[Reasons for fresh frozen plasma transfusion in a general hospital]. / Motivos de transfusión de plasma fresco congelado en un hospital general.

OBJECTIVE: To assess the fresh-frozen plasma (FFP) transfusion indications in a Mexican hospital. SETTING: A general hospital for federal government employees located in the city of Morelia, State of Michoacan, Mexico. MATERIAL AND METHODS: We evaluated all FFP transfusions between February and August, 1998 classifying them as appropriate or inappropriate according to the recent FFP-transfusion guidelines: correction of known coagulation factor deficiencies with bleeding and correction of microvascular bleeding when prothrombin and activated partial thromboplastin time are > 1.6 times normal (coagulation index o CI), urgent reversal of warfarin therapy, antithrombin III deficiency, thrombotic thrombocytopenic purpura treatment, liver transplant and acute disseminated intravascular coagulation. RESULTS: 78 patients with 292 FFP units transfused were analyzed: in 20 patients the indication was clotting support, 16 with CI < 1.5 and four with CI > 1.6, one with blood loss and one with surgical procedure; hypoalbuminemia in 10; hypovolemia in eight; unidentified reason in 33 and others in seven patients. Eleven units (3.76%) were considered properly transfused whereas 281 (96.23%) were inadequately indicated.

[Prevalence of viral antibodies and syphilis serology in blood donors from a hospital]. / Prevalencia de anticuerpos virales y reaginas luéticas en donadores de sangre de un hospital.

OBJECTIVE: To establish the prevalence of viral antibodies and luetic reagins in blood donors in a Mexican hospital. SETTING: A third level general hospital for government employees located in the city of Morelia, State of Michoacan, Mexico. MATERIAL AND METHODS: Blood samples were collected from 10,077 healthy volunteer donors in a seven year period (01/01/90 to 12/31/96). Serologic tests were performed for HIV antibodies (anti-HIV), HBsAg and RPR. Anti-HCV were tested in 7,256 samples collected from 07/01/92 to 12/31/96. RESULTS: Anti-HIV was found in 19 donors (0.18%), HBsAg in 34 (0.33%), RPR in 12 (0.11%) and anti-HCV in 22 (0.30%). These prevalence rates are in agreement with reports from other Mexican blood banks.

Antiphospholipid antibodies in patients with idiopathic autoimmune haemolytic anemia.

Isolated cases of anti-phospholipid antibody (aPL)-associated idiopathic autoimmune haemolytic anemia (IAHA) have been recently described. To assess the significances of this association, we studied by ELISA the presence of aPL in sera from 18 patients with IAHA and 14 patients with non-autoimmune haemolysis (NON-AH). Four IAHA cases and none of the NON-AH controls showed IgM anticardiolipin antibodies (aCL) that crossreacted extensively with zwitterionic as well as with other anionic phospholipids. IgG aCL were detected in 6 patients with IAHA and in 1 patient with NON-AH; there was little cross-reactivity with other phospholipids. Our results suggest that antiphospholipid antibodies are present in a substantial number of patients with IAHA. This humoral response does not seem to be secondary to the haemolysis proper. The potential pathogenic significance of this finding is discussed.

[Change in the quality of life as an indicator of the clinical course of disease. Comparison of 2 indices]. / El cambio en la calidad de vida como indicador de curso clínico de la enfermedad. Comparación de dos índices.

Quality of life is an important outcome measurement to judge disease impact and response to treatment; however it is very difficult to measure. We compared the MacKenzie's Change in Maximal Function Index (CMFI) with the Change in Quality of Life Index (CQLI) developed by our group. Both indices were applied on admission and upon discharge of 23 medical and surgical inpatients. The CQLI's interobserver reliability was somewhat better (Ri = 0.69) than that of the CMFI (Kw = 0.49). Both indices correlated with patient, close relative and physician assessments (rs = 0.52 to 0.86, p < 0.05). There was no correlation with Karnofsky scores. Both showed adequate responsiveness with Guyatt's coefficients between 2 and 4. Ninety five percent of the patients thought the questionnaires were easy to answer and approximately 5 minutes were enough to complete them. Both indices seem to perform better when applied by a social worker than when applied by a physician. Our results suggest that it is feasible to obtain consistent estimates of changes in quality of life. Either one of these indices may be used to assess the impact of medical intervention.

[Treatment of chronic refractory idiopathic thrombocytopenia purpura. 10 years experience at the Salvador Zubiran National Institute of Nutrition]. / Tratamiento de la púrpura trombocitopénica idiopática crónica refractaria. Experiencia de diez años en el Instituto Nacional de la Nutrición Salvador Zubirán.

A total of 126 patients with chronic idiopathic thrombocytopenic purpura were diagnosed from January 1980 to January 1990 in our institute. In this group of patients, 21 were refractory to prednisone therapy, splenectomy or both, or had had a relapse after a good response with these treatments. They were given other therapies. There was enough information for evaluation in 16 of the 21 patients. The treatment responses were classified according to the post-therapy platelet counts: complete response (CR) = > 150 x 10(9)/L for more than three months; partial response (PR) = 50-150 x 10(9)/L for more than three months; any response (AR) = CR + PR; no response (NR) = < 50 x 10(9)/L. There were 15 women and one male. The median age was 41 years (range 11 to 65). 6-mercaptopurine was given in all patients with CR = 31.2%, PR = 18.8%, AR = 50% and NR = 50%. Seven patients received cyclophosphamide with CR = 28.6%, PR = 14.3%, AR = 42.9% and NR = 57%. Vincristine was given in four patients with only one PR. Interferon alpha 2B was given in four patients with two transitory PR. One patient received colchicine and vitamin C without response. It is concluded that 6-mercaptopurine and cyclophosphamide are useful drugs in refractory thrombocytopenic purpura.

[Non-Hodgkin's lymphoma secondary to Hodgkin's disease treated with chemo- and radiotherapy. Report of a case]. / Linfoma no Hodgkin secundario a enfermedad de Hodgkin tratada con quimio- y radioterapias. Informe de un caso.

In 18 years of experience in the use of combined chemotherapy in Hodgkin's disease at the Instituto Nacional de la Nutrición Salvador Zubirán, the first case of non-Hodgkin's lymphoma secondary to Hodgkin's disease was identified. The patient was a 23 year old male who initially developed a nodular sclerosis type of Hodgkin's disease. Three years later, the biopsies showed lymphocyte predominance type of Hodgkin's disease. Finally, one year later, the patient developed a diffuse small cleaved cell lymphoma. Non-Hodgkin's lymphoma occurring in patients treated with combined chemotherapy and radiotherapy after Hodgkin's disease is a rare complication. We believe that the genesis of a second neoplasm in these cases may be due to both disturbances in the cellular immunity intrinsic to Hodgkin's disease and the treatment with combined chemotherapy and radiotherapy.

[Neuropathy caused by metronidazole. Report of a case and review of the literature]. / Neuropatía por metronidazol. Informe de un caso y revisión de la literatura.

A case of sensory neuropathy secondary to prolonged administration of metronidazole (MT) and tinidazole (TNZ) is reported. The patient received in the 6 months prior to admission, enough cumulative MT and TNZ to explain the development of a secondary neuropathy as reported in the literature. The present case is particularly interesting due to the length of evolution (38 months) which is the most prolonged reported up to now. It is also the first MT and TNZ neuropathy case reported in Spanish.