Reacción hemolítica transfusional tardía en un paciente con anemia de células falciformes: reporte de un caso / Delayed hemolytic reaction to transfusion in sickle cell anemia: report of one case

Sickle cell anemia was a rare disease in Chile, especially in adults, however the recent immigration wave from Haiti is changing this scenario. We report a 29 year old black female from Haiti with a non-disclosed history of sickle cell anemia. She was transfused with two units of red blood cells, found unconscious and with jaundice five days later and admitted to the hospital. On admission she had a hemoglobin of 3.3 g/dL, a total bilirubin of 5.08 mg/dL, a LDH of 1,306 Ui/L. She was transfused again, worsening her condition. An alloimmunization and delayed hemolytic reaction was suspected. A direct Coombs test was positive. She was treated with steroids and her serum hemoglobin rose progressively.

Efecto de la implementación de recomendaciones de sedoanalgesia en una UCI general / Effect of the implementation of recommendations about sedoanalgesia in a general ICU

A great part of the patients in an Intensive Care Unit (ICU) need sedo-analgesia (SA), specially in mechanic ventilation (MV). Our unit is a general ICU where a diversity of therapeuticschemes and farmacological presentations have been used, without standard practices. At a first stage we introduced SA recommendations, reinforcing its use. We conducted the present study to evaluate its effect in our clinical practice. Methodology: Indicators of adverse incidents were registered, associated to MV, mortality, permanence in MV,hospitalization in ICU, use of medicines and cost, the results were measured during the 3 months prior to beginning and the 3 months following implementation of the SA recommendations, which ruled the use of the association of midazolam (MZ) (Dormonid (R), Laboratorio Roche (R) and morphine; in cases of the renal insufficiency, hemo-dynamic instability or allergic reaction it was chosen to associate MZ and fentanyl, both associations in continuous infusion and with suspension of morning sedation. The sedation level had to be evaluated with ramsay scale. Neurological patients were excluded. It was considered "strict compliance" when the recommended combination of medicines were utilized, adjusted by sedation scale and with matinal suspension; "partial compliance" when these were utilized without complying with the scale adjustement or the matinal suspension. The results obtained were analyzed utilizing the Primer(R) statistical program. Results: Before the introduction of the recommendations we observed an average MV duration of 5,8 days (Range: 1-82), duration of ICU hospitalization of 9,8 days (Range: 1-101), a mortality of 28 per cent, one case of auto-extubation, with the use of one average dose of MZ of 10±1,8 mg/hr, with a montly use of MZ in the unit of 22,2 g., a montly expense in sedatives, analgesics and relaxants of US$3018. After its introduction we observed an average duration at MV of 4,5 days (Range: 1-41) (NS), duration of hospitalization at ICU of 5,0 days (Range: 1-45) (p=0,001), a mortality of 22 per cent (NS), one case of auto-extubation, with an average dose of MZ of 4,2 g. (p=0,001), a montly expense in sedatives, analgesics and relaxants of US$809 (p=0,0001). Average compliance with the recommendations was 68 per cent (46 per cent partial, 22 per cent strict).

El test de lisis con glicerol acidificado, un método de screening para esferocitosis hereditaria: evaluación y valor diagnóstico / The scidified glycerol lysis test, a screening method for inherited spherocytosis

Se evaluó un método de screening para esferocitosis hereditaria, el test de lisis con Glicerol Acidificado (AGTL). En la evaluación se utilizaron 75 muestras de sangre de individuos normales (recién nacidos y adultos) y 20 patológicas (Esferocitosis Hereditaria, Insuficiencia Renal Crónica, Trastorno Hematológico Maligno y Daño Hepático). A base de los resultados obtenidos, se concluye lo siguiente: la temperatura de lectura más adecuada es 37-C; las muestras pueden ser conservadas por 24 hrs. a 4§C; los valores de referencia normal para recién nacidos y adultos son >2.100 y >1.200 segundos, respectivamente y que el método posee una sensibilidad de 100%

Afasia transcortical motora: dos casos clínicos / Transcortical motor aphasia: 2 clinical cases

Se presentan dos pacientes con una afasia no fluida, con buena comprensión verbal y una excelente repetición de fonemas, palabras y frases. La tomografía axial computarizada demostró en ambos casos lesiones córtico-subcorticales anteriores del hemisferio izquierdo. Se discute la desaferentación del área motora primaria del lenguaje (área de Broca), como mecanismo de la afasia transcortical motora