Letter to the Editor
Blood transfusion during haemodialysis improves systemic tissue oxygenation: A case report
La transfusión de sangre durante la hemodiálisis mejora la oxigenación sistémica del tejido: un reporte de un caso
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array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Susumu" "apellidos" => "Ookawara" "email" => array:1 [ 0 => "su-ooka@hb.tp1.jp" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Yuichiro" "apellidos" => "Ueda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Takayuki" "apellidos" => "Uchida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Masaya" "apellidos" => "Kofuji" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Hideyuki" "apellidos" => "Hayasaka" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Taro" "apellidos" => "Hoshino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Kaoru" "apellidos" => "Tabei" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 8 => array:3 [ "nombre" => "Yoshiyuki" "apellidos" => "Morishita" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Minami-Uonuma City Hospital, Niigata, Japan" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La transfusión de sangre durante la hemodiálisis mejora la oxigenación sistémica del tejido: un reporte de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1479 "Ancho" => 1666 "Tamanyo" => 172219 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Changes in regional oxygen saturation (rSO<span class="elsevierStyleInf">2</span>) of the forehead (A), liver (B), and lower leg (C) as per the oxygenation values of cerebral, hepatic, and muscle tissue, respectively, under hemodialysis (HD) with or without blood transfusion. rSO<span class="elsevierStyleInf">2</span> ratio is defined as the ratio of rSO<span class="elsevierStyleInf">2</span> value at <span class="elsevierStyleItalic">t</span> (min) during HD and the initial rSO<span class="elsevierStyleInf">2</span> value before HD (rSO<span class="elsevierStyleInf">2</span> at <span class="elsevierStyleItalic">t</span> (min) during HD/initial rSO<span class="elsevierStyleInf">2</span> before HD).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tissue oxygenation is maintained through various mechanisms, including blood pressure, circulating blood volume, and hemoglobin (Hb) concentration. In particular, Hb itself is considered an important factor because of its oxygen transportation function to systemic organs. Therefore, it is evident that oxygen supply would decrease in a severe anemic state.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Recent reports have demonstrated the measurement of regional oxygen saturation (rSO<span class="elsevierStyleInf">2</span>), a real-time marker of tissue oxygenation using near-infrared spectroscopy (NIRS).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> Measurement of rSO<span class="elsevierStyleInf">2</span> by using NIRS is a straightforward non-invasive procedure, which can be performed continuously. Nevertheless, only a few studies have investigated the association between systemic tissue oxygenation and the increase in Hb levels after blood transfusion in hemodialysis (HD) patients. In the current case study, we were able to monitor changes in the rSO<span class="elsevierStyleInf">2</span> of brain, liver, and lower-limb muscles during HD with and without blood transfusion.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 79-year-old woman undergoing HD was admitted to our hospital with acute obstructive suppurative cholangitis. Upon admission, we administered intravenous antibiotics and performed endoscopic biliary drainage, which resulted in a gradual improvement of her symptoms. Her anemia had been previously managed with an erythropoietin-beta (3000<span class="elsevierStyleHsp" style=""></span>IU/session, 3 times/week); however, her Hb levels decreased to 6.8<span class="elsevierStyleHsp" style=""></span>g/dL. Therefore, blood transfusion during HD was performed. She provided written informed consent to participate in monitoring of her systemic rSO<span class="elsevierStyleInf">2</span> during HD with or without blood transfusion. The rSO<span class="elsevierStyleInf">2</span> levels were monitored at the forehead, right hypochondriac region above the liver, and lower leg above the gastrocnemii muscles by using the INVOS 5100c (Covidien Japan). She received a transfusion of 560<span class="elsevierStyleHsp" style=""></span>mL of concentrated red blood cells during HD and her Hb levels increased from 6.8 to 10.0<span class="elsevierStyleHsp" style=""></span>g/dL after HD (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Furthermore, we compared the time course of rSO<span class="elsevierStyleInf">2</span> ratio in each organ, with and without blood transfusion. The rSO<span class="elsevierStyleInf">2</span> ratio was defined as the ratio of rSO<span class="elsevierStyleInf">2</span> values at <span class="elsevierStyleItalic">t</span> (min) during HD and initial rSO<span class="elsevierStyleInf">2</span> value before HD. As shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, the changes in rSO<span class="elsevierStyleInf">2</span> ratio during HD without blood transfusion were modest in each organ, whereas the rSO<span class="elsevierStyleInf">2</span> ratio at each organ increased with blood transfusion, particularly in cerebral and hepatic regions.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In the world including United States, Europe, and Japan in around 1990, the use of erythropoiesis stimulating agents (ESA) in clinical settings was approved, which dramatically improved the Hb levels in patients with HD. However, even in the present day, blood transfusion during HD is still necessary for improving Hb levels in HD patients with severe anemia. Indeed, in comparison of blood transfusion frequency between ESA responsive and hyporesponsive HD patients, hyporesponsive patients had approximately 5 to 7-fold higher burden of blood transfusion than those with responsiveness.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> In addition, changes in systemic oxygenation induced by blood transfusion during HD have not been investigated extensively.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The brain has an auto-regulatory mechanism to maintain cerebral oxygenation. In HD patients, normalization of hematocrit by ESA did not increase cerebral oxygenation.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Moreover, cerebral oxygenation in these patients was well-maintained when compared to pre-dialysis patients,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and cerebral rSO<span class="elsevierStyleInf">2</span> values did not change by ultrafiltration under well-managed Hb levels.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> In the present case, rSO<span class="elsevierStyleInf">2</span> values did not change in any organ during HD without blood transfusion, which is similar to a previous report.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> On the other hand, each rSO<span class="elsevierStyleInf">2</span> values improved with an increase in Hb levels after blood transfusion. Particularly in the brain, oxygen supply decreases in patients with severe anemia<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>; furthermore, acute anemia by phlebotomy induces the deterioration of intracellular oxygen reactions in mice.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Thus, presence of severe anemia may lead to a decrease in cerebral oxygenation despite the auto-regulatory mechanism of the brain. Therefore, the improvement of cerebral oxygenation after blood transfusion could be explained by the increase of oxygen-carrying capacity, which is associated with the increase in Hb levels.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Regarding the changes in rSO<span class="elsevierStyleInf">2</span> of each organ after blood transfusion, the improvement of lower-limb muscular rSO<span class="elsevierStyleInf">2</span> was relatively lower than that of cerebral and hepatic rSO<span class="elsevierStyleInf">2</span> even in this case without peripheral artery disease. In HD patients, the prevalence of subclinical peripheral artery disease reached around 20–25%,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and its presence may directly influence the lower-limb muscular rSO<span class="elsevierStyleInf">2</span> via a decrease in oxygen supply induced by the dysfunction of macro- and micro-circulation. Furthermore, the skeletal muscle index has been reported to be lower in HD patients than in healthy subjects.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Therefore, the changes in lower-limb muscular rSO<span class="elsevierStyleInf">2</span> value during HD might be influenced by the circulatory impairment and skeletal muscle weakness. However, the mechanism responsible for the differences in rSO<span class="elsevierStyleInf">2</span> improvement between different organs, induced by blood transfusion during HD, remains unclear and requires further investigation.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Our study suggests that blood transfusion during HD could be an effective method to improve tissue oxygenation, particularly cerebral and hepatic oxygenation in HD patients with severe anemia.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financing</span><p id="par0035" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest statement</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have declared that no conflict of interest exists.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financing" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest statement" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1479 "Ancho" => 1666 "Tamanyo" => 172219 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Changes in regional oxygen saturation (rSO<span class="elsevierStyleInf">2</span>) of the forehead (A), liver (B), and lower leg (C) as per the oxygenation values of cerebral, hepatic, and muscle tissue, respectively, under hemodialysis (HD) with or without blood transfusion. rSO<span class="elsevierStyleInf">2</span> ratio is defined as the ratio of rSO<span class="elsevierStyleInf">2</span> value at <span class="elsevierStyleItalic">t</span> (min) during HD and the initial rSO<span class="elsevierStyleInf">2</span> value before HD (rSO<span class="elsevierStyleInf">2</span> at <span class="elsevierStyleItalic">t</span> (min) during HD/initial rSO<span class="elsevierStyleInf">2</span> before HD).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">BP, blood pressure; BUN, blood urea nitrogen; Cr, creatinine; Hb, hemoglobin; HD, hemodialysis.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">HD without blood transfusion \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">HD with blood transfusion \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Body weight, kg</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Before \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>After \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">BP, mmHg</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Before \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">147/71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">118/93 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>After \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">149/74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">173/75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Pulse, beats/min</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Before \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>After \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Hb, g/dL</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Before \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>After \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">BUN, mg/dL</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Before \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>After \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Cr, mg/dL</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Before \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>After \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Albumin, g/dL</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Before \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>After \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1476026.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Vital signs and laboratory findings under HD with or without blood transfusion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cerebral blood flow and vasodilatory capacity in anemia secondary to chronic renal failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 14 | 8 | 22 |
| 2024 Octubre | 47 | 38 | 85 |
| 2024 Septiembre | 65 | 26 | 91 |
| 2024 Agosto | 95 | 70 | 165 |
| 2024 Julio | 53 | 22 | 75 |
| 2024 Junio | 97 | 48 | 145 |
| 2024 Mayo | 89 | 46 | 135 |
| 2024 Abril | 70 | 41 | 111 |
| 2024 Marzo | 48 | 33 | 81 |
| 2024 Febrero | 46 | 36 | 82 |
| 2024 Enero | 42 | 25 | 67 |
| 2023 Diciembre | 37 | 27 | 64 |
| 2023 Noviembre | 59 | 40 | 99 |
| 2023 Octubre | 57 | 37 | 94 |
| 2023 Septiembre | 44 | 30 | 74 |
| 2023 Agosto | 46 | 30 | 76 |
| 2023 Julio | 46 | 22 | 68 |
| 2023 Junio | 42 | 26 | 68 |
| 2023 Mayo | 47 | 33 | 80 |
| 2023 Abril | 49 | 20 | 69 |
| 2023 Marzo | 58 | 28 | 86 |
| 2023 Febrero | 44 | 24 | 68 |
| 2023 Enero | 45 | 31 | 76 |
| 2022 Diciembre | 78 | 46 | 124 |
| 2022 Noviembre | 76 | 52 | 128 |
| 2022 Octubre | 84 | 70 | 154 |
| 2022 Septiembre | 61 | 43 | 104 |
| 2022 Agosto | 71 | 47 | 118 |
| 2022 Julio | 62 | 52 | 114 |
| 2022 Junio | 63 | 45 | 108 |
| 2022 Mayo | 52 | 47 | 99 |
| 2022 Abril | 105 | 66 | 171 |
| 2022 Marzo | 113 | 55 | 168 |
| 2022 Febrero | 109 | 52 | 161 |
| 2022 Enero | 79 | 45 | 124 |
| 2021 Diciembre | 68 | 40 | 108 |
| 2021 Noviembre | 65 | 54 | 119 |
| 2021 Octubre | 72 | 55 | 127 |
| 2021 Septiembre | 79 | 43 | 122 |
| 2021 Agosto | 68 | 50 | 118 |
| 2021 Julio | 64 | 47 | 111 |
| 2021 Junio | 60 | 39 | 99 |
| 2021 Mayo | 132 | 69 | 201 |
| 2021 Abril | 272 | 90 | 362 |
| 2021 Marzo | 71 | 45 | 116 |
| 2021 Febrero | 70 | 26 | 96 |
| 2021 Enero | 52 | 34 | 86 |
| 2020 Diciembre | 44 | 26 | 70 |
| 2020 Noviembre | 36 | 18 | 54 |
| 2020 Octubre | 39 | 34 | 73 |
| 2020 Septiembre | 52 | 23 | 75 |
| 2020 Agosto | 41 | 33 | 74 |
| 2020 Julio | 84 | 16 | 100 |
| 2020 Junio | 106 | 37 | 143 |
| 2020 Mayo | 118 | 29 | 147 |
| 2020 Abril | 135 | 21 | 156 |
| 2020 Marzo | 106 | 28 | 134 |
| 2020 Febrero | 87 | 28 | 115 |
| 2020 Enero | 58 | 21 | 79 |
| 2019 Diciembre | 40 | 29 | 69 |
| 2019 Noviembre | 77 | 27 | 104 |
| 2019 Octubre | 113 | 16 | 129 |
| 2019 Septiembre | 115 | 26 | 141 |
| 2019 Agosto | 98 | 20 | 118 |
| 2019 Julio | 119 | 24 | 143 |
| 2019 Junio | 105 | 36 | 141 |
| 2019 Mayo | 92 | 25 | 117 |
| 2019 Abril | 134 | 41 | 175 |
| 2019 Marzo | 111 | 36 | 147 |
| 2019 Febrero | 81 | 26 | 107 |
| 2019 Enero | 87 | 30 | 117 |
| 2018 Diciembre | 213 | 51 | 264 |
| 2018 Noviembre | 362 | 29 | 391 |
| 2018 Octubre | 233 | 15 | 248 |
| 2018 Septiembre | 150 | 32 | 182 |
| 2018 Agosto | 75 | 19 | 94 |
| 2018 Julio | 82 | 15 | 97 |
| 2018 Junio | 86 | 15 | 101 |
| 2018 Mayo | 107 | 18 | 125 |
| 2018 Abril | 187 | 9 | 196 |
| 2018 Marzo | 175 | 13 | 188 |
| 2018 Febrero | 168 | 5 | 173 |
| 2018 Enero | 104 | 15 | 119 |
| 2017 Diciembre | 159 | 12 | 171 |
| 2017 Noviembre | 77 | 22 | 99 |
| 2017 Octubre | 56 | 11 | 67 |
| 2017 Septiembre | 78 | 12 | 90 |
| 2017 Agosto | 107 | 13 | 120 |
| 2017 Julio | 30 | 8 | 38 |
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