Letter to the Editor
New Paradigms in Patient Blood Management in Surgery
Nuevos paradigmas en el «patient blood management» en cirugía
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"https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X14002164?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217350771400489X?idApp=UINPBA00004N" "url" => "/21735077/0000009300000001/v1_201501140027/S217350771400489X/v1_201501140027/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "New Paradigms in Patient Blood Management in Surgery" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "59" "paginaFinal" => "61" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Antonio García Erce, Ana Isabel Peral García" "autores" => array:2 [ 0 => array:4 [ "nombre" => "José Antonio" "apellidos" => "García Erce" "email" => array:2 [ 0 => "joseerce@vodafone.es" 1 => "joseerce@ono.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ana Isabel" "apellidos" => "Peral García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Hematología y Hemoterapia, Hospital San Jorge, Huesca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "AWGE-GIEMSA" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Ahorro de Sangre, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevos paradigmas en el «patient blood management» en cirugía" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read the study by Feliu<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> with interest, as well as the accompanying editorial by Dr. Sabaté.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> We would like to congratulate the former for their elegant article, which once again demonstrates the role of preoperative anemia as the only avoidable predictive factor for perioperative transfusion.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We would like to clarify, however, some concepts discussed in both texts that are not a true representation of the proper management of blood product resources. In the Editorial, Dr. Sabaté<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> affirms that, “The indication for blood cross-matching tests and the mandatory ordering of blood products follow historical rules. For many surgical procedures, the sole criterion used for preoperative blood ordering is prevention.” We would like to state that, in contrast with what was written in the article and in accordance with current Spanish legislation<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> (RD 1088/2005), scientific evidence and national and international recommendations, blood compatibility tests (cross-matching) and universal blood reserves are far from being required and their routine use should be avoided in most hospitals. Such measures consume material resources without improving safety. They also entail immobilizing stock, which consequently leads to the aging and deterioration of blood components as well as the eventual loss of some due to expiration.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The current legal framework in our country<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> (<a class="elsevierStyleCrossRef" href="#sec0005">Addendum</a>) establishes the need for blood compatibility tests before administering any type of red blood cell component, except in cases with urgent requirements.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This requirement should always be ordered in writing by the physician treating the patient. Mandatory recipient blood tests include<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>: ABO blood typing; antigen typing, Rho (D); and, in the case of red blood cell transfusion, anti-erythrocyte antibody study using the indirect antiglobulin test (known as Coombs indirect) or another technique with similar or superior sensitivity. Only when the irregular red blood cell antibody count is positive is it recommended to identify them and do major cross-match testing (which tests recipient serum vs. donor red blood cells). Therefore, neither cross-match testing nor blood reserve are mandatory for surgery as long as there is a guaranteed supply from the Transfusion Center. Furthermore, in cases of patients with no history of transfusions, transplantations or pregnancies in the previous 3 months, the lab results from the sample are valid for 3 months.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Moreover, we know that the safest and most effective measure to avoid transfusion reactions is correct and complete patient identification, in addition to restricting the use of blood products to the lowest effective dose.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> To this end, unequivocal verification is required prior to the administration of blood or component transfusion by the person who is administering it, which includes patient identification data as well as that of the blood unit or blood product.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Verification of the compatibility between the patient and the blood unit should include: (a) comparison of the identity given by the patient with the data from the laboratory compatibility test and (b) verification of the patient's blood type with the blood type indicated on the blood unit label.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Likewise, current regulations require a correctly completed, signed prescription or request for transfusion, as well as patient consent after having been informed of the risks and benefits of this therapy, as well as any possible alternatives<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> (<a class="elsevierStyleCrossRef" href="#sec0005">Addendum</a>). Dr. Sabaté mentions only a few of these in his Editorial. Recently, an update has been published for the “Seville” document of Alternatives to Blood Transfusion, endorsed by 6 Spanish scientific societies.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The first and most effective is administering the transfusion of packed red blood cells with “restrictive” criteria. Transfusion is recommended to maintain hemoglobin (Hb) levels between 70 and 90<span class="elsevierStyleHsp" style=""></span>g/l in order to reduce the rate of transfusions, with a level of evidence 1A. Controlled studies done in adult and pediatric euvolemic critical patients (both medical and surgical) have demonstrated that most cases tolerate Hb levels as low as 70–80<span class="elsevierStyleHsp" style=""></span>g/l without negative effects. Said Hb levels are also recommended but the American Association of Blood Banks<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and the Cochrane Review.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Patient tolerance to normovolemic anemia is conditioned by the cardiopulmonary reserve, blood loss volume and velocity, and the acute or chronic nature of the anemia. The second pillar for managing anemia and avoiding transfusion is stimulation of erythropoiesis and the active treatment of anemia, fundamentally with ferrotherapy for gastrointestinal diseases.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,9,10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, the availability of alternatives to transfusion and the current legal framework have meant that, right now, most Transfusion Departments at second and third-level hospitals in our country employ dynamic resource management. This means that cross-matching and preoperative blood reserves are only used in cases with positive irregular antibodies. This management avoids immobilizing blood products that would later deteriorate, without threatening patient safety.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García Erce JA, Peral García AI. Nuevos paradigmas en el «patient blood management» en cirugía. Cir Esp. 2015;93:59–61.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Article 15. Administration of blood and components</span></p> <p id="par0040" class="elsevierStylePara elsevierViewall">The administration of blood and components will be ordered with a physician's prescription. Whenever possible, the physician establishing the indication will (after explaining the risks and benefits of the therapy as well as any possible alternatives) obtain informed patient consent, as defined in Law 41/2002, 14 November, which regulates patient autonomy, rights and responsibilities in matters of clinical documentation and information, particularly in articles 5, 8, 9, and 10.</p> <p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Article 16. Transfusion requests</span></p> <p id="par0050" class="elsevierStylePara elsevierViewall">Requests for total blood or blood component transfusions will include enough information to identify the recipient and the physician who has prescribed it, as well as the medical reasons that are the basis for the indication.</p> <p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Article 17. Recipient blood samples</span></p> <p id="par0060" class="elsevierStylePara elsevierViewall">Blood samples should be identified unequivocally with the data of the recipient. There should likewise be a mechanism that would be able to identify the person who took the sample and the date on which it was taken.</p> <p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Article 18. Recipient blood tests</span></p> <p id="par0070" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0075" class="elsevierStylePara elsevierViewall">Before administering any homologous red blood cells, compatibility tests will be done, except in cases of urgent requirement, defined as those in which a delay in the supply of blood or blood components may endanger the patient's life. The physician treating the patients will justify the urgent need for transfusion in writing. Compatibility tests will include those from Addendum <span class="elsevierStyleSmallCaps">VII</span> and will be done even when the blood or components have already been sent for transfusion.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0080" class="elsevierStylePara elsevierViewall">When the recipient has received a transfusion or cell or organ transplantation in the last 3 months, or if the patient is a woman who has been pregnant, the patient sample for compatibility tests will be taken within the 72<span class="elsevierStyleHsp" style=""></span>h prior to transfusion.</p></li></ul></p> <p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Article 19. Safety measures</span></p> <p id="par0090" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">1.</span><p id="par0095" class="elsevierStylePara elsevierViewall">Prior to the administration of blood or blood product transfusion, the person who is performing the transfusion should unequivocally confirm the patient identification data and the identification data from the blood unit or blood component intended for him/her.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">2.</span><p id="par0100" class="elsevierStylePara elsevierViewall">The verification of patient/blood unit compatibility will entail:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">a.</span><p id="par0105" class="elsevierStylePara elsevierViewall">Comparison of the identity provided by the patient with the data from the laboratory compatibility test.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">b.</span><p id="par0110" class="elsevierStylePara elsevierViewall">Verification of the patient blood group with the blood type indicated on the label of the blood unit.</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">3.</span><p id="par0115" class="elsevierStylePara elsevierViewall">The expiration date should be checked to confirm that the unit has not expired.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">4.</span><p id="par0120" class="elsevierStylePara elsevierViewall">The identification number and the type of transfused units will be recorded in the patient's medical file in order to guarantee donor-recipient traceability.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">5.</span><p id="par0125" class="elsevierStylePara elsevierViewall">Each transfusion center and unit that distributes or administers blood and blood components for transfusion should have a procedure that guarantees proper identification of patients, pre-transfusion samples and blood components administered. Likewise, the final destination of each unit of blood should be traceable.</p></li></ul></p>" "etiqueta" => "Addendum" "titulo" => "Articles Extracted from Royal Decree 1088/2005, 16 September, which Establish the Technical Requirements and Minimal Conditions for Blood Donation, Transfusion Centers and Services" "identificador" => "sec0005" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preoperative blood ordering in elective colon surgery: requirement or routine?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Feliu" 1 => "J.C. Rueda" 2 => "L. Ramiro" 3 => "M. Olona" 4 => "J. Escuder" 5 => "F. 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Fung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-157-1-201206190-00429" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2012" "volumen" => "157" "paginaInicial" => "49" "paginaFinal" => "58" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22751760" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.L. Carson" 1 => "P.A. Carless" 2 => "P.C. Hebert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD002042.pub3" "Revista" => array:5 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2012" "volumen" => "4" "paginaInicial" => "CD002042" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22513904" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravenous iron in digestive diseases: a clinical (re)view" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Gomollón" 1 => "J.P. Gisbert" 2 => "J.A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 11 | 7 | 18 |
| 2024 September | 16 | 3 | 19 |
| 2024 August | 23 | 5 | 28 |
| 2024 July | 12 | 2 | 14 |
| 2024 June | 13 | 2 | 15 |
| 2024 May | 16 | 5 | 21 |
| 2024 April | 13 | 6 | 19 |
| 2024 March | 25 | 3 | 28 |
| 2024 February | 19 | 3 | 22 |
| 2024 January | 13 | 6 | 19 |
| 2023 December | 26 | 2 | 28 |
| 2023 November | 21 | 3 | 24 |
| 2023 October | 25 | 4 | 29 |
| 2023 September | 22 | 2 | 24 |
| 2023 August | 15 | 1 | 16 |
| 2023 July | 32 | 5 | 37 |
| 2023 June | 20 | 1 | 21 |
| 2023 May | 17 | 4 | 21 |
| 2023 April | 13 | 3 | 16 |
| 2023 March | 13 | 4 | 17 |
| 2023 February | 11 | 3 | 14 |
| 2023 January | 23 | 4 | 27 |
| 2022 December | 11 | 8 | 19 |
| 2022 November | 13 | 7 | 20 |
| 2022 October | 14 | 10 | 24 |
| 2022 September | 16 | 21 | 37 |
| 2022 August | 15 | 9 | 24 |
| 2022 July | 18 | 9 | 27 |
| 2022 June | 7 | 5 | 12 |
| 2022 May | 12 | 8 | 20 |
| 2022 April | 14 | 7 | 21 |
| 2022 March | 17 | 4 | 21 |
| 2022 February | 9 | 5 | 14 |
| 2022 January | 17 | 8 | 25 |
| 2021 December | 15 | 15 | 30 |
| 2021 November | 11 | 19 | 30 |
| 2021 October | 11 | 9 | 20 |
| 2021 September | 16 | 5 | 21 |
| 2021 August | 17 | 10 | 27 |
| 2021 July | 15 | 8 | 23 |
| 2021 June | 12 | 8 | 20 |
| 2021 May | 16 | 10 | 26 |
| 2021 April | 23 | 5 | 28 |
| 2021 March | 22 | 14 | 36 |
| 2021 February | 21 | 3 | 24 |
| 2021 January | 20 | 11 | 31 |
| 2020 December | 12 | 8 | 20 |
| 2020 November | 10 | 8 | 18 |
| 2020 October | 16 | 6 | 22 |
| 2020 September | 13 | 8 | 21 |
| 2020 August | 14 | 7 | 21 |
| 2020 July | 6 | 10 | 16 |
| 2020 June | 8 | 7 | 15 |
| 2020 May | 11 | 11 | 22 |
| 2020 April | 11 | 5 | 16 |
| 2020 March | 7 | 1 | 8 |
| 2020 February | 10 | 11 | 21 |
| 2020 January | 15 | 11 | 26 |
| 2019 December | 22 | 6 | 28 |
| 2019 November | 20 | 11 | 31 |
| 2019 October | 11 | 4 | 15 |
| 2019 September | 8 | 3 | 11 |
| 2019 August | 18 | 6 | 24 |
| 2019 July | 15 | 14 | 29 |
| 2019 June | 41 | 6 | 47 |
| 2019 May | 66 | 16 | 82 |
| 2019 April | 23 | 12 | 35 |
| 2019 March | 11 | 4 | 15 |
| 2019 February | 14 | 3 | 17 |
| 2019 January | 7 | 3 | 10 |
| 2018 December | 7 | 5 | 12 |
| 2018 November | 16 | 3 | 19 |
| 2018 October | 21 | 2 | 23 |
| 2018 September | 22 | 4 | 26 |
| 2018 August | 6 | 1 | 7 |
| 2018 July | 21 | 2 | 23 |
| 2018 June | 3 | 1 | 4 |
| 2018 May | 16 | 3 | 19 |
| 2018 April | 41 | 2 | 43 |
| 2018 March | 14 | 0 | 14 |
| 2018 February | 3 | 0 | 3 |
| 2018 January | 17 | 1 | 18 |
| 2017 December | 10 | 2 | 12 |
| 2017 November | 13 | 1 | 14 |
| 2017 October | 18 | 1 | 19 |
| 2017 September | 12 | 2 | 14 |
| 2017 August | 14 | 2 | 16 |
| 2017 July | 14 | 0 | 14 |
| 2017 June | 15 | 8 | 23 |
| 2017 May | 18 | 1 | 19 |
| 2017 April | 11 | 3 | 14 |
| 2017 March | 13 | 38 | 51 |
| 2017 February | 7 | 4 | 11 |
| 2017 January | 17 | 1 | 18 |
| 2016 December | 14 | 9 | 23 |
| 2016 November | 30 | 5 | 35 |
| 2016 October | 34 | 7 | 41 |
| 2016 September | 48 | 15 | 63 |
| 2016 August | 27 | 4 | 31 |
| 2016 July | 15 | 1 | 16 |
| 2016 June | 11 | 9 | 20 |
| 2016 May | 25 | 12 | 37 |
| 2016 April | 10 | 10 | 20 |
| 2016 March | 24 | 16 | 40 |
| 2016 February | 17 | 8 | 25 |
| 2016 January | 20 | 14 | 34 |
| 2015 December | 17 | 10 | 27 |
| 2015 November | 17 | 10 | 27 |
| 2015 October | 22 | 6 | 28 |
| 2015 September | 20 | 9 | 29 |
| 2015 August | 18 | 5 | 23 |
| 2015 July | 13 | 6 | 19 |
| 2015 June | 15 | 5 | 20 |
| 2015 May | 18 | 7 | 25 |
| 2015 April | 12 | 4 | 16 |
| 2015 February | 4 | 1 | 5 |
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