Novel method for determining when a field-collected donor unit is sufficiently full.

BACKGROUND: Whole blood (WB) collections can occur downrange for immediate administration. An important aspect of these collections is determining when the unit is sufficiently full. This project tested a novel method for determining when a field collection is complete. METHODS: The amount of empty space at the top of WB units, destined to become LTOWB or separated into components, that were collected at blood centers or hospitals was measured by holding a WB unit off the ground and placing the top of a piece of string where the donor tubing entered the bag. The string was marked where it intersected the top of the column of blood in the bag and measured from the top. The WB units were also weighed. RESULTS: A total of 15 different bags, two of which were measured in two different filling volumes, from 15 hospitals or blood centers were measured and weighed. The most commonly used blood bag, Terumo Imuflex SP, had a median string length of 9 mm (range: 2-24 mm) and weighed a median of 565.1 g (range: 524.8-636.7 g). CONCLUSION: Pieces of string can be precut to the appropriate length depending on the type of bag before a mission where field WB collections might be required and a mark placed on the bag before the collection commences to indicate when the unit is full.

Insuficiência renal aguda / Acute renal failure

A Insuficiência Renal Aguda (IRA) pode estar associada a várias etiologias no organismo humano,sendo este um dos motivos da importância dispensada àa esta doença. A prevenção é a principal ferramenta do médico e quando esta não foi possível, o tratamento visa afastar as principais causas,com investigação das demais e medidas de suporte para manter a viabilidade renal, muitas das vezes com êxito. A taxa de mortalidade em pacientes com IRA não se alterou muito nos últimos 30 anos. Os óbitos podem ocorrer em consequência da doença de base e não da própria IRA, pois o rim é um dos poucos órgãos cuja função pode ser substituída em parte por longos períodos (ex. diálise).

The Acute Renal Failure (ARF) can be related to several etiologies in the human organism, being one ofthe reasons of the importance given to this disease. The prevention is the doctor's main tool and, whenit is not possible, the treatment looks forward repelling the main causes, also investigating the othersand keeping supportive care to maintain the renal viability, most of the times, successfully. The mortalityrate in patients with ARF did not change much in the last 30 years. The deaths can occur as a result of theunderlying disease and not of ARF, because the kidney is one of the few organs which function can besubstituted, in part, for long periods (ex. dialysis).

Manejo das complicações agudas da doença falciforme / Management of acute complications of sickle cell disease

Anemia falciforme (HbSS) é uma doença autossômica recessiva caracterizada pela herança homozigotada hemoglobina S (HbS). Clinicamente apresenta-se com anemia hemolítica e vaso-oclusão. O termo doença falciforme engloba a anemia falciforme e heterozigozes compostas com hemoglobina S,como S? talassemia e hemoglobinopatia SC, além de outras associações menos comuns. São várias as complicações agudas na doença falciforme: crises vaso-oclusivas, infecções por microorganismos encapsulados, principalmente do trato respiratório e septicemia, síndrome torácica aguda, sequestro esplênico, priapismo, Acidente Vascular Cerebral (AVC) e crise aplástica. O conhecimento das intercorrências na Doença Falciforme é de extrema importância para todos os níveis de atendimento destes pacientes. A detecção precoce das complicações possibilita tratamento adequado e diminuição da morbimortalidade relacionada a elas.

Sickle cell anemia (SCA) is an autosomal recessive disease characterized by the presence of hemoglobinS. It presents with hemolytic anemia e vaso-occlusives phenomena. The term sickle cell disease (SCD)includes the SCA and a group of compound heterozygous states in which the person has only one copy of the mutation that causes HbS and one copy of another abnormal haemoglobin allele, like sickle hemoglobinC disease (HbSC), sickle beta-thalassaemia and other rarer combinations. There are many acute complications of SCD: vaso-occlusives crisis, encapsulated organisms infections, mainly of the airways and sepsis, acute chest syndrome, splenic sequestration, priapism, stroke and aplastic crisis.The knowledge of these complications is very important for all grades of medical assistence. The early detection allows appropriate treatment and reduction of the morbidity and mortality associated with the disease.

Anticoagulação em pacientes hospitalizados / Anticoagulation in hospitalized patients

Os eventos tromboembólicos, principalmente o tromboembolismo venoso, acrescem importante morbidade e mortalidade e representam a segunda causa mais comum de complicações em pacientes hospitalizados. A anticoagulação é o tratamento padrão nestes casos, porém frequentemente seu manejo é complexo e requer conhecimento adequado tanto da farmacologia das drogas quanto da fisiologia da coagulação. Este artigo revê alguns pontos essenciais para quem lida com esses eventos e fornece noções práticas do manejo dos antagonistas da vitamina K e dos anticoagulantes parenterais.

Thromboembolic events, particularly venous thromboembolism, add significant morbidity and mortality and represent the second most common cause of complications in hospitalized patients. Anticoagulation is the standard treatment in these cases, but often their management is complex and requires adequate knowledge of both the pharmacology of drugs and the physiology of coagulation. This article reviews some key points to those who deal with these events and provides practical notions of management of vitamin K antagonists and parenteral anticoagulants.