RESUMO
BACKGROUND: Exchange transfusion is a highly complex procedure that requires high levels of expertise. Trainee paediatricians do not have adequate training in exchange transfusion because opportunities to perform this procedure in practice are scarce. This protocol seeks to compare two educational interventions for exchange transfusion that allow students to develop competencies to perform the technique in an appropriate and safe way. METHODS/DESIGN: This is a randomized parallel single-blind clinical trial with allocation by simple randomization to the educational intervention (simulation or a digital didactic environment). Students from the paediatric specialization who volunteer to participate will be included. A practical evaluation of the procedure will be performed through a simulated scenario using a standardized clinical case. The main outcome is defined as the result of evaluation using the Objective Structured Clinical Examination; superior performance will be defined when the percentage is greater than or equal to 85%, and non-superior performance will be defined when the result is less than 84%. The chi-square independence test or the Fisher exact test will be used to evaluate the effect of the interventions. Multivariate analysis will be performed using a non-conditional logistic regression model. Stata 15® software will be used. DISCUSSION: Exchange transfusion is a procedure that requires expertise to achieve adequate outcomes. The inclusion of new educational strategies, such as simulation and digital didactic environments, is seen as a training option that can improve performance in clinical skills, reduce adverse events and increase the level of trust. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04070066. Registered on 28 August 2019. https://clinicaltrials.gov.
Assuntos
Competência Clínica/normas , Transfusão Total/métodos , Pediatria/educação , Competência Clínica/estatística & dados numéricos , Colômbia/epidemiologia , Simulação por Computador , Escolaridade , Transfusão Total/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Icterícia Neonatal/diagnóstico , Icterícia Neonatal/terapia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco , Método Simples-Cego , Estudantes de MedicinaRESUMO
Fetomaternal transfusion (FMT) is defined by the transfer of fetal blood into the maternal circulation. The incidence of massive FMT is estimated to be approximately 0.2-0.9 % of births. Although a number of etiologies have been associated with FMT, most causes remain unidentified and the pregnancy is usually asymptomatic. The most frequent symptom is the decrease in fetal movements (26 %) in relation to severe anemia. Several diagnostic modalities for FMT are described (Kleihauer stain, flow cytometry). We describe a case of a newborn with chronic anemia secondary to FMT who, after treatment with transfusions of red blood cells, presented volume overload and clinical worsening as a complication. In this case, our patient needed exchange transfusion for definitive improvement without disability.
La transfusión feto-materna es el paso de eritrocitos fetales a la circulación materna. Cuando es masiva, tiene una incidencia aproximada del 0,2-0,9 %. Generalmente, se desconoce el agente desencadenante, pero, en ocasiones, se pueden identificar factores de riesgo. En el embarazo, suele ser asintomática; el síntoma más frecuente es la disminución de los movimientos fetales (el 26 %) en relación con la anemia grave. Se diagnostica mediante la detección de hemoglobina fetal en la sangre materna (test de Kleihauer o citometría de flujo). Se presenta a un recién nacido con anemia crónica secundaria a la transfusión fetomaterna, que, después del tratamiento con transfusión de concentrado de hematíes, tuvo como complicación síntomas de sobrecarga de volumen y empeoramiento clínico. Tras la realización de una exanguinotransfusión, evolucionó favorablemente, sin secuelas.
Assuntos
Anemia Neonatal/etiologia , Transfusão Total/métodos , Transfusão Feto-Materna/complicações , Adolescente , Anemia Neonatal/terapia , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Índice de Gravidade de DoençaRESUMO
In spite of significant strides in the treatment of sickle cell disease (SCD), SCD crises are still responsible for high morbidity and early mortality. While most patients initially seek care in the acute setting for a seemingly uncomplicated pain episode (pain crisis or vaso-occlusive crisis), this initial event is the primary risk factor for potentially life-threatening complications. The pathophysiological basis of these illnesses is end-organ ischemia and infarction combined with the downstream effects of hemolysis that results from red blood cell sickling. These pathological changes can occur acutely and lead to a dramatic clinical presentation, but are frequently superimposed over a milieu of chronic vasculopathy, immune dysregulation, and decreased functional reserve. In the lungs, acute chest syndrome is a particularly ominous lung injury syndrome with a complex pathogenesis and potentially devastating sequelae, but all organ systems can be affected. It is, therefore, critical to understand the SCD patients' susceptibility to acute complications and their risk factors so that they can be recognized promptly and managed effectively. Blood transfusions remain the mainstay of therapy for all severe acute crises. Recommendations and indications for the safest and most efficient implementation of transfusion strategies in the critical care setting are therefore presented and discussed, together with their pitfalls and potential future therapeutic alternatives. In particular, the importance of extended phenotypic red blood cell matching cannot be overemphasized, due to the high prevalence of severe complications from red cell alloimmunization in SCD.
Assuntos
Síndrome Torácica Aguda/terapia , Anemia Aplástica/terapia , Anemia Falciforme/terapia , Antibacterianos/uso terapêutico , Insuficiência de Múltiplos Órgãos/terapia , Oxigenoterapia , Púrpura Trombocitopênica Trombótica/terapia , Acidente Vascular Cerebral/terapia , Síndrome Torácica Aguda/etiologia , Síndrome Torácica Aguda/fisiopatologia , Anemia Aplástica/etiologia , Anemia Aplástica/fisiopatologia , Anemia Falciforme/complicações , Anemia Falciforme/fisiopatologia , Tipagem e Reações Cruzadas Sanguíneas/métodos , Progressão da Doença , Transfusão de Eritrócitos/métodos , Transfusão Total/métodos , Humanos , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Dor/etiologia , Manejo da Dor , Síndrome da Leucoencefalopatia Posterior , Púrpura Trombocitopênica Trombótica/etiologia , Púrpura Trombocitopênica Trombótica/fisiopatologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologiaAssuntos
Bilirrubina/história , Eritroblastose Fetal/história , Transfusão Total/história , Publicações Periódicas como Assunto/história , Bilirrubina/sangue , Eritroblastose Fetal/sangue , Eritroblastose Fetal/terapia , Transfusão Total/métodos , História do Século XX , Humanos , Recém-Nascido , Pediatria/históriaRESUMO
OBJECTIVES: We conducted a retrospective study to examine the optimal regimen of transfusion and whether preoperative transfusion is needed in patients with Sickle cell anaemia (SCA) undergoing a Total hip arthroplasty (THA). Then, we assessed the incidence of perioperative complications rates among patients assigned to different transfusion regimens to propose finally the safety transfusion protocol. BACKGROUND: Preoperative transfusions are usually given to reduce or prevent perioperative complications to SCA patients undergoing THA. There is no consensus however on the best regimen of transfusion. STUDY DESIGN AND METHODS: During the period of 2000 to 2010, 14 patients with SCA (sex-ratio 0.4) with a mean age of 36 years underwent 16 THA (primary or revision). Three groups were differentiated according preoperatively protocol transfusion. Group 1: exchange transfusion (EXT), group 2: simple transfusion (ST), group 3: no transfusion (NT). RESULTS: Overall, preoperative transfusion was performed in 43.7% of cases and complications rate was 50%. In the group 1 (EXT) including five patients (31%), severe complications occurred in four patients (80%). in the group 2, including two patients (12.5%), no complications were observed. In the group 3, including nine patients (56%), complications occurred in four procedures (44.5%), the half of them were haemolytic complications. CONCLUSION: Our results support the decision to transfuse, ST, preoperatively only if the patient is significantly below their steady-state haemoglobin (Hb) level. Transfusion can be used intraoperatively according Hb level and/or the blood loss volume. Exchange transfusion appeared mostly to be related to postoperative morbidity rates.
Assuntos
Anemia Falciforme/terapia , Artroplastia de Quadril/efeitos adversos , Transfusão de Eritrócitos/métodos , Transfusão Total/métodos , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Anemia Falciforme/complicações , Anemia Falciforme/cirurgia , Transfusão de Eritrócitos/efeitos adversos , Feminino , França , Humanos , Incidência , Complicações Intraoperatórias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Adulto JovemRESUMO
En pacientes con anemia falciforme, el circuito de circulación extracorpórea promueve la polimerización de la hemoglobina y la formación de drepanocitos. La exanguinotransfusión reduce los niveles circulantes de hemoglobina S. Reportamos el manejo de un niño con anemia falciforme homocigótica que requirió cirugía de cierre de comunicación interauricular. Se realizó exanguinotransfusión parcial intraoperatoria disminuyendo los niveles de hemoglobina S de 89 por ciento a 23 por ciento. La circulación extracorpórea fue conducida en normotermia utilizando cardiología fría, realizando el procedimiento quirúrgico en paro sinusal.
In patients with sickle cell anemia, the extracorporeal circulation circuit promotes the polymerization of hemoglobin and sickle cell formation. Exchange transfusion reduces circulating levels of hemoglobin S. We report the management of a child with homozygous sickle cell anemia who required surgical closure of atrial septal defect. Partial intraoperative exchange transfusion was performed that decreased hemoglobin S levels from 89 percent to 23 percent. Cardiopulmonary bypass was conducted at normothermia with cold blood cardioplegia and the surgical procedure was performed in sinus arrest.
Assuntos
Humanos , Masculino , Pré-Escolar , Anemia Falciforme/terapia , Ponte Cardiopulmonar/métodos , Transfusão Total/métodos , Circulação Extracorpórea , HomozigotoRESUMO
Pertussis is a contagious disease that may develop a serious clinical picture by hypoxemia and pulmonary hypertension refractory to treatment. The syndrome of hyperviscosity and arteriolar thrombosis is responsible for the cardiocirculatory collapse. Our objective is to describe the evolution of a series of patients with severe pertussis, some of whom received exchange transfusion (ET) as an alternative treatment. We analyzed 41 patients' clinical charts with diagnosis of pertussis treated in the Pediatric Intensive Care Units during the 2003-2011 period. The mean age was 2.38 months. In the 90.2% of cases, the cause of admission to PICU was respiratory failure; 75% required mechanical respiratory support and 39% developed pulmonary hypertension. The overall mortality was 41.4%. Nine patients were treated by ET, 5 died. Conclusion. Severe pertussis is associated with high mortality. ET reduced the mass of circulating leukocytes in 53.5%; ET could be an alternative to conventional treatment, although controlled studies are required to assert it.