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1.
Medicina (B Aires) ; 79(5): 391-396, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31671389

RESUMO

High serum levels of vitamin B12 or cobalamin, also called hypervitaminemia B12, is a frequently underestimated biological abnormality. According to the literature, some of the entities related to this finding are solid neoplasia (primary or metastatic) and acute or chronic hematological diseases. Other causes include liver disorders, monoclonal gammapathy of undetermined significance, renal failure and, less frequently, excess of vitamin B12 intake, inflammatory or autoimmune diseases, and transient hematological disorders (neutrophilia and secondary eosinophilia). This article reports on causes of hypervitaminosis B12, our experience and a review of the literature.


Assuntos
Transtornos Nutricionais/sangue , Transtornos Nutricionais/etiologia , Vitamina B 12/sangue , Lesão Renal Aguda/sangue , Lesão Renal Aguda/complicações , Doenças Hematológicas/sangue , Doenças Hematológicas/complicações , Humanos , Hepatopatias/sangue , Hepatopatias/complicações , Neoplasias/sangue , Neoplasias/complicações , Vitamina B 12/efeitos adversos
2.
Clin Lab ; 65(9)2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31532106

RESUMO

BACKGROUND: Bone marrow core biopsy is a routine component of comprehensive marrow evaluation, and adequacy criteria have been recommended. However, the effectiveness of these adequacy criteria for diagnostic bone marrow evaluation needs to be reassessed in the current era of extensive ancillary testing. We aimed to determine the impact of core biopsy length and intertrabecular area of evaluable bone marrow on overall adequacy for diagnostic marrow evaluation at our tertiary care institution. METHODS: Five hundred sequential cases of iliac crest bone marrow sampling were identified by retrospective re-view at our tertiary care institution. In this cohort, 470 core biopsies were obtained for histologic evaluation. Data including gross core biopsy length, number of intertrabecular 40x high power fields of evaluable marrow, and other pathologic/clinical parameters were compiled. RESULTS: The mean core biopsy length was 1.2 cm, and only 23% measured the recommended ≥ 1.5 cm. However, 96% of the core biopsies were interpretable and contributed to the comprehensive bone marrow evaluation. Notably, 100% of biopsies with ≥ 5.5 intertrabecular areas were contributory. Ancillary testing including immunophenotypic, cytogenetic, and/or molecular studies were performed in > 99% of cases. CONCLUSIONS: When histology was integrated with ancillary testing, the overall diagnosis was substantially limited in only 0.4% of cases and material deemed entirely insufficient in 0.4%. The number of intertrabecular 40x areas of evaluable marrow is a better predictor of adequacy than core biopsy length, and adequacy criteria should be revised in this era of extensive ancillary testing.


Assuntos
Exame de Medula Óssea/métodos , Doenças Hematológicas/diagnóstico , Neoplasias Hematológicas/diagnóstico , Centros de Atenção Terciária , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Medula Óssea/patologia , Exame de Medula Óssea/normas , Criança , Pré-Escolar , Feminino , Doenças Hematológicas/sangue , Neoplasias Hematológicas/sangue , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
3.
Med. intensiva (Madr., Ed. impr.) ; 43(5): 281-289, jun.-jul. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183240

RESUMO

Objetivos: Analizar las complicaciones hematológicas y las necesidades transfusionales en niños tratados con oxigenación por membrana extracorpórea (ECMO). Diseño: Estudio retrospectivo. Ámbito: Unidad de cuidados intensivos pediátricos. Pacientes: Niños menores de 18 años tratados con ECMO entre septiembre de 2006 y noviembre de 2015. Intervenciones: Ninguna. Variables de interés: Características clínicas, de la ECMO, anticoagulación, parámetros hematológicos y de coagulación, transfusiones y evolución clínica. Resultados: Se estudiaron 100 pacientes con una mediana de edad de 11 meses. Presentaron sangrado 76; el mediastino fue la localización más frecuente; 39 precisaron revisión quirúrgica. En los primeros 3 días de ECMO, el 97% de los pacientes precisaron transfusión de hematíes (34,4 ml/kg al día), el 94% plaquetas (21,1ml/kg al día) y el 90% plasma (26,6ml/kg al día). Los pacientes posquirúrgicos, con imposibilidad de salida de la circulación extracorpórea, los que presentaron sangrado al inicio de la ECMO, los que precisaron revisión quirúrgica y los que tuvieron canulación transtorácica requirieron mayor volumen de transfusiones. Se produjeron tromboembolias en 14 pacientes y hemólisis en 33. La mortalidad de los niños que presentaron sangrado al inicio de ECMO (57,6%) fue significativamente mayor que la del resto (37,5%) (p = 0,048). Conclusiones: Los niños tratados con ECMO presentan una elevada incidencia de sangrado y precisan un gran volumen de transfusiones. El postoperatorio de cirugía, el sangrado al inicio de la ECMO, la necesidad de revisión quirúrgica, la imposibilidad de salida de la circulación extracorpórea y la canulación transtorácica se asocian a un mayor volumen de transfusiones. Los niños que sangraron al inicio de la ECMO presentaron mayor mortalidad


Objectives: To analyze the hematological complications and need for transfusions in children receiving extracorporeal life support (ECLS). Design: A retrospective study was carried out. Setting: A pediatric intensive care unit. Patients: Children under 18 years of age subjected to ECLS between September 2006 and November 2015. Interventions: None. Variables of interest: Patient and ECLS characteristics, anticoagulation, hematological and coagulation parameters, transfusions and clinical course. Results: A total of 100 patients (94 with heart disease) with a median age of 11 months were studied. Seventy-six patients presented bleeding. The most frequent bleeding point was the mediastinum and 39 patients required revision surgery. In the first 3days, 97% of the patients required blood transfusion (34.4ml/kg per day), 94% platelets (21.1ml/kg per day) and 90% plasma (26.6ml/kg per day). Patients who were in the postoperative period, those who were bleeding at the start of ECLS, those requiring revision surgery, those who could not suspend extracorporeal circulation, and those subjected to transthoracic cannulation required a greater volume of transfusions than the rest of the patients. Thromboembolism occurred in 14 patients and hemolysis in 33 patients. Mortality among the children who were bleeding at the start of ECLS (57.6%) was significantly higher than in the rest of the patients (37.5%) (P=.048). Conclusions: Children subjected to ECLS present high blood product needs. The main factors related to transfusions were the postoperative period, bleeding at the start of ECLS, revision surgery, transthoracic cannulation, and the impossibility of suspending extracorporeal circulation. Children with bleeding suffered greater mortality than the rest of the patients


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Oxigenação por Membrana Extracorpórea/métodos , Transfusão de Sangue/tendências , Unidades de Terapia Intensiva Pediátrica , Doenças Hematológicas/sangue , Estudos Retrospectivos , Substitutos Sanguíneos/uso terapêutico , Tromboembolia/mortalidade , Mortalidade Infantil , Hemorragia/complicações , Anticoagulantes , Modelos Logísticos , Hemólise , Doenças Hematológicas/complicações , Doenças Hematológicas/etiologia
4.
Gynecol Oncol ; 154(1): 138-143, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31079832

RESUMO

OBJECTIVE: To evaluate hematologic adverse effect profiles associated with frontline platinum-based chemotherapy in ovarian cancer patients according to BRCA 1/2 mutational status. METHODS: Patients with high-grade serous ovarian cancer and a known BRCA mutational status who received in frontline 6 cycles of Carboplatin (AUC 5) plus Paclitaxel 175 mg/mq were retrospectively selected from our databases. Hematologic toxicity profiles of BRCA mutated patients were compared to non-mutated patients, according to EORTC Common Terminology Criteria for Adverse Events (CTCAE_4.02). RESULTS: Totally, 176 women of whom 58 (33%) were BRCA1/2 mutation carriers - 40 BRCA1 (69%) and 18 (31%) BRCA2 mutations carriers - and 118 (67%) non-carriers were identified. A significant higher frequency of thrombocytopenia (24% vs 5%; p < 0.001), anemia (21% vs 7%; p = 0.006) and neutropenia (62% vs 27%; p ≤0.001) was observed in BRCA mutated patients, resulting in a higher percentage of granulocyte-colony stimulating growth factors injection (12% versus 1%, p < 0.001) and dose delay (19% versus 27%, p = 0.005). The multivariate analysis confirmed that granulocyte-colony stimulating growth factors injection and dose delay were statistically significantly more frequent in BRCA mutated patients (OR 2.567, 95% CI 1.136-5.798, p = 0.035; OR 3.860, 95% CI 1.098-13.570, p = 0.023). Finally, the total number of hematologic adverse events compared between the two groups of patients during the entire treatment period showed a substantial higher rate of hematologic adverse events in BRCA mutated population. CONCLUSIONS: Germline BRCA 1/2 mutations are associated with a higher hematologic toxicity in patients with ovarian cancer who underwent platinum-based chemotherapy.


Assuntos
Cistadenocarcinoma Seroso/tratamento farmacológico , Genes BRCA1 , Genes BRCA2 , Mutação em Linhagem Germinativa , Doenças Hematológicas/induzido quimicamente , Doenças Hematológicas/genética , Neoplasias Ovarianas/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Proteína BRCA1/genética , Proteína BRCA2/genética , Carboplatina/administração & dosagem , Carboplatina/efeitos adversos , Estudos de Coortes , Cistadenocarcinoma Seroso/sangue , Cistadenocarcinoma Seroso/genética , Cistadenocarcinoma Seroso/patologia , Feminino , Predisposição Genética para Doença , Doenças Hematológicas/sangue , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/patologia , Paclitaxel/administração & dosagem , Paclitaxel/efeitos adversos , Estudos Retrospectivos
5.
Diabetes Res Clin Pract ; 152: 71-78, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31082446

RESUMO

AIMS: Using routine HbA1c measurement to determine the prevalence of diabetes mellitus (known and previously unrecognized) and their hospital outcomes among hematology and oncology inpatients. METHODS: This was a prospective, observational study. Routine automated HbA1c testing was performed in all hematology and oncology inpatients aged ≥54 years at a tertiary hospital, July 2013-January 2015. The outcome measures were: (i) prevalence of known and previously unrecognized diabetes, and (ii) hospital outcomes: length-of-stay (LOS), intensive-care-unit (ICU) admission, 30-day/18-month readmission, and 18-month mortality. RESULTS: Over the 18-month study period, 1076 inpatients aged ≥54 years were admitted to hematology (n = 298) and oncology (n = 778) units: 21% had known diabetes and 7% had previously unrecognized diabetes. Patients with known diabetes had a longer LOS (IRR: 1.18, 95%CI: 1.02-1.37, p = 0.03), compared to those without diabetes, adjusting for age, hemoglobin level, estimated-glomerular-filtration-rate, admission specialty unit, Charlson's comorbidity index score, and glucocorticoid exposure. No significant differences were observed in ICU admission, 30-day/18-month readmission, and 18-month mortality among patients with known, previously unrecognized and no diabetes (p ≥ 0.05). CONCLUSIONS: Approximately one in five hematology or oncology inpatients aged ≥54 years had known diabetes, and one in fourteen had previously unrecognized diabetes. Those with known diabetes had a longer hospital stay. Routine HbA1c measurement is can be useful for identifying previously unrecognized diabetes, particularly among patients with high glucocorticoid exposure. Further study is required to determine cost-effectiveness in screening for unrecognized diabetes and optimal management of these patients.


Assuntos
Diabetes Mellitus/diagnóstico , Testes Diagnósticos de Rotina , Hemoglobina A Glicada/análise , Doenças Hematológicas/sangue , Neoplasias/sangue , Idoso , Idoso de 80 Anos ou mais , Complicações do Diabetes/sangue , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Testes Diagnósticos de Rotina/métodos , Feminino , Hemoglobina A Glicada/metabolismo , Doenças Hematológicas/complicações , Doenças Hematológicas/diagnóstico , Doenças Hematológicas/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Prevalência , Prognóstico , Centros de Atenção Terciária
6.
Transfus Apher Sci ; 58(3): 300-303, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31036518

RESUMO

Peripheral blood stem cell transplantation (PBSCT) is now widely used in both malignant and non-malignant hematologic diseases as a treatment strategy. Using this approach, a controversial group of donors is children weighing 20 kg or less. The aim of this study was to evaluate results of allogeneic and autologous PBSCT and also the efficacy of our suggested alternative method for a custom prime in cell harvesting of this group. All the participants' demographic and laboratory data were collected before apheresis. A total of 37 individuals participated in this study of which 12 and 25 of them were categorized in autologous and allogeneic groups respectively. For the apheresis procedure, a central venous access was used as well as the custom prime method with some changes. Apheresis details, as well as CD34 and CD3 cell counts in the allogeneic and autologous groups, were calculated. In this study, 91.9% (N = 34) of all individuals achieved the minimal amount of cells for PBSCT (2 × 106 CD34+ cells/kg) in one session. On the other hand, 12% (N = 3) of donors in the allogeneic group achieved the minimal threshold in 2 apheresis sessions. During the leukapheresis a total processed blood volume/total blood volume ratio (TPBV/TBV) was calculated as 4.64 ± 1.06 and 5.18 ± 0.73 fold in the allogeneic and autologous groups respectively. The mean of harvested CD34 cells in allogeneic and autologous groups was 5.28 ± 3.47 × 106 and 3.57 ± 2.9 × 106 cells/kg respectively. Likewise, in the allogeneic group, the mean of the harvested CD3 cell count was 339 ± 141 × 106/kg. Also, the median day of white blood cell (WBC) engraftment was 14 and 13 for allogeneic and autologous groups respectively. Furthermore, the median day of platelet engraftment was 19.5 for both allogeneic and autologous groups. Among the recipients of the allogeneic group, acute graft versus host disease (aGVHD) was detected in 56% (N = 14) of patients and this was also correct for chronic GVHD. Taken together, it was shown, despite the probable complications of peripheral blood stem cell apheresis in donors weighing less than 20 kg; that it is possible to perform this procedure without any complication during the leukapheresis.


Assuntos
Doenças Hematológicas/terapia , Leucaférese , Transplante de Células-Tronco de Sangue Periférico , Células-Tronco de Sangue Periférico , Doença Aguda , Aloenxertos , Autoenxertos , Peso Corporal , Criança , Pré-Escolar , Estudos Transversais , Feminino , Doença Enxerto-Hospedeiro/sangue , Doença Enxerto-Hospedeiro/epidemiologia , Doença Enxerto-Hospedeiro/etiologia , Doenças Hematológicas/sangue , Doenças Hematológicas/epidemiologia , Humanos , Lactente , Masculino
7.
Transfus Apher Sci ; 58(3): 351-356, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31064732

RESUMO

Transfusion of red cell concentrates is an essential lifesaving treatment for patients with massive bleeding or red blood cell disorders. However, correlations between blood transfusion from female donors, especially in sex mismatched transfusions, and a risk of mortality has been reported. A systematic understanding of how sex-mismatched transfusion can contribute to negative outcomes is still lacking. Here, we propose that variations in stored red blood cell products from female and male blood donors may be related to different characteristics of subpopulations of RBCs in units. As very little attention has been paid to this topic, the aim of this review is to investigate biological mechanisms implicated in negative outcomes of sex-mismatched transfusion. This review discusses basic hematology differences in the blood from female and male donors. Also, observational studies that linked donor sex with adverse transfusion outcome are reviewed. We present three physiological mechanisms (oxygen delivery, coagulation and microvesiculation) that could be impacted by sex-mismatched transfusions.


Assuntos
Doadores de Sangue , Incompatibilidade de Grupos Sanguíneos , Transfusão de Sangue , Eritrócitos , Caracteres Sexuais , Reação Transfusional , Incompatibilidade de Grupos Sanguíneos/sangue , Incompatibilidade de Grupos Sanguíneos/patologia , Eritrócitos/metabolismo , Eritrócitos/patologia , Feminino , Doenças Hematológicas/sangue , Doenças Hematológicas/patologia , Doenças Hematológicas/terapia , Humanos , Masculino , Reação Transfusional/sangue , Reação Transfusional/etiologia , Reação Transfusional/patologia
8.
Int J Lab Hematol ; 41 Suppl 1: 170-176, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31069968

RESUMO

The majority of errors in laboratory medicine occur in the pre- and postanalytical phases of the testing process. Although the causes of these errors are largely common to all laboratory medicine specialties, it is important for the haematology laboratory to understand the particular impact of some on automated counting. The preanalytical phase is the stage of greatest risk but preanalytical errors may go undetected until postanalytical validation and interpretation. The challenges in the postanalytical phase include the standardisation of reference intervals against which results can be interpreted and the impact of just a small difference in reference interval for a key analyte such as haemoglobin concentration. Quality indicators against which pre- and postanalytical error incidence are measured are a source of information that can be used to improve services but laboratories struggle to collect good quality data.


Assuntos
Automação Laboratorial , Erros de Diagnóstico/prevenção & controle , Doenças Hematológicas , Testes Hematológicos , Controle de Qualidade , Automação Laboratorial/instrumentação , Automação Laboratorial/métodos , Automação Laboratorial/normas , Doenças Hematológicas/sangue , Doenças Hematológicas/diagnóstico , Testes Hematológicos/instrumentação , Testes Hematológicos/métodos , Humanos
9.
Int J Lab Hematol ; 41 Suppl 1: 102-116, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31069972

RESUMO

INTRODUCTION: Rapid technological advancements in clinical molecular genetics have increased our diagnostic and prognostic capabilities in health care. Understanding these assays, as well as how they may change over time, is critical for pathologists, clinicians, and translational researchers alike. METHODS: This review provides a practical summary and basic reference for current molecular genetic technologies, as well as new testing methodologies that are in use, gaining momentum, or anticipated to contribute more broadly in the future. RESULTS: Here, we discuss DNA and RNA based methodologies including classic assays such as the polymerase chain reaction (PCR), Sanger sequencing, and microarrays, to more cutting-edge next-generation sequencing (NGS) based assays and emerging molecular technologies such as cell-free DNA (cfDNA) or circulating tumor DNA (ctDNA), and NGS-based detection of infectious disease organisms. CONCLUSION: This review serves as a basic foundation for knowledge in current and emerging clinical molecular genetic technologies.


Assuntos
Ácidos Nucleicos Livres/genética , Doenças Hematológicas/diagnóstico , Doenças Hematológicas/genética , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Reação em Cadeia da Polimerase/métodos , Ácidos Nucleicos Livres/sangue , Doenças Hematológicas/sangue , Humanos
10.
Acta Haematol ; 141(4): 201-208, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943466

RESUMO

BACKGROUND/AIMS: Storage iron turnover has remained poorly understood since 1953. In addition, errors in measurements of the storage iron turnover rate (SIT) by ferrokinetics have been detected and the causes of those errors need to be elucidated. METHODS: A new, computer-assisted method, "serum ferritin kinetics," was introduced for the quantitation of ferritin iron and hemosiderin iron. Ferrokinetics and non-ferrokinetic methods were used to determine the body iron turnover rate. RESULTS AND CONCLUSION: Using serum ferritin kinetics, patients with normal iron stores and iron overload were found to have 2 iron pathways between ferritin and hemosiderin: recovery of ferritin taking iron from hemosiderin in iron mobilization and iron transformation from ferritin to hemosiderin in iron deposition. In addition, underestimation of the SIT by ferrokinetics was confirmed by comparing SIT by ferrokinetics with the standard SIT as the sum of SIT of 3 major iron-storing cells. This underestimation was caused by extra radio-iron fixation to red cells. Ferrokinetics does not give the actual body iron turnover due to the behavioral difference between radio-iron and pre-existing body iron. Recent findings on ferritin and hemosiderin iron turnover will be a potential tool for the diagnosis and therapy of hematological disorders.


Assuntos
Eritrócitos/metabolismo , Ferritinas/sangue , Doenças Hematológicas/sangue , Hemossiderina/metabolismo , Sobrecarga de Ferro/sangue , Ferro/sangue , Animais , Humanos
11.
Basic Clin Pharmacol Toxicol ; 125(2): 117-122, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30916851

RESUMO

Cytochrome P450 3A (CYP3A) is the most relevant drug-metabolizing enzyme in human beings involved in the elimination of about 50% of the marketed drugs. Comprehensive in vivo data of CYP3A activity in palliative patients with haematological diseases are missing. Therefore, CYP3A activity was determined under real-life clinical conditions in patients to gain knowledge about dose adjustments for supportive therapies and symptom management in haematology. The single-arm, prospective trial obtained a 4-hours pharmacokinetic profile of midazolam after oral administration of a microdose as marker substance from each enrolled patient. Plasma concentrations of midazolam and its primary metabolite 1'-hydroxy-midazolam were quantified by mass spectrometry techniques. CYP3A activity was calculated as partial metabolic clearance from an established limited sampling area under the curve. All other drugs taken by the participating patients were considered as well as recent laboratory test results and the patients' diagnoses. Partial metabolic clearance of midazolam in patients with haematological diseases was highly variable (36.9 ± 52.7 L/h). In comparison with the CYP3A activity of healthy individuals, this was a highly significant 30% reduction of activity (P < 0.0001). Dosing of major CYP3A substrate drugs needs to be reduced in palliative patients with haematological diseases, otherwise escalation of debilitating symptoms due to drug interactions might occur.


Assuntos
Citocromo P-450 CYP3A/metabolismo , Fármacos Hematológicos/farmacologia , Doenças Hematológicas/tratamento farmacológico , Midazolam/farmacocinética , Cuidados Paliativos/métodos , Administração Oral , Adulto , Idoso , Área Sob a Curva , Variação Biológica da População , Estudos de Casos e Controles , Interações de Medicamentos , Voluntários Saudáveis , Fármacos Hematológicos/uso terapêutico , Doenças Hematológicas/sangue , Humanos , Taxa de Depuração Metabólica , Midazolam/administração & dosagem , Pessoa de Meia-Idade , Estudos Prospectivos
12.
Cad Saude Publica ; 35(2): e00091618, 2019 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-30758455

RESUMO

Mercury is a metal found in the environment from natural and anthropogenic sources. It is highly toxic to ecosystems and living beings. Most human exposures come from ingestion of contaminated seafood, outgassing from dental amalgam or occupational exposure (e.g. gold mining), among other cases. Large populations are exposed to mercury, making it a very important issue from the public health perspective. Adverse health effects are commonly seen in the nervous system, but every organ is a potential target, such as the bone marrow. The main goal of this study was to assess the available evidence on human exposure to mercury and its hematological effects. A search strategy was constructed, including key terms (MeSH, text word and equivalents) for querying 2 repositories of master dissertation and PhD thesis (Fiocruz/ARCA and University of São Paulo) and 4 different electronic databases: BVS/LILACS, MEDLINE/PubMed, Scopus and TOXLINE/NIH, for articles published from 1950 to February 2018. There was no language restriction and a tool (EPHPP) was used to assess the quality of included studies. According to pre-established criteria, 80 studies were retrieved, all of them observational (48 case reports, 24 cross-sectional, 6 case series and 2 cohorts), comprising 9,284 people. Despite the fact that most exposed ones (6,012) had normal blood cell count and mercury hematological effects did not seem very usual (1,914 cases: 14 severe and 29 deaths), three studies reported association (ß) for anemia, lymphopenia, neutrophilia and basophilia. We concluded that the gathered information pointed to mercury hematotoxic effects, some of them may be serious and even fatal.


Assuntos
Exposição Ambiental/efeitos adversos , Doenças Hematológicas/induzido quimicamente , Intoxicação por Mercúrio/sangue , Mercúrio/efeitos adversos , Mercúrio/análise , Brasil , Contagem de Células , Monitoramento Ambiental , Doenças Hematológicas/sangue , Doenças Hematológicas/classificação , Testes Hematológicos , Humanos , Compostos de Mercúrio/envenenamento , Exposição Ocupacional/efeitos adversos
13.
Int J Hematol ; 109(4): 451-462, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30725359

RESUMO

It has been reported that B7H1 and B7H3 play a role in graft-versus-host disease (GVHD), the major cause of treatment-related mortality (TRM) in haploidentical hematopoietic stem cell transplantation (haplo-HSCT) patients; however, the prognostic value of these factors has not been defined. We retrospectively collected 64 haplo-HSCT patients in our hospital from 2013 to 2014, as well as 38 HLA-matched-HSCT patients during the same period as the control group. We analyzed B7H1, B7H3, PD1, soluble CD25, ST2 and TNFR1 at 0 day, + 7 days, + 14 days and + 28 days after HSCT. The + 7 days/+ 14 days B7H1/B7H3 and + 28 days ST2 serum levels were higher in patients with aGVHD who underwent haplo-HSCT. Moreover, + 7 days B7H1/B7H3 serum levels were predictive of grade III-IV aGVHD (B7H1: AUC = 0.830, P < 0.001; B7H3: AUC = 0.775, P = 0.001). Haplo-HSCT patients with higher + 7 days B7H1/B7H3 or + 28 days ST2 serum levels had poor GVHD-related mortality (GRM) (B7H1: P < 0.001; B7H3: P = 0.002; ST2: P = 0.047). Multivariate analysis revealed that the + 7 days B7H1 serum level (P = 0.041), as well as viral infection (P = 0.015) and donor age (P = 0.012), could independently predict GRM. Collectively, we found that + 7 days B7H1/B7H3 serum levels can predict grade III-IV aGVHD, while only the + 7 days B7H1 serum level, together with viral infection and donor age, could independently predict GRM in patients with haplo-HSCT.


Assuntos
Antígenos B7/sangue , Antígeno B7-H1/sangue , Doença Enxerto-Hospedeiro , Doenças Hematológicas , Transplante de Células-Tronco Hematopoéticas , Doença Aguda , Adolescente , Adulto , Fatores Etários , Aloenxertos , Intervalo Livre de Doença , Feminino , Doença Enxerto-Hospedeiro/sangue , Doença Enxerto-Hospedeiro/mortalidade , Doenças Hematológicas/sangue , Doenças Hematológicas/mortalidade , Doenças Hematológicas/terapia , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Taxa de Sobrevida , Viroses/sangue , Viroses/mortalidade
14.
Rev Med Interne ; 40(4): 232-237, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30773236

RESUMO

Many factors can contribute to the risk of venous thrombosis observed in hemolytic diseases. Some mechanisms are related to hemolysis by itself, while others seem more specific to each disease. Despite recent advances in the quantification of this risk and in understanding its physiopathology, the association of hemolysis with venous thrombosis is often unknown. The purpose of this general review is to clarify the main pro-thrombotic mechanisms during hemolysis and to synthesize the clinical data currently available. We will focus on the main types of hemolytic pathologies encountered in current practice, namely paroxysmal nocturnal hemoglobinuria, hemoglobinopathies, auto-immune hemolytic anemia and thrombotic microangiopathies.


Assuntos
Doenças Hematológicas , Hemólise/fisiologia , Anemia Hemolítica/sangue , Anemia Hemolítica/complicações , Anemia Hemolítica/diagnóstico , Doenças Hematológicas/sangue , Doenças Hematológicas/classificação , Doenças Hematológicas/diagnóstico , Doenças Hematológicas/etiologia , Humanos , Fatores de Risco , Trombose/complicações , Trombose/diagnóstico , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia
15.
Arch. Soc. Esp. Oftalmol ; 94(2): 85-89, feb. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-180370

RESUMO

Paciente de 66 años en seguimiento por retinopatía diabética refractaria a múltiples modalidades de tratamiento a pesar del buen control metabólico que refiere pérdida de peso progresiva. Por este motivo se decide realizar un estudio sistémico, detectándose anemia, elevación de la velocidad de sedimentación globular e hiperproteinemia a expensas de un pico monoclonal de IgM. Posteriormente, mediante la biopsia de médula ósea y el estudio genético, se llega al diagnóstico de macroglobulinemia de Waldenström. La macroglobulinemia de Waldenström es una patología linfoproliferativa de escasa frecuencia cuya principal manifestación es a través del síndrome de hiperviscosidad. Este puede producir signos oftalmológicos detectables mediante funduscopia y pruebas de imagen. El estudio multimodal es útil en el diagnóstico y seguimiento de la afectación retiniana. La incorporación de la angiografía por tomografía de coherencia óptica permite un estudio más preciso de los trastornos microvasculares que se pueden presentar a nivel del polo posterior


A 66 year-old patient, monitored for diabetic retinopathy refractory to multiple treatment methods despite a good metabolic control, referred to progressive weight loss. For this reason, a systemic study was performed, detecting anaemia, elevation of the erythrocyte sedimentation rate, and hyperproteinaemia due to elevated serum levels of monoclonal IgM. Subsequently, by performing a bone marrow biopsy and genetic study, the diagnosis of Waldenström macroglobulinaemia was made. Waldenström's macroglobulinaemia is a low frequency lymphoproliferative disease, for which the main manifestation is a hyperviscosity syndrome that can produce ophthalmological signs detectable by funduscopy and imaging tests. A multimodal study is useful in the diagnosis and monitoring of retinal involvement. The incorporation of angiography by optical coherence tomography allows a more precise study of the microvascular disorders that may occur at the posterior pole level


Assuntos
Idoso , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/patologia , Macroglobulinemia de Waldenstrom/classificação , Macroglobulinemia de Waldenstrom/diagnóstico , Pacientes/classificação , Doenças Hematológicas/sangue , Doenças Hematológicas/classificação , Doenças Hematológicas/diagnóstico , Epitélio/diagnóstico por imagem , Epitélio/patologia
16.
JACC Cardiovasc Interv ; 12(1): 1-11, 2019 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-30621965

RESUMO

Transcatheter aortic valve replacement (TAVR) is well established for treating patients with severe aortic stenosis considered at intermediate to high surgical risk. Blood disorders such as anemia, thrombocytopenia, and acquired type 2A von Willebrand disease are relatively frequent in TAVR candidates, and multiple studies to date have highlighted their potential clinical association with mortality and/or bleeding complications post-TAVR. The present review provides an overview of various blood disorders observed pre- and post-TAVR, with special focus on their incidence, etiology, clinical association, and management.


Assuntos
Estenose da Valva Aórtica/cirurgia , Doenças Hematológicas/epidemiologia , Hemostasia , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Anemia/sangue , Anemia/epidemiologia , Estenose da Valva Aórtica/sangue , Estenose da Valva Aórtica/mortalidade , Feminino , Doenças Hematológicas/sangue , Doenças Hematológicas/mortalidade , Doenças Hematológicas/terapia , Humanos , Incidência , Masculino , Hemorragia Pós-Operatória/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Trombocitopenia/sangue , Trombocitopenia/epidemiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento , Doenças de von Willebrand/sangue , Doenças de von Willebrand/epidemiologia
17.
J Cardiothorac Vasc Anesth ; 33(5): 1393-1406, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30201404

RESUMO

Disorders affecting red blood cells (RBCs) are uncommon yet have many important physiologic considerations for patients undergoing cardiac surgery. RBC disorders can be categorized by those that are congenital or acquired, and further by disorders affecting the RBC membrane, hemoglobin, intracellular enzymes, or excessive RBC production. A foundational understanding of the physiologic derangement for these disorders is critical when considering perioperative implications and optimization, strategies for cardiopulmonary bypass, and the rapid recognition and treatment if complications occur. This review systematically outlines the RBC disorders of frequency and relevance with an emphasis on how the disorder affects normal physiologic processes, a review of the literature related to the disorder, and the implications and recommendations for patients undergoing cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Eritrócitos/fisiologia , Doenças Hematológicas/sangue , Doenças Hematológicas/diagnóstico , Assistência Perioperatória/métodos , Transfusão de Sangue Autóloga/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Eritrócitos Anormais/fisiologia , Doenças Hematológicas/cirurgia , Humanos
19.
Biosens Bioelectron ; 123: 69-76, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30321758

RESUMO

We present a rapid and label-free method for hematologic screening for diseases and syndromes, utilizing quantitative phase imaging (QPI) and machine learning. We aim to establish an efficient blood examination framework that does not suffer from the drawbacks of conventional blood assays, which are incapable of profiling single cells or require labeling procedures. Our method involves the synergistic employment of QPI and machine learning. The high-dimensional refractive index information arising from the QPI-based profiling of single red blood cells is processed to screen for diseases and syndromes using machine learning, which can utilize high-dimensional data beyond the human level. Accurate screening for iron-deficiency anemia, reticulocytosis, hereditary spherocytosis, and diabetes mellitus is demonstrated (>98% accuracy) using the proposed method. Furthermore, we highlight the synergy between QPI and machine learning in the proposed method by analyzing the performance of the method.


Assuntos
Técnicas Biossensoriais , Eritrócitos , Doenças Hematológicas/sangue , Holografia , Humanos , Aprendizado de Máquina , Microscopia , Reticulocitose
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