The erythrocyte alloimmunisation in patients with sickle cell anaemia: a systematic review.

Transfusion therapy is a common practice in the treatment of anaemia and can cause erythrocyte alloimmunisation. To systematise data related to erythrocyte alloimmunisation in patients with sickle cell disease (SCD), a bibliographic search was carried out in September 2017 to search for studies in four electronic databases. (i) Referring to the original work, (ii) being cohort or case-control, (iii) having been developed with individuals with SCD and (iv) having evaluated the erythrocyte alloimmunisation. Two reviewers identified the articles for inclusion in the study, extracted the predetermined data and carried out the evaluation of the methodological quality of the work. 21 studies were selected; the studies included data on 20 636 individuals (children and adults), were mostly published in the last 10 years, were developed in the United States and had high methodological quality. The occurrence of erythrocyte alloimmunisation ranged from 4·4 to 76%, and there was a higher rate of alloimmunisation against antigens of the Rh system. The risk factors for alloimmunisation were age; gender (female); red blood cell (RBC) units received; presence of ≥1 autoantibodies, TNF-α, interleukin (IL1B), human leukocyte antigens (HLA)-DRB1 gene polymorphisms; first blood transfusion (BT) after 5 years of age, transfusion episodic, multiple or during inflammatory events, acute chest syndrome (ACS) and vase-occlusive crisis (VOC); increased percentage of CD41 T memory cells; and positive direct antiglobulin test. Transfusion policies should be developed to protect the patient and his or her health based on the main factors associated with its incidence.

Spine trauma due to diving: main features and short-term neurological outcome.

STUDY DESIGN: This is a retrospective study. OBJECTIVES: The aim of this study is to examine the main features and short-term neurological outcomes associated with injuries to the spine due to diving into water in a Latin American country. SETTING: Salvador, Brazil. PATIENT SAMPLE: A total of 1324 subjects were admitted with spinal trauma between 1991 and 2006 (inclusive). Subjects aged between 14 and 65 years who sustained diving injuries corresponded to 10.6% (N=140) of the cases. OUTCOME MEASURES: Neurological status was determined by the Frankel Functional Scale (FFS) on admission and discharge. The FFS was secondarily converted to the American Spinal Injury Association impairment scale. METHODS: This study is a patient record database review that examines demographic and injury-related characteristics, details of hospital treatment and neurological status at the time of discharge. RESULTS: Males (N=129) outnumbered females (N=11) in a proportion of 12:1 (mean age: 28.62 years). The cervical spine region was the most affected area (92.1%) and 45% of the cases presented with tetraplegia. On admission, neurologically complete lesions accounted for 32.1% of the overall cases and 45.7% were neurologically intact. The mean length of stay (7.7 weeks) did not differ with regard to treatment option (P=0.83). During hospitalization, patients with incomplete neurological impairment had shorter lengths of stay and showed more neurological improvement than those with complete lesions (P=0.26 and 64.5 versus 2.2%, P<0.0001). CONCLUSION: Diving spine injuries have a high tetraplegia rate. Neurological recovery and shorter length of stay are associated with incomplete lesions.