Estimulación facial con factores de crecimiento plaquetario en consulta de Dermatología / Facial stimulation with platelet growth factors in Dermatology consultation

RESUMEN El envejecimiento es un proceso complejo que trae consigo cambios celulares, histológicos y cutáneos. Estos últimos son una de sus manifestaciones más evidentes. El plasma rico en plaquetas es una fuente fiable de obtención de células para regenerar tejidos; por su fácil disponibilidad es un material inocuo. La bioestimulación con el mismo, por su parte, es un conjunto de procedimientos para activar las funciones anabólicas de los fibroblastos, producción de colágeno, elastina y ácido hialurónico. La tendencia al empleo de este en tratamientos antiedad es cada vez mayor. El objetivo de este trabajo fue realizar una actualización del tema, para exponer aspectos importantes sobre formas de aplicación, indicaciones, complicaciones y contraindicaciones. Existen varios métodos para la bioestimulación facial, tales como la realización de pápulas, napagge y retroinyección. Se han empleado en alopecia androgénica, areata, envejecimiento cutáneo, etc. Las complicaciones más observadas son dolor, eritema, ardor y sangrado local. Entre las contraindicaciones más comunes se observan el herpes simple recidivante, coagulopatías, tratamiento con anticoagulantes, colagenopatías y neoplasias (AU).

ABSTRACT Aging is a complex process that brings with it cellular, histological and cutaneous changes, the latter being one of its most obvious manifestations. Platelet-rich plasma is a reliable source of cells to regenerate tissues; due to its easy availability, it is a harmless material. Bio-stimulation with it is a set of procedures to activate the fibroblasts anabolic functions and the production of collagen, elastin and hyaluronic acid. The tendency to use it in anti-aging treatments increases faster and faster. The objective of this work was updating the topic to expose important aspects about application methods, indications, complications and contraindications. There are several methods of applying facial bio-stimulation such as performing papules, napagge, and retroinjection. It has been used in androgenic alopecia, alopecia areata, cutaneous ageing, etc. The most commonly found complications are pain, erythema, burning and local bleeding. The most common contraindications include recidivist herpes simplex, coagulopaties, anticoagulant treatment, collagen-related diseases and neoplasms (AU).

Aplicación del plasma rico en plaquetas en enfermedades de la superficie ocular / Application of platelet-rich plasma in ocular surface diseases

La enfermedad de la superficie ocular incluye a un grupo de patologías con diversas etiologías, síntomas y hallazgos clínicos que comparten la producción de reacción inflamatoria y daño de esta superficie. El uso de derivados hemáticos para el tratamiento de patologías de la superficie ocular se ha incrementado en el área de la oftalmología, ya que su composición es análoga a la de la lágrima natural. Con el objetivo de mostrar la terapia celular como una nueva disciplina científica a aplicar en nuestro medio, se realizó una búsqueda automatizada sobre el tema, teniendo en cuenta las publicaciones de los últimos 5 años. Se utilizó la plataforma Infomed, cuya información fue resumida para la elaboración del informe final, donde se expone que los colirios de hemoderivados proveen estrategias de tratamiento eficaces y seguras para pacientes con afecciones oftálmicas. El colirio de plasma rico en plaquetas ofrece una opción exitosa de tratamiento en numerosas afecciones de la superficie ocular. Sin embargo, estudios adicionales son necesarios para establecer la seguridad y la eficacia de este tipo de terapias(AU)

Ocular surface diseases are a group of conditions of different etiologies, symptoms and clinical findings with the common features of developing an inflammatory reaction and damaging the ocular surface. Use of blood-derived products for the treatment of ocular surface disorders has increased in ophthalmic care, since their composition is similar to that of natural tears. With the purpose of presenting cell therapy as a new scientific discipline that could be used in our environment, an automated search was conducted about the topic which included publications from the last five years. The search was performed on the Infomed platform, and the information obtained was summarized into a final report stating that blood-derived eye drops provide effective and safe treatment strategies for patients with ophthalmic conditions. Platelet-rich plasma eye drops are a potentially successful treatment option for many ocular surface disorders. However, further studies are required to establish the safety and effectiveness of this type of therapy(AU)

Características clinicoepidemiológicas de pacientes tratados con hemoderivados en un hospital de Santiago de Cuba / Clinical and epidemiological characteristics of patients treated with blood-derivatives in a hospital from Santiago de Cuba

Introducción: El uso de hemoderivados es una práctica habitual en los hospitales y muy efectiva en determinadas situaciones clínicas. Objetivo: Caracterizar clínica y epidemiológicamente a pacientes tratados con hemoderivados en el Hospital Provincial Docente Dr. Joaquín Castillo Duany de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y transversal de 394 pacientes que estuvieron ingresados en el Hospital Provincial Docente Dr. Joaquín Castillo Duany de Santiago de Cuba, desde enero hasta junio de 2018, que recibieron transfusión de hemoderivados. Los datos se obtuvieron de las historias clínicas y para el procesamiento se empleó el paquete estadístico SPSS, versión 23. Resultados: En la serie predominaron el sexo masculino (50,7 %), la transfusión de eritrocitos y los pacientes transfundidos con cifras de hemoglobina entre 70 y 89 g/L (47,7 %). En el Servicio de Cirugía General fue donde más se transfundió (43,2 %) y, en general, se detectaron múltiples deficiencias en las órdenes de transfusiones. Conclusiones: No existieron diferencias significativas en cuanto al sexo y los pacientes intervenidos quirúrgicamente fueron los que más recibieron este tratamiento. Hubo incumplimiento del protocolo hospitalario previsto y la omisión de datos en las órdenes de transfusiones afectó la calidad de la hemovigilancia.

Introduction: The use of blood-derivatives is an usual practice in hospitals and very effective in certain clinical situations. Objective: To characterize clinical and epidemiologically patients treated with blood-derivatives at Dr. Joaquín Castillo Duany Teaching Provincial Hospital in Santiago de Cuba. Methods: A descriptive and cross-sectional study of 394 patients that were admitted to Dr. Joaquín Castillo Duany Teaching Provincial Hospital and received blood-derivatives transfusion was carried out in Santiago de Cuba, from January to June, 2018. The data were obtained from the medical records and for its processing the SPSS statistical package, version 23 was used. Results: In the series there was a prevalence of the male sex (50.7 %), transfusion of erythrocytes and transfused patients with hemoglobin figures between 70 and 89 g/L (47.7 %). There were more transfusions in the General Surgery Service (43.2 %) and, in general, multiple deficiencies were detected in the orders of transfusions. Conclusions: As for sex there were no significant differences and patients surgically intervened were those that received this treatment more times. There was no fulfilment of the foreseen hospital protocol and the omission of data in the orders of transfusions affected the blood safety quality.

Hemoterapia en el paciente gravemente enfermo / Hemotherapy in the seriously ill patients

Introducción: Para mejorar la estabilidad hemodinámica, trastornos de la coagulación, perfusión hística, capacidad de transporte de oxígeno, entre otros, en el paciente crítico se hace necesario la transfusión de sangre y derivados. Objetivo: Caracterizar la población de pacientes graves que recibieron tratamiento con sangre y hemoderivados. Métodos: Se realizó un estudio descriptivo y transversal en 199 pacientes ingresados en la unidad de cuidados intensivos del Hospital General Orlando Pantoja Tamayo del municipio Contramaestre, provincia Santiago de Cuba, desde enero de 2016 hasta abril de 2019. Las variables analizadas fueron: edad, sexo, causas de hemoterapia, tipo de componente sanguíneo empleado, frecuencia de administración, reacciones adversas y estado al egreso. Se utilizó el porcentaje para resumir la información, así como el test chi cuadrado para identificar asociación estadística. Resultados: Predominaron el sexo femenino (56,7 por ciento) y la edad comprendida entre 65 años y más, con el diagnóstico de politraumatizados, sangrado digestivo alto y sepsis. El concentrado de hematíes fue el más empleado y la frecuencia de administración, en una ocasión, fue en la categoría que más reacciones adversas se encontró (56,6 por ciento); el empleo en cuatro o más ocasiones incrementó la mortalidad. Conclusiones: El concentrado de hematíes fue el hemoderivado más administrado, la administración en una ocasión fue la que más reacciones adversas provocó y la mayoría fueron del tipo inmediatas inmunológicas(AU)

Introduction: To improve hemodynamic stability, coagulation disorders, tissue perfusion, oxygen transport capacity, among others, the transfusion of blood and plasma derivatives is necessary in the critically-ill patient. Objective: To characterize the population of seriously-ill patients who received treatment with blood and hemoderivatives. Methods: A descriptive and cross-sectional study was carried out with 199 patients admitted to the intensive care unit of Orlando Pantoja Tamayo General Hospital in Contramaestre Municipality, Santiago de Cuba Province, from January 2016 to April 2019. The variables analyzed were age, sex, causes for hemotherapy, type of blood component used, frequency of administration, adverse reactions, and discharge status. Percentage was used to summarize the information. Also, the chi-square test was used to identify statistical association. Results: There was a predominance of the female sex (56.7%) and of the age 65 years and older, with diagnosis of polytrauma, high digestive bleeding, and sepsis. The red blood cell concentrate was the most used and the frequency of administration, on one occasion, occurred in the category with the highest amount of adverse reactions (56.6%). Administration on four or more occasions increased mortality. Conclusions: The red blood cell concentrate was the most administered hemoderivative. Administration on one occasion that caused the most adverse reactions and most were immediate immunological ones(AU)

Importancia de la sangre, hemoderivados y las donaciones voluntarias de sangre / Importance of voluntary blood donations. Blood and blood products

RESUMEN La terapia transfusional demanda de sólidos conocimientos para lograr planear y ejecutar un plan de trabajo integral para el logro del bienestar de la persona que lo requiera. El personal que desarrolla su profesión en aspectos relacionados con las transfusiones sanguíneas debe estar en una actualización continua de conocimientos, orientados a desarrollar nuevas técnicas así como medidas de seguridad. El objetivo de este trabajo fue abordar acerca de la importancia del uso de la sangre como recurso terapéutico, y el valor hermanado de la donación voluntaria y generoso de sangre lo que vincula al individuo a una nueva conducta y actitud hacia el mundo exterior natural, socia. La sangre constituye la materia prima esencial para los bancos de sangre, de ella se obtiene el plasma, glóbulos rojos, glóbulos blancos, plaquetas, hemoderivados y otros productos biológicos para terapias en la medicina transfusional. La donación voluntaria es una acción desprendida por el solo hecho de ayudar a otros a los que no se conoce, no sólo es la más generosa y la más ética, es el pilar de los servicios modernos de donación y transfusión sanguínea (AU).

SUMMARY Transfusion therapy demands solid knowledge to plan and perform a comprehensive work plan to achieve the wellbeing of persons needing it. The staff whose profession is related with blood transfusions should be continuously updating their knowledge, trying to develop new techniques and secure practices. The aim of this article was approaching the importance of using blood as therapeutic resource and the associated value of generous and voluntary donation, linking individuals to a new behavior and attitude to the natural and social outside world. Blood is the essential raw material for blood banks, obtaining from it plasma, red blood cells, white blood cells, platelets, blood products and other biological products for therapies in transfusion medicine. Voluntary donation is a disinterested action just for the fact of helping unknown persons. It is not only the most generous and the most ethical action, but it is also the support of the modern blood donation and transfusion services (AU).

Incidence of acute hepatitis C in Brazil: temporal trend of cases notified between 2007 and 2018 / Incidência de hepatite C aguda no Brasil: tendência temporal dos casos notificados entre 2007­2018

Introduction: With the improvement of biosafety and quality of blood products, hepatitis C virus (HCV) transmission decreased in Brazil. Analyzing temporal trends in the incidence of acute cases may indicate how current HCV circulation is. Objective: To analyze the temporal trend of acute hepatitis C cases from 2007 to 2018. Methods: Analysis of reported cases of acute hepatitis C, using data from the National System of Notifiable Diseases (Sistema Nacional de Agravos de Notificação ­ SINAN) and the Health Surveillance Department, Ministry of Health. The non-parametric Cusick test was applied to analyze temporal trend. Results: 6,199 cases of acute HCV were reported between 2007 and 2018. The annual incidence rate ranged from 0.17 cases per 100,000 inhabitants in 2007 at 0.28 (2018) (p=0.005). Regarding the age group, the trend of increased notifications was significant in individuals <5 years (p=0.025) and >40 years (p=0.008) of age. Conclusion: Despite the few acute cases reported annually, there has been an increase in recent years, especially in age extremes. Cases in >40 years may mean that some of them are not new, but chronic infections, or because of the growing importance of sexual transmission as a consequence of relaxation in safe sex. Despite possible inconsistencies and weaknesses in the notification systems, these numbers are of concern, justifying efforts to review cases for better classification and clarification of contagion routes

Introdução: Com a melhoria da biossegurança e qualidade dos hemoderivados, houve queda da transmissão do vírus da hepatite C (HCV) no Brasil. Analisar tendência temporal da incidência de casos agudos pode indicar como está a circulação do HCV atualmente. Objetivo: Analisar a tendência temporal dos casos de hepatite C aguda entre 2007 e 2018 no país. Métodos: Análise de casos notificados de hepatite C aguda, utilizando dados do Sistema Nacional de Agravos de Notificação e da Secretaria de Vigilância em Saúde, do Ministério da Saúde. Teste não paramétrico de Cusick foi aplicado para analisar tendência temporal. Resultados: Foram notificados 6.199 casos de hepatice C aguda entre 2007 e 2018. A taxa de incidência anual variou de 0,17 casos por 100 mil habitantes em 2007 a 0,28 (2018) (p=0,005). Quanto à faixa etária, tendência de aumento de notificações mostrou-se significativa em indivíduos <5 anos (p=0,025) e >40 anos (p=0,008). Conclusão: Apesar dos poucos casos agudos notificados anualmente, houve aumento em anos recentes, especialmente nos extremos etários. Os casos em >40 anos podem significar que alguns deles não sejam infecções novas, mas crônicas ou por crescente importância da transmissão sexual, como consequência de relaxamento quanto à prática de sexo seguro. Em que se pesem as possíveis inconsistências e fragilidades nos sistemas de notificação, esses números trazem preocupação, justificando esforços para revisão dos casos para melhor classificação e esclarecimentos das rotas de contágio.

Actualización en plasma rico en plaquetas / Platelet rich plasma update

Resumen El plasma rico en plaquetas es un producto derivado de la sangre, rico en péptidos y proteínas de señalización intercelular, así como citoquinas capaces de intervenir en cada una de las etapas de la regeneración de varios tejidos. Principalmente, se le han atribuido efectos antiinflamatorios en diferentes lesiones, así como otros efectos biológicos sobre las células y tejidos. A la fecha, no existe un protocolo estándar de producción o preparación, tampoco se ha descrito una dosis específica; la forma de aplicación es muy variable y depende de la condición por tratar. A pesar de ello, se han visto efectos positivos en campos como: odontología, ortopedia, dermatología, medicina reconstructiva, oftalmología, medicina deportiva, medicina vascular, entre otros. Su regulación es muy diversa a nivel internacional. Aunque hay expectativas con el tratamiento de plasma rico en plaquetas, no hay suficientes ensayos clínicos robustos que brinden un alto nivel de evidencia para validarlo como un tratamiento de rutina frente a determinada condición clínica. Además, no se pueden comparar fácilmente los resultados de diferentes investigaciones, por la variabilidad en el método de preparación y por la falta de homogeneidad en las lesiones tratadas, entre otros factores. Es por lo anterior que resulta necesario desarrollar más investigaciones serias que conlleven al establecimiento de un protocolo estandarizado, así como demostrar la efectividad de este nuevo tratamiento, de forma que se culmine con la implementación de nuevas terapias validadas y autorizadas para garantizar una mejoría real a los pacientes.

Abstract Platelet-rich plasma is a blood-derived product, rich in peptides and intercellular signaling proteins and cytokines capable of intervening in each stage of the regeneration of various tissues. Mainly, it has been attributed anti-inflammatory effects in different lesions, as well as other biological effects on cells and tissues. To date, there is no standard production or preparation protocol, nor has a specific dose been described. The form of application is very variable and depends on the condition to be treated. Despite this, positive effects have been seen in different fields such as: dentistry, orthopedics, dermatology, reconstructive medicine, ophthalmology, sports medicine, vascular medicine among others. Its regulation is very diverse internationally. Although there is a lot of expectation with the treatment of platelet-rich plasma, there are not enough robust clinical trials that provide a high level of evidence to validate it as a routine treatment for a certain clinical condition. In addition, the results of different investigations cannot be easily compared due to the variability in the method of preparation and the lack of homogeneity in the treated lesions, among other factors. It is for this reason that it is necessary to develop more serious investigations that lead to the establishment of a standardized protocol, as well as to demonstrate the effectiveness of this new treatment and culminate with the implementation of new validated and authorized therapies to guarantee a real improvement to the patients.

Complicaciones de las derivaciones urinarias heterópicas no continentes: Ureterostomías cutáneas vs conducto ileal / Complications of Non-continent Heteropic Urinary Derivations: Skin Ureterostomies vs Ileal Duct

Introducción Y Objetivos Las derivaciones del tracto urinario abarcan una amplia gama de técnicas quirúrgicas, siendo la causa más frecuente para su uso la patología urotelial maligna. De las derivaciones urinarias no continentes heterótopicas las más utilizadas son el conducto ileal y las ureterostomias cutáneas. La elección de la técnica dependerá de la patología de base, las condiciones del paciente y la experiencia del cirujano. El objetivo de este trabajo es determinar las complicaciones tempranas (≤30 días) y tardías (>30 días) de derivaciones urinarias heterópicas no continentes (DUHNC) tipo conducto ileal (CI) vs ureterostomias cutáneas (UC). Métodos Se realizó un estudio descriptivo retrospectivo de los pacientes llevados a DUHNC tipo CI o UC, desde enero del 2008 a julio del 2016, en un centro de referencia para patología oncológica. Se evaluó: edad, género, comorbilidades, escala de Karnofsky, patología quirúrgica, sangrado, ASA, tiempo quirúrgico, estancia hospitalaria, complicaciones tempranas y tardías. Resultados De los 70 pacientes incluidos, 26 con UC y 44 con CI, prevaleciendo el género masculino en ambos grupos. El promedio de edad fue de 66 y 63 años respectivamente y el indice Karnofsky en todos los pacientes fue superior al 90%. La causa más frecuente fue patología maligna de vejiga. El tiempo quirúrgico fue mayor en los pacientes del CI, siendo estadísticamente significativo (p = 0.000). El sangrado fue similar en ambas técnicas quirúrgicas requiriendo transfusión de hemoderivados el 92,3% de los pacientes con UC y 88,6% de los CI. La estancia hospitalaria no tuvo diferencias. En cuanto a las complicaciones tempranas, la más frecuente en ambos grupos fue el choque hipovolémico (61% UC y 58% CI). De las complicaciones tardías la sepsis urinaria prevaleció en ambos grupos (34% y 18% respectivamente) y la estrechez del estoma y la anastomosis ureteroileal se presentaron en las UC y en los CI respectivamente. La mortalidad en el transoperatorio fue del 12,8%. Conclusiones Las DUHNC como las ureterostomias cutáneas o el conducto ileal son técnicas quirúrgicas con tasas de sangrado, transfusión y estancia hospitalaria similares, pero con una menor proporción de complicaciones tanto tempranas como tardías en los pacientes llevados a conducto ileal

Introduction and Objectives The derivations of the urinary tract cover a wide range of surgical techniques, being the most frequent cause for its use the malignant urothelial pathology. Of the urinary diversions, the heterotopic continents are the ileal conduit and the cutaneous ureterostomies. The choice of technique will depend on the underlying pathology, the patient's conditions and the experience of the surgeon. The aim of this study is to determine the early complications (≤30 days) and late complications (> 30 days) of noncontinental heteropic urinary diversions (NHUD) type ileal conduit (IC) vs cutaneous ureterostomies (CU). Methods A retrospective descriptive study was conducted of patients referred to NHUD type CI or CU, from January 2008 to July 2016, in a referral center for oncological pathology. We evaluated: age, gender, comorbidities, Karnofsky scale, surgical pathology, bleeding, ASA, surgical time, hospital stay, early and late complications. Results Of the 70 patients included, 26 with CU and 44 with IC, the male gender prevailing in both groups. The average age was 66 and 63 years respectively and the Karnofsky index in all patients was over 90%. The most frequent cause was malignant pathology of the bladder. Surgical time was higher in IC patients, being statistically significant (p = 0.000). Bleeding was similar in both surgical techniques requiring transfusion of blood products 92.3% of patients with CU and 88.6% of IC. The hospital stay did not differ. Regarding the early complications, the most frequent in both groups was hypovolemic shock (61% CU and 58% CI). Of the late complications, urinary sepsis prevailed in both groups (34% and 18% respectively) and the narrowing of the stoma and the ureteroileal anastomosis were present in the CU and in the IC, respectively. The mortality in the transoperative period was 12.8%. Conclusions NHUD such as cutaneous ureterostomies or ileal conduit are surgical techniques with similar rates of bleeding, transfusion and hospital stay, but with a lower proportion of complications both early and late in patients taken to the ileal conduit.

Técnicas de recomposição de componentes do sangue para fins terapêuticos / Techniques for restoring blood components for therapeutic purposes

O uso de técnicas de recomposição de componentes do sangue para fins terapêuticos sem a necessidade de transfusão de sangue apresenta uma grande perspectiva de desenvolvimento futuro. A preocupação com a redução das necessidades de transfusão de sangue e derivados nos períodos trans e pós-operatórios sempre existiu devido à incidência de complicações correlatas às transfusões, principalmente com o risco de transmissão de doenças, como a AIDS, hepatite, malária e doença de Chagas. Todas as medidas que possam ser usadas para que haja a redução do volume de sangue transfundido são válidas, por isso esse artigo tem como objetivo identificar as estratégias clínicas existentes e assim foram analisados todos os métodos e alternativas disponíveis, como o uso da eritropoetina recombinante humana (rhEPO), a doação autóloga, uso de hemoderivados e as soluções carreadoras de oxigênio. Para o século XXI, haverá grandes mudanças em relação às estratégias clínicas com um grande foco no aperfeiçoamento da segurança e aumento de produtos hemoderivados

Suministros y uso de productos sanguíneos, banco de sangre del Hospital Escuela Universitario, Tegucigalpa, Honduras / Supply and use of the blood products, blood bank of the University School Hospital, Tegucigalpa, Honduras

Un banco de sangre es el ente encargado de la obtención de unidades sanguíneas: sangre total, eritrocitos,plasma, plaquetas, crioprecipitado; mantenimiento (tamizaje y refrigeración) y distribución, cuando es intrahospitalario además de estas funciones, abastece las salas de hospitalización que soliciten estos insumos. Objetivo: describir las principales fuentes de obtención de unidades sanguíneas, diferimiento, prevalencia de enfermedades transmisibles por vía transfusional, uso y descarte de hemoderivados Material y Métodos: estudio descriptivo, retrospectivo, transversal. Se analizaron los registros de la base de datos del Banco de Sangre del Hospital Escuela Universitario, año 2014, se identificó número y tipo de donantes, causas de diferimiento, donantes que presentaron reactividad en el tamizaje, componentes sanguíneos descartados y transfundidos y unidades de origen extrahospitalario. Resultados: la información fue conformada por 22 124 registros de donantes potenciales, 99.6% donantes de reposición y 0.4% donantes voluntarios; de estos se rechazó 3 724(16.8%) por incumplir los requisitos de donación. Se tamizaron 18 400 unidades: seroprevalencia para anti-core hepatitis B de 1.76%, Chagas 1.15%, T. Pallidum 1.1%, VIH 0.5%, Hepatitis C 0.4%, HBsAg 0.3%, HTLV I/II 0.3%. Se descartaron 14 745 unidades: plasma 75%, glóbulos rojos 9.9%, unidades seropositivas 6.9% y otros 8%. Se transfundieron 38 594 unidades: glóbulos rojos 43%, plasma fresco congelado 26%, plaquetas 18% y otros 13%. Se transfundieron adicionalmente 3,803 unidades provenientes de la Cruz Roja Hondureña: plaquetas 57%, plasma 27%, crioprecipitado 15%, otros 0.55%; otras instituciones proveyeron 698 unidades plaquetas 36%, plasma fresco congelado 21%, crioprecipitado 21% y otros 12%. Conclusiones: se observó una deficiente cantidad de donantes voluntarios, las unidades sanguíneas se obtienen principalmente de donantes de reposición, desconociendo la causa de la mayoría de diferimientos. Las prevalencias encontradas son coherentes con las establecidas por la OMS; el hemoderivado más descartado es el plasma, siendo proporcionalmente mayor a las cifras de la OMS, el hemoderivado más trasfundidos son glóbulos rojos que comparado con datos del Instituto Nacional de Salud colombiano es proporcionalmente menor. Las unidades transfundidas provenientes de otras instituciones muestran una reducción significativa y se destaca el alto grado de autonomía alcanzado...(AU)

Criterios actuales en la medicina transfusional perioperatoria / Current opinions in perioperative transfusion medicine

Blood transfusion as well as blood conservation strategies are the basis of so-called transfusion medicine, which is founded on the multidisciplinary work of anaesthesiologists, surgeons, haematologists, internists, etc. Its main objective is to avoid unnecessary transfusions. It is out of the question that a knowledge of transfusion indications, with the application of physiological triggers for red blood cells and the use of viscoelastic test-based guidelines for plasma and platelets, forces us to stay constantly abreast of the latest guidelines in this field. It is true that the blood products transfused today are the safest ever, although a zero-risk situation is impossible to reach. So, it is always important to keep in mind, as an essential part of transfusion medicine, a balance between risk and benefits in the indication of every single hemoderivate we prescribe. Taking into account the need for better criteria in the final transfusion decision, trying to use every resource available to minimise allogenic blood administration (also avoiding infra-transfusion), the concept of "patient blood management" has been developed. Its main objective for the surgical patient is to optimise preparation in the preoperative period, to minimise blood loss and bleeding during surgery, as well as to optimise the physiological tolerance of anaemia in the postoperative period

La transfusión de hemoderivados y sus técnicas de ahorro son la base de la medicina transfusional, que se fundamenta en el trabajo multidisciplinario de anestesiólogos, cirujanos, hematólogos, internistas, entre otros. Su objetivo esencial es disminuir o evitar las denominadas transfusiones innecesarias. No cabe duda de que el conocimiento de las indicaciones de administración de cada uno de los hemoderivados, con la aplicación de los triggers fisiológicos cuando se hace referencia a los concentrados de hematíes, o de la monitorización con pruebas de viscoelasticidad cuando se habla de la transfusión de hemostáticos, hacen que debamos ser conocedores de las nuevas tendencias decisionales en este campo. La sangre que se transfunde en el momento actual es la más segura que hemos tenido nunca, pero es imposible llegar al "riesgo cero", por lo que siempre es necesario tener en cuenta, como parte de la medicina transfusional, el equilibrio entre riesgo y beneficio en la indicación de cada uno de los hemoderivados que administramos. A partir de la premisa de transfundir con mejor criterio, tratando de emplear todos los recursos para minimizar la transfusión de sangre alogénica sin entrar en la infratransfusión, se desarrolla el concepto de "patient blood management", cuya esencia es la óptima preparación del paciente, la minimización del sangrado y las pérdidas hemáticas durante la cirugía y el aprovechamiento y la optimización de la reserva fisiológica de cada paciente en el posoperatorio

Intervenciones de enfermería para la seguridad en el manejo de la terapia transfusional / Nursing interventions for safety in the management of transfusion therapy / Intervenções de enfermagem para segurança na gestão da terapia transfusional

INTRODUCTION. The transfusion therapy is an intervention that saves life or quickly improves a serious condition, however, may lead to complications acute or delayed; It includes risks that can have serious or fatal consequences despite the strict controls that precede the transfusion. It is one of the greatest achievements of modern medicine, which has allowed lower mortality, prolong and improve the quality of life for many people with different disorders. METHODS. We performed a systematic search of articles at Pubmed, care, and blood transfusion Web sites (Lilacs, Elsevier, Scielo, Medigraphic, who, Imbiomed) related to the theme were limited to humans, documents published during the last 5 years, in English or Spanish, the clinical practice guidelines document type and validated the MeSh terms used blood transfusion. The strategy of search gave 488 results, of which are used 20 documents in the preparation of the Guide.RESULTS. Within them main strategies for it security in the therapy transfusion this it training to the personal, the verification of the transfusion correct with the hemocomponente correct: component, amount, speed of transfusion, type of filter and the need of premedication. CONCLUSIONS. The main nursing intervention in this guide highlight double effort in their care to the patient, transfusions, is processes of high responsibilities that demands extreme care, additional interventions of his pathology, and are aimed at improving health conditions

INTRODUCTION. The transfusion therapy is an intervention that saves life or quickly improves a serious condition, however, may lead to complications acute or delayed; It includes risks that can have serious or fatal consequences despite the strict controls that precede the transfusion. It is one of the greatest achievements of modern medicine, which has allowed lower mortality, prolong and improve the quality of life for many people with different disorders. METHODS. We performed a systematic search of articles at Pubmed, care, and blood transfusion Web sites (Lilacs, Elsevier, Scielo, Medigraphic, who, Imbiomed) related to the theme were limited to humans, documents published during the last 5 years, in English or Spanish, the clinical practice guidelines document type and validated the MeSh terms used blood transfusion. The strategy of search gave 488 results, of which are used 20 documents in the preparation of the Guide. RESULTS. Within them main strategies for it security in the therapy transfusion this it training to the personal, the verification of the transfusion correct with the hemocomponente correct: component, amount, speed of transfusion, type of filter and the need of premedication. CONCLUSIONS. The main nursing intervention in this guide highlight double effort in their care to the patient, transfusions, is processes of high responsibilities that demands extreme care, additional interventions of his pathology, and are aimed at improving health conditions

Introdução. A terapia de transfusão é uma intervenção que salva a vida ou melhora rapidamente uma condição séria, no entanto, pode levar a complicações agudas ou atrasadas; Ele inclui os riscos que podem ter consequências graves ou fatais, apesar dos controles estritos que precedem a transfusão. Um deles é grandes conquistas da medicina moderna, que permitiu diminuir a mortalidade, prolongar e melhorar a qualidade de vida de muitas pessoas com diferentes transtornos. MÉTODOS. É realizada uma busca sistemática dos artigos no Pubmed, cuidados e sites da Web (Lilacs, Scielo, Elsevier, Medigraphic, quem e Imbiomed) relacionadas com o sangue de transfusão do assunto é limitada ao ser humano, documentos publicados durante os últimos 5 anos, em idioma inglês ou espanhol, o tipo de documento de guias de prática clínica e é usado termos validado a malha transfusão de sangue. A estratégia de busca foi 488 resultados, dos quais 20 documentos foram utilizados na elaboração do guia. RESULTADOS. Dentro as principais estratégias para a segurança na transfusão terapia está fornecendo treinamento para os funcionários, a verificação da transfusão correta com o hemocomponente correto: componente, a quantidade, a velocidade de transfusão, o tipo de filtro e a necessidade de pré-medicação. CONCLUSÕES. Intervenções de enfermagem principal neste esforço de duplo destaque guia em seus cuidados ao paciente, desde a transfusão do ato em si, é um processo de alta responsabilidade que demandam cuidados de fim, adicional a eles próprios da sua patologia, intervenções e destinam-se a melhorar as condições de saúde

Cuidado de enfermería en la administración de hemoderivados / Nursing care in the administration of blood products

Introducción: El objetivo de la investigación fue identificar los cuidados de enfermería en la administración de hemoderivados. Materiales y Métodos: Estudio descriptivo de revisión sistemática de la literatura, mediante búsqueda de artículos en bases de datos como SciELO, Medigraphic y Medline, durante el segundo semestre del 2014 publicados entre los años 2000 y 2014 escritos en inglés, portugués y español. Resultados: la administración de hemoderivados es un procedimiento realizado por la enfermera y requiere responsabilidad, manejo meticuloso de la atención a la persona y aplicación correcta de un protocolo para prevenir complicaciones. Los cuidados se dividieron en tres; aquellos que se llevan a cabo antes de la administración, que a su vez se subdividen en administrativos, los cuales requieren compromiso ético-legal dando cumplimiento a normas establecidas y los de tipo asistencial; en segundo lugar se encuentran los que hacen referencia a los generados durante el proceso de transfusión y por último los que corresponden al finalizar tal proceso. Discusión y Conclusiones: Durante la revisión no se encontró un documento completo que soportara los cuidados de enfermería en la administración de hemoderivados por lo cual se tomaron de las diferentes fuentes bibliográficas. Tampoco se identificó un consenso nacional e internacional de estos cuidados y se evidenció que la enfermera desempeña un papel fundamental en la administración de hemoderivados puesto que permanece más tiempo con el paciente.

Introduction: The research objective was to identify the level of nursing care in the administration of blood products. Materials and Methods: Descriptive investigation about previous research articles. We conducted a comprehensive systematic review of the literature in databases such as SciELO, Medigraphic and Medline in the second semester of 2014. Articles were published in English, Portuguese and Spanish, with abstracts available in the period 2000 to 2014. Results: The administration of blood products is a process performed by nurses. The rationale for this is that nurses have responsibility and they are meticulous about their patients care. In addition nurses must follow protocols to prevent complications. Care is divided into three categories; before, during and after. Before administration of blood and its derives which includes administrative work and the measurement of vital signs. Administrative work requires a compromise between ethical and legal procedures that must be followed. Others care during administration and the end after administration. Discussion and Conclusions: During research nothing was found about care related to the administration of blood products. In order to work through this problem the best opinions of care were taken from each article. There is no National and International consensus on care in the administration of blood products. Nurses play an important role the administration of blood products because they are always at their patients side.

Contexto de criação e breve história da Hemobrás / Context of creation and brief history of Hemobrás

Descreve as razões que impulsionaram a criação da Hemobrás no âmbito do Estado brasileiro, cujo objetivo é fomentar a produção industrial de hemoderivados, prioritariamente para tratamento de pacientes do Sistema Único de Saúde (SUS). Além disso, narrade modo breve a história da empresa, recortando três períodos de seu desenvolvimento institucional e destacando as conquistas e os desafios enfrentados em cada um deles.

Describes the reasons that led to the creation of Hemobrás within the Brazilian state, whose purpose is to promote industrial production of blood products, primarily for the treatment of patients from the Unified Health System. Furthermore, briefly recounts the historyof the company, cropping three periods of its institutional development and highlighting conquests and challenges faced in each one of them.

O papel da Organização Pan–Americana da Saúde no fortalecimento dos Sistemas Nacionais de Sangue: a cooperação técnica como instrumento para implementação da Política Nacional de Sangue, Componentes e Hemoderivados no Brasil / The contribution of the Pan American Health Organization in strengthening National Blood Systems: the technical cooperation as an instrument for the implementation of the National Blood Policy, Compounds and blood products in Brazil

Este trabalho de natureza descritiva buscou relatar o papel da OrganizaçãoPan–Americana da Saúde (OPAS) na cooperação técnica referente ao fortalecimento dos sistemas nacionais de sangue da região das Américas, com ênfase no Sistema Nacional de Sangue (SINASAN) brasileiro. Foram utilizados como fontes documentais as resoluções da Organização Mundial da Saúde e da OPAS e os termos de cooperação celebrados entre a OPAS, o Ministério da Saúde e a Empresa Brasileira de Biotecnologia e hemoderivados dentre os resultados, destaca–se o necessário papel articulador da OPAS para o desenvolvimento de parcerias estratégicas com as instituições brasileiras que compõem e apoiamo SINASAN, objetivando a realização de cooperação técnica para o fortalecimento dos sistemas de sangue dos países da região.

This descriptive work looks at presenting the technical cooperation provided by the Pan American Health Organization (PAHO) in contribution to strengthening National Blood Systems in the Americas, with special emphasis on the National Blood System in Brazil (SINASAN). Resolutions adopted by PAHO and WHO member states have been used as references, as well as the Agreement of Cooperation established between PAHO and Hemobras (Brazilian Public Company for biological and blood products). As a result, we stress the relevant rol of PAHO as a catalyzer in the development of strategic partnership among SINASAN players in Brazil, andtherefore the technical rol that the Organization (PAHO) plays in the Region as a broker.

A Hemobrás como ferramenta de incorporação tecnológica para produção nacional de biomedicamentos / Hemobrás as a tool of technology incorporations for national production of biopharmaceutical products

Para cumprir sua missão de produzir medicamentos hemoderivados e biotecnológicos, a Hemobrás constrói, na cidade de Goiana–PE, a sua unidade fabril e garante a incorporação dos seus primeiros processos produtivos através de acordos de transferênciade tecnologia. O primeiro contrato foi firmado com o Laboratório Francês de Biotecnologia (LFB) e possibilitará a produção nacional dos medicamentos hemoderivados. Um segundo contrato, firmado com a empresa Baxter Internacional, tornará a Hemobrás detentora da tecnologia de produção industrial da proteína Fator VIII a partir de tecnologia do DNA recombinante. O presente trabalho sintetiza as características dos processos deincorporação tecnológica da Hemobrás, contextualizados nas políticas públicas de investimento no setor produtivo nacional da saúde, com foco na ampliação do acesso aos medicamentosconsiderados de alto custo no âmbito do SUS e na redução da dependênciade importações.

To accomplish the mission of producing hemoderivative and biotechnologicalmedicine, Hemobrás is building their producing unit in Goiânia–PE. Through technology transference agreements, the company is also assuring the absorption of their first productive processes. The first contract was closed with the French Biotechnology Laboratory and will make the national production of hemoderivative medicine. A second contract closed with Baxter International will turn Hemobrás into the owner of technology capable of industrially producing the Factor VIII Protein, from recombinant DNA technology. This work summerizes the characteristics of Hemobrás’s technological absorption processes, contextualized by public investmentpolicies concerned to the health–related national producing sector, focused in increasing the access to medicine considered high–cost within Brazilian Health System (SUS) and the reductionof imported products dependence.

A regulação sanitária brasileira e a Hemobrás / Brazilian sanitary regulation and Hemobrás

A Hemobrás é uma empresa criada para possibilitar o acesso, pela população,aos medicamentos produzidos a partir do plasma humano e oriundos de processos biotecnológicos. Todo o ciclo produtivo de tais medicamentos é regulado por legislações sanitárias, as quais serão apresentadas e discutidas neste trabalho. Observamos que muitas destas normas são antigas e precisam de reformulação para atender melhor o grande avanço dos últimos anos nesta área, pois não condizem mais com o novo cenário brasileiro e mundial. Além disso, a Hemobrás tem exercido um papel relevante para o amadurecimento e o progresso das normas que regulamentam o setor de medicamentos no Brasil.

The Hemobrás is a company created to facilitate access by the population to medicines made from human plasma and derived from biotechnological processes. Throughout the production cycle of these drugs is regulated by sanitary laws, which were presented and discussed in this paper. We note that many of these standards are old and need reshaping to better meet the great advance in recent years in this area, because more do not fit with the new Brazilian and global scenario. Furthermore, Hemobrás has played an important role for the maturation and advancement of standards governing the drug industry in Brazil.