Caracterização da prática de medicação pré ato transfusional em unidade de onco-hematologia e conhecimento de médicos e enfermeiros

Abstract

Introduction: One of the most notable interventions in medicine is blood transfusion, including its components (hemocomponents) and derivatives (hemoderivatives). However, transfusion reactions, which encompass any adverse event resulting from the transfusion process, are a significant concern in this field. Objective: This study aimed to evaluate and characterize the practice of pre-transfusion medication and the perceptions of physicians and nurses regarding this conduct. Materials and Methods: The research was conducted in the Chemotherapy Center and the Onco-Hematology Ward of the Hematology, Hemotherapy, and Oncology Unit at HC-UFTM. This is a descriptive exploratory study, where data related to the practice of pre-medication were obtained from both physical and electronic medical records of patients undergoing transfusions for the management of onco-hematological diseases throughout the year 2021. To characterize the knowledge of prescribing physicians and assisting nurses, semi-structured interviews were conducted by the researcher with the consent of participants through a Free and Informed Consent Term. Results: During the period, 688 transfusion events were performed. Of these, 522 (75.87%) involved the use of pre-medication, with the most frequent application for platelet concentrates (100% for apheresis and 91.69% for random concentrates). Regarding the characterization of physicians and nurses, the majority of the physicians reported prescribing pre-medication in cases of a history of previous transfusion reactions; concerning the type of HC for which they most frequently prescribe, 80% indicated random platelet concentrates; with respect to the most prescribed medication(s), 60% cited diphenhydramine and 40% indicated dipyrone; in relation to previous transfusion reactions, 100% referred to consultation with the Hemotherapy Service; all stated that they collected the “Informed Consent and Awareness Term” from 100% of the patients. Among the nursing staff, 50% claimed that pre-medication was used in 70% to 80% of transfusions; 70% indicated that antihistamines were the most prescribed, which aligns with the prescribers' information; only 40% reported seeking alternative measures to pre-medication, such as bedside observation, and 90% expressed apprehension about administering HC without established pre-medication. We observed a widespread practice of pre-medication, highlighting a conservative approach that has been systematically questioned and contested. The high rates of pre-medication, with the use of antihistamines and analgesics, underscore the need for reformulation and adoption of protocols that adhere to good medical practices (GMPs) and a constant pursuit of preventive strategies, alternatives to pre-medication, and even to transfusion, emphasizing restrictive transfusion practices through appropriate patient management. A considerable portion of the nursing staff exhibited apprehension about conducting transfusions without established pre-medication, a concern shared by the prescribers, indicating the need for awareness regarding the importance of patient safety, without the risks of potential iatrogenesis from the medications used, which are often unnecessary.