ADT-PR-337-005 Manejo de Reacciones Transfusionales

8/2/2019 ADT-PR-337-005 Manejo de Reacciones Transfusionales

http://slidepdf.com/reader/full/adt-pr-337-005-manejo-de-reacciones-transfusionales 1/19

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sbef{n |m|bo 4 ln s~s anhmln{gpblms/ sn c{nbe ob [nl Ebcgmebo ln Kbecms ln

Sbef{n w no Cmesnim Ebcgmebo ln Kbecms ln Sbef{n w sn lgc|be m|{bslgstmsgcgmens smk{n ob hb|n{gb%

• LNC[N\M 2><3 LN 2776 B[\ ;; W ;39 Tm{ no c~bo sn {nfobhne|b no hbenim

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ob Geh~emln`gcgnecgb Blr~g{glb !SGLB' w obs m|{bs Ne`n{hnlblns ln

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• [NSMO^CGME 206 LN 27769 Tn{ ob c~bo sn ns|bkoncne tb{bhn|{ns r~nbsnf~{ne ob fb{be|`b ln ob cboglbl ln ob sbef{n%

• [NSMO^CGME 24<3 LN ;4409 Hgegs|n{gm ln ob T{m|nccgme Smcgbo% Tm{ ob c~bo

sn ns|bkoncne obs cmelgcgmens r~n lnkne c~htog{ oms t{ns|blm{ns ln Sn{pgcgms

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snf~{glbl lno {ncnt|m{% Obs [B\ sn t~nlne bsmcgb{ cme ob cboolbl 4 snf~{glbl

ln oms cmhtmene|ns sbef~genms/ 4 kgne/ cme `bc|m{ns t{mtgms ln cblb tbcgne|n/ln hben{b r~n no hgshm cmhtmene|n sbef~genm bo sn{ |{bes`~elglm b m|{m

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tnr~nems pbsms sbef~ènms/ cmes~hgnelm oms cmhtmene|ns ln ob cbscblb ln

ob cmbr~obcome w obs tobr~n|bs% BG bfm|b{sn oms `bc|m{ns ln ob cmbr~obcgme ns

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• NG t{m`nsgmebo nstncgbogyblm lno Sn{pgcgm ln \{bes`~sgme w ~e {nt{nsne|be|n

lno nr~gtm ln b~lg|m{gb hnlgcb/ w no hnlgcm b cb{fm lno tbcgne|n/ sme oms

{nstmesbkons ln ob oepns|grbcgme w cobsg`gcbcgme ln obs {nbccgmens|{bes`~sgmebons t{nsne|blbs ne ob oes|g|~cgme%

• NG T{m`nsgmebo Nstncgbogyblm lno Sn{pgcgm ln \{bes`~sgme ns {nstmesbkon lnob em|g`gcbc|me mkogfb|m{gb hnes~bo b ob [NL MGS\[G\BO LN KBECMS LNSB%EF[N W SN[PGC"MS LN \[BES@^SGME SBEF^GENB cme no `m{hb|m

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lnhbs e~hn{bons lnkne lgogfnecgb{sn no l`b abkgo lnst~ns ln {ntm{|blb ob

[B\ ne no snf~ghgne|m cmei~e|m r~n sn {nbggyb %

• \mlbs obs {nbccgmens blpn{sbs b ob |{bes`~sgme lnkne t{nsne|b{sn be|n noCm{eg|n ln \{bes`~sgmens%

6% LNSB[[MOOM9

6%2%FNEN[BOGLBLNS

Sn ab ns|ghblm r~n bo hnems no 24. ln obs |{bes`~sgmens t{nsne|be bof~eb

cobsn ln {nbccgme blpn{sb/ w no 4/>. ln nogbs sme cmesgln{blbs sn{gbs msnpn{bs%

NG {ncmemcghgne|m {btolm w no hbenim ln ob {nbccgme t~nlne sbopb{ ob pglb ln omstbcgne|ns gepmo~c{blms% Oms n{{m{ns ne blan{g{sn b oms t{mcnlghgne|ms cm{{nc|ms

sme ob cb~sb hbs `{nc~ne|n ln {nbccgmens |{bes`~sgmebons anhmog|gcbs r~n tmene

ne tnogf{m ob pglb lno tbcgne|n % Tm{ cmesgf~gne|n ob lncgsgme ln |{bes`~sgme lnkn

ns|b{ kbsblb ne ob pbom{bcgme t{npgb ln ob {nobcgme {gnsfm9 knen`gcgm ln cblbtbcgne|n ne tb{|gc~ob{%

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• [nbccgmens `nk{gons em anhmA|gcbs9 Ln`geglb cmhm ~e gec{nhne|m ne ob|nhtn{b|~{b cm{tm{bo ln hbs ln 2´C cme {nstnc|m b ob |nhtn{b|~{b ln kbsn bo

gegcgb{ ob |{bes`~sgme% Ob `gnk{n t~nln ns|b{ bcm{etbeblb ln nscbom {`m 4 |nhkom{%

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cmes|g|~wne tm{ sg hgshms ~eb {nbccgme `nk{go sge ~e gec{nhne|m ln ob |nhtn{b|~{b%

Tbfgeb < ln 27




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Obs {nbccgmens `nk{gons em anhmo`|gcbs btb{ncne ne no 4/>. ( 0. ln obs

|{bes`~sgmens ln n{g|{mcg|ms% Obs {ncnt|m{bs h~o|gtb{bs w oms tbcgne|ns

h~o|g|{bes`~elglms |gnene hbwm{ `{nc~necgb ln t{nsne|bcgme ln ob ne|glbl%

NG hbenim ln obs {nbccgmens `nk{g"ns em anhmo`|gcbs lnkn geco~g{ ob s~stnesgme

gehnlgb|b ln ob |{bes`~sgme% NG c~bl{m `nk{go ~s~bohne|n ns b~|moghg|blm bo cbkm ln

; 4 3 am{bs% Sn t~nln blhgegs|{b{ bor~e be|gtg{n|gcm cmhm no bcn|bhgem`ne !>44

Hf%'% Ob bl{egegs|{bcgme ln bstg{ges ns|b cme|{sgelgcblb tm{ s~ n`nc|m smk{n ob

`~ecgme tobr~n|b{gb%

Ne tbcgne|ns cme be|ncnlne|ns ln ns|n |gtm ln {nbccgmens sn lnkn ~|gogyb{ sbef{n

tmk{n ne on~cmcg|ms w hnlgcbcg0e t{n|{bes{~sgcebo !ns|n{mglns/ be|gags|bhègcms'%

• [nbccgmens bon{rgcbs9 Sn b|{gk~wne b gb nqtmsgcg0e b s~s|becgbs smo~kons ne no

tobshb lno lmebe|n r~n sn ~ene b cme be|gc~n{tms t{n`m{hblms ln |gtm GfN

smk{n ob s~tn{`gcgn ln oms hbs|mcg|ms/ 24 c~bo cb~sb ob |gkn{bc|me ln ags|bhgeb%

Sn t{nsne|be tm{ {nbccgme ln t{m|nèbs tobs{eb|gcbs lno t{ml~c|m b |{bes`~elg{

cme be|`fnems lno {ncnt|m{: oms sè|mhbs sme t{~{g|m/ {bsa/ {~km{gybcgme/ ne cbsm

ln snpn{glbl ln ob {nbccg0e t~nln oGnfb{ b beb`gobqgb cme t{nsnecgb ln

{~tm|nesgme w k{mecmnstbshm% NG |{b|bhgne|m {nr~gn{n s~stneln{ ob |{bes`~sgme/

hbe|nen{ ob pneb tn{hnbkon cme smo~cgme sbogeb w blhgegs|{b{ be|gags|bhègcm w

ne cbsm ln beb`gobqgb sn blhgegs|{b bl{nebogeb/ ns|n{m gln w mqgfnem|n{btgb%

Ns ob {nbccgme hbs `{nc~ne|n ne ob |{bes`~sgme ln tobr~n|bs%

• [nbccgmens anhmA|gcbs bf~lbs9 Sn t{nsne|be lne|{m ln obs t{ghn{bs ;< am{bs

ln ob |{bes`~sgme%

Ob f{bpnlbl ln ns|n |gtm ln {nbccgmens lntneln lno |gtm ln gecmhtb|gkgoglbl/ ob

pnomcglbl ln ob ge`~sgme w ob cbe|glbl ln sbef{n |{bes`~elglb%

Oms hbs f{bpns sme oms r~n c~{sbe cme anhmogsgs ge|{bpbsc~ob{/ lns|bcbelm ne|{n

nogbs ob gecmhtb|gkgoglbl lno sgs|nhb BKM%

Ob an{emogsgs ge|{bpbsc~ob{ t~nln cb~sb{ ~eb bc|gpbcgme lno sgs|nhb ln

cmhtonhne|m cme ogkn{bcgme ln neyghbs pbsmbc|gpbs/ t~lgnelm lb{ o~fb{ b

gens|bkgoglbl pbsc~ob{/ cmobtsm cb{lgmt~o{emeb{/ cmbr~|bcgme ge|{bpbsc~ob{

lgsnhgeblb cme {gnsfm ln samcj w `{bcbsm {nebo% B ns|n `{bcbsm {nebo cme|{gk~wn ob

kgtm|nesgme/ ob pbsmcmes|{gccgme/ ob `m{hbcg0e ln hgc{m|{mhkms ne pbsms {nebons wob onsgme |~k~ob{ tm{ anhmfomkge~{gb%

Oms sgfems w sge|mhbs geco~wne `gnk{n/ w nscbom`{gms/ eb~snbs/ pmhg|m/ lgsenb/

|br~gcb{lgb/ egtm|nesgme/ sbef{blm w anhmfomkge~{gb% Ob `boob {nebo ns ~eb

cm{etecbcgme |b{lgb% Sn t{nsne|b blnh bs lmom{ ne oms òbecms bklmhgebons/ ob

nstbolb/ no |m{bq/ ob cbknyb w ne no sg|gm ln ob ge`~sgme% N" sbef{blm genstn{blm sn

lnkn b ob cmbr~obcgce ge|{bpbsc~ob{ lgsn{egeblb r~n sn t{nsne|b ne bof~ems

tbcgne|ns%

Tbfgeb > ln 27



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%- Hbe|nen{ ob t{nsgme b{|n{gbo sgs|02gcb cme G`r~glms ge|{bpnemsms r~n

fb{be|gcne ob tn{`~sgme tn{g`n{gcb/ !bo{nlnlm{ ln 244 hfAf' %

%- Hbe|nen{ ~eb lg~{nsgs s~tn{gm{ b 244 hooam{b% Cme no ~sm ln ò~glms w

lg~{n|gcms lno |gtm `~{msnhglb 4 ln hbeg|m"%

%- Pgfgob{ ob btb{gcgme ln CGL%

Obs {nbccgmens an{em|o|gcbs nq|{bpbsc~"b{ns sme abkg|~bohne|n cb~sblbs tm{

be|g c~n{tms lgs|ge|ms lno sgs|nhb BKM/ |3" &uS cmhm J ne / L ~ ``w w Jgll% Ns|bs s~none

t{ml~cg{ `gnk{n cme benhgybcgme w b~{ene|m ln gb kggg{{~kgeb/ cme ~e cmmhks

lg{nc|m tmsg|gpm% Fnen{bohne|n em >n bcmhtb{gbe ln sge|m{ebs snpn{ms%Oms aboobyfms ln obkm{b|m{gm gec"~wne anhmfomkge~{gb/ b~hne|m ln ob anhmfomkgeb

ogk{n w ob bc|gpglbl ln obc|b|m lns{~m{mrnensb agtn{kgog{{~kgenhgb w lgshge~cgme ln

ob abt|mfomkgeb% Ne cbsms ln `boob {nebo b~hne|b no eg|{mrnem ~{ngcm ne sbef{n w

ob c{nb|gegeb% Ob t{~nkb lg{nc|b ln be|gfgmk~ggeb t~nln sn{ tmsg|gpb cme ~e tb|{me

ln cbhtm hgq|m sg sn |{bes`~elgn{me n{g|{mcg|ms gecmhtb|gkons%

Obs {nbccgmens anhmog|gcbs hbs snpn{bs sn t{nsne|be c~belm oms n{g|{mcg|ms

|{bes`~elglms ge|n{bc|~be cme be|gc~n{tms t{n`m{h blms ne no {ncnt|m{% Lgcab

ge|n{bccgme gegcgb ob bc|gpbcgme ln ob pgb lno cmhtonhne|m/ ln obs cg|mr~gebs/ ln oms

`bc|m {ns ln ob cmbr~obcgme w ln oms ln{ebs nonhne|ms ln ob {nst~ns|b geòb{eb|m{gb

sgs|n{{~cb

%:& Bohbcnebhgne|m geblnc~blm ln ob sbef{n

%:& Smk{ncbone|bhgne|m

%:& Hnycob ln ob sbef{n cme smo~cgmens agtm|megcbs 4 agtn{|megcbs

p ^|gogybcgme ln bf~ibs h~w `gebs 4 |{bes`~sgme cme kmhkbs b nonpblb t{nsgme%

• Anh02gsgs em geh~en9 Fnen{b"hne|n ns|be bsmcgblbs b hbo hbenim lno

cmhtmene|n 4 ln |ncegcbs ln |{bes`~sg0e geblnc~blbs/ cmhm tb{ ninhtom9

Tbrgeb 0 ln 27

Obs hbeg`ns|bcgmens gec"~wne b~hne|m ln |b anhbfomkgeb ogk{n/ anhmfomkge~{gb/

agtn{jbonhgb w b{{g|hgbs cb{lgbcbs

Lnkglm b r~n abw an{emogsgs nq|n{e b / ob cmel~c|b b snf~g{ cmesgs|n ne {n|g{b{ no

cmhtmene|n w hbe|nen{ no bccnsm pnemsm% Ns ghtm{|be|n ob {nbogybcgme tn{gmlgcblno tm|bsgm sn{gcm w ln t{~nkbs ln nonc|{mcb{lgmf{b``b% Lnkn bsnf~{b{sn ~e fbs|m

~{geb{gm blnc~blm%

• Lbem t~ohmeb{ bf~lm {nobcgmeblm cme ob |{bes`~sgme !\[B^'9 Oms cbsms ln

\[BOG sn t{nsne|be abkg|~bohne|n l~{be|n b lnst~ns ln ob |{bes`~sgme%

Fnen{bohne|n sme cb~sblms tb{ ob |{bes`~sgme ln cmecne|{blm ln tobr~n|bs 4

tobshb/ b~er~n oms n{g|{mcg|ms |bhkgne sn abe {nobcgmeblb% Oms soe|m{ebs



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{nstg{b|m{gb bf~lb 4 hbeg`gns|b b||n{bcgm{ns {blgmomrgcbs cmesgs|ne|n cme nlnhb

t~ghmeb{ kgob|n{bo/ sge r~n nqgs|b npgln{gcgb cooegcb ln `bo"b cb{lgbcb ^ m|{b cb~sb

ln `boob {nstg{b|m{gb%

NG \[BOG sn ab b|{gk~{lm b ob t{nsnecgb ln be|gc~n{tms ne no tobshb ln ob ~eglbl

|{bes`~elglb r~n S0 lg{grne cme|{b oms Co&o|gfnems lno sgs|nhb AOB 4 ln

f{be~omcg|ms !en~|{m`g|ms' t{nsne|ns ne no {ncnt|m{% \b{ekgne sn ab {nobcgmeblm

cme ob t{nsnecgb ln hnlgbmm{ns

|{bes`~elgmb r~n bc|gpbe oms

cbtg|b{ns t~&{emeb{ns

|I' be|n{gm{% b~hne|b ob

|ceeblms ne ob ~eolbl

!ong !scntgm{ w cb~sbe ~eb onsgme ne oms

F|9C9M"n 9 9b2ns w `bpm{ncn obne {b{bs mcbsgmens sme

oms be|&c~n{tms ln" {ncnm|m{ cme|{b |ms as~cmcg|ms {n{ebene|ns

lno lmebe|n w lnsnecblnebe :MS hgs{ems npne|ms cnsc{g|ms% NG tobshb ln

{eOin{ns h~o||tb{bs t~nln gec{n{ene|b{ no {gnscm ln \[BoON" |{b|bhgne|m bs ln sctm{|n% Sb lnkn s~stneln{ 9b |{bes`~sgme w bi~s|b{ n"

smtm{|n pne|g|b|m{gm%

n Smk{ncb{fb c|{c~ob|m{|b9 Sn hbs g&bcgg+ene|n ne tbcgne|ns cme

bo|n{bcgmens cb{lgm{mr|cbs/ {nebons W&t~ohmeb{ns r~n blnh bs tblncne benhgb%

Oms egens w becgbecs sme gb tmm{bcgme ne b%|m {gnsrm Ob ge`~sgme h~w {btglb 4 ln

lnhbsgblm pmo~{ene SMg&: `bc|m{ns cme|em~wne|ns b ns|b cmht~cbc gme / smk{n |mlm

ne cbsm ln sbef{n cme ob{fm tn{%mln ln bohbcnebhgne|m%

Tm{ ns|n hm|gpn% ns|n |gtm ln tbcgne|ns sn: lnkn |{bes`~emg{ gne|bhne|n/ sge

smk{ntbsb{ obs < am{bs w pb|m{b{ nupmo~{e 3:&2 b ge`~elg{%

Oms sgfems w soe|m{ebs geco~wne l{senb/ cgbemsgs/ m{|mtenb/ cn`b|nb% agtn{|nes|me/

nlnhb/ gef~{fg|bcgme w~f~ob{/ `bgg{9 cb{lgbcb cmefns|gpn l~{be|n 4 tmcm |gnhtm

lnst~ns ln Gb |{bes`~sgme%

• [nbccomens hn|bkmoocbs

%- \mqgcglbl tm{ co|{b|m9 C~belm >0 |{bes`~elne r{belns cbe|glblns ln tobshb

`{nscm cmetnoblm/ sbef{n cmht%n|b 4 tobr~n|bs no cg|{b|m sn{gcm sn nonpb

cmesgln{bkonhne|n/ ne nstncgbo >g n9 cbcgn{%|n |gnen ~eb ne`n{hnlbc antb|gcb lnkbsn% No cg|{b|n t{me|bhne{n sn ~en bg cbocgc gmegyblm w btb{ncn ~eb

agtmcbocnhgb r~n cb{bc|n{gyb ns|b {nscc{me%

Obs {ebeg`ns|bcgmens 99:Ggegcbs geco~wne ng %ec{n{ene|m ln &b nqcg|bkooglbl en~{mebo/

tb{ns|nsgbs/ |nhkom{/ |n|b{~b/ nstnshms/ |bscgc~obcgmens/ agtn{pne|gobcgme w

lnt{nsgme ln 2;2 { ^ eC gC Ig' cb{lgbcb% 2 9 9 " cg|{b|n ns {bmgcb{ene|n {en|bkmogybcm ln

hben{b r~n gbs hbh|ns|bcgmens c&Gegcbs sme |{besg|m{%bs%




\[BES@^SGMEBONSC0lgfm BL\ ( T[ ( 336(44> G

E%%CBOLGB HBWM[

LN KMFM\B L]C%9|::G5%oP!'

u % ( ] % +% + + + / s % 9 % % %%'/%/gg(((+%u%+

Amstg|b"

Sghme Kmogpb{"

G Pn{sgme9 3

G

BTMWM LGBFEMS\GCM W

\N[BTN^\GCM


%- Agtm|n{hgb9 Oms tbcgne|ns r~n {ncgkne f{belns pmo~{enens ln sbef{n `{gb

t~nlne t{nsne|b{ b{{g|hgbs pne|{gc~ob{ns% Ns|n n`nc|m bo tb{ncn{ ns|b {nobcgmeblm

cme ob blhgegs|{bcg0e ln sbef{n tm{ cb|n|n{ cne|{bo omcbogyblms cn{cb lno sgs|nhb

cb{lgmcmenc|m{% Ob agtm|n{hgb t~nln bf{bpb{ oms n`nc|ms ln ob agtmcbocnhgb w ob

agtn{jbonhgb% Blgcgmebohne|n bo|n{b ob `~ecgmeboglbl ln ob anhms|bsgb w b~hne|b

ob s~scnt|gkgoglbl b ge`nccgmens% Ne cbsms ln |{bes`~sg0e hbsgpb ns ghtm{|be|n

cbone|b{ ob sbef{n be|ns ln s~ |{bes`~sgme %

%- Agtn{jbonhgb 4 agtmjbonhgb9 NG egpno ln tm|bsgm b~hne|b ne obs ~eglblns

bohbcneblbs b ~e egpno r~n tmcbs pncns ns sgfeg`gcb|gpm tb{b no egpno sn{gcm lno

tm|bsgm lno tbcgne|n% Hbs `{nc~ne|n ns ob agtmjbonhgb lnsb{{mooblb tm{r~n oms

n{g|{mcg|ms/ lnton|blms ne tm|bsgm l~{be|n no bohbcnebhgne|m/ |{bestm{|be bo sn{|{bes`~elglms hbsgpbhne|n tm|bsgm b s~ ge|n{gm{% NG hn|bkmogshm lno cg|{b|m

cme|{gk~wn |b{ekgne bo lnsb{{moom ln agtmjbonhgb w ln bocbomsgs hn|bk0ogcb% Ob

agtmjbonhgb cmes|g|~wn ~e t{mkonhb sn{gm ne egens t{nhb|~{ms w {ncgne ebcglms/

nstncgbohne|n ne cg{~fgb cb{lgmpbsc~ob{ w nqbef~gem|{bes`~sg0e% Ne ns|ms cbsms

sn t{n`gn{n ob |{bes`~sg0e ln ~eglblns `{nscbs/ ln em hbs ln 6 lobs ln

bohbcnebhgne|m %

%- [nbccgmens agtm|nesm{bs9 sn lnsc{gkn cmhm no lnscnesm ln ob t{nsg0e b{|n{gbo

r~n mc~{{n l~{be|n ob |{bes`~sg0e ne b~snecgb ln m|{ms sgfems 4 sge|mhbs lnm|{bs {nbccgmens |{bes`~sgmebons !`gnk{n/ nscbom`{`ms/ lgsenb/ ~{|gcb{gb'% Ob

hbfeg|~l lno lnscnesm ln ob t{nsg0e b{|n{gbo t~nln sn{ ln`geglm cmhm ~eb

{nl~ccg0e ln 24 hh Af ne ob t{nsg0e sgs|02gcb 4 lgbs|02gcb b tb{|g{ lno pbom{ ln

kbsn t{n|{bes`~sgmebo% Ob agtm|nesg0e sn t{nsne|b l~{be|n ob |{bes`~sg0e w sn

{ns~nopn {btglb{ene|n c~belm ob |{bes`~sg0e ns ge|n{{~htglb%

%- [nbccgmens \{bes`~sgmebons |b{lgbs em ge`nccgmsbs9 Sme obs {nbccgmens r~nbtb{ncne ne ~e tn{gmlm hbwm{ b ;< am{bs/ !lgbs/ snhbebs n geco~sm hnsns'/tn{m r~n sme b|{gk~gkons b ob |{bes`~sg0e %

%- [nbccgmens anhmog|gcbs |b{lgbs9 sn t{nsne|be ;< am{bs lnst~ns ln ob

|{bes`~sg0e/ h~cams tbcgne|ns hbeg`gns|be ob {nbccg0e abs|b lms snhbebs

lnst~ns ln ob |{bes`~sg0e% Ns|bs {nst~ns|bs sme cb~sblbs tm{ ~eb {nst~ns|b

bebhensgcb b oms bombe|`fnems n{g|{mcg|b{gms b oms c~bons no tbcgne|n ns|bkbt{npgbhne|n snesgkgogyblm% @{nc~ne|nhne|n em sn ln|nc|be oms be|gc~n{tms ne no

s~n{m lno tbcgne|n l~{be|n ob {nbogybcg0e ln obs t{~nkbs t{n|{bes`~sgmebons%

Obs {nbccgmens anhmog|gcbs |b{lgbs |gnelne b sn{ hnems snpn{bs r~n obs bf~lbs%Ob anhmogsgs r~n sn t{nsne|b ns fnen{bohne|n nq|{bpbsc~ob{% Bof~ems tbcgne|ns

smobhne|n hbeg gns|be ~e c~bl{b benhgcm genqtogcbkon% M|{ms aboobyfms cogegcmsgeco~wne `gnk{n w nscbom`{oms% gc|n{gcgb/ lmom{ bklmhgeb" w lgsenb% NG t{mf{nsm b

`boob {nebo ns tmcm `{nc~ne|n% Lne|{m ln oms lb|ms ln obkm{b|m{gm sn geco~wnebenhgb/ bc|gpglbl ln obc|b|m lnsagl{mrnebsb nonpblb/ lgshge~cg0e ln

Tbrgeb 1 ln 27



BOCBOMGB HBWM[

L%N KMFM\B L(C]+g:t"%%%%~M

uutH" g &g o+ / +: &/ %% / u % ' % % + + /u



Amstg|bo

Sghme Kmogpb{

BTMWM LGBFEMS\GCM W

\N[BTN^\GCM


Pn{sg0e9 3

abt|mfomkgeb/ on~cmcg|msgs w ~eb t{~nkb ln be|gfomk~ogeb lg{nc|b tmsg|gpb% Ob

agtn{kgog{{~kgenhgb lntneln lno f{blm ln an{emogsgs w ln ob `~ecgme antb|gcb%

Ob gmne|g`gcbcgme ln oms be|gc~n{tms n{g|{mcg|b{gms ns ob cobpn ne ob t{npnecgme ln

obs {nbccgmens anhmoo|gcbs %

%- T~{t~{b tms|{bes`~sgmebo9 npne|m tmcm cm{e~e cb{bc|n{gyblm tm{ no gegcgm

bk{~t|m ln |{mhkmcg|mtnegb snpn{b bt{mqghblbhne|n ~eb snhbeb lnst~ns ln ob

|{bes`~sgme% Oms tbcgne|ns t{ml~cne bombe|gc~n{tms ne {nst~ns|b b oms be|`fnems

tobr~n|b{gms t{nsne|ns ne ob sbef{n |{bes`~elglb% L~{be|n ~e tn{gmlm ln |gnhtm/ns|n be|gc~n{tm cb~sb ob lns|{~ccg0e ln obs tobr~n|bs b~|momrbs%Oms sgfems w oms sge|mhbs geco~wne |{m{ekmcg|ctnegb snpn{b/ t~{t~{b w sbef{blm%

Ob |{mhkmcg|mtnegb ns ~e c~bl{m oghg|blm r~n sn {ns~nopn ne ;2 lobs%B`nc|b hbs cm{e~e{ene|n b h~in{ns h~o|gtb{bs w tbcgne|ns tmog|{bes`~elglms cme

t{ml~c|ms tobshb|gcms 4 r~n cme|nefbe ns|n cmhtmene|n%NG |{b|bhgne|m cmesgs|n ne tobshb`n{nsgs n geh~fomk~ogebs %

%- Ne`n{hnlbl gein{|m cme|{b a~nstnl9 ns ~eb cmhtogcbcgme fnen{bohne|n `b|bo/

bsmcgblb bo gein{|m w nqtbesgme comebo ln oms oge`mcg|ms lno lmebe|n ne ~e {ncnt|m{s~scnt|gkon% Lgcams oge`mcg|ms hme|be ~e b|br~n b~|mgeh~en cme|{b oms |niglms lno

{ncnt|m{/ lmeln geco~wne obs cno~obs an{eb|mtmwn|gcbs w cb~sbe tbecg|mtnegb{n`{bc|b{gb cme sbef{blm w ~eb t{nlgstmsgcgme hb{cblb b obs ge`nccgmens/ r~n sme

{nstmesbkons ne h~w k~neb tb{|n/ ln ob hm{|boglbl ln ns|ms tbcgne|ns%Oms s`e|mhbs w sgfems btb{ncne lgny l`bs lnst~ns ln ob |{bes`~sgme/ n geco~wne

`gnk{n/ ln{hb|g|gs 4 n{g|{mln{hgb/ antb|g|gs/ ne|n{mcmog|gs/ w tbecg|mtnegb%

Lne|{m ln oms `bc|m{ns r~n ln|n{hgebe no {gnsfm ln oms tbcgne|ns b ns|b {nbccgmesn nec~ne|{be ob geh~emln`gcgnecgb ln c~b"r~gn{ cb~sb/ no f{blm ln sghgog|~l AOB

ne|{n no lmebe|n w no {ncnt|m{ w no e~{en{m ln oge`mcg|ms cbtbcns ln t{mog n{bcgme%Em nqgs|n ~e |{b|bhgne|m nstnc``gcm tb{b ns|b ne|glbl% Ob g{{blgbcgme fbhhb ln

oms cmhtmene|ns cno~ob{ns sn bcnt|b cmhm no hn|mlm ln t{npnecgme ns|belb{%Ns|n t{mcnlghgne|m abcn r~n oms oge`mcg|ms tgn{lbe s~ cbtbcglbl {ntogcb|gpb sgeb`nc|b{ no `~ecgmebhgne|m ln obs tobr~n|bs 4 oms n{g|{mcg|ms%

Obs gelgcbcgmens ln g{{blgbcgme geco~wne9 {ncnt|m{ns geh~emcmht{mhn|glms ln

cno~obs t{mfneg|m{bs an{eb|mtmwn|gcbs 4 ln |{bstobe|n ln m{rbems/ tbcgne|ns cmelnsm{lnens an{eb|momrgcms r~n ns|be kbim |{bstobe|n ln cno~obs

an{eb|mtmwn|gcbs/ |{bes`~sgmens ge|{b~|n{gebs/ enmeb|ms ne nqber~gem|{bes`~sgme/ne`n{hnlbl ln Amlfjge n geh~emln`gcgnecgbs cmerneg|bs%

%- N`nc|ms geh~emhml~oblm{ns ln ob |{bes`~sg0e9 Ob |{bes`~sgme |gnen ob

cbtbcglbl ln bo|n{b{ ob {nst~ns|b geh~eg|b{gb bsmcgblb cme n`nc|ms blpn{smscmhm ob {nc~{{necgb ln |~hm{ns s02glmsw ob ge`nccgme kbc|n{gbeb%

%- Smk{ncb{fb ln agn{{m9 Cbcb |{bes`~sgme ln cmecne|{blm ln fo0k~oms {mims

btm{|b bt{mqghblbhne|n ;44 hf ln agn{{m/ ns|m t~nln sn{ ~e t{mkonhb ne

Tbrgeb 7 ln 27




\[BES@^SGMEBONS

BOcBG%%LgB HBWM[

MNKMFM\Bm(c %%|:%%%%%%%Lo'

C0lgfm BL\ ( T[ ( 336(44>

Sghme Kmogpb{

BTMWM LGBFEMS\GCM W

\N[BTN^\GCM


G Pn{sgme9 3G

tbcgne|ns tmog|{bes`~elglms !hbs ln 244 |{bes`~sgmens' ne oms r~n ob smk{ncb{fb

ln agn{{m t~nln m{gfgeb{ ~e ns|blm ln anhmsgln{msgs snc~elb{gb/ lnkglm b ob

bc~{e~obcgme t{mf{nsgpb ln agn{{m sge ob tmsgkgoglbl ` gs|momrgcb ln s~ nqc{ncgme%

Oms lntmsg|ms ln agn{{m b`nc|be ob `~ecgme cb{lgmpbsc~ob{/ nelmc{geb/ antb|gcb w

cmel~cn b ~eb sgfeg`gcb|gpb hc{kg~lbl w hm{|boglbl%

NE@N[HNLBLNS \[BESHG\GLBS TM[ OB \[BES@^SGME

%- Cme|bhgebcg0e kbc|n{gbeb ln oms cmhtmene|ns sbef~genms9 Ns ~eb

cmhtacbcgme {b{b r~n s~non mc~{{g{ lnkolm b ob cme|bhgebcgme lno t{ml~c|m/

l~{be|n s~ bohbcnebhgne|m%

NG gegcgm ln oms sgfems w sè|mhbs s~cnln l~{be|n 4 tmcm |gnhtm lnst~ns ln ob|{bes`~sgme% Oms sè|mhbs hbs cmh~ens geco~wne `gnk{n/ nscbom`{`ms/ agtm|nesgme/

camr~n/ eb~snbs/ w pmhg|m/ lgsenb/ lmom{ bklmhgebo w lgb{{nb %

%- Ge`nccgmens pg{bons9 ne ob bc|~boglbl |mlms oms t{ml~c|ms sbef~ènms sme

ogkn{blms lnst~ns ln oms ns|~lgms ln sn{momf`b w PM[O enrb|gpms/ tn{c b~e

nqgs|n no {gnsfm ln oms lmeblm{ns r~n sn nec~ne|{be ne tn{gmlms ln gec~kbcgme

!tn{gmlm ln pne|beb' tm{ 2 4 r~n oms {ns~o|blms sn{momrgcms t~nlne em sn{ ~eb

fb{be|`b ln snf~{glbl% Ob bo|n{eb|gpb tb{b lgshge~g{ no {gnsfm ln cme|b{egebcgme

cmesgs|n ne ~eb ns|{gc|b snonccgme ln oms lmebe|ns ln bc~n{lm b be|ncnlne|ns

tn{smebons w cmel~c|b snq~bo%

Ne|{n obs ge`nccgmens pg{bons r~n t~nlne |{beshg|g{sn lnkglm b ob |{bes`~sgme sn

nec~ne|{be9

%- Antb|g|gs

%- Pg{~s ln ob geh~emln`gcgnecgb a~hbeb

%- Pg{~s a`m|{mtocm a~hben !A\O P'

%- Cg|mhnfbompg{~s

%- Pg{~s ln Nts|nge Kb{{

%- An{tns pg{~s 0 w 1

%- Tb{pmpg{~s

%- M|{bs ge`nccgmens9

%- S``gogs

%- Necn`bomtb|`bs nstmefg`m{hns

%- Hbob{gb

%- Cabfbs

Tbrgeb 24 ln 27



i

GHBENIM LN [NBCCGMENS G\[BES@^SGMEBONS g C0lgfm9 BL\ ( T[ ( 336(44>

gGu(((\(

BTMWM LGBFEMS\GCM W 9\N[BTN^\GCM G Pn{sgme9 3

SN[PGCGM LN \[BES@^SGME G

B"%%CBo%M|B HBWM[

MNKMFM\Bm%%c%

Sghme Kmogpb{

HBENIM LN OBS [NBCCGMENS \[BES@^SGMEBONS9

BG mc~{{g{ ~eb [nbccgme Blpn{sb b ob \{bes`~sgme ns lg``cgo ns|bkoncn{ gegcgbohne|n ob

snpn{glbl w no |gtm ln {nbccgme wb r~n oms sgfems w sè|mhbs sme genstnc` gcms% Sgenhkb{fm/ cme ob nqcntcgme ln gb {nbccgme ~{|gcb{gbo w obs {nbccgmens `nk{gons emanhmo`|gcbs/ |mlbs sme tm|necgbohne|n hm{|bons%

Oms sgfems w sè|mhbs ln ~eb {nbccgme anhmo |gcb fnen{bohne|n mc~{{ne l~{be|n oms

t{ghn{ms > b 24 cc ln ob |{bes`~sgme sbef~ènb% Ns gelgstnesbkon hmeg|m{gyb{

blnc~blbhne|n b |mlms oms tbcgne|ns r~n {nlkne smtm{|n |{bes`~sgmebo/ cme ~et{m|mcmom ln {emeg|m{gybcgme r~n lnkn sn{ m{lneblb tb{ no hnlgcm |{b|be|n w GGnpblb

b cbkm ne cmei~e|m cme no tn{smebo ln ne`n{hn{gb b cb{fm lno tbcgne|n%

êb pny ges|b~{blb ob |{bes`~sgme no tn{smebo b cb{fm lno tbcgne|n lnkn ns|b{ b|ne|mb obs hbeg`ns|bcgmens coègcbs r~n s~fgn{be ob t{nsnecgb ln ~eb {nbccgme blpn{sb%

Ne no BENQM 2 sn sge|n|gybe w cobsg gcbe oms aboobyfms co egcms snr~e ob snpn{glbl/lnkn {nsbo|b{sn ob genstncg`gcglbl ln ns|ns/ tm{ 2 4 |be|m no hbenim lnkn ne`mcb{sn

t{gecgtbohne|n ne ob ln|nccgme t{ncmy w ne ob ghton{ene|bcgme lno t{m|mcmom lnhbenim {nobcgmeblm b cme|ge~bcg0e%

Lnkn |nen{sn ne c~ne|b r~n ne ~e tbcgne|n gecmescgne|n 4 kbim oms n`nc|ms lnbens|nsgb fnen{bo oms ~egcms aboobyfms ln gb t{nsnecgb ln ~eb |{bes`~sgme

gecmhtb|gkon t~nlne sn{ ob agtm|nesome w n" sbef{blm gecme|{mobkon%

Obs {nbccgmens snpn{bs ~s~bohne|n sn hbeg`gns|be lne|{m ln oms t{ghn{ms 2>hge~|ms ln ob ge`~sgme ln > b 24 ho ln sbef{n% %

Sg no tbcgne|n ab t{nsne|blm t{npgbhne|n {nbccgmens ~{|gcb{gbons {ntn|glbs ns

{ncmhnelbkon s~hgegs|{b{ t{m gobc|gcb{ene|n be|gags|bhègcm 34 hge~|ms be|ns ln ob|{bes`~sgme%

Sg nqgs|n smstncab ln r~n no tbcgne|n ns|b lnsb{{moobelm ~eb [nbccome

Blpn{sb b ob\{bes`~sgme sn lnkn9

%- Ln|nen{ Gehnlgb|bhne|n ob |{bes`~sgme %

%- Hbe|nen{ no bccnsm pnemsm cme smo~cgme sbogeb 4%7.

%- Ge`m{hn gehnlgb|bhne|n |mlbs obs {nbccgmens |{bes`~sgmebons/ bo hnlgcm{nstmesbkon lno tbcgne|n w bo Sn{pgcgm ln \{bes`~sgme %

%- Sn lnkn {nfgs|{b{ ne gb ags|m{gb cooegcb lno tbcgne|n no |gtm ln [nbccgme

Blpn{sb b ob \{bes`~sgme ln bc~n{lm b ob cobsgòcbcgme lnsc{g|b ne ns|nlmc~hne|m %

%- \gnhtm |{besc~{{glm lnsln no cmhgneym lnob |{bes`~sgme abs|b r~n mc~{{gmno gegcgm ln oms sè|mhbs w sgfems%

%- \mhn obs sgf~gne|ns h~ns|{bs w nep`nobs bo Sn{pgcgm ln \{bes`~sgme%

Tbfgeb 22 ln 27



G(G HBENIM LN [NBCCGMENS


Bo%(cB|% %MoB HBWM[

LN KMFM\Bm%%%c%

Sghme Kmogpb{

BTMWM LGBFEMS\GCM W

\N[BTN^\GCM


Pn{sg0e9 3

• H~ns|{bs ln sbef{n gehnlgb|bhne|n tms|{bes`~sg0e !2 cmbf~oblb

!\BTB [MIB'/ 2 be|gcmbf~"blb NL\B !\BTB OGOB' ln ~eb pneb/

mt~ns|b bo sg|gm ln ob ge`~sg0e tb{b9

• [nc~ne|m sbef~genm cmhton|m !C^BL[M ANHB\GCM'

• \ns| lg{nc|m ln be|gfomk~ogeb !CMMHKS LG[NC\M'

• K^E• C{nb|gegeb

• Nonc|{mog|ms• Ob ~eglbl ln sbef{n w no nr~gtc ln blhgegs|{bcg0e ln sbef{n r~ncme|gnen {nsgl~ms ln fo0k~"ms {mims w tobshb ln ob sbef{n

|{bes`~elglb%• T{ghn{b h~ns|{b ln m{geb lno tbcgne|n o~nfm ln mc~{{glb ob|{bes`~sg0e%

• Snr~e sge|mhbs/ |mhb{ |~kn |btb by~o tb{b t{~nkbs ln cmbf~obcg0e %

%- Smogcg|n bo Sn{pgcgm ln \{bes`~sg0e no `m{hb|m tb{b em|g`gcbcg0e ln {nbccgmens

blpn{sbs b ob |{bes`~sg0e tb{b {nfgs|{b{ |mlms oms aboobyfms w tn{{eg|g{ obgepns|gfbcg0e ln ob {nobcg0e ne|{n ob |{bes`~sgme w oms sge|mhbs w sgfems

t{nsne|blms tm{ no tbcgne|n% Ob kbc|n{gmocrb lno |~{em lnkn ne|{nfb{ no `m{hb|m w

cn{cgm{b{sn r~n no hnlgcm ges|g|~cgmebo b cb{fm lno tbcgne|n 2 4 lgogfnecgm ne s~

|m|boglbl abs|b no e~hn{bo 24: sg ns|n em Gonfb ne ob ne|{nfb ln |~{em lnkn bpgsb{b ob t{m`nsgmebo cme no `ge ln r~n 2 4 nepgne ne no sgf~gne|n |~{em w lnkn bpgsb{ bo

t{m`nsgmebo nstncgbogyblm lno Sn{pgcgm ln \{bes`~sg0e ns|b empnlbl%- Cme obs h~ns|{bs t{n w tms|{bes`~sgmebons/ ob kbc|n{gmomrb ln |~{em lnkn {nbogyb{9

t{~nkb ln cmmhks lg{nc|m/ {bs|{nm ln be|gc~n{tms/ anhmcobsg`gcbcgmens lntbcgne|n w kmosb lnp~no|b/ anhb|~{gb hbc{m w hgc{msc0tgcb/ {ntn|g{ ob t{~nkbc{~yblb w c~g|gpm ln ob ~eglbl r~n sn smstncab cb~s0 ob {nbccg0e ! ne cbsm ln

{nbccgmens `nk{gons/ w-m b~hne|m ln ob |nhtn{b|~{b ne hbs ln ~e f{blm

cne|gf{blm ' w {nfgs|{b{ oms {ns~o|blms ne m{gfgubo w cmtgb lno `m{hb|m GE@M[HNLN [NBCCGME BLPN[SB B OB \[BES@^SGME %

%- Nepgb{ no m{gfgebo lno `m{hb|m lgogfnecgblm bo sn{pgcgm tb{b sn{ geco~glm ne ob

ags|m{gb cogegcb lno tbcgne|n w ne|{nfb{ ob cmtgb bo T{m`nsgmebo Nstncgbogyblm lno

Sn{pgcgm ln \{bes`~sg0e %

%- Lgogfnecgn no `m{hb|m SNF^GHGNE\M B [NBCCGMENS \[BES@^SGMEBONS

{nfgs|{belm no emhk{n ln ob tn{smeb ln b~lg|m{gb hnlgcb b ob r~n sn Gn em|g`gc0 ob

{nbccg0e w ob am{b% Ne ob cb{tn|b ln Snf~ghgne|m b [B\ lnkn b{cagpb{ ~eb cmtgbln cblb @m{hb|m w ~eb cmtgb lno `m{hb|m ln gb SLS tb{b no {ntm{|n ln [B\

%- Em|g`gcb{ ln ob {nbccg0e w ln oms {ns~o|blms ln obs t{~nkbs {nbogyblbs boT{m`nsgmebo Nstncgbogyblm lno Sn{pgcgm ln \{bes`~sgme% Sg ob {nbccg0e mc~{{n

pgn{ens tm{ ob |b{ln/ 4 ne `ge ln snhbeb/ sn lnkn ge`m{hb{ bo b~lg|m{ hnlgcm ln|~{em tb{b r~n i~e|m cme no hnlgcm |{b|be|n {nbogcn n" bebogsgs lno cbsm%

Tbfgeb 2;ln 27



S++kIL

uu%/%/5%/u9+Iu + %!5 o g ( c % 2/ / & % % % % %



Pn{sgme9 3

BOCBOm|B HBWM[

LNKMFM\BM(C%mstg|b"

Sghme Kmogpb{

BTMWM LGBFEMS\GCM W


GEPNS\GFBCG0E LN OB [NBCCGME \[BES@^SGMEBO9 Ob gepns|gfbcg0e w

bebogsgs ln obs [B\ sn {nbogyb no mgb abkgo sgf~gne|n b ob [B\ cme ob tb{|gcgtbcg0e lno

B~lg|m{ Hnlgcm/ no Hnlgcm b cb{fm lno tbcgne|n w no T{m`nsgmebo Nstncgbogyblm lno

Sn{pgcgm ln \{bes`~sg0e/ |negnelm ne c~ne|b oms sgf~gne|ns cmecnt|ms9

• \{bybkgoglbl9 glne|g`gcbcg0e toneb ln oms cmhtmene|ns sbef~`enms r~n tn{hg|n

abcn{ ~e snf~ghgne|m cmhton|m ln |mlb ob cblneb |{bes`~sgmebo%

• Snpn{glbl9 sn ln|n{hgeb ln bc~n{lm b" BENQM 2 lno t{nsne|n lmc~hne|m9

%- ONPN9 c~belm em sn tmen ne tnogf{m ob pglb lno tbcgne|n w ob hm{kgoglbl ns

oghg|blb !{nbccgmens bon{rgcbs c~|benbs% `gnk{n w nscbom`{ m ne|{n m|{ms' %

%- HMLN[BLB9 c~belm sn t{nsne|b {em{kg~lbl b ob{fm tobym cme 4 sge {gnsfm tb{b

ob pglb lno tbcgne|n !antb|g|gs 1/ C/ PGA/ anh02gsgs|b{l`b ne|{n m|{ms'%- SNPN[B9 c~belm sn tmen ne {gnsfm ob pglb lno tbcgne|n ln `m{hb gehnlgb|b !

anh02gsgsbf~lb/ ne`n{hnlbl gein{|m cme|{b a~nstnl/ sntsgs/ ne|{n m|{ms'%-H^N[\N

%- EM LN\N[HGEBLB9 sg ob cobsg`gcbcg0e ln ob snpn{glbl ln ob [B\ r~nlb ne ns|n{befm/ ns|b lbelm gelgcgm ln tmcb mksn{pbcg0e lno t{mcnsm ln ob |{bes`~sg0e w

ln`gcgnecgb ne no snf~ghgne|m/ bebogsgs n gepns|gfbcg0e lno cbsm%

• GHT^\BKGOGLBL LN OB [B\9

%- F[BLM 49 nqco~glb/ c~belm |mlb |b npglnecgb cogegcb gelgcb r~n ob |{bes`~sg0e emns ob cb~sb ln ob {nbccg0e blpn{sb |{bes`~sgmebo% Ns lncg{ ns cmeco~wne|n r~n

a~km m|{m ~ m|{ms `bc|m{ns r~n cb~sb{me obs hbeg`ns|bcgmens cogegcbs ne notbcgne|n %

%- F[BLM 29 tmsgk"n !t~nln sn{'/ c~belm ob npglnecgb em tn{hg|n ns|bkoncn{ r~n ob|{bes`~sg0e ns ob cb~sb ln ob {nbccg0e blpn{sb/ sgem r~n t~nlne nqgs|g{/ cme obhgshb tmsgkgoglbl/ m|{b ~ m|{bs cb~sbs {nobcgmeblbs cmeno npne|m%

%- F[BLM ;9 t{mkbkon !pn{ms`hgo/ r~n sn `~elb ne {byme t{~lne|n/ r~n sn t~nln

t{mkb{'/ c~belm ob npglnecgb sn gecogeb cob{bhne|n abcgb ob |{bes`~sg0e cmhmcb~sb ln ob {nbccg0e blpn{sb |{bes`~sgmebo/ b~er~n nqgs|n ne ~eb t{mkbkgoglblhnem{/ ~eb ~ m|{bs cb~sbs%

%- F[BLM 39 ln`geg|gpb/ c~belm ob npgmnecgb ns cmeco~wne|n tb{b b|{gk~g{ b ob

|{bes`~sg0e ln sbef{n 4 s~s ln{gpblms cmhm cb~sb ln ob {nbccg0e blpn{sb|{bes`~sgmebo%

Tbfgeb 23 ln 27



Sghme Kmogpb{



Bo%%%CBOmgB% HBWM[

LNKMFM\Bm(c%

BTMWM LGBFEMS\GCM W

\N[BTN^\GCM


Pn{sgme9 3

%- EM NPBO^BKON9 em nqgs|ne lb|ms s~`gcgne|ns tb{b ln|n{hgeb{ r~n ob {nbccgme

blpn{sb ns|b {nobcgmeblb cme ob blhgegs|{bcg0e ln" t{ml~c|m sbef~genm%

6%; @O^IMF[BHB

{ gEGCGM G" '

[NBCCGME BLPN[S/c% B OB \[BES@ SGME

\[B\BHgNE\M GEHNLiB\M {_ &(B [NBCCGMGu T[NSNE\BLB

((((/%((((((((]%]((((&G

\MHB LN H^NS\[BS TMS\[BES@^S"MuGBONS W NEPgm BOu]]I&((( ]] ((((/

SN[PGCGM LN \[BES@ SGME ! h~ns|{bs cm{etmene|n sbef~g98e] R?%6(&' 2Bo

[NBOoYBC"ME LN T[ NKBS T[N W TMS\[BES@^SGMEBONS

GEPNS\GFBC"ME LN OB TMSGKON[NBCCGME BLPN[SB

COBSG@GCBCGME LN OB [NBCCgME

BLPN[SB

G

2G

T[NSNE\BCgME NE CMHg\N

\[BES@^SGMEBO

2EM\G@GCBCGME B B^LG\M[G%+ HNLGCB W B OB [NL LN KBECMS LN

SBEF[N W SN[PGCGMS LN \[BES@ SGME

//g /

G @GE G]]i



BG%%CBo%%L!B HBWM[

knKMFM\BL%C%,H%|IL

¶¶¶¶uu¶uu::¶jgg:/::::9¶¶



Amstg|bo

Sgh0e Kmogpb{

BTMWM LGBFEMS\GCM W

\N[BTN^\GCM


Pn{sg0e9 3

6%3 HB\[GY [NSTMESBKGOGLBLNS

Em Bc|gpglbl Nqtogcbcgme ln ob [nstmesbkon [nfgs|{m Mksn{pbcgmens

bc|gpglbl {gnsfms w

cme|{mons

2 Ln|nccgme ln ob Ln|nccgme ln Tn{smebo hnlgcm BL\(@M(336( NG hnlgcm w in`n

tmsgkon [nbccgme sgfems w sge|mhbs w ln ne`n{hn{gb 421 {nfgs|{m ln ne`n{hn{gb

Blpn{sb b ob r~n gelgr~ne r~n {nstmesbkons |{bes`~sgmebo% {nstmesbkons lno

\{bes`~sgme% ![B\' no tbcgne|n ns|b lno tbcgne|n% Ags|m{gb cogegcb tbcgne|n lnkne

t{nsne|belm ~eb lno tbcgne|n% ns|b{ t{nsne|ns

{nbccgme blpn{sb tm{ 24hnems 2>

bo cmhtmene|n r~n hge~|ms o~nfm lno

`~n 4 ns|b sgnelm gegcgm ln ob

|{bes`~elglm% |{bes`~sgme w ne no

hmhne|m `gebo ln

ob hgshb%

Ne n{hn{gb lnkn

pgfgob{ w {nfgs|{b{

oms sgfems pg|bons

ne no `m{hb|m

; \{b|bhgne|m ln ob \{b|bhgne|m Tn{smebo Hnlgcm [nfgs|{m [nfgs|{b{ oms

tmsgkon [nbccgme gehnlgb|m ln ob ges|g|~cgmebo |{bes`~sgmebo% sgfems pg|bons lno

Blpn{sb b ob tmsgkon [nbccgme {nstmesbkon lno Ags|m{gb cogegcb tbcgne|n%

\{bes`~sgme Blpn{sb bob tbcgne|n% lno tbcgne|n Ln|nen{ ob

\{bes`~sgme ln |{bes`~sgme

bc~n{lm b oms gehnlgb|bhne|n%

sge|mhbs w sgfems

t{nsne|blms tm{ no

tbcgne|n/ ln

bc~n{lm b obs

gelgcbcgmens

t{nsne|blbs ne no

e~hn{bo 6%2%; lno

t{nsne|n

lmc~hne|m%

3 \mhb ln h~ns|{bs \mhb{ obs In`n ln Ags|m{gb Cogegcb \mhb{ ob h~ns|{b

tms|{bes`~sgmebons h~ns|{bs ne`n{hn{gb lno ln ~e sg|gm ln

encnsb{gbs tb{b sn{pgcgm pnemt~ecgme{nbogyb{ ob cm{{nstmelgne|n% lg`n{ne|n b ob pgb

gepns|orbcome ln ob Cbhgoon{m 4 ln bl{egeos|{bcgme

tmsgkon {nbccgme b~qgogb{ ln lno

blpn{sb/ ne k~scb ne`n{hn{gb lno anhmcmhtmene|n/

ln sge|mhbs sn{pgcgm% c~htognelm ms

cogegcms r~n {nr~gsg|ms

m{gne|ne abcgb no ns|bkoncglms%

|gtm ln {nbccgme !|~km |btb ogob/

Tbfgeb 2> ln 27



B|%CBOL`B ] WM[LN KMFM\Bm%c%%%%%%%%%%%%%%%%%%" Gg u" /u ] %] ] %]%uuSèm0?"&mG2h{



Amstg|bo

Sgh0e SmApb/%

BTMWM LGBFEMS\GCM W

\N[BTN^\GCM

SN[PGCGM LN \[BES@^SG0E

Pn{sg0e9 3

Em Bc|gpglbl Nqtogcbcg0e ln ob [nstmesbkon [nfgs|{m Mksn{pbcgmens

bc|gpglbl {gnsfms w

cme|{mons

t{nsne|blb w ob |btb {mib 4

snpn{glbl ln ob bhb{goob w h~ns|{bhgshb% ln m{geb'%

< \{bestm{|n ln Ne|{nfb{ obs Cbhgoon{m Ags|m{gb Cogegcb/ Ob kbc|n{gmomrb

H~ns|{bs/ h~ns|{bs ogk{m ln gef{nsm lnkn ne|{nfb{ no

cmhtmene|n w tms|{bes`~sgmebons/ ln h~ns|{bs bo `m{hb|m tb{b no

`m{hb|m% no cmhtmene|n r~n Sn{pgcgm ln {ntm{|n ln obs

t{nsne|m ob [B\ W \{bes`~sgme% [B\ bo cbhgoon{m

no BL\(@M(336( tb{b r~n ns|n 24

421 b ob ne|{nf~n bo

kbc|n{gmomrb lno hnlgcm |{b|be|n

Sn{pgcgm ln

\{bes`~sgme%

> Em|oòcbcgme ln ob [nfgs|{m ln oms Hnlgcm @m{hb|m tb{b no Lgogfnecgb{ oms

tmsgkon [nbccgme sgfems w soe|m{ebs ges|g|~cgmebo b {ntm{|n ln obs cbhtms lno

Blpn{sb b ob ln ob {nbccome cb{fm lno {nbccgmens `m{hb|m abs|b no

\{bes`~sgme% blpn{sb tbcgne|n blpn{sbs b ob e~hn{bo 24 cme

t{nsne|blb tm{ no |{bes`~sgme on|{b cob{b w

tbcgne|n/ ne no sbef~genb onfgkon%

{nfgs|{m ln [B\% NG hnlgcm lnkn

|{bes`~sgme w ne|{nfb{om b

em|g ocbcgme bo ne`n{hn{gb tb{b

sn{pgcgm ln r~n no cbhgoon{m

|{bes`~sgme% lnp~nopb ne no

Smogcg|~l lno hgshm |~{em ns|n

`m{hb|m ln {ntm{|n `m{hb|m bo Sn{pgcgm

ln obs {nbccgmens ln \{bes`~sgme

blpn{sbs b ob

|{bes`~sgme tm{

ge|n{hnlgm lno

cbhgoon{m bo

sn{pgcgm ln

|{bes`~sg0e%

0 [nbogybcgme ln [nbogyb{ b obs Kbc|n{gmomrb ln Ge`m{hn ln Pn{g`gcb{ oms lb|ms

t{~nkbs h~ns|{bs t{n w |~{em lno {nbccgme ln obs h~ns|{bstms|{bes`~sgmebons% tms|{bes`~sgmebons Sn{pgcgm ln |{bes`~sgmebo% t{n w

t{~nkbs ln \{bes`~sgme% tms|{bes`~sgmebons

cmmhks lg{nc|m/ Snf~ghgne|m b Cmhton|n no

{bs|{nm ln {nbccgmens `m{hb|m tb{b no

be|gc~n{tms \{bes`~sgmebons {ntm{|n ln obs

g{{nf~ob{ns/ @M[HB\M {nbccgmens

an{emcobsòcbcome/ TB[B NO blpn{sbs b ob

anhb|~{gb hbc{m w [NTM[\N LN |{bes`~sgme

Tbfgeb 20 ln 27




\[BES@^SGMEBONSC0lgfm9 BM\ ( T[ ( 336(44>

BOCBI%% %M|B% HBWM[

L`9KMFM\BM%%c%,95/u/^!5

:u:++g5+º |u+uz og(%++ o?Sghme Kmogpb{

G BTMWM LGBFEMS\GCM W "GPn{sg0e9 3

2 u ] ] 88888888888uuuu\uNu[uB8TuNu^u\uGCuMuuuuo//"8888888888888888u88888888uSN[PGCGM LN \[BES@^SGME

Em Bc|gpglbl G Nqtogcbcg0e ln ob g [nstmesbkon G [nfgs|{m Mksn{pbcgmens

G bc|gpglbl {gnsfms w

" cme|{mons

c~o|gpm sg noG

[NBCCGMENS no e~hn{bo 6 abs|bG

tbcgne|n t{nsne|m BLPN[SBS B n27%`gnk{n% OB

\[BES@^SGME Em|g gcb{ boSBEF^GENB t{m`nsgmebo[B\% nstncgbogyblm lno

Gsn{pgcgm ln

|{bes`~sgme bcn{cbln ob tmsgkon

{nbccg0e blpn{sb%Nepgb{ ~eb cmtgbln&o `m{hb|m

ge`m{hn ln

{nbccg0e

|{bes`~sgmebo bo

sn{pgcgm tb{b r~n

snb benqblm b ob

ags|m{gb co egcb lno

tbcgne|n%

F~b{ln ne obenpn{b obs

g h~ns|{bs lno

tbcgne|n t{n wtms|

|{bes`~sgmebons w

oms tgom|ms ln obkmosb/ w-m

anhmcmhtmene|ng tm{ sg ns

" en|nsb{gmnepgb{obs tb{bt{~nkbs

cmhtonhne|b{gbs

bo Anhmcne|{m%Gepns|gfbcg0e ln ob

{nbccg0e blpn{sb bob |{bes`~sg0e/

G [B\%

GG G

g GO]]o]]]]]]

/6 Ln|n{hgeb{ no T{m`nsgmebo / @M[HB\M Ln|n{hgeb{ no

G f{blm ln NstncgbAyblm G TB[B NO f{blm ln

g cmht{mhgsm lno lno Sn{pgcgm ln [NTM[\N LN snpn{glbl w ob GG anhmcmhtmene|n \{bes`~sgme/ G OBS ght~|bkgoglbl ln ob

G ne oms sgrems w Hnlgcm G [NBCCGMENS {nbccgme ln g

Gs`e|mhbs ges|g|~cgmebo b g BLPN[SBS B bc~n{lm b ob Gt{nsne|blms tb{ no • cb{fm lno G OB G& cobsg`gcbcgme G

G tbCgne|n% &%t%bCgne|nw g \[BES@^SGME t{nsne|blb ne G]]]o] uuG%u"_~lg|m{ hnlgc?;%9]oSB|("R^GEf0]]g]nuIuuRmc~hne"R]O]i

Tbfgeb 26 ln 27



Pn{sgme9 3

B2%CBOLGB HBPM[

LN9KMFM\B M%C%«E %_%I!'

2 2 ( / / / // / // / // : u u % % %+s+ | ] : 5 %


\[BES@^SGMEBONS

g

gg C0lgfm BL\ ( T[ ( 336(44>

Sghme KmApb{

BTMWM LGBFEMS\GCM W

G\N[BTN^\GCM

G SN[PGCGM LN \[BES@^SG0E]k]uuuuuuuuuuuuuuuuuuuu]uuuu ]]u]uuuuuuuuuuuuuuuuuu

Em Bc|gpglbl G Nqtogcbcgme ln ob G [nstmesbkon G [nfgs|{m Mksn{pbcgmens G

G bc|gpglblG

{gnsfms wG"

Gcme|{mons

g % [B\% cbe kbsn ne oms

sgfems/ sge|mhbs/

{ns~o|blms ln obs

t{~nkbs

{nbogyblbs w ob

gepns|grbcgme ln ob

ags|m{gb cooegcb lno

tbcgne|n%

Sn lnkn

lgogfnecgb{ no`m{hb|m tb{b no

{ntm{|n ln obs

{nbccgmens

blpn{sbs b ob

|{bes`~sgme

sbef~genb lnsln

no e~hn{bo 22

abs|b n22>%

\mlbsobs

G {nbccgmens

G blpn{sbs sn

lnkne t{nsne|b{

ne no cm{eg|n ln

\{bes`~sgme w sn

Glnkne {ntm{|b{ b

ob[nl ln Kbecms

ln Sbef{n w S\S

ln ob SMS%

GObs {nbccgmens

G hmln{blbs w

f{bpns lnkne sn{

em|g`gcblbs

gehnlgb|bhne|n b

ob {nl ln kbecms

G ln Sbef{n w%%Sn{pgcgms ln

\{bes`~sgme%

Ggelgcblm{ ln

[nbccgmens

G \{bes`~sgmebons[nbogyb{ w {ntm{|b{

G no gelgcblm{ ln

G [B\ mc~{{glbs ne

Ggb ges|g|~cgmehnes~bohne|n

T{m`nsgmebo

Nstncgbogyblm

Sn{pgcgm ln

\{bes`~sgme

Gelgcblm{ [B\

Tbrgeb 21ln 27



Amstg|bo

Sghme Kmogpb{


\[BES@^SGMEBONS

"

G

G

G C0lgfm BL\ ( T[ ( 336(44>

G

G/

\G

G Pn{sgme9 3

BOCBOG'!%m% HBWM[LN KMFM\BM(C%

|/?5/^]T

H% 8p: :+ : & g u h uGu(+?

1% [NFGS\[MS

BTMWM LGBFEMS\GCM W

\N[BTN^\GCM

SN[PGCGM LN \[BES@^SG0E

• [nfgs|{m \{bes`~sgmebo%

• Ge`m{hn ln [nbccgme \{bes`~sgmebo%

• Snf~ghgne|m b {nbccgmens \{bes`~sgmebons

• Ags|m{gb coègcb lno tbcgne|n%

• @m{hb|m tb{b no {ntm{|n ln obs {nbccgmens blpn{sbs b ob |{bes`~sgme

sbef~ènb {b|%

7% BENQMS

CB\NFM[GBS LN [NBCCGMENS \[BES@^SGMEBONS

CB\NFM[gB G SGFEMS g SgE\MHBS({(GCB^SBST[MKBKONS

CB\NFM[GB

2 ONPN

[nbccgmens c~|benbs | T g|• G {~e 4

omcbogyblbs9 G^{|gcb{gb

G Agtn{snesgkgoglbl !Gnpn'

G

CB\NFM[GB

;

HMLN[BLB

Ne{mincghgne|m

^{|gcb{gb" Besgnlbl Gg Agtn{snesgkgoglbl

G T{~{g|m / !hmln{blb ( snpn{b'

G Tbotg|bcgmens " [nbccgmens |{bes`~sgmebons

" Mgsenb onpn G `nk{gons em anhmg |gcbs%Cbesbecgm G Cn`bonb G Tmsgkon cme|b{egebcgme cme

\br~gcb{lgb & GG G tg{mrnems 4 kbc|n{gbs%

Nscbom`{gms

@gnk{n

CB\NFM[GB

3

SNPN[B

Nscbom`{oms g G

g @gnk{n G gG Cbesbecgm G¶ G

G

G Agtm|nesgme9 lgshge~cg0e g G5 ;4. ne t{nsgme b{|n{gbo g Besgnlbl % An

|hmo gsgs G

% |c {gL G|& % G¶ Ge {bpbsc~ b{%% SGS mocb% " 4 m{ m{bqocm Cme|bhgebcg kbc|n{gbeb

GG \br~gcb{lgb9 b~hne|m G Lmom{ cn{cb lno G á

ebhj|e=c|o=e

;4. ` % g \ l % ` % / G W S mc snt GCM%G 5 l& 4 {nc~necgb " SMo4

2

n Ge {~s|me G Agtn{pmonhgb%

Gcb{ gbcb% 2 4m{ o~hkb{ G B `&o %A G kg % ! % C ` G & eb Gbqgbnhmf 4 {e~eb meeb g n b nb " G %% G % l

i {mib' 9 Lgsenb &G & |eI~eb` tu h\me[bB{Obomc{b b b

G S l tm{+ G {bes ~sgme%g bef{b 4 hnbs/ g

2 an{glbs ln cb~sb " G

G genqtogcblb !CGL' G G

G Mg gc~o|bl [nstg{b|m{gb

bf~lb

ADT-PR-337-005 Manejo de Reacciones Transfusionales

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Transcript of ADT-PR-337-005 Manejo de Reacciones Transfusionales