Recomendaciones medicoquirúrgicas para disminuir el uso y pérdida de derivados sanguíneos
Palabras clave:
sustitutos sanguíneos, preservación de la sangre, transfusión sanguínea, testigos de JehováResumen
El uso de los derivados sanguíneos ha venido disminuido en la práctica médica, dado el aumento de enfermedades transmitidas por las transfusiones y la concientización de los médicos de considerar a la transfusión como un verdadero trasplante con todas sus complicaciones; los cirujanos se ven enfrentados a la negativa de los pacientes ha recibir derivados sanguíneos por convicciones personales o religiosas, como es el caso de los testigos de Jehová.
Existen muchas medidas para disminuir el uso y pérdida de sangre en cirugía, que abarcan desde una buena técnica quirúrgica, pasando por el uso de sustancias que favorecen el volumen de eritrocitos, como la eritropoyetina e hierro; sustancias antifibrinolíticas como los análogos de la lisina, y medidas intraoperatorias (como el salvador de células) y técnicas anestésicas para reducir la pérdida de sangre. En este artículo se presenta el caso de un paciente testigo de Jehová manejado con algunas de estas medidas y se realiza una revisión sobre las recomendaciones actuales en prácticas transfusionales avanzadas.
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Referencias bibliográficas
1. Blood Conservation and Transfusion Alternatives Satellite Symposium, Saturday, August 26, 2000 Toronto, Ontario, Canada in conjunction with the 28th World Congress of the International Society of Hematology.
2. Van Der Linden, Philippe. Perioperative blood conservation strategies: an update for clinicians. Can Anesth 2003; 50.
3. The Royal College of Surgeons of England. Code of practice for the surgical management of Jehovah’s witnesses 2002, published by the Royal College of Surgeons of England.
4. The New York Center for Bloodless Medicine an surgery guide.
5. ¿Cómo puede salvarle la vida la sangre? 1990 watch Tower Bible and tract society Pennsylvania, New York Inc. Revista Atalaya.
6. Mann M, Votto J, Kambe J. Management of the severely anemic patient who refuses transfusion: lessons learned during the care of a Jehovah’s witness. Ann Inter Med 1992; 117: 1042-1048.
7. Sagrada Biblia, XXXIX Congreso Eucarístico Internacional de Bogotá, Colombia, 1968.
8. Dixon L. Los testigos de Jehová el desafío quirúrgico / ético. JAMA 1981; 246: 2471-2472.
9. Dixon L. Transfusiones de sangre: ¿De quién es la decisión? ¿La conciencia de quién debe respetarse? NY State J Med, 1988; 88: 463-464,
10. Guzmán MF, Morales de MC, Franco E. De la responsabilidad civil médica. Ediciones Rosaristas, primera edición, 1995.
11. Cortés A. Alternativas farmacológicas a las transfusiones de sangre y componentes. Colom Méd 1994; 25: 73-82.
12. Niels Q, Stten B, Birgit W, Carnsten P. Recombinant human erythropoietin and hemoglobin concentration at operation and during the postoperative period: reduced need for blood transfusions in patients undergoing colorectal surgery- prospective double - blind placebo - controlled study. World J Surg 1999; 23: 30-35.
13. Rutherford C, Schneider T, Hilton D, David K. Efficacy of different regimens for recombinant human erythropoietin in a simulated perisurgical setting: the importance of iron availability in optimizing response. Am J Med 1994; 96.
14. Alexander K, Gombotz H, Gootfried F. Subcutaneous recombinant human erythropoietin and autologous blood donation before coronary artery bypass surgery. Anesth Analg 1993; 76: 102-106.
15. Adamson J, Spivak J. Physiologic basis for the pharmacologic use of recombinant human erythropoietin in surgery and cancer treatment. Surgery 1994.
16. Consensus Conference: Blood Management Surgical Practice Guidelines. Am J Surg 1995; 170.
17. Ramos H, Satoru T, Yoogooo K, Evangelos F, Howard D. Liver transplantation without the use of blood products. Arch Surg 1994; 129: 528-533.
18. Cardemil G, Rodríguez M, Reyes D. Resultados del programa de atención médico-quirúrgica sin uso de sangre ni hemoderivados del Hospital Clínico de la Universidad de Chile. Rev Chil Cir 2004; 56: 232-236.
19. MacIntyre A. Blood transfusion and hemostatic management in the perioperative period. Can J Anaesth, 1992; 39: Pt 2, R101-114.
20. Fugh-Bermann A. Herb drug interactions. Lancet 2000; 355: 134-138.
21. Faris P, Spende K, Larholt M. The predictive power of baseline hemoglobin for transfusion risk in surgery patients. Orthopedics, 1999; 22 (suppl): s135-s140.
22. Torzilli G, Makuuchi K, Inoue E. No mortality liver resection for hepatocelular carcinoma in cirrhotic and noncirrhotic patients; in there a way? A prospective analysis of our approach. Arch Surg 1999; 134: 984-992.
23. Sabiston DC. Principles of operative surgery: antisepsis, technique sutures and drains. Textbook of surgery. The Biological Basis of Modern Surgical Practice, 15a edition, Philadelphia, WB Saunders, 1997; 253-263.
24. Sugrue M, Amours D, Joshipura M. Introduction: damage control at the start of 21st century. Injury 2004; 35: (suppl) 639-641; Elsevier editorial.
25. Malasagne B, Cherqui R. Safety of selective vascular clamping for major hepatectomies. J Am Coll Surg 1998; 187: 482-486.
26. Schneeberger A, Schulz R. Blood loss in total hip arthroplasty. Lateral position combined with preservation of the capsule versus supine position combined with capsulectomy. Arch Orthop Trauma Surg 1998; 117: 47-49.
27. De Rai P, Rebulla H. Postsplenectomy blood salvage in anemic patient. JAMA 1987; 258: 1332.
28. Healy W, Pfeifer S, Kurtz U. Evaluation of autologous she blood for autotransfusion after orthopaedic surgery. Clin Orthop 1994; 299: 53-59.
29. Cooley DA. Conservation of blood during cardiovascular surgery. Am J Surg 1995; 170: (suppl) 53S-59S.
30. Purdham RS. Reduced blood loss with hemodynamic stability during controlled hypotensive anesthesia for Lefort I maxillary osteotomy using high dose fentanyl: a retrospective study. CRNA 1996; 33-46.
31. Jones R, Moulton M. Central venous pressure and its effect on blood loss during liver resection. Br J Surg 1998; 85: 1058-1060.
32. Testa LD, Tobias F. Pharmacologic drugs for controlled hypotension. J Clin Anesth 1995; 7: 326-337.
33. Scott NB. Regional anaesthesia and surgical morbidity. Br J Surg 1988; 75: 44-48.
34. Grass J. Surgical outcome: regional anesthesia and analgesia versus general anaesthesia. Anesthesiol Rev 1993; 20: 117-125.
35. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg 1998; 187: 620-625.
36. Deliberate hypotensive anesthesia with labetalolin reconstructive surgery for scoliosis, Acta Anaesthesiol Sin, 1996; 34: 203-207.
37. Johnson R, Murphy U. The role of desmopressin in reducing blood loss during lumbar fusions. Surg Gynecol Obstet 1990; 171: 106-110.
38. Karski Y, Teasdale R. Prevention of bleeding after cardiopulmonary bypass with high - dose tranexamic acid. J Thorac Cardiovasc Surg 1995; 110: 835-842.
39. Brown G, Thwaites R. Tranexamic acid is effective in decreasing postoperative bleeding and transfusions in primary coronary artery bypass surgery: a double blind randomized placebo controlled trial. Anesth Analg 1997; 85: 963-970.
40. Llau V, García-Pérez M. Increased safety in the administration of aprotinin, need for a test dose. Nesth Analg 2000; 90: 770-771.
41. Kesten SA, de Hoyas C, Chaparro L. Aprotinin reduced blood loss in lung transplant recipients. Ann Thorac Surg 1995; 59: 877-879.
42. Lentschesner C, Cottin H. Reduction of blood loss and transfusion requirement by aprotinin in posterior lumbar spine fusion. Anesth Analg 1999; 89: 590-597.
43. Porte Y, Moleenar T, Begliomini U. Aprotinin and transfusion requirements in orthoptic liver transplantation: a multicentric randomized double blind trial. Lancet 2000; 335: 1303-1309.
44. Jaramillo M. Medicina transfusional, principios y práctica médico-quirúrgica. Proyecto Aventis, 2003.
45. Szalay D, Wong T, Lindsay T. Impact of red cell salvage on transfusion requirements during elective abdominal aortic aneurysm repair. Ann Vasc Surg 1999; 13: 576-581.
46. Goodnough L, Monk G, Sicard H. Intraoperative salvage in patients undergoing elective abdominal aortic aneurysm repair: an analysis of costs and benefits. J Vasc Surg 1996; 24: 213-218.
47. Assessment of the availability of intraoperative autotransfusion in urological operations. J Urol 1997; 157: 1777-1780.
48. Heiss M, Anwar T, Delanoff C, Algayer H. Perisurgical erythropoietin application in anemic patients with colorectal cancer: a double - blind randomized study. Surgery 1996.
2. Van Der Linden, Philippe. Perioperative blood conservation strategies: an update for clinicians. Can Anesth 2003; 50.
3. The Royal College of Surgeons of England. Code of practice for the surgical management of Jehovah’s witnesses 2002, published by the Royal College of Surgeons of England.
4. The New York Center for Bloodless Medicine an surgery guide.
5. ¿Cómo puede salvarle la vida la sangre? 1990 watch Tower Bible and tract society Pennsylvania, New York Inc. Revista Atalaya.
6. Mann M, Votto J, Kambe J. Management of the severely anemic patient who refuses transfusion: lessons learned during the care of a Jehovah’s witness. Ann Inter Med 1992; 117: 1042-1048.
7. Sagrada Biblia, XXXIX Congreso Eucarístico Internacional de Bogotá, Colombia, 1968.
8. Dixon L. Los testigos de Jehová el desafío quirúrgico / ético. JAMA 1981; 246: 2471-2472.
9. Dixon L. Transfusiones de sangre: ¿De quién es la decisión? ¿La conciencia de quién debe respetarse? NY State J Med, 1988; 88: 463-464,
10. Guzmán MF, Morales de MC, Franco E. De la responsabilidad civil médica. Ediciones Rosaristas, primera edición, 1995.
11. Cortés A. Alternativas farmacológicas a las transfusiones de sangre y componentes. Colom Méd 1994; 25: 73-82.
12. Niels Q, Stten B, Birgit W, Carnsten P. Recombinant human erythropoietin and hemoglobin concentration at operation and during the postoperative period: reduced need for blood transfusions in patients undergoing colorectal surgery- prospective double - blind placebo - controlled study. World J Surg 1999; 23: 30-35.
13. Rutherford C, Schneider T, Hilton D, David K. Efficacy of different regimens for recombinant human erythropoietin in a simulated perisurgical setting: the importance of iron availability in optimizing response. Am J Med 1994; 96.
14. Alexander K, Gombotz H, Gootfried F. Subcutaneous recombinant human erythropoietin and autologous blood donation before coronary artery bypass surgery. Anesth Analg 1993; 76: 102-106.
15. Adamson J, Spivak J. Physiologic basis for the pharmacologic use of recombinant human erythropoietin in surgery and cancer treatment. Surgery 1994.
16. Consensus Conference: Blood Management Surgical Practice Guidelines. Am J Surg 1995; 170.
17. Ramos H, Satoru T, Yoogooo K, Evangelos F, Howard D. Liver transplantation without the use of blood products. Arch Surg 1994; 129: 528-533.
18. Cardemil G, Rodríguez M, Reyes D. Resultados del programa de atención médico-quirúrgica sin uso de sangre ni hemoderivados del Hospital Clínico de la Universidad de Chile. Rev Chil Cir 2004; 56: 232-236.
19. MacIntyre A. Blood transfusion and hemostatic management in the perioperative period. Can J Anaesth, 1992; 39: Pt 2, R101-114.
20. Fugh-Bermann A. Herb drug interactions. Lancet 2000; 355: 134-138.
21. Faris P, Spende K, Larholt M. The predictive power of baseline hemoglobin for transfusion risk in surgery patients. Orthopedics, 1999; 22 (suppl): s135-s140.
22. Torzilli G, Makuuchi K, Inoue E. No mortality liver resection for hepatocelular carcinoma in cirrhotic and noncirrhotic patients; in there a way? A prospective analysis of our approach. Arch Surg 1999; 134: 984-992.
23. Sabiston DC. Principles of operative surgery: antisepsis, technique sutures and drains. Textbook of surgery. The Biological Basis of Modern Surgical Practice, 15a edition, Philadelphia, WB Saunders, 1997; 253-263.
24. Sugrue M, Amours D, Joshipura M. Introduction: damage control at the start of 21st century. Injury 2004; 35: (suppl) 639-641; Elsevier editorial.
25. Malasagne B, Cherqui R. Safety of selective vascular clamping for major hepatectomies. J Am Coll Surg 1998; 187: 482-486.
26. Schneeberger A, Schulz R. Blood loss in total hip arthroplasty. Lateral position combined with preservation of the capsule versus supine position combined with capsulectomy. Arch Orthop Trauma Surg 1998; 117: 47-49.
27. De Rai P, Rebulla H. Postsplenectomy blood salvage in anemic patient. JAMA 1987; 258: 1332.
28. Healy W, Pfeifer S, Kurtz U. Evaluation of autologous she blood for autotransfusion after orthopaedic surgery. Clin Orthop 1994; 299: 53-59.
29. Cooley DA. Conservation of blood during cardiovascular surgery. Am J Surg 1995; 170: (suppl) 53S-59S.
30. Purdham RS. Reduced blood loss with hemodynamic stability during controlled hypotensive anesthesia for Lefort I maxillary osteotomy using high dose fentanyl: a retrospective study. CRNA 1996; 33-46.
31. Jones R, Moulton M. Central venous pressure and its effect on blood loss during liver resection. Br J Surg 1998; 85: 1058-1060.
32. Testa LD, Tobias F. Pharmacologic drugs for controlled hypotension. J Clin Anesth 1995; 7: 326-337.
33. Scott NB. Regional anaesthesia and surgical morbidity. Br J Surg 1988; 75: 44-48.
34. Grass J. Surgical outcome: regional anesthesia and analgesia versus general anaesthesia. Anesthesiol Rev 1993; 20: 117-125.
35. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg 1998; 187: 620-625.
36. Deliberate hypotensive anesthesia with labetalolin reconstructive surgery for scoliosis, Acta Anaesthesiol Sin, 1996; 34: 203-207.
37. Johnson R, Murphy U. The role of desmopressin in reducing blood loss during lumbar fusions. Surg Gynecol Obstet 1990; 171: 106-110.
38. Karski Y, Teasdale R. Prevention of bleeding after cardiopulmonary bypass with high - dose tranexamic acid. J Thorac Cardiovasc Surg 1995; 110: 835-842.
39. Brown G, Thwaites R. Tranexamic acid is effective in decreasing postoperative bleeding and transfusions in primary coronary artery bypass surgery: a double blind randomized placebo controlled trial. Anesth Analg 1997; 85: 963-970.
40. Llau V, García-Pérez M. Increased safety in the administration of aprotinin, need for a test dose. Nesth Analg 2000; 90: 770-771.
41. Kesten SA, de Hoyas C, Chaparro L. Aprotinin reduced blood loss in lung transplant recipients. Ann Thorac Surg 1995; 59: 877-879.
42. Lentschesner C, Cottin H. Reduction of blood loss and transfusion requirement by aprotinin in posterior lumbar spine fusion. Anesth Analg 1999; 89: 590-597.
43. Porte Y, Moleenar T, Begliomini U. Aprotinin and transfusion requirements in orthoptic liver transplantation: a multicentric randomized double blind trial. Lancet 2000; 335: 1303-1309.
44. Jaramillo M. Medicina transfusional, principios y práctica médico-quirúrgica. Proyecto Aventis, 2003.
45. Szalay D, Wong T, Lindsay T. Impact of red cell salvage on transfusion requirements during elective abdominal aortic aneurysm repair. Ann Vasc Surg 1999; 13: 576-581.
46. Goodnough L, Monk G, Sicard H. Intraoperative salvage in patients undergoing elective abdominal aortic aneurysm repair: an analysis of costs and benefits. J Vasc Surg 1996; 24: 213-218.
47. Assessment of the availability of intraoperative autotransfusion in urological operations. J Urol 1997; 157: 1777-1780.
48. Heiss M, Anwar T, Delanoff C, Algayer H. Perisurgical erythropoietin application in anemic patients with colorectal cancer: a double - blind randomized study. Surgery 1996.
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Publicado
2005-06-20
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Jiménez J., C. E. Recomendaciones Medicoquirúrgicas Para Disminuir El Uso Y pérdida De Derivados sanguíneos. Rev Colomb Cir 2005, 20, 105-117.
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