Efecto de la aplicación del programa Patient blood management en el abordaje de las artroplastias de cadera y rodilla programada / Effect of the application of the "Patient blood management" programme on the approach to elective hip and knee arthroplasties

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

Effect of the application of the "Patient blood management" programme on the approach to elective hip and knee arthroplasties. / Efecto de la aplicación del programa Patient blood management en el abordaje de las artroplastias de cadera y rodilla programada.

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.

Transfusión de hematíes D positivo a pacientes seleccionados D negativo / Transfusion of D positive red cells to selected D-negative patients

INTRODUCCIÓN: La transfusión isogrupo ABO D es la práctica transfusional habitual, sin embargo, cuando no se dispone de sangre D negativo puede ser preciso transfundir concentrados de hematíes D positivo a pacientes D negativo. Estos pacientes pueden desarrollar aloanticuerpos anti-D en los siguientes 3 meses a la exposición. MATERIAL Y MÉTODO: En los últimos 18 años, hemos experimentado situaciones de escasez de sangre D negativo, en las que hemos aplicado un protocolo clínico asistencial, seleccionando s los pacientes según el riesgo de aloinmunización y de requerimientos transfusionales crónicos. Se realizó una recogida prospectiva de estos pacientes, analizando principalmente la aloinmunización y la mortalidad. RESULTADOS: Tras las aplicación del protocolo se han transfundido unidades D positivo al 3% de los pacientes D negativo, con una tasa de aloinmunización conocida del 12,3%, siendo mayor en los pacientes más jóvenes y en aquellos que han recibido mayor número de unidades. No se detectaron complicaciones secundarias a la inmunización y la mortalidad en este grupo fue menor. CONCLUSIÓN: La transfusión de hematíes D positivo a pacientes D negativo no solo es una práctica segura para pacientes seleccionados, sino que además permite optimizar el uso de un producto en situaciones de escasez

BACKGROUND: To transfuse packed red blood cells isogroup ABO D is a usual transfusion practice. However, when there is not enough D negative blood available, we can transfuse positive red blood cells to negative patients. Immunocompetent D negative individuals may develop serologically detectable anti-D antibodies within 3 months after exposure to D positive red blood cells. MATERIAL AND METHOD: Over the last 18 years, we have experienced situations of D negative blood cell scarcity. In these situations, we have applied a clinical assistance protocol, selecting patients with lower risk of alloimmunization and chronic transfusion requirements. We have retrospectively evaluated this policy for the use of D positive red blood cells in D negative patients, focussing on alloinmunization and mortality. RESULTS: Applying the protocol, 3% of D negative patients were transfused with D positive units, with an alloimmunization rate of 12.3%. The rate of alloimmunization was higher in the younger age group and in those transfused with more units. No haemolytic reactions were reported. Mortality in the alloimmunized group was lower. CONCLUSION: The use of D positive red blood cells in selected D negative patients does not induce adverse reactions, is a safe practice and allows saving of a product that is sometimes limited

Transfusion of D positive red cells to selected D-negative patients. / Transfusión de hematíes D positivo a pacientes seleccionados D negativo.

BACKGROUND: To transfuse packed red blood cells isogroup ABO D is a usual transfusion practice. However, when there is not enough D negative blood available, we can transfuse positive red blood cells to negative patients. Immunocompetent D negative individuals may develop serologically detectable anti-D antibodies within 3 months after exposure to D positive red blood cells. MATERIAL AND METHOD: Over the last 18 years, we have experienced situations of D negative blood cell scarcity. In these situations, we have applied a clinical assistance protocol, selecting patients with lower risk of alloimmunization and chronic transfusion requirements. We have retrospectively evaluated this policy for the use of D positive red blood cells in D negative patients, focussing on alloinmunization and mortality. RESULTS: Applying the protocol, 3% of D negative patients were transfused with D positive units, with an alloimmunization rate of 12.3%. The rate of alloimmunization was higher in the younger age group and in those transfused with more units. No haemolytic reactions were reported. Mortality in the alloimmunized group was lower. CONCLUSION: The use of D positive red blood cells in selected D negative patients does not induce adverse reactions, is a safe practice and allows saving of a product that is sometimes limited.