Transfusions in the Emergency department: Are there other care alternatives?

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"tieneTextoCompleto" => true "saludo" => "Dear Director," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "455" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L.A. Sánchez-Muñoz, I. Usategui-Martín, J. Martín-Guerra, M. Martín-Merino" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L.A." "apellidos" => "Sánchez-Muñoz" "email" => array:1 [ 0 => "lsanchezmunoz@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Usategui-Martín" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Martín-Guerra" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Martín-Merino" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Transfusión en Urgencias: ¿Existen dispositivos asistenciales alternativos?" ] ] "textoCompleto" => "We would like to congratulate Quintana-Díaz et al. on their study of the appropriateness of transfusions in emergency departments (EDs).<a class="elsevierStyleCrossRef" href="#bib0005">1</a> We would like to provide some brief observations on the methodology and on the use of EDs for non-emergency procedures.One of the exclusion criteria used by the authors was critical bleeding or massive transfusion; however, 8.6% of the patients presented with hemorrhagic shock and one patient received seven units of red blood cells. With respect to the appropriateness criteria, two of the transfusion thresholds used in the study are lower than those included in the 2015 Guidelines from the Spanish Society of Blood Transfusion,<a class="elsevierStyleCrossRef" href="#bib0010">2</a> which could have elevated the rate of inappropriateness. In the guidelines, one of thresholds in chronic anemia is Hb <7 g/dL (vs. Hb <5 g/dL) and in acute anemia is Hb <8 g/dL (vs. Hb <7 g/dL or 7–8.9 g/dL with risk factors and/or hemodynamic instability).This work shows that EDs are used to transfuse patients with medical pathologies (93%) with subacute-chronic anemia attributable to antiplatelet therapies-anticoagulants in 57% of cases, without active bleeding who, after the procedure, are discharged (69% on the same day).Internal medicine and hematology departments (through rapid diagnostic units, continuity of care units, or quick anemia clinics), with the support of the day hospital, have experience in transfusion or the use of intravenous iron in stable patients, avoiding referral to EDs.<a class="elsevierStyleCrossRefs" href="#bib0015">3–5</a> These units also cover other needs that cannot be taken on by saturated EDs, such as the etiological study and treatment of anemia, management of anticoagulation-antiplatelet therapy, and other factors that affect bleeding (proton pump inhibitors, blood pressure control, concomitant drugs), or, along with primary care, follow-up on the patient if necessary.To sum up, the work by Quintana-Díaz et al. underlines the need to adjust the use of transfusion in regard to its indication, its volume, and in the healthcare unit that performs it.FinancingThis work has not received any type of funding.Conflicts of interestThe authors declare that they do not have any conflicts of interest." 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Rev Clin Esp. 2020;220:455." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transfusión en Urgencias: algo más que una transfusión de sangre" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Quintana-Díaz" 1 => "E.M. Andrés-Esteban" 2 => "J. Sánchez-Serrano" 3 => "A. Martínez-Virto" 4 => "R. Juárez-Vela" 5 => "J.A. García-Erce" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2019.10.002" "Revista" => array:2 [ "tituloSerie" => "Rev Clin Esp." 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