Gastric precancerous lesions and Helicobacter pylori infection in relatives of gastric cancer patients from Northeastern Brazil.

BACKGROUND: Helicobacter pylori infection predisposes to gastric cancer. First-degree relatives of patients with gastric cancer have an increased risk of developing the disease. AIM: To evaluate the prevalence of gastric precancerous gastric lesions and H. pylori infection in first-degree relatives of non-cardia gastric cancer patients. METHODS: Gastric cancer relatives (n = 104) from a region with high prevalence of H. pylori infection and gastric cancer were invited for screening endoscopy; 80% of them had dyspeptic symptoms. The control group was composed of patients (n = 118) who concurrently underwent upper gastrointestinal endoscopy for investigation of dyspepsia with no family history of gastric cancer. The groups were matched for gender, age and social class. H. pylori status was evaluated by urease test, and histology and histological parameters were assessed according to the Houston Updated Sydney System. RESULTS: The prevalence of H. pylori infection was high in both the relative (84.7%) and the control (75.9%) groups. Corpus-predominant gastritis was more frequently observed in the relative group, whereas antral gastritis predominated in the controls. The density of lymphoid follicles was higher among the relatives. Also, intestinal metaplasia in the corpus and dysplasia were more prevalent in the cancer relative group than in the control group. Early gastric cancer was detected in 1 relative of gastric cancer patient with high-grade dysplasia. CONCLUSION: Individuals with a family history of non-cardia gastric cancer need to be routinely screened for H. pylori infection and precancerous gastric lesions.

Post-transfusion red cell alloimmunisation in patients with acute disorders and medical emergencies

Alloimmunisation following red cell transfusion is a complication in patients with chronic diseases requiring multiple transfusions. The aim of this study was to determine the frequency of alloimmunisation, to identify involved alloantibodies, to establish risk factors and to quantify the alloimmunisation risk in patients with acute disorders who received red cell transfusion at the Instituto Dr. José Frota from January 1999 to January 2001. Of the 5,690 recipients who received 16,547 units of red blood cells, 4,025 were men and 1,665 were women. Recipients with previous alloimmunisation or with time of hospital stay less than one week were excluded (n = 501). Red cell alloantibodies were detected in 120 recipients (2.1 percent): 60 men (1.49 percent) and 60 women (3.60 percent). Alloimmunisation was 2.4 fold more frequent in women and 93.33 percent of the women were pregnant prevously. The average number of units transfused in the alloimmunised recipients was 4.68: 4.97 units in men and 4.40 units in women. In non-alloimmunised recipients the average was 2.87 units and the risk of alloimmunisation was 0.83 percent: 0.59 percent in men and 1.44 percent in women. The most frequent allo-antibodies were: anti-E (18.25 percent) and anti-D (16.06 percent) from a total of 137 allo-antibodies detected. The median time for detection of allo-antibodies was 20.88 days. The risk of alloimmunisation detected was high considering the average number of units transfused. The age of recipients and the longer life expectancy increase the probability of further transfusion requirements in this group. Our findings point out the necessity of modifications in the current medical transfusion support indication, including in patients with acute disorders in order to prevent alloimmunisation.

A aloimunização eritrocitária após transfusão de concentrado de hemácias é uma complicação em pacientes com doenças crônicas que necessitam de transfusões de repetição. Esse estudo objetivou determinar a freqüência de aloimunização, identificar os aloanticorpos, estabelecer os fatores de risco envolvidos e quantificar o risco de aloimunização em pacientes com condições clínicas agudas, submetidos à transfusão de concentrados de hemácias no Instituto Doutor José Frota, utilizando a técnica de gel centrifugação. Foram analisados 5.690 receptores transfundidos com 16.547 concentrados de hemácias, sendo 4.025 do sexo masculino e 1.665 do sexo feminino. Foram excluídos 501 receptores com aloimunização prévia ou tempo de permanência hospitalar inferior a uma semana. Em 120 receptores (2,1 por cento) foram detectados aloanticorpos eritrocitários, sendo 60 do sexo masculino (1,49 por cento) e 60 do sexo feminino (3,60 por cento). A aloimunização foi 2,4 vezes mais freqüente no sexo feminino, sendo que 93,33 por cento das mulheres tinham história de gestação prévia. A média transfusional nos receptores aloimunizados foi de 4,68 bolsas, sendo 4,97 bolsas nos homens e 4,40 bolsas nas as mulheres. Nos pacientes não aloimunizados a média transfusional foi de 2,87 bolsas. O risco de aloimunização foi de 0,83 por cento, sendo 0,59 no sexo masculino e 1,44 por cento no sexo feminino. Os aloanticorpos detectados com maior freqüência foram anti-E (18,25 por cento) e anti-D (16,06 por cento) de um total de 137 aloanticorpos. O tempo médio de detecção dos aloanticorpos foi de 20,88 dias. O risco de aloimunização observado foi elevado para a média transfusional de receptores. A média de idade dos pacientes e o aumento da expectativa de vida aumentam a possibilidade de que transfusões posteriores sejam necessárias, sinalizando a necessidade de modificar o atual suporte hemoterápico a esses pacientes.