Applicability of an instrument to identify human leukocyte antigen-compatible donors for platelet transfusions

ABSTRACT Background: The selection of compatible human leukocyte antigen platelets has been associated with improved platelet increments. Therefore, an effective strategy would be the selection of donors who are genetically compatible according to the human leukocyte antigen system. Nonetheless, this is costly as it concerns a highly polymorphic system, which requires a large bank of genotyped donors. Methods: This study evaluated the feasibility of virtual crossmatching using EpVix software, which simplifies the identification of compatible donors or donors with acceptable incompatibilities. Results: Forty-three oncohematological patients were evaluated, in 96 platelet transfusion episodes with 16.3% of the patients being found to be refractory to platelet transfusions. Eight alloimmunized, multitransfused patients were selected to evaluate human leukocyte antigen compatibility against a bank of 336 platelet donors. At least partially compatible donors were found for all patients. The number of compatible donors was found to be inversely proportional to the human leukocyte antigen-panel reactive antibody score of each patient. It was noted that five patients with scores of 15% or less had at least 190 compatible donors; four fully compatible donors were found for two other patients with scores greater than 80% and only one patient (score of 93%) did not have a fully compatible donor. However, for this last patient, 40 donors were partially compatible according to the software. Conclusion: The results showed the effectiveness of the use of the EpVix tool to identify potential platelet donors for multitransfused and/or alloimmunized patients, even with a small number of human leukocyte antigen genotyped donors available.

Gestação de alto risco: fatores associadosem município doNoroeste paranaense / High-risk pregnancy: associated factors in a municipality of the northwest of the state of Paraná

Este estudo teve o objetivo de identificar a prevalência e os fatores de risco associados à gestação de alto risco em um município do Noroeste Paranaense. Trata-se de um estudo transversal,epidemiológico, de abordagem quantitativa, desenvolvido com gestantes de alto risco que frequentaram uma Unidade Básica de Saúde em 2014. Para a coleta de dados utilizou-se uma amostra de 97 prontuários de gestantes estratificadas como alto risco. Dados sociodemográficos, obstétricos, neonatais e clínicos compuseram as variáveis independentes. A variável dependente foi possuir múltiplos fatores de risco. Para medir a associação entre as variáveis adotou-se a Odds Ratio, com intervalo de confiança de 95%, e o teste qui-quadrado de Yates corrigido, para a análise bivariada, considerando-se significativas as associações cujo valor dep fosse <0,05.Quanto aos resultados, prevaleceram as gestantes adultas (84,5%),com companheiros (75,3%). Sobre escolaridade, 46,4% apresentaram entre 10 e 12 anos de estudos,66% das gestantes tiveram número de pré-natal com mais de 07 consultas, 26,8% tiveram de um a três abortos ea cesariana predominou em relação ao parto vaginal (69,1%).Os fatores de risco estiveram vinculados às condições clínicas preexistentes, sendo mais prevalentes o tabagismo (16,3%), obesidade mórbida (11,4%)e hipertensão arterial sistêmica (HAS) (10,2%). Gestantes menores de 20 anos tiveram cinco vezes mais chances de terem múltiplos fatores de risco. Caracterizar e utilizar métodos eficazes para a identificação e prevenção dos fatores de risco gestacionais contribui diretamente para a redução da mortalidade materna e infantil...

This study aimed to identify the prevalence and risk factors associated with high-risk pregnancies in a municipality in the Northwest of the state of Paraná. It is an analytical, cross-section a land epidemiological study with high-risk pregnant women who attended a Basic Health Unit (BHU)in 2014. For data collection we used a sample of 97 charts of pregnant women stratified as of high risk. Sociodemographic, obstetric, neonatal and clinical data composed the independent variables. The dependent variable was to have multiple risk factors. To measure the association between the variables, odds ratio was adopted, with 95% confidence interval, and Yates’ chi-square test corrected for bivariate analysis, with associations whose p value was <0.05 being considered significant. As for the results, adult pregnant women (84.5%) with partners (75.3%) were prevalent. About education level, 46.4% had between 10 to 12 years of study, 66% of pregnant women had more than 7 pre-natal visits, 26.8% had between one and three abortions, and cesarean section predominated over vaginal birth (69.1%).The risk factors were linked to pre-existing medical conditions, with themore prevalent being smoking (16.3%),morbidobesity (11.4%) and hypertension (10.2%). Pregnant women under 20 years of age had five times more odds to have multiple risk factors. To characterize and use effective methods to identify and prevent gestational risk factors contributes directly to the reduction of maternal and infant mortality...

Tradução e adaptação semântica para versão em português do Stressful Life Events Schedule (SLES) / Translation and semantic adaptation for the version in Portuguese of the Stressful Life Events Schedule / Traducción y adaptación semántica de la versión en portugués del Stressful Life Events Schedule (SLES)

O Stressful Life Events Schedule (SLES) é um instrumento que visa investigar a presença e o impacto de eventos de vida estressantes (EVE) ocorridos nos últimos 12 meses. O objetivo deste trabalho é traduzir e adaptar por equivalência semântica os itens da escala para a língua portuguesa. Seis etapas foram realizadas: (1) Tradução; (2) Retrotradução; (3) Revisão técnica e adaptação semântica; (4) Avaliação e validação do conteúdo e do significado geral considerando o contexto da população; (5) Realização de uma medida de confiabilidade em relação ao construto dependência/independência dos EVE; e (6) Produção da versão final do instrumento. O tempo verbal se manteve na maioria dos itens da escala. Algumas alterações foram necessárias como um acréscimo da variação de alguns termos. A versão adaptada demonstrou ser de fácil aplicação, não tendo sido avaliada como extensa e contemplando um número considerável de EVE.

The Stressful Life Events Schedule (SLES) is an instrument to investigate the presence and impact of stressful life events (SLE) occurred during the latest 12 months. The aim of this study is to translate and adapt, through semantic equivalence, the items from the instrument to the Portuguese language. The process had six steps: (1) Translation; (2) Backtranslation; (3) Technical review and semantic adaptation; (4) Assessment and content validation and overall meaning, considering the context of the population; (5) A measure of reliability was conducted in relation to the dependence/ independence construct; and (6) Production of the final version of the instrument. The verbal conjugation was maintained in most of the scale's items. Some changes were required, such as an addition of the variation of some terms. The adapted version proved to be of easy application, not too extensive and contemplating a considerable number of SLE.

El Stressful Life Events Schedule (SLES) es una escala que objetiva investigar la presencia y el impacto de los acontecimientos vitales estresantes (EVE) en los últimos 12 meses. El objetivo del presente estudio es traducir y adaptar por equivalencia semántica los ítems de la escala para la lengua portuguesa. Las seis etapas realizadas fueron: (1) traducción y (2) retraducción, (3) revisión técnica y adaptación semántica, (4) evaluación y validación del contenido y del significado general teniendo en cuenta el contexto de la población, (5) realización de una medida de fiabilidad para el constructo dependencia / independencia de los EVE, y (6) producción de la versión final del instrumento. El tiempo verbal se mantuvo en la mayoría de los ítems de la escala. Algunas modificaciones fueran necesarias, tales como el aumento de la variación de algunos términos. La versión adaptada se mostró de fácil aplicación, no evaluada como extensa y contemplando un número considerable de EVE.

Identification of platelet refractoriness in oncohematologic patients

OBJECTIVES: To identify the occurrence and the causes of platelet refractoriness in oncohematologic patients. INTRODUCTION: Platelet refractoriness (unsatisfactory post-transfusion platelet increment) is a severe problem that impairs the treatment of oncohematologic patients and is not routinely investigated in most Brazilian services. METHODS: Forty-four episodes of platelet concentrate transfusion were evaluated in 16 patients according to the following parameters: corrected count increment, clinical conditions and detection of anti-platelet antibodies by the platelet immunofluorescence test (PIFT) and panel reactive antibodies against human leukocyte antigen class I (PRA-HLA). RESULTS: Of the 16 patients evaluated (median age: 53 years), nine (56 percent) were women, seven of them with a history of pregnancy. An unsatisfactory increment was observed in 43 percent of the transfusion events, being more frequent in transfusions of random platelet concentrates (54 percent). Platelet refractoriness was confirmed in three patients (19 percent), who presented immunologic and non-immunologic causes. Alloantibodies were identified in eight patients (50 percent) by the PIFT and in three (19 percent) by the PRA-HLA. Among alloimmunized patients, nine (64 percent) had a history of transfusion, and three as a result of pregnancy (43 percent). Of the former, two were refractory (29 percent). No significant differences were observed, probably as a result of the small sample size. CONCLUSION: The high rate of unsatisfactory platelet increment, refractoriness and alloimmunization observed support the need to set up protocols for the investigation of this complication in all chronically transfused patients, a fundamental requirement for the guarantee of adequate management.