Molecular HPA genotyping by microarray in Brazilian blood donors.

BACKGROUND: Human platelet antigens (HPA) polymorphisms may cause HPA alloimmunization, platelet (PLT) refractoriness, fetomaternal alloimmune thrombocytopenia, and posttransfusion purpura. Characterized by significant racial admixture, the Brazilian population might benefit from the knowledge about HPA frequency to guide decision-making concerning PLT transfusion. STUDY DESIGN AND METHODS: HPA frequencies were determined in 158 DNA samples from Brazilian blood donors by microarray for HPA-1 to -9, -11, and -15. A HPA-2 discrepancy was solved by polymerase chain reaction with sequence-specific primers (PCR-SSP) and sequencing. RESULTS: While a alleles were predominant for HPA-1 to -9 and -11, b alleles were absent for HPA-6, -7, -8, and -11. HPA-3 and HPA-15 had a higher prevalence of ab genotypes. One case of HPA-4ab and two cases of HPA-9abw were detected, the latter not previously described in Brazilian blood donors. One sample was not interpretable for HPA-2 due to a GPIb 468 C>G mutation; this donor was characterized as HPA-2ab by PCR-SSP and sequencing. CONCLUSION: Allele frequencies were comparable to those described in other Brazilian studies. Rare HPA-9 alleles were described in Brazilians for the first time. A mutation near the HPA-2 polymorphism suggests that complementary methods might be necessary in specific cases. PLT genotyping by microarray proved to be fast, accurate, and reliable.

A cross-sectional study of umbilical cord blood donor profiles and their influence on umbilical cord blood collection in a Brazilian hospital.

BACKGROUND AIMS: Umbilical cord blood (UCB) cells are a new alternative to bone marrow source for hematopoietic stem cell transplantation and their use has increased in the last decade. Thus efforts are being made to improve the umbilical cord blood unit's quality. Besides compatibility, other factors, such as the total nucleated cell (TNC) count and the percentage of CD34(+) cells in the product, are very important for a successful transplant outcome. Our aim was to describe our donor population and assess the best cord blood collection technique at Hospital Israelita Albert Einstein's cord blood bank (São Paulo, Brazil). METHODS: This was a retrospective study in which all analyses were performed simultaneously. A Student's t-test was used for qualitative variables for non-matched samples. For qualitative analyses, we used either the chi-square test or the exact Fisher's test. RESULTS: The stratification of the population characteristics allowed us to determine which ones had an impact on unit volume, TNC count and percentage of CD34(+) cells. A significant correlation was observed between donor characteristics and the quality of UCB units as related to maternal and gestational age, type of pregnancy, route of delivery, cord blood collection technique and birth weight. CONCLUSIONS: We found that cord blood collection technique and newborn weight were significantly correlated with the TNC content. The collection technique used at our institution significantly improved the UCB unit volume and consequently the TNC count. Some findings, such as the impact of maternal age and newborn weight, have led us to re-evaluate our protocol in order to achieve better results.

Genotyping of Human Platelet Antigens by BeadChip Microarray Technology.

Human platelet antigen (HPA) typing plays a critical role in the diagnosis of fetal/neonatal alloimmune thrombocytopenia, and the prevention of posttransfusion purpura and refractoriness to platelet transfusions. The recent development of high-throughput genotyping methods, allowing simultaneous genotyping of as many as 17 HPAs, is of utmost interest for saving time and money. Here, we describe a microarray technology named "BeadChip," designed for HPA-1 to -9, -11, and -15 genotyping of up to 96 individuals, in approximately 5 h. This technology was used to study allele frequencies in Brazilian blood donors, considering the heterogeneous ethnic composition.

Bone marrow stroma in childhood myelodysplastic syndrome: composition, ability to sustain hematopoiesis in vitro, and altered gene expression.

We studied bone marrow stromal cell cultures from patients with childhood myelodysplastic syndromes (MDS, refractory anemia with excess of blasts, RAEB) and from matched normal donors. Stromal cell monolayers were characterized as myofibroblasts by the expression of smooth muscle alpha-actin, collagen IV, laminin and fibronectin. When normal cord blood cells were plated onto myelodysplastic stromas, a pathologic cell differentiation was observed, indicating altered myelosupportive properties. cDNA array analysis showed that patient stromas expressed increased levels of thrombospondin-1, collagen-I alpha2-chain, osteoblast-specific factor-2 and osteonectin, indicating the presence of increased osteoblast content, as confirmed by enhanced alkaline phosphatase synthesis. Alterations in the myelodysplastic stroma environment might contribute to abnormal hematopoiesis in this pathology.

Successful management of neonatal alloimmune thrombocytopenia in the second pregnancy: a case report.

Neonatal alloimmune thrombocytopenia is a serious disease, in which the mother produces antibodies against fetal platelet antigens inherited from the father; it is still an underdiagnosed disease. This disease is considered the platelet counterpart of the RhD hemolytic disease of the fetus and newborn, yet in neonatal alloimmune thrombocytopenia the first child is affected with fetal and/or neonatal thrombocytopenia. There is a significant risk of intracranial hemorrhage and severe neurological impairment, with a tendency for earlier and more severe thrombocytopenia in subsequent pregnancies. This article reports a case of neonatal alloimmune thrombocytopenia in the second pregnancy affected and discusses diagnosis, management and the clinical importance of this disease.

Prevalence of erythrocyte alloimmunization in polytransfused patients.

OBJECTIVE: To determine the incidence and the rate of red blood cell alloimmunization in polytransfused patients. METHODS: A polytransfused patient was defined as having received at least 6 units of red cell concentrates during a 3-month period. The records of all patients (n = 12,904) who had received red blood cell units were examined retrospectively by searching the computer database at Hospital Israelita Albert Einstein in São Paulo, Brazil, over a 6-year period, between 2003 and 2009. RESULTS: During this time, 77,049 red cell concentrate transfusions were performed in 12,904 patients. There were 3,044 polytransfused patients, 227 of whom (7.5%) presented with irregular erythrocyte antibodies. The prevalence of alloantibody specificity was: Anti-E>anti-D>anti-K>anti-C>anti-Dia>anti-c>anti-Jka>anti-S in 227 polytransfused patients. We found combinations of alloantibodies in 79 patients (34.8%), and the most common specificities were against the Rh and/or Kell systems. These antibodies show clinical significance, as they can cause delayed hemolytic transfusion reactions and perinatal hemolytic disease. About 20% of the patients showed an IgG autoantibody isolated or combined with alloantibodies. Interestingly, a high incidence of antibodies against low frequency antigens was detected in this study, mainly anti-Dia. CONCLUSION: Polytransfused patients have a high probability of developing alloantibodies whether alone or combined with autoantibodies and antibodies against low frequency antigens. Transfusion of red blood cells with a phenotype-compatible with RH (C, E, c), K, Fya, and Jka antigens is recommended for polytransfused patients in order to prevent alloimmunization and hemolytic transfusion reactions.

Successful management of neonatal alloimmune thrombocytopenia in the second pregnancy: a case report / Sucesso no manejo da trombocitopenia aloimune neonatal na segunda gestação: relato de caso

Neonatal alloimmune thrombocytopenia is a serious disease, in which the mother produces antibodies against fetal platelet antigens inherited from the father; it is still an underdiagnosed disease. This disease is considered the platelet counterpart of the RhD hemolytic disease of the fetus and newborn, yet in neonatal alloimmune thrombocytopenia the first child is affected with fetal and/or neonatal thrombocytopenia. There is a significant risk of intracranial hemorrhage and severe neurological impairment, with a tendency for earlier and more severe thrombocytopenia in subsequent pregnancies. This article reports a case of neonatal alloimmune thrombocytopenia in the second pregnancy affected and discusses diagnosis, management and the clinical importance of this disease.

A púrpura trombocitopênica neonatal aloimune é uma doença grave, na qual a mãe produz anticorpos contra antígenos plaquetários fetais herdados do pai, e é ainda subdiagnosticada na prática clínica. É considerada o equivalente plaquetário da doença hemolítica do recém-nascido, com a diferença que o primeiro filho é afetado, apresentando trombocitopenia fetal e/ou neonatal. Há risco significativo de hemorragia intracraniana e sequelas neurológicas graves, com tendência a trombocitopenia mais grave e mais precoce nas gestações subsequentes. Este artigo relata um caso de trombocitopenia aloimune neonatal na segunda gestação afetada e discute diagnóstico, manejo e importância clínica dessa doença na prática clínica.

Incidência de aloimunização eritrocitária em pacientes poli transfundidos / Prevalence of erythrocyte alloimmunization in polytransfused patients

Objective: To determine the incidence and the rate of red blood cell alloimmunization in polytransfused patients. Methods: A polytransfused patient was defined as having received at least 6 units of red cell concentrates during a 3-month period. The recordsof all patients (n = 12,904) who had received red blood cell units were examined retrospectively by searching the computer database at Hospital Israelita Albert Einstein in São Paulo, Brazil, over a 6-year period, between 2003 and 2009. Results: During this time, 77,049 red cell concentrate transfusions were performed in 12,904 patients. There were 3,044 polytransfused patients, 227 of whom (7.5%) presented with irregular erythrocyte antibodies. The prevalence of alloantibody specificity was: Anti-E>anti-D>anti-K>anti-C>anti-Dia>anti-c>anti-Jka>anti-S in 227 polytransfused patients. We found combinations of alloantibodies in 79 patients (34.8%), and the most commonspecificities were against the Rh and/or Kell systems. These antibodies show clinical significance, as they can cause delayed hemolytic transfusion reactions and perinatal hemolytic disease. About 20% of the patients showed an IgG autoantibody isolatedor combined with alloantibodies. Interestingly, a high incidence of antibodies against low frequency antigens was detected in this study, mainly anti-Dia. Conclusion: Polytransfused patients have a high probability of developing alloantibodies whetheralone or combined with autoantibodies and antibodies against low frequency antigens. Transfusion of red blood cells with a phenotype-compatible with RH (C, E, c), K, Fya, and Jka antigens is recommended for polytransfused patients in order to preventalloimmunization and hemolytic transfusion reactions.

Objetivo: Determinar a incidência e a taxa de aloimunização eritrocitária em pacientes politransfundidos. Métodos: Foram classificados como politransfundidos todos os pacientes que receberam no mínimo 6 unidades de concentrado de hemácias no período de 3 meses. Foram examinados retrospectivamente os prontuários de todos os pacientes(n = 12.904) que receberam transfusões de unidades de hemácias procurados nas bases de dados computadorizados do Hospital Israelita Albert Einstein, em São Paulo (SP), no período de 6 anos, entre 2003 e 2009. Resultados: Nesse período foram realizadas 77.049 transfusões de concentrado de hemácias em 12.904 pacientes. Os pacientes politransfundidos totalizaram 3.044, sendo que 227 (7,5%) apresentam anticorpos eritrocitários irregulares. A prevalência da especificidade dos aloanticorpos encontrados nos 227 pacientes politransfundidos foi: Anti-E>anti-D>anti-K>anti-C>anti-Dia>antic>anti-Jka>anti-S. Em 79 pacientes (34,8%) foram encontradas associações de aloanticorpos e as combinações mais freqüentes foram dos anticorpos dos sistemas Rh e/ou Kell. Esses anticorpos têm importância clínica, pois podem causar reações transfusionais hemolíticas tardias e doença hemolítica perinatal. Cerca de 20% dos pacientes apresentavam autoanticorpo IgG isolado ou em associação com aloanticorpos. Um achado interessante neste estudo foi a alta incidência de anticorpos contra antígenos de baixa frequência, com predomínio anti-Dia. Conclusão: Pacientes politransfundidos têm alta probabilidade de desenvolver aloanticorpos isolados ou em associação com autoanticorpos e anticorpos contra antígenos de baixa frequência. A transfusão de concentrado de hemácias com fenótipo compatível para os antígenos RH (C, E, c), K, Fya, e Jka deve ser recomendada para o grupo de pacientes politransfundidos, com objetivo de evitar a aloimunização e a reação transfusional hemolítica.

Avaliaçao da bulimia nervosa em pacientes com transtorno do humor através da escala BITE (Bulimic Investigatory Test, Edinburgh): resultados preliminares / Assesment of bulimia nervosa in patients with humor disorder using the BITE scale (Bulimic Investigatory Test, Edinburgh): preliminary results

Quarenta e quatro pacientes ambulatoriais (33 mulheres, 11 homens) do Grupo de Estudo de Doenças Afetivas - GRUDA-IPq-HC-FMUSP foram submetidos a entrevistas através da escala BITE (Bulimic Investigatory Test, Edinburgh) objetivando avaliar a frequência de bulimia nervosa em pacientes com transtorno do humor. O estudo constatou que nenhum paciente preenchia os critérios para bulimia nervosa; no entanto, 13,6 por cento (seis mulheres, cinco unipolar e um bipolar) apresentaram um BITE compatível com uma subcategoria do DSM-IV, o Binge Eating Disorder. Tais pacientes apresentaram os episódios bulímicos após iniciarem uso de medicaçöes antidepressivas. Estes resultados, se confirmados com amostras maiores, podem sugerir diagnóstico de Binge Eating Disorder induzido por antidepressivos

Avaliacao da bulimia nervosa em pacientes com transtorno do humor atraves da escala BITE (Bulimic Investigatory Test, Edinburgh): resultados preliminares

Quarenta e quatro pacientes ambulatoriais (33 mulheres, 11 homens) do Grupo de Estudos de Doencas Afetivas - GRUDA-IPq-HC-FMUSP foram submetidos a entrevistas atraves da escala BITE (Bulimic Investigatory Test, Edinburgh) objetivando avaliar a frequencia de bulimia nervosa em pacientes com transtorno do humor. O estudo constatou que nenhum paciente preenchia os criterios para bulimia nervosa; no entanto, 13,6 por cento (seis mulheres, cinco unipolar e um bipolar) apresentaram um BITE compativel com uma subcategoria do DSM-IV, o Binge Eating Disorder. Tais pacientes apresentaram os episodios bulimicos apos iniciarem uso de medicacoes antidepressivas. Estes resultados, se confirmados com amostras maiores, podem sugerir diagnostico de Binge Eating Disorder induzido por antidepressivos.