Transfusion of ABO non-identical platelets increases the severity of trauma patients at ICU admission

ABSTRACT Background: Transfusion of ABO-compatible non-identical platelets (PTLs), fresh plasma (FP) and red blood cells (RBCs) has been associated with increased morbidity and mortality of recipients. Trauma victims are frequently exposed to ABO non-identical products, given the need for emergency transfusions. Our goal was to evaluate the impact of the transfusion of ABO non-identical blood products on the severity and all-cause 30-day mortality of trauma patients. Methods: This was a retrospective single-center cohort, which included trauma patients who received emergency transfusions in the first 24 h of hospitalization. Patients were divided in two groups according to the use of <3 or ≥3 ABO non-identical blood products. The patient severity, measured by the Acute Physiology and Chronic Health Evaluation (APACHEII) score at ICU admission, and the 30-day mortality were compared between groups. Results: Two hundred and sixteen trauma patients were enrolled. Of these, 21.3% received ≥3 ABO non-identical blood products (RBCs, PLTs and FP or cryoprecipitate). The transfusion of ≥3 ABO non-identical blood products in the first 24 h of hospitalization was independently associated with a higher APACHEII score at ICU admission (OR = 3.28 and CI95% = 1.48-7.16). Transfusion of at least one unit of ABO non-identical PTLs was also associated with severity (OR = 10.89 and CI95% = 3.38-38.49). Transfusion of ABO non-identical blood products was not associated with a higher 30-day mortality in the studied cohort. Conclusion: The transfusion of ABO non-identical blood products and, especially, of ABO non-identical PLTs may be associated with the greater severity of trauma patients at ICU admission. The transfusion of ABO non-identical blood products in the trauma setting is not without risks.

Associação da quimiotoxicidade com o estado (de la quimiotoxicidad con el estado) nutricional em pacientes oncológicos / Nutritional status and chemotoxicity in oncology patients

Introdução: O câncer é uma enfermidade caracterizada pelo (El cáncer es una enfermedad que se caracteriza por el) crescimento desordenado de células, cujo tratamento com quimioterapia atua no seu controle ou (cuyo tratamiento con quimioterapia actúa en su control o) remissão e pode prolongar a sobrevida. No entanto (Sin embargo), a quimioterapia pode causar uma série de efeitos colaterais, denominados quimiotoxicidade, levando ao déficit nutricional e comprometendo sua tolerância e (llevando al déficit nutricional y comprometiendo su tolerancia y) eficácia. Objetivo: Verificar a associação da quimiotoxicidade com o estado nutricional de pacientes oncológicos. Métodos: Estudo transversal, de caráter retrospectivo, com análise de prontuário (con análisis de historia clínica) de pacientes com neoplasia de tumores sólidos, com 3 ciclos realizados de quimioterapia. Foram coletadas variáveis (Fueron contempladas variables) sociodemográficas, clínicas, antropométricas e a quimiotoxicidade foi categorizada conforme a National Cancer Institute (NCI). Resultados: Foram avaliados 126 pacientes, com idade média 54.6 ± 13.9 anos, predominantemente do sexo feminino (68.3%). As neoplasias mais prevalentes foram mama (51%) e trato gastrointestinal (34.5%) e o estadiamento IV foi prevalente (con prevalencia del estadio IV) (40.5%). A quimiotoxicidade apresentou-se desde o primeiro ciclo, com 52.5% de toxicidade bioquímica. Comparando o primeiro e terceiro ciclo não foi observada associação significativa entre a toxicidade e o índice de massa corporal (IMC), leucócitos, plaquetas e hemoglobina, mas observou-se tendência na toxicidade (pero se observó una tendencia en la toxicidad) de neutrófilos (p = 0.053). A toxicidade gastrointestinal afetou significativamente a perda de peso durante o (la pérdida de peso durante el) tratamento (p = 0.024). Conclusão: A quimiotoxicidade foi observada desde o primeiro ciclo, no entanto apenas a toxicidade do trato gastrointestinal apresentou (sin embargo, solo la toxicidad del tracto gastrointestinal presentó una) associação com a perda de peso corporal.

Introduction: Cancer is a disease characterized by the uncontrolled growth of cells, whose treatment with chemotherapy acts as a control or remission and may prolong survival. However, chemotherapy can cause a number of side effects, called chemotoxicity, leading to malnutrition and compromising its effectiveness and tolerance. Objective: To investigate the association between chemotoxicity and the nutritional status of cancer patients. Methods: Longitudinal and retrospective study with chart analysis of patients with cancer of solid tumors, with at least 3 cycles of chemotherapy performed. Sociodemographic, clinical, anthropometric variables were collected and chemotoxicity was categorized according to the National Cancer Institute (NCI, 1999). Results: We evaluated 126 patients, mean age of 54.6 ± 13.9 years, predominantly female (68.3%). The most common cancers were breast (51%) and gastrointestinal tract (34.5%) and most were classified as stage IV (40.5%). Chemotoxicity showed up from the first cycle, with 52.5% biochemical toxicity. Comparing the first and the third cycles, no difference in toxicity was observed in relation to body mass index (BMI), white blood cells, platelets and hemoglobin; but there was a trend in the association of toxicity with neutrophils (p = 0.053). The GI toxicity significantly affected weight loss during treatment (p = 0.024). Conclusion: chemotoxicity was observed from the first cycle; however only the toxicity of the gastrointestinal tract was associated with weight loss.