O HEV é um patógeno viral, transmitido principalmente pela via fecal-oral e responsável por grandes surtos de hepatite em todo o mundo. A hepatite E é considerada a hepatite com transmissão entérica mais frequente no mundo, e um importante problema de saúde pública. Por apresentar uma fase sanguínea assintomática e ser um agente emergente, cuja incidência vem aumentando ao longo da última década, o HEV é também considerado um problema para a hemoterapia, uma vez que põe em risco a segurança transfusional, devido ao risco de sua transmissão por transfusão sanguínea. No Brasil, sua ocorrência e características ainda não são compreendidas e os estudos disponíveis são limitados. Objetivo: Determinar a prevalência do HEV em doadores de sangue do Hemocentro de Ribeirão Preto no ano de 2015. Material e Métodos: Foram selecionados aleatoriamente 1.000 doadores de sangue do Hemocentro de Ribeirão Preto no período de janeiro a dezembro de 2015. Inicialmente, foi realizada a pesquisa de anticorpos da classe IgG do HEV em plasma, utilizando a metodologia de imuno-ensaio enzimático (ELISA). As amostras que se apresentaram reagentes (positivas ou inconclusivas) para IgG HEV, foram submetidas à pesquisa de antígenos virais, também por metodologia ELISA. Paralelamente aos testes sorológicos, foi realizado o teste molecular para a detecção de RNA viral, aplicando a técnica de PCR em tempo real e utilizando primers desenhados para a região mais conservada do vírus (ORF-3). Resultados: Entre as 1.000 amostras testadas, 124 foram positivas para a pesquisa de anticorpos anti-HEV IgG e 5 foram inconclusivas. A soroprevalência encontrada foi de 12,5%. A maior prevalência encontrada foi na faixa etária de 50-59 anos (21,2%, p<0,01), porém com aumento significativo entre os 40 e 69 anos de idade. A menor prevalência encontrada foi no grupo etário de 18 a 29 anos (3,9%). A soroprevalência foi proporcionalmente maior entre os indivíduos do gênero masculino (14,3%, p<0,06) em relação aos indivíduos do sexo feminino (10,4%). Nenhuma das amostras testadas foi positiva para a pesquisa de antígenos HEV e nem para a detecção de RNA viral. Conclusão: A soroprevalência do vírus da hepatite E encontrada entre os doadores de sangue de Ribeirão Preto foi alta (12,5%) e compatível com os dados nacionais de soroprevalência entre doadores. A viremia não pode ser estabelecida, pois não foram encontrados casos de HEV RNA positivos. / HEV is a viral pathogen, transmitted primarily by the fecal-oral route and responsible for large outbreaks of hepatitis worldwide. Hepatitis E is considered the most common transmissible enteric hepatitis in the world, and is currently considered a major public health problem. Because it presents an asymptomatic blood stage and is an emerging agent whose incidence has increased over the last decade, HEV is also considered a problem for hemotherapy, since it jeopardizes transfusion safety due to the risk of its transmission by transfusion. In Brazil its occurrence and characteristics are poorly understood and available studies are limited. Objective: To determine the prevalence of HEV in blood donors at the Hemocentro de Ribeirão Preto in the year 2015. Material and Methods: 1.000 blood donors were randomly selected from the Hemocentro of Ribeirão Preto from January to December 2015. Initially, a HEV IgG antibody was investigated in plasma, using ELISA (enzyme immunoassay). As samples that presented reagents (positive or inconclusive) for HEV IgG, they were submitted to the research of viral antigens, also by ELISA methodology. In parallel to the serological tests, it was carried out for molecular testing to detect viral RNA, applying a real-time PCR technique and using primers designed for a more conserved region of the virus (ORF-3). Results: Among 1,000 tested samples, 124 were positive for anti-HEV IgG antibodies and 5 were inconclusive. One seroprevalence was found to be 12.5%. A higher prevalence was found in the age range of 50-59 years (21.2%, p<0,001), but with a significant increase between 40 and 69 years of age. The lowest prevalence was found for the 18-29 age group (3.9%). Seroprevalence was proportionally higher among males (14.3%, p<0,06) than among female users (10.4%). It was not evaluated for a HEV antigen search or for viral RNA detection. Conclusion: A seroprevalence of hepatitis E virus found among blood donors from Ribeirão Preto and high (12.5%) and compatible with data from seroprevalence among donors. Viremia cannot be established because no cases of positive RNA HEV have been found

Em todo serviço de hemoterapia, a questão da segurança transfusional gera grande preocupação, visto que não existe transfusão isenta de risco de contaminação. Este trabalho tem como objetivo sugerir ao Centro de Hematologia e Hemoterapia do estado de Santa Catarina (HEMOSC), uma proposta de programa de uso de plasma de quarentena visando a segurança transfusional. O plasma de quarentena é aquele originado de um doador de repetição, que apresentou todos os testes sorológicos para doenças hemotransmissíveis não reagentes em doação anterior, até que o doador realize uma nova doação, este hemocomponente é mantido em quarentena, evitando o uso do mesmo em período de janela imunológica. Se todos os testes laboratoriais exigidos pela legislação vigente mantiverem-se não reativos após a nova doação, a unidade de plasma é liberada para uso. Sugere-se adequações no sistema de informática, referentes a triagem clínica e processamento do sangue, especificações para armazenamento e congelamento de plasma. Após análise da produção de plasma da hemorrede catarinense nos anos de 2012 e 2013, foi possível constatar que a instituição apresenta grande potencial para implantação da proposta, sendo necessário adequações na área física dos setores de processamento da hemorrede / Throughout the hemotherapy service, the question of transfusion safety generates great concern, whereas there is no free risk transfusion of contamination. This work aims to suggest to the Center of Hematology of the state of Santa Catarina (Hemosc) a proposal for use of quarantine plasma program to transfusion safety. The quarantine plasma that is originated from a donor replay, which showed all the non-reactive serologic tests for diseases transmissible by blood previous donation until the donor make a new donation, the blood component is kept in quarantine, avoiding the use of it in window periods. If all laboratory tests required by law are kept non-reactive after the new donation, the plasma unit is released for use. To implement the program for this product, adjustments in the computer system, related to recruitment, clinical screening, processing of blood, and specifications for storage and freezing of plasma is needed. After analysis of plasma production in Santa Catarina in 2012 and 2013, we acknowledge that the institution has a great potential for deployment of the proposal, being necessary adjustments in the physical area of the sectors of processing of the HEMOSC

Esse estudo teve por objetivo avaliar a viabilidade e qualidade in vitro do concentrado de hemácias felino (CHF), colhido e armazenado em bolsas e produtos nacionais, remanufaturadas, pelo Laboratório de Hemoterapia do Serviço de Anestesia da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, de acordo com normas definidas por órgãos regulamentadores como a ANVISA. Foram analisados parâmetros bioquímicos e hematológicos de 24 unidades de CHF nos dias 0, 14 e 21 de armazenamento. Utilizou-se sistema fechado para colheita e armazenamento do sangue com solução de anticoagulante-preservativa CPDA-1. A avaliação consistiu na mensuração de porcentagem de hematócrito, hemoglobina total, hemoglobina extracelular, porcentagem de hemólise, concentrações de potássio, lactato, glicose, ATP, pH, bicarbonato, pressão de CO2 e O2, inspeção visual da bolsa e cultura microbiológica aeróbia e anaeróbia. Os resultados obtidos foram avaliados estatisticamente por meio de testes paramétricos, sendo que as determinações de hematócrito, hemoglobina total não apresentaram variação significante nos 21 dias de preservação, enquanto os de potássio, lactato, pO2 aumentaram gradativamente de forma significante. Os níveis de ATP, glicose, pH, bicarbonato e pCO2 reduziram de forma significante com o decorrer do tempo. Não houve alteração à inspeção visual das bolsas de sangue, nem crescimento de microorganismos nas culturas realizadas. Por meio destas avaliações constatouse que o sistema remanufaturado com produtos nacionais pode ser empregado com segurança para obtenção de sangue felino tendo-se em vista que se manteve estéril, com eficiente conservação do concentrado de hemácias felino em CPDA-1 até o 21º dia de armazenamento. / This study aimed to evaluate the feasibility and quality of in vitro feline packed red blood cells (CHF), harvested and stored in bags and domestic products, manufactured, Hematology Laboratory at the Department of Anesthesia, Faculty of Veterinary Medicine, University of São Paulo, according to standards set by regulatory bodies such as ANVISA. Were analyzed biochemical and hematological parameters 24 units of CHF on days 0, 14 and 21 of storage. We used a closed system for collection and storage of blood with preservative-anticoagulant solution CPDA-1. The evaluation consisted in measuring percentage of hematocrit, total hemoglobin, extracellular hemoglobin, percentage of hemolysis, potassium concentrations, lactate, glucose, ATP, pH, bicarbonate, CO2 and O2 pressure, visual inspection of the bag and aerobic and anaerobic microbiological culture . The results were statistically analyzed using parametric tests, and determinations of hematocrit, total hemoglobin showed no significant variation within 21 days of preservation, while potassium lactate, pO2 gradually increased significantly. ATP levels, glucose, pH, pCO2 and bicarbonate decreased significantly with time. There was no change to the visual inspection of blood bags, or growth of microorganisms in the cultures performed. Through these evaluations it was found that the system refilled with domestic products can be used safely for obtaining blood feline bearing in mind that remained sterile, efficient storage of red blood cells feline in CPDA-1 until the 21 th days of storage.

Orientador: Paulo Eduardo Neves Ferreira Velho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T03:36:54Z (GMT). No. of bitstreams: 1 Pitassi_LuizaHelenaUrso_D.pdf: 10118032 bytes, checksum: 2717c0557147ebb4a9a080297c902cd6 (MD5) Previous issue date: 2013 / Resumo: O gênero Bartonella constitui um grupo de patógenos zoonóticos re-emergentes e negligenciados que têm sido associados a um amplo espectro de doenças humanas graves. As Bartonella spp. são bacilos gram-negativos que infectam hemácias e células endoteliais, que podem causar infecção crônica ou mesmo fatal. As bartoneloses humanas mais conhecidas são a doença de Carrión, febre das trincheiras, doença da arranhadura do gato e angiomatose bacilar. Como existem espécies de Bartonella intraeritrocitárias e que podem causar infecção persistente e assintomática em humanos, objetivou-se avaliar o risco potencial de transmissão de Bartonella spp. por transfusão sanguínea. No primeiro estudo, os eritrócitos humanos foram infectados com B. henselae em 30 min e 1, 5, 10, e 72 h para a avaliação ultraestrutural por microscopia eletrônica de transmissão (ME). A B. henselae foi vista aderida a eritrócitos humanos 10 h após a inoculação e no interior de eritrócitos após 72 h. A localização intraeritrocitária de B. henselae havia sido mostrada em eritrócitos de gatos, mas nunca antes identificada em eritrócitos humanos. Foi realizado um segundo estudo para determinar as características ultraestruturais da Bartonella spp. nas células do sangue, pois estas informações eram muito limitadas. Este trabalho definiu os parâmetros para se caracterizar a bactéria no interior de células sanguíneas à ME. Um terceiro estudo, utilizando a ME e cultura de bactérias, demonstrou a capacidade da B. henselae sobreviver em uma unidade de concentrado de hemácias armazenada a 4° C durante 35 dias. A viabilidade de B. henselae em unidades de células vermelhas do sangue define o potencial de infecção associada à transfusão de doadores de sangue assintomáticos. Os receptores de transfusão de sangue muitas vezes são ou podem tornar-se imunodeficientes, apresentando o risco de desenvolver formas graves de bartonelose. Utilizando-se parâmetros ultraestruturais da infecção por Bartonella sp., relatou-se um caso de bartonelose como causa de morte 72h após uma transfusão. Um jovem com anemia aplástica, após receber várias transfusões sanguíneas, apresentou estado de choque e morreu após transfusão de um concentrado de hemácias. Os achados da ME permitiram o diagnóstico de infecção por Bartonella sp.. Foi investigada nesta tese a prevalência da Bartonella spp. em uma amostra de 500 doadores de sangue voluntários de Campinas, estado de São Paulo, Brasil, utilizando sorologia, cultura líquida e sólida, PCR e sequenciamento como métodos de identificação destes patógenos. Os anticorpos contra B. henselae e B. quintana foram detectados em 16,2% e 32%, respectivamente. O DNA das Bartonella spp. foi sequenciado e demonstrado em 3,2% do sangue doado (B. henselae em 15 amostras e B. clarridgeiae em uma) e em 1,2% foi documentada, por meio do isolamento do agente, bacteremia por B. henselae. Este estudo revelou a presença de patógenos no sangue de doadores assintomáticos que não estão sendo rastreados no sangue doado e que podem ser responsáveis por doenças não diagnosticadas em pacientes imunodeficientes. Os resultados apresentados estabelecem a necessidade de uma reavaliação por autoridades de saúde pública dos riscos e do impacto da transmissão da Bartonella spp. através de transfusões sanguíneas, especialmente para os pacientes imunodeficientes. Esforços devem ser feitos para a melhoria dos métodos de diagnóstico com sensibilidade suficiente para excluir a Bartonella spp. em doadores de sangue e para proteger os receptores de transfusão de sangue / Abstract: The genus Bartonella is a group of re-emerging zoonotic and neglected pathogens that have been associated with a wide range of serious human diseases. Bartonella spp. are gram-negative bacilli that infect red blood cells and endothelial cells, which can cause chronic infection or even fatal. In humans, Bartonella spp. are known causative agents of Carrion's disease, trench fever, cat scratch disease and bacillary angiomatosis. As they are intra-erythrocytic bacteria and can cause persistent infection and asymptomatic in humans, our objective for this proposal was evaluate the potential risk of transmission of Bartonella spp. by blood transfusion. In the first study, human erythrocytes were infected with B. henselae in 30 min and 1, 5, 10, and 72h for ultrastructural evaluation by transmission electron microscopy (TEM). B. henselae was seen adhering to human erythrocytes 10h after inoculation and inside the erythrocyte after 72 h. Intraerythrocytic localization of B. henselae has been demonstrated in cat erythrocytes, but never before identified in human erythrocytes. A second study was conducted to determine the ultrastructural features of the Bartonella spp. on blood cells because this information was very limited. This paper set the parameters to characterize the bacteria within the blood cell using TEM. A third study using TEM and bacterial culture demonstrated the ability of B. henselae to survive in a unit of red blood cells stored at 4°C for 35 days. The viability of B. henselae in units of red blood cells defines the potential for infection associated with transfusion in asymptomatic blood donors. Recipients of blood transfusions often are or may become immunodeficient, with the risk of developing severe forms of bartonellosis. Using the ultrastructural findings for the diagnosis of Bartonella sp. infection, we reported a case of bartonellosis as cause of death 72 h after transfusion. A young man with aplastic anemia who had received multiple blood transfusions went into shock and died after transfusion of a red blood cell. The findings of TEM allowed the diagnosis of infection with Bartonella sp.. Was investigated in this thesis the prevalence of Bartonella spp. in 500 volunteer blood donors from Campinas, São Paulo State, Brazil, using serology, solid and liquid culture, PCR and sequencing as methods for identifying these pathogens. Antibodies against B. henselae and B. quintana were detected in 16.2% and 32%, respectively. Bartonella sp. DNA was demonstrated in 3,2% of donated blood (15 infected with B. henselae and one with B. clarridgeiae) and 1.2% had B. henselae documented bacteremia by isolation of the agent. This study reveals the presence of pathogens in asymptomatic blood donors who are not being screened in donated blood and may be responsible for undiagnosed diseases in immunodeficient patients. The results presented establish the need for re-evaluation by public health officials of the risks and impact of Bartonella spp. transmission through blood transfusions, especially to immunocompromised patients. Efforts should be made towards improve diagnostic tests with sufficient sensitivity to rule out Bartonella ssp. infection in blood donors to protect transfusion recipients / Doutorado / Clinica Medica / Doutora em Clínica Médica

In this research paper, the effectiveness of Strategic Planning in Blood Transfusion Services in South Africa was investigated. A brief general overview of relevant aspects that specifically relate to the strategic planning of Services and not-for-gain organisations was presented. The literature study included an explanation of the steps involved in the strategic planning process and the guidelines to develop and implement each of these effectively. The research methodology consisted of three phases: Phase 1 - A literature study to determine the most effective strategic plan for a not-for-gain organisation. Phase 2 - An empirical study to determine the effectiveness of the strategic planning processes in practice by means of a survey among the Blood Transfusion Services in South Africa. Phase 3 - The findings from the literature study and empirical study were used to evaluate whether effective strategic planning is implemented in the Blood Transfusion Services in South Africa. The following recommendations and conclusions were made: The Blood Transfusion Services that have not yet started seeking the opinion of all the stakeholders involved in the organisation should strongly consider implementing this strategy as part of the services provided to the community. The services operate as individual organisations, but clearly influence each other within the industry and the changes within the external environment form part of the elements that are considered by the services when determining the strategic direction of the services. All the services identify the major areas for which objectives need to be set to assist the organisations in achieving long-term prosperity, but they do not all set objectives in these areas. When it comes to strategic issues, all the services state that they identify these, but not all pre-determine criteria for evaluating the strategic issues. Guidelines for the effective implementation of the strategies of choice by lower managers or supervisors are not developed by all the services, nor do most of the services have control mechanisms in place to assist in effective implementation of the strategic planning process.

Introduction<p><p>La drépanocytose, affection génétique concernant 1 à 2% de la population en Afrique sub-saharienne, est une maladie chronique dont l’un des traitements essentiels est la transfusion sanguine. Kisangani, une ville du Nord-est de la République Démocratique du Congo, compte environ un million d’habitants et près de 30 000 naissances par an. Elle est caractérisée entre autre par l’endémie malarienne, la fréquence élevée dans la population des virus de l’immunodéficience humaine (VIH), des virus des hépatites B (VHB) et C (VHC) et la carence d’autosuffisance en sang. Le don de sang est fait par des donneurs volontaires et par des donneurs de remplacement. Les tests VIH et VHB sont réalisés chez les donneurs depuis les années 80, celui de VHC depuis fin 2004. Dans ce contexte, définir des actions prioritaires pour assurer, en général et en particulier pour les patients drépanocytaires, la sécurité transfusionnelle la plus optimale possible est essentiel. <p><p>Méthodologie<p><p>Afin de déterminer les prévalences d’infections virales, les marqueurs sérologiques du VIH, VHB et VHC ont été recherchés chez 4637 donneurs de sang (2236 volontaires et 2401 de remplacement) du Centre Provincial de Transfusion et des hôpitaux de Kisangani. Chez 140 patients drépanocytaires suivis dans un centre médical de Kisangani, 127 ont été transfusés. Parmi eux, 79 sont « polytransfusés » et 94 ont été transfusés avant 2004. Outre la sérologie VIH, VHB et VHC, l’allo-immunisation anti-HLA et anti-érythrocytaire ont été recherchées et les indications de transfusion déterminées. Afin d’estimer la prévalence de la drépanocytose à la naissance, l’HbS a été identifiée systématiquement par focalisation isoélectrique sur du sang du cordon ombilical de 520 nouveau-nés suivis dans cinq maternités de Kisangani. Afin de déterminer les indications transfusionnelles dans la drépanocytose à Kisangani, un relevé de ces indications a été réalisé pour ces mêmes 127 patients drépanocytaires transfusés. Afin de comparer l’usage de la transfusion à Kisangani et à Bruxelles pour des complications non liées à l’environnement, les 140 patients drépanocytaires suivis à Kisangani ont été comparés à 195 patients suivis à Bruxelles ;parmi eux, 71 patients ont pu être appariés pour l’âge. <p><p>Résultats<p><p>La prévalence des marqueurs viraux chez les donneurs de sang est de l’ordre de 4% pour le VIH, de 5% pour le VHB et de 4% pour le VHC. Les séroprévalences de VIH (2,2 vs 4,1%) et VHB (3,0 vs 4,6%) sont moindres chez les donneurs bénévoles par rapport aux donneurs de remplacement. La prévalence du VIH et du VHB observée chez les donneurs bénévoles était plus élevée en 2006 qu’en 2004. Treize patients drépanocytaires non transfusés ne sont pas porteurs des marqueurs viraux. Six pourcent des patients qui ont une sérologie VHC positive sont des polytransfusés ;1% chez ceux qui avaient reçu une ou deux transfusions. Suite au retard d’introduction du dépistage VHC chez les donneurs, une séroprévalence pour le VHC de 7 % des malades pour seulement 0,7% pour celle du VIH et de 1,4% pour celle du VHB a été démontrée. Le fait qu’aucun patient transfusé après 2004, n’a été trouvé positif au VHC alors que 10 % l’ont été parmi ceux transfusés avant 2004 montre le bénéfice de l’introduction de moyens simples et peu coûteux. Deux (1,6 %) patients étaient porteurs d’anticorps anti-HLA et 13 (10%) des anticorps anti-érythrocytaires (2 anti-C-D, 1 anti-E et 1 anti-C-D-E). Aucun des patients n’étaient porteurs des anticorps anti-Kell (K), anti-Kidd (Jka et Jkb) ou anti-Duffy. La prévalence de la drépanocytose chez les nouveau-nés de Kisangani est d’environ 1 %. A Kisangani, outre l’anémie liée à la malaria (46 %), un facteur environnemental, 34 % des transfusions ont été administrées pour des crises douloureuses simples. En comparaison, aucun patient suivi à Bruxelles n’a été transfusé pour cette indication. Cette attitude est probablement à mettre en relation avec la méconnaissance de la maladie par le personnel médical et par les familles des malades. L’anémie chronique de ces patients est souvent mal connue et interprétée comme une anémie aiguë. <p><p>Conclusion<p><p>Un encouragement des dons bénévoles sans exclure les donneurs de remplacement est nécessaire pour continuer à accroître l’approvisionnement en sang. Afin d’améliorer la sécurité transfusionnelle, la généralisation des tests simples de dépistage des donneurs de sang comme ceux du VHC devrait constituer une priorité dans les centres de transfusion. Avec une prévalence d’environ 1%, la drépanocytose est une affection fréquente à Kisangani. Pour ces patients drépanocytaires, établir des recommandations concernant les indications transfusionnelles permettrait de leur éviter des transfusions inappropriées. <p><p>Abstract<p><p>Introduction <p><p>Sickle cell disease (SCD), a genetic disorder that affects 1% to 2% of the population in sub-Saharan Africa, is a chronic disease in which blood transfusion is one of the essential treatments. Kisangani, a town in north-eastern Democratic Republic of Congo, has about one million inhabitants and nearly 30 000 births per year. It is characterized among others by the endemic malarial, a high frequency in the population of human immunodeficiency virus (HIV), hepatitis B (HBV) and C (HCV) virus, but also a lack of self-sufficiency in blood. Blood donation is given by volunteers and replacement donors. HBV and HIV screening tests are performed in donors since the 80s, while for HCV it is available only since late 2004. In that context in view to ensure blood transfusion safety, it is essential to define priority actions, in general and especially for patients with sickle cell disease.<p><p>Methodology <p><p>To determine the prevalence of viral infections, serological markers for HIV, HBV and HCV were investigated in 4637 blood donors (2236 volunteers and 2401 replacement) of the Provincial Center of Transfusion and hospitals in Kisangani. Among 140 SCD-patients followed in a medical centre in Kisangani, 127 were transfused; 79 were considered as “multiple-transfused” and 94 were transfused before 2004. HIV, HBV and HCV seroprevalences, alloimmunization anti-HLA and against red blood cells were determined as well as the indications for transfusion. <p>To estimate the prevalence of SCD at birth, HbS was identified by isoelectric focusing on umbilical cord blood of 520 newborns in five maternities of Kisangani.<p>To determine the indications for transfusion in SCD patients at Kisangani, these indications were recorded for the 127 SCD transfused patients.<p>To compare the use of transfusion in Kisangani and in Brussels for clinical events unrelated to the environment, the 140 SCD-patients followed in Kisangani were compared with the 195 SCD-patients followed in Brussels and 71 patientsin both groups could be matched for age. <p><p><p>Results <p><p>The prevalence of viral markers among blood donors is around 4% for HIV, 5% for HBV and 4% for HCV. The seroprevalence of HIV (2.2 vs. 4.1%) and HBV (3.0 vs. 4.6%) were lower among volunteer donors compared to replacement donors. The prevalence of HIV and HBV infection observed among blood donors was higher in 2006 than in 2004.<p>Thirteen non-transfused sickle cell patients were not carriers of any serological viral marker. The SCD-patients HCV(+) were “multiple-transfused” patients (6%) or those who received one or two transfusions (1%). Following the delayed introduction of HCV donor screening, a HCV seroprevalence of 7% of patients for only 0.7% for the HIV and 1.4% for the HBV was demonstrated. The fact that no patients transfused after 2004 were HCV(+) compared to 10% of those transfused before 2004 shows the benefit of the introduction of a simple and inexpensive screening test. Two (1.6%) patients had anti-HLA antibodies and 13 (10%) red blood cells antibodies (2 anti-CD, 1 anti-E and an anti-C-D-E). None of the patients displayed Kell (K), Kidd (Jka and Jkb) or Duffy red cells antibodies.<p>The prevalence of sickle cell disease in newborns of Kisangani is about 1%. In Kisangani, in addition to anaemia due to malaria (46%), an environmental factor, 34% of transfusions were administered for uncomplicated painful crises. In comparison, no patient followed in Brussels were transfused for that indication. This attitude is likely to be related with the ignorance of the disease by the medical staff and patients’ families. The chronic anaemia of those patients is often poorly understood and interpreted as acute anaemia.<p><p>Conclusion<p><p>Encouragement of voluntary donations without excluding the replacement donors is needed to pursue to increase the blood supply. To improve blood safety, the generalization of simple tests for screening blood donors as those for HCV should be a priority in transfusion centres. With a prevalence of about 1%, the SCD is a common disease in Kisangani. For those SCD-patients, establish guidelines for indications of transfusion would avoid inappropriate transfusion.<p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

Les antigènes de groupes sanguins érythrocytaires peuvent être responsables d’une allo-immunisation anti-érythrocytaire et d’accidents immuno-hémolytiques lors de transfusion ou de grossesse. La transfusion des populations d’Afrique sub-saharienne est complexifiée par l’absence d’expression d’antigènes publics, l’expression d’antigènes privés et l’expression d’antigènes partiels en particulier pour le système RH. L’étude des systèmes de groupes sanguins d’intérêt transfusionnel chez les donneurs de Bamako a confirmé l’efficacité de la stratégie du génotypage multiplex incluant des polymorphismes d’appels pour identifier des donneurs rares, qui permet d’accéder aux phénotypes déduits des prélèvements. L’exploration du système RH réalisée par séquençage chez les Dogons et les Peulhs de Mopti met clairement en évidence que la diversité allélique et la fréquence de certains allèles RH sont fonction de l’ethnicité. Un nouvel haplotype associant un allèle RHD*DIVa codant pour un antigène D partiel, des antigènes ce potentiellement partiels, et une réactivité partielle anti-C, a été identifié chez les Dogons. L’exploration des allèles codant pour les antigènes de haute et basse fréquence en Afrique subsaharienne d’Est en Ouest constitue un exemple d’étude qui distingue clairement les populations d’Afrique subsaharienne de celles d’Europe par des différences de fréquences des allèles définissant la diversité génétique d’une population par rapport à une autre. Des orientations stratégiques en fonction du contexte local ont été identifiées pour l’évolution de la transfusion au Mali dans les prochaines années. / Blood group antigens may be responsible for alloimmunization and immuno-hemolytic accidents during transfusion or pregnancy. The transfusion of of sub-Saharan Africa populations is complex due to absence of high antigens expression, low antigens expression and partial antigens expression particularly for RH system.The study of blood group for transfusion of interest among donors in Bamako confirmed the effectiveness of multiplex genotyping strategy including polymorphisms calls to identify the rare donors, which permit access to phenotypes derived samples. In a second phase, the exploration of RH blood group system by sequencing among Dogon and Fulani in Mopti clearly shows that the allelic diversity and the frequency of some alleles RH depend on the ethnicity. A new haplotype RHD*DIVa/RHCE*ceTI(D2) combining an RHD*DIVa allele encoding a partial D antigen, potentially partial ce antigens, and a partial reactivity with anti-C, was identified among Dogon. In a third phase, the exploration of alleles encoding of the high and low frequency antigens in sub-Saharan Africa from East to West is an example of a study that clearly makes a difference between the populations of sub-Saharan African and those of Europe in terms of frequencies of alleles that define genetic diversity of one population compared to another. Thus, knowledge of ethnicity is more relevant than knowing the geographical origin in order to optimize transfusion in Saharan Africa and in European countries where some of these populations live. Guidelines strategic in relation with the local context have been identified for development of transfusion for next years in Mali.

The dissertation takes the form of an impact study. It is based on a ten month period of research involving a literature review, interviews with headmasters of secondary schools who gave permission to survey their students, educational talks to secondary school learners and a survey of 500 learners from different schools in the Mthatha region. Purpose: The research endeavour addressed the problem of investigating the effectiveness of blood donor education in secondary schools in Mthatha region. Design/methodology/approach: This study employed a questionnaire-based survey. Five schools namely Mthatha High School, Holy Cross High School, Strategic High School; St Johns’ College and Zamukulungisa High School participated in this study. The Statistical Analysis System was employed to assess the association between the awareness strategies and general donor response. A chi–square test of association, based on the p –value approach, was used to achieve the results. Findings: This study finds that a blood donor education programme can increase blood donation awareness; benefit the schools and community, thus increasing the blood donor base. Receiving information as to the criteria for blood donation and how each individual donation is used to save a life is seen as a powerful means of reinforcement. Research limitations/implications: Further research is recommended on a large scale, involving all schools in Mthatha region. The research was delayed because it employed a new approach and a team had to be appointed before the blood donor centre can be opened. It is further recommended a once–off educational programme is not ideal because learners may not have received blood donation education before and should be repeated in follow-up sessions. Originality: This is the first research study looking at the effectiveness of a blood donor education programme in Mthatha secondary schools.

O curto tempo de armazenamento dos hemocomponentes é um dos fatores que dificulta e limita a quantidade de sangue que pode ser efetivamente armazenada, o que é uma desvantagem na medicina veterinária, pois o acesso a doadores é restrito e a demanda é contínua e cada vez maior na prática de clínicas e hospitais veterinários. Durante o armazenamento do sangue em baixas temperaturas, seja sob a forma de sangue total ou concentrado de eritrócitos, há uma queda intensa de metabólitos importantes para a viabilidade e funcionalidade dos eritrócitos. O desenvolvimento de meios e soluções de preservação sanguínea possibilitou o armazenamento dos eritrócitos e, consequentemente, facilitou o trabalho dos bancos de sangue. Portanto, a busca por melhores formas e soluções para preservação capazes de evitar ou diminuir estes efeitos prejudiciais durante o seu armazenamento é contínua, para que ao final se obtenha uma melhor qualidade do sangue transfundido. O presente trabalho avaliou o concentrado de eritrócitos felino armazenado na solução de CPDA-1 e CPD/SAGM durante 35 dias. Os dados laboratoriais foram comparados entre grupos e ao longo do tempo. Neste experimento foram utilizadas 10 bolsas de concentrado de eritrócitos felino divididos em dois grupos de cinco para avaliação de cada um dos aditivos. Os parâmetros laboratoriais K+, Na+, Cl-, lactato, HCO3-, amônia, glicose e pH foram avaliados nos dias 1, 7, 14, 21, 28 e 35 após a coleta. Vários parâmetros (K+, lactato, HCO3, glicose e cloreto) demonstraram que a solução CPD/SAGM manteve o metabolismo energético do eritrócito mais estável. Com este trabalho, foi possível entender melhor as alterações metabólicas sofridas pelos eritrócitos felinos durante o armazenamento. Concluímos que, apesar da solução CPD/SAGM se mostrar mais eficaz in vitro, são necessários mais estudos com relação aos hemocomponentes em gatos e à sua viabilidade pós-transfusional. / The short shelf life of blood products is one factor that complicates and limits the amount of blood that can be effectively stored, and it is a disadvantage in veterinary practice, because the access to donors is restricted and the demand is continuous and increasing at veterinary clinics and hospitals. During blood storage at low temperatures, either as whole blood or as packed red cells, there is a significant decrease of metabolites that are important for the viability and functionality of erythrocytes. The development of blood preservation solutions has enabled the storage of red blood cells and improved the service at the blood banks. Therefore, the search for better ways and blood preservation solutions to avoid or reduce these harmful effects during the storage conditions is continuous, in order to obtain the best blood product to be transfused. This study evaluated 10 bags of feline erythrocyte concentrate divided into two groups, stored in CPDA-1 and CPD/SAGM solutions during 35 days. The laboratory data were compared between groups and over time. K+, Na+, Cl-, lactate, HCO3-, ammonia, glucose and pH were assessed on days 1, 7, 14, 21, 28, and 35 after collection. On various parameters (K+, Cl-, HCO3-, glucose and lactate) solution of CPD/SAGM kept the energy metabolism of red blood cells more stable. With these results we can better understand the biochemical changes of feline erythrocytes during storage. We conclude that, although the CPD/SAGM solution shown to be more effective, more studies are needed to improve knowledge of feline blood components and post-transfusion viability.

Orientador: Egle Novaes Teixeira / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia Civil, Arquitetura e Urbanismo / Made available in DSpace on 2018-08-26T13:52:27Z (GMT). No. of bitstreams: 1 Vicente_ClaudiaSpegiorin_D.pdf: 5969713 bytes, checksum: ed0a90aaf19195b916ebd3398b2868c0 (MD5) Previous issue date: 2014 / Resumo: Os hemocomponentes, concentrados de hemácias, concentrados de plaquetas e plasma, são os produtos obtidos a partir do sangue total doado pelo doador de sangue. São os principais produtos de um serviço de hemoterapia, e devem ter características que garantam a segurança da terapia transfusional. No acompanhamento da cadeia geradora de resíduo do Hemocentro de Campinas, o descarte de unidades de sangue total e de hemocomponentes chama a atenção. A Metodologia de Produção mais Limpa (P+L) é uma ferramenta interessante para tratar as causas destes eventos, pois, através dela, é possível analisar as causas de geração deste resíduo, promover a minimização e a busca por soluções que tragam benefícios sociais, econômicos e ambientais. Neste estudo foi analisado o fluxo das bolsas plásticas para coleta de sangue de doadores desde a aquisição até a finalização da transfusão, tendo como referência a metodologia da P+L para identificar as causas e as possibilidades de minimização do descarte de unidades sangue total e de hemocomponentes em cada processo. Foram identificadas seis oportunidades de P+L, uma no processo de Gestão de Materiais, três no processo de Coleta de Sangue Total, duas no processo de Processamento, e uma no processo do Laboratório de Compatibilidade. Os respectivos planos de monitoramento definidos incluíram ações de gerenciamento dos processos de trabalho, mudança de técnica e mudança de material. As principais barreiras identificadas estão relacionadas aos recursos econômicos, ao dimensionamento de recursos humanos, e ao planejamento de ações de captação de doadores e coleta de sangue total sem considerar a capacidade operacional da unidade de processamento. Na análise do lay out da área física e do fluxo de atividades da sala de coleta identificou-se pontos críticos que induzem ao erro e podem gerar o descarte. Conclui-se que a aplicação da Metodologia P+L possibilita a identificação das causas de descarte e das quantidades descartadas, as ações propostas podem promover a minimização da geração deste resíduo e no acompanhamento das ações propostas e dos resultados, definidos nos planos de monitoramento para cada oportunidade, cria-se um ciclo ininterrupto da aplicação contínua de uma estratégia preventiva de geração de resíduo, tal qual preconizada na definição de P+L feita pela UNIDO / Abstract: Blood components, packed red cells, platelet concentrates and plasma, are the products obtained from whole blood donated by blood donors. These are the main products of a transfusion service, and must have features that ensure the safety of transfusion therapy. In monitoring the chain of waste generated by the Blood Center of Campinas, the disposal of units of whole blood and blood components draws attention. The Methodology of Cleaner Production (CP) is an interesting tool for addressing the causes of these events, enabling the analysis of the causes of this waste generation, promoting the minimization of this waste and for seeking solutions that bring social, economic and environmental benefits. In this study the flow of plastic bags for blood donors was analyzed; from acquisition to completion of transfusion, using the P + L methodology as the reference to identify the causes of the disposal of units of whole blood and blood products and possibilities for minimizing waste discard in each process. Six opportunities of CP were identified, one in the process of Material Management, three in the process of Whole Blood Collection, two in the process of blood processing, and one in the Compatibility Laboratory process. Monitoring plans included management actions, defined work processes, technical changes and material changes. The main barriers identified were related to economic resources, design of human resources, donor recruitment planning and collection of whole blood without considering the operational capacity of the processing unit. During the analysis of the physical layout of the area and the flow of activities in the collection room, critical points inducing error and generating waste were identified. We concluded that the application of the CP methodology enabled the identification of the causes of waste and of the quantities discarded, moreover the actions proposed could promote minimization of waste generation and that the monitoring of proposed actions and outcomes, defined in the monitoring plans at every opportunity, created a continuous cycle of application of preventive strategies for waste generation, as recommended by UNIDO / Doutorado / Saneamento e Ambiente / Doutora em Engenharia Civil