Case report
Management of peri-operative anaemia in a patient with rare alloantibodies scheduled for oesophagectomy
Manejo de la anemia perioperatoria en paciente con aloanticuerpos programada para esofagectomía
Read
1
Timeswas read the article
0
Total PDF
1
Total HTML
Share statistics
array:24 [ "pii" => "S2341192918300970" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.01.022" "estado" => "S300" "fechaPublicacion" => "2018-08-01" "aid" => "906" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:403-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935618300100" "issn" => "00349356" "doi" => "10.1016/j.redar.2018.01.006" "estado" => "S300" "fechaPublicacion" => "2018-08-01" "aid" => "906" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Anestesiol Reanim. 2018;65:403-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 103 "formatos" => array:2 [ "HTML" => 55 "PDF" => 48 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CASO CLÍNICO</span>" "titulo" => "Manejo de la anemia perioperatoria en paciente con aloanticuerpos programada para esofagectomía" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "403" "paginaFinal" => "406" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Management of peri-operative anaemia in a patient with rare alloantibodies scheduled for oesophagectomy" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. García, M.P. Blanco, S. Riaño, I. González-Mendibil, T. Carrascosa, M.T. Antolín" "autores" => array:6 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "García" ] 1 => array:2 [ "nombre" => "M.P." "apellidos" => "Blanco" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Riaño" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "González-Mendibil" ] 4 => array:2 [ "nombre" => "T." "apellidos" => "Carrascosa" ] 5 => array:2 [ "nombre" => "M.T." "apellidos" => "Antolín" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192918300970" "doi" => "10.1016/j.redare.2018.01.022" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300970?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935618300100?idApp=UINPBA00004N" "url" => "/00349356/0000006500000007/v1_201807200902/S0034935618300100/v1_201807200902/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2341192918300830" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.01.020" "estado" => "S300" "fechaPublicacion" => "2018-08-01" "aid" => "902" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:407-12" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Nondiabetic ketoacidosis in a pregnant woman due to acute starvation with concomitant influenza A (H1N1) and respiratory failure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "407" "paginaFinal" => "412" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cetoacidosis no diabética en una mujer embarazada, debido a inanición aguda con gripe A (H1N1) concomitante e insuficiencia respiratoria" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 844 "Ancho" => 950 "Tamanyo" => 55673 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Plain chest radiography in the intensive care unit revealed a bilateral patchy consolidation. This is predominantly in the lingula and possibly left lower lobe. Further consolidation is seen in the perihilar region on the right side with a more distal wedge area of opacification in the right upper lobe. There appears to be some volume loss in the right upper lobe. There are no pleural effusions. Appearances would be in keeping with an infective process.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Skalley, S. Rodríguez-Villar" "autores" => array:2 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Skalley" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Rodríguez-Villar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935618300069" "doi" => "10.1016/j.redar.2018.01.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935618300069?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300830?idApp=UINPBA00004N" "url" => "/23411929/0000006500000007/v1_201807260406/S2341192918300830/v1_201807260406/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192918300842" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.01.021" "estado" => "S300" "fechaPublicacion" => "2018-08-01" "aid" => "909" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:398-402" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Open heart surgery for management of right auricular thrombus related to central venous catheterization" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "398" "paginaFinal" => "402" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cirugía a corazón abierto para el tratamiento de trombo auricular derecho relacionado con cateterización venosa central" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 882 "Ancho" => 950 "Tamanyo" => 64310 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Contrast-enhanced computed tomography scan showing right atrial thrombus (arrow) attached to the central venous catheter.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.F. Ribeiro, I.S. Neto, I. Maia, C. Dias" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A.F." "apellidos" => "Ribeiro" ] 1 => array:2 [ "nombre" => "I.S." "apellidos" => "Neto" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Maia" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Dias" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935618300136" "doi" => "10.1016/j.redar.2018.01.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935618300136?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300842?idApp=UINPBA00004N" "url" => "/23411929/0000006500000007/v1_201807260406/S2341192918300842/v1_201807260406/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Management of peri-operative anaemia in a patient with rare alloantibodies scheduled for oesophagectomy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "403" "paginaFinal" => "406" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. García, M.P. Blanco, S. Riaño, I. González-Mendibil, T. Carrascosa, M.T. Antolín" "autores" => array:6 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "García" "email" => array:1 [ 0 => "eduardo.garciapascual@osakidetza.eus" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.P." "apellidos" => "Blanco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Riaño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "I." "apellidos" => "González-Mendibil" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "T." "apellidos" => "Carrascosa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "M.T." "apellidos" => "Antolín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Galdakao-Usansolo, Galdakao, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Hematología, Hospital Galdakao-Usansolo, Galdakao, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Área de Hospitalización, Hospital Galdakao-Usansolo, Galdakao, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo de la anemia perioperatoria en paciente con aloanticuerpos programada para esofagectomía" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Multimodal rehabilitation, otherwise known as fast-track surgery or enhanced recovery after surgery (ERAS), consists of a series of perioperative measures and strategies designed to reduce the secondary stress caused by surgical interventions (Sx), thereby hastening postoperative recovery of surgical patients and reducing the risk of complications and mortality.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Programmes designed to optimise the status of surgical patients at risk of blood transfusion, known as patient blood management, were developed independently but are now an integral part of ERAS perioperative strategies.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the management of a patient scheduled for oesophagectomy due to neoplasia. A blood analysis performed for the purpose of ordering blood for transfusion showed the presence of alloantibodies, which made it practically impossible to obtain compatible blood.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 64-year-old woman classified as American Society of Anesthesiologists class 2. She was diagnosed with mid-oesophageal squamous-cell carcinoma, with no signs of locoregional infiltration, with subcarinal adenopathy measuring 1<span class="elsevierStyleHsp" style=""></span>cm. The patient was scheduled for laparoscopic oesophagectomy. Her history included chronic oesophagitis that started at the age of 3, due to caustic ingestion. She had required oesophageal dilatation on several occasions, and also presented fibromyalgia and generalised osteoarthritis. Her background treatment was lansoprazole, tramadol, paracetamol, escitalopram and lormetazepam.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Sx was postponed because cross-testing showed the presence of anti-K and anti-Fy (b) specific alloantibodies, and panagglutination with the rest of the cells, making it impossible to obtain fully compatible blood, even from close relatives. The initial study was conducted at the Basque Centre of Human Tissue and Transfusions in Galdakao-Usansolo Hospital, and samples were sent to the Blood and Tissue Bank (BTB) of Barcelona for confirmation. The BTB of Barcelona detected the aforementioned anti-K and anti-Fy (b) alloantibodies, in addition to anti-JMH alloantibodies. The patient was John Milton Hagen (JMH) antigen-negative. Compatibility tests were performed using the LISS-Coombs and LISS-Coombs papain method (DG Gel<span class="elsevierStyleSup">®</span> System; Diagnostic Grifols SA, Barcelona, Spain). Other anti-JMH studies performed were: polyethylene glycol alloadsorption and challenging the patient's plasma with red blood cells. Only 5 bags of 90–95% compatible blood were found, and there was therefore a risk of more or less severe haemolysis, depending on the amount of blood needed to be transfused. The blood bank recommended only transfusing the bags in a life-threatening emergency. Lab tests showed: Hb 13.2; ferritin 23; transferrin saturation 26.6; vitamin B12, folic acid, iron ions and transferrin were normal. After discussing the situation, the Surgery, Haematology and Anaesthesiology departments agree to start treatment with erythropoietin, followed by IV iron, oral vitamin B12 and folate. Due to the difficulty in obtaining compatible allogeneic blood, the patient was enrolled in a preoperative autologous donation programme with the aim of obtaining 3 bags of autologous blood, normalising ferraemia, and maintaining Hb at minimum 12<span class="elsevierStyleHsp" style=""></span>g/dl immediately before surgery. The patient was informed and specific consent was obtained.</p><p id="par0025" class="elsevierStylePara elsevierViewall">On the day Sx, about 1 month after the date initially scheduled, the patient arrived at the operating room with Hb 11.5<span class="elsevierStyleHsp" style=""></span>g/dl and normal ferretin levels; 3 bags of autologous and 4 bags of allogeneic blood were available. Given the high risk of transfusion-induced haemolytic reaction, the blood bank recommended only using the allogenic blood in case of extreme emergency. We decided to prepare the CATS<span class="elsevierStyleSup">®</span> blood recovery system (Continuous Autologous Transfusion System-CATS<span class="elsevierStyleSup">®</span>; Fresenius Kabi Spain, SAU, Barcelona, Spain) should the patient present acute haemorrhage, to reinfuse salvaged blood if it was unavoidable. A peripheral venous line (20<span class="elsevierStyleHsp" style=""></span>G) had been placed when the patient was on the ward. Prior to induction, the patient was given antibiotic prophylaxis with 2<span class="elsevierStyleHsp" style=""></span>g of cefazolin, and 2<span class="elsevierStyleHsp" style=""></span>mg of midazolam were also administered. An epidural catheter (EC) was placed at the T7–T8 segment with the patient in a sitting position, the left radial artery was cannulated, and the right internal jugular vein was cannulated using ultrasound guidance. An additional peripheral vein (14 G) was also cannulated.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Anaesthesia was induced with 150<span class="elsevierStyleHsp" style=""></span>μg fentanyl and propofol using a TCI pump, followed later by 70<span class="elsevierStyleHsp" style=""></span>mg rocuronium. The patient was also given 4<span class="elsevierStyleHsp" style=""></span>mg hydrocortisone. After induction, orotracheal intubation was performed with size 37 left-sided Robertshaw double lumen tube using video laryngoscopy, and placement was checked with a fibreoptic bronchoscope. Anaesthesia was maintained with continuous TCI of propofol, remifentanil and rocuronium. EtCO<span class="elsevierStyleInf">2</span>, SpO<span class="elsevierStyleInf">2</span>, ECG, urine output, temperature, cardiac output and neuromuscular relaxation were monitored, and a nasogastric tube was inserted. Surgery was started with the patient in the prone position. Right thoracoscopy was performed to immobilise the oesophagus after one-lung ventilation with collapse of the right lung. The patient remained haemodynamically stable. Ventilation was uneventful, with good pressure and respiratory volume; EtCO<span class="elsevierStyleInf">2</span> was around 40–45 and saturation measured by pulse oximetry was 95–97, with FiO<span class="elsevierStyleInf">2</span> of 0.8. The patient was then placed in the supine position and laparoscopic gastric bypass was performed. Finally, left lateral cervicotomy was performed, with oesophageal dissection and manual end-to-end anastomosis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">A total of 3080<span class="elsevierStyleHsp" style=""></span>mg propofol, 6.89<span class="elsevierStyleHsp" style=""></span>mg remifentanil and 260<span class="elsevierStyleHsp" style=""></span>mg rocuronium were administered during the procedure, which lasted 9<span class="elsevierStyleHsp" style=""></span>h 11<span class="elsevierStyleHsp" style=""></span>min. We also administered 1500<span class="elsevierStyleHsp" style=""></span>ml Plasmalyte, 750<span class="elsevierStyleHsp" style=""></span>ml 6% Voluven and 2000<span class="elsevierStyleHsp" style=""></span>ml 0.9% NaCl. Blood loss was estimated at 1000<span class="elsevierStyleHsp" style=""></span>ml. Two hours before the end of Sx, 6<span class="elsevierStyleHsp" style=""></span>ml <span class="elsevierStyleSmallCaps">l</span>-bupivacaine 0.125% and 50<span class="elsevierStyleHsp" style=""></span>μg fentanyl were administered via the EC, and continuous perfusion of 4<span class="elsevierStyleHsp" style=""></span>ml/h <span class="elsevierStyleSmallCaps">l</span>-bupivacaine 0.0625% was started. At the end of Sx, the double-lumen tube was replaced with a number 8 tube using a Cook exchanger with subglottic aspiration, after performing the leak test. The patient received 3<span class="elsevierStyleHsp" style=""></span>mg midazolam and 6<span class="elsevierStyleHsp" style=""></span>mg morphine before she was transferred to the postanaesthesia recovery room under mechanical ventilation. Transfer was uneventful. A blood panel performed immediately after surgery showed Hb 10.6<span class="elsevierStyleHsp" style=""></span>g/dl. No transfusion, not even autologous blood, was required at any time, and the patient was discharged home 23 days after Sx with Hb 10.1<span class="elsevierStyleHsp" style=""></span>g/dl.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">This patient presented a risk of perioperative transfusion due to surgical indication. Although she was slightly hypoferritinaemic, she was not anaemic. Anti-K, anti Fy(b) and anti-JMH alloantibodies were detected during testing prior to ordering blood products, making it all but impossible to obtain compatible blood. We obtained a few bags of RBC, but compatibility could not be guaranteed, and there was a risk of haemolysis; thus, transfusion was unavoidable.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The clinical significance of each of these antibodies differs. The incidence of the Fy(b) antigen of the Duffy system is 83% in Caucasians, 23% in blacks and 18.5% in Asians. However, individuals that do not produce Fy antigens in their red blood cells can express them in endothelial cells, the renal tubule epithelium, pulmonary alveoli and Purkinje cells of the cerebellum, in addition to the thyroids, colon and spleen. This means that some of these individuals would not be donors for patients with Fy(b) alloantibodies, and obtaining Fy antigen-free blood in our setting, though not impossible, is always a challenge. These antibodies are involved in haemolytic transfusion reactions.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The Kell K antigen is rare, but is found in up to 25% of Arabs. In addition to red blood cells, the K antigen can be found in myeloid tissues, lymphatic organs, heart and skeletal muscle, and the nervous system. Obtaining K antigen-free blood is easier than Fy antigen-free bags, but K antigens are the third most potent, after those of the ABO and Rh blood groups, at triggering a potentially fatal immune reaction.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Over 99% of patients are known to carry the JMH antigen, but individuals with anti-JMH antibodies have not been associated with adverse transfusion events. This is why it is not considered clinically significant, and serologically incompatible blood units can be used for transfusion.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Even though the presence of anti-JMH would not in itself be problematic, the presence and clinical significance of other alloantibodies made it advisable to avoid transfusion unless unavoidable.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Although intraoperative blood salvage and preoperative autologous donation are not routine practice in oncological surgery in our hospital, there is evidence that these procedures do not increase morbidity and mortality and would be advisable in certain cases.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a> This is why, given the circumstances, we decided to connect the CATS<span class="elsevierStyleSup">®</span> blood saver, although ultimately it was not needed.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Given the potential transfusion risks, all the parties involved (patient, surgeon, haematologist and anaesthesiologist) agreed to proceed with the perioperative blood management strategy described above, in addition to the usual strategies followed in our hospital. The thresholds established in these programmes were achieved, and transfusion was avoided.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The perioperative anaemia management algorithm used in our hospital adheres fairly strictly to recent recommendations,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> although it has been adapted to our setting, and does not require the patient to be present during the preoperative anaemia work-up. These non-contact consultations conducted by certain anaesthesiologists are easier for patients, and can speed up treatment and the introduction of changes in the protocol on the basis of individual test results.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1065108" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1013118" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1065107" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1013119" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-10-05" "fechaAceptado" => "2018-01-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1013118" "palabras" => array:4 [ 0 => "Patient blood management" 1 => "Rare alloantibodies" 2 => "Fast-track surgery" 3 => "Enhanced recovery after surgery" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1013119" "palabras" => array:4 [ 0 => "Patient blood management" 1 => "Aloanticuerpos irregulares" 2 => "Rehabilitación multimodal quirúrgica" 3 => "Programa de recuperación intensificado" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A description is presented on the management of a patient with an oesophageal neoplasm scheduled for oesophagectomy. Alloantibodies were detected during a blood components reservation procedure, which made it almost impossible to obtain compatible blood. Peri-operative anaemia management or “Patient Blood Management” should be routinely performed in all patients at transfusion risk. This strategy has been considered as one of the actions to bear in mind in fast-track surgery or enhanced recovery after surgery.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Describimos el manejo de una paciente programada para esofagectomía por neoplasia a la que durante el proceso de reserva de hemoderivados le fueron detectados aloanticuerpos, que prácticamente imposibilitaban la obtención de sangre compatible. El manejo de la anemia perioperatoria («patient blood management») se debe realizar rutinariamente en los pacientes quirúrgicos con riesgo de transfusión. Esta estrategia se ha considerado como una de las medidas a tener en cuenta en la rehabilitación multimodal quirúrgica o programa de recuperación intensificada.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García E, Blanco MP, Riaño S, González-Mendibil I, Carrascosa T, Antolín MT. Manejo de la anemia perioperatoria en paciente con aloanticuerpos programada para esofagectomía. Rev Esp Anestesiol Reanim. 2018;65:403–406.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Calvo JM, del Valle E, Ramírez JM, Loinaz C, Martín C, Nogueiras C, et al. Grupo de trabajo. Vía clínica de recuperación intensificada en cirugía abdominal (RICA). Ministerio de Sanidad, Servicios Sociales e Igualdad. Instituto Aragonés de Ciencias de la Salud [accessed 5.12.17]." ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optimización del paciente quirúrgico con riesgo de transfusión “patient blood management”: el nuevo paradigma de la medicina perioperatoria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Bisbe" 1 => "M. Basora" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0034-9356(15)30001-3" "Revista" => array:7 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2015" "volumen" => "62" "numero" => "Suppl 1" "paginaInicial" => "1" "paginaFinal" => "2" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26320338" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manejo preoperatorio de la anemia en cirugía oncológica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "O. Díaz-Cambronero" 1 => "S. Matoses-Jaén" 2 => "N. García-Claudio" 3 => "N. García-Gregorio" 4 => "J. Molins-Espinosa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0034-9356(15)30007-4" "Revista" => array:7 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2015" "volumen" => "62" "numero" => "Suppl 1" "paginaInicial" => "45" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26320344" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Chapter 9; The Duffy blood group]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2271/ [accessed 23.12.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood groups and red cell antigens [Internet]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Dean" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2005" "editorial" => "National Center for Biotechnology Information (US)" "editorialLocalizacion" => "Bethesda, MD" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Chapter 8; The Kell Blood Group]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2270/ [accessed 23.12.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood groups and red cell antigens [Internet]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Dean" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2005" "editorial" => "National Center for Biotechnology Information (US)" "editorialLocalizacion" => "Bethesda, MD" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "JMH blood group system: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.T. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Immunohematology" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "18" "paginaFinal" => "23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25238240" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Jiménez-Marco T, editor. Guía sobre la transfusión de componentes sanguíneos y derivados plasmáticos. Barcelona: Sociedad Española de Transfusión Sanguínea y Terapia Celular." ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood salvage and cancer surgery: a meta-analysis of available studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.H. Waters" 1 => "M. Yazer" 2 => "Y. Chen" 3 => "J. Kloke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1537-2995.2011.03555.x" "Revista" => array:6 [ "tituloSerie" => "Transfusion" "fecha" => "2012" "volumen" => "52" "paginaInicial" => "2167" "paginaFinal" => "2173" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22321196" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Documento Sevilla de Consenso sobre alternativas a la transfusión de sangre alogénica. Actualización del Documento Sevilla" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.R. Leal-Noval" 1 => "M. Muñoz" 2 => "M. Asuero" 3 => "E. Contreras" 4 => "J.A. García-Erce" 5 => "J.V. Llau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2012.12.003" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2013" "volumen" => "60" "paginaInicial" => "263.e1" "paginaFinal" => "263.e25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23415109" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Algoritmo para el tratamiento de la anemia preoperatoria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Bisbe" 1 => "M. Basora" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0034-9356(15)30004-9" "Revista" => array:7 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2015" "volumen" => "62" "numero" => "Suppl 1" "paginaInicial" => "27" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26320341" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006500000007/v1_201807260406/S2341192918300970/v1_201807260406/en/main.assets" "Apartado" => array:4 [ "identificador" => "65601" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006500000007/v1_201807260406/S2341192918300970/v1_201807260406/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300970?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2018 December | 1 | 0 | 1 |
