Avaliação clínica e laboratorial de pacientes admitidos com anemia grave em um hospital universitário / Clinical and laboratory evaluation of patients admitted with severe anemia at a university hospital

Introdução: A anemia é definida como massa eritrocitária insuficiente para transportar oxigênio aos tecidos, e, frequentemente, representa a presença de uma doença subjacente. Pacientes hospitalizados com anemia grave podem apresentar piores desfechos clínicos. Objetivo: Determinar a frequência das etiologias de anemia grave em pacientes hospitalizados, avaliando comorbidades mais prevalentes, exames realizados, necessidades transfusionais e mortalidade durante internação. Métodos: Estudo observacional, retrospectivo, com pacientes com anemia grave (hemoglobina ≤7,0 g/dL) que realizaram transfusão de hemácias entre janeiro de 2018 e dezembro de 2019 em um Hospital Universitário. Foram coletados dados sociodemográficos, clínicos (motivo da internação, comorbidades, exames realizados, etiologia da anemia, duração e desfecho da internação, necessidade de readmissão), laboratoriais (níveis de hemoglobina; contagem de leucócitos, neutrófilos, linfócitos, plaquetas; volume corpuscular médio eritrocitário; níveis séricos de ferritina, vitamina B12) e transfusionais. Resultados: Foram incluídos 141 pacientes, com média de idade de 52,3 anos e predomínio do sexo feminino. A maior parte dos pacientes foi direcionada para a internação a partir de ambulatórios do próprio hospital, principalmente devido a quadros infecciosos. As etiologias mais prevalentes para anemia foram carencial (32,6%) e associada à inflamação (21,3%). Cerca de 16% dos pacientes evoluíram para óbito e cerca de 19% necessitaram de nova hospitalização. Discussão: Os pacientes hospitalizados com anemia grave representam um grupo de grande morbimortalidade. Chama a atenção a prevalência da etiologia carencial, uma causa sensível à atenção primária. Destaca-se também a proporção de pacientes portadores de uma doença de base possivelmente associada à anemia, mostrando a importância da atenção à saúde no cenário ambulatorial. Conclusão: A anemia aumenta significativamente a morbimortalidade em pacientes hospitalizados. Profissionais de saúde devem estar atentos ao surgimento e agravamento da anemia em pessoas com doenças crônicas, assim como às causas carenciais. Além disso, estabelecer a etiologia da anemia é necessário para um tratamento precoce e eficiente.

Introduction: Anemia is defined as insufficient erythrocyte mass to transport oxygen to the tissues and often represents the presence of an underlying disease. Hospitalized patients with severe anemia may have worse clinical outcomes. Objective: To determine the frequency of the main etiologies of severe anemia in hospitalized patients, assessing the most prevalent comorbidities, laboratory tests performed, transfusion needs, and all-cause mortality during hospitalization. Methods: This is an observational, retrospective study involving patients with severe anemia (hemoglobin ≤ 7.0 g/dL) who received red blood cell transfusion between January 2018 and December 2019 at an University Hospital. Sociodemographic and clinical data were collected (reason for admission, comorbidities, tests performed, anemia etiology, duration and outcome of hospitalization, need for readmission), as well as laboratory data (hemoglobin levels, leukocyte count, neutrophils, lymphocytes, platelets, mean corpuscular volume, serum levels of ferritin, vitamin B12) and transfusion data. Results: A total of 141 patients were included, with a mean age of 52.3 years and a predominance of females. Most patients were admitted from the hospital's outpatient clinics, mainly due to infectious conditions. The most prevalent etiologies for anemia were nutritional deficiency (32,6%) and inflammation-associated (21,3%). Approximately 16% of patients progressed to death, and around 19% required readmission. Discussion: Hospitalized patients with severe anemia represent a high morbidity and mortality group. The prevalence of nutritional deficiency as an etiology is noteworthy, as it is a condition sensitive to primary care. The proportion of patients with an underlying disease possibly associated with anemia is also highlighted, emphasizing the importance of healthcare attention in the outpatient setting. Conclusion: Anemia significantly increases morbidity and mortality in hospitalized patients. Healthcare professionals should be vigilant about the onset and worsening of anemia in individuals with chronic diseases, as well as nutritional deficiencies. Additionally, establishing the etiology of anemia is essential for early and efficient treatment.

Validation of the Brazilian version of the VERITAS-Pro scale to assess adherence to prophylactic regimens in hemophilia

Abstract Introduction: Prophylaxis is the treatment of choice for patients with severe hemophilia. Low adherence may limit the effectiveness of the prophylactic regimen, thereby compromising outcomes. Objective: The objective of this study was to validate the Brazilian version of the VERITAS-Pro prophylaxis adherence scale, originally an American questionnaire that can be answered by the individual responsible for prophylaxis as well as by an observer. Methods: The scale has 24 questions divided into six subscales: Routine, Dosage, Plan, Remember, Skip and Communicate. Participants were recruited at a blood center in southeastern Brazil for validation and reliability analyses. Validation measures included the results obtained using analog visual scales of adherence, interval between medication dispensed by the treatment center pharmacy and the percentage of recommended doses administered and infusions registered in the patients' logs. Results: The study included 32 individuals responsible for prophylaxis and five observers. The internal consistency was very good for the VERITAS-Pro total score, excellent for the Remember, Skip and Communicate subscales, good for the Dosage subscale, and acceptable for the Routine and Plan subscales. Twelve participants answered the questionnaire on more than one occasion to evaluate reproducibility. The intraclass correlation coefficient was excellent. Regarding convergent validity, the VERITAS-Pro scores were moderately correlated with the global adherence scale and with infusion log records, but showed a weak correlation with pharmacy dispensation records. Conclusion: The Brazilian version of VERITAS-Pro is a valid and reliable instrument, enabling the understanding of specific factors related to non-adherence and allowing targeted interventions for proper treatment.

Health-related quality of life in hemophilia: results of the Hemophilia-Specific Quality of Life Index (Haem-a-Qol) at a Brazilian blood center

BACKGROUND Studies on health-related quality of life are based on the increasingly evident need for medical care not to be limited to preventing death, but to focus instead on the value of health. OBJECTIVE This study aimed to measure the health-related quality of life in hemophilia, using the Hemophilia- Specific Quality of Life (Haem-A-QoL) questionnaire and describe the socioeconomic characteristics and health conditions of these patients. METHODS The Brazilian version of the Hemophilia-Specific Quality of Life questionnaire was administered to hemophiliac adults, treated in an on-demand regime at the Juiz de Fora Regional Blood Center - HEMOMINAS Foundation. The patients were interviewed about demographic and socioeconomic data and their understanding of the questionnaire. Clinical data were collected from medical records. The Mann-Whitney U test was used for statistical analysis. The level of significance was set for p-values < 0.05. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, version 15.0). RESULTS Thirty-nine patients were evaluated. The mean age was 36.8 years. 84.6% had hemophilia A; 20.5% of the patients had hemophilia classified as mild, 41% as moderate and 38.5% as severe. The records of 10.5% of the patients registered seropositivity for anti-HIV and 57.9% for anti-HCV. Target joints were detected in 69.2%. The mean total Hemophilia-Specific Quality of Life score was 35.55. 'Sports and leisure'and 'Physical health'were the most impaired dimensions and the dimension 'Relationship and partners'was the least impaired. The Hemophilia-Specific Quality of Life scores showed good discriminant validity for hemophilia severity (p-value = 0.001), HIV-infection (p-value = 0.02), HCV-infection (p-value = 0.01) and the presence of target joints (p-value < 0.001)...

Clinical and functional evaluation of the joint status of hemophiliac adults at a Brazilian blood center

BACKGROUND: Hemophilia is a potentially disabling condition as hemophilic arthropathy develops early in life and is progressive, especially in patients treated in an on-demand regime. Objective: This study aimed to describe the structural joint status and the functional independence score of hemophiliac adults and correlate structural damage with the functional deficits found in these patients. METHODS: Hemophiliacs at the Juiz de Fora Regional Blood Center - HEMOMINAS Foundation, aged 18 years and over and treated in an on-demand regime, were clinically evaluated in respect to structural joint damage using the World Federation of Hemophilia Physical Examination Scale (WFH-PE) and functional deficits using the Functional Independence Score in Hemophilia (FISH). The Spearman rank test was used to evaluate the correlation between the two scores. RESULTS: Thirty-nine patients were evaluated. The mean age was 36.8 years. Target joints were detected in 69.2% of patients studied. The mean Physical Examination Scale and Functional Independence Score were 16.87 and 25.64, respectively. Patients with mild hemophilia showed no significant joint involvement. Patients with severe or moderate hemophilia had similar results regarding structural damage (p-value < 0.001) and functional deficits (p-value = 0.001). There was statistical significance in the correlation between the two scores (r = -0.850; p-value = 0.01). CONCLUSIONS: The World Federation of Hemophilia Physical Examination Scale and Functional Independence Score in Hemophilia may be useful to clinically assess structural joint damage and functional deficits in hemophiliacs as the tools are inexpensive and easy to administer and may be able to detect hemophilic arthropathy, which results from recurrent hemarthrosis and is common in the population studied.

Leucemias agudas: primeiros sinais e sintomas em pacientes menores de 20 Anos no Hospital Universitário de Juiz de Fora / Universidade Federal de Juiz de Fora Medical research: how to improve students´ involvement

As leucemias agudas são as causas de câncer mais comuns na infância e seus sinais e sintomas, na maioria dos casos , são inespecíficos no inicío da doença; o que retarda o diagnóstico e consequentemente o tratamento. Este Trabalho visa analisar os prontuários de pacientes com diagnósticos e assim alertar os profissionais de saúde para que estes façam o diagnóstico mais alertar os profissionais da saúde para que estes façam o diagnóstico mais proprecocemente. Dentre os achados mais frequentes encontram-se: palidez (96,4%); febre (82,14%); hepatomegalia (75%); esplenomegalia (71,4%); linfadenomegalia (53,6%); anemia (92,9%); leucocitose (64,3); neutropenia (46,4%);trombocitopenia (88,5%) e blastos (71,43%).

Doença de Behçet: relato de caso / Behçet's disease: a case report

A doença de Behçet é uma afecção multissistêmica com alterações mucocutâneas, oculares, urogenitais, vasculares, articulares e neurológicas. Os autores apresentam o caso de uma mulher de 33 anos, com história de turvação visual e úlceras orais e genitais recorrentes que requereu internação hospitalar pelo acometimento do estado geral. Após exame oftalmológico, fez-se o diagnóstico de doença de Behçet, iniciando-se tratamento com remissão completa das úlceras e melhora das alterações oculares e do estado geral. O objetivo do artigo é alertar para a importância do diagnóstico e tratamento precoces dessa doença para evitar sequelas como a cegueira.

Behcet's disease is recognized as a multisystemic disorder, featuring mucocutaneous, ocular, urogenital, vascular, articular and neurologic envolvement. The authors present the case of 33-years-old woman with visual blurring and recurrent oral and genital ulcers, requering admission due to general impairment. The diagnosis of Behçet's disease followed an ophtalmic examination, with treatment bringing about complete remission of the ulcers and improvement of both ocular involvement and general symptons. The purpose of this article is to warn for the importance of an early diagnosis and treatment to avoid sequelaes, as blindness.