Aplasia medular tratada exitosamente con ciclosporina en un paciente en hemodiálisis crónica / Bone marrow aplasia during hemodialysis successfully treated with cyclosporine: report of one case

A 28 years old male on chronic hemodialysis for 40 months due to a IgA crescentic glomerulonephritis developed pancytopenia (hematocrit 16 percent, white blood cell count 3.800 mm3 and platelets 11.000 mm3. The bone marrow aspirate showed erythropoietic hyperplasia. Hemolytic anemia, folate or vitamin B12 deficiency and paroxysmal nocturnal hemoglobinuria were ruled out. Steroids were given with a transient elevation of red cells and platelets, which lasted only for some weeks. Afterwards, intravenous immunoglobulin was given without benefit. Two months after, a bone marrow biopsy and a bone marrow magnetic resonance imaging showed severe aplasia. Cyclosporine was started with a rapid increase in blood cells count. Eight months later, he received a renal transplant from a cadaveric donor. Immunosupression was achieved with cyclosporine, prednisone and mycofenolate mofetil. The patient required hemodialysis for the first three weeks and a mild acute cellular rejection was treated with methylprednisolone. At discharge, 6 weeks later, serum creatinine was 2.4 mg/dl and creatinine clearance 37.6 ml/min. During the first months after transplant, platelet count and hemoglobin decreased and a bone marrow biopsy showed only mild hypoplasia. Four months after renal transplant the hematocrit was 43 percent, white blood cell count 6.600 mm3 and platelets, 150.000 mm3 and did not change during the first year of follow up (Rev Méd Chile 2004; 132: 989-94).

Síndrome hemorragíparo por exposición a raticida: comunicación de un caso / Bleeding disorder caused by exposure to a rodenticide: report of 1 case

We report a 22 years old male, admitted to the emergency room due to a life threatening coagulation disorder, with prothrombin times fluctuation between 5 and 37 percent and very low activity of factors II, VII, IX and X. In the month prior to the admission, the patient had used the rodenticide difethialone, without any precaution to avoid accidental exposure. The patient was maintained with fresh frozen plasma until oral vitamin K1 was obtained. This medication corrected the coagulation disorder

Nuevas estrategias para reducir el uso de sangre homóloga / New strategies for avoiding the use of homologous blood

During the last years, themain risks associated with blood transfusion have been enphasized: transmission of infections, specially after the indentification of the human immunodeficiency virus and its transmission through blood transfusion caused public concern, and other infectious agents as hepatitis C virus, HTL V-I and cytomegalovirus were added to the list of the transfusion transmissable agents. In recent years, publications about increased recurrence of certain cancer in transfused patients let to the investigators to look to the immunological effects of blood tranfusion. Keeping this risks in mind, it has been necessary to find new strategies for avoidint the transfusion of homologous blood. These strategies started with the right prescription of blood transfusion, only when the benefits are more significant than the potential risks and the development of autologous blood transfusion in its differente forms: as predeposit, acute normovolemic haemodilution and intra and postoperatory blood salvage