Profile of hemotherapy care and the safety of the transfusion process

SUMMARY OBJECTIVE: This study aimed to evaluate the safety of the transfusion process in a public teaching hospital and to outline the profile of the hemotherapy care provided. METHODS: This was an exploratory, descriptive, and prospective study with a quantitative approach and grounded in field research. Data were obtained from medical and nursing records and active search. RESULTS: Concentrated red blood cells were the most transfused blood component. Inadequate indications of blood components were detected in 15% of Concentrated red blood cells transfusions, 20% of fresh plasma, 29.2% of platelet concentrates, and 36.4% of cryoprecipitates. Filling out the blood component request forms, the nursing checklist and the entry book were inadequate in 88.3, 92.8, and 69.5% of the procedures, respectively. CONCLUSIONS: Faults were identified throughout the transfusion process, revealing inadequate compliance with current standards and legislation, essential in minimizing the occurrence of errors and maximizing the safety of transfusion. Studies of this nature reinforce the need for continued research in this field.

Chagas disease: Performance analysis of immunodiagnostic tests anti-Trypanosoma cruzi in blood donors with inconclusive screening results

ABSTRACT Background: The screening of Trypanosoma cruzi-infected blood donors using two serological techniques frequently leads to conflicting results. This fact prompted us to evaluate the diagnostic performance of four "in-house" immunodiagnostic tests and two commercially available enzyme-linked immunosorbent assays (ELISAs). Material and Methods: One hundred and seventy-nine blood donors, whose screening for Chagas disease was doubtful, underwent three in-house ELISAs, one in-house immunoblotting test (TESA-blot), and two commercial ELISAs (bioMérieux and Wiener) in an attempt to define the presence or absence of infection. Simultaneously, 29 donors with previous positive results from three conventional serological tests and 30 donors with constant negative results were evaluated. Results: The ELISA-Wiener showed the highest rate in sensitivity (98.92%) and the ELISA-bioMérieux, the highest specificity (99.45%), followed by the TESA-blot, which showed superior performance, with lower false-negative (2.18%) and false-positive (1.12%) rates. In series, the combination composed of the TESA-blot and ELISA-bioMérieux showed slightly superior performance, with trifunctional protein deficiency (TFP) = 0.01%. Conclusion: Our study confirms the high sensitivity and specificity of commercial kits. To confirm the presence or absence of T. cruzi infection, the combination of TESA-blot and ELISA-bioMérieux may be suggested as the best alternative. Individually, the TESA-blot performed the closest to the gold standard; however, it is not commercially available.

Chronic osteo-articular changes in patients with sickle cell disease

Abstract Background: Sickle cell disease (SCD) is an autosomal recessive genetic disease in which a mutation occurs in the β-globin chain gene, resulting in abnormal hemoglobin levels. In an environment with reduced oxygen concentration, red blood cells change their conformation, resulting in chronic hemolysis and consequent anemia and vaso-occlusive crises with injuries to several organs, with a significant impairment of the osteoarticular system. This study aimed to verify the chronic osteoarticular alterations and their association with clinical and laboratory characteristics of patients with SCD with a more severe phenotype (SS and Sβ0), on a steady-state fasis. Methods: Fifty-five patients were referred to a medical consultation with a specialized assessment of the locomotor system, followed by laboratory tests and radiographic examinations. Results: In total, 74.5% patients had hemoglobinopathy SS; 67.3% were female; and 78.2% were non-whites. The mean patient age was 30.5 years. Most patients (61.8%) reported up to three crises per year, with a predominance of high-intensity pain (65.5%). Radiographic alterations were present in 80% patients. A total of 140 lesions were identified, most which were located in the spine, femur, and shoulders. Most lesions were osteonecrosis and osteoarthritis and were statistically associated with the non-use of hydroxyurea. Conclusions: There was a high prevalence of chronic osteoarticular alterations, which was statistically associated only with the non-regular use of hydroxyurea.(AU)

Quimioterapia intratecal: percepções e significados atribuídos por pacientes com câncer hematológico / Intrathecal chemotherapy: perceptions and meanings attributed by patients with hematological cancer / Quimioterapia intratecal: percepciones y signficados atribuidos por pacientes com cáncer hematológico

Objetivo: analisar os significados e as percepções dos pacientes submetidos à quimioterapia intratecal sobre esse tratamento. Método: estudo descritivo de abordagem quantiqualitativa, desenvolvida com 13 participantes atendidos em uma central de quimioterapia de um hospital universitário do interior de Minas Gerais, entre os anos de 2015 a 2016, cujos dados, obtidos por meio de entrevistas, foram submetidos à análise do discurso do sujeito coletivo. Aprovado pelo Comitê de Ética em Pesquisa da instituição campo do estudo. Resultados: dos dados codificados emergiram cinco discursos: desconhecimento do tratamento, dor, ansiedade, fé e esperança. Conclusão: a quimioterapia intratecal é desconhecida pelos pacientes em tratamento, causando ansiedade, dor e reações adversas as quais trazem prejuízo para a qualidade de vida desses indivíduos. Com isso criam-se mecanismos de enfrentamento da doença por meio da fé e da esperança.

Objective: analyze the meanings and perceptions of patients undergoing intrathecal chemotherapy about this treatment Method: qualitative and descriptive study carried out with 13 participants attended at a Chemotherapy Center of a University Hospital in the interior of Minas Gerais, from 2015 to 2016, whose data were submitted to the analysis of the collective subject discourse. Approved by the Research Ethics Committee of the study development institution. Results: the information obtained through the interviews was coded and five discourses emerged: lack of treatment, pain, anxiety, faith and hope. Conclusion: intrathecal chemotherapy is unknown to patients undergoing treatment, causing anxiety, pain and adverse reactions that impair their quality of life. This creates mechanisms for coping with the disease through faith and hope.

Objetivo: analizar los significados y las percepciones de los pacientes sometidos a quimioterapia intratecal sobre este tratamiento. Método: estudio de enfoque cuantitativo y descriptivo desarrollado con 13 participantes atendidos en un Centro de Quimioterapia de un Hospital Universitario en el interior de Minas Gerais, entre 2015 y 2016, cuyos datos fueron sometidos al análisis del discurso del sujeto colectivo. Aprobado por el Comité de Ética en Investigación de la institución de desarrollo del estudio. Resultados: la información obtenida a través de las entrevistas fue codificada y surgieron cinco discursos: falta de tratamiento, dolor, ansiedad, fe y Esperanza. Conclusión: la quimioterapia intratecal es desconocida para los pacientes sometidos a tratamiento, lo que causa ansiedad, dolor y reacciones adversas que deterioran su calidad de vida. Esto crea mecanismos para hacer frente a la enfermedad a través de la fe y la esperanza.

Applicability of an instrument to identify human leukocyte antigen-compatible donors for platelet transfusions

ABSTRACT Background: The selection of compatible human leukocyte antigen platelets has been associated with improved platelet increments. Therefore, an effective strategy would be the selection of donors who are genetically compatible according to the human leukocyte antigen system. Nonetheless, this is costly as it concerns a highly polymorphic system, which requires a large bank of genotyped donors. Methods: This study evaluated the feasibility of virtual crossmatching using EpVix software, which simplifies the identification of compatible donors or donors with acceptable incompatibilities. Results: Forty-three oncohematological patients were evaluated, in 96 platelet transfusion episodes with 16.3% of the patients being found to be refractory to platelet transfusions. Eight alloimmunized, multitransfused patients were selected to evaluate human leukocyte antigen compatibility against a bank of 336 platelet donors. At least partially compatible donors were found for all patients. The number of compatible donors was found to be inversely proportional to the human leukocyte antigen-panel reactive antibody score of each patient. It was noted that five patients with scores of 15% or less had at least 190 compatible donors; four fully compatible donors were found for two other patients with scores greater than 80% and only one patient (score of 93%) did not have a fully compatible donor. However, for this last patient, 40 donors were partially compatible according to the software. Conclusion: The results showed the effectiveness of the use of the EpVix tool to identify potential platelet donors for multitransfused and/or alloimmunized patients, even with a small number of human leukocyte antigen genotyped donors available.

Clinical and epidemiological profile of alloimmunized and autoimmunized multi-transfused patients against red blood cell antigens in a blood center of Minas Gerais

ABSTRACT Background: The large diversity of red blood cell antigens favors, especially in multi-transfused patients, the occurrence of autoimmunization and alloimmunization with the risk of hemolytic transfusion reactions. Thus, this study aimed to determine the rates of alloimmunization and autoimmunization in these individuals, as well as the types of alloantibodies and their systems, clinical and epidemiological aspects and the frequency of autoimmunity in alloimmunized and non-alloimmunized patients. Methods: In a retrospective study, 153 multi-transfused patients from 2006 to 2014 were evaluated. Sixty-eight had onco-hematological diseases, 64 had hemoglobinopathies and 21 had chronic renal failure. Descriptive analyses were carried out with the proportions being compared using the chi-square test, with the significance level set at 5%. Results: The Rh system was the most frequently involved (53.11%) and anti-E and anti-K (Kell system) were the most prevalent alloantibodies (21.87% each). Autoantibodies were found in ten patients (6.54%) with the percentages of autoimmunization in alloimmunized and non-alloimmunized individuals being 29.16% and 2.32%, respectively (p = 0.0001). There was a significant difference between autoimmunization and the number of transfusions (16.21% in 6-10 vs. 5.26% <6 vs. 2.56% >10; p = 0.0203) and diseases (19.04% in chronic renal failure vs. 6.25% in hemoglobinopathies vs. 2.94% in onco-hematological diseases; p = 0.0329). Conclusion: The results show a strong correlation between alloimmunization and autoimmunization. Moreover, they reinforce the need for further studies on the clinical and epidemiological profile of multi-transfused patients in relation to alloimmunity and autoimmunity, especially the latter, for a better understanding of its etiopathogenesis and physiopathogenesis.

Evaluation of cross reactivity between Trypanosoma cruzi and Leishmania infantum in serologically ineligible blood donors due to chagas diseas

Inconclusive serological screening for Trypanosoma cruzi has been a problem for blood banks. This study examined the performance of serological techniques for Chagas disease in reagent samples from blood bank screenings and verified the possibilities of cross reactivity with visceral leishmaniasis. 68 samples of reagent donors tested with ELISA for Chagas disease were evaluated by other techniques and for the detection of anti-Leishmania antibodies. Four donors (5.9%) with positive results for T. cruzi were positive for ELISA Kalazar Detect (visceral leishmaniasis),three of which were confirmed by Western blot. This study confirms the specificity of the tests for Chagas disease in blood banks and reinforces the urgent adoption of measures to assess the real risk of transfusion transmission of visceral leishmaniasis

Cholelithiasis and its complications in sickle cell disease in a university hospital

Abstract Introduction: The clinical manifestations of sickle cell disease are related to the polymerization of hemoglobin S. The chronic hemolysis caused by this condition often causes the formation of gallstones that can migrate and block the common bile duct leading to acute abdomen. Objective: This study aimed to evaluate the profile of patients with sickle cell disease and cholelithiasis. Methods: Patients with sickle cell disease were separated into groups according to the presence or absence of cholelithiasis. Socioepidemiological and clinical characteristics, such as gender, age, use of hydroxyurea and the presence of other hemoglobinopathies were researched in the medical records of patients. Results: A hundred and seven patients with sickle cell anemia were treated at the institution. Of these, 27 (25.2%) had cholelithiasis. The presence of cholelithiasis was higher in the 11–29 age group than in younger than 11 years and over 29 years. No association was found for the presence of cholelithiasis with gender, use of hydroxyurea or type of hemoglobinopathy (hemoglobin SS, hemoglobin SC or sickle beta-thalassemia). Sixteen of the patients had to be submitted to cholecystectomy with 14 of the surgeries being performed by laparoscopy. Complications were observed in three patients and one patient died for reasons unrelated to the surgery. Conclusion: A quarter of patients with sickle cell disease had gallstones, more commonly in the 11- to 29-year age range. Patients should be monitored from childhood to prevent cholelithiasis with preoperative, intra-operative and postoperative care being crucial to reduce the risk of complications in these patients.

Evaluation of the effectiveness of packed red blood cell irradiation by a linear accelerator

Irradiation of blood components with ionizing radiation generated by a specific device is recommended to prevent transfusion-associated graft-versus-host disease. However, a lin- ear accelerator can also be used in the absence of such a device, which is the case of the blood bank facility studied herein. In order to evaluate the quality of the irradiated packed red blood cells, this study aimed to determine whether the procedure currently employed in the facility is effective in inhibiting the proliferation of T lymphocytes without damaging blood components. The proliferation of T lymphocytes, plasma potassium levels, and the degree of hemolysis were evaluated and compared to blood bags that received no irradiation. Packed red blood cell bags were irradiated at a dose of 25 Gy in a linear accelerator. For this purpose, a container was designed to hold the bags and to ensure even distribution of irradiation as evaluated by computed tomography and dose-volume histogram. Irradiation was observed to inhibit the proliferation of lymphocytes. The percentage of hemolysis in irradiated bags was slightly higher than in non-irradiated bags (p-value >0.05), but it was always less than 0.4% of the red cell mass. Although potassium increased in both groups, it was more pronounced in irradiated red blood cells, especially after seven days of storage, with a linear increase over storage time. The findings showed that, at an appropriate dosage and under validated conditions, the irradiation of packed red blood cells in a linear accelerator is effective, inhibiting lymphocyte proliferation but without compromising the viability of the red cells.

Length and caliber of the rectosigmoid colon among patients with Chagas disease and controls from areas at different altitudes

Introduction In this study, we investigated radiological changes in the sigmoid colon in chagasic patients by comparing their colon lengths and caliber with those of non-chagasic living in the same region and non-chagasic living at high altitudes. Methods A total of 317 individuals were evaluated using clinical, serological and radiological methods and divided into three groups: 1) one hundred and nine non-chagasic individuals from Uberaba, Brazil; 2) sixty-one non-chagasic from Puno, Peru; 3) one hundred forty-seven chagasics examined in Uberaba, being 62 without megacolon (3A), 72 with megacolon (3B) and 13 with doubtful diagnosis of megacolon (3C). Results In group 2, the sigmoid colon had a significantly larger caliber (p=0.001) and the rectosigmoid colon was longer (p<0.001) than group 1. In subgroup 3A, the sigmoid colon (p<0.001) and rectum (p<0.001) had a significantly larger caliber and the rectosigmoid was longer (p<0.001) than that of the non-chagasic individuals. In subgroup 3B, the rectosigmoid was longer in all patients, and the caliber of the sigmoid was significantly larger than that of subjects in subgroups 3A and 3C (p<0.001). Conclusions Morphometric analysis confirms that Chagas disease may increase the caliber and length of the rectosigmoid. Our results suggest that altitude, ethnicity and diet may have influenced the size and length of the rectosigmoid of andean patients. .

Aureobasidium pullulans infection in a patient with chronic lymphocytic leukemia

Saprophytic fungi are being increasingly recognized as etiologic agents of mycoses in immunosuppressed patients. We report a case of subcutaneous infiltration by Aureobasidium pullulans, likely due to traumatic inoculation, in a neutropenic patient during chemotherapy for chronic lymphocytic leukemia. The patient was treated with amphotericin B deoxycholate but was subsequently switched to itraconazole, which improved the lesion. This case highlights the importance of considering unusual fungal infections in critically ill patients such as those who are immunosuppressed due to chemotherapy. Diagnostic techniques and effective antifungal therapy have improved the prognosis of these cases.

The importance of hemovigilance in the transmission of infectious diseases

Background: Hemovigilance is an organized system of surveillance throughout the transfusion chain intended to evaluate information in order to prevent the appearance or recurrence of adverse reactions related to the use of blood products. Objective: The aims of this study were to assess the late reporting of incidents related to possible seroconversion in respect to age, marital status and ethnical background, annual variations in late reporting, the number of reports opened and closed, seroconversion of donors and transfusions of blood products within the window period. Methods: This retrospective, descriptive study used data on blood donations in the blood bank in Uberaba during the period from 2004 to 2011. Some socio-epidemiological characteristics of the donors and serology test results of donors and recipients were analyzed in respect to the late reporting of incidents related to possible seroconversion. The Chi-square test, odds ratio and a regression model were used for statistical analysis. Results: From 2004 to 2011, the blood bank in Uberaba collected 117,857 blood bags, 284 (0.24%) of which were investigated for late reported incidents. The profile of the donors was less than 29 years old, unmarried and non-Whites. Differences in age (p-value < 0.0001), marital status (p-value = 0.0002) and ethnical background (p-value < 0.0001) were found to be statistically significant. There was no statistical difference between men and women (0.24% and 0.23% respectively; p-value = 0.951). The number of late reported incidents increased until 2008 followed by a downward trend until 2011. ...

Sexuality and sickle cell anemia

BACKGROUND: Sickle cell disease, the most common hereditary blood disease in the world, is the result of an atypical hemoglobin called S (Hb S) which, when homozygous (Hb SS) is the cause of sickle cell anemia. Changes of puberty, correlated with a delayed growth spurt, begin late in both male and female sickle cell anemia individuals with repercussions on sexuality and reproduction. The objectives of this exploratory and descriptive study were to characterize the development of sexuality in adults with sickle cell anemia by investigating the patient's perception of their sex life, as well as the information they had and needed on this subject. METHODS: Twenty male and female sickle cell anemia patients treated at the Hemocentro Regional de Uberaba (UFTM) with ages between 19 and 47 years old were enrolled. A socioeconomic questionnaire and a semi-structured interview on sexuality, reproduction and genetic counseling were applied. RESULTS: This study shows that the sickle cell anemia patients lacked information on sexuality especially about the risks of pregnancy and the possible inheritance of the disease by their children. Moreover, the sexual life of the patients was impaired due to pain as well as discrimination and negative feelings experienced in close relationships. CONCLUSION: The health care of sickle cell anemia patients should take into account not only the clinical aspects of the disease, but also psychosocial aspects by providing counseling on sexuality, reproduction and genetics, in order to give this population the possibility of a better quality of life.

Pain measurement as part of primary healthcare of adult patients with sickle cell disease

OBJECTIVE: The aim of this exploratory, cross-sectional study was to evaluate pain in sickle cell disease patients and aspects related to primary healthcare. METHODS: Data were obtained through home interviews. The assessment instruments (body diagram, Numerical Pain Scale, McGill Pain Questionnaire) collected information on the underlying disease and on pain. Data were analyzed using the Statistical Package for Social Sciences program for Windows. Associations between the subgroups of sickle cell disease patients (hemoglobin SS, hemoglobin SC, sickle β-thalassemia and others) and pain were analyzed using contingency tables and non-parametric tests of association (classic chi-square, Fisher's and Kruskal-Wallis) with a level of 5% (p-value < 0.05) being set for the rejection of the null hypothesis. RESULTS: Forty-seven over 18-year-old patients with sickle cell disease were evaluated. Most were black (78.7%) and female (59.6%) and the mean age was 30.1 years. The average number of bouts of pain annually was 7.02; pain was predominantly reported by individuals with sickle cell anemia (hemoglobin SS). The intensity of pain (Numeric Pain Scale) was 5.5 and the quantitative index (McGill) was 35.9. This study also shows that patients presented a high frequency of moderately painful crises in their own homes. CONCLUSION: According to these facts, it is essential that pain related to sickle cell disease is properly identified, quantified, characterized ...

Prevalence of Chagas disease in blood donors at the Uberaba Regional Blood Center, Brazil, from 1995 to 2009 / Prevalência da doença de Chagas em doadores de sangue do Hemocentro Regional de Uberaba, Brasil, entre 1995 e 2009

INTRODUCTION: A retrospective study was conducted to assess the occurrence of blood donations that were ineligible due to Chagas disease infection from 1995 to 2009 at the Uberaba Regional Blood Center (HRU), Brazil, verify the tendency of this ineligibility, and describe the epidemiologic profile of the donors. METHODS: Retrospective studies of serological ineligibility due to Chagas disease, statistical analysis by means of the chi-square test and odds ratio, study of the tendencies using a dispersion graph and the linear correlation coefficient (r) were performed. RESULTS: In the period under study, a 0.2% serum prevalence of ineligibility due to Chagas disease was found, with a significant drop in ineligible donations from 2001 to 2009. Among the serum positive-donors, there was a significant predominance among those aged 30 years or above and non-single individuals. CONCLUSIONS: The results show a rate of occurrence that is lower than that described in literature, as well as a progressive drop during the 15 years under assessment. Such results are a consequence of systematic combat of the vector since the 70s and the progressive and consistent increase of returning donors, resulting in a drop of the contamination risk factor by means of blood transfusion and in the improvement of the quality of hemotherapy practices in the HRU.

INTRODUÇÃO: Estudo retrospectivo com o objetivo de avaliar a ocorrência de doações inaptas para doença de Chagas entre 1995 e 2009 no Hemocentro Regional de Uberaba (HRU), Brasil; verificar a tendência dessa inaptidão e descrever o perfil epidemiológico dos doadores. MÉTODOS: Estudo retrospectivo da inaptidão sorológica para doença de Chagas; análise estatística pelo teste do qui quadrado e odds ratio; estudo de tendência a partir do gráfico de dispersão e do coeficiente de correlação linear (r). RESULTADOS: No período em estudo foi encontrada uma soroprevalência de inaptidão para doença de Chagas de 0.2% com queda significativa de doações inaptas de 2001 a 2009. Dentre os soropositivos, observou-se predomínio significante na idade superior ou igual a 30 anos, e estado civil casado e outros. CONCLUSÕES: Os resultados demonstram taxa de ocorrência menor que as descritas na literatura, além de queda progressiva no decorrer dos 15 anos avaliados. Tais resultados são consequência do combate sistemático ao vetor a partir dos anos 70 e do progressivo e consistente aumento de doadores de retorno, resultando em queda do risco de contaminação via transfusão de sangue e na melhora da qualidade da hemoterapia praticada no HRU.

Distribution of QPY and RAH haplotypes of granzyme B gene in distinct Brazilian populations / Distribuição dos haplótipos QPY e RAH do gene da granzima B em grupos populacionais brasileiros

INTRODUCTION: The cytolysis mediated by granules is one of the most important effector functions of cytotoxic T lymphocytes and natural killer cells. Recently, three single nucleotide polymorphisms (SNPs) were identified at exons 2, 3, and 5 of the granzyme B gene, resulting in a haplotype in which three amino acids of mature protein Q48P88Y245 are changed to R48A88H245, which leads to loss of cytotoxic activity of the protein. In this study, we evaluated the frequency of these polymorphisms in Brazilian populations. METHODS: We evaluated the frequency of these polymorphisms in Brazilian ethnic groups (white, Afro-Brazilian, and Asian) by sequencing these regions. RESULTS: The allelic and genotypic frequencies of SNP 2364A/G at exon 2 in Afro-Brazilian individuals (42.3% and 17.3%) were significantly higher when compared with those in whites and Asians (p < 0.0001 and p = 0.0007, respectively). The polymorphisms 2933C/G and 4243C/T also were more frequent in Afro-Brazilians but without any significant difference regarding the other groups. The Afro-Brazilian group presented greater diversity of haplotypes, and the RAH haplotype seemed to be more frequent in this group (25%), followed by the whites (20.7%) and by the Asians (11.9%), similar to the frequency presented in the literature. CONCLUSIONS: There is a higher frequency of polymorphisms in Afro-Brazilians, and the RAH haplotype was more frequent in these individuals. We believe that further studies should aim to investigate the correlation of this haplotype with diseases related to immunity mediated by cytotoxic lymphocytes, and if this correlation is confirmed, novel treatment strategies might be elaborated.

INTRODUÇÃO: A citólise mediada por grânulos é uma das mais importantes funções efetoras de linfócitos T citotóxicos e células natural killer. Recentemente, três polimorfismos de nucleotídeo único foram identificados nos éxons 2, 3 e 5 do gene da granzima B, resultando em um haplótipo em que três aminoácidos da proteína madura Q48P88Y245 são alterados para R48A88H245, o que leva à perda da atividade citotóxica da proteína. No presente estudo, avaliamos a frequência desses polimorfismos em populações brasileiras. MÉTODOS:Avaliamos a frequência desses polimorfismos em grupos étnicos brasileiros (brancos, afro-brasileiros e asiáticos) por sequenciamento. RESULTADOS: As frequências alélica e genotípica do polimorfismo 2364A/G no éxon 2 em indivíduos afro-brasileiros (42,3% e 17,3%) foram significativamente maiores (p < 0,0001 e p = 0,0007) quando comparadas a brancos e asiáticos. Os polimorfismos 2933C/G e 4243C/T também foram mais frequentes em afro-brasileiros, mas sem diferença significativa. O grupo afro-brasileiro apresentou maior diversidade de haplótipos e o haplótipo RAH foi mais frequente nesse grupo (25%), seguidos pelos brancos (20,7%) e asiáticos (11,9%), semelhante à frequência apresentada na literatura. CONCLUSÕES: Há uma maior frequência de polimorfismos em afro-brasileiros e o haplótipo RAH foi mais frequente nesses indivíduos. Acreditamos que novos estudos devem ter como objetivo a investigação da correlação deste haplótipo com doenças relacionadas com a imunidade mediada por linfócitos citotóxicos, e se essa correlação for confirmada, novas estratégias de tratamento poderão ser elaboradas.

Ocorrência da sorologia positiva para hepatite B nos doadores de sangue do Hemocentro Regional de Uberaba (MG) no período de 1995 a 2009 / Occurrence of positive serology for hepatitis B among blood donors at a blood bank in the city of Uberaba (MG), Brazil, between 1995 and 2009

Introdução: As infecções pelo vírus da hepatite B (HBV) constituem grave problema de saúde pública. A transmissão por via transfusional é uma das principais formas de contágio do vírus. Objetivos: Calcular a prevalência de doadores soropositivos, no período de 1995 a 2008, analisando-os quanto ao perfil epidemiológico, tendência e presença dos marcadores HBsAg eAnti-HBc. Métodos: Estudo retrospectivo dos doadores inaptos (ELISA), no Hemocentro Regional de Uberaba (HRU), através de teste qui quadrado e cálculo de odds ratio; análise de associação a partir do gráfico de dispersão e do coeficiente de correlação linear (r), com nível de significânciade 5por cento. Resultados: No período de 1995 a 2008, o HRU contou com 60811 doadores de sangue, sendo a prevalência de inaptos 5,6por cento; respectivamente: HBsAg positivo/Anti-HBc- 0,2por cento (120 doadores); HBsAg-/Anti-HBc positivo 5,24por cento (3192) e HBsAg positivo/Anti-HBc positivo 0,16por cento (101). Em relação ao perfilepidemiológico, observou-se predomínio significativo do gênero masculino; faixa etária maior ou igual a 30 anos; estado civil casados e outros quando comparados com os solteiros; não caucasóides e procedentes de Uberaba. Conclusão: Observa-se tendência decrescente de inaptidão no períodoestudado.

Etiology of anemia of blood donor candidates deferred by hematologic screening

OBJECTIVE: Iron deficiency is the most common cause of anemia and one of the main factors in the clinical deferral of blood donors. This fact prompted the current study that aimed to determine the prevalence and etiology of anemia in blood donor candidates and to evaluate the hematological screening technique used for the exclusion of these donors. METHODS: This was a prospective study that compared two groups (Anemic and Non-anemic). Initially screening for anemia was performed by manually measuring hemoglobin (Bioclin® Kit); the results were subsequently compared with an automated screening method (Coulter T-890). The etiology was investigated by hemoglobin electrophoresis in alkaline and acid pH, Hb A2 dosage and measurement of the ferritin concentration by immunoagglutination. Differences and associations of interest were analyzed using the Yates and McNemar's Chi-square tests and the Fisher, Mann-Whitney, Wilcoxon and Kruskal-Wallis tests. RESULTS: The deferral rate due to anemia was 4.2%; iron deficiency was identified in 37.5% and beta thalassemia in 9.3% of the excluded candidates. There was a significant discrepancy between the two techniques used to measure hemoglobin with 38.1% of initially deferred donors presenting normal hemoglobin levels by the automated method. CONCLUSION: The results show a high rate of blood donors being deferred for anemia and confirm that iron deficiency is the most prevalent cause. The discrepancies found by comparing screening methods suggest that hemoglobin and hematocrit levels should be confirmed before deferring a donor due to anemia; this may increase supplies in blood banks.

Performance of six diagnostic tests to screen for Chagas disease in blood banks and prevalence of Trypanosoma cruzi infection among donors with inconclusive serology screening based on the analysis of epidemiological variables

OBJECTIVE: The frequent occurrence of inconclusive serology in blood banks and the absence of a gold standard test for Chagas'disease led us to examine the efficacy of the blood culture test and five commercial tests (ELISA, IIF, HAI, c-ELISA, rec-ELISA) used in screening blood donors for Chagas disease, as well as to investigate the prevalence of Trypanosoma cruzi infection among donors with inconclusive serology screening in respect to some epidemiological variables. METHODS: To obtain estimates of interest we considered a Bayesian latent class model with inclusion of covariates from the logit link. RESULTS: A better performance was observed with some categories of epidemiological variables. In addition, all pairs of tests (excluding the blood culture test) presented as good alternatives for both screening (sensitivity > 99.96% in parallel testing) and for confirmation (specificity > 99.93% in serial testing) of Chagas disease. The prevalence of 13.30% observed in the stratum of donors with inconclusive serology, means that probably most of these are non-reactive serology. In addition, depending on the level of specific epidemiological variables, the absence of infection can be predicted with a probability of 100% in this group from the pairs of tests using parallel testing. CONCLUSION: The epidemiological variables can lead to improved test results and thus assist in the clarification of inconclusive serology screening results. Moreover, all combinations of pairs using the five commercial tests are good alternatives to confirm results.