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Revista Brasileira de Hematologia e Hemoterapia, Volume: 35, Número: 1, Publicado: 2013
  • The results of the International Consortium on Acute Promyelocytic Leukemia: a 'proof of concept' of networking as a strategy to improve the outcome of treatment of hematological malignancies in developing countries

    Rego, Eduardo Magalhães
  • Febrile neutropenia studies in Brazil: treatment and cost management based on analyses of cases Scientific Comments

    Bellesso, Marcelo
  • Comment on: "Clinical and functional evaluation of the joint status of hemophiliac adults at a Brazilian blood center" Scientific Comments

    Beeton, Karen
  • Comments on: "Impact of iron overload on interleukin-10 levels, biochemical parameters and oxidative stress in patients with sickle cell anemia" Scientific Comments

    Driss, Adel
  • Comments on: molecular matching of red blood cells is superior to serological matching in sickle cell disease patients Scientific Comments

    Nance, Sandra Taddie; Keller, Margaret A
  • Stress-induced hyperglycemia is a valuable biomarker in febrile neutropenia Scientific Comments

    Carmona-Bayonas, Alberto; Font, Carme; Ayala de la Peña, Francisco
  • The effect of taurine addition on the complete blood count Scientific Comments

    Yassin, Maged Mohammed
  • Oxidative stress in sickle cell disease Scientific Comments

    Queiroz, Raphael Ferreira; Lima, Emerson Silva
  • Neutropenic patients and their infectious complications at a University Hospital Original Articles

    Lima, Stella Sala Soares; França, Monique Sedlmaier; Godoi, Camila Cristina Gonçalves; Martinho, Glaucia Helena; Jesus, Lenize Adriana de; Romanelli, Roberta Maia de Castro; Clemente, Wanessa Trindade

    Resumo em Inglês:

    OBJECTIVE: The aim of this study was to analyze the characteristics and infectious complications of neutropenic patients in a referral hospital. METHODS: A cross-sectional study was carried out between April and September 2008, which enrolled all neutropenic patients identified by daily blood counts in the Universidade Federal de Minas Gerais. Demographic data and information on infections were obtained from the Hospital Infection Control Committee. Statistical analysis was performed using the Statistical Package for Social Sciences. RESULTS: One hundred and sixteen patients were followed up during 129 hospitalizations. The patients had a mean age of 48.7 years old. Sixty-four (55.2%) patients were male and 25 (21.6%) died during the follow-up. In 97 (75.2%) of the hospitalizations, patients had episodes of febrile neutropenia. Patients classified as low-riskhad a mortality rate of 16.2% (n = 12) vs. 39.1% (n = 9) among high-risk patients (p-value = 0.02). The death rate of the patients who had been submitted to hematopoietic stem cell transplantation was 13.5% (n = 5)vs. 26.7% (n = 16) among patients not submitted to transplantation (p-value = 0.13). Of the 155 infections diagnosed, 45.5% were defined as clinically documented. The etiological agent most frequently isolated was Escherichia coli and the main topography reported was bloodstream infections. The most used antimicrobial agents were cefepime, vancomycin and fluconazole. Approximately 24% of patients evolved with impaired renal function during hospitalization. CONCLUSION: Most reported infections in neutropenic patients were defined as clinically documented, which shows the importance of suspicion in patients without specific signs and symptoms for early diagnosis and the need for the classification of risk for timely interventions.
  • Clinical and functional evaluation of the joint status of hemophiliac adults at a Brazilian blood center Original Articles

    Ferreira, Adriana Aparecida; Bustamante-Teixeira, Maria Teresa; Leite, Isabel Cristina Gonçalves; Corrêa, Camila Soares Lima; Rodrigues, Daniela de Oliveira Werneck; Cruz, Danielle Teles da

    Resumo em Inglês:

    BACKGROUND: Hemophilia is a potentially disabling condition as hemophilic arthropathy develops early in life and is progressive, especially in patients treated in an on-demand regime. Objective: This study aimed to describe the structural joint status and the functional independence score of hemophiliac adults and correlate structural damage with the functional deficits found in these patients. METHODS: Hemophiliacs at the Juiz de Fora Regional Blood Center - HEMOMINAS Foundation, aged 18 years and over and treated in an on-demand regime, were clinically evaluated in respect to structural joint damage using the World Federation of Hemophilia Physical Examination Scale (WFH-PE) and functional deficits using the Functional Independence Score in Hemophilia (FISH). The Spearman rank test was used to evaluate the correlation between the two scores. RESULTS: Thirty-nine patients were evaluated. The mean age was 36.8 years. Target joints were detected in 69.2% of patients studied. The mean Physical Examination Scale and Functional Independence Score were 16.87 and 25.64, respectively. Patients with mild hemophilia showed no significant joint involvement. Patients with severe or moderate hemophilia had similar results regarding structural damage (p-value < 0.001) and functional deficits (p-value = 0.001). There was statistical significance in the correlation between the two scores (r = -0.850; p-value = 0.01). CONCLUSIONS: The World Federation of Hemophilia Physical Examination Scale and Functional Independence Score in Hemophilia may be useful to clinically assess structural joint damage and functional deficits in hemophiliacs as the tools are inexpensive and easy to administer and may be able to detect hemophilic arthropathy, which results from recurrent hemarthrosis and is common in the population studied.
  • Impact of iron overload on interleukin-10 levels, biochemical parameters and oxidative stress in patients with sickle cell anemia Original Articles

    Barbosa, Maritza Cavalcante; Santos, Talyta Ellen Jesus dos; Souza, Geane Félix de; Assis, Lívia Coêlho de; Freitas, Max Victor Carioca; Gonçalves, Romélia Pinheiro

    Resumo em Inglês:

    OBJECTIVE: The aim of this study was to evaluate the impact of iron overload on the profile of interleukin-10 levels, biochemical parameters and oxidative stress in sickle cell anemia patients. METHODS: A cross-sectional study was performed of 30 patients with molecular diagnosis of sickle cell anemia. Patients were stratified into two groups, according to the presence of iron overload: Iron overload (n = 15) and Non-iron overload (n = 15). Biochemical analyses were performed utilizing the Wiener CM 200 automatic analyzer. The interleukin-10 level was measured by capture ELISA using the BD OptEIAT commercial kit. Oxidative stress parameters were determined by spectrophotometry. Statistical analysis was performed using GraphPad Prism software (version 5.0) and statistical significance was established for p-values < 0.05 in all analyses. RESULTS: Biochemical analysis revealed significant elevations in the levels of uric acid, triglycerides, very low-density lipoprotein (VLDL), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), urea and creatinine in the Iron overload Group compared to the Non-iron overload Group and significant decreases in the high-density lipoprotein (HDL) and low-density lipoprotein (LDL). Ferritin levels correlated positively with uric acid concentrations (p-value < 0.05). The Iron overload Group showed lower interleukin-10 levels and catalase activity and higher nitrite and malondialdehyde levels compared with the Non-iron overload Group. CONCLUSION: The results of this study are important to develop further consistent studies that evaluate the effect of iron overload on the inflammatory profile and oxidative stress of patients with sickle cell anemia.
  • Molecular matching of red blood cells is superior to serological matching in sickle cell disease patients Original Articles

    Costa, Daiane Cobianchi da; Pellegrino Jr, Jordão; Guelsin, Gláucia Andréia Soares; Ribeiro, Karina Antero Rosa; Gilli, Simone Cristina Olenscki; Castilho, Lilian

    Resumo em Inglês:

    OBJECTIVE: To evaluate the usefulness of DNA methods to provide a means to precisely genotypically match donor blood units for the antigen-negative type of 35 sickle cell disease patients. METHODS: Red blood cell units were investigated for ABO, D, C, c, E, e, K, Fyª, Fy b, Jkª, Jk b, S, s, Diª and RH variants by performing a molecular array (Human Erythrocyte Antigen BeadChipTM, BioArray Solutions), polymerase chain reaction followed by restriction fragment length polymorphism analysis and sequencing of patient samples and donor units that had been serologically matched based on the ABO, Rh and K phenotypes and the presence of antibodies. RESULTS: Matches for 21 of 35 sickle cell disease patients presented discrepancies or mismatches for multiple antigens between the genotype profile and the antigen profile of their serologically-matched blood units. The main discrepancies or mismatches occurred in the RH, FY, JK and MNS systems. Eight Rh alloimmunized patients presented RHD and RHCE variants that had not been serologically identified. According to these results better matches were found for the patients with genotyped units and the patients benefited as shown by better in vivo red blood cell survival. CONCLUSION: Molecular matching is superior to serological matching in sickle cell disease patients, decreasing the risk of transfusion reactions, especially delayed transfusion reactions to existing alloantibodies and preventing alloimmunization.
  • Hyperglycemia increases the complicated infection and mortality rates during induction therapy in adult acute leukemia patients Original Articles

    Matias, Carolina do Nascimento; Lima, Vladmir; Teixeira, Heberton Medeiros; Souto, Fernanda Ribeiro; Magalhães, Vera

    Resumo em Inglês:

    OBJECTIVE: To determine the prevalence of hyperglycemia during induction therapy in adult patients with acute leukemia and its effect on complicated infections and mortality during the first 30 days of treatment. METHODS: An analysis was performed in a retrospective cohort of 280 adult patients aged 18 to 60 years with previously untreated acute leukemia who received induction chemotherapy from January 2000 to December 2009 at the Hemocentro de Pernambuco (HEMOPE), Brazil. Hyperglycemia was defined as the finding of at least one fasting glucose measurement > 100 mg/dL observed one week prior to induction therapy until 30 days after. The association between hyperglycemia and complicated infections, mortality and complete remission was evaluated using the Chi-square or Fisher's exact tests by the Statistical Package for Social Sciences (SPSS) in the R software package version 2.9.0. RESULTS: One hundred and eighty-eight patients (67.1%) presented hyperglycemia at some moment during induction therapy. Eighty-two patients (29.3%) developed complicated infections. Infection-related mortality during the neutropenia period was 20.7% (58 patients). Mortality from other causes during the first 30 days after induction was 2.8%. Hyperglycemia increased the risk of complicated infections (OR 3.97; 95% confidence interval: 2.08 - 7.57; p-value < 0.001) and death (OR 3.55; 95% confidence interval: 1.77-7.12; p-value < 0.001) but did not increase the risk of fungal infections or decrease the probability of achieving complete remission. CONCLUSION: This study demonstrates an association between the presence of hyperglycemia and the development of complicated infections and death in adult patients during induction therapy for acute leukemia.
  • Effect of the addition of the antioxidant taurine on the complete blood count of whole blood stored at room temperature and at 4ºC for up to 7 days Original Articles

    Sirdah, Mahmoud Mohammed; Abushahla, Abdelnasser Kassem; Al-Sarraj, Heba Abd Allah

    Resumo em Inglês:

    BACKGROUND: The complete blood count is one of the most common routine tests. This study aimed to evaluate possible effects of the antioxidant taurine on the complete blood count of whole blood stored at room temperature and at 4ºC over seven days. METHODS: Venous blood samples of 25 healthy males were distributed into two sets of tubes with each set of four tubes containing 50 µL of solutions with zero, 2.5 g/L, 5 g/L, 10 g/L taurine. The tubes were kept at room temperature or at 4ºC. Complete blood counts were performed on seven successive days. The mean percentage changes [Δ = (mean value - mean baseline value) / mean baseline value x 100] were calculated and compared. RESULTS: Complete blood count parameters exhibited different patterns of behavior which were affected by the storage temperature, time and taurine concentration. Taurine at room temperature significantly enhancedthe stability of: the platelet count over seven days (Δ7 at 2.5, 5 and 10 g/L taurine were 5.45, 6.11, and 5.80 x 10(9) cells/L, respectively); the red blood cell count over five days (Δ5 at 2.5, 5 and 10 g/L taurine were 1.59, 2.79, and 1.98 x 10(12) cells/L, respectively); mean corpuscular hemoglobin over five days (Δ5 at 2.5, 5 and 10 g/L taurine were -0.91,-1.52 and -0.84 fl respectively); and red cell distribution width over two days (Δ2 at 2.5, 5 and 10 g/L taurine were 0.90%, 1.30% and -0.1%, respectively). No additional stabilizing effects of taurine were reported for the mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, hematocrit and hemoglobin, while it negatively affected the white blood cell stability. CONCLUSION: Complete blood count parameters exhibited variable stability patterns in respect to temperature, time and taurine concentration.
  • Protective effect of flavonoids against reactive oxygen species production in sickle cell anemia patients treated with hydroxyurea Original Articles

    Henneberg, Railson; Otuki, Michel Fleith; Furman, Aline Emmer Ferreira; Hermann, Priscila; Nascimento, Aguinaldo José do; Leonart, Maria Suely Soares

    Resumo em Inglês:

    OBJECTIVE: The aim of this study was to evaluate the protective effects of quercetin, rutin, hesperidin and myricetin against reactive oxygen species production with the oxidizing action of tert-butylhydroperoxide in erythrocytes from normal subjects and sickle cell anemia carriers treated with hydroxyurea. METHODS: Detection of intracellular reactive oxygen species was carried out using a liposoluble probe, 2',7'-dichlorfluorescein-diacetate (DCFH-DA). A 10% erythrocyte suspension was incubated with flavonoids (quercetin, rutin, hesperidin or myricetin; 30, 50, and 100 µmol/L), and then incubated withtert-butylhydroperoxide (75 µmol/L). Untreated samples were used as controls. RESULTS: Red blood cell exposure to tert-butylhydroperoxide resulted in significant increases in the generation of intracellular reactive oxygen species compared to basal levels. Reactive oxygen species production was significantly inhibited when red blood cells were pre-incubated with flavonoids, both in normal individuals and in patients with sickle cell anemia. Quercetin and rutin had the highest antioxidant activity, followed by myricetin and hesperidin. CONCLUSION: Flavonoids, in particular quercetin and rutin, showed better antioxidant effects against damage caused by excess reactive oxygen species characteristic of sickle cell anemia. Results obtained with patients under treatment with hydroxyurea suggest an additional protective effect when associated with the use of flavonoids.
  • Bone marrow transplantation and acute myeloid leukemia: Brazilian guidelines Special Article

    Silla, Lucia Mariano da Rocha; Dulley, Frederico; Saboya, Rosaura; Paton, Eduardo; Kerbauy, Fabio; Arantes, Adriano de Moraes; Hamerschlak, Nelson
  • Immunological characteristics of mesenchymal stem cells Review Article

    Machado, Cíntia de Vasconcellos; Telles, Paloma Dias da Silva; Nascimento, Ivana Lucia Oliveira

    Resumo em Inglês:

    Although bone marrow is the main source, mesenchymal stem cells have already been isolated from various other tissues, such as the liver, pancreas, adipose tissue, peripheral blood and dental pulp. These plastic adherent cells are morphologically similar to fibroblasts and have a high proliferative potential. This special group of cells possesses two essential characteristics: self-renewal and differentiation, with appropriate stimuli, into various cell types. Mesenchymal stem cells are considered immunologically privileged, since they do not express costimulatory molecules, required for complete T cell activation, on their surface. Several studies have shown that these cells exert an immunosuppressive effect on cells from both innate and acquired immunity systems. Mesenchymal stem cells can regulate the immune response in vitro by inhibiting the maturation of dendritic cells, as well as by suppressing the proliferation and function of T and B lymphocytes and natural killer cells. These special properties of mesenchymal stem cells make them a promising strategy in the treatment of immune mediated disorders, such as graft-versus-host disease and autoimmune diseases, as well as in regenerative medicine. The understanding of immune regulation mechanisms of mesenchymal stem cells, and also those involved in the differentiation of these cells in various lineages is primordial for their successful and safe application in different areas of medicine.
  • Testicular myeloid sarcoma: case report Case Report

    Zago, Luzia Beatriz Ribeiro; Ladeia, Antônio Alexandre Lisbôa; Etchebehere, Renata Margarida; Oliveira, Leonardo Rodrigues de

    Resumo em Inglês:

    Myeloid sarcomas are extramedullary solid tumors composed of immature granulocytic precursor cells. In association with acute myeloid leukemia and other myeloproliferative disorders, they may arise concurrently with compromised bone marrow related to acute myeloid leukemia, as a relapsed presentation, or occur as the first manifestation. The testicles are considered to be an uncommon site for myeloid sarcomas. No therapeutic strategy has been defined as best but may include chemotherapy, radiotherapy and/or hematopoietic stem cell transplantation. This study reports the evolution of a patient with testicular myeloid sarcoma as the first manifestation of acute myeloid leukemia. The patient initially refused medical treatment and died five months after the clinical condition started.
  • Beta-S globin haplotypes in patients with sickle cell anemia: one approach to understand the diversity in Brazil Letter To Editor

    Okumura, Jéssika Viviani; Lobo, Clarisse Lopes de Castro; Bonini-Domingos, Claudia Regina
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