of transfusion therapy on the same basis throughout the country, analyze it, correct it if necessary and to lead. Together with the guide, it is published in cooperation with SA Põhja-Eesti Regionalhaigla Updated additional material on blood components prepared by the Blood Center specifications and additional materials prepared by the Estonian Society of Anesthesiologists 10 on the treatment of antithrombotic drugs in scheduled surgery and emergencies in situations. Treatment area and target group of the treatment manual The treatment guide describes a patient with anemia and/or bleeding risk pre-operative diagnostics and outpatient treatment and diagnostics and treatment of patients with acute bleeding, including massive transfusion. Also emergency transfusion treatment related to obstetric care and the need to check all patients who have undergone acute blood loss in the future improvement. The treatment manual is mainly intended for emergency use

Ravijuhendi koostamise vajadus Eestis on ilmunud 2005. aastal "Inimverest valmistatud ravimpreparaatide kasutamise Eesti juhend" (1), mille koostamise eesmärk oli anda esimene põhjalikum eestikeelne ülevaade verepreparaatide kasutamise nüüdisaegsetest põhimõtetest. See juhend on aidanud luua teoreetilist alust kõigile patsientidele ühtlase kvaliteediga transfusioonravi tagamiseks, kuid nagu juhendi koostajad esile toovad, on selle juhendi lähtepunkt ravivahend, mitte haigusseisund. Pidades silmas, et mujal maailmas on hakatud järjest enam järgima patsiendi vere käsituse kontseptsiooni (ingl patient blood management), on vajadus koostada uus ravijuhend, milles tutvustatakse transfusioonravi kasutamist patsiendist ja tema haigusseisunditest lähtuvalt. Patsiendi vere käsitus on nüüdisaegse transfusioloogia tõenduspõhine multidistsiplinaarne kontseptsioon, mis püüab optimeerida vereülekannet vajava patsiendi ravi. Raviotsuse tegemisel asetatakse kesksele kohale patsient, kelle enda vere säästmine on kõige olulisem, ja kliinilist tulemust püütakse saavutada ilma verekomponentide ebavajaliku ülekandeta. Praeguseks on patsiendi vere käsituse programmi juurutatud paljudes riikides, nt Austraalias, Suurbritannias, Ameerika Ühendriikides, Saksamaal jne. Juhendiga soovitakse rõhutada, kui oluline on preoperatiivne hindamine ja analüüside tegemine ning vajaduse korral patsiendi ravi korrigeerimine, et vähendada vereülekannet saavate patsientide arvu. Aneemia, äge verejooks ja vereülekanne on kolm sõltumatut riskifaktorit, mis mõjutavad patsiendi ravitulemust ebasoodsalt. Vereülekannet saanud patsientide suremus on suurem ja haigestumus (sh kardiaalne, renaalne, respiratoorne ja haava tüsistuste esinemine) sagedasem, haiglaravi aeg on pikem ning intensiivravivajadus ja ravikulud on suuremad, kui samas seisundis vereülekannet mittesaanud patsientidel. Kaasajastatud ravijuhend annab võimaluse hinnata transfusioonravi praktikat samadel alustel kogu riigis, seda analüüsida, vajaduse korral korrigeerida ja juhtida. Juhendiga koos avaldatakse koostöös SA Põhja-Eesti Regionaalhaigla Verekeskusega valminud ajakohastatud lisamaterjal verekomponentide spetsifikatsioonide kohta ja Eesti Anestesioloogide Seltsi koostatud lisamaterjalid antitrombootiliste ravimite käsitlusest plaanilises kirurgias ja erakorralistes situatsioonides. Ravijuhendi käsitlusala ja sihtrühm Ravijuhendis kirjeldatakse aneemiaga ja/või veritsusriskiga patsiendi operatsioonile eelnevat diagnostikat ja ambulatoorset ravi ning ägeda verejooksuga patsientide diagnostikat ja ravi, sh massiivset transfusiooni. Samuti käsitletakse juhendis sünnitusabiga seonduvat erakorralist transfusioonravi ja vajadust kontrollida edaspidi kõikide ägeda verekaotuse läbi teinud patsientide paranemist. Ravijuhend on peamiselt mõeldud kasutamiseks erakorralise

Blood transfusion

This guideline covers the assessment for and management of blood transfusions in adults, young people and children over 1 year old. It covers the general principles of blood transfusion, but does not make recommendations relating to specific conditions.

Blood donor selection: guidelines on assessing donor suitability for blood donation

These WHO guidelines, Blood donor selection: guidelines on assessing donor suitability for blood donation have been developed to assist blood transfusion services in countries that are establishing or strengthening national systems for the selection of blood donors. They are designed for use by policy makers in national blood programmes in ministries of health, national advisory bodies such as national blood commissions or councils, and blood.

Towards 100% voluntary blood donation: a global framework for action / Dons de sang volontaires: objectif 100%: cadre mondial d'action

Blood transfusion is a core service within health care systems and individuals who donate their blood provide a unique contribution to the health and survival of others. Every country faces an ongoing challenge to collect sufficient blood from safe donors to meet national requirements. This framework for global action outlines broad goals, strategies and action points that will enable countries to move towards 100% voluntary blood donation. The specific objectives are to provide information and guidance on the vital role of voluntary blood donors in assuring the availability of stable and sufficient supplies of safe blood for transfusion and propose a series of interlinking strategies and suggestions for concrete action at national and community levels to scale up voluntary blood donor programmes with heightened commitment and support from governments, partners and other stakeholders.

La transfusion sanguine est un élément principal des systèmes de soins de santé et les donneurs de sang apportent une contribution remarquable à la santé et à la survie des autres. Chaque pays est confronté en permanence à des problèmes pour recueillir suffisamment de sang auprès de donneurs sûrs afin de satisfaire aux besoins nationaux. Ce cadre en faveur d'une action mondiale expose des stratégies, des mesures et des objectifs généraux qui permettront aux pays de se rapprocher de 100% de dons de sang volontaires.

Bases da quimioprofilaxia na enfermidade de Chagas / Basis of the chemoprophylaxis in Chagas' disease

No presente artigo é abordado, em linhas gerais, a quimioprofilaxia para transmissao da moléstia de Chagas.

Opinion y debate en Medicina Transfusional: el Banco de Sangre durante una catástrofe / Opinion and debate in Transfusional Medicine: the Blood Bank in a cataclysm

En casos de desastres masivos hay gran solidaridad por parte de la población para donar sangre, pero solamente se podrá aprovechar si se cuenta con un Banco de Sangre que esté organizado adecuadamente para afrontar esta situación, que cuente con un plan con capacidad operativa, de fácil interpretación. Es indispensable el adiestramiento del personal, contar con stock, recursos, red de comunicaciones, servicios alternos de energía eléctrica, y fundamentalmente un "Banco Viviente". En situaciones de catástrofe, la medicina es muy diferente de la que habitualmente se brinda; no se podrán realizar maniobras sofisticadas con equipos de alta complejidad.

Análisis de seguridad cualitativo en sistemas médicos: fallas humanas activas y latentes y su impacto en los sistemas transfusionales / Qualitative security analysis of medical systems: active and latent human failures and their impact in transfusions systems

Debido a características naturales de la cognición humana, actos inseguros se cometen durante las tareas habituales. El impacto y consecuencias de los errores humanos en sistemas complejos han sido ampliamente documentados y estudiados, y distintas técnicas y metodologías de análisis fueron desarrolladas. No hemos hallado casos publicados de secuencias accidentales analizadas mediante tales técnicas en la literatura médica en castellano, por lo que nos pareció novedoso hacerlo. Se realizó el análisis retrospectivo del evento indeseado "infección accidental de paciente neutropénico con germen intrahospitalario" utilizando en forma combinada técnicas de análisis de causa raíz, análisis de acciones humanas y análisis de secuencias accidentales. Se identificaron claramente factores causales de errores activos del personal, fallas en el diseño del sistema y deficiencias en la cultura de seguridad de la organización y sus individuos. Finalmente proponemos un glosario en español, por primera vez, con los contenidos necesarios para sentar bases de esta nueva modalidad dentro de la medicina. En conclusión, los resultados obtenidos proveen importantes datos acerca de la seguridad. La aplicación de estos métodos en forma sistemática podría significar una herramienta eficaz para mejorar la seguridad de los procesos transfusionales.

Screening donated blood for transfusion-transmissible infections: recommendations

Blood transfusion is a life-saving intervention that has an essential role in patient management within health care systems. WHO recommends the following integrated strategy for the provision of safe blood and blood products and safe, efficacious blood transfusion.