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Introducción: La transfusión de hemocomponentes constituye una práctica médica importante y frecuente a nivel mundial. El uso apropiado de transfusión de hemocomponentes salva millones de vidas; sin embargo, la prescripción inadecuada de estas transfusiones expone al paciente a riesgos transfusionales y disminuye su disponibilidad para quienes realmente lo necesitan, y más en un hospital de mediana complejidad como el Santa María de Cutervo, donde solo se transfunde concentrado de hematíes. Objetivo: Describir las prescripciones inadecuadas de transfusión de concentrado de hematíes en el hospital del MINSA nivel II-1 Santa María de Cutervo – periodo 2019-2020. Materiales y Métodos: Estudio observacional descriptivo transversal retrospectivo. Se evaluaron 168 solicitudes transfusionales, realizadas entre 2019 y 2020, seleccionadas de manera aleatoria simple. Todas las fichas de la muestra cumplieron con el criterio de inclusión de contar con los datos necesarios para su valoración Se valoraron como inadecuadas aquellas prescripciones que no cumplieron con los criterios establecidos en el “Compendio para el uso clínico de Sangre y Componentes” del Programa Nacional de Hemoterapia y Bancos de Sangre (PRONAHEBAS) – MINSA. Mediante estadística descriptiva se calcularon frecuencias y porcentajes de las prescripciones de transfusión inadecuadas. Resultados: 30,4% de las solicitudes fueron valoradas como inadecuadas. El promedio de hemoglobina de los pacientes transfundidos fue de 7,63 g/dl, el de hematocrito de 23,9%. Gíneco-obstetricia tuvo la mayor frecuencia de prescripciones inadecuadas (30/79). El diagnóstico de mayor frecuencia de prescripción inadecuada fue politraumatismo con un 70,0% (7/10). Los médicos no especialistas fueron los que prescribieron inadecuadamente con más frecuencia. / Introduction: Blood transfusion is an important and frequent medical practice worldwide. The appropriate use of blood component transfusion saves millions of lives. However, the inappropriate prescription of these transfusions exposes the patient to transfusion risks and decreases availability for those who truly need it, especially in a medium-complexity hospital like Santa María de Cutervo, where only packed red blood cells are transfused. Objective: To describe the inappropriate prescriptions of Packed Red Blood Cell transfusion in the MINSA level II-1 Santa María de Cutervo hospital - period 2019-2020. Materials and Methods: A retrospective descriptive cross-sectional observational study was conducted. A total of 168 transfusion requests made between 2019 and 2020 were randomly selected. All the records in the sample met the inclusion criteria of having the necessary data for evaluation. Prescriptions that did not meet the criteria established in the "Compendium for the Clinical Use of Blood and Components" of the National Hemotherapy and Blood Banks Program (PRONAHEBAS) - MINSA were considered inappropriate. Descriptive statistics were used to calculate the frequencies and percentages of inappropriate transfusion prescriptions. Results: 30.4% of the requests were evaluated as inappropriate. The average hemoglobin level of transfused patients was 7.63 g/dl, and the average hematocrit level was 23.9%. Gynecology and obstetrics had the highest frequency of inappropriate prescriptions (30/79). The most frequent diagnosis associated with inappropriate prescription was polytrauma with a rate of 70.0% (7/10). Non-specialist doctors were the ones who prescribed inappropriately most frequently.

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background Occult blood loss from the gastrointestinal tract (GIT), causing iron deficiency often with anaemia, can be diagnostically and therapeutically challenging. This is because the endoscopic and radiologic tests may be negative due to the slow, chronic and intermittent nature of the gastrointestinal bleeding, making timing key in detection and localisation of the bleed. These limitations can be approached using two different radioactive isotopes. Firstly, we tested the sensitivity of extending Cr-51 RBC for 21 days relative to 5 days to detect GIT bleeding and its use to optimise timing of a Tc-99m RBC study for GIT blood loss localisation. Finally, we tested if the information provided by the Tc-99m RBC study aided gastroenterologic intervention for anatomical localisation of a lesion. Method In this retrospective review, after obtaining institutional and ethics committee approval, records of patients referred for evaluation of possible GIT blood loss were reviewed. In each; daily appearance of radiochromium in stool was measured in the whole body counter. In those cases exceeding 50 ml/day, a technetium-99m (Tc-99m) localization study was performed. These studies were correlated with clinical findings. Results A total of 59 Cr-51 RBC studies were carried out in 36 females and 21 males (n = 57). In 32 (54%) the radiochromium results were positive with 75% of the bleeding incidences occurring after 5 days of stool collection. Of 17 cases in whom Tc-99m RBC imaging studies were performed, 14 (82%) were positive with specific anatomical sites successfully defined in twelve. In all patients with blood loss of >100 ml/24h, Tc-99m RBC were positive and localised. Ten of the 17 Tc-99m RBC studies were further investigated and half diagnosed with small-bowel angiodysplasia. Conclusion This sequential twin isotope method is practical in revealing otherwise silent intestinal haemorrhage. Although it has good patient acceptability and clinical as well as diagnostic utility in management, further studies are required to clearly establish a cut-off level of blood loss for performing imaging studies and the impact of the findings on the overall patient management. / AFRIKAANSE OPSOMMING: Agtergrond Die evaluasie van okkulte bloedverlies uit die gastro-intestinale kanaal (GIT), met gevolglike ystertekort anemie, kan diagnosties en terapeuties uitdagend wees. Dit is omdat endoskopiese en radiologiese ondersoeke negatief mag wees as gevolg van die stadige, chroniese en intermitterende aard van die gastro-intestinale bloeding, wat die presiese tydstip van opsporing en lokalisering van die bloeding krities belangrik maak. Hierdie beperkings kan aangespreek word deur twee verskillende radioaktiewe isotope te gebruik. Eerstens is die sensitiwiteit van die verlenging van die Cr-51 RBS studie tot 21 dae in plaas van 5 dae om die GIT bloeding op te spoor, getoets, asook die gebruik daarvan om die optimale tyd vir ‘n Tc-99m RBS studie om die GIT bloedverlies te lokaliseer, vas te stel. Laastens is getoets of die inligting van die Tc-99m RBS studie wel bygedra het tot die gastroenterologiese ingreep om die letsel anatomies te lokaliseer. Metode Na institusionele en etiese komitee toestemming is inligting van pasiënte wat vir die evaluering van ‘n moontlike GI bloedverlies verwys is, in hierdie retrospektiewe oorsig nagegaan. Die daaglikse voorkoms van radioaktiewe chroom in stoelgangmonsters is in ‘n heelliggaamteller gemeet. In gevalle waar dit 50 ml/dag oorskry het, is ‘n tegnesium 99m (Tc 99m) studie gedoen. Hierdie studies is met die kliniese bevindinge gekorreleer. Resultate ‘n Totaal van 59 Cr-51 RBS studies is in 36 vroue en 21 mans (n = 57) gedoen. Die gemerkte chroomstudies was positief in 32 (54%), met 75% van die bloedings wat meer as 5 dae na versameling van die stoelgang plaasgevind het. In veertien (82%) van die 17 gevalle waar Tc-99m RBS studies gedoen is, was die studies positief. Spesifieke anatomiese gebiede van bloeding kon in 12 hiervan suksesvol bevestig word. Tc-99m RBS studies was positief in al die pasiënte met ‘n bloedverlies van >100 ml/24h, en kon gelokaliseer word. Tien van die 17 Tc-99m RBS studies is verder ondersoek en die helfte daarvan gediagnoseer met dunderm angiodisplasie. Gevolgtrekking Die opeenvolgende twee isotoopmetode om andersins asimptomatiese dermbloeding op te spoor, is prakties uitvoerbaar. Alhoewel die studies goed deur pasiënte aanvaar is, en ook van kliniese en diagnostiese waarde in die hantering van die pasiënte is, is verdere studies nodig om die afsnypunt vir die hoeveelheid bloedverlies om beeldingstudies uit te voer, sonder twyfel vas te stel, asook om die impak van die bevindings op ‘n groter pasiëntpopulasie vas te stel.