Resultados de la participación del Departamento de Medicina Transfusional sobre la indicación de sangre desplasmatizada durante el perioperatorio de cirugía cardíaca

  • Maximiliano Berro Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Hemoterapia y Medicina Transfusional. Asistente
  • Pierina Barindelli Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Hemoterapia y Medicina Transfusional. Residente
  • María Laura Fraga Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Hemoterapia y Medicina Transfusional. Posgrado
  • Cristina de la Torre Universidad de la República, Facultad de Medicina, Hospital de Clínicas. Licenciada en Neumocardiología
  • Juan Insagaray Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Hemoterapia y Medicina Transfusional. Prof. Agdo
  • Ismael Rodríguez Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Hemoterapia y Medicina Transfusional. Profesor Director
Palabras clave: TRANSFUSIÓN SANGUÍNEA, CIRUGÍA TORÁCICA

Resumen

Introducción: la transfusión de sangre desplasmatizada es una de las intervenciones más frecuente y variable durante la cirugía cardiaca. Esta puede ser beneficiosa, pero también puede provocar resultados adversos. La mayoría de los estudios en los últimos años han relacionado su administración con un aumento de la morbimortalidad. 
Material y métodos: realizamos un estudio retrospectivo, observacional, de casos y controles que analizó la asociación de la transfusión de sangre desplasmatizada con la aplicación de un protocolo de atención para optimizar la terapia transfusional en el perioperatorio de cirugía cardíaca. 
Resultados y conclusiones: mediante la aplicación de este protocolo se observó una disminución en la transfusión de sangre en el intraoperatorio sin producirse cambios en la mortalidad ni en los días de internación.

Citas

(1) Koch CG, Li L, Duncan AI, Mihaljevic T, Cosgrove DM, Loop FD, et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 2006; 34(6)):1608-16.
(2) Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth 2008; 11(1):15-9.
(3) Karkouti K, Wijeysundera DN, Yau TM, Callum JL, Cheng DC, Crowther M, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation 2009; 119(4):495-502.
(4) Engoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg 2002; 74(4):1180-6.
(5) 5. Murphy GJ, Angelini GD. Indications for blood transfusion in cardiac surgery. Ann Thorac Surg 2006; 82(6):2323-34.
(6) Pérez-Valdivieso JR, Monedero P, García-Fernández N, Vives M, Lavilla FJ, Bes-Rastrollo M. Transfusión intraoperatoria en cirugía cardiaca: estudio retrospectivo anidado de casos y controles. Rev Esp Anestesiol Reanim 2013; 60(2):79-86.
(7) Vincent JL, Lelubre C. Preoperative transfusions to limit the deleterious effects of blood transfusions. Anesthesiology 2012; 116(3):513-4.
(8) Hajjar LA, Vincent JL, Galas FR, Nakamura RE, Silva CM, Santos MH, et al. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA 2010; 304(14):1559-67.
(9) Slight RD, Nzewi O, McClelland DB, Mankad PS. Red cell transfusion in elective cardiac surgery patients: where do we go from here? Br J Anaesth 2009; 102(3):294-6.
(10) Bennett-Guerrero E, Zhao Y, O’Brien SM, Ferguson TB Jr, Peterson ED, Gammie JS, et al. Variation in use of blood transfusion in coronary artery bypass graft surgery. JAMA 2010; 304(14):1568-75.
(11) Snyder-Ramos SA, Möhnle P, Weng YS, Böttiger BW, Kulier A, Levin J, et al; Investigators of the Multicenter Study of Perioperative Ischemia; MCSPI Research Group. The ongoing variability in blood transfusion practices in cardiac surgery. Transfusion 2008; 48(7):1284-99.
(12) Bracey AW. Blood transfusion in cardiac surgery: a highly varied practice. Transfusion 2008; 48(7):1271-3.
(13) Holst LB, Petersen MW, Haase N, Perner A, Wetterslev J. Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis. BMJ 2015; 350:h1354.
(14) Medicina Transfusional en el perioperatorio: pautas clínicas de indicaciones de hemocomponentes y hemoderivados. Biomedicina 2007; 3:209-26.
(15) Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2013; 30(6):270-382.
(16) Society of Thoracic Surgeons Blood Conservation Guideline Task Force; Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion; International Consortium for Evidence Based Perfusion. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 2011; 91(3):944-82.
(17) Leal-Noval SR, Muñoz M, Asuero M, Contreras E, García-Erce JA, Llau JV, et al. 2013 Documento Seville Consensus Document on alternatives to allogenic blood transfusion: An update on the Seville Document. Rev Esp Anestesiol Reanim 2013; 60(5):263.e1-263.e25.
(18) Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, et al; Clinical Transfusion Medicine Committee of the AABB. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med 2012; 157(1):49-58.
(19) Murphy MF, Wallington TB, Kelsey P, Boulton F, Bruce M, Cohen H, et al; British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the clinical use of red cell transfusions. Br J Haematol 2001; 113(1):24-31.
(20) Australian Government. National Health and Medical Research Council, Australasian Society of Blood Transfusion. Clinical practice guidelines: appropriate use of red blood cells. Sydney, Australia: NHMRC/ASBT, 2001.
(21) American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology 2006; 105(1):198-208.
(22) Murphy GJ, Reeves BC, Rogers CA, Rizvi SI, Culliford L, Angelini GD. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 2007; 116(22):2544-52.
(23) Bhaskar B, Dulhunty J, Mullany DV, Fraser JF. Impact of blood product transfusion on short and long-term survival after cardiac surgery: more evidence. Ann Thorac Surg 2012; 94(2):460-7.
(24) Bernard AC, Davenport DL, Chang PK, Vaughan TB, Zwischenberger JB. Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg 2009; 208(5):931-7.
(25) Cooper HA, Rao SV, Greenberg MD, Rumsey MP, McKenzie M, Alcorn KW, et al. Conservative versus liberal red cell transfusion in acute myocardial infarction (the CRIT Randomized Pilot Study). Am J Cardiol 2011; 108(8): 1108-11.
(26) Engoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg 2002; 74(4):1180-6.
(27) Möhnle P, Snyder-Ramos SA, Miao Y, Kulier A, Böttiger BW, Levin J, et al; Multicenter Study of Perioperative Ischemia (McSPI) Research Group. Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients. Intensive Care Med 2011; 37(1):97-109.
(28) Reeves BC, Murphy GJ. Increased mortality, morbidity, and cost associated with red blood cell transfusion after cardiac surgery. Curr Opin Anaesthesiol 2008; 21(5):669-73.
(29) Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth 2008; 11(1):15-9.
(30) Surgenor SD, DeFoe GR, Fillinger MP, Likosky DS, Groom RC, Clark C, et al. Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure. Circulation 2006; 114(1 Suppl):I43-8.
(31) Society of Thoracic Surgeons Blood Conservation Guideline Task Force; Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg 2007; 83(5 Suppl):S27-86.
(32) Doyle BJ, Rihal CS, Gastineau DA, Holmes DR Jr. Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention: implications for contemporary practice. J Am Coll Cardiol 2009; 53(22):2019-27.
(33) Weinberg JA, MacLennan PA, Vandromme-Cusick MJ, Magnotti LJ, Kerby JD, Rue LW 3rd, et al. The deleterious effect of red blood cell storage on microvascular response to transfusion. J Trauma Acute Care Surg 2013; 75(5):807-12.
(34) Weiskopf RB, Feiner J, Toy P, Twiford J, Shimabukuro D, Lieberman J, et al. Fresh and stored red blood cell transfusion equivalently induce subclinical pulmonary gas exchange deficit in normal humans. Anesth Analg 2012; 114(3):511-9.
(35) Mirski MA, Frank SM, Kor DJ, Vincent JL, Holmes DR Jr. Restrictive and liberal red cell transfusion strategies in adult patients: reconciling clinical data with best practice. Crit Care 2015; 19:202.
Publicado
2016-03-31
Cómo citar
1.
Berro M, Barindelli P, Fraga ML, de la Torre C, Insagaray J, Rodríguez I. Resultados de la participación del Departamento de Medicina Transfusional sobre la indicación de sangre desplasmatizada durante el perioperatorio de cirugía cardíaca. Rev. Méd. Urug. [Internet]. 31 de marzo de 2016 [citado 20 de enero de 2020];32(1):19-4. Disponible en: http://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/182
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