Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
PREPARAZIONE DEL PAZIENTE 
CHIRURGICO PROTESICO: 
PREDEPOSITO E TERAPIA 
MARZIALE: QUALE RUOLO E 
MODELLO DI STRATEGIA 
OP...
MONDO TRASFUSIONALE OGGI 
Emovigilanza 
Virus emergenti 
Nuove patologie 
RISCHIO 
TRASFUSIONALE 
TRALI 
ATR 
HtR 
GVHD 
T...
SHOT 2012
Gestione preoperatoria 
*Inquadramento 
clinico-anamnestico 
adeguato; 
Determinazione 
laboratoristica 
analitica; 
Inizi...
MULTIMODAL APPROACH 
PREPARAZIONE DEL PAZIENTE 
Diagnostica ematologica 
Diagnostica 
emorragica/coagulativa 
METODICHE AN...
PERCORSO ASSISTENZIALE INTERDISCIPLINARE 
ANESTESISTA EMATOLOGO CHIRURGO 
Step 
Preop 
Step 
Intraop 
Step 
Postop
FASE PREOPERATORIA - CONSULENZA DI MEDICINA TRASFUSIONALE 
CORRELAZIONE 
ANESTESIOLOGICA 
PO CENTRALIZZATE 
ELABORAZIONE D...
CONSULENZA TRASFUSIONALE 
1 
• Valutazione Anamnestica e 
Laboratoristica ed esame 
obiettivo 
2 
• Individuazione di stat...
VALUTAZIONE ANAMNESTICA E LABORATORISTICA 
ESAME OBIETTIVO 
Comorbilità 
Parametri laboratoristici 
e strumentali 
Interfe...
2 INDIVIDUAZIONE STATI ANEMICI PREOPERATORI 
Mortalità Morbilità Degenza 
Ospedaliera 
ANEMIA PERIOPERATORIA
INQUADRAMENTO DIAGNOSTICO
Uno stato anemico non diagnosticato è 
presente in una percentuale compresa tra il 5 
ed il 75% dei pazienti chirurgici 
C...
2013
A 
CRITERI DIAGNOSTICI PER 
SIDEROPENIA MANIFESTA 
• Hb< 10,5 F e < 13,5 M 
• MCV < 80 fl 
B 
• Ferritina sierica < 15 ng/...
Supplementazione orale di ferro 
Ferro 
• Ferro 
solfato 
• 100 mg 
Ferro 
• Ferro 
saccarato 
• 80 mg 
Ferro 
• Ferro 
bi...
RISPOSTA TERAPEUTICA 
Criteri Posologici 
dose 
110-200 mg/die 
( adulti) 
4-6 mg/die 
(bambini ) 
target 
>Reticolociti 
...
Tipo N° Δ Hb 
(g/dL) 
Δ% RET Δ FER 
(ng/mL) 
Δ % SAT 
Gruppo A 40 -0,61±0,34 0,36%±0,40% -16,4±21,4 -3,3%±5,5% 
Gruppo B 2...
Nuove terapie parenterali.. 
FERROCARBOSSIMALTOSIO 
DOSE SINGOLA MASSIMA : fino a 1000 mg di ferro 
PRIMO FARMACO CON TOTA...
Terapia di 
supporto 
autodonazione, 
Uso perichirurgico 
Scarsa 
compliance, 
Malassorbimento 
Insufficienza 
renale cron...
Individuazione di diatesi emorragica e/o 
Anamnesi familiare e personale 
Screening di laboratorio 
1 e 2° livello 
Diates...
ALGORITMO PER BLEEDING SCORE’SYSTEM
ALGORITMO PER IL BLEEDING SCORE’ System
3 FASE PREOPERATORIA 
P 
• Piano terapeutico individualizzato 
• Terapia di supporto perioperatoria 
B 
• Strategie di ris...
Tipologia 
d’in tervento e 
gestione 
perichirurgica 
Patrimonio 
ematologico 
individuale 
Timing 
di 
prelievo
PREDONAZIONE AUTOLOGA 
VANTAGGI SVANTAGGI
INDICAZIONI PER LA PREDONAZIONE AUTOLOGA 
BRITISH COMMITTEE FOR STANDARDS IN HAEMATOLOGY_PREDEPOSIT AUTOLOGOUS BLOOD 
DONA...
CONTROINDICAZIONI AL PREDEPOSITO AUTOLOGO 
°Angina 
instabile e 
cardiopatia 
ischemica 
riferita e/o 
documentabile 
°Car...
RISERVE MARZIALI DEL PAZIENTE SIDEROPESSI 
Capacità 
eritropoietica 
del paziente 
MIDOLLARE 
Tempo di 
risposta 
midollar...
Coordinamento 
infermieristico 
INFORMAZIONI DETTAGLIATE 
AL PAZIENTE 
VALUTAZIONE PARAMETRI 
VITALI 
VALUTAZIONE COMPLIAN...
ESPERIENZA SIMT SAN CAMILLO_FORLANINI 
2007-2013 
AREA DEDICATA 
Risorse umane e strumentali 
Integrazione equipe 
periope...
GRAZIE PER LA CORTESE ATTENZIONE
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
2014 orthopea milano -  rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale r...
Upcoming SlideShare
Loading in …5
×

2014 orthopea milano - rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale ruolo e modello di strategia operativa

654 views

Published on

2014 orthopea milano - rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale ruolo e modello di strategia operativa

Published in: Health & Medicine
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

2014 orthopea milano - rondinelli - preparazione del paziente chirurgico protesico predepostio e terapia marziale quale ruolo e modello di strategia operativa

  1. 1. PREPARAZIONE DEL PAZIENTE CHIRURGICO PROTESICO: PREDEPOSITO E TERAPIA MARZIALE: QUALE RUOLO E MODELLO DI STRATEGIA OPERATIVA. MARIA BEATRICE RONDINELLI UOC SIMT AO SANCAMILLO-FORLANINI-ROMA Milano,3-4 Aprile 2014
  2. 2. MONDO TRASFUSIONALE OGGI Emovigilanza Virus emergenti Nuove patologie RISCHIO TRASFUSIONALE TRALI ATR HtR GVHD TRIM STORAGE LESION TRALI SANGUE :RISORSA LIMITATA INVECCHIAMENTO DELLA POPOLAZIONE DIRETTIVE EUROPEE DECRETI LEGISLATIVI LINEE GUIDA RACCOMANDAZIONI AUMENTO DEI PAZIENTI CHIRURGICI AUMENTO DEI COSTI TRASFUSIONALI DIRETTI ED INDIRETTI EMOCOMPONENTI DI GRADO FARMACEUTICO
  3. 3. SHOT 2012
  4. 4. Gestione preoperatoria *Inquadramento clinico-anamnestico adeguato; Determinazione laboratoristica analitica; Inizio terapia con ESA e Ferro endovena entro 24 h; Supporto Trasfusionale secondo trigger conformi. Gestione Intraoperatoria Garanzia di adeguate misure anestesiologiche; Uso di sigillanti emostatici tipo colla di Fibrina Adeguata profilassi tromboembolica ; Uso di antifibrinolitici (Tranex ev a scopo antiemorragico ) Controllo emorragia POC Testing Gestione Postoperatoria Adeguata stabilizzazione emodinamica; Uso di ESA e terapia marziale parenterale; Riduzione prelievi ematici per prevenzione anemia iatrogena Supporto Trasfusionale secondo trigger conformi. MULTIMODAL APPROACH : algoritmo assistenziale Equipe chirurgica-anestesiologica-trasfusionale
  5. 5. MULTIMODAL APPROACH PREPARAZIONE DEL PAZIENTE Diagnostica ematologica Diagnostica emorragica/coagulativa METODICHE ANESTESIOLOGICHE-CHIRURGICHE RECUPERO PERIOPERATORIO Monitoraggio emostatico coagulativo MONITORAGGIO PERIOPERATORIO TRIGGERS TRASFUSIONALI Terapia di supporto
  6. 6. PERCORSO ASSISTENZIALE INTERDISCIPLINARE ANESTESISTA EMATOLOGO CHIRURGO Step Preop Step Intraop Step Postop
  7. 7. FASE PREOPERATORIA - CONSULENZA DI MEDICINA TRASFUSIONALE CORRELAZIONE ANESTESIOLOGICA PO CENTRALIZZATE ELABORAZIONE DI UN PROGRAMMA TIMING ADEGUATO (28-30 gg)
  8. 8. CONSULENZA TRASFUSIONALE 1 • Valutazione Anamnestica e Laboratoristica ed esame obiettivo 2 • Individuazione di stati anemici preoperatori • Diatesi emorragiche e/o trombofiliche 3 • Piano terapeutico supporto • Strategie di risparmio ottimizzate
  9. 9. VALUTAZIONE ANAMNESTICA E LABORATORISTICA ESAME OBIETTIVO Comorbilità Parametri laboratoristici e strumentali Interferenze farmacologiche Alloimmunizzazione eritrocitarie pregresse (TCI ) Stato sierologico Patologie autoimmunitarie (TCD) 1
  10. 10. 2 INDIVIDUAZIONE STATI ANEMICI PREOPERATORI Mortalità Morbilità Degenza Ospedaliera ANEMIA PERIOPERATORIA
  11. 11. INQUADRAMENTO DIAGNOSTICO
  12. 12. Uno stato anemico non diagnosticato è presente in una percentuale compresa tra il 5 ed il 75% dei pazienti chirurgici Caratteristiche peculiari del paziente chirurgico ( età, interf.farmac.) Parametri laboratoristici basali e di funzionalità d’organo Grado di complessità dell’intervento chirurgico
  13. 13. 2013
  14. 14. A CRITERI DIAGNOSTICI PER SIDEROPENIA MANIFESTA • Hb< 10,5 F e < 13,5 M • MCV < 80 fl B • Ferritina sierica < 15 ng/dL • Sideremia < 60 mcg/dL C • Recettore x TRF solubile >28 nM D • Assenti depositi di ferro nei macrofagi midollari E • Saturazione della TRF < 15%
  15. 15. Supplementazione orale di ferro Ferro • Ferro solfato • 100 mg Ferro • Ferro saccarato • 80 mg Ferro • Ferro bisglicinato-chelato • 14 mg ASSORBIMENTO PER OS MAX A STOMACO VUOTO 27% ASSORBIMENTO CON LATTE 17% ASSORBIMENTO A STOMACO PIENO 5 % ASSORBIMENTO CON VIT.C 30%
  16. 16. RISPOSTA TERAPEUTICA Criteri Posologici dose 110-200 mg/die ( adulti) 4-6 mg/die (bambini ) target >Reticolociti 3-5 gg Max 5 gg target > 1gr/100cc in 1 sett. >2gr/100cc in 3 sett. Mancata Risposta 1) Scarsa Compliance 2) Infezioni ,Tumori 3) Stillicidio Ematico 4) Assunzione di inibitori protonici, antiacidi; antiistaminici 5) Regime alimentare
  17. 17. Tipo N° Δ Hb (g/dL) Δ% RET Δ FER (ng/mL) Δ % SAT Gruppo A 40 -0,61±0,34 0,36%±0,40% -16,4±21,4 -3,3%±5,5% Gruppo B 20 -1,31±0,60 0,23%±0,69% -28,0±22,9 -13,1%±8,2% Endpoints studio bisglicinato chelato
  18. 18. Nuove terapie parenterali.. FERROCARBOSSIMALTOSIO DOSE SINGOLA MASSIMA : fino a 1000 mg di ferro PRIMO FARMACO CON TOTALE DOSE INFUSION (TDI ) 20mg/KG MINORI EFFETTI COLLATERALI SISTEMATIZZATI MINORI COSTI DI OSPEDALIZZAZIONE MAGGIORE STABILITA’ RISPOSTA DOSE TERAPEUTICA PRESENTI DA POCO IN ITALIA , USO CODIFICATO NORD EUROPA
  19. 19. Terapia di supporto autodonazione, Uso perichirurgico Scarsa compliance, Malassorbimento Insufficienza renale cronica Perdite ematiche intestinali Reazioni anafilattiche Reazioni sistematizzate Problemi organizzativi Indicazioni Svantaggi
  20. 20. Individuazione di diatesi emorragica e/o Anamnesi familiare e personale Screening di laboratorio 1 e 2° livello Diatesi trombofilica Interazioni farmacologiche Diatesi emorragica Tromboelastometrie Studio di Aggregometria piastrinica 2 trombofilica
  21. 21. ALGORITMO PER BLEEDING SCORE’SYSTEM
  22. 22. ALGORITMO PER IL BLEEDING SCORE’ System
  23. 23. 3 FASE PREOPERATORIA P • Piano terapeutico individualizzato • Terapia di supporto perioperatoria B • Strategie di risparmio integrate e condivise M • Consenso informato • Compliance del paziente
  24. 24. Tipologia d’in tervento e gestione perichirurgica Patrimonio ematologico individuale Timing di prelievo
  25. 25. PREDONAZIONE AUTOLOGA VANTAGGI SVANTAGGI
  26. 26. INDICAZIONI PER LA PREDONAZIONE AUTOLOGA BRITISH COMMITTEE FOR STANDARDS IN HAEMATOLOGY_PREDEPOSIT AUTOLOGOUS BLOOD DONATION AND TRANSFUSION “2010” ( GRADING 1 C+) Pazienti con gruppi rari Pazienti con alloimmunizzazioni multiple • Pazienti che rifiutano la trasfusione allogenica • Pazienti con diatesi emorragica
  27. 27. CONTROINDICAZIONI AL PREDEPOSITO AUTOLOGO °Angina instabile e cardiopatia ischemica riferita e/o documentabile °Cardiopatie congenite cianotiche °Stenosi Aortica severa CONTROINDICAZIONI ° Vasculopatia occlusiva cerebrale severa • Ipertensione severa non cntrollata • Epilessia
  28. 28. RISERVE MARZIALI DEL PAZIENTE SIDEROPESSI Capacità eritropoietica del paziente MIDOLLARE Tempo di risposta midollare IL1 IL6 EPO ENDOGENA EPO ESOGENA Goodnough LT . BLOOD 2000 Erytthropoietin,iron and erythropoiesis
  29. 29. Coordinamento infermieristico INFORMAZIONI DETTAGLIATE AL PAZIENTE VALUTAZIONE PARAMETRI VITALI VALUTAZIONE COMPLIANCE COORDINAMENTO PO CENTRALIZZATE CASELLA DI POSTA ELETTRONICA
  30. 30. ESPERIENZA SIMT SAN CAMILLO_FORLANINI 2007-2013 AREA DEDICATA Risorse umane e strumentali Integrazione equipe perioperatoria elettiva ed urgenza PAC Diagnostici PAC terapeutici POC testing Day-service Paz Paz. trasfusi Paz.non transfusi Unità allog. 1150 891 259 674 1290 502 788 279 2007-2008 2011-2013
  31. 31. GRAZIE PER LA CORTESE ATTENZIONE

×