REDUCCIÓN DE TRANSFUSIONES ALOGÉNICAS EN CIRUGÍA CARDÍACA EMPLEANDO UN PROGRAMA DE AHORRO DE SANGRE

Antecedents and objectives: Cardiac surgery has been a process which traditionally requires large amounts of homologous blood transfusions. Due to the negative effects on perioperative morbimortality, and its cost, some alternatives have been developed in order to reduce or avoid giving a transfusion to the patients. The aim of this study is to put into practice and assess the effectiveness of a strategy for reducing the use of allogeneic transfusions in the cardiac surgery perioperative at the Ernesto Che Guevara Cardiology Hospital. Method: 151 patients, who were operated on with or without extracorporeal circulation, and who were inserted in a blood saving program that included acute intentional normovolemic hemodilution with autotransfusion during the year 2008, were studied in order to assess the effectiveness of such strategies. Results: It was possible to avoid the transfusions with allogeneic components in 55 percent of the patients (56.0 percent from the group intervened with extracorporeal circulation (ECC), and 52.64 percent of the patients operated on without ECC) and the patients who received the transfusions needed a smaller amount of allogeneic blood components, as well as fewer units administered through the transfusion. Conclusions: The strategies for saving blood were effective in order to reduce the homologous transfusions in the cardiac surgery perioperative.Antecedentes y objetivos: La cirugía cardíaca ha sido por tradición un procedimiento donde se consume gran cantidad de transfusiones homólogas. Debido a los efectos negativos sobre la morbimortalidad perioperatoria y los costos, se han intentado desarrollar alternativas para reducir o evitar transfundir a los pacientes. El objetivo de esta investigación es aplicar y conocer la efectividad de una estrategia para reducir el uso de las transfusiones alogénicas en el perioperatorio de cirugía cardíaca en el Cardiocentro Ernesto Che Guevara. Método: Estudiamos a 151 pacientes operados con y sin circulación extracorpórea que fueron insertados en un programa de ahorro de sangre, incluyendo hemodilución normovolémica intencional aguda con autotransfusión, durante el año 2008, para determinar la efectividad de dichas estrategias. Resultados: Se logró evitar transfundir con componentes alogénicos al 55 % de los operados (56,0 % del grupo intervenido con circulación extracorpórea (CEC), y 52,64 % de los pacientes operados sin CEC) y los pacientes transfundidos requirieron una cantidad baja de componentes sanguíneos alogénicos, así como un número reducido de unidades administradas por transfusión. Conclusiones: Las estrategias de ahorro de sangre fueron efectivas para reducir las transfusiones homólogas en el perioperatorio de cirugía cardíaca

REDUCCIÓN DE TRANSFUSIONES ALOGÉNICAS EN CIRUGÍA CARDÍACA EMPLEANDO UN PROGRAMA DE AHORRO DE SANGRE / The reduction of allogeneic blood transfusions in cardiac surgery using a blood saving program

Antecedents and objectives: Cardiac surgery has been a process which traditionally requires large amounts of homologous blood transfusions. Due to the negative effects on perioperativemorbimortality, and its cost, some alternatives have been developed in order to reduce or avoid giving a transfusion to the patients. The aim of this study is to put into practice and assess theeffectiveness of a strategy for reducing the use of allogeneic transfusions in the cardiac surgery perioperative at the Ernesto Che Guevara Cardiology Hospital. Method: 151 patients, who were operated on with or without extracorporeal circulation, and who were inserted in a blood saving program that included acute intentional normovolemic hemodilution with autotransfusion during theyear 2008, were studied in order to assess the effectiveness of such strategies. Results: It was possible to avoid the transfusions with allogeneic components in 55 percent of the patients (56.0 percent from the group intervened with extracorporeal circulation (ECC), and 52.64 percent of the patients operated on without ECC) and the patients who received the transfusions needed a smaller amount of allogeneic blood components, as well as fewer units administered through the transfusion. Conclusions: The strategies for saving blood were effective in order to reduce the homologous transfusions in the cardiac surgery perioperative

SHOCK* ANAFILÁCTICO ATÍPICO PERIOPERATORIO. PRESENTACIÓN DE UN CASO Y REVISIÓN DE LA LITERATURA

The shock is a potentially fatal condition in which arterial blood pressure is too low to sustain the vital functions of the body. It is the consequence a serious arterial hypotension caused by a decrease in the volume of circulating blood, an inadequate pumping of the heart or an excessive relaxation (dilatation) of the blood vessel walls. The case of a serious anaphylactic shock in the perioperative period of an incisional abdominal hernioplasty in a patient suffering from heart disease is presented. The precise diagnosis was delayed due to the presence of atypical manifestations and the lack of information concerning the patient�s history of allergy to cephazolin, which was used as antibiotic prophylaxis.El shock es un estado potencialmente mortal en el cual la presión arterial es demasiado baja para mantener las funciones vitales; es la consecuencia de una hipotensión arterial grave causada por una disminución del volumen de sangre circulante, una inadecuada función de bombeo del corazón o una excesiva relajación (dilatación) de las paredes de los vasos sanguíneos. Se presenta un caso de un shock anafiláctico grave en el perioperatorio de hernioplastia incisional abdominal de una paciente con cardiopatía, cuyo diagnóstico preciso fue demorado al presentar manifestaciones poco típicas y desconocerse los antecedentes de alergia a la cefazolina empleada como antibioprofilaxis

SHOCK ANAFILÁCTICO ATÍPICO PERIOPERATORIO. PRESENTACIÓN DE UN CASO Y REVISIÓN DE LA LITERATURA / Perioperative atypical anaphylactic shock: report of a case and review of the literature

The shock is a potentially fatal condition in which arterial blood pressure is too low to sustain thevital functions of the body. It is the consequence a serious arterial hypotension caused by adecrease in the volume of circulating blood, an inadequate pumping of the heart or an excessiverelaxation (dilatation) of the blood vessel walls. The case of a serious anaphylactic shock in theperioperative period of an incisional abdominal hernioplasty in a patient suffering from heart diseaseis presented. The precise diagnosis was delayed due to the presence of atypical manifestations andthe lack of information concerning the patient’s history of allergy to cephazolin, which was used asantibiotic prophylaxis

Efectos de la hemodiluciónnormovolémicacon autodonaciónde bajo volumen sobre algunos parámetros hematológicos en la cirugía cardiovascular con circulación extracorpórea

Introduction and Objectives: Cardiac surgery with extracorporeal circulation is characterized by large perioperative blood loss and multifactorial disorders of coagulation parameters. For these reasons, there is frequent use of allogeneic transfusions. The purpose of this study was to determine the effects of intentional normovolemic hemodilution, with low volume autologous donation, on some hematological parameters in patients undergoing cardiopulmonary bypass. Method: A longitudinal, comparative, prospective study was performed in 27 patients who underwent cardiovascular surgery with cardiopulmonary bypass, subjected to intentional low volume normovolemic hemodilution. The following parameters were studied: the patient's blood volume, bleeding count, hematocrit figures, platelet count, thromboplastin time and INR before and after hemodilution and autotransfusion. Results: A blood volume average extraction of 10.5% for men and 13,12 % for women was found, with a highly significant reduction in hematocrit, and a significant reduction in platelet, although both variables were within normal values, without involvement of the coagulation parameters with hemodilution. After autotransfusion, a highly significant increase in hematocrit and platelet count was found, with significant reduction of thromboplastin time and INR. Conclusions: The low volume normovolemic hemodilution does not produce clinically important changes in the studied hematological parameters, and autotransfusion after cardiopulmonary bypass improves these parameters.Antecedentes y objetivos: La cirugía cardíaca con circulación extracorpórea se caracteriza por grandes pérdidas hemáticas perioperatorias y alteraciones mul Por estas razones es frecuente el empleo de transfusiones alogénicas. El propósito de este trabajo fue determinar los efectos de la hemodilución normovolémica intencional, con autodonación de bajo volumen, sobre algunos parámetros hematológicos en el paciente intervenido con circulación extracorpórea. Método: Estudio longitudinal, comparativo, prospectivo, en 27 pacientes a los que se les realizó cirugía cardiovascular con circulación extracorpórea, sujetos a hemodilución normovolémica intencional de bajo volumen. Se estudiaron parámetros, como: volemia del enfermo, cuantía de la sangría, cifras de hematócrito, conteo de plaquetas, tiempo de tromboplastina e INR, antes y después de la hemodilución y de la autotransfusión. Resultados: Se encontró una extracción promedio de 10,5 % de la volemia para los hombres y 13,12 % para las mujeres, con reducción altamente significativa del hematócrito, y significativa de las plaquetas, aunque ambas variables se mantuvieron dentro de valores normales, sin existir afectación de los parámetros de la coagulación con la hemodilución; luego de la autotransfusión se encontró un incremento altamente significativo del hematócrito y del conteo de plaquetas, con reducción significativa de los tiempos de tromboplastina e INR. Conclusiones: La hemodilución normovolémica de bajo volumen no produce alteraciones clínicas importantes de los parámetros hematológicos estudiados, y la autotransfusión posterior a la derivación cardiopulmonar mejora estos parámetros. Palabras clave: Transfusión de sangre antóloga, hemodilución, cirugía torácic

EFECTOS DE LA HEMODILUCIÓN NORMOVOLÉMICA CON AUTODONACIÓN DE BAJO VOLUMEN SOBRE ALGUNOS PARÁMETROS HEMATOLÓGICOS EN LA CIRUGÍA CARDIOVASCULAR CON CIRCULACIÓN EXTRACORPÓREA / Effects of normovolemic hemodilution with low volume autologous donations on various hematological parameters in cardiovascular surgery with cardiopulmonary bypass

Introduction and Objectives: Cardiac surgery with extracorporeal circulation is characterized by large perioperative blood loss and multifactorial disorders of coagulation parameters. For these reasons, there is frequent use of allogeneic transfusions. The purpose of this study was to determine the effects of intentional normovolemic hemodilution, with low volume autologous donation, on some hematological parameters in patients undergoing cardiopulmonary bypass. Method: A longitudinal, comparative, prospective study was performed in 27 patients who underwent cardiovascular surgery with cardiopulmonary bypass, subjected to intentional low volume normovolemic hemodilution. The following parameters were studied: the patient's blood volume, bleeding count, hematocrit figures, platelet count, thromboplastin time and INR before and after hemodilution and autotransfusion. Results: A blood volume average extraction of 10.5% for men and 13,12 % for women was found, with a highly significant reduction in hematocrit, and a significant reduction in platelet, although both variables were within normal values, without involvement of the coagulation parameters with hemodilution. After autotransfusion, a highly significant increase in hematocrit and platelet count was found, with significant reduction of thromboplastin time and INR. Conclusions: The low volume normovolemic hemodilution does not produce clinically important changes in the studied hematological parameters, and autotransfusion after cardiopulmonary bypass improves these parameters