HIV - ELISA negativo com NAT positivo: uma realidade em Hemoterapia: [carta ao editor] / HIV - Negative ELISA and positive NAT: a reality in Blood Banking: [letter to editor]

Transfusion safety is a major concern all over the world with newtechnologies being developed to increase the protection of patients.Developed countries and some Brazilian private blood banks havealready implemented tests to detect HIV and HCV nucleic acid material(NAT). Despite the increase in transfusion safety promoted bythese tests, financers and administrators are resistant to pay for itswidespread implementation. We report here on the detection of awindow period for HIV identified by the NAT test: A donor candidateshowed up at the blood bank in August 2007 and after a clinicalinterview and hematological screening he was considered suitablefor donation and did not choose self-exclusion. All serologic testswere negative except NAT for HIV. Twelve days after donating, thedonor returned to draw another blood sample, which was positivefor NAT for HIV and combined ELISA Ag/Ab. On this occasion, hereported that he was being treated for pneumonia and had hadhomosexual relationships within the 4 weeks preceding blooddonation. One week after this second sample, a third one wascollected, which resulted in being positive for NAT, ELISA Ag/Aband ELISA HIV ½. This report illustrates the importance ofperforming the most sensitive serologic screening tests possible inblood donors, and reiterates the responsibility of physicians, hospitalsand financers. It is important to emphasize the obligation of usingevery available resource in order to increase transfusion safety asneglect is an ethical infraction with legal responsibilities. Rev. bras.hematol.hemoter.2008; 30(4):330-331.

Plasmaférese como tratamento de glomeruloesclerose segmentar focal (GESF) recorrente após transplante renal. Relato de caso e revisão da literatura / Plasmapheresis as a therapy for relapsed focal segmental glomerulosclerosis (FSGS) after kidney transplantation: case report and a review of the literature

A glomerulosclerose segmentar focal (GESF) é uma doença renal caracterizada por síndrome nefrótica, com freqüente progressão para insuficiência renal terminal. Nesta fase, o transplante renal, tanto com doador cadáver como intervivos, aparece como a única opção terapêutica para esses pacientes. Contudo, após o transplante renal, a taxa de recorrência de GESF é alta, chegando até 50 por cento dos casos. Nesta situação, a causa parece estar relacionada a um "fator humoral" circulante, responsável pelo aumento da permeabilidade glomerular. A remoção desse "fator humoral", por meio da plasmaférese terapêutica, aparece como uma boa opção de tratamento para esses pacientes. Neste artigo descreveremos o caso de um paciente masculino de 12 anos de idade, com diagnóstico de glomeruloesclerose segmentar focal recorrente após transplante renal, submetido a tratamento com plasmaférese. Após cinco sessões o paciente evoluiu com melhora sustentada da função renal. O uso de plasmaférese para tratamento da glomeruloesclerose segmentar focal pré e pós-transplante renal ainda é limitado, a maioria dos estudos apresentando resultados de curto prazo ou com pequeno número de pacientes. Alguns fatores preditivos de boa resposta ao tratamento têm sido identificados por diversos autores, dentre eles o início precoce do tratamento após a recorrência e a baixa idade. O número de sessões necessárias para atingir a remissão varia bastante e deve ser determinado individualmente. Outra possibilidade apresentada pelos autores é a plasmaférese profilática, não sendo possível até agora determinar sua eficácia. O caso apresentado é um exemplo de glomeruloesclerose recorrente com ótima resposta a plasmaférese terapêutica, evidenciando o potencial dessa modalidade de tratamento nesta situação e reforçando a necessidade de mais estudos.

Focal segmental glomerulosclerosis (FSGS) is a renal disease characterized by a nephrotic syndrome frequently evolving to end-stage renal failure. At this stage, renal transplantation, using either cadaver or live donors, is the only therapeutic option. However, after renal transplantation relapse is high, at a rate of 50 percent on average. The cause seems to be related to a peripheral humoral factor responsible for increasing glomerular permeability. The clearance of this factor by apheresis is today considered a good therapeutic option. We describe the case of a 12-year-old male patient, with relapsed FSGS after renal transplantation, who was treated by plasmapheresis. After five procedures a sustained improvement in the renal function was obtained. Reports published on plasmapheresis for the treatment of FSGS before and after renal transplantation are still limited to short-term results involving a small number of patients. Some predictive factors for good responses were identified by several investigators including the early start of treatment after relapse and lower ages. The number of plasmapheretic procedures to reach remission varies widely, and should be determined on a case to case basis. Another possibility presented by some investigators is prophylactic plasmapheresis, but this still lacks evidence on efficacy. This case report is an example of FSGS with a good response to plasmapheretic procedures, showing a potential benefit of this treatment. However, further controlled studies involving a higher number of patients are necessary.