Abstract Introduction Umbilical cord blood is an alternative source of hematopoietic progenitor cells for bone marrow transplantation; however, it is associated with a higher graft failure rate. The presence of a high rate of nucleated red blood cells (NRBCs) seems to be related to a greater capacity for engraftment, although is also associated with fetal distress conditions. We analyzed the correlation of the NRBC with quality parameters and its association with the utilization score of a cord blood unit. Study design and method Data of 3346 units collected in a public cord blood bank from May 2010 to December 2017 were analyzed, retrospectively, to identify factors associated with an increased number of nucleated red blood cells and its correlation with the engraftment capacity measured through total nucleated cells (TNCs) and CD34 positive cells. We also evaluated the utilization score of these units and identified an NRBC cutoff associated with a higher score. Results The median volume collected was 104 mL (42-255), the pre-processing TNC count was 144.77 × 107 (95.46-477.18), the post-processing TNC count was 119.44 × 107 (42.7-477.18), the CD34 count was 4.67 × 106 (0.31-48.01), the NRBC count was 5 (0-202) and the utilization score was 0.0228 (0.00143-0.9740). The NRBC showed a correlation with the collected volume, TNC and CD34 positive cells and a higher utilization score and the receiver operating characteristic (ROC) curve analysis identified the five NRBC/100 leukocytes cutoff that correlates better with the probability of use. No association with pathological conditions and the NRBC rate was observed. Conclusions The NRBC is a feasible parameter for the screening of the cord blood unit (CBU) and the minimum cutoff of five NRBC/100 leukocytes can be a strategy in conjunction with the TNC to identify better units for cord blood bank sustainability. transplantation however NRBCs (NRBCs 334 201 retrospectively TNCs (TNCs CD CD3 10 42255, 42255 42 255 , (42-255) preprocessing pre processing 14477 144 77 144.7 95.46477.18, 954647718 95.46 477.18 95 46 477 18 (95.46-477.18) postprocessing post 11944 119 44 119.4 42.7477.18, 42747718 42.7 7 (42.7-477.18) 467 4 67 4.6 0.3148.01, 0314801 0.31 48.01 0 31 48 01 (0.31-48.01) 0202 202 (0-202 00228 0228 0.022 0.001430.9740. 00014309740 0.00143 0.9740 . 00143 9740 (0.00143-0.9740) ROC (ROC NRBC100 100 NRBC/10 use observed CBU (CBU sustainability 33 20 1 4225 25 (42-255 1447 14 144. 46477 95.46477.18 95464771 9546 95.4 47718 477.1 9 47 (95.46-477.18 1194 11 119. 7477 42.7477.18 4274771 427 42. (42.7-477.18 6 4. 3148 0.3148.01 031480 031 0.3 4801 48.0 3 (0.31-48.01 020 (0-20 0022 022 0.02 001430 0.001430.9740 0001430974 000143 0.0014 09740 0.974 0014 974 (0.00143-0.9740 NRBC10 NRBC/1 2 422 (42-25 4647 95.46477.1 9546477 954 95. 4771 477. (95.46-477.1 747 42.7477.1 427477 (42.7-477.1 314 0.3148.0 03148 03 0. 480 48. (0.31-48.0 02 (0-2 002 0.0 0.001430.974 000143097 00014 0.001 0974 0.97 001 97 (0.00143-0.974 NRBC1 NRBC/ (42-2 464 95.46477. 954647 (95.46-477. 74 42.7477. 42747 (42.7-477. 0.3148. 0314 (0.31-48. (0- 00 0.001430.97 00014309 0001 0.00 097 0.9 (0.00143-0.97 (42- 95.46477 95464 (95.46-477 42.7477 4274 (42.7-477 0.3148 (0.31-48 (0 0.001430.9 0001430 000 09 (0.00143-0.9 (42 95.4647 (95.46-47 42.747 (42.7-47 0.314 (0.31-4 ( 0.001430. (0.00143-0. (4 95.464 (95.46-4 42.74 (42.7-4 (0.31- 0.001430 (0.00143-0 (95.46- (42.7- (0.31 (0.00143- (95.46 (42.7 (0.3 (0.00143 (95.4 (42. (0. (0.0014 (95. (0.001 (95 (0.00 (9 (0.0

ABSTRACT Introduction: The Zika Virus (ZIKV) is a single-stranded RNA genome virus, belonging to the family Flaviviridae, genus Flavivirus. Outbreaks around the world have demonstrated that the presence of asymptomatic viremic blood donors provides an increase in the risk of transfusion transmission (TT) and nucleic acid test (NAT) screening has been proposed to ensure the blood safety. This study implemented an “in-house” method to detect ZIKV RNA in blood sample donations. Methods: Primary plasma tubes are submitted to nucleic acid extraction on an automated platform. After extraction, the NAT set-up is performed in the robotic pipettor, in which an amplification mixture containing primers and probes for ZIKV and Polio vaccine virus (PV) are added in duplex as an internal control. The real-time polymerase chain reaction is then performed in a thermocycler, using the protocol established by the supplier. Results: From May 2016 to May 2018, 3,369 samples were collected from 3,221 blood donors (confidence coefficient 95%), of which 31 were considered false positive (0.92%), as they did not confirm initial reactivity when repeated in duplicates and 14 (0.42%) had their results invalid due to repeat failure in the internal control, 4 (0.12%), due to insufficient sample volume and 2 (0.05%), due to automatic pipettor failures. No Zika RNA reactive sample was identified. Conclusion: The test showed feasible to be incorporated into the blood screening routine. Our data do not indicate the need to screen for ZIKV RNA in São Paulo during the evaluated period. However, a generic NAT system covering a group of flaviviruses which are circulating in the region, such as DENV and YFV, among others, could be a useful tool.

ABSTRACT Objective The objective of the present study is to evaluate the association of red blood cell distribution width with acute kidney injury in sepsis. Methods This is a retrospective study of 849 critically ill patients with sepsis in intensive care unit. Demographic data, renal function, inflammation, complete blood count, and acid-base parameters were compared between acute kidney injury and non-acute kidney injury groups. Therefore, a multivariate analysis was performed to observe independent predictive factors. Results Comparatively, higher levels of C-reactive protein, lactate, red blood cell distribution width, and Simplified Acute Physiology Score 3 were found in the acute kidney injury group. The study showed a higher frequency of women, hemoglobin (Hgb) concentration, platelets, bicarbonate and PaO2/FiO2 ratio in the non-acute kidney injury group. In addition, there was an independent association of comorbidity-chronic kidney disease [OR 3.549, 95%CI: 1.627-7.743; p<0.001], urea [OR 1.047, 95%CI: 1.036-1.058; p<0.001] and RDW [OR 1.158, 95%CI: 1.045-1.283; p=0.005] with acute kidney injury in sepsis patients. Conclusion As an elective risk factor, red blood cell distribution width was independently associated with sepsis-related acute kidney injury. Thus, red blood cell distribution width acts like a predictive factor for sepsis-induced acute kidney injury in intensive care unit admission.

Objetivo: Avaliar fatores que afetam o rendimento da coleta em pacientes submetidos à leucaférese de grande volume para obtenção de células-tronco hematopoiéticas do sangue periférico para autotransplante. Métodos: Análise retrospectiva de 304 doadores de células-tronco hematopoiéticas de sangue periférico para autotransplante submetidos à mobilização com fator de crescimento hematopoiético (geralmente G-CSF), associado ou não à quimioterapia, no Hospital Israelita Albert Einstein, de Fevereiro de 1999 a Junho de 2010. O objetivo da coleta foi obter pelo menos 2 × 106 CD34+ células/kg peso. Os fatores pré-mobilização incluíam idade, sexo e diagnóstico do paciente. Os parâmetros pós-mobilização avaliados foram contagem de leucócitos, células imaturas, células mononucleares, células CD34+, plaquetas e nível de hemoglobina no sangue periférico. O efeito desses fatores no rendimento da coleta de CTH foi investigado por meio de regressão logística (análise univariada e multivariada). Resultados: A análise univariada revelou os seguintes fatores pré-mobilização estatisticamente significantes: diagnóstico de leucemia mieloide aguda (p = 0,017) e outras doenças hematológicas (p = 0,023), células imaturas circulantes (p = 0,001), granulócitos (p = 0,002), nível de hemoglobina (p = 0,016) e contagem de células CD34+ no sangue periférico (p < 0,001) no primeiro dia de coleta. Entretanto, só a contagem de células CD34+ no sangue periférico manteve-se associada de forma significante ao rendimento ruim da coleta de células-tronco hematopoiéticas na análise multivariada. Conclusão: Neste estudo, a contagem de células CD34+ no sangue periférico foi o único fator significantemente associado ao rendimento da coleta de células-tronco hematopoiéticas com leucaférese de grande volume para autotransplante.

Objective: To evaluate factors affecting peripheral blood hematopoietic stem cell yield in patients undergoing large-volume leukapheresis for autologous peripheral blood stem cell collection. Methods: Data from 304 consecutive autologous peripheral blood stem cell donors mobilized with hematopoietic growth factor (usually G-CSF), associated or not with chemotherapy, at Hospital Israelita Albert Einstein between February 1999 and June 2010 were retrospectively analyzed. The objective was to obtain at least 2 × 106 CD34+ cells/kg of body weight. Pre-mobilization factors analyzed included patient's age, gender and diagnosis. Post mobilization parameters evaluated were pre-apheresis peripheral white blood cell count, immature circulating cell count, mononuclear cell count, peripheral blood CD34+ cell count, platelet count, and hemoglobin level. The effect of pre and post-mobilization factors on hematopoietic stem cell collection yield was investigated using logistic regression analysis (univariate and multivariate approaches). Results: Pre-mobilization factors correlating to poor CD34 + cell yield in univariate analysis were acute myeloid leukemia (p = 0.017) and other hematological diseases (p = 0.023). Significant post-mobilization factors included peripheral blood immature circulating cells (p = 0.001), granulocytes (p = 0.002), hemoglobin level (p = 0.016), and CD34+ cell concentration (p < 0.001) in the first harvesting day. However, according to multivariate analysis, peripheral blood CD34+ cell content (p < 0.001) was the only independent factor that significantly correlated to poor hematopoietic stem cell yield. Conclusion: In this study, peripheral blood CD34+ cell concentration was the only factor significantly correlated to yield in patients submitted to for autologous collection.