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"textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Once again, we would like to thank and congratulate Dr. Sánchez-Muñoz et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> for their comments. As they indicate, we recognize that the transfusion appropriateness criteria applied were conservative in relation to hemodynamically stable patients with chronic anemia. Despite this, both in this experience and in the pilot study in which we validated the methodology,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the lack of appropriateness of the transfusion in the voluntarily analyzed departments was high.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We share with authors—and it is our clinical experience in various autonomous communities—the observation of the overuse of emergency departments (EDs) to refer patients with moderate-severe anemia who are asymptomatic and hemodynamically stable to be transfused based merely on blood test criteria.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">As they propose, we advocate for the existence of pre-established circuits and specific units—such as day hospitals, home hospitalization units, and even primary care (PC) centers with appropriate infrastructure—for the proper management and treatment of anemia, mainly with intravenous iron (IVFe), with or without an associated transfusion.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">What’s more, the existence of hospital or territorial Patient Blood Management (PMB) coordinators who integrate the care of not just surgical patients with anemia, but also of patients with medical diseases and those cared for in EDs should be promoted.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This role of PBM coordinator, a leader of a work group that generally forms part of the center’s hemotherapy committee and recognized by the management, could be carried out by a physician in one of the disciplines involved in the appropriate use of transfusions and their alternatives. It would also promote interaction among levels of care, including PC and other extrahospital units.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this sense, we concur that the development of alternative units to conventional hospitalization must be promoted. These could be day hospitals, rapid diagnostic or continuity of care units, quick anemia clinics, or home hospitalization units. These alternatives could allow for the evaluation and treatment of moderate-severe anemia while avoiding unnecessary hospitalization and, most of all, overloading EDs.</p></span>"
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