RESUMEN
Implementation of international guidelines in Latin American settings requires additional considerations (ie, values and preferences, resources, accessibility, feasibility, and impact on health equity). The purpose of this guideline is to provide evidence-based recommendations about the diagnosis of venous thromboembolism (VTE) and its management in children and during pregnancy. We used the GRADE ADOLOPMENT method to adapt recommendations from 3 American Society of Hematology (ASH) VTE guidelines (diagnosis of VTE, VTE in pregnancy, and VTE in the pediatric population). ASH and 12 local hematology societies formed a guideline panel comprising medical professionals from 10 countries in Latin America. Panelists prioritized 10 questions about the diagnosis of VTE and 18 questions about its management in special populations that were relevant for the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context. In comparison with the original guideline, there were significant changes in 2 of 10 diagnostic recommendations (changes in the diagnostic algorithms) and in 9 of 18 management recommendations (4 changed direction and 5 changed strength). This guideline ADOLOPMENT project highlighted the importance of contextualizing recommendations in other settings based on differences in values, resources, feasibility, and health equity impact.
Asunto(s)
Hematología , Tromboembolia Venosa , Femenino , Embarazo , Niño , Humanos , Estados Unidos , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiología , América Latina , Medicina Basada en la Evidencia/métodosRESUMEN
Las hemorragias y la enfermedad tromboembólica venosa (ETEV) figuran entre las cinco causas más frecuentes de morbilidad y mortalidad materna en el mundo. Revisamos la evaluación y el manejo actualizado de las causas obstétricas de la hemorragia posparto (HPP), así como el diagnóstico y manejo de condiciones hematológicas que pueden causar o agravar la HPP, por ejemplo: coagulación intravascular diseminada, enfermedad de von Willebrand, trombocitopenia autoinmune y las microangiopatías trombóticas. Revisamos el rol del síndrome antifosfolípido y las trombofilias hereditarias como factores predisponentes a pérdidas fetales recurrentes y la ETEV en el embarazo y las recomendaciones actuales para la prevención de ambas complicaciones. Asimismo, repasamos el abordaje diagnóstico y líneas de manejo de la ETEV. Un objetivo adicional fue enfatizar la importancia del trabajo colaborativo multidisciplinario para lograr el manejo exitoso de las gestantes con las complicaciones obstétricas y hematológicas descritas.
Bleeding and venous thromboembolism (VTE) are among the five most common causes of morbidity and mortality in pregnant women worldwide. This review describes the current evaluation and management of the obstetric causes of postpartum hemorrhage (PPH), as well as the diagnosis and management of hematologic conditions which can cause or worsen PPH, such as disseminated intravascular coagulation, von Willebrand disease, autoimmune thrombocytopenia and the thrombotic microangiopathies. It also describes the role of the antiphospholipid syndrome and inherited thrombophilia as predisposing factors for recurrent pregnancy loses and VTE, and the current recommendations for the prevention of both complications. As well, the current diagnostic approach and management of ETEV are described. An additional objective of this Review is to emphasize the importance of a collaborative multidisciplinary approach for the successful management of the obstetric and hematologic complications herein described.
RESUMEN
Introducción: La neutropenia congénita grave se define como el recuento de neutrófilos inferior a 500 células/mm3, se caracteriza por presentar infecciones a repetición en diferentes órganos desde los primeros meses de vida, además del riesgo de desarrollar una transformación leucémica. Reporte de caso: Lactante de 7 meses quien presentó abscesos a repetición desde el primer mes de edad, en el hemograma se evidenció neutropenia grave, posteriormente se diagnosticó leucemia mieloide aguda por citometría de flujo, finalmente falleció por choque séptico. Conclusión: Lactante con neutropenia congénita desarrolló una transformación leucémica no asociada a tratamiento previo con factor estimulante de granulocitos (G-CSF), se espera contar en un futuro con más estudios para poder determinar qué otros factores además del G-CSF están implicados en la transformación leucémica de los pacientes con neutropenia congénita para poder brindar mejores alternativas diagnósticas y terapéuticas en los pacientes afectados por esta enfermedad.
Background:Severe congenital neutropenia is defined as neutrophil count less than 500 cells/mm3, it is characterized by presenting repeated infections in different organs since the first months of life, in addition to the risk of developing leukemic transformation. A7-month-old infant Case report:presented with recurrent abscesses since the first month of life, progressive neutropenia in the hemogram, later acute myeloid leukemia was diagnosed by flow cytometry, and finally died of septic shock. Infant with Conclusion:congenital neutropenia developed a leukemic transformation not associated to previous treatment with granulocyte stimulating factor (G-CSF). More studies are expected in the future to determine which other factors besides G-CSF are involved in the leukemic transformation of patients with congenital neutropenia in order to provide better diagnostic and therapeutic alternatives in patients affected by this disease.
RESUMEN
BACKGROUND: From 2017 to 2020, the American Society of Hematology (ASH) collaborated with 12 hematology societies in Latin America to adapt the ASH guidelines on venous thromboembolism (VTE). OBJECTIVE: To describe the methods used to adapt the ASH guidelines on venous thromboembolism. METHODS: Each society nominated 1 individual to serve on the guideline panel. The work of the panel was facilitated by the 2 methodologists. The methods team selected 4 of the original VTE guidelines for a first round. To select the most relevant questions, a 2-step prioritization process was conducted through an on-line survey and then through in-person discussion. During an in-person meeting in Rio de Janeiro, Brazil, from 23 April through 26 April 2018, the panel developed recommendations using the ADOLOPMENT approach. Evidence about health effects from the original guidelines was reused, but important data about resource use, accessibility, feasibility, and impact in health equity were added. RESULTS: In the guideline accompanying this paper, Latin American panelists selected 17 questions from an original pool of 49. Of the 17 questions addressed, substantial changes were introduced for 5 recommendations, and remarks were added or modified for 12 recommendations. CONCLUSIONS: By using the evidence from an international guideline, a significant amount of work and time were saved; by adding regional evidence, the final recommendations were tailored to the Latin American context. This experience offers an alternative to develop guidelines relevant to local contexts through a global collaboration.