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OBJECTIVE: To evaluate the adequacy of the prescription of red cell concentrates by emergency physicians. METHODS: A cross-sectional study based on the survey of transfusion requests records completed by emergency physicians, from May/2018 to April/2019, in an emergency hospital. Adequacy in the indication, volume, and subtype (filtered, irradiated, and washed) of prescribed erythrocytes were evaluated. To compare the qualitative data, we used the χ2 test. The significance level adopted was 5%. RESULTS: One thousand and twenty-two transfusions were evaluated. The indication, volume, and subtypes were correct in 72.7%, 45.9%, and 81.6% respectively. Transfusion in symptomatic patients presented superior adequacy when compared to asymptomatic individuals with significant statistical difference (indication: 79,6% vs 67.2%, p <0.001; Volume: 63.5% vs 31.7%, p <0.001; subtype: 85.3% vs 78.7%, p 0.006). Among clinical situations, there were more errors in sepsis (39.7%) and pneumonia (36.3%). More than half of the prescriptions presented excessive volume, raising the risk of circulatory overload, observing that the mean age was 60.6 years. The specific analysis of the prescribed subtypes showed adequacy of 17.9% in the filtered, 1.7% in the irradiated, and none in the washed. Thirty transfusions should have been filtered, but the prescriber did not request the subtype. CONCLUSION: One hypothesis for the observed inaccuracies is inadequate medical training on the subject, both in undergraduate and medical residency, associated with a lack of continuing education on transfusion protocols. The transfusion Committee received the results of this study with a proposal for continuing education measures on transfusion hemotherapy.

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SUMMARY OBJECTIVE To evaluate the adequacy of the prescription of red cell concentrates by emergency physicians. METHODS A cross-sectional study based on the survey of transfusion requests records completed by emergency physicians, from May/2018 to April/2019, in an emergency hospital. Adequacy in the indication, volume, and subtype (filtered, irradiated, and washed) of prescribed erythrocytes were evaluated. To compare the qualitative data, we used the χ2 test. The significance level adopted was 5%. RESULTS One thousand and twenty-two transfusions were evaluated. The indication, volume, and subtypes were correct in 72.7%, 45.9%, and 81.6% respectively. Transfusion in symptomatic patients presented superior adequacy when compared to asymptomatic individuals with significant statistical difference (indication: 79,6% vs 67.2%, p <0.001; Volume: 63.5% vs 31.7%, p <0.001; subtype: 85.3% vs 78.7%, p 0.006). Among clinical situations, there were more errors in sepsis (39.7%) and pneumonia (36.3%). More than half of the prescriptions presented excessive volume, raising the risk of circulatory overload, observing that the mean age was 60.6 years. The specific analysis of the prescribed subtypes showed adequacy of 17.9% in the filtered, 1.7% in the irradiated, and none in the washed. Thirty transfusions should have been filtered, but the prescriber did not request the subtype. CONCLUSION One hypothesis for the observed inaccuracies is inadequate medical training on the subject, both in undergraduate and medical residency, associated with a lack of continuing education on transfusion protocols. The transfusion Committee received the results of this study with a proposal for continuing education measures on transfusion hemotherapy.

RESUMO OBJETIVO Avaliar a adequação da prescrição de concentrados de hemácias por médicos emergencistas. MÉTODOS Estudo transversal por levantamento de fichas de requisição de transfusões preenchidas por médicos emergencistas, no período de maio de 2018 a abril de 2019, em um hospital de emergências. Foram avaliadas as adequações na indicação, volume e subtipo (filtradas, irradiadas e lavadas) de hemácias prescritas. Para comparação dos dados qualitativos, utilizamos o teste de χ2. O nível de significância adotado foi de 5%. RESULTADOS Foram avaliadas 1.022 transfusões. A indicação, o volume e os subtipos estavam corretos em 72,7%, 45,9% e 81,6%, respectivamente. A transfusão prescrita em pacientes sintomáticos apresentou adequação superior quando comparada aos assintomáticos, com diferença estatística significativa (indicação: 79,6% vs 67,2% - p<0,001; volume: 63,5% vs 31,7% - p<0,001; subtipo: 85,3% vs 78,7% - p 0,006). Entre as situações clínicas, ocorreram mais erros na sepse (39,7%) e pneumonia (36,3%). Mais da metade das prescrições apresentavam volume excessivo, elevando o risco de sobrecarga circulatória, observando-se que a média da idade foi 60,6 anos. A análise específica dos subtipos prescritos apresentou adequação de 17,9% nas filtradas, 1,7% nas irradiadas e nenhuma das lavadas. Trinta transfusões deveriam ter sido filtradas, porém o prescritor não solicitou o subtipo. CONCLUSÃO Uma hipótese para as incorreções observadas é a formação médica inadequada sobre o assunto, tanto na graduação como na residência médica, associada à falta de atualização nos protocolos transfusionais. O comitê transfusional recebeu os resultados deste estudo com proposta de medidas de educação permanente sobre hemoterapia transfusional.

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INTRODUCTION: The Rh system is the most polymorphic and immunogenic of all systems of blood groups. Currently more than 49 antigens were identified with five major antigens D, C, c, E, e. Knowledge of the molecular basis of the Rh system permitted the understanding of both the mechanism of Rh phenotype on the antigen variants of RHD and RHCE In Caucasians the primary mechanism of D-negative phenotype is the complete deletion of RHD gene, while the black Africans is the presence of pseudogene and gene hybrid RHD-CE (3-7)-D. OBJECTIVE: To determine the prevalence gene pseudogene and hybrid gene and standardization of molecular techniques in method of Taqman on real-time PCR for RHD genotyping. PATIENTS AND METHODS: 203 samples of D-negative donor were used to establish and validate the effectiveness of RHD genotyping in real-time PCR using Taqman technology. The extraction was performed using a commercial kit QIAmp DNA mini kit. Samples exon 10 and 7 positive were submitted to amplification of exon 5, confirming the pseudogene RHDΨ, whereas exon 10+exon 7--for the hybrid gene (C) cdes and mutation C733G (Leu245Val) of the RHCE gene. RESULTS: Twenty-five (12.3%) samples were positive, 14 amplified for both exons 10 and 7 while in 11 only for the exon 10. When extended the screening using exon 10, 7 and 5, only 06 amplified. The pseudogene was present in 07 samples (3.5%) and the hybrid RHD-CE (3-7) in 04 (1.97%), while in 177 (87.2%) of Rh negative donors were RHD gene deletion. In 07 samples not amplified for exon 3 had mutated and the mutation C733G antigen. CONCLUSION: The prevalence of pseudogene was 3.5% and the gene hybrid RHD-CE of 1.9%. This approach for real-time PCR as a complementary tool is technically feasible and the results of this study helped develop a new strategy for RHD genotyping.

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JUSTIFICATIVA E OBJETIVOS: A glomerulosclerose segmentar e focal (GESF) é uma doença progressiva e sem tratamento curativo, levando ao longo da sua progressão à insuficiência renal crônica (IRC) e a outras complicações, sendo a plasmaférese um dos poucos recursos terapêuticos. O objetivo deste estudo foi relatar um caso em que a plasmaférese terapêutica foi utilizada durante o acompanhamento do paciente, mostrando a recorrência da doença mesmo em uso contínuo da plasmaférese. RELATO DE CASO: Paciente do sexo masculino, 13 anos, diagnosticado com GESF e importante comprometimento da função renal, submetido a transplante com posterior rejeição e piora do quadro, sendo submetido à seções periódicas de plasmaférese frente a constante piora clínica e às poucas opções terapêuticas. CONCLUSÃO: Ainda controversa, a plasmaférese é indicada no tratamento da GESF recorrente. A intervenção precoce em pacientes transplantados com GESF recorrente é capaz de mudar o prognóstico ao longo da evolução para IRC. Neste paciente não apresentou resposta satisfatória ao tratamento, mesmo sendo realizadas sessões pré e imediatamente após o segundo transplante e ao longo de seu acompanhamento com o objetivo de diminuir a proteinúria e a recorrência.

BACKGROUND AND OBJECTIVES: Focal segmental glomerulosclerosis (FSGS) is a progressive disease without curative treatment, bringing along their progression to chronic renal failure (CRF) and other complications, plasmapheresis one of the few therapeutic resources. The aim of this study was to report a case in which the plasma therapy was used during the monitoring of the patient showing recurrence of disease even in continuous use of plasmapheresis. CASE REPORT: Male patient, 13 years, diagnosed with FSGS with significant renal disease underwent renal transplant rejection and subsequent worsening of symptoms, underwent plasmapheresis front sections of the periodic steady worsening clinical and few therapeutic options. CONCLUSION: Still controversial, plasmapheresis is indicated for the treatment of FSGS. Early intervention in transplant patients with recurrent FSGS is capable of changing the prognosis during the evolution to CRF. The patient showed no satisfactory response to treatment with plasmapheresis, although sessions held before and immediately after the second transplant and throughout their follow in order to reduce proteinuria and the recurrence.

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The Rh system is the most polymorphic and immunogenic for all blood group systems. Currently more than 49 antigens were identified with five major antigens D, C, c, E, e. Knowledge of the Rh system's molecular basis, since its first cloning 17 years ago, allowed to understand the mechanism of Rh-negative phenotype and the variants of antigens as RHD and RHCE. Deletions, gene rearrangements and insertions are the main mutations. In Caucasians the primary mechanism of Rh-negative phenotype is the complete RHD gene deletion, while in African descendants it is the presence of pseudogene and gene RHDψ hybrid RHD-CE (4-7)-D. The authors analyze the structure of the Rh complex in red cells, molecular basis of the Rh system, mechanisms of Negativity RHD and weak and incomplete expression of RHD.

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O sistema Rh é o mais polimórfico e imunogênico de todos os sistemas de grupos sanguíneos. Atualmente mais de 49 antígenos foram identificados sendo cinco principais os antígenos D, C, c, E, e. O conhecimento das bases moleculares do sistema Rh desde a sua primeira clonagem há 17 anos possibilitou o entendimento tanto do mecanismo do fenótipo Rh negativo quanto das variantes dos antígenos RHD e RHCE. As deleções, rearranjos gênicos e as inserções são as principais mutações encontradas. Nos caucasianos, o mecanismo principal do fenótipo Rh negativo é a completa deleção do gene RHD, enquanto nos afrodescendentes é a presença do pseudogene RHDψ e do gene híbrido RHD-CE (4-7)-D. Os autores analisam a estrutura do complexo Rh nas hemácias, as bases moleculares do Sistema Rh, os mecanismos de negatividade RHD, além da Expressão fraca e parcial de D.

The Rh system is the most polymorphic and immunogenic for all blood group systems. Currently more than 49 antigens were identified with five major antigens D, C, c, E, e. Knowledge of the Rh system's molecular basis, since its first cloning 17 years ago, allowed to understand the mechanism of Rh-negative phenotype and the variants of antigens as RHD and RHCE. Deletions, gene rearrangements and insertions are the main mutations. In Caucasians the primary mechanism of Rh-negative phenotype is the complete RHD gene deletion, while in African descendants it is the presence of pseudogene and gene RHDψ hybrid RHD-CE (4-7)-D. The authors analyze the structure of the Rh complex in red cells, molecular basis of the Rh system, mechanisms of Negativity RHD and weak and incomplete expression of RHD.

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Os autores estudam os resultados obtidos com a técnica de neurectomia em 37 pés operados em pacientes portadores de neuroma de Morton, durante os últimos 14 anos. Baseados num interrogatório atual e revisäo dos casos, concluem que devem continuar o método adotado, uma vez que se mostrou satisfatório e seus resultados foram uniformemente bons, sem ocorrência de seqüelas.

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