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Quintana-Diaz M, Nanwani-Nanwani K, Marcos-Neira P, Serrano-Lázaro A, Juarez-Vela R, Andrés-Esteban EM. Epidemiology of blood transfusion in the Spanish Critical Care Units: «Transfusion Day». Med Intensiva 2022; 46:123-131. [PMID: 34996742 DOI: 10.1016/j.medine.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/29/2020] [Accepted: 08/27/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the transfusion practice in the ICUs in Spain, according to national and international recommendations (guidelines). DESIGN Prospective, cross-sectional, multi-centre study. SCOPE Data collection was carried out by means of a questionnaire sent electronically to the Heads of Service of 111 ICUs in Spain. PARTICIPANTS 1,448 patients were included, aged 61.8 (SD 15.7) years, 66.2% male, with an SOFA of 4.7 ± 3.8 and average stay of 10.62 ± 17.49 days. VARIABLES Demographic and clinical variables of the patients were collected, as well as variables related to the transfusion act. RESULTS Of the 1,448 patients, 9.9% received al least one transfusion of any blood product, 3.7% fresh plasma, 3.9% platelets and 8.9% red blood cell concentrate, mainly by analytical criteria (36.2%). Hemoglobin had a mean of 7.8 g/dL (95% CI: 6-9-8.5) and 9.8 g/dL (95% CI: 8.5-11.2) before and after the transfusion, respectively, p < 0.001. The transfusion units had a mean of 2.5 ± 2.4 per patient. The most commonly used blood product was red blood cell concentrate (CH) (90.2%). Patients admitted for surgery had a higher transfusion rate (14.4%) than those admitted for medical pathology (8.9%) (p = 0.006). 5.4% (7/129) of patients who received CH died compared to 2.4% (31/1302) who did not (p = 0.04). Mortality of transfused patients was higher. The transfusion rate in most of hospitals was 5% to 20%, with 18 hospitals (16.21%) having transfusion rates between 20% and 50%. Hospitals with PBM programs and mass transfusion programs had a lower transfusion rate, although not statistically significant. CONCLUSIONS In this multicenter cross-sectional study, a transfusion prevalence of 9.9% was observed in Spanish Critical Care Units. The most frequent blood product transfused was red blood cells and the main reasons for transfusion were acute anemia with hemodynamic impact and analytical criteria. Mortality of transfused patients was higher.
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Affiliation(s)
- M Quintana-Diaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Spain
| | - K Nanwani-Nanwani
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Spain
| | - P Marcos-Neira
- Servicio de Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - A Serrano-Lázaro
- Servicio de Medicina Intensiva, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - R Juarez-Vela
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Spain; Universidad de la Rioja, Logroño, La Rioja, Spain.
| | - E M Andrés-Esteban
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Spain; Universidad Rey Juan Carlos, Madrid, Spain
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Payán-Pernía S, Ruiz Llobet A, Remacha Sevilla ÁF, Egido J, Ballarín Castán JA, Moreno JA. Sickle cell nephropathy. Clinical manifestations and new mechanisms involved in kidney injury. Nefrologia 2021; 41:373-382. [PMID: 36165106 DOI: 10.1016/j.nefroe.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/03/2020] [Indexed: 06/16/2023] Open
Abstract
Kidney problems are among the most common complications in sickle cell disease (SCD). They occur early in childhood and are one of the main factors related to mortality in these patients. The main underlying pathogenic mechanisms are vaso-occlusion and haemolysis. The renal medulla has ideal conditions for the sickling of red cells due to its low partial pressure of oxygen, high osmolarity and acidic pH. Initially, sickle-cell formation in the vasa recta of the renal medulla causes hyposthenuria. This is universal and appears in early childhood. Microscopic and macroscopic haematuria also occur, in part related to renal papillary necrosis when the infarcts are extensive. Release of prostaglandins in the renal medulla due to ischaemia leads to an increase in the glomerular filtration rate (GFR). Adaptively, sodium reabsorption in the proximal tubule increases, accompanied by increased creatinine secretion. Therefore, the GFR estimated from creatinine may be overestimated. Focal segmental glomerulosclerosis is the most common glomerular disease. Albuminuria is very common and reduction has been found in 72.8% of subjects treated with ACE inhibitors or ARB. Recent evidence suggests that free haemoglobin has harmful effects on podocytes, and may be a mechanism involved in impaired kidney function in these patients. These effects need to be better studied in SCD, as they could provide a therapeutic alternative in sickle cell nephropathy.
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Affiliation(s)
- Salvador Payán-Pernía
- Unidad de Eritropatología, Unidad de Gestión Clínica de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC), Sevilla, Spain.
| | - Anna Ruiz Llobet
- Servicios y Unidades de Referencia (CSUR) de Eritropatología Hereditaria, Hospital Sant Joan de Déu - Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Servicio de Hematología Pediátrica, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca, Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ángel Francisco Remacha Sevilla
- Servicios y Unidades de Referencia (CSUR) de Eritropatología Hereditaria, Hospital Sant Joan de Déu - Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Servicio de Hematología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Egido
- Laboratorio de Enfermedades Renales, Vasculares y Diabetes, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Juan Antonio Moreno
- Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Instituto Maimónides de Investigaciones Biomédicas de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain.
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Otamendi Goicoechea I, Zalba Marcos S, Ascensión Zabalegui Goicoechea M, Galbete A, Osinaga Alcaraz M, García Erce JA. Anaemia prevalence in pregnant population. Med Clin (Barc) 2021; 158:270-273. [PMID: 33846002 DOI: 10.1016/j.medcli.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Gestational anaemia, which has specific haemoglobin (Hb) reference values in each trimester of gestation, increases the risk of maternal mortality and complications both in pregnancy and in the first months of the newborn's life. The objective of this study is to evaluate haemoglobin levels in pregnant women in our population, to determine the prevalence of gestational anaemia and to propose reference values specific to them. MATERIAL AND METHODS Retrospective study of all blood counts requested in pregnancy and postpartum controls during 2019. RESULTS 9995 gestation haemograms corresponding to 5507 pregnant women were reviewed. Of these, 1134 patients underwent complete follow-up in 2019. The prevalence data for anaemia were 1.8%, 11.8% and 13.2% in each trimester respectively, and the global prevalence in pregnancy was 22.6%. Regarding postpartum anaemia, its prevalence with respect to all pregnant women was 2.99%, increasing to 38.2% in those patients with complications during delivery. CONCLUSIONS The prevalence of gestational anaemia in our population is somewhat higher than in countries like ours. Therefore, there is room for improvement in our current clinical protocols. It is important to assess updating analytical controls with other more adequate parameters to determine iron reserves, as this is the main cause of anaemia.
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Affiliation(s)
- Isabel Otamendi Goicoechea
- Servicio de Análisis Clínicos, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Navarra, España
| | - Saioa Zalba Marcos
- Servicio de Hematología y Hemoterapia, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Navarra, España
| | - M Ascensión Zabalegui Goicoechea
- Servicio de Análisis Clínicos, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Navarra, España
| | - Arkaitz Galbete
- Navarrabiomed-Complejo Hospitalario de Navarra-Universidad Pública de Navarra (UPNA), REDISSEC; IdiSNA, Pamplona, Navarra, España
| | - Maite Osinaga Alcaraz
- Servicio de Ginecología y Obstetricia, Hospital García Orcoyen, Estella, Servicio Navarro de Salud, Osasunbidea, Pamplona, Navarra, España
| | - José Antonio García Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Navarra, Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, España; PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, España.
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Pascual-Guàrdia S, Ferrer A, Díaz Ó, Caguana AO, Tejedor E, Bellido-Calduch S, Rodríguez-Chiaradia DA, Gea J. Absence of Relevant Clinical Effects of SARS-COV-2 on the Affinity of Hemoglobin for O 2 in Patients with COVID-19. Arch Bronconeumol 2021; 57:S0300-2896(21)00113-7. [PMID: 33875283 PMCID: PMC7997137 DOI: 10.1016/j.arbres.2021.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/20/2022]
Abstract
Pulmonary involvement in COVID-19 is frequently associated with alterations in oxygenation. The arterial partial pressure of oxygen (PaO2) is the most clinically used variable to assess such oxygenation, since it decisively influences the oxygen transported by hemoglobin (expressed by its percentage of saturation, SaO2). However, two recent studies conducted respectively in silico and using omic techniques in red blood cells of COVID-19 patients have suggested that SARS-CoV-2 could decrease the affinity of oxygen for the hemoglobin (which would imply that PaO2 would overestimate SaO2), and also reduce the amount of this carrier molecule. OBJECTIVE To evaluate this hypothesis in blood samples from COVID-19 patients. METHODS Blood gases of all COVID-19 patients performed in our laboratory in two months were included, as well as those from two control groups: synchronous patients with negative PCR for SARS-CoV-2 (SCG) and a historical group (HCG). Both SaO2 and venous saturations (SvO2) measured by cooximetry (COX) were compared separately with those calculated using the Kelman (K), Severinghaus (SV) and Siggaard-Andersen (SA) equations in each group. RESULTS Measured and calculated SaO2 and SvO2 were practically equivalent in all groups. Intraclass correlation coefficients (ICC) for SaO2 in COVID-19 were 0.993 for COX-K and 0.992 for both COX-SV and COX-SA; being 0.995 for SvO2 for either COX-K, COX-SV or COX-SA. Hemoglobin and ferritin were slightly higher in COVID-19 compared to SCG and HCG (hemoglobin, p < 0.001 for both; ferritin, p < 0.05 for SCG and p < 0.001 for HCG). CONCLUSION Under clinical conditions SARS-CoV-2 does not have an appreciable influence on the affinity of oxygen for the hemoglobin, nor on the levels of this carrier molecule. Therefore, PaO2 is a good marker of blood oxygenation also in COVID-19.
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Affiliation(s)
- Sergi Pascual-Guàrdia
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Antoni Ferrer
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Óscar Díaz
- Laboratorio de Referencia de Cataluña, El Prat de Llobregat, España
| | - Antonio O Caguana
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Elvira Tejedor
- Laboratorio de Referencia de Cataluña, El Prat de Llobregat, España
| | - Salomé Bellido-Calduch
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Diego A Rodríguez-Chiaradia
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España
| | - Joaquim Gea
- Servicio de Neumología, Hospital del Mar-IMIM. DCEXS, Universitat Pompeu Fabra. CIBERES, ISCIII. BRN, Barcelona. España.
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Esquinas-Requena JL, García-Nogueras I, Hernández-Zegarra P, Atienzar-Núñez P, Sánchez-Jurado PM, Abizanda P. [Anemia and frailty in older adults from Spain. The FRADEA Study]. Rev Esp Geriatr Gerontol 2021; 56:129-135. [PMID: 33771359 DOI: 10.1016/j.regg.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/26/2020] [Accepted: 01/25/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The objective was to examine the prevalence of anemia according to the state of frailty and to analyze the relationship between anemia, hemoglobin concentration and frailty in a cohort of Spanish older adults. MATERIAL AND METHODS Cross-sectional substudy of the FRADEA (Frailty and Dependency in Albacete) cohort, a population-based concurrent cohort study conducted in people older than 69 years of Albacete (Spain). Of the 993 participants included in the first wave, 790 were selected with valid data on anemia and frailty. Anemia was defined according to the criteria of the World Health Organization (hemoglobin less than 13 g/dL in men and 12 g/dL in women). Frailty was assessed using the Fried's phenotype. The association between anemia, hemoglobin concentration and frailty was determined by binary logistic regression adjusted for age, sex, educational level, institutionalization, comorbidity, cognitive status, body mass index, polypharmacy, creatinine, glucose and total white blood cell count. RESULTS The mean age was 79 years. The prevalence of anemia was 19.6%. The prevalence of anemia was significantly higher in frail subjects (29.6%) compared to prefrail (16.6%) and robust ones (6%), p<0.001. The average hemoglobin concentrations were significantly lower in frail (12.7 g/dL), compared to the prefrail (13.5 g/dL) and robust participants (14.4 g/dL), p < 0.001. In the fully adjusted regression model, anemia was associated with frailty (OR 1.95; 95% CI: 1.02-3.73, p<0.05), and similarly, the average hemoglobin concentrations showed a significant association with frailty (OR 0.79; 95% CI: 0.66-0.96, p < 0.05). CONCLUSION Anemia in older adults, defined according to WHO criteria, is independently associated with frailty.
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Affiliation(s)
| | | | - Pablo Hernández-Zegarra
- Servicio de Medicina Interna, Hospital General La Mancha Centro, Alcázar de San Juan, España
| | - Pilar Atienzar-Núñez
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Pedro Manuel Sánchez-Jurado
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España; CIBERFES, Instituto de Salud Carlos III, Madrid, España
| | - Pedro Abizanda
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España; CIBERFES, Instituto de Salud Carlos III, Madrid, España
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Payán-Pernía S, Ruiz Llobet A, Remacha Sevilla ÁF, Egido J, Ballarín Castán JA, Moreno JA. Sickle cell nephropathy. Clinical manifestations and new mechanisms involved in kidney injury. Nefrologia 2021; 41:373-82. [PMID: 33714630 DOI: 10.1016/j.nefro.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Kidney problems are among the most common complications in sickle cell disease (SCD). They occur early in childhood and are one of the main factors related to mortality in these patients. The main underlying pathogenic mechanisms are vaso-occlusion and haemolysis. The renal medulla has ideal conditions for the sickling of red cells due to its low partial pressure of oxygen, high osmolarity and acidic pH. Initially, sickle-cell formation in the vasa recta of the renal medulla causes hyposthenuria. This is universal and appears in early childhood. Microscopic and macroscopic haematuria also occur, in part related to renal papillary necrosis when the infarcts are extensive. Release of prostaglandins in the renal medulla due to ischaemia leads to an increase in the glomerular filtration rate (GFR). Adaptively, sodium reabsorption in the proximal tubule increases, accompanied by increased creatinine secretion. Therefore, the GFR estimated from creatinine may be overestimated. Focal segmental glomerulosclerosis is the most common glomerular disease. Albuminuria is very common and reduction has been found in 72.8% of subjects treated with ACE inhibitors or ARB. Recent evidence suggests that free haemoglobin has harmful effects on podocytes, and may be a mechanism involved in impaired kidney function in these patients. These effects need to be better studied in SCD, as they could provide a therapeutic alternative in sickle cell nephropathy.
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Cases A, Puchades MJ, de Sequera P, Quiroga B, Martin-Rodriguez L, Gorriz JL, Portolés J. Iron replacement therapy in the management of anaemia in non-dialysis Chronic kidney disease patients: Perspective of the Spanish Nephrology Society Anaemia Group. Nefrologia 2021; 41:123-136. [PMID: 36166211 DOI: 10.1016/j.nefroe.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/14/2020] [Indexed: 06/16/2023] Open
Abstract
This work presents an update on the management of iron deficiency in patients with chronic kidney disease (CKD), either with or without anaemia. A review is made of the recommendations of the guidelines for the treatment of iron deficiency in CKD. It also presents new studies on iron deficiency in patients with CKD, as well as new findings about iron therapy and its impact on clinical outcomes. Anaemia is a common complication of CRF, and is associated with a decrease in the quality of life of the patients, as well as an increase in morbidity and mortality. Iron deficiency (absolute or functional) is common in non-dialysis chronic kidney disease patients, and may cause anaemia or a low response to erythropoiesis-stimulating agents. For this reason, the clinical guidelines for the treatment of the anaemia in Nephrology indicate the correction of the deficiency in the presence of anaemia. Iron replacement therapy is indicated in patients with CKD and anaemia (Hb < 12 g/dl) in accordance with the guidelines. There is no unanimity in the indication of iron replacement therapy in patients with Hb > 12 g/dl, regardless of whether they have an absolute or functional iron deficiency. Intravenous iron replacement therapy is safe, more efficient and rapid than oral therapy for achieving an increase haemoglobin lels and reducing the dose of erythropoiesis-stimulating agents. For the administration of intravenous iron in non-dialysis chronic renal failure patients a strategy of high doses and low frequency would be preferred on being more convenient for the patient, preserves better the venous capital, and is safe and cost-effective. Iron plays an essential role in energy metabolism and other body functions beyond the synthesis of haemoglobin, for which the iron deficiency, even in the absence of anaemia, could have harmful effects in patients with CKD. The correction of the iron deficiency, in the absence of anaemia is associated with functional improvement in patients with heart failure, and in muscle function or fatigue in patients without CKD. Despite the evidence of benefits in the correction of iron deficiency in patients with CKD, more studies are required to evaluate the impact of the correction of the iron deficiency in the absence of anaemia on morbidity and mortality, quality of life and physical capacity, as well as the long-term effect of oral and intravenous iron replacement therapy in this population.
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Affiliation(s)
| | - Maria Jesús Puchades
- Servicio de Nefrología, Hospital Clínico, INCLIVA, Universidad de Valencia, Valencia, Spain
| | - Patricia de Sequera
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Borja Quiroga
- Servicio de Nefrología, Hospital Universitario de la Princesa, Madrid, Servicio de Nefrología, Hospital Clínico, Valencia, INCLIVA, Universidad de Valencia, Spain
| | - Leyre Martin-Rodriguez
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro Majadahonda, REDInREN ISCiii 016/009/009 RETYC, Majadahonda, Madrid, Spain
| | - José Luis Gorriz
- Servicio de Nefrología, Hospital Clínico, INCLIVA, Universidad de Valencia, Valencia, Spain.
| | - José Portolés
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro Majadahonda, REDInREN ISCiii 016/009/009 RETYC, Majadahonda, Madrid, Spain
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Cases A, Puchades MJ, de Sequera P, Quiroga B, Martin-Rodriguez L, Gorriz JL, Portolés J; en representación del Grupo de Anemia de la S.E.N. Iron replacement therapy in the management of anaemia in non-dialysis chronic renal failure patients: Perspective of the Spanish Nephrology Society Anaemia Group. Nefrologia 2021; 41:123-36. [PMID: 33516607 DOI: 10.1016/j.nefro.2020.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022] Open
Abstract
This work presents an update on the management of iron deficiency in patients with chronic renal failure (CRF), either with or without anaemia. A review is made of the recommendations of the guidelines for the treatment of iron deficiency in CRF. It also presents new studies on iron deficiency in patients with CRF, as well as new findings about iron deficiency and its impact on clinical outcomes. Anaemia is a common complication of CRF, and is associated with a decrease in the quality of life of the patients, as well as an increase in morbidity and mortality. Iron deficiency (absolute or functional) is common in non-dialysis chronic renal failure patients, and may cause anaemia or a low response to erythropoiesis-stimulating agents. For this reason, the clinical guidelines for the treatment of the anaemia in Nephrology advise the correction of the deficiency in the presence of anaemia. Iron replacement therapy is indicated in patients with CRF and anaemia (Hb < 12 g/dL) in accordance with the guidelines. There is no unanimity in the indication of iron replacement therapy in patients with Hb>12 g/dL, regardless of whether they have an absolute or functional iron deficiency. Intravenous iron replacement therapy is safe, more efficient and rapid than oral therapy for achieving an increase haemoglobin levels and reducing the dose of erythropoiesis-stimulating agents. For the administration of intravenous iron in non-dialysis chronic renal failure patients a strategy of high doses and low frequency would be preferred on being more convenient for the patient, better conserving of the venous tree, and on being safe and cost-effective. Iron plays an essential role in energy metabolism and other body functions beyond the synthesis of haemoglobin synthesis, for which the iron deficiency, even in the absence of anaemia, could have a harmful effect in patients with CRF. The correction of the iron deficiency, in the absence of anaemia is associated with functional improvement in patients with heart failure, and in muscle function or fatigue in patients without CRF. Despite the evidence of benefits in the correction of iron deficiency in patients with CRF, more studies are required to evaluate the impact of the correction of the iron deficiency in the absence of anaemia on morbidity and mortality, quality of life and physical capacity, as well as the long-term effect of oral and intravenous iron replacement therapy in this population.
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9
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Quintana-Diaz M, Nanwani-Nanwani K, Marcos-Neira P, Serrano-Lázaro A, Juarez-Vela R, Andrés-Esteban EM. Epidemiology of blood transfusion in the Spanish Critical Care Units: «Transfusion Day». Med Intensiva 2020; 46:S0210-5691(20)30317-X. [PMID: 33087293 DOI: 10.1016/j.medin.2020.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/29/2020] [Accepted: 08/27/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe the transfusion practice in the ICUs in Spain, according to national and international recommendations (guidelines). DESIGN Prospective, cross-sectional, multi-centre study. SCOPE Data collection was carried out by means of a questionnaire sent electronically to the Heads of Service of 111 ICUs in Spain. PARTICIPANTS 1,448 patients were included, aged 61.8 (SD 15.7) years, 66.2% male, with an SOFA of 4.7±3.8 and average stay of 10.62±17.49 days. VARIABLES Demographic and clinical variables of the patients were collected, as well as variables related to the transfusion act. RESULTS Of the 1,448 patients, 9.9% received al least one transfusion of any blood product, 3.7% fresh plasma, 3.9% platelets and 8.9% red blood cell concentrate, mainly by analytical criteria (36.2%). Hemoglobin had a mean of 7.8g/dL (95% CI: 6-9-8.5) and 9.8g/dL (95% CI: 8.5-11.2) before and after the transfusion, respectively, p<0.001. The transfusion units had a mean of 2.5±2.4 per patient. The most commonly used blood product was red blood cell concentrate (90.2%). Patients admitted for surgery had a higher transfusion rate (14.4%) than those admitted for medical pathology (8.9%) (p=0.006). 5.4% (7/129) of patients who received red blood cell concentrate died compared to 2.4% (31/1302) who did not (p=0.04). Mortality of transfused patients was higher. The transfusion rate in most of hospitals was 5% to 20%, with 18 hospitals (16.21%) having transfusion rates between 20% and 50%. Hospitals with PBM programs and mass transfusion programs had a lower transfusion rate, although not statistically significant. CONCLUSIONS In this multicenter cross-sectional study, a transfusion prevalence of 9.9% was observed in Spanish critical care units. The most frequent blood product transfused was red blood cells and the main reasons for transfusion were acute anemia with hemodynamic impact and analytical criteria. Mortality of transfused patients was higher.
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Affiliation(s)
- M Quintana-Diaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España; Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, España
| | - K Nanwani-Nanwani
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España; Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, España
| | - P Marcos-Neira
- Servicio de Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España
| | - A Serrano-Lázaro
- Servicio de Medicina Intensiva, Hospital Clínico Universitario de Valencia, Valencia, España
| | - R Juarez-Vela
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, España; Universidad de la Rioja, Logroño, La Rioja, España.
| | - E M Andrés-Esteban
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, España; Universidad Rey Juan Carlos, Madrid, España
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10
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Esquinas-Requena JL, Lozoya-Moreno S, García-Nogueras I, Atienzar-Núñez P, Sánchez-Jurado PM, Abizanda P. [Anemia increases mortality risk associated with frailty or disability in older adults. The FRADEA Study]. Aten Primaria 2020; 52:452-461. [PMID: 31506204 PMCID: PMC8054287 DOI: 10.1016/j.aprim.2019.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/17/2019] [Accepted: 07/09/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyze if anemia increases 10-year mortality risk associated to frailty and disability in older adults. DESIGN Substudy of the FRADEA population-based concurrent cohort study (Frailty and dependence in Albacete), with a 10-year follow-up (2007-2017) in people older than 69years. SETTING Albacete city, Spain. PARTICIPANTS Of the 993 participants included in the first wave, 790 were selected with valid data on function (frailty and disability), anemia and vital status at 10years. MAIN MEASUREMENTS Anemia was defined according to the criteria of the World Health Organization (hemoglobin <13g/dL in men and <12g/dL in women). A functional classification variable was created, including frailty and disability, identifying four progressive functional levels: robust, prefrail, frail and disabled in basic activities of daily life, using frailty phenotype and Barthel index respectively. A new eight categories variable was constructed combining the four functional groups with the presence or absence of anemia. The association with mortality was determined by Kaplan-Meier and Cox proportional hazards analysis adjusted for age, sex, comorbidity, polypharmacy, institutionalization and creatinine. RESULTS Mean age was 79years and 59.6% were women. 393 participants (49.7%) died during the follow-up period. The median survival was 98.4months (interquartile range 61). The risk of mortality increased from the levels with better functionality to those with worse functionality, and for each subgroup it was higher in the participants with anemia. Prefrail without anemia HR [hazard ratio] 1.59 (95%CI 1.07-2.36) and with anemia HR 2.37 (95%CI 1.38-4.05). Frail without anemia HR 3.18 (95%CI 1.68-6.02) and with anemia HR 4.42 (95%CI 1.99-9.84). Disabled without anemia HR 3.81 (95%CI 2.45-5.84) and with anemia HR 5.48 (95%CI 3.43-8.76). CONCLUSION Anemia increases the risk of mortality associated with frailty and disability in older adults.
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Affiliation(s)
| | - Silvia Lozoya-Moreno
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | | | - Pilar Atienzar-Núñez
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Pedro Manuel Sánchez-Jurado
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España; CIBERFES, Instituto de Salud Carlos III, Madrid, España
| | - Pedro Abizanda
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España; CIBERFES, Instituto de Salud Carlos III, Madrid, España.
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11
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Castilla Martín Y, Aliacar García C, González Moya C, Pol Tres C, Meca González B, Pérez Ayuso JJ. Transfusion needs in patients admitted for fracture of femur. Enferm Clin (Engl Ed) 2020; 31:31-35. [PMID: 32303466 DOI: 10.1016/j.enfcli.2020.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/31/2020] [Accepted: 02/12/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the variables and predictive factors associated with the administration and frequency of the allogenic blood transfusion (ABT) on patients diagnosed with fracture of femur requiring surgical intervention. The secondary objective was to describe the frequency and quantity of ABT on those patients. METHOD A retrospective transversal observational study was performed on patients admitted to the Sagrat Cor hospital of Barcelona with a diagnosis of fractured femur that required surgical intervention in 2016. Several demographic variables were gathered along with the clinical data and outcome of transfused and non-transfused patients, including the type of fracture. RESULTS The overall sample was 257 patients. Of the patients studied, 52.9% required blood transfusion support. Patients who required ABT had haemoglobin values on admission of 11.01 gdl while those that did not require transfusion had an average value of 12.97 g/dl. Of the patients, 42.8% were on anticoagulant and/or antiplatelet therapy before the fracture occurred. CONCLUSIONS More than half the patients admitted for fracture of femur received blood transfusion. The data collected showed that the hospital transfusion policy offered satisfactory results. Factors associated with the need for ABT were haemoglobin levels on admission and the type of fracture. Age and ASA risk (classification system of the American Society of Anesthesiologists) were also risk factors for ABT. This information could be useful for blood saving protocols. Finally, we think that it is important that all patients that are hospitalised with a diagnosis of fracture of femur and require surgery have a blood reserve request made, given that a high percentage of them, at any time during their stay, will be transfused.
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Affiliation(s)
| | | | | | - Cristina Pol Tres
- Servicio de Transfusiones, Hospital del Sagrat Cor, Barcelona, España
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12
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Quintana-Díaz M, Andrés-Esteban EM, Sánchez-Serrano J, Martínez-Virto A, Juárez-Vela R, García-Erce JA. Transfusions in the Emergency department: More than a blood transfusion. Rev Clin Esp 2019; 220:393-399. [PMID: 31744619 DOI: 10.1016/j.rce.2019.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 11/17/2022]
Abstract
Increasing haemoglobin and haematocrit levels with blood transfusions has been the gold standard for treating severe anaemia; however, the indication for transfusing concentrated red blood cells is based merely on a few laboratory markers, such as haemoglobin and haematocrit levels, rather than based on the symptoms according to clinical practice guidelines, the implementation of legal regulations and the consensus achieved by the hospitals' transfusion committees. The aim of this multicentre study was to reassess the suitability of the indication for transfusing concentrated red blood cells and the volumes transfused in emergency departments. We established an observational, multicentre, cross-sectional design with 2 participating centres: the La Paz University Hospital and the Hospital of Salamanca. In total, we obtained data from 381 patients, 220 (57.74%) of whom were men with an average age of 71.4±14.0 years and 161 (42.26%) of whom were women with an average age of 75.3±15.3 years (P<.001). The most prevalent underlying diseases in the patients who underwent transfusions were heart disease, which included haemorrhaging due to antiplatelet or anticoagulant therapy (57.7%), haemato-oncologic (15.3%) diseases and neurological disease. Only 54.9% (209/381) of the prescriptions for transfusion were considered appropriate, with significant differences according to the indication.
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Affiliation(s)
- M Quintana-Díaz
- Servicio de Urgencias, Hospital Universitario La Paz, Grupo PBM, Instituto de Investigación-IdiPAZ, Madrid, España
| | - E M Andrés-Esteban
- Universidad Rey Juan Carlos, Grupo PBM, Instituto de Investigación-IdiPAZ, Madrid, España
| | - J Sánchez-Serrano
- Servicio de Urgencias, Hospital Universitario de Salamanca, Instituto de Investigación-IdiPAZ, Salamanca, España
| | - A Martínez-Virto
- Servicio de Urgencias, Hospital Universitario La Paz, Grupo PBM, Instituto de Investigación-IdiPAZ, Madrid, España
| | - R Juárez-Vela
- Universidad de La Rioja, Logroño, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España.
| | - J A García-Erce
- Banco de Sangre y Tejidos de Navarra (Navarra), Grupo PBM, Instituto de Investigación -IdiPAZ, Madrid, España
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13
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Chen XT, Yang S, Yang YM, Zhao HL, Chen YC, Zhao XH, Wen JB, Tian YR, Yan WL, Shen C. Exploring the relationship of peripheral total bilirubin, red blood cell, and hemoglobin with blood pressure during childhood and adolescence. J Pediatr (Rio J) 2018; 94:532-538. [PMID: 29107800 DOI: 10.1016/j.jped.2017.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/16/2017] [Accepted: 07/05/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Total bilirubin is beneficial for protecting cardiovascular diseases in adults. The authors aimed to investigate the association of total bilirubin, red blood cell, and hemoglobin levels with the prevalence of high blood pressure in children and adolescents. METHODS A total of 3776 students (aged from 6 to 16 years old) were examined using cluster sampling. Pre-high blood pressure and high blood pressure were respectively defined as the point of 90th and 95th percentiles based on the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Both systolic and diastolic blood pressure were standardized into z-scores. RESULTS Peripheral total bilirubin, red blood cell and hemoglobin levels were significantly correlated with age, and also varied with gender. Peripheral total bilirubin was negatively correlated with systolic blood pressure in 6- and 9-year-old boys, whilst positively correlated with diastolic blood pressure in the 12-year-old boys and 13- to 15-year-old girls (p<0.05). Higher levels of red blood cell and hemoglobin were observed in pre-high blood pressure and high blood pressure students when compared with their normotensive peers (p<0.01). The increases in red blood cell and hemoglobin were significantly associated with high blood pressure after adjusting for confounding factors. The ORs (95% CI) of each of the increases were 2.44 (1.52-3.92) and 1.04 (1.03-1.06), respectively. No statistical association between total bilirubin and high blood pressure was observed (p>0.05). CONCLUSION Total bilirubin could be weakly correlated with both systolic and diastolic blood pressure, as correlations varied with age and gender in children and adolescents; in turn, the increased levels of red blood cell and hemoglobin are proposed to be positively associated with the prevalence of high blood pressure.
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Affiliation(s)
- Xiao-Tian Chen
- Nanjing Medical University, School of Public Health, Department of Epidemiology, Nanjing, China
| | - Song Yang
- People's Hospital of Yixing City, Affiliated Yixing People's Hospital of Jiangsu University, Department of Cardiology, Yixing, China
| | - Ya-Ming Yang
- Center for Disease Control and Prevention of Yixing City, Yixing, China
| | - Hai-Long Zhao
- People's Hospital of Yixing City, Affiliated Yixing People's Hospital of Jiangsu University, Department of Cardiology, Yixing, China
| | - Yan-Chun Chen
- People's Hospital of Yixing City, Affiliated Yixing People's Hospital of Jiangsu University, Department of Cardiology, Yixing, China
| | - Xiang-Hai Zhao
- People's Hospital of Yixing City, Affiliated Yixing People's Hospital of Jiangsu University, Department of Cardiology, Yixing, China
| | - Jin-Bo Wen
- Nanjing Medical University, School of Public Health, Department of Epidemiology, Nanjing, China
| | - Yuan-Rui Tian
- Nanjing Medical University, School of Public Health, Department of Epidemiology, Nanjing, China
| | - Wei-Li Yan
- Children's Hospital of Fudan University, Department of Clinical Epidemiology, Shanghai, China
| | - Chong Shen
- Nanjing Medical University, School of Public Health, Department of Epidemiology, Nanjing, China.
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14
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López A, Gómez L, Petinal G, Adán N, Alvarado S, Carballo N. Is a blood sample for hemoglobins in the transfusional range reliable? Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65:246-251. [PMID: 29500058 DOI: 10.1016/j.redar.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the correlation and agreement in our unit and population of hemoglobin in gasometry versus hematology analyzer, to evaluate errors in transfusion or lack thereof. RESULTS strong association between Point-of-care (POC) and hematimetry, with P<.001, with a coefficient of determination r2 of 0.56, an intraclass correlation coefficient of 0.63 and a Lin's concordance correlation coefficient of 0.65. For hemoglobins less than 7g/dL, a success rate of 29.41% was obtained. CONCLUSIONS Low-moderate agreement of POC hemoglobin with standard haemothymetry. High probability of errors in the indication of transfusion based on gasometer hemoglobins, especially in low hemoglobins.
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Affiliation(s)
- A López
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Galicia, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España.
| | - L Gómez
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Galicia, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - G Petinal
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Galicia, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - N Adán
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Galicia, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - S Alvarado
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Galicia, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - N Carballo
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Galicia, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
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15
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Maqueda-Palau M, Pérez-Juan E. Blood volume extracted from the critical patient in the first 24 hours after admission. Enferm Intensiva (Engl Ed) 2017; 29:14-20. [PMID: 29275137 DOI: 10.1016/j.enfi.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/10/2017] [Accepted: 09/25/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To calculate the number of analytical tests and blood volume drawn during the first 24hours of admission to the Intensive Care Unit (ICU). To analyse values of basal haemoglobin and at 24hours, relate them to blood loss, weight variation, and scoring system. METHOD An observational descriptive pilot study. Variables studied: age, sex, diagnosis on admission, analytical tests extracted, waste quantity before the extraction of samples, total volume blood extracted in 24hours, weight variation, APACHE, SAPS, basal haemoglobin and at 24hours. Statistical analysis with SPSS vs 20.0. Variables correlation sex, weight variation, the number of analytical tests and haemoglobin change. RESULTS The study included 100 patients. The average number of extractions per patient/day was 7.2 (±2.6). The average waste quantity was 32.61ml (±15.8). The blood volume used for determinations was 48.18ml / 24h (±16.74). The haemoglobin value decreased in the first 24hours of admission, being higher in men (P<.05). The scoring systems were statistically significant for levels of haemoglobin (Hb1 -0.3; P=.001; Hb2 -0.4; P=.001). CONCLUSIONS Of the total volume of blood extracted in ICU, 40% belongs to a volume of waste and 60% of blood is used for analytical tests. There is a decrease in haemoglobin exists 24hours after admission of the critical patient. Statistically, it has not been possible to demonstrate its relation with the number of analytical tests.
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Affiliation(s)
- M Maqueda-Palau
- Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma, Marllorca, España.
| | - E Pérez-Juan
- Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma, Marllorca, España
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16
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Abstract
Hemoglobin optimization and treatment of preoperative anemia in surgery with a moderate to high risk of surgical bleeding reduces the rate of transfusions and improves hemoglobin levels at discharge and can also improve postoperative outcomes. To this end, we need to schedule preoperative visits sufficiently in advance to treat the anemia. The treatment algorithm we propose comes with a simple checklist to determine whether we should refer the patient to a specialist or if we can treat the patient during the same visit. With the blood count test and additional tests for iron metabolism, inflammation parameter and glomerular filtration rate, we can decide whether to start the treatment with intravenous iron alone or erythropoietin with or without iron. With significant anemia, a visit after 15 days might be necessary to observe the response and supplement the treatment if required. The hemoglobin objective will depend on the type of surgery and the patient's characteristics.
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Affiliation(s)
- E Bisbe Vives
- Servicio de Anestesiología y Reanimación, Hospital del Mar, IMIM ((Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, España.
| | - M Basora Macaya
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
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17
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García-Soler P, Camacho Alonso JM, González-Gómez JM, Milano-Manso G. Noninvasive hemoglobin monitoring in critically ill pediatric patients at risk of bleeding. Med Intensiva 2016; 41:209-215. [PMID: 28034464 DOI: 10.1016/j.medin.2016.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/10/2016] [Accepted: 06/28/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the accuracy and usefulness of noninvasive continuous hemoglobin (Hb) monitoring in critically ill patients at risk of bleeding. DESIGN An observational prospective study was made, comparing core laboratory Hb measurement (LabHb) as the gold standard versus transcutaneous hemoglobin monitoring (SpHb). SETTING Pediatric Intensive Care Unit of a tertiary University Hospital. PATIENTS Patients weighing >3kg at risk of bleeding. INTERVENTIONS SpHb was measured using the Radical7 pulse co-oximeter (Masimo Corp., Irvine, CA, USA) each time a blood sample was drawn for core laboratory analysis (Siemens ADVIA 2120i). VARIABLES Sociodemographic characteristics, perfusion index (PI), pleth variability index, heart rate, SaO2, rectal temperature, low signal quality and other events that can interfere with measurement. RESULTS A total of 284 measurements were made (80 patients). Mean LabHb was 11.7±2.05g/dl. Mean SpHb was 12.32±2g/dl (Pearson 0.72, R2 0.52). The intra-class correlation coefficient was 0.69 (95%CI 0.55-0.78)(p<0.001). Bland-Altman analysis showed a mean difference of 0.07 ±1.46g/dl. A lower PI and higher temperature independently increased the risk of low signal quality (OR 0.531 [95%CI 0.32-0.88] and 0.529 [95%CI 0.33-0.85], respectively). CONCLUSIONS SpHb shows a good overall correlation to LabHb, though with wide limits of agreement. Its main advantage is continuous monitoring of patients at risk of bleeding. The reliability of the method is limited in cases with poor peripheral perfusion.
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Affiliation(s)
- P García-Soler
- Unidad de Cuidados Intensivos Pediátricos, Hospital Regional Universitario, Málaga, España.
| | - J M Camacho Alonso
- Unidad de Cuidados Intensivos Pediátricos, Hospital Regional Universitario, Málaga, España
| | - J M González-Gómez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Regional Universitario, Málaga, España
| | - G Milano-Manso
- Unidad de Cuidados Intensivos Pediátricos, Hospital Regional Universitario, Málaga, España
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18
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Díez-López C, Lupón J, de Antonio M, Zamora E, Domingo M, Santesmases J, Troya MI, Boldó M, Bayes-Genis A. Hemoglobin Kinetics and Long-term Prognosis in Heart Failure. ACTA ACUST UNITED AC 2016; 69:820-6. [PMID: 27318441 DOI: 10.1016/j.rec.2016.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/04/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES The influence of hemoglobin kinetics on outcomes in heart failure has been incompletely established. METHODS Hemoglobin was determined at the first visit and at 6 months. Anemia was defined according to World Health Organization criteria (hemoglobin < 13g/dL for men and hemoglobin < 12g/dL for women). Patients were classified relative to their hemoglobin values as nonanemic (both measurements normal), transiently anemic (anemic at the first visit but not at 6 months), newly anemic (nonanemic initially but anemic at 6 months), or permanently anemic (anemic in both measurements). RESULTS A total of 1173 consecutive patients (71.9% men, mean age 66.8±12.2 years) were included in the study. In all, 476 patients (40.6%) were considered nonanemic, 170 (14.5%) had transient anemia, 147 (12.5%) developed new-onset anemia, and 380 (32.4%) were persistently anemic. During a follow-up of 3.7±2.8 years after the 6-month visit, 494 patients died. On comprehensive multivariable analyses, anemia (P < .001) and the type of anemia (P < .001) remained as independent predictors of all-cause mortality. Compared with patients without anemia, patients with persistent anemia (hazard ratio [HR] = 1.62; 95% confidence interval [95%CI], 1.30-2.03; P < .001) and new-onset anemia (HR = 1.39; 95%CI, 1.04-1.87, P = .03) had higher mortality, and even transient anemia showed a similar trend, although without reaching statistical significance (HR = 1.31; 95%CI, 0.97-1.77, P = .075). CONCLUSIONS Anemia, especially persistent and of new-onset, and to a lesser degree, transient anemia, is deleterious in heart failure.
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Affiliation(s)
- Carles Díez-López
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Lupón
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta de Antonio
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabet Zamora
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Domingo
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Javier Santesmases
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria-Isabel Troya
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria Boldó
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
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19
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Durán Agüero S, Fernández Godoy E, Carrasco Piña E. [Not Available]. NUTR HOSP 2016; 33:18. [PMID: 27019245 DOI: 10.20960/nh.v33i1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 11/02/2022] Open
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20
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Colomina MJ, Basora Macaya M. [Optimization of preoperative hemoglobin levels in patients without anemia and/or patients who undergo surgery with high blood loss]. ACTA ACUST UNITED AC 2015; 62 Suppl 1:35-40. [PMID: 26320342 DOI: 10.1016/s0034-9356(15)30005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To minimize allogeneic blood transfusions (ABTs) during complex surgery and surgery with considerable blood loss risk, various blood-sparing techniques are needed (multimodal approach). All surgical patients should be assessed with sufficient time to optimize hemoglobin levels and iron reserves so that the established perioperative transfusion strategy is appropriate. Even if the patient does not have anemia, improving hemoglobin levels to reduce the risk of ABT is justified in some cases, especially those in which the patient refuses a transfusion. Treatment with iron and/or erythropoietic agents might also be justified for cases that need a significant autologous blood reserve to minimize ABT during surgery with considerable blood loss.
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Affiliation(s)
- M J Colomina
- Servicio de Anestesiología y Reanimación, Área de Traumatología, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | - M Basora Macaya
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
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21
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Martínez-Castelao A, Cases A, Carballada AT, Iranzo JT, Bronsoms J, Vallès-Prats M, Monserrat DT, Jimenez EM. Clinical impact of the ERBP Working Group 2010 Recommendations for the anemia management in chronic kidney disease not on dialysis: ACERCA study. Nefrologia 2015; 35:179-88. [PMID: 26300512 DOI: 10.1016/j.nefro.2015.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 12/03/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The Anemia Working Group of ERBP in 2010 recommended a target hemoglobin (Hb) level in the range of 11-12 g/dL, without intentionally exceeding 13 g/dL during the treatment with erythropoiesis stimulating agents (ESAs). This study evaluated if there was a clinical impact of this statement in the anemia management of chronic kidney disease (CKD) patients treated with ESAs not on dialysis in routine clinical practice in Spain. METHODS This was an observational and cross-sectional study carried out in CKD patients not on dialysis in Spain who initiated ESA treatment (naïve), or were shifted from a previous ESA to another ESAs (converted) since January 2011. RESULTS Of 441 patients evaluated, 67.6% were naïve and 32.4% were converted. At the study visit, 42.5% of naïve patients achieved the Hb target of 11-12 g/dL, with a mean Hb of 11.3±1.3 g/dL (vs 10.1±0.9 g/dL at the start of ESA therapy). Only 35.3% of converted patients maintained Hb levels within the recommended target at the study visit. Yet, 8.2% of naïve patients and 7.9% of those converted had Hb levels >13 g/dL. Hb levels were similar across subgroups of patients, regardless of the presence of significant comorbidities. CONCLUSIONS Anemia management in CKD patients treated with ESAs by Spanish nephrologists seems to be aimed at preventing Hb levels <11 g/dL, while <50% of patients were within the narrow recommended Hb target range. This, together with the lack of individualization in Hb targets according to patients' comorbidities show that there is still room for improvement in renal anemia management in the clinical setting.
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Affiliation(s)
- Alberto Martínez-Castelao
- Servicio de Nefrología. Hospital Universitario de Bellvitge. IDIBELL. Hospitalet, Barcelona (Spain).
| | - Aleix Cases
- Servicio de Nefrología. Hospital Clínic. Barcelona (Spain)
| | | | | | | | - Martí Vallès-Prats
- Servicio de Nefrología. Hospital Universitario Dr. Josep Trueta. Girona (Spain)
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Abstract
Postoperative anemia is a common finding in patients who undergo major surgery, and it can affect early rehabilitation and the return to daily activities. Allogeneic blood transfusion is still the most widely used method for restoring hemoglobin levels rapidly and effectively. However, the potential risks of transfusions have led to the review of this practice and to a search for alternative measures for treating postoperative anemia. The early administration of intravenous iron appears to improve the evolution of postoperative hemoglobin levels and reduce allogeneic transfusions, especially in patients with significant iron deficiency or anemia. What is not clear is whether this treatment heavily influences rehabilitation and quality of life. There is a lack of well-designed, sufficiently large, randomized prospective studies to determine whether postoperative or perioperative intravenous iron treatment, with or without recombinant erythropoietin, has a role in the recovery from postoperative anemia, in reducing transfusions and morbidity rates and in improving exercise capacity and quality of life.
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Affiliation(s)
- E Bisbe Vives
- Servicio de Anestesiología y Reanimación, Hospital del Mar, Barcelona, España.
| | - L Moltó
- Servicio de Anestesiología y Reanimación, Hospital del Mar, Barcelona, España
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Aguirre Arenas J, Chávez Villasana A, Medina Carranza BE, García Villegas EA, Carrasco Quintero MDR, Guarneros Soto N. [Impact of the provision of fortified cornmeal on anemia in preschoolers in the indigenous areas of Mexico]. Gac Sanit 2013; 27:541-4. [PMID: 23810524 DOI: 10.1016/j.gaceta.2013.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 04/17/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To estimate changes in anemia status in preschool age children at 9 months after the provision of soy- and iron-fortified cornflour. METHODS A non-experimental pre-post evaluation study was performed in a sample of 98 boys and 96 boys aged between 6 and 24 months. We analyzed demographic, anthropometric, and biochemical variables. RESULTS During the 9-month period, the hemoglobin level increased from 11.0 to 11.9 mg/dL (p<0,001). The prevalence of anemia (hemoglobin <11.0mg/dL) decreased from 52.6% to 25.3% (p<0,001). The indicators of height for age and body mass index changed from -2.1 (-5.5 to 2.8) to -2.3 (-6.5 to 1.3) (p<0,001) and from 0,4 (-3.1 to 2.9) to 0,7 (-2.2 to 3.9) (p<0,001), respectively. CONCLUSIONS The decreased prevalence of anemia suggests that the provision of soy- (3%) and iron-fortified flour is a viable alternative for combating childhood anemia.
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Affiliation(s)
- Judith Aguirre Arenas
- Departamento de Nutrición Aplicada y Educación Nutricional, Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México D.F., México.
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Benítez Cantero JM, Jurado García J, Ruiz Cuesta P, González Galilea A, Muñoz García-Borruel M, García Sánchez V, Gálvez Calderón C. [Early evaluation of anaemia in patients with acute gastrointestinal bleeding: venous blood gas analysis compared to conventional laboratory]. Med Clin (Barc) 2013; 141:332-7. [PMID: 23103108 DOI: 10.1016/j.medcli.2012.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 07/10/2012] [Accepted: 07/12/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Evaluation of patients with acute gastrointestinal bleeding (AGB) requires early clinical evaluation and analysis. The aim of this study is to evaluate early concordance of hemoglobin (Hb) and hematocrit (HTC) levels determined by conventional venous blood gas analysis (VBG) and by conventional Laboratory in Emergencies (LAB). PATIENTS AND METHODS Observational and prospective study of patients admitted in the Gastrointestinal Haemorrhage Unit with both high and low AGB. Demographic and clinical variables and simultaneous venous blood samples were obtained to determine Hb and HTC by VBG and LAB. Concordance in both methods was analysed by intra-class correlation coefficient (ICC) and Bland-Altman analysis. RESULTS One hundred and thirty-two patients were included: 87 (65.9%) males, average age 66.8 years. VBG overestimated Hb in 0.49 g/dl (95% confidence interval: 0.21-0.76) with respect to LAB. Concordance was very high in Hb (ICC 0.931) and high in HTC (0.899), with the Bland-Altman graphs showing both concordance and overestimation of Hb levels determined by VBG. In 19 patients (14.39%), Hb by VBG exceeded in more than 1g/dL the final determination obtained by LAB. CONCLUSIONS Early determination of Hb and HTC in patients with AGB by VBG provides reliable results in the initial evaluation of anaemia. VBG systematically overestimates Hb values by less than 0.5 g/dl, and therefore clinical and hemodynamic evaluation of the bleeding patient should prevail over analytical results.
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