RESUMO
OBJECTIVE: To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital. METHODS: A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets. RESULTS: Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication. CONCLUSION: The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.
Assuntos
Transfusão de Plaquetas/estatística & dados numéricos , Prescrições/normas , Trombocitopenia/terapia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Centros de Atenção Terciária , Trombocitopenia/prevenção & controleRESUMO
OBJECTIVES: To assess the safety and efficacy of a Food and Drug Administration-approved pathogen-reduced platelet (PLT) product in children, as ongoing questions regarding their use in this population remain. STUDY DESIGN: We report findings from a quality assurance review of PLT utilization, associated red blood cell transfusion trends, and short-term safety of conventional vs pathogen-reduced PLTs over a 21-month period while transitioning from conventional to pathogen-reduced PLTs at a large, tertiary care hospital. We assessed utilization in neonatal intensive care unit (NICU) patients, infants 0-1 year not in the NICU, and children age 1-18 years (PED). RESULTS: In the 48 hours after an index conventional or pathogen-reduced platelet transfusion, respectively, NICU patients received 1.0 ± 1.4 (n = 91 transfusions) compared with 1.2 ± 1.3 (n = 145) additional platelet doses (P = .29); infants 0-1 year not in the NICU received 2.8 ± 3.0 (n = 125) vs 2.6 ± 2.6 (n = 254) additional platelet doses (P = .57); and PEDs received 0.9 ± 1.6 (n = 644) vs 1.4 ± 2.2 (n = 673) additional doses (P < .001). Time to subsequent transfusion and red cell utilization were similar in every group (P > .05). The number and type of transfusion reactions did not significantly vary based on PLT type and no rashes were reported in NICU patients receiving phototherapy and pathogen-reduced PLTs. CONCLUSIONS: Conventional and pathogen-reduced PLTs had similar utilization patterns in our pediatric populations. A small, but statistically significant, increase in transfusions was noted following pathogen-reduced PLT transfusion in PED patients, but not in other groups. Red cell utilization and transfusion reactions were similar for both products in all age groups.
Assuntos
Transfusão de Plaquetas/efeitos adversos , Reação Transfusional/epidemiologia , Adolescente , Infecções Bacterianas/prevenção & controle , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Controle de Infecções , Transfusão de Plaquetas/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Viroses/prevenção & controleRESUMO
ABSTRACT Objective: To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital. Methods: A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets. Results: Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication. Conclusion: The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.
RESUMO Objetivo: Verificar a adequação na prescrição de concentrado de plaquetas por pediatras em diferentes setores da pediatria de um hospital geral. Métodos: Estudo transversal avaliando 218/227 fichas de requisição de concentrado de plaquetas de crianças e adolescentes (zero a 13 anos), de janeiro de 2007 a abril de 2015 pelos pediatras do pronto-socorro, enfermaria e unidade de terapia intensiva. Excluíram-se as requisições em portadores de doenças hematológicas e aquelas sem o número de plaquetas. Resultados: Crianças com menos de 12 meses receberam 98 prescrições de concentrado de plaquetas (45,2%). A maioria das transfusões foi profiláticas (165; 79%). Em relação ao local da transfusão, 39 (18%) foram no pronto-socorro, 27 (12,4%) na enfermaria e 151 (69,6%) na unidade de terapia intensiva. O gatilho, o volume prescrito e o subtipo de concentrado de plaquetas foram adequados em 59 (28,2%), 116 (53,5%) e 209 (96,3%) das transfusões, respectivamente. Prescrições para pacientes com hemorragia apresentaram adequação em 42 (95,5%) transfusões, enquanto para crianças sem hemorragia houve adequação em 17 (10,3%) vezes. A inadequação mais comum em relação ao volume foi a prescrição acima da recomendação (95; 43,8%). Foram prescritos oito concentrados de plaquetas sem indicação de solicitação de subtipos. Conclusão: Os resultados obtidos nesse estudo mostraram que a prescrição de transfusão de concentrado de plaquetas foi mais adequada em crianças com hemorragia ativa em comparação com a transfusão profilática. Houve tendência à prescrição de volumes elevados e de subtipos de plaquetas, o que não se justifica segundo os protocolos atuais. O ensino da medicina transfusional deve ser mais valorizado na graduação e na residência médica.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Trombocitopenia/terapia , Transfusão de Plaquetas/estatística & dados numéricos , Prescrições/normas , Trombocitopenia/prevenção & controle , Estudos Transversais , Centros de Atenção TerciáriaRESUMO
BACKGROUND: Thrombelastography platelet mapping is a useful assay to assess antiplatelet therapy. Inhibited response to the adenosine diphosphate receptor on platelets occurs early after injury, but recent work suggests this alteration occurs even with minor trauma. However, the utility of thrombelastography platelet mapping, specifically the percent of adenosine diphosphate receptor inhibition, in predicting outcomes and guiding platelet transfusion in trauma-induced coagulopathy remains unknown We assessed the role of percent of adenosine diphosphate-inhibition in predicting survival, requirement for massive transfusion or platelet transfusion in patients at risk for trauma-induced coagulopathy. METHODS: Thrombelastography platelet mapping was assessed in 303 trauma activation patients from 2014-2016 and in 89 healthy volunteers. Percent of adenosine diphosphate-inhibition is presented as median and interquartile range. We compared the area under the receiver operating characteristic curve of percent of adenosine diphosphate-inhibition, platelet count, and rapid thrombelastography maximum amplitude for in-hospital mortality, massive transfusion (>10 red blood cells or death/6 hours), and platelet transfusion (>0 platelet units or death/6 hour). RESULTS: Overall, 35 (11.5%) patient died, 27 (8.9%) required massive transfusion and 46, platelet transfusions (15.2%). Median percent of adenosine diphosphate-inhibition was 42.5% (interquartile range: 22.4-69.1%), compared with 4.3 % (interquartile range: 0-13.5%) in healthy volunteers (P < .0001). Patients that died, had a massive transfusion, or platelet transfusion had higher percent of adenosine diphosphate-inhibition than those that did not (P < .05 for all). However, percent of adenosine diphosphate-inhibition did not add significantly to the predictive performance of maximum amplitude or platelet count for any of the 3 outcomes, after adjustment for confounders. Subgroup analyses by severe traumatic brain injury, severe injury and requirement of red blood cells showed similar results. CONCLUSION: Adenosine diphosphate receptor inhibition did not add predictive value to predicting mortality, massive transfusion, or platelet transfusion. Thus, the role of thrombelastography platelet mapping as a solitary tool to guide platelet transfusions in trauma requires continued refinement.
Assuntos
Difosfato de Adenosina/sangue , Transtornos da Coagulação Sanguínea/terapia , Transfusão de Eritrócitos/estatística & dados numéricos , Mortalidade Hospitalar , Transfusão de Plaquetas/estatística & dados numéricos , Ferimentos e Lesões/complicações , Adulto , Idoso , Biomarcadores/sangue , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/mortalidade , Estudos de Casos e Controles , Bases de Dados Factuais , Transfusão de Eritrócitos/normas , Feminino , Humanos , Masculino , Testes de Função Plaquetária , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Tromboelastografia , Ferimentos e Lesões/sangue , Ferimentos e Lesões/mortalidadeRESUMO
OBJECTIVE: Human blood is the only source of red blood cells, platelets and plasma, and includes the clotting factors. Transfusion of concentrated erythrocyte and blood products is a simple form of organ transplant, the benefits of blood transfusion are real, and the life of the patients depends on how is used. to know the transfusion adherence to the recommendations in the Hospital of High Specialty of Veracruz. METHOD: For a period of 12 months an audit took place in the Transfusion Service of the Hospital of High Specialty of Veracruz, México, on a basis of 3 168 requests for transfusion from which 2314 corresponded to erythrocyte concentrate, 220 to platelet concentrate, 493 to fresh frozen plasma and 41 to cryoprecipitate. RESULTS AND CONCLUSIONS: An analysis of concordance was made with the different established regulations for a right indication and the results showed that 2171 (67.26%) were appropriate and 1037 were inadequate, which means that the lack of academic training in medicine transfusional affects the risk for patients and cost for Health Institutions.
Assuntos
Transfusão de Eritrócitos/normas , Fidelidade a Diretrizes/normas , Auditoria Médica , Plasma , Transfusão de Plaquetas/normas , Transfusão de Eritrócitos/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitais Especializados , Humanos , México , Transfusão de Plaquetas/estatística & dados numéricos , Estudos Retrospectivos , Fatores de TempoRESUMO
BACKGROUND: The relative incidence of bleeding and thrombotic events and the use of blood products in hospitalized cirrhosis patients have not been widely reported. We aimed to estimate the magnitude of bleeding events and venous thrombosis in consecutive hospitalized cirrhotic patients over a finite time period and to examine the amount and indications for blood product use in cirrhosis patients admitted to a tertiary care center. RESULTS: Among patients admitted with decompensated liver disease, 34 (40%) suffered bleeding events (about one-half non-variceal) and 6 patients (7%) suffered deep venous thrombosis. In the blood product survey, 168 patients were transfused with plasma or platelets during the survey inter- vals. Liver disease patients accounted for 7.7% of the total but disproportionately consumed 32.4% (46 of 142) of the units of plasma mostly administered as prophylaxis. In contrast, cirrhosis patients received only 7 of the 53 units of platelets transfused (13.2%) during the survey intervals. CONCLUSIONS: Coagulation issues constitute a common problem in patients with liver disease. Recent advances in laboratory testing have shown that stable cirrhosis patients are relatively hypercoagulable. The result of this prospective survey among decompensated (unstable) cirrhosis patients shows that, while DVT is not uncommon, bleeding (non-variceal in one half) remains the dominant clinical problem. This situation likely sustains the common practice of plasma infusion in these patients although its use is of unproven and questionable benefit. Better clinical tools are needed to refine clinical practice in this setting.
Assuntos
Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Hemorragia/epidemiologia , Hemorragia/terapia , Cirrose Hepática/epidemiologia , Cirrose Hepática/terapia , Trombose Venosa/epidemiologia , Trombose Venosa/terapia , Coagulação Sanguínea , Pesquisas sobre Atenção à Saúde , Hemorragia/sangue , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Cirrose Hepática/sangue , Transfusão de Plaquetas/estatística & dados numéricos , Estudos Prospectivos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Fatores de Tempo , Trombose Venosa/sangue , Virginia/epidemiologiaRESUMO
La trombocitopenia es uno de los trastornos hematológicos más frecuentemente observados durante el período neonatal, especialmente en recién nacidos enfermos, prematuros y en los neonatos hospitalizados en las unidades de cuidados intensivos neonatales (UCIN). La incidencia actual de trombocitopenia neonatal en los pacientes de las UCIN oscila entre el 25 por ciento y el 30 por ciento, y de éstos, el 20 por ciento desarrollarán trombocitopenia severa (recuentos plaquetarios menores de 50.000/mm3) [1, 2, 3, 4] y hasta un 60 por ciento se desconoce la etiología y la fisiopatología [2, 4, 5], lo que ha llevado a las malas prácticas médicas como son el uso indiscriminado de antibióticos de amplio espectro, abuso de las transfusiones, postergación de procedimientos diagnósticos y terapéuticos y cambios en los lípidos de la nutrición parenteral. Por tal motivo el llamado es a replantear al diseño de guías de práctica médica individualizadas en los neonatos trombocitopénicos, a fomentar la investigación para el conocimiento de este problema y evitar la iatrogenia causada por la falta de un tratamiento óptimo en estos pacientes.Palabras clave: trombocitopenia neonatal, unidad de cuidados intensivos neonatales, plaquetas, transfusión de plaquetas, trombocitopenia aloinmune.Orozco-Rojas CA, Aguirre-Jaramillo OH. Trombocitopenia multifactorial en los recién nacidos hospitalizados en las unidades de cuidados intensivos neonatales. Medicina & Laboratorio 2005; 11: 177-194.Módulo 1 (La clínica y el laboratorio), número 53. Editora Médica Colombiana S.A., 2005.
Assuntos
Trombocitopenia/complicações , Trombocitopenia/congênito , Transfusão de Plaquetas/estatística & dados numéricosRESUMO
We report our experience of allogeneic peripheral blood stem cell transplantation using non-myeloablative conditioning regimens delivered and supported on an outpatient basis. A group of 44 patients underwent 47 allograft procedures using peripheral blood stem cells. Approximately one third of the individuals did not require red blood cells transfusions: the median of transfused red blood cells units was 1 (range 0-10). In addition one out of three did not require platelet transfusions either, the median of platelet transfusions being 1 (range 0-6). In fourteen allografts (30%) neither red blood cells nor platelet transfusions were used. An inverse correlation was found between the number of CD34 cells infused and the PRBC and PLT transfusion requirements, those patients receiving high numbers of CD34 cells needing fewer transfusions of both PRBC and platelets. The possibility of conducting allografts without transfusion of blood products in some patients may result in a decrease in both cost and the risks stemming from exposure to human blood derivatives.
Assuntos
Transfusão de Eritrócitos/estatística & dados numéricos , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco de Sangue Periférico , Transfusão de Plaquetas/estatística & dados numéricos , Condicionamento Pré-Transplante/métodos , Vidarabina/análogos & derivados , Adolescente , Adulto , Bussulfano , Criança , Pré-Escolar , Ciclofosfamida , Ciclosporina , Feminino , Filgrastim , Fator Estimulador de Colônias de Granulócitos , Mobilização de Células-Tronco Hematopoéticas , Humanos , Masculino , Metotrexato , Pessoa de Meia-Idade , Neoplasias/terapia , Transplante de Células-Tronco de Sangue Periférico/estatística & dados numéricos , Estudos Prospectivos , Proteínas Recombinantes , Transplante HomólogoRESUMO
STUDY DESIGN: We conducted a historic cohort study of neonates who received platelet transfusions at the National Institute of Perinatology, Mexico City, from January 1997 to May 2000. We obtained descriptive and outcome data, and assessed demographic and laboratory means of predicting "good candidates" for a future recombinant thrombopoietin (rTpo) trial. RESULTS: A minority of the transfused patients (11.4%) received only one transfusion; the majority (88.6%) received multiple transfusions. Neonates who received one or more platelet transfusions were more likely to die (24.5% mortality) than neonates who received no platelet transfusions (3.7% mortality). Regression analyses indicated that the presence of liver disease was the best predictor of a "good candidate" for rTpo administration. CONCLUSION: The majority of neonates in our institution who receive platelet transfusions receive multiple, not single, transfusions. Receiving any platelet transfusion is a marker for high risk of death. Neonates with liver disease who receive platelet transfusions might be a reasonable group for a phase I rTpo trial.
Assuntos
Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Transfusão de Plaquetas/estatística & dados numéricos , Trombocitopenia/epidemiologia , Trombocitopenia/terapia , Estudos de Coortes , Feminino , Humanos , Mortalidade Infantil , Recém-Nascido , Masculino , México/epidemiologia , Seleção de Pacientes , Valor Preditivo dos Testes , Trombopoetina/administração & dosagem , Trombopoetina/uso terapêuticoAssuntos
Humanos , Trombocitopenia/diagnóstico , Trombocitopenia/etiologia , Trombocitopenia/terapia , Transfusão de Plaquetas/estatística & dados numéricos , Transfusão de Plaquetas/efeitos adversos , Transfusão de Plaquetas , Heparina/efeitos adversos , Cuidados Críticos , Cirurgia Torácica , Parada Cardíaca , Sepse , Histiocitose de Células não Langerhans , Síndrome Pulmonar por Hantavirus , Síndrome AntifosfolipídicaRESUMO
Se presenta el caso de una niña de 9 años, eutrófica, que ingresa con astenia, anorexia, hipertrofia gingival, hepatoesplenomegalia y petequia y hematomas. La citología de médula ósea es característica de Leucemia promielocítica aguda, confirmada por citoquímica y cariotipo con la característica translocación de brazos largos entre los cromosomas 15 y 17. A pesar de las graves complicaciones infecciosas que presentó, la respuesta terapéutica fue buena, hallándose en remisión hasta la actualidad. (AU)
Assuntos
Humanos , Feminino , Leucemia Promielocítica Aguda/diagnóstico , Leucemia Promielocítica Aguda/genética , Leucemia Promielocítica Aguda/complicações , Leucemia Promielocítica Aguda/prevenção & controle , Leucemia Promielocítica Aguda/terapia , Leucemia Promielocítica Aguda/mortalidade , Leucemia Promielocítica Aguda/tratamento farmacológico , Hemorragia Retiniana/diagnóstico , Melena/diagnóstico , Translocação Genética , Indução de Remissão/métodos , Transfusão de Plaquetas/estatística & dados numéricos , Células da Medula Óssea/citologiaRESUMO
OBJECTIVE: The purpose of this paper was to evaluate the trends in the use of blood products in our hospital during the last six years. We selected for the study packed red cells and platelet products since they are the most frequently used, on a unit per unit basis they represent a larger component of the transfusion service budget and finally are the most frequent units involved in transfusion reactions. METHODS: The variables in the data bank that were utilized to study included, patients transfused, patients operated, units transfused, units prepared, and units discarded. From these variables we constructed the following new variables, Cross match to Transfusion ratio, units transfused to patients transfused ratio, units transfused to patients operated ratio, and finally patients operated to patients transfused ratio. The data was then organized by year and transported to SPSS software where the null hypothesis was tested through an analysis of the variance (ANOVA). RESULTS: The number of patients who underwent coronary artery bypass surgery increased over the last six years. An average increase of six additional patients per month was documented. An increase in the total number of packed Red Cells units transfused was seen with a mean of 167 units per month in 1992, 182 units in 1994 and 187 units in 1996. (p = .425). A mean of 45 patients per month were transfused in 1992 as compared to 55 and 56 in 1994 and 1996 respectively. (p = .009). The ratio of patients operated to patients transfused decreased from 1.65 in 1992 to 1.3 and 1.4 in 1992 and 1996. (p = .021) The intensity of Red Cell use in patients undergoing surgery was analyzed by using the ratio of number of red cell units transfused by the number of patients operated and transfused. This ratio was 3.7 in 1992, 3.2 in 1994 and 3.3 in 1996. (p = .032) The use of platelets transfusion in the cardiovascular surgery arena appears to have changed very slightly over the five years in our institution. A non-significant trend in the number of patients who are operated and are transfused with platelets is noted, along with a mild decrease in the intensity of platelet use per patient transfused. NON CARDIOVASCULAR SERVICE: The number of patients transfused with packed Red Cells has not changed significantly in this service since 1992. The mean number of units transfused per month in 1992 and in 1994 was close to 222. In 1996, a mean number of 230 units per month were transfused. (p = .172) The mean number of patients transfused increased slightly from 74.5 patients per month in 1992 to 77.5 in 1994 and 77.7 in 1996. (p = .585) The intensity of Red Cell transfusion support decreased somewhat with 2.98 in 1992 to 2.87 and 2.95 in 1994 and 1996. (p = .806) A marked increase in the number of platelet transfusion was documented. A mean number of 192 units were transfused in 1992 per month as compared to 333 and 360 in 1994 and 1996. (p = .27) This increase in platelet use was associated to an increase in the number of patients who were transfused with 9 per month in 1992 and 16.5 and 16.4 in 1994 and 1996. (p = .005) The mean number of platelet transfused per patient decreased in a non significant fashion with 19.9 units and 20.6 units per transfused patient in 1992 and in 1994 to 19.2 units in 1996. (p = .861). CONCLUSION: We have been able to define distinct changes in the trends of blood product utilization in our institution.