BackgroundSeveral irregular red blood cell alloantibodies, produced by alloimmunization of antigens in transfusions or pregnancies, have clinical importance because they cause hemolysis in the fetus and newborn and in transfused patients.Objectivea prospective analysis of patients treated by the surgical and clinical emergency services of Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (HC/UFTM), Brazil was performed to correlate alloimmunization to clinical and epidemiological data.MethodsBlood samples of 143 patients with initial negative antibody screening were collected at intervals for up to 15 months after the transfusion of packed red blood cells. Samples were submitted to irregular antibody testing and, when positive, to the identification and serial titration of alloantibodies. The Fisher Exact test and Odds Ratio were employed to compare proportions.ResultsFifteen (10.49%) patients produced antibodies within six months of transfusion. However, for 60% of these individuals, the titers decreased and disappeared by 15 months after transfusion. Anti-K antibodies and alloantibodies against antigens of the Rh system were the most common; the highest titer was 1:32 (anti-K). There was an evident correlation with the number of transfusions.ConclusionsGiven the high incidence of clinically important red blood cell alloantibodies in patients transfused in surgical and clinical emergency services, we suggest that phenotyping and pre-transfusion compatibilization for C, c, E, e (Rh system) and K (Kell system) antigens should be extended to all patients with programmed surgeries or acute clinical events that do not need emergency transfusions.

Background: Neonatal screening for congenital hypothyroidism (CH) in premature infants is not as well established as in term newborns regarding age and number of samples. Aims: 1. To evaluate the effectiveness of the protocol recommended by the Neonatal Screening Program of the State of Minas Gerais (PETN-MG) for CH neonatal screening in very low birth weight premature infants. 2. To estimate the prevalence of delayed TSH elevation and thyroid function alterations in the target population. Methods: TSH was assessed by ELISA on the 5 th , 10 th and 30 th days of life in all newborns with gestational age <32 weeks and/or very low birth weight (VLB) (<1,500 g) in the period from October 2004 to September 2006. Results: Out of the 14,462 newborns screened, 2,647 were premature with gestational age <32 weeks and/or VLB. Forty-four cases of altered TSH were found and 11 infants underwent treatment. Delayed TSH elevation was detected in 66% of altered cases. Five out of the 11 cases were detected in the second sample and five cases were only detected in the third sample. Conclusion:The high prevalence of thyroid function alterations that demanded treatment (1:242) and delayed TSH elevation in VLB premature infants reinforce the need for a specific protocol, based on retesting procedures, for CH neonatal screening. KEY WORDScongenital hypothyroidism, premature newborn, neonatal screening, very low birth weight VOLUME 23, NO. 1-2,2010 45 Brought to you by |

A fenotipagem eritrocitária pré-transfusional é um importante procedimento para aumentar a segurança das transfusões sangüíneas, sendo realizada rotineiramente no Hemocentro Regional de Uberaba-MG (HRU) desde 1996. O presente trabalho tem como objetivo geral avaliar a freqüência de anticorpos antieritrocitários irregulares em politransfundidos, de 1997 a 2005. Através de estudo retrospectivo foram levantados dados no arquivo do HRU de todos os pacientes aloimunizados, realizou-se análise estatística descritiva e comparam-se as proporções pelo teste "Z". Dos 23.220 transfundidos no período, com média de 5,7 transfusões por paciente, observou-se a ocorrência de aloimunização em 173 (0,75%). Os sistemas Rh e Kell juntos tiveram freqüência superior a 70%. A proporção do anti-D foi significativamente maior nas mulheres (p<0,05) e não houve diferença no sistema Rh entre brancos e não-brancos. Quanto à faixa etária, 70% tinham mais de 30 anos. Dos 73 pacientes que tiveram a doença de base registrada, 39,73% eram portadores de anemias agudas, 31,51% de anemias crônicas e 28,77% de doenças oncológicas ou onco-hematológicas. Aproximadamente 70% dos anticorpos foram identificados até a décima transfusão. A baixa ocorrência da aloimunização no HRU reforça a importância da fenotipagem eritrocitária para todos os pacientes dependentes de transfusões crônicas, bem como da sua implantação na rotina de todos os serviços de hemoterapia.

BackgroundThe large diversity of red blood cell antigens favors, especially in multi-transfused patients, the occurrence of autoimmunization and alloimmunization with the risk of hemolytic transfusion reactions. Thus, this study aimed to determine the rates of alloimmunization and autoimmunization in these individuals, as well as the types of alloantibodies and their systems, clinical and epidemiological aspects and the frequency of autoimmunity in alloimmunized and non-alloimmunized patients.MethodsIn a retrospective study, 153 multi-transfused patients from 2006 to 2014 were evaluated. Sixty-eight had onco-hematological diseases, 64 had hemoglobinopathies and 21 had chronic renal failure. Descriptive analyses were carried out with the proportions being compared using the chi-square test, with the significance level set at 5%.ResultsThe Rh system was the most frequently involved (53.11%) and anti-E and anti-K (Kell system) were the most prevalent alloantibodies (21.87% each). Autoantibodies were found in ten patients (6.54%) with the percentages of autoimmunization in alloimmunized and non-alloimmunized individuals being 29.16% and 2.32%, respectively (p = 0.0001). There was a significant difference between autoimmunization and the number of transfusions (16.21% in 6–10 vs. 5.26% <6 vs. 2.56% >10; p = 0.0203) and diseases (19.04% in chronic renal failure vs. 6.25% in hemoglobinopathies vs. 2.94% in onco-hematological diseases; p = 0.0329).ConclusionThe results show a strong correlation between alloimmunization and autoimmunization. Moreover, they reinforce the need for further studies on the clinical and epidemiological profile of multi-transfused patients in relation to alloimmunity and autoimmunity, especially the latter, for a better understanding of its etiopathogenesis and physiopathogenesis.

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