Letter to the Editor
Hemolysis, hyperkalemia and the transfusion of packed old red blood cells in critically ill patients
Hemólisis, hipercalemia y transfusión de concentrados de hematíes viejos en pacientes críticos
a Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain
b Instituto Aragonés de Ciencias de la Salud (IACS), Spain
c Grupo de Trabajo de la SETS «Hemoterapia basada en el sentido común», Spain
d Grupo idiPaz de Investigación en PBM, Spain
e Departamento de Medicina, Universidad Autónoma, Madrid, Spain
f Servicio Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain
g Grupo de Trabajo de Hemoderivados, SEMICYUC, Spain
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García Erce, M. Quintana Díaz" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J.A." "apellidos" => "García Erce" "email" => array:2 [ 0 => "jagarciaerce@gmail.com" 1 => "joseerce@ono.com" ] "referencia" => array:5 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 4 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Quintana Díaz" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto Aragonés de Ciencias de la Salud (IACS), Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Grupo de Trabajo de la SETS «Hemoterapia basada en el sentido común», Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Grupo idiPaz de Investigación en PBM, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Medicina, Universidad Autónoma, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Grupo de Trabajo de Hemoderivados, SEMICYUC, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemólisis, hipercalemia y transfusión de concentrados de hematíes viejos en pacientes críticos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with great interest Chacón-Alves et al.’s work<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> on post-transfusion hemolysis in anemic critically ill patients who are stable at 72<span class="elsevierStyleHsp" style=""></span>h. We wish to congratulate the authors for their new approach. We share with the authors their worry on the effectiveness and safety of allogeneic blood transfusion (ABT) that should be administered not for the management of anemia, but <span class="elsevierStyleItalic">“to transfuse the minimal necessary amount to reverse the symptoms and signs of hypoxia or reach safe concentrations of hemoglobin (Hb) based on the clinical characteristics of each patient at a given time”</span>.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> The ABT is a transient measure, and we should not just treat one analytical number, because we could end up having the same need if we don’t treat the cause. We propose a change toward the paradigm of “optimal or adequate use”.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Above all, when it comes to the methodology used and results from their work, we would like to know whether they considered several risk factors associated with the ABT of packed red blood cell (PRBC) concentrates. Has the age of the PRBC concentrate been registered? The age has been related with a lower viability of erythrocytes. In some countries and several Spanish autonomous communities, the expiration date of PRBC has been dropped to 35 days, and attempts have been made to make it go further down to 28–31 days only. Also, the age of the PRBC concentrate has been associated with a higher risk of hyperkalemia, the appearance of post-transfusion cardiovascular events,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,4</span></a> and respiratory distress. Have the levels of post-transfusion potassium been estimated? Was the higher or lower compatibility of the PRBC administered, or the presence of irregular antibodies ever analyzed?</p><p id="par0015" class="elsevierStylePara elsevierViewall">Similarly, we would like to know if the effectiveness of transfusion could be confirmed: if the increase of transfusion Hb observed was the same or higher than expected. Also, we would like to know if the volume and content of Hb of the PRBC concentrate administered and their association with the increase of post-transfusion Hb and degree of hemolysis found were analyzed; also, if this increase was adjusted to the patient's weight and volemia. Also, it would be interesting to know how many patients eventually needed a second PRBC concentrate. The administration of one single PRBC concentrate can be a valid option.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Besides, taking into consideration the recommendations established by the American Association of Blood Banks (AABB),<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> and the Blood Products Working Party (BPWP)<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6,7</span></a> (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>), of reducing or minimizing unnecessary blood transfusions—to avoid “vampirism”, and conducting them early in the morning, we would like to know whether there were any differences compared to the concentration of Hb the next day.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Finally, we would like to know whether the transfusion protocol included the administration of pre-medication, and whether this medication was administered to all patients or just a selected few, and whether some post-transfusion diuretic was administered as well. If so, we would like to know if these medications administered were in the results found.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We don’t want to bid farewell without reiterating our congratulations and commitment to collaborate conducing one multicenter study.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García Erce JA, Quintana Díaz M. Hemólisis, hipercalemia y transfusión de concentrados de hematíes viejos en pacientes críticos. Med Intensiva. 2018;42:261–262.</p>" ] ] "multimedia" => array:2 [ 0 => 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:1 [ "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">A) Project quality compromise agreed by the Spanish scientific societies</span> \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>1. The empirical antibiotic treatment initiated after hospital admission due to serious infection should not be continued without prior daily assessment of its convenience, and possible therapeutic de-escalation. \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>2. Blood tests should not be conducted routinely, out of the specific clinical indications. \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>3. No daily chest X-ray should be conducted at the ICU. \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>4. Isolation measures should not be maintained, established in patients with confirmed communicable disease during their stay at the ICU. The measures should go on for as long as the infectious disease, or colonization lasts. \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>5. Blood cell concentrates should not be transfused in non-bleeding critically ill patients who remain hemodynamically stable, who have no heart disease or central nervous system disease, and hemoglobin concentrations >7<span class="elsevierStyleHsp" style=""></span>g/dl. \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="elsevierStyleVsp" style="height:0.5px"></span> \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="elsevierStyleItalic">B) Strong recommendations by the Blood Products Working Party</span> \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>1. There is one transfusion threshold of specific blood cell concentrates specific for different populations of critically ill patients. \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>2. Avoid frozen fresh plasma transfusions in critically ill patients without active hemorrhages, despite the alterations present in the clotting times. \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>3. Consider one transfusion threshold of specific platelets for the different populations of critically ill patients. \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>4. Transfuse blood cell components “unit by unit” (especially blood cell concentrates) in patients without active hemorrhages. \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>5. Reverse the antivitamin K anticoagulants with prothrombin complex concentrates in life-threatening situations or urgent interventions. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737588.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Recommendations from the Spanish Society of Intensive, Critical and Coronary Unit Medical Care.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>: Callum et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1. Don’t transfuse more units of blood than absolutely necessary. \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">2. Don’t transfuse red blood cells for iron deficiency without hemodynamic instability. \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">3. Don’t routinely use blood products to reverse warfarin. \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">4. Don’t perform serial blood counts on clinically stable patients. \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">5. Don’t transfuse O negative blood except to O negative patients and in emergencies for women of child bearing potential with unknown blood group. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737589.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Do-not-do recommendations from the American Association of Blood Banks (AABB).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemólisis tras la transfusión de concentrados de hematíes en pacientes con trauma grave" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Chacón-Alves" 1 => "M. Chico-Fernández" 2 => "C. García-Fuentes" 3 => "L. Umezawa-Makikado" 4 => "E. Alted-López" 5 => "J.C. Montejo-González" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2016.01.004" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2016" "volumen" => "40" "paginaInicial" => "455" "paginaFinal" => "456" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26947526" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Forum for debate: safety of allogeneic blood transfusion alternatives in the surgical/critically ill patient" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Muñoz Gómez" 1 => "E. Bisbe Vives" 2 => "M. Basora Macaya" 3 => "J.A. García Erce" 4 => "A. Gómez Luque" 5 => "S.R. Leal-Noval" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2015.05.006" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2015" "volumen" => "39" "paginaInicial" => "552" "paginaFinal" => "562" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26183121" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective study on red blood cell transfusion related hyperkalemia in critically ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Raza" 1 => "M. Ali Baig" 2 => "C. Chang" 3 => "R. Dabas" 4 => "M. Akhtar" 5 => "A. Khan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.14740/jocmr2123w" "Revista" => array:6 [ "tituloSerie" => "J Clin Med Res" "fecha" => "2015" "volumen" => "7" "paginaInicial" => "417" "paginaFinal" => "421" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25883703" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac arrests associated with hyperkalemia during red blood cell transfusion: a case series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.M. Smith" 1 => "S.J. Farrow" 2 => "J.D. Ackerman" 3 => "J.R. Stubbs" 4 => "J. Sprung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ane.0b013e318164f03d" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2008" "volumen" => "106" "paginaInicial" => "1062" "paginaFinal" => "1069" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18349174" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The AABB recommendations for the Choosing Wisely campaign of the American Board of Internal Medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.L. Callum" 1 => "J.H. Waters" 2 => "B.H. Shaz" 3 => "S.R. Sloan" 4 => "M.F. Murphy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/trf.12802" "Revista" => array:6 [ "tituloSerie" => "Transfusion" "fecha" => "2014" "volumen" => "54" "paginaInicial" => "2344" "paginaFinal" => "2352" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25100209" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Recomendaciones de la Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias. Proyecto Compromiso por la calidad de las sociedades científicas en España. Available from: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.msc.es/organizacion/sns/planCalidadSNS/pdf/SOCIEDAD%20ESP%20MIC%20UNIDCORONARIAS%200K.pdf">http://www.msc.es/organizacion/sns/planCalidadSNS/pdf/SOCIEDAD ESP MIC UNIDCORONARIAS 0K.pdf</a> [accessed September 2016]" ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Recomendaciones de interés elevado del Grupo de Trabajo de Transfusiones y Hemoderivados de la Sociedad Española se Medicina Intensiva Crítica y Unidades Coronarias. Availble from: <a id="intr0015" class="elsevierStyleInterRef" href="http://www.semicyuc.org/sites/default/files/p%20indiv%20gt.pdf">http://www.semicyuc.org/sites/default/files/p indiv gt.pdf</a> [accessed September 2016]." ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack345246" "titulo" => "Acknowledgement" "texto" => "<p id="par0035" class="elsevierStylePara elsevierViewall">We wish to thank the transfusion centers that provide us with the best and most fresh blood components.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004200000004/v1_201805050438/S2173572718300626/v1_201805050438/en/main.assets" "Apartado" => array:4 [ "identificador" => "64268" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004200000004/v1_201805050438/S2173572718300626/v1_201805050438/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718300626?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 72 | 27 | 99 |
| 2024 September | 83 | 38 | 121 |
| 2024 August | 135 | 61 | 196 |
| 2024 July | 132 | 34 | 166 |
| 2024 June | 140 | 56 | 196 |
| 2024 May | 73 | 36 | 109 |
| 2024 April | 74 | 44 | 118 |
| 2024 March | 71 | 30 | 101 |
| 2024 February | 67 | 35 | 102 |
| 2024 January | 82 | 35 | 117 |
| 2023 December | 111 | 34 | 145 |
| 2023 November | 122 | 33 | 155 |
| 2023 October | 100 | 37 | 137 |
| 2023 September | 90 | 39 | 129 |
| 2023 August | 86 | 11 | 97 |
| 2023 July | 70 | 23 | 93 |
| 2023 June | 74 | 16 | 90 |
| 2023 May | 68 | 30 | 98 |
| 2023 April | 61 | 19 | 80 |
| 2023 March | 95 | 35 | 130 |
| 2023 February | 119 | 44 | 163 |
| 2023 January | 87 | 18 | 105 |
| 2022 December | 107 | 56 | 163 |
| 2022 November | 97 | 40 | 137 |
| 2022 October | 79 | 33 | 112 |
| 2022 September | 64 | 27 | 91 |
| 2022 August | 69 | 42 | 111 |
| 2022 July | 50 | 35 | 85 |
| 2022 June | 51 | 24 | 75 |
| 2022 May | 65 | 43 | 108 |
| 2022 April | 51 | 38 | 89 |
| 2022 March | 88 | 47 | 135 |
| 2022 February | 70 | 33 | 103 |
| 2022 January | 76 | 41 | 117 |
| 2021 December | 82 | 47 | 129 |
| 2021 November | 88 | 41 | 129 |
| 2021 October | 113 | 75 | 188 |
| 2021 September | 93 | 41 | 134 |
| 2021 August | 87 | 45 | 132 |
| 2021 July | 61 | 30 | 91 |
| 2021 June | 75 | 24 | 99 |
| 2021 May | 85 | 53 | 138 |
| 2021 April | 274 | 101 | 375 |
| 2021 March | 173 | 24 | 197 |
| 2021 February | 116 | 38 | 154 |
| 2021 January | 117 | 32 | 149 |
| 2020 December | 112 | 26 | 138 |
| 2020 November | 117 | 22 | 139 |
| 2020 October | 87 | 44 | 131 |
| 2020 September | 90 | 23 | 113 |
| 2020 August | 65 | 19 | 84 |
| 2020 July | 49 | 21 | 70 |
| 2020 June | 62 | 21 | 83 |
| 2020 May | 64 | 19 | 83 |
| 2020 April | 93 | 21 | 114 |
| 2020 March | 35 | 12 | 47 |
| 2020 February | 216 | 35 | 251 |
| 2020 January | 69 | 28 | 97 |
| 2019 December | 57 | 17 | 74 |
| 2019 November | 112 | 30 | 142 |
| 2019 October | 63 | 16 | 79 |
| 2019 September | 37 | 18 | 55 |
| 2019 August | 45 | 17 | 62 |
| 2019 July | 39 | 22 | 61 |
| 2019 June | 22 | 11 | 33 |
| 2019 May | 53 | 26 | 79 |
| 2019 April | 19 | 11 | 30 |
| 2019 March | 23 | 21 | 44 |
| 2019 February | 22 | 29 | 51 |
| 2019 January | 28 | 23 | 51 |
| 2018 December | 44 | 19 | 63 |
| 2018 November | 33 | 49 | 82 |
| 2018 October | 30 | 22 | 52 |
| 2018 June | 0 | 1 | 1 |
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