Transfusión de plaquetas en el recién nacido / Platelet transfusion in the newborn

La trombocitopenia (cifra de plaquetas inferior a 150 x 10 Elevado a 9/L) es uno de los problemas hematológicos más frecuente en los recién nacidos, sobre todo en los prematuros enfermos. El objetivo de este trabajo es realizar un revisión de la práctica transfusional y de los tipos de preparados disponibles para la transfusión de plaquetas en el neonato. Existen tres métodos diferentes para obtener concentrados de plaquetas. Hasta 2007 los concentrados de plaquetas se obtenían a partir de plasma rico en plaquetas de sangre total.En la actualidad, se producen a partir de sangre total, mezclando los buffy-coat, o capa leucoplaquetaria, de 4-5 donantes (CPB). El otro método de obtención de concentrados de plaquetas es la plaquetoaféresis (CPA).En cuanto a eficacia, los CPB y CPA contienen una concentración similar de plaquetas (incluso podría ser superior en los CPB). Los estudios comparativos han mostrado una cierta equivalencia terapéutica en los incrementos plaquetarios postransfusionales y efectos hemostáticos. La seguridad infecciosa en medicina transfusional es actualmente altísima. Además, ambos productos están leucorreducidos, y no existen diferencias significativas en cuanto a la capacidad de aloinmunización HLA. Por otra parte, mantener componentes CPA y alícuotas de éstos para asegurar un soporte plaquetario en pediatría, con todos los grupos sanguíneos, implicaría inevitablemente un alto índice de caducidad. Podemos concluir que los concentrados de plaquetas CPB son los más adecuados para nuestros neonatos. Los CPA serían la primera opción tan sólo en los pacientes con trombocitopenia resistente por aloinmunización HLA (AU)

Thrombocytopenia (platelet count lower than 150 x 10 to elevate 9/L) is one of the most frequent hematological issues in the newborn, especially in the premature infant. The aim of this work is to perform a review of transfusion practice and the types of preparations available for the newborn platelet transfusion. There are three different methods to obtain platelets for transfusion. Until the year 2007 they were obtained from platelet rich plasma of whole blood. Nowadays they are produced from whole blood as well, but mixing the buffy coats of four or five donors (APC). The other method used is of the platelets concentrations by platelets can also be apheresis (PCB).In terms of effectiveness, platelet concentrates APC and PCB offer a similar number of platelets, even higher in APC. Comparative studies have shown therapeutical equivalence in terms of post transfusion platelet increase and hemostatic effects. From an infectious point of view, security in transfusion medicine is quite high nowadays. What is more, both products are leukocyte depleted, and there are no significative differences in the capacity to induce HLA alloimmunization. On the other hand, storing enough PCB concentrates for all the blood groups in pediatrics would imply high losses due to short expiration dates. We can conclude that APC platelet concentrates are the most adequate for our neonates. PCB would be the first option only in patients with refractory thrombocytopenia associated with HLA alloimmunization (AU)

Residual risk of transfusion-transmitted viral infections in Spain, 1997-2002, and impact of nucleic acid testing.

Estimates of the risk of bloodborne viral infections are essential for monitoring the safety of the blood supply and the impact of new screening tests. Incidence rates of seroconversion and the residual risk for HBV, HIV and HCV were calculated among Spanish repeat donors between 1997 and 1999 at 22 blood donation centres, and at 7 centres between 2000 and 2002. The residual risk per million donations was estimated to be 18.67 for HBV, 2.49 for HIV and 10.96 for HCV (between 1997 and 1999). For the 2000-2002 period, the residual risk per million donations was estimated to be 9.78 for HBV, 2.48 for HIV and 3.94 for HCV. Between 1999 and 2003, about 3.4 million donations were tested by NAT, mainly in pools of 44 donations, in 12 of the 22 Spanish blood donation centres participating in the study. Eight anti-HCV negative and HCV-RNA positive donations were found, which represent an approximate yield of 1/420,000, versus a projected yield of 1/240,000 obtained from 1995-1997 data. The residual risks of transfusion-transmitted viral infections in Spain were low, and with the implementation of NAT these risks are even lower.

Residual risk of transfusion-transmitted viral infections in Spain, 1997-2002, and impact of nucleic acid testing.

Estimates of the risk of bloodborne viral infections are essential for monitoring the safety of the blood supply and the impact of new screening tests. Incidence rates of seroconversion and the residual risk for HBV, HIV and HCV were calculated among Spanish repeat donors between 1997 and 1999 at 22 blood donation centres, and at 7 centres between 2000 and 2002. The residual risk per million donations was estimated to be 18.67 for HBV, 2.49 for HIV and 10.96 for HCV (between 1997 and 1999). For the 2000-2002 period, the residual risk per million donations was estimated to be 9.78 for HBV, 2.48 for HIV and 3.94 for HCV. Between 1999 and 2003, about 3.4 million donations were tested by NAT, mainly in pools of 44 donations, in 12 of the 22 Spanish blood donation centres participating in the study. Eight anti-HCV negative and HCV-RNA positive donations were found, which represent an approximate yield of 1/420 000, versus a projected yield of 1/240 000 obtained from 1995-1997 data. The residual risks of transfusion-transmitted viral infections in Spain were low, and with the implementation of NAT these risks are even lower.

Infections due to sandfly fever virus serotype Toscana in Spain.

Of the sandfly fever viruses known to be human pathogens (serotypes Toscana [TOS], Sicilian [SFS], and Naples [SFN]), only TOS has demonstrated neurotropic activity. Infections by TOS have been reported in Mediterranean countries, but the virus was previously isolated only in Italy and Portugal. We isolated 15 strains of TOS between 1988 and 1996 from the cerebrospinal fluid of patients with acute aseptic meningitis in Granada, Spain. This finding led us to study the presence of antibodies to TOS, SFS, and SFN in 1,181 adults and 87 children from different regions of Spain. We found that the prevalence of antibodies to these viruses was 26.2%, 2.2, and 11.9%, respectively; these rates imply that TOS infections are common in Spain.