Reações transfusionais em idosos internados em hospital público: análise de sinais e sintomas e propostas de protocolo para a hemovigilância

Abstract

Introduction: In view of the changes in the Brazilian age pyramid, the country now has a larger contingent of older people from 60 years of age since 1960. Because aging is a dynamic and progressive process, permeated by declining functions, the elderly become more susceptible to functional limitations, to the exacerbation of pre-existing diseases or conditions and, consequently, to hospitalization. One of the beneficial therapeutic methods adopted in the context of hospitalization is transfusion therapy, which consists of the use of blood components to improve specific clinical conditions. Despite its effectiveness, compliance with good practices in the blood cycle stages, and being appropriately indicated and performed, it implies risks that include transfusion reactions. These reactions can be classified as immediate, when they occur within 24 hours from the beginning of the transfusion, and late, which manifest after this period. From this perspective, haemovigilance is structured as a set of surveillance procedures aimed at improving transfusion safety and reducing the occurrence or recurrence of transfusion reactions and other incidents. Although there were evolutions in the hemovigilance system, the underreporting of these events is still a reality that is detrimental to the patient and the performance of health teams. Given the interest in the constitution of information on hemovigilance related to elderly patients, this research was conducted. Objectives: To identify the occurrence of signs and symptoms of non-communicable immediate transfusion reactions related to red blood cell transfusion in elderly patients from 60 years old admitted to a public hospital in Federal District and to propose a protocol for reporting transfusion reactions to standardize professional conduct in the Public Health System of Federal Distrito, Brazil. Method: an observational study was carried out with a quantitative analysis of 516 red blood cell transfusions in hospitalized elderly patients that occurred between June and December 2017 and a literature review to draft a protocol for notification of transfusion reactions. Results: of 1,113 red blood cell transfusions performed in the elderly from June to December 2017 in the hospital studied, 708 (63.6%) occurred in the elderly hospitalized. Of these, 26.1% (185) did not have records of blood component request or infusion in the medical records and 7 (0.9%) were not found with the data reported in the coordinating blood center traceability system, totaling a sample of 516 (72.9%) transfusions in 258 patients at the time and place of the study. In 12 transfusions, there were adverse manifestations and, therefore, the transfusion reaction rate found was 2.3%. Respiratory disorders (33.3%) and fever (23.8%) were the most common. Through evidence from the literature and health and normative guidelines, a protocol that standardizes the procedures for communication and notification of transfusion reactions for the units of the public district health network was structured. Developed products: original article and protocol in the standard defined by the Permanent Committee of Health Care Protocols of the State Department of Health of the Federal District, Brasília, DF, Brazil. Conclusions: The training of professionals working in transfusion practice is mandatory to ensure safe care, free from avoidable damage and diligent in adverse circumstances and risk to the elderly recipient of blood components. By adhering to the structured protocol, the results are expected to improve the performance of hemotherapy professionals and the consequent reduction of underreporting of transfusion reactions.