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Parra Salinas I, Domingo JM, García-Erce JA. [Autoimmune hemolytic anemia: Extended phenotype or genotype?]. Med Clin (Barc) 2024; 162:356. [PMID: 38151369 DOI: 10.1016/j.medcli.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 12/29/2023]
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Payán-Pernía S, Pérez-Simón JA, García-Erce JA. Comment on: Intravenous iron for critically ill children. Comparison of three dose regimens. Pediatr Blood Cancer 2024; 71:e30857. [PMID: 38251819 DOI: 10.1002/pbc.30857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Salvador Payán-Pernía
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS)-CSIC, Universidad de Sevilla, Sevilla, Spain
| | - José Antonio Pérez-Simón
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS)-CSIC, Universidad de Sevilla, Sevilla, Spain
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García-Erce JA, Jericó C. [It's necessary the effective implementation of PBM "Patient Blood Management" programs]. Med Clin (Barc) 2023; 161:248-250. [PMID: 37244857 DOI: 10.1016/j.medcli.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 05/29/2023]
Affiliation(s)
- José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, España; Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org); Grupo Español de Rehabilitación Multimodal (GERM); Grupo de Investigación Gestión en el Paciente Sangrante-PBM, Instituto de Investigación Sanitaria, Hospital Universitaria La Paz (IdiPAZ), Madrid, España.
| | - Carlos Jericó
- Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org); Grupo Español de Rehabilitación Multimodal (GERM); Grupo de Investigación Gestión en el Paciente Sangrante-PBM, Instituto de Investigación Sanitaria, Hospital Universitaria La Paz (IdiPAZ), Madrid, España; Servicio de Medicina Interna, Complex Hospitalari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España
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Leache L, Gutiérrez-Valencia M, Saiz LC, Uriz J, Bolado F, García-Erce JA, Cantarelli L, Erviti J. Letter: Albumin-Does formulation matter? Authors' reply. Aliment Pharmacol Ther 2023; 57:1484-1485. [PMID: 37243460 DOI: 10.1111/apt.17546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Juan Uriz
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - Federico Bolado
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - José Antonio García-Erce
- Navarra's Blood and Tissue Bank, Navarre Health Service, Pamplona, Spain
- Grupo Español de Rehabilitación Multimodal (GERM), Aragon Health Science Institute, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Lorenzo Cantarelli
- Department of Hospital Pharmacy, University Hospital of Canary Islands (CHUC), Santa Cruz de Tenerife, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
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Abad-Motos A, Ripollés-Melchor J, Jericó C, Bisbe E, Basora M, Colomina MJ, Becerra-Bolaños Á, Bermúdez-López M, Massa-Gómez C, Albaladejo-Magdalena J, Solar-Herrera A, Pérez-Chrzanowska H, Yárnoz C, Fedriani-de-Matos JJ, Blanco-Del-Val B, Fabián-González D, Bellver J, Redondo-Enríquez JM, Serrat-Puyol J, Abad-Gurumeta A, Zorrilla-Vaca A, Aldecoa C, García-Erce JA. Identification of the haemoglobin level associated with a lower risk of complications after total hip and knee arthroplasty. Acta Anaesthesiol Scand 2023; 67:629-639. [PMID: 36795045 DOI: 10.1111/aas.14217] [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: 07/14/2022] [Revised: 12/16/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Preoperative anaemia is associated with poor outcomes in surgical patients, but the preoperative haemoglobin cut-off that determines lower morbidity in total knee arthroplasty (TKA) and total hip arthroplasty (THA) is not well established. METHODS Planned secondary analysis of data collected during a multicentre cohort study of patients undergoing THA and TKA in 131 Spanish hospitals during a single 2-month recruitment period. Anaemia was defined as haemoglobin <12 g dl-1 for females and < 13 g dl-1 for males. The primary outcome was the number of patients with 30-day in-hospital postoperative complications according to European Perioperative Clinical Outcome definitions and specific surgical TKA and THA complications. Secondary outcomes included the number of patients with 30-day moderate-to-severe complications, red blood cell transfusion, mortality, and length of hospital stay. Binary logistic regression models were constructed to assess association between preoperative Hb concentrations and postoperative complications, and variables significantly associated with the outcome were included in the multivariate model. The study sample was divided into 11 groups based on preoperative Hb values in an effort to identify the threshold at which increased postoperative complications occurred. RESULTS A total of 6099 patients were included in the analysis (3818 THA and 2281 TKA), of whom 8.8% were anaemic. Patients with preoperative anaemia were more likely to suffer overall complications (111/539, 20.6% vs. 563/5560, 10.1%, p < .001) and moderate-to-severe complications (67/539, 12.4% vs. 284/5560, 5.1%, p < .001). Multivariable analysis showed preoperative haemoglobin ≥14 g dl-1 was associated with fewer postoperative complications. CONCLUSION Preoperative haemoglobin ≥14 g dl-1 is associated with a lower risk of postoperative complications in patients undergoing primary TKA and THA.
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Affiliation(s)
- Ane Abad-Motos
- Department of Anaesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
- Department of Anaesthesiology, Hospital Universitario Donostia, San Sebastián, Spain
- Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | - Javier Ripollés-Melchor
- Department of Anaesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
- Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain
| | - Carlos Jericó
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Barcelona, Spain
| | - Elvira Bisbe
- Department of Anaesthesiology, Parc de Salut Mar, Barcelona, Spain
| | | | - Maria J Colomina
- Department of Anaesthesiology, Hospital Universitario de Bellvitge, Barcelona, Spain
- Universidad de Barcelona, Barcelona, Spain
| | - Ángel Becerra-Bolaños
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - María Bermúdez-López
- Department of Anaesthesiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Cristina Massa-Gómez
- Department of Anaesthesiology, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain
| | | | - Ana Solar-Herrera
- Department of Anaesthesiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Hanna Pérez-Chrzanowska
- Department of Anaesthesiology, Hospital Cantoblanco, Hospital Universitario La Paz, Madrid, Spain
| | - Carlos Yárnoz
- Department of Anaesthesiology, Hospital Universitario Donostia, San Sebastián, Spain
| | | | | | - David Fabián-González
- Department of Anaesthesiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Jorge Bellver
- Department of Anaesthesiology, Hospital Universitario Dr Peset, Valencia, Spain
| | | | | | - Alfredo Abad-Gurumeta
- Department of Anaesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
- Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | | | - César Aldecoa
- Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
- Department of Anaesthesiology, Hospital Universitario Rio Hortega, Valladolid, Spain
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Parra Salinas I, García-Erce JA. Answer to: «Iron overload refractory to phlebotomies in a patient with hereditary hemochromatosis type 1». Med Clin (Barc) 2023:S0025-7753(23)00169-0. [PMID: 37095052 DOI: 10.1016/j.medcli.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Ingrid Parra Salinas
- Servicio de Hematología y Hemoterapia, Hospital de Barbastro, Barbastro, Huesca, España.
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7
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Leache L, Gutiérrez-Valencia M, Saiz LC, Uriz J, Bolado F, García-Erce JA, Cantarelli L, Erviti J. Meta-analysis: Efficacy and safety of albumin in the prevention and treatment of complications in patients with cirrhosis. Aliment Pharmacol Ther 2023; 57:620-634. [PMID: 36524316 DOI: 10.1111/apt.17344] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/13/2022] [Accepted: 11/26/2022] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Albumin is used in multiple situations in patients with cirrhosis, but the evidence of its benefit is not always clear. The aim was to synthesise the evidence on the efficacy and safety of albumin compared to other treatments or no active intervention in cirrhotic patients. MATERIALS AND METHODS We conducted a systematic review including randomised controlled trials (RCTs) published in MEDLINE, EMBASE and CENTRAL up to May 2022. We assessed all-cause mortality, liver transplant, cirrhosis complications of any type and serious adverse events (SAEs). Second, AEs, hospital readmission, length of hospital stay, need for paracentesis and quality of life (QoL) were evaluated. Meta-analyses with Mantel-Haenszel method and random-effects model were performed. RESULTS Fifty studies (5118 participants) were included. Albumin was associated with a reduction in mortality in cirrhotic patients with spontaneous bacterial peritonitis (SBP) (RR 0.49, 95% CI 0.32-0.75; low certainty) and hepatic encephalopathy (HE) (RR 0.53, 95% CI 0.34-0.83; low certainty) when compared to no administration of albumin, but not in other scenarios. In general, no additional benefit of albumin was found in liver transplants, SAEs or cirrhosis complications (low/very low certainty). Long-term administration (>3 months) of albumin led to a reduction in cirrhosis complications (RR 0.75, 95% CI 0.57-0.97; low certainty), hospital readmissions, length of hospital stay, need for paracentesis and improvement of QoL. CONCLUSION Albumin may reduce mortality risk in cirrhotic patients with SBP or HE. No benefit was identified in reducing liver transplants or SAEs. Long-term administration may be associated with a lower risk of cirrhosis complications and need for paracentesis.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Juan Uriz
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - Federico Bolado
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - José Antonio García-Erce
- Navarra's Blood and Tissue Bank, Navarre Health Service, Pamplona, Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Aragon Health Science Institute, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Lorenzo Cantarelli
- Department of Hospital Pharmacy, University Hospital of Canary Islands (CHUC), Santa Cruz de Tenerife, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
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Juárez-Vela R, Quintana-Diaz M, Rodríguez-Calvo A, Santos-Sánchez JÁ, Gero-Escapa M, Gallego-Curto E, Satústegui-Dordá PJ, Sánchez-González JL, Jericó C, Ruiz de Viñaspre-Hernández R, Gil-Fernández G, García-Erce JA. Profile and characteristics of the adequacy of blood transfusions in Trauma Intensive Care. A cross sectional multicenter study. Front Public Health 2023; 11:1133191. [PMID: 37020819 PMCID: PMC10067921 DOI: 10.3389/fpubh.2023.1133191] [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: 12/28/2022] [Accepted: 02/24/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction Major trauma is one of the major health care problems facing modern society, trauma systems require careful planning to achieve an ideal level of coverage for the population. The Patient Blood Management Program is an integrated and global strategy to provide patient care that aims to assess and address, when possible, the etiology of blood abnormalities rather than transfuse without treating the underlying cause. We aimed to describe the factors that are associated with the clinical decision to transfuse polytraumatized patients admitted to the Intensive Care Unit (ICU). Method We performed a cross sectional multicenter study of patients admitted to ICUs for trauma in 14 Spanish hospitals from September 2020 to December 2021. Results A total of 69 patients were treated in the emergency room due to polytrauma, 46% of them were considered serious in the initial triage. Thirty were caused by a fall from considerable height (43.47%), followed by 39 patients admitted due to trac accidents (56.52%). The location of the trauma was mainly cranioencephalic, followed by thoracic trauma. Of the 69 patients, 25 received a blood transfusion during their ICU stay (36.23%). Discussion No significant differences were observed between transfused and non-transfused patients, except for the severity scales, where transfused patients have a higher score on all the scales assessed in the ICU except for the Revised Trauma Score. As we can see, the incidence of kidney failure was also different between the groups analyzed, reaching 44.00% in transfused patients and 13.64% in the group of patients without blood transfusion, p = 0.005. In this sense, 92.00% of the transfusions performed were inadequate according to the criteria of Hb in blood prior to the decision to transfuse (Hb < 9). Our data support the need to consider clinical practice guidelines regarding blood transfusion and its practices.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Program in Medicine and Surgery, Autonomous University of Madrid, Madrid, Spain
- Department of Nursing, Research Group in Care (GRUPAC), University of La Rioja, Logroño, Spain
- Center of Biomedical Research of La Rioja (CIBIR), Logroño, Spain
| | - Manuel Quintana-Diaz
- Doctoral Program in Medicine and Surgery, Autonomous University of Madrid, Madrid, Spain
- Intensive Care Unit, PBM Group, IdiPAZ, Hospital La Paz, Madrid, Spain
| | - Antonio Rodríguez-Calvo
- Complex Hospital University of Salamanca, Salamanca, Spain
- Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - José Ángel Santos-Sánchez
- Complex Hospital University of Salamanca, Salamanca, Spain
- Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | | | | | - Pedro José Satústegui-Dordá
- Research Group of the University of Zaragoza B43_20R Water and Environmental Health, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | | | - Carlos Jericó
- Internal Medicine Department, Complex Hospitalari Moisés Broggi, Sant Joan Despí, Spain
| | - Regina Ruiz de Viñaspre-Hernández
- Department of Nursing, Research Group in Care (GRUPAC), University of La Rioja, Logroño, Spain
- Center of Biomedical Research of La Rioja (CIBIR), Logroño, Spain
- *Correspondence: Regina Ruiz de Viñaspre-Hernández
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Juárez-Vela R, García-Erce JA, Gea-Caballero V, Ruiz de Viñaspre-Hernandez R, Santos-Sánchez JÁ, Sánchez-González JL, Andrés-Esteban EM, Czapla M, Tejada CI, Nanwani-Nanwani KL, Serrano-Lázaro A, Quintana-Díaz M. A Cohort Study in Intensive Care Units: Health Decisions Related to Blood Transfusion during the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11154396. [PMID: 35956012 PMCID: PMC9368991 DOI: 10.3390/jcm11154396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Critically ill polytrauma patients with hemorrhage require a rapid assessment to initiate hemostatic resuscitation in the shortest possible time with the activation of a massive transfusion or a critical hemorrhage management protocol. The hospital reality experienced during the COVID-19 pandemic in all countries was critical, as it was in Spain; according to the data published daily by the Ministry of Health on its website, during the period of this study, the occupancy rate of intensive care units (ICUs) by patients diagnosed with the novel coronavirus disease (COVID-19) rose to 23.09% in Spain, even reaching 45.23% at the end of January 2021. We aimed to analyze the changes observed during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic period regarding the effectiveness of Spanish ICUs in terms of mortality reduction. We present a cross-sectional study that compares two cohorts of patients admitted to ICUs across all autonomous communities of Spain with a diagnosis of polytrauma. Results: Only age was slightly higher at admission during the first wave of the pandemic (47.74 ± 18.65 vs. 41.42 ± 18.82 years, p = 0.014). The transfusion rate during the pandemic increased by 10.4% compared to the previous stage (p = 0.058). Regarding hemostatic components, the use of tranexamic acid increased from 1.8% to 10.7% and fibrinogen concentrates from 0.9% to 1.9%. In the case of prothrombin complex concentrates, although there was a slight increase in their use, there were no significant differences during the pandemic compared to the previous period. Conclusion: Mortality showed no difference before and during the pandemic, despite the observed change in the transfusion policy. In summary, the immediate and global implementation of patient blood management (PBM) based on clinical transfusion algorithms should be mandatory in all hospitals in our country.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Program in Medicine and Surgery, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain; (R.J.-V.); (M.Q.-D.)
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
| | - José Antonio García-Erce
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Bank of Blood and Tissue of Navarra, Government of Navarra, 31008 Pamplona, Spain
- Correspondence:
| | - Vicente Gea-Caballero
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Faculty of Health Sciences, Valencian International University, 46002 Valencia, Spain
| | - Regina Ruiz de Viñaspre-Hernandez
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
| | - José Ángel Santos-Sánchez
- Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain;
- Salamanca Hospital Complex, 37008 Salamanca, Spain
| | | | - Eva María Andrés-Esteban
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Department of Business Economics and Applied Economy, Faculty of Legal and Economic Sciences, University Rey Juan Carlos, 28032 Madrid, Spain
| | - Michał Czapla
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
- Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Clara Isabel Tejada
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
| | - Kapil Laxman Nanwani-Nanwani
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- La Paz Hospital Intensive Care Unit, 28046 Madrid, Spain
| | - Ainhoa Serrano-Lázaro
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Intensive Care Unit, Hospital Clinico de Valencia, 46010 Valencia, Spain
| | - Manuel Quintana-Díaz
- Doctoral Program in Medicine and Surgery, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain; (R.J.-V.); (M.Q.-D.)
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- La Paz Hospital Intensive Care Unit, 28046 Madrid, Spain
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Juárez-Vela R, Andrés-Esteban EM, Santolalla-Arnedo I, Ruiz de Viñaspre-Hernández R, Benito-Puncel C, Serrano-Lázaro A, Marcos-Neira P, López-Fernández A, Tejada-Garrido CI, Sánchez-González JL, Quintana-Díaz M, García-Erce JA. Epidemiology and Associated Factors in Transfusion Management in Intensive Care Unit. J Clin Med 2022; 11:jcm11123532. [PMID: 35743602 PMCID: PMC9225042 DOI: 10.3390/jcm11123532] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Severe traumatic injury is one of the main global health issues which annually causes more than 5.8 million worldwide deaths. Uncontrolled haemorrhage is the main avoidable cause of death among severely injured individuals. Management of trauma patients is the greatest challenge in trauma emergency care, and its proper diagnosis and early management of bleeding trauma patients, including blood transfusion, are critical for patient outcomes. Aim: We aimed to describe the epidemiology of transfusion practices in severe trauma patients admitted into Spanish Intensive Care Units. Material and Methods: We performed a multicenter cross-sectional study in 111 Intensive Care Units across Spain. Adult patients with moderate or severe trauma were eligible. Distribution of frequencies was used for qualitative variables and the mean, with its 95% CI, for quantitative variables. Transfusion programmes, the number of transfusions performed, and the blood component transfused were recorded. Demographic variables, mortality rate, hospital stay, SOFA-score and haemoglobin levels were also gathered. Results: We obtained results from 109 patients. The most transfused blood component was packet red blood cells with 93.8% of total transfusions versus 43.8% of platelets and 37.5% of fresh plasma. The main criteria for transfusion were analytical criteria (43.75%), and acute anaemia with shock (18.75%) and without haemodynamic impact (18.75%). Conclusion: Clinical practice shows a ratio of red blood cells, platelets, and Fresh Frozen Plasma (FFP) of 2:1:1. It is necessary to implement Massive Transfusion Protocols as they appear to improve outcomes. Our study suggests that transfusion of RBC, platelets and FFP in a 2:1:1 ratio could be beneficial for trauma patients.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Programme in Medicine and Surgery, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain;
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
- Research Institute IdiPaz, 28029 Madrid, Spain;
| | - Eva María Andrés-Esteban
- Research Institute IdiPaz, 28029 Madrid, Spain;
- Department of Business Economics and Applied Economy, Faculty of Legal and Economic Sciences, Rey Juan Carlos University, 28933 Madrid, Spain
| | - Ivan Santolalla-Arnedo
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
| | | | | | | | - Pilar Marcos-Neira
- Intensive Care Unit, Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | | | - Clara Isabel Tejada-Garrido
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
- Correspondence: (C.I.T.-G.); (M.Q.-D.)
| | | | - Manuel Quintana-Díaz
- Research Institute IdiPaz, 28029 Madrid, Spain;
- Intensive Care Unit, University Hospital of La Paz, 28046 Madrid, Spain;
- Correspondence: (C.I.T.-G.); (M.Q.-D.)
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11
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García-Erce JA, Jericó C, Abad-Motos A, Rodríguez García J, Antelo Caamaño ML, Domingo Morera JM, Sola Lapeña C, Arroyo JL, Fernández Fuertes F, Zalba Marcos S, Cerdán Rodríguez G, Laso Morales MJ, Bueno Cabrera JL, Chica E, Recasens V, Zabalegui A, Balen E, Urrechaga E, Abad-Gurumeta A, Quintana Díaz M. PBM: Now more than ever necessary. Revista Española de Anestesiología y Reanimación (English Edition) 2022; 69:351-354. [PMID: 35760689 PMCID: PMC9226968 DOI: 10.1016/j.redare.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/30/2021] [Indexed: 11/24/2022]
Affiliation(s)
- J A García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, España, 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, Spain.
| | - C Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí Barcelona, Spain
| | - A Abad-Motos
- Servicio de Anestesiología, Hospital Universitario Infanta Leonor de Madrid, Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - J Rodríguez García
- Servicio de Medicina Preventiva, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - M L Antelo Caamaño
- Servicio de Apoyo a la Gestión Clínica y Continuidad Asistencial, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - J L Arroyo
- Banco de Sangre y Tejidos de Cantabria, Santander, Spain
| | - F Fernández Fuertes
- Servicio Hematología y Hemoterapia, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - S Zalba Marcos
- Servicio de Hematología y Hemoterapia, Hospital García Orcoyen, Estella (Navarra), Spain
| | - G Cerdán Rodríguez
- Servicio de Anestesiología, Hospital García Orcoyen, Estella (Navarra), Spain
| | - M J Laso Morales
- Servicio de Anestesiología, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - J L Bueno Cabrera
- Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - E Chica
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Getafe, Getafe, Spain
| | - V Recasens
- Servicio de Hematología y Hemoterapia, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Zabalegui
- Servicio de Análisis Clínico, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - E Balen
- Servicio de Cirugía General, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - E Urrechaga
- Biocruces Bizkaia Research Institute, Bilbao, Spain
| | - A Abad-Gurumeta
- Servicio de Anestesiología, Hospital Universitario Infanta Leonor de Madrid, Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - M Quintana Díaz
- Servicio de Cuidados Intensivos, Hospital Universitario La Paz, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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12
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Enguita-Germán M, Librero J, Leache L, Gutiérrez-Valencia M, Tamayo I, Jericó C, Gorricho J, García-Erce JA. Role of the AB0 blood group in COVID-19 infection and complications: A population-based study. Transfus Apher Sci 2022; 61:103357. [PMID: 35148968 PMCID: PMC8762836 DOI: 10.1016/j.transci.2022.103357] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/05/2022] [Accepted: 01/15/2022] [Indexed: 12/16/2022]
Abstract
Since the beginning of the COVID-19 pandemic, the ABO blood group has been described as a possible biological marker of susceptibility for the disease. This study evaluates the role of ABO group on the risk of SARS-CoV-2 infection and related complications in a population-based cohort including 87,090 subjects from the Navarre population (Northern Spain) with no history of SARS-CoV-2 infection and with known ABO blood group, after one year of the pandemic (May 2020 - May 2021). The risk of infection, hospitalization, Intensive Care Unit (ICU) admission and death was analyzed using multivariate logistic regression, adjusting for possible confounding variables. A lower risk of infection was observed in group 0 vs non-0 groups [OR 0.94 (95 %CI 0.90-0.99)], a higher risk of infection in group A vs non-A groups [OR 1.09 (95 %CI 1.04-1.15)] and a higher risk of infection in group A vs group 0 [OR 1.08 (95CI 1.03-1.14)] (when the 4 groups are analyzed separately). No association was observed between blood groups and hospitalization, ICU admission, or death in SARS-CoV-2 infected subjects. Regarding the risk of SARS-CoV-2 infection, we observed a protective role of group O and a greater risk in the A group.
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Affiliation(s)
- Mónica Enguita-Germán
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Julián Librero
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Leire Leache
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Spain.
| | | | - Ibai Tamayo
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain.
| | - Javier Gorricho
- Servicios de Evaluación y Difusión de Resultados, Servicio Navarro de Salud-Osasunbidea, Spain.
| | - José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain; Grupo idiPAZ de «Investigación en PBM», Madrid, Spain.
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13
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Jericó C, Zalba-Marcos S, Quintana-Díaz M, López-Villar O, Santolalla-Arnedo I, Abad-Motos A, Laso-Morales MJ, Sancho E, Subirà M, Bassas E, Ruiz de Viñaspre-Hernández R, Juárez-Vela R, García-Erce JA. Relationship between ABO Blood Group Distribution and COVID-19 Infection in Patients Admitted to the ICU: A Multicenter Observational Spanish Study. J Clin Med 2022; 11:jcm11113042. [PMID: 35683430 PMCID: PMC9181327 DOI: 10.3390/jcm11113042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 02/01/2023] Open
Abstract
Since the beginning of the COVID-19 pandemic in December 2019, a relationship between the ABO blood group type and the novel coronavirus SARS-CoV-2, the etiological agent of COVID-19, has been reported, noting that individuals with the O blood group are the least likely to be infected. Spain is one of the most badly affected countries worldwide, with high rates of patients diagnosed, hospitalized, and deceased due to COVID-19 infection. The present study aimed to analyze the possible relationship of ABO in COVID-19 patients hospitalized in different Spanish centers during the first wave of the COVID-19 pandemic, for which the ABO group was available. Physicians from the transfusion services of different Spanish hospitals, who have developed a multicenter retrospective observational study, were invited to participate voluntarily in the research and 12,115 patients with COVID-19 infection were admitted to the nine participating hospitals. The blood group was known in 1399 cases (11.5%), of which 365 (26.1%) were admitted to the ICU. Regarding the distribution of ABO blood groups, a significant increase in the non-O blood groups and reduction for the O blood group was observed in patients hospitalized due to COVID-19, compared to the reference general population. Among the patients admitted to the ICU, after multivariate analysis, adjusted for the rest of the confounding variables, patients with the O blood group presented a significantly lower risk for admission to the ICU. We conclude that an association was observed between patients with the O blood group and their lower susceptibility to SARS-CoV-2 infection, both for those admitted to the hospitalization ward and for those who required admission to the ICU.
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Affiliation(s)
- Carlos Jericó
- Internal Medicine Department, Complex Hospitalari Moisés Broggi, 08970 Sant Joan Despí, Spain;
| | - Saioa Zalba-Marcos
- Haematology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain;
| | - Manuel Quintana-Díaz
- PBM Research Group, Idi-Paz Research Institute, 28046 Madrid, Spain; (M.Q.-D.); (J.A.G.-E.)
- Intensive Care Unit, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Olga López-Villar
- Transfusion Service, Haematology Department, Hospital Universitario de Salamanca, 37007 Salamanca, Spain;
| | | | - Ane Abad-Motos
- Anaesthesia Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain;
| | | | - Esther Sancho
- Haematology Department, Hospital General de Granollers, 08402 Granollers, Spain;
| | - Maricel Subirà
- Haematology Department, Hospital Sagrat Cor, 08029 Barcelona, Spain;
| | - Eva Bassas
- Anaesthesia Department, Complex Hospitalari Moisés Broggi, 08970 Sant Joan Despí, Spain;
| | | | - Raúl Juárez-Vela
- PBM Research Group, Idi-Paz Research Institute, 28046 Madrid, Spain; (M.Q.-D.); (J.A.G.-E.)
- Department of Nursing-GRUPAC, University of La Rioja, La Rioja, 26006 Logroño, Spain;
- Correspondence: (R.R.d.V.-H.); (R.J.-V.)
| | - José Antonio García-Erce
- PBM Research Group, Idi-Paz Research Institute, 28046 Madrid, Spain; (M.Q.-D.); (J.A.G.-E.)
- Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, 31003 Pamplona, Spain
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14
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Casellas Caro M, Hidalgo MJC, García-Erce JA, Baquero Úbeda JL, Torras Boatella MG, Gredilla Díaz E, Ruano Encinar M, Martín Bayón I, Nicolás Picó J, Arjona Berral JE, Muñoz Solano A, Jiménez Merino S, Cerezales M, Cuervo J. Applying reflective multicriteria decision analysis to understand the value of therapeutic alternatives in the management of gestational and peripartum anaemia in Spain. BMC Pregnancy Childbirth 2022; 22:157. [PMID: 35216553 PMCID: PMC8881868 DOI: 10.1186/s12884-022-04481-w] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the FeminFER project was to assess the value of ferric carboxymaltose following a multicriteria decision analysis in obstetrics and gynaecology in Spain. METHODS Ferric carboxymaltose (FCM) and ferrous sulphate were evaluated using the EVIDEM framework. Ten stakeholders participated to collect different perspectives. The framework was adapted considering evidence retrieved with a PICO-S search strategy and grey literature. Criteria/subcriteria were weighted by level of relevance and an evidence-based decision-making exercise was developed in each criterion; weights and scores were combined to obtain the value of intervention relative to each criterion/subcriterion, that were further combined into the Modulated Relative Benefit-Risk Balance (MRBRB). RESULTS The most important criterion favouring FCM was Compared Efficacy/Effectiveness (0.183 ± 0.07), followed by Patient Preferences (0.059 ± 0.10). Only Direct medical costs criterion favoured FS (-0.003 ± 0.03). MRBRB favoured FCM; 0.45 ± 0.19; in a scale from -1 to + 1. CONCLUSIONS In conclusion, considering the several criteria involved in the decision-making process, participants agreed with the use of FCM according to its MRBRB.
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Affiliation(s)
- Manel Casellas Caro
- Department of Obstetrics, Hospital Universitari Vall d´Hebron, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - María Jesús Cancelo Hidalgo
- Department of Obstetrics and Gynecology, Hospital Universitario Guadalajara, Calle Donante de Sangre, 19002, Guadalajara, S/N, Spain
| | - José Antonio García-Erce
- Banco de Sangre Y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Calle Irunlarrea, 3, 31008, Pamplona, Spain
- Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de La Salud, Avenida San Juan Bosco, 13, 50009, Zaragoza, Spain
- PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana, 261, 28046, Madrid, Spain
| | | | - Maria Glòria Torras Boatella
- Àrea d'Innovació, Hospital Universitari Bellvitge, Carrer de La Feixa Llarga, L'Hospitalet de Llobregat, 08907, Barcelona, S/N, Spain
- Institut Català de La Salut, Barcelona, Spain
| | - Elena Gredilla Díaz
- Anaesthesia Department, Hospital La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain
| | | | - Israel Martín Bayón
- CS Polop-La Nucía, Avenida de Sagi Barba, 24, Polop, La Nucía, 03520, Alicante, Spain
| | - Jordi Nicolás Picó
- Hospital Universitari Mutua Terrasa, Plaça del Doctor Robert, 5, 08221, Terrassa, Spain
| | | | - Alberto Muñoz Solano
- Department of Obstetrics and Gynecology, Hospital Universitario Marqués de Valdecilla, Avenida de Valdecilla, 25, 39008, Santander, Spain
| | | | - Mónica Cerezales
- Axentiva Solutions S.L., Calle Monte Cerrau, 28, 33006, Asturias, Oviedo, Spain
| | - Jesús Cuervo
- Axentiva Solutions S.L., Calle Monte Cerrau, 28, 33006, Asturias, Oviedo, Spain.
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15
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Juárez-Vela R, Andrés-Esteban EM, Gea-Caballero V, Sánchez-González JL, Marcos-Neira P, Serrano-Lázaro A, Tirado-Anglés G, Ruiz-Rodríguez JC, Durante Á, Santolalla-Arnedo I, García-Erce JA, Quintana-Díaz M. Related Factors of Anemia in Critically Ill Patients: A Prospective Multicenter Study. J Clin Med 2022; 11:jcm11041031. [PMID: 35207301 PMCID: PMC8878830 DOI: 10.3390/jcm11041031] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 12/20/2022] Open
Abstract
Anemia is common in critically ill patients; almost 95% of patients admitted to intensive care units (ICUs) have hemoglobin levels below normal. Several causes may explain this phenomenon as well as the tendency to transfuse patients without adequate cause: due to a lack of adherence to protocols, lack of supervision, incomplete transfusion request forms, or a lack of knowledge about the indications, risks, and costs of transfusions. Daily sampling to monitor the coagulation parameters and the acid-base balance can aggravate anemia as the main iatrogenic factor in its production. We studied the association and importance of iatrogenic blood loss and other factors in the incidence of anemia in ICUs. We performed a prospective, observational, multicenter study in five Spanish hospitals. A total of 142 patients with a median age of 58 years (IQI: 48-69), 71.83% male and 28.17% female, were admitted to ICUs without a diagnosis of iatrogenic anemia. During their ICU stay, anemia appeared in 66.90% of the sample, 95 patients, (95% CI: 58.51-74.56%). Risk factors associated with the occurrence of iatrogenic anemia were arterial catheter insertion (72.63% vs. 46.81%, p-value = 0.003), venous catheter insertion (87.37% vs. 72.34%, p-value = 0.023), drainages (33.68% vs. 12. 77%, p-value = 0.038), and ICU stay, where the longer the stay, the higher the rate of iatrogenic anemia (p-value < 0.001). We concluded that there was a statistical significance in the production of iatrogenic anemia due to the daily sampling for laboratory monitoring and critical procedures in intensive care units. The implementation of patient blood management programs could address these issues.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Program in Medicine and Surgery, Autonomous University of Madrid, 28049 Madrid, Spain;
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Department of Nursing, GRUPAC, University of La Rioja, 26004 Logroño, Spain;
| | - Eva María Andrés-Esteban
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Department of Business Economics and Applied Economy, Faculty of Legal and Economic Sciences, University Rey Juan Carlos, 28032 Madrid, Spain
| | - Vicente Gea-Caballero
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Faculty of Health Sciences, International University of Madrid, 46010 Valencia, Spain
| | | | - Pilar Marcos-Neira
- Intensive Care Unit, Germans Trial I Pujol Hospital, 08916 Badalona, Spain;
| | | | | | - Juan Carlos Ruiz-Rodríguez
- Shock, Organ Dysfunction and Resuscitation Research Group, Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron, 08035 Barcelona, Spain;
| | - Ángela Durante
- Department of Nursing, GRUPAC, University of La Rioja, 26004 Logroño, Spain;
| | - Iván Santolalla-Arnedo
- Department of Nursing, GRUPAC, University of La Rioja, 26004 Logroño, Spain;
- Correspondence: (I.S.-A.); (J.A.G.-E.)
| | - José Antonio García-Erce
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Blood and Tissue Bank of Navarra, Navarre Health Service, 31015 Pamplona, Spain
- Correspondence: (I.S.-A.); (J.A.G.-E.)
| | - Manuel Quintana-Díaz
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Intensive Care Unit, La Paz University Hospital, 28046 Madrid, Spain
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16
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Rodríguez García J, Domingo Morera JM, García-Erce JA. Vaccination to blood donors. Med Clin (Engl Ed) 2022; 158:142-144. [PMID: 36569280 PMCID: PMC9765944 DOI: 10.1016/j.medcle.2021.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Juan Rodríguez García
- Servicio de Medicina Preventiva, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, España; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain; PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain,Corresponding author
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17
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Ruiz de Viñaspre-Hernández R, García-Erce JA, Rodríguez-Velasco FJ, Gea-Caballero V, Sufrate-Sorzano T, Garrote-Cámara ME, Urra-Martínez R, Juárez-Vela R, Czapla M, Santolalla-Arnedo I. Variability in Oral Iron Prescription and the Effect on Spanish Mothers' Health: A Prospective Longitudinal Study. J Clin Med 2021; 10:jcm10215212. [PMID: 34768732 PMCID: PMC8584634 DOI: 10.3390/jcm10215212] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background: No consensus exists regarding the hemoglobin (Hb) values that define postpartum anemia. Knowledge is currently lacking regarding prescription and consumption practices, which prevents evaluating the rational use of iron supplementation postpartum. Aim: In this study, our objective was to describe this practice and analyze its association with maternal health outcomes. Methods: A prospective observational study was conducted with 1010 women aged between 18 and 50. The hemoglobin value on the first postpartum day; the prescription schedule at hospital discharge; iron consumption; and data on hemoglobin, serum ferritin, maternal fatigue, type of breastfeeding, and perceived health six weeks after delivery were collected. Findings: Oral iron was prescribed to 98.1% of mothers with anemia and 75.8% without anemia. At the same Hb value, the maximum amount of total iron prescribed was between 8 and 10 times greater than the minimum amount. Iron intake was significantly lower than prescribed (p < 0.01). At six weeks, anemic mothers who took iron presented a 3.6-, 3-, and 2.4-times lower probability of iron deficiency, anemia, and abandoning breastfeeding, respectively. Discussion: Postpartum iron intake shows a protective effect on iron deficiency and anemia at six weeks, but not on fatigue or self-perceived health level. Conclusion: We conclude that there is wide variability in the prescription regimen. Oral iron supplementation can benefit mothers with anemia and harm those without. Subsequent studies should further explore the Hb figure that better discriminates the need for postpartum iron.
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Affiliation(s)
- Regina Ruiz de Viñaspre-Hernández
- Centro de Salud “Cascajos”, Servicio Riojano de Salud, Government of La Rioja, 26002 Logroño, Spain;
- GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
| | - José Antonio García-Erce
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain;
- Hematologist, Bank of Blood and Tissue, Government of Navarra, 31015 Pamplona, Spain
| | | | - Vicente Gea-Caballero
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain;
- Faculty of Health Sciences, International University of Valencia, 46010 Valencia, Spain
- Correspondence: (V.G.-C.); (R.J.-V.)
| | - Teresa Sufrate-Sorzano
- GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
| | - María Elena Garrote-Cámara
- GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
| | - Raquel Urra-Martínez
- Servicio Riojano de Salud, Hospital San Pedro, Government of La Rioja, 26006 Logroño, Spain;
| | - Raúl Juárez-Vela
- GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain;
- Correspondence: (V.G.-C.); (R.J.-V.)
| | - Michał Czapla
- Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, 51-516 Wroclaw, Poland;
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Iván Santolalla-Arnedo
- GRUPAC, Biomedical Research Center of La Rioja (CIBIR), Research Unit on Health System Sustainability (GISSOS), Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (T.S.-S.); (M.E.G.-C.); (I.S.-A.)
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18
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García-Erce JA, Jericó C, Abad-Motos A, Rodríguez García J, Antelo Caamaño ML, Domingo Morera JM, Sola Lapeña C, Arroyo JL, Fernández Fuertes F, Zalba Marcos S, Cerdán Rodríguez G, Laso Morales MJ, Bueno Cabrera JL, Chica E, Recasens V, Zabalegui A, Balen E, Urrechaga E, Abad-Gurrumenta A, Quintana Díaz M. PBM: Now more than ever necessary. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00181-X. [PMID: 34563367 PMCID: PMC8486592 DOI: 10.1016/j.redar.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 01/12/2023]
Affiliation(s)
- J A García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, España; 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.
| | - C Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí Barcelona, España
| | - A Abad-Motos
- Servicio de Anestesiología, Hospital Universitario Infanta Leonor de Madrid; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, España
| | - J Rodríguez García
- Servicio de Medicina Preventiva, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - M L Antelo Caamaño
- Servicio de Apoyo a la Gestión Clínica y Continuidad Asistencial, Complejo Hospitalario de Navarra, Pamplona, España
| | | | | | - J L Arroyo
- Banco de Sangre y Tejidos de Cantabria, Santander, España
| | - F Fernández Fuertes
- Servicio Hematología y Hemoterapia, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, España
| | - S Zalba Marcos
- Servicio de Hematología y Hemoterapia, Hospital García Orcoyen, Estella (Navarra), España
| | - G Cerdán Rodríguez
- Servicio de Anestesiología, Hospital García Orcoyen, Estella (Navarra), España
| | - M J Laso Morales
- Servicio de Anestesiología, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - J L Bueno Cabrera
- Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - E Chica
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Getafe, Getafe, España
| | - V Recasens
- Servicio de Hematología y Hemoterapia, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Zabalegui
- Servicio de Análisis Clínico, Complejo Hospitalario de Navarra, Pamplona, España
| | - E Balen
- Servicio de Cirugía General, Complejo Hospitalario de Navarra, Pamplona, España
| | - E Urrechaga
- Biocruces Bizkaia Research Institute, Bilbao, España
| | - A Abad-Gurrumenta
- Servicio de Anestesiología, Hospital Universitario Infanta Leonor de Madrid; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, España
| | - M Quintana Díaz
- Servicio de Cuidados Intensivos, Hospital Universitario La Paz; PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, España
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19
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Zalba Marcos S, Antelo Caamaño ML, García-Erce JA. [Reply]. Med Clin (Barc) 2021; 157:e283. [PMID: 34059354 PMCID: PMC8101785 DOI: 10.1016/j.medcli.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Saioa Zalba Marcos
- Servicio de Hematología y Hemoterapia, Complejo Hospitalario de Navarra, Pamplona, España,Autora para correspondencia
| | - María Luisa Antelo Caamaño
- Servicio de Apoyo a la Gestión Cínica y Continuidad Asistencial, Complejo Hospitalario de Navarra, Pamplona, España
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20
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Beverina I, Jericó C, Quintana-Díaz M, García-Erce JA. Therapeutic Alternative to Transfusion in Nonpregnant Women With Iron Deficiency Anemia Caused by Uterine Blood Loss. J Emerg Med 2021; 60:565-566. [PMID: 33902882 DOI: 10.1016/j.jemermed.2020.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/12/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Ivo Beverina
- Blood Transfusion Centre, Legnano General Hospital, Legnano, Italy
| | - Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain; Department of Medicine, Autonomous University of Madrid, Madrid, Spain; PBM Group, Hospital La Paz, Institute for Health Research, Madrid, Spain
| | - Manuel Quintana-Díaz
- Department of Medicine, Autonomous University of Madrid, Madrid, Spain; PBM Group, Hospital La Paz, Institute for Health Research, Madrid, Spain; Intensive Care Unit, University Hospital La Paz, Madrid, Spain
| | - José Antonio García-Erce
- PBM Group, Hospital La Paz, Institute for Health Research, Madrid, Spain; Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
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21
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García-Erce JA, Romón-Alonso Í, Jericó C, Domingo-Morera JM, Arroyo-Rodríguez JL, Sola-Lapeña C, Bueno-Cabrera JL, Juárez-Vela R, Zalba-Marcos S, Abad-Motos A, Gea-Caballero V, Santolalla-Arnedo I, Quintana-Díaz M. Blood Donations and Transfusions during the COVID-19 Pandemic in Spain: Impact According to Autonomous Communities and Hospitals. Int J Environ Res Public Health 2021; 18:ijerph18073480. [PMID: 33801650 PMCID: PMC8037479 DOI: 10.3390/ijerph18073480] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 01/28/2023]
Abstract
Worldwide, the COVID-19 pandemic has caused a decline in blood donations, between 30% and 70% in some of the most affected countries. In Spain, during the initial eight weeks after the State of Emergency was decreed on 14 March 2020, in the weekly reports of the Health Ministry, an average decrease of 20% was observed between 11 and week 25 compared with the 2018 donation. We aimed to investigate the impact of the COVID-19 pandemic on blood donations and blood distribution in four autonomous communities, and to explore the evolution of the consumption of blood components (BCs) in ten hospitals of six autonomous communities. We performed a prospective study of grouped cohorts on the donation and distribution of blood in four regional transfusion centers in four autonomous communities in Spain, and a retrospective study of the consumption of blood components in ten hospitals in six autonomous communities. Regarding donations, there was no significant decrease in donations, with differences between autonomous communities, which started between 1 and 15 March 2020 (−11%). The increase in donations in phase II (from 26 May 2020) stands out. Regarding consumption, there was a significant reduction in the consumption of packed red blood cells (RBCs) (24.5%), plasma (45.3%), and platelets (25.3%) in the central period (16 March–10 May). The reduction in the consumption of RBCs was significant in the period from 1–15 March. Conclusions: The COVID-19 pandemic has affected the donation and consumption of BCs.
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Affiliation(s)
- José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro Salud, Grupo Español de Rehabilitación Multimodal (GERM), IACS, Zaragoza, Grupo IdiPaz. Madrid, 31008 Pamplona, Spain;
| | - Íñigo Romón-Alonso
- Servicio Hematología y Hemoterapia, Universitario Marqués de Valdecilla, 39003 Santander, Spain;
| | - Carlos Jericó
- Hospital Sant Joan Despí de Barcelona Servicio de Medicina Interna, 08970 Barcelona, Spain;
| | | | | | | | - José Luis Bueno-Cabrera
- Servicio Hematología-Hemoterapia, Hospital Universitario Puerta de Hierro, 28222 Majadahonda-Madrid, Spain;
| | - Raúl Juárez-Vela
- Departamento de Enfermería, Universidad de la Rioja, Centro de Investigación Biomédica de La Rioja CIBIR-GISOSS, 26004 Logroño, Spain
- Correspondence: (R.J.-V.); (I.S.-A.)
| | - Saioa Zalba-Marcos
- Servicio Hematología-Hemoterapia, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Ane Abad-Motos
- Servicio Anestesia y Reanimación, Hospital Infanta Leonor, 28031 Madrid, Spain;
| | - Vicente Gea-Caballero
- Health Research Institut La Fe, Adscript Center Universidad de Valencia, Nursing School La Fe, 46026 Valencia, Spain;
| | - Iván Santolalla-Arnedo
- Departamento de Enfermería, Universidad de la Rioja, Centro de Investigación Biomédica de La Rioja CIBIR-GISOSS, 26004 Logroño, Spain
- Correspondence: (R.J.-V.); (I.S.-A.)
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Grupo IdiPaz. Madrid, 28046 Madrid, Spain;
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22
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Ormazabal Vélez I, Induráin Bermejo J, Espinoza Pérez J, Imaz Aguayo L, Delgado Ruiz M, García-Erce JA. Two patients with rituximab associated low gammaglobulin levels and relapsed covid-19 infections treated with convalescent plasma. Transfus Apher Sci 2021; 60:103104. [PMID: 33637467 PMCID: PMC7894088 DOI: 10.1016/j.transci.2021.103104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/25/2020] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 02/06/2023]
Abstract
Patients with haematological malignancies are considered to be a risk group for developing severe Coronavirus disease (Covid-19). Because of the limitations of therapeutic options, the development of new treatment strategies is mandatory, such as convalescent plasma (CP). Herein we report the use of CP therapy as an off-label indication in two lymphoma patients with relapsed COVID-19 in the setting of low gammaglobulin levels because of previous rituximab chemo-immunotherapy. Both were PCR positive for SARS-CoV-2 but had an absence of antibodies to the virus more than one month later of symptoms initiation. They developed important respiratory and neurological complications. After CP infusion, neutralising antibodies were detected and viral load dissapeared in both patients leading to clinical improvement with no more Covid-19 relapse.
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Affiliation(s)
| | | | | | - Laura Imaz Aguayo
- Department of Neurology, Navarra University Hospital, Pamplona, Spain
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23
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Zalba Marcos S, Antelo ML, Galbete A, Etayo M, Ongay E, García-Erce JA. [Infection and thrombosis associated with COVID-19: Possible role of the ABO blood group]. Med Clin (Barc) 2020; 155:340-343. [PMID: 32814635 PMCID: PMC7346773 DOI: 10.1016/j.medcli.2020.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 12/24/2022]
Abstract
Introducción La infección por SARS-CoV-2 presenta gran heterogeneidad clínica, desde asintomática hasta cuadros clínicos graves con un desenlace fatal. Algunos autores refieren el grupo sanguíneo ABO como posible marcador biológico de susceptibilidad para la enfermedad. Pacientes y métodos Se ha recogido a los pacientes ingresados con infección por COVID-19 y se ha analizado la incidencia por grupos en relación con la base poblacional de la Comunidad Foral de Navarra, así como sus principales complicaciones y evolución. Resultados Los pacientes de grupo O ingresados con infección por COVID-19 son proporcionalmente menos respecto a la base poblacional, sin ser la diferencia estadísticamente significativa. Los grupos AB y B son un 38% más en el grupo de infectados que en la población. El grupo B ha presentado significación estadística en cuanto al número de complicaciones trombóticas junto con mayor tasa de ingreso en unidades de Cuidados Intensivos. Conclusión El estudio sugiere menor susceptibilidad a la infección de los pacientes de grupos O y mayor riesgo de complicaciones en el grupo B. Hacen falta estudios con mayor tamaño muestral para poder obtener resultados significativos.
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Affiliation(s)
- Saioa Zalba Marcos
- Servicio de Hematología y Hemoterapia, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - María Luisa Antelo
- Servicio de Apoyo a la Gestión Clínica y Continuidad Asistencial, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Arkaitz Galbete
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, IDISNA, REDISSEC, Pamplona, Navarra, España
| | - Maialen Etayo
- Servicio de Hematología y Hemoterapia, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Eva Ongay
- Servicio de Análisis Clínicos, Hospital García Orcoyen, Estella-Lizarra, Navarra, España
| | - José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Navarra, España; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, España; Grupo idiPAZ de «Investigación en PBM», Madrid, España.
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24
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Ripollés-Melchor J, Ramírez-Rodríguez JM, Casans-Francés R, Aldecoa C, Abad-Motos A, Logroño-Egea M, García-Erce JA, Camps-Cervantes Á, Ferrando-Ortolá C, Suarez de la Rica A, Cuellar-Martínez A, Marmaña-Mezquita S, Abad-Gurumeta A, Calvo-Vecino JM. Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study. JAMA Surg 2020; 154:725-736. [PMID: 31066889 DOI: 10.1001/jamasurg.2019.0995] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Enhanced Recovery After Surgery (ERAS) care has been reported to be associated with improvements in outcomes after colorectal surgery compared with traditional care. Objective To determine the association between ERAS protocols and outcomes in patients undergoing elective colorectal surgery. Design, Setting, and Participants The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study is a multicenter, prospective cohort study of 2084 consecutive adults scheduled for elective colorectal surgery who received or did not receive care in a self-declared ERAS center. Patients were recruited from 80 Spanish centers between September 15 and December 15, 2017. All patients included in this analysis had 1 month of follow-up. Exposures Colorectal surgery and perioperative management were the exposures. Twenty-two individual ERAS items were assessed in all patients, regardless of whether they were included in an established ERAS protocol. Main Outcomes and Measures The primary study outcome was moderate to severe postoperative complications within 30 days after surgery. Secondary outcomes included ERAS adherence, mortality, readmissions, reoperation rates, and hospital length of stay. Results Between September 15 and December 15, 2017, 2084 patients were included in the study. Of these, 1286 individuals (61.7%) were men; mean age was 68 years (interquartile range [IQR], 59-77). A total of 879 patients (42.2%) presented with postoperative complications and 566 patients (27.2%) developed moderate to severe complications. The number of patients with moderate or severe complications was lower in the ERAS group (25.2% vs 30.3%; odds ratio [OR], 0.77; 95% CI, 0.63-0.94; P = .01). The overall rate of adherence to the ERAS protocol was 63.6% (IQR, 54.5%-77.3%), and the rate for patients from hospitals self-declared as ERAS was 72.7% (IQR, 59.1%-81.8%) vs non-ERAS institutions, which was 59.1% (IQR, 50.0%-63.6%; P < .001). Adherence quartiles among patients receiving the highest and lowest ERAS components showed that the patients with the highest adherence rates had fewer moderate to severe complications (OR, 0.34; 95% CI, 0.25-0.46; P < .001), overall complications (OR, 0.33; 95% CI, 0.26-0.43; P < .001), and mortality (OR, 0.27; 95% CI, 0.07-0.97; P = .06) compared with those who had the lowest adherence rates. Conclusions and Relevance An increase in ERAS adherence appears to be associated with a decrease in postoperative complications.
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Affiliation(s)
- Javier Ripollés-Melchor
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain
| | - José M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of General Surgery, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Rubén Casans-Francés
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of Anaesthesia and Perioperative Medicine. Lozano Blesa University Hospital, Zaragoza, Spain
| | - César Aldecoa
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of Anaesthesia and Perioperative Medicine, Río Hortega University Hospital, Valladolid, Spain
| | - Ane Abad-Motos
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain
| | - Margarita Logroño-Egea
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Department of Anaesthesia and Perioperative Medicine, Alava University Hospital, Alava, Spain
| | - José Antonio García-Erce
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain.,Anemia Working Group Spain, Barcelona, Spain
| | - Ángels Camps-Cervantes
- Department of Anaesthesia and Critical Care, Vall d´Hebrón University Hospital, Barcelona, Spain
| | - Carlos Ferrando-Ortolá
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of Anaesthesia and Perioperative Medicine, Hospital Clínic Universitat de Barcelona, Barcelona, Spain
| | - Alejandro Suarez de la Rica
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of Anaesthesia and Critical Care, La Paz University Hospital, Madrid, Spain
| | - Ana Cuellar-Martínez
- Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of Anaesthesia and Critical Care, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sandra Marmaña-Mezquita
- Department of Anaesthesia and Perioperative Medicine, Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Alfredo Abad-Gurumeta
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain
| | - José M Calvo-Vecino
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of Anaesthesia and Critical Care, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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25
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Abad-Motos A, Ripollés-Melchor J, Jericó C, Basora M, Aldecoa C, Cabellos-Olivares M, Navarro-Pérez R, Bisbe E, García-Erce JA. Patient Blood Management for primary hip and knee replacement. A survey among POWER.2 study researchers. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:237-244. [PMID: 32165061 DOI: 10.1016/j.redar.2020.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/20/2019] [Revised: 12/28/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Implementation of Patient Blood Management programs remain variable in Europe, and even in centres with well-established PBM programs variability exists in transfusion practices. OBJECTIVES AND METHODS We conducted a survey in order to assess current practice in perioperative Patient Blood Management in patients undergoing total hip and knee replacement among researchers involved in POWER.2 Study in Spain (an observational prospective study evaluating enhanced recovery pathways in orthopaedic surgery). RESULTS A total of 322 responses were obtained (37.8%). Half of responders check Haemoglobin levels in patients at least 4 weeks before surgery; 35% treat all anaemic patients, although 99.7% consider detection and treatment of preoperative anaemia could influence the postoperative outcomes. Lack of infrastructure (76%) and lack of time (51%) are the main stated reasons not to treat anaemic patients. Iron status is routinely checked by 19% before surgery, and 36% evaluate it solely in the anaemic patient. Hb<9.9 g/dl is the threshold to delay surgery for 61% of clinicians, and 22% would consider transfusing preoperatively clinically stable patients without active bleeding. The threshold to transfuse patients without cardiovascular disease is 8 g/dl for 43%, and 7 g/dl for 34% of the responders; 75% of clinicians consider they use "restrictive thresholds", and 90% follow the single unit transfusion policy. CONCLUSIONS The results of our survey show variability in clinical practice in Patient Blood Management in major orthopaedic surgery, despite being the surgery with the greatest tradition in these programs.
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Affiliation(s)
- A Abad-Motos
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España.
| | - J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España
| | - C Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí-Moisés Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Anemia Working Group España (AWGE)
| | - M Basora
- Servicio de Anestesiología y Reanimación, Hospital Clínic Universitari, Barcelona, España; Anemia Working Group España (AWGE)
| | - C Aldecoa
- Servicio de Anestesiología y Reanimación, Hospital Universitario Río Hortega, Valladolid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España
| | - M Cabellos-Olivares
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Guadalajara, Guadalajara, España
| | - R Navarro-Pérez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Clínico San Carlos, Madrid, España
| | - E Bisbe
- Servicio de Anestesiología y Reanimación, Parc de Salut Mar, Barcelona, España; Anemia Working Group España (AWGE)
| | - J A García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Anemia Working Group España (AWGE)
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26
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Ripollés-Melchor J, Abad-Motos A, Díez-Remesal Y, Aseguinolaza-Pagola M, Padin-Barreiro L, Sánchez-Martín R, Logroño-Egea M, Catalá-Bauset JC, García-Orallo S, Bisbe E, Martín N, Suárez-de-la-Rica A, Cuéllar-Martínez AB, Gil-Trujillo S, Estupiñán-Jiménez JC, Villanova-Baraza M, Gil-Lapetra C, Pérez-Sánchez P, Rodríguez-García N, Ramiro-Ruiz A, Farré-Tebar C, Martínez-García A, Arauzo-Pérez P, García-Pérez C, Abad-Gurumeta A, Miñambres-Villar MA, Sánchez-Campos A, Jiménez-López I, Tena-Guerrero JM, Marín-Peña O, Sánchez-Merchante M, Vicente-Gutiérrez U, Cassinello-Ogea MC, Ferrando-Ortolá C, Berges-Gutiérrez H, Fernanz-Antón J, Gómez-Ríos MA, Bordonaba-Bosque D, Ramírez-Rodríguez JM, García-Erce JA, Aldecoa C. Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2). JAMA Surg 2020; 155:e196024. [PMID: 32049352 DOI: 10.1001/jamasurg.2019.6024] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery. Objective To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Design, Setting, and Participants This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019. Exposures Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not. Main Outcomes and Measures The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality. Results During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P < .001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P < .001) and moderate to severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84; P < .001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR, 4-6] days; OR, 0.97; 95% CI, 0.96-0.99; P < .001). Conclusions and Relevance An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes.
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Affiliation(s)
- Javier Ripollés-Melchor
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid
| | - Ane Abad-Motos
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid
| | - Yolanda Díez-Remesal
- Department of Anaesthesia and Critical Care, Ramón y Cajal University Hospital, Madrid, Spain
| | - Marta Aseguinolaza-Pagola
- Department of Anaesthesia, Donostia University Hospital/Donostia Unibertsitate Ospitalea, San Sebastián, Spain
| | - Lidia Padin-Barreiro
- Department of Anaesthesia, Complejo Hospitalario Universitario De Vigo-Eoxi Vigo, Vigo, Spain
| | - Rubén Sánchez-Martín
- Department of Anaesthesia, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Juan C Catalá-Bauset
- Department of Anaesthesia, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Silvia García-Orallo
- Department of Anaesthesia, Hospital Universitario Sierrallana, Torrelavega, Spain
| | - Elvira Bisbe
- Department of Anaesthesia, Hospitales del Parc de Salut Mar, Barcelona, Spain
| | - Nuria Martín
- Department of Anaesthesia, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alejandro Suárez-de-la-Rica
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia and Critical Care, La Paz University Hospital, Madrid, Spain
| | - Ana B Cuéllar-Martínez
- Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia and Critical Care, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Silvia Gil-Trujillo
- Department of Anaesthesia, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | - Cristina Gil-Lapetra
- Department of Anaesthesia, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | | | | | - Alvaro Ramiro-Ruiz
- Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carla Farré-Tebar
- Department of Anaesthesia, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | | | | | | | - Alfredo Abad-Gurumeta
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid
| | | | | | | | | | - Oliver Marín-Peña
- Department of Orthopedia, Infanta Leonor University Hospital, Madrid, Spain
| | | | | | | | - Carlos Ferrando-Ortolá
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Jesús Fernanz-Antón
- Department of Anaesthesia, Hospital Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
| | - Manuel A Gómez-Ríos
- Department of Anaesthesia, Complejo Hospitalario Universitario de A Coruña, Coruña, Spain
| | | | - José M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain.,Department of Surgery, Lozano Blesa University Hospital, Zaragoza, Spain
| | - José Antonio García-Erce
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain
| | - César Aldecoa
- Spanish Perioperative Audit and Research Network (REDGERM).,Grupo Español de Rehabilitación Multimodal, Enhanced Recovery After Surgery Spain Chapter, Madrid.,Department of Anaesthesia and Perioperative Medicine, Río Hortega University Hospital, Valladolid, Spain
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Parra Salinas I, Recasens Flores V, Montañés MÁ, García-Erce JA. Therapeutic erythroapheresis: Experience in patients with polycythemia vera and secondary erythrocytosis. Med Clin (Barc) 2020; 154:16-19. [PMID: 30795904 DOI: 10.1016/j.medcli.2018.12.016] [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: 07/23/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Abstract
Therapeutic erythrocytapheresis (TE) is a more efficient strategy compared to phlebotomy to deplete levels of haematocrit in primary and secondary erythrocytosis. OBJECTIVE To analyse response rate and safety profile of TE in polycythemia vera (PV) and secondary erythrocytosis (SE). PATIENTS AND METHOD Retrospective review of all patients with PV or SE treated with TE, due to phlebotomy failure, or comorbidities that prevented changes of blood volumen. RESULTS 217 TE sessions (48 PV and 79 SE) corresponding to 20 patients (12 ES and 8 PV). Response were achieved in 87.5% of PV patients and in 50% of SE patients. Adverse effects related to TE performance occurred in 7.08%. CONCLUSION Despite our small sample size and the heterogeneous nature of the patients included, we can postulate that TE is a secure strategy that can achieve haematocrit depletion in a shorter time than phlebotomy, specifically in PV patients and in selected cases of SE with expected haemodynamic intolerance to phlebotomies or in patients who fail to respond to phlebotomies.
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Affiliation(s)
| | | | | | - José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Pamplona, España; Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en sentido común», España.
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Jericó Alba C, Abad-Motos A, Ripollés-Melchor J, García-Erce JA. Evaluación y tratamiento del déficit de hierro con o sin anemia en rehabilitación multimodal de cirugía bariátrica. Cir Esp 2020; 98:58-59. [DOI: 10.1016/j.ciresp.2019.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/09/2019] [Accepted: 08/16/2019] [Indexed: 01/13/2023]
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Jericó Alba C, Ramírez-Rodríguez JM, García-Erce JA. Development of Patient Blood Management programs in vascular surgery, another emerging challenge or an urgent need? Med Clin (Barc) 2019; 153:472-473. [PMID: 31122720 DOI: 10.1016/j.medcli.2019.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Carlos Jericó Alba
- Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org); Servicio de Medicina Interna, Hospital Sant Joan Despí-Moisés Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España
| | - José M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network (REDGERM); Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter; Department of General Surgery, Hospital Universitario Lozano Blesa, Zaragoza, España
| | - José Antonio García-Erce
- Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org); Spanish Perioperative Audit and Research Network (REDGERM); Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter; Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en sentido común».
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Menéndez-Jándula B, García-Erce JA, Zazo C, Larrad-Mur L. Correction to: Long-term effectiveness and safety of self-management of oral anticoagulants in real-world settings. BMC Cardiovasc Disord 2019; 19:263. [PMID: 31771510 PMCID: PMC6880353 DOI: 10.1186/s12872-019-1268-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Menéndez-Jándula B, García-Erce JA, Zazo C, Larrad-Mur L. Long-term effectiveness and safety of self-management of oral anticoagulants in real-world settings. BMC Cardiovasc Disord 2019; 19:186. [PMID: 31375070 PMCID: PMC6679483 DOI: 10.1186/s12872-019-1168-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/23/2019] [Indexed: 02/02/2023] Open
Abstract
Background The patient self-management (PSM) is an effective approach for controlling the international normalized ratio, INR, within the therapeutic range. Nevertheless, most of the literature derives from randomized clinical trials, and no from routine clinical practice. The main objective of the present study was to evaluate long-term effectiveness and safety of PSM of oral anticoagulants (OACs) in real-world settings. Methods This prospective cohort study involved 808 patients who were trained for PSM between July 2009 and March 2012, and followed-up for a maximum observational period of 5 years. The follow-up consisted of a visit to the physician every 6 months. All patients used the same type of portable coagulometer, able to store digitally up to 100 INR measurements. Effectiveness outcomes included the percentage of patients within the therapeutic range, the time within therapeutic range (TTR), and the evolution of the TTR over 365 days of follow-up. Long-term safety profile of PSM included the incidence of all-cause deaths and complications (thromboembolic or hemorrhagic) reported between July 2009 and June 2014, and the time to event. Results The median follow-up was 3.3 years. The percentage of patients within therapeutic INR target range was 67.5%. The median TTR was 71.5%. The TTR increased over the follow-up period, either overall and regarding target INR. All-cause mortality was 2.4 per 100 patient-years (59 cases). The thromboembolic event rate was 0.9 per 100 patient-years (24 cases). The rate of major hemorrhages was 0.45 per 100 patient-years. Patients who drop out the PSM to perform the conventional management had greater rates of complications: 2.4, 1.8, and 3.4 per 100 patient-years for thromboembolic complications, major hemorrhagic events, and mortality, respectively. Conclusions The PSM of OACs is effective for maintaining patients within the INR therapeutic range for a long period of time in routine clinical practice. Results of the present study suggest that its effectiveness is at least comparable to the conventional management. Moreover, it seems safe in real-world settings, by preventing all-cause mortality, and thromboembolic and major hemorrhagic complications. Trial registration This study was not a trial, thus registration was not required.
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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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Rivilla Marugán L, Lorente Aznar T, Molinero Rodriguez M, García-Erce JA. [Anaemia and the elderly: Critical review of its definition and prevalence]. Rev Esp Geriatr Gerontol 2019; 54:189-194. [PMID: 31164237 DOI: 10.1016/j.regg.2019.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/03/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVES The prevalence of anaemia is an important health indicator, although there is little rigorous information gathered on the elderly population, particularly in those over 80 years old. The same criteria that are used in the general population are often used to define anaemia in the elderly. The epidemiological data collected by the WHO in 1968 (that have been used to generalise this criteria), did not include the population over 65 years-old. Two objectives are established, which includes a critical review of the available evidence on whether the criteria used to define anaemia in the adult population can be extrapolated to the elderly, and a review of publications on the prevalence of anaemia in the elderly over 80 years-old. MATERIAL AND METHODS A systematic bibliographic search was performed on the established objectives. RESULTS Although the WHO criteria, based on data from 1968, are widely used, other possible cut-off points have been proposed for elderly people. A total of 20 studies were found that were conducted in North America and Europe, with only 70,000 patients, and different age criteria. The prevalence of anaemia ranges between 3% and 63%, depending on the diagnostic criteria, age, and whether they were institutionalised or not. CONCLUSIONS Anaemia is a very prevalent disease in elderly patients. The collection of large databases is necessary to determine more adequate diagnostic criteria.
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Affiliation(s)
- Laura Rivilla Marugán
- Medicina Familiar y Comunitaria, Centro de Salud de Sabiñánigo, Servicio Aragonés de Salud, Huesca, España
| | - Teófilo Lorente Aznar
- Medicina Familiar y Comunitaria, Centro de Salud de Sabiñánigo, Servicio Aragonés de Salud, Huesca, España
| | - Mónica Molinero Rodriguez
- Medicina Familiar y Comunitaria, Centro de Salud de Sabiñánigo, Servicio Aragonés de Salud, Huesca, España
| | - José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en sentido común».
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Jericó Alba C, M Ramírez-Rodríguez J, Ripollés-Melchor J, García-Erce JA. Transfusion and/or anemia as risk factors for infection in rectal surgery: Association or causality? Cir Esp 2019; 97:242-243. [PMID: 30857735 DOI: 10.1016/j.ciresp.2019.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Carlos Jericó Alba
- Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org); Servicio de Medicina Interna, Hospital Sant Joan Despí-Moisés Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España
| | - José M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network (REDGERM); Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter; Departamento de Cirugía General, Hospital Universitario Lozano Blesa, Zaragoza, España
| | - Javier Ripollés-Melchor
- Spanish Perioperative Audit and Research Network (REDGERM); Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter; Departamento de Anestesia y Cuidados Críticos, Hospital Universitario Infanta Leonor, Madrid, España; Universidad Complutense de Madrid, Madrid, España
| | - José Antonio García-Erce
- Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org); Spanish Perioperative Audit and Research Network (REDGERM); Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter; Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, España; Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en sentido común».
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Muñoz M, García-Erce JA. Respuesta. Med Clin (Barc) 2019; 152:205-206. [DOI: 10.1016/j.medcli.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 06/10/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
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Jericó Alba C, Herrera Rodríguez A, García-Erce JA. [Effectiveness and safety of alpha-erythropoietin in the (orthopaedic) patient over 65 years old]. Rev Esp Geriatr Gerontol 2019; 54:123-124. [PMID: 30396786 DOI: 10.1016/j.regg.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/01/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Carlos Jericó Alba
- Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org), España; Servicio de Medicina Interna, Hospital Sant Joan Despí-Moisés Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España
| | - Antonio Herrera Rodríguez
- Catedrático Emérito de Cirugía Ortopédica y Traumatología, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España
| | - José Antonio García-Erce
- Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org), España; Spanish Perioperative Audit and Research Network (REDGERM), España; Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, España; Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, España; Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en sentido común».
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Ripollés-Melchor J, Abad-Motos A, Logroño-Egea M, Aldecoa C, García-Erce JA, Jiménez-López I, Cassinello-Ogea C, Marín-Peña O, Ferrando-Ortolá C, de la Rica AS, Gómez-Ríos MA, Sánchez-Martín R, Abad-Gurumeta A, Casans-Francés R, Mugarra-Llopis A, Varela-Durán M, Longás-Valién J, Ramiro-Ruiz Á, Cuellar-Martínez AB, Ramírez-Rodríguez JM, Calvo-Vecino JM. Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty. POWER.2 Study: Study Protocol for a Prospective, Multicentre, Observational Cohort Study. Turk J Anaesthesiol Reanim 2019; 47:179-186. [PMID: 31183463 DOI: 10.5152/tjar.2019.87523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/13/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022] Open
Abstract
Objective The number of indications for total hip replacement (THR) and total knee replacement (TKR) surgery is increasing. Enhanced recovery after surgery (ERAS) represents the next step in the evolution of standardised care. The primary aim of this study is to measure the in-hospital 30-day medical and surgical postoperative complications rate. The study's secondary aims are to determine the length of stay, 30-day mortality rate, 30-day reoperation and readmission rates, the ERAS overall compliance and predefined ERAS individual items compliance. Methods This multicentre, prospective, observational study will include adult patients (aged >18 years) undergoing elective THR and TKR surgery. Consecutive patients undergoing surgery within the 2-month data collection period will be included. Centres that offer the THR and/or TKR surgery will be eligible to participate. The data collection will be done through an online data collection form via a secure, password-protected platform at each centre with predefined data fields. Results Ethical approval for this study has been obtained from the Comité de Ética de la Investigación de la Comunidad Autónoma de Aragón (C.P.-C.I. PI18/135; on 23 May 2018). It was prospectively registered on 27 June 2018, at www.clinicaltrials.gov with identification no. NCT03570944. Conclusion The study will be disseminated through the SPARN-RedGERM, SEDAR, GERM and through social media. Peer-reviewed publications will be published under corporate authorship, including POWER.2 Study Group and SPARN-RedGERM.
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Affiliation(s)
- Javier Ripollés-Melchor
- Department of Anesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,Spanish Perioperative Audit and Research Network (REDGERM), Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, Spain
| | - Ane Abad-Motos
- Department of Anesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,Spanish Perioperative Audit and Research Network (REDGERM), Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, Spain
| | - Margarita Logroño-Egea
- Spanish Perioperative Audit and Research Network (REDGERM), Spain.,Department of Anesthesia and Perioperative Medicine, Alava University Hospital, Alava, Spain
| | - César Aldecoa
- Spanish Perioperative Audit and Research Network (REDGERM), Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, Spain.,Department of Anesthesia and Perioperative Medicine, Río Hortega University Hospital, Valladolid, Spain
| | - José Antonio García-Erce
- Spanish Perioperative Audit and Research Network (REDGERM), Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, Spain.,Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain.,Anemia Working Group Spain (AWGE), Spain
| | - Ignacio Jiménez-López
- Department of Anesthesia and Critical Care, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Oliver Marín-Peña
- Department of Hip-Knee Orthopedic Surgery, Infanta Leonor University Hospital, Madrid, Spain
| | - Carlos Ferrando-Ortolá
- Spanish Perioperative Audit and Research Network (REDGERM), Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, Spain.,Department of Anesthesia and Perioperative Medicine, Hospital Clínic Universitat de Barcelona, Barcelona, Spain.,CIBER Enfermedades Respiratorias, Instituto Carlos III, Madrid, Spain
| | - Alejandro Suárez de la Rica
- Spanish Perioperative Audit and Research Network (REDGERM), Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, Spain.,Department of Anesthesia and Critical Care, La Paz University Hospital, Madrid, Spain
| | - Manuel A Gómez-Ríos
- Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, Spain.,Department of Anesthesia and Critical Care, Hospital Universitario de A Coruña, Spain
| | - Rubén Sánchez-Martín
- Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, Spain.,Department of Anesthesia and Critical Care, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Alfredo Abad-Gurumeta
- Department of Anesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, Spain
| | - Rubén Casans-Francés
- Spanish Perioperative Audit and Research Network (REDGERM), Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, Spain.,Department of Anesthesia and Critical Care, Infanta Elena University Hospital, Valedemoro, Spain
| | - Ana Mugarra-Llopis
- Department of Anesthesia and Perioperative Medicine, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Marina Varela-Durán
- Spanish Perioperative Audit and Research Network (REDGERM), Spain.,Department of Anesthesia and Critical Care, Complejo Hospitalario Universitario de Pontevedra, Hospital de Montecelo, Pontevedra, Spain
| | - Javier Longás-Valién
- Spanish Perioperative Audit and Research Network (REDGERM), Spain.,Department of Anesthesia and Perioperative Medicine, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Álvaro Ramiro-Ruiz
- Department of Anesthesia and Critical Care, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana B Cuellar-Martínez
- Spanish Perioperative Audit and Research Network (REDGERM), Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, Spain.,Department of Anesthesia and Perioperative Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network (REDGERM), Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, Spain.,Department of General Surgery, Lozano Blesa University Hospital, Zaragoza, Spain
| | - José M Calvo-Vecino
- Spanish Perioperative Audit and Research Network (REDGERM), Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Enhanced Recovery After Surgery (ERAS) Spain Chapter, Spain.,Department of Anesthesia and Critical Care, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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Rodríguez-García J, Zarrabeitia-Puente R, Fernández-Santos R, García-Erce JA. Infection prevention in patients with hereditary hemorrhagic telangiectasia. Haematologica 2018; 103:e491-e492. [PMID: 30270206 DOI: 10.3324/haematol.2018.200873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Juan Rodríguez-García
- Unit of Vaccination of the Immunocompromised Patients, Preventive Medicine Department, Son Espases University Hospital Palma, Balearic Islands, Spain
| | - Roberto Zarrabeitia-Puente
- Hereditary Hemorrhagic Telangiectasia Unit, Internal Medicine Department, Sierrallana Hospital, Torrelavega, Cantabria, Spain
| | - Rafael Fernández-Santos
- Unit of Vaccination of the Immunocompromised Patients, Preventive Medicine Department, Obispo Polanco Hospital, Teruel, Spain
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Ripollés-Melchor J, García-Erce JA, Vincent JL. Transfusion thresholds and red blood cells transfusion focused on tissue oxygenation. Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65:363-365. [PMID: 29657065 DOI: 10.1016/j.redar.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 06/08/2023]
Affiliation(s)
- J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España.
| | - J A García-Erce
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en sentido común», España; Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org), España; Grupo idiPAZ de «Investigación en PBM», Madrid, España
| | - J-L Vincent
- Department of Intensive Care, Erasme University Hospital (Université Libre de Bruxelles), Bruselas, Bélgica
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Barni S, Gascòn P, Petrelli F, García-Erce JA, Pedrazzoli P, Rosti G, Giordano G, Mafodda A, Múñoz M. Position paper on management of iron deficiency in adult cancer patients. Expert Rev Hematol 2017; 10:685-695. [PMID: 28656800 DOI: 10.1080/17474086.2017.1343140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Disorders of iron metabolism are commonly seen in onco-hematological clinical practice. Iron-deficiency anemia and cancer-associated anemia are usually treated with supportive therapies. Optimal management of these conditions are discussed in this perspective paper. Areas covered: A position paper discussing a number of hot topics on anemia in cancer patients is presented. The main areas covered by experts in the field are: definitions, prevalence and consequences of anemia and iron deficiency, incidence of anemia resulting from targeted therapies, importance of anemia diagnosis and monitoring, evaluation of iron status before and during treatment, role of transfusions and erythropoiesis-stimulating agents, management of iron deficiency with or without anemia, parenteral iron supplementation, role of new oral iron formulations, safety and cost issues regarding different iron compounds and administration routes. Expert commentary: Despite the availability of newer therapeutic options for its management, anemia still represents a major complication of treatment in cancer patients (surgery, chemotherapy, radiotherapy, targeted therapies), aggravating physical impairment, and negatively affecting general outcome. The view expressed by the panelists, attendees of the 4th Mediterranean Course on Iron Anemia, summarizes what they consider optimal clinical practice for screening, diagnosis, treatment and monitoring of iron deficiency and anemia in cancer patients.
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Affiliation(s)
- Sandro Barni
- a Oncology Department , Medical Oncology Unit , Treviglio , Italy
| | - Pere Gascòn
- b Division of Medical Oncology , Hospital Clinic, University of Barcelona , Barcelona , Spain
| | - Fausto Petrelli
- a Oncology Department , Medical Oncology Unit , Treviglio , Italy
| | | | - Paolo Pedrazzoli
- d Medical Oncology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - Giovanni Rosti
- d Medical Oncology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - Giulio Giordano
- e General Medicine and Hematology Department , General Medicine and Hematology Regional Hospital 'A. Cardarelli' , Campobasso , Italy
| | - Antonio Mafodda
- f Medical Oncology Unit , A.O. B.M.M , Reggio Calabria , Italy
| | - Manuel Múñoz
- g Peri-operative Transfusion Medicine , School of Medicine, University of Malaga , Malaga , Spain
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41
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Rodríguez-García J, Fernández-Santos R, Zarrabeitia-Puente R, García-Erce JA. Vaccination of patients with hereditary haemorrhagic telangiectasia. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.medcle.2015.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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42
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Canillas F, Gómez-Ramírez S, García-Erce JA, Pavía-Molina J, Gómez-Luque A, Muñoz M. “Patient Blood Management” in orthopedic surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Canillas F, Gómez-Ramírez S, García-Erce JA, Pavía-Molina J, Gómez-Luque A, Muñoz M. "Patient blood management" in orthopaedic surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:137-49. [PMID: 25650076 DOI: 10.1016/j.recot.2014.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/30/2014] [Revised: 09/24/2014] [Accepted: 11/13/2014] [Indexed: 01/28/2023] Open
Abstract
Orthopaedic and trauma surgical procedures (OTS) can lead to significant blood losses and acute postoperative anaemia, which in many cases requires allogeneic blood transfusions (ABT). The clinical, economic and logistical disadvantages of ABT have promoted the development of multidisciplinary and multimodal programs generically known as Patient Blood Management (PBM) programs, which have as their objective to reduce or eliminate the need for ABT and improve clinical outcomes. These programs are supported by the implementation of four groups of perioperative measures: (1) use of restrictive transfusion criteria; (2) stimulation of erythropoiesis; (3) reduction of bleeding; and (4) autologous blood transfusion. In this article, a review is presented of the effectiveness, safety and recommendations of applicable strategies in OTS, as well as the barriers and requirements to the development and implementation of PBM programs in this surgical specialty.
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Affiliation(s)
- Fernando Canillas
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Cruz Roja, Madrid, España.
| | - Susana Gómez-Ramírez
- GIEMSA, Medicina Transfusional Perioperatoria, Facultad de Medicina, Universidad de Málaga, Málaga, España
| | | | - José Pavía-Molina
- GIEMSA, Medicina Transfusional Perioperatoria, Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - Aurelio Gómez-Luque
- Servicio de Anestesiología y Reanimación, Hospital Clínico Virgen de la Victoria, Málaga, España
| | - Manuel Muñoz
- GIEMSA, Medicina Transfusional Perioperatoria, Facultad de Medicina, Universidad de Málaga, Málaga, España
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44
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Rodríguez-García J, Fernández-Santos R, Zarrabeitia-Puente R, García-Erce JA. [Vaccination of patients with hereditary hemorrhagic telangiectasia]. Med Clin (Barc) 2014; 144:572-3. [PMID: 25441027 DOI: 10.1016/j.medcli.2014.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/04/2014] [Indexed: 01/28/2023]
Affiliation(s)
- Juan Rodríguez-García
- Servicio de Medicina Preventiva, Calidad y Seguridad del Paciente, Gerencia de Atención Especializada Áreas III y IV, Hospital de Sierrallana, Torrelavega, Cantabria, España.
| | | | - Roberto Zarrabeitia-Puente
- Unidad de telangiectasia hemorrágica hereditaria (HHT), Servicio de Medicina Interna, Gerencia de Atención Especializada Áreas III y IV, Hospital de Sierrallana, Torrelavega, Cantabria, España
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45
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Leal-Noval SR, Muñoz M, Asuero M, Contreras E, García-Erce JA, Llau JV, Moral V, Páramo JA, Quintana M. [2013: The Seville document on consensus on the alternatives to allogenic blood transfusion. Update to the Seville document. Spanish Societies of Anaesthesiology (SEDAR), Haematology and Haemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Haemostasis (SETH) and Blood Transfusion (SETS)]. Farm Hosp 2014; 37:209-35. [PMID: 23789799 DOI: 10.7399/fh.2013.37.3.133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to TSA (AABT) have emerged, but there is a huge variability with respect to their indications and appropriate use. This variability results from the interplay of a number of factors, which include physicians specialty, knowledge and preferences, degree of anaemia, transfusion policy, and AABT availability. Since the ABBT are not harmless and may not meet costeffectiveness criteria, such avariability is unacceptable. The Spanish Societies of Anaesthesiology (SEDAR), Haematology and Haemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Haemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these six Societies have conducted a systematic review of the medical literature and developed the «2013. Seville Document of Consensus on Alternatives to Allogeneic Blood Transfusion», which only considers those AABT aimed to decrease the transfusion of packed red cells. The AABTs are defined as any pharmacological and non-pharmacological measure aimed to decrease the transfusion of of red blood cell concentrates, while preserving the patient safety. For each AABT, the main question is formulated, positively or negatively, as: «Does or does not this particular AABT reduce the transfusion rate?» All the recommendations on the use of AABTs were formulated according to the GRADE (Grades of Recommendation Assessment, Development and Evaluation) methodology.
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Fernández-Santos R, Rodríguez-García J, García-Erce JA. [Vaccination of patients with chronic lymphocytic leukemia]. Med Clin (Barc) 2014; 142:561-2. [PMID: 24378150 DOI: 10.1016/j.medcli.2013.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 09/05/2013] [Indexed: 11/28/2022]
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Matarraz S, Paiva B, Díez-Campelo M, Bárrena S, Jara-Acevedo M, Gutiérrez ML, Sayagués JM, Sánchez ML, Bárcena P, Garrastazul MP, Berruezo MJ, Duran JM, Cerveró C, García-Erce JA, Florensa L, Méndez GD, Gutierrez O, Del Cañizo MC, van Dongen JJM, San Miguel JF, Orfao A. Immunophenotypic alterations of bone marrow myeloid cell compartments in multiple myeloma patients predict for myelodysplasia-associated cytogenetic alterations. Leukemia 2014; 28:1747-50. [PMID: 24625552 DOI: 10.1038/leu.2014.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- S Matarraz
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - B Paiva
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain
| | - M Díez-Campelo
- Department of Hematology, University Hospital, IBSAL and University of Salamanca, Salamanca, Spain
| | - S Bárrena
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - M Jara-Acevedo
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - M L Gutiérrez
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - J M Sayagués
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - M-L Sánchez
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - P Bárcena
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
| | - M P Garrastazul
- Department of Hematology, Hospital Punta Europa, Algeciras, Spain
| | - M J Berruezo
- Department of Hematology, Hospital Punta Europa, Algeciras, Spain
| | - J M Duran
- Department of Hematology, Hospital La Línea, Cádiz, Spain
| | - C Cerveró
- Department of Hematology, Hospital Virgen de la Luz, Cuenca, Spain
| | | | - L Florensa
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - G D Méndez
- Department of Hematology, Hospital de Jerez, Cádiz, Spain
| | - O Gutierrez
- Department of Hematology, Rio Hortega Hospital, Valladolid, Spain
| | - M C Del Cañizo
- Department of Hematology, University Hospital, IBSAL and University of Salamanca, Salamanca, Spain
| | - J J M van Dongen
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J F San Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain
| | - A Orfao
- Department of Medicine, Centro de Investigación del Cáncer (IBMCC, University of Salamanca-CSIC) and IBSAL, Salamanca, Spain
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Muñoz M, Gómez-Ramírez S, Martín-Montañez E, Pavía J, Cuenca J, García-Erce JA. Perioperative intravenous iron: an upfront therapy for treating anaemia and reducing transfusion requirements. NUTR HOSP 2013; 27:1817-36. [PMID: 23588429 DOI: 10.3305/nh.2012.27.6.6087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 08/07/2012] [Indexed: 12/01/2022] Open
Abstract
Perioperative anaemia, with iron deficiency being its leading cause, is a frequent condition among surgical patients, and has been linked to increased postoperative morbidity and mortality, and decreased quality of life. Postoperative anaemia is even more frequent and is mainly caused by perioperative blood loss, aggravated by inflammation-induced blunting of erythropoiesis. Allogenic transfusion is commonly used for treating acute perioperative anaemia, but it also increases the rate of morbidity and mortality in surgical and critically ill patients. Thus, overall concerns about adverse effects of both preoperative anaemia and allogeneic transfusion have prompted the review of transfusion practice and the search for safer and more biologically rational treatment options. In this paper, the role of intravenous iron therapy (mostly with iron sucrose and ferric carboxymaltose), as a safe and efficacious tool for treating anaemia and reducing transfusion requirements in surgical patients, as well as in other medical areas, has been reviewed. From the analysis of published data and despite the lack of high quality evidence in some areas, it seems fair to conclude that perioperative intravenous iron administration, with or without erythropoiesis stimulating agents, is safe, results in lower transfusion requirements and hastens recovery from postoperative anaemia. In addition, some studies have reported decreased rates of postoperative infection and mortality, and shorter length of hospital stay in surgical patients receiving intravenous iron.
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Affiliation(s)
- M Muñoz
- Transfusion Medicine, School of Medicine, University of Málaga, Málaga, Spain.
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Muñoz M, Gómez-Ramírez S, Cuenca J, García-Erce JA, Iglesias-Aparicio D, Haman-Alcober S, Ariza D, Naveira E. Very-short-term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery: a pooled analysis of observational data from 2547 patients. Transfusion 2013; 54:289-99. [DOI: 10.1111/trf.12195] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 02/11/2013] [Accepted: 02/15/2013] [Indexed: 12/13/2022]
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50
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Leal-Noval SR, Muñoz M, Asuero M, Contreras E, García-Erce JA, Llau JV, Moral V, Páramo JA, Quintana M, Basora M, Bautista-Paloma FJ, Bisbe E, Bóveda JL, Castillo-Muñoz A, Colomina MJ, Fernández C, Fernández-Mondéjar E, Ferrándiz C, García de Lorenzo A, Gomar C, Gómez-Luque A, Izuel M, Jiménez-Yuste V, López-Briz E, López-Fernández ML, Martín-Conde JA, Montoro-Ronsano B, Paniagua C, Romero-Garrido JA, Ruiz JC, Salinas-Argente R, Sánchez C, Torrabadella P, Arellano V, Candela A, Fernández JA, Fernández-Hinojosa E, Puppo A. [The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document]. Med Intensiva 2013; 37:259-83. [PMID: 23507335 DOI: 10.1016/j.medin.2012.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 12/12/2012] [Accepted: 12/19/2012] [Indexed: 02/06/2023]
Abstract
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: « Does this particular AABT reduce the transfusion rate or not?» All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.
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Affiliation(s)
- S R Leal-Noval
- Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias.
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