Caracterización de donantes de sangre con rastreo de anticuerpos irregulares positivo en Montería, Colombia 2012-2015 / Blood donors characterization with positive irregular antibodies in Montería, Colombia 2012- 2015

Introducción: Los anticuerpos irregulares corresponden a aquellos distintos a los anticuerpos naturales anti-A o anti-B, los cuales pueden aparecer en respuesta a la exposición a un antígeno eritrocitario extraño (transfusión o trasplante) o por incompatibilidad materno-fetal. Objetivo: Caracterizar a los donantes con rastreo de anticuerpos irregulares positivo de un banco de sangre de Montería, Colombia, durante el periodo 2012-2015. Métodos: Estudio transversal y retrospectivo, con fuente de información secundaria, basada en los resultados del rastreo de anticuerpos en los donantes de un banco de sangre de Montería, Colombia, entre los años 2012 y 2015. La población estuvo conformada por todos los donantes voluntarios registrados en el tiempo del estudio (35 248 donantes), a quienes se les realizó rastreo de anticuerpos. Como muestra, se seleccionaron todos los casos que tuvieron resultados positivos (71 donantes). Los datos fueron organizados en tablas y analizados en el software SPSS 21.0, Microsoft Excel y en Epidat versión 3.1. Resultados: El 0,2 por ciento de la población presentó un rastreo de anticuerpos positivo con un intervalo de confianza entre 0,15 y 0,25 por ciento. Los anticuerpos irregulares fueron más frecuentes en los hombres y en donantes O Rh positivo. Se encontraron Ac irregulares con 13 especificidades diferentes, con predomino de anti-M, anti-Lea, anti-D y anti-E y porcentajes respectivos de 27,78 por ciento, 20,83 por ciento, 9,72 por ciento y 8,33 por ciento. El 50 por ciento de los donantes tenía 30,5 años o menos, el 49,3 por ciento había donado previamente y el 9,9 por ciento recibió al menos una transfusión en algún momento de su vida. Conclusión: La frecuencia de donantes con rastreo de anticuerpos irregulares positivo fue baja, el sexo masculino presentó mayor porcentaje, se detectó principalmente en el grupo sanguíneo O y dentro de los anticuerpos irregulares, anti-M presentó una mayor frecuencia(AU)

Introduction: Irregular antibodies correspond to those other than natural anti-A or anti-B antibodies, which may appear in response to exposure to a foreign erythrocyte antigen (transfusion or transplantation) or due to maternal-fetal incompatibility. Objective: To characterize the donors with positive irregular antibody screening of a blood bank in Monteria, Colombia during the period 2012-2015. Methods: Cross-sectional and retrospective study, with secondary information source, based on the results of the antibody screening in donors of a blood bank in Monteria, Colombia from 2012 to 2015. The population consisted of all voluntary donors registered in the study time (35 248 donors), who were screened for antibodies. As a sample, all cases that had positive results (71 donors) were selected. The data was organized in tables and analyzed in the software SPSS 21.0, Microsoft Excel and in Epidat version 3.1. Results: 0.2 percent of the population presented a positive antibody screen with a confidence interval between 0.15 and 0.25 percent Irregular antibodies were more frequent in men and in O Rh positive donors. Thirteen types of irregular antibodies were found, with predominance of anti-M, anti-Lea, anti-D and anti-E and respective percentages of 27.78 percent, 20.83 percent, 9.72 percent and 8.33 percent. 50 percent of the donors were 30.5 years old or less, 49.3 percent had previously donated and 9.9 percent received at least one transfusion at some point in their lives. Conclusion: The frequency of donors with irregular positive antibody screening was low, the male sex had a higher percentage, it was detected mainly in blood group O and within the irregular antibodies, anti-M showed a higher frequency(AU)

Polyclonal anti T-lymphocyte antibody therapy monitoring in kidney transplant recipients: comparison of CD3+ T cell and total lymphocyte counts / Monitoramento da terapia com anticorpo policlonal antilinfócitos T em transplantados renais: comparação da contagem de células T CD3+ e de linfócitos totais

ABSTRACT Objective: To investigate the correlation between total lymphocyte and CD3+ T cell counts in peripheral blood in renal transplant patients treated with anti-thymocyte globulin, and discuss related outcomes. Methods: A single-center, retrospective study involving 226 patients submitted to kidney transplant between 2008 and 2013, and treated with anti-thymocyte globulin for induction or treatment of cellular rejection. Doses were adjusted according to CD3+ T cell or total lymphocyte counts in peripheral blood. Results: A total of 664 paired samples were analyzed. The Spearman's correlation coefficient was 0.416 (p<0.001) for all samples combined; the overall Kappa coefficient was 0.267 (p<0.001). Diagnostic parameters estimated based on total lymphocyte counts were also calculated using the number of CD3+ T cells (gold standard), with a cut off of >20 cells/mm3. Conclusion: Total lymphocyte and CD3+ T cell counts in peripheral blood are not equivalent monitoring strategies in anti-thymocyte globulin therapy.

RESUMO Objetivo: Investigar a correlação entre a contagem de linfócitos totais e células T CD3+ no sangue periférico em receptores de transplante renal submetidos a tratamento com globulina antitimocitária, e discutir resultados relacionados. Métodos: Estudo retrospectivo de centro único envolvendo 226 pacientes submetidos a transplante renal entre 2008 e 2013 e tratados com globulina antitimocitária, para fins de indução ou tratamento de rejeição celular. As doses foram ajustadas de acordo com a contagem de células T CD3+ ou linfócitos totais no sangue periférico. Resultados: No total, 664 amostras pareadas foram analisadas. O coeficiente de correlação de Spearman para as amostras em geral foi de 0,416 (p<0,001) e o coeficiente Kappa, de 0,267 (p<0,001). Os parâmetros diagnósticos estimados com base na contagem de linfócitos totais foram recalculados, empregando-se o número de células T CD3+ (padrão-ouro) e adotando-se o ponto de corte >20 células/mm3. Conclusão: A contagem de linfócitos totais no sangue periférico não substitui a contagem de células T CD3+ enquanto estratégia de monitorização da terapia à base de globulina antitimocitária.

Haemolytic disease of newborn.

Hemolytic disease of the newborn (HDN) occurs due to maternal IgG antibodies crossing the placenta thereby producing hemolysis mainly due to Rh, ABO and Kell groups. A systematic approach to the Rh HDN involves an obstetric history of previous isoimmunized baby, timing and regular monitoring of maternal Rh antibodies and pigment assay of amniotic fluid. Timely decision regarding in utero transfusion and early termination of pregnancy based on the maternal monitoring has radically improved the outcome of these babies. Antenatal prophylaxis with anti D has resulted in great reduction in the magnitude of Rh problem. The fetal blood sampling and in-utero intravenous transfusions has made it possible for almost 100% survival of isoimmunized pregnancies without hydrops. Alternative methods--IVIG and plasma exchange are still of limited application. ABO HDN though common is not a serious form of disease and dose not warrants invasive antenatal monitoring. Anti-Kell is found in patients having received multiple transfusions and the rapid progress of hemolysis in them may not allow such systematic follow up as in Rh HDN.