Revista Brasileira De Hematologia Research Articles

Identifying and analyzing the effects of electric fields on erythrocyte sedimentation rate.

Introduction: The influence of electric field on the nature of blood flow and cells is controversial. Erythrocytes sedimentation rate (ESR) examination is a recommended approach to diagnose a few health conditions such as polymyalgia rheumatic and temporal arteritis. Aim: In this study, we aimed to evaluate the effect of electric field on ESR of human male and female blood samples. Method: Healthy blood samples were exposed with electric field (in-vitro) with various exposure intensities. The Westergren method used to examine ESR in-vitro. Results: An increase of ESR was shown in blood samples of both genders at low to high exposure intensities. Female blood samples got a higher ESR than that of male blood samples at low exposure filed. However, that trend turned to opposite at high exposure electric field. Compare to untreated blood samples, the largest rate of ERS variation, for male and female blood samples, were about 140% versus a 135% respectively due to 72 V/m of exposure. Conclusion: Consequently, electric field produces an influence on the blood red cells sedimentation depending on the exposure intensity. References ALI, F. M., S. MOHAMED, W. & MOHAMED, M. R. 2003. Effect of 50 Hz, 0.2 mT magnetic fields on RBC properties and heart functions of albino rats. Bioelectromagnetics: Journal of the Bioelectromagnetics Society, The Society for Physical Regulation in Biology and Medicine, The European Bioelectromagnetics Association, 24, 535-545. BASKURT, O. K. & MEISELMAN, H. J. 2013. Erythrocyte aggregation: basic aspects and clinical importance. Clinical hemorheology and microcirculation, 53, 23-37. BRIGDEN, M. L. 1999. Clinical utility of the erythrocyte sedimentation rate. American family physician, 60, 1443-1450. FERNANDES, H. P., CESAR, C. L. & BARJAS-CASTRO, M. D. L. 2011. Electrical properties of the red blood cell membrane and immunohematological investigation. Revista brasileira de hematologia e hemoterapia, 33, 297-301. IINO, M. 1997. Effects of a homogeneous magnetic field on erythrocyte sedimentation and aggregation. Bioelectromagnetics: Journal of the Bioelectromagnetics Society, The Society for Physical Regulation in Biology and Medicine, The European Bioelectromagnetics Association, 18, 215-222. JUUTILAINEN, J. & LAHTINEN, T. 1985. Effects of low frequency electric fields on the sedimentation rate of human blood. Preliminary observations. International journal of biometeorology, 29, 243-252. KIZILOVA, N., BATYUK, L. & BARANETS, V. Human red blood cell properties and sedimentation rate: a biomechanical study. The International Conference of the Polish Society of Biomechanics, 2018. Springer, 3-22. MUSTAFA, B. T., YABA, S. & ISMAIL, A. H. Impacts of In Vivo Exposure Static Magnetic Field to Blood Viscosity. Materials Science Forum, 2020a. Trans Tech Publ, 369-378. MUSTAFA, B. T., YABA, S. P. & ISMAIL, A. H. 2020b. Influence of the static magnetic field on red blood cells parameters and platelets using tests of CBC and microscopy images. Biomedical Physics & Engineering Express, 6, 025004. MUSTAFA, B. T., YABA, S. P. & ISMAIL, A. H. 2019. A review of the Effects of Magnetic Field on main blood cells: in vivo and in vitro experiments. ZANCO Journal of Pure and Applied Sciences, 31, 40-50. SOX JR, H. C. & LIANG, M. H. 1986. The erythrocyte sedimentation rate. Guidelines for rational use. Annals of internal medicine, 104, 515-523. VENNAPUSA, B., DE LA CRUZ, L., SHAH, H., MICHALSKI, V. & ZHANG, Q.-Y. 2011. Erythrocyte sedimentation rate (ESR) measured by the Streck ESR-Auto Plus is higher than with the Sediplast Westergren method: a validation study. American journal of clinical pathology, 135, 386-390. YAMAGISHI, A. 1990. Biological systems in high magnetic field. Journal of magnetism and magnetic materials, 90, 43-46.

Diffuse large B cell gastric lymphoma a rare disease: the effort to obtain scientific data in a multicenter, multinational retrospective trial.

The paper by Delamain et al., published in this issue ofthe Revista Brasileira de Hematologia e Hemoterapia (RBHH),addresses the main findings of DLBCGL in a multicenter retro-spective study with 104 patients from three countries, Brazil,Portugal and Italy. This kind of study is very important in rarediseasessincethemajorityoftherecommendationsarebasedondatafromcaseseries,ratherthanlargerandomizedtrials.

Bioengineering coagulation factors for improved hemophilia treatments: Comment on: the mutation F309S increases FVIII secretion in human cell line.

The implementation of prophylaxis with regular factor VIII (FVIII) replacement for patients with hemophilia radically changed the clinical presentation of this condition, from a disease characterized by progressive disabling musculoskeletal complications, to one compatible with an active and virtually normal lifestyle. In Brazil, although most adults with severe hemophilia still suffer the impact of musculoskeletal complications in their quality of life, 1 the recent implementation of universal prophylaxis will certainly change this situation for the next generation of patients. This scenario posits a challenge to government and healthcare providers, for whom guaranteeing a reliable and safe source of FVIII concentrate has become more than ever, a strategic issue. This is the context that underscores the importance of the study by Fantacini et al. in this issue of the Revista Brasileira de Hematologia e Hemoterapia, in which the authors used a combined strategy to improve recombinant FVIII production, based on ‘rational mutagenesis’, chemical chaperones, and human cell lines. 2 Rational mutagenesis consists in the introduction of DNA variations (and hence, amino acid changes) aimed at improving the function of a recombinant protein, based on previous knowledge about protein structure and function. The power of rational mutagenesis was well-illustrated by the identi“cation in 1988 of a residue in coagulation factor IX (FIX) whose change

Five years of implementation of guidelines in hematology and transfusion medicine in Brazil.

In 2009, the Associacao Brasileira de Hematologia e Hemoterapia (ABHH) started to participate in an important mission proposed by the Associacao Medica Brasileira (AMB) and the Conselho Federal de Medicina named “Project Guidelines”. This project had already been adopted by some other specialties. It aims to determine diagnostic, monitoring, prevention and therapeutic practices according to the best scientific evidence available in the international literature. Some attempts had already been made within hematology, but without systematization or continuity. Thus the ABHH brought together a group of experts representative of the most important teaching and research institutions of Brazil and from the most varied areas of knowledge in hematology to discuss diverse issues. After training, this group prepared several guidelines from the results of systematic investigations of the literature. Seventeen priority themes, working groups and their coordinators were defined as were the start and end dates for each issue. It was decided that all the reports would be published in Portuguese in the journal of the Associacao Medica Brasileira (RAMB) and in English in the Revista Brasileira de Hematologia e Hemoterapia (RBHH). The working methodology included regular meetings between the group of researchers and those who were carrying out the systematic reviews of the literature. The most important questions were identified by experts of different fields within clinical hematology, pediatric hematology and transfusion medicine. The first set of guidelines, completed and published in 2012, was related to chronic myeloid leukemia,1 an

Goals, globalization and the impact factor of the journal.

Over the years, as editors of Revista Brasileira de Hematologia e Hemoterapia (RBHH), we have faced different issues. The irst of these, an observation that sometimes became a question, is about the purpose of the journal. To answer this question it is necessary to return to the journal’s origins in the 1980s. In those dificult times of discretion, Brazil was different and the Sociedade Brasileira de Hematologia e Hematologia (SBHH) was going through a period of restructuring and controversy about the role of hemotherapy in the country. In a irm and decisive action, remunerated blood donation was banned in Brazil. The SBHH had published a monthly newsletter since 1973 which aimed to promote the activities of the Executive Board of the society and informing everyone about what was going on in hematology and transfusion medicine across the country. At a time when there was little information, when for most it was dificult to access scientiic journals, it was said that for some corners of the country, this was the only accessible communication about hematology and transfusion medicine. An international congress of hematology was hosted by the city of Buenos Aires, Argentina, in 1984 when the Board of the SBHH, in a daring act involving four or ive people, modiied the format of the newsletter and launched instead a prototype of the scientiic journal that circulated during the event. At that point the primary objective and heresy of the creators was to move forward and to mark a scientiic position, a criticism that the SBHH received, in addition to attracting young people

The Guidelines Project: Brazilian guidelines for acute promyelocytic leukemia

The Guidelines Project of the Associacao Medica Brasileira (AMB) and of the Conselho Federal de Medicina (CFM) began in 2000 with specialist societies participating in the preparation of the texts. The guidelines are based on research and contain solid advice on the diagnosis, therapy, and prevention of diseases. Grounded in evidence-based medicine, they seek to answer specific or crucial questions regarding the disease. A review of the literature is performed and, using pre-established criteria, studies on the disease are selected and graded according to their characteristics and type. Randomized clinical trials and meta-analyses have the highest value (A). Second in importance are observational and clinical studies (B), then case reports and case series (C), and finally, publications of consensuses and opinions (D). Due to the methodology employed, current systematic reviews are clearly more relevant when compared to those written in the past. Historically, reviews were much more based on personal opinions and subject to the author's interest, that is, more concerned with the individual point of view and based on personal experience.1 The Associacao Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) began to participate effectively in the development of the guidelines of the AMB in 2009, with contributions by several experts as shown in Table 1; previously, the collection was limited, with fewer themes. After 2012, guidelines on several diseases were completed and published in the Revista Brasileira de Hematologia e Hemoterapia (RBHH); chronic myelogenous leukemia,2 multiple myeloma,3 and diagnosis4 and treatment of immune thrombocytopenic purpura.5 It is also important to quote other systematic reviews published in the RBHH, such as preventive practices in longterm hematopoietic stem cell transplantation survivors, with the participation of experts from several different countries.6 The consensus of the Sociedade Brasileira de Transplante de Medula Ossea (SBTMO) produced the famous 'Pink Book'; this was rounded out with two publications on transplantation in acute myeloid leukemia7 and autoimmune diseases.8 Table 1 Guidelines published on hematological diseases. Acute promyelocytic leukemia (APL) has well-defined clinical, cytogenetic, and morphological characteristics; it encompasses 10% to 15% of all myeloid-type leukemias. Its molecular bases are well defined, with different variations influencing the treatment of patients.9 The results, as reported by the International Consortium on APL, established the treatment strategies and the conduct for the disease in developing countries.10,11 The guidelines for the diagnosis and treatment of APL12 are published in this issue of the RBHH, the first in 2014, thereby adding to those already published. Hopefully, this will stimulate other experts to continue this hard work, aiming to contribute to medical practice and to solidify the knowledge on the diagnoses and treatment of hematologic diseases.

Comment: seroprevalence of HTLV-1/2 among blood donors in the state of Maranhão Brazil✰✰See paper by Viana GM et al. on pages 50-3

The human T-cell lymphotropic virus type 1 (HTLV-1) was the first retrovirus identified in humans, and is the causal agent of HTLV-1-associated myelopathy (also known as tropical spastic paraparesis [HAM/TSP]) and adult T-cell leukemia/lymphoma (ATLL). HTLV-1 has been neglected mainly due to the misconception that it is a low morbidity viral infection. Recently evidence has been accumulating that a large percentage of HTLV-1-infected subjects, previously only considered as carriers, have disease due to the virus, such as sicca syndrome, chronic periodontitis, overactive bladder, erectile dysfunction, uveitis, and HTLV-1-associated arthropathy.1 It is estimated that approximately 20 million individuals are infected by HTLV-1 worldwide; Brazil is considered to be the country with the highest number of cases. Epidemiologic studies have pointed out that HTLV-1 is documented in all states of Brazil.2 In this issue of the Revista Brasileira de Hematologia e Hemoterapia a seroepidemiologic study showed a prevalence of 0.15% of HLTV-1 infection among blood donors in the State of Maranhao.3 Moreover, there was a high percentage (68.6%) of co-infected individuals with hepatitis B virus (HBV). Epidemiologic studies performed over 20 years in Brazil have contributed to evaluate the changes in the prevalence Scientific comment

The last issue of the year, a retrospective and a new perspective for the Revista Brasileira de Hematologia e Hemoterapia.

The last issue of the year, a retrospective and a new perspective for the Revista Brasileira de Hematologia e Hemoterapia.

The consequence of stacking by Brazilian journals

The consequence of stacking by Brazilian journals

I protest against the method used to evaluate scientific production used in Brazil

I protest against the method used to evaluate scientific production used in Brazil

Difficult blood donor choices: dance, feast or donate blood?

Difficult blood donor choices: dance, feast or donate blood?

Comment on: One window-period donation in two years of individual donor-nucleic acid test screening for hepatitis B, hepatitis C and human immunodeficiency virus

Since 1999 blood transfusion services around the world have been implementing nucleic acid amplification tests (NAAT) to screen for hepatitis C (HCV) RNA, human immunodeficiency virus (HIV) RNA and hepatitis B (HBV) DNA to improve the safety of the blood supply. Initially HCV RNA and HIV RNA NAAT screening was implemented and more recently HBV DNA NAAT screening commenced. In the beginning mini pools (MP) of 98 were used due to the manual complex systems available which were not suitable for high throughput because of the stringent laboratory requirements(1). Over the years the pool sizes have decreased to either 16 as used in the USA(2) or even smaller such as 6 as used by many European and Asian countries(3-5). South Africa, in 2005, was the first country in the world to implement individual donation (ID) screening for all three viruses of all donations(6). NAAT screening in parallel with serological screening has allowed the classification of HIV positive donations as window period, concordant and elite controller infections. HCV positive donations can be classified as window period, concordant and resolved infections and HBV positive donations can be classified as Window period, HBsAg only, acute concordant, occult and anti-HBc only infections. Since the implementation of NAAT for HBV DNA screening, vaccine breakthrough infections have also been recognized(7). The article in this issue of the Revista Brasileira de Hematologia e Hemoterapia (RBHH) entitled One window-period donation in two years of individual donor-nucleic acid test screening for hepatitis B, hepatitis C and human immunodeficiency virus by Levi et al. describes the first two years of screening for HIV RNA, HCV RNA and HBV DNA using ID NAAT in a small Brazilian blood center(8). From a total of 24,441 donations, no additional yield was obtained for HIV and HCV and they showed a 35% clearance rate for HCV and no elite controllers for HIV. The primary objective of the paper is to describe an unusual HBV yield case. This case tested HBsAg and anti-HBc negative and had an anti-HBs titer of 18 IU/mL. On follow up, the anti-HBs rose to 109 IU/mL, however in four samples over seven months no HBsAg or anti-HBc reactivity occurred. Sequencing confirmed the donation as a genotype A2 vaccine breakthrough infection. This is unusual as most documented breakthrough infections have been of the non-A2 genotype due to the vaccine comprising an A2 virus(7). The authors also showed 19 cases of HBsAg positive with no other HBV marker reactivity. It would be interesting to understand whether the authors viewed these donations as true or false infections in light of the investigations being done in the USA in the context of potentially removing HBsAg screening if HBV NAAT and anti-HBc screening is performed. Although this paper describes a small number of donations screened by ID-NAAT, if extrapolated to the larger Brazilian donor base and the prevalence and incidence is similar to that presented by Levi et al., then ID-NAAT could have a large impact on the safety of the blood supply particularly for HBV and HIV due to the high prevalence and incidence of the diseases, respectively.

The effect of taurine addition on the complete blood count

The complete blood count (CBC), also known as hemogram or blood panel, one of the components of the routine physical examination, aims to provide a lot of information to the physician regarding the state of a person's general health. The CBC is frequently used as an essential screening test for a wide range of conditions and disorders, including anemia, infection and leukemia. The CBC test, which is reliably performed by automated machines in most laboratories, measures the quantity of all the cellular part of the blood: red blood cells (RBC), whiteblood cells (WBC) and platelets (PLT). Additionally, the CBC affords some valuable information on other indices related to each type of blood cell. Any abnormities (increases or decreases) in blood cell counts or related indices as revealed by the CBC may indicate an underlying medical condition that directs and justifies further, more specific, laboratory investigations to confirm the diagnosis(1,2). For trustworthy results, the CBC test should be performed within a certain time limit which may be affected by the type of anticoagulant used and the preservation temperature and, to some extent, the automatic cell counter used(3,4). However, in different circumstances, processing blood samples is not possible within these time limits; hence blood samples received at the laboratories are either discarded or proceeded with doubtful reliability. In the current issue of the Revista Brasileira de Hematologia e Hemoterapia, Sirdah et al .provide a new prospect to extending the time limit for trustworthy CBC test results(5). In their study the authors added the naturally-occurring s-sulfonated amino acid, taurine, to K3-EDTA blood and tracked the changes on a daily basis for seven successive days at two different temperatures: ambient and refrigerated. The selection of taurine as an additive to the K3-EDTA blood is felicitous due to the striking beneficial effects of taurine on biological systems and cells which include antioxidation, inhibition of lipid peroxidation, stabilization of biomembranes, and maintenance of intracellular ions homeostasis(6). The significance of the study of Sirdah et al. is not limited to the promising results achieved; it could also encourage future studies to investigate the trustworthiness of the CBC over time using other chemical compounds. However, in future works, the blood film should be evaluated which may reveal the positively or negatively effects of taurine on RBC poikilocytosis. As taurine may exert beneficial effects on biomembrane stabilization, it is worthwhile to investigate the effect of taurine on RBC rheological properties. Finally, the study of Sirdah et al. demonstrates the feasibility of adding an antioxidant to wholeblood collected in K3-EDTA tubes which exhibited different patterns of reliability on CBC parameters over time. Moreover, it creates an opportunity to conduct further comprehensive comparative studies to evaluate other antioxidants and chemical compounds on the stability and reliability of laboratory tests that depend on the cellular components of the whole blood over time.

A novel strategy for the screening for platelet refractoriness: prospects and limitations

A novel strategy for the screening for platelet refractoriness: prospects and limitations

Comment on: "Clinical and functional evaluation of the joint status of hemophiliac adults at a Brazilian blood center"

In this issue of the Revista Brasileira de Hematologia e Hemoterapia, Ferreira et al. present a study entitled Clinical and functional evaluation of the joint status of hemophiliac adults at a Brazilian blood center(1). The authors are to be commended for presenting their paper on the outcomes of the clinical and functional evaluation of adults with hemophilia from a Hemophilia Centre in Brazil. The findings identify the importance of evaluating this specific group of patients with hemophilia in order to develop a deep understanding of their physical status and the problems that this can pose for the individuals concerned. The findings will also provide evidence to begin to address the issues raised in the study and it is hoped that this will ultimately improve patient outcomes. The use of standardized measures is essential in this regard and the authors have used two well established tools to assess the adults in the study. This scientific comment will make three observations on the findings outlined in the paper - The importance of primary prophylaxis - The use of standardized measures - The lack of engagement with physiotherapy

Neutropenic diet and quality of food: a critical analysis

Neutropenic diet and quality of food: a critical analysis

Red cell and human leukocyte antigen alloimmunization in candidates for renal transplantation: a reality

Red cell and human leukocyte antigen alloimmunization in candidates for renal transplantation: a reality

Human T lymphotropic virus types 1 and 2: a point of view

Reported at the beginning of the 1980s, Human T lymphotropic viruses type 1 and 2 (HTLV1, HTLV 2) were the first retroviruses to have been detected in human beings. HTLV 1 was isolated from adult T-cell leukemia (ATL) and first described by Takatsuki et al. in Japan in 1976, as a malignancy that only affects T cells and only in adults(1, 2). Albeit infrequent, HTLV-1 infection may lead to severe morbidity when it causes malignancy or degenerative conditions. The virus can also cause mild immune deficiency even in the absence of any malignancy. Fatal neurologic diseases, such as HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP), uveitis, iritis, peripheral neuropathies, and arthritis can also be caused by HTLV-1. All these diseases can be autoimmune, but their exact mechanisms are not yet known(3). Human T lymphotropic virus type 2 (HTLV-2) was discovered in a patient with a T-cell variant of hairy cell leukemia. The virus has been associated with increased mortality and morbidity, risk for pneumonia and bronchitis, urinary tract infections, and rare neurologic manifestations. HTLV infection is life-long and disease symptoms can manifest some 20-40 years post-infection(4-6). Recently, an increased prevalence of psychiatric symptoms was described among HTLV-seropositive patients(7,8). Prevalence greatly varies in different regions of the world. HTLV-1 is endemic in southwestern Japan, in the Caribbean Islands, and in Central Africa. Carriers have been identified in South America, Papua New Guinea, the Solomon Islands, South China, and other isolated populations such as the Australia Aborigines. HTLV-2 can also be found in some Native American populations. HTLV-1 is transmitted by blood, through sexual contact, injectable drug use and from mother to offspring through breastfeeding(1-6). HTLV-2 is most often found in injectable drug users and in their sexual partners. As a consequence of the transmission routes, all blood donated at the Red Cross Blood Centers in Japan has been subjected to HTLV-1 antibody screening since November 1986 and carrier mothers have been instructed to refrain from breastfeeding to prevent HTLV-1 transmission(9-11). In the United States, screening began at the end of 1988 and in the entire world since 1990(12-15). At the beginning, blood donor screening was performed with enzyme immunoassays (EIAs) for antibodies against HTLV-1 and later against HTLV-1/2, which led to the unnecessary deferral of a great number of individuals. Confirmatory testing could be performed by Western blot but this was expensive and took a long time. Nowadays screening is performed by chemiluminescent immunoassay with a lower risk of false positives(16). Up to now there is no available licensed confirmatory test. The efficacy of this test reduces the number of indeterminate results and could be better than the lookback procedure for HTLV-1/2(17). Confirmatory testing by polymerase chain reaction (PCR), albeit expensive, is used in the great majority of blood banks around the world. The same serological difficulties are observed in Brazil as confirmatory testing is only performed by research groups in some blood banks. HTLV-1/2 infection is endemic in Brazil(18-22) and testing blood donors has been mandatory since 1993. Recently, Carneiro-Proentti et al.(22) analyzed all blood donations of three regional Brazilian Blood Banks located in Sao Paulo, Minas Gerais and Pernambuco during 2007-2009. Serological results were confirmed by Western blot. Results concerning donor age, gender, education status, and race confirmed the previously published results from other Brazilian blood banks(23,25). Prevalence increased with age, was higher among women and Blacks and was inversely correlated to the level of education. Prevalence variations in different blood banks were expected and probably reflect population origins (higher in Pernambuco than in Sao Paulo and Minas Gerais). The overall incidence rate was 3.59 per 100,000 person-years and the residual risk was 5.0/100,000 per repeat donor blood unit transfused, that is, lower than previously reported in southern Brazil(25). Seroprevalence rates were in the order of 1 to 2 per thousand first time donors which is higher than in the United States and Europe but lower than in the Brazilian general population(24). Besides HTLV screening difficulties, the public health system is also not prepared to confirm and counsel serum-positive donors thus creating a difficult situation as the virus can be transmitted through breastfeeding and the disease can appear almost 30 years after a serological positive result. Preventive measures, the follow up of donors and confirmatory testing procedures must be improved. In this issue of the Revista Brasileira de Hematologia e Hemoterapia, Lima et al. bring new data from the Caruaru Blood Center in Pernambuco(26).

Comments on: Molecular matching of red blood cells is superior to serological matching in sickle cell disease patients

Comments on: Molecular matching of red blood cells is superior to serological matching in sickle cell disease patients

Anemia in the elderly: an important clinical problem

A paper written by Sgnaolin et al.(1) is published in this issue of the Revista Brasileira de Hematologia e Hemoterapia. The authors present a study about the frequency of anemia of 1058 people of 60 years old or more living in a community-based population in Porto Alegre, Brazil. Blood samples were taken from all participants and the hematological parameters [hemoglobin, mean cell volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW)] were analyzed. They observed a frequency of anemia of 12.8%, which was higher in women than in men. The majority of anemic patients presented with normocytic and normochromic anemia, but when they evaluated the erythrocyte morphology the anemic population had almost 10 times more microcytosis than the non-anemic subjects.