Ferric carboxymaltose (FCM) can be used in Patient Blood Management (PBM) to promote the optimization of preoperative haemoglobin (Hb), which aims to minimise the use of allogeneic blood components and improve clinical outcomes, with better cost-effectiveness. This was an observational study conducted in a retrospective and multicentre cohort with adults from elective orthopaedic, cardiac and colorectal surgeries, treated according to local standards of PBM with allogeneic blood product transfusions (ABTs) on demand and with FCM to correct iron deficiency with or without anaemia. In this work, only the first pillar of the PBM model issue by Directorate-General for Health (DGS) was evaluated, which involves optimising Hb in the preoperative period with iron treatment if it’s necessary/indicated. Before the implementation of PBM in Portugal, most patients did not undergo preoperative laboratory evaluation with blood count and iron kinetics. Therefore, the existence of Iron Deficiency Anaemia (IDA) or Iron Deficiency (ID) without anaemia was not early detected, and there was no possibility of treating these patients with iron in order to optimise their Hb and/or iron stores. Those patients ended up being treated with ABTs on demand. A total of 405 patients from seven hospitals were included; 108 (26.7%) underwent FCM preoperatively and 197 (48.6%) were transfused with ABTs on demand. In the FCM preoperative cohort, there was an increase in patients with normal preoperative Hb, from 14.4 to 45.7%, before and after FCM, respectively, a decrease from 31.7 to 9.6% in moderate anaemia and no cases of severe anaemia after FCM administration, while 7.7% of patients were severely anaemic before FCM treatment. There were significant differences (p < 0.001) before and after correction of preoperative anaemia and/or iron deficiency with FCM in Hb, serum ferritin and transferrin saturation rate (TS). In the ABT group, there were significant differences between pre- and postoperative Hb levels (p < 0.001). Hb values tended to decrease, with 44.1% of patients moving from mild anaemia before transfusion to moderate anaemia in the postoperative period. Concerning the length of hospital stay, the group administered with ABTs had a longer hospital stay (p < 0.001). Regarding the clinical outcomes of nosocomial infection and mortality, there was no evidence that the rate of infection or mortality differed in each group (p = 0.075 and p = 0.243, respectively). However, there were fewer nosocomial infections in the FCM group (11.9% versus 21.2%) and mortality was higher in the transfusion group (21.2% versus 4.2%). Economic analysis showed that FCM could reduce allogenic blood products consumption and the associated costs. The economic impact of using FCM was around 19%. The preoperative Hb value improved when FMC was used. Patients who received ABTs appeared to have a longer hospital stay. The FCM group reported fewer infections during hospitalisation. The economic results showed savings of around €1000 for each patient with FCM administration. The use of FCM as part of the PBM program had a positive impact on patients’ outcomes and on economic results. However, it will be essential to perform studies with a larger sample to obtain more robust and specific results.

RESUMO A epidemia de gripe pneumónica ocorreu em Portugal num momento em que o país enfrentava enormes dificuldades de natureza económica, política e sanitária. Chega a um país rural e pobre, envolvido na Grande Guerra de 1914-18, e que se debate com a carência de géneros e a carestia de vida, e com uma fortíssima crise social e política. Apesar de o país estar habituado a sucessivas epidemias, o carácter imprevisto e violento da pneumónica (estima-se que tenha provocado quase 140 mil mortos num país com cerca de 6 milhões de habitantes) fez com que a resposta dos agentes políticos e sanitários fosse marcada por factores ligados à conjuntura (crise económica, social e política) e de tipo estrutural (condições higiénicas e sanitárias deficientes, falta de meios em capital económico, de médicos e de medicamentos, impotência do conhecimento médico para debelar a epidemia). Palavras-chave Gripe pneumónica, autoridades de saúde pública, agentes políticos, PortugalABSTRACT The Spanish influenza epidemic occurred in Portugal when this country faced enormous economic, political and sanitary problems. The country was poor, living mainly from agriculture and was involved in the First World War. There were food shortages, a high cost of living, as well as a strong social and political crisis. Although people were used to deal with successive epidemic diseases, the sudden and violent character of the Spanish influenza took everybody by surprise. According to some estimation it killed about 140 thousand in a 6 million person's country. The answer of the political and sanitary agents was marked by contextual factors (the economic, social and political crisis) as well as by structural ones (very poor hygienic and sanitary conditions, lack of financial resources, of doctors and medicines, impotence of medical knowledge in dealing with the pandemic).

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Desde a década de 1720 que a administração ultramarina portuguesa produziu ordens régias com vista a recolher e organizar informações padronizadas sobre a população do império. Estes processos ganharam uma dimensão particular no Brasil, durante a segunda metade do século XVIII, mas foram transversais a quase todos os territórios (em África, no Índico e no Oriente), dando origem a um extenso corpus documental constituído por várias centenas de mapas estatísticos. Inspirando-se nos princípios da aritmética política e do fisiocratismo as elites políticas portuguesas entenderam a população como um recurso de Estado que se deveria calcular, regular e canalizar segundo as conveniências da Coroa. Este artigo pretende descrever os modelos de ordens e de mapas estatísticos, bem como a sua evolução. Na linha de autores pioneiros como Dauril Alden e Maria Luiza Marcílio defenderemos o seu enorme potencial no cálculo de estimativas demográficas para o período colonia

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