We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
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The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Anticoagulants are the treatment of choice for venous thromboembolic disease. They are also used in patients with a heart arrhythmia or heart condition that predisposes them to having a systemic embolism (formation of a clot or thrombus that travels from the heart to any blood vessel in the body) or from the heart to the veins in the brain causing a stroke.
Anticoagulants are medication that modify blood clotting so that a thrombus or clot does not form inside the blood vessels. The main effect is to slow the blood’s clotting time.
There are different types of anticoagulants: injectable or oral.
Low molecular weight or unfractionated heparin. Should be started at therapeutic doses as soon as thrombosis is suspected, even before the diagnosis is confirmed, or as prophylaxis (prevention), at prophylactic doses, when the person has one or more risk factors that could trigger a venous thromboembolism (such as hip or knee replacement surgery). They are administered at fixed doses according to the patient’s weight, the type of thrombosis being treated or risk factor being controlled.
They are used as maintenance therapy when oral anticoagulants are contraindicated (e.g. pregnancy) or have been ineffective.
They are used as maintenance treatment (longer use) and are given on confirmation of the diagnosis of deep vein thrombosis or pulmonary embolism. There are two types of oral anticoagulants: vitamin K antagonists and direct-acting.
The anticoagulant treatment is controlled with blood tests or capillary blood tests (by pricking the patient's finger). Monitoring of patients on anticoagulant treatment is done by haematology and haemotherapy specialists.
Hematopoietic Stem Cell Transplant (HPSCT) is the definitive treatment for many primary immunodeficiency disorders (PID). It is a total replacement of the blood cells in our body. It is also called a bone marrow transplant (BMT).
The aim of this treatment is to regenerate a haematopoiesis (the process by which the different types of blood cells form, mature, and circulate from stem cells), which has been eliminated by administering drugs or ionizing radiation, followed by the implantation of the donor's immune system, which is able to recognise and attack the malignant cells in the patient.
In this way, the bone marrow stem cells (factory of the defences) are changed for those of a healthy person (the donor). To undergo this process the patient is admitted to hospital for between one and three months.
1st step:
2nd step:
3rd step:
Bone marrow donation has several features that differ from conventional blood donation, given that it involves obtaining the stem cells (haematopoietic progenitors) that give rise to the several types of cells in circulating blood, and which will allow the recipient’s bone marrow to be repopulated.
Haematopoietic progenitors can be donated in two ways:
Together with haemodialysis, peritoneal dialysis is an extra-renal filtration procedure. Kidney failure is treated with dialysis, a word that means “pass through”, and which uses the patient’s peritoneum as a filter. The peritoneum is the membrane that lines the abdominal cavity and it has a large surface area of around one square metre. This peritoneal membrane can filter out substances that need to be removed from the body (urea, potassium, phosphorus and many others) when filled with a glucose-rich dialysis fluid that encourages waste to be passed from the patient’s blood into it.
The procedure is as follows: a catheter is inserted into the navel for introducing the dialysis fluid. This fluid is left in the peritoneal cavity for some time and then exchanged for new fluid. This is repeated several times.
Peritoneal dialysis can be performed at the patient’s home and also at night, which is an important factor to maintain the patient's quality of life.
Possible complications of peritoneal dialysis are peritonitis or infection of the dialysis fluid which can lead to infection and inflammation of the peritoneum. Treatment with antibiotics is effective for this complication.
Haemodialysis is usually considered to an intermediary step between advanced kidney failure and a kidney transplant.
Haemodialysis is an extra-renal filtration procedure that replaces kidney function using an external system. It acts as a filter for the patient's blood by connecting to the patient’s circulatory system via a catheter or by being directly inserted into the vein, usually in the arm. In other cases, an arteriovenous fistula may be created, connecting an artery to a vein beneath the skin on the arm. When an artery is connected to a vein, pressure in the vein increases, strengthening the vein walls. This stronger vein is able to withstand the needles used in haemodialysis and greater blood flow is achieved.
People with kidney failure starting a haemodialysis programme typically have less than 10% of normal kidney function. Above this figure, haemodialysis is usually not necessary.
Haemodialysis must be performed regularly in four-hour sessions, usually three times a week, although the duration and frequency will depend on the patient and their circumstances.
Haemodialysis is based on biophysics in the sense that the blood passes through a filter and exchanges substances with the fluid on the other side of the filter, which is circulated by a machine. The exchange gets rids of the urea, potassium, phosphorus and other waste substances that build up due to lack of kidney function. These substances partly pass through the membrane by themselves, as there are different concentrations of the substances and they tend to equalise, and is also due to the changes in pressure exerted by the haemodialysis machine.
Possible complications of haemodialysis are the infection of the catheter or being unable to find a viable vascular access site in patients who have had dialysis for many years.
Haemodialysis may continue for years, although it is usually an intermediate step between kidney failure and transplant.
A kidney transplant is the best treatment for chronic kidney failure and significantly improves the quality of life for patients with a lack of kidney function and who need haemodialysis or peritoneal dialysis. Nowadays this is a routine procedure, which is not risk-free but which does allow patients subsequently to lead a normal, or close to normal, life. The transplant process consists of surgery to connect the renal artery and vein and also the ureter of the transplanted kidney to the recipient's bladder.Following a few hours in the Intensive Care Department for monitoring, the patient will be transferred to the nephrology ward and will remain there for a few days before progressively resuming their normal life.
It is very important to consider that people who receive a kidney transplant will have to take medication for the rest of their lives to ensure the body does not reject the transplanted organ. Regular appointments to monitor the functioning of the transplanted kidney and the levels in the blood of medication used to control rejection are also necessary. The medication used partly reduces the body’s defences and can allow opportunistic infections and neoplastic diseases to occur. Strict monitoring of immunosuppression levels must therefore be carried out at all times. A kidney biopsy may be necessary at different stages of the kidney transplant’s evolution in order to determine the condition of the organ, as blood tests only give an indirect indication. The life expectancy of patients who have had a kidney transplant may be similar to that of the general population, but other factors mentioned must be taken into account in addition to cardiovascular health such as weight, blood sugar levels and lipids in the blood in addition to arterial pressure.
Performing a kidney transplant requires careful preparation once the patient is experiencing kidney failure. A kidney donor must be found. This may be a living donor or a kidney from a deceased person. Outcomes are very good in both instances, and the choice of which to use depends on the personal situation of each patient. For example, a kidney from a living donor would be chosen if someone volunteers to donate and if compatibility tests carried out before the transplant are positive. If there is no donor, a kidney from a deceased donor will be considered, providing the compatibility tests are positive.
Diagnostic tests related to kidney transplant include the assessment performed before it is carried out. These are general assessments of the recipient's health to ensure they will be able to recovery from the surgery without any issues and also immunology tests to minimise the risk of organ rejection. Tests to prepare for the transplant include imaging tests (ultrasound and CT scan) to determine the implantation area, compatibility tests, and subsequent follow-up tests for monitoring (ultrasounds and blood tests).
To ensure the success of a transplant, in other words, good initial function that lasts over time:
Over 500 transplants are carried out in Catalonia every year, with very good transplanted kidney survival rates. However, this is variable and cannot be predicted in each case. As advances in knowledge and technology are made, we are increasingly able to accurately monitor and control transplanted kidneys to lengthen their lifespan.
Biotechnology and translational research (which creates a network of different biomedical specialisations) will be able to make important advances over the coming years. The success of kidney transplants nowadays is largely down to the precise nature of the medication used to prevent rejection.
Although there is no treatment to cure chronic fatigue syndrome, a multidisciplinary therapeutic approach can help to improve patients’ quality of life. The aim is to reduce the symptoms of the condition and the chronic problems associated with it in order to overcome possible limitation in daily life.
A multidisciplinary therapeutic approach for patients with CFS should be based on four key elements:
There are four basic parts to treating renal insufficiency.
Controlling arterial pressure, if it is high; levels of urea; the balance of mineral salts (sodium, potassium, calcium, phosphorus, magnesium); acidity and anaemia. Analytical testing provides a lot of information which enables the origin and severity of the kidney disease to be established.
A kidney biopsy allows a microscopic study that is often essential. Genetic testing also provides very important information.
There are three different levels of treatment:
a) medical, with the use of medication or hormones to substitute the alterations mentioned. A diet that creates little urea or that contains low levels of potassium, drugs to control excess or lack of sodium, potassium, calcium, phosphorus, magnesium or acidity. And medication to treat anaemia.
b) extrarenal purification methods: haemodialysis (passing the blood through an external circuit to purify it and filter out toxic substances using a suitable filter), and peritoneal dialysis, during which a solution is circulated inside the patient's peritoneal cavity and is then extracted, taking the toxic substances usually expelled through urine with it.
c) kidney transplant from a living or deceased donor. In this instance, the new kidney takes over the functions of the diseased kidney. How long a kidney graft lasts varies and relies on controlling episodes of organ rejection that may occur after transplant. A young patient with kidney insufficiency may require more than one kidney transplant over their lifetime, although the useful life of these grafts is increasing day by day thanks to new immunosuppressant drugs.
Most strokes occur when the clots pass through a blood vessel or block blood flow in this area, which is called an ischemic stroke.
The treatment for strokes takes several forms, mainly surgical and pharmacological.
Drug therapy aims to dissolve clots obstructing circulation as quickly as possible by using drugs called thrombolytics.
If administered within 3 hours of the onset of the first symptoms, thrombolytics allow us to limit the damage and disability caused by a stroke.
Before administering this treatment, we must:
The drug dissolves the clot that prevents blood circulation in the affected brain area.
The most common risk is cerebral haemorrhage.
Although a migraine cannot be cured, proper treatment can alleviate pain and prevent future occurrences.
Migraines can be alleviated with:
In the first group, there are anti-inflammatory drugs and triptans. Preventive treatment is indicated when migraines are very common or do not respond adequately to symptomatic treatment.
The choice between symptomatic and preventative treatment must be taken by a doctor. It is very important to avoid self-medication, to prevent the onset of chronic daily headaches, which is triggered by abuse of analgesic medication. Prescription-free drugs that are used frequently or in large doses can cause other problems.
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