Hemofilia adquirida tratada con anti CD20, un anticuerpo anti linfocito B / Acquired hemophilia a treated with rituximab. Report of one case

We report a 54-year-old male presenting with a history or recurrent nose bleeds and ecchymoses. The coagulation study showed a prolongedpartial thromboplastin time, a factor VIII of 8 percent and a high inhibitor titer (193 Bethesda units). A diagnosis of acquired hemophilia A was reached. The patient was initially treated with cyclophosphamide for seven months without response. Therefore rituximab in doses of 375 mglm²Iweek for four weeks was started. After starting treatment, the patient had a hematoma in the psoas muscle with a concomitantfactor VIII ofless than 5 percent, thatwas treated with local measures. Thereafter, aprogressive reduction in inhibitor titers was observed, until its disappearance atfive months of treatment. Factor VIII levéis normalized and the patient has not experienced abnormal bleeding episodes. The patient remains in remission after 67 months offollow up. Rituximab, a chimeric monoclonal antibody against theprotein CD 20 is an effective treatment in acquired hemophilia A.

Autotrasplante (AT) de progenitores hematopoyéticos en mieloma múltiple: Experiencia clínica / Autologous transplant (AT) with peripheral-blood stem-cell rescue for multiple myeloma: A clinical experience

Background:Multiple myeloma is rarely curable. Advances in high dose chemotherapy and stem cell transplantation have improved overall survival and event-free disease periods, but relapses are inevitable. Aim: To report our experience with AT in multiple myeloma, between 1994 and 2003. Material and Methods: Retrospective analysis of 20 patients (12 women), with a mean age of 51.1 years. VAD (vincristine, doxorubicin and dexamethasone) was used as initial therapy in 19 patients. High dose cyclophosphamide (11 patients) and variations of VAD regimen (7) associated with granulocyte colony stimulating factor were used for peripheral-blood stem cell harvest. The conditioning regimen consisted of melphalan 200 mg/m2 followed by the reinfusion of peripheral-blood stem cells 24 hours later. The median number of CD34 cells infused was 3,3x106/kg. Three patients were subjected to a second auto graft and one to a non-myeloablative transplant. Mean follow up was 35.5 months. Results: Mucositis and febrile neutropenia were common complications. The median number of days for neutrophyl engraftment was 9 (range 8-11) and for platelets, 10 (range 7-13). No patient died. Complete remission was obtained in 60% (12/20), progession-free survival was 30 months and overall median survival, 47 months. Conclusions: The AT with high-dose melphalan is a safe procedure in our hospital, without mortality and engraftment in all the patients. Complete remission and progression free survival were similar to those reported abroad but the overall median survival was lower.

Prescripción de la vacuna anti influenza por médicos institucionales y estudiantes de especialidades médicas en un hospital docente / Influenza vaccine prescription by faculties and medical fellows in an universitary hospital

A study was designed aimed to know rates of influenza vaccine prescriptions among medical staff personnel and postgraduate medical student in a tertiary care teaching hospital. Data was collected by a questionnaire asking forprevious year prescription, age of patients seen at the outpatient clinic, years of professional experience and other potential factors that may influence its use. A total of 103 physicians were consulted, including 14.8 percent of 452 staff physicians and 16.3 percent of 220 postgraduate medical students. Forty percent of the requested doctors indicated influenza vaccine during 1999. This rate was quite similar among doctors that work seeing older persons at outpatient clinics (43.5 percent). Rates were similar among staff doctors and postgraduate medical students. Prescription of the vaccine was more frequently declared among physicians working at the Internal Medicine Department although differences with other services were not significant. Thirty percent of the vaccine indications were temporarily inadequate and used after the reasonable time-frame before the influenza season. Influenza vaccine is an underprescribed preventive strategy

Usos clínicos de la plasmaféresis terapéutica / Clinical uses of therapeutic plasmapheresis

La plasmaféresis, palabra acuñada por John Jacob Abel en 1914, se refiere a retirar o remover el plasma sanguíneo con devolución del resto de los componentes sanguíneos hacia el donante o paciente. Aunque en el pasado se utilizaron métodos manuales, solo con la introducción de bolsas de sangre estériles, equipos desechables y el desarrollo de máquinas separadoras de células han permitido hoy realizar los procedimientos de plasmaféresis de manera segura y eficaz. El objetivo principal de los procedimientos de plasmaféresis es la remoción del plasma y con ello el retiro del elemento responsable del daño patológico. Actualmente las máquinas de plasmaféresis poseen una moderna tecnología computacional (microprocesadores) que permiten programar el procedimiento completo. Utilizan sensores ópticos para detectar la interfase deseada y proceder a recolectar el hemocomponente. El gran incremento en las indicaciones clínicas de la plasmaféresis en los últimos 20 años es reflejo del desarrollo de esta nueva tecnología y también se debe a un mejor conocimiento de la fisiopatología de las enfermedades. En este artículo se resumen las indicaciones actuales de la plasmaféresis terapéutica