Hematología

Página del Gobierno de la Rioja que contiene información textual y vídeos de 5 temas: 1.El valor de ser donante de sangre y de células madre. ¿Por qué no tú?, 2.El autotrasplante de células madre. Perdámosle el miedo, 3.Tratamientos de quimioterapia. Nuevas formas de administración más cómodas y seguras, 4. Tratamiento anticoagulante oral. ¿Qué hay de nuevo? y 5.Anemias en la población general. ¿Qué podemos hacer para evitarlas?.

[Prescreening of the activity of alanine aminotransferase enhances the cost-effectiveness of blood storage].

The cost-effectiveness of prescreening for alanine aminotransferase (ALT) activity was evaluated in blood donors before donation. Since September 15, 2006, the Krasnodar Territory blood transfusion station has examined more than 32 thousand donors in this fashion. A Reflotron Plus biochemical analyzer (Roche Diagnostics, Switzerland) was used. In 2008, 1230 subjects with increased ALT activity were withdrawn from donation. A total of 17,096 persons were examined. Their examination cost 1,219,457.8 rubles. Non-productive outlays of 7,773,919.8 rubles were prevented. The savings amounted to 6,554,462.12 rubles. Prescreening for ALT was found to be cost-effective if the rate of positive results in the donor population was 1.13% or more.

Cigarette smoking blocks the protective expression of Nrf2/ARE pathway in peripheral mononuclear cells of young heavy smokers favouring inflammation.

Cigarette smoking is an important risk factor for atherosclerosis, a chronic inflammatory disease. However the underlying factors of this effect are unclear. It has been hypothesized that water-soluble components of cigarette smoke can directly promote oxidative stress in vasculature and blood cells. Aim of this study was to study the relationship between oxidative stress and inflammation in a group of young smokers. To do this we evaluated: 1) the oxidation products of phospholipids (oxPAPC) in peripheral blood mononuclear cells (PBMC); 2) their role in causing PBMC reactive oxygen species (ROS) generation and changes in GSH; 3) the expression of the transcription factor NF-E2-related factor 2 (Nrf2) and of related antioxidant genes (ARE); 4) the activation of NF-kB and C-reactive protein (CRP) values. We studied 90 healthy volunteers: 32 non-smokers, 32 moderate smokers (5-10 cigarettes/day) and 26 heavy smokers (25-40 cigarettes/day). OxPAPC and p47phox expression, that reasonably reflects NADPH oxidase activity, were higher in moderate smokers and heavy smokers than in non-smokers (p<0.01), the highest values being in heavy smokers (p<0.01). In in vitro studies oxPAPC increased ROS generation via NADPH oxidase activation. GSH in PBMC and plasma was lower in moderate smokers and heavy smokers than in non-smokers (p<0.01), the lowest values being in heavy smokers (p<0.01). Nrf2 expression in PBMC was higher in moderate smokers than in non-smokers (p<0.01), but not in heavy smokers, who had the highest levels of NF-kB and CRP (p<0.01). In in vitro studies oxPAPC dose-dependently increased NF-kB activation, whereas at the highest concentrations Nrf2 expression was repressed. The small interference (si) RNA-mediated knockdown of NF-kappaB/p65 increased about three times the expression of Nrf2 stimulated with oxPAPC. Cigarette smoke promotes oxPAPC formation and oxidative stress in PBMC. This may cause the activation of NF-kB that in turn may participate in the negative regulation of Nrf2/ARE pathway favouring inflammation.

Prevalence of resistence to activated protein C (APC-resistance) in blood donors in Kosovo.

One of the most frequent hereditary causes of thrombophilia is, without a doubt, resistance to Activated Protein C (APC-resistance), which is a consequence of point mutation in gene coding for coagulation Factor V (Factor V Leiden) in 90-95% of cases. The aim of this paper was to determine prevalence of APC-resistance in a group of healthy blood donors. The size of the group is quite representative of Kosovo Albanians. A total of 944 blood donors were examined (537 males and 407 females), for whom APC-resistance was determined by functional methods of coagulation using the kit ACTICLOT(R) Protein C Resistance. Method is based on the test of APTT determined twice: first in the presence and second in the absence of activated Protein C (APC). The ratio of these two values constitutes is called Activated Protein C- Sensitivity Ratio (APC-SR). From 944 examined donors, pathologic values of APC-SR (1,3-1,9) were found in 32 persons (3,4% of the total number). The distribution among sexes was 3,35% (18/537) in male and 3,43% (14/407) in female subjects. The mean values of APC-SR (1,64 in male and 1,71 in female subjects) were not significantly different (P = 0,22). Based on these results, we conclude that the prevalence of APC resistance in Albanian population of Kosovo is within the lower limit of prevalence in general population in different countries of European countries, which, according to some authors ranges is from 3 to 7%.

Transfusion in the age of molecular diagnostics.

DNA-based tests are increasingly being used to predict a blood group phenotype to improve transfusion medicine. This is possible because genes encoding 29 of the 30 blood group systems have been cloned and sequenced, and the molecular bases associated with most antigens have been determined. RBCs carrying a particular antigen, if introduced into the circulation of an individual who lacks that antigen (through transfusion or pregnancy), can elicit an immune response. It is the antibody from such an immune response that causes problems in clinical practice and the reason why antigen-negative blood is required for safe transfusion. The classical method of testing for blood group antigens and antibodies is hemagglutination; however, it has certain limitations, some of which can be overcome by testing DNA. Such testing allows conservation of antibodies for confirmation by hemagglutination of predicted antigen-negativity. High-throughput platforms provide a means to test relatively large numbers of donors, thereby opening the door to change the way antigen-negative blood is provided to patients and to prevent immunization. This review summarizes how molecular approaches, in conjunction with conventional hemagglutination, can be applied in transfusion medicine.

Implementation experiences of ISO/IEEE11073 standard applied to new use cases for e-health environments.

Recent advances in biomedical engineering and continuous technological innovations in last decade are promoting new challenges, especially in e-Health environments. In this context, the medical devices interoperability is one of the interest fields wherein these improvements require a standard-based design in order to achieve homogeneous solutions. Furthermore, the spreading of wearable devices, oriented to the paradigm of patient environment and supported by wireless technologies as Bluetooth or ZigBee, is bringing new medical use cases based on Ambient Assisted Living, home monitoring of elderly, heart failure, chronic, under palliative care or patients who have undergone surgery, urgencies and emergencies, or even fitness auto-control and health follow-up. In this paper, several implementation experiences based on ISO/IEEE11073 standard are detailed. These evolved e-Health services can improve the quality of the patient's care, increase the user's interaction, and assure these e-Health applications to be fully compatible with global telemedicine systems.

Experiencia en colectas de sangre móviles en una comunidad estudiantil universitaria / Experience on mobile blood collection in university student

Uno de los pilares fundamentales de la seguridad transfusional es la obtención de sangre a partir de donantes altruistas. Las colectas de sangre con equipos móviles es una estrategia que favorece este tipo de donaciones. En este artículo se describen las estrategias y los resultados obtenidos en la ejecución de colectas móviles realizadas en un centro de formación universitaria. Las colectas se organizaron conjuntamente entre el centro de sangre y la Escuela de Tecnología Médica de la Universidad de Talca. La actividad se realizó con alumnos, quienes se organizaron en distintas comisiones. Durante un periodo de 6 años se realizaron 9 colectas y se lograron 352 donantes seleccionados voluntarios, de los cuales el 16 % correspondió a donantes repetidos. Se concluye que la ejecución de colectas de sangre móviles en comunidades de educación superior es una buena estrategia para incrementar el porcentaje de sangre obtenida desde donantes voluntarios.

One of the main pillars of the transfusion safety is the blood collection from altruistic donors. Blood collection using mobile equipments is a strategy favoring this type of donations. In present paper are described the strategies and the results obtained in execution of mobile collections performed in a university training center. Collections were organized together between the blood center and the Medical Technologic School from the Talca University. Activity was carried out with students who were organized in different commissions. Over a period of 5 years, 9 collections were performed achieving 352 volunteer selected donors, from which the 16% was of repeated donors. We concluded that execution of mobile blood collections in higher education community is a good strategy to increase the percentage of blood obtained from volunteer donors.

Age-related donor return patterns among first-time blood donors in the United States.

BACKGROUND: Committed repeat donors are vital to the continued success of blood collections, yet the effect of age of first-time (FT) donation on return behavior is poorly described. Sixteen-year-old donors are increasingly allowed to donate and have the highest rates of adverse events, which negatively impacts return behavior. STUDY DESIGN AND METHODS: Annual cohorts of allogeneic FT donors from 2005 and 2006 were selected within the American Red Cross system and followed for 25 and 13 months, respectively. Return and total yield rates among different age groups were compared. RESULTS: A total of 2.3 million FT donors from 2005 and 2006 gave 4.2 million donations during the study. Sixteen- to 19-year old FT donors made up 41% of the FT donor base in 2005 and 16-, 17-, 18-, and 19-year-olds, respectively, had initial return rates of 62, 52, 35, and 28% and yield rates of 2.0, 1.76, 1.51, and 1.41 over 13 months. Multivariate analysis of FT yield rates shows that younger (16 and 17 years) and older (50+ years) donors, males, blood group O donors, and those without any initial adverse reaction are most likely to return. Increasing severity of donor adverse reactions correlated with a reduction in yield and return rates. CONCLUSION: FT 16-year-old donors had the highest return and yield rates despite the negative impact of increased adverse event rates. Donation at young age is critical to building a cadre of committed repeat donors but donor reactions must be addressed to ensure the donors' well-being and to sustain return behavior.

Preoperative autologous blood donation versus intraoperative blood salvage: intraindividual analyses and modeling of efficacy in 1103 patients.

BACKGROUND: Preoperative autologous blood donation (PABD) and intraoperative blood salvage (IBS) represent established blood conservation measures. However, data comparing PABD to IBS are very sparse. STUDY DESIGN AND METHODS: We analyzed data from 1103 patients undergoing PABD and subsequent major orthopedic surgery in one center. We then used a validated model to compare PABD to IBS. We calculated maximal allowable blood losses (MABLs) for both IBS and PABD. We also identified criteria for efficacious use of either PABD or IBS. Our calculations were based on exclusive application of either technique, complete exhaustion of predeposited or salvaged blood, and one round of IBS. RESULTS: The vast majority of patients would have tolerated greater MABLs if subjected to IBS rather than PABD (425 of 432 with 1 PABD unit, 580 of 664 patients with 2 PABD units, 3 of 7 patients with 3 PABD units). For a few patients, however, our model demonstrated greater MABL with PABD than with IBS. These patients were characterized by 1) lower initial hematocrit (Hct), 2) recovery from PABD with return to baseline Hct or above by the time of surgery, and 3) longer time between first PABD and surgery. CONCLUSION: IBS appears to be the superior blood conservation technique if PABD cannot be performed under optimal conditions. Tolerable predonation anemia and sufficient time for regeneration appear to be crucial for post-PABD erythropoiesis. If these goals cannot be accomplished, PABD should be abandoned and be replaced by IBS.

The resurgence of granulocyte transfusions.

Granulocyte transfusion can be used as supportive therapy in patients with life-threatening neutropenia caused by bone marrow failure or in patients with neutrophil dysfunction. Emerging evidence demonstrates the benefits of granulocyte transfusions to treat infections in patients after treatment with high-dose chemotherapy, particularly the chemotherapy associated with conditioning for hematopoietic stem cell transplant. There has been an increased interest in the use of therapeutic granulocyte transfusion in recent years due to the ability to use granulocyte colony-stimulated factors to produce higher doses of granulocytes for transfusion. Other factors that influence the outcome of transfusion include the type of infection being treated, the likelihood of recipient marrow recovery, and recipient alloimmunization. This article provides a historical perspective on granulocyte transfusion and an overview of its clinical use.

Eager blood donor.

Blood donor questionnaire is an integral component of blood safety, designed to identify and disqualify donors who do not fit certain criteria. One of the criteria is the time interval between 2 consecutive donations because repeated blood donors are exposed to adverse effects of frequent donations. We describe a 19-year-old healthy Israeli Defense Forces male soldier who has been detected by the Israeli National Blood Services only after his fifth voluntary blood donation within 12 weeks. The soldier was asymptomatic, yet blood examination revealed iron deficiency anemia with a low ferritin level. This case demonstrates the limitations of blood donation processing, which fortunately ended with no substantial morbidity. We discuss the possible obstacles in that process.

Spontaneously arising red cells with a McLeod-like phenotype in normal donors.

Very few human genes can be used to identify spontaneous inactivating somatic mutations. We hypothesized that because the XK gene is X-linked, it would be easy to identify spontaneously arising red cells with a phenotype resembling the McLeod syndrome, which results from inherited XK mutations. Here, by flow cytometry, we detect such phenotypic variants at a median frequency of 9 x 10(-6) in neonatal cord blood samples and 39 x 10(-6) in healthy adults (p=0.004). It may be possible to further investigate the relationship between aging, mutations, and cancer using this approach.

Low CD34 collection from a healthy blood progenitor cell donor: a case report.

BACKGROUND: Transplantation of hematopoietic progenitor cells is widely used to ameliorate the consequences of bone marrow failure. In allogeneic transplantation, peripheral blood progenitor cells (PBPCs) from an HLA-matched donor are collected by apheresis and then identified using flow cytometric methods as being CD34 marker positive cells. CASE REPORT: A 25-year-old healthy male was matched with an obese 106 kg 23-year-old female diagnosed with acute lymphoblastic lymphoma. After a routine course of G-CSF induction, a 2-day PBPC collection procedure with a collection volume of 12 L/day was planned. All samples for CD34 estimation were shipped, stored, and tested according to the laboratory standard regulations. Testing was performed per International Society for Hematotherapy and Graft protocol, and CD34+ cells were immunophenotyped using monoclonal antibody against CD34 and CD45 by multicolor flow cytometry. RESULTS: The cumulative yield of both collections was 70.6 x 10(6) CD34+ cells (0.67 x 10(6) CD34+ cells/kg), which fell short of the requested dose of 530 x 10(6) (5 x 10(6) CD34+ cells/kg). Surprisingly, the recipient engrafted successfully and 12 days posttransplant short tandem repeat testing demonstrated only T cells of donor origin in the peripheral blood. CONCLUSION: To our knowledge, no successful engraftment has been reported as yet with such a poor collection of PBPC. The amountof transfused CD34+ cells (0.67 x 10(6)/kg) was significantly less than the minimum required amount (5x 10(6)/kg).

An academic-based hospital donor site: do physicians donate blood?

The objectives of this prospective, cross-sectional study were to characterize blood donors in an academic-based hospital donor center, to determine whether physicians donate, and to elucidate the donation impetus. A confidential survey was issued to presenting, potential donors over 200 weekdays. Three questions were asked: their role at the institution, if and when they had previously donated blood, and what prompted the current donation. The majority of the 687 respondents were institution-affiliated (73.5%) and 79.3% had previously donated, with a median of 3 mo since the prior donation. Only 21 (3.1%) respondents were physicians. The predominant reasons for donor presentation were an appointment, knowing it had been 8 wk since the last donation, and contact by the blood center to donate. This study shows the dearth of physician blood donors and a strong cohort of institution-affiliated repeat donors. Physicians represent a potential, stable, and sustainable donor pool; further studies are needed to establish physician recruitment programs.

Reference percentiles of hematological and biochemical iron values of blood donors in Port Harcourt, Nigeria.

In a setting where there is no functional blood transfusion service, there is a need to establish reference values which will assist in determining the cut-off values of the donor pool and also to evaluate anemia. Three hundred and forty eight blood donors of both sexes, aged 18 to 62 years were studied in a cross-sectional descriptive study. Four biochemical parameters: serum ferritin (SF), serum iron (SI), total iron binding capacity (TIBC) and transferrin saturation (TS) and four hematological parameters: hemoglobin (Hb), packed cell volume (PCV), total white blood cell count (WBC) and erythrocyte sedimentation rate (ESR), were assessed. The median and percentile ranges (10-90% percentile) of the biochemical and hematological parameters were as follows: SF 46.8 ng/ml (0.0-173.1), SI 85.9 microg/dl (19.7-338.0), TIBC 224.7 microg/dl (60.9-541.4), TS 41.2% (15.3-90.6), Hb 12.9 g/dl (7.74-15.6), PCV 38.0% (22.9-47.0), WBC 4.5 x 10(9)/l (3.0-8.0) and ESR 8.0 mm/h (1.0-24.6). The sex of the blood donor volunteers was found to exert an influence on SF, SI, TIBC and WBC in favor of the female; P<0.001. The age of the blood donors had a significant influence on some of the variables especially the hematological variables such as Hb, PCV and ESR (P<0.001). At a cut-off value of Hb 12.0 g/dl, SF 15.0 ng/ml and TS 16, 10.4 and 6.0% had iron deficiency and iron deficiency anemia respectively in this study population. There is a high percentage of iron deficiency anemia in this donor population and this calls for urgent attention.