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ObjectiveThis study aimed at identifying associations between the participation of transfusion services in immunohematology external quality control programs and their accuracy in immunohematology testing and adaptation to technical and legal operational procedures.MethodsFrom 2007 to 2009, a cross-sectional study was conducted in 219 transfusion services of the State of Minas Gerais who participated in this investigation by responding to a questionnaire and conducting a proficiency test comprising: ABO and RhD phenotyping, irregular RBC antibody screening and cross-matching. Frequencies and bivariate analysis followed by binary logistic regression were used for statistical analysis.ResultsTransfusion services who participated in external quality control programs (32.4%) and those that did not (67.6%) obtained worrying error percentages in proficiency tests which may significantly increase blood transfusion risks. Shortfalls related to the establishment of protocols, standards and internal quality control were also significant. On comparing the two groups, transfusion services that participated in these programs had a 2.35 times higher chance of correct results in the proficiency panel testing, a 3.16 higher chance of having transfusional records and a 2.81 higher chance of performing preventive maintenance of equipment.ConclusionThe study showed that independent factors associated to participation in external quality control programs suggest that more investment in internal quality control procedures is necessary and that more attention should be paid to current legislation.

ObjectiveThis study aimed to verify the performance of blood transfusion committees in transfusion services linked to the public blood bank network of the state of Minas Gerais. MethodsA cross-sectional observational study was conducted between 2007 and 2008 using questionnaires and proficiency tests to evaluate the reporting and investigation of transfusion reactions comparing transfusion services with and without transfusion committees in the public transfusion services of the state of Minas Gerais. ResultsNineteen of Hemominas own transfusion services and 207 that contracted the services of the foundation located in 178 municipalities were visited between 2007 and 2008. Established transfusion committees were present in 63.4% of the services visited. Transfusion incidents were reported by 53 (36.8%) transfusion services with transfusion committees and by eight (9.6%) without transfusion committees (p < 0.001) with 543 (97.5%) and 14 (2.5%) notifications, respectively. Of the reported transfusion incidents, 40 (75.5%) transfusion services with transfusion committees and only two (25%) of those without transfusion committees investigated the causes. ConclusionThe incidence of notification and investigation of the causes of transfusion reactions was higher in transfusion services where a transfusion committee was present. Despite these results, the performance of these committees was found to be incipient and a better organization and more effective operation are required.

Adipose tissue can impact differently depending on its localization and amount of stored fat. Marrow adipose tissue (MAT) expansion occurs in catabolic conditions associated with bone loss, such as anorexia nervosa and glucocorticoid therapy. Conversely, obesity is related to high or normal BMD and no change in MAT. Our aim was to evaluate the relationship of lipids depots with bone mass and MAT in conventionally treated T1D and T1D subjects submitted to hematopoietic stem cell transplantation (HSCT). The study comprised 3 groups matched by age, gender, height and weight: Control (13M/11F; 29±6 years; 67.4±14.4 Kg; 1.68±0.08 m; 23.8±3.7 Kg/m 2), T1D (13M/10F; 32±13 years; 72.3±10.6 Kg; 1.69±0.08 m; 25.3±3.4 Kg/m 2 ,17±11 years of diabetes duration) e T1D-HSCT (5M/4F; 25±6 years; 66.9±11 Kg; 1.72±0.11 m; 22.5±2.2 Kg/m 2 ; 6 months to 10 years after HSCT). Blood samples were collected to evaluate glycemic control. BMD were assessed by DXA. 1-H magnetic resonance spectroscopy (1,5T) was used to evaluate MAT [fat/(fat+water) %] in L3 vertebrae. Subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intrahepatic lipids (IHL) were also evaluated by MRI. Only T1D exhibited poor metabolic control (HbA1c: Control=5.3±0.3%; T1D=9.6±2.2%; T1D-HSCT=6.4±0.5%; p<0.0001). Most T1D patients were overweighed (57%). BMD was similar between groups (e.g. L1-L4: Control=0.995±0.138 g/cm 2 ; T1D=0.977±0.132 g/cm 2 ; T1D-HSCT=0.971±0.115 g/cm 2 ; p>0.05). Low bone mass (Z-score>-2,0 or T-score>-1,0) prevalence among individuals was 12,5% (n=3) in the Control group, 26% (n=6) in the T1D conventionally treated group and 11% (n=1) in the T1D-HSCT group. SAT was higher in T1D whereas there was no difference in VAT, IHL and MAT (Control: 34.4±11.7 %; T1D: 34.2±8.5%; T1D-HSCT: 40.3±8.5%; p>0.05). Also, there no difference in MAT lipid composition between groups (p>0.05). SAT had a positive association with femoral neck BMD (for each unity of SAT = 0.0000055 g/cm 2 of BMD; p=0.02). Also, IHL had an inverse relationship with total hip and lumbar spine BMD (for each unity of IHL =-0.012 g/cm 2 of BMD; p=0.03). Other factors such as age and glycemic control also had a negative impact on bone mass. There was a positive correlation between VAT and IHL (r=0.40) whereas no association between IHL and MAT was found. Cholesterol (for each unity of cholesterol = 0.09% of MAT; p=0.0006) was an important preditor of MAT in L3. Yet, age (for each unity of age = 0.252% of MAT; p=0.0006) had a significant association with saturated fraction of MAT and male gender (-1.379% of MAT, p<0.0001) was a negative factor for the unsaturated fraction of MAT. Moreover, MAT did not have any association with lumbar spine BMD. Therefore, T1D bone mass was preserved and there were no changes in MAT content, independently of clinical treatment. This could be related to the nutritional status of T1D subjects. SAT accumulation was higher in T1D conventionally treated subjects compared to T1D-HSCT individuals probably due to more intense peripheral hyperinsuline...

BackgroundDespite significant advances, the practice of blood transfusion is still a complex process and subject to risks. Factors that influence the safety of blood transfusion include technical skill and knowledge in hemotherapy mainly obtained by the qualification and training of teams.ObjectiveThis study aimed to investigate the relationship between professional categories working in transfusion services of the public blood bank network in the State of Minas Gerais and their performance in proficiency tests.MethodsThis was an observational cross-sectional study (2007-2008) performed using a specific instrument, based on evidence and the results of immunohematology proficiency tests as mandated by law.ResultsThe error rates in ABO and RhD phenotyping, irregular antibody screening and cross-matching were 12.5%, 9.6%, 43.8% and 20.1%, respectively. When considering the number of tests performed, the error rates were 4.6%, 4.2%, 26.7% and 11.0%, respectively. The error rates varied for different professional categories: biochemists, biologists and biomedical scientists (65.0%), clinical pathology technicians (44.1%) and laboratory assistants, nursing technicians and assistant nurses (74.6%). A statistically significant difference was observed when the accuracy of clinical pathology technicians was compared with those of other professionals with only high school education (p-value < 0.001). This was not seen for professionals with university degrees (p-value = 0.293).ConclusionThese results reinforce the need to invest in training, improvement of educational programs, new teaching methods and tools for periodic evaluations, contributing to increase transfusion safety and improve hemotherapy in Brazil.