Puesta al día sobre transfusión masiva
DOI:
https://doi.org/10.29193/RMU.39.2.6Palabras clave:
HEMORRAGIA, TRANSFUSIÓN SANGUÍNEA, TRANSFUSIÓN MASIVA, PROTOCOLO DE TRANSFUSIÓN MASIVA, RESUCITACIÓN, HEMOSTASIS, SANGRE TOTAL, HEMODERIVADOS, PROTOCOLOS CLÍNICOS, REANIMACIÓN DE CONTROL DE DAÑOSResumen
La transfusión masiva plantea desafíos clínicos, organizacionales y logísticos para el personal de la salud en general y los servicios de Medicina Transfusional en particular. No existe una definición universalmente aceptada de transfusión masiva, las definiciones más comúnmente utilizadas se basan en el número de unidades de sangre administradas dentro de un cierto período de tiempo. La mayoría de los eventos de transfusión masiva ocurren en el contexto de hemorragias graves en pacientes quirúrgicos, politraumatizados, con hemorragia gastrointestinal u obstétrica. La reanimación de control de daños y los protocolos de transfusión masiva son las estrategias más utilizadas actualmente para el tratamiento inicial, seguidas de un tratamiento personalizado, dirigido por objetivos, mediante la monitorización de la coagulación en tiempo real mediante estudios viscoelásticos. Existen una serie de controversias alrededor del tratamiento óptimo, incluyendo el uso de sangre total, la relación de hemocomponentes a utilizar, el uso de concentrados de factores de la coagulación, y la indicación óptima del ácido tranexámico. El estudio de los productos ideales para el tratamiento de los pacientes con sangrado masivo se ha convertido en un área de gran interés de la investigación científica. El contexto clínico en el que ocurrió el evento hemorrágico, el número de hemocomponentes transfundidos, la edad del paciente y las comorbilidades son los predictores más importantes de la sobrevida a corto y largo plazo. Esta revisión narrativa explora el estado actual del conocimiento sobre la transfusión masiva, así como los avances que podemos esperar en el futuro cercano.
Citas
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10) Zatta AJ, McQuilten ZK, Mitra B, Roxby DJ, Sinha R, Whitehead S, et al. Massive Transfusion Registry Steering. Elucidating the clinical characteristics of patients captured using different definitions of massive transfusion. Vox Sang 2014; 107(1):60-70. doi: 10.1111/vox.12121.
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12) Thomasson RR, Yazer MH, Gorham JD, Dunbar NM. International assessment of massive transfusion protocol contents and indications for activation. Transfusion 2019; 59(5):1637-43. doi: 10.1111/trf.15149.
13) Gipson JS, Wood EM, Cole-Sinclair MF, McQuilten Z, Waters N, Woodford NW. Major haemorrhage fatalities in the Australian national coronial database. Emerg Med Australas 2018; 30(3):382-8. doi: 10.1111/1742-6723.12915.
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2023-05-31
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1.
Berro M. Puesta al día sobre transfusión masiva. Rev. Méd. Urug. [Internet]. 31 de mayo de 2023 [citado 21 de diciembre de 2024];39(2):e401. Disponible en: https://revista.rmu.org.uy/index.php/rmu/article/view/1030
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Trabajos de Revisión o Actualización y Puestas al día
