Alfredo Mendrone | Universidade de São Paulo (original) (raw)

Papers by Alfredo Mendrone

Research paper thumbnail of A comprehensive protocol to evaluate the use of blood and its components in Latin America and the Caribbean

Revista panamericana de salud pública = Pan American journal of public health, 2015

Blood transfusion safety is a critical part of appropriate health care. Considering the limited i... more Blood transfusion safety is a critical part of appropriate health care. Considering the limited information available on the use of blood and its components in Latin America and the Caribbean, the Grupo Cooperativo iberoamericano de Medicina Transfusional (Ibero-American Cooperative Group for Transfusion Medicine; GCIAMT), through its Research and International Affairs committees, carried out a project to develop a protocol that would facilitate the evaluation of blood usage at the country, jurisdiction, and institutional levels in varied country contexts. Experts in blood safety from the Pan American Health Organization (Washington, DC, United States), the University of São Paulo (São Paulo, Brazil), the Hemocentro of São Paulo (São Paulo, Brazil), and GCIAMT designed a 2-step comprehensive blood-use evaluation protocol: step 1 collects data from blood requests, and step 2, from medical charts. At a minimum, 1 000 analyzed requests are necessary; as such, study periods vary dependi...

Research paper thumbnail of Risk factors for human immunodeficiency virus infection among blood donors in Sao Paulo, Brazil, and their relevance to current donor deferral criteria

Transfusion

BACKGROUND: The objective of this study was to investigate risk factors of human immunodeficiency... more BACKGROUND: The objective of this study was to investigate risk factors of human immunodeficiency virus (HIV)-seropositive blood donors in Brazil and to determine if current donor deferral criteria are appropriate.STUDY DESIGN AND METHODS: Demographic and behavioral data among cases with confirmed HIV seropositivity (n = 272) were compared with those who had a false-positive serology (n = 468) between January 1999 and December 2003 in a case-control analysis with logistic regression.RESULTS: Risk factors that should have resulted in predonation deferral were reported by 48.9 percent of HIV-positive and 9.4 percent of false-positive donors. In multivariate analysis, male cases were significantly more likely to report male-male sex (adjusted odds ratio [AOR], 26.2; 95% confidence interval [CI], 7.8-87.4), a previous sexually transmitted disease diagnosis (AOR, 3.2; 95% CI, 1.5-6.9), exchanging money for sex (AOR, 2.1; 95% CI, 1.0-4.2), and at least two partners in the past 12 months (...

Research paper thumbnail of Patavino #SP Transfusion 2012

BACKGROUND: Brazilian blood centers ask candidate blood donors about the number of sexual partner... more BACKGROUND: Brazilian blood centers ask candidate blood donors about the number of sexual partners in the past 12 months. Candidates who report a number over the limit are deferred. We studied the implications of this practice on blood safety. STUDY DESIGN AND METHODS: We analyzed demographic characteristics, number of heterosexual partners, and disease marker rates among 689,868 donations from three Brazilian centers between July 2007 and December 2009. Donors were grouped based on maximum number of partners allowed in the past 12 months for each center. Chi-square and logistic regression analysis were conducted to examine associations between demographic characteristics, number of sex partners, and individual and overall positive markers rates for human immunodeficiency virus (HIV), human T-lymphotropic virus Types 1 and 2, hepatitis B virus, hepatitis C virus, and syphilis. RESULTS: First-time, younger, and more educated donors were associated with a higher number of recent sexual partners, as was male sex in São Paulo and Recife (p < 0.001). Serologic markers for HIV and syphilis and overall were associated with multiple partners in São Paulo and Recife (p < 0.001), but not in Belo Horizonte (p = 0.05, p = 0.94, and p = 0.75, respectively). In logistic regression analysis, number of recent sexual partners was associated with positive serologic markers (adjusted odds ratio [AOR], 1.2-1.5), especially HIV (AOR, 1.9-4.4). CONCLUSIONS: Number of recent heterosexual partners was associated with HIV positivity and overall rates of serologic markers of sexually transmitted infections. The association was not consistent across centers, making it difficult to define the best cutoff value. These findings suggest the use of recent heterosexual contacts as a potentially important deferral criterion to improve blood safety in Brazil. ABBREVIATIONS: AOR(s) = adjusted odds ratio(s);

Research paper thumbnail of Autologous hematopoietic stem cell transplantation for mantle cell lymphoma

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2000

This study evaluated the outcomes of patients who underwent high-dose chemotherapy (HDC) and auto... more This study evaluated the outcomes of patients who underwent high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (autoHSCT) for mantle cell non-Hodgkin's lymphoma and the effect of clinical and treatment characteristics. The clinical outcome and prognostic factors in 40 patients who underwent HDC and autoHSCT for mantle cell lymphoma between June 1991 and August 1998 were analyzed. With a median follow-up of 24 months for the surviving patients (range, 4-68 months), the 2-year overall survival was 65% and the 2-year event-free survival (EFS) was 36%. In univariate analysis, characteristics predictive of a poor EFS were blastic morphology (P = .019) and the patient having received 3 or more prior chemotherapy regimens (P = .004). In a multivariate analysis, the only factor associated with a poor EFS was the number of prior chemotherapy regimens. Those patients who received 3 or more prior therapies had a 2-year EFS of 0%, and those who received <...

Research paper thumbnail of Impacto da recusa de candidatos à doação de sangue devido aos critérios para prevenção da doença de Creutzfeldt-Jacob e sua variante

Revista Brasileira de Hematologia e Hemoterapia, 2005

A doença de Creutzfeldt-Jacob (CJD) e sua variante (vCJD) são doenças neurológicas fatais, degene... more A doença de Creutzfeldt-Jacob (CJD) e sua variante (vCJD) são doenças neurológicas fatais, degenerativas, com longo período de incubação. Recentemente, um possível caso de transmissão de vCJD por transfusão sangüínea foi descrito. A partir de 2001 adotamos critérios para recusa de candidatos baseados em dados da literatura, Portarias e Resoluções do Ministério da Saúde. Avaliamos retrospectivamente o porcentual de recusas anuais na triagem clínica de 1.015.587 candidatos à doação, referentes aos critérios relacionados a CJD e vCJD, de janeiro de 2001 a dezembro de 2004. Este porcentual correspondeu a 0,0049% em 2001, 0,0051% em 2002, 0,092% em 2003 e 0,098% em 2004, representando recusa definitiva de 726 (0,068%) candidatos. A causa mais freqüente de recusa por CJD ou vCJD foi permanência no Reino Unido > 6 meses (259 recusas) seguido de transplante de córnea (203 recusas) e uso de hormônio do crescimento de origem humana (151 recusas). Embora o número de recusas relacionados a CJD e sua variante seja baixo em nossa Instituição, observamos um aumento gradativo anual, que provavelmente relaciona-se à adição de novos critérios. Diferentemente de outros países, estas recusas não afetaram nosso estoque de sangue e componentes. Com os dados obtidos, consideramos que, na nossa população, podemos manter o "Princípio da Precaução" sem causar prejuízo no fornecimento de sangue e componentes aos nossos pacientes. Rev. bras. hematol. hemoter. 2005; 27(2):106-109. Palavras-chave: Doadores de sangue; Doença de Creutzfeldt-Jacob; príons.

Research paper thumbnail of Prevalência da infecção pelo citomegalovírus: a importância de estudos locais

Revista Brasileira de Hematologia e Hemoterapia, 2010

Research paper thumbnail of Sangue periférico como fonte de células para terapia celular

Revista Brasileira de Hematologia e Hemoterapia, 2009

Research paper thumbnail of Does offering human immunodeficiency virus testing at the time of blood donation reduce transfusion transmission risk and increase disclosure counseling? Results of a randomized controlled trial, São Paulo, Brazil

Transfusion, 2015

In a randomized controlled trial (RCT) in a blood bank in São Paulo, we tested the hypotheses tha... more In a randomized controlled trial (RCT) in a blood bank in São Paulo, we tested the hypotheses that offering client-centered human immunodeficiency virus (HIV) counseling and testing to blood donors would: 1) reduce the risk of HIV contamination in the blood supply by diverting higher-risk, test-seeking donors away from donation and 2) increase return for results and referrals to care. We randomly selected weeks between August 2012 and May 2013 when donors were offered HIV counseling and testing (n = 6298), leaving usual procedure weeks as control (n = 5569). Few candidate donors chose HIV testing (n = 81, 1.3%). There was no significant difference in herpes simplex virus Type 2 (HSV-2) prevalence (a marker of sexual risk) among donors during intervention weeks compared to control (10.4% vs. 11.1%, p = 0.245). No donor choosing testing was HIV infected, and there was no difference in HSV-2 prevalence between testers and donors (9.9% vs. 10.4%, p = 0.887). Returning for positive results did not differ between testers and donors (three of three vs. 58 of 80, p = 0.386). A higher proportion of donors acknowledged that HIV testing was a strong motivation to donate during intervention weeks compared to control (2.6% vs. 2.0%, p = 0.032). The evidence of our RCT is that offering HIV counseling and testing at the time of donation would not change the risk of contamination in the blood supply, nor improve results disclosure and referral to care.

Research paper thumbnail of Apheresis in developing countries around the World

Journal of Clinical Apheresis, 2014

Research paper thumbnail of Real-time symptomatic case of transfusion-transmitted dengue

Transfusion, 2015

Dengue virus transmission by blood transfusion is a rarely reported event. During a dengue outbre... more Dengue virus transmission by blood transfusion is a rarely reported event. During a dengue outbreak in São Paulo city, a regular plateletpheresis donor informed the blood bank of being diagnosed a few days after donation. The recipient was hospitalized and displayed symptoms and laboratory evidence of dengue after transfusion. The donor was immunoglobulin (Ig)G, IgM, and polymerase chain reaction nonreactive on the index sample, seroconverting 20 days later. The platelet units were transfused into two patients. One of them developed fever 3 days after transfusion, with high viral load. His pretransfusion sample was negative for IgG, IgM, and dengue RNA, while the second recipient did not show any symptoms nor laboratory evidence of dengue infection. This case brings additional evidence that dengue is indeed transmissible by blood transfusion and clinical manifestations, although rare, do occur.

Research paper thumbnail of Is there justification for universal leukoreduction?

Revista Brasileira de Hematologia e Hemoterapia, 2014

rev bras hematol hemoter. 2 0 1 4;3 6(4):237

Research paper thumbnail of Alpha-1-antitrypsin deficiency associated with panniculitis treated with plasma exchange therapy

International Journal of Dermatology, 2004

Background Alpha-1-antitrypsin is the principal serum protease inhibitor. In addition to the well... more Background Alpha-1-antitrypsin is the principal serum protease inhibitor. In addition to the well-recognized association with early-onset emphysema and cirrhosis, alpha-1-antitrypsin deficiency may be associated with panniculitis. The treatment of this type of panniculitis presents a significant challenge. Previous attempts using immunosuppressive, antiinflammatory, and cytotoxic drugs have shown variable results.

Research paper thumbnail of The impact of policies to restrict the use of plasma containing products and apheresis platelets from female donors to mitigate transfusion related acute lung injury (TRALI) in Brazil

Transfusion and Apheresis Science, 2013

Background and Objectives: Although the incidence of TRALI is unknown in Brazil, some blood cente... more Background and Objectives: Although the incidence of TRALI is unknown in Brazil, some blood centers have adopted strategies to prevent TRALI. We evaluated the impact of three policies to mitigate TRALI on the supply of blood products: to divert the production of whole blood-derived plasma from female donors; to defer all female donors from apheresis platelet collections, and to defer only multiparous female donors from apheresis platelet collections. Materials and Methods: Data from allogeneic whole blood and apheresis platelet donations from April 2008 to December 2009 were collected in three Brazilian blood centers and the impact of the aforementioned strategies was evaluated. Results: Of 544,814 allogeneic blood donations, 30.8% of whole blood plasma and 24.1% of apheresis platelet donations would be reduced if only male donor plasma was issued for transfusion and all female donors were deferred from apheresis donation, respectively. If only multiparous donors were deferred from apheresis donation, there would be a 5% decrease of all apheresis platelet collections. Conclusion: Restricting the use of whole blood derived plasma to male-only donors and deferring all female apheresis platelet donors would impact two out of three Brazilian blood centers. A deferral policy on multiparous apheresis platelet donors may be acceptable as a temporary measure, but may cause more stress on a system that is already working at its limit.

Research paper thumbnail of Impact of allogeneic 2-RBC apheresis on iron stores of Brazilian blood donors

Transfusion and Apheresis Science, 2009

One limiting factor for automated two-red blood cells collections (2-RBC) is its potential iron d... more One limiting factor for automated two-red blood cells collections (2-RBC) is its potential iron depletion. We analyzed hematological parameters and iron balance before, two and four months after 2-RBC of 96 non-supplemented male donors. Four months after 2-RBC, ferritin level was significantly lower (P < 0.01) than baseline levels and the number of donors who presented ferritin <30 ng/ml increased from 18 to 47. We concluded that four months was not sufficient for iron recuperation in the population studied. In an attempt to avoid iron depletion after 2-RBC, we recommend augmentation in the interval between blood donations and pre-donation ferritin measurement.

Research paper thumbnail of Factors affecting hematopoietic progenitor cell mobilization: An analysis of 307 patients

Transfusion and Apheresis Science, 2008

We reviewed the data of 307 patients treated with autologous bone marrow transplantation with the... more We reviewed the data of 307 patients treated with autologous bone marrow transplantation with the aim to identify factors associated with poor hematopoietic stem cell (HSC) mobilization after administration of cyclophosphamide and granulocyte-colony stimulating factor. Success in mobilization was defined when &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 2.0 x 10(6) CD34+ cells/kg weight could be collected with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 3 leukapheresis procedures. Success was observed in 260 patients (84.7%) and nonsuccess in 47 patients (15.3%). According to the stepwise regression model: diagnosis, chemotherapy load, treatment with mitoxantrone and platelet count before mobilization were found to be independent predictive factors for HSC mobilization. These results could help in the previous recognition of patients at risk for non response to mobilization and allow to plan an alternative protocol for this group of patients.

Research paper thumbnail of Profile of blood donors with serologic tests reactive for the presence of syphilis in São Paulo, Brazil

Transfusion, 2009

BACKGROUND-Syphilis screening of blood donors is a common practice worldwide, but very little is ... more BACKGROUND-Syphilis screening of blood donors is a common practice worldwide, but very little is known about the meaning of a positive serologic test for syphilis in blood donors and the risk profile of these donors. The aim of this study was to determine the demographic characteristics and risk behaviors of blood donors with recent and past syphilis and their implications for blood bank testing and deferral strategies.

Research paper thumbnail of Analysis of donor deferral at three blood centers in Brazil

Research paper thumbnail of Anemia screening in potential female blood donors: comparison of two different quantitative methods

Transfusion, 2009

BACKGROUND: Anemia screening before blood donation requires an accurate, quick, practical, and ea... more BACKGROUND: Anemia screening before blood donation requires an accurate, quick, practical, and easy method with minimal discomfort for the donors. The aim of this study was to compare the accuracy of two quantitative methods of anemia screening: the HemoCue 201 + (Aktiebolaget Leo Diagnostics) hemoglobin (Hb) and microhematocrit (micro-Hct) tests. STUDY DESIGN AND METHODS: Two blood samples of a single fingerstick were obtained from 969 unselected potential female donors to determine the Hb by HemoCue 201 + and micro-Hct using HemataSTAT II (Separation Technology, Inc.), in alternating order. From each participant, a venous blood sample was drawn and run in an automatic hematology analyzer (ABX Pentra 60, ABX Diagnostics). Considering results of ABX Pentra 60 as true values, the sensitivity and specificity of HemoCue 201 + and micro-Hct as screening methods were compared, using a venous Hb level of 12.0 g per dL as cutoff for anemia. RESULTS: The sensitivities of the HemoCue 201 + and HemataSTAT II in detecting anemia were 56 percent (95% confidence interval [CI], 46.1%-65.5%) and 39.5 percent (95% CI, 30.2%-49.3%), respectively (p < 0.001). Analyzing only candidates with a venous Hb level lower than 11.0 g per dL, the deferral rate was 100 percent by HemoCue 201 + and 77 percent by HemataSTAT II. The specificities of the methods were 93.5 and 93.2 percent, respectively. CONCLUSION: The HemoCue 201 + showed greater discriminating power for detecting anemia in prospective blood donors than the micro-Hct method. Both presented equivalent deferral error rates of nonanemic potential donors. Compared to the micro-Hct, HemoCue 201 + reduces the risk of anemic female donors giving blood, specially for those with lower Hb levels, without increasing the deferral of nonanemic potential donors. ABBREVIATIONS: HiCN = hemiglobincyanide; micro-Hct = microhematocrit. From the Fundação Total 969 117 101 * Data are reported as number (%).

Research paper thumbnail of Interdonation intervals and patterns of return among blood donors in Brazil

Transfusion, 2012

Background-In Brazil, most of donations come from repeat donors, but there is little data on retu... more Background-In Brazil, most of donations come from repeat donors, but there is little data on return behavior of donors.

Research paper thumbnail of Prevalence of serologic markers for hepatitis B and C viruses in Brazilian blood donors and incidence and residual risk of transfusion transmission of hepatitis C virus

Transfusion, 2013

We evaluate the current prevalence of serologic markers for hepatitis B virus (HBV) and hepatitis... more We evaluate the current prevalence of serologic markers for hepatitis B virus (HBV) and hepatitis C virus (HCV) in blood donors and estimated HCV incidence and residual transfusion-transmitted risk at three large Brazilian blood centers. STUDY DESIGN AND METHODS: Data on whole blood and platelet donations were collected from January through December 2007, analyzed by center; donor type; age; sex; donation status; and serologic results for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc), and anti-HCV. HBV and HCV prevalence rates were calculated for all first-time donations. HCV incidence was derived including interdonation intervals that preceded first repeat donations given during the study, and HCV residual risk was estimated for transfusions derived from repeat donors. RESULTS: There were 307,354 donations in 2007. Overall prevalence of concordant HBsAg and anti-HBc reactivity was 289 per 100,000 donations and of anti-HCV confirmed reactivity 191 per 100,000 donations. There were significant associations between older age and hepatitis markers, especially for HCV. HCV incidence was 3.11 (95% confidence interval, 0.77-7.03) per 100,000 person-years, and residual risk of HCV window-phase infections was estimated at 5.0 per million units transfused. CONCLUSION: Improvement in donor selection, socioeconomic conditions, and preventive measures, implemented over time, may have helped to decrease prevalence of HBV and HCV, relative to previous reports. Incidence and residual risk of HCV are also diminishing. Ongoing monitoring of HBV and HCV markers among Brazilian blood donors should help guide improved recruitment procedures, donor selection, laboratory screening, and counseling strategies.

Research paper thumbnail of A comprehensive protocol to evaluate the use of blood and its components in Latin America and the Caribbean

Revista panamericana de salud pública = Pan American journal of public health, 2015

Blood transfusion safety is a critical part of appropriate health care. Considering the limited i... more Blood transfusion safety is a critical part of appropriate health care. Considering the limited information available on the use of blood and its components in Latin America and the Caribbean, the Grupo Cooperativo iberoamericano de Medicina Transfusional (Ibero-American Cooperative Group for Transfusion Medicine; GCIAMT), through its Research and International Affairs committees, carried out a project to develop a protocol that would facilitate the evaluation of blood usage at the country, jurisdiction, and institutional levels in varied country contexts. Experts in blood safety from the Pan American Health Organization (Washington, DC, United States), the University of São Paulo (São Paulo, Brazil), the Hemocentro of São Paulo (São Paulo, Brazil), and GCIAMT designed a 2-step comprehensive blood-use evaluation protocol: step 1 collects data from blood requests, and step 2, from medical charts. At a minimum, 1 000 analyzed requests are necessary; as such, study periods vary dependi...

Research paper thumbnail of Risk factors for human immunodeficiency virus infection among blood donors in Sao Paulo, Brazil, and their relevance to current donor deferral criteria

Transfusion

BACKGROUND: The objective of this study was to investigate risk factors of human immunodeficiency... more BACKGROUND: The objective of this study was to investigate risk factors of human immunodeficiency virus (HIV)-seropositive blood donors in Brazil and to determine if current donor deferral criteria are appropriate.STUDY DESIGN AND METHODS: Demographic and behavioral data among cases with confirmed HIV seropositivity (n = 272) were compared with those who had a false-positive serology (n = 468) between January 1999 and December 2003 in a case-control analysis with logistic regression.RESULTS: Risk factors that should have resulted in predonation deferral were reported by 48.9 percent of HIV-positive and 9.4 percent of false-positive donors. In multivariate analysis, male cases were significantly more likely to report male-male sex (adjusted odds ratio [AOR], 26.2; 95% confidence interval [CI], 7.8-87.4), a previous sexually transmitted disease diagnosis (AOR, 3.2; 95% CI, 1.5-6.9), exchanging money for sex (AOR, 2.1; 95% CI, 1.0-4.2), and at least two partners in the past 12 months (...

Research paper thumbnail of Patavino #SP Transfusion 2012

BACKGROUND: Brazilian blood centers ask candidate blood donors about the number of sexual partner... more BACKGROUND: Brazilian blood centers ask candidate blood donors about the number of sexual partners in the past 12 months. Candidates who report a number over the limit are deferred. We studied the implications of this practice on blood safety. STUDY DESIGN AND METHODS: We analyzed demographic characteristics, number of heterosexual partners, and disease marker rates among 689,868 donations from three Brazilian centers between July 2007 and December 2009. Donors were grouped based on maximum number of partners allowed in the past 12 months for each center. Chi-square and logistic regression analysis were conducted to examine associations between demographic characteristics, number of sex partners, and individual and overall positive markers rates for human immunodeficiency virus (HIV), human T-lymphotropic virus Types 1 and 2, hepatitis B virus, hepatitis C virus, and syphilis. RESULTS: First-time, younger, and more educated donors were associated with a higher number of recent sexual partners, as was male sex in São Paulo and Recife (p < 0.001). Serologic markers for HIV and syphilis and overall were associated with multiple partners in São Paulo and Recife (p < 0.001), but not in Belo Horizonte (p = 0.05, p = 0.94, and p = 0.75, respectively). In logistic regression analysis, number of recent sexual partners was associated with positive serologic markers (adjusted odds ratio [AOR], 1.2-1.5), especially HIV (AOR, 1.9-4.4). CONCLUSIONS: Number of recent heterosexual partners was associated with HIV positivity and overall rates of serologic markers of sexually transmitted infections. The association was not consistent across centers, making it difficult to define the best cutoff value. These findings suggest the use of recent heterosexual contacts as a potentially important deferral criterion to improve blood safety in Brazil. ABBREVIATIONS: AOR(s) = adjusted odds ratio(s);

Research paper thumbnail of Autologous hematopoietic stem cell transplantation for mantle cell lymphoma

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2000

This study evaluated the outcomes of patients who underwent high-dose chemotherapy (HDC) and auto... more This study evaluated the outcomes of patients who underwent high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (autoHSCT) for mantle cell non-Hodgkin's lymphoma and the effect of clinical and treatment characteristics. The clinical outcome and prognostic factors in 40 patients who underwent HDC and autoHSCT for mantle cell lymphoma between June 1991 and August 1998 were analyzed. With a median follow-up of 24 months for the surviving patients (range, 4-68 months), the 2-year overall survival was 65% and the 2-year event-free survival (EFS) was 36%. In univariate analysis, characteristics predictive of a poor EFS were blastic morphology (P = .019) and the patient having received 3 or more prior chemotherapy regimens (P = .004). In a multivariate analysis, the only factor associated with a poor EFS was the number of prior chemotherapy regimens. Those patients who received 3 or more prior therapies had a 2-year EFS of 0%, and those who received <...

Research paper thumbnail of Impacto da recusa de candidatos à doação de sangue devido aos critérios para prevenção da doença de Creutzfeldt-Jacob e sua variante

Revista Brasileira de Hematologia e Hemoterapia, 2005

A doença de Creutzfeldt-Jacob (CJD) e sua variante (vCJD) são doenças neurológicas fatais, degene... more A doença de Creutzfeldt-Jacob (CJD) e sua variante (vCJD) são doenças neurológicas fatais, degenerativas, com longo período de incubação. Recentemente, um possível caso de transmissão de vCJD por transfusão sangüínea foi descrito. A partir de 2001 adotamos critérios para recusa de candidatos baseados em dados da literatura, Portarias e Resoluções do Ministério da Saúde. Avaliamos retrospectivamente o porcentual de recusas anuais na triagem clínica de 1.015.587 candidatos à doação, referentes aos critérios relacionados a CJD e vCJD, de janeiro de 2001 a dezembro de 2004. Este porcentual correspondeu a 0,0049% em 2001, 0,0051% em 2002, 0,092% em 2003 e 0,098% em 2004, representando recusa definitiva de 726 (0,068%) candidatos. A causa mais freqüente de recusa por CJD ou vCJD foi permanência no Reino Unido > 6 meses (259 recusas) seguido de transplante de córnea (203 recusas) e uso de hormônio do crescimento de origem humana (151 recusas). Embora o número de recusas relacionados a CJD e sua variante seja baixo em nossa Instituição, observamos um aumento gradativo anual, que provavelmente relaciona-se à adição de novos critérios. Diferentemente de outros países, estas recusas não afetaram nosso estoque de sangue e componentes. Com os dados obtidos, consideramos que, na nossa população, podemos manter o "Princípio da Precaução" sem causar prejuízo no fornecimento de sangue e componentes aos nossos pacientes. Rev. bras. hematol. hemoter. 2005; 27(2):106-109. Palavras-chave: Doadores de sangue; Doença de Creutzfeldt-Jacob; príons.

Research paper thumbnail of Prevalência da infecção pelo citomegalovírus: a importância de estudos locais

Revista Brasileira de Hematologia e Hemoterapia, 2010

Research paper thumbnail of Sangue periférico como fonte de células para terapia celular

Revista Brasileira de Hematologia e Hemoterapia, 2009

Research paper thumbnail of Does offering human immunodeficiency virus testing at the time of blood donation reduce transfusion transmission risk and increase disclosure counseling? Results of a randomized controlled trial, São Paulo, Brazil

Transfusion, 2015

In a randomized controlled trial (RCT) in a blood bank in São Paulo, we tested the hypotheses tha... more In a randomized controlled trial (RCT) in a blood bank in São Paulo, we tested the hypotheses that offering client-centered human immunodeficiency virus (HIV) counseling and testing to blood donors would: 1) reduce the risk of HIV contamination in the blood supply by diverting higher-risk, test-seeking donors away from donation and 2) increase return for results and referrals to care. We randomly selected weeks between August 2012 and May 2013 when donors were offered HIV counseling and testing (n = 6298), leaving usual procedure weeks as control (n = 5569). Few candidate donors chose HIV testing (n = 81, 1.3%). There was no significant difference in herpes simplex virus Type 2 (HSV-2) prevalence (a marker of sexual risk) among donors during intervention weeks compared to control (10.4% vs. 11.1%, p = 0.245). No donor choosing testing was HIV infected, and there was no difference in HSV-2 prevalence between testers and donors (9.9% vs. 10.4%, p = 0.887). Returning for positive results did not differ between testers and donors (three of three vs. 58 of 80, p = 0.386). A higher proportion of donors acknowledged that HIV testing was a strong motivation to donate during intervention weeks compared to control (2.6% vs. 2.0%, p = 0.032). The evidence of our RCT is that offering HIV counseling and testing at the time of donation would not change the risk of contamination in the blood supply, nor improve results disclosure and referral to care.

Research paper thumbnail of Apheresis in developing countries around the World

Journal of Clinical Apheresis, 2014

Research paper thumbnail of Real-time symptomatic case of transfusion-transmitted dengue

Transfusion, 2015

Dengue virus transmission by blood transfusion is a rarely reported event. During a dengue outbre... more Dengue virus transmission by blood transfusion is a rarely reported event. During a dengue outbreak in São Paulo city, a regular plateletpheresis donor informed the blood bank of being diagnosed a few days after donation. The recipient was hospitalized and displayed symptoms and laboratory evidence of dengue after transfusion. The donor was immunoglobulin (Ig)G, IgM, and polymerase chain reaction nonreactive on the index sample, seroconverting 20 days later. The platelet units were transfused into two patients. One of them developed fever 3 days after transfusion, with high viral load. His pretransfusion sample was negative for IgG, IgM, and dengue RNA, while the second recipient did not show any symptoms nor laboratory evidence of dengue infection. This case brings additional evidence that dengue is indeed transmissible by blood transfusion and clinical manifestations, although rare, do occur.

Research paper thumbnail of Is there justification for universal leukoreduction?

Revista Brasileira de Hematologia e Hemoterapia, 2014

rev bras hematol hemoter. 2 0 1 4;3 6(4):237

Research paper thumbnail of Alpha-1-antitrypsin deficiency associated with panniculitis treated with plasma exchange therapy

International Journal of Dermatology, 2004

Background Alpha-1-antitrypsin is the principal serum protease inhibitor. In addition to the well... more Background Alpha-1-antitrypsin is the principal serum protease inhibitor. In addition to the well-recognized association with early-onset emphysema and cirrhosis, alpha-1-antitrypsin deficiency may be associated with panniculitis. The treatment of this type of panniculitis presents a significant challenge. Previous attempts using immunosuppressive, antiinflammatory, and cytotoxic drugs have shown variable results.

Research paper thumbnail of The impact of policies to restrict the use of plasma containing products and apheresis platelets from female donors to mitigate transfusion related acute lung injury (TRALI) in Brazil

Transfusion and Apheresis Science, 2013

Background and Objectives: Although the incidence of TRALI is unknown in Brazil, some blood cente... more Background and Objectives: Although the incidence of TRALI is unknown in Brazil, some blood centers have adopted strategies to prevent TRALI. We evaluated the impact of three policies to mitigate TRALI on the supply of blood products: to divert the production of whole blood-derived plasma from female donors; to defer all female donors from apheresis platelet collections, and to defer only multiparous female donors from apheresis platelet collections. Materials and Methods: Data from allogeneic whole blood and apheresis platelet donations from April 2008 to December 2009 were collected in three Brazilian blood centers and the impact of the aforementioned strategies was evaluated. Results: Of 544,814 allogeneic blood donations, 30.8% of whole blood plasma and 24.1% of apheresis platelet donations would be reduced if only male donor plasma was issued for transfusion and all female donors were deferred from apheresis donation, respectively. If only multiparous donors were deferred from apheresis donation, there would be a 5% decrease of all apheresis platelet collections. Conclusion: Restricting the use of whole blood derived plasma to male-only donors and deferring all female apheresis platelet donors would impact two out of three Brazilian blood centers. A deferral policy on multiparous apheresis platelet donors may be acceptable as a temporary measure, but may cause more stress on a system that is already working at its limit.

Research paper thumbnail of Impact of allogeneic 2-RBC apheresis on iron stores of Brazilian blood donors

Transfusion and Apheresis Science, 2009

One limiting factor for automated two-red blood cells collections (2-RBC) is its potential iron d... more One limiting factor for automated two-red blood cells collections (2-RBC) is its potential iron depletion. We analyzed hematological parameters and iron balance before, two and four months after 2-RBC of 96 non-supplemented male donors. Four months after 2-RBC, ferritin level was significantly lower (P < 0.01) than baseline levels and the number of donors who presented ferritin <30 ng/ml increased from 18 to 47. We concluded that four months was not sufficient for iron recuperation in the population studied. In an attempt to avoid iron depletion after 2-RBC, we recommend augmentation in the interval between blood donations and pre-donation ferritin measurement.

Research paper thumbnail of Factors affecting hematopoietic progenitor cell mobilization: An analysis of 307 patients

Transfusion and Apheresis Science, 2008

We reviewed the data of 307 patients treated with autologous bone marrow transplantation with the... more We reviewed the data of 307 patients treated with autologous bone marrow transplantation with the aim to identify factors associated with poor hematopoietic stem cell (HSC) mobilization after administration of cyclophosphamide and granulocyte-colony stimulating factor. Success in mobilization was defined when &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 2.0 x 10(6) CD34+ cells/kg weight could be collected with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 3 leukapheresis procedures. Success was observed in 260 patients (84.7%) and nonsuccess in 47 patients (15.3%). According to the stepwise regression model: diagnosis, chemotherapy load, treatment with mitoxantrone and platelet count before mobilization were found to be independent predictive factors for HSC mobilization. These results could help in the previous recognition of patients at risk for non response to mobilization and allow to plan an alternative protocol for this group of patients.

Research paper thumbnail of Profile of blood donors with serologic tests reactive for the presence of syphilis in São Paulo, Brazil

Transfusion, 2009

BACKGROUND-Syphilis screening of blood donors is a common practice worldwide, but very little is ... more BACKGROUND-Syphilis screening of blood donors is a common practice worldwide, but very little is known about the meaning of a positive serologic test for syphilis in blood donors and the risk profile of these donors. The aim of this study was to determine the demographic characteristics and risk behaviors of blood donors with recent and past syphilis and their implications for blood bank testing and deferral strategies.

Research paper thumbnail of Analysis of donor deferral at three blood centers in Brazil

Research paper thumbnail of Anemia screening in potential female blood donors: comparison of two different quantitative methods

Transfusion, 2009

BACKGROUND: Anemia screening before blood donation requires an accurate, quick, practical, and ea... more BACKGROUND: Anemia screening before blood donation requires an accurate, quick, practical, and easy method with minimal discomfort for the donors. The aim of this study was to compare the accuracy of two quantitative methods of anemia screening: the HemoCue 201 + (Aktiebolaget Leo Diagnostics) hemoglobin (Hb) and microhematocrit (micro-Hct) tests. STUDY DESIGN AND METHODS: Two blood samples of a single fingerstick were obtained from 969 unselected potential female donors to determine the Hb by HemoCue 201 + and micro-Hct using HemataSTAT II (Separation Technology, Inc.), in alternating order. From each participant, a venous blood sample was drawn and run in an automatic hematology analyzer (ABX Pentra 60, ABX Diagnostics). Considering results of ABX Pentra 60 as true values, the sensitivity and specificity of HemoCue 201 + and micro-Hct as screening methods were compared, using a venous Hb level of 12.0 g per dL as cutoff for anemia. RESULTS: The sensitivities of the HemoCue 201 + and HemataSTAT II in detecting anemia were 56 percent (95% confidence interval [CI], 46.1%-65.5%) and 39.5 percent (95% CI, 30.2%-49.3%), respectively (p < 0.001). Analyzing only candidates with a venous Hb level lower than 11.0 g per dL, the deferral rate was 100 percent by HemoCue 201 + and 77 percent by HemataSTAT II. The specificities of the methods were 93.5 and 93.2 percent, respectively. CONCLUSION: The HemoCue 201 + showed greater discriminating power for detecting anemia in prospective blood donors than the micro-Hct method. Both presented equivalent deferral error rates of nonanemic potential donors. Compared to the micro-Hct, HemoCue 201 + reduces the risk of anemic female donors giving blood, specially for those with lower Hb levels, without increasing the deferral of nonanemic potential donors. ABBREVIATIONS: HiCN = hemiglobincyanide; micro-Hct = microhematocrit. From the Fundação Total 969 117 101 * Data are reported as number (%).

Research paper thumbnail of Interdonation intervals and patterns of return among blood donors in Brazil

Transfusion, 2012

Background-In Brazil, most of donations come from repeat donors, but there is little data on retu... more Background-In Brazil, most of donations come from repeat donors, but there is little data on return behavior of donors.

Research paper thumbnail of Prevalence of serologic markers for hepatitis B and C viruses in Brazilian blood donors and incidence and residual risk of transfusion transmission of hepatitis C virus

Transfusion, 2013

We evaluate the current prevalence of serologic markers for hepatitis B virus (HBV) and hepatitis... more We evaluate the current prevalence of serologic markers for hepatitis B virus (HBV) and hepatitis C virus (HCV) in blood donors and estimated HCV incidence and residual transfusion-transmitted risk at three large Brazilian blood centers. STUDY DESIGN AND METHODS: Data on whole blood and platelet donations were collected from January through December 2007, analyzed by center; donor type; age; sex; donation status; and serologic results for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc), and anti-HCV. HBV and HCV prevalence rates were calculated for all first-time donations. HCV incidence was derived including interdonation intervals that preceded first repeat donations given during the study, and HCV residual risk was estimated for transfusions derived from repeat donors. RESULTS: There were 307,354 donations in 2007. Overall prevalence of concordant HBsAg and anti-HBc reactivity was 289 per 100,000 donations and of anti-HCV confirmed reactivity 191 per 100,000 donations. There were significant associations between older age and hepatitis markers, especially for HCV. HCV incidence was 3.11 (95% confidence interval, 0.77-7.03) per 100,000 person-years, and residual risk of HCV window-phase infections was estimated at 5.0 per million units transfused. CONCLUSION: Improvement in donor selection, socioeconomic conditions, and preventive measures, implemented over time, may have helped to decrease prevalence of HBV and HCV, relative to previous reports. Incidence and residual risk of HCV are also diminishing. Ongoing monitoring of HBV and HCV markers among Brazilian blood donors should help guide improved recruitment procedures, donor selection, laboratory screening, and counseling strategies.