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          Analizamos los conocimientos de médicos generales y especialistas de la Caja Nacional de Salud, sobre indicaciones, beneficios y riesgos de las transfusiones sanguíneas y de hemocomponentes antes de la implementación del nuevo formulario de solicitud de transfusión de sangre y/o hemocomponentes del Programa Nacional de Sangre y de la Caja Nacional de Salud. Distribuimos 207 encuestas autoaplicadas a médicos generales y especialistas de diferentes hospitales y centros médicos de la Caja Nacional de Salud regional La Paz; las encuestas contenían 8 preguntas extraídas del último acápite del nuevo formulario de solicitud de transfusión sanguínea. Se incluyeron según criterios 141 encuestas. El 90.8% de los profesionales esperaron encontrar mejoría clínica con la transfusión, el 99.3% conocen los riesgos de transmisión de infecciones a través de estas, el 92.9% evalúan los beneficios y riesgos antes de indicarla y el 66.6% de profesionales registran en la historia clínica las razones de su indicación; sin embargo, existe poco conocimiento sobre alternativas terapéuticas antes de transfundir y las indicaciones de transfusión sanguínea no son uniformes. La estrategia de ahorro de transfusión tiene que partir de la capacitación del personal médico relacionado con su indicación, de la elaboración de un manual del uso adecuado de hemocomponentes y de protocolos de utilización de estimulantes hematínicos y folatos en casos de rescate preoperatorio, anemias ferropénicas y megaloblásticas y de la conformación de comités de hemovigilancia de acuerdo a las políticas del Programa Nacional de Sangre.

          Translated abstract

          We analyzed the knowledge of general and specialists doctors from the Caja Nacional de Salud, about indications, benefits and risks of blood transfusions and blood derivatives before the implementation of the new blood transfusion application form or blood derivatives of the National Blood Program and the Caja Nacional de Salud. We distributed 207 self applied enquiries to general and specialist medics from different hospitals and medical centers from the Caja Nacional de Salud, the enquiries included 8 questions extracted from the last paragraph of the new blood transfusion application form; 141 enquires were included by criteriain the study; 90.8% of professionals expected to find clinical improvement with transfusion, 99.3% know the transmission of infection risks through these, 92.9% evaluated benefits and risks before commanding the blood transfusion, 66.6% of register in the clinical history the reasons for the indication, however, there is a few knowledge about the therapeutic alternatives before transfuse and the blood transfusion indications are not uniform. The transfusion-saving strategy has to begin with the training of medical personnel related to indications, the development of a adequate user manual of blood derivatives and stimulants haematinics and folates use protocols in preoperative rescue cases, ferropenic, megaloblastic anemias and the creation hemosurveillance committee in accordance with the policies of the National Blood Program.

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          Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention.

          As the risks of allogeneic blood transfusion (ABT)-transmitted viruses were reduced to exceedingly low levels in the US, transfusion-related acute lung injury (TRALI), hemolytic transfusion reactions (HTRs), and transfusion-associated sepsis (TAS) emerged as the leading causes of ABT-related deaths. Since 2004, preventive measures for TRALI and TAS have been implemented, but their implementation remains incomplete. Infectious causes of ABT-related deaths currently account for less than 15% of all transfusion-related mortality, but the possibility remains that a new transfusion-transmitted agent causing a fatal infectious disease may emerge in the future. Aside from these established complications of ABT, randomized controlled trials comparing recipients of non-white blood cell (WBC)-reduced versus WBC-reduced blood components in cardiac surgery have documented increased mortality in association with the use of non-WBC-reduced ABT. ABT-related mortality can thus be further reduced by universally applying the policies of avoiding prospective donors alloimmunized to WBC antigens from donating plasma products, adopting strategies to prevent HTRs, WBC-reducing components transfused to patients undergoing cardiac surgery, reducing exposure to allogeneic donors through conservative transfusion guidelines and avoidance of product pooling, and implementing pathogen-reduction technologies to address the residual risk of TAS as well as the potential risk of the next transfusion-transmitted agent to emerge in the foreseeable future.
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            Risk associated with preoperative anemia in cardiac surgery: a multicenter cohort study.

            Preoperative anemia is an important risk factor for perioperative red blood cell transfusions, which are associated with postoperative morbidity and mortality. Whether preoperative anemia also is an independent risk factor for adverse outcomes after cardiac surgery, however, has not been fully elucidated. In this multicenter cohort study, data were collected on 3500 consecutive patients who underwent cardiac surgery during 2004 at 7 academic hospitals. The prevalence of preoperative anemia, defined as hemoglobin <12.5 g/dL, and its unadjusted and adjusted relationships with the composite outcome of in-hospital death, stroke, or acute kidney injury were obtained. The overall prevalence of preoperative anemia was 26%, with values ranging from 22% to 30% at the participating hospitals. After the exclusion of patients who had severe preoperative anemia (hemoglobin <9.5 g/dL) or preoperative kidney failure and those who underwent emergency surgery, the composite outcome was observed in 7.5% of patients (247 of 3286). The unadjusted odds ratio for the composite outcome in anemic versus nonanemic patients was 3.6 (95% confidence interval, 2.7 to 4.7). The risk-adjusted odds ratios, obtained by multivariable logistic regression and propensity-score matching to control for important confounders (including comorbidities, institution, surgical factors, and blood transfusion), were 2.0 (95% confidence interval, 1.4 to 2.8) and 1.8 (95% confidence interval, 1.2 to 2.7), respectively. Preoperative anemia is independently associated with adverse outcomes after cardiac surgery. Future studies should determine whether therapies aimed at treating preoperative anemia would improve the outcomes of patients undergoing cardiac surgery.
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              Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case-control study.

              To determine the incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of critically ill patients. In a retrospective cohort study, patients with transfusion-related acute lung injury were identified using the consensus criteria of acute lung injury within 6 hrs after transfusion. Inclusion criterion was a length of intensive care unit admission >48 hrs. Patients developing transfusion-related acute lung injury were matched (on age, sex, and admission diagnosis) to transfused control subjects and patients developing acute lung injury from another origin. Tertiary referral hospital. All first-admitted patients from November 1, 2004, until October 1, 2007, to the intensive care unit. None. Of 5208 admitted patients, 2024 patients had a length of stay >48 hrs, of whom 109 were suspected transfusion-related acute lung injury cases. Compared with transfused control subjects, risk factors for transfusion-related acute lung injury were emergency cardiac surgery (odds ratio, 17.6 [1.8-168.5]), hematologic malignancy (odds ratio, 13.1 [2.7-63.8]), massive transfusion (odds ratio, 4.5 [2.1-9.8]), sepsis (odds ratio, 2.5 [1.2-5.2]), mechanical ventilation (odds ratio, 3.0 [1.3-7.1], and high Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.1 [1.0-1.1]; p < .03 for all). The volume of platelets and plasma transfused was associated with transfusion-related acute lung injury in the univariate analysis. However, this association disappeared in the multivariate analysis. Compared with acute lung injury control subjects, risk factors for transfusion-related acute lung injury were sepsis (odds ratio, 2.4 [1.1-5.3]) and high Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.1 [1.0-1.1]), whereas pneumonia (odds ratio, 0.4 [0.2-0.7]) was a negative predictive factor. Patients with transfusion-related acute lung injury had a longer duration of mechanical ventilation compared with transfused control subjects and acute lung injury control subjects (231 [138-472] vs. 71 [46-163] and 70 [42-121] hrs, p < .001). Also, 90-day survival of patients with transfusion-related acute lung injury was lower compared with transfused control subjects and acute lung injury control subjects (53% vs. 75% and 83%, p < .02). Transfusion-related acute lung injury is common in critically ill patients. Transfusion-related acute lung injury may contribute to an adverse outcome associated with transfusion. This study identifies transfusion-related acute lung injury risk factors, which may aid in assessing the risks and benefits of transfusion in critically ill patients.

                Author and article information

                Role: ND
                Role: ND
                Role: ND
                Revista Médica La Paz
                Rev. Méd. La Paz
                Colegio Médico de La Paz (La Paz, , Bolivia )
                : 17
                : 2
                : 21-28
                [01] La Paz orgnameCaja Nacional de Salud orgdiv1Hospital Materno-Infantil Bolivia romarudo@ 123456yahoo.es
                [02] La Paz orgnameCaja Nacional de Salud Bolivia

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                : 03 August 2011
                : 28 September 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 32, Pages: 8

                SciELO Bolivia

                Terapia transfusional,riesgos transfusionales,alternativas terapéuticas,transfusion therapy,transfusional risks,therapeutic alternatives


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