Una mirada crítica a las consideraciones preanalíticas de gases sanguíneos / Uma análise crítica das considerações pré-analíticas dos gases sangüíneos / A critical look at the preanalytical considerations of blood gases

Introducción: uno de los asuntos menos discutidos y que poco se entiende del mismo, es la seguridad del paciente. Hace poco tiempo se ha convertido en un tema ubicuo y polémico, especialmente para algunas organizaciones médicas. Objetivo: sistematizar referentes teóricos relacionados con las particularidades del proceso de toma de muestra y análisis de los gases en sangre. Método: se revisan los principales elementos que gravitan en esta fase para el análisis de los gases sanguíneos, así como la influencia que estos pueden tener en la calidad de los resultados y las prácticas clínicas y de laboratorio para optimizarla. Desarrollo: la fase preanalítica es aquella que antecede a la realización de un ensayo o estudio de laboratorio e incluye la preparación del paciente, la confección de la solicitud de análisis y los cuidados para la obtención de las muestras. La atención que el médico de asistencia y el personal del laboratorio concedan a esta fase es directamente proporcional a la calidad de los resultados que se obtendrán. Conclusiones: el análisis de pH y gases sanguíneos deben ser considerados siempre como un estudio de urgencia. La muestra no debe permanecer por más de diez minutos a temperatura ambiente y cuando el análisis demore más de 15 minutos, la muestra deberá ser conservada en agua con hielo(AU)

Introduction: one of the least discussed issues and that little is understood about it, is patient safety. It has recently become a ubiquitous and controversial issue, especially for some medical organizations. Objective: to systematize theoretical references related to the particularities of the process of sample taking and analysis of blood gases. Method: the main elements that gravitate in this phase are analyzed for the blood gas analysis, as well as the influence that these can have on the quality of the results and the clinical and laboratory practices to optimize it. Development: the preanalytical phase is the one that precedes the performance of a trial or laboratory study and includes the preparation of the patient, the preparation of the analysis request and the care for obtaining the samples. The attention that the attending physician and laboratory staff give to this phase is directly proportional to the quality of the results that will be obtained. Conclusions: the analysis of pH and blood gases should always be considered as an emergency study. The sample should not remain for more than ten minutes at room temperature and when the analysis takes more than 15 minutes, the sample should be stored in ice water(au)

Introdução: uma das questões menos discutidas e que pouco é entendido sobre isso, é a segurança do paciente. Tornou-se recentemente uma questão onipresente e controversa, especialmente para algumas organizações médicas. Objetivo: sistematizar referenciais teóricos relacionados às particularidades do processo de coleta de amostras e análise de gases sangüíneos. Método: os principais elementos que gravitam nesta fase são analisados para a gasometria, assim como a influência que estes podem ter na qualidade dos resultados e nas práticas clínicas e laboratoriais para otimizá-la. Desenvolvimento: a fase pré-analítica é aquela que precede a realização de uma pesquisa ou estudo laboratorial e inclui a preparação do paciente, a elaboração do pedido de análise e o cuidado para obtenção das amostras. A atenção que o médico assistente e o pessoal de laboratório dão a essa fase é diretamente proporcional à qualidade dos resultados que serão obtidos. Conclusões: a análise do pH e dos gases sanguíneos deve ser sempre considerada como um estudo de emergência. A amostra não deve permanecer por mais de dez minutos em temperatura ambiente e quando a análise demora mais de 15 minutos, a amostra deve ser armazenada em água gelada(AU)

Analysis of economic and social costs of adverse events associated with blood transfusions in Spain / Análisis de costes económicos y sociales asociados a reacciones adversas de transfusiones sanguíneas en España

Objective: To calculate, for the first time, the direct and social costs of transfusion-related adverse events in order to include them in the National Healthcare System's budget, calculation and studies. In Spain more than 1,500 patients yearly are diagnosed with such adverse events. Method: Blood transfusion-related adverse events recorded yearly in Spanish haemovigilance reports were studied retrospectively (2010-2015). The adverse events were coded according to the classification of Diagnosis-Related Groups. The direct healthcare costs were obtained from public information sources. The productivity loss (social cost) associated with adverse events was calculated using the human capital and hedonic salary methodologies. Results: In 2015, 1,588 patients had adverse events that resulted in direct health care costs (4,568,914Euros) and social costs due to hospitalization (200,724Euros). Three adverse reactions resulted in patient death (at a social cost of 1,364,805Euros). In total, the cost of blood transfusion-related adverse events was 6,134,443Euros in Spain. For the period 2010-2015: the trends show a reduction in the total amount of transfusions (2 vs. 1.91MEuros; -4.4%). The number of adverse events increased (822 vs. 1,588; +93%), as well as their related direct healthcare cost (3.22 vs. 4.57MEuros; +42%) and the social cost of hospitalization (110 vs 200MEuros; +83%). Mortality costs decreased (2.65 vs. 1.36MEuros; -48%). Discussion: This is the first time that the costs of post-transfusion adverse events have been calculated in Spain. These new figures and trends should be taken into consideration in any cost-effectiveness study or trial of new surgical techniques or sanitary policies that influence blood transfusion activities

Objetivo: Calcular por primera vez los costes económicos y sociales relacionados con las reacciones adversas postransfusionales para actualizar estudios e incluirlos en los presupuestos del Sistema Nacional de Salud. En España, anualmente, más de 1500 pacientes sufren dichas reacciones adversas. Método: Se estudiaron retrospectivamente (periodo 2010-2015) las reacciones adversas a la transfusión recopiladas anualmente en los informes nacionales de hemovigilancia. Dichas reacciones se codificaron mediante clasificación de Grupos Relacionados con el Diagnóstico. Los costes directos sanitarios se obtuvieron de fuentes públicas de información. La pérdida en productividad (coste social) asociada a las reacciones adversas se contabilizó utilizando los métodos del capital humano y salarios hedónicos, respectivamente. Resultados: En el año 2015, en España, 1588 pacientes tuvieron reacciones adversas que derivaron en costes sanitarios (4.568.914 Euros) y costes sociales debido a hospitalización (200.724 Euros). Tres reacciones adversas resultaron en muerte del paciente (1.364.805 Euros). Como suma, el coste total de las reacciones adversas a la transfusión fue de 6.134.443 Euros. Periodo 2010-2015: la tendencia refleja una reducción en el número total de transfusiones (2 vs. 1,91 MEuros; -4,4%), un incremento en el número de reacciones adversas (822 vs. 1.588; +93%), en costes sanitarios (3,22 vs. 4,57MEuros; +42%) y en costes sociales (110 vs. 200MEuros; +83%), y un descenso en costes de mortalidad (2,65 vs. 1,36MEuros; -48%). Discusión: Por primera vez se han calculado en España los costes de las reacciones adversas a la transfusión. Los nuevos datos y tendencias deberían ser considerados en estudios de coste-eficiencia sobre técnicas quirúrgicas o políticas sanitarias con repercusión en actividades de transfusión sanguínea

Rates and reasons for blood donor deferral, Shiraz, Iran. A retrospective study / Taxas e razões para o diferimento de doadores de sangue, Shiraz, Irã. Um estudo retrospectivo

CONTEXT AND OBJECTIVE: Knowledge of the reasons for donor deferral can help in planning more efficient recruitment strategies and evaluating donor selection criteria. This study aimed to investigate the rates and reasons for donor deferral. DESIGN AND SETTING: Retrospective study at Shiraz Blood Transfusion Center, Shiraz, Iran. METHODS: 141,820 volunteers were interviewed confidentially by physicians before blood donation. The rate of and reasons for donor deferral were investigated according to demographic characteristics. The data were analyzed using the comparison-of-proportions test of the MedCalc statistical software. RESULTS: 43,839 people (30.9%) who had come for blood donation were deferred, 1,973 (4.5%) of them permanently. The deferral rate was significantly higher among women, single individuals and first-time donors, compared with men, married individuals and those with a history of previous donation (P < 0.0001). The deferral rate was significantly higher in the 17 to 30-year-old group (P < 0.05). The reasons for deferral were divided into five categories: risk factors possibly related to HIV or hepatitis (43.6%), underlying diseases (31.9%), non-eligible conditions (13.5%), medications that interfere with blood donation (7.8%) and risk factors that may relate to bacterial or viral infections except HIV and hepatitis infections (3.2%). CONCLUSION: Effective measures are required for documenting the impact of deferral on blood availability, monitoring the effectiveness of and need for deferral, and determining the reasons and rates of deferral. .

CONTEXTO E OBJETIVO: Conhecimentos sobre os motivos do adiamento da doação de sangue podem ajudar a planejar estratégias mais eficientes de recrutamento e avaliar critérios de seleção de doadores. O objetivo foi investigar as taxas e os motivos para o adiamento da doação. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo no centro de transfusão de sangue de Shiraz, Irã. MÉTODOS: 141.820 voluntários foram entrevistados confidencialmente por médicos antes da doação de sangue. A taxa e as razões para o adiamento da doação foram pesquisadas de acordo com características demográficas. Os dados foram analisados com o teste de comparação de proporções do software estatístico MedCalc. RESULTADOS: 43.839 pessoas (30.9%) encaminhadas para doação tiveram sua doação diferida, sendo 1.973 permanentemente. A taxa de adiamento foi significativamente maior entre as mulheres, solteiras e doadoras de primeira vez, em comparação com os homens, casados e os com história de doação anterior (P < 0,0001). A taxa de adiamento foi significativamente maior no grupo de 17-30 anos de idade (P < 0,05). As razões para o adiamento foram divididas em cinco categorias: fatores de risco que podem estar relacionados com HIV ou hepatite (43,6%), doenças subjacentes (31,9%), condições não elegíveis (13,5%), medicamentos que interferem na doação (7,8%) e fatores de risco que podem estar relacionados com infecções bacterianas ou virais, exceto infecções de HIV e hepatite (3,2%). CONCLUSÃO: São necessárias medidas eficazes para documentar ...

Seroprevalencia de Toxoplasma gondii en donantes de sangre en la provincia de Guantánamo / Seroprevalence of Toxoplasma gondii in blood donors from the province of Guantánamo

Los riesgos de contaminación con Toxoplasma gondii a través de las transfusiones, están incrementados por la incidencia de este parásito en donantes y la tolerancia de este a los procesos de preparación y almacenamiento de la sangre, por lo que resulta peligroso para los grupos de riesgo. Esta enfermedad no es de declaración obligatoria en Cuba. El interés de conocer el comportamiento epidemiológico de esta parasitosis nos condujo a estudiar 562 muestras de donantes de sangre de la provincia de Guantánamo, donde resultaron positivos para IgG anti T. gondii el 47,0 porciento, con más del 62 porciento de positividad en los municipios de Baracoa y Maisí, con mayor prevalencia en áreas rurales. Los valores de seropositividad observados en los grupos etários estudiados y la relación entre sexo no fue significativa, aunque el contacto con el parásito en el grupo de edad entre 18 y 40 años fue superior. Estos datos seroepidemiológicos alertan sobre la necesidad de proponer acciones de control en el uso de hemoderivados en los grupos de riesgo

The risk of contamination with Toxoplasma gondii via blood transfusion is increased by the incidence of this parasite in donors and its tolerance to blood processing and storage processes, which turns it into a hazard for risk groups. This disease is not notifiable in Cuba. The interest in learning about the epidemiological behavior of this parasitosis led us to study 562 blood donor samples from the province of Guantánamo, 47.0 percent of which tested positive for anti-T. gondii IgG, with over 62 percent positivity in the municipalities of Baracoa and Maisí, and higher prevalence in rural areas. Neither the seropositivity values found in the age groups studied nor their sex distribution were significant, though contact with the parasite was higher in the 18-40 age group. These seroepidemiological data point to the need to propose control actions for the use of blood products in risk groups

Seroprevalencia de Toxoplasma gondii en donantes de sangre en la provincia de Guantánamo / Seroprevalence of Toxoplasma gondii in blood donors from the province of Guantánamo

Los riesgos de contaminación con Toxoplasma gondii a través de las transfusiones, están incrementados por la incidencia de este parásito en donantes y la tolerancia de este a los procesos de preparación y almacenamiento de la sangre, por lo que resulta peligroso para los grupos de riesgo. Esta enfermedad no es de declaración obligatoria en Cuba. El interés de conocer el comportamiento epidemiológico de esta parasitosis nos condujo a estudiar 562 muestras de donantes de sangre de la provincia de Guantánamo, donde resultaron positivos para IgG anti T. gondii el 47,0 porciento, con más del 62 porciento de positividad en los municipios de Baracoa y Maisí, con mayor prevalencia en áreas rurales. Los valores de seropositividad observados en los grupos etários estudiados y la relación entre sexo no fue significativa, aunque el contacto con el parásito en el grupo de edad entre 18 y 40 años fue superior. Estos datos seroepidemiológicos alertan sobre la necesidad de proponer acciones de control en el uso de hemoderivados en los grupos de riesgo(AU)

The risk of contamination with Toxoplasma gondii via blood transfusion is increased by the incidence of this parasite in donors and its tolerance to blood processing and storage processes, which turns it into a hazard for risk groups. This disease is not notifiable in Cuba. The interest in learning about the epidemiological behavior of this parasitosis led us to study 562 blood donor samples from the province of Guantánamo, 47.0 percent of which tested positive for anti-T. gondii IgG, with over 62 percent positivity in the municipalities of Baracoa and Maisí, and higher prevalence in rural areas. Neither the seropositivity values found in the age groups studied nor their sex distribution were significant, though contact with the parasite was higher in the 18-40 age group. These seroepidemiological data point to the need to propose control actions for the use of blood products in risk groups(AU)

A hemovigilância no processo de administração de transfusão de hemocomponente para qualidade e segurança do paciente / Hemovigilance in the blood component transfusion administration process for patient quality and safety

O estudo partiu da premissa que a inserção de uma tecnologia irá auxiliar na produção de informações para conhecimento e educação nos processos que necessitam de acompanhamento, monitoramento e avaliação contínua das ações contribuindo com a implementação da política de formação direcionada. Objetivo geral Desenvolver um instrumento de acompanhamento do processo de administração de transfusão de hemocomponente para mitigação e rastreabilidade de incidentes transfusionais. Metodologia estudo descritivo realizado através de observação sistemática do processo de administração de transfusão de hemocomponente em uma instituição pública federal, localizada no Rio de Janeiro com foco no tratamento e cirurgia das doenças cardiovasculares. O estudo foi realizado conforme resolução n°466 de 2012 do Conselho Nacional de Saúde, submetido à Plataforma Brasil e aprovado pelo Comitê de Ética em Pesquisa (CEP) da UNIRIO sob n° CAAE: 51244015.9.0000.5285 e CEP da instituição em que foi realizada a pesquisa sob o n° CAAE: 51244015.9.3001.5272. Foram observadas, 30 transfusões sanguíneas durante os meses de Junho e Julho de 2016. Resultados o estudo evidenciou que conforme o grau de risco, considerando a probabilidade e a severidade dos itens avaliados, todas as etapas do processo avaliado, apresentou Percentual de Conformidades (PC) baixo, ou seja, menor que 60% classificando-as quanto ao potencial grau de risco em alto risco. Conclusão os resultados apontam que mediante a avaliação das conformidades do processo de administração de transfusão sanguínea, há necessidade de uma gestão de ações de vigilância considerando os riscos inerentes identificados, de maneira proativa a fim de prevenir incidentes e minimizar danos associados à terapia, através da implantação de capacitação e educação permanente relacionada à temática. O instrumento irá auxiliar na rastreabilidade, monitorização e mitigação dos riscos de incidentes transfusionais de forma a garantir a qualidade e segurança de todo o processo

The study started from the premise that the insertion of a technology will help in the production of information for knowledge and education in the processes that need monitoring, monitoring and continuous assessment of the actions contributing to the implementation of the targeted training policy. General Objective To develop an instrument to monitor the blood transfusion administration process for the mitigation and traceability of transfusion incidents. Methodology A descriptive study was carried out through a systematic observation of the process of blood transfusion administration at a federal public institution, located in Rio de Janeiro, focused on the treatment and surgery of cardiovascular diseases. The study was carried out according to resolution n ° 466 of 2012 of the National Health Council, submitted to the Brazil Platform and approved by the Research Ethics Committee (CEP) of UNIRIO under n ° CAAE: 51244015.9.0000.5285 and CEP of the institution in which it was performed the research under CAAE: 51244015.9.3001.5272. Thirty blood transfusions were observed during the months of June and July 2016. Results The study showed that according to the degree of risk, considering the probability and severity of the evaluated items, all stages of the evaluated process presented Percentage of Conformities (PC), that is, less than 60%, classifying them for the potential high-risk degree. Conclusion, the results indicate that by evaluating the conformity of the process of blood transfusion administration, there is a need for a management of surveillance actions considering the inherent risks identified, in a proactive way in order to prevent incidents and minimize damage associated with therapy, through implementation of training and permanent education related to the theme. The instrument will assist in the traceability, monitoring and mitigation of the risks of transfusion incidents in order to guarantee the quality and safety of the entire process

Seroprevalence of transfusion-transmissible infections and evaluation of the pre-donation screening performance at the provincial hospital of tete, mozambique

The World Health Organization recommends universal and quality-controlled screening of blood donations for the major transfusion-transmissible infections (TTIs): human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis. The study objectives were to determine the seroprevalence of these TTIs among blood donors at the Provincial Hospital of Tete, Mozambique, and to assess the local pre-donation screening performance. All consenting voluntary and replacement candidate blood donors were consecutively included from February to May 2009. Sera of all candidates, independent of deferral by questionnaire, were submitted to screening with quality-assured rapid or simple assays for HIV, HBV surface antigen (HBsAg), HCV and syphilis. Assays locally used by the blood bank for HBV and syphilis screening were run in parallel to quality-assured external assays supplied during the study, and all discordant samples were submitted to confirmation testing in reference laboratories in Mozambique and Belgium. Of 750 consenting candidates (50.5% of voluntary donors), 71 (9.5%) were deferred by the questionnaire, including 38 specifically because of risk behavior for TTI. Of the 679 non-deferred candidates, 127 (18.7%) had serological confirmation of at least one TTI, with a lower prevalence in voluntary than in replacement donors (15.2% versus 22.4%, p = 0.016). Seroprevalence of HIV, HBsAg and syphilis infections was 8.5%, 10.6 % and 1.2%. No confirmed HCV infection was found. Seroprevalence of TTIs was similar in the 38 candidates deferred for TTI risk as in the non-deferred group, except for HBsAg (26.3 % versus 10.6 %; p = 0.005). The local assays used for HBV and syphilis had sensitivities of 98.4% and 100% and specificities of 80.4% and 98.8% respectively. This resulted in the rejection of 110 of the 679 blood donations (16.2%) because of false positive results.The seroprevalence of TTIs after questionnaire screening is high in Tete, Mozambique, but HCV infection does not appear as a major issue. The questionnaire did not exclude effectively HIV-infected donor candidates, while the locally used assays led to unnecessary rejection of many safe donations. A contextualized questionnaire and consistent use of quality-assured assays would considerably improve the current screening procedure for blood donation.

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.

Creación de la red de servicios de medicina transfusional y bancos de sangre del Ministerio de Salud Pública y Asistencia Social, para su regionalización y categorización: acuerdo ministerial No. 529-2011 / Creation of the network of transfusion medicine services and blood banks of the Ministry of Public Health and Social Assistance, for its regionalization and categorization: ministerial agreement No. 529-2011

El objetivo de crear esta red, es la de integrar todos los servicios de la medicina transfusional y los bancos de sangre. En el documento se establecen las funciones de la mencionada red. Incluye las definiciones de los conceptos relacionados al tema principal, además de la infraestructura que deberá tener cada centro, incluidos el equipo y recurso humano y técnico. Enumera la ubicación de los distintos centros de medicina transfusional y los bancos de sangre, destacando como de "referencia" los de los hospitales San Juan de Dios y Roosevelt, los mismos cuentan con los dos bancos principales de sangre del país. Hace la diferencia entre un banco de sangre regional y un centro de trasfusión, detallando igualmente la infraestructura, características, servicios y personal de estos últimos.