RESUMO
Introducción: La anemia es frecuentemente subdiagnosticada dada su vaga sintomatología. Estudios con evaluación subjetiva-visual por expertos describen signos tomográficos sugerentes de anemia, tales como el septo denso. Proponemos que lectores con entrenamiento básico realicen mediciones objetivas de alto poder estadístico para la detección de anemia. Material y Métodos: Se cruzaron datos de tomografía computarizada (TC) de tórax no contrastada (2021) con medición de hemoglobina plasmática (Hb) realizada 24 horas antes o después del estudio tomográfico. Dos estudiantes de Medicina, previamente entrenados, realizaron mediciones de Unidades Hounsfield (UH) en el septo interventri-cular (SIV) y cavidades ventriculares derecho (VD) e izquierdo (VI). Las relaciones SIV/VI y SIV/VD se correlacionaron con los valores de Hb. Se analizó la variabilidad interob-servador y se determinó el punto de corte óptimo para detectar anemia. Resultados: En una muestra de 112 casos, hubo alta concordancia interobservador con r de 0,85 (VD), 0,67 (SIV) y 0,87 (VI). La relación SIV/VI obtuvo el mayor AUC con 0,86 (IC 95%: 0,72 a 0,91), con una sensibilidad de 80% y especificidad de 88% utilizando un punto de corte de 1,15. Conclusiones: La razón SIV/VI con punto de corte de 1,15 es un parámetro confiable para detectar anemia mediante TC de tórax no contrastada, en observadores con entrenamiento básico.
Introduction: Anemia is frequently underdiagnosed given its vague symptomatology. Studies with subjective-visual evaluation by experts describe tomographic signs suggestive of anemia, such as a dense septum. This study aims to evaluate if readers with basic training can perform high statistical value measurements for anemia detection. Material and Methods: Data of non-contrast thoracic computed tomography (CT) (2021) with a measurement of plasma hemoglobin (Hb) performed 24 hours before or after the CT were identified. Two previously trained medical students performed measurements of Hounsfield Units (HU) on the interventricular septum (IVS) and right (RV) and left (LV) ventricular cavities. The SIV/VI and SIV/VD ratios were correlated with Hb values. Interobserver variability was analyzed and the optimal cut-off point to detect anemia was determined. Results: In a sample of 112 cases, there was a high interobserver correlation with r of 0.85 (VD), 0.67 (SIV), and 0.87 (VI). SIV/VI ratio obtained the highest AUC with 0.86 (95% CI: 0.72 to 0.91), with a sensitivity of 80% and specificity of 88% using a cut-off point of 1.15. Conclusions: The SIV/VI ratio with a cut-off point of 1.15 is a reliable parameter to detect anemia using non-contrast chest CT in observers with basic training.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Tomografia , Anemia/diagnóstico por imagem , Estudantes de Medicina , Tórax/diagnóstico por imagem , Hemoglobinas , Chile , Septo Interventricular/diagnóstico por imagem , Ventrículos do CoraçãoRESUMO
Perinatal hemolytic disease occurs secondary to a hemolytic phenomenon of immune origin resulting in fetal or neonatal anemia. A 38-year-old pregnant woman was referred to the Department of high risk Obstetrics, Hospital Universitario La Paz Madrid because of presenting a dichorionic diamniotic twin pregnancy spontaneously, pre-pregnancy diabetes poorly controlled and severe alloinmunization anti-D. Her first pregnancy ended in a normal delivery at term; in the period of 4 years, she has three newborn with 36, 34 and 40 weeks respectively, who die with a week of life. After that, two intrauterine fetal death occur at 26 weeks of gestation. The patient who is RhD negative, suffers anti-D inmunization with a antibody titration of 1/1024 with 14 weeks of gestation. Twelve plasmapheresis, eight doses of anti-D inmunoglobulins and intrauterine transfusions has been the treatment received. A severe anemia is found during the ultrasound control of the middLe cerebral artery peak systolic velocity in both twins since the 16th week. It remains stable thanks to the treatment. Finally at the 28th week of gestation, pregnancy is terminated with a cesarean section. The twins are born alive and premature, but with good general state. The measurement of the middle cerebral artery peak systolic velocity predicts moderate-severe fetal anemia cases, which are the most important in the clinical management because of the need of active treatment or finish the pregnancy.
Assuntos
Doenças em Gêmeos/terapia , Gravidez de Gêmeos , Isoimunização Rh/terapia , Adulto , Anemia/diagnóstico por imagem , Anemia/embriologia , Anemia/etiologia , Cesárea , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Doenças em Gêmeos/diagnóstico por imagem , Doenças em Gêmeos/imunologia , Feminino , Sangue Fetal , Doenças Fetais/etiologia , Idade Gestacional , Humanos , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/embriologia , Plasmaferese , Gravidez , Complicações na Gravidez/dietoterapia , Complicações na Gravidez/tratamento farmacológico , Gravidez de Alto Risco , Isoimunização Rh/diagnóstico por imagem , Isoimunização Rh/imunologia , Sístole , Gêmeos Dizigóticos , Ultrassonografia , gama-Globulinas/uso terapêuticoRESUMO
Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disorder of elderly people. Cardiac dysfunction is a marker of grim prognosis in MDS. We evaluated cardiac dysfunction of MDS patients with or without transfusion dependency by tissue doppler echocardiography. We found the average values of ventricular end-systolic and end-diastolic volumes in transfusion dependency MDS group higher than others. These results were strongly correlated to hemoglobin levels. Tissue Doppler Echocardiography should be routinely performed in MDS patients to detect preclinical cardiac alterations and prevent more heart insults in this group of chronic anemic aged patients.
Assuntos
Anemia/diagnóstico por imagem , Biomarcadores/análise , Ecocardiografia Doppler , Síndromes Mielodisplásicas/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/etiologia , Feminino , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Disfunção Ventricular Esquerda/etiologiaRESUMO
OBJECTIVE: To verify the correlation between fetal splenic artery Doppler velocimetry and fetal hemoglobin (Hb) levels in Rh alloimmunization. METHODS: Splenic artery Doppler peak systolic velocity (PSV) and pulsatility index (PI) were obtained before cordocentesis in rhesus-alloimmunized fetuses. Doppler was performed before 80 cordocentesis in 36 patients between 20 and 35 weeks of gestation. Mild, moderate and severe anemia were defined as a Hb deficit of >or=2, >or=5 and >or=7 g/dl respectively. RESULTS: Anemia was noted in 64% of the fetuses and moderate and severe anemia in 18 and 21%. Splenic artery PSV was higher in groups with moderate (p = 0.001) and severe (p < 0.000) anemia but not in the group with mild anemia (p = 0.189) when compared to non-anemic fetuses. Splenic artery PI was higher only in the severely anemic group (p = 0.001). CONCLUSIONS: The splenic artery PI and PSV are higher in fetuses with severe anemia.
Assuntos
Anemia/embriologia , Doenças Fetais/fisiopatologia , Isoimunização Rh/complicações , Artéria Esplênica/fisiopatologia , Adulto , Anemia/diagnóstico por imagem , Anemia/fisiopatologia , Velocidade do Fluxo Sanguíneo , Cordocentese , Feminino , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/etiologia , Humanos , Fluxometria por Laser-Doppler , Gravidez , Artéria Esplênica/diagnóstico por imagem , UltrassonografiaRESUMO
BACKGROUND: Fetal anemia is a common result of alloimmunization and is an important cause of fetal congestive heart failure resulting in heart dilation. Fetuses suspected of having heart failure present a higher Cardiofemoral Index and an increase in plasma BNP levels, because the cardiac hormonal system is activated by increased heart wall stretch due to increased left ventricular volume and pressure overload. METHODS: Our group studied 33 pregnant women (22-31 weeks' gestation at the first cordocentesis) referred for intrauterine fetal transfusion due to severe red blood cells isoimmunization. Up to 6 h prior to each cordocentesis, all fetuses were submitted to ultrasonography measurements where the Cardiofemoral Index was calculated. Samples of blood from the umbilical vein were collected for hemoglobin concentration and blood gas measurements. Plasma levels of BNP were determined with the use of plasma that had previously been frozen and thawed once. Plasma BNP was measured by radioimmunoassay. Pearson's correlation test and regression analysis were used to determine the association between the plasma concentration of BNP and the Cardiofemoral Index of the anemic fetuses with RH alloimmunization. RESULTS: Anemia was severe in 17 (50%) fetuses, mild in 9 (26.47%) and in 8 patients (23.53%) the fetuses were not anemic; hemoglobin ranged from 3.10 to 15.70 g/dl. The Cardiofemoral Index ranged from 0.43 to 0.87 and it was altered (>or=0.59) in 23 fetuses. A significant positive correlation was observed between BNP plasma fetal concentration and Cardiofemoral Index (Pearson r=0.61, P<0.0001). CONCLUSIONS: These results suggest that fetal plasma concentration of BNP may increase in fetuses with heart dilation leading to a positive association between Cardiofemoral Index and plasma concentration of BNP.
Assuntos
Anemia/diagnóstico , Doenças Fetais/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Isoimunização Rh/sangue , Adulto , Anemia/sangue , Anemia/diagnóstico por imagem , Estudos Transversais , Feminino , Fêmur/anatomia & histologia , Fêmur/diagnóstico por imagem , Doenças Fetais/sangue , Doenças Fetais/diagnóstico por imagem , Feto , Ventrículos do Coração/anatomia & histologia , Ventrículos do Coração/diagnóstico por imagem , Hemoglobinas/metabolismo , Humanos , Gravidez , Estatísticas não Paramétricas , Ultrassonografia Pré-Natal , Adulto JovemRESUMO
BACKGROUND: pregnant women with Rh alloimmunization (RhA) are submitted to invasive procedures to assess fetal anemia (FA). Recently a non-invasive approach to FA diagnosis has been proposed using Doppler ultrasound (DU) to identify increased peak velocity of systolic blood flow (Vm) in the middle cerebral artery (MCA). METHODOLOGY: eleven Rh alloimmunized pregnant women with serum red-cell antibody titers > 1:16 were included. Twenty-four procedures were done measuring the VmMCA followed by cordocentesis and fetal hemoglobin (FH) analysis. Pearson's linear correlation was calculated between the multiples of the median (MoM) of the VmMCA and the MoM of the FH, as well as the sensitivity, specificity and positive predictive value (PPV) for FA prediction. RESULTS: we found FA (FH mean = 6 g/dL) in 12 of 24 evaluations with a VmMCA mean of 1.5 MoM and a range from 1.22 to 1.68 MoM; in the remaining 12 cases the FH was normal (FH mean = 13.1 g/dL) with a VmMCA mean of 0.97 MoM and a range from 0.35-1.17 MoM (p < 0.001). Eleven fetuses with anemia had a MoM of the VmMCA above 1.29, except one with 1.22 MoM. The linear correlation between the MoM of the VmMCA and the MoM of FH was 0.83. The sensitivity of the MoM of the VmMCA to detect FA was 91%, specificity of 100% and PPV of 100%. CONCLUSIONS: DU measurement of the VmMCA was a useful non-invasive technique to evaluate FA. The sensitivity and PPV for FA diagnosis in RhA was above 90%.
Assuntos
Anemia/sangue , Anemia/diagnóstico por imagem , Doenças Fetais/sangue , Doenças Fetais/diagnóstico por imagem , Isoimunização Rh , Ultrassonografia Doppler , Ultrassonografia Pré-Natal , Feminino , Humanos , Valor Preditivo dos Testes , Gravidez , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To assess whether a significant correlation exists between the echographic measurement of biventricular outer diameter and the pretransfusional serum concentration of fetal hemoglobin and whether that echographic measurement can be used as a noninvasive marker of fetal anemia. METHODS: A prospective cross-sectional study was carried out comprising 65 cordocenteses performed in 36 anemic fetuses of mothers with isoimmunization to the Rh antigen. The biventricular outer diameter (BOD) was obtained by M-mode evaluation. Previous to the transfusion, a 0.5-mL fetal blood sample was obtained for hemoglobin measurement with spectrophotometry in the Hemocue device. The minimum square regression was used with p < 0.05 and multivariate analysis were used as statistical analysis. RESULTS: An inverse correlation was observed between the fetal hemoglobin concentration before transfusion and the BOD measurement, and a direct correlation was observed between the BOD measurement and gestational age. In addition, multivariate analysis showed that fetal hemoglobin concentration decreases as BOD increases, independently of the influence of gestational age on that parameter. CONCLUSION: An inverse correlation exists between fetal hemoglobin concentration and BOD measurement, regardless of gestational age. The findings suggest that BOD may become an echographic predictor of the hemoglobin level of fetuses of isoimmunized pregnant women.
Assuntos
Anemia/diagnóstico por imagem , Ecocardiografia/métodos , Sangue Fetal/química , Hemoglobinas/análise , Isoimunização Rh/sangue , Anemia/sangue , Biomarcadores/sangue , Estudos Epidemiológicos , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Oximetria , GravidezRESUMO
BACKGROUND: Red cell alloimmunization is an important cause of perinatal morbidlity and mortality. Invasive procedures used to diagnose fetal anemia are associated with serious fetal and maternal complications. The development of noninvasive techniques as Doppler ultrasound can help us in the fetal anemia diagnosis. OBJECTIVES: To evaluate the effect of the Doppler ultrasound in prediction of fetal anemia caused by red cell alloimmunization. Strategy search: Relevant studies were identified by reviewing the registry of COCHRANE, and OVID, PROQUEST, MEDLINE and EMBASE data bases from 1966 to 2004. SELECTION CRITERIA: All prospective studies with clinically relevant results with comparison of Doppler ultrasound in fetal umbilical artery, fetal descendent aorta, middle cerebral fetal artery or esplecnic fetal artery with hemoglobin or fetal hematocrit. DATA COLLECTION AND ANALYSIS: Data were extracted from each report. The quality revision of the studies and the data compilation were made by the reviewers. MAIN RESULTS: Eighteen articles were included. Two studies reached the level of evidence 1 for diagnostic tests. The diagnostic tests had variations depending on the different cut-off of each study. Studies with level 1 of evidence reported detection of 100% for moderate to severe fetal anemia. CONCLUSIONS: Implementation of Doppler ultrasound for prediction of fetal anemia in complicated pregnancies with alloimmunization could reduce the number of invasive procedures and therefore its complications. The level of present evidence reveals to us that the studies do not fulfill the criteria of methodological quality.
Assuntos
Anemia/diagnóstico por imagem , Eritroblastose Fetal/prevenção & controle , Sangue Fetal/diagnóstico por imagem , Isoimunização Rh , Ultrassonografia Doppler , Ultrassonografia Pré-Natal , Anemia/sangue , Anemia/embriologia , Anemia/genética , Aorta/diagnóstico por imagem , Aorta/embriologia , Eritroblastose Fetal/sangue , Eritroblastose Fetal/diagnóstico por imagem , Medicina Baseada em Evidências , Feminino , Histocompatibilidade Materno-Fetal , Humanos , Troca Materno-Fetal , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/embriologia , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Isoimunização Rh/imunologia , Sistema do Grupo Sanguíneo Rh-Hr/genética , Sensibilidade e Especificidade , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/embriologia , Ultrassonografia Doppler/métodos , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagemRESUMO
Five patients in early childhood had moderate to marked anemia and clinically demonstrable thick long bones of the extremities with radiologic features of diaphyseal dysplasia. Although the anemia was persistent and not responsive to hematinics, prednisolone was administered to two of these patients and caused remarkable improvement of the anemia in both. Roentgenologic examination carried out after 1 year of corticosteroid therapy in one patient and after 11 years in another showed considerable improvement of the bony changes. The clinical and radiologic examinations of these patients and their follow-up study suggest that they may constitute an unusual group of patients with diaphyseal dysplasia associated with anemia, hitherto not well defined.