Anda di halaman 1dari 4

British Guidelines on the management of

anaemia and red cell


transfusion in adult critically ill patients
Andrew Retter et al *

Duncan Wyncoll,1 Rupert Pearse,3 Damien Carson,4 Stuart McKechnie,5 Simon


Stanworth,6
Shubha Allard,7 Dafydd Thomas,8 Tim Walsh9 and British Committee for Standards in
Haematology
1Intensive Care Unit, Guys & St. Thomas Hospital, 2Haematology Department, Guys &
St. Thomas Hospital, Lambeth, 3Intensive Care Unit, Royal London Hospital,
Whitechapel, London, 4Department of Anaesthetics, South Eastern HSC Trust, Belfast,
5Adult Intensive Care Unit, John Radcliffe Hospital, 6NHS Blood & Transplant, Oxford
Radcliffe Hospitals Trust, Oxford, 7Department of Haematology, Royal London Hospital,
Whitechapel, London, 8Intensive Care Unit, Morriston Hospital, ABMUHB, Swansea, and
9Critical Care and Centre for Inflammation Research, Edinburgh Royal Infirmary,
Edinburgh University, Edinburgh, UK
British Journal of Haematology, 2013, 160, 445464.

_______________________________________________________________
Recopilacion y Traduccin:
JC. Vergara.

(Junio 2013)

Summary of recommendations

SUMARIO DE RECOMENDACIONES

General intensive care

Cuidados intensivos generales

A transfusion threshold of 70 g/l or below, with a target Hb


range of 7090 g/l, should be the default for all critically ill
patients, unless specific co-morbidities or acute illness
related factors modify clinical decision-making (Grade 1B).

El umbral de transfusin predeterminado para todos los


pacientes en estado crtico debe ser 70 g / l o menos, con
un objetivo de Hgb en un rango de 70 a 90 g / l, a menos
que comorbilidades especficas o factores relacionados
con la enfermedad aguda modifiquen la toma de
decisiones clnicas (Grado 1B).

Transfusion triggers should not exceed 90 g/l in most


critically ill patients (Grade 1B).

El trigger de transfusin no deben exceder de 90 g / l en la


mayora de los pacientes crticos (Grado 1B).

Alternatives to red cell transfusion

Alternativas a la transfusin de glbulos rojos

Erythropoietin should not be used to treat anaemia in


critically ill patients until further safety and efficacy data are
available (Grade 1B).

La eritropoyetina no debe utilizarse para tratar la anemia


en pacientes crticos hasta que estn disponibles ms
datos sobre su seguridad y eficacia (Grado 1B).

In the absence of clear evidence of iron deficiency, routine


iron supplementation is not recommended during critical
illness (Grade 2D).

En ausencia de pruebas claras de dficit de hierro, no se


recomienda la administracin rutinaria de suplementos de
hierro durante la enfermedad crtica. (Grado 2D).

Blood sampling techniques

Tcnicas de muestreo de sangre

The introduction of blood conservation devices should be


considered to reduce phlebotomy-associated blood loss
(Grade 1C).

La introduccin de dispositivos de conservacin de sangre


debe ser considerada para reducir la prdida de sangre
asociada a las flebotomas. (Grado 1C).

Paediatric blood sampling tubes can be effective for reducing Los tubos peditricos de muestreo pueden ser eficaces
para reducir la prdida iatrognica de sangre (Grado 2C).
iatrogenic blood loss (Grade 2C).
TRALI and TACO*

TRALI y TACO

Pre-transfusion clinical assessment should be undertaken


including concomitant medical conditions that increase
the risk of TACO (cardiac failure, renal impairment,
hypoalbuminaemia, fluid overload; Grade 1D).

Debe llevarse a cabo una evaluacin clnica previa a la


transfusin incluyendo condiciones concomitantes que
aumenten el riesgo de TACO (insuficiencia cardaca,
insuficiencia renal, hipoalbuminemia, sobrecarga de
lquidos; Grado 1D).

Attention to the rate of transfusion together with careful


fluid balance and appropriate use of diuretic cover (e.g.
furosemide) can reduce the risk of TACO (Grade 1D).

La atencin al ritmo de transfusin, junto con un cuidadoso


balance de lquidos, y el uso adecuado de cobertura
diurtica (p. ej. furosemida) puede reducir el riesgo de
TACO (Grado 1D).

Patients developing acute dyspnoea with hypoxia and


bilateral pulmonary infiltrates during or within 6 h of
transfusion should be carefully assessed for the probability of
TRALI and patients should be admitted to a critical care area
for supportive treatment and monitoring (Grade 1D).

Los pacientes que desarrollen disnea aguda con hipoxia e


infiltrados pulmonares bilaterales durante o dentro de las
6 h de transfusin, deben evaluarse cuidadosamente
para la probabilidad de TRALI, y deben ser ingresados en
un rea de cuidados crticos para tratamiento y
monitorizacin (Grado 1D).

Any adverse events or reactions related to transfusion


should be appropriately investigated and reported via
systems for local risk management, and also to National
Haemovigilance Shemes (Grade 1D).

Los eventos adversos o reacciones relacionadas con la


transfusin deben ser investigados e informados
debidamente a travs de sistemas para la gestin local
del riesgo, y tambin para Nacional Hemovigilancia
Shemes (Grado 1D).

* TACO: transfusion-associated circulatory overload

Red cell storage duration

Duracin de los glbulos rojos almacenados

The evidence base is insufficient to support the


administration of fresher blood to critically ill patients (Grade
2B).

La evidencia es insuficiente para apoyar la administracin


de 'sangre fresca' en pacientes crticos (Grado 2B).

Sepsis

Sepsis

In the early resuscitation of patients with severe sepsis, if


there is clear evidence of inadequate DO2*, transfusion of
RBCs to a target Hb of 90100 g/l should be considered
(Grade 2C).

En el periodo temprano de la reanimacin de pacientes con


sepsis grave, si existe una clara evidencia de DO2*
inadecuado, se debe considerar la transfusin de RBC
para un objetivo de Hgb de 90-100 g / l (Grado 2C).

During the later stages of severe sepsis, a restrictive


approach to transfusion should be followed with a target
Hb of 7090 g/l (Grade 1B).

Durante las ltimas etapas de la sepsis grave, se debe


seguir un enfoque restrictivo para la transfusin con un
objetivo de Hb de 70-90 g / l (Grado 1B).

Neurocritical care

Cuidado Neurocrticos

In patients with TBI the target Hb should be 7090 g/l


(Grade 2D).

En los pacientes con lesin cerebral traumtica el objetivo


para la Hb debe ser 70 a 90 g / l (Grado 2D).

In patients with TBI and evidence of cerebral ischaemia


the target Hb should be >90 g/l (Grade 2D).

En los pacientes con lesin cerebral traumtica y evidencia


de isquemia cerebral el objetivo para la Hb debe ser> 90
g / l (Grado 2D).

In patients with SAH the target Hb should be 80100 g/l


(Grade 2D).

En los pacientes con HSA el objetivo para la Hb debe ser


80-100 g / l (Grado 2D).

In patients presenting to the ICU with an acute ischaemic


stroke the Hb should be maintained above 90 g/l (Grade
2D).

Ischaemic heart disease

Cardiopata isqumica

In patients suffering from ACS the Hb should be maintained


at >80 g/l (Grade 2C).

En los pacientes de UCI con un ACV isqumico agudo la


Hb se debe mantener por encima de 90 g / l (Grado 2D).

En pacientes con SCA deberan mantenerse una Hb> 80


g / l (Grado 2C).

Anaemic critically ill patients with stable angina should


have a Hb maintained >70 g/l (Grade 2C).

En pacientes crticos anmicos con angina estable debe


mantenerse una Hb> 70 g / l (Grado 2C).

Weaning

Destete

Red cell transfusion transfusion should not be used as a


strategy to assist weaning from mechanical ventilation
when the Hb is >70 g/l (Grade 2C).

La transfusin de glbulos rojos no debe utilizarse como


estrategia para ayudar a la retirada de la ventilacin
mecnica cuando la Hb es> 70 g / l (Grado 2C).

-----

-----

Disclaimer

Advertencia

While the advice and information in these guidelines is


believed to be true and accurate at the time of going to
press, neither the authors, the British Society for
Haematology
nor the publishers accept any legal responsibility for the
content of these guidelines.

Aunque el asesoramiento y la informacin de esta gua se


cree que es verdadera y exacta en el momento de la
publicacin, ni los autores, ni la Sociedad Britnica de
Hematologa, ni el editor aceptan responsabilidad legal
alguna por el contenido de estas directrices.

* Global oxygen delivery

* Disponibilidad de O2