La formación y especialización médica en medicina transfusional / Medical training and specialization in transfusion medicine

Introducción: Para una práctica transfusional segura se requiere una formación en medicina transfusional. Objetivo: Determinar la manera en que se integran los contenidos y las habilidades de medicina transfusional en la formación y la especialización médica en Cuba. Métodos: Se hizo un estudio educacional, analítico, de corte transversal en la Universidad de Ciencias Médicas de Camagüey, desde marzo de 2020 hasta julio de 2021. Se realizó un análisis documental para precisar cómo se integraban los contenidos y las habilidades de medicina transfusional al currículo para la formación de médicos, a los programas de estudio del internado vertical en 26 especialidades médicas, y a 29 planes de estudio y programas de especialización en Cuba. Resultados: El currículo para la formación de médicos en Cuba no incluye medicina transfusional. La asignatura que más contribuye a la formación en esta área del saber es Sangre y Sistema inmune. Los contenidos y las habilidades de medicina transfusional solo se incluyen expresamente en nueve programas de estudio del internado vertical y en 12 planes de estudio y programas de especialización. Conclusiones: Existe una insuficiente integración de los contenidos y las habilidades de medicina transfusional en el currículo de la carrera de medicina en Cuba, situación que se manifiesta también en los programas de estudios de los internados verticales y en la mayoría de los programas de las especialidades médicas.

Introduction: Safe transfusion practice requires training in transfusion medicine. Objective: To determine the way in which transfusion medicine contents and skills are integrated into medical training and specialization in Cuba. Methods: An educational, analytical and cross-sectional study was carried out at Universidad de Ciencias Médicas de Camagüey, from March 2020 to July 2021. A documentary analysis was conducted to determine how transfusion medicine contents and skills were integrated into the curriculum for the training of physicians, into the study programs of the vertical internship in 26 medical specialties, as well as into 29 study plans and specialization programs in Cuba. Results: The curriculum for the training of physicians in Cuba does not include transfusion medicine. The subject that most contributes to training in this area of knowledge is Blood and Immune System. Transfusion medicine contents and skills are only expressly included in nine vertical internship study programs and in twelve study plans and specialization programs. Conclusions: There is insufficient integration of transfusion medicine contents and skills in the Cuban medical major curriculum, a situation that is also manifested in the study programs of vertical internships and in most of the medical specialties programs.

Uso de componentes sanguíneos en el Hospital Docente Provincial Oncológico María Curie en Camagüey / Use of blood components at the Oncologica l University Hospital Marie Curie of Camagüey

Introducción: La comunidad médica en muchas partes del mundo está preocupada porque se indica realizar más transfusiones que lo recomendado. La transfusión de sangre alogénica se ha considerado erróneamente un procedimiento exento de peligros y con beneficios indiscutibles; además, no es una forma totalmente segura para tratar la anemia asociada al cáncer. Objetivo: Analizar el consumo de componentes sanguíneos en el Hospital Docente Provincial Oncológico María Curie en Camagüey. Métodos: Estudio descriptivo, longitudinal, retrospectivo, sustentado en el análisis del consumo hospitalario de componentes sanguíneos en el período enero 2018 a diciembre 2021. Las variables analizadas fueron: cantidad mensual de unidades transfundidas de componentes sanguíneos, celulares y plasmáticos; el total de pacientes ingresados y transfundidos y la tasa de hemoterapia por cada 1000 ingresos hospitalarios. Resultados: El concentrado de eritrocitos fue el componente sanguíneo más solicitado en el período desde 2018 hasta 2021 (excepto en tres meses). La tasa de hemoterapia se mantuvo por encima de 245 hemocomponentes transfundidos por cada 1000 pacientes ingresados. Conclusiones: El consumo de hemocomponentes, según el cumplimiento de la tasa de hemoterapia, fue evaluado de mal en los años desde 2018 hasta 2021. Se sugiere mejorar la seguridad del paciente y la calidad de la asistencia médica con la aplicación imprescindible del método clínico, la preparación en medicina transfusional, el establecimiento de los consensos de criterios que sirvan de guía para el tratamiento de la anemia asociada a cáncer y la atención centrada en el paciente (tratamientos personalizados).

Introduction: Around the world, the Medical Community concerned with blood transfusions being recommended more than it is indicated. Allogenic blood transfusions have been erroneously considered as a safe procedure with unquestionable benefits; as well as it is not completely safe for cancer anemia treatment. Objective: To analyse the use of blood components at the Oncological Hospital Marie Curie of Camagüey Method: Longitudinal, descriptive study, retrospectively sustained in the analysis of the consumption of blood components at the hospital from January 2018 to December 2021. Analysed variables were the monthly quantity of transfused units, cellular and plasma, blood products, total of admitted patients, total transfused patients and haemotherapy rate for each 1000 patients admitted at the hospital. Results: Red blood cells were the most requested components during the study period. From 2018 to 2021 (except three months). Haemotherapy rate stayed above 245 blood component transfused by each 1000 admitted patients. Conclusions: According to compliance with the haemotherapy rate, the use of blood components was evaluated unfavorably in analyzed period. With the indispensable application of the clinical method, education in transfusion medical practice, the consensus criteria as a guide for anemia cancer treatment, and patient-centered attention (personalized treatments), will improve the patient's safety and the quality of the medical treatment.

Funciones de enfermería en los procederes de aféresis / Nursing functions in cell therapy procedures

Introducción: Con el paso de los años, la profesión de enfermería ha ganado terreno en diferentes áreas de la medicina y su acción ha llegado a esferas que se creía exclusivas de otros profesionales del sector de la salud, como la Medicina Transfusional y Terapia celular. Objetivo: Describir las funciones de enfermería en los procederes de aféresis. Análisis y síntesis de la información: El trabajo de enfermería se basa en la aplicación de la metodología para la implementación de los cuidados que realiza. El intercambio directo con la persona permite identificar sus necesidades, facilita planear, controlar, ejecutar y evaluar las actividades que se realizan en la práctica diaria. Dentro del área de la Medicina Transfusional el accionar de enfermería es fundamental, ya que puede intervenir en diferentes fases del proceso de la donación de sangre, realiza la centrifugación del componente a obtener, transfunde o implanta componentes sanguíneos y atiende las reacciones adversas del individuo. Conclusiones: La acción de enfermería en la actividad de aféresis para diferentes procedimientos es primordial para preservar la salud del donante y el paciente, así como en la creación o modificación de protocolos de trabajo con mayor eficiencia, eficacia y efectividad en base a los conocimientos y la experiencia en este campo lo que genera una espiral de desarrollo continuo que obliga a la constante actualización en el tema.

Introduction: With the step of the years, the infirmary profession has won land in different areas of the medicine and its action has arrived to spheres that it was believed they were exclusive of other professionals of the sector of the health, as the Medicine Transfusional and cellular Therapy. Objective: to describe the nursing functions in the aphaeresis procedures. Analysis and synthesis of the information: The infirmary work is based on the application of the methodology for the implementation of the cares that he/she carries out. The direct exchange with the patient allows to identify its necessities, as well as it facilitates to drift, to control, to execute and to evaluate the activities that are carried out in the daily practice. Inside the area of the transfusion medicine working of infirmary is fundamental, since it can intervene in different phases of the process of the donation of blood, he/she carries out the centrifugation of the component to obtain, it transfuses or it implants sanguine components and he/she assists the patient's adverse reactions. Conclusions: The nurse action in the aphaeresis activity for different procedures is primordial to preserve the donor's health and the patient, as well as in the creation or modification of work protocols with bigger efficiency, effectiveness and effectiveness based on the knowledge and the experience in this field what generates a hairspring of continuous development that he/she forces to the constant bring up to date in the topic.

Tromboelastometría rotacional, el electrocardiograma de la coagulación / Rotational thromboelastometry. The electrocardiogram of coagulation

Resumen: La tromboelastometría evalúa los cambios viscoelásticos en el proceso de coagulación. Nos ofrece una representación gráfica de la formación del coágulo, la estabilidad del mismo y la presencia de lisis. La tromboelastometría rotacional es una herramienta diagnóstica que representa de forma gráfica la funcionalidad del coágulo para un manejo dirigido e individualizado de la coagulopatía asociada a hemorragia. En este trabajo se puntualiza cómo la tromboelastometría rotacional es a la coagulación como el electrocardiograma es al corazón.

Abstract: Thromboelastometry evaluates viscoelastic changes in the coagulation process. It offers us a graphic representation of the formation of the clot, its stability and the presence of lysis. Rotational thromboelastometry is a diagnostic tool that graphs the functionality of the clot, for a targeted and individualized management of bleeding-associated coagulopathy. In this work it is specified how rotational thromboelastometry is to coagulation as the electrocardiogram is to the heart.

Ciencias básicas en el proceso docente del técnico superior en Análisis Clínico y Medicina Transfusional / Basic sciences in the teaching process of the lab technician in Clinical Analysis and Transfusion Medicine

RESUMEN Fundamento: el diseño curricular debe partir de las exigencias sociales; este permite la determinación de las cualidades a alcanzar por el egresado y la estructura organizacional del proceso docente a nivel de carrera. Objetivo: valorar la importancia de las ciencias básicas en el plan del proceso docente del técnico superior en Análisis Clínico y Medicina Transfusional, por su influencia en la formación laboral del futuro egresado. Métodos: se realizó una investigación documental en el período comprendido entre septiembre y noviembre de 2019 en la Universidad de Ciencias Médicas de Camagüey. Se emplearon métodos teóricos: análisis-síntesis e inductivo-deductivo; y empíricos: el análisis documental a partir del cual se realizaron valoraciones cualitativa y cuantitativa del plan del proceso docente del técnico superior en Análisis Clínico y Medicina Transfusional. Resultados: en el plan del proceso docente de esta carrera no aparecen las asignaturas clasificadas por ciclos y se evidencia una disminución considerable del ciclo básico. Conclusiones: la valoración realizada evidencia que falta precisión del papel que juega cada ciclo de las asignaturas en el plan del proceso docente, lo que influye negativamente en su cientificidad y se demuestra que tiene una elevada carga laboral, ya que el estudiante desde sus primeros años se encuentra vinculado al trabajo diario en el servicio asistencial en el que adquiere habilidades propias de la profesión.

ABSTRACT Background: curricular design must start from social demands; this allows the determination of the qualities to be achieved by the graduate and the organizational structure of the teaching process at degree level. Objective: to assess the importance of basic sciences in the plan of the teaching process of the lab technician in Clinical Analysis and Transfusion Medicine, due to its influence on the job training of future graduates. Methods: a documentary research was carried out in the period from September to November 2019 at Camagüey University of Medical Sciences. Theoretical methods were used: analysis-synthesis and inductive-deductive; and empirical ones: the documentary analysis from which qualitative and quantitative evaluations were made of the plan of the teaching process of the lab technician in Clinical Analysis and Transfusion Medicine. Results: in the plan of the teaching process of this degree, the subjects classified by cycles do not appear and there is a considerable decrease in the basic cycle. Conclusions: the assessment carried out shows that there is a lack of precision in the role that each cycle of the subjects play in the plan of the teaching process, which negatively influences its scientific approach and shows that it has a high workload, since the student from its early years is linked to daily work in the healthcare service in which it acquires distinctive skills of the profession.

Elementos de las competencias en medicina transfusional para la especialidad Anestesiología y Reanimación / Elements of transfusion medicine competencies in Anesthesiology and Reanimation

Introducción: El desempeño competente del personal médico en medicina transfusional implica profundos conocimientos que no recibe durante el proceso formativo. Objetivo: Identificar elementos para la normalización de la competencia en medicina transfusional para la especialidad Anestesiología y Reanimación. Métodos: Estudio educacional de corte transversal. Se realizó un análisis documental sobre normalización de las competencias profesionales en Cuba y sobre los componentes de la competencia en medicina transfusional para la especialidad. Asimismo, se examinaron los contenidos y habilidades de medicina transfusional en el programa de la residencia. Finalmente, fueron entrevistados profesores de la especialidad. Resultados: La competencia abarca conocimientos sobre riesgos de transmisión de infecciones al paciente, prescripción segura de componentes sanguíneos, reconocimiento de las reacciones transfusionales, ejecución y enseñanza al no graduado de los procedimientos para la transfusión de sangre alogénica. Implica conocer y actualizarse en los aspectos éticos, científicos y legales involucrados. Incluye demostrar conocimientos, habilidades y valores para la preparación preoperatoria de los pacientes con anemia, riesgo hemorrágico y otras enfermedades hematológicas, para el empleo de alternativas y para el ahorro de componentes sanguíneos. Los profesores reconocieron que al comenzar la residencia es necesario un entrenamiento, para luego poder realizar una práctica transfusional segura. Conclusiones: Ser competente en medicina transfusional, subdisciplina de la especialidad Anestesiología y Reanimación, demanda movilizar un conjunto de conocimientos, habilidades, actitudes y valores de manera simultánea, interrelacionada y oportuna para transfundir menos y mejor, con más seguridad y menor costo(AU)

Introduction: Competent performance by the health care personnel in transfusion medicine implies deep knowledge not received during training. Objective: Identify elements of competence standardization in transfusion medicine for the specialty of anesthesiology and resuscitation. Methods: A cross-sectional educational study was conducted. A document analysis was carried out about standardization of professional competences in Cuba and about the components of competence in transfusion medicine for the specialty. Examination was also performed of transfusion medicine contents and skills in the residency program. Finally, professors from the specialty were interviewed. Results: Competence comprises knowledge about risks for the transmission of infections to patients, safe prescription of blood components, identification of transfusion reactions, and performance of and undergraduate training in allogeneic blood transfusion procedures. It implies knowledge and updated awareness of the ethical, scientific and legal aspects involved. It includes demonstrating knowledge, skills and values related to preoperative preparation of patients with anemia, hemorrhagic risk and other hematologic diseases, to use alternatives and save blood components. The professors recognized that training is required at the start of the residency program to ensure the performance of safe transfusion practices. Conclusions: Being competent in transfusion medicine, a subdiscipline of the specialty of Anesthesiology and Resuscitation, requires mobilization of a set of knowledge, skills, attitudes and values in a simultaneous, interrelated and timely fashion to transfuse less but better, with greater safety and at a lower cost(AU)

Seropositivity of HIV and associated factors in donors of a blood bank in the city of Medellin - Colombia, 2005 - 2018 / Seropositividad de vih y factores asociados en donantes de un banco de sangre de la ciudad de medellín - colombia, 2005 - 2018

RESUMEN El objetivo de esta investigación fue estimar la seropositividad de VIH y factores asociados en donantes de un banco de sangre de la ciudad de Medellín - Colombia, 2005 - 2018. Se realizó un estudio transversal en 166 603 donantes del banco de Sangre de la Escuela de Microbiología de la Universidad de Antioquia. Las estimaciones se basaron en proporciones y razones de odds con sus intervalos de confianza del 95 %. La mayoría de donantes fueron del Valle de Aburrá, 50,2 % hombres, 65,4 % altruistas, 59,3 % de primera vez y 81,2 % captados fuera de las instalaciones del Banco. La seropositividad general de VIH fue 0,275 % (IC 95 %=0,25-0,30), en las frecuencias específicas fue del 0,324 % en hombres y 0,224 % en mujeres; 0,299 % en donantes con edad entre 18 - 40 años, 0,212% en los de 41 - 65 años, 0,333 % en los de primera vez; 0,213 % en los no repetitivos y 0,149 % en los donantes repetitivos. Se concluye que la seropositividad de la infección fue similar en comparación con investigaciones previas, con un descenso importante desde el 2013. El riesgo de infección fue estadísticamente mayor en los hombres, los menores de 40 años y donantes de primera vez. Esto es importante para conocer la línea base y evaluar acciones de prevención en la población de estudio, orientar estudios etiológicos y mejorar políticas de hemovigilancia.

ABSTRACT The objective of this study was to estimate the seropositivity of HIV and associated factors in donors of a blood bank in the city of Medellín- Colombia, 2005 - 2018. A cross-sectional study in 166 603 donors of the Blood Bank of the School of Microbiology. Estimates were based proportions and odds ratios with 95 % confidence intervals. The majority of donors were from the Aburrá Valley, 50.2 % men, 65.4 % altruistic, 59.3 % first time and 81.2 % received outside the blood bank. The general seropositivity of HIV was 0.275 % (95 % CI = 0.25-0.30), the specific proportions were 0.324 % in men and 0.224 % in women; 0.299 % in donors with 18-40 years old and 0.212 % in the group of41-6540 years old, and 0.333 % in donors of first-time, 0.213 % in non-repetitive and 0.149 % in repetitive donors. The conclusion was that the seropositivity of the infection was similar in comparison with previous investigations, with a significant decrease since 2013. The risk of infection was statistically higher in men, under 40 years and first-time donors. All this takes is important to know the baseline and evaluate prevention actions in the study population, guide etiological studies, and improve hemovigilance policies.

Programa de superación profesional en medicina transfusional para la especialidad Anestesiología y Reanimación / A professional upgrading program in transfusion medicine for the specialty of anesthesiology and resuscitation

Introducción: La superación profesional debe propiciar el desarrollo de competencias para un mejor desempeño laboral. El desempeño competente del personal médico en medicina transfusional requiere profundos conocimientos teóricos y prácticos que no recibe durante el proceso formativo. Objetivo: Diseñar un programa de posgrado dirigido a la especialidad Anestesiología y Reanimación para el desarrollo de la competencia en medicina transfusional. Métodos: Estudio realizado en la Universidad de Ciencias Médicas de Camagüey entre marzo 2016 a diciembre de 2018. Se efectuó un análisis documental para identificar los componentes de la competencia. Se investigaron las actividades provinciales de superación profesional sobre medicina transfusional y, en el programa de la residencia, las habilidades relacionadas. Se identificaron mediante cuestionario las necesidades sentidas de aprendizaje, estas guiaron el diseño del programa de posgrado que se validó por criterio de especialistas y un preexperimento. Resultados: Fueron pocas las actividades de superación profesional referidas sobre medicina transfusional; el programa de la residencia solo incluye algunas habilidades. Se diseñó el programa de un diplomado basado en las etapas de planificación curricular en educación médica, las necesidades de aprendizaje identificadas y los componentes de la competencia. La mayoría de los especialistas lo evaluaron de excelente. En el preexperimento la valoración de los educandos fue positiva. Conclusiones: El programa del diplomado se corresponde con las proyecciones, normativas y estrategias del MINSAP para el desempeño profesional competente en medicina transfusional en la especialidad Anestesiología y Reanimación; está avalado científica, técnica y pedagógicamente y es adaptable a otros contextos(AU)

Introduction: Professional upgrading should promote the development of skills for better occupational performance. The competent performance of the medical personnel in transfusion medicine requires in-depth theoretical and practical knowledge that they do not receive during the training process. Objective: To design a postgraduate program aimed at the specialty Anesthesiology and Resuscitation for the development of competence in transfusion medicine. Methods: Study carried out at the University of Medical Sciences of Camagüey, between March 2016 and December 2018. A documental analysis was carried out to identify the competence components. We investigated the provincial professional upgrading activities on transfusion medicine together with related skill in the residence program, related skills. We identified, though questionnaire, the learning needs experienced; these guided the design of the postgraduate program, which was validated by criteria of specialists and through pre-experiment. Results: There were few professional upgrading activities referred to about transfusion medicine; the residence program includes only some skills. A diploma course program was designed based on the stages of curricular planning in medical education, the learning needs identified, and the competence components. Most of the specialists evaluated it as excellent. In the pre-experiment, the evaluation by the students was positive. Conclusions: The diploma course program is in correspondence with the projections, regulations and strategies of the MINSAP for competent professional performance in transfusion medicine within the specialty of Anesthesiology and Resuscitation; it is scientifically, technically and pedagogically validated and is adaptable to other settings(AU)

Blood typing in positive DEA 1 dogs: comparative analysis between immunochromatography, hemagglutination and flow cytometry / Tipificação sanguínea em cães AEC 1 positivo: análise comparativa entre a imunocromatografia, hemoaglutinação e citometria de fluxo

Blood typing techniques have been improved to ensure greater safety for transfusion procedures. Typification for the DEA 1 antigen through flow cytometry should offer more reliability to routine immunohematology in donor and recipient dogs. Currently, the DEA 1 group is starting to be an autosomal dominant allelic system with the DEA 1 negative type and its variations of positivity. The present study investigated the DEA 1 antigen using the techniques of immunochromatography, hemagglutination and flow cytometry. Among the positive animals for the DEA 1 group, typified by flow cytometry, medium intensities of fluorescence were found, which are indicative of weak, moderate and strong antigenicity. This enabled the division of the DEA 1 group into weak positive, moderate positive and strong positive. The blood typing techniques for the DEA 1 group by flow cytometry, agglutination and immunochromatography had positive (Spearman r=0.70) and statistically significant (p>0.0001) correlations.(AU)

As técnicas de tipificação sanguínea vêm sendo aperfeiçoadas para garantir maior segurança aos procedimentos transfusionais. A tipificação para o antígeno AEC 1 com o emprego da citometria de fluxo poderá oferecer mais confiabilidade à rotina da imunohematologia em cães doadores e receptores. Na atualidade, o grupo AEC 1 passou a ser denominado como um sistema alélico autossômico dominante com o tipo AEC 1 negativo e suas variações de positividade. O presente trabalho comparou os resultados de três técnicas utilizadas para a pesquisa do antígeno AEC 1: cromatografia; hemoaglutinação e citometria de fluxo. Dentro dos indivíduos positivos para o grupo AEC 1, tipificados pela citometria de fluxo, foram encontradas intensidades médias de fluorescência indicadoras de antigenicidade fraca, moderada e forte, podendo-se dividir o grupo AEC 1 em positivo fraco, positivo moderado e positivo forte. As técnicas de tipificação sanguínea para o grupo AEC 1 por cromatografia, hemoaglutinação e citometria de fluxo apresentaram correlação positiva (Spearman r=0,70) e estatisticamente significativa (p<0,0001).(AU)

Prescription of red cell concentrates by emergency physicians

SUMMARY OBJECTIVE To evaluate the adequacy of the prescription of red cell concentrates by emergency physicians. METHODS A cross-sectional study based on the survey of transfusion requests records completed by emergency physicians, from May/2018 to April/2019, in an emergency hospital. Adequacy in the indication, volume, and subtype (filtered, irradiated, and washed) of prescribed erythrocytes were evaluated. To compare the qualitative data, we used the χ2 test. The significance level adopted was 5%. RESULTS One thousand and twenty-two transfusions were evaluated. The indication, volume, and subtypes were correct in 72.7%, 45.9%, and 81.6% respectively. Transfusion in symptomatic patients presented superior adequacy when compared to asymptomatic individuals with significant statistical difference (indication: 79,6% vs 67.2%, p <0.001; Volume: 63.5% vs 31.7%, p <0.001; subtype: 85.3% vs 78.7%, p 0.006). Among clinical situations, there were more errors in sepsis (39.7%) and pneumonia (36.3%). More than half of the prescriptions presented excessive volume, raising the risk of circulatory overload, observing that the mean age was 60.6 years. The specific analysis of the prescribed subtypes showed adequacy of 17.9% in the filtered, 1.7% in the irradiated, and none in the washed. Thirty transfusions should have been filtered, but the prescriber did not request the subtype. CONCLUSION One hypothesis for the observed inaccuracies is inadequate medical training on the subject, both in undergraduate and medical residency, associated with a lack of continuing education on transfusion protocols. The transfusion Committee received the results of this study with a proposal for continuing education measures on transfusion hemotherapy.

RESUMO OBJETIVO Avaliar a adequação da prescrição de concentrados de hemácias por médicos emergencistas. MÉTODOS Estudo transversal por levantamento de fichas de requisição de transfusões preenchidas por médicos emergencistas, no período de maio de 2018 a abril de 2019, em um hospital de emergências. Foram avaliadas as adequações na indicação, volume e subtipo (filtradas, irradiadas e lavadas) de hemácias prescritas. Para comparação dos dados qualitativos, utilizamos o teste de χ2. O nível de significância adotado foi de 5%. RESULTADOS Foram avaliadas 1.022 transfusões. A indicação, o volume e os subtipos estavam corretos em 72,7%, 45,9% e 81,6%, respectivamente. A transfusão prescrita em pacientes sintomáticos apresentou adequação superior quando comparada aos assintomáticos, com diferença estatística significativa (indicação: 79,6% vs 67,2% - p<0,001; volume: 63,5% vs 31,7% - p<0,001; subtipo: 85,3% vs 78,7% - p 0,006). Entre as situações clínicas, ocorreram mais erros na sepse (39,7%) e pneumonia (36,3%). Mais da metade das prescrições apresentavam volume excessivo, elevando o risco de sobrecarga circulatória, observando-se que a média da idade foi 60,6 anos. A análise específica dos subtipos prescritos apresentou adequação de 17,9% nas filtradas, 1,7% nas irradiadas e nenhuma das lavadas. Trinta transfusões deveriam ter sido filtradas, porém o prescritor não solicitou o subtipo. CONCLUSÃO Uma hipótese para as incorreções observadas é a formação médica inadequada sobre o assunto, tanto na graduação como na residência médica, associada à falta de atualização nos protocolos transfusionais. O comitê transfusional recebeu os resultados deste estudo com proposta de medidas de educação permanente sobre hemoterapia transfusional.

Red blood cell prescription and recognition of transfusion reactions by pediatricians / Prescrição de hemácias e reconhecimento de reações transfusionais por pediatras

ABSTRACT Objective To assess the level of knowledge of emergency pediatricians on red blood cell transfusions and their reactions. Methods Written survey with emergency pediatricians from a pediatric hospital. Results Less than 20% of pediatricians showed appropriate knowledge on prescribing red blood cells and recognition of transfusion reactions. There was no significant statistical regarding time since graduation and blood transfusion classes in undergraduate studies or during medical residency. Conclusion Pediatricians have insufficient knowledge about red blood cell transfusions and recognition of transfusion reactions.

RESUMO Objetivo Avaliar o conhecimento de pediatras emergencistas sobre transfusão de concentrados de hemácias e reações transfusionais. Métodos Aplicação de formulário para pediatras emergencistas de um hospital pediátrico. Resultados Menos de 20% dos participantes demonstraram conhecimento adequado sobre prescrição de concentrados de hemácias e reconhecimento de reações transfusionais. Não houve diferença estatística significativa quando avaliados o tempo de formação profissional e o fato de ter recebido aula de hemoterapia na graduação ou na residência médica. Conclusão Os pediatras têm conhecimento insuficiente sobre prescrição de concentrados de hemácias e reconhecimento de reações transfusionais.

Case report of patient blood managment guided by rotational thromboelastometry in Mexico and literature review.

INTRODUCTION: Thromboelastometry evaluates viscoelastic changes in the coagulation process. It offers a graphic representation of the formation of the coagulum, its stability and the presence of lysis. OBJECTIVE: This first case of transfusion management guided by thromboelastography in Mexico and we conducted a review of the literature. METHOD: A metasearch search was performed (PubMed, Scielo, Medigraphic) with the words thromboelastometry, coagulopathy, transfusion medicine and the most influential works were included. CONCLUSIONS: The rotational thromboelastometry is a diagnostic tool that graphs the functionality of the clot, for a directed and individualized management of the coagulopathy associated with bleeding.

INTRODUCCIÓN: La tromboelastometría evalúa los cambios viscoelásticos en el proceso de coagulación. Ofrece una representación gráfica de la formación del coágulo, su estabilidad y la presencia de lisis. OBJETIVO: Se notifica el primer caso de manejo transfusional guiado por tromboelastografía en México con revisión de la bibliografía. MÉTODO: Se realizó una búsqueda en metabuscadores (PubMed, Scielo, Medigraphic) con las palabras tromboelastometría, coagulopatía y medicina transfusional y se incluyeron los trabajos más influyentes. CONCLUSIONES: La tromboelastometría rotacional es una herramienta diagnóstica que grafica la funcionalidad del coágulo para un manejo dirigido e individualizado de la coagulopatía relacionada con ­hemorragia.

Frequência do grupo sanguíneo DEA 1.1 em cães atendidos no Hospital Veterinário da UFMT (Sinop/MT), risco de sensibilização de cães DEA 1 negativos e da ocorrência de reação transfusional hemolítica por ocasião de uma segunda transfusão de sangue / DEA 1.1 blood group frequency in dogs attended at the veterinary hospital of UFMT (Sinop/MT), risk of DEA 1 negative dog sensitization and occurrence of hemolytic transfusion reaction in a second blood transfusion

Objetivou-se identificar a frequência do grupo sanguíneo DEA 1.1 em cães de Sinop, Mato Grosso, Brasil, para auxiliar a seleção de doadores e receptores de sangue compatíveis e, adicionalmente, avaliar o risco de reações transfusionais em cães sensibilizados. Além disso, a partir dos resultados obtidos, selecionar potenciais doadores de sangue para compor um banco de dados. Um total de 195 cães adultos (de 1 a 4 anos de idade), machos e fêmeas, mestiços e puros, que nunca haviam recebido transfusões de sangue, foram triados no Hospital Veterinário da Universidade do Mato Grosso. A tipagem sanguínea DEA 1.1 foi realizada utilizando-se ensaio imunocromatográfico comercialmente disponível para DEA 1.1 (Quick Test DEA 1.1, Alvedia, Lyon, França). Os resultados demonstraram uma frequência geral de 65% para cães DEA 1.1 positivos (n = 126) e 35% para cães DEA 1 negativos (n = 69). O risco geral de sensibilização de cães DEA 1 negativos após uma primeira transfusão com sangue DEA 1.1 positivo foi calculado em 23%, enquanto o risco deste receptor sensibilizado receber sangue DEA 1.1 positivo em uma segunda transfusão e desenvolver uma reação hemolítica aguda foi calculado em 5%. A tipagem sanguínea dos cães permitiu sua inserção como doadores de sangue tipados para o grupo DEA 1 em um banco de dados preliminar e garantiu a segurança das transfusões de sangue.

The goal of this research was to identify the frequency of the DEA 1.1 blood group in dogs from Sinop, Mato Grosso, Brazil, to help in the recruitment of compatible blood donors and recipients, and to assess the risk of transfusion reactions in previously sensitized dogs. Also, from the obtained results, to pick potential blood donors to compose a data bank. 195 adult dogs (1 to 4 years old), males and females, mongrel and purebred dogs were screened at the Veterinary Hospital of the University of Mato Grosso. The DEA 1.1 blood typing was performed using commercially available immunochromatographic strip for DEA 1.1 (Quick Test DEA 1.1, Alvedia, Lyon, France). The results showed a general frequency of 65% for DEA 1.1 positive dogs (n = 126) and 35% for DEA 1 negative dogs (n = 69). The general risk of sensitization of a DEA 1 negative dog following a first transfusion with DEA 1.1 positive blood was 23%, while the risk of this sensitized recipient to receive DEA 1.1 positive blood in a second transfusion and to develop an acute hemolytic reaction was calculated to be 5%. The blood typing of the dogs allowed their classification as DEA 1 typed blood donors, in a preliminary data bank, and also ensured the safety of blood transfusions.

DEA 1. 1 blood group frequency in dogs attended at the veterinary hospital of UFMT (Sinop/MT), risk of DEA 1 negative dog sensitization and occurrence of hemolytic transfusion reaction in a second blood transfusion / Frequência do grupo sanguíneo DEA 1. 1 em cães atendidos no Hospital Veterinário da UFMT (Sinop/MT), risco de sensibilização de cães DEA 1 negativos e da ocorrência de reação transfusional hemolítica por ocasião de uma segunda transfusão de sangue

The goal of this research was to identify the frequency of the DEA 1.1 blood group in dogs from Sinop, Mato Grosso, Brazil, to help in the recruitment of compatible blood donors and recipients, and to assess the risk of transfusion reactions in previously sensitized dogs. Also, from the obtained results, to pick potential blood donors to compose a data bank. 195 adult dogs (1 to 4 years old), males and females, mongrel and purebred dogs were screened at the Veterinary Hospital of the University of Mato Grosso. The DEA 1.1 blood typing was performed using commercially available immunochromatographic strip for DEA 1.1 (Quick Test DEA 1.1, Alvedia, Lyon, France). The results showed a general frequency of 65% for DEA 1.1 positive dogs (n = 126) and 35% for DEA 1 negative dogs (n = 69). The general risk of sensitization of a DEA 1 negative dog following a first transfusion with DEA 1.1 positive blood was 23%, while the risk of this sensitized recipient to receive DEA 1.1 positive blood in a second transfusion and to develop an acute hemolytic reaction was calculated to be 5%. The blood typing of the dogs allowed their classification as DEA 1 typed blood donors, in a preliminary data bank, and also ensured the safety of blood transfusions.

Objetivou-se identificar a frequência do grupo sanguíneo DEA 1.1 em cães de Sinop, Mato Grosso, Brasil, para auxiliar a seleção de doadores e receptores de sangue compatíveis e, adicionalmente, avaliar o risco de reações transfusionais em cães sensibilizados. Além disso, a partir dos resultados obtidos, selecionar potenciais doadores de sangue para compor um banco de dados. Um total de 195 cães adultos (de 1 a 4 anos de idade), machos e fêmeas, mestiços e puros, que nunca haviam recebido transfusões de sangue, foram triados no Hospital Veterinário da Universidade do Mato Grosso. A tipagem sanguínea DEA 1.1 foi realizada utilizando-se ensaio imunocromatográfico comercialmente disponível para DEA 1.1 (Quick Test DEA 1.1, Alvedia, Lyon, França). Os resultados demonstraram uma frequência geral de 65% para cães DEA 1.1 positivos (n = 126) e 35% para cães DEA 1 negativos (n = 69). O risco geral de sensibilização de cães DEA 1 negativos após uma primeira transfusão com sangue DEA 1.1 positivo foi calculado em 23%, enquanto o risco deste receptor sensibilizado receber sangue DEA 1.1 positivo em uma segunda transfusão e desenvolver uma reação hemolítica aguda foi calculado em 5%. A tipagem sanguínea dos cães permitiu sua inserção como doadores de sangue tipados para o grupo DEA 1 em um banco de dados preliminar e garantiu a segurança das transfusões de sangue.

Medicina y Cirugía sin Sangre La Experiencia de Solca Guayaquil / Medicine and Surgery without Blood The Experience of Solca Guayaquil

Introducción: Los riesgos asociados con las Transfusiones de Sangre Alogénicas (TSA) son ampliamente conocidos y han contribuido a nuevos paradigmas de tratamiento para la medicina y cirugía sin sangre. Por tanto, es importante contar con estrategias terapéuticas efectivas y prácticas que sirvan como alternativas al uso de TSA. Este informe describirá las estrategias aplicadas a los pacientes de este reporte. Métodos: Estudio retrospectivo descriptivo de alternativas a la TSA utilizadas en SOLCA Guayaquil con pacientes que no aceptaron TSA bajo ninguna circunstancia, entre los años 2011 y 2017. La estrategia terapéutica se basó en un diagnóstico temprano y un tratamiento agresivo de la anemia y cualquier tipo de sangrado activo. Se utilizó eritropoyetina, hierro y folato, según requerimientos del paciente. Todos los pacientes quirúrgicos recibieron ácido tranexámico y otros hemostáticos tópicos según necesidad. Resultados: De 73 pacientes oncológicos, el 68.5 % eran no quirúrgicos, de este grupo el 62 % recibió quimioterapia. La hemoglobina aumentó hasta 12.6 g/dL. Por tratamiento global por paciente se administraron hasta 3000 mg de hierro, 140.000 unds de eritropoyetina y megadosis de vitamina C fue aplicada con una media de 24 gramos. Todos los pacientes aumentaron sus niveles de hemoglobina en un promedio de 25 días. Conclusión: Es esencial iniciar un tratamiento temprano, preventivo y coordinado con un equipo multidisciplinario comprometido a estos esquemas. Los pacientes respondieron bien a los medicamentos y las dosis recibidas y no se informaron efectos secundarios. También podemos ver que estas estrategias son efectivas y factibles de aplicar.

Introduction: Risks associated with the Allogeneic Blood Transfusions (ABT) are widely known and have contributed to new treatment paradigms for bloodless medicine and surgery. Therefore, it is essential to have effective therapeutic strategies that serve as alternatives to ABTs. This report describes the strategies applied to patients in this paper. Methods: A Retrospective descriptive study of ABT alternatives used in SOLCA Guayaquil with patients who did not accept ABTs under any circumstances, between 2011 and 2017. The therapeutic strategy was an early diagnosis and an aggressive treatment of anemia and any active bleeding. Erythropoietin, iron, and folate were applied, according to the patient's requirements. All surgical patients received tranexamic acid and other hemostatics as needed. Results: Of 73 cancer patients, 68.5% were non-surgical, 62% of the group received chemotherapy. For global treatment per patient, up to 3000 mg of iron was administered, 140,000 units of erythropoietin and megadoses of vitamin C were applied with an average of 24 grams. All patients increased their hemoglobin levels by an average of 25 days. All patients increased their hemoglobin levels by an average of 25 days. Conclusion: It is essential to start early treatment, prevent and coordinate with a multidisciplinary team committed to these schemes. The patients responded well to the medications, and the doses received, and no side effects were reported. We can also see that these strategies are practical and feasible to apply.

Caracterización de donadores seropositivos por trypanosoma cruzi y su manejo, banco de sangre, Hospital Escuela, Tegucigalpa, 2016 / Characterization and management of Trypanosoma cruzi seropositive donors, Blood Bank, Hospital Escuela, Tegucigalpa, 2016

Antecedentes: La eliminación de la transmisión no-vectorial de Trypanosoma cruzi es objetivo nacional de salud pública. La seroprevalencia en donadores de sangre es blanco de estrategias de eliminación de la Enfermedad de Chagas. Objetivo: Caracterizar donadores seropositivos por T. cruzi y su manejo en el Banco de Sangre, Hospital Escuela, Tegucigalpa, 2016. Metodología: Estudio descriptivo transversal sobre muestra aleatoria de 150 donadores de sangre, mayores de 18 años de edad, seleccionados a partir de un sub-grupo de 726 casos seropositivos por enfermedades de notificación obligatoria. Los donadores seropositivos por T. cruzi fueron invitados a participar mediante seguimiento telefónico. Se registró información sobre diagnóstico, características sociodemográficas, notificación, referencia y seguimiento. El protocolo fue aprobado por comité de ética institucional, Facultad de Ciencias Médicas UNAH. Resultados: Se identificaron 30 casos seropositivos por T. cruzi (20.0%, IC95% 13.3-26.7), edad media 39.1 años, sexo masculino 66.7% (20), procedentes de regiones centro-sur-oriente y de bajo nivel socioeconómico. De estos 30 casos, 15 respondieron y aceptaron participar; de estos, 6 informaron que se les notificó el resultado serológico y 5 fueron referidos para evaluación y tratamiento. Entre estos 5, en un caso se realizó una segunda prueba diagnóstica. Ninguno fue notificado sobre su aptitud para donar sangre. Conclusión: Los casos identificados son adultos jóvenes, con relación hombre a mujer 2:1. Es necesario implementar un sistema de registro nacional de notificación y seguimiento de casos identificados en los bancos de sangre. Este sistema debe estar integrado al sistema de vigilancia de la Secretaría de Salud de Honduras...(AU)

Quality control in the different stages of producing red blood cell concentrate from dogs / Controle de qualidade nas diferentes etapas de produção do concentrado de hemácias em cães

The objective of this study was to perform a quality control assessment of red blood cells after standardization of the blood production stages. For this purpose, separation of the blood components to obtain red blood cells, the storage of the blood packets and an evaluation of blood quality were performed. The mean (± SD) volume, globular volume, hemoglobin and hemolysis percentage of the red blood cell concentrate were 299.77±30.08mL, 60.87±2.60%, 20.57±0.93g/DL and 0.09±0.07%, respectively. The means (± SD) of the volume, globular volume, total hemoglobin percentage of hemolysis and hemoglobin per unit of packed red blood cells after the storage period (8.83±6.73 days) were 57.55±3.01%, 20.30±0.89 0, 20±0.12%, and 60.90±7.65. The red blood cell packets were within the parameters of quality control established by Health Ministry legislation in humans and allow us to conclude that the standardization of blood production stages involves the selection of donors until the end of storage and is necessary to produce quality red blood cells. Quality control aims to find possible flaws in the procedures to be repaired, increasing transfusion safety.(AU)

O objetivo deste estudo foi realizar o controle de qualidade do concentrado de hemácias após a padronização das etapas de produção do sangue. Para isso, realizou-se separação de hemocomponentes para obtenção de concentrado de hemácias, armazenamento das bolsas de sangue e avaliação da qualidade delas. Os valores médios (± DP) do volume, do volume globular, da hemoglobina e do percentual de hemólise do concentrado de hemácias foram: 299,77±30,08mL, 60,87±2,60%, 20,57±0,93g/DL e 0,09±0,07%, respectivamente. Os valores médios (± DP) do volume globular, da hemoglobina total percentual de hemólise e da hemoglobina por unidade de concentrado de hemácias após o período de armazenamento (8,83±6,73 dias) foram: 57,55±3,01%, 20,30±0,89 0,20±0,12%, 60,90±7,65. As bolsas de concentrado de hemácias ficaram dentro dos parâmetros de controle de qualidade estabelecidos pela legislação do Ministério da Saúde em humanos e possibilitaram concluir que a padronização das etapas de produção do sangue envolve desde a seleção de doadores até o final do armazenamento e é necessária para produzir concentrado de hemácias com qualidade. O controle de qualidade visa encontrar possíveis falhas nos procedimentos para que estas possam ser reparadas, aumentando, assim, a segurança transfusional.(AU)

Frequency of dog erythrocyte antigen 1 blood group and risk of incompatible transfusion in dogs of different breeds and mongrels from the city of Salvador - BA, Brazil / Frequência do antígeno eritrocitário canino 1 e risco de transfusão incompatível em cães de diferentes raças e mestiços da cidade de Salvador-BA, Brasil

The dog erythrocyte antigen 1 (DEA 1) is the most immunogenic blood group in dogs, and blood transfusions may trigger some undesirable effects in veterinary patients, which are directly associated with incompatible transfusions. The present study aimed to investigate the frequency of positive DEA 1 blood group in blood donor dogs from a blood bank in Salvador, Bahia, Brazil, and also to calculate the risk of managing incompatible blood in both first and second transfusion. A number of 203 dogs of different breeds, aged between 1 and 8 years, weighing 28 kg, with no degree of kinship and of both sexes in Salvador - BA, Brazil were evaluated to investigate the blood type DEA 1 frequency, by means of chromatography and flow cytometry tests for blood typing. The risk of incompatible blood transfusion in either a first or a second transfusion was also calculated. The frequency of the DEA 1 group ranged from 0% to 100% in various breeds, but with a mean positivity of 62.07% (126/203). And the lowest risk of an DEA 1 negative animal receiving DEA 1 positive blood within the group of animals evaluated was 0.92% at a first transfusion; and the risk of the same animal receiving incompatible blood for the DEA group 1 in the second transfusion was 0.008%. The highest risk of an DEA 1 negative animal receiving DEA 1 positive blood from these animals was 69.12%; and the risk of receiving incompatible blood for DEA 1 was 47.77%. In conclusion, the frequency of the DEA 1 group varied between the studied breeds and the risk of incompatible blood transfusions varies according to donor and recipiente breeds, but this can be overridden if blood typing tests are performed along with the cross-reaction test for compatibility.

O antígeno eritrocitário canino 1 (AEC 1) é o grupo sanguíneo mais imunogênico em cães, podendo as transfusões sanguíneas desencadearem alguns efeitos indesejáveis nos pacientes veterinários. Estes estão diretamente associados à transfusões incompatíveis. O presente trabalho teve como objetivo estudar a frequência do grupo sanguíneo AEC 1 em cães doadores de sangue de um banco de sangue de Salvador-BA, Brasil, e calcular o risco de administrar sangue incompatível tanto em uma primeira quanto em uma segunda transfusão. Foram avaliados 203 cães de diversas raças, de ambos os sexos, com idade entre 1 e 8 anos, peso a partir de 28 kg, sem nenhum grau de parentesco originários de Salvador ­ BA, Brasil, para pesquisa da frequência do tipo sanguíneo AEC 1, por meio de testes de imunocromatografia e citometria de fluxo para tipagem sanguínea. E calculado o risco de transfusão sanguínea incompatível tanto em uma primeira como em uma segunda transfusão. A frequência do grupo AEC 1 variou entre as raças estudadas de 0% a 100%, porém com uma positividade média de 62,07% (126/203). O menor risco de um animal AEC 1 negativo receber sangue AEC 1 positivo, dentro do grupo dos animais avaliados foi de 0,92% em uma primeira transfusão e o risco do mesmo animal receber sangue incompatível para o gruo AEC 1 na segunda transfusão foi de 0,008%. Quanto ao maior risco de um animal AEC 1 negativo receber sangue AEC 1 positivo destes animais foi de 69,12% e o risco do mesmo receber sangue incompatível para o AEC 1 foi de 47,77%. A frequência do grupo AEC 1 variou entre as raças estudadas e o risco de transfusões incompatíveis variou de acordo com as raças doadoras e receptoras, mas esse risco pode ser anulado se sempre forem realizados os testes para tipagem sanguínea junto com a prova de reação cruzada para compatibilidade.

Evaluation of platelet concentrate prescription in pediatric patients at a tertiary care hospital / Avaliação da prescrição de concentrado de plaquetas em pacientes pediátricos em hospital terciário

ABSTRACT Objective: To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital. Methods: A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets. Results: Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication. Conclusion: The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.

RESUMO Objetivo: Verificar a adequação na prescrição de concentrado de plaquetas por pediatras em diferentes setores da pediatria de um hospital geral. Métodos: Estudo transversal avaliando 218/227 fichas de requisição de concentrado de plaquetas de crianças e adolescentes (zero a 13 anos), de janeiro de 2007 a abril de 2015 pelos pediatras do pronto-socorro, enfermaria e unidade de terapia intensiva. Excluíram-se as requisições em portadores de doenças hematológicas e aquelas sem o número de plaquetas. Resultados: Crianças com menos de 12 meses receberam 98 prescrições de concentrado de plaquetas (45,2%). A maioria das transfusões foi profiláticas (165; 79%). Em relação ao local da transfusão, 39 (18%) foram no pronto-socorro, 27 (12,4%) na enfermaria e 151 (69,6%) na unidade de terapia intensiva. O gatilho, o volume prescrito e o subtipo de concentrado de plaquetas foram adequados em 59 (28,2%), 116 (53,5%) e 209 (96,3%) das transfusões, respectivamente. Prescrições para pacientes com hemorragia apresentaram adequação em 42 (95,5%) transfusões, enquanto para crianças sem hemorragia houve adequação em 17 (10,3%) vezes. A inadequação mais comum em relação ao volume foi a prescrição acima da recomendação (95; 43,8%). Foram prescritos oito concentrados de plaquetas sem indicação de solicitação de subtipos. Conclusão: Os resultados obtidos nesse estudo mostraram que a prescrição de transfusão de concentrado de plaquetas foi mais adequada em crianças com hemorragia ativa em comparação com a transfusão profilática. Houve tendência à prescrição de volumes elevados e de subtipos de plaquetas, o que não se justifica segundo os protocolos atuais. O ensino da medicina transfusional deve ser mais valorizado na graduação e na residência médica.

Hiperentorno educativo sobre infecciones transmitidas por la sangre / Educational hypercontext on infections transmitted by blood

Con el objetivo de elevar los conocimientos acerca de medicina transfusional en profesionales de la salud que cursan el posgrado, se decidió elaborar un producto informático que incluyera los temas correspondientes a la transmisión de infecciones bacterianas por medio de la sangre y las medidas de prevención para lograr una hemoterapia de mayor seguridad. Dicho producto fue desarrollado en la plataforma virtual Chreasoft 3.2, y en él aparecen diferentes módulos que enlazan imágenes y texto, lo cual posibilita una mejor comprensión de la materia y contribuye a motivar el aprendizaje(AU)

With the objective of increasing the knowledge about transfusional medicine in postdegree students health professionals, it was decided to elaborate a computer product that included the topics corresponding to the transmission of bacterial infections by means of blood and the preventive measures to achieve a safer hemotherapy. This product was developed in the Chreasoft 3.2 virtual platform, in which different units appear connecting images and text, that facilitates a better understanding of the matter and contributes to motivate the learning(AU)