Pérdida de derivados sanguíneos: Recomendaciones medicoquirúrgicas para disminuir su uso
Loss of blood derivatives: Medical-surgical recommendations to reduce their use
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Jiménez Jiménez, C. E. (2005). Pérdida de derivados sanguíneos: Recomendaciones medicoquirúrgicas para disminuir su uso. Revista Repertorio De Medicina Y Cirugía, 14(3), 118–129. https://doi.org/10.31260/RepertMedCir.v14.n3.2005.392
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Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
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El uso de los derivados sanguíneos ha venido disminuyendo en la práctica médica dado el aumento de enfermedades transmitidas por las transfusiones y el conocimiento claro de los médicos al considerar la transfusión como un verdadero transplante con todas sus complicaciones. Los cirujanos nos vemos enfrentados a la negativa de algunos pacientes para 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 la pérdida de sangre en cirugía, que abarca desde una buena técnica quirúrgica, pasando por el uso de sustancias que favorezcan el volumen de glóbulos rojos, como la eritropoyetina y el hierro, sustancias antifibrinolíticas como los análogos de la lisina, medidas intraoperatorias para disminuir la pérdida de sangre, como el salvador de células y técnicas anestésicas con el mismo fin. En este artículo se presenta un paciente Testigo de Jehová, manejado con algunas de estas medidas y se hace una revisión sobre las recomendaciones actuales en prácticas transfusionales avanzadas.
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Referencias
1. Blood conservation and Transfusión alternatives 28th Congress of the International Society of Hematology, 2000 aug 26; Toronto, Canadá. P 5-48
2. Linder van der P. Perioperative blood conservation strategies: an update for clinicians. Can J of Anaesth 2003;.50 (6)
3. Code of practice for the surgical management oj jehovah's witnesses. London: Council of the Royal College of Surgeons of England, 2000. p 1-19; 35-43
4. The New York Center for Bloodless Medicine and sugery, guide. 2003, Br. J. Surg 1998; 75 (4): 44-48.
5. Glenn P. ¿Cómo puede salvarle la vida la sangre? 1990 watch Tower Bible and tract Society Pensilvania. Atalaya 1990; 23-7
6. Man M, Votto J, Kambe J. Managaement of the severely anemic patient who refuses transfusion: lessons learned during the care of a Jehovah's witness. Ann Intern Med 1992; 117: 1042-48.
7. Sagrada Biblia, XXXIX Congreso Eucarístico Internacional de Bogota, 1968.
8. Dixon L. Los testigos de Jehová el desafio quirúrgico JAMA 1981, nov; 246: 2471-72.
9. Dixon L. Transfusiones de sangre: ¿De quien es la decisión? ¿La conciencia de quien debe respetarse? J Med 1988; 88: 463-4.
10. Guzman MF, Morales de MC, Franco E. De la Responsabilidad Civil Médica. Bogotá: Ediciones Rosarista, 1995.
11. Cortes A. Alternativas farmacológicas a las transfusiones de sangre y componentes. Col Médica 1994;25:73-82.
12. Niels Q. Stten B. Birgit W. Carnsten P. Recombinant Human Erythropoietin and Hemoglobin Concentration at Operatio and during the postoperative period: Reduced need for blood transfusions in patients undergoing colorectal surgery- Prospective Double - blind placebo - controlled study. World J Sury 1999; 23: 30-5.
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. American J Med 1994; 96
14. Alexander K. Gombotz H. Gootfried F. Subcutaneous Recombinant Human Erythropoietin and autologous blood donation before coronary artery Bypass surgery. Anesthesia Analg 1993; 76: 102-6.
15. Adamson J. Spivak J. Physiologic basis for the pharmacologic use of reombinant human erythropoietin in surgery and cancer treatment. Surgery; Jan1994.
16. Guidelines Consensus Conference: Blood Management Surgical Practice Am J Surg; 1995: 170 (6A).
17. Ramos H, Satoru T, Yoog000 K. Evangelos F Howard D. Liver transplantation withouth the use of blood products. Arch Surg 1994; 129:528-533.
18. Cardemil G, Rodríguez M, Reyes D. Resultados del programa de atención medico-quirúrgica sin uso de sangre no hemoderivados del Hospital Clínico de la Universidad de Chile. Rev Chilena Cirugía 2004; 56 (3): 232-36.
19. Maclntyre A. Blood transfusion and hemostatic management in the perioperative period. Can J Anaesth 1992; 39 (5): Pt 2 R 101-14.
20. Fugh-Bermann A. Herb Drug interactions. Lancet 2002; 355 (9198): 134-38.
21. Faris P. Spende K, Larholt M.O. The predicitive power of baseline hemoglobinfor transfusion risk in surgeey patients. Orthopedics 1999:22 (1) Suppl S 135-40
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 (9): 984-9.
23. Sabiston D,C. Principies of operative surgery: antisepsis, technique sutures and drains; Textbook of surgery ; the Biological Basis of Modem Surgical Practice, 15 th ed. Philadelphia. Saunders , 1997. pp. 253-63.
24. Amours D. Joshipura M, Introduction : Damage control at the start of 21st century. Sugrue M. Injury 2004; 35: suppl 639-41.
25. B,Cherqui R. Safety of selective vascular clamping for major hepatectomies. Malasagne. 1998; 187 (5): 482-86.
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 (1-2): 47-9.
27. Postsplenectomy blood salvage in anemic patient; De Rai P.; Rebulla H.; JAMA, 258, N. 10 (1987),1332.
28. Evaluation of autologous she blood for autotransfusion alter orthopaedic surgery; Healy W.; Pfeifer S.; Kurtz U.; Clin. Orthop., N. 299 (1994), 53-59.
29. Conservation of blood during cardiovascular surgery, Cooley D.A; American Journal of Surgery , 170 , N. 6A, Suppl. (1995), 53S-59S.
30. Reduction of blood loss and transfusion requirement by aprotinin in posterior lumbar spine fusion ;Lentschesner C.; Cottin H., Anesth. Analg. 89, N. 3, (1999), 590-597.
31. Central venous pressure and its effect on blood loss during liver resection ; Jones R.; Moulton M.; Br. J. Surg. 85 N. 8 (1998), 1058-1060.
32. Pharmacologic drugs for controlled hypotension; Testa L.D.; Tobias F.; j. Clin. Anesth.,7, N. 4 (1995),326-337.
33. Scott N. B. Regional anaesthesia and surgical morbidity. Br, J, Surg 1099; 75 (4): 44-p.
34. Grass J. Surgical outcome: regional anesthesia and analgesia versus general anaesthesia. Anesthesiol 1993; 20 (4): 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 187, N. 6 (1998);620-625
36. Deliberate hypotensive anesthesia with labetalolin reconstructive surgery for scoliosis, Acta Anaesthesiol Sin, 34 N. 4; (1996); 203-207.
37. The role of desmopressin in reducing blood loss during lumbar fusions; Johnson R.; Murphy U.; Surg. Gynecol. Obstet.; 171, n. 3 (1990), 106-110.
38. Prevention of bleeding after cardiopulmonary bypass with high - dose tranexamic acid; Karski Y.; Teasdale R., J. Thorac. Cardiovasc. Surg. ,110, N.3, (1995), 835-42.
39. Tranexamic acid is effective in decreasing postoperative bleeding and transfusions in primary coronary artery bypass surgery : a double blind randomized palcebo controlled trial; Brown G.; Thwaites R.; Anesth. Analg. 85; n.5 (1997), 963-70.
40. Increased safety in the administration of aprotinin , need for a test dose; Llau V.; García- Pérez M., Nesth. Analg. 90, N. 3 (2000) , 770-71.
41. Kesten S.A. Hoyas de C. Chaparrto I. Aprtinin reduced blood loss in lung transplant recipiente Ann Thorac, Surg 1995; 59 (4): 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 (3): 590-97.
43. aprotinin and transfusion requirements in orthoptic liver transplantation : a multicentric randomised double blind trial ; Porte Y., Moleenar T., Begliomini U ; Lancet, 335, N. 9212; (2000), 1303-1309.
44. Jaramillo M. Medicina Transfusional, Principios y practica medico quirúrgica. Bogotá: Proyecto Aventis, 2003.
45. Szalay D, Wong T, Lindsay T. Impact of red cell salvage on transfusión requirements during elective abdominal aortic aneurysm repair Ann. Vasc Surg 1999; 13 (6): 576-81.
46. Goodnough L. Monk G. Sicard H, J. Intraoperative salvage in patients undergoing elective abdominal aortic aneurysm reapir: an análisis of costs and benefits . J. Vasc. Surg 1996; 24 (2): 213-18.
47. Assesment of the availability of intraoperative autotransfusion in urological operations. J Urol 1997; 157 (5): 1777-80.
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; my.
2. Linder van der P. Perioperative blood conservation strategies: an update for clinicians. Can J of Anaesth 2003;.50 (6)
3. Code of practice for the surgical management oj jehovah's witnesses. London: Council of the Royal College of Surgeons of England, 2000. p 1-19; 35-43
4. The New York Center for Bloodless Medicine and sugery, guide. 2003, Br. J. Surg 1998; 75 (4): 44-48.
5. Glenn P. ¿Cómo puede salvarle la vida la sangre? 1990 watch Tower Bible and tract Society Pensilvania. Atalaya 1990; 23-7
6. Man M, Votto J, Kambe J. Managaement of the severely anemic patient who refuses transfusion: lessons learned during the care of a Jehovah's witness. Ann Intern Med 1992; 117: 1042-48.
7. Sagrada Biblia, XXXIX Congreso Eucarístico Internacional de Bogota, 1968.
8. Dixon L. Los testigos de Jehová el desafio quirúrgico JAMA 1981, nov; 246: 2471-72.
9. Dixon L. Transfusiones de sangre: ¿De quien es la decisión? ¿La conciencia de quien debe respetarse? J Med 1988; 88: 463-4.
10. Guzman MF, Morales de MC, Franco E. De la Responsabilidad Civil Médica. Bogotá: Ediciones Rosarista, 1995.
11. Cortes A. Alternativas farmacológicas a las transfusiones de sangre y componentes. Col Médica 1994;25:73-82.
12. Niels Q. Stten B. Birgit W. Carnsten P. Recombinant Human Erythropoietin and Hemoglobin Concentration at Operatio and during the postoperative period: Reduced need for blood transfusions in patients undergoing colorectal surgery- Prospective Double - blind placebo - controlled study. World J Sury 1999; 23: 30-5.
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. American J Med 1994; 96
14. Alexander K. Gombotz H. Gootfried F. Subcutaneous Recombinant Human Erythropoietin and autologous blood donation before coronary artery Bypass surgery. Anesthesia Analg 1993; 76: 102-6.
15. Adamson J. Spivak J. Physiologic basis for the pharmacologic use of reombinant human erythropoietin in surgery and cancer treatment. Surgery; Jan1994.
16. Guidelines Consensus Conference: Blood Management Surgical Practice Am J Surg; 1995: 170 (6A).
17. Ramos H, Satoru T, Yoog000 K. Evangelos F Howard D. Liver transplantation withouth the use of blood products. Arch Surg 1994; 129:528-533.
18. Cardemil G, Rodríguez M, Reyes D. Resultados del programa de atención medico-quirúrgica sin uso de sangre no hemoderivados del Hospital Clínico de la Universidad de Chile. Rev Chilena Cirugía 2004; 56 (3): 232-36.
19. Maclntyre A. Blood transfusion and hemostatic management in the perioperative period. Can J Anaesth 1992; 39 (5): Pt 2 R 101-14.
20. Fugh-Bermann A. Herb Drug interactions. Lancet 2002; 355 (9198): 134-38.
21. Faris P. Spende K, Larholt M.O. The predicitive power of baseline hemoglobinfor transfusion risk in surgeey patients. Orthopedics 1999:22 (1) Suppl S 135-40
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 (9): 984-9.
23. Sabiston D,C. Principies of operative surgery: antisepsis, technique sutures and drains; Textbook of surgery ; the Biological Basis of Modem Surgical Practice, 15 th ed. Philadelphia. Saunders , 1997. pp. 253-63.
24. Amours D. Joshipura M, Introduction : Damage control at the start of 21st century. Sugrue M. Injury 2004; 35: suppl 639-41.
25. B,Cherqui R. Safety of selective vascular clamping for major hepatectomies. Malasagne. 1998; 187 (5): 482-86.
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 (1-2): 47-9.
27. Postsplenectomy blood salvage in anemic patient; De Rai P.; Rebulla H.; JAMA, 258, N. 10 (1987),1332.
28. Evaluation of autologous she blood for autotransfusion alter orthopaedic surgery; Healy W.; Pfeifer S.; Kurtz U.; Clin. Orthop., N. 299 (1994), 53-59.
29. Conservation of blood during cardiovascular surgery, Cooley D.A; American Journal of Surgery , 170 , N. 6A, Suppl. (1995), 53S-59S.
30. Reduction of blood loss and transfusion requirement by aprotinin in posterior lumbar spine fusion ;Lentschesner C.; Cottin H., Anesth. Analg. 89, N. 3, (1999), 590-597.
31. Central venous pressure and its effect on blood loss during liver resection ; Jones R.; Moulton M.; Br. J. Surg. 85 N. 8 (1998), 1058-1060.
32. Pharmacologic drugs for controlled hypotension; Testa L.D.; Tobias F.; j. Clin. Anesth.,7, N. 4 (1995),326-337.
33. Scott N. B. Regional anaesthesia and surgical morbidity. Br, J, Surg 1099; 75 (4): 44-p.
34. Grass J. Surgical outcome: regional anesthesia and analgesia versus general anaesthesia. Anesthesiol 1993; 20 (4): 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 187, N. 6 (1998);620-625
36. Deliberate hypotensive anesthesia with labetalolin reconstructive surgery for scoliosis, Acta Anaesthesiol Sin, 34 N. 4; (1996); 203-207.
37. The role of desmopressin in reducing blood loss during lumbar fusions; Johnson R.; Murphy U.; Surg. Gynecol. Obstet.; 171, n. 3 (1990), 106-110.
38. Prevention of bleeding after cardiopulmonary bypass with high - dose tranexamic acid; Karski Y.; Teasdale R., J. Thorac. Cardiovasc. Surg. ,110, N.3, (1995), 835-42.
39. Tranexamic acid is effective in decreasing postoperative bleeding and transfusions in primary coronary artery bypass surgery : a double blind randomized palcebo controlled trial; Brown G.; Thwaites R.; Anesth. Analg. 85; n.5 (1997), 963-70.
40. Increased safety in the administration of aprotinin , need for a test dose; Llau V.; García- Pérez M., Nesth. Analg. 90, N. 3 (2000) , 770-71.
41. Kesten S.A. Hoyas de C. Chaparrto I. Aprtinin reduced blood loss in lung transplant recipiente Ann Thorac, Surg 1995; 59 (4): 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 (3): 590-97.
43. aprotinin and transfusion requirements in orthoptic liver transplantation : a multicentric randomised double blind trial ; Porte Y., Moleenar T., Begliomini U ; Lancet, 335, N. 9212; (2000), 1303-1309.
44. Jaramillo M. Medicina Transfusional, Principios y practica medico quirúrgica. Bogotá: Proyecto Aventis, 2003.
45. Szalay D, Wong T, Lindsay T. Impact of red cell salvage on transfusión requirements during elective abdominal aortic aneurysm repair Ann. Vasc Surg 1999; 13 (6): 576-81.
46. Goodnough L. Monk G. Sicard H, J. Intraoperative salvage in patients undergoing elective abdominal aortic aneurysm reapir: an análisis of costs and benefits . J. Vasc. Surg 1996; 24 (2): 213-18.
47. Assesment of the availability of intraoperative autotransfusion in urological operations. J Urol 1997; 157 (5): 1777-80.
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; my.
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