Melca Maria Oliveira Barros

Expression levels of CD47, CD35, CD55, and CD59 on red blood cells and signal-regulatory protein-α,β on monocytes from patients with warm autoimmune hemolytic anemia

BACKGROUND: Animal models have shown that CD47‐deficient mice develop severe autoimmune hemolytic anemia (AIHA) because the binding of red blood cell (RBC) CD47 to signal‐regulatory protein (SIRP‐α) on macrophages contributes to the inhibition of phagocytosis. In contrast, complement‐inhibitory proteins such as CD35, CD55, and CD59 may protect RBCs against the lysis by complement.

A very strict guideline reduces the number of erythrocyte transfusions in preterm infants.

Background and Objectives  Benefits of adopting restrictive guidelines for erythrocyte transfusions are still controversial. The objective of this study was to verify if a very strict guideline could reduce erythrocyte transfusions in preterm infants without adverse outcomes.

Transfusões de sangue no choque séptico: 7,0g/dL é mesmo o limite adequado?

Objective To evaluate the immediate effects of red blood cell transfusion on central venous oxygen saturation and lactate levels in septic shock patients with different transfusion triggers. Methods We included patients with a diagnosis of septic shock within the last 48 hours and hemoglobin levels below 9.0g/dL Patients were randomized for immediate transfusion with hemoglobin concentrations maintained above 9.0g/dL (Group Hb9) or to withhold transfusion unless hemoglobin felt bellow 7.0g/dL (Group Hb7). Hemoglobin, lactate, central venous oxygen saturation levels were determined before and one hour after each transfusion. Results We included 46 patients and 74 transfusions. Patients in Group Hb7 had a significant reduction in median lactate from 2.44 (2.00 - 3.22) mMol/L to 2.21 (1.80 - 2.79) mMol/L, p = 0.005, which was not observed in Group Hb9 [1.90 (1.80 - 2.65) mMol/L to 2.00 (1.70 - 2.41) mMol/L, p = 0.23]. Central venous oxygen saturation levels increased in Group Hb7 [68.0 (64.0 - 72.0)% to 72.0 (69.0 - 75.0)%, p < 0.0001] but not in Group Hb9 [72.0 (69.0 - 74.0)% to 72.0 (71.0 - 73.0)%, p = 0.98]. Patients with elevated lactate or central venous oxygen saturation < 70% at baseline had a significant increase in these variables, regardless of baseline hemoglobin levels. Patients with normal values did not show a decrease in either group. Conclusion Red blood cell transfusion increased central venous oxygen saturation and decreased lactate levels in patients with hypoperfusion regardless of their baseline hemoglobin levels. Transfusion did not appear to impair these variables in patients without hypoperfusion. ClinicalTrials.gov NCT01611753Objective: To evaluate the immediate effects of red blood cell transfusion on central venous oxygen saturation and lactate levels in septic shock patients with different transfusion triggers. Methods: We included patients with a diagnosis of septic shock within the last 48 hours and hemoglobin levels below 9.0g/dL Patients were randomized for immediate transfusion with hemoglobin concentrations maintained above 9.0g/dL (Group Hb9) or to withhold transfusion unless hemoglobin felt bellow 7.0g/dL (Group Hb7). Hemoglobin, lactate, central venous oxygen saturation levels were determined before and one hour after each transfusion. Results: We included 46 patients and 74 transfusions. Patients in Group Hb7 had a significant reduction in median lactate from 2.44 (2.00 - 3.22) mMol/L to 2.21 (1.80 - 2.79) mMol/L, p = 0.005, which was not observed in Group Hb9 [1.90 (1.80 - 2.65) mMol/L to 2.00 (1.70 - 2.41) mMol/L, p = 0.23]. Central venous oxygen saturation levels increased in Group Hb7 [68.0 (64.0 - 72.0)% to 72.0 (69.0 - 75.0)%, p < 0.0001] but not in Group Hb9 [72.0 (69.0 - 74.0)% to 72.0 (71.0 - 73.0)%, p = 0.98]. Patients with elevated lactate or central venous oxygen saturation < 70% at baseline had a significant increase in these variables, regardless of baseline hemoglobin levels. Patients with normal values did not show a decrease in either group. Conclusion: Red blood cell transfusion increased central venous oxygen saturation and decreased lactate levels in patients with hypoperfusion regardless of their baseline hemoglobin levels. Transfusion did not appear to impair these variables in patients without hypoperfusion. ClinicalTrials.gov NCT01611753

Autoimmune hemolytic anemia: transfusion challenges and solutions

php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). International Journal of Clinical Transfusion Medicine 2017:5 9–18 International Journal of Clinical Transfusion Medicine Dovepress

Transfusional profile in different types of intensive care units

BACKGROUND AND OBJECTIVES anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units. METHODS prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusional profile were collected, a univariate analysis was done, and the results were considered significant at p ≤ 0.05. RESULTS 408 transfusions were analyzed in 71 patients. The mean hemoglobin concentration on admission was 9.7 ± 2.3g/dL and the pre-transfusional concentration was 6.9 ± 1.1g/dL. The main indications for transfusion were hemoglobin concentration (49%) and active bleeding (32%). The median number of units transfused per episode was 2 (1-2) and the median storage time was 14 (7-21) days. The number of patients transfused with hemoglobin levels greater than 7 g/dL and the number of bags transfused per episode were significantly different among intensive care units. Patients who received three or more transfusions had longer mechanical ventilation time and intensive care unit stay and higher mortality after 60 days. There was an association of mortality with disease severity but not with transfusional characteristics. CONCLUSIONS the practice of blood products transfusion was partially in agreement with the guidelines recommended, although there are differences in behavior between the different profiles of intensive care units. Transfused patients evolved with unfavorable outcomes. Despite the scarcity of blood in blood banks, the mean storage time of the bags was high.

Reduction of exposure to blood donors in preterm infants submitted to red blood cell transfusions using pediatric satellite packs

OBJECTIVE: In preterm newborn infants transfused with erythrocytes stored up to 28 days, to compare the reduction of blood donor exposure in two groups of infants classified according to birth weight. METHODS: A prospective study was conducted with preterm infants with birth weight <1000g (Group 1) and 1000-1499g (Group 2), born between April, 2008 and December, 2009. Neonates submitted to exchange transfusions, emergency erythrocyte transfusion, or those who died in the first 24 hours of life were excluded. Transfusions were indicated according to the local guideline using pediatric transfusion satellite bags. Demographic and clinical data, besides number of transfusions and donors were assessed. . Logistic regression analysis was performed to determine factors associated with multiple transfusions. RESULTS: 30 and 48 neonates were included in Groups 1 and 2, respectively. The percentage of newborns with more than one erythrocyte transfusion (90 versus 11%), the median number of transfusions (3 versus 1) and the median of blood donors (2 versus 1) were higher in Group 1 (p<0.001), compared to Group 2. Among those with multiple transfusions, 14 (82%) and one (50%) presented 50% reduction in the number of blood donors, respectively in Groups 1 and 2. Factors associated with multiple transfusions were: birth weight <1000g (OR 11.91; 95%CI 2.14-66.27) and presence of arterial umbilical catheter (OR 8.59; 95%CI 1.94-38.13), adjusted for confounders. CONCLUSIONS: The efficacy of pediatrics satellites bags on blood donor reduction was higher in preterm infants with birth weight <1000g.OBJETIVO Em prematuros transfundidos com hemacias preservadas por ate 28 dias, comparar a reducao de exposicao a doadores em dois grupos de pacientes, de acordo com o peso ao nascer. METODOS Estudo prospectivo de prematuros com peso ao nascer <1000g (Grupo 1) e de 1000-1499g (Grupo 2), nascidos entre abril de 2008 e dezembro de 2009. Excluiram-se os recem-nascidos submetidos a exsanguineotransfusao, transfusao de emergencia ou obito antes de 24 horas de vida. As transfusoes foram indicadas conforme rotina do servico, utilizando-se bolsas de transferencia pediatricas. Analisaram-se dados demograficos, clinicos e numero de transfusoes e doadores. Utilizou-se regressao logistica para analise de fatores associados as multiplas transfusoes. RESULTADOS Incluiram-se 30 prematuros no Grupo 1 e 48 no Grupo 2. A porcentagem de prematuros que receberam mais de uma transfusao de hemacias (90 versus 11%), a mediana do numero de transfusoes (3 versus 1) e mediana de doadores (2 versus 1) foram maiores no Grupo 1, comparado ao Grupo 2 (p<0,001). Entre aqueles com transfusoes multiplas, 14 (82%) e um (50%) prematuros apresentaram reducao de 50% de doadores respectivamente nos Grupos 1 e 2. Os fatores associados a multiplas transfusoes foram peso ao nascer <1000g (OR 11,91; IC95% 2,14-66,27) e presenca de cateter arterial umbilical (OR 8,59; IC95% 1,94-38,13), controlados para variaveis de confusao. CONCLUSOES A eficacia das bolsas de transferencia pediatricas para reduzir a exposicao a doadores de sangue foi maior em prematuros com peso ao nascer <1000g.

Analysis of polymorphisms of TNF-α, LT-α, IL-10, IL-12 and CTLA-4 in patients with warm autoimmune haemolytic anaemia.

Introduction:  Autoimmune haemolytic anaemia (AIHA) is defined as the increased destruction of red blood cells (RBCs) in the presence of anti‐RBC autoantibodies and/or complement. Its pathogenesis is multifactorial and includes changes in mechanisms of cytokine production and functionality. A number of recent studies have implicated cytokines polymorphisms in the pathogenesis of autoimmune diseases. The aim of this study was to determine the frequency of polymorphisms of tumour necrosis factor alpha (TNF‐α), lymphotoxin‐α (LT‐α), interleukin 10 (IL‐10), interleukin 12 (IL‐12) and cytotoxic T‐lymphocyte antigen‐4 (CTLA‐4) in patients with AIHA in comparison with healthy individuals.

Kidd system antigens and kidney disease

he Kidd blood group system (ISBT009), identified in 1951, as the ninth blood group system and it is considered the inth most clinically important. Antigens of the Kidd blood roup system are expressed on type 3 glycoproteins, also nown as the urea transporter B (UT-B). The JK protein is xpressed on red blood cells (RBCs) and in the endothelium of he descending vasa recta and epithelial surfaces of the renal nner medulla.1 Evidence of the function of the Kidd blood roup system first came to light from the observation in 1982 hat Jk (a-b-) RBCs were resistant to lysis in 2 M urea in conrast to RBCs with normal Kidd antigens. RBCs having normal K phenotypes will lyse within 30 s as the urea is transported nto the cells, followed by a rapid osmotic influx of water. ecause of the lack of urea transport and therefore no water ptake, Jk (a-b-) cells remain intact after two minutes, which emonstrates the role of the JK protein in facilitating rapid rea transport across the RBC membrane.2 The major physioogic role for urea transporters is in the urinary concentrating echanism. However, no clinical sequela was found in two atients with the Jk null phenotype suggesting the presence f compensatory mechanisms.3 The paper by Caprioli et al.4 published in this issue of the evista Brasileira de Hematologia e Hemoterapia investigates posible relations between the absence of Jka or Jkb antigens n patients with chronic kidney disease. This is interesting ecause individuals with the Jk (a-b-) phenotype had lower rine-concentrating ability, however if patients with chronic idney disease present some difference in the Kidd phenotype, he distribution remains unknown. Moreover, the location of he JK antigens on renal cells raises fascinating questions

Reducción de la exposición a donantes de sangre en prematuros sometidos a transfusiones de hematíes con uso de bolsas de transferencia pediátrica

OBJECTIVE: In preterm newborn infants transfused with erythrocytes stored up to 28 days, to compare the reduction of blood donor exposure in two groups of infants classified according to birth weight. METHODS: A prospective study was conducted with preterm infants with birth weight <1000g (Group 1) and 1000-1499g (Group 2), born between April, 2008 and December, 2009. Neonates submitted to exchange transfusions, emergency erythrocyte transfusion, or those who died in the first 24 hours of life were excluded. Transfusions were indicated according to the local guideline using pediatric transfusion satellite bags. Demographic and clinical data, besides number of transfusions and donors were assessed. . Logistic regression analysis was performed to determine factors associated with multiple transfusions. RESULTS: 30 and 48 neonates were included in Groups 1 and 2, respectively. The percentage of newborns with more than one erythrocyte transfusion (90 versus 11%), the median number of transfusions (3 versus 1) and the median of blood donors (2 versus 1) were higher in Group 1 (p<0.001), compared to Group 2. Among those with multiple transfusions, 14 (82%) and one (50%) presented 50% reduction in the number of blood donors, respectively in Groups 1 and 2. Factors associated with multiple transfusions were: birth weight <1000g (OR 11.91; 95%CI 2.14-66.27) and presence of arterial umbilical catheter (OR 8.59; 95%CI 1.94-38.13), adjusted for confounders. CONCLUSIONS: The efficacy of pediatrics satellites bags on blood donor reduction was higher in preterm infants with birth weight <1000g.OBJETIVO Em prematuros transfundidos com hemacias preservadas por ate 28 dias, comparar a reducao de exposicao a doadores em dois grupos de pacientes, de acordo com o peso ao nascer. METODOS Estudo prospectivo de prematuros com peso ao nascer <1000g (Grupo 1) e de 1000-1499g (Grupo 2), nascidos entre abril de 2008 e dezembro de 2009. Excluiram-se os recem-nascidos submetidos a exsanguineotransfusao, transfusao de emergencia ou obito antes de 24 horas de vida. As transfusoes foram indicadas conforme rotina do servico, utilizando-se bolsas de transferencia pediatricas. Analisaram-se dados demograficos, clinicos e numero de transfusoes e doadores. Utilizou-se regressao logistica para analise de fatores associados as multiplas transfusoes. RESULTADOS Incluiram-se 30 prematuros no Grupo 1 e 48 no Grupo 2. A porcentagem de prematuros que receberam mais de uma transfusao de hemacias (90 versus 11%), a mediana do numero de transfusoes (3 versus 1) e mediana de doadores (2 versus 1) foram maiores no Grupo 1, comparado ao Grupo 2 (p<0,001). Entre aqueles com transfusoes multiplas, 14 (82%) e um (50%) prematuros apresentaram reducao de 50% de doadores respectivamente nos Grupos 1 e 2. Os fatores associados a multiplas transfusoes foram peso ao nascer <1000g (OR 11,91; IC95% 2,14-66,27) e presenca de cateter arterial umbilical (OR 8,59; IC95% 1,94-38,13), controlados para variaveis de confusao. CONCLUSOES A eficacia das bolsas de transferencia pediatricas para reduzir a exposicao a doadores de sangue foi maior em prematuros com peso ao nascer <1000g.

Redução da exposição a doadores de sangue em prematuros submetidos a transfusões de hemáciascom uso de bolsas de transferência pediátricas

OBJECTIVE: In preterm newborn infants transfused with erythrocytes stored up to 28 days, to compare the reduction of blood donor exposure in two groups of infants classified according to birth weight. METHODS: A prospective study was conducted with preterm infants with birth weight <1000g (Group 1) and 1000-1499g (Group 2), born between April, 2008 and December, 2009. Neonates submitted to exchange transfusions, emergency erythrocyte transfusion, or those who died in the first 24 hours of life were excluded. Transfusions were indicated according to the local guideline using pediatric transfusion satellite bags. Demographic and clinical data, besides number of transfusions and donors were assessed. . Logistic regression analysis was performed to determine factors associated with multiple transfusions. RESULTS: 30 and 48 neonates were included in Groups 1 and 2, respectively. The percentage of newborns with more than one erythrocyte transfusion (90 versus 11%), the median number of transfusions (3 versus 1) and the median of blood donors (2 versus 1) were higher in Group 1 (p<0.001), compared to Group 2. Among those with multiple transfusions, 14 (82%) and one (50%) presented 50% reduction in the number of blood donors, respectively in Groups 1 and 2. Factors associated with multiple transfusions were: birth weight <1000g (OR 11.91; 95%CI 2.14-66.27) and presence of arterial umbilical catheter (OR 8.59; 95%CI 1.94-38.13), adjusted for confounders. CONCLUSIONS: The efficacy of pediatrics satellites bags on blood donor reduction was higher in preterm infants with birth weight <1000g.OBJETIVO Em prematuros transfundidos com hemacias preservadas por ate 28 dias, comparar a reducao de exposicao a doadores em dois grupos de pacientes, de acordo com o peso ao nascer. METODOS Estudo prospectivo de prematuros com peso ao nascer <1000g (Grupo 1) e de 1000-1499g (Grupo 2), nascidos entre abril de 2008 e dezembro de 2009. Excluiram-se os recem-nascidos submetidos a exsanguineotransfusao, transfusao de emergencia ou obito antes de 24 horas de vida. As transfusoes foram indicadas conforme rotina do servico, utilizando-se bolsas de transferencia pediatricas. Analisaram-se dados demograficos, clinicos e numero de transfusoes e doadores. Utilizou-se regressao logistica para analise de fatores associados as multiplas transfusoes. RESULTADOS Incluiram-se 30 prematuros no Grupo 1 e 48 no Grupo 2. A porcentagem de prematuros que receberam mais de uma transfusao de hemacias (90 versus 11%), a mediana do numero de transfusoes (3 versus 1) e mediana de doadores (2 versus 1) foram maiores no Grupo 1, comparado ao Grupo 2 (p<0,001). Entre aqueles com transfusoes multiplas, 14 (82%) e um (50%) prematuros apresentaram reducao de 50% de doadores respectivamente nos Grupos 1 e 2. Os fatores associados a multiplas transfusoes foram peso ao nascer <1000g (OR 11,91; IC95% 2,14-66,27) e presenca de cateter arterial umbilical (OR 8,59; IC95% 1,94-38,13), controlados para variaveis de confusao. CONCLUSOES A eficacia das bolsas de transferencia pediatricas para reduzir a exposicao a doadores de sangue foi maior em prematuros com peso ao nascer <1000g.