[The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document]. / 2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Actualización del Documento Sevilla.

Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: « Does this particular AABT reduce the transfusion rate or not?¼ All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.

[The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document]. / 2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Actualización del Documento Sevilla.

Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: "Does this particular AABT reduce the transfusion rate or not?" All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.

Perioperative stimulation of erythropoiesis with intravenous iron and erythropoietin reduces transfusion requirements in patients with hip fracture. A prospective observational study.

BACKGROUND AND OBJECTIVES: Patients undergoing surgery for hip fracture (HF) often receive perioperative allogeneic blood transfusions (ABT) to avoid anaemia. However, concerns about the adverse effects of ABT have prompted the review of transfusion practice and the search for a safer treatment of perioperative anaemia. MATERIALS AND METHODS: We prospectively investigated the effect of a blood-saving protocol of perioperative iron sucrose (3 x 200 mg/48 h, intravenously) plus erythropoietin (1 x 40,000 IU, subcutaneously) if admission haemoglobin level < 130 g/l, on transfusion requirements and postoperative morbid-mortality in patients with HF (group 2; n= 83). A parallel series of 41 HF patients admitted to another surgical unit within the same hospital served as the control group (group 1). Perioperative blood samples were taken for haematimetric, iron metabolism and inflammatory parameter determination. RESULTS: This blood-saving protocol reduced the number of transfused patients (P < 0.001), the number of transfused units (P < 0.0001), increased the reticulocyte count and improved iron metabolism. In addition, the blood-saving protocol also reduced the rate of postoperative infections (P = 0.016), but not the 30-day mortality rate or the mean length of hospital stay. CONCLUSIONS: The blood-saving protocol implemented seems to reduce ABT requirements in patients with HF, and is associated with a lower postoperative morbidity. The possible mechanisms involved in these effects are discussed.

[The Ottawa ankle guidelines: analysis of their validity as clinical decision guidelines in the indication of X-rays for ankle and/or middle-foot injuries]. / Reglas del tobillo de Ottawa: análisis de su validez como reglas de decisión clínica en la indicación de radiografías en los traumatismos de tobillo y/o medio pie.

OBJECTIVE: To analyse the validity of the Ottawa ankle guidelines (OAG) as clinical decision guidelines in the indications of X-rays for ankle and/or middle-foot traumas in primary care. DESIGN: Observational, with application of the OAG and prospective measurement of the results.Setting. Hospital casualty. PATIENTS: Adults who attended casualty for ankle or middle-foot traumas between 1st June 1999 and 31th March 2000. Criteria for exclusion were: under 18, pregnancy, grave sensory and/or awareness disturbances, multi-trauma or multi-contusion patients, traumas over a week old, skin lesions as side-effects of the trauma, X-ray in other department, high inflammation or oedema hindering palpation of bone protuberances. MEASUREMENTS: Application of the OAG and X-ray on all patients, regardless of the result of the OAG. Calculation of sensitivity, negative predictive value, specificity and positive predictive value. RESULTS: 56 of a sample of 494 patients had a fracture (11.34%), 34 in the malleolus area (6.9%) and 22 in the middle-foot area (4.44%). OAG sensitivity was 96.43% (95% CI, 94.8-98). Negative predictive value was 97.22% (95.77-98.67). Specificity was 15.98% (12.75-19.21), and positive predictive value was 12.8% (9.86-15.74). CONCLUSIONS: The OAG are valid in primary care as guidelines to decide whether to request X-rays for patients with ankle or middle-foot traumas.

[Epidemic outbreak of hepatitis B from the tattoo in gypsy families]. / Brote epidémico de hepatitis B por tatuaje en familias de étnia gitana.

BACKGROUND: To document an outbreak of Hepatitis B in a gypsy community in the Upper Aragón region, as well as the control measures adopted. METHODS: Documented study of Hepatitis B cases and families, including an epidemiological survey and the determining of hepatitis B viral indicators (MVHB) using immunoenzymatic methods. RESULTS: 84.8% participation (39/45). During the months of February and March 1988, 5 cases of Hepatitis B were detected in a gypsy community in the Upper Aragon region (12.8% attack rate, 5/39), with an average age of 13.0 + 7.3, (4 women and one man). Four of the cases detected had previously undergone tatooing. The fifth case was due to direct transmission from mother to a recently born child. The MVHB study of families showed a further two cases. MVHB rate being 17.9% (7/39). Vaccinations were given to all persons susceptible to the disease. CONCLUSIONS: It is suggested that tatooing could be a significant factor to be considered in relation to the transmission of Hepatitis B in gypsy communities. Due to the high rate of incidence of the disease in this ethnic group, general vaccination is prescribed.

Analysis of hepatitis B surface antigen expression on leucocyte subpopulations by two-color fluorescence with flow cytometry.

We have analyzed the expression of HBsAg on different subpopulations of peripheral blood cells from hepatitis B virus (HBV) infected patients using two-color immunofluorescence and flow cytometry. An average of 7.4 +/- 0.8% and 9.8 +/- 1.2% HBsAg + cells were found among cells from acute and chronic hepatitis B patients, respectively. When studied by two-color immunofluorescence, HBsAg was limited to cells expressing the B-cell restricted antigen CD19 (16.7 +/- 2.4%), whereas for the other subsets studied (CD3+, CD4+, CD8+, CD67+, CD68+) the percentage of positivity was lower than 4%. The expression of viral antigen on B cells might be relevant for a number of functional interactions between HBsAg+ B and T lymphocytes.