Papers by José Antonio García Erce
Revista clínica española, 2020
Iron deficiency (ID) due to blood loss, absorption disorders and dietary deficiencies causes iron... more Iron deficiency (ID) due to blood loss, absorption disorders and dietary deficiencies causes iron-deficiency anaemia, whose treatment seeks to eliminate the underlying cause and restore haemoglobin and iron deposits. Typically, the latter 2 of these objectives can be achieved through oral iron therapy. Intravenous iron administration (IIA) should be limited to those patients refractory or intolerant to oral preparations or who require rapid repletion. The indiscriminate use of IIA can increase morbidity and mortality due to iatrogenic overload. This fact, coupled with the growing popularity of IIA and the lack of reference guidelines in Spanish, led the Spanish Erythropathology Group of the Spanish Society of Haematology and ଝ Please cite this article as: García Erce JA et al. Manejo del déficit de hierro en distintas situaciones clínicas y papel del hierro intravenoso:
Medicina Clínica (english Edition), Nov 1, 2020
BACKGROUND AND OBJECTIVES The "Patient Blood Management" (PBM) programmes have demonstr... more BACKGROUND AND OBJECTIVES The "Patient Blood Management" (PBM) programmes have demonstrated their value in the continuous improvement of care practice, due to continuous systematic reviewing of results and their dynamic and multidisciplinary updating in accordance with new clinical evidence. Our goal is to demonstrate the effectiveness of simple protocols, applicable in second level hospitals. PATIENTS AND METHODS 702 patients undergoing scheduled arthroplasty from 2011 to 2018 were retrospectively analysed. During this period, the evolution of transfusion rates and anaemia and bleeding management were recorded in the patients' computerised clinical histories. RESULTS Stages and transfusion rates were: Year 2011-2012, "Universal self-donation programme": 62.4%; year 2013, "Optimization of preoperative haemoglobin and universal self-donation withdrawal", 22.5%; year 2015, "Stopping the use of cell-savers and drains", 13.2%; and year 2017, "Introduction of routine tranexamic acid", 3.6%. A significant reduction in the transfusion rate and volume (P<.001) and the average hospital stay (8 to 6 days) (P<.001) was achieved. In multivariate models, transfused patients have a .5-day stay and there is a trend towards a reduction in complications, being fewer in patients receiving tranexamic acid (OR .44). CONCLUSION A simple progressive and multidisciplinary PBM programme, with continued re-evaluation, has allowed a reduction in transfusion rates and average hospital stay.
Medicina Intensiva, Sep 1, 2022
Medicina Clínica (english Edition), Jun 1, 2020
Background: To transfuse packed red blood cells isogroup ABO D is a usual transfusion practice. H... more Background: To transfuse packed red blood cells isogroup ABO D is a usual transfusion practice. However, when there is not enough D-negative blood available, we can transfuse positive red blood cells to negative patients. Immunocompetent D-negative individuals may develop serologically detectable anti-D antibodies within 3 months after exposure to D-positive red blood cells. Material and method: Over the last 18 years, we have experienced situations of D-negative blood cell scarcity. In these situations, we have applied a clinical assistance protocol, selecting patients with lower risk of alloimmunization and chronic transfusion requirements. We have retrospectively evaluated this policy for the use of D-positive red blood cells in D-negative patients, focussing on alloimmunization and mortality. Results: Applying the protocol, 3% of D-negative patients were transfused with D-positive units, with an alloimmunization rate of 12.3%. The rate of alloimmunization was higher in the younger age group and in those transfused with more units. No haemolytic reactions were reported. Mortality in the alloimmunized group was lower. Conclusion: The use of D-positive red blood cells in selected D-negative patients does not induce adverse reactions, is a safe practice and allows saving of a product that is sometimes limited.
Anales De Medicina Interna, May 1, 2002
Frontiers in Medicine
Gastrointestinal (GI) bleeding is associated with considerable morbidity and mortality. Red blood... more Gastrointestinal (GI) bleeding is associated with considerable morbidity and mortality. Red blood cell (RBC) transfusion has long been the cornerstone of treatment for anemia due to GI bleeding. However, blood is not devoid of potential adverse effects, and it is also a precious resource, with limited supplies in blood banks. Nowadays, all patients should benefit from a patient blood management (PBM) program that aims to minimize blood loss, optimize hematopoiesis (mainly by using iron replacement therapy), maximize tolerance of anemia, and avoid unnecessary transfusions. Integration of PBM into healthcare management reduces patient mortality and morbidity and supports a restrictive RBC transfusion approach by reducing transfusion rates. The European Commission has outlined strategies to support hospitals with the implementation of PBM, but it is vital that these initiatives are translated into clinical practice. To help optimize management of anemia and iron deficiency in adults wi...
Medicina Intensiva (English Edition)
Universidad de Zaragoza, Apr 21, 2011
Cirugía Española (English Edition), 2021
Revista española de anestesiología y reanimación, 2004
To determine the effect of risk factors for allogenic blood transfusion in surgery for trochanter... more To determine the effect of risk factors for allogenic blood transfusion in surgery for trochanteric hip fractures. A retrospective study of all the trochanteric hip fracture patients older than 65 years who underwent surgery to repair trochanteric hip fracture related to osteoporosis in 2000 and 2001 in a regional hospital. Data recorded were age; gender; type of fracture (international AO classification); level of anesthetic risk (ASA classification); hemoglobin concentration and hematocrit upon admission, on the day of surgery and 2 days later; time elapsing between admission and surgery; blood transfusion and blood product use. One hundred two patients (29 men and 73 women) with trochanteric hip fractures were studied. Mean (+/- SD) patient age was 82.9 +/- 8.8 years (range, 65-99 years). Upon admission, mean hemoglobin was 123 +/- 18.1 g/L (range, 56-154 g/L), hematocrit was 37% +/- 5% (range, 10%-40%). Time elapsing until surgery was 3.5 +/- 1.6 days (range, 0-8 days). Admissio...
Resumen. Objetivo: Analizar las comunicaciones a congresos nacionales e internacionales de grupos... more Resumen. Objetivo: Analizar las comunicaciones a congresos nacionales e internacionales de grupos multidisciplinarios españoles, y realizar un metaanálisis para estimar el posible beneficio de la autotransfusión predepósito (ATPD) en nuestro entorno. Material y Métodos: Se han revisado los resúme
Resumen. Objetivo: Estudiar las necesidades transfusionales en la cirugía de fracturas trocantére... more Resumen. Objetivo: Estudiar las necesidades transfusionales en la cirugía de fracturas trocantéreas tratadas con sistema tornillo-placa deslizante DHS y analizar los posibles factores predictores. Material y métodos: Se realizó un estudio retrospectivo de los pacientes intervenidos con este sistema durante los años 1995-1999 en el Hospital Universitario Miguel Servet. Se excluyeron los menores 65 años, o hemopatías, fracturas patológicas y anticoagulados. Se analizaron: edad, sexo, tipo de fractura según la clasificación AO, riesgo anestésico, hemograma al ingreso y postoperatorio; demora quirúrgica, tranfusiones, y aparición de infecciones. Se utilizó el test de X2 de Pearson para las variables cualitativas; y la t-Student para variables cuantitativas, así como un análisis de regresión logística. Resultados: Se incluyeron 301 pacientes. De las fracturas 125 fueron tipo A1 y 176 A2 según la AO. Proporción varones/mujeres: 76/225; edad 78,9 años; ASA: I, 53 (17,6%); II, 97 (32,2%); III, 138 (45,8%) y IV, 13 (,3%). Los valores de hemoglobina al ingreso fueron de 128,7 g/L y en el postoperatorio de 101 g/L. Se transfundieron 186 (61,8%) pacientes con una media de 1,4 ± 1,3 unidades de concentrados de hematíes. Se ha presentado infección en 89 (29,6%) pacientes: 79 (26,2%) del tracto urinario, 7 (2,3%) respiratoria y 8 (2,7%) de herida quirúrgica. La mortalidad en el primer mes fue del 6%. Hubo una asociación de la edad (p<0,001), con la presencia de infecciones (p = 0,019), con el nivel bajo de hemoglobina al ingreso (p < 0,001) y en el postoperatorio inmediato (p < 0,001). Las infecciones se han relacionado con la edad alta (p < 0,001), ASA elevada (p = 0,019), nivel de hemoglobina al ingreso bajo (p = 0,026), larga estancia hospitalaria (p < 0,001), mayor tasa de transfusión (p = 0,019) y mayor volumen transfundido (p = 0,004). Se ha identificado el tipo de fractura según la clasificación AO (p = 0,02), la edad (p = 0,005) y el nivel de Hb al ingreso (p < 0,001) como predictores independientes de transfusión. Conclusiones: La Hb es el factor predictor más importante de transfusión sanguínea en pacientes con fractura trocantérica de fémur asociándose a altas tasas de infección posquirúrgica. Summary. Background: To determine clinical and hematological characteristics that could affect the use of blood and the incidence of infections in patients with hip fractures (HF) treated with a dynamic hip screw (DHS). Patients and Methods: A retrospective study of all the HF patients during 5 years (January 1995-December 1999) treated with a dynamic hip screw (DHS"). No patient was excluded. Age, gender, elapsed time, anesthesia risk (ASA), type of HF (AO classification), transfusion; hemoglobin (Hb) at admission and first postoperative (POD#1) were examined. We analyzed the infection incidence (CDC criteria), place and severity. The statistical univariate analysis included Student's t-test for numeric variables and Pearson's chi-squared test for string variables. There was considered to be a statistically significant difference (SSD) when p < 0.05. A multivariate stepwise logistic regression model was used. Results: Three hundred and one patients with HF were studied. 125 A1 and 176 A2, according to the AO classification. Male/female ratio: 76/225; age 78.97 years; ASA: I, 53 (17.6%); II, 97 (32.2%); III, 138 (45.8%), and IV, 13 (4.3%). Hb values on the day of admission: 12.87 g/dL and POD#1: 10.1 g/dL. A total of 186 (61.8%) patients were transfused with an average 1.42 red cell concentrate (range: 0-6). 89 (29.6%) had an infection: 79 (26.2%) urinary tract infection (UTI), 7 (2.3%) pneumonia and 8 (2.7%) superficial wound. A 6% died in the first month. At univariant study of transfusion act, the transfused patients were older (p < 0.001), suffered more infections (p = 0.019), more UTI (p = 0.003), had lower Hb on day 0 (p < 0.001) and POD#1 (p < 0.001). When infections were analyzed, the patients were older (p < 0.001), had higher ASA (p = 0.019), lower Hb at day 0 (p < 0.026), longer stay (p < 0.001), were transfused more (p = 0.019), and received more transfusions (p = 0.004). The logistic regression analysis identified only the type of HF, the age and the Hb level (p < 0.05) as independent predictors of transfusion. Comments: In patients with HF the Hb is the most important predictor of blood transfusion, and it is associated with a higher rate of postsurgical infection.
Introducción. La implantación de prótesis unilateral de rodilla es una técnica quirúrgica que se ... more Introducción. La implantación de prótesis unilateral de rodilla es una técnica quirúrgica que se asocia a una pérdida hemática que oscila entre 700 a 1000 cc en cirugía primaria, pudiendo alcanzar los 2000 cc en casos de cirugía de revisión. El porcentaje de pacientes en quienes se utiliza esta técnica que precisan reposición hemática oscila entre 4 a 46 % (1,2). Sin embargo, esta práctica no está exenta de riesgos. La transfusión de sangre alogénica puede ser vehículo de enfermedades infeccionas, con un riesgo de transmisión de VIH de 1 / 225.000 unidades transfundidas, para la hepatitis B de 1/200.000 y para la hepatitis C de 1/30.000 a 1/150.000. Las reacciones febriles postransfusionales ocurren entre el 1 a 3% de los casos y las reacciones hemolíticas de origen inmunológico suceden en 1 de cada 100.000 casos, frecuentemente atribuibles a errores burocráticos en el manejo de las unidades. Existe el riesgo de aloinmunización y se le atribuye una mayor incidencia
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Papers by José Antonio García Erce