PTI y embarazo: una experiencia con rituximab / ITP and pregnancy: an experience with rituximab

El Púrpura Trombocitopénico Idiopático (PTI) es una patología asociada a una de cada 500 a 1000 gestantes. Su reconocimiento oportuno y adecuado manejo durante el embarazo, permite reducir la morbimortalidad tanto materna como fetal. Los corticoides como tratamiento de primera línea para PTI en embarazadas, es igual que en población general, con respuestas observadas entre el 5° y 7° día, alcanzando un 50 - 60% de éxito. El caso que presentamos se trata de una gestante en el 2° trimestre tardío con PTI refractario al tratamiento con corticoides, con muy bajos niveles de plaquetas y alto riesgo de hemorragia, por lo cual se decide el uso de Rituximab, un anticuerpo monoclonal (categoría C de la FDA) con escasa prescripción en el embarazo. Exponemos nuestra experiencia en este caso.

Idiopathic thrombocytopenic purpura ( ITP) is a condition associated with each 500-1000 pregnancies . Its early recognition and proper management during pregnancy, can reduce both maternal and fetal morbidity and mortality. Corticosteroids as first-line treatment for ITP in pregnant women is the same as in the general population, with responses observed between the 5th and 7th day, approximately 50-60 % of patients respond favorably. The case presented is a pregnant patient in the 2th trimester with refractory ITP treatment with corticosteroids, very low levels of platelets and high risk of bleeding so the use of Rituximab is decided, a monoclonal antibody (category C FDA) with little prescription in pregnancy. We describe our experience in this case.

Estudio clínico y epidemiológico en donantes de sangre seropositivos por trypanosoma cruzi / Clinical and epidemiological study of blood donors seropositive for Chagas disease

One hundred eleven seropositive donors, detected between 1994 and 1996, were studied. Serological reactions were confirmed with ELISA and indirect immunofluorescence reactions. Those confirmed as positive were subjected to a clinical-epidemiological questionnaire, physical examination, EKG and barium enema or swallow according to symptoms. Results: Seventy individuals were confirmed as positive for Chagas disease. Most of them lived at least once in an endemic zone for Chagas positive for Chagas disease. Most of them lived at least once in an endemic zone for Chagas disease or in a sun-dried clay brick house. Forty percent of individuals knew reduviid bugs and 14 pecent had been bitten by these insects. Twenty six percent of these subjects had an abnormal EKG (6 percent with bradicardia). No digestive diseases attributable to Chagas disease were detected. Conclusions: The high prevalence of problems attributable to Chagas disease among seropositive blood donors underscores the need of an epidermiological follow up of these individuals