Uludağ Üniversitesi Tıp Fakültesi Araştırma Hastanesi acil servisinde kan ve kan ürünleri transfüzyonu yapılan hastaların epidemiyolojik incelenmesi
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Date
2011
Authors
Esen, Mehmet
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalışma, 01.06. 2009 31.12. 2009 tarihleri arasında Uludağ Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi Acil Servisinde kan ve kan ürünü transfüzyonu yapılan hastaların demografik özelliklerini, transfüzyon endikasyonlarını, kullanılan kan ürünü miktar ve cinsi ile gelişen reaksiyonlarını dökümante etmek amacıyla prospektif olarak yapılmıştır.Transfüzyon yapılan hasta sayısının 434 olduğu görülmüştür. Hastaların %54.6'sını erkek, %46.4'ünü kadın hastalar oluşturmuştur. En fazla transfüzyon %35.5 ile 65 yaş üstü hastalara yapılmıştır. Transfüzyon yapılan hastaların %32'si 15-49 yaş, %30.9'u 49-65 yaş ve %1.6'sı 15 yaş altı hastalardan oluşmuştur.Transfüze edilen ürünlerin %56.5'inin eritrosit süspansiyonu (ES), %11.3'ünün taze donmuş plazma (TDP), %11.3'ünün trombosit süspansiyonu (TS), %9.2'sinin ES + TS, %6.9'unun ES + TDP, %2.1'inin Faktör VII ve Faktör VIII, %0.7'sinin TDP + TS, %0.9'unun ES + TDP + TS, %0.7'sinin ise TDP + Faktör olduğu saptanmıştır.Acil serviste transfüzyon yapılan hastaların %43'ünü hematolojik rahatsızlığı olan, %20.1'ni ise onkolojik rahatsızlığı olan hastalar oluşturmuştur. Transfüzyon yapılan hastalarda transfüzyon kararının %19.6'sı acil tıp asistanları tarafından, %80.4'ü ise konsültan hekim tarafından verilmiştir. Transfüzyon yapılan hastaların %62.7'sinin transfüzyon öyküsü olduğu saptanmıştır. Bu hastaların % 8.5'ine ise son bir hafta içinde transfüzyon yapıldığı belirlenmiştir.Hastalar vital parametreleri açısından değerlendirildiğinde, %83'ünde patoloji saptanmamış, %3.4'ünde hipotansiyon, %2.1'inde taşikardi %1.1'inde ateş, %9.7'sinde hipotansiyon + taşikardi ve %0.7'sinde ise hipotansiyon+ taşikardi + ateş olduğu görülmüştür.Transfüzyon yapılan hastalar hemoglobin miktarı açısından incelendiğinde %40.6'sının 7g/dl altında, %13.1'inin 7-8 g/dl arasında, %26.7'sinin 8-10 g/dl arasında ve %19.6'sının 10 g/dl üstünde olduğu belirlenmiştir. Eritrosit süspansiyonu en çok hemoglobin değerleri 7 g/dl altında olan hastalara, TS ise en çok trombosit sayısı 10-20x103/mm3 arasında olan hastalara verilmiştir. Taze donmuş plazma transfüzyonu yapılan hastaların %51'inde oral antikoagülan kullanımına bağlı kanama olduğu tespit edilmiştir.Çalışmamızda %1.2 hastaya acil 0 Rh negatif, %1.8 hastaya da coombs (+) kan transfüzyonu yapılmıştır.Transfüzyon yapılan hastaların %3.9'unda transfüzyonla ilişkili akut komplikasyonlar gelişmiştir. Bu komplikasyonlar incelendiğinde %1.2'sinin akut febril nonhemolitik reaksiyon (FNHR), %1.1'inin dolaşım yüklenmesi, %0.9'unun alerjik reksiyon, %0.7'sinin ise hem FNHR hem de alerjik reaksiyon olduğu gözlenmiştir.Transfüzyon yapılan hastaların %76.5'i acil servisten taburcu edilmiş, %19.4'ü hastaneye yatırılmış, %2.5'i başka bir sağlık kuruluşuna sevk edilmiş ve %1.6'sı da acil serviste ölmüştür.Çalışmamız süresince elde ettiğimiz tüm bu tespitler ışığında, acil serviste çok sayıda transfüzyon yapıldığını, endikasyon belirlemede belirli bir protokole bağlı kalınmadığını ve daha çok poliklinik takibinde olan hastalara ve destek niteliğinde transfüzyon yapıldığını söyleyebiliriz.Acil transfüzyon kararı; hangi amaçla ve ne için transfüzyon yapıldığının bilincinde olunarak, laboratuar düzelmeden çok klinik düzelmenin takibi yapılarak ve gerçek acil transfüzyon gerekliliği ortaya konularak verilmelidir.
This study was designed prospectively to investigate the demographic data of the patients which had blood and blood products in Uludag University Medicine Faculty Research Hospital Emergency Service between June 2009-December 2009, also to investigate the endications for blood products used, the amount and the type of the products used and to document the reactions and compare the data with the literature.The percentage of transfused blood products was as following: 56.5% erythrocyte suspention, 11.3% fresh frozen plasma, 11.3% platelet suspention, 9.2% ES + TS, 6.9% ES + TDP, 2.1% factor replacement, 0.7% TDP + TS, 0.9%?u ES + TDP + TS, 0.7% TDP + factor.Within the patients who had blood product transfusion; 54.6% were male and 46.4% were female. 35.7% of the patients were older than 65. 31.6% of the patients were between the ages 15-49, 30.4% were between the ages 49-65 and 1.6% were younger than 15.Most of the patients who had blood product transfusion in Emergency Service were hematology and oncology patients with 43% and 20.1% respectively. The physician who decided to transfuse was emergency residant with 19.6% and mostly consultant physician with 80.4%. 62.7% of the patients had transfusion before. 8.5% of the patients had transfusion at last one week. 83.0% patients had normal vital parameters, 3.4% had hypotension, 2.1% had tachycardia,1.1% had fever, 9.7% had hypotension and tachycardia and 0.7% had both hypotension and tachycardia and fever. 40.6% of the patients had hemoglobine level under 7g/dl, 13.1% of the patients had between 7-8 g/dl, 26.7% of the patients had between 8-10 g/dl and 19.6% of the patients had above 10 g/dl. The pateints who transfused erytrocyte suspension were mostly the group who had hemoglobin under 7 g/dl. Platelet was transfused mostly for thrombocytopenia and whom platelet count were between 10-20x103/mm3.The patients who had given fresh frozen plasma were oral anticoagulant users with 51% (with mostly hematuri). 1.2% of the patients had emergent 0 Rh (-) blood transfusion. 1.8% of the patients had coombs + blood transfusion.Within the all transfused patients 3.9% had acute complication related transfusion. 1.2% of them were acute febrile nonhemolytic reaction (FNHR), 1.1% were heart failure, 0.9% were allergic reaction, 0.7% both FNHR and allergic reaction.While 76.5% of all transfused patients discharged from emergency department, 19.4% hospitalized, 2.5% sent to other hospitals and 1.6% dead in emergency department.By the light of all our findings we can easily say that lots of transfusion performed in emergency department, transfusion protocols usually is not followed and most of the transfusion is performed in order to support outpatient clinic.Emergency transfusion decision should be performed with true emergency indication, follow-up with clinical response rather than laboratory response and consciousness about the aim of transfusion.
This study was designed prospectively to investigate the demographic data of the patients which had blood and blood products in Uludag University Medicine Faculty Research Hospital Emergency Service between June 2009-December 2009, also to investigate the endications for blood products used, the amount and the type of the products used and to document the reactions and compare the data with the literature.The percentage of transfused blood products was as following: 56.5% erythrocyte suspention, 11.3% fresh frozen plasma, 11.3% platelet suspention, 9.2% ES + TS, 6.9% ES + TDP, 2.1% factor replacement, 0.7% TDP + TS, 0.9%?u ES + TDP + TS, 0.7% TDP + factor.Within the patients who had blood product transfusion; 54.6% were male and 46.4% were female. 35.7% of the patients were older than 65. 31.6% of the patients were between the ages 15-49, 30.4% were between the ages 49-65 and 1.6% were younger than 15.Most of the patients who had blood product transfusion in Emergency Service were hematology and oncology patients with 43% and 20.1% respectively. The physician who decided to transfuse was emergency residant with 19.6% and mostly consultant physician with 80.4%. 62.7% of the patients had transfusion before. 8.5% of the patients had transfusion at last one week. 83.0% patients had normal vital parameters, 3.4% had hypotension, 2.1% had tachycardia,1.1% had fever, 9.7% had hypotension and tachycardia and 0.7% had both hypotension and tachycardia and fever. 40.6% of the patients had hemoglobine level under 7g/dl, 13.1% of the patients had between 7-8 g/dl, 26.7% of the patients had between 8-10 g/dl and 19.6% of the patients had above 10 g/dl. The pateints who transfused erytrocyte suspension were mostly the group who had hemoglobin under 7 g/dl. Platelet was transfused mostly for thrombocytopenia and whom platelet count were between 10-20x103/mm3.The patients who had given fresh frozen plasma were oral anticoagulant users with 51% (with mostly hematuri). 1.2% of the patients had emergent 0 Rh (-) blood transfusion. 1.8% of the patients had coombs + blood transfusion.Within the all transfused patients 3.9% had acute complication related transfusion. 1.2% of them were acute febrile nonhemolytic reaction (FNHR), 1.1% were heart failure, 0.9% were allergic reaction, 0.7% both FNHR and allergic reaction.While 76.5% of all transfused patients discharged from emergency department, 19.4% hospitalized, 2.5% sent to other hospitals and 1.6% dead in emergency department.By the light of all our findings we can easily say that lots of transfusion performed in emergency department, transfusion protocols usually is not followed and most of the transfusion is performed in order to support outpatient clinic.Emergency transfusion decision should be performed with true emergency indication, follow-up with clinical response rather than laboratory response and consciousness about the aim of transfusion.
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Keywords
Kan, Kan ürünü, Transfüzyon, Acil, Blood, Blood product, Emergency, Transfusion
Citation
Esen, M. (2011). Uludağ Üniversitesi Tıp Fakültesi Araştırma Hastanesi acil servisinde kan ve kan ürünleri transfüzyonu yapılan hastaların epidemiyolojik incelenmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.