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"textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">1</span></a> We would like to provide some brief observations on the methodology and on the use of EDs for non-emergency procedures.</p><p id="par0010" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">2</span></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).</p><p id="par0015" class="elsevierStylePara elsevierViewall">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).</p><p id="par0020" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">3–5</span></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.</p><p id="par0025" class="elsevierStylePara elsevierViewall">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.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financing</span><p id="par0030" class="elsevierStylePara elsevierViewall">This work has not received any type of funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflicts of interest.</p></span></span>"
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