Morbilidad asociada al soporte transfusional en pacientes pediátricos con leucemia aguda en el Instituto Nacional de Cancerología
Resumen
Introducción: La leucemia aguda representa el cáncer más común en pediatría. Los tratamientos actuales hacen necesario un soporte hematológico constante que incrementa los riesgos de complicaciones como fiebre, reacciones alérgicas, reacciones inmunológicas, infecciones y reacción injerto contra huésped.
Objetivo: El presente trabajo se realizó con el objetivo de determinar la morbilidad asociada con el soporte transfusional en pacientes pediátricos con leucemia aguda, para lo cual se realizó un estudio retrospectivo en pacientes transfundidos menores de 15 años con diagnóstico de leucemia aguda linfoblástica y mieloblástica entre enero de 1999 y julio de 2000.
Materiales, métodos y resultados: Se analizaron 75 pacientes. Se administraron en total 468 transfusiones: 218 (46,6%) unidades de glóbulos rojos empacados y 250 (53,4%) unidades de plaquetas; se trataron 257 (54,9%) unidades ya fuera con irradiación, filtro deleucocitador o técnica de aféresis. Las complicaciones derivadas de la transfusión fueron escasas (1,92%): tres relacionadas con la administración de glóbulos rojos: fiebre, exantema y hemolisis; y seis relacionadas con la transfusión de plaquetas: urticaria, refractariedad plaquetaria y anafilaxis.
Conclusión: En la población pediátrica con diagnóstico de leucemia aguda en el Instituto Nacional de Cancerología la morbilidad asociada a las transfusiones durante el año y medio del estudio fue baja y no se pudo establecer su relación con el tratamiento que se da a los productos transfundidos.
Biografía del autor/a
Martha Vizcaino Valderrama, Instituto Nacional de Cancerología
Hemato-oncóloga Pediatra Departamento de Oncología Pediátrica INC.
Amaranto Suárez Mattos, Instituto Nacional de Cancerología
Oncólogo Pediatra Departamento de Oncología Pediátrica INC.
Jorge Alberto Hernández Künzel, Instituto Nacional de Cancerología
Especialista en Entrenamiento Departamento de Oncología Pediátrica INC.
Alexandra Restrepo, Instituto Nacional de Cancerología
Especialista en Entrenamiento Departamento de Oncología Pediátrica INC.
Referencias bibliográficas
Robins L General principles of the epidemiology of childhood cancer. In: Pizzo P, Poplack D. Principles and Practice of Pediatric Oncology. Third Edition. Lippincott Raven Publishers. Philadelpia-New York. 1997. p. 1-11.
Lanzkowsky Ph. Leukemias. In: Manual of Pediatric Hematology and Oncology. Third Edition. Academic Press. 1999. p. 359-413.
Pui C-H. Childhood Leukemias. N Engl J Med 1995;332:561-585. https://doi.org/10.1056/NEJM199506153322407
Argolin J, Poplack D. Acute lymphoblastin leukemia. In: Pizzo Py Poplack D. Principles and Practice of Pediatric Oncology. Third Edition. Lippincott Raven Publishers. Philadelpia-New York. 1997. p. 409-62.
Golub Ty Weinstein H, Grier H. Acute myelogenus leukemia. In: Pizzo P} Poplack D. Principles and Practice of Pediatric Oncology. Third Edition. Lippincott Raven Publishers. Philadelpia-New York. 1997. p.463-82.
Buchanan G. Hematologic supportive care of pediatric cancer patiente. In: Pizzo P, Poplack D. Principles and Practice of Pediatric Oncology. Third Edition. Lippincott Raven Publishers. Philadelpia-New York. 1997. p.1051-68.
Rossi Ey Simon T. Trombocytopenia and platelets transfusion. In: Rossi E., Simon LP, Moss G, Goult S. Principles of Transfusion Medicine. Second edition. Baltimore Williams-Wilkins; 1996. p.257-62.
Heyman M, Schijfer C. Platelet transfusion in patient receiving chemotherapy. In: Rossi E, Simon LPy Moss G, Goult S. Principles of Transfusion Medicine. Second edition. Baltimore Williams-Wilkins; 1996. p.263-74.
Webb Jy Anderson K. Transfusion support in acute leukemias. Sem Oncol 1994;24:141-46.
Walter D. Leukoreduced blood components laboratory and clinical. In: Rossi E, Simon LP, Moss Gy Goult S. Principles of transfusion medicine. Second edition. Baltimore Williams-Wilkins; 1996. p.353-74.
Leitman S. Leukocyte inactivation by blood irradiation. In: Rossi E, Simon LP, Moss G, Goult S. Principles of Transfusion Medicine. Second edition. Baltimore Williams-Wilkins; 1996. p.375-83.
Bowden R, Slichter S, Sayers M et al. Use of leukocyte depleted platelets and citomegalovirus seronegative red blood cells for prevention of primary citomegalovirus infection after marrow transplant. Blood 1991; 78: 246-50. https://doi.org/10.1182/blood.V78.1.246.246
Lanzkowsky Ph. Supportive care and manage ment of oncology emergencies. In: Manual of Pediatric Hematology and Oncology. Third Edition. Academic Press. 1999. p. 669-718.
Lorenzo My Davis JW, Negin S, Kaups K, Parks S, Brubaker D etal. Can ringer's lactate be used safely with blood transfusions?. Am J Surg 1998;175:308-310. https://doi.org/10.1016/S0002-9610(98)00011-7
Manno S. Novedades en transfusiología. Clin Ped N Am 1997;4:743-55.
Shulman I. Transmission of parasitic infections by blood transfusion. In: Rossi E, Simon LP, Moss G, Goult S. Principles of Transfusion Medicine. Second edition. Baltimore Williams-Wilkins; 1996. p.733-38.
Bordin J, Heddle N, Blajchman. Biologic effects of leukocytes present in tranfused cellular blood products. Blood 1994; 84: 1703-21. https://doi.org/10.1182/blood.V84.6.1703.1703
Marwijk M, Prooijein H, Moes M et al. Use of leukocyte depleted platelet concentrates for the prevention of refractoriness and primary HLA alloinmunization: A prospective randomized trial. Blood 1991;77:201-5. https://doi.org/10.1182/blood.V77.1.201.201
Barnard D, FeusnerJ, Wolff L. Blood component therapy. In: Ablin A. Supportive Care of Children With Cancer. Second edition. The Johns Hopkins University Press. Baltimore. 1997. p.37-46.
Roberts G, SacherR. Transfusion associated graft versus host disease. In: Rossi E, Simon LP, Moss G, Goult S. Principles of Transfusion Medicine. Second edition. Baltimore Williams-Wilkins; 1996. p.785-802.
MoroffG, George V, Siegl A et al. The influence or irradiation on stored platelets. Transfusion 1986;26:453-6. https://doi.org/10.1046/j.1537-2995.1986.26587020124.x
Anderson K, Weinstein H. Transfusion associated graft versus host disease. N Eng J Med 1990; 323: 315-21. https://doi.org/10.1056/NEJM199002013220507
GreenbaumB. Tranfusion associated graft versus host disease: Historical perspectives, incidence and corrent use of irradiated blood products. J Clin Oncol 1991;9:1889-1902. https://doi.org/10.1200/JCO.1991.9.10.1889
Norol F, Bierfling PH, Roudot-Thoraval F, Le Coeur F, Rieux C, Lavaux A et al. Platelet transfusion: a dose response study. Blood 1998;92(4):1448-53. https://doi.org/10.1182/blood.V92.4.1448
Kruskall M. The perils of platelet transfusions. N Eng J Med 1997;337(26):1914-15. https://doi.org/10.1056/NEJM199712253372609
Sintnicolaas K, Sizoo W et al. Delayed allo inmunization by random single donor plateletn transfusion. A randomized study to compare single donor and multiple donor platelet transfusions in cancer patient with severe thrombocytopenia. Lancet 1981;1:750-53. https://doi.org/10.1016/S0140-6736(81)92626-X
Schiffer C, Slichter S. Platelet transfusions from single donors. N Eng J Med 1982;307:245-47. https://doi.org/10.1056/NEJM198207223070410
Simon T. Plateletpheresis. In: Rossi E., Simon LP., Moss G, Goult S. Principles of transfusion medicine. Second edition. Baltimore Williams-Wilkins; 1996. Pg.547-50.
Wandt H, Frank M, Ehninger G et al. Safety and cost effectiveness or a lOxlO/lt trigger for profilactic platelet transfusion compared with the traditional 20x10/lt trigger: a prospective comparative trial in 105 patients with leukemia. Blood 1998;91:3601-06. https://doi.org/10.1182/blood.V91.10.3601
Gmur J, Burger J, Schanz U et al. Safety of stringent prophylactic platelet transfusion policy for patients with acute leukemia. Lancet 1991;338:1223-26. https://doi.org/10.1016/0140-6736(91)92098-M
Williamson L, Wimpers J, Williamson P et al. Bedside filtration of blood products in the prevention of HLA alloinmunization: a rando mized study. Blood 1994;83:3028-35. https://doi.org/10.1182/blood.V83.10.3028.3028
Heddle N, Blajchman M. The leukodepletion of cellular blood products in the prevention of HLA alloinmunization and refractoriness to allogenic platelet transfusion. Blood 1995;85:603-5. https://doi.org/10.1182/blood.V85.3.603.bloodjournal853603
Sintnilaas K, Marwijk M, Prooijein H et al. Leukocyte depletion of random single donor platelet transfusions does not prevent secundary human leukocyte atigen alloinmunization and refractoriness: a randomized prospective study. Blood 1995;85:824-28. https://doi.org/10.1182/blood.V85.3.824.bloodjournal853824
Saarinen U, Kekomaki R, Siimes M, et al. Effective prophylaxis against platelet refratoriness in multitransfused patients by used or leucocyte free bloods components. Blood 1990;75:512-17. https://doi.org/10.1182/blood.V75.2.512.512
Friedberg R, Donnelly S, Boyd J et al. Clinical and blood bank factors in the management of platelet refractoriness and alloinmunization. Blood 1993;8:3428-34. https://doi.org/10.1182/blood.V81.12.3428.3428
Brecher M. Hemolytic transfusion reactions. In: Rossi E, Simon LP, Moss G, Goult S. Principles of Transfusion Medicine. Second edition. Baltimore Williams-Wilkins; 1996. p.747-64.
Stack J, Judge J, Snyder E. Febrile andnoinmune transfusion reaction. In: Rossi E, Simon LP, Moss G, Goult S. Principles of Transfusion Medicine. Second edition. Baltimore Williams-Wilkins; 1996. P. 773-84.
Pierce R, Reich L, Mayer K. Hemolysis following platelet transfusions from ABO incompatible donors. Transfusion 1985;25:60-62. https://doi.org/10.1046/j.1537-2995.1985.25185116506.x
Carreras L. Efectos secundarios inmunológicos y no inmunológicos de la hemoterapia. En: Enciclopedia Iberoamericana de Hematología. Ediciones Universidad de Salamanca. 1992. Tomo IV. p.279-92.
The trial to reduce alloinmunization to platelets study group. Leukocyte reduction and ultraviolet B irradiation of platelets to prevent allo inmunization and refractoriness to platelet transfusion. NEng JMed 1997;337(26):1861-9. https://doi.org/10.1056/NEJM199712253372601
Hamerschlack N. Enfermedades infecciosas transmitidas por transfusión. En: Enciclopedia Iberoamericana de Hematología. Ediciones Universidad de Salamanca. 1992. Tomo TV. p.293-301.
Alter H. Transfusion transmitted non A, non B and Hepatitis C virus. In: Rossi E, Simon LP, Moss Gt Goult S. Principles of Transfusion Medicine. Second edition. Baltimore Williams-Wilkins; 1996. p.687-98.
Busch M. Transfusion associated AIDS. In: Rossi E, Simon LP, Moss Gf Goult S. Principles of Transfusion Medicine. Second edition. Baltimore Williams-Wilkins; 1996. 699-708.
Gunter Ky Luban N. Transfusion transmitted Cytomegalovirus and Epstein Barr virus disease. In: Rossi Et Simon LP, Moss G, Goult S. Principles of Transfusion Medicine. Second edition. Baltimore Williams-Wilkins; 1996. 717-32.
Wick M, Moore S, Taswell H. Non A non B hepatitis associated with blood transfusion. Transfusion 1985;25:93-98. https://doi.org/10.1046/j.1537-2995.1985.25285169225.x
Arico M, Maggiore G, Silini E et al. Hepatitis C virus infection in children treated for acute lymphoblastic leukemia. Blood 1994; 84: 2919-22. https://doi.org/10.1182/blood.V84.9.2919.2919
Paul M, Sanders J, Ruggiero F, Andrews T, Ungar D, Eyster E. Chronic hepatitis C virus infection in leukemia survivors: prevalence, viral load, and severity of liver diseas. Blood 1999;93(11):3672-77. https://doi.org/10.1182/blood.V93.11.3672
Regan F, Hewitt P, Barbara J, Contreras M. Prospective investigation of transfusion transmitted infection in recipients of over 20.000 units of blood. BMJ 2000;320:403-6. https://doi.org/10.1136/bmj.320.7232.403
Registro Institucional de Cáncer. Subdirección de Epidemiología, Registro, Investigación Clínica, Promoción y Prevención. Instituto Nacional de Cancerología. 1998.
Cómo citar
Descargas
Descargas
Publicado
Número
Sección
Licencia
Todos los derechos reservados.