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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">2</a> the lack of appropriateness of the transfusion in the voluntarily analyzed departments was high.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">3</a>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">3,4</a>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">5</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">4–6</a>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." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Quintana-Díaz M, Jericó-Alba C, Zalba-Marcos S, García-Erce JA. Réplica a «Transfusión en urgencias: ¿existen dispositivos asistenciales alternativos?». Rev Clin Esp. 2020;220:456." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transfusión en Urgencias: ¿Existen dispositivos asistenciales alternativos?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.A. Sánchez-Muñoz" 1 => "I. Usategui-Martín" 2 => "J. Martín-Guerra" 3 => "M. Martín-Merino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2020.02.008" "Revista" => array:2 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2020" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "USEES-URG Research Group. Appropriate use of red blood cell transfusion in emergency departments: a study in five emergency departments" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Quintana Díaz" 1 => "A.M. Borobia" 2 => "J.A. García Erce" 3 => "C. Maroun-Eid" 4 => "S. Fabra" 5 => "A. Carcas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2450/2016.0324-15" "Revista" => array:6 [ "tituloSerie" => "Blood Transfus" "fecha" => "2017" "volumen" => "15" "paginaInicial" => "199" "paginaFinal" => "206" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27416566" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of outpatient treatment with intravenous iron in selected primary care patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Rivilla Marugán" 1 => "T. Lorente Aznar" 2 => "J.A. García-Erce" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2018.10.004" "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2020" "volumen" => "154" "paginaInicial" => "66" "paginaFinal" => "67" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of iron deficiency in various clinical conditions and the role of intravenous iron: Recommendations of the Spanish Erythropathology Group of the Spanish Society of Haematology and Haemotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.A. García Erce" 1 => "A. Altés" 2 => "M. López Rubio" 3 => "A.F. Remacha" 4 => "en representación del Grupo Español de Eritropatología de la Sociedad Española de Hematología y Hemoterapia" 5 => "Otros componentes del Grupo Español de Eritropatología de la Sociedad Española de Hematología y Hemoterapia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2019.09.004" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2020" "volumen" => "220" "paginaInicial" => "31" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31783987" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "From blood saving programs to patient blood management and beyond" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Ripollés-Melchor" 1 => "C. Jericó-Alba" 2 => "M. Quintana-Díaz" 3 => "J.A. García-Erce" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2018.02.027" "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2018" "volumen" => "151" "paginaInicial" => "368" "paginaFinal" => "373" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Papel del internista en un programa de optimización de uso transfusional" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Jericó- Alba" 1 => "J.A. García-Erce" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2018" "volumen" => "150" "paginaInicial" => "469" "paginaFinal" => "474" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022000000007/v2_202010040643/S2254887420300825/v2_202010040643/en/main.assets" "Apartado" => array:4 [ "identificador" => "71813" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Correspondence" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000007/v2_202010040643/S2254887420300825/v2_202010040643/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300825?idApp=WRCEE"]

Revista Clínica Española (English Edition)

ISSN: 2254-8874

Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Ten issues are published each year, including mostly originals, reviews and consensus documents.

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