Browsing by Author "Rodrigues, T"
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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.
- 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.
- Risk factors for bronchopulmonary dysplasia in five portuguese neonatal intensive care unitsPublication . Guimarães, H; Rocha, G; Vasconcellos, G; Proença, E; Carreira, ML; Sossai, MR; Morais, B; Martins, I; Rodrigues, T; Severo, MThe pathogenesis of bronchopulmonary dysplasia (BPD) is clearly multifactorial. Specific pathogenic risk factors are prematurity, respiratory distress, oxygen supplementation, mechanical ventilation (MV), inflammation, patent ductus arteriosus (PDA), etc. AIM: To evaluate BPD prevalence and to identify risk factors for BPD in five Portuguese Neonatal Intensive Care Units in order to develop better practices the management of these newborns. MATERIAL AND METHODS: 256 very low birth weight infants with gestational age (GA) <30 weeks and/or birthweight (BW) <1250 g admitted in five Portuguese NICUs, between 2004 and 2006 were studied. A protocol was filled in based on clinical information registered in the hospital charts. BPD was defined as oxygen dependency at 36 weeks of postconceptional age. RESULTS: BPD prevalence was 12.9% (33/256). BPD risk decreased 46% per GA week and of 39% per 100g BW. BPD risk was significantly higher among newborns with low BW (adj OR= 0.73, 95% CI=0.57- 0.95), severe hyaline membrane disease (adj OR= 9.85, 95% CI=1.05-92.35), and those with sepsis (adj OR=6.22, 95% CI=1.68-23.02), those with longer duration on ventilatory support (42 vs 3 days, respectively in BPD and no BPD patients, p <0.001) and longer duration of FiO2>0.30 (85 vs 5 days, respectively in BPD and no BPD patients, p <0.001). COMMENTS: The most relevant risk factors were low birth weight, severe hyaline membrane disease, duration of respiratory support and oxygen therapy, and nosocomial sepsis. The implementation of potentially better practices to reduce lung injury in neonates must be addressed to improve practices to decrease these risk factors.
- 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.