A púrpura trombocitopênica neonatal aloimune é uma doença grave, na qual a mãe produz anticorpos contra antígenos plaquetários fetais herdados do pai, e é ainda subdiagnosticada na prática clínica. É considerada o equivalente plaquetário da doença hemolítica do recém-nascido, com a diferença que o primeiro filho é afetado, apresentando trombocitopenia fetal e/ou neonatal. Há risco significativo de hemorragia intracraniana e sequelas neurológicas graves, com tendência a trombocitopenia mais grave e mais precoce nas gestações subsequentes. Este artigo relata um caso de trombocitopenia aloimune neonatal na segunda gestação afetada e discute diagnóstico, manejo e importância clínica dessa doença na prática clínica.

Neonatal alloimmune thrombocytopenia is a serious disease, in which the mother produces antibodies against fetal platelet antigens inherited from the father; it is still an underdiagnosed disease. This disease is considered the platelet counterpart of the RhD hemolytic disease of the fetus and newborn, yet in neonatal alloimmune thrombocytopenia the first child is affected with fetal and/or neonatal thrombocytopenia. There is a significant risk of intracranial hemorrhage and severe neurological impairment, with a tendency for earlier and more severe thrombocytopenia in subsequent pregnancies. This article reports a case of neonatal alloimmune thrombocytopenia in the second pregnancy affected and discusses diagnosis, management and the clinical importance of this disease.

Objective: To describe general data on nucleic acid/serology testing and report the first hepatitis B-nucleic acid testing yield case of an immunized donor in Brazil. Methods: A total of 24,441 donations collected in 2010 and 2011 were submitted to individual nucleic acid testing for hepatitis B, hepatitis C and human immunodeficiency virus using the TaqMan® MPX kit (Roche) on the Cobas s201 platform, in addition to routine screening for serological markers. Nucleic acid testing-reactive donations were further evaluated by real-time polymerase chain reaction using Cobas AmpliPrep/Cobas TaqMan hepatitis B virus, hepatitis C virus and human immunodeficiency virus tests. Results: Thirty-two donations were reactive by nucleic acid testing, 31 were also serologically reactive and one first-time donor was identified as having hepatitis B in the window period. Follow-up samples showed increasing titers of anti-HBs rising from 19 UI/mL in the index donation to 109 IU/mL seven months later attributable to his vaccination history. Curiously, this donor was never reactive for HbsAg nor for anti-HBc. In the yield donation, he was concomitantly reactive for syphilis (enzyme immunoassay and fluorescent treponemal antibody-absorption; venereal disease research laboratory non-reactive). Overall, six donors (0.02%) were characterized as occult hepatitis B. A total of 35% of the confirmed (recombinant immunoblot assay positive) hepatitis C donations were nucleic acid testing non-reactive and no human immunodeficiency virus "elite controller" was identified. Conclusion: The yield rate (1:24,441; 95% confidence interval: 1:9,537 - 1:89,717) contrasts to the North American rate (1:410,540 donations) and strongly advocates the adoption of nucleic acid testing for hepatitis B in Brazil despite the increasing rate of anti-HBs reactive subjects due to the successful immunization program.

OBJETIVO: Avaliar a contaminação bacteriana da câmara anterior, após facoemulsificação não complicada, com tamanhos diferentes de incisões e lentes intra-oculares. MÉTODOS: Foi realizado estudo prospectivo randomizado, de 80 olhos de 80 pacientes, submetidos à facoemulsificação sob anestesia tópica, distribuídos aleatoriamente em dois grupos iguais. No grupo A foram alocados os pacientes submetidos à cirurgia com incisão de 3,0 mm, lente intra-ocular dobrável de silicone implantadas com injetor. No grupo B os pacientes foram submetidos à cirurgia com incisão de 5,8 mm e implante de lente intra-ocular de polimetilmetacrilato de peça única, com pinça. Ao final de cada cirurgia, uma amostra do líquido da câmara anterior foi colhida e semeada em meios de cultura para bactérias. RESULTADOS: A cultura do líquido da câmara anterior foi positiva em 2,5% dos casos do grupo A e em 5,0% do grupo B. Não houve diferença estatisticamente significante entre os dois grupos (chi2 = 0, 380, p> 0,05). CONCLUSÃO: O implante de lente intra-ocular através de incisão menor, não resultou em menor contaminação da câmara anterior na cirurgia de facoemulsificação.

PURPOSE: To evaluate bacterial anterior chamber contamination following uncomplicated phacoemulsification with differents sizes of incisions. METHODS: Prospective randomized study, 80 eyes, 80 patients divided into two groups, were submitted to phacoemulsification with topical anaesthesia. In group A, with 40 patients, surgery was perfomed with 3.0 mm incision and silicone intraocular lens implant with injector. In group B the surgery was done with 5.8 mm incision and polymethylmethacrylate intraocular lens implant with forceps. Anterior chamber aspirate was taken for culture upon completion of surgery in each case. RESULTS: Anterior chamber cultures were positive in 2.5% of the cases in group A, and 5.0% in group B (chi-square test = 0.380, p>0.05), frequencies of contamination were not significantly different. CONCLUSION: Intraocular lens implant through a smaller incision did not decrease anterior chamber contamination in phacoemulsification.