PATIENT BLOOD MANAGEMENT. DR GARCÍA ERCE. Pamplona mayo 2017

ldquoPatient Blood Managementrdquo

COMPLEJO HOSPITALARIO DE NAVARRA

Pamplona (Navarra)

11 de mayo de 2017

Dr Joseacute Antonio Garciacutea-ErceBANCO DE SANGRE Y TEJIDOS DE NAVARRA

GIEMSA AWGE IdiPAz 49 IACSGrupo de Trabajo de la SETS ldquoHemoterapia basada en el sentido comuacutenrdquo

Conflictos de intereacutes

Asesor externo- AMGEN Oncologiacutea 20102012- Roche Anemia 2009- Ditassa-Ferrer 2004

Charlas estudios investigacioacuten y ayudas a congresos-Vifor-UriachFerralinze-Janssen-CilagBraun-Astra-Tech de Aztra ZenecaWell-HealthGSK-Sanofi AventisEsteveNovartisOctapharma-Cobe-CaridianRoche OncologiacuteaAMGEN Oncologia

COORDINADOR Grupo de Trabajo de la SETS ldquoHEMOTERAPIA BASADA EN EL SENTIDO COMUacuteNrdquoMiembro del CAT 2002-2005Miembro del Documento de Sevilla ldquoAlternativas a la TransfusioacutenrdquoMiembro del Documento LatinoAmericano de la AnemiaMiembro de GIEMSA Secretario AWGESocio SETSAEHHNATAEditor Asociado Revista ANEMIA wwwrevistaanemiaorgMiembro Comiteacute Cientiacutefico NATA y TATMEx Representante de la SEHH en la ONTColaborador del Choosing Wisely en Anestesiologiacutea y Reanimacioacuten

PATIENT BLOOD MANAGEMENT

PATIENT BLOOD MANAGEMENTConflictos de intereacutes


Dr Manuel Quintana DiacuteazServicio de Cuidados Intensivos Hospital Universitario La Paz Madrid

Prof Manolo Muntildeoz GoacutemezGIEMSA Facultad de Medicina Universidad de Maacutelaga

Dr Jorge Cuenca EspieacuterrezDepartment of Orthopaedic Surgery University Hospital Miguel Servet Zaragoza

Dra Dordf Elvira Bisbe Vives Servicio de Anestesiologiacutea y Reanimacioacuten Hospital de La Esperanza Barcelona

Prof Antonio Herrera RodriacuteguezCaacutetedra Department of Orthopaedic Surgery Zaragoza

Dra Dordf MendazaJefa de Servicio Farmacia Hospitalaria University Hospita Miguel Servet Zaragoza

Dras Peral Garciacutea Fornet y Bueno Cabrera

Servicio de Anestesiologiacutea y Reanimacioacuten Hospital Puerta de Hierro Madrid

Dr Miguel Montoro Huguet

Servicio de Digestivo Servicio de Digestivo Hospital San Jorge (Huesca)

Dra Laura Rivilla Dr Teo Lorente Dra Moacutenica Molinero Dr Blanes etc

CAP Sabintildeaacutenigo (Huesca)

Agradecimientos

wwwawgeorg

ETIOLOGIacuteAETIOPATOGENIA

PATIENT BLOOD MANAGEMENTINTRODUCCIOacuteN

LEGISLACIOacuteN


LEGISLACIOacuteN


LEGISLACIOacuteNLey Foral 12013 de 30 de enero por la que se crea y se regula el Banco de Sangre y Tejidos de Navarra

Artiacuteculo 4 Objetivos

El Banco de Sangre y Tejidos de Navarra tiene como objetivos generalesa) Velar por el cumplimiento del Real Decreto 10882005hellip

d) Conseguir la autosuficiencia de sangre y hemoderivados en Navarra

f) Promover la disminucioacuten de la exposicioacuten a sangre homoacuteloga y hemoderivados actualizando y divulgando recomendaciones de uso e indicaciones y potenciando otras alternativas a la transfusioacuten incluyendo todas las modalidades de autotransfusioacuten

j) Promover programas de formacioacuten del personal del Banco de Sangre y Tejidos de Navarra de caraacutecter continuo que incluiraacuten programas de buenas praacutecticas



Artiacuteculo 5 Funciones

1 Como Centro Comunitario de Transfusioacuten desempentildearaacute las funciones siguientes

a) Coordinar las actuaciones de los Centros y Servicios en la Red de transfusioacuten y de ceacutelulas y tejidos humanos de Navarra

n) Fomentar programas de autotransfusioacuten ahorro de sangre y esquemas miacutenimos de transfusioacuten en todos los centros hospitalarios de la Comunidad

p) Implantar programas de formacioacuten del personal vinculado a la hemoterapia

12 Patients should be informed of the known risks and benefits of blood transfusion andor alternative therapiesand have the right to accept or refuse the procedure Any valid advance directive should be respected

Principle of patientrsquos autonomy

15 Genuine clinical need should be the only basis for transfusion therapy

Ethical principles of beneficence and justice

Legislacioacuten vigente


Regan y Taylor BMJ 2002Shander Semin Hematol 2004

Muntildeoz et al Med Clin 2007Shander Farmer y Hoffman Oncologist 2011


Costes de produccioacuten y administracioacuten elevados (350euro)

Sangre humana un recurso limitado

TSA no estaacute libre de riesgos

Errores de identificacioacuten (116000)

Dantildeo pulmonar (TRALI) (15000)

Sobrecarga de fluidos (TACO) (1100)

Recidiva de caacutencer (TRIM)

Infeccioacuten postoperatoria (TRIM)

Prolongacioacuten de la estancia

Dudosa eficacia


RIESGOS TRANSFUSIOacuteN




Carson JL et al Red blood cell transfusion a clinical practice guideline from the AABB Ann Intern Med 2012 Jul 3157(1)49-58

Adverse effects of RBC transfusion contrasted with other risksRisk is depicted on a logarithmic scale

Fatalities Reported to FDA Following Blood Collection and Transfusion

Periacuteodo 2009-2013 190 fallecimientos documentados2009 44 rsquo10 40 rsquo11 30 rsquo12 38 y rsquo13 38

72 45







Fallecimientos

Modificado Garciacutea Erce JA et al NATA 2014

2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13

ABO Hemolytic Reaction 1 3 1 0 2 1 1 0 9no ABO Hemolytic Reaction 0 0 1 1 0 1 1 1 5

TACO 0 1 0 0 1 0 0 1 3

Bacterial Infection 1 1 1 0 0 0 0 0 3

Allergical Reaction 1 0 0 0 0 0 0 0 1

TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33




Reacciones patoloacutegicas que pueden que no sean evitables

Probable o posiblemente prevenibles con la mejora de la praacutectica y la monitorizacioacuten

Eventos adversos causados por errores







TRANSFUSIOacuteN DEL PACIENTE ONCOLOacuteGICO

The findings of the 1998 meta-analysis were confirmed with small variations in some estimates Identification of 237 references Thirty-six studies on 12127 patients were included 23 showed a detrimental effect of PBT 22 used also multivariable analyses and 14 found PBT to be an independent prognostic factor

Pooled estimates of PBT effect on colorectal cancer recurrence yielded overall OR of 142 (95 CI 120 to 167) against transfused patients in randomized controlled studies

Stratified meta-analyses confirmed these findings also when stratifying patients by site and stage of disease The PBT effect was observed regardless of timing type and in a dose-related fashion although heterogeneity was detected Data on surgical techniques was not available for further analysis



Paraacutemetro No transfundidos(n=214)

Transfundidos(n=214)

P

Fallo renal agudo 38 (178) 56 (262) lt005

Infeccioacuten nosocomial 14 (65) 34 (159) lt005

Estancia UCI 4 [3 ndash 7] 5 [3 ndash 9] lt005

Readmisioacuten UCI 4 (19) 16 (74) lt005

Mortalidad hospitalaria 28 (131) 45 (210) lt005

214 parejas de pacientes con Hb 7-9 gdL igualados por gravedad

Intensive Care Med 2013 39 445-453

CortestiacuteaModifiicada Prof M Muntildeoz


Anemia aguda intra- yo post-operatoria

Peacuterdida perioperatoria de sangre en cirugiacutea major electiva

Transfusioacuten de sangre alogeacutenica

El problema cliacutenico ldquoclaacutesicordquo


RIESGOS DE LA ANEMIA ldquoTransfusionalrdquo

Rosencher et al OSTHEO Study Transfusion 2003

Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)

uarr10 TSA por darr1 gdL Hb

Modificada Cortesiacutea Prof M Muntildeoz


Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl

Garciacutea Erce JA Cuenca J Solano VM FACTORES PREDICTIVOS DE LA NECESIDAD DE TRANSFUSION EN LA FRACTURA SUBCAPITAL DE CADERA EN PACIENTES DE MAacuteS DE 65 ANtildeOS Med Clin 2003120(5)161-6

Haemoglobin level and transfusion risk



MAGNITUD GLOBAL DEL PROBLEMA Prevalencia

Wen-Chih Wu et al JAMA 2007 297 2481 ndash 2488

Haematocrit lt 39

Procedure Patients (n) n

General surgery 106 340 45 478 428 Urology 59 157 21 408 362 Orthopaedics 57 636 25 131 436 Periferic vascular 47 734 24 865 521 Thoracic 14 051 6 780 483 Others 25 393 9 308 367

Overall 310 311 132 970 428


ldquoAnemia prequiruacutergicardquo


Grusson et al J Orthop Trauma 2002 16 39-44Adunsky et al Arch Gerontol Geriatr 2003 36 75-81

Halm et al J Orthop Trauma 2004 18 369-374Izuel-Rami et al Farm Hosp 2005 29 250-257

Muntildeoz et al 2009 (Miguel Servet 2007)

Estudio (antildeo) Pacientes Definicioacuten

anemia Prevalencia anemia ()

Grusson (2002) 395 OMS 456 Adunsky (2003) 293 Hb lt13 gdL 737 Halm (2004) 550 OMS 404 Izuel-Rami (2005) 329 OMS 404 Muntildeoz (2009) 432 Hb lt13 gdL 495

Total 1702 567 OMS Hb lt12 gdL Hb lt13 gdL

ldquoAnemia en fractura de caderardquo






PREOPERATORIO

POSTOPERATORIO


RIESGOS DE LA ANEMIA PREQUIRUacuteRGICAA

um

en

to d

el ri

es

go


RIESGOS DE LA ANEMIA PREQUIRUacuteRGICA

239286 patients 65 years of older who underwent noncardiac surgery in 1997 to 2004 at veteran hospitals nationwide 94 who received intraoperative blood transfusions

Wu WC et al Ann Surg 2010 252 11-17



N 31857 pacientes del ldquoAmerican College of Surgeons 2007-2009 National Surgery QualityImporovenment Programrdquo Database prospectiva multiceacutentrica (gt250) EEUU

RIESGOS DE LA ANEMIA PREQUIRUacuteRGICAPATIENT BLOOD MANAGEMENT

Anemia PacientesN ()

MortalidadOR (IC 95)

Morbilidad OR (IC 95)

No-aneacutemicos 158196 (694) 1 1

Aneacutemicos 69229 (304) 142 (131 ndash 154) 135 (130 ndash 140)

Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)

Moderado - grave 11359 (50) 144 (129 ndash 160) 156 (147 ndash 166)

Total 227425 pacientes Leve anemia Hto gt29 ndash lt3639 Moderada-grave anemia Hto le29

One o more cardiac respiratory renal neurologic or surgical wound complications

sepsis or deep venous thrombosis (30d postOP)

copy ModifficadaCortesiacutea Prof M Muntildeoz







Anemia OR ajustada [IC 95] P

Transfusioacuten alogeacutenica 47 [38 ndash 58] lt0001

Estancia gt5 diacuteas 25 [19 ndash 34] lt0001

Readmisioacuten 90 diacuteas 14 [11 ndash 19] lt0005

5165 proacutetesis de rodilla o cadera6 centros fast-track daneses (Enero 2010 ndash Diciembre 2011)662 aneacutemicos (13) seguacuten criterio OMS




Ann Thorac Surg 2014



Maturity AssessmentPatient BloodManagement

Dra Elvira Bisbe Servicio de Anestesiologiacutea Hospital del Parc de Salut Mar Coordinadora de MAPBM wwwmapbmorg

Metodologiacutea middot Benchmark middot Gestioacuten Cliacutenica

182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52

Informacioacuten a disposicioacuten del hospitalIndicadores agregados del Centro y detalle por proceso cliacutenico

PTC PTR NEO COLO-RECTabierta

NEO COLO-RECTlaparoscopia

CECValvular

Fractura de feacutemur

Hemorragia digestiva

Graacutefica Tasa de transfusioacuten por centro y patologiacutea

0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4

PILAR 1 Pacientes anemia preoperatoria tratados

0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17

Proacutetesis de cadera

Neoplasias de colon y recto abiertas

PILAR 3 Valor medio de Hb previa a la transfusioacuten

54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14


Proacutetesis de rodilla

Neopl de colon y recto

abiertas


laparoscoacutepicas

Valvularescardiacas


Hemorragiasdigestivas

14 Actos transfusionales de una unidad

55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100

RESULTADOS Tasa de transfusioacuten

Intervenciones de proacutetesis de cadera

56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50

H7 H12 H1 H3 H16 H14 H2 H17 H18 H6 H13 H9 H10 H4 H15 H5 H11 H8

RESULTADOS Estancia ajustada

57

0

2

4

6

8

10

12

H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 H15 H16 H17 H18 Norma

No Transfundidos Transfundidos

uarr43



Los hospitales que tienen menos de 25 transfundidos se muestran en gris

P-valor 001216

P-valor 000344

0

5

10

15

20

25

30

H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 H15 H16 H17 H18 Norma


uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58

Intervenciones valvulares cardiacas

Intervenciones de fracturas de feacutemur


P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma

No Transfundido Transfundido

uarr294

RESULTADOS Complicaciones Ajustadas

59




P-valor 001196

P-valor 001036

RESULTADOS Mortalidad Ajustada

60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016

MAGNITUD GLOBAL DEL PROBLEMA

PrevalenciaEtiologiacutea

Riesgos de la anemia prequiruacutergica

Riesgos de la transfusioacuten periquiruacutergica

ldquoPATIENT BLOOD MANAGEMENTrdquo

MANEJO INTEGRAL DEL PACIENTE


To promote improvements in the quality of the clinical transfusion process which is defined as

Transfusion of the right unit of blood to the right patient at the right time and in the right condition and according to appropriate guidelines

A chain of integrated events that begins with a correct decision that the patient needs blood and ends with an assessment of the clinical outcome of the transfusion Its goal is to achieve optimal use of blood

2010PBM Manejo de la anemia

The outcome optimal use of blood is defined as

The safe clinically effective and efficient use of

donated human blood

Safe No adverse reactions or infections

Clinically effective Benefits the patient

Efficient No unnecessary transfusions

Transfusion at the time the patient needs it

2010


Los estudios indican que los productos sanguiacuteneos se usan amenudo de forma inapropiada tanto en los paiacuteses desarrolladoscomo en los paiacuteses en desarrollo

Las transfusiones innecesarias y las praacutecticas peligrosas y loserrores de transfusioacuten comprometeraacuten gravemente la seguridadexponiendo a los enfermas al riesgo de sufrir reaccionestransfusionales graves e infecciones transmitidas

El uso innecesario reduce gravemente la disponibilidad deproductos sanguiacuteneos para los pacientes que los necesitan

httpwwwwhointbloodsafetyclinical_useen


POSTGRADO UNIVERSITARIO EN BLOOD MANAGEMENT

It is necessary to reduce the unnecessary transfusions This can beachieved through the appropriate clinical use of blood avoidingthe needs for transfusion and use of alternatives to transfusion

The commitment of the health authorities health care providersand clinicians are important in prevention early diagnosis andtreatment of diseasesconditions that could lead to the need forblood transfusion


Blood transfusion is an essential part of modern health care Used correctly itcan save life and improve health However as with any therapeutic interventionit may result in acute or delayed complications and carries the risk oftransmission of infectious agents



BLOODCONSERVATION

BLOODMANAGEMENT

PATIENTBLOODMANAGEMENTCortesiacutea Dr Quintana

PROGRAMAS DE AHORRO DE SANGRE

httpswwwyoutubecomwatchv=8AQxzjvaa4U

httpswwwyoutubecomwatchv=cDbvjcFixuM


Optimizacioacutenperioperatoriaeritropoyesis

Minimizacioacuten del sangrado

coagulopatiacutea

Tolerancia a la anemia

postoperatoria

Mejorresultado

cliacutenico

Cortesiacutea Prof MuntildeozNECESIDAD PATIENT BLOOD MANAGEMENT


WHA 6312 (resolution) Availability safety and quality of blood products 2010 Available at httpappswhointgbebwhapdf_filesWHA63A63_R12-enpdf

Optimizacioacuten de la

eritropoyesis

Minimizacioacuten de las peacuterdidas sanguiacuteneas

Optimizacioacuten de la tolerancia a la

anemia

Los Servicios de Salud deben establecer Programas Multidisciplinares y Multimodales

para el manejo perioperatorio de los pacientes basados en







httpwwweurope-pbmeuabout

PBM EUROPA

PATIENT BLOOD MANAGEMENTPBM EUROPA




PBM EUROPA

Aims

Main Tasks

Key messages

The key messages of PBM are Anaemia andor bleeding is detrimental for patients Transfusions carry a much bigger hazard ratio than previouslyrealized In hemodynamically stable patients transfusion should not be the default response to anaemia andor bleeding PBM has the potential to prevent and treat anaemia and bloodloss thus avoids transfusion and therefore improves patientsafety andoutcomes



PBM EUROPA

Aims

Main Tasks

Key messages

Effective PBM can deliver improved patient outcomes throughthe conservation and management of patientrsquos own blood andbetter management of co-morbidities

Effective PBM optimises appropriate use of the limited donorblood supply

Effective PBM minimises the cost associated with theprocurement and delivery of blood and bloodproducts

Benefits of effective PBM



PBM EUROPA




SANGRE AUTOacuteLOGAbull Donacion preoperatoriabull Hemodilucioacutenbull Recuperacioacuten perioperatoria

CRITERIOS TRANSFUSIONAL

ldquoRESTRICTIVOrdquo

Hb lt70-80 gL

REDUCCIOacuteN SANGRADO

bull Aprotininabull Antifibrinoliticosbull Desmopresinabull rFVIIa

ESTIMULACIOacuteNERITROPOYESIS

bull Vitamina B12

bull Acido Foacutelicobull rHuEpobull Hierro

Alternativasa la TSA

Spanish Consensus Statement on alternatives to allogeneic blood transfusion the2013 update of the Seville Documentldquo Blood Transfus 2013 Jun 171-25


Criterios generales de indicacioacuten

Uso adecuadobull Presencia de signos o siacutentomas de hipoxiatisularbull Ausencia de tratamiento especiacutefico de laanemiabull Refractariedad al tratamiento especiacuteficobull La situacioacuten cliacutenica del paciente precisa unareposicioacuten inmediata de la masa eritrocitaria


CRITERIOS ldquoRESTRICTIVOSrdquo TRANSFUSIONALES




The FOCUS studyCarson y cols NEJM 2011 365 2453-62

bull 2016 oldie patients with Hb lt10 gdL after hip fracture repair surgerybull Cardiovascular disease antecedent or risk factorbull Liberal criteria transfuse if Hb lt 10 gdLbull Resctrive criteria transfuse if signssymptoms or Hb lt 8 gdL

IAMAngina inestableFCCInfeccioacutenMortalidad hospitalFACIT-Fatiga 60dNo deambulacioacuten 60dMortalidad 60d

Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43

Postoperative side effects

Restrictive Transfusion Criteria


Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014

998 pacientes criacuteticos en shock seacutepticoEstrategia transfusioacuten restrictiva No diferencia en mortalidad

Hb 7 gdL evidencia nuevo umbral transfusional


CRITERIOS ldquoRESTRICTIVOSrdquo TRANSFUSIONALESNEJM 1 Octubre 2014




First Recommendation

The AABB recommends a restrictive RBC transfusion thresholdin which the transfusion is not indicated until the Hb level is7gdL for hospitalized adult patients who are hemodynamicallystable including critically ill patients rather than a liberal threshold when the Hb level is 10gdL (strong recommendation

moderate quality evidence)

For patients undergoing orthopedic surgery or cardiac surgeryand those with preexisting cardiovascular disease the AABB recommends a restrictive RBC transfusion threshold (Hb levelof 8gdL) (strong recommendationmoderate quality evidence)

The restrictive Hb transfusion threshold of 7 gdL is likely comparable with 8 gdL butRCT evidence is not available for all patient categories


iexcliexclEs que tiene

3 g de HbQue no es por no

transfundir

Si hay que trasfundir

se trasfunde

pero trasfundir

pa naacute es tonteriacutea

PATIENT BLOOD MANAGEMENTldquoDE UNO EN UNOrdquo

httpwwwchoosingwiselyorgdoctor-patient-lists

CONCENTRADOS DE HEMATIacuteES

PBM Manejo de la anemia



PBM RIESGOS TRANSFUSIOacuteN

ldquoThe safest blood transfusioacuten ishellipthe one donacutet givenrdquo

Please DO SOMETHING TREAT THE ANAEMIA WISE AND NICELY





Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM

Spanish Consensus Statement on alternatives to allogeneic blood transfusion the 2013 update of the Seville Documentldquo Blood Transfus 2013 Jun 171-25



ANEMIA Y ldquoPATIENT BLOOD MANAGEMENTrdquo

Preoperatorio





Preoperatorio



20-30

mgdiacutea

Muacutesculo(250 mg)

Meacutedula oacutesea(300 mg)

Eritrocitos(2000 mg)

Macroacutefagos SRE(500 mg)

Hiacutegado(1000 mg)

Absorcioacuten intestinal de hierro(1-2 mgdiacutea)

Transferrina(3 mg)

Peacuterdidas de hierro(1-2 mgdiacutea)

Hierro IV

IRON LOSTIRON BLOCKIRON GIVEN


Deteccioacuten de la anemia preferiblemente al menos 28

diacuteas antes del procedimiento quiruacutergico o invasivo

Clasificacioacuten de la anemia para implementar el mejor

tratamiento posible siempre que sea posible

ORTHODOX approach

Goodnough et al NATA guidelines BJA 201110613-22Seville Document Update Blood Transfusion 2013 copy CortesiacuteaModfiificado Prof M Muntildeoz



Whenever clinically feasible patients undergoing elective surgery

with a high risk of severe postoperative anaemia should have their

haemoglobin level and iron status tested preferably at least 28

days before the surgical procedure For patients gt60 yr old

vitamin B12 and folic acid should also be measured








ORTHODOX approach


Anemia ldquoinexplicablerdquo deberiacutea ser investigada maacutes

especiacuteficamente y el procedimiento quiruacutergico

retrasado si es posible

Los deacuteficits hematiacutenicos auacuten sin anemia deberiacutean

ser suplementadostratados para permitir

bull La mjoer optimizacioacuten de la Hb Preoperatoria

bull Hastening the recovery from postoperative anaemia



PBM Manejo de la anemia preoperatoria

Br J Anaesth 2011 107 477-478copy Prof M Muntildeoz



ORTHODOX approach


The PRAGMATIC approach



A PRAGMATIC APPROACHBalgrist University Hospital Zurich (2009 - 2011)

Theusinger et al Blood Transfusion 2014 195-203

Indication of

MOS

Anaesthetic

assessment (4-6 weeks prior

surgery)

Contact

Family Doctor

Hb

lt13 gdL1000 mg iron iv

40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb

lt13 gdL 1000 mg iron iv

40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage

Topical haemostatics

Restrictive transfusion

(Hb lt8 gdL plusmn signs)

Meticulous haemostasis

Immediate preoperative

assessment

Modified copy Prof M Muntildeoz



A PRAGMATIC APPROACH Balgrist University Hospital Zurich A 4-years audit (2008-2011)

Transfusion rates according to period anaemia status and type of surgery

- PBM control (2008 n2150) + PBM study period (2009-2011 n6721)

Anaemia on day of surgery decreased from 154 vs 9 () 176 to 129

() in THR and 155 to 78 () in TKR Transfusion rates decreased from

207 vs 128() 218 to 157 () in THR from 193 to 49 () in TKR


Non-anaemic patients on DS Anaemic patients on DS


() plt0001)



ORTHODOX approach



The OPPORTUNITY approach

Very short-term perioperative IV iron plusmn ESA

What can we do if

this time-frame in not available


PBM Manejo de la anemia perioperatoria

- Grade of recommendation ldquoFor patients undergoing orthopaedic surgery expected todevelop severe postoperative anaemia we currently suggest IViron administration during the perioperative periodrdquo

For all other surgeries no evidence-based recommendation can be madeWe strongly recommend that large prospective randomised controlledtrials are undertaken in patients undergoing surgery expected to developsevere post operative anaemia



Transfusion 2013 Apr 15 doi 101111trf12195 [Epub ahead of print]

4 Spanish hospitals (October 2002 ndash December 2011)

Muntildeoz et al Transfusion 2014 54 289 ndash 299



Respect to control very short-term perioperative IV ironadministration with or without rHuEPO significantly reduced(plt001)

No clinically relevant AEs were observed

The scheduled IV iron dose (200-600 mg) may not cover total iron loss especially in patients with preoperative iron deficiency

Preoperative rHuEPO was only administered in 351 out of 1059 patients presenting with Hb level lt13 gdL and no contraindication

Transfusioacuten y resultados postoperatorios


Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)


PBM Manejo de la anemia postoperatoria


Fe sucrosa 200 mg iv48 h (3 d)

EPO 40000 UI sc ifHblt13 gdL

PerioperativeIV iron + EPO


Perioperative

IV iron + EPO



Postoperatorio

PBM Manejo de la anemia postreoperatoria




Actualizacioacuten Documento Sevilla 2013

Como adyuvante del tratamiento con AEEs en la anemia inducida por quimioterapia (GRADE 1A)

Mujeres con anemia debido a sangrado ginecoloacutegico (GRADE 1B)

Anemia postparto moderada-a-grave (GRADE 1B)

Anemia en enfermedad inflamatoria intestinal (GRADE 1B)

Como tratamiento uacutenico en la anemia del caacutencer (GRADE 2B)

En periacuteodo pre- o peri-operatorio de la cirugiacutea mayor sangrante (ortopeacutedica ginecoloacutegica caacutencer etc) (GRADE 2B)

RB

RB

RB

RB

R B

R B


Blood Transfus 2016 Mar14(2)126-33 doi 10245020150176-15

Fast-Track Anaemia Clinic at the Emergency Department Cost-analysis of

intravenous iron administration for treating iron deficiency anaemia

Quintana-Diacuteaz M Muntildeoz-Romo R Goacutemez-Ramiacuterez S Paviacutea J Borobia M Garciacutea-Erce JA Muntildeoz

MBlood Transfus 2016 (press)

Blood Transfus 2016 14 199-205 DOI 10245020160246-15


- ERITROPOYETINA Alfa Administracioacuten pre (peri) operatoriaPacientes de cirugiacutea ortopeacutedica programada con anemia

(Hb entre 10 y 13 gdL) y sangrado moderado-alto Grade 1A)

bull 600 UIKg por semana durante tres semanas antes (diacuteas -21 -14 y -7) y el diacutea de la cirugiacutea

bull 300 UIKg diariamente durante 10 diacuteas consecutivos antes de la cirugiacutea el diacutea de la misma y 4 diacuteas posteriores

bull Asegurarnos de que los pacientes no presentan deficiencias de hierro al comienzo del tratamiento (FeIV) y que reciben tromboprofilaxis

iexclSe desconoce cual es la dosis miacutenima eficaz


AGENTES ESTIMULANTES ERITROPOYESIS

ANEMIA ONCOLOacuteGICA

TRATAMIENTO CON FE DEL PACIENTE ONCOLOacuteGICO


TRANSFUSIOacuteN SANGUIacuteNEA

RESPUESTA HEMATOLOacuteGICA




Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash

Peacuterdida de Hemoglobina

(hierro)

Sangrado

25 45

Masa eritrocitaria

Procedicimientos quiruacutergicos mayores (ortopeacutedicos trauma cardiaca caacutencer etc)




Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash

Peacuterdida de sanguiacutenea

Sangrado

25 35

Masa eritrocitaria



Auto -Transfusioacuten

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash

REDUCCIOacuteNSANGRADO






Hb lt70-80 gL




bull Vitamina B12






ldquoEVITAR EL VAMPIRISMOrdquo




ANALIacuteTICASEXTRACCIONES



RECUPERACIOacuteN PERIOPERATORIA

bull Cirugia ortopedica electiva

Artroplastia de rodilla o cadera GRADE 1B

Escoliosis o patologiacutea espinal compleja (gt3 niveles)

GRADE 1C

PTR PTC Columna

EVIDENCIA 1A

RECUPERACIOacuteN INTRAOPERATORIA


PBM Trabajo multidisciplinar

No se puede hacer en solitario


GerenciaHospital

Apoyo

Organizacioacuten

Compromiso Anestesioacutelogos GeneralistasHematoacutelogosCirujanos

Liderazgo Coordinador del programa de PBM

Conocimiento Sangrado Alternativas CostesTransfusioacutenAnemia

AutoridadesSanitarias

Fondos

Legislacioacuten

SociedadesMedicas

Guiacuteas depraacutectica

cliacutenica

Consejo

Planificacioacuten Implementacioacuten Evaluacioacuten





JA Garciacutea-Erce et al Change of red cell transfusion use and distribution in a General Hospital ((2008-2015) Transfusion Medicine 2016 (Supl 1)NATA 2016

Grupo de Trabajo ldquoHemoterapia basada en el sentido comuacutenrdquo

ldquoPATIENT BLOOD MANAGEMENTrdquo (PBM) REDUCCIOacuteN DE LA TRANSFUSIOacuteN SANGUIacuteNEA DE

CADUCIDAD Y DE AHORRO ECONOacuteMICO

Dr Joseacute Antonio Garciacutea-Erce Dra Baacuterbara Meneacutendez Jaacutendula

Agradecimientos Marisa CEBOLLERO Mordf Pilar HOSPITAL ARA Mariacutea DOLZ Maria Alastruey Pila COSTA Eva PUYUELO Mercedes BORREL RONCALES Camino Concha Isabel Miguel Eugenio ZAZO Lourdes BORRELPROF MANUEL MUNtildeOZ GOacuteMEZ

Madrid 27 de julio de 2016

Estimadoa Dra Garciacutea Erce

Con motivo del LVIII Congreso Nacional de la SEHH y del XXXII Congreso Nacional de la SETH que se celebraraacute en Santiago de Compostela del 20 al 22 de octubre de 2016 es un placer notificarle que

Una vez evaluadas todas las comunicaciones por los miembros del comiteacute evaluador la comunicacioacuten titulada PATIENT BLOOD MANAGEMENT REDUCTION OF BLOOD TRANSFUSION WASTAGE AND COSTS ha sido aceptada para su presentacioacuten en formato Poacutester Comentado

Para el enviacuteo del poacutester se pondraacute a su disposicioacuten la plataforma PosterSessionOnline a la que podraacute acceder a traveacutes de la web del congreso (wwwsehhsethcom) La fecha liacutemite para su enviacuteo seraacute el 6 de octubre hasta las 2350 horas

El nuacutemero asignado a su poacutester es PC-331

Este poacutester deberaacute ser presentado por el primer autor el 20102016 en la zona de poacutesters dentro del aacuterea SEHH - BANCO DE SANGRE Y PRAacuteCTICA TRANSFUSIONAL y con el siguiente horario 1700-1830 H

El tiempo asignado a los posters comentados es de 2 minutos seguidos por un maacuteximo de 1 minuto para preguntas

Los posters se montaraacuten a partir del jueves diacutea 20 a las 0800 h y podraacuten ser retirados el saacutebado diacutea 22 a partir de las 1300 h

Para solucionar cualquier duda teacutecnica en el proceso de enviacuteo ponemos a su disposicioacuten un

servicio de atencioacuten telefoacutenica (917362385) El horario de atencioacuten es L - V 8h30 - 14h00 -

15h00 - 17h30 (Invierno) L - V 8h00 - 15h00 (Verano) tambieacuten puede enviar la consulta por

correo electroacutenico customerpostersessiononlinees

Ademaacutes de ser difundidos viacutea electroacutenica todos los posters seraacuten impresos e identificados de forma individual y enviados al congreso doacutende se habilitaraacute una zona de recogida Le facilitamos el DOI para la biblioteca virtual 103252psoes58SEHH2016

Le recordamos que es imprescindible la inscripcioacuten del primer firmante en el congreso para poder presentar la comunicacioacuten y para su publicacioacuten en la revista oficial del congreso

0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results

Garciacutea-Erce JA et al NATA Dublin 2016

Evolution Transfusion by services (II)

-6258

-6006

-4650

-5742

-4505

-5124

317

-5140

Datos del Banco de Sangre



EPIGRAPH

ldquoAll great work is the fruit of patience and perseverance combined with tenaciousconcentration on a subject over a period of months or yearsrdquo

Dr Santiago Ramoacuten y Cajal

Navarra-AragoacutenMedicineacutes Nobel Prize

PBM en fractura de cadera

Please DONATe and tranfuse WISELY

Conflictos de intereacutes

Asesor externo- AMGEN Oncologiacutea 20102012- Roche Anemia 2009- Ditassa-Ferrer 2004

Charlas estudios investigacioacuten y ayudas a congresos-Vifor-UriachFerralinze-Janssen-CilagBraun-Astra-Tech de Aztra ZenecaWell-HealthGSK-Sanofi AventisEsteveNovartisOctapharma-Cobe-CaridianRoche OncologiacuteaAMGEN Oncologia

COORDINADOR Grupo de Trabajo de la SETS ldquoHEMOTERAPIA BASADA EN EL SENTIDO COMUacuteNrdquoMiembro del CAT 2002-2005Miembro del Documento de Sevilla ldquoAlternativas a la TransfusioacutenrdquoMiembro del Documento LatinoAmericano de la AnemiaMiembro de GIEMSA Secretario AWGESocio SETSAEHHNATAEditor Asociado Revista ANEMIA wwwrevistaanemiaorgMiembro Comiteacute Cientiacutefico NATA y TATMEx Representante de la SEHH en la ONTColaborador del Choosing Wisely en Anestesiologiacutea y Reanimacioacuten
















Agradecimientos

wwwawgeorg



LEGISLACIOacuteN


LEGISLACIOacuteN

































Dudosa eficacia










72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH




















Agradecimientos

wwwawgeorg



LEGISLACIOacuteN


LEGISLACIOacuteN

































Dudosa eficacia










72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH



















Agradecimientos

wwwawgeorg



LEGISLACIOacuteN


LEGISLACIOacuteN

































Dudosa eficacia










72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






wwwawgeorg



LEGISLACIOacuteN


LEGISLACIOacuteN

































Dudosa eficacia










72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH







LEGISLACIOacuteN


LEGISLACIOacuteN

































Dudosa eficacia










72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH







LEGISLACIOacuteN

































Dudosa eficacia










72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






































Dudosa eficacia










72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH































Dudosa eficacia










72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH
























Dudosa eficacia










72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH


















Dudosa eficacia










72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH













72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH












72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH










72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








72 45







Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH










Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








Fallecimientos


2006 2007 2008 2009 2010 2011 2012 2013TOTAL

2006-13


TACO 0 1 0 0 1 0 0 1 3



TRALI 2 2 0 2 1 1 2 2 12

TOTAL 5 7 3 3 4 3 4 4 33





















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH


























P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH
























P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH



















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH

















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH















P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH










P

















Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH














Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH













Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








Hemoglobina (gdL)

Pro

bab

ilid

ad t

ran

sfu

sioacute

n (

)

Mujeres

Hombres

1680 PTC PTR

312

Pac

ien

tes

()

Hemoglobina (gdL)




Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






Hb 130-140 gl

100

75

62

46

25

0 20 40 60 80 100

T

RA

NSF

USI

ON

Hb lt 110 gl Hb 110-120 gl Hb 120-130 gl

Hb gt 140 gl







Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








Haematocrit lt 39



Overall 310 311 132 970 428

















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH



















PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








PREOPERATORIO

POSTOPERATORIO



um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH







um

en

to d

el ri

es

go














Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH


















Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH













Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH











Leve 57870 (254) 141 (130 ndash 153) 131 (126 ndash 136)


























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH
























182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






















182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH














182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH












182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH









182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






182

95

232

144

571

486516

0

10

20

30

40

50

60

70

80

90

100

5162017 52




CECValvular




0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






0 0 03 4 6

9 11 13

3842

53

61

Norma206

0

10

20

30

40

50

60

70

80

90

100

H2 H3 H15 H10 H8 H12 H6 H5 H11 H17 H16 H7 H4


0 0 0 0 0 0 0

8 1014

20

39

65

Norma106

0

10

20

30

40

50

60

70

80

90

100

H2 H5 H6 H8 H10 H11 H15 H12 H3 H4 H16 H7 H17




54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH







54

848 854 840890 874

834

761

0

2

4

6

8

10

12

14




abiertas


laparoscoacutepicas

Valvularescardiacas




55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH







55




abiertas


laparoscoacutepicas

Valvularescardiacas



723 706

650

528

663696

647

0

10

20

30

40

50

60

70

80

90

100



56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








56

6

89

1011 11

13 1314 15

22 2223 24

26

40

43

46

Norma182

0

5

10

15

20

25

30

35

40

45

50



57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH







57

0

2

4

6

8

10

12



uarr43




P-valor 001216

P-valor 000344

0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






0

5

10

15

20

25

30



uarr132

0

5

10

15

20

25

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr338


58




P-valor 000086

P-valor 000001

00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






00

25

50

75

100

125

150



uarr543

00

50

100

150

200

250

300

350

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr294


59




P-valor 001196

P-valor 001036


60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH







60

00

10

20

30

40

50

60

70

80

90

H1 H5 H8 H11 H12 H14 H15 H16 H18 Norma


uarr468

00

10

20

30

40

50

60

70

80



uarr319




P-valor 010517

P-valor 007016














donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH



















donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH












donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








donated human blood





2010














BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH


















BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH













BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH







BLOODCONSERVATION

BLOODMANAGEMENT








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH











coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








coagulopatiacutea


postoperatoria

Mejorresultado

cliacutenico





eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH







eritropoyesis



anemia










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH










PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








PBM EUROPA





PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH










PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








PBM EUROPA

Aims

Main Tasks

Key messages




PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








PBM EUROPA

Aims

Main Tasks

Key messages







PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








PBM EUROPA







Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH












Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH











Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH










Hb lt70-80 gL




bull Vitamina B12















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH
















Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH













Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH











Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH









Liberal Restrictivo

23 3802 0327 3583 5920 14

418plusmn73 423plusmn74409 43852 43




Pac

ien

tes

()

TSA CR 41 vs CL 96




NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH









NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH







NEJM 1 Octubre 2014
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH


















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH
















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH















transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH














transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








transfundir


se trasfunde

pero trasfundir















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH



















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH


















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH
















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH















Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH













Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH












Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH










Hb lt70-80 gL




bull Vitamina B12



Spaniard PBM





Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








Preoperatorio





Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH









Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








Preoperatorio



20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH







20-30

mgdiacutea







Transferrina(3 mg)


Hierro IV







ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH











ORTHODOX approach
















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH



















ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH











ORTHODOX approach















ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH











ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








ORTHODOX approach







Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH










Indication of

MOS

Anaesthetic


surgery)

Contact

Family Doctor

Hb


40000 U EPO sc

1 mg Vit B12 sc

5 mgd Folate oral

Hb


40000 U EPO sc

1 mg Vit B12 sc

Surgery

Postoperative

YES

NO

NO

YES

NO

YES

Hb lt13 gdL

2W

n=4736

n=867

n=1985

(295)

n=6721

n=1807

n=178

(9)n=26

(15)

n=152

n=0Cell salvage






assessment













() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH

















() plt0001)



ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








ORTHODOX approach





What can we do if



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH























Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH



















Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH














Tran

sfu

sio

n (

)

Po

stO

P in

fect

ion

(

)

30

d m

ort

alit

y (

)

Ho

spit

al s

tay

(day

s)








Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH













Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH










Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






Perioperative

IV iron + EPO



Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH







Postoperatorio












RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH















RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH














RB

RB

RB

RB

R B

R B

























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH





























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH
























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH























Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH














Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH












Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH








Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

Tratamiento Anemia

TransfusionHe

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


(hierro)

Sangrado

25 45

Masa eritrocitaria





Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH







Blood loss (mL)

ι0

ι500

ι1000

ι1500

ι2000

ι2500

ι3000

He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash


Sangrado

25 35

Masa eritrocitaria




He

mo

glo

bin

a (g

dL)

9 ndash

11 ndash

13 ndash

7 ndash

5 ndash

15 ndash







Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH










Hb lt70-80 gL




bull Vitamina B12

















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH


















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH
















GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH














GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH












GRADE 1C

PTR PTC Columna

EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






EVIDENCIA 1A






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH









GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






GerenciaHospital

Apoyo

Organizacioacuten





Fondos

Legislacioacuten

SociedadesMedicas


cliacutenica

Consejo



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH




























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH



























0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH






0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Surgical

Emergencies

Medical

Critical Care

Nephrology

Oncology

Hematology

Results



-6258

-6006

-4650

-5742

-4505

-5124

317

-5140




EPIGRAPH









EPIGRAPH








EPIGRAPH






EPIGRAPH






Health & Medicine

PATIENT BLOOD MANAGEMENT. DR GARCÍA ERCE. Pamplona mayo 2017