Patient Blood Management Program Implementation: Comprehensive Recommendations and Practical Strategies.

INTRODUCTION: Blood transfusion is one of the most common medical practices worldwide. However, current scientific literature has shown that the immunomodulatory effects of blood transfusion are associated with an increased likelihood of infection, prolonged hospitalization, and morbimortality. Also, it means high costs for healthcare systems. METHODS: In this context, acknowledging that blood transfusions are essentially heterologous cell transplantations, the use of therapeutic options has gained strength and is collectively known as the patient blood management (PBM) program. PBM is an approach based on three main pillars: (1) treating anemias and coagulopathies in an optimized manner, especially in the preoperative period; (2) optimizing perioperative hemostasis and the use of blood recovery systems to avoid the loss of the patient's blood; (3) anemia tolerance, with improved oxygen delivery and reduced oxygen demand, particularly in the postoperative period. RESULTS: Current scientific evidence supports the effectiveness of PBM by reducing the need for blood transfusions, decreasing associated complications, and promoting more efficient and safer blood management. Thus, PBM not only improves clinical outcomes for patients but also contributes to the economic sustainability of healthcare systems. CONCLUSION: The aim of this review was to summarize PBM strategies in a comprehensive, evidence-based approach through a systematic and structured model for PBM implementation in tertiary hospitals. The recommendations proposed herein are from researchers and experts of a high-complexity university hospital in the network of the Sistema Único de Saúde, presenting itself as a strategy that can be followed as a guideline for PBM implementation in other settings.

Successful Case of Double Valve Replacement Surgery Using Autologous Blood Transfusion: A Patient's Autonomy Preserved with Excellent Clinical Outcome.

BACKGROUND A blood cell saver, or autotransfusion system, is used to collect, wash, and return autologous blood collected from the surgical patient. This report describes a 55-year-old man who underwent combined mitral and aortic valve replacement surgery with cardiopulmonary bypass and had a successful outcome following intraoperative and postoperative autologous blood transfusion using a blood cell saver. CASE REPORT The patient did not accept blood transfusion for reasons of religious conscience and was in a critical condition, receiving palliative care. He needed combined mitral and aortic valve replacement surgery. The surgery was conducted using a cell saver (Sorin Xtra Autotransfusion System) in the intraoperative and postoperative periods for 24 h, to resolve this challenging case, from a technical and ethical point of view. The volume of red blood cells recovered intraoperatively was 1430 mL, with a hematocrit level of 40%, and 690 mL, with a hematocrit of 35%, in the postoperative period. Therefore, a significant volume of autologous blood was recovered. The autologous blood transfusion resulted in an excellent clinical outcome for the patient, who was discharged on the ninth postoperative day. CONCLUSIONS We can conclude that the use of a blood cell saver in cardiac surgery, in both intra- and postoperative periods, resulted in the maintenance of adequate hemoglobin and hematocrit levels, no infection postoperatively, and rapid and complete recovery of the patient. Thus, the use of the blood cell saver guaranteed the individual's autonomy to refuse blood products safely, with good clinical results, and without dependence on allogeneic blood transfusions.

Alcoholic neuropathy associated with chronic alcohol intake.

Alcoholic neuropathy (AN), a debilitating condition that mainly affects chronic alcohol drinkers, is thought to cause lesions in the peripheral nervous system leading to sensory, autonomic, and motor dysfunctions. Despite many studies, the pathogenesis of these lesions is still not completely understood. We investigated few aspects on the development of alcohol-induced peripheral neuropathy, by assessing sensory, motor and autonomic functions, as well as stereological analysis of axonal fibers and myelin sheath of the sciatic nerve. Twelve male Wistar rats were divided into Control group and Alcohol group that was submitted to Two Bottle-Choice Paradigm of intermittent and voluntary alcohol solution intake (20%; v/v) during eight weeks. At the end of treatment, three different sensorium-motor tests were applied - Tactile Sensitivity, Thermal Sensitivity, and Functional Observational Battery (FOB). Quantitative morphometric analysis of sciatic nerve structures was performed by stereological method. Alcohol concentration in the blood was measured to analyze possible correlation between availability of alcohol in the blood and the magnitude of the peripheral nerve lesion. Our data showed a peripheral effect of chronic alcohol intake associated with hyperalgesia and a process of demyelination with a strong correlation with alcohol consumption. This process was associated with increased tactile sensitivity, with behavioral reflexes such as locomotor hyperactivity, changes in gait and balance, and autonomic reflexes such as piloerection.

Effect of chronic alcohol intake on motor functions on the elderly.

Alcohol use disorder (AUD) is a chronic and progressive disease influenced by genetic, psychosocial, and environmental factors. The consequences of alcohol consumption involve alterations in neural circuits of emotion and cognition, as well as in the motor planning circuit. Furthermore, during the natural aging process, several biochemical and functional alterations are also observed with neurological consequences. Thus, considering the consequences of chronic alcohol consumption on neural systems and natural aging process, we aimed to analyze the degree of motor and functional impairment in elderly with chronic alcohol consumption. Sixty elderly underwent an analysis of alcohol consumption profile (Alcohol Use Disorders Identification Test - AUDIT) that divided them into a control group (CON) and an alcohol group (ALC). The analysis of quality of life was performed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), the analysis of motor function was performed using the Borg Scale, the Six-Minute Walk Test (6MWT) and the Motor Scale for Elderly (MSE). We were able to conclude that the misuse of alcohol by the elderly promotes significant physical limitations. These limitations result in a worsening of functional capacity of walking and various dimensions of motor ability: fine motor skill, global coordination, balance, body scheme, spatial organization, temporal organization, and general motor aptitude. Besides the physical limitations caused by alcohol use, the quality of life in their physical, mental, and social aspects was reduced. Thus, actions are required to help the elderly understand these losses and exercise control over alcohol misuse.

Effects of Low-level Laser Therapy on Muscle Repair in Rats with Chronic Alcohol Intake

ABSTRACT This study aimed to investigate the effects of low-level laser therapy (LLLT) on muscle repair in rats with chronic alcohol intake. Thirty male Wistar rats were distributed into three groups: injured tibialis anterior (TA) muscle without treatment (IC); chronic ingestion of alcohol plus injured TA muscle (AI); and chronic ingestion of alcohol plus injured TA plus LLLT (AIL). Each group was divided into two different subgroups, and rats were sacrificed on days 3 and 7 post-injury. Morphological features in the injured areas were similar with or without alcohol intake (IC and AI); however, LLLT promoted a decrease in the number of inflammatory cells and destroyed zones, as well as improved tissue organization (AIL). In general, alcohol intake caused a decrease in myogenic regulatory factors (MyoD and myogenin) and vascular endothelial growth factor in the AI group. Moreover, LLLT promoted recovery of these factors to the same level as in animals without alcohol intake (IC and AIL). LLLT was able to increase the expression of myogenic and vascular growth factors and stimulate skeletal muscle regeneration in rats with chronic alcohol intake.