Epidemiology and Associated Factors in Transfusion Management in Intensive Care Unit
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Sample
2.3. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Characteristics of the ICUs
3.3. Clinical Transfusion Practice
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Spahn, D.R.; Bouillon, B.; Cerny, V.; Duranteau, J.; Filipescu, D.; Hunt, B.J.; Komadina, R.; Maegele, M.; Nardi, G.; Riddez, L.; et al. The European guideline on management of major bleeding and coagulopathy following trauma: Fifth edition. Crit. Care 2019, 23, 98. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- World Health Organization. Injuries and Violence: The Facts Publication Edn. 2014. Available online: https://www.who.int/violence_injury_prevention/key_facts/en/#:~:text=About%205.8%20million%20people%20die,tuberculosis%20and%20HIV%2FAIDS%20combined (accessed on 3 March 2022).
- Fu, T.S.; Jing, R.; McFaull, S.R.; Cusimano, M.D. Health & Economic Burden of Traumatic Brain Injury in the Emergency Department. Can. J. Neurol. Sci. 2016, 43, 238–247. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Cost of Injuries and Violence in the United States United States. 23 January 2020. Available online: https://www.cdc.gov/injury/wisqars/overview/cost_of_injury.html (accessed on 3 March 2022).
- Prin, M.; Li, G. Complications and in-hospital mortality in trauma patients treated in intensive care units in the United States, 2013. Inj. Epidemiol. 2016, 3, 18. [Google Scholar] [CrossRef] [Green Version]
- Defunciones Según la Causa de la Muerte, Año 2016. Notas de Prensa. 21 December 2017. Available online: https://www.ine.es/prensa/edcm_2016.pdf (accessed on 3 March 2022).
- Chico-Fernández, M.; Llompart-Pou, J.A.; Guerrero-López, F.; Sánchez-Casado, M.; García-Sáez, I.; Mayor-García, M.D.; Egea-Guerrero, J.; Fernández-Ortega, J.F.; Bueno-González, A.; González-Robledo, J.; et al. Epidemiology of severe trauma in Spain. Registry of trauma in the ICU (RETRAICU). Pilot phase. Med. Intensiva 2016, 40, 327–347. [Google Scholar] [CrossRef] [PubMed]
- Gruen, R.L.; Jurkovich, G.J.; McIntyre, L.K.; Foy, H.M.; Maier, R.V. Patterns of errors contributing to trauma mortality: Lessons learned from 2,594 deaths. Ann. Surg. 2006, 244, 371–380. [Google Scholar] [CrossRef] [PubMed]
- Curry, N.; Hopewell, S.; Dorée, C.; Hyde, C.; Brohi, K.; Stanworth, S. The acute management of trauma hemorrhage: A systematic review of randomized controlled trials. Crit. Care 2011, 15, R92. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Maegele, M.; Schöchl, H.; Cohen, M.J. An update on the coagulopathy of trauma. Shock 2014, 41 (Suppl. 1), 21–25. [Google Scholar] [CrossRef]
- Leibner, E.; Andreae, M.; Galvagno, S.M.; Scalea, T. Damage control resuscitation. Clin. Exp. Emerg. Med. 2020, 7, 5–13. [Google Scholar] [CrossRef]
- World Health Organization. Updated 18 October 2019. Available online: http://www.who.int/bloodsafety/clinical.use/en/ (accessed on 5 March 2022).
- Marik, P.E.; Corwin, H.L. Efficacy of red blood cell transfusion in the critically ill: A systematic review of the literature. Crit. Care Med. 2008, 36, 2667–2674. [Google Scholar] [CrossRef]
- Anthes, E. Evidence-based medicine: Sabe blood, sabe lives. Nature 2015, 520, 24–26. [Google Scholar] [CrossRef] [Green Version]
- Rogers, M.A.; Rohde, J.M.; Blumberg, N. Haemovigilance of reactions associated with red blood cell transfusion: Comparison across 17 countries. Vox Sang. 2016, 110, 266–277. [Google Scholar] [CrossRef] [PubMed]
- Boutin, A.; Moore, L.; Lauzier, F.; Chassé, M.; English, S.; Zarychanski, R.; McIntyre, L.; Griesdale, D.; Fergusson, D.A.; Turgeon, A.F. Transfusion of red blood cells in patients with traumatic brain injuries admitted to Canadian trauma health centres: A multicentre cohort study. BMJ Open 2017, 7, e014472. [Google Scholar] [CrossRef] [PubMed]
- Quintana-Diaz, M.; Nanwani-Nanwani, K.; Marcos-Neira, P.; Serrano-Lázaro, A.; Juarez-Vela, R.; Andrés-Esteban, E.M. Epidemiology of blood transfusion in Intensive Care Services in Spain: “Transfusion Day”. Med. Intensiva 2020, 46, 123–131. [Google Scholar] [CrossRef]
- Andrés-Esteban, E.M.; Quintana-Diaz, M.; Ramírez-Cervantes, K.L.; Benayas-Peña, I.; Silva-Obregón, A.; Magallón-Botaya, R.; Santolalla-Arnedo, I.; Juárez-Vela, R.; Gea-Caballero, V. Outcomes of hospitalized patients with COVID-19 according to level of frailty. PeerJ 2021, 9, e11260. [Google Scholar] [CrossRef] [PubMed]
- Lauren, E.; Vikatmaa, L.; Kerkela, E.; Kivipuro, T.; Krusius, T.; Syrjala, M.; Ihalainen, J.; Pettilä, V. Red blood cell transfusion in southern Finland form 2011–2016: A quality audit. Transfus. Med. 2019, 29, 41–47. [Google Scholar] [CrossRef] [PubMed]
- Leal-Novala, S.R.; Muñoz, M.; Asuero, M.; Contreras, E.; García-Erce, J.A.; Llau, J.V.; Moral, V.; Páramo, J.A.; Quintana, M.; Basora, M.; et al. Document Sevilla (2013) of Consensus on alternatives to allogeneic blood transfusion. Update of the Seville Document. Med. Intensiva 2013, 37, 259–283. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Doctor, A. How to guide transfusion decision-making? That is the question. Pediatr. Crit. Care Med. 2014, 15, 895–896. [Google Scholar] [CrossRef] [Green Version]
- Vallet, B.; Adamczyk, S.; Barreau, O.; Lebuffe, G. Physiologic transfusion triggers. Best Pract. Res. Clin. Anaesthesiol. 2007, 21, 173–181. [Google Scholar] [CrossRef]
- Como, J.J.; Dutton, R.P.; Scalea, T.M.; Edelman, B.B.; Hess, J.R. Blood transfusion rates in the care of acute trauma. Transfusion 2004, 44, 809–813. [Google Scholar] [CrossRef]
- Camazine, M.N.; Hemmila, M.R.; Leonard, J.C.; Jacobs, R.A.; Horst, J.A.; Kozar, R.A.; Rosemar, A.; Bochicchio, G.V.; Nathens, A.B.; Cryer, H.M.; et al. Massive transfusion policies at trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program. J. Trauma Acute Care Surg. 2015, 78 (Suppl. 1), S48–S53. [Google Scholar] [CrossRef]
- Patil, V.; Shetmahajan, M. Massive transfusion and massive transfusion protocol. Indian J. Anaesth. 2014, 58, 590–595. [Google Scholar] [CrossRef] [PubMed]
- Baker, S.P.; O’Neill, B.; Haddon, W.; Long, W.B. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J. Trauma 1974, 14, 187–196. [Google Scholar] [CrossRef] [PubMed]
- Rawal, G.; Kumar, R.; Yadav, S.; Singh, A. Anemia in Intensive Care: A Review of Current Concepts. J. Crit. Care Med. 2016, 2, 109–114. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Stein, P.; Kaserer, A.; Sprengel, K.; Wanner, G.A.; Seifert, B.; Theusinger, O.M.; Spahn, D.R. Change of transfusion and treatment paradigm in major trauma patients. Anaesthesia 2017, 72, 1317–1326. [Google Scholar] [CrossRef] [Green Version]
- Mueller, M.M.; Van Remoortel, H.; Meybohm, P.; Aranko, K.; Aubron, C.; Burger, R.; Carson, J.L.; Cichutek, K.; de Buck, E.; Devine, D.; et al. Patient Blood Management: Recommendations from the 2018 Frankfurt Consensus Conference. JAMA 2019, 321, 983–997. [Google Scholar] [CrossRef]
- Napolitano, L.M. Anemia and Red Blood Cell Transfusion: Advances in Critical Care. Crit. Care Clin. 2017, 33, 345–364. [Google Scholar] [CrossRef]
- Franchini, M.; Marano, G.; Veropalumbo, E.; Masiello, F.; Pati, I.; Candura, F.; Profili, S.; Catalano, L.; Piccinini, V.; Pupella, S.; et al. Patient Blood Management: A revolutionary approach to transfusion medicine. Blood Transfus. 2019, 17, 191–195. [Google Scholar] [CrossRef]
- Phan, H.H.; Wisner, D.H. Should we increase the ratio of plasma/platelets to red blood cells in massive transfusion: What is the evidence? Vox Sang. 2010, 98, 395–402. [Google Scholar] [CrossRef]
- McQuilten, Z.K.; Crighton, G.; Brunskill, S.; Morison, J.K.; Richter, T.H.; Waters, N.; Murphyc, M.F.; Wooda, E.M. Optimal Dose, Timing and Ratio of Blood Products in Massive Transfusion: Results from a Systematic Review. Transfus. Med. Rev. 2018, 32, 6–15. [Google Scholar] [CrossRef]
- Lilly, C.M.; Badawi, O.; Liu, X.; Gill, C.S.; Harris, I. Red Blood Cell Product Transfusion Thresholds and Clinical Outcomes. J. Intensive Care Med. 2020, 35, 494–501. [Google Scholar] [CrossRef]
- Holcomb, J.B.; Tilley, B.C.; Baraniuk, S.; Fox, E.E.; Wade, C.E.; Podbielski, J.M.; del Junco, D.J.; Brasel, K.J.; Bulger, E.M.; Callcut, R.A.; et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: The PROPPR randomized clinical trial. JAMA 2015, 313, 471–482. [Google Scholar] [CrossRef] [PubMed]
- Rowell, S.E.; Barbosa, R.R.; Allison, C.E.; Van, P.Y.; Schreiber, M.A.; Trauma Outcomes Group. Gender-based differences in mortality in response to high product ratio massive transfusion. J. Trauma 2011, 71 (Suppl. 3), S375–S379. [Google Scholar] [CrossRef] [PubMed]
- Marcolini, E.G.; Albrecht, J.S.; Sethuraman, K.N.; Napolitano, L.M. Gender Disparities in Trauma Care: How Sex Determines Treatment, Behavior, and Outcome. Anesthesiol. Clin. 2019, 37, 107–117. [Google Scholar] [CrossRef] [PubMed]
- Gombotz, H.; Schreier, G.; Neubauer, S.; Kastner, P.; Hofmann, A. Gender disparities in red blood cell transfusion in elective surgery: A post hoc multicentre cohort study. BMJ Open 2016, 6, e012210. [Google Scholar] [CrossRef] [PubMed]
- Chant, C.; Wilson, G.; Friedrich, J.O. Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged ICU length of stay: A cohort study. Crit. Care 2006, 10, R140. [Google Scholar] [CrossRef] [Green Version]
- Guerado, E.; Medina, A.; Mata, M.I.; Galvan, J.M.; Bertrand, M.L. Protocols for massive blood transfusion: When and why, and potential complications. Eur. J. Trauma Emerg. Surg. 2016, 42, 283–295. [Google Scholar] [CrossRef] [PubMed]
- Jacob, M.; Kumar, P. The challenge in management of hemorrhagic shock in trauma. Med. J. Armed. Forces India 2014, 70, 163–169. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Dupuis, C.; Garrouste-Orgeas, M.; Bailly, S.; Adrie, C.; Goldgran-Toledano, D.; Azoulay, E.; Ruckly, S.; Marcotte, G.; Souweine, B.; Darmon, M. Effect of Transfusion on Mortality and Other Adverse Events Among Critically Ill Septic Patients: An Observational Study Using a Marginal Structural Cox Model. Crit. Care Med. 2017, 45, 1972–1980. [Google Scholar] [CrossRef]
- Zilberberg, M.D.; Stern, L.S.; Wiederkehr, D.P.; Doyle, J.J.; Shorr, A.F. Anemia, transfusions and hospital outcomes among critically ill patients on prolonged acute mechanical ventilation: A retrospective cohort study. Crit. Care 2008, 12, R60. [Google Scholar] [CrossRef] [Green Version]
- Ghiani, A.; Sainis, A.; Sainis, G.; Neurohr, C. Anemia and red blood cell transfusion practice in prolonged mechanically ventilated patients admitted to a specialized weaning center: An observational study. BMC Pulm. Med. 2019, 19, 250. [Google Scholar] [CrossRef] [Green Version]
- Páramo, J.A. Prediction and treatment of bleeding in patients under anticoagulant treatment. Med. Clin. 2021, 156, 20–25. [Google Scholar] [CrossRef] [PubMed]
- Shander, A.; Javidroozi, M.; Lobel, G. Patient Blood Management in the Intensive Care Unit. Transfus. Med. Rev. 2017, 31, 264–271. [Google Scholar] [CrossRef] [PubMed]
- Dasta, J.; Mody, S.H.; McLaughlin, T.; Leblanc, J.; Shen, Y.; Genetti, M.; Raut, M.K.; Piech, C.T. Current management of anemia in critically ill patients: Analysis of a database of 139 hospitals. Am. J. Ther. 2008, 15, 423–430. [Google Scholar] [CrossRef] [PubMed]
- Moerman, J.; Vermeulen, E.; Van Mullem, M.; Badts, A.M.; Lybeert, P.; Compernolle, V.; Georgsen, J. Post-transfusion hemoglobin values and patient blood management. Acta Clin. Belg. 2019, 74, 164–168. [Google Scholar] [CrossRef] [PubMed]
- Willems, S.A.; Kranenburg, F.J.; Le Cessie, S.; Marang-van de Mheen, P.J.; Kesecioglu, J.; van der Bom, J.G.; Arbous, M.S. Variation in red cell transfusion practice in the intensive care unit—An international survey. J. Crit. Care 2020, 55, 140–144. [Google Scholar] [CrossRef]
- British Committee for Standards in Haematology. Guidelines for the use of platelet transfusions. Br. J. Haematol. 2003, 122, 10–23. [Google Scholar] [CrossRef] [Green Version]
- Kaufman, R.M.; Djulbegovic, B.; Gernsheimer, T.; Kleinman, S.; Tinmouth, A.T.; Capocelli, K.E.; Cipolle, M.D.; Cohn, C.S.; Fung, M.K.; Grossman, B.J.; et al. Platelet transfusion: A clinical practice guideline from the AABB. Ann. Intern. Med. 2015, 162, 205–213. [Google Scholar] [CrossRef] [Green Version]
- Estcourt, L.J.; Birchall, J.; Allard, S.; Bassey, S.; Hersey, P.; Kerr, J.; Mumford, A.; Stanworth, S.; Tinegate, H. Guidelines for the use of platelet transfusions. Br. J. Haematol. 2017, 176, 365–394. [Google Scholar] [CrossRef]
Polytrauma Patients | Rest of Patients | p-Value | ||||
---|---|---|---|---|---|---|
(n = 109) | (n = 1330) | |||||
Frequency | % | Frequency | % | |||
Age (mean ± SD) | 41.42 ± 18.82 | 62.61 ± 15.06 | <0.001 | |||
Gender | Men | 93 | 85.32 | 858 | 64.56 | <0.001 |
Women | 16 | 14.68 | 471 | 35.44 | ||
SOFA-score (mean ± SD) | 5.04 ± 3.46 | 4.71 ± 3.87 | 0.406 | |||
ICU stay (mean ± SD) | 13.31 ± 20.53 | 10.40 ± 17.25 | 0.092 | |||
Mechanical ventilation | No | 45 | 41.28 | 714 | 53.81 | 0.012 |
Yes | 64 | 58.72 | 613 | 46.19 | ||
Extrarenal purification | No | 107 | 98.17 | 1209 | 91.04 | 0.010 |
Yes | 2 | 1.83 | 119 | 8.96 | ||
Anticoagulated patient | No | 102 | 94.44 | 1056 | 79.94 | <0.001 |
Yes | 6 | 5.56 | 265 | 20.06 | ||
Anti-aggregate patient | No | 101 | 92.66 | 1019 | 76.79 | <0.001 |
Yes | 8 | 7.34 | 308 | 23.21 | ||
ECMO * | No | 107 | 98.17 | 1313 | 99.09 | 0.983 |
Yes | 2 | 1.83 | 12 | 0.91 | ||
Transfusion | No | 92 | 84.40 | 1201 | 90.50 | 0.041 |
Yes | 17 | 15.60 | 126 | 9.50 |
Variable Frequency (n) | Percentage (%) | ||
---|---|---|---|
Type of hospital | |||
Public | 109 | 98 | |
Private | 2 | 2 | |
Bed numbers in the hospital | |||
<500 | 34 | 31 | |
500–1000 | 44 | 40 | |
>1000 | 33 | 30 | |
* ICU’s Bed numbers | 23.41 ± 10.31 (6–48) | ||
Transfusion protocol | |||
No | 43 | 39 | |
Yes | 68 | 61 | |
Massive transfusion protocol | |||
No | 24 | 22 | |
Yes | 87 | 78 | |
* PBM programme | |||
No | 72 | 65 | |
Yes | 39 | 35 |
Polytrauma Patients | Rest of Patients | p-Value | ||||
---|---|---|---|---|---|---|
Frequency | % | Frequency | % | |||
Age (mean ± SD) | 39.00 ± 19.67 | 66.00 ± 14.37 | <0.001 | |||
Gender | Men | 11 | 64.71 | 87 | 69.05 | 0.717 |
Women | 6 | 35.29 | 30 | 30.95 | ||
SOFA-score (mean ± SD) | 7.00 ± 3.75 | 7,00 ± 3.95 | 0.424 | |||
* ICU stay (mean ± SD) | 5.00 ± 28.95 | 5.50 ± 14.37 | 0.764 | |||
Mechanical ventilation | No | 3 | 17.65 | 44 | 34.92 | 0.155 |
Yes | 14 | 82.35 | 82 | 65.08 | ||
Extrarenal purification | No | 16 | 94.12 | 100 | 79.37 | 0.145 |
Yes | 1 | 5.88 | 26 | 20.63 | ||
Anticoagulated patient | No | 16 | 94.12 | 89 | 72.36 | 0.052 |
Yes | 1 | 5.88 | 34 | 27.64 | ||
Anti-aggregate patient | No | 13 | 76.47 | 101 | 80.16 | 0.723 |
Yes | 4 | 23.53 | 25 | 19.84 | ||
* ECMO | No | 17 | 100.00 | 121 | 96.03 | 0.403 |
Yes | 0 | 0.00 | 5 | 3.97 |
Transfusion | Polytrauma Patients | Rest of Patients | p-Value | |||
---|---|---|---|---|---|---|
(n = 17) | (n = 126) | |||||
Frequency | % | Frequency | % | |||
Reason for transfusion | Acute anaemia with haemodynamic impact | 3 | 17.65% | 44 | 34.92% | 0.582 |
Acute anaemia without haemodynamic impact | 3 | 17.65% | 27 | 21.43% | ||
By analytical criteria | 7 | 41.18% | 45 | 35.71% | ||
Previous intervention or invasive procedure | 2 | 11.76% | 9 | 7.14% | ||
Others | 2 | 11.76% | 9 | 7.14% | ||
Blood component | Red blood cells concentrate | 15 | 88.24% | 113 | 89.68% | 0.736 |
Fresh frozen plasma | 7 | 41.18% | 48 | 38.10% | 0.940 | |
Platelets | 7 | 41.18% | 50 | 39.68% | 0.848 | |
Number of transfusion events | 1 | 7 | 41.18% | 100 | 79.37% | 0.707 |
2 | 6 | 35.29% | 13 | 10.32% | ||
3 | 1 | 5.88% | 8 | 6.35% | ||
4 | 2 | 11.76% | 2 | 1.59% | ||
5 or more | 1 | 5.88% | 3 | 2.38% | ||
Transfusion control | No | 3 | 17.65% | 18 | 14.29% | 0.481 |
Yes, in 1 h | 1 | 5.88% | 11 | 8.73% | ||
Yes, in 2 h | 5 | 29.41% | 16 | 12.70% | ||
Yes, in 3 h | 2 | 11.76% | 19 | 15.08% | ||
Yes, in more than 3 h | 6 | 35.29% | 62 | 49.21% |
Transfused Patient Previous | Post-Transfusion | p-Value | ||||||
---|---|---|---|---|---|---|---|---|
Median | P25 | P75 | Median | P25 | P75 | |||
Polytrauma patient | haemoglobin | 8.6 | 8.1 | 10.4 | 9.65 | 8.6 | 10.75 | 0.077 |
MCV | 91.2 | 87.7 | 95 | 91.8 | 87.9 | 92.5 | 0.979 | |
INR | 1.13 | 1 | 1.2 | 1.1 | 1 | 1.27 | 0.353 | |
platelets | 151 | 129 | 246 | 183 | 122 | 224 | 0.988 | |
Other patient | haemoglobin | 7.6 | 6.9 | 8.6 | 9 | 8.4 | 10 | <0.001 |
MCV | 90 | 86.6 | 95 | 90 | 85.7 | 93.5 | 0.004 | |
INR | 1.2 | 1.08 | 1.5 | 1.22 | 1.09 | 1.42 | 0.055 | |
platelets | 148 | 78 | 220 | 137 | 79 | 192 | 0.990 |
Risk Factor OR | p-Value | IC95% | Inferior | Superior |
---|---|---|---|---|
Trauma | 1.75 | 0.049 | 1.01 | 3.36 |
Anticoagulated | 1.54 | 0.045 | 1.00 | 2.43 |
SOFA | 1.13 | 0.000 | 1.08 | 1.18 |
VM | 1.58 | 0.037 | 1.03 | 2.44 |
Haemoglobin previous | 0.89 | 0.008 | 0.82 | 0.97 |
Hosmer–Lemeshow p-value | 0.839 | |||
C-statistic | 0.787 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Juárez-Vela, R.; Andrés-Esteban, E.M.; Santolalla-Arnedo, I.; Ruiz de Viñaspre-Hernández, R.; Benito-Puncel, C.; Serrano-Lázaro, A.; Marcos-Neira, P.; López-Fernández, A.; Tejada-Garrido, C.I.; Sánchez-González, J.L.; et al. Epidemiology and Associated Factors in Transfusion Management in Intensive Care Unit. J. Clin. Med. 2022, 11, 3532. https://doi.org/10.3390/jcm11123532
Juárez-Vela R, Andrés-Esteban EM, Santolalla-Arnedo I, Ruiz de Viñaspre-Hernández R, Benito-Puncel C, Serrano-Lázaro A, Marcos-Neira P, López-Fernández A, Tejada-Garrido CI, Sánchez-González JL, et al. Epidemiology and Associated Factors in Transfusion Management in Intensive Care Unit. Journal of Clinical Medicine. 2022; 11(12):3532. https://doi.org/10.3390/jcm11123532
Chicago/Turabian StyleJuárez-Vela, Raúl, Eva María Andrés-Esteban, Ivan Santolalla-Arnedo, Regina Ruiz de Viñaspre-Hernández, Carmen Benito-Puncel, Ainhoa Serrano-Lázaro, Pilar Marcos-Neira, Alba López-Fernández, Clara Isabel Tejada-Garrido, Juan Luis Sánchez-González, and et al. 2022. "Epidemiology and Associated Factors in Transfusion Management in Intensive Care Unit" Journal of Clinical Medicine 11, no. 12: 3532. https://doi.org/10.3390/jcm11123532
APA StyleJuárez-Vela, R., Andrés-Esteban, E. M., Santolalla-Arnedo, I., Ruiz de Viñaspre-Hernández, R., Benito-Puncel, C., Serrano-Lázaro, A., Marcos-Neira, P., López-Fernández, A., Tejada-Garrido, C. I., Sánchez-González, J. L., Quintana-Díaz, M., & García-Erce, J. A. (2022). Epidemiology and Associated Factors in Transfusion Management in Intensive Care Unit. Journal of Clinical Medicine, 11(12), 3532. https://doi.org/10.3390/jcm11123532