Browsing by Author "Rebelo, S"
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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.
- Cinco anos de experiência de TMA nos dadores de sangue do Hospital Amadora-SintraPublication . Soares, F; Gaspar, R; Rebelo, S; Barra, A; Barradas, AIntrodução: O risco de uma transfusão transmitir uma infecção a HIV, HIW e HVC é predominantemente associado a doações em que as infecções se encontram em estádios precoces e escapam aos outros testes de rotina. Assim em 2002 iniciamos o teste de Transcripção Mediada por Amplificação (TMA) aos nossos dadores diminuindo o período de janela das infecções referidas, aumentando a segurança transfusional. Material e Métodos: Foram testadas 26665 amostras no período compreendido entre Junho de 2002 a Dezembro de 2006. Inicialmente usamos o teste Chiron Procleix HCV/HIV tendo em 2004 passado para o Procleix Ultrio Assay HVC, HIV, HBV. Paralelamente efectuamos os testes Elisa segundo a lei portuguesa. Conclusão: O uso dos teste TMA em dadores singulares é fazível, aumenta a segurança transfusional detectando dadores em período de janela e não afecta o sangue disponível em stock.
- Cytomegalovirus (CMV) and transfusion therapy: prevalence of cmv seropositivity in a portuguese blood donor population (2007-2014)Publication . Cardoso, E; Lichtner, A; Barra, A; Costa, C; Plácido, C; Nunes, C; Ferreira, M; Rebelo, S; Santos, C; Mota, MBackground: Cytomegalovirus (CMV or human herpesvisrus-5) is a common infection and not clinically significant in immunocompetent individuals. It’s the most important herpesvirus with reference to transfusion and, as all human herpesvirus, has the capability to lie dormant in tissues after an acute infection. The risk of CMV infectivity is still a major problem in immunocompromised patients requiring transfusion therapy, and should be minimized in CMV-negative pregnant women, fetuses, premature infants and neonats, transplant recipients and other severely immunosuppressed patients. The residual risk of transfusion-transmitted CMV infection is between 2.3% and 3% for leucocyte-reduced blood components, and the additional use of anti-CMV screened blood components decreases this risk to less than 1%, which, in our point of view, justifies the non-abandonment of CMV-seronegative blood bank inventories, especially in high prevalent populations. There is substantial variation in the donor rates of CMV seropositivity described in the literature (20-95%) and it seems to be inversely related to improved hygiene and living conditions. The same principle applies to the seroconversion rate per year. Aims: To determine the prevalence of CMV seropositivity and CMV seroconversion rate per year in a Portuguese blood donor population over an eight-year period of time (2007-2014), and compare it to those mentioned in other studies. Methods: Blood samples from donors were analyzed during the period 2007-2014 (8 years), and tested for detection of anti-CMV antibodies (‘total’ anti-CMV ELISA-based assays, capable of detecting both IgG and IgM class antibodies- Siemens Enzygnost® Anti-CMV/IgG+IgM), as they belonged to a first-time or to a previously tested CMV-seronegative donor. The prevalence of CMV seropositivity and the seroconversion rate per year were retrospectively determined among this blood donors population. Results: A total of 42.286 blood collections were analyzed. The prevalence of CMV infection was determined for each year: 2007 – 86.4%; 2008 – 87,2%; 2009 – 86.5%; 2010 – 88.9%; 2011 – 90.2%; 2012 – 89.7%; 2013 – 91,3%; 2014 – 89,4%. The CMV seroconversion rate per year was 1.43% (average age of seroconversion 36.4 years old; 81.8% men and 18,2% women). Summary/Conclusions: All blood components transfused in Portugal are leucocyte-reduced. We try to provide CMV seronegative blood components to all patients in high risk CMV infection, even in a high prevalent population as ours. The existence of CMV-seronegative blood bank inventories does not reflect practice countrywide, but is still important for some high-risk groups of patients, and allows us to respond to the needs of our hospital and other institutions (whenever possible).
- Marcadores serológicos nos dadores de sangue: casuística do serviço de sangue do HFF, de 2006 a 2009Publication . Barra, A; Barradas, A; Ferreira, R; Costa, C; Mota, M; Pereira, T; Rebelo, SIntrodução: A segurança transfusional, da qual faz parte o rastreio das doenças transmitidas pela transfusão, continua a ser uma das grandes preocupações na prática de imuno-hemoterapia, apesar dos critérios de aprovação de dadores serem cada vez mais restritivos. Com a introdução dos TAN no rastreio das Hepatites B e C e do HIV1, o período de janela foi reduzido, contribuindo assim para um aumento da segurança transfusional. A necessidade de aumentar as dádivas, o aumento dos custos associados à realização de análises e os resultados e níveis de segurança obtidos faz com que hoje se levantem novas questões. Pretendemos partilhar a evolução estatística dos resultados, no laboratório de diagnóstico de doenças transmissíveis no nosso serviço. Material e métodos: De Janeiro de 2006 a Junho de 2009, foram analisadas 18.068 dádivas homólogas, sendo realizados por rotina, a cada dádiva, os testes por método de microELISA: AgHBs; AcHBc; AcHBs; AcHCV; AcHIV1,2; AcHTLVI,II; AcTP e TMA HBV/HCV/HIV1. Foram utilizados como métodos confirmatórios RIBA, WB e TPPA. Foi feito trabalho estatístico adequado. Resultados (ver poster) Conclusões: Não tivemos nenhum resultado positivo (confirmado) para HTLV. O ano em que se verificou um maior número de positividades foi o de 2007, com uma maior frequência de sífilis (0.26%) e HCV (0.06%). Tal como nos outros anos estudados foi nos dadores de primeira vez no serviço que se verificaram maioritária ou exclusivamente as positividades (sífilis 76.8%e HCV 100%). Todos os dadores AcHBc positivo e AcHBs positivo com título <100 tiveram TMA negativo. Os nossos resultados levam-nos a levantar algumas questões: 1. Não será importante revermos os critérios para realizar o HTLV? 2. Não será pertinente rever o título de 100 para dadores AcHBc+, AcHBs+ e TMA negativo? 3. Nos casos de sífilis antigas e curadas, deverá manter-se o critério de suspender definitivamente o dador
- Transfusão de doentes RhD- com CES RhD+: a experiência do Serviço de Sangue do Hospital Fernando Fonseca (2004-2007)Publication . Barra, A; Barradas, A; Guerreiro, T; Costa, C; Pereira, F; Rebelo, S; Silva, A; Simões, A; Venâncio, BINTRODUÇÃO: Idealmente na prática transfusional devemos respeitar o grupo ABO e o fenótipo Rh. A falta de disponibilidade de Concentrados Eritrocitários (CEs) RhD- nas quantidades desejáveis, nem sempre nos permite satisfazer esta exigência. O objectivo deste estudo foi avaliar possíveis alo-imunizações nos receptores RhD- que fossem transfundidos com CEs RhD+ e eventuais reacções adversas à transfusão nestes mesmos receptores. MATERIAL E MÉTODOS: No nosso Serviço, a prática transfusional manda que se possam transfundir alguns doentes RhD- com CEs RhD+. Excluídos estão: os doentes em que se despiste anti-D, mulheres em idade fértil, crianças, recém-nascidos, doentes com doença susceptível de múltiplas transfusões. Dos testes pré-transfusionais, faz obrigatoriamente parte a determinação do grupo ABO, do RhD, a PAJ (um meio de antiglobulina e enzimático) e o teste de antiglobulina directo. RESULTADOS: De 01-01-2004 a 09-04-2007, foram transfundidos no nosso Serviço, 69 doentes RHD- com 280 unidades de CEs RhD+. Dos doentes estudados, 40 (58%) eram do sexo feminino e 29 (32%) eram do sexo masculino. Com idades correspondidas entre os 31 e 94 anos e com uma média de idades de 74,8 anos. Dos doentes, 3 (4,3%), todos do sexo feminino, desenvolveram ac. Anti-D. Destas, para além do anti-D uma desenvolveu também ac.anti-C. Não se registou nenhuma reacção adversa à transfusão. CONCLUSÕES: Devido á baixa prevalência de doentes imunizados (4,3%) e a ausência de reacções adversas á transfusão, pensamos que poderemos, nas situações clinicas acima descritas e sempre que tenhamos falta de CEs RhD-, continuar a transfundir doentes RhD- com CEs RhD- sem que isto represente prejuízo para os doentes, permitindo-nos uma gestão mais adequada dos CEs RhD- disponíveis.
- 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.
- Transfusion therapy and sickle cell diseasePublication . Barra, A; Barradas, A; Cardoso, E; Costa, C; Ferreira, R; Fontes, A; Mota, M; Moura, H; Oliveira, C; Pereira, F; Rebelo, S; Rodrigues, T; Santos, L; Silva, A; Silva, I; Simões, A; Soares, F; Venâncio, BBackground: Sickle cell disease is a very common hemoglobinopathy. The main goal of transfusion therapy in sickle cell disease is to prevent thrombotic events, improve tissue oxygenation and treat anaemia complications. However the risk of all immunization is well known. Since 2001 our service has been doing a tight surveillance work in sickle cell patients, creating a database of about 15,000 studied blood donors. Aims: We want to share our experience in transfusion of sickle cell patients and highlight the importance to have a computer database with compatible donors in order to reduce all immunization in these patients. Methods: We have studied the above described donors for the following blood group systems ABO, Rh, Kell, Duffy, Kidd, MNSs, Lutheran, P (P1) and haemoglobin S. For each transfusion demand for these patients we research in our computer data base the more likely compatible donor. From January 2007 to January 2011 we studied 64 patients. To transfuse these patients we followed the protocol described above. We transfused these patients with red cells of compatible donors pre investigated. We perform pre transfusion tests in all patients. Results : Have been studied 64 patients who needed red cells transfusion, 30 were females and 34 were males. The range of ages was from 1 to 46 years old. 55 patients were black (85.9%). We have been able to transfuse these patients with red cells of 135 compatible donors from database. We performed 439 red cell concentrate (RCC) transfusions (average per patient 6.85). The patient with the biggest supply was transfused with 22 RCC and we didn’t find in this case any clinically significant red cell alloantibody. We had 7 positive antibody screenings, 2 were anti-Lea, 2 anti-E and 3 were inconclusive. Summary/Conclusions: In our study all patients with clinically significant alloantibody were previously transfused in other institution. We didn’t find any alloantibody in patients exclusively transfused in our department. Our experience transfusing sickle cell disease patients reveals that RCC compatible to antigens of the groups mentioned above greatly reduce all immunization. Hence the importance of the existence in urgency blood department of extended phenotype donors files.