Búsqueda e identificación de anticuerpos irregulares en la población de Antofagasta / Screening and identification of irregular antibodies in population of Antofagasta

In the last years, the medicine transfusional has generated big advances in the area of the conservation and managing of the blood fractions, especially in the detection of incompatibilities between donors and recipients, using monoclonal antibodies powerful and new methods that detect antibodies in very low concentrations. The majority of the blood banks agree to provide compatible blood for the antigens ABO and Rho (D), because opposite to them the antibodies produce the more severe transfusional reactions. Nevertheless, there are many reactions that seemingly slip by for the clinical one in 4 hours later to the transfusion, period in which a narrower alertness is had in the patient. These antibodies (irregular antibodies) involved in many late reactions are capable of haemolyse red cells incompatible after 12, 24 or up to 72 hours of realized the transfusion, causing the death to the patient when the haemolysis is intravascular, without its manages to suspect that the reason was a reaction transfusional. This work had as general aim detect and identify the presence of irregular antibodies in samples tried of recipients and donors of the Bank of Blood of the Regional Hospital of Antofagasta, proving that the major number corresponded to the system Kell, with an incident of 25.42% of the Anti K O positive, 16.95% of the Anti K A positive.

En los últimos años, la medicina transfusional ha generado grandes avances en el área de la conservación y manejo de las fracciones sanguíneas, especialmente en la detección de icompatibidades entre donantes y receptores, utilizando antisueros monoclonales potentes y nuevos métodos que detectan anticuerpo concentraciones muy bajas. La mayoría de bancos de sangre se conforman, con proporcionar sangre compatible para los antígenos ABO y (D), porque frente a ellos los anticuerpos producen las reacciones transfusionales más severas. Sin embargo, hay muchas reacciones que aparentemente pasan inadvertidas para el clínico en las 4 horas posteriores a la transfusión, período en el que se tiene una vigilancia más estrecha en el paciente. Estos anticuerpos (anticuerpos irregulares) implicados en muchas reacciones tardías son capaces de hemolizar eritrocito es incompatibles después de 12, 24 o hasta 72 horas de realizada la transfusión, ocasionando la muerte al paciente cuando la hemólisis es intravascular, sin que se llegue a sospechar que la causa fue una reacción transfusional. Este trabajo tuvo como objetivo general detectar e identificar la presencia de anticuerpos irregulares en muestras procesadas de receptores y donantes del Banco de Sangre del Hospital Regional de Antofagasta, resultando que el mayor número correspondió al sistema Kell, con una incidencia de 25,42% del Anti K O positivo, 16,95% del Anti K A positivo.

Freqüência de anticorpos irregulares em politransfundidos no Hemocentro Regional de Uberaba-MG, de 1997 a 2005 / Frequency of irregular antibodies in multiple-transfused patients at the Regional Blood Bank of Uberaba, from 1997 to 2005

A fenotipagem eritrocitária pré-transfusional é um importante procedimento para aumentar a segurança das transfusões sangüíneas, sendo realizada rotineiramente no Hemocentro Regional de Uberaba-MG (HRU) desde 1996. O presente trabalho tem como objetivo geral avaliar a freqüência de anticorpos antieritrocitários irregulares em politransfundidos, de 1997 a 2005. Através de estudo retrospectivo foram levantados dados no arquivo do HRU de todos os pacientes aloimunizados, realizou-se análise estatística descritiva e comparam-se as proporções pelo teste "Z". Dos 23.220 transfundidos no período, com média de 5,7 transfusões por paciente, observou-se a ocorrência de aloimunização em 173 (0,75 por cento). Os sistemas Rh e Kell juntos tiveram freqüência superior a 70 por cento. A proporção do anti-D foi significativamente maior nas mulheres (p<0,05) e não houve diferença no sistema Rh entre brancos e não-brancos. Quanto à faixa etária, 70 por cento tinham mais de 30 anos. Dos 73 pacientes que tiveram a doença de base registrada, 39,73 por cento eram portadores de anemias agudas, 31,51 por cento de anemias crônicas e 28,77 por cento de doenças oncológicas ou onco-hematológicas. Aproximadamente 70 por cento dos anticorpos foram identificados até a décima transfusão. A baixa ocorrência da aloimunização no HRU reforça a importância da fenotipagem eritrocitária para todos os pacientes dependentes de transfusões crônicas, bem como da sua implantação na rotina de todos os serviços de hemoterapia.

Testing of the pre-transfusional blood phenotype, which has been carried out at the Regional Blood Bank in Uberaba since 1996, is an important procedure to improve safety of blood transfusions. This study aims to describe the frequency of irregular red blood cell antibodies in multiple-transfused patients from 1997 to 2005. In a retrospective study, data from all alloimmunized patients were collected from the blood bank files. Descriptive statistical analysis was performed and a comparison of proportions was made using the Z test. Alloimmunization was observed in 173 (0.75 percent) of the 23,220 transfused patients, with an average of 5.7 transfusions per patient. The frequency of the Rh and Kell systems jointly was over 70 percent. The proportion of anti-D was significantly higher in women (p<0.05) and no difference was noted in the Rh system between Caucasians and non-Caucasians. Seventy percent (70 percent) of the patients were over 30 years of age. Out of the 73 patients with registered diseases, 39.73 percent had acute anemias, 31.51 percent chronic anemias and 28.77 percent oncological or onco-hematologic diseases. Approximately 70 percent of antibodies were discovered before the 10th transfusion. The low frequency of alloimmunization observed at the Regional Blood Bank of Uberaba reinforces the importance of pre-transfusional blood phenotype screening for all multiple-transfused patients as well as its adoption as a common practice in all hemotherapy center.

Investigación de anticuerpos irregulares en hemoterapia / Irregular antibodies investigation in hemotherapy

Se estudió la presencia de anticuerpos irregulares en 8141 pacientes encontrándose que el más frecuente corresponde al anti-E del sistema Rh-Hr. Los grupos con mayor exposición y frecuencia a transfusiones presentaron porcentajes mayores.