[Clinical-biological analysis of thrombotic thrombocytopenic purpura in the General University Hospital of Alicante during 1983-2006]. / Características clínico-biológicas de las púrpuras trombocitopénicas trombóticas tratadas entre los años 1983-2006 en el Hospital General Universitario de Alicante.

OBJECTIVE: Our study aimed to evaluate the patients diagnosed of thrombotic thrombocytopenic purpura in our hospital during the last 23 years. METHODS: We have made a retrospective study of the clinical records of 25 patients diagnosed of TTP between 1983-2005, describing the clinical, epidemiological and laboratory data. RESULTS: Twenty-five cases were diagnosed. Mean age was 39 years, 64% women and 36% men, 44% had suffered headaches, 4% fever, 32% neurological focality, 12% renal disorders, 36% hemorrhagic disease and 16% thromboembolic disease. TTP etiology was: 72% idiopathic, 8% pregnancy, 4% Human Immunodeficiency Virus, 4% myasthenia gravis, 4% pulmonary neoplasm and 4% puerperium. Medium hemoglobin level was 9 g/dl, leucocytes 8700/mm3 and platelets 12000/mm3. Patients received a median of 5 plasmapheresis. Mean time to relapse was two months. Other treatments for TTP were aspirin (16%), cyclosporine (4%), vincristine (4%) and splenectomy (4%). CONCLUSIONS: PTT incidence in our region has increased in recent years, probably due to an increase in the immigrant population not included in the census, among the most relevant reasons. In our study, renal disorders and presence of fever were less frequently described than in other reports. There was no correlation between the number of plasmapheresis and likelihood of relapse. Most relapses were in idiopathic TTP.

[Need for a pre-deposit autotransfusion program for patients undergoing elective surgery]. / Necesidad de un programa de autotransfusión con predepósito en pacientes sometidos a cirugía programada.

INTRODUCTION: Preoperative autologous hemodonation is a very useful procedure, but it is not exempt from risks. To reduce them we must ascertain the frequency of autologous donation and the amount of blood needed for each intervention. The objective of this work is to know which are the subsidiary interventions of autotransfusion, which are true necessities of blood for them. PATIENTS AND METHODS: All the crossmatched blood units preserved for surgical procedures that might be allocated for autotransfusion were controlled. The source service, the type of intervention, and the number of units requested and transfused were identified. RESULTS: 269 surgical interventions were controlled. For these interventions, 666 units of blood were reserved. No blood transfusion was necessary in 69% of the surgical operations. The number of units transfused was 229 (26.28%). Traumatology and Heart Surgery were the services that demanded more blood. The procedure with greatest requirements of blood units was the total knee replacement. Hysterectomy was the intervention with the lowest percentage of utilization of reserved blood (5.26%). CONCLUSIONS: Autotransfusion should be offered to all patient in need of knee or hip replacement and those who are subjected to heart surgery with extracorporeal circulation. Patients who are programmed for interventions with a low percentage of utilization of blood, should know these findings, in order that they don't feel subjected to unnecessary procedures.

[Serum erythropoietin levels in newborn infants at term]. / Niveles de eritropoyetina sérica en recién nacidos a término.

INTRODUCTION: There are many differences between fetal and adult erythropoiesis, but in both cases erythropoietin (EPO) is the critical controlling haemopoiesis. EPO can be measured in fetal blood by the 16th gestational week, and its levels show a gradual rise to term in parallel with the rise in haemoglobin levels. The aim of this study was to determine EPO levels in normal newborns and correlate them with the delivery, maternal EPO and pregnancy complications. PATIENTS AND METHODS: Serum levels of EPO were measured in 71 postpartum women and their respective newborns. There were no prematures. We also determine mother and child haemoglobin. Three groups of term pregnancies were compared: those delivered vaginally with and without vacuum and those delivered by cesarean section. We also investigate the presence of pregnancy complications. RESULTS: The mean serum EPO in the mother group was 20.7 +/- 18.3 mU/mL (2-80) with no differences from that observed in the newborn group, 19.3 +/- 17.5 mU/mL (2.5-80). There were no differences between the form of delivery. Mothers show higher levels of EPO than the normal population (p < 0.001). CONCLUSIONS: We obtained normal EPO levels for mothers and newborns for our area, similarly to the previously described ones.