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<jats:p><jats:bold>BACKGROUND:</jats:bold> Acetaminophen and diphenhydramine are commonly used as pretransfusion medications to prevent transfusion reactions. The purpose of this study was to prospectively compare the risk of transfusion reactions in hematology/oncology patients who receive acetaminophen with diphenhydramine or placebo before transfusion.</jats:p><jats:p><jats:bold>STUDY DESIGN AND METHODS:</jats:bold> A randomized, double‐blind, placebo‐controlled transfusion reaction study of 315 eligible patients was performed. Inclusion criteria were patients aged 18 to 65 years admitted to the leukemia or bone marrow transplant (BMT) services. Patients were excluded if they had a known allergy to either acetaminophen or diphenhydramine or had a documented history of a febrile or allergic transfusion reaction. All blood products were administered using a leukofilter. Study medications were given 30 minutes before transfusions and no other acetaminophen or diphenhydramine was given within 4 hours of administration of the study medications. Patients were monitored for the development of reaction symptoms within 4 hours after the transfusion.</jats:p><jats:p><jats:bold>RESULTS:</jats:bold> A total of 154 active drug patients were compared to 161 placebo patients. There was no significant difference in the overall risk of transfusion reactions between the two groups. However, analysis of specific reaction types revealed a significant decrease in the risk of febrile reactions when pretransfusion medication is used in addition to bedside leukoreduction.</jats:p><jats:p><jats:bold>CONCLUSIONS:</jats:bold> Pretransfusion medication of leukemia or BMT patients without a history of transfusion reaction does not decrease the overall risk of transfusion reactions. However, pretransfusion medication may decrease the risk of febrile nonhemolytic transfusion reactions to leukoreduced blood products.</jats:p>

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Red blood cell alloimmunization is the first cause of fetal and neonatal anemia. Alloimmunizations with anti‐PP1P<jats:sup>k</jats:sup> or anti‐P can cause recurrent miscarriages and hemolytic disease of the fetus and newborn in the 2nd and 3rd trimesters of pregnancy. We report on a pregnant patient immunized with anti‐P and a history of recurrent miscarriages.</jats:p></jats:sec><jats:sec><jats:title>Case Report</jats:title><jats:p>This P<jats:sub>2</jats:sub><jats:sup>k</jats:sup> (GLOB:‐1; P1PK:‐1,3) patient had a first pregnancy marked by a caesarean at 38 weeks of gestation (WG) for non‐reassuring fetal heart rate. Then, she had three early spontaneous miscarriages. The fifth pregnancy began with a high titer of anti‐P at 128. Early initiation of treatment with Intravenous Immunoglobulins (IVIg) and plasma exchanges (PE) starting at 5 WG permitted us to reduce the titer of anti‐P below 32. A healthy infant was delivered by caesarean at 38 WG without anemia at birth and no exchange transfusion was required.</jats:p></jats:sec><jats:sec><jats:title>Discussion and Review of the Literature</jats:title><jats:p>The P and P<jats:sup>k</jats:sup> antigens are expressed on placental, trophoblastic, and embryonic cells. This explains why P<jats:sub>1</jats:sub><jats:sup>k</jats:sup> (GLOB:‐1; P1PK:1,3), P<jats:sub>2</jats:sub><jats:sup>k</jats:sup> (GLOB:‐1; P1PK:‐1,3), or Tj(a‐)/p (GLOB:‐1; P1PK:‐1,‐3) patients are prone to recurrent abortions in the first trimester of pregnancy. A literature review demonstrated 87% (68/78) of miscarriages in p patients. However, publication biases are possible with the most severe cases being reported.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Immunizations to P and PP1P<jats:sup>k</jats:sup> antigens differ from others in their physiopathology and precocity. The association of PE and IVIg seems to be an effective treatment in the management of anti‐PP1P<jats:sup>k</jats:sup> or anti‐P fetomaternal incompatibilities.</jats:p></jats:sec>