Antonio Fabron Junior

Lesão pulmonar aguda associada à transfusão

Transfusion-related acute lung injury (TRALI) is a serious clinical syndrome associated with the transfusion of plasma-containing blood components. Recently, TRALI has come to be recognized as the leading cause of transfusion-related death in the United States and United Kingdom. This complication typically presents as shortness of breath, hypoxemia, hypotension, fever and noncardiogeneic pulmonary edema, all occurring during or within 6 h after transfusion. Although the mechanism of TRALI has not been fully elucidated, it has been associated with human leukocyte antigen antibodies (class I, class II or neutrophil alloantigens) and with biologically active mediators in stored cellular blood components. Most of the donors implicated in cases of TRALI are multiparous women. Rarely diagnosed, TRALI can be confused with other causes of acute respiratory failure. Greater knowledge regarding TRALI on the part of clinicians could be crucial in preventing and treating this severe complication of blood transfusion.

Brazilian Thalassemia Association protocol for iron chelation therapy in patients under regular transfusion

In the absence of an iron chelating agent, patients with beta-thalassemia on regular transfusions present complications of transfusion-related iron overload. Without iron chelation therapy, heart disease is the major cause of death; however, hepatic and endocrine complications also occur. Currently there are three iron chelating agents available for continuous use in patients with thalassemia on regular transfusions (desferrioxamine, deferiprone, and deferasirox) providing good results in reducing cardiac, hepatic and endocrine toxicity. These practice guidelines, prepared by the Scientific Committee of Associação Brasileira de Thalassemia (ABRASTA), presents a review of the literature regarding iron overload assessment (by imaging and laboratory exams) and the role of T2* magnetic resonance imaging (MRI) to control iron overload and iron chelation therapy, with evidence-based recommendations for each clinical situation. Based on this review, the authors propose an iron chelation protocol for patients with thalassemia under regular transfusions.

Ferro endovenoso no tratamento da anemia ferropriva: seguro e eficaz

Todos os investigadores envolvidos na tipagem deleucemias e linfomas sao frequentemente chamados para darsua opiniao avalizada em quase todos os casos, mesmo na-queles casos que parecem facilmente classificaveis por cito-logia convencional. Alem disso, a citometria de fluxo e fun-damental para a distincao entre leucemia linfoide aguda ima-tura (ALL) e leucemia mieloide aguda (AML), subtipagemimunologica e predicao de anormalidades biomolecularescariotipicas, expressao de marcadores prognosticos, desco-berta de moleculas potencialmente exploraveis como objeti-vo para imunoterapia (CD20, CD52, CD33), presenca e quanti-ficacao do numero de celulas na doenca residual minima,avaliacao de clonalidade de celulas B e celulas T, entre mui-tas outras caracteristicas passiveis de identificacao por cito-metria de fluxo.A estrutura mais acessivel a citometria de fluxo e a su-perficie da celula, mas podemos avaliar tambem estruturas eantigenos intracitoplasmaticos e intranucleares. O que tornaa membrana especial e a presenca facilmente detectavel deuma quantia enorme de diferentes proteinas de superficieque sao usadas para varias funcoes como adesao, ligacao defatores de crescimento ou quimiocinas, adesao a fracao Fcdas imunoglobulinas ou complemento, atividade enzimaticae transporte de ions. Por outro lado, a avaliacao de antigenosintracelulares permite a identificacao de diversas moleculasassociadas a enzimas como a deoxinucleotidil transferase ter-minal (TdT), moleculas intermediarias, como a cadeia intra-celular, proteinas tirosina-quinases, que sao alvos potenci-ais de terapia por drogas como o imitinib, componentes decascatas de sinalizacao, citocinas, moleculas ligadas a feno-menos citoliticos como as granzimas e a perfurina, moleculasassociadas a apoptose como as caspases e proteinas do com-plexo Bcl, avaliacao da perda do potencial de membrana dasmitocondrias, quantificacao de compostos reativos deriva-dos do oxigenio e da atividade de mieloperoxidase, entremuitas outras.O artigo de Pereira