Challenges in providing compatible blood with Rh genotype-matching in Brazilian patients with sickle cell disease.

OBJECTIVES: The aim of this study was to verify the possibility of performing prophylactic Rh genotype-matching in Brazilian patients with sickle cell disease (SCD) and identify the genotypes that are lacking or insufficient in our donor cohort. BACKGROUND: Rh alloimmunisation is still a challenge in transfused patients with SCD. Rh genotype-matching may mitigate Rh alloimmunisation. METHODS/MATERIALS: We examined the transfusion requests for antigen-matched donor units in SCD patients with Rh variants and compared the Rh altered alleles in the patients to the Rh allele frequency in a selected donor population. For each patient and donor, RBC antigen genotyping was performed using HEA, RHD and RHCE BeadChip arrays. Sequencing was used to clarify inconclusive results. Twenty-one patients and 956 Brazilian blood donors were genotyped. RESULTS: According to our matching strategies, 47·6% of patients filled most of their unit requests, but 52·4% of patients had insufficient donors to fill their annual transfusion needs. We found different combinations of RHCE variant alleles in patients and donors, but the most frequent genotypes that are lacking or insufficient in our donor cohort are those associated with the lack of hrB and hrS high prevalence antigens and those co-inherited with altered RHD alleles. CONCLUSION: Our study shows that the provision of compatible blood with Rh genotype-matching in Brazilian patients with SCD can be feasible but challenging and, efficient strategies of recruitment of African-Brazilian donors must be developed.

Stromal IL2 is related to the neutrophil/lymphocyte ratio in epithelial ovarian cancer.

INTRODUCTION: There is a need for the development of new biomarkers for diagnosis and prognosis of ovarian cancer, which can ideally serve as targets for new therapeutic modalities and individualization of treatment. The objectives of this study were to determine the prognostic significance of the neutrophil/lymphocyte ratio in the peripheral blood of patients with ovarian cancer and tumor staging, and to associate this marker with the immune expression of a panel of cytokines. METHODS: The study included 24 patients with malignant ovarian neoplasia treated at the Pelvic Mass Outpatient Clinic of the Clinical Hospital of the Federal University of Triângulo Mineiro. The neutrophil/lymphocyte ratio was calculated as the absolute number of neutrophils divided by the absolute number of lymphocytes. Expression of the cytokines was evaluated by the immunohistochemistry method (IL2, IL5, IL6, IL8, IL10 and TNF-R1). Fisher's statistical test was used for the comparisons of immunohistochemical expression with the neutrophil/lymphocyte ratio, and the unpaired T-Test was used in the analysis of the association of this ratio with tumor staging. RESULTS: A neutrophil/lymphocyte ratio > 2.6 was significantly higher in the more advanced stages (II-IV) of malignant ovarian neoplasia (p = 0.0098). In addition, this ratio > 2.6 was associated with IL2 stromal immunostaining (1-3) (p = 0.0472). CONCLUSION: Stromal IL-2 is associated with higher a neutrophil/lymphocyte ratio, suggesting a worse prognosis in ovarian cancer and its role in tumor immunology; a neutrophil/lymphocyte ratio > 2.6 is associated with more advanced stages of malignant ovarian neoplasia.

Venous communication between the right and left kidneys: a rare anatomic variation / Comunicación venosa entre los riñones derecho e izquierdo: una rara variación anatómica

Renal vascular anatomic variations, especially of the renal arteries, have been observed in about 20-30 percent of cases, which are very often verified in the left antimere. These variations showed two or three renal arteries stemming directly from the aorta. These anatomic variations have been considered extremely important risk factors in surgical proceedings by different authors. The dissection of a cadaver showed an uncommon venous feature in addition to renal artery variation, specially, in the left antimere. A direct venous communication between left and right kidneys was verified without there being any relation to the inferior cava vein or common iliac veins. Thus, the knowledge of blood vessel anatomic variation is an important element to improve surgical techniques as well as to provide precise analyses of urological and radiological proceedings in different renal diseases. Specially, taking into consideration that hard traction of the renal pedicle could rupture the vessels, leading to lethal hemorrhaging.

Se han observado variaciones anatómicas vasculares renales, especialmente de las arterias renales, en una frecuencia alrededor del 20 a 30 por ciento de los casos, cuya incidencia se verifica a menudo en el antímero izquierdo. En estas variaciones, de acuerdo con lo que se notó, dos o tres arterias renales provenían directamente de la aorta. Distintos autores han considerado que estas variaciones anatómicas son factores de riesgo extremadamente importantes en los procedimientos quirúrgicos. En esta investigación, por medio de la disección de un cadáver, se observó una característica venosa rara, además de la variación de la arteria renal, especialmente en el antímero izquierdo. Se verificó una comunicación venosa directa entre los ríñones izquierdo y derecho, pese al hecho que no sea común cualquier relación con la vena cava inferior o las venas ilíacas comunes. Así, el conocimiento de la variación anatómica del vaso sanguíneo es un elemento importante para implementar técnicas quirúrgicas, así como proporcionar análisis exactos de procedimientos urológicos y radiológicos en diversas enfermedades renales, pues se debe considerar además que la tracción dura del pedículo renal podría romper los vasos y ocasionar una hemorragia mortal.