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1.
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
2.
Pan Afr Med J ; 34: 31, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31762899

RESUMEN

Introduction: Unsafe transfusion practices can put millions of people at risk of Transfusion Transmissible Infections (TTIs). In Kenya the current blood transfusion scheme involves screening of blood for HIV, Hepatitis B virus (HBV), Hepatitis C virus (HCV) and syphilis. Malaria is also a blood-borne disease which is not currently screened for. In Kenya blood donor selection criteria were reviewed in 2009. Regular review of effectiveness of donor selection criteria can help reduce TTIs prevalence amongst donors and thus make the blood supply safer. Methods: A cross sectional study was conducted between November 2011 to January 2012 among 594 blood donors in the Regional Blood Transfusion Center Nakuru and Tenwek Mission Hospital. Socio-demographic characteristics and associated risk factors were collected using a standard blood transfusion service questionnaire. Donors were obtained through systematic sampling. Each donor sample was screened, for HIV-1 and HIV-2, HBV, HCV, syphilis and malaria parasites. Results: The overall prevalence of TTIs was 14.1%, which ranged from 0.7% for malaria to 5.6% for HBsAg. Blood donors who were married (P=0.0057), had non-formal or just primary education (P=0.0262), had multiple sexual partners (P=0.0144) and in informal occupation (P=0.0176) were at higher risk of HIV positivity. History of blood transfusion/blood products (P=0.0055), being married (P=0.0053) were high risk factors associated with positive syphilis. Being male (P=0.0479) was a high risk factor to HBV infection. Conclusion: The prevalence of TTIs indicates a need to review the questionnaire and apply it strictly for donor selection. The 0.7% prevalence of malaria, poses a serious health risk to non-immune recipients of transfusion. Malaria should be included among mandatory TTI tests in Kenya.


Asunto(s)
Donantes de Sangre/estadística & datos numéricos , Transfusión Sanguínea/normas , Selección de Donante/métodos , Reacción a la Transfusión/epidemiología , Adolescente , Adulto , Seguridad de la Sangre , Estudios Transversales , Femenino , Humanos , Kenia , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Factores Sexuales , Encuestas y Cuestionarios , Adulto Joven
3.
Lancet Haematol ; 6(12): e606-e615, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31631023

RESUMEN

BACKGROUND: Blood transfusions are an important resource of every health-care system, with often limited supply in low-income and middle-income countries; however, the degree of unmet need for blood transfusions is often unknown. We therefore aimed to estimate the blood transfusion need and supply at national level to determine gaps in transfusion services globally. METHODS: We did a modelling study involving 195 countries and territories. We used blood component preparation data from 2011-13 to estimate blood availability for 180 (92%) of 195 countries from the WHO Global Status Report on Blood Safety and Availability. We calculated disease-specific transfusion needs per prevalent case for 20 causes in the USA using the National (Nationwide) Inpatient Sample dataset between the years 2000 and 2014, and the State Inpatient Databases between 2003 and 2007 from the Healthcare Cost and Utilization Project. Using prevalence estimates for the USA from the Global Burden of Disease (GBD) 2017 study, we estimated the ideal disease specific-transfusion rate as the lowest rate from the years 2000 to 2014. We applied this rate to GBD prevalence results for 195 countries to estimate transfusion needs. Unmet need was the difference between the estimated supply and need. FINDINGS: In 2017, the global blood need was 304 711 244 (95% uncertainty interval [UI] 293 064 637-314 049 479) and the global blood supply was 272 270 243 (268 002 639-276 698 494) blood product units, with a need-to-supply ratio of 1·12 (95% UI 1·07-1·16). Of the 195 countries, 119 (61%) did not have sufficient blood supply to meet their need. Across these 119 countries, the unmet need totalled 102 359 632 (95% UI 93 381 710-111 360 725) blood product units, equal to 1849 (1687-2011) units per 100 000 population globally. Every country in central, eastern, and western sub-Saharan Africa, Oceania, and south Asia had insufficient blood to meet their needs. INTERPRETATION: Our data suggest that the gap between need and supply is large in many low-income and middle-income countries, and reinforce that the WHO target of 10-20 donations per 1000 population is an underestimate for many countries. A continuous expansion and optimisation of national transfusion services and implementation of evidence-based strategies for blood availability is needed globally, as is more government support, financially, structurally, and through establishment of a regulatory oversight to ensure supply, quality, and safety in low-income and middle-income countries. FUNDING: National Institutes of Health.


Asunto(s)
Bancos de Sangre/provisión & distribución , Transfusión Sanguínea , Salud Global , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Evaluación de Necesidades/estadística & datos numéricos , Bancos de Sangre/economía , Bancos de Sangre/normas , Bancos de Sangre/estadística & datos numéricos , Seguridad de la Sangre/normas , Seguridad de la Sangre/estadística & datos numéricos , Transfusión Sanguínea/economía , Transfusión Sanguínea/normas , Transfusión Sanguínea/estadística & datos numéricos , Geografía , Carga Global de Enfermedades , Salud Global/economía , Salud Global/normas , Salud Global/estadística & datos numéricos , Costos de la Atención en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/normas , Humanos , Modelos Teóricos , Evaluación de Necesidades/economía , Evaluación de Necesidades/organización & administración , Evaluación de Necesidades/normas , Áreas de Pobreza , Prevalencia
4.
Clin Orthop Surg ; 11(3): 265-269, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31475045

RESUMEN

Background: Hip fracture surgery (HFS) is often associated with perioperative blood loss, and it frequently necessitates transfusion. However, the hemoglobin (Hb) threshold for transfusion remains controversial in hip fracture patients. We evaluated the usefulness of the restrictive strategy and preoperative intravenous iron supplementation in HFS. Methods: We retrospectively reviewed the medical records of 1,634 patients (> 60 years of age) who underwent HFS between May 2003 and June 2014 and were followed up for 1 year or more after surgery. We used the liberal transfusion strategy until May 2009 to determine the transfusion threshold; afterwards, we switched to the restrictive transfusion strategy. Patients with the restrictive transfusion strategy (restrictive group) received intravenous iron supplementation before surgery. We compared the transfusion rate, morbidity, and mortality of the restrictive group with those of the patients with the liberal transfusion strategy (liberal group). Results: Preoperative intravenous iron supplementation was not associated with any adverse reactions. The transfusion rate was 65.3% (506/775) in the liberal group and 48.2% (414/859) in the restrictive group (p < 0.001). The mean hospital stay was shorter in the restrictive group (21.5 vs. 28.8 days, p < 0.001). There was no significant difference in the postoperative medical complications including myocardial infarction and cerebrovascular event. Mortality at postoperative 30, 60, and 90 days was similar between the two groups. Conclusions: Our blood management protocol involving restrictive strategy combined with preoperative intravenous iron supplementation appears to be effective and safe in HFS of elderly patients.


Asunto(s)
Anemia/terapia , Transfusión Sanguínea/normas , Fracturas de Cadera/cirugía , Compuestos de Hierro/administración & dosificación , Administración Intravenosa , Anciano , Anciano de 80 o más Años , Anemia/etiología , Pérdida de Sangre Quirúrgica , Suplementos Dietéticos , Femenino , Hemoglobinas/análisis , Fracturas de Cadera/sangre , Humanos , Masculino , Procedimientos Ortopédicos , Hemorragia Posoperatoria/terapia , Cuidados Preoperatorios , Estudios Retrospectivos
5.
Vox Sang ; 114(8): 853-860, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31489645

RESUMEN

BACKGROUND: Management of major gastrointestinal bleeding (GIB) may require massive transfusion (MT), but limited data are available. Upper and lower GIB have different aetiologies, prognosis, bleeding patterns and outcomes. Better understanding of current transfusion management and outcomes in these patients is important. We sought to define and validate an algorithm based on clinical coding data to distinguish critical upper and lower GIB using data from the Australian and New Zealand Massive Transfusion Registry (ANZ-MTR). STUDY DESIGN AND METHODS: Australian and New Zealand Massive Transfusion Registry hospital-source data on adult patients receiving a MT (defined as ≥5 red cell units within 4 h) for any bleeding context were used. An algorithm allocating ICD-10-AM codes into 'probable' or 'possible' causes of GIB was developed and applied to the ANZ-MTR. Source medical records of 69 randomly selected cases were independently reviewed to validate the algorithm. RESULTS: Of 5482 MT cases available from 25 hospitals, 716 (13%) were identified as GIB with 538/716 (75%) categorized 'probable' and 178/716 'possible' GIB. Upper and lower GIB causes of MT were identified for 455/538 (85%) and 76/538 (14%) 'probable' cases, respectively; 7/538 (1·3%) cases had both upper and lower GIB. Allocation by the algorithm into a 'probable' GIB category had a 95·7% (CI: 90-100%) positive predictive value when validated against source medical records. CONCLUSION: An algorithm based on ICD-10-AM codes can be used to accurately categorize patients with luminal GIB as the primary reason for MT, enabling further study of this critically unwell and resource-intensive cohort of patients.


Asunto(s)
Transfusión Sanguínea/normas , Codificación Clínica/métodos , Hemorragia Gastrointestinal/clasificación , Sistema de Registros , Adulto , Anciano , Algoritmos , Australia , Codificación Clínica/normas , Estudios de Cohortes , Femenino , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Estudios Retrospectivos
6.
Malays J Pathol ; 41(2): 161-167, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31427551

RESUMEN

INTRODUCTION: Overnight transfusion (OT) is the blood transfusion taking place from 9pm to 8am. During this period, patients are exposed to increased risk of errors. This cross-sectional study aims to determine the incidence and practice of OT in Universiti Kebangsaan Malaysia Medical Centre. MATERIALS & METHODS: Data from all OT in June and mid-July 2017 were collected from recipients' cards, transfusion request forms and patient's case files, regarding discipline involved, indications, time intervals from request of blood transfusion to the completion of OT on patients, monitoring of patients and adverse reactions. RESULTS: A total of 1285 transfusion cases were identified during the study period. 216 (16.8%) cases were OT while the 1069 (83.2%) cases were non-OT. Surgery discipline has the highest (30.1%) OT. The indications of OT were acute clinical need: 82.9%, less acute clinical need: 13.9% and no clinical need: 3.2%. A huge delay (average: 5 hours 40 minutes) in starting transfusion after grouping and crossmatching (GXM) completion was noted. Besides, 25.9% cases took <4 hours to complete OT; 83.4% cases did not have proper transfusion monitoring and three transfusion reactions were reported. DISCUSSION: Although most of the OT cases had appropriate clinical indications, the transfusion can be commenced earlier at day time rather than overnight. Cases without absolute indication should avoid OT. The poor monitoring of patient during OT had posed risks to patients' life if an adverse transfusion reaction happened. The major reason for OTs was a huge delay in starting transfusion after the GXM completion. The contravention of 4-hour infusion rule increased the patients' risk of developing bacterial sepsis. The practice of OT should be discouraged wherever possible except for clinically indicated cases.


Asunto(s)
Transfusión Sanguínea/métodos , Hospitales de Enseñanza , Adolescente , Adulto , Anciano , Transfusión Sanguínea/normas , Niño , Estudios Transversales , Femenino , Hospitales de Enseñanza/métodos , Hospitales de Enseñanza/normas , Humanos , Malasia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Reacción a la Transfusión/epidemiología , Adulto Joven
7.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(4): 307-309, 2019 Jul 30.
Artículo en Chino | MEDLINE | ID: mdl-31460729

RESUMEN

This capacitive venous transfusion alertor is based on rise time of RC circuit and input capture function of timer in the microcontroller. The measure element of alertor is integrated with circuit board, it has the advantages of simple structure and low cost. Combined with narrow band intent of things(NB-IoT) technology to upload data, it can reduce the workload of medical personnel and caregivers, avoid unnecessary trouble and danger.


Asunto(s)
Algoritmos , Transfusión Sanguínea , Sistemas Microelectromecánicos , Transfusión Sanguínea/instrumentación , Transfusión Sanguínea/normas , Diseño de Equipo/normas , Sistemas Microelectromecánicos/normas
9.
Transfus Clin Biol ; 26(3): 155-159, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31255509

RESUMEN

INTRODUCTION: Different evaluations conducted on blood safety between 2004 and 2013 in Africa showed some progress in most countries. This paper describes the current status of the availability and access to safe blood in the Region. METHODS: A cross-sectional survey was conducted from January to December 2018. Data were collected through a questionnaire prepared using key indicators of blood safety and analysis was done using Excel 2010 and results were compared to those of the 2013. RESULTS: A total of 2,678 blood centres were reported including 244 (9%) stand-alone and 2,434 (91%) hospital based. Amongst these countries, 90.2% had a blood policy, 60.1% participated in an External Quality Assessment Scheme for Transfusion Transmissible Infections screening, 12% had accredited blood services, 73.2% had national guidelines on clinical use of blood and 78% had a government budget. The total number of blood units collected was 4,899,913 and the average proportion of voluntary blood donations was 71%. Plasma-derived medicinal products were included in the national essential medicines list in 52.6% of countries. The average proportion of units of blood tested for infections was 99.5% for HIV, 92.3% for HBV, 98.9% for HCV, 98.8% for syphilis. The percentage of whole blood separated into blood components was 63.4%. CONCLUSION: Countries in the region continue to improve availability and access to safe blood, but challenges still remain and call for concrete actions required to reach universal access to quality and safe blood for transfusion throughout the region.


Asunto(s)
Seguridad de la Sangre , Transfusión Sanguínea/estadística & datos numéricos , África/epidemiología , Bancos de Sangre/normas , Bancos de Sangre/estadística & datos numéricos , Donantes de Sangre/estadística & datos numéricos , Seguridad de la Sangre/normas , Seguridad de la Sangre/estadística & datos numéricos , Transfusión Sanguínea/normas , Estudios Transversales , Encuestas de Atención de la Salud , Humanos , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Sífilis/prevención & control , Sífilis/transmisión , Reacción a la Transfusión/epidemiología , Reacción a la Transfusión/prevención & control , Viremia/diagnóstico , Viremia/epidemiología , Virosis/prevención & control , Virosis/transmisión , Organización Mundial de la Salud
10.
Diabetes Metab Syndr ; 13(3): 2033-2036, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31235132

RESUMEN

BACKGROUND: Hyperlipidemia can be caused by abnormal elevation of lipids and lipoproteins in the blood. This increased can lead to heart disease. Risks which can be controlled include alcohol intake, physical activity, smoking, high blood pressure and genetic factors. Markers of increased cardiovascular risk appear to be lower in regular blood donor compared with single time donors as reflected by significantly lower total cholesterol and LDL levels. And it has been thought that there will be a direct relationship between lower risks of Heart diseases with repeated blood donation. AIM: The aim of the present study is to determine the effect of blood donation on single time and repeat donors by assessing their lipid levels and their family history of heart diseases. MATERIAL & METHODS: This cross-sectional study was carried out on (n = 80) random blood donors from the department of Transfusion Medicine KGMU. RESULTS: A significant correlation was found amongst hyperlipidemic level in single time donor & repeat donors and in donors with family history of heart diseases (p < 0.05). A positive association was found between hyperlipidemia with donor's weight (p < 0.05). CONCLUSION: Screening random donor platelets for hyperlipidemia and correlating the condition with other donor criteria like family history of heart diseases, types of donors, donors weight age and gender will help in making the patients safe as well as the donor deferral criteria more stringent to improve the quality of blood supply and will enable blood bankers to supply safe blood and improve the guidelines for blood safety.


Asunto(s)
Bancos de Sangre/normas , Donantes de Sangre/provisión & distribución , Seguridad de la Sangre , Transfusión Sanguínea/normas , Selección de Donante/métodos , Hiperlipidemias/fisiopatología , Tamizaje Masivo , Adolescente , Adulto , Anciano , Transfusión Sanguínea/estadística & datos numéricos , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Hiperlipidemias/diagnóstico , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven
11.
Curr Opin Anaesthesiol ; 32(5): 574-579, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31157627

RESUMEN

PURPOSE OF REVIEW: Transfusion is a common practice during neurosurgery. However, there is no evidence-based consensus on transfusion practice in neurosurgery. This review summarizes the evidence pertinent to the commonly used transfusion triggers in neurosurgical patients. RECENT FINDINGS: In the field of neurosurgery, there is only one randomized controlled trial, performed in patients with traumatic brain injury, to investigate the transfusion trigger of red blood cells. There is a lack-of-quality evidence pertinent to the transfusion triggers of other blood products. Most of the transfusion triggers used for neurosurgical patients are extrapolated from the evidence based on studies performed in nonneurosurgical patients. Clinical experience and expert opinions have played a major role in transfusion practice in neurosurgery. SUMMARY: There is a scarcity of high-quality outcome-based evidence for transfusion practice in neurosurgery. In the absence of quality evidence, the transfusion practice in neurosurgical patients should be based on the understanding of the complex pathophysiology related to anemia and coagulopathy and the balance between the risks and benefits associated with blood product transfusion. The practice guided by tissue oximeter and viscoelastic tests appears promising, but needs to be validated by future studies.


Asunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Transfusión Sanguínea/normas , Medicina Basada en la Evidencia/normas , Procedimientos Neuroquirúrgicos/efectos adversos , Reacción a la Transfusión/prevención & control , Adulto , Anemia/etiología , Anemia/prevención & control , Trastornos de la Coagulación Sanguínea/etiología , Trastornos de la Coagulación Sanguínea/prevención & control , Niño , Consenso , Humanos , Neurocirugia/normas , Guías de Práctica Clínica como Asunto
12.
Rev Med Inst Mex Seguro Soc ; 57(1): 30-35, 2019 Apr 01.
Artículo en Español | MEDLINE | ID: mdl-31071252

RESUMEN

The residual risk of transfusion-related infections has decreased dramatically in countries that have routinely implemented serological screening. Most of the donation in Mexico is from replacement practice, a risk factor for positive serology. In Mexico, the altruistic donation is only 2.7%. The heterogeneity of technical factors, regional factors and internal policies of each center influences the variability of data on the prevalence of positive screening, as well as the prevalence of confirmed cases. The main advantage of nucleic acid technology is the detection of donors in the period of serological window or occult infections, being occult hepatitis reports in Mexican donors from 1 to 3.4%. The limitation of available technology, the scope of the clinic and perspectives, invites us to improve technology and health policies in the interest of transfusion safety.


Asunto(s)
Seguridad de la Sangre/métodos , Transfusión Sanguínea/normas , Reacción a la Transfusión/prevención & control , Seguridad de la Sangre/tendencias , Transfusión Sanguínea/tendencias , Humanos , México/epidemiología , Mejoramiento de la Calidad/tendencias , Reacción a la Transfusión/epidemiología
13.
Am Surg ; 85(4): 409-413, 2019 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-31043203

RESUMEN

Since the Transfusion Requirements in Critical Care trial, studies have shown that acutely ill patients can drift as a low as 5 g/dL. This study reviews a transfusion trigger change to 6.5 g/dL, which we hypothesize will conserve resources and improve quality of care. This is a retrospective chart review at an urban Level I trauma center from January through December 2015 after our trauma service changed the transfusion trigger from 7 to 6.5 g/dL. Outcomes in patients before (TT7) and after (TT6.5) the change in transfusion threshold were then compared. One hundred thirty-one discrete patients were included in this trial, with 285 instances of a hemoglobin of 7 g/dL or less and 178 transfusions. Seventy-two patients were before the change in threshold and 59 after. There was no change in length of hospital stay, ICU stay, ventilator days, mortality, and organ system failure after change in the transfusion threshold. After initiation of a more conservative threshold, 72 units of blood were saved. Decreased transfusion threshold was associated with no worse outcomes associated with decreased resource utilization.


Asunto(s)
Transfusión Sanguínea/normas , Cuidados Críticos/normas , Heridas y Traumatismos/terapia , Adulto , Anciano , Protocolos Clínicos , Cuidados Críticos/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Resultado del Tratamiento
14.
Transfusion ; 59(S2): 1429-1438, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30980748

RESUMEN

BACKGROUND: Despite countless advancements in trauma care a survivability gap still exists in the prehospital setting. Military studies clearly identify hemorrhage as the leading cause of potentially survivable prehospital death. Shifting resuscitation from the hospital to the point of injury has shown great promise in decreasing mortality among the severely injured. MATERIALS AND METHODS: Our regional trauma network (Southwest Texas Regional Advisory Council) developed and implemented a multiphased approach toward facilitating remote damage control resuscitation. This approach required placing low-titer O+ whole blood (LTO+ WB) at helicopter emergency medical service bases, transitioning hospital-based trauma resuscitation from component therapy to the use of whole blood, modifying select ground-based units to carry and administer whole blood at the scene of an accident, and altering the practices of our blood bank to support our new initiative. In addition, we had to provide information and training to an entire large urban emergency medical system regarding changes in policy. RESULTS: Through a thorough, structured program we were able to successfully implement point-of-injury resuscitation with LTO+ WB. Preliminary evaluation of our first 25 patients has shown a marked decrease in mortality compared to our historic rate using component therapy or crystalloid solutions. Additionally, we have had zero transfusion reactions or seroconversions. CONCLUSION: Transfusion at the scene within minutes of injury has the potential to save lives. As our utilization expands to our outlying network we expect to see a continued decrease in mortality among significantly injured trauma patients.


Asunto(s)
Bancos de Sangre , Conservación de la Sangre/normas , Transfusión Sanguínea/normas , Redes Comunitarias , Servicios Médicos de Urgencia , Hemorragia/terapia , Resucitación , Centros Traumatológicos , Sistema del Grupo Sanguíneo ABO , Bancos de Sangre/organización & administración , Bancos de Sangre/normas , Redes Comunitarias/organización & administración , Redes Comunitarias/normas , Soluciones Cristaloides/administración & dosificación , Servicios Médicos de Urgencia/organización & administración , Servicios Médicos de Urgencia/normas , Femenino , Hemorragia/mortalidad , Humanos , Masculino , Texas , Centros Traumatológicos/organización & administración , Centros Traumatológicos/normas
15.
Transfusion ; 59(S2): 1459-1466, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30980759

RESUMEN

BACKGROUND: French military operations in the Sahel conducted since 2013 over more than 5 million square kilometers have challenged the French Military Health Service with specific problems in prolonged field care. STUDY DESIGN AND METHODS: To describe these challenges, we retrospectively analyzed the prehospital data from the first 5 years of these operations within a delimited area. RESULTS: One hundred eighty-three servicemen of different nationalities were evacuated, mainly as a result of explosions (73.2%) or gunshots (21.9%). Their mean number evacuation was 2.2 (minimum, 1; maximum, 8) per medical evacuation with a direct evacuation from the field to a Role 2 medical treatment facility (MTF) for 62% of them. For the highest-priority casualties (N = 46), the median time [interquartile range] from injury to a Role 2 MTF was 130 minutes [70 minutes to 252 minutes], exceeding 120 minutes in 57% of cases and 240 minutes in 26%. The most frequent out-of-hospital medical interventions were external hemostasis, airway and hemopneumothorax management, hypotensive resuscitation, analgesia, immobilization, and antibiotic administration. Prehospital transfusion (RBCs and/or lyophilized plasma) was started three times in the field, two times during helicopter medical evacuation, and five times in tactical fixed wing medical aircraft. Lyophilized plasma was confirmed to be particularly suitable in these settings. One of the specific issues involved in lengthy prehospital time was the importance to reassess and convert tourniquets prior to Role 2 MTF admission. CONCLUSION: Main challenges identified include reducing evacuation times as much as possible, preserving ground deployment of sufficiently trained medics and medical teams, optimization of transfusion strategies, and strengthening specific prolonged field care equipment and training.


Asunto(s)
Transfusión Sanguínea , Servicios Médicos de Urgencia , Medicina Militar , Personal Militar , Resucitación , Heridas y Traumatismos/terapia , Adulto , Ambulancias Aéreas , Transfusión Sanguínea/métodos , Transfusión Sanguínea/normas , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/organización & administración , Servicios Médicos de Urgencia/normas , Femenino , Francia , Humanos , Masculino , Medicina Militar/métodos , Medicina Militar/organización & administración , Medicina Militar/normas , Resucitación/métodos , Resucitación/normas , Heridas y Traumatismos/mortalidad
16.
Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi ; 35(2): 169-173, 2019 Feb.
Artículo en Chino | MEDLINE | ID: mdl-30975283

RESUMEN

Objective To explore clinical significance of transfusion safety by analyzing the results of screening the irregular antibodies and antibody identification. Methods The micro-column gel test cards were used to screen and identify irregular antibodies of 31 858 inpatients. Results Among the 31 858 cases, 31 517 (98.92%) had positive results in RhD detection, and 341 (1.08%) had negative results in RhD detection. The number of patients who had positive results in screening the irregular antibodies was 92 cases and the positive rate was 0.3%. The highest detected rate of positive results in screening the irregular antibodies was obtained in the patients with hematologic diseases at a rate of 2.21% (11/497), closely followed by the pregnant women at a rate of 0.72% (31/4313). The 92 cases had positive results in antibody identification, including 45 cases of anti-E (48.91%), 11 cases of anti-D (11.96%), 10 cases of anti-c (10.87%), 6 cases of anti-Lea (6.52%), 5 cases of anti-Ec (5.44%), 5 cases of anti-M (5.44%), and 10 cases of other antibodies. Conclusion Screening the irregular antibodies and antibody identification before blood transfusion can effectively avoid the adverse reactions of blood transfusion and improve the quality of blood transfusion.


Asunto(s)
Anticuerpos , Transfusión Sanguínea , Anticuerpos/sangre , Anticuerpos/clasificación , Transfusión Sanguínea/normas , Femenino , Humanos , Masculino , Embarazo , Reacción a la Transfusión/prevención & control
17.
Vox Sang ; 114(4): 394-396, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30820949

RESUMEN

Human immuno virus screening assays have improved in sensitivity over the last 20 years and our data demonstrates that there is no evidence of missed HIV positive window period donations since the introduction of pooled HIV NAT screening. Here we recommend that extensive lookback investigations are not routinely required if the most recent negative donation is negative on individual sample HIV PCR testing.


Asunto(s)
Bancos de Sangre/normas , Donantes de Sangre , Seguridad de la Sangre/normas , Selección de Donante/métodos , Infecciones por VIH/sangre , Infecciones por VIH/diagnóstico , Seguridad de la Sangre/métodos , Transfusión Sanguínea/métodos , Transfusión Sanguínea/normas , Inglaterra , Seropositividad para VIH/sangre , Humanos , Técnicas de Amplificación de Ácido Nucleico , Reacción en Cadena de la Polimerasa , Reproducibilidad de los Resultados , Gales
18.
Crit Care ; 23(1): 89, 2019 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-30871608

RESUMEN

BACKGROUND: Anemia is frequent among patients with traumatic brain injury (TBI) and is associated with an increased risk of poor outcome. The optimal hemoglobin concentration to trigger red blood cell (RBC) transfusion in patients with TBI is not clearly defined. METHODS: All eligible consecutive adult patients admitted to the intensive care unit (ICU) with moderate or severe TBI were randomized to a "restrictive" (hemoglobin transfusion threshold of 7 g/dL), or a "liberal" (threshold 9 g/dL) transfusion strategy. The transfusion strategy was continued for up to 14 days or until ICU discharge. The primary outcome was the mean difference in hemoglobin between groups. Secondary outcomes included transfusion requirements, intracranial pressure management, cerebral hemodynamics, length of stay, mortality and 6-month neurological outcome. RESULTS: A total of 44 patients were randomized, 21 patients to the liberal group and 23 to the restrictive group. There were no baseline differences between the groups. The mean hemoglobin concentrations during the 14-day period were 8.4 ± 1.0 and 9.3 ± 1.3 (p < 0.01) in the restrictive and liberal groups, respectively. Fewer RBC units were administered in the restrictive than in the liberal group (35 vs. 66, p = 0.02). There was negative correlation (r = - 0.265, p < 0.01) between hemoglobin concentration and middle cerebral artery flow velocity as evaluated by transcranial Doppler ultrasound and the incidence of post-traumatic vasospasm was significantly lower in the liberal strategy group (4/21, 3% vs. 15/23, 65%; p < 0.01). Hospital mortality was higher in the restrictive than in the liberal group (7/23 vs. 1/21; p = 0.048) and the liberal group tended to have a better neurological status at 6 months (p = 0.06). CONCLUSIONS: The trial reached feasibility criteria. The restrictive group had lower hemoglobin concentrations and received fewer RBC transfusions. Hospital mortality was lower and neurological status at 6 months favored the liberal group. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02203292 . Registered on 29 July 2014.


Asunto(s)
Transfusión Sanguínea/métodos , Traumatismos Craneocerebrales/terapia , Adulto , Anemia/complicaciones , Anemia/terapia , Transfusión Sanguínea/normas , Brasil , Traumatismos Craneocerebrales/fisiopatología , Estudios de Factibilidad , Femenino , Escala de Coma de Glasgow , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad
19.
J Infect Chemother ; 25(7): 489-493, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30827859

RESUMEN

BACKGROUND: Ebola virus disease (EVD) was endemic to Africa in 2014-2016. Supportive therapies have been shown to improve the outcome of EVD, and additional supportive therapy including blood transfusion therapy and external circulation could be needed in the event of a future global outbreak. However, pre-transfusion testing policies and guidelines have not yet been established in Japan. METHODS: We conducted a cross-sectional study of blood transfusion therapy for EVD patients at three designated hospitals for serious communicable diseases in Tokyo. In each hospital, we surveyed blood transfusion therapy policy, blood transfusion protocol, presence of a specialist in the department of transfusion medicine, facility capacity for pre-transfusion compatibility testing, and types of personal protective equipment available. RESULTS: One hospital had a cross-matched compatible blood transfusion policy, one had a cross-matched compatible blood transfusion policy only when the patient's ABO and RhD type is previously known, and the third had not created a policy. Two hospitals had a department of transfusion medicine. These two hospitals had a special testing unit for serious communicable diseases, while the other had a portable unit for testing. There were no major differences noted in available personal protective equipment. CONCLUSION: Policies and protocols differ among hospitals. The choice of blood transfusion policy and pre-transfusion testing is largely dependent on equipment and human resources. Further discussion is required to develop national guidelines for blood transfusion therapy in patients with serious communicable diseases, including countermeasures against complications and ethical issues related to the safety of patients and healthcare workers.


Asunto(s)
Transfusión Sanguínea/normas , Enfermedades Transmisibles/terapia , Fiebre Hemorrágica Ebola/terapia , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Reacción a la Transfusión/prevención & control , Enfermedades Transmisibles/transmisión , Estudios Transversales , Personal de Salud/normas , Fiebre Hemorrágica Ebola/transmisión , Humanos , Políticas , Guías de Práctica Clínica como Asunto , Ropa de Protección/normas , Tokio
20.
Curr Opin Anaesthesiol ; 32(2): 206-212, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30817397

RESUMEN

PURPOSE OF REVIEW: Anticoagulants in general, but especially the relatively new direct oral anticoagulants and platelet inhibitors, pose a great challenge for physicians in the hemorrhaging patient. The aim of the present review is to provide an overview on recent studies dealing with the reversal of anticoagulation in the hemorrhaging patient and to describe our therapeutic emergency strategy for those patients. RECENT FINDINGS: A specific antidote for dabigatran is already on the market and antidotes for the direct and indirect factor Xa inhibitors are in development. Moreover, bleeding under platelet inhibitors remains critical with very little evidence on effective reversal strategies. SUMMARY: To reverse anticoagulation in the hemorrhaging patient, specific antidotes should be the first option if available, followed by four-factor prothrombin complex concentrate (PCC), activated PCC and recombinant activated factor seven as the emergency strategy. Fibrinogen concentrate, antifibrinolytics and oral charcoal, respectively, can be considered as an additional measure. Massive blood loss and thrombocytopenia should be treated independently according to the respective, local guidelines for (massive) transfusion of blood and blood products.


Asunto(s)
Antifibrinolíticos/uso terapéutico , Antitrombinas/efectos adversos , Hemorragia/terapia , Inhibidores de Agregación Plaquetaria/efectos adversos , Administración Oral , Antifibrinolíticos/farmacología , Antifibrinolíticos/normas , Antitrombinas/administración & dosificación , Coagulación Sanguínea/efectos de los fármacos , Pruebas de Coagulación Sanguínea , Transfusión Sanguínea/normas , Carbón Orgánico/administración & dosificación , Terapia Combinada/métodos , Terapia Combinada/normas , Relación Dosis-Respuesta a Droga , Hemorragia/inducido químicamente , Hemorragia/diagnóstico , Hemorragia/mortalidad , Humanos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Guías de Práctica Clínica como Asunto , Diálisis Renal/normas , Resultado del Tratamiento
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