¿Por qué continuamos transfundiendo dos unidades de sangre a la vez si con una sola podría ser suficiente?
Palabras clave:
TRANSFUSIÓN SANGUÍNEA, ESTÁNDARES DE REFERENCIA
Resumen
La transfusión de sangre ha sido identificada como uno de los procedimientos médicos más sobreutilizados en pacientes hospitalizados. Una estrategia que permitiría reducir la exposición de los pacientes a la sangre es a través de la implementación de una política de transfusión de una sola unidad, en lugar de dos, para pacientes estables, sin hemorragia y con anemia sintomática. La decisión de transfundir sangre es compleja y depende de varios factores, además, los riesgos de la transfusión se deben sopesar contra los beneficios esperados. La transfusión de dos unidades de sangre a la vez ya no se considera una forma de tratamiento “estándar” para pacientes anémicos sin sangrado activo. Existe una gran oportunidad para reducir el uso excesivo de la transfusión y fomentar las transfusiones de una sola unidad.
Citas
(1) Goodnough L, Maggio P, Hadhazy E, Shieh L, Hernández-Boussard T, Khari P, et al. Restrictive blood transfusion practices are associated with improved patient outcomes. Transfusion 2014; 54(10 Pt 2):2753-9. doi: 10.1111/trf. 12723.
(2) Yang W, Thakkar R, Gehrie E, Chen W, Frank S. Single-unit transfusions and hemoglobin trigger: relative impact on red cell utilization. Transfusion 2017; 57(5):1163-70. doi: 10.1111/trf.14000.
(3) Bowman Z, Fei N, Ahn J, Wen S, Cumpston A, Shah N, et al. Single versus double-unit transfusion: Safety and efficacy for patients with hematologic malignancies. Eur J Haematol 2019; 102(5):383-8. doi: 10.1111/ejh.13211.
(4) Cass R, Blumberg N. Single-unit blood transfusion: doubtful dogma defeated. JAMA 1987; 257(5):628-9.
(5) Mintz P. Single-unit blood transfusions. N Engl J Med 1983; 309(10):614. doi: 10.1056/nejm198309083091015.
(6) Thomson A, Farmer S, Hofmann A, Isbister J, Shander A. Patient blood management - a new paradigm for transfusion medicine? ISBT Sci Ser 2009; 4:423-35. doi: 10.1111/j.1751-2824.2009.01251.x.
(7) Adams R, Lundy J. Anesthesia in cases of poor surgical risk: some suggestions for decreasing the risk. Surgery, Gynecology & Obstetrics. 1942; 74:1011-19.
(8) Hébert P, Wells G, Blajchman M, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999; 340(6):409-17. doi: 10.1056/NEJM199902113400601.
(9) Lacroix J, Hébert P, Hutchison J, Hume H, Tucci M, Ducruet T, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med 2007; 356(16):1609-19. doi: 10.1056/NEJMoa066240.
(10) Hajjar L, Vincent J, Galas F, Nakamura R, Silva C, Santos M, et al. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA 2010; 304(14):1559-67. doi: 10.1001/jama.2010.1446.
(11) Carson J, Terrin M, Noveck H, Sanders D, Chaitman B, Rhoads G, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 2011; 365(26):2453-62. doi: 10.1056/NEJMoa1012452.
(12) Villanueva C, Colomo A, Bosch A. Transfusion for acute upper gastrointestinal bleeding. N Engl J Med 2013; 368(14):1362-3. doi: 10.1056/NEJMc1301256.
(13) Robertson C, Hannay H, Yamal J, Gopinath S, Goodman J, Tilley B. Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial. JAMA 2014; 312(1):36-47. doi: 10.1001/jama.2014.6490.
(14) Holst L, Haase N, Wetterslev J, Wernerman J, Guttormsen A, Karlsson S, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med 2014; 371(15):1381-91. doi: 10.1056/NEJMoa1406617.
(15) Mazer C, Whitlock R, Fergusson D, Hall J, Belley-Cote E, Connolly K, et al. Restrictive or liberal red-cell transfusion for cardiac surgery. N Engl J Med 2017; 377(22):2133-44. doi: 10.1056/NEJMoa1711818.
(16) Carson J, Guyatt G, Heddle N, Grossman B, Cohn C, Fung M, et al. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA 2016; 316(19):2025-35. doi: 10.1001/jama.2016.9185.
(17) Mueller M, Van Remoortel H, Meybohm P, Aranko K, Aubron C, Burger R, et al. Patient blood management: recommendations from the 2018 Frankfurt Consensus Conference. JAMA 2019; 321(10):983-97. doi: 10.1001/jama.2019.0554.
(18) Retter A, Wyncoll D, Pearse R, Carson D, McKechnie S, Stanworth S, et al. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. Br J Haematol 2013; 160(4):445-64. doi: 10.1111/bjh.12143.
(19) Ferraris V, Davenport D, Saha S, Austin P, Zwischenberger J. Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Arch Surg 2012; 147(1):49-55. doi: 10.1001/archsurg.2011.790.
(20) Koch C, Li L, Duncan A, Mihaljevic T, Cosgrove D, Loop F, 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. doi: 10.1097/01.CCM.0000217920.48559.D8.
(21) Santos A, Sousa A, Piotto R, Pedroso J. Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft. Rev Bras Cir Cardiovasc 2013; 28(4):509-17. doi: 10.5935/1678-9741.20130083.
(22) Anthes E. Evidence-based medicine: Save blood, save lives. Nature 2015; 520(7545):24-6. doi: 10.1038/520024a.
(23) Podlasek S, Thakkar R, Rotello L, Fleury T, Demski R, Ness P, et al. Implementing a “Why give 2 when 1 will do?” Choosing Wisely campaign. Transfusion 2016; 56(9):2164. doi: 10.1111/trf.13664.
(24) Berger M, Gerber B, Arn K, Senn O, Schanz U, Stussi G. Significant reduction of red blood cell transfusion requirements by changing from a double-unit to a single-unit transfusion policy in patients receiving intensive chemotherapy or stem cell transplantation. Haematologica 2012; 97(1):116-22. doi: 10.3324/haematol.2011.047035.
(25) Ma M, Eckert K, Ralley F, Chin-Yee I. A retrospective study evaluating single-unit red blood cell transfusions in reducing allogeneic blood exposure. Transfus Med 2005; 15(4):307-12. doi: 10.1111/j.0958-7578.2005.00592.x.
(26) Chantepie S, Mear J, Parienti J, Bazin A, Benabed K, Cheze S, et al. Blood transfusion in hematologic intensive care unit. Transfusion 2017; 57(2):296-302. doi: 10.1111/trf.13908.
(27) Carson J, Carless P, Hebert P. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2012; 4(4):CD002042. doi: 10.1002/14651858.CD002042.pub3.
(28) Heyes J, Kelly P, Monaghan K, Lawn M, Dhesi A, Mijovic A. A single unit transfusion policy reduces red cell transfusions in general medical in-patients. QJM 2017; 110(11):735-9. doi: 10.1093/qjmed/hcx150.
(29) Shih A, Liu A, Elsharawi R, Crowther M, Cook R, Heddle N. Systematic reviews of guidelines and studies for single versus multiple unit transfusion strategies. Transfusion 2018; 58(12):2841-60. doi: 10.1111/trf.14952.
(30) Thakkar R, Podlasek S, Rotello L, Ness P, Frank S. Two-unit red cell transfusions in stable anemic patients. J Hosp Med 2017; 12(9):747-9. doi: 10.12788/jhm.2806.
(2) Yang W, Thakkar R, Gehrie E, Chen W, Frank S. Single-unit transfusions and hemoglobin trigger: relative impact on red cell utilization. Transfusion 2017; 57(5):1163-70. doi: 10.1111/trf.14000.
(3) Bowman Z, Fei N, Ahn J, Wen S, Cumpston A, Shah N, et al. Single versus double-unit transfusion: Safety and efficacy for patients with hematologic malignancies. Eur J Haematol 2019; 102(5):383-8. doi: 10.1111/ejh.13211.
(4) Cass R, Blumberg N. Single-unit blood transfusion: doubtful dogma defeated. JAMA 1987; 257(5):628-9.
(5) Mintz P. Single-unit blood transfusions. N Engl J Med 1983; 309(10):614. doi: 10.1056/nejm198309083091015.
(6) Thomson A, Farmer S, Hofmann A, Isbister J, Shander A. Patient blood management - a new paradigm for transfusion medicine? ISBT Sci Ser 2009; 4:423-35. doi: 10.1111/j.1751-2824.2009.01251.x.
(7) Adams R, Lundy J. Anesthesia in cases of poor surgical risk: some suggestions for decreasing the risk. Surgery, Gynecology & Obstetrics. 1942; 74:1011-19.
(8) Hébert P, Wells G, Blajchman M, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999; 340(6):409-17. doi: 10.1056/NEJM199902113400601.
(9) Lacroix J, Hébert P, Hutchison J, Hume H, Tucci M, Ducruet T, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med 2007; 356(16):1609-19. doi: 10.1056/NEJMoa066240.
(10) Hajjar L, Vincent J, Galas F, Nakamura R, Silva C, Santos M, et al. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA 2010; 304(14):1559-67. doi: 10.1001/jama.2010.1446.
(11) Carson J, Terrin M, Noveck H, Sanders D, Chaitman B, Rhoads G, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 2011; 365(26):2453-62. doi: 10.1056/NEJMoa1012452.
(12) Villanueva C, Colomo A, Bosch A. Transfusion for acute upper gastrointestinal bleeding. N Engl J Med 2013; 368(14):1362-3. doi: 10.1056/NEJMc1301256.
(13) Robertson C, Hannay H, Yamal J, Gopinath S, Goodman J, Tilley B. Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial. JAMA 2014; 312(1):36-47. doi: 10.1001/jama.2014.6490.
(14) Holst L, Haase N, Wetterslev J, Wernerman J, Guttormsen A, Karlsson S, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med 2014; 371(15):1381-91. doi: 10.1056/NEJMoa1406617.
(15) Mazer C, Whitlock R, Fergusson D, Hall J, Belley-Cote E, Connolly K, et al. Restrictive or liberal red-cell transfusion for cardiac surgery. N Engl J Med 2017; 377(22):2133-44. doi: 10.1056/NEJMoa1711818.
(16) Carson J, Guyatt G, Heddle N, Grossman B, Cohn C, Fung M, et al. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA 2016; 316(19):2025-35. doi: 10.1001/jama.2016.9185.
(17) Mueller M, Van Remoortel H, Meybohm P, Aranko K, Aubron C, Burger R, et al. Patient blood management: recommendations from the 2018 Frankfurt Consensus Conference. JAMA 2019; 321(10):983-97. doi: 10.1001/jama.2019.0554.
(18) Retter A, Wyncoll D, Pearse R, Carson D, McKechnie S, Stanworth S, et al. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. Br J Haematol 2013; 160(4):445-64. doi: 10.1111/bjh.12143.
(19) Ferraris V, Davenport D, Saha S, Austin P, Zwischenberger J. Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Arch Surg 2012; 147(1):49-55. doi: 10.1001/archsurg.2011.790.
(20) Koch C, Li L, Duncan A, Mihaljevic T, Cosgrove D, Loop F, 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. doi: 10.1097/01.CCM.0000217920.48559.D8.
(21) Santos A, Sousa A, Piotto R, Pedroso J. Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft. Rev Bras Cir Cardiovasc 2013; 28(4):509-17. doi: 10.5935/1678-9741.20130083.
(22) Anthes E. Evidence-based medicine: Save blood, save lives. Nature 2015; 520(7545):24-6. doi: 10.1038/520024a.
(23) Podlasek S, Thakkar R, Rotello L, Fleury T, Demski R, Ness P, et al. Implementing a “Why give 2 when 1 will do?” Choosing Wisely campaign. Transfusion 2016; 56(9):2164. doi: 10.1111/trf.13664.
(24) Berger M, Gerber B, Arn K, Senn O, Schanz U, Stussi G. Significant reduction of red blood cell transfusion requirements by changing from a double-unit to a single-unit transfusion policy in patients receiving intensive chemotherapy or stem cell transplantation. Haematologica 2012; 97(1):116-22. doi: 10.3324/haematol.2011.047035.
(25) Ma M, Eckert K, Ralley F, Chin-Yee I. A retrospective study evaluating single-unit red blood cell transfusions in reducing allogeneic blood exposure. Transfus Med 2005; 15(4):307-12. doi: 10.1111/j.0958-7578.2005.00592.x.
(26) Chantepie S, Mear J, Parienti J, Bazin A, Benabed K, Cheze S, et al. Blood transfusion in hematologic intensive care unit. Transfusion 2017; 57(2):296-302. doi: 10.1111/trf.13908.
(27) Carson J, Carless P, Hebert P. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2012; 4(4):CD002042. doi: 10.1002/14651858.CD002042.pub3.
(28) Heyes J, Kelly P, Monaghan K, Lawn M, Dhesi A, Mijovic A. A single unit transfusion policy reduces red cell transfusions in general medical in-patients. QJM 2017; 110(11):735-9. doi: 10.1093/qjmed/hcx150.
(29) Shih A, Liu A, Elsharawi R, Crowther M, Cook R, Heddle N. Systematic reviews of guidelines and studies for single versus multiple unit transfusion strategies. Transfusion 2018; 58(12):2841-60. doi: 10.1111/trf.14952.
(30) Thakkar R, Podlasek S, Rotello L, Ness P, Frank S. Two-unit red cell transfusions in stable anemic patients. J Hosp Med 2017; 12(9):747-9. doi: 10.12788/jhm.2806.
Publicado
2021-03-31
Cómo citar
1.
Berro M, Rodríguez I. ¿Por qué continuamos transfundiendo dos unidades de sangre a la vez si con una sola podría ser suficiente?. Rev. Méd. Urug. [Internet]. 31 de marzo de 2021 [citado 16 de diciembre de 2024];37(1):e37112. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/677
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