Diagnóstico y manejo de la anemia en el embarazo: estudio comparativo en mujeres de zonas urbanas y rurales / Diagnosis and management of anemia in pregnancy: a comparative study of urban and rural women

Objetivo: Comparar el diagnóstico y manejo de la anemia durante el embarazo en mujeres de zonas urbanas y rurales. Métodos: Estudio descriptivo transversal, basado en un análisis de una encuesta nacional de salud del 2022. Se incluyeron registros de 18 889 mujeres con un embarazo en los últimos 5 años. Se estimaron frecuencias y porcentajes ponderados; además se aplicó la prueba chi cuadrado a un nivel de significancia del 0,05. Resultados: Al 94 % de mujeres se les realizó el descarte de anemia, este procedimiento fue más frecuente en zonas urbanas (94,9 %), comparado a las rurales (91,1 %). La mayor parte de las mujeres no recibió el diagnóstico de anemia, pero no hubo diferencias entre las zonas rurales (29,8 %) y urbanas (28,3 %). Respecto a la indicación y cumplimiento del tratamiento para la anemia, esto fue significativamente mayor en las parejas urbanas, con un porcentaje de 96,7 % y 65,5 %, respectivamente. Conclusión: En las zonas urbanas, fue mayor el porcentaje de mujeres en quienes se realizó descarte de anemia, así como la indicación del tratamiento y su cumplimiento. El diagnóstico de anemia no mostró diferencias entre ambas zonas(AU)

Objective: To compare the diagnosis and management of anemia during pregnancy in urban and rural women. Methods: Cross-sectional descriptive study, based on an analysis of a national health survey from 2022. Records of 18889 women with a pregnancy in the last 5 years were included. Frequencies and weighted percentages were estimated; in addition, the chi-square test was applied at a significance level of 0.05. Results: 94% of women were screened for anemia; this procedure was more frequent in urban areas (94.9%) compared to rural areas (91.1%). Most women were not diagnosed with anemia, but there was no difference between rural (29.8%) and urban (28.3%) areas. Regarding indication and adherence to treatment for anemia, this was significantly higher in urban couples, at 96.7% and 65.5%, respectively. Conclusion: In urban areas, the percentage of women of anemia ruling out, as well as treatment indication and compliance was higher. The diagnosis of anemia showed no differences between the two areas(AU)

Red blood cell transfusions in preterm infants in 2021: a narrative review / Transfusão de células vermelhas em prematuros em 2021: uma revisão narrativa

Anemia is frequent in preterm infants. Red blood cell transfusion practices vary between different centers. The objective of this study was to review red blood cell transfusion practices in preterm infants between 2020 and 2021. This was a narrative review that included studies published on PubMed (Medline) and Web of Science between October 2020 and October 2021. Ten studies were included finally. Red blood cell transfusion frequency was variable. Some neonatal units did not report transfusion protocols. Most studies reported volumes of 10-15 ml/kg per transfusion. The implementation of an anemia care bundle and adoption of restrictive transfusion resulted in a reduction in the number of transfusions, the volume transfused, and a reduction in the rate of multiple transfusions. We suggest that neonatal units that care for preterm infants should have a transfusion protocol based on the best evidence available and this issue may improve.

A anemia é frequente nos bebês prematuros. As práticas de transfusão de glóbulos vermelhos variam entre os diferentes hospitais. O objetivo deste estudo foi revisar as práticas de transfusão de glóbulos vermelhos em bebês prematuros entre 2020 e 2021. Esta foi uma revisão narrativa que incluiu estudos publicados no PubMed (Medline) e Web of Science entre outubro de 2020 e outubro de 2021. Dez estudos foram definitivamente incluídos. A frequência de transfusão de glóbulos vermelhos foi variável. Algumas unidades neonatais não relataram protocolos de transfusão. A maioria dos estudos relatou volumes de 10-15 ml/kg por transfusão. A implantação de um conjunto de cuidados para anemia e a adoção de transfusão restritiva resultaram em uma redução do número de transfusões, do volume transfundido e uma redução na taxa de transfusões múltiplas. Sugerimos que as unidades neonatais que prestam cuidados a bebês prematuros devem ter um protocolo de transfusão baseado em evidências para que todo esse problema melhore.

Complicaciones y mortalidad en pacientes neurocríticos / Complications and mortality in neurocritic patients

Objetivo: Relacionar las complicaciones y el riesgo de muerte en pacientes neurocríticos admitidos en la unidad de cuidados intensivos (UCI) del Hospital Universitario de Caracas durante un período de 5 meses. Métodos: investigación observacional, prospectiva, descriptiva. La muestra estuvo conformada por 65 pacientes neurocríticos, ≥ 18 años, con patologías médicas o quirúrgicas, ingresados en la UCI. El análisis estadístico incluyó la determinación de frecuencias, promedios, porcentajes y medias para descripción de variables y el T de Student. Resultados: La edad promedio fue 50,98 ± 16,66 años; la población masculinarepresentó el 50,76%. Entre las complicaciones, la mayor incidencia correspondió a las no infecciosas (70,77 %) y los trastornos ácido-básicos de tipo metabólico, la anemia y las alteraciones electrolíticas fueron las más frecuentes; el 29,23% de los pacientes presentaron complicaciones infecciosas, y la neumonía asociada a ventilación mecánica fue la más frecuente (73,91 %). La comorbilidad con mayor incidencia fue hipertensión arterial sistémica (53,84%). El 90.70% requirió ventilación mecánica y el tiempo en VM fue 4.29 ± 6.43 días. La estancia en UCI fue 5.96 ± 7.72 días. El 29,23% presentó un puntaje en la escala APACHE II entre 5-9; el SAPS II presentó mayor incidencia entre los 6-21 y 22-37 puntos con (66,70%); el SOFA al ingreso se reportó < 15 puntos en 98,46% y > 15 en 1,53%. La mortalidad del grupo fue 23,08 % (n=15). Conclusiones: Las complicaciones no infecciosas predominaron sobre las infecciosas las primeras íntimamente relacionadas con la mortalida(AU)

Objective: To relate complications and the risk of death in neurocritical patients admitted to the intensive care unit (ICU) of the University Hospital of Caracas during a period of 5 months. Methods: observational, prospective, descriptive research. The sample was made up of 65 neurocritical patients, ≥ 18 years old, with medical or surgical pathologies, admitted to the ICU.The statistical analysis included the determination of frequencies, averages, percentages and meansfor description of variables and Student's T.Results: The average age was 50.98 ± 16.66 years; the male population represented 50.76%. Among the complications, the highest incidence corresponded to non-infectious complications (70.77%) and metabolic acid-base disorders, anemia and electrolyte alterations were the most frequent; 29.23% of patients presented infectious complications, and pneumonia associated with mechanical ventilation was the most frequent (73.91%). The comorbidity with the highest incidence was systemic arterial hypertension (53.84%), 90.70% required mechanical ventilation and the time on MV was 4.29 ± 6.43 days. The ICU stay was 5.96 ± 7.72 days. 29.23% had a score on the APACHE II scale between 5-9; SAPS II presented the highest incidence between 6-21 and 22-37 points with (66.70%); The SOFA upon admission was reported to be < 15 points in 98.46% and > 15 in 1.53%. The mortality of the group was 23.08% (n=15). Conclusions: Non-infectious complications predominated over infectious complications, the former being closely related to mortalit(AU)

Características de los niños hospitalizados que recibieron transfusiones de sangre desplasmatizada durante el 2019: Hospital Pediátrico-Centro Hospitalario Pereira Rossell / Characteristics of hospitalized children who received deplasmatized blood transfusions during 2019: Hospital Pediátrico-Centro Hospitalario Pereira Rossell / Características das crianças hospitalizadas que receberam transfusões de sangue desplasmatizado durante 2019: Hospital Pediátrico-Centro Hospitalario Pereira Rossell

Introducción: la terapia transfusional es un procedimiento terapéutico que ha contribuido a disminuir la mortalidad, y mejorar la calidad de vida de pacientes con diversas patologías. La utilización de guías en la práctica transfusional, contribuye a la utilización racional de las mismas. Objetivo: describir las características de los niños de 1 mes a 14 años 11 meses hospitalizados en el Centro Hospitalario Pereira Rossell durante el 2019 que recibieron transfusión de sangre desplasmatizada. Metodología: estudio descriptivo retrospectivo. Se incluyeron los niños entre 1 mes y 14 años 11 meses asistidos en emergencia, unidad de reanimación, cuidados moderados, intermedios e intensivos del Centro Hospitalario Pereira Rossell. Variables: edad, sexo, área de asistencia, motivo de ingreso, indicación de transfusión, cifras de Hb pre y post-transfusión, clasificación de la anemia, dosis. Resultados: se incluyeron 160 transfusiones correspondientes a 97 pacientes, 56% eran de sexo masculino. Media de edad 3 años, 52% < 1 año. El motivo de ingreso más frecuente fue patología respiratoria infecciosa 37%. El 79% fueron transfundidos en unidad de cuidados intermedios e intensivos. Media Hb pre-transfusión 7,45 g/dL y post-transfusión de 10,1 g/dL. Predominó la anemia moderada, normocítica-normocrómica, pura. La dosis media de sangre desplasmatizada transfundida fue 12 cc/kg. Conclusiones: en esta serie predominaron los pacientes de sexo masculino y menores a un año que ingresaron principalmente por patología respiratoria infecciosa. La mayoría de los pacientes transfundidos estaban en cuidados intensivos. Futuros estudios, de diseño prospectivo, que incluyan pacientes de todos los escenarios asistenciales y de otros prestadores de salud, contribuirán a continuar el estudio de los pacientes transfundidos y a la elaboración de recomendaciones o protocolos locales.

Introduction: Transfusion therapy is a therapeutic procedure that has contributed to reducing mortality and improving the quality of life of patients with various pathologies. The use of guides in transfusion practice contributes to their rational use. Objective: To describe the characteristics of children from 1 month to 14 years 11 months who were hospitalized in the Centro Hospitalario Pereira Rossell during 2019 who received a red blood cell transfusion. Methodology: Retrospective descriptive study. Children aged 1 month to 14 years and 11 months assisted in the emergency, moderate, intermediate and intensive care of the Centro Hospitalario Pereira Rossell were included in the study. Variables: age, sex, area of care, reason for admission, indication for transfusion, Hb figures before and after transfusion, classification of anaemia, dose. The study protocol was approved by the Institutional Ethics Committee. Results:160 transfusions corresponding to 97 patients were included, 56% were male. Mean age 3 years, 52% <1 year. The most frequent reason for admission was infectious respiratory disease 37%. 79% were transfused in the intermediate and intensive care unit. Mean Hb pre-transfusion 7.45 g/dL and post- transfusion of 10.1 g/dL. Moderate, normocytic-normochromic, pure anaemia predominated. The mean dose of deplasmatized blood transfused was 12 cc/kg. Conclusions: In this series, male patients less than one year of age predominated, admitted mainly for infectious respiratory disease. Most of the transfused patients were in intensive care. Future studies of prospective design that include patients from all healthcare settings and from other healthcare providers, will contribute to continuing the study of transfused patients and to the development of local recommendations or protocols.

Introdução: a terapia transfusional é um procedimento terapêutico que tem contribuído para reduzir a mortalidade e melhorar a qualidade de vida de pacientes com diversas patologias. A utilização de diretrizes na prática transfusional contribui para o seu uso racional. Objetivo: descrever as características das crianças de 1 mês a 14 anos e 11 meses internadas no Centro Hospitalario Pereira Rossell durante o ano de 2019 que receberam transfusão de sangue desplasmatizado. Metodologia: estudo descritivo retrospectivo. Foram incluídas crianças com idade entre 1 mês e 14 anos e 11 meses atendidas na emergência, unidade de reanimação, cuidados moderados, intermediários e intensivos do Centro Hospitalario Pereira Rossell. Variáveis: idade, sexo, área de atendimento, motivo da admissão, indicação de transfusão, valores de Hb pré e pós-transfusão, classificação da anemia, dose. Resultados: foram incluídas 160 transfusões correspondentes a 97 pacientes, 56% eram do sexo masculino. A idade média foi de 3 anos, 52% < 1 ano. O motivo mais frequente de admissão foi pato- logia respiratória infecciosa (37%). 79% foram transfundidos na unidade de tratamento intermediário e intensivo. Hb média pré-transfusional de 7,45 g/dL e Hb pós-transfusional de 10,1 g/dL. Predominou a anemia moderada, normocítica-normocrômica e pura. A dose média de sangue desplasmatizado transfundida foi de 12 cc/kg. Conclusões: nesta série, houve uma predominância de pacientes do sexo masculino com menos de um ano de idade que foram admitidos principalmente por patologia respiratória infecciosa. A maioria dos pacientes transfundidos estava em tratamento intensivo. Estudos prospectivos futuros incluindo pacientes de todos os ambientes de atendimento e outros presta- dores de serviços de saúde, contribuirão para um estudo mais aprofundado dos pacientes transfundidos e para o desenvolvimento de recomendações ou protocolos locais.

Prevalence of Anemia in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis / 生物医学与环境科学（英文）

OBJECTIVE@#Anemia is a common public health concern in patients with type 2 diabetes worldwide. This study aimed to identify the prevalence of anemia among patients with diabetes.@*METHODS@#Electronic databases, including PubMed, Scopus, Web of Sciences, and Google Scholar, were searched systematically for studies published between 2010 and 2021. After removing duplicates and inappropriate reports, the remaining manuscripts were reviewed and appraised using theNewcastle-Ottawa Scale (NOS) tool. A random-effects model was used to calculate the pooled estimates of the extracted data using Stata version 17. Heterogeneity of the studies was assessed using the Q statistic.@*RESULTS@#A total of 51 articles containing information on 26,485 patients with diabetes were included in this study. The articles were mainly from Asia (58.82%) and Africa (35.29%). The overall prevalence of anemia was 35.45% (95% CI: 30.30-40.76), with no evidence of heterogeneity by sex. Among the two continents with the highest number of studies, the prevalence of anemia in patients with diabetes was significantly higher in Asia [40.02; 95% CI: 32.72-47.54] compared to Africa [28.46; 95% CI: 21.90-35.50] ( P for heterogeneity = 0.029). Moreover, there has been an increasing trend in the prevalence of anemia in patients with diabetes over time, from [15.28; 95% CI: 9.83-22.21] in 2012 to [40.70; 95% CI: 10.21-75.93] in 2022.@*CONCLUSION@#Globally, approximately 4 in 10 patients with diabetes suffer from anemia. Therefore, routine anemia screening and control programs every 3 months might be useful in improving the quality of life of these patients.

Association of ABCB1 gene polymorphisms rs1128503, rs2032582, rs4148738 with anemia in patients receiving dabigatran after total knee arthroplasty / 中华创伤杂志(英文版)

PURPOSE@#Dabigatran is usually prescribed in recommended doses without monitoring of the blood coagulation for the prevention of venous thromboembolism after joint arthroplasty. ABCB1 is a key gene in the metabolism of dabigatran etexilate. Its allele variants are likely to play a pivotal role in the occurrence of hemorrhagic complications.@*METHODS@#The prospective study included 127 patients with primary knee osteoarthritis undergoing total knee arthroplasty. Patients with anemia and coagulation disorders, elevated transaminase and creatinine levels as well as already receiving anticoagulant and antiplatelet therapy were excluded from the study. The association of ABCB1 gene polymorphisms rs1128503, rs2032582, rs4148738 with anemia as the outcome of dabigatran therapy was evaluated by single-nucleotide polymorphism analysis with a real-time polymerase chain reaction assay and laboratory blood tests. The beta regression model was used to predict the effect of polymorphisms on the studied laboratory markers. The probability of the type 1 error (p) was less than 0.05 was considered statistically significant. BenjaminiHochberg was used to correct for significance levels in multiple hypothesis tests. All calculations were performed using Rprogramming language v3.6.3.@*RESULTS@#For all polymorphisms there was no association with the level of platelets, protein, creatinine, alanine transaminase, prothrombin, international normalized ratio, activated partial thromboplastin time and fibrinogen. Carriers of rs1128503 (TT) had a significant decrease of hematocrit (p = 0.001), red blood count and hemoglobin (p = 0.015) while receiving dabigatran therapy during the postoperative period compared to the CC, CT. Carriers of rs2032582 (TT) had a significant decrease of hematocrit (p = 0.001), red blood count and hemoglobin (p = 0.006) while receiving dabigatran therapy during the postoperative period compared to the GG, GT phenotypes. These differences were not observed in carriers of rs4148738.@*CONCLUSION@#It might be necessary to reconsider thromboprophylaxis with dabigatran in carriers of rs1128503 (TT) or rs2032582 (TT) polymorphisms in favor of other new oral anticoagulants. The long-term implication of these findings would be the reduction of bleeding complications after total joint arthroplasty.

Transfusión intrauterina, hidrops fetal no inmune: reporte de un caso / Intrauterine transfusion, non-immune fetal hydrops: case report / Transfusão intrauterina, hidropisia fetal não imune: relato de caso

Introducción: el hidrops fetal es grave, de mal pronóstico y alta morbimortalidad, a pesar de mejoras diagnósticas y terapéuticas desarrolladas en los últimos tiempos. El pronóstico estará determinado por la etiología y posibilidades terapéuticas asociadas a mejores resultados, a la edad gestacional, al diagnóstico y al nacimiento, si bien cabe destacar que no existen suficientes estudios de seguimiento a largo plazo. El diagnóstico ecográfico es confirmatorio, siendo la principal complejidad identificar la etiología y plantear la estrategia terapéutica adecuada. Descripción del caso: presentamos una paciente con diagnóstico de hidrops fetal de tipo no inmune y su abordaje terapéutico. La causa del hidrops correspondió a anemia fetal severa, requiriendo la realización de tres procedimientos con exanguinotransfusión parcial intrauterina mediante cordocentesis. A las 33 semanas, se decidió la finalización del embarazo, con buena evolución neonatal. Conclusión: el hidrops fetal aumenta la morbimortalidad fetal y neonatal, siendo un enorme desafío para el equipo tratante, que requiere de un equipo asistencial interdisciplinario. El conocimiento de esta patología permite realizar un abordaje completo, orientar a la etiología, realizando un diagnóstico oportuno y la selección adecuada del tratamiento. Como en este caso, al identificar la anemia severa como causa del hidrops, es mandatorio definir el manejo para los fetos candidatos a terapia intrauterina.

Introduction: fetal hydrops is a serious condition with a poor prognosis and high morbidity and mortality, despite improvements in diagnostics and therapeutics in recent years. Prognosis is determined by the etiology and therapeutic options associated with better outcomes, gestational age, diagnosis, and birth, although it should be noted that there are not enough long-term follow-up studies. Ultrasound diagnosis is confirmatory, with the main challenge being to identify the etiology and propose the appropriate therapeutic strategy. Description of the case: we present a patient diagnosed with non-immune fetal hydrops and its therapeutic approach. The cause of hydrops was severe fetal anemia, requiring 3 procedures with intrauterine partial exsanguination transfusion through Cordocentesis. At 33 weeks, the decision was made to terminate the pregnancy, with good neonatal outcomes. Conclusions: fetal hydrops increases fetal and neonatal morbidity and mortality, posing a significant challenge for the treating team and requiring an interdisciplinary healthcare team. Understanding this condition allows for a comprehensive approach, guiding the etiology, providing timely diagnosis, and selecting appropriate treatment. As in this case, identifying severe anemia as the cause of hydrops mandates defining the management for fetuses eligible for intrauterine therapy.

Introdução: a hidropisia fetal é grave, com mau prognóstico e elevada morbimortalidade, apesar das melhorias diagnósticas e terapêuticas desenvolvidas nos últimos tempos. O prognóstico será determinado pela etiologia e possibilidades terapêuticas associadas a melhores resultados, idade gestacional, diagnóstico e nascimento, embora se deva salientar que não existem estudos suficientes de seguimento a longo prazo. O diagnóstico ultrassonográfico é confirmatório, sendo a principal complexidade identificar a etiologia e propor a estratégia terapêutica adequada. Descrição do caso: apresentamos uma paciente com diagnóstico de hidropisia fetal não imune e sua abordagem terapêutica. A causa da hidropisia correspondeu a anemia fetal grave, sendo necessária a realização de 3 procedimentos com exsanguineotransfusão intrauterina parcial por meio de cordocentese. Às 33 semanas foi decidida a interrupção da gravidez, com boa evolução neonatal. Conclusão: a hidropisia fetal aumenta a morbimortalidade fetal e neonatal, sendo um enorme desafio para a equipe responsável pelo tratamento, necessitando de uma equipe de atendimento interdisciplinar. O conhecimento desta patologia permite uma abordagem completa, orientação sobre a etiologia, diagnóstico atempado e seleção do tratamento adequado. Assim como neste caso, quando se identifica anemia grave como causa da hidropisia, é obrigatória a definição do manejo para os fetos candidatos à terapia intrauterina.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Assessment and management of postoperative anemia

Abstract Postoperative anemia is a complex clinical issue that requires attention due to its ramifications on the patient's recovery and prognosis. Originating from multiple determinants, such as intraoperative blood loss, hemolysis, nutritional deficiencies, systemic inflammation and impact on the bone marrow, postoperative anemia has varied and often challenging presentations. Patients undergoing major surgical procedures, in particular, are susceptible to developing anemia due to the considerable associated blood loss. Accurate diagnosis plays a crucial role in the approach, requiring meticulous hematological analysis, including hemoglobin, hematocrit and reticulocyte count, as well as an in-depth investigation of the underlying causes. An additional challenge arises in the form of the excessive practice of phlebotomy during hospitalization for clinical monitoring. Although it is essential to assess the progression of anemia, frequent removal of blood may contribute to iatrogenic anemia, further delaying recovery and possibly increasing susceptibility to infection.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Assessment and management of coagulation in the preoperative period

Abstract Managing coagulation disorders and potential bleeding risks, especially in the context of anticoagulant medications, is of immense value both clinically and prior to surgery. Coagulation disorders can lead to bleeding complications, affecting patient safety and surgical outcomes. The use of Patient Blood Management protocols offers a comprehensive, evidence-based approach that effectively addresses these challenges. The problem is to find a delicate balance between preventing thromboembolic events (blood clots) and reducing the risk of bleeding. Anticoagulant medications, although crucial to preventing clot formation, can increase the potential for bleeding during surgical procedures. Patient blood management protocols aim to optimize patient outcomes by minimizing blood loss and unnecessary transfusions.

Lesión pulmonar aguda producida por transfusión (TRALI): Reporte de caso / Transfusion-induced acute lung injury (TRALI): Case report

Introducción: La lesión pulmonar aguda (TRALI) y la sobrecarga circulatoria (TACO) son las principales causas de morbilidad y mortalidad relacionadas con la transfusión. La TRALI se presenta durante o después de las transfusiones de plasma y sus derivados, o por inmunoglobulinas en alta concentración intravenosa; se asocia a procesos sépticos, cirugías y transfusiones masivas. La TACO es la exacerbación de manifestaciones respiratorias en las primeras 6 horas postransfusión. Reporte caso: Paciente de sexo masculino de 38 días de vida, ingresó al servicio de urgencias con un cuadro clínico de 8 días de evolución, caracterizado por dificultad respiratoria dado por retracciones subcostales y aleteo nasal sin otro síntoma asociado, con antecedentes de importancia de prematuridad y bajo peso al nacer. El reporte de hemograma arrojó cifras compatibles con anemia severa, por lo que requirió transfusión de glóbulos rojos empaquetados desleucocitados. El paciente presentó un cuadro respiratorio alterado en un periodo menor a 6 horas, por lo que se descartaron causas infecciosas y finalmente se consideró cuadro compatible con TRALI. Conclusiones: Se debe considerar una lesión pulmonar aguda relacionada con una transfusión de sangre si se produce una insuficiencia respiratoria aguda durante o inmediatamente después de la infusión de hemoderivados que contienen plasma.

Introduction: Acute lung injury (TRALI) and circulatory overload (TACO) are the main causes of transfusion-related morbidity and mortality. TRALI occurs during or after transfusions of plasma or its derivatives, or by immunoglobulins in high intravenous concentration; it is associated with septic processes, surgeries, and massive transfusions. TACO is the exacerbation of respiratory manifestations in the first 6 hours post transfusion. Case report: A 38-day-old male was admitted to the emergency department with clinical symptoms experienced over the course of 8 days and characterized by respiratory distress due to subcostal retractions and nasal flaring with no other associated symptoms. Important antecedents included prematurity and low birth weight. The hemogram report showed figures compatible with anemia, which benefited from transfusion of packed red blood cells without leukocytes. In a period of less than 6 hours, the patient presented altered respiratory symptoms, practitioners ruled out infectious causes and finally considered clinical signs compatible with TRALI. Conclusion: Acute lung injury related to blood transfusion should be considered if acute respiratory failure occurs during or immediately after infusion of plasma-containing blood products.

Iron deficiency and child psychomotor development in a rural region of Chota, Peru, 2022 / Deficiencia de hierro y desarrollo psicomotor infantil en una zona rural de Chota, Perú 2022 / Deficiência de ferro e desenvolvimento psicomotor infantil em uma área rural de Chota, Peru 2022

Introduction: Iron deficiency and psychomotor developmental delay are two public health problems that cause high childhood morbidity and mortality worldwide, which can be related to social, economic, cultural and health factors that affect the environment where children and their family live. Objective: To determine the relationship between iron deficiency anemia and psychomotor development in children aged 2 to 4 years treated at the Cuyumalca Clinic, Chota. Materials and methods: Relational, cross-sectional study conducted on 48 children, who underwent hemoglobin testing through a portable hemoglobinometer and were subjected to the Psychomotor Development Test. Results: 31.2% of the children displayed some type of anemia, with the most common being moderate anemia (17.7%). On average, 10.9% showed some type of psychomotor developmental delay, including coordination (6.3%), language (8.4%), motor skills (16.7%), and overall development (12.5%). 4.2% of the children who had minor to moderate anemia showed developmental delay risks in the three assessed areas as well as in their overall development. Conclusion: There is no statistically significant relationship between iron deficiency anemia and several domains of psychomotor development, including coordination, language, motor skills as well as overall development.

Introducción: La deficiencia de hierro y las alteraciones en el desarrollo psicomotor son dos problemas de salud pública que causan una alta morbimortalidad infantil alrededor del mundo. Los estudios apuntan a que esto se relaciona con los factores sociales, económicos, culturales y sanitarios en los que el niño y su familia vive. Objetivo: Determinar la relación entre anemia ferropénica y desarrollo psicomotor en niños de 2 a 4 años atendidos en el Puesto de Salud de Cuyumalca, Chota. Materiales y métodos: Estudio relacional, transversal, desarrollado con 48 niños a quienes se les realizó un dosaje de hemoglobina con hemoglobinómetro portátil y se les aplicó el Test de Desarrollo Psicomotor. Resultados: El 31,2% de niños presentaron algún tipo de anemia, siendo la anemia moderada la más frecuente (16,7%); en promedio 10,9% evidenciaron alguna alteración en el desarrollo psicomotor en coordinación (6,3%), lenguaje (8,4%), motricidad (16,7%) y desarrollo global (12,5%). El 4,2% de niños con riesgo para el desarrollo presentaron anemia leve o moderada en las tres áreas evaluadas, al igual que en el desarrollo global. Conclusión: No existe relación estadística significativa entre anemia ferropénica y desarrollo psicomotor para las áreas de coordinación, lenguaje y motricidad; además del desarrollo global.

Introdução: A deficiência de ferro e as alterações no desenvolvimento psicomotor são dois problemas de saúde pública que causam elevada morbidade e mortalidade infantil em todo o mundo. Estudos sugerem que isso está relacionado aos fatores sociais, econômicos, culturais e de saúde em que vivem a criança e sua família. Objetivo: Determinar a relação entre anemia ferropriva e desenvolvimento psicomotor em crianças de 2 a 4 anos atendidas no Posto de Saúde Cuyumalca, Chota. Materiais e métodos: Estudo relacional, transversal, desenvolvido com 48 crianças que realizaram dosagem de hemoglobina com hemoglobinômetro portátil e foi aplicado o Teste de Desenvolvimento Psicomotor. Resultados: 31,2% das crianças apresentaram algum tipo de anemia, sendo a anemia moderada a mais frequente (16,7%); em média, 10,9% apresentaram alguma alteração no desenvolvimento psicomotor na coordenação (6,3%), linguagem (8,4%), motricidade (16,7%) e desenvolvimento global (12,5%). 4,2% das crianças em risco de desenvolvimento apresentaram anemia leve ou moderada nas três áreas avaliadas, bem como no desenvolvimento global. Conclusão: Não há relação estatística significativa entre anemia ferropriva e desenvolvimento psicomotor para as áreas de coordenação, linguagem e motricidade; bem como o desenvolvimento global.

Anemia y el desarrollo de la psicomotricidad en la primera infancia / Anemia and the development of psychomotor skills in early childhood / Anemia e desenvolvimento psicomotor na primeira infância

Los bajos niveles de hemoglobina se definen como una concentración baja de hemoglobina en la sangre. La activad metabólica cerebral está vinculada con el desarrollo psicomotor. El desarrollo psicomotor durante la infancia se desarrolla a partir de los reflejos innatos, se organizan en esquemas de conducta, se internalizan durante el segundo año de vida como modelos de pensamiento. En Perú, se contabilizan el 50.99% de los niños con bajos niveles de concentración de hemoglobina en menores de 3 años. Objetivo. Identificar la relación entre la anemia y el desarrollo de la psicomotricidad en la primera infancia. Materiales y Métodos. Para evaluar los niveles de hemoglobina se empleó el método de la azidametahemoglobina, con un hemoglobinómetro, y para evaluar el desarrollo psicomotor se empleó la escala del desarrollo psicomotor. En el estudio participaron 32 niños de 6 a 24 meses de edad. Resultados. El 40,6% presenta niveles de hemoglobina entre 14,2 - 17.2 g/dl, el 31,3% presenta niveles de hemoglobina entre 13.2 -14.1 g/dl seguido del 25,0% que presenta niveles de hemoglobina entre 10,2 -13.1 g/dl y el 3.1% presenta niveles de hemoglobina <10.2 g/dl; respecto al desarrollo psicomotor expresados en coeficiente de desarrollo se evidencia que el 59.4% de niños muestran un desarrollo normal seguido del 31.3% de niños que presenta un desarrollo en riesgo y 9.4% en retraso. Conclusiones. El coeficiente de desarrollo del niño(a) se encontró que la mayoría tiene un desarrollo psicomotor normal seguido de riesgo y de retraso, a pesar que mayoría tiene un coeficiente de desarrollo normal

Low hemoglobin levels are defined as a low hemoglobin concentration in the blood. Brain metabolic activity is linked to psychomotor development. Psychomotor development during infancy develops from innate reflexes, which are organized in behavioral schemes and internalized during the second year of life as thought models. In Peru, 50.99% of children under 3 years of age have low hemoglobin concentration levels. Objective. To identify the relationship between anemia and psychomotor development in early childhood. Materials and Methods. To evaluate hemoglobin levels, the azidametahemoglobin method was used, with a hemoglobinmeter, and to evaluate psychomotor development the psychomotor development scale was used. Thirty-two children aged 6 to 24 months participated in the study. Results. 40.6% presented hemoglobin levels between 14.2 - 17.2 g/dl, 31.3% presented hemoglobin levels between 13.2 -14.1 g/dl followed by 25.0% presenting hemoglobin levels between 10.2 -13.1 g/dl and 3.1% presented hemoglobin levels <10. 2 g/dl; with respect to psychomotor development expressed in development coefficient, 59.4% of children show normal development followed by 31.3% of children with development at risk and 9.4% with delayed development. Conclusions. The development coefficient of the child showed that most of the children have a normal psychomotor development followed by at risk and retardation, although most of them have a normal development coefficient.

Níveis baixos de hemoglobina são definidos como uma baixa concentração de hemoglobina no sangue. A atividade metabólica do cérebro está ligada ao desenvolvimento psicomotor. O desenvolvimento psicomotor durante a infância se desenvolve a partir de reflexos inatos, que são organizados em padrões de comportamento e internalizados durante o segundo ano de vida como padrões de pensamento. No Peru, 50,99% das crianças com menos de 3 anos de idade têm baixas concentrações de hemoglobina. Objetivo. Identificar a relação entre a anemia e o desenvolvimento psicomotor na primeira infância. Materiais e métodos. Para avaliar os níveis de hemoglobina, foi usado o método da azidameta-hemoglobina, com um hemoglobinômetro portátil HemoCue® Hb 201+ e, para avaliar o desenvolvimento psicomotor, foi usada a escala de desenvolvimento psicomotor. Trinta e duas crianças com idade entre 6 e 24 meses participaram do estudo. Resultados. 40,6% tinham níveis de hemoglobina entre 14,2 - 17,2 g/dl, 31,3% tinham níveis de hemoglobina entre 13,2 -14,1 g/dl, seguidos por 25,0% com níveis de hemoglobina entre 10,2 -13,1 g/dl e 3,1% com níveis de hemoglobina <10. 2 g/dl; com relação ao desenvolvimento psicomotor expresso em coeficiente de desenvolvimento, é evidente que 59,4% das crianças apresentam um desenvolvimento normal, seguido por 31,3% de crianças que apresentam um desenvolvimento em risco e 9,4% em atraso. Conclusões. O coeficiente de desenvolvimento infantil mostrou que a maioria das crianças tem um desenvolvimento psicomotor normal, seguido por risco e atraso, embora a maioria delas tenha um coeficiente de desenvolvimento normal.

Effects of Virtual Health Messages on Maternal Therapeutic Adherence for Childhood Anemia / Efecto de los mensajes virtuales en salud sobre la adherencia terapéutica materna de anemia infantil / O efeito das mensagens virtuais de saúde na adesão materna ao tratamento da anemia infantil

Introducción: la adherencia terapéutica de anemia infantil es un tópico abordado en los servicios de salud, con resultados poco satisfactorios; por lo tanto, la implementación de esta estrategia favorecerá una mayor adherencia al tratamiento con sulfato ferroso. Objetivo: evaluar el efecto de los mensajes virtuales en salud sobre la adherencia terapéutica materna de anemia infantil. Materiales y Métodos: se desarrolló un estudio preexperimental y longitudinal entre noviembre y diciembre de 2022, en el cual participaron 24 madres de niños diagnosticados con anemia; la adherencia se determinó mediante un test y el análisis inferencial por medio de la prueba de Wilcoxon. Resultados: Las madres tenían entre 18 y 29 años (50,0 %), procedencia rural (66,7 %), primaria completa (33,3 %), amas de casa (83,3 %) y convivientes (79,2 %). En el pretest, se observó alta adherencia en factores sociales (50 %), personal de salud (75 %), enfermedad (87,5 %), persona que suplementa y paciente (75,5 %), y adherencia media en factores relacionados a la suplementación (54,2 %); en el postest, la adherencia alta se presentó en factores sociales (100,0 %), personal de salud (100,0 %), enfermedad (87,5 %), suplementación (95,8 %), persona que suministra el sulfato ferroso y paciente (100,0 %). La adherencia global fue media en el pretest (50,0 %) y alta en el postest (100,0 %). La recepción de mensajes fue alta para el test global (62,6 %), mensajes recordatorios (79,2 %), informativos (79,2 %) y motivacionales (75,0 %). Conclusión: los mensajes virtuales en salud tienen un efecto positivo en la adherencia terapéutica materna de anemia infantil (p < 0,05) y su inclusión en los servicios primarios de salud contribuirá favorablemente en la obtención de resultados óptimos.

Introdução: a adesão ao tratamento da anemia infantil é um tema abordado nos serviços de saúde, com resultados insatisfatórios; portanto, a implementação dessa estratégia favorecerá uma maior adesão ao tratamento com sulfato ferroso. Objetivo: avaliar o efeito das mensagens virtuais de saúde na adesão materna ao tratamento da anemia infantil. Materiais e método: foi realizado um estudo pré-experimental e longitudinal entre novembro e dezembro de 2022, do qual participaram 24 mães de crianças diagnosticadas com anemia; a adesão foi determinada por meio de um teste e a análise inferencial, por meio do teste de Wilcoxon. Resultados: as mães tinham entre 18 e 29 anos de idade (50 %), eram de áreas rurais (66,7 %), concluíram o ensino fundamental (33,3 %), eram donas de casa (83,3 %) e viviam juntas (79,2 %). No pré-teste, foi observada alta adesão em fatores sociais (50 %), equipe de saúde (75 %), doença (87,5 %), pessoa que suplementa e paciente (75,5 %), e adesão média em fatores relacionados à suplementação (54,2 %); no pós-teste, foi observada alta adesão em fatores sociais (100 %), equipe de saúde (100 %), doença (87,5 %), suplementação (95,8 %), pessoa que fornece sulfato ferroso e paciente (100 %). A adesão geral foi média no pré-teste (50 %) e alta no pós-teste (100 %). A recepção das mensagens foi alta para o teste geral (62,6 %), lembretes (79,2 %), mensagens informativas (79,2 %) e motivacionais (75 %). Conclusões: as mensagens virtuais de saúde têm um efeito positivo na adesão materna ao tratamento da anemia infantil (p < 0,05) e sua inclusão nos serviços de saúde primários contribuirá favoravelmente para a otimização dos resultados.

Introduction: Therapeutic adherence for childhood anemia is addressed in health services with unsatisfactory results. Therefore, the implementation of this strategy will favor greater adherence to treatment with ferrous sulfate. Objective: To evaluate the effect of virtual health messages on maternal therapeutic adherence for childhood anemia. Materials and Methods: A pre-experimental and longitudinal study was developed between November and December 2022, in which 24 mothers of children diagnosed with anemia participated. Adherence was determined using a test and inferential analysis through the Wilcoxon test. Results: The mothers were between 18 and 29 years old (50.0 %), of rural origin (66.7 %), who completed primary school (33.3 %), housewives (83.3 %), and cohabitants (79.2 %). In the pre-test, high adherence was observed in social factors (50 %), health personnel (75 %), illness (87.5 %), and person supplementing the ferrous sulfate and the patient (75.5 %). The overall adherence was medium in the pre-test (50.0 %) and high in the post-test (100.0 %). Message reception was high for the overall test (62.6 %), reminder (79.2 %), informational (79.2 %), and motivational (75.0 %) messages. Conclusion: Virtual health messages have a positive effect on maternal therapeutic adherence for childhood anemia (p < 0.05) and their inclusion in primary health services will contribute favorably to obtaining optimal results.

Hemoglobina Denver, una causa de desaturación en oximetría de pulso. Reporte de caso en un paciente pediátrico / Hemoglobin Denver, a cause of desaturated pulse oximetry. A pediatric case report

Las hemoglobinopatías son trastornos genéticos que afectan a la molécula de hemoglobina (Hb). Las mutaciones en las cadenas a o b que alteran el tetrámero de Hb pueden modificar la capacidad de la molécula para unirse al oxígeno. Las hemoglobinopatías con baja afinidad al oxígeno pueden presentarse con cianosis y una lectura alterada de la oximetría de pulso, lo que lleva a pruebas innecesarias y, a veces, invasivas para descartar afecciones cardiovasculares y respiratorias. En el siguiente reporte de caso, presentamos a una paciente pediátrica, asintomática, que se presentó a la consulta por detección de desaturación en oximetría de pulso. Las pruebas de laboratorio iniciales mostraron una anemia normocítica, normocrómica. Las muestras de gas venoso demostraron una p50 elevada. Después de extensas herramientas de diagnóstico, se diagnosticó una variante de Hb con baja afinidad al oxígeno, Hb Denver.

Hemoglobinopathies are genetic disorders that affect the hemoglobin (Hb) molecule. Mutations in the alpha or beta chains altering the Hb tetramer may modify the molecule's oxygen-binding capacity. Hemoglobinopathies with low oxygen affinity may occur with cyanosis and an altered pulse oximetry reading, leading to unnecessary and sometimes invasive tests to rule out cardiovascular and respiratory conditions. In the case report described here, we present an asymptomatic pediatric patient who consulted for desaturated pulse oximetry. Her initial laboratory tests showed normocytic, normochromic anemia. Venous blood gas samples showed an elevated p50. After using extensive diagnostic tools, a variant of Hb with low oxygen affinity was diagnosed: Hb Denver.

Diseño y Validación de una Aplicación Móvil, para el Diagnóstico de Anemia en Pre-Escolares. Estudio de Precisión Diagnóstica / Design and Validation of a Mobile Application for the Diagnosis of Anemia in Preschoolers. Diagnostic Accuracy Study

La anemia afecta a miles de niños. Para el diagnóstico se cuantifica la hemoglobina (Hb); técnica que no se encuentra al alcance de toda la población. Contar con un instrumento validado de fácil aplicación, puede ayudar al diagnóstico. El objetivo de este estudio fue validar una aplicación móvil (APP) para diagnosticar anemia en niños de 2 a 5 años, aplicable por padres o tutores. Estudio de validación de escalas. Mediante búsqueda bibliografía se recopilaron ítems y dominios relacionados con anemia en niños. Una vez reducidos, se construyó un cuestionario para pilotaje, con tres hematólogos pediatras. El resultado de este fue posteriormente validado por 22 expertos mediante aplicación de escalas tipo Likert. Los ítems validados, se contrastaron con la Hb de niños de 267 niños de 2 a 5 años de los andes ecuatorianos (2.560 msnm). Se determinó asociación de los ítems con Hb y con los resultados obtenidos y se construyó la APP. 14 ítems fueron analizados. Todos ellos puntuaron sobre la mediana de la distribución (35,5 puntos) y fueron valorados por, al menos el 50 % de los expertos. Se seleccionaron palidez palmar, astenia y sueño en horas no habituales. Todos mostraron asociación significativa con anemia (p<0,05), y fueron aplicados como preguntas a padres o tutores y contrastados con el valor de Hb. Sensibilidad y especificidad para palidez fue: 85,1 % y 85,0 %; astenia: 72,3 % y 87,7 %; sueño en horas no habituales: 68,1 % y 87,7 %; palidez más astenia o sueño: 95,7 % y 74,6 %; y debilidad más sueño: 92,5 % y 76,8 %. Se desarrolló y validó una APP para diagnóstico de anemia en niños de 2 a 5 años aplicable por padres o tutores.

SUMMARY: Anemia affects thousands of children, and to reach a diagnosis, hemoglobin (Hb) is quantified. This technique however, is not always accessible to the general population. Therefore, the availability of a validated instrument can be useful in the diagnosis. The aim of this study was to validate a mobile application (APP), to diagnose anemia in children from 2 to 5 years old, applicable by parents or guardians. Scale validation study. Through a bibliographic search, items and domains related to anemia in children were collected. Once reduced, a pilot questionnaire was constructed with three pediatric hematologists. The result was later validated by 22 experts through the application of the Likert-type scales. The validated items were contrasted with the Hb of children of 267 children from 2 to 5 years of age from the Ecuadorian Andes (2,560 meters above sea level). The association of the items with Hb and with the results obtained was determined, and the APP was constructed. 14 items were analyzed. All of them scored above the median of the distribution (35.5 points) and were valued by at least 50 % of the experts. Palmar pallor, asthenia, and sleep at unusual hours were selected. All showed a significant association with anemia (p<0.05) and were applied as questions to parents or guardians and contrasted with the Hb value. Sensitivity and specificity for pallor was: 85.1 % and 85.0 %; asthenia: 72.3 % and 87.7 %; sleep at unusual hours: 68.1 % and 87.7 %; paleness plus fatigue or sleepiness: 95.7 % and 74.6 %; and weakness plus sleep: 92.5 % and 76.8 %. An APP for the diagnosis of anemia in children from 2 to 5 years old applicable by parents or guardians was developed and validated.

Efectividad del mousse de sangrecita y nivel de hemoglobina en los niños de 3 años en las instituciones educativas iniciales, Ica-Perú / Effectiveness of sangrecita mousse little blood and hemoglobin level in children from 3 years of age in the initial educational institutions Ica-Peru

El estudio tuvo como Objetivo: Evaluar la efectividad del mousse de sangrecita en los niveles de hemoglobina en los niños de dos instituciones Educativas iniciales. Materiales y métodos: Estudio Experimental con diseño cuasi experimental de corte longitudinal, la población de estudio estuvo conformada por 80 niños los cuales todos participaron (consentimiento de los padres), 52 niños fueron de la IEI de Ica y 28 de la IEI de Comatrana, para la muestra se realizó un muestreo no probabilístico mediante el descarte de anemia utilizando el analizador de hemoglobina (hemoQ), microcubetas, lancetas y demás implementos, de ellos 9 niños tuvieron una hemoglobina <=11gr/dl quienes ingresaron al programa de mousse de sangrecita. Se elaboró una ficha de control. Resultados: Después de 7 semanas de consumir el mousse de sangrecita los 9 niños que ingresaron al programa de las dos IEI, se evidencio un incremento en sus niveles de hemoglobina superior al primer control. Conclusiones: El consumo de mousse de sangrecita es efectiva en el tratamiento de la anemia en niños de la IEI incrementando el nivel de hemoglobina. (AU)

The Objective of the study was to evaluate the effectiveness of blood mousse on hemoglobin levels in children from two initial educational institutions. Materials and Methods: Study experimental Quasi-experimental desing of longitudinal cut, the study population was made up of 80 children who all participated (parental consent), 52 children were from the IEI of Ica and 28 from the IEI of Comatrana, for the sample a non-probability sampling was carried out by discarding anemia using the hemoglobin analyzer (hemoQ), microcuvettes, lancets andother implements, of them 9 children had a hemoglobin < = 11gr / dl who would enter the blood mousse program. A control sheet was drawn up. Results: After 7 weeks of consuming the blood mousse of the 9 children who entered the program of the two IEI, there was evidence of an increase in their hemoglobin levels higher than the first control. Conclusions: The consumption of blood mousse is effective in the treatment of anemia in children with IEI by increasing the level of hemoglobin. (AU)

Mielopatía por déficit de cobre: serie de casos y revisión de la literatura / Myelopathy due to copper deficiency: A case series and review of the literature

El déficit de cobre puede presentarse como una mielopatía y manifestarse como una ataxia sensorial secundaria a una desmielinización de los cordones posteriores de la médula espinal. Puede acompañarse de citopenias, principalmente anemia y leucopenia. Se presenta una serie de casos de tres pacientes con mielopatía por déficit de cobre, diagnosticados y manejados desde el año 2020 al 2022 en un hospital universitario de alta complejidad en Colombia. Dos de los casos eran mujeres. El rango de edad fue entre 57 y 68 años. En los tres casos, los niveles séricos de cobre estaban disminuidos y en dos de ellos, se descartaron diferentes causas de mielopatía que afectan los cordones posteriores de la médula espinal como el déficit de vitamina B12, vitamina E y ácido fólico, tabes dorsal, mielopatía por virus de la inmunodeficiencia humana, esclerosis múltiple e infección por el virus linfotrópico humano de tipo I y II, entre otras. Sin embargo, un paciente tenía deficiencia de vitamina B12 asociada con de cobre en el momento del diagnóstico de la mielopatía. En los tres casos hubo ataxia sensitiva y en dos, la paraparesia fue el déficit motor inicial. Se deben incluir siempre la determinación de los niveles de cobre dentro del abordaje diagnóstico de todo paciente con enfermedad gastrointestinal crónica, con diarrea crónica, síndrome de mala absorción o reducción significativa de la ingestión en la dieta, y que desarrolle síntomas neurológicos sugestivos de compromiso de los cordones, ya que se ha reportado que el retraso en el diagnóstico de las mielopatías se asocia con pobres desenlaces neurológicos.

Copper deficiency can present as myelopathy by the manifestation of sensory ataxia, secondary to demyelination of the posterior cords of the spinal cord, accompanied by cytopenia, mainly anemia, and leukopenia. Case series study of three patients with myelopathy due to copper deficiency, diagnosed and managed from 2020 to 2022 in a highly complex university hospital in Colombia. Regarding gender, two cases were female patients. The age range was between 57 and 68 years. In all three cases serum copper levels were decreased, and in two of these, different causes of myelopathy affecting the posterior cords of the spinal cord were ruled out, such as vitamin B12, vitamin E and folic acid deficiency, tabes dorsalis, myelopathy due to human immunodeficiency virus, multiple sclerosis and infection by the human lymphotropic virus type I and II, among others. However, at the moment of the myelopathy diagnosis, one patient had vitamin B12 deficiency associated with copper insufficiency. All three cases presented sensory ataxia, and in two, paraparesis was the initial motor deficit. The diagnostic approach must include copper levels assessment in every case of patients with chronic gastrointestinal pathology, chronic diarrhea, malabsorption syndrome, or significant reduction in dietary intake; and the development of neurological symptoms that may suggest cord involvement. It has been reported that a delay in diagnosis can lead to poor neurological outcomes.