Navegando por Palavras-chave "neutropenia"
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- ItemSomente MetadadadosEpidemiology and risk factors for bloodstream infections after allogeneic hematopoietic stem cell transplantion(Edizioni Internazionali Srl, 2007-04-01) Cappellano, Paola [UNIFESP]; Viscoli, Claudio; Bruzzi, Paolo; Van Lint, Maria Teresa; Pereira, Carlos Alberto Pires [UNIFESP]; Bacigalupo, Andrea; Univ Genoa; Universidade Federal de São Paulo (UNIFESP)A total of 315 patients who underwent allogeneic Hematopoietic Stem Cell Transplantation (HSCT) during a 4year period were analysed with the aim of collecting information on bloodstream infections (BSI). Eighty-four patients (27%) developed 112 BSI, with a cumulative risk of 20.6% at 30 days and 27.7% at 180 days. Overall, 127 pathogens were isolated, 95 (75%) gram-positive cocci, 27 (21%) gram-negative rods and 5 (4%) fungi. Enterococcus sp. accounted for 46 of 127 (36%) isolates. In a multivariable analysis only including baseline factors, the type of transplant was the only factor significantly associated with the risk of BSI and the risk was higher for patients receiving transplant from mismatched or unrelated donors.In a case-control study aimed at evaluating the predictive role of additional factors during transplant, the risk appeared to be higher in patients with a positive CMV antigenemia (p=0.03; OR of 4.82; 95% CI, 1.21-19.17), long duration of severe granulocytopenia (p=0.015; OR 7.53; 95% CI, 1.92 - 29.58) and lower platelet count (p<0.001; OR 0.14; 95% CI, 0.05 - 0.40). By day 180 post-transplant, 87 (28%) out of 314 patients had died. The cumulative risk of death was significantly higher among patients with BSI than among other patients.
- ItemAcesso aberto (Open Access)Evaluation of ticarcillin/clavulanic acid versus ceftriaxone plus amikacin for fever and neutropenia in pediatric patients with leukemia and lymphoma(Brazilian Society of Infectious Diseases, 2003-04-01) Petrilli, Antonio Sergio [UNIFESP]; Cypriano, Monica [UNIFESP]; Dantas, Lenice Silva [UNIFESP]; Lee, Lúcia Martino [UNIFESP]; Luisi, Maria Flávio Augusto Vercillo [UNIFESP]; Silva, Katia Veronica Torres B. [UNIFESP]; Pereira, Carlos Alberto Pires [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: The empirical use of antibiotic treatments is widely accepted as a means to treat cancer patients in chemotherapy who have fever and neutropenia. Intravenous monotherapy, with broad spectrum antibiotics, of patients with a high risk of complications is a possible alternative. METHODS: We conducted a prospective open-label, randomized study of patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy. Patients received either monotherapy with ticarcillin/clavulanic acid (T) or ceftriaxone plus amikacin (C+A). RESULTS: Seventy patients who presented 136 episodes were evaluated, 68 in each arm of the study. The mean neutrophil counts at admission were 217cells/mm³ (T) and 201cells/mm³ (C+A). The mean duration of neutropenia was 8.7 days (T) and 7.6 days (C+A). Treatment was successful without the need for modifications in 71% of the episodes in the T group and 81% in the C+A group (p=0.23). Treatment was considered to have failed because of death in two episodes (3%) in the T group and three episodes (4%) in the C+A group, and because of a change in the drug applied in one episode in the T group and two episodes in the C+A group. Overall success was 96% (T) and 93% (C+A). Adverse events that occurred in group T were not related to the drugs used in this study. CONCLUSION: In pediatric and adolescent patients with leukemia or lymphoma, who presented with fever and neutropenia, during chemotherapy, ticarcillin/clavulanic acid was as successful as the combination of ceftriaxone plus amikacin. It should be considered an appropriate option for this group of patients at high risk for infections.
- ItemAcesso aberto (Open Access)Human neutrophil alloantigens systems(Academia Brasileira de Ciências, 2009-09-01) Moritz, Elyse [UNIFESP]; Norcia, Ângela M. M. I. [UNIFESP]; Cardone, José D. B. [UNIFESP]; Kuwano, Sachie T. [UNIFESP]; Chiba, Akemi Kuroda [UNIFESP]; Yamamoto, Mihoko [UNIFESP]; Bordin, Jose Orlando [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Neutrophil alloantigens are involved in a variety of clinical conditions including immune neutropenias, transfusion-related acute lung injury (TRALI), refractoriness to granulocyte transfusions and febrile transfusion reactions. In the last decade, considerable progress has been made in the characterization of the implicated antigens. Currently, seven antigens are assigned to five human neutrophil antigen (HNA) systems. The HNA-1a, HNA-1b and HNA-1c antigens have been identified as polymorphic forms of the neutrophil Fcγ receptor IIIb (CD16b), encoded by three alleles. Recently, the primary structure of the HNA-2a antigen was elucidated and the HNA-2a-bearing glycoprotein was identified as a member of the Ly-6/uPAR superfamily, which has been clustered as CD177. The HNA-3a antigen is located on a 70-95 kDa glycoprotein; however, its molecular basis is still unknown. Finally, the HNA-4a and HNA-5a antigens were found to be caused by single nucleotide mutations in the αM (CD11b) and αL (CD11a) subunits of the leucocyte adhesion molecules (β2 integrins). Molecular and biochemical characterization of neutrophil antigenshave expanded our diagnostic tools by the introduction of genotyping techniques and immunoassays for antibody identification. Further studies in the field of neutrophil immunology will facilitate the prevention and management of transfusion reactions and immune diseases caused by neutrophil antibodies.
- ItemAcesso aberto (Open Access)The meaning of neutropenia and homecare needs according to caregivers of children with cancer(Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo, 2009-12-01) Gelesson, Débora Duarte; Hiraishi, Liliane Yumi; Ribeiro, Letícia Alves; Pereira, Sônia Regina [UNIFESP]; Gutiérrez, Maria Gaby Rivero de [UNIFESP]; De Domenico, Edvane Birelo Lopes [UNIFESP]; Hospital e Maternidade Santa Marina; Universidade de São Paulo (USP); Grupo de Apoio ao Adolescente e à Criança com Câncer Instituto de Oncologia Pediátrica; Universidade Federal de São Paulo (UNIFESP)This study aimed to understand the meanings caregivers attributed to the process of caring for a neutropenic child at home and know their needs for orientation related to care for these children. This descriptive study was carried out at the Pediatric Oncology Institute through semi-structured interviews, involving eleven caregivers. Data were organized according to the content analysis technique and interpreted according to Social Representations theory. Results indicate changes in the physical environment, people and human relationships, evidencing crises and transition towards stability. The following care procedures raised doubts: hyperthermia, body, food and environmental hygiene, risks of interpersonal contact and special care. The conclusion is that caregivers need technical and emotional preparedness to cope with the reported difficulties, including aggravating situations.
- ItemSomente MetadadadosNeutropenia autoimune secundária em portadores de lupus eritematoso sistêmico(Universidade Federal de São Paulo (UNIFESP), 2013-01-30) Cruz, Lafayette Cavalcanti Bezerra Dias [UNIFESP]; Bordin, Jose Orlando Bordin [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Systemic Lupus Erythematosus (SLE) is a systemic inflammatory disease with multiple organ involvement. Hematological changes in the criteria reviewed include hemolytic anemia, leukopenia, lymphopenia and thrombocytopenia, and no report of neutropenia. It is understood that neutropenia in SLE may occur as a result of various etiologies, like medications, bone marrow dysfunction and autoimmune reaction. Objectives: 1) Identify, in SLE patients with neutropenia, the presence of neutrophilic autoantibodies. 2) Determine the population profile in this sample of patients. Patients and Methods: we determined the presence of neutrophilic autoantibodies in serum samples of 20 patients with SLE, selected by neutropenia <1600 cells/mm3, from the rheumatology clinic in HSP / UNIFESP. We used the immunofluorescence granulocyte (GIFT) technique by flow cytometry and fluorescence microscopy after isolation of mononuclear cells and granulocytes from blood cells by sedimentation to 5% Dextran, followed by centrifugation on Ficoll-Paque (d = 1.077, Pharmacia), with viability greater than 80% by reaction with Trypan Blue. Incubated with antiserum (anti-HNA1a,-1b, -1b, -2a, -3a e -4a, obtained from the American Red Cross, North Central Blood Services, St. Paul, MN). In a later step, we used granulocyte from male-blood group-AB volunteer donors with serum of patients in research, with the same prior technique, identifying autoantibodies. All patients also underwent collection of bone marrow, serum protein electrophoresis, immunoglobulin levels and serology for hepatitis B, hepatitis C, HIV and cytomegalovirus. Results: All cases were female, with normal myelogram, negative serology, without hypogammaglobulinemia. Neutrophilic autoantibodies were present in 60% of samples, with 40% remaining showing viability below the cut-off limit for the study. Conclusions: This study reveals the presence of neutrophilic autoantibodies as the cause of neutropenia in patients with Systemic Lupus Erythematosus. In spite of the lack of other similar researches, we found in this work autoantibodies HNA1a and HNA2a, granulocyte antigens of greater frequency in the population.