Test de reserva de sangre preoperatorio en cesáreas electivas de bajo riesgo: ¿es realmente necesario?

espanolObjetivo: el test de tipaje y escrutinio se ha postulado en Espana como la prueba pretransfusional de eleccion en cirugia programada. Actualmente, solo el 1,1-1,7% de las pacientes a las que se realiza una cesarea precisan transfusion sanguinea. El objetivo fue valorar la necesidad de realizar test de reserva de sangre preoperatorio en las cesareas electivas de bajo riesgo, atendiendo al analisis racional de sobrereserva, riesgo-beneficio y coste-efectividad e identificando los factores que comportaron una mayor perdida hematica. Material y metodos: se diseno un estudio observacional, descriptivo y retrospectivo. Se incluyo a 189 mujeres sometidas a cesarea electiva en el hospital de Denia en el periodo entre 2015 y 2016. Todas ellas disponian de un test de reserva de sangre preoperatorio. Se excluyeron las cesareas urgentes y las pacientes con indicacion de cesarea electiva que iniciaron dinamica de parto o rotura prematura de membranas. Resultados: de las 189 cesareas, unicamente una (0,005%) preciso transfusion sanguinea de manera preoperatoria, por presentar una hemoglobina de 7 g/dl. Todos los indicadores de reserva sanguinea mostraron sobrereserva en cesareas electivas. El descenso de hemoglobina se asocio a una edad gestacional inferior a 40 semanas, mayor edad materna y mayor hemoglobina preoperatoria. Conclusiones: los datos obtenidos tras el analisis estadistico de la muestra nos han permitido eliminar el test de reserva de sangre preoperatorio en cesareas electivas de nuestro protocolo. Se mantendra en los diagnosticos con mayor riesgo de sangrado y segun indicacion del obstetra y/o anestesiologo. EnglishObjective: Type and screen test has been implement in Spain as pre-transfusional elective test in programmed surgery. Currently, only 1.1-1.7% of patients undergoing cesarean section require blood transfusion. To assess the need to make a pre-operative blood reserve test in elective cesarean sections based on the rational analysis of over-reserve, risk-benefit and cost-effectiveness and identifying which factors lead to an increase in blood loss. Material and methods: An observational, descriptive and retrospective study was designed. 189 women were included to be operated by an elective cesarean section at Denia’s Hospital, between 2015 and 2016. All of them had a preoperative blood test reserve. Urgent cesarean sections and patients with elective cesarean section indication who started labor contractions or premature rupture of membranes were excluded. Results: Only one of the 189 women included (0.005%) was given a preoperative blood transfusion, because of the hemoglobin level was 7 g/dl. All blood reserve parameters show over-reserve in elective cesarean sections. The decrease of hemoglobin was associated with a gestational age less than 40 weeks, greater maternal age and greater preoperative hemoglobin. Conclusions: Data obtained after statistical analysis of the sample allowed us to remove the blood reserve test in elective cesarean sections of our protocol. It will be kept in diagnoses with greater bleeding risk and according to the obstetrician and/or anesthesiologist indications.