Estudio prospectivo de las complicaciones asociadas a la biopsia percutánea en riñón nativo: experiencia en un centro / Prospective study of the complications associated with percutaneous renal biopsy of native kidneys: experience in a centre

Introducción: La biopsia renal percutánea (BRP) es una exploración invasiva fundamental para el estudio de enfermedades renales que lleva asociada una apreciable morbilidad. Estudios retrospectivos han mostrado que el 10-20 % de los casos presentan complicaciones menores y el 1,2-6,6 % complicaciones consideradas mayores. Sin embargo, este aspecto no ha sido examinado prospectivamente. Objetivo: El objetivo del estudio fue evaluar prospectivamente las complicaciones asociadas a la BRP en el riñón nativo. Métodos: Estudio prospectivo desde enero de 2009 hasta mayo de 2013 de las BRP realizadas por nefrólogos en riñón nativo bajo control ecográfico. Se analizaron variables clínicas y analíticas. Definimos complicación menor como la caída de la hemoglobina (Hb) de más de 1 g/dl y complicación mayor la necesidad de transfusión o técnica invasiva. Resultados: En este período se han realizado 241 BRP. La edad media de los pacientes fue de 49 años (± 17), la mayoría eran varones (56 %) y el 58,1 % padecían hipertensión arterial. Se realizaron dos punciones en el 51 %. Se observaron complicaciones menores en 46 pacientes (19,1 %) y mayores en 9 pacientes (3,7 %). En el análisis univariante, la Hb pre-BRP fue 10,3 g/dl (± 1,3) en aquellos que desarrollaron complicaciones mayores y 12,3 g/dl (± 2,2) en los demás (p = 0,003); en el análisis multivariante: OR 0,51, IC 95 %(0,2-0,9), p < 0,05. Conclusiones: La BRP es un procedimiento no exento de riesgos, ya que las complicaciones menores se presentaron en el 19,1 % y las mayores en el 3,7 % de los casos. La Hb pre-BRP es un factor de riesgo independiente para el desarrollo de complicaciones mayores (AU)

Background: Percutaneous renal biopsy (PRB) is a key invasive technique in the study of kidney disease and it is associated with considerable morbidity. Retrospective studies have shown minor complications in 10%-20% and major complications in 1.2%-6.6% of cases. However, this aspect has not been studied prospectively. Objective: The aim of our study was to prospectively assess complications related to PRB in the native kidney. Methods: From January 2009 to May 2013, we prospectively analysed PRB performed by nephrologists in native kidneys under ultrasound guidance. We analysed clinical and laboratory variables. We defined minor complications as the decrease in haemoglobin (Hb) of more than 1g/dL and major complications as the need for a transfusion or invasive technique. Results: 241 PRB were performed over this period. The mean patient age was 49 years (±17), the majority (56%) were male and 58.1% had high blood pressure. In 51% of cases, we carried out 2 punctures. There were minor complications in 46 patients (19.1%) and major complications in 9 patients (3.7%). In the univariate analysis, pre-PRB Hb was 10.3g/dL (±1.3) in patients with major complications and 12.3g/dL (±2.2) in the remaining patients (p=.003); in the multivariate analysis: OR 0.51, 95% CI (0.2-0.9),p<.05. Conclusions: PRB is a procedure that is not without risk, since minor complications occurred in 19.1% and major complications in 3.7% of cases. Pre-PRB Hb is an independent risk factor for the development of major complications (AU)

Hemoglobin decline in cancer patients receiving chemotherapy without an erythropoiesis-stimulating agent.

PURPOSE: The aim of this study was to examine the rate and timing of hemoglobin decline from <10 g/dL to <9 g/dL in cancer patients receiving chemotherapy. METHODS: Pooled data from the placebo arms of six randomized, controlled trials (RCTs) of darbepoetin alfa and data from an aggregated US community oncology clinic electronic medical records (EMR) database were analyzed. Patients had baseline hemoglobin ≥10 g/dL (RCTs) or baseline hemoglobin between ≥10 g/dL and <11 g/dL (EMR episodes) that declined to <10 g/dL at least once during the study period. The proportion of patients/episodes with hemoglobin decline to <9 g/dL by 3, 6, and 9 weeks without erythropoiesis-stimulating agents was estimated from data in each of the data sources, as was the rate of transfusions in the RCTs. RESULTS: Data from 411 patients receiving placebo in the RCTs and 10,523 patients (10,942 episodes) in the EMR database were analyzed. Forty percent and 35 % of RCT patients and EMR episodes, respectively, had a hemoglobin decline from <10 g/dL to <9 g/dL at week 3, 54 % and 43 % at week 6, and 58 % and 46 % at week 9. Of patients in the RCTs, 43 % required an RBC transfusion. CONCLUSIONS: Hemoglobin can rapidly decline in cancer patients receiving chemotherapy with hemoglobin levels around 10 g/dL, particularly in patients ≥65 years of age. The rapid rate of hemoglobin decline in these patients should be considered for optimal anemia management.

Disminución de la hemoglobina en pacientes postquirúrgicos y muestras sanguíneas diagnósticas / Decrease of hemoglobin in post-surgical patients and diagnostic blood testing

La anemia es un problema frecuente en los pacientes ingresados en cuidados intensivos. Su etiología es multifactorial, aumentando los requerimientos transfusionales y la morbimortalidad. Objetivo: conocer la prevalencia de anemia y transfusión de los pacientes postquirúrgicos durante los cinco primeros días de ingreso en la unidad e reanimación y si existe relación con las pérdidas sanguíneas por la obtención de muestras analíticas .Material y métodos: estudio descriptivo, observacional y retrospectivo, de los pacientes ingresados en la unidad de reanimación postquirúrgica, desde enero a diciembre de 2008, del Hospital Universitario de "La Princesa" (Madrid). Se incluyeron en el estudio los pacientes postquirúrgicos ingresados en la unidad de reanimación durante un tiempo igual o superior a cinco días. Se excluyeron del estudio a los fallecidos durante ese periodo, sometidos a cirugía cardiaca, los politraumatizados y aquéllos con una tendencia hemorrágica mayor a la habitual. Se analizaron datos relativos a la anemia, las transfusiones y las pérdidas de masa eritrocitaria y volumen sanguíneo de las extracciones de muestras para análisis. Resultados: se han revisado las historias clínicas de los 65 pacientes ingresados que cumplían los criterios de inclusión. La prevalencia de (..) (AU)

Anemia is a common problem in patients admitted to the Intensive Care Unit. It has a multifactorial etiology, with increased transfusion requirements and higher morbimortality. Objective: to ascertain the prevalence of anemia and the transfusion of post-surgical patients during the first five days of admission to the recovery room, and if there is blood loss related to the collection of blood samples for laboratory work. Material and methods: a descriptive, observational and retrospective study of patients admitted to the postoperative recovery unit, from January to december 2008, at the "The Princess" University Hospital (Madrid). Post-surgical patients admitted to the recovery room for a period of no less than five days were included in the study. Those patients who had died during the study period, those who had undergone cardiac surgery, those with multiple trauma injuries and those with a tendency higher than usual to bleed were excluded from analysis. Data relative to anemia, transfusions and loss of blood volume and red cell (..) (AU)

[Drepanocytosis with alpha and beta(o) thalassemia: a case report]. / Drépanocytose beta(o) thalassémique associée à une alpha thalassémie: à propos d'un cas.

We describe the case of a Sickle Cell Trait associated with alpha and beta(o) thalassemia at an young man without clinical abnormality. Capillary electrophoresis showed S haemoglobin at 67%, F haemoglobin at 29%, A2 haemoglobin at 4% and an absence of A haemoglobin. Accurate diagnosis was found by techniques of molecular biology.

Beta-thalassaemia and sickle cell anaemia as paradigms of hypercoagulability.

Thalassaemia and sickle cell disease (SCD) represent the most common forms of hereditary haemolytic anaemia and result from a partial or complete lack of synthesis of one of the major alpha- or beta-globin chains of haemoglobin A or from a single amino acid mutation (beta(6Glu-->Val)) of the beta-globin chain respectively. Although they have different pathophysiologies, patients with these conditions manifest both biochemical and clinical evidence of hypercoagulability. While the frequency of various thrombotic complications may vary in beta-thalassaemia and homozygous SCD [sickle cell anaemia (SCA)], patients with both diseases manifest decreased levels of natural anticoagulant proteins, as well as increased markers of thrombin generation and platelet activation. The abnormal phospholipid membrane assymetry present in the red blood cells of beta-thalassaemia and SCA patients, with resultant phosphatidylserine exposure appears to play a significant role in the aetiology of the observed hypercoagulable state. This review presents the available data on the aetiology and clinical manifestations of the coagulation and platelet activation that exist in both beta-thalassaemia and SCA, as well as the potential therapeutic implications resulting from this hypercoagulability.

Hemoglobin concentration in pregnant women. Experience from Moshi, Tanzania.

BACKGROUND: Anemia in pregnancy is common in Tanzania. Previous information on distribution of hemoglobin concentration in total populations is scarce. METHODS: Standard measurement of hemoglobin concentration in consecutive first visit attenders at the antenatal care clinic in Moshi, 1991-1994, for a total of 1800, divided into three series of 600 each. RESULTS: Hemoglobin concentrations ranged from 41 to 146 g/l, mean 96.9 and s.d. 16.3. For international comparison, 74.5% were below 110 g/l and 7.0% below 70 g/l. The median was 97.0; other percentiles were 10th: 75.0, 90th: 116.0. The distribution did not change with mother's age, but in the years 1991 and 1994 there were more low hemoglobin values than in the intervening years. CONCLUSIONS: Low hemoglobin concentrations are prevalent among pregnant women in Moshi, Tanzania. Seven percent were found to have severe anemia, defined as a hemoglobin concentration below 70 g/l.