ABSTRACT
Background: Refractoriness continues to he a major complication of platelet transfusion therapy in patients with multiple transfusions: Despite most cases are secondary to non-immune causes, the most serious is that associated to alloimmunization. The incidence and consequences of HLA and non-HLA (platelet specific) antibodies are unknown in our country. Aim: To prospectively determinate the frequency and characteristic of post transfusion alloimmunization and the incidence of platelet specific antibodies. Patients and methods: Forty one adults and 24 children with a recently diagnosed malignancy and undergoing chemotherapy that required multiple transfusions were studied. Screening for antiplatelet antibodies (platelet membrane ELISA) was performed before the first transfusion, every four weeks or whenever the 1 hour corrected count increment for platelet transfusions was lower that 5000. Platelet specific antibodies werw identified with a monoclonal antibody-specific immobilization of platelet antigens (MAIPA), with anti-GPIIb, GPIIb/IIIa, GPIa/lia and anti-HLA class I. Results: Adult patients received an averafge of 10.2 ñ 5.5 units of red blood cells and 58.6 ñ 35.4 units of platelets. Children received 4.8 ñ 3.7 units of red blood cells and 9.6 ñ 6.7 units of platelets. HLA antibodies appeared in 7 of 41 adult patients (17 percent), platelet specific alloantibodies were found in two patients (one anti GP Ia/IIa and one anti GP ib). Platelet refractoriness appeared in three alloimmunized patients. No Child had detectable serum antibodies during follow up. Conclusions: Platel transfusion refractoriness of immune origin occurs infrequently in our population and the presence of platelet antibodies does not mean that it will appear. The use of leukocyte depleted blood components to prevent refractoriness cannot be justified at this time
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Adolescent , Adult , Middle Aged , Hematologic Neoplasms/immunology , Isoantibodies/isolation & purification , Platelet Transfusion/adverse effects , Anemia, Refractory/immunology , Antibody Formation/immunologyABSTRACT
The antiemetic effect of tropisetron was studied in 97 cancer patients (67 men, 30 women) receiving cisplatin in doses of 75 mg/m² or higher. On 279 chemotherapy cycles studied (max 6 per patient) 5 mg of tropisetron was admonistered once a day i.v. on day 1 and p.o. on day 2 to 6. Efficacy preventing vomiting and nausea was measured in 24 hour period as: complete control 0 episodes, major control 1 to 2 episodes, minor control 3 to 4 episodes and no control 5 or more episodes. Satisfactory vomiting control (complete and major) was 69 percent, 63 percent, 82 percent,88 percent, 96 percent and 96 percent in days 1 to 6 of cycle 1. Satisfactory nausea control (complete and major) for the same day was 70, 66, 72, 85 92 and 97 percent. Similar data was obtained for the subsequeny cycles. Complete vomiting control was obtained in 47, 35, 56, 72, 81 and 84 percent and for nausea in 42, 39, 48, 64, 81 and 87 percent. 19 patients presented adverse effects (19,6 percent). Only 2 headache episodes had a definitive relation with antiemetic drug. 12 patients discontinued the medication; 6 due to drug inefficacy, 2 to illness unrelated to the drug, 1 to lack of collaboration, and 3 due to other reasons. We conclude that tropisetron allows satisfactory control of acute and delayed vomiting in a high percentage of patients treated with high doses of cisplatin. The drug does not have significant secondary effects. Tropisetron administration in only 1 daily dose implies an evident advantage and a treatment cost reduction
Subject(s)
Humans , Male , Female , Vomiting/drug therapy , Cisplatin/adverse effects , Nausea/drug therapy , Antiemetics/administration & dosage , Serotonin Antagonists/pharmacokinetics , Drug Therapy/adverse effectsABSTRACT
Los linfomas cutáneos constituyen un amplio espectro dentro de los linfomas no Hodgkin. Se clasifican según su origen en T y B. Para los linfomas T se utiliza la clasificación de Jaffe: Micosis fungoide, síndrome de Sézary, leucemia linfocítica crónica de células T -leucemia linfoma T del adulto -linfomas angiocéntricos y papulosos linfomatoide; siendo la micosis fungoide y el síndrome de Sézary los más frecuentes. Se describe la etiopatogenia, clínica, histopatología y tratamiento de estas neoplasias. Los linfomas cutáneos que derivan de los linfocitos B son muy infrecuentes y es probable que la piel sea sólo un órgano de invasión secundaria. Se describe la clínica, histología y tratamiento de estos linfomas que se clasifican de acuerdo al grupo de trabajo Workin Formulation