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- ItemAcesso aberto (Open Access)Anemia e transfusões de concentrados de hemácias em pacientes graves nas UTI brasileiras (pelo FUNDO-AMIB)(Associação de Medicina Intensiva Brasileira - AMIB, 2006-09-01) Lobo, Suzana Margareth; Vieira, Silvia Rios; Knibel, Marcos Freitas; Grion, Cintia Magalhães Carvalho; Friedman, Gilberto; Valiatti, Jorge Luis [UNIFESP]; Machado, Flávia Ribeiro [UNIFESP]; Chiavone, Paulo Antonio; Paciência, Luis Eduardo Miranda; Paula, Juarez De; Guimarães, Sérgio Mussi; Costa, João Luiz Ferreira; Costa Filho, Rubens Carmo; Borges, Gleida Alves; Gama, Hemerson Casado; Grilo, Marcellus Gazola; Torres, Kerginaldo Paulo; Franco, Rubens Sérgio Da Silva; Pinto, Jorge Eduardo Silva Soares; David, Cid Marcos; Faculdade de Medicina de São José do Rio Preto; Universidade de São Paulo (USP); UFRGS Departamento de Medicina Interna HC de Porto Alegre; Universidade Paris VI; UFRJ CTI dos Hospitais Cardiotrauma Ipanema e São Lucas; AMIB; Universidade Estadual de Londrina; UFRGS FAMED HCPA; Faculdade de Medicina de Catanduva; Universidade Federal de São Paulo (UNIFESP); Fundação Padre Albino UTI do Complexo Hospitalar; Santa Casa de Misericórdia de São Paulo; Hospital Unimed de Limeira; UTI do Hospital Regional de Assis; AMIB Departamento de Medicina; American College; Fundação Getúlio Vargas; Hospital Pró Cardíaco; UNIRIO; FGV; Hospital Santa Helena de Goiânia; Hospital evangélico de Cachoeiro de Itapemirim Unidade coronariana; SBN; Hospital Evangélico Cachoeiro de Itapemirim UTI Adulto e Coronariana; UFRJ; UFRN Hospital Onofre Lopes UTI; Hospital Novo AtibaiaBACKGROUND AND OBJECTIVES: Anemia of critical illness is a multifactorial condition caused by blood loss, frequent phlebotomies and inadequate production of red blood cells (RBC). Controversy surrounds the most appropriate hemoglobin concentration trigger for transfusion of RBC. We aimed to evaluate transfusion practices in Brazilian ICUs. METHODS: A prospective study throughout a 2-week period in 19 Brazilian ICUs. Hemoglobin (Hb) level, transfusion rate, organ dysfunction assessment and 28-day mortality were evaluated. Primary indication for transfusion and pretransfusion hemoglobin level were collected for each transfusion. RESULTS: Two hundred thirty-one patients with an ICU length of stay longer than 48h were included. An Hb level lower than 10 g/dL was found in 33% on admission in the ICU. A total of 348 RBC units were transfused in 86 patients (36.5%). The mean pretransfusion hemoglobin level was 7.7 ± 1.1 g/dL. Transfused-patients had significantly higher SOFA score (7.9 ± 4.6 vs 5.6 ± 3.8, p < 0.05, respectively), days on mechanical ventilation (10.7 ± 8.2 vs 7.2 ± 6.4, p < 0.05) and days on vasoactive drugs (6.7 ± 6.4 vs 4.2 ± 4.0, p < 0.05) than non-transfused patients despite similar APACHE II scores (15.2 ± 8.1 vs 14.2 ± 8.1, NS). Transfused patients had higher mortality rate (43.5%) than non-transfused patients (36.3%) (RR 0.60-1.15, NS). Only one patient (0.28%) had febrile non-hemolytic transfusion and urticarial reactions. CONCLUSIONS: Anemia is common in critically ill patients.It seems from the present study that transfusion practices in Brazil have had a more restrictive approach with a lower limit transfusion trigger.
- ItemAcesso aberto (Open Access)Anemia hemolítica auto-imune e outras manifestações imunes da leucemia linfocítica crônica(Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular, 2005-12-01) Bordin, Jose Orlando [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Chronic lymphocytic leukemia (CLL) is frequently associated with autoimmune diseases directed against hematopoietic cells, including autoimmune hemolytic anemia (AIHA), immune thrombocytopenic purpura (ITP), pure red cell aplasia (PRCA), and immune neutropenia. CLL represents the diagnosis in up to 15% of the patients with AIHA, and in 50% of the patients with AIHA secondary to malignancy. ITP occurs in 2% and PRCA in about 1% of all CLL patients. Prednisone is the first-line treatment for immune cytopenia related to CLL. About 60% of patients relapse when treatment is stopped therefore splenectomy, intravenous immunoglobulin, or cyclosporine are reasonable second-line treatments. Although the data on pathophysiology are very limited, it appears that the autoimmune mechanisms are related to the activity of the leukemic B lymphocytes that act as aberrant antigen-presenting cells, and are effective in processing and presenting proteins derived from red cells or platelets to auto-reactive TH cells. TH cells specific for certain auto-antigens escape from control mechanisms and when activated may initiate auto-immune disease. Patients with AIHA secondary to CLL should not receive fludarabine because there is an increased frequency of severe and fatal AIHA in patients treated with purine nucleoside analogues. Patients who are more immunosuppressed due to several previous treatments are at higher risk for developing this auto-immune complication.
- ItemSomente MetadadadosThe care of a child with multiple trauma and severe anemia who was a Jehovah's Witness(Taylor & Francis Ltd, 2006-06-01) Digieri, Luciana Andrea; Pistelli, Ivan Pollastrini; De Carvalho, Cid Eduardo; Universidade Federal de São Paulo (UNIFESP)Jehovah's Witness followers do not accept blood derived transfusions and available methods for avoiding transfusion have been used with degrees of success, demonstrating that the probability of death after trauma in these patients may not be significantly different from religious groups. in this report, we describe the case of a child victim of a multiple trauma with severe anemia due to blood loss, whose family would not authorize blood transfusion because of their Jehovah's Witness faith. We discuss the current indications for restricting transfusion, as well as highlighting new tools that contribute to the success of minimizing blood loss, thus avoiding transfusion.
- ItemSomente MetadadadosEvaluation of recent techniques for detection of red blood cell antibodies in sera of reference samples, patients, pregnant women, and blood donors(Wiley-Blackwell, 1996-01-01) deCastilho, L. M.; Pellegrino, J.; Bechelli, APP; LePennec, P. Y.; Mendes, N. F.; Universidade Federal de São Paulo (UNIFESP)The sensitivity of the low ionic strength solution antiglobulin test (LISS-AGT), polyethylene glycol antiglobulin test (PEG-AGT), low ionic strength solution solid-phase antiglobulin test (LISS-SPAT), gel low ionic strength solution antiglobulin test (GEL-LISS), and gel papain Bst (GEL-PAP) was compared in titration studies of 460 sera containing identified IgG alloantibodies. the GEL-PAP was 100% sensitive to detect Rh antibodies, whereas the PEG-AGT was the most sensitive to detect Kell, Duffy, Kidd, Ss, and rare blood group antibodies. the better performance of PEG-AGT was especially obvious with Kell, Duffy, and Ss antibodies (S = 100%). When the sensitivity of the LISS-AGT, PEG-AGT, GEL-LISS, and GEL-PAP was evaluated in different routines, the GEL-LISS showed to be more sensitive than PEG-AGT in the detection of clinically significant antibodies. These discrepant results showed that the performance of a technique may change when it is applied as a routine. (C) 1996 Wiley-Liss, Inc.
- 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)Reação transfusional hiper-hemolítica em pacientes portadores de anemia falciforme: relato de dois casos(Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular, 2002-12-01) Terzian, Cláudia Cristina Naufel [UNIFESP]; Braga, Josefina Aparecida Pellegrini [UNIFESP]; Cançado, Rodolfo Delfini; Langhi Junior., Dante Mário; Bordin, Jose Orlando [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Casa de São Paulo Faculdade de Ciências MédicasThe chronic character of sickle cell anemia associated with the greater capacity to liberate oxygen by the Hb S, results in patients exhibiting few symptoms in relation to the anemia and they do not require regular hemacias transfusions. Nevertheless, in the face of acute complications, the additional drop in hemoglobin can precipitate an imbalance in the cardio-respiratory function and put the life of the patient at risk, making blood transfusion therapy of utmost importance. In the light of the increased frequency of transfusions to which these patients are submitted, knowledge of the main risks and an adequate diagnosis of the complications caused by transfusional therapy are of fundamental importance. An atypical form of transfusional reaction, denominated hyperhemolytic transfusional reaction was recently described in sickle cell anemia patients after the transfusion of apparently compatible hemacias. In this case, previous conditions can exacerbate the hemolytic condition and put the life of the patient at risk. The pathophysiological conditions of this disease are not yet understood well and the treatment consists of suspending transfusions, corticoid therapy and / or administration of immunoglobulin. The aim of this work is o present two case reports of hyperhemolytic transfusional reaction in sickle cell anemia patients.
- ItemSomente MetadadadosRed blood cell alloimmunization in sickle cell disease: the influence of racial and antigenic pattern differences between donors and recipients in Brazil(Wiley-Blackwell, 1996-07-01) Moreira Junior, Gilberto [UNIFESP]; Bordin, Jose Orlando [UNIFESP]; Kuroda, Akemi [UNIFESP]; Kerbauy, José [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Red blood cell (RBC) transfusions are widely used in the management of patients with sickle cell disease (SCD). However, repeated RBC transfusions are often complicated by RBC alloimmunization. To investigate whether the frequency of RBC alloimmunization could be accounted for by racial and RBC phenotype differences between donors and recipients in Brazil, in this study we compared the RBC phenotype of 100 SCD patients with that observed in 120 randomly selected blood donors. A comparison of the RBC phenotype between the two groups revealed a statistically significant increase in the frequency of the C antigen in the donor population (P < 0.01), but no significant difference was observed for the A, B, D, c, E, e, K, k, Fy(a), M, N, S, s, and Jk(a) antigens. Using standard techniques (indirect antiglobulin test, enzyme treatment, and low-ionic-strength solution) we observed an RBC alloimmunization rate of 12.9% (11/85) in the SCD patients. Fifteen alloantibodies were detected in 11 patients, and most (80%) involved antigens in the Rhesus and Kelt systems. This observed RBC alloimmunization rate in SCD patients in Brazil is lower than that reported by studies from North America, suggesting that the requirement for extended antigen-matched RBC transfusion for SCD patients in the setting of a RBC phenotype concordant donor-recipient population may not be cost-effective in some countries. (C) 1996 Wiley-Liss, Inc.
- ItemSomente MetadadadosRegulatory CD4(+) T lymphocytes after allogeneic transfusion in orthopaedic surgical patients(Wiley-Blackwell, 2017) Pereira, Luciana de Andrade [UNIFESP]; Baiocchi, Otavio Carvalho Guimarães [UNIFESP]; Silva, Joyce Matie Kinoshita da [UNIFESP]; Takata, Edmilson Takehiro [UNIFESP]; Bordin, Jose Orlando [UNIFESP]
- ItemSomente MetadadadosStrict red blood cell transfusion guideline reduces the need for transfusions in very-low-birthweight infants in the first 4 weeks of life: a multicentre trial(Blackwell Publishing Ltd, 2005-02-01) Dos Santos, Amelia Miyashiro [UNIFESP]; Santos, N. dos; Guinsburg, Ruth [UNIFESP]; Kopelman, B. I.; Araujo Peres, C. de; Lima Taga, M. F. de; Shinzato, A. R.; Costa, HDF; Universidade Federal de São Paulo (UNIFESP)Background and Objectives Very-low-birthweight infants are among the most heavily transfused patients. the objective of this study was to verify if the introduction of a strict guideline would reduce the need for red blood cell transfusions in the first 4 weeks of life in these neonates.Materials and Methods This was a multicentre prospective study of two cohorts of very-low-birthweight infants transfused in accordance with the recommendations of a neonatologist (Phase 1) or according to previously published guidelines (Phase 2).Results in the first 28 days of life, 102 patients (68.5%) in Phase 1 and 117 (59.7%) in Phase 2 were transfused. the number of transfusions was 1.9 +/- 2.0 in Phase 1 and 1.4 +/- 1.6 in Phase 2 (P = 0.01). After adjusting for gestational age, blood loss and the presence of respiratory distress syndrome, the strict guideline reduced the number of transfusions in 17.6% (IC 95%-30.5% to -2.6%).Conclusions the strict guideline was effective in reducing erythrocyte transfusions in very-low-birthweight infants.