{"id":12923,"date":"2017-12-15T18:38:22","date_gmt":"2017-12-15T18:38:22","guid":{"rendered":"https:\/\/staging.awgp.pt\/testes\/?p=12923"},"modified":"2025-04-22T15:22:34","modified_gmt":"2025-04-22T15:22:34","slug":"patient-blood-management-envolve-cirurgioes-imunohemoterapeutas-e-anestesiologistas","status":"publish","type":"post","link":"https:\/\/staging.awgp.pt\/testes\/patient-blood-management-envolve-cirurgioes-imunohemoterapeutas-e-anestesiologistas\/","title":{"rendered":"Patient Blood Management \u00abenvolve cirurgi\u00f5es, imunohemoterapeutas e anestesiologistas\u00bb"},"content":{"rendered":"<style type=\"text\/css\"><\/style>[cmsmasters_row data_padding_bottom=&#8221;50&#8243; data_padding_top=&#8221;0&#8243; data_bg_parallax_ratio=&#8221;0.5&#8243; data_bg_size=&#8221;cover&#8221; data_bg_attachment=&#8221;scroll&#8221; data_bg_repeat=&#8221;no-repeat&#8221; data_bg_position=&#8221;top center&#8221; data_color=&#8221;default&#8221; data_bot_style=&#8221;default&#8221; data_top_style=&#8221;default&#8221; data_padding_right=&#8221;3&#8243; data_padding_left=&#8221;3&#8243; data_width=&#8221;boxed&#8221;][cmsmasters_column data_width=&#8221;1\/1&#8243;][cmsmasters_text animation_delay=&#8221;0&#8243;]<\/p>\n<p>&nbsp;<\/p>\n<p>O conceito j\u00e1 \u00e9 muito antigo, mas a verdade \u00e9 que a implementa\u00e7\u00e3o do PBM, em toda a sua extens\u00e3o, dever\u00e1 estar limitada a uma minoria de hospitais em Portugal. O objetivo do programa \u00e9 fazer com que o sangue &#8220;seja utilizado de forma conservadora e restritiva&#8221;.<\/p>\n<p>Ant\u00f3nio Robalo Nunes diz que o Patient Blood Management (PBM) \u201c\u00e9 um anglicismo que praticamente j\u00e1 desistimos de traduzir\u201d. E acrescenta que, \u201cnuma tradu\u00e7\u00e3o pessoal\u201d, arriscaria chamar-lhe gest\u00e3o hematol\u00f3gica do doente. Trata-se de &#8220;valorizar o sangue como recurso \u00fanico e insubstitu\u00edvel, procurando minimizar a utiliza\u00e7\u00e3o de sangue alog\u00e9nico, numa estrat\u00e9gia de redu\u00e7\u00e3o transfusional&#8221;.<\/p>\n<p><strong>Reduzir exposi\u00e7\u00e3o &#8220;ao aut\u00eantico banquete imunol\u00f3gico&#8221;<\/strong><\/p>\n<p>\u201cTransfundir \u00e9 uma terap\u00eautica altamente utilizada e, apesar de ser basicamente segura, n\u00e3o deixa de ter alguns riscos associados. As institui\u00e7\u00f5es t\u00eam, portanto, o dever de se concertar no sentido de se transfundir menos, expondo menos o doente ao aut\u00eantico banquete imunol\u00f3gico que representa cada transfus\u00e3o\u201d, considera o m\u00e9dico.<\/p>\n<p>Diretor do Servi\u00e7o de Imunohemoterapia\/Medicina Transfusional do Hospital das For\u00e7as Armadas (Polo de Lisboa) e presidente do Anemia Working Group Portugal (AWGP), Ant\u00f3nio Robalo Nunes sublinha que \u201ctransfundir \u00e9 seguro, mas n\u00e3o tem risco zero\u201d.<\/p>\n<p>&nbsp;<\/p>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"wp-image-12928 alignleft\" src=\"https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_01-Dr_Robalo-300x158.jpg\" alt=\"\" width=\"499\" height=\"263\" srcset=\"https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_01-Dr_Robalo-300x158.jpg 300w, https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_01-Dr_Robalo-440x232.jpg 440w, https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_01-Dr_Robalo-580x305.jpg 580w, https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_01-Dr_Robalo.jpg 655w\" sizes=\"(max-width: 499px) 100vw, 499px\" \/><\/p>\n<p><strong>&#8220;O dif\u00edcil \u00e9 passar os programas \u00e0 pr\u00e1tica&#8221;<\/strong><\/p>\n<p>O PBM n\u00e3o pode deixar de ter um forte v\u00ednculo \u00e0 atividade cir\u00fargica porque, normalmente, em qualquer institui\u00e7\u00e3o, mais de 50% do sangue \u00e9 consumido em cen\u00e1rio cir\u00fargico. Mas o programa n\u00e3o \u00e9 qualquer coisa que esteja predefinida, que se possa importar e instalar num hospital. O nosso entrevistado explica porqu\u00ea:<\/p>\n<p>\u201cCada unidade hospitalar, em fun\u00e7\u00e3o da sua matriz assistencial, tem que implementar um programa cujo princ\u00edpio \u00e9 sempre o mesmo, centralizado no doente e valorizando o seu sangue como recurso \u00fanico, mas com aspetos funcionais que s\u00e3o necessariamente diferentes de hospital para hospital. Diferentes pela sua dimens\u00e3o, a sua complexidade, o tipo de val\u00eancias que possuem, etc.\u201d<\/p>\n<p>E salienta:\u00a0\u201cFazer programas de PBM \u00e9 f\u00e1cil. O dif\u00edcil \u00e9 pass\u00e1-los \u00e0 pr\u00e1tica.&#8221;<\/p>\n<p><strong>Assente em tr\u00eas pilares<\/strong><\/p>\n<p>O princ\u00edpio global do PBM assenta em tr\u00eas pilares, no que respeita \u00e0 atividade cir\u00fargica, sendo que o primeiro passa por otimizar o doente antes da cirurgia, no sentido de diminuir, sinalizar, diagnosticar e tratar uma anemia que possa existir.<\/p>\n<p>\u201cAt\u00e9 porque se sabe que a anemia, por si s\u00f3, \u00e9 o principal fator de probabilidade para que ocorra a necessidade transfusional no intraoperat\u00f3rio\u201d, lembra Ant\u00f3nio Robalo Nunes, acrescentando que tamb\u00e9m \u00e9 necess\u00e1rio avaliar as altera\u00e7\u00f5es da compet\u00eancia hemost\u00e1tica, assumindo o imunohemoterapeuta um papel importante nesta fase.<\/p>\n<p>O segundo pilar \u201c\u00e9 claramente intraoperat\u00f3rio, muito na depend\u00eancia das val\u00eancias cir\u00fargicas e da Anestesiologia, e tem que ver com a monitoriza\u00e7\u00e3o e a diminui\u00e7\u00e3o das perdas hemorr\u00e1gicas\u201d. Finalmente, o pilar p\u00f3s-operat\u00f3rio, \u201conde tem que haver uma an\u00e1lise muito criteriosa dos cen\u00e1rios que poder\u00e3o determinar a necessidade transfusional\u201d.<\/p>\n<p>Segundo Ant\u00f3nio Robalo Nunes, \u201cestamos perante um programa que necessita de uma grande concerta\u00e7\u00e3o a n\u00edvel institucional e que envolve cirurgi\u00f5es, imunohemoterapeutas e anestesiologistas. Estes s\u00e3o os grandes parceiros que v\u00e3o contribuir para que, no fim da linha, haja uma pol\u00edtica de minimiza\u00e7\u00e3o da utiliza\u00e7\u00e3o de transfus\u00f5es de sangue\u201d.<\/p>\n<p>Essa diminui\u00e7\u00e3o das transfus\u00f5es induz, automaticamente, ganhos em sa\u00fade, pois, verifica-se que h\u00e1 determinados indicadores \u2013 relativamente \u00e0 taxa de infe\u00e7\u00e3o hospitalar, \u00e0 dura\u00e7\u00e3o dos internamentos, ou, por exemplo, \u00e0 recidiva de neoplasias \u2013 que melhoram, mas tamb\u00e9m \u00e9 financeiramente vantajosa.<\/p>\n<p><strong>Implementa\u00e7\u00e3o do PBM em Portugal: Poupar 67 milh\u00f5es de euros\/ano<\/strong><\/p>\n<p>O Anemia Working Group Portugal realizou um estudo a n\u00edvel nacional, utilizando dados da Administra\u00e7\u00e3o Central do Sistema de Sa\u00fade (ACSS) e do Instituto Portugu\u00eas do Sangue e Transplanta\u00e7\u00e3o (IPST), com o objetivo de perceber qual o impacto que teria a implementa\u00e7\u00e3o do PBM a n\u00edvel nacional, \u201cnuma l\u00f3gica de sa\u00fade p\u00fablica e n\u00e3o de sa\u00fade institucional\u201d, sublinha Ant\u00f3nio Robalo Nunes.<\/p>\n<p>Concluiu-se que, para al\u00e9m de um conjunto de ganhos em sa\u00fade, seria gerada uma poupan\u00e7a da ordem dos 67 milh\u00f5es de euros\/ano.<\/p>\n<p><img decoding=\"async\" class=\"wp-image-12929 alignleft\" src=\"https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_02-Dr_Robalo-300x158.jpg\" alt=\"\" width=\"586\" height=\"309\" srcset=\"https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_02-Dr_Robalo-300x158.jpg 300w, https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_02-Dr_Robalo-440x232.jpg 440w, https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_02-Dr_Robalo-580x305.jpg 580w, https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_02-Dr_Robalo.jpg 655w\" sizes=\"(max-width: 586px) 100vw, 586px\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><sup>&#8220;Haver uma equipa coesa, motivada, que funcione e que veja resultados \u00e9 a retroalimenta\u00e7\u00e3o positiva do programa\u201d <\/sup><sup>(na foto, com Paula Mateus, enfermeira no Hospital de Dia Polivalente do HFAR-Polo de Lisboa)<\/sup><\/p>\n<p>De acordo com o presidente do AWGP, tal \u201cimplicaria a realiza\u00e7\u00e3o de mais algumas consultas, que basicamente n\u00e3o s\u00e3o muito onerosas, e a eventual utiliza\u00e7\u00e3o de f\u00e1rmacos alternativos \u2013 ferro intravenoso, vitamina B12, \u00e1cido f\u00f3lico e agentes capazes de controlar as altera\u00e7\u00f5es de coagula\u00e7\u00e3o \u2013 que nos possam ajudar a conseguir a otimiza\u00e7\u00e3o do doente\u201d.<\/p>\n<p>Os dados j\u00e1 foram, inclusive, apresentados a n\u00edvel internacional, no congresso da Network for Advancements of Transfusion Alternatives (NATA), em Floren\u00e7a, e na reuni\u00e3o da American Association of Blood Banks, nos EUA. O AWGP vai, ali\u00e1s, ter uma participa\u00e7\u00e3o ativa na pr\u00f3xima edi\u00e7\u00e3o do congresso da NATA, que ser\u00e1 em Lisboa, em abril de 2018.<\/p>\n<p><strong>O exemplo do Hospital das For\u00e7as Armadas (Polo de Lisboa)<\/strong><\/p>\n<p>O programa de Patient Blood Management arrancou no HFAR-Polo de Lisboa no passado dia 3 de junho, com o apoio da Dire\u00e7\u00e3o Cl\u00ednica. Embora ainda seja recente, \u201cest\u00e1 a funcionar com uma elevada taxa de referencia\u00e7\u00e3o, j\u00e1 com casos particularmente bem-sucedidos e em rela\u00e7\u00e3o aos quais, em condi\u00e7\u00f5es normais, seria quase inevit\u00e1vel a utiliza\u00e7\u00e3o de sangue no intraoperat\u00f3rio\u201d.<\/p>\n<p>\u201cConseguimos n\u00e3o o fazer, nomeadamente em doentes oncol\u00f3gicos da Cirurgia Geral, bem como na Ortopedia, na Urologia, na Ginecologia, na Cirurgia Vascular e na Cirurgia Pl\u00e1stica\u201d, refere Ant\u00f3nio Robalo Nunes. A grande dificuldade, diz, \u201c\u00e9 combater o constrangimento, o atavismo, as barreiras, a resist\u00eancia \u00e0 novidade, e gerar o entusiasmo de todo o grupo, sendo que se trata de uma tarefa inevitavelmente multidisciplinar\u201d.<\/p>\n<p><img decoding=\"async\" class=\"wp-image-12930 alignleft\" src=\"https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_03-Dr_Robalo-300x158.jpg\" alt=\"\" width=\"499\" height=\"263\" srcset=\"https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_03-Dr_Robalo-300x158.jpg 300w, https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_03-Dr_Robalo-440x232.jpg 440w, https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_03-Dr_Robalo-580x305.jpg 580w, https:\/\/staging.awgp.pt\/testes\/wp-content\/uploads\/2019\/07\/PBM_03-Dr_Robalo.jpg 655w\" sizes=\"(max-width: 499px) 100vw, 499px\" \/>O m\u00e9dico insiste num aspeto: \u201cAs tr\u00eas especialidades \u2013 Cirurgia, Anestesiologia e Imunohemoterapia \u2013 t\u00eam de estar obrigatoriamente presentes, sempre sinalizadoras e fechando o circuito. \u00c9 preciso que o doente v\u00e1 otimizado para a cirurgia, mas tamb\u00e9m \u00e9 necess\u00e1rio que encontre uma equipa motivada para utilizar as t\u00e9cnicas de minimiza\u00e7\u00e3o de perda hemorr\u00e1gica intraoperat\u00f3ria, sendo que tem de se manter o doente sinalizado no p\u00f3s-operat\u00f3rio.&#8221;<\/p>\n<p>Conforme explica, cada institui\u00e7\u00e3o tem de pensar o seu programa de PBM em fun\u00e7\u00e3o da sua matriz e das suas caracter\u00edsticas: &#8220;N\u00e3o \u00e9 poss\u00edvel copiar outro programa, as pessoas s\u00e3o diferentes, as l\u00f3gicas tamb\u00e9m, o perfil assistencial n\u00e3o \u00e9 igual.&#8221;<\/p>\n<p>\u201cUma coisa importante que n\u00f3s temos aqui, um instrumento precioso para o sucesso deste programa, \u00e9 a exist\u00eancia de um local onde os doentes possam ser otimizados no pr\u00e9-operat\u00f3rio, que \u00e9, obviamente, um Hospital de Dia Polivalente\u201d, revela Ant\u00f3nio Robalo Nunes. \u201cA estrutura de um ambiente de ambulat\u00f3rio \u00e9 absolutamente essencial\u201d, frisa.<\/p>\n<p>[\/cmsmasters_text][\/cmsmasters_column][\/cmsmasters_row]\n","protected":false},"excerpt":{"rendered":"<p>[cmsmasters_row data_padding_bottom=&#8221;50&#8243; data_padding_top=&#8221;0&#8243; data_bg_parallax_ratio=&#8221;0.5&#8243; data_bg_size=&#8221;cover&#8221; data_bg_attachment=&#8221;scroll&#8221; data_bg_repeat=&#8221;no-repeat&#8221; data_bg_position=&#8221;top center&#8221; data_color=&#8221;default&#8221; data_bot_style=&#8221;default&#8221; data_top_style=&#8221;default&#8221; data_padding_right=&#8221;3&#8243; data_padding_left=&#8221;3&#8243; data_width=&#8221;boxed&#8221;][cmsmasters_column data_width=&#8221;1\/1&#8243;][cmsmasters_text animation_delay=&#8221;0&#8243;] &nbsp; O conceito j\u00e1 \u00e9 muito antigo, mas a verdade \u00e9 que a implementa\u00e7\u00e3o do PBM, em toda a sua extens\u00e3o, dever\u00e1 estar limitada a uma minoria de hospitais em Portugal. O objetivo do programa \u00e9 fazer com&#8230;<\/p>\n","protected":false},"author":1,"featured_media":12833,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[333,62,71],"tags":[66,76,77,67],"class_list":["post-12923","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-arquivo","category-imprensa","category-online","tag-awgp","tag-pateint-blood-management","tag-pbm","tag-robalo-nunes"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Patient Blood Management \u00abenvolve cirurgi\u00f5es, imunohemoterapeutas e anestesiologistas\u00bb - AWGP - Testes<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"pt_PT\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Patient Blood Management \u00abenvolve cirurgi\u00f5es, imunohemoterapeutas e anestesiologistas\u00bb - AWGP - Testes\" \/>\n<meta property=\"og:description\" content=\"[cmsmasters_row data_padding_bottom=&#8221;50&#8243; data_padding_top=&#8221;0&#8243; data_bg_parallax_ratio=&#8221;0.5&#8243; data_bg_size=&#8221;cover&#8221; data_bg_attachment=&#8221;scroll&#8221; data_bg_repeat=&#8221;no-repeat&#8221; data_bg_position=&#8221;top center&#8221; data_color=&#8221;default&#8221; data_bot_style=&#8221;default&#8221; data_top_style=&#8221;default&#8221; data_padding_right=&#8221;3&#8243; data_padding_left=&#8221;3&#8243; data_width=&#8221;boxed&#8221;][cmsmasters_column data_width=&#8221;1\/1&#8243;][cmsmasters_text animation_delay=&#8221;0&#8243;] &nbsp; O conceito j\u00e1 \u00e9 muito antigo, mas a verdade \u00e9 que a implementa\u00e7\u00e3o do PBM, em toda a sua extens\u00e3o, dever\u00e1 estar limitada a uma minoria de hospitais em Portugal. 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