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2.
Medicine (Baltimore) ; 100(7): e24678, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607807

RESUMEN

BACKGROUND: This study aimed to explore the role of tranexamic acid (TXA) in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery. METHODS: In this meta-analysis, a comprehensive search of literatures was performed from PubMed, Embase, Cochrane Library, and Web of Science from inception to June 23rd, 2020. Weighed mean difference (WMD) was used as the effect size for measurement data, and risk ratio for enumeration data. Publication bias was assessed by Begg test. RESULTS: Totally 23 studies (11 randomized controlled trials and 12 cohort studies) involving 1621 participants were enrolled in this meta-analysis. The results showed that the administration of TXA can significantly decrease the intraoperative [WMD: -215.655, 95%CI: (-307.462, -123.847), P < .001], postoperative [WMD: -69.213, 95%CI: (-104.443, -33.983), P = .001] and total [WMD: -284.388, 95%CI: (-437.66, -131.116), P < .001] volumes of blood loss of patients undergoing multilevel spine surgery. It can also significantly reduce the intraoperative [WMD: -333.775, 95%CI: (-540.45, -127.099), P = .002] and postoperative [WMD: -114.661, 95%CI: (-219.58, -9.742), P = .032] volumes of transfusion. In addition, TXA was found to significantly increase the preoperative [WMD: 0.213, 95%CI: (0.037, 0.389), P = .018] and postoperative [WMD: 0.433, 95%CI: (0.244, 0.622), P < .001] hemoglobin levels as well as the preoperative platelet count [WMD: 14.069, 95%CI: (0.122, 28.015), P = .048]. CONCLUSION: The administration of TXA can effectively reduce blood loss and transfusion, and improve hemoglobin levels and preoperative platelet count in patients undergoing multilevel spine surgery.


Asunto(s)
Antifibrinolíticos/uso terapéutico , Pérdida de Sangre Quirúrgica/prevención & control , Transfusión Sanguínea/normas , Procedimientos Neuroquirúrgicos/efectos adversos , Ácido Tranexámico/uso terapéutico , Adolescente , Adulto , Anciano , Antifibrinolíticos/administración & dosificación , Transfusión Sanguínea/estadística & datos numéricos , Estudios de Casos y Controles , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Ácido Tranexámico/administración & dosificación
3.
Med. clín (Ed. impr.) ; 155(10): 425-433, nov. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-198327

RESUMEN

ANTECEDENTES Y OBJETIVOS: Los programas de Patient blood management (PBM) han demostrado su valor en la mejora continua de la práctica asistencial, gracias a la revisión sistemática de resultados y a su actualización dinámica y multidisciplinar, de acuerdo con las nuevas evidencias clínicas. Nuestro objetivo es demostrar la efectividad y seguridad de protocolos sencillos, aplicables en hospitales de segundo nivel. PACIENTES Y MÉTODOS: Se han analizado retrospectivamente 702 pacientes intervenidos de artroplastia programada desde 2011 hasta 2018. Durante este periodo se ha registrado en la historia clínica de los pacientes la evolución transfusional y el manejo de la anemia y el sangrado. RESULTADOS: Fases y tasas de transfusión: año 2011-2012 «Programa autodonación universal»: 62,4%; año 2013 «inicio optimización de hemoglobina preoperatoria y retirada autodonación universal» 22,5%; año 2015 «suspensión del uso de recuperadores y los drenajes» 13,2%; y año 2017 «inicio de uso de ácido tranexámico (ATX)» 3,6%. Se ha conseguido una reducción significativa de la tasa y el número de concentrados de hematíes transfundidos (p < 0,001) y de la estancia media hospitalaria (de 8 a 6 días) (p < 0,001). En los modelos multivariantes los pacientes transfundidos tienen 0,5 días más de estancia y se observa una tendencia a la reducción en complicaciones, siendo menores en los pacientes que reciben ATX (OR 0,44). CONCLUSIÓN: Un programa PBM sencillo, progresivo y multidisciplinar, con reevaluación continuada, ha permitido reducir la transfusión y la estancia media hospitalaria en un hospital de segundo nivel


BACKGROUND AND OBJECTIVES: The "Patient Blood Management" (PBM) programmes have demonstrated their value in the continuous improvement of care practice, due to continuous systematic reviewing of results and their dynamic and multidisciplinary updating in accordance with new clinical evidence. Our goal is to demonstrate the effectiveness of simple protocols, applicable in second level hospitals. PATIENTS AND METHODS: 702 patients undergoing scheduled arthroplasty from 2011 to 2018 were retrospectively analysed. During this period, the evolution of transfusion rates and anaemia and bleeding management were recorded in the patients' computerised clinical histories. RESULTS: Stages and transfusion rates were: Year 2011-2012, "Universal self-donation programme": 62.4%; year 2013, "Optimization of preoperative haemoglobin and universal self-donation withdrawal", 22.5%; year 2015, "Stopping the use of cell-savers and drains", 13.2%; and year 2017, "Introduction of routine tranexamic acid", 3.6%. A significant reduction in the transfusion rate and volume (P<.001) and the average hospital stay (8 to 6 days) (P<.001) was achieved. In multivariate models, transfused patients have a .5-day stay and there is a trend towards a reduction in complications, being fewer in patients receiving tranexamic acid (OR .44). CONCLUSION: A simple progressive and multidisciplinary PBM programme, with continued re-evaluation, has allowed a reduction in transfusion rates and average hospital stay


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Resultado del Tratamiento , Anemia/diagnóstico , Hemorragia/prevención & control , Estudios de Cohortes , Transfusión Sanguínea/normas , Estudios Retrospectivos , Cuidados Preoperatorios , Anemia/terapia , Pérdida de Sangre Quirúrgica/prevención & control , Tiempo de Internación/estadística & datos numéricos , Profilaxis Antibiótica
4.
Clin Lab Med ; 40(4): 587-601, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33121624

RESUMEN

SARS-CoV-2 (also known as COVID-19) has been an unprecedented challenge in many parts of the medical field with blood banking being no exception. COVID-19 has had a distinctly negative effect on our blood collection nationwide forcing blood banks, blood centers, and the US government to adopt new policies to adapt to a decreased blood supply as well as to protect our donors from COVID-19. These policies can be seen distinctly in patient blood management and blood bank operations. We are also faced with developing policies and procedures for a nontraditional therapy, convalescent plasma; its efficacy and safety is still not completely elucidated as of yet.


Asunto(s)
Bancos de Sangre , Transfusión Sanguínea/normas , Infecciones por Coronavirus , Control de Infecciones/organización & administración , Pandemias , Neumonía Viral , Betacoronavirus , Bancos de Sangre/métodos , Bancos de Sangre/tendencias , Donantes de Sangre/provisión & distribución , Seguridad de la Sangre , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Humanos , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Formulación de Políticas , Medicina Transfusional/normas , Medicina Transfusional/tendencias
7.
Vox Sang ; 115(6): 536-542, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32384164
8.
Emerg Med J ; 37(6): 370-378, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32376677

RESUMEN

OBJECTIVE: In the era of damage control resuscitation of trauma patients with acute major haemorrhage, transfusion practice has evolved to blood component (component therapy) administered in a ratio that closely approximates whole blood (WB). However, there is a paucity of evidence supporting the optimal transfusion strategy in these patients. The primary objective was therefore to establish if there is an improvement in survival at 30 days with the use of WB transfusion compared with blood component therapy in adult trauma patients with acute major haemorrhage. METHODOLOGY: A systematic literature search was performed on 15 December 2019 to identify studies comparing WB transfusion with component therapy in adult trauma patients and mortality at 30 days. Studies which did not report mortality were excluded. Methodological quality of included studies was interpreted using the Cochrane risk of bias tool, and rated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Search of the databases identified 1885 records, and six studies met the inclusion criteria involving 3255 patients. Of the three studies reporting 30-day mortality (one randomised controlled trial (moderate evidence) and two retrospective (low and very low evidence, respectively)), only one study demonstrated a statistically significant difference between WB and component therapy, and two found no statistical difference. Two retrospective studies reporting in-hospital mortality found no statistical difference in unadjusted mortality, but both reported statistically significant logistic regression analyses demonstrating that those with a WB transfusion strategy were less likely to die. CONCLUSION: Recognising the limitations of this systematic review relating to the poor-quality evidence and limited number of included trials, it does not provide evidence to support or reject use of WB transfusion compared with component therapy for adult trauma patients with acute major haemorrhage. PROSPERO REGISTRATION NUMBER: CRD42019131406.


Asunto(s)
Transfusión Sanguínea/métodos , Hemorragia/terapia , Heridas y Traumatismos/complicaciones , Adulto , Transfusión de Componentes Sanguíneos/métodos , Transfusión de Componentes Sanguíneos/normas , Transfusión de Componentes Sanguíneos/tendencias , Transfusión Sanguínea/normas , Transfusión Sanguínea/tendencias , Hemorragia/etiología , Hemorragia/fisiopatología , Humanos , Resucitación/instrumentación , Resucitación/métodos , Heridas y Traumatismos/terapia
9.
Transfusion ; 60(8): 1778-1784, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32442333

RESUMEN

BACKGROUND: The aim of this study was to estimate the number of blood donors during the COVID-19 incubation period across China. STUDY DESIGN AND METHODS: In this study, we developed a predictive model to estimate the number of blood donors during the COVID-19 incubation period among 34 provincial regions in China. Our main assumption was that blood donors of all ages in different regions have a stable blood donation intention and the same infection risk. RESULTS: First, we estimated the number of blood donors during the COVID-19 incubation period in Wuhan city, Hubei Province, and China, from December 31, 2019 to March 17, 2020. Second, we compared the number of blood donors during the COVID-19 incubation period in all provinces across China. In addition, we found that if all RBCs, plasma, and cryoprecipitation were stored in isolation until the 14th day, the potential risk of SARS-CoV-2 transmission through blood transfusion was reduced by at least 65.77% after the blood donor safely passed the COVID-19 incubation period. Moreover, if the detection of SARS-CoV-2 RNA was carried out on all platelets, the potential risk would be reduced by 77.48%. CONCLUSIONS: Although the risk is low, with the rapid spread of the COVID-19 and the appearance of alarmingly high infectivity and a high fatality rate, appropriate measures should be taken by health departments to ensure the safety of clinical blood.


Asunto(s)
Donantes de Sangre/estadística & datos numéricos , Seguridad de la Sangre/métodos , Transfusión Sanguínea/normas , Infecciones por Coronavirus/transmisión , Neumonía Viral/transmisión , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , Donantes de Sangre/provisión & distribución , Conservación de la Sangre , China , Infecciones por Coronavirus/prevención & control , Humanos , Periodo de Incubación de Enfermedades Infecciosas , Pandemias/prevención & control , Neumonía Viral/prevención & control , Cuarentena , ARN Viral/sangre
11.
J Trauma Acute Care Surg ; 88(6): 855-865, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32459450

RESUMEN

BACKGROUND: Major hemorrhage is a significant cause of mortality and morbidity around the world. There is currently no consensus on the best empirical transfusion strategy. The current National Institute for Clinical Excellence (NICE) guidelines suggest a ratio of 1:1 of red blood cells and plasma. The aim of this study is to compare this to alternative strategies identified through review of the available literature with the objective of identifying the best protocol for mortality outcomes and complication rates. METHODS: A systematic review of the literature was conducted using four databases. Inclusion and exclusion criteria were applied to produce a suitable list of randomized control trials for review. Critical appraisal of each article was then performed, using a Scottish Intercollegiate Guidelines Network-approved checklist, in duplicate and was subject to further independent scrutiny when required. RESULTS: Evidence suggests that early administration of cryoprecipitate within the standard practiced major hemorrhage protocol is associated with a lower risk of mortality. Other strategies suggested a negative impact. Complications including incidence of thromboembolic events, multiple organ failure and sepsis as well as length of stay in hospital following activation of the different protocols and overall transfusion requirements were assessed. No clear optimal protocol was identified from our analysis. CONCLUSION: This project demonstrates that there is no significant clarity regarding morbidity and mortality. As a preliminary recommendation, cryoprecipitate supplementation suggests more favorable mortality over the current protocol. Due to the limited sample populations, we recommend the inclusion of retrospective/prospective cohort studies to bolster the statistical power of any future reviews until randomized control trials of sufficient power are available. LEVEL OF EVIDENCE: Systematic review, Level III.


Asunto(s)
Transfusión Sanguínea/métodos , Hemorragia/terapia , Heridas y Traumatismos/terapia , Transfusión Sanguínea/normas , Hemorragia/etiología , Hemorragia/mortalidad , Humanos , Tiempo de Internación/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Análisis de Supervivencia , Resultado del Tratamiento , Heridas y Traumatismos/complicaciones , Heridas y Traumatismos/mortalidad
12.
Transfusion ; 60(5): 897-907, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32319687

RESUMEN

In the United States, postpartum hemorrhage (PPH) accounts for 4.6% of all maternal deaths and is responsible for major peripartum medical and surgical morbidity. Therefore, a national health priority is to ensure that women who experience severe PPH receive timely, appropriate, and effective treatment. In this article, we describe our system-wide approach for the planning and delivery of women with suspected placenta accreta spectrum disorder, a condition associated with life-threatening blood loss at the time of delivery. We also highlight current evidence related to transfusion decision making and hemostatic monitoring during active postpartum bleeding. Specifically, we describe how we activate and use the massive transfusion protocol to obtain sufficient volumes and types of blood products. We also describe how we use viscoelastic monitoring (thromboelastography) and standard laboratory tests to assess the maternal coagulation profile. Finally, we review the findings of recent studies examining the potential efficacy of tranexamic acid and fibrinogen concentrate as adjuncts for PPH prevention and treatment. We describe how we have incorporated these drugs into PPH treatment protocols at our institution.


Asunto(s)
Hemorragia Posparto/terapia , Pruebas de Coagulación Sanguínea , Transfusión Sanguínea/métodos , Transfusión Sanguínea/normas , Femenino , Hemostáticos/uso terapéutico , Humanos , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/normas , Periodo Posparto , Embarazo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tromboelastografía
15.
Metas enferm ; 23(3): 50-56, abr. 2020. tab, graf, ilus
Artículo en Español | IBECS | ID: ibc-194509

RESUMEN

OBJETIVO: determinar si es correcta la identificación a través de las pulseras identificativas y de grupo sanguíneo en los pacientes intervenidos de cirugía ortopédica. MÉTODO: estudio descriptivo transversal. La población de estudio fueron los pacientes intervenidos de cirugía ortopédica de prótesis de rodilla y cadera en el Hospital Universitario de Burgos. Técnica de recogida de los datos: observación directa. Variables de estudio: sexo; edad; tipo de cirugía; lado de la cirugía; colocación de pulseras; portador de vía venosa; canalización de vía en quirófano; calibre; retirada de las pulseras; sustitución de las pulseras; tiempo sin pulseras; vía y pulsera en el mismo brazo y planta de origen. RESULTADOS: se analizaron 153 casos. El 100% de los pacientes contaba con una pulsera identificativa y el 98% tenía pulsera de grupo sanguíneo. Fue necesario retirar por colocación incorrecta el 27% de las pulseras identificativas y el 29% de las de grupo sanguíneo; todas fueron sustituidas. La media del tiempo que el paciente pasó en el quirófano sin pulsera con datos personales fue de 51,62 minutos y sin la pulsera de grupo sanguíneo de 50,36 minutos. CONCLUSIONES: la gran mayoría de los pacientes se encontraban correctamente identificados a través de las dos pulseras, aunque por necesidades de la cirugía en algunos casos debían retirarse quedando los pacientes sin identificar durante aproximadamente una hora. La comunicación e información con las enfermeras resulta fundamental para mejorar la calidad de los cuidados y la seguridad del enfermo


OBJECTIVE: to determine if there is an adequate use of identification and blood type wristbands in patients undergoing ortophedic surgery. METHOD: a cross-sectional descriptive study. The study population consisted of patients who had undergone orthopedic surgery for knee and hip prosthesis at the Hospital Universitario de Burgos. Data collection technique: direct observation. Study variables: gender, age, type of surgery, side of surgery, wristband placement, central venous line, IV line catheterization at the operating room, gauge, wristband removal, wristband replacement, time without wristbands, IV line and wristband in the same arm, and ward of origin. RESULTS: the study analyzed 153 cases; 100% of patients had an identification wristband, and 98% had blood type wristbands. It was necessary to remove 27% of the identification wristbands and 29% of the blood type wristbands due to incorrect placement; all of them were replaced. The mean time that the patient stayed at the operating room without a personal data wristband was 51.62 minutes, and 50.36 minutes without blood type wristband. CONCLUSIONS: the vast majority of patients were adequately identified through the two wristbands; though, for surgical requirements, in some cases these had to be removed, and patients were unidentified during approximately one hour. Communication and information with nurses becomes essential in order to improve the quality of care and patient safety


Asunto(s)
Humanos , Sistemas de Identificación de Pacientes/normas , Enfermería de Quirófano/organización & administración , Enfermería Ortopédica/organización & administración , Seguridad del Paciente , Sistemas de Identificación de Pacientes/clasificación , Estudios Transversales , Transfusión Sanguínea/enfermería , Transfusión Sanguínea/normas
16.
Vox Sang ; 115(5): 405-423, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32124457

RESUMEN

BACKGROUND AND OBJECTIVES: Blood transfusion is inherently associated with risks, and little is known regarding the available quality and safety measures in developing countries. No studies or census has been carried out, and therefore, no data on this compelling issue are available. MATERIALS AND METHODS: Data emanating from eight Arabic eastern/southern Mediterranean countries who responded to five surveys were collected and tabulated. RESULTS: Asepsis during phlebotomy, screening for serological and immuno-haematological parameters and appropriate storage conditions are maintained across all countries. Variations in blood component processing exist. Universal leucoreduction is systematically applied in Lebanon. Nucleic acid testing is only performed in Egypt. Aphaeresis procedure, leucoreduction and quality control for blood components are virtually inexistent in Mauritania. Written donor questionnaire is absent in Algeria and Tunisia. Most donor deferral periods for infectious agents are inconsistent with international standards. CONCLUSION: Gaps in the processing and in the quality/safety measures applied to the manufacture of blood components are quite evident in most eastern/southern Mediterranean countries. The decision of establishing an effective collaboration network and an independent body - aside from WHO - composed of specialists that oversees all transfusion activities in these countries is certainly a crucial step towards ensuring an optimum level of blood safety.


Asunto(s)
Transfusión Sanguínea/normas , Tamizaje Masivo , África del Norte , Humanos , Líbano , Región Mediterránea , Seguridad del Paciente , Garantía de la Calidad de Atención de Salud
17.
Med. paliat ; 27(1): 44-53, ene.-mar. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-194823

RESUMEN

INTRODUCCIÓN: El 5-17,5 % de los pacientes terminales requieren transfusión con hemoderivados por anemia crónica, siendo las indicaciones para transfundir los niveles de hemoglobina (< 12 g dl) y los síntomas. El objetivo de este estudio fue analizar los beneficios que obtienen estos pacientes con el tratamiento con hemoderivados. MÉTODOS: Revisión sistemática realizando la búsqueda en las bases de datos Medline, IBECS y The Cochrane Library. Se acotó a inglés y español, pacientes terminales adultos, tratamiento con hemoderivados y estudios de casos y controles, cohortes, descriptivos y ensayos clínicos. RESULTADOS: Se seleccionaron 17 artículos de 297 encontrados: 1 casos-control, 1 caso clínico, 1 cualitativo y 14 descriptivos. 9 señalaron beneficios en síntomas, 4 mejoría de la hemoglobina sérica, y 4 combinaron las dos mediciones. CONCLUSIONES: Todos los estudios habían aplicado el nivel de hemoglobina para indicar transfusión. La fatiga, la disnea y los niveles de hemoglobina mejoran tras la terapia, pero no mejoran la calidad de vida o la supervivencia


INTRODUCTION: Chronic anemia is a common condition among terminal patients, and between 5% and 17.5% of patients require blood transfusions. The main indications for transfusion are based on hemoglobin levels (< 12 g/dL) and symptomatology. The objective was to analyze the benefits of treatment with blood transfusions in these patients. METHODS: A systematic review of the Medline, IBECS, and The Cochrane Library databases was performed. Inclusion criteria: papers written in Spanish or English, adult terminal patient population, and specific types of studies: clinical trials, case-control studies, cohort studies, and descriptive studies. RESULTS: Seventeen articles were selected from a total of 297 - 1 case-control study, 1 clinical case report, 1 qualitative research, and 14 descriptions. Nine showed benefits in symptoms, 4 found improvement in serum hemoglobin, and 4 combined these two measurements. CONCLUSIONS: All the articles had applied the hemoglobin level criterion to indicate transfusion. Fatigue, dyspnea, and hemoglobin levels improve after therapy, but quality of life and survival do not improve


Asunto(s)
Humanos , Cuidado Terminal/métodos , Transfusión Sanguínea/métodos , Cuidados Paliativos , Transfusión Sanguínea/normas , Anemia/sangre , Anemia/complicaciones , Medicamentos Hemoderivados
18.
Am Surg ; 86(1): 35-41, 2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-32077414

RESUMEN

A massive transfusion protocol (MTP) was implemented at a Level I trauma center in 2007 for patients with massive blood loss. A goal ratio of plasma to pheresed platelets to packed red blood cells (PRBCs) of 1:1:1 was established. From 2007 to 2014, trauma nurse clinicians (TNCs) administered the MTP during initial resuscitation and anesthesia personnel administered the MTP intraoperatively. In 2015, TNCs began administering the MTP intraoperatively. This study evaluates intraoperative blood product ratios and crystalloid volume administered by anesthesia personnel or TNCs. A retrospective review of trauma registry patients requiring MTP from 2007 to 2017 was performed. Patient data were stratified according to MTP administration by either anesthesia personnel (2007-2015) or TNCs (2015-2017). Ninety-seven patients were included with 54 anesthesia patients and 44 TNC patients. Patients undergoing resuscitation by MTP administered by TNCs received less median crystalloid (3000 mL vs 1500 mL, P < 0.001). The ratio of plasma:PRBC (0.75 vs 0.93, P = 0.027) and platelets:PRBC (0.75 vs 1.04, P = 0.003) was found to be significantly closer to 1:1 for TNC patients. MTP intraoperative blood product administration by TNCs reduced the amount of infused crystalloid and improved adherence to MTP in achieving a 1:1:1 ratio of blood products.


Asunto(s)
Transfusión Sanguínea/normas , Hemorragia/enfermería , Cuidados Intraoperatorios , Enfermeras Clínicas , Resucitación/enfermería , Heridas y Traumatismos/cirugía , Adulto , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Sistema de Registros , Estudios Retrospectivos , Centros Traumatológicos
19.
Transfusion ; 60(4): 786-798, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32104927

RESUMEN

BACKGROUND: Blood transfusion is a lifesaving intervention for millions of recipients worldwide every year. Storing blood makes this possible but also promotes a series of alterations to the metabolism of the stored erythrocyte. It is unclear whether the metabolic storage lesion is correlated with clinically relevant outcomes and whether strategies aimed at improving the metabolic quality of stored units, such as hypoxic storage, ultimately improve performance in the transfused recipient. STUDY DESIGN AND METHODS: Twelve healthy donor volunteers were recruited in a two-arm cross-sectional study, in which each subject donated 2 units to be stored under standard (normoxic) or hypoxic conditions (Hemanext technology). End-of-storage measurements of hemolysis and autologous posttransfusion recovery (PTR) were correlated to metabolomics measurements at Days 0, 21, and 42. RESULTS: Hypoxic red blood cells (RBCs) showed superior PTR and comparable hemolysis to donor-paired standard units. Hypoxic storage improved energy and redox metabolism (glycolysis and 2,3-diphosphoglycerate), improved glutathione and methionine homeostasis, decreased purine oxidation and membrane lipid remodeling (free fatty acid levels, unsaturation and hydroxylation, acyl-carnitines). Intra- and extracellular metabolites in these pathways (including some dietary purines) showed significant correlations with PTR and hemolysis, though the degree of correlation was influenced by sulfur dioxide (SO2 ) levels. CONCLUSION: Hypoxic storage improves energy and redox metabolism of stored RBCs, which results in improved posttransfusion recoveries in healthy autologous recipients-a Food and Drug Administration gold standard of stored blood quality. In addition, we identified candidate metabolic predictors of PTR for RBCs stored under standard and hypoxic conditions.


Asunto(s)
Conservación de la Sangre/métodos , Eritrocitos/metabolismo , Hipoxia , Adulto , Donantes de Sangre , Conservación de la Sangre/normas , Transfusión Sanguínea/normas , Estudios Transversales , Femenino , Voluntarios Sanos , Hemólisis , Humanos , Masculino , Recuperación de la Función , Trasplante Autólogo
20.
BMJ Open Qual ; 9(1)2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31986114

RESUMEN

BACKGROUND: Transfusion is a common procedure for neonates receiving intensive care management. Recognising a paucity of patient blood management (PBM) programmes in neonates, we aimed to embed blood management and best transfusion principles in the neonatal intensive care unit (NICU) by aligning local policies, providing targeted education and partnering with parents. METHODS: Practice-based evidence for clinical practice improvement (PBE-CPI) methodology was used. Previous hospital accreditation audits were reviewed and a neonate-specific transfusion audit was developed. Audit was performed at baseline and repeated following the intervention period. NICU clinicians received targeted education in obtaining informed consent, prescription and safe administration of blood components during a 'Blood Month' awareness period. A neonate-specific parent handout about transfusion was developed in partnership with parents. A pilot video demonstrating a shared consent discussion was also developed to assist in the consent process. Parents' knowledge, concerns and feedback regarding transfusion practice was sought at baseline (survey) and on project completion (experience trackers). RESULTS: Neonate-specific baseline transfusion audit showed inconsistent consent, monitoring and documentation processes in neonatal transfusions. Post-targeted education audit showed improvement in these parameters. The targeted PBM and transfusion-related education delivered during 'Blood Month' was well-received by staff. Parents' feedback about the NICU transfusion consenting process was consistently positive. NICU medical and nursing clinicians (n=25) surveyed agreed that the parent handout was well set out, easy to understand and recommended that it be used to complement practice. CONCLUSION: PBE-CPI tools aligned with Australian PBM guidelines for clinicians and parents were well-accepted by clinical stakeholders and were associated with practice improvement in PBM awareness and transfusion consent processes. This PBE-CPI project developed NICU-specific consent information, not previously available, by partnering with parents to ensure quality of care in transfusion practice. Adoption of this also helps to meet accreditation for Australian Blood Management Standards. These strategies and tools translate readily into other NICUs to embed and support best PBM and transfusion practice.


Asunto(s)
Transfusión Sanguínea/normas , Práctica Clínica Basada en la Evidencia/normas , Unidades de Cuidado Intensivo Neonatal , Cuidado Intensivo Neonatal/normas , Australia , Personal de Salud/educación , Humanos , Recién Nacido , Recien Nacido Prematuro , Consentimiento Informado/normas , Padres/educación , Encuestas y Cuestionarios
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