Celso Carlos de Campos Guerra

Human T-lymphotropic virus type I and type II infections and correlation with risk factors in blood donors from São Paulo, Brazil

BACKGROUND: Little is known about the prevalence of and risk factors for human T‐lymphotropic virus type I and type II (HTLV‐I, HTLV‐II) infections in Brazil. STUDY DESIGN AND METHODS: Sera from 17,063 healthy Brazilian donors were screened by enzyme‐linked immunosorbent assay for antibody to HTLV‐I/II between August 1991 and July 1993. Repeatedly reactive samples were confirmed by Western blot, and discrimination between HTLV‐I and HTLV‐II was made by polymerase chain reaction or synthetic peptide enzyme‐linked immunosorbent assay. A univariate analysis was performed on demographic and serologic data. RESULTS: HTLV‐I infection was demonstrated in 83 percent of the 30 donors with reactive serologic tests (0.15% of the total tested [17,063]; 95% CI, 0.09‐0.20) and HTLV‐II infection in 17 percent (0.03% of the total tested [17,063]; 95% CI, 0.01‐0.05). HTLV‐I‐positive donors were more likely than reference groups to be of Asian ethnicity (odds ratio [OR] 15.1; reference group: whites), more than 50 years old (OR 4.2; reference group: 20–29 years old), and positive for antibody to hepatitis C virus (anti‐HCV) (OR 21.8) or to hepatitis B core (antigen) (anti‐HBc) (OR 5.7). HTLV‐II showed a significant association with anti‐HCV (OR 75.2) and anti‐HBc (OR 21.8). Eleven of the 25 HTLV‐I‐ positive donors were counseled. Family origin in endemic areas of Japan (n = 4), prior blood transfusion (n = 3), or sexual contact with prostitutes (n = 1) were the risk factors reported by 8 donors. In 3 white men, no risk factors could be identified. CONCLUSION: Both HTLV‐I and HTLV‐II occur among Brazilian blood donors. HTLV‐I is associated with Asian ethnicity, greater age, and the presence of anti‐HCV and anti‐HBc. Three HTLV‐I‐positive donors had a history of blood transfusion, which emphasizes the need for HTLV‐I/II screening in Brazil.

Iron stores and coagulation parameters in patients with hypoxemic polycythemia secondary to chronic obstructive pulmonary disease: the effect of phlebotomies

UNLABELLED This study was designed to determine the effects of phlebotomy on iron body contents and coagulation tests of COPD patients with polycythemia secondary to hypoxemia. Seventeen patients with COPD and hematocrits higher than 54 percent (mean Hct: 57 +/- 0.49 percent), who had not received anti-inflammatory or antiplatelet aggregation agents recently. Their mean forced expiratory volume at 1 second (FEV1) was 0.92 +/- 0.11 L. INTERVENTION Blood work was collected to evaluate the following: serum iron and ferritin levels, total iron binding capacity, transferrin saturation index, fibrinogen plasma levels, activated partial thromboplastin time, platelet count, platelet aggregation measurements, and thromboelastography coagulation parameters. The blood samples were obtained before and about 7 days after the hematocrit correction by 300-400 ml phlebotomies done every other day. The mean number of phlebotomies done for each patient was 4.4. Postphlebotomy iron serum levels decreased from 90.1 +/- 14.8 to 59.7 +/- 9.9 mg/dl and the ferritin serum levels from 133.8 +/- 37.9 to 70.8 +/- 32.7 ng/ml (p < 0.05). Regarding the coagulation studies, there were significant increases in the platelet count, from 227,300 +/- 13,900 to 312,500 +/- 30,200 per mm3, and in the maximum clot amplitude (a) obtained by thromboelastography (from 53.6 +/- 1.4 percent to 60.4 +/- 1.1 percent). The coagulation time (k) of the thromboelastography also decreased significantly, from 7.5 +/- 0.7mm prephlebotomy to 4.5 +/- 0.3mm postphlebotomy. Although the coagulation changes were small amount, the observed significant decrease in iron contents may have clinical implications.

Plaquetopenias: diagnóstico usando citometria de fluxo e anticorpos antiplaquetas

OBJECTIVE To identify antiplatelet antibodies by flow cytometry (direct method) in patients with thrombocytopenia. METHODS Between January 1997 and March 2004 a total of 15100 patients were referred to the Centro de Hematologia de São Paulo for hematological investigation of several diagnoses (anemia, leukopenia, thrombocytopenia, coagulation abnormalities, adenomegaly, leukemia and others). Of those, 1057 were referred because of thrombocytopenia and were divided into two groups: Group Idiopathic thrombocytopenic purpura, with no identifiable cause; and Group Other thrombocytopenia, which included low normal platelet counts cause to be established, hepatitis C and HIV infection, hypersplenism, EDTA-induced artifacts, laboratory error, and other causes. Flow cytometry immunophenotyping was done in 115 cases to identify platelet autoantibodies (direct method). RESULTS Of the total number of patients, 1057 (7%) presented low platelet counts, 670 were females (63.4%) and age range of one to 75 years. Of the 115 cases (9.7%) submitted to immunophenotyping, the results were positive in 40% and the test was inconclusive in 5%. Idiopathic thrombocytopenic purpura was found in 52% of patients, more often in women. Hepatitis C virus infection was found in 7% and HIV infection in 1%. Low normal platelet counts were found in 17%, laboratory errors in 6%, and laboratory artifacts in 1% of cases. Platelet autoantibodies were found in 76.9% of all idiopathic thrombocytopenic purpura cases. It was negative in 83.3% of the low normal counts. CONCLUSION antiplatelet autoantibodies when present help to diagnose idiopathic thrombocytopenic purpura. When absent, suggest other causes of thrombocytopenia.

50 anos da Sociedade Brasileira de Hematologia e Hemoterapia

Em maio de 2000 foi comemorado oJubileu de Ouro da Sociedade Brasileira deHematologia e Hemoterapia. Foram 50 anosde intensa atividade no aprimoramento dasnossas especialidades e no desenvolvimentodos medicos para melhor atender a seuspacientes.Ja na sua fundacao, os participantesdecidiram por uma Sociedade que englobassea Hematologia e a Hemoterapia. Tiveram apercepcao do intimo relacionamento que veioa se concretizar nestes 50 anos. A SBHH cumpriuo seu papel, aglutinando os medicos queescolheram o sangue como seu objetivo.Realizou 25 congressos nacionais, inumerasjornadas, simposios e cursos procurando reciclaros especialistas para melhor desempenho desuas atuacoes.Ao criar os Titulos de Especialista emHematologia e Hemoterapia, consolidou aprofissao no cenario medico nacional.Com os titulos de proficiencia abre umestimulo para os profissionais de niveluniversitario aprimorarem seus conhecimentos.A edicao de uma Revista de Hematologiae Hemoterapia permite a divulgacao dostrabalhos cientificos produzidos no Brasil paraconhecimento dos medicos especialistas. OHemoNews leva aos socios noticias breves doque acontece na area.Leva a comunidade e com ela interage, aoterminar com a doacao remunerada de sangue.Participa de campanhas para doacao voluntariae para esclarecimentos a populacao como aCruzada contra a Anemia.Colabora ativamente em varias Comissoesligadas ao Ministerio da Saude na area desangue, levando sua experiencia e espiritocritico.Estimulou, patrocinou e cooperou naformacao de protocolos para tratamento daleucemia aguda na infância, que colocou oBrasil no mesmo nivel de paises desenvolvidospelo bom resultado alcancado.Estimula e colabora na melhoria daqualidade do sangue com o Programa deControle Externo em Sorologia e deImunohematologia.Ajuda a introduzir uma moderna gestaocom o Sistema da Qualidade em Hemoterapia.Cria instrumentos para aferir estaqualidade, como o Programa de Acreditacaodas Unidades Hemoterapicas.Assim, podemos constatar que a SBHH tevepassado, tem presente e certamente com otrabalho de todos, tera futuro.

Avaliação da importância da coloração de Perls na rotina de mielogramas de pacientes com anemia associada a uma ou mais citopenias em sangue periférico

As sindromes mielodisplasicas (SMD) sao um grupo heterogeneo de doencas malignas das celulas-tronco hematopoeticas, classificadas segundo a Organizacao Mundial da Saude (OMS) em: anemia refrataria, anemia refrataria com sideroblastos em anel, citopenia refrataria com displasia de multilinhagens, anemia refrataria com excesso de blastos, sindrome mielodisplasica inclassificavel e sindrome mielodisplasica associada com anormalidade isolada do cromossomo 5q(del). Na anemia refrataria com sideroblastos em anel observam-se hiperplasia e displasia eritroide com presenca de 15% ou mais de sideroblastos em anel. Utilizamos neste estudo a coloracao de Perls em esfregacos de medula ossea de pacientes com idade superior a 40 anos e que apresentavam uma ou mais citopenias no sangue periferico associada a anemia. Por tratar-se de tecnica de manejo facil e agil sugerimos seu emprego em esfregacos de aspirado de medula ossea de pacientes que apresentem os achados laboratoriais acima, pois, dentre os casos analisados 18,7% apresentavam mais que 10 grânulos sideroticos circundando a terca parte ou mais do nucleo do precursor eritroide (sideroblasto em anel), sugerindo ao hematologista um possivel diagnostico de Sindrome Mielodisplasica com Sideroblastos em Anel (SMD-ARSA). Importante relatar que a grande maioria destes casos com aumento de sideroblastos em anel nao foi encaminhada ao nosso servico, com suspeita de SMD, e em somente um caso foi solicitada a realizacao da coloracao de Perls.