Victorino Camila Augusta, Faria João Carlos Pina, Suano-Souza Fabíola Isabel, Sarni Roseli Oselka Saccardo
Faculdade de Medicina do ABC, Santo André, SP, Brazil.
Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2019 Aug 19;17(4):eAO4720. doi: 10.31744/einstein_journal/2019AO4720.
To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital.
A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets.
Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication.
The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.
验证综合医院不同儿科科室的儿科医生开具血小板浓缩液处方的合理性。
一项横断面研究，由急诊室、病房和重症监护室的儿科医生评估2007年1月至2015年4月期间218/227例儿童和青少年（0至13岁）的血小板浓缩液记录。排除血液系统疾病患者及未记录血小板数量的患者的申请记录。
12个月以下儿童接受了98次血小板浓缩液输注（45.2%）。大多数输血为预防性输血（165次；79%）。关于输血地点，39次（18%）在急诊室，27次（12.4%）在病房，151次（69.6%）在重症监护室。输血的触发因素、规定体积和血小板浓缩液亚型分别在59次（28.2%）、116次（53.5%）和209次（96.3%）输血中合理。出血患者的输血合理性为42次（95.5%），而无出血儿童的输血合理性为17次（10.3%）。与体积相关的最常见不合理情况是处方超过推荐量（95次；43.8%）。有8次血小板浓缩液的处方申请了亚型但无适应证。
本研究结果表明，与预防性输血相比，活动性出血儿童接受血小板浓缩液输血更为合理。存在开具超出当前方案规定的高剂量和不合理血小板亚型的倾向。输血医学教学在本科和住院医师培训中应得到更多重视。
