Browsing by Author "Gil, A"
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- Casuistic of related blood donations incidents in HPFF Blood DepartmentPublication . Barra, A; Barradas, A; Gil, A; Costa, C; Silva, I; Rebelo, S; Simões, A; Rodrigues, T; Moura, H; Santos, L; Soares, FBackground Related blood donations incidents (RBDI) have to be reported to the Portuguese Haemovigilance Blood Group since de last year. In our department we have a manual system of incidents registration since 2006. We understand how is important the analysis of this data to prevent future incidents. Aims We want in some way to share our results aimed a better prevention of this incidents. Methods Data of RBDI between March of 2006 and December of 2009. This register include date, ID, age, sex, weight, time of incidents in relation to donation, donation status (first-time vs. repeat), type of incidents, the time window between last meal and donation. Measures to ease RBDI, past donor history and haemoglobin value before donation (g/dl). Results Between March of 2006 and December of 2009 we have registered 122 (0.60%) RDBI, in a total of 20067 allogeneic donations, 68.58% donations from men and 31.42% from women. RBDI were 70 in men (0.50% of male donations) and 52 in women (0.82% of female donations). The age of studied donors ranged between 19 and 62 ears old with an average of 32.21 ears (19-30 - 34.43%; 31-40 - 25,4%; 41-50 - 16,4%; 50-62 - 13,1%) . The average of weight was 70.1 Kilos. We found 96.2% of early RBDI (< 1h) and 3.8% were late (> 1h). RBDI was verified in 20 first time donors, 61 in donors who have donated less than 5 times and 41 in donors with more than 5 donations. What concern to past donor history 18 (14.75%) of blood donors that had RBDI tell us that they already have at least one BDI in past blood donations. We had to interrupted blood donation in 4 (3.27%) occasions. Hb average was 14.29 g/dl. In the first 6 months of the year RBDI are about half of those in the second semester. In most cases the RBDI happened within 10 minutes after initiation of blood donation and the last food intake occurred on average 1.5 hours prior to donation. Signs and symptoms. Most RBDI reversed with simple procedures (Trendelemburg donor position, drinking a sweet juice or water and heating of some biscuits). We didn’t find severe RDBI. Summary/conclusions In conclusion we can say that in our study most frequent RBDI were non-severe (vasovagal reaction), RBDI are few (~1/200 donations). RBDI were more frequent in young people. Early RBDI are more frequent than late. It seems that women are more likely to have BDI. We have not found a direct relationship between the level of Hb and RBDI. We found a relationship between the donations and the seasons, and in the warmer seasons there is a greater tendency to be RDBI. Probably in future we have to take steps to prevent RDBI.
- Human plasma derived prothrombin complex concentrate (OCTAPLEX), the HFF, EPE: Blood Department experience.Publication . Barra, A; Barradas, A; Cardoso, E; Costa, C; Gil, A; Rodrigues, T; Silva, A; Simões, A; Venâncio, BBackground: The HPDPCC was introduced in our clinical practice in 2005, and it has some specific clinical recommendations . We use Octaplex mostly to recert coagulation parameters in patients whose status require their quick conversion, mainly to reverse oral anticoagulation. We initially started using Octaplex in lower doses than the recommended by the drug leaflet, trying to find an optimal dose, aiming to avoid side effects. Aims: Our goals are to share our experience using Octaplex in clinical practice, demonstrating that we can obtain rapid results with minimal dose, without adverse events. Methods: We only included in this study patients who have done Octaplex (1unit – 20ml) and have results of measurement of their International Normalized Ratio (INR) before and after the infusion of prothrombin complex concentrate. The INR was determined using the fully automated hemostasis analyser BCS XP System (Siemens) and the reagent Innovin (Dade Behring). The period of the study was, 2005-2010, and included 87 patients with different diseases. The INR results upper than 10 were counted like 10 because the laboratory doesn’t quantify values higher than this. Results: The patients were 64 men and 23 women, with ages ranged between 18 and 85-years-old, average 66,5-years-old 53 were under treatment with oral anticoagulants (OAC), 22 with liver impairment (1.1), and 12 with other pathologies (OP). The INR before treatment varied from 10 (maximal value) to 1.4 (minimal value), the average values were 6.72 to the patients under OAC, 2.15 to the patients with LI and 3.39 to the patients with OP. After treatment the average values were 2.0 to the OAC 1.84 to the LI and 1.76 to the OP. After treatment the maximal value of the INR was 6.9 and the minimal 0.9. The average number of units used to revert the patients clinical status were for OAC 1.62 (in an average of 1.4 number of intakes), for LI 2 units (1 intake) and for OP 2.75 units (1.42 intakes). We didn’t find any adverse post-administration events. Summary/Conclusions: We found better results in the administration of Octaplex in patients doing OAC, where the 1.62 units (in 1.04 intakes) lowered the INR average from 6.72 to 2.0. The dose used to resolve our clinical cases were much lower than the recommended in the drug leaflet. We didn’t find any adverse events in this dose. The clinical practice feedback suggests a quicker INR conversion comparing to fresh frozen plasma.
- Inquéritos a dadores: um passo mais no sistema da qualidadePublication . Costa, C; Barradas, A; Barra, A; Gil, AO Hospital Fernando Fonseca (HFF) foi o primeiro hospital a ser certificado pelo prestigiado King’s Fund Health Quality Service. O serviço de sangue deste hospital foi recertificado pela NP EN ISO 9001:2000, em Dezembro de 2008 e até Outubro de 2010. A “Qualidade em Saúde” tem, segundo os autores, várias definições e existem muitas maneiras de verificarmos se os sistemas de qualidade instituídos estão a funcionar. Para o dador, que é um elo da maior importância no nosso serviço, a qualidade é a medida da sua satisfação como tal. Com o objectivo de melhorar continuamente o nosso trabalho realizamos e analisamos inquéritos de satisfação aos nossos dadores periodicamente.
- Optimização do uso do complexo de protrombina: uma experiência do Serviço de ImunohemoterapiaPublication . Gil, A; Barra, A; Barradas, A
- Prevalence of HLA antibodies in post pregnancies female blood donorsPublication . Barra, A; Barradas, A; Cardoso, E; Costa, C; Fontes, A; Gil, A; Oliveira, C; Ramalhete, L; Rodrigues, T; Sancho, MR; Silva, I; Simões, A; Trindade, HBackground: Transfusion related acute lung injury (TRALI) is known as transfusion hazard with high morbidity and mortality rate. Mainly HLA class II have been associated with TRALI. Preventive measures are in the exclusion of donor female as they carry any these antibodies. Aim: We study a group of female blood donor with prior history of two or more pregnancies (G2), one (G1) pregnancy and without any pregnancy (G0) for detection of HLA antibodies. Methods: We collected a total of 108 samples between September and December of 2010 (G2-56; G1-19 and G0-33 samples). For detection of HLA antibodies we used the LABScreen Mixed Assay which is multiplex technique that detects anti HLA Class I and II 1gG antibodies. Microparticles (beads) are coated with HLA antigens. Those beads have a combination of two dyes, and for each set of beads the dyes proportions are different so that the bead sets can be distinguished. Positivity was defined when the ratio is equal or higher than 4. Results: In the totality of the 108 study samples we found positivity for HLA class I antibodies in 22% (G2-32%, G1-26%, G0-3%) and for HLA class II antibodies in 17% of samples (G2-27%, G1-5%, and G0-6%). Positivity for both HLA class I and II antibodies was found only in G2 samples (18%) and G1 samples (5%). Our study also shows a 12% of positivity only for HLA class I antibodies (G2-14%, G1-21%, G0-3%) and a 6% of positivity only for HLA class II antibodies (G2-9%, G1-0%, G0-6%). Conclusions: Our study reveals higher prevalence of HLA class I and II antibodies in G2 population . Women with both positive HLA Class I and II antibodies have been excluded for blood donation in order to prevent TRALI in recipients. This study will continue with a higher number of samples. Idea was to test all this women to HLA class antibodies prior to each blood donation.
- Teste à cabeceira e confirmação positiva da transfusão: dois procedimentos do sistema de hemovigilância utilizados no Serviço de Sangue do HFF, EPEPublication . Barradas, A; Barra, A; Cardoso, E; Costa, C; Gil, A; Pereira, FA hemovigilância é definida “como o conjunto de procedimentos de vigilância relacionados com eventos ou reações adversas graves ou inesperadas em dadores ou recetores” e o acompanhamento epidemiológico dos dadores. Tem como objetivo final a prevenção da recorrência destes eventos ou reacções [1]. A confirmação positiva da transfusão e o teste à cabeceira são dois dos procedimentos do sistema de hemovigilância, utilizados no nosso serviço, com o objectivo de aumentar a segurança transfusional. O artigo foca-se na prática transfusional de vários serviços do Hospital Professor Doutor Fernando Fonseca (HFF, EPE), verificando se os doentes foram efetivamente transfundidos e se o teste à cabeceira foi realizado. Foram analisados entre 21 de Novembro de 2011 e 30 de Abril de 2012, 1457 pedidos de transfusão. Constatou-se que todos os serviços do HFF em que foram realizadas transfusões de CE, utilizaram testes á cabeceira. Verificou-se uma incidência de testes efectivamente realizados de 84,9% e confirmação positiva de transfusão em 100% dos doentes. Os resultados permitem-nos concluir que a confirmação positiva da transfusão e o teste à cabeceira são procedimentos que fazem, efectivamente, parte das práticas transfusionais do Hospital Professor Doutor Fernando Fonseca, EPE, permitindo assim um incremento da segurança transfusional.
- Transfusion of RHD negative patients with RHD positive red cells concentrates: the HPFF, EPE Blood Department experience (2002-2010)Publication . Barra, A; Barradas, A; Cardoso, E; Costa, C; Fontes, A; Gil, A; Oliveira, C; Pereira, F; Rebelo, SBackground: In transfusion practice we should respect the ABO group and the Rh phenotype. The lack of availability of red cells concentrates [RCC] RhD negative in the quantities desired, do nol always make it possible to satisfy that requirement, especially in urgency. In our practice we never transfuse RhD in some groups of patients RhD negative, like women of childbearing age, children, newborns, patients with disease likely to need multiple transfusions [eg oncologic patients]. Alms: The purpose of this study was to assess possible alloimmunization in RhD negative receivers who were transfused with RhD positive RCC and try to interpret some findings. Methods: We included in this study all patients RhD negatives who received RhD positive RCC in our department from 2002 to 2010, all of them have been made an antibody screening by IAT and Enzyme before transfusing. We used for antibody screening the Card-ID “LISS/Coombs”, with the test cell reagents ID-Diacell I-II-III and the Card-ID “NaCl, enzyme test and cold agglutinins” with the test cell reagents Diacell I-II-III P. In case of positive results in the tests we used for antibody identification the ID-Cards “LIDSS/Coombs” with the ID-Panel and/or the “NaCl, enzyme test and cold agglutinins” with the ID-Panel P. When we had doubts in antibody indentification with the ID-Panel we tried resolve Them using the ID-Dia-Panel plus 6 (All the reagents and cards are DiaMed). The results for negative antibody screening were considered only if this was confirmed 72 hours after the transfusion with RhD positive RCC. Results: From 2002 to 2010 in our department, we transfused 177 patients RhD negative with 621 units os RhD positive RCC. Only 96 patients had inclusion criteria. They had heen transfused with 415 units RhD positive (average 4,48 units/patient), 52 (54,2%) were male and 44 (45,8%) were female. Average age was 77 years old, varying between 23 and 96 years old, 21 (21,9%) patients had positive antibody screening after transfusion and 75 (78,1%) didn’t. Those who were positive, in right (8,3%) were identified isolated anti-D antibodies, seven (7,3%) anti-D and others antibodies, one (1,0%) anti-Lua antibodies and five (5,2%) were inconclusive. Between the patients with positive antibody screening the average age was 77,5 years old, varying between 53 and 89 years old, the total of transfused RCC in this group was 101 (average 4,8 units/patient) and 11 (52,4 %) were male and 10 (47,6%) were female. The patients with negative antibody screening had an average age of 75,1 years old, varying between 23 and 96 years old, the total of transfused RCC in this group was 314 (average 4,5 units/patient) and 41 (54,7%) were male and 34 (45,3%) were female. Summary/conclusions: In our study 21,9% of RhD negative patients transfused with RCC RhD positive had a positive antibody screening. Studying this variables, we couldn’t explain why some patients develop antibodies and others don’t. Maybe in future studies we have include other variables.
- Urgência e transfusãoPublication . Gil, A; Cardoso, E; Barra, A; Costa, C; Barradas, A1. Introdução: O recurso terapêutico à transfusão em urgência não é substituível e por isso deve ser aplicado quando necessário sendo o risco versus beneficio avaliado. 2. Objectivos: O objectivo deste trabalho é apresentar a evolução do consumo dos componentes e derivados do sangue entre 2008 e 2010 nos serviços de urgência do HFF e o número de doentes transfundidos. 3. Métodos: Considerou-se como Serviços de Urgência (SU): 1)Urgência Geral/S.O. (UG) 2)Bloco de Partos (BP) 3)Urgência Pediátrica (UP) Estudou-se o número de Concentrados Eritrocitários (CEs), Plaquetas (CPP), Crioprecipitados (CR), Plasma Inativado (PI), Complexo de Protrombina Humano (CPH), transfundidos nos SU, de 2008/10. 4. Resultados: De 2008/10 a Urgência consumiu 27,2% do total de componentes sanguíneos utilizados no hospital. a)Relação doentes internados/doentes transfundidos (%) na UG, BP e UP, com diferentes Componentes/Derivados (CD) (ver poster). b)Número de componentes utilizados por doentes transfundidos (ver poster). 5. Discussão/conclusão: Assistiu-se à diminuição da percentagem doentes internados/doentes transfundidos com CEs na UG, mantendo-se no BP e aumentando na UP. Estes valores reflectem uma boa relação de comunicação entre os serviços, com consensos nos critérios de transfusão