Transfusion-associated adverse events incidence and severity after the implementation of an active hemovigilance program with 24 h follow-up. A prospective cohort study.

BACKGROUND: Hemovigilance (HV) is usually based on voluntary reports (passive HV). Our aim is to ascertain credible incidence, severity, and mortality of transfusion-associated adverse events (TAAEs) using an active HV program. STUDY DESIGN AND METHODS: Prospective cohort study to estimate transfusion risk after 46,488 transfusions in 5830 patients, using an active HV program with follow-up within the first 24 h after transfusion. We compared these results to those with the previously established passive HV program during the same 30 months of the study. We explored factors associated with the occurrence of TAAEs using generalized estimating equations models. RESULTS: With the active HV program TAAEs incidence was 57.3 (95% CI, 50.5-64.2) and mortality 1.1 (95% CI, 0.13-2.01) per 10,000 transfusions. Incidence with the new surveillance model was 14.0 times higher than with the passive. Most events occurred when transfusions had already finished (60.2%); especially pulmonary events (80.4%). Three out of five deaths and 50.3% of severe TAAEs were pulmonary. In the multivariate analysis surgical patients had half TAAEs risk when compared to medical patients (OR, 0.53; 95% CI, 0.34-0.78) and women had nearly twice the risk of a pulmonary event compared to men (OR, 1.84; 95% CI, 1.03-3.32). Patient's age, blood component type, or blood component shelf-life were unrelated to TAAEs risk. DISCUSSION: Active hemovigilance programs provide additional data which may lead to better recognition and understanding of TAAEs and their frequency and severity.

Anticoncepción, embarazo y enfermedades respiratorias minoritarias / Contraception, Pregnancy and Rare Respiratory Diseases

El 3% de las enfermedades raras son neumopatías. Las mejoras en la supervivencia y en la calidad de vida hacen que las pacientes con enfermedades respiratorias minoritarias deseen planificar su vida reproductiva. Esta revisión intenta presentar la experiencia acumulada en el campo de la salud reproductiva en estas mujeres. En diversas enfermedades respiratorias minoritarias se ha identificado una base genética. La combinación del diagnóstico genético preimplantacional, la reproducción asistida y las técnicas de biología molecular permite realizar el estudio genético de los embriones, antes de ser transferidos al útero; por tanto, puede evitarse el riesgo de transmitir una determinada enfermedad o alteración cromosómica en las parejas de elevado riesgo y se puede, también, realizar un diagnóstico prenatal mediante biopsia corial o amniocentesis. Como norma general, debemos personalizar el método anticonceptivo evaluando el estado general de la mujer y las posibilidades de embarazo, complicaciones y la posibilidad futura de trasplante pulmonar. En la linfangioleiomiomatosis y la hipertensión pulmonar primaria el embarazo se considera contraindicado. En la primera existe un riesgo muy elevado de neumotórax y de pérdida de función pulmonar. En la segunda, la mortalidad alcanza el 33%. En fibrosis quística se estima que cada año un 4% de las pacientes se quedan embarazadas y no se observa un deterioro de la función pulmonar. Existen circunstancias especiales en el parto a tener en cuenta y riesgos anestésicos específicos. La presente revisión sugiere que tanto la decisión sobre la anticoncepción como la contraindicación de un embarazo o las condiciones de su seguimiento deben ser individualizadas y multidisciplinares(AU)

Three percent of rare diseases are pneumopathies. Improvements in survival and quality of life have led to a new situation where patients with rare respiratory diseases want to plan their reproductive lives. The intention of this review is to present the experience accumulated in the field of the reproductive health of these women. In several rare respiratory diseases, a genetic base has been identified. The combination of preimplantation genetic diagnosis, assisted reproduction and molecular biology techniques enable embryos to be studied genetically before being transplanted into the uterus. Therefore, the risk for transmitting a certain disease or chromosome alteration may be avoided in high-risk couples, and prenatal diagnoses may be done by chorionic villus sampling or amniocentesis. As a general rule, contraceptive methods should be personalized by evaluating the general state of female patients as well as their possibilities for pregnancy, complications and the future possibility of lung transplantation. In lymphangioleiomyomatosis and primary pulmonary hypertension, pregnancy is considered a contraindication. In the former, there is a very high risk for pneumothorax and loss of lung function. In the latter, mortality reaches 33%. In cystic fibrosis, it is estimated that each year 4% of patients become pregnant and there is no observed loss in lung function. There are special circumstances in childbirth that should be considered as well as specific anesthesia risks. The present review suggests that the decision about contraceptive methods, pregnancy as a contraindication or conditions for managing a pregnancy should be both individualized and multidisciplinary(AU)

Maternidad y trasplante pulmonar: experiencia española / Maternity and Lung Transplantation: Cases in Spain

Se han notificado 18 trasplantadas de pulmón que han tenido hijos. Las complicaciones detectadas son: hipertensión arterial (50%), diabetes mellitus (21%), preeclampsia (13%), infecciones (21%), rechazo (30%), pérdida de función del injerto (23%) y menor porcentaje de nacidos vivos que en portadoras de otros órganos trasplantados. Otros aspectos a tener en cuenta son: potencial riesgo de alteraciones fetales dado que los fármacos empleados como profilaxis del rechazo atraviesan la barrera placentaria; así como mayor riesgo de infección y alteraciones de lo niveles de fármacos por los cambios en el metabolismo propios del embarazo y el puerperio. Se describen los 2 casos en España de mujeres trasplantadas de pulmón que han tenido hijos tras el trasplante. Aunque el embarazo pueda tener una evolución similar a las que experimentan personas no trasplantadas, se debe recomendar evitarlo y la mujer debe conocer el elevado riesgo de morbimortalidad fetal y materna existente(AU)

We contacted and analyzed the data of 18 lung transplant recipients who had had children. The complications we detected included: hypertension (50%), diabetes mellitus (21%), preeclampsia (13%), infection (21%), rejection (30%), loss of graft function (23%) and a lower percentage of live births than in transplant recipients of other organs. Other aspects to keep in mind are: the potential risk for fetal alterations (caused by drugs used as prophylaxis against rejection crossing the placental barrier); greater risk for infection and alterations in drug levels due to changes in metabolism typical of pregnancy and postpartum period. We describe the two cases in Spain of female lung transplant recipients who have had children after transplantation. Although pregnancy in these cases can have a similar evolution as in non-transplanted women, doctors should recommend their transplanted patients to avoid becoming pregnant, while explaining the high risk of both fetal and maternal morbidity and mortality after transplantation(AU)

Maternity and lung transplantation: cases in Spain.

We contacted and analyzed the data of 18 lung transplant recipients who had had children. The complications we detected included: hypertension (50%), diabetes mellitus (21%), preeclampsia (13%), infection (21%), rejection (30%), loss of graft function (23%) and a lower percentage of live births than in transplant recipients of other organs. Other aspects to keep in mind are: the potential risk for fetal alterations (caused by drugs used as prophylaxis against rejection crossing the placental barrier); greater risk for infection and alterations in drug levels due to changes in metabolism typical of pregnancy and postpartum period. We describe the two cases in Spain of female lung transplant recipients who have had children after transplantation. Although pregnancy in these cases can have a similar evolution as in non-transplanted women, doctors should recommend their transplanted patients to avoid becoming pregnant, while explaining the high risk of both fetal and maternal morbidity and mortality after transplantation.

Contraception, pregnancy and rare respiratory diseases.

Three percent of rare diseases are pneumopathies. Improvements in survival and quality of life have led to a new situation where patients with rare respiratory diseases want to plan their reproductive lives. The intention of this review is to present the experience accumulated in the field of the reproductive health of these women. In several rare respiratory diseases, a genetic base has been identified. The combination of preimplantation genetic diagnosis, assisted reproduction and molecular biology techniques enable embryos to be studied genetically before being transplanted into the uterus. Therefore, the risk for transmitting a certain disease or chromosome alteration may be avoided in high-risk couples, and prenatal diagnoses may be done by chorionic villus sampling or amniocentesis. As a general rule, contraceptive methods should be personalized by evaluating the general state of female patients as well as their possibilities for pregnancy, complications and the future possibility of lung transplantation. In lymphangioleiomyomatosis and primary pulmonary hypertension, pregnancy is considered a contraindication. In the former, there is a very high risk for pneumothorax and loss of lung function. In the latter, mortality reaches 33%. In cystic fibrosis, it is estimated that each year 4% of patients become pregnant and there is no observed loss in lung function. There are special circumstances in childbirth that should be considered as well as specific anesthesia risks. The present review suggests that the decision about contraceptive methods, pregnancy as a contraindication or conditions for managing a pregnancy should be both individualized and multidisciplinary.