RESUMEN
BACKGROUND AND OBJECTIVES: Spinal surgery has been shown to have a high blood transfusion requirement. Preoperative autologous blood donation (PABD) is a strategy to reduce the allogeneic transfusions in this subset of patients. MATERIAL AND METHODS: We retrospectively reviewed transfusion outcome of patients undergoing elective major spinal surgery from 2005 to 2011, and included in the PABD program. Transfusion outcome was compared with a group of patients that did not enter in the program during the same period. RESULTS: A total of 148 patients were included in the program during the analyzed period. Patients in the PABD program benefited from reduced exposure to allogeneic blood (Odds Ratio: 0.077, 95% confidence interval 0.043-0.140). However, 12.16% (n=18) of these patients received also allogeneic blood (total 40 red blood cell units). Univariate analysis showed the following parameters as significantly predictors of transfusion: inclusion in the program (p<0.000), number of levels fused (Odds Ratio: 1.143, p=0.010), and number of autologous red blood cells donated (Odds Ratio: 1.906, p<0.000). CONCLUSIONS: The preoperative autologous blood donation program designed in our hospital was effective for reducing allogeneic transfusion in mostly young patients under major elective spinal surgery. However and as expected, their inclusion in the program increased the risk to be transfused.
Asunto(s)
Donantes de Sangre , Transfusión de Sangre Autóloga , Procedimientos Quirúrgicos Electivos , Cuidados Preoperatorios , Columna Vertebral/cirugía , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The Consensus Document on Alternatives to Allogenic Blood Transfusion (AABT) has been drawn up by a panel of experts from 5 scientific societies. The Spanish Societies of Anesthesiology (SEDAR), Critical Care Medicine and Coronary Units (SEMICYUC), Hematology and Hemotherapy (AEHH), Blood Transfusion (SETS) and Thrombosis and Hemostasis (SETH) have sponsored and participated in this Consensus Document. Alternatives to blood transfusion have been divided into pharmacological and non-pharmacological, with 4 modules and 12 topics. The main objective variable was the reduction of allogenic blood transfusions and/or the number of transfused patients. The extent to which this objective was achieved by each AABT was evaluated using the Delphi method, which classifies the grade of recommendation from A (supported by controlled studies) to E (non-controlled studies and expert opinion). The experts concluded that most of the indications for AABT were based on middle or low grades of recommendation, "C", "D", or "E", thus indicating the need for further controlled studies.
Asunto(s)
Hemorragia/terapia , Ácido Aminocaproico/administración & dosificación , Ácido Aminocaproico/efectos adversos , Ácido Aminocaproico/uso terapéutico , Antifibrinolíticos/administración & dosificación , Antifibrinolíticos/efectos adversos , Antifibrinolíticos/uso terapéutico , Aprotinina/administración & dosificación , Aprotinina/efectos adversos , Aprotinina/uso terapéutico , Pérdida de Sangre Quirúrgica/prevención & control , Sustitutos Sanguíneos/administración & dosificación , Sustitutos Sanguíneos/efectos adversos , Sustitutos Sanguíneos/uso terapéutico , Transfusión de Sangre Autóloga , Coloides/administración & dosificación , Coloides/efectos adversos , Coloides/uso terapéutico , Soluciones Cristaloides , Desamino Arginina Vasopresina/administración & dosificación , Desamino Arginina Vasopresina/efectos adversos , Desamino Arginina Vasopresina/uso terapéutico , Medicina Basada en la Evidencia , Factor VIIa/administración & dosificación , Factor VIIa/efectos adversos , Factor VIIa/uso terapéutico , Hematínicos/administración & dosificación , Hematínicos/efectos adversos , Hematínicos/uso terapéutico , Hemodilución , Hemorragia/tratamiento farmacológico , Hemostáticos/administración & dosificación , Hemostáticos/efectos adversos , Hemostáticos/uso terapéutico , Humanos , Hierro/administración & dosificación , Hierro/efectos adversos , Hierro/uso terapéutico , Soluciones Isotónicas/administración & dosificación , Soluciones Isotónicas/efectos adversos , Soluciones Isotónicas/uso terapéutico , Recuperación de Sangre Operatoria , Hemorragia Posoperatoria/tratamiento farmacológico , Premedicación , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Ácido Tranexámico/administración & dosificación , Ácido Tranexámico/efectos adversos , Ácido Tranexámico/uso terapéuticoRESUMEN
El Documento de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica (ATSA) ha sido elaborado por un panel de expertos pertenecientes a 5 sociedades científicas. Han participado y patrocinado las sociedades españolas de Anestesiología (SEDAR), Medicina Intensiva (SEMICYUC), Hematología y Hemoterapia (AEHH), Transfusión sanguínea (SETS) y Trombosis y Hemostasia (SETH). Las alternativas a la transfusión se han clasificado en farmacológicas y no farmacológicas, con un total de 4 módulos y 12 tópicos. La disminución de las transfusiones de sangre alogénica y/o el número de pacientes transfundidos fue la principal variable objetivo. El grado de cumplimiento de este objetivo, para cada ATSA, se llevó a cabo siguiendo la metodología Delphi, que clasifica el grado de recomendación desde «A» (apoyado por estudios controlados) hasta «E» (estudios no controlados y opinión de expertos). Los expertos concluyeron que la mayor parte de las indicaciones de las ATSA se sustentan en grados de recomendación medios y bajos, «C», «D» o «E», precisándose nuevos estudios controlados (AU)
The Consensus Document on Alternatives to Allogenic Blood Transfusion (AABT) has been drawn up by a panel of experts from 5 scientific societies. The Spanish Societies of Anesthesiology (SEDAR), Critical Care Medicine and Coronary Units (SEMICYUC), Hematology and Hemotherapy (AEHH), Blood Transfusion (SETS) and Thrombosis and Hemostasis (SETH) have sponsored and participated in this Consensus Document. Alternatives to blood transfusion have been divided into pharmacological and non-pharmacological, with 4 modules and 12 topics. The main objective variable was the reduction of allogenic blood transfusions and/or the number of transfused patients. The extent to which this objective was achieved by each AABT was evaluated using the Delphi method, which classifies the grade of recommendation from A (supported by controlled studies) to E (non-controlled studies and expert opinion). The experts concluded that most of the indications for AABT were based on middle or low grades of recommendation, «C», «D», or «E», thus indicating the need for further controlled studies (AU)