Forum for debate: Safety of allogeneic blood transfusion alternatives in the surgical/critically ill patient

In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use. The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues.

Efectividad de distintas pautas de tratamiento de la anemia perioperatoria en pacientes ancianos con fractura de cadera

OBJECTIVE

To describe and study the effectiveness of the perioperative anaemia treatment patterns for patients older than 64 with hip fracture.

METHOD

Three groups of patients were compared: Group 1: Oral iron or without iron therapy. Group 2: low doses of intravenous iron. Group 3: treated according to a blood saving programme including intravenous iron, alpha epoetin and restrictive transfusional criteria. The homogeneity of gender, age, type of fracture, ASA, preoperative period and perisurgical bleeding affecting drug consumption within the groups was analyzed. The effectiveness of the treatments was determined by means of transfusional rate, postoperative haemoglobin levels, and postoperative length of stay and infection rate.

RESULTS

329 patients were checked. Patients were comparable. Patients included in Group 3 were transfused less than the rest (36.5 of patients in group 3 vs. 52.0% in group 1 and 67.6% in group 3, p = 0.002). Decreases in the infection rate and mean postoperative stay in group 3 were not significant. Haemoglobin levels at 48 hours post surgery were higher in group 1 but haemoglobin levels at the seventh day post surgery were similar for the three groups.

CONCLUSIONS

The above mentioned blood saving programme has been observed to be effective in decreasing transfusional requirements without increasing morbidity. However, further prospective studies are needed in order to define the cost-effectiveness of this programme and to determine its role in the reduction of posttransfusional infections and postoperative length of stay.

[Simple bone cysts in childhood. Retrospective study of 15 cases and review of literature]

We present a review of 15 cases of simple bone cyst treated by curettage and bone grafting or intralesional steroids injection. We analysed the localisation, cyst activity, the number of cavities and the occupied area, valuing the results according to the Neer and Chigira classification. We have noticed a higher rate' of cure with curettage and bone grafting than with steroids injection (p: 0.01). The activity of the cyst, the uni-multilocutarity and the area related to a greater index of recurrence and failure in the cases treated by steroids injection, although this is statistically non significant.

[Giant cell reparative granuloma: report of a case and review of the literature]

We report a case of giant cell reparative granuloma involving proximal phalanx of the index finger. Differential diagnosis with other lytic lesions of the phalanges is analysed and surgical treatment performed is explained. After 24 months follow-up there is no recurrence and finger function is normal.