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Aim: In placenta-mediated pregnancy complications, evidence-based guidelines are based on studies with controversial results or expert opinion. In this context, the implementation of those guidelines is quite different among physicians. Our aim was to analyze the management of PMC in a real-world scenario. Methods: From 2010 until 2016, we started the “TEAM Project” as a nested project within a working group of the Spanish Society of Thrombosis and Hemostasis (SETH : Sociedad Espanola de Trombosis y Hemostasia). Results: We included 666 women with PMC, including recurrent pregnancy loss (50%), fetal death (25%), preeclampsia- eclampsia (20%), intrauterine growth restriction (5%) and placental abruption. Although a thrombophilia test was indicated in more than 80% of these patients, antiphospholipid antibodies were tested in less than 70% cases. The presence of PT20210A mutation and positive antiphospholipid antibodies were the most common findings observed. Among the 257 women with previous PMC who were assessed for thrombotic risk, 88.7% received antithrombotic prophylaxis, most frequently (46.8%) low molecular weight heparin (LMWH)+aspirin (AAS) and recurrence was observed in 14% of women. Conclusion: This is the first observational, multicentric and multidisciplinar phase IV study analyzing the real-life clinical management of PMC and other hemostatic/thrombotic events in women from Spain and Uruguay. Our results evidence a lack of homogeneity in the management of these complications as a result of the wide discordance among the existing guidelines, as well as a need for a call to action in fetal-maternal medicine.

Hyperhemolysis syndrome (HHS) is characterized by severe intravascular hemolysis with a decrease in the reticulocyte count, which is triggered and aggravated by transfusion and cannot be explained by standard immunohematological studies. A nationwide study was conducted in order to retrospectively identify thalassemia patients with HHS in Spain in order to assess pre-disposing mechanisms for this syndrome. For this, the expression of adhesion (CD49, CD36) and complement-related molecules (C3a, CD59) and the levels of reticulocyte apoptosis and macrophage activation were measured in 4 thalassemia patients with HHS, 14 patients without HHS, and 10 healthy subjects. Five of the six thalassemia patients had δβ-thalassemia. The patients were not alloimmunized prior to the syndrome, which was developed after the first transfusion in all but one case. Patients with δβ-thalassemia did not respond to corticoids or immunoglobulins; only splenectomy was successful. The expression of CD49 (α4β1 integrin) was far higher in patients who had experienced HHS (85.07 ± 18.46 vs. 46.28 ± 24.31; p

Resumen Antecedentes y objetivos En los ultimos anos los anticoagulantes orales directos (ACOD) se han convertido en una alternativa a los antagonistas de la vitamina K (AVK) para la prevencion del ictus y embolia sistemica en pacientes con fibrilacion auricular no valvular (FANV), asi como para la prevencion y tratamiento de la trombosis venosa profunda. Los ensayos clinicos han demostrado la no inferioridad y la potencial superioridad en comparacion con la warfarina, lo cual permite ampliar las opciones de anticoagulacion. En nuestro medio, las Unidades de Tratamiento Anticoagulante (UTA) y los Centros de Atencion Primaria (CAP) son los encargados de la educacion, seguimiento, control de adherencia y del manejo en situaciones especiales de los pacientes anticoagulados. Estas consideraciones han motivado la preparacion del presente documento de consenso, que tiene como objetivo establecer recomendaciones que incorporen los hallazgos de la investigacion cientifica a la practica clinica para mejorar la calidad asistencial en el ambito de la anticoagulacion. Material y metodos Un grupo de expertos del Grupo Catalan de Trombosis (TROMBOC@T) ha revisado la bibliografia publicada entre 2007 y 2016 para poder establecer recomendaciones basadas en la evidencia clinica. Resultados Como resultado del proyecto se han establecido un conjunto de recomendaciones de caracter practico que facilitaran el tratamiento, educacion, seguimiento y manejo en situaciones especiales de los pacientes anticoagulados con ACOD. Conclusiones El aumento progresivo del uso de los ACOD requiere establecer y homogeneizar las directrices de actuacion clinica en el paciente anticoagulado con estos antitromboticos tanto en las UTA como en los CAP.

Summary Objective We performed a systematic review and meta-analysis of studies to evaluate the diagnostic accuracy of expression of CD64 on polymorphonuclear neutrophils (PMN) as a marker for bacterial infection. Methods The analysis included studies of patients from all age groups that prospectively evaluated CD64 expression on PMNs for the diagnosis of bacterial infection. We evaluated the methodological quality of the studies according to the 25-item criteria developed by the Standards for Reporting of Diagnostic Accuracy (STARD) committee. We calculated a summary receiver operating characteristic (SROC) curve across studies included in the meta-analysis. Results The methodological quality score of the 13 included studies ranged from 9 to 16 points (maximum score was 25 points). The pooled sensitivity and specificity for CD64 expression on PMNs were 79% (95% CI: 70–86%) and 91% (95% CI: 85–95%), respectively. The area under curve (AUC) was 0.94. Conclusions On the basis of this meta-analysis, CD64 expression on PMNs could be a useful diagnostic cell-based parameter of bacterial infections. However, published studies about this topic showed a low methodological quality.

The purpose of this study was to evaluate the diagnostic accuracy and prognostic value of neutrophil CD64 expression for bacterial infection in febrile adult patients presenting to our hospital emergency department. We prospectively included 132 patients with fever ≥ 38oC (≥ 100.4oF) during the last 24 hours and we measured CD64 expression on neutrophils the day after admission at the emergency department. We followed the patients until full recovery or death. There were 115 (87%) patients with bacterial infection and 108 (94%) of them survived. There were 17 (13%) patients without bacterial infection and 12 (71%) of them survived. Patients with bacterial infection and patients who survived showed a CD64 index higher when compared with patients without bacterial infection and patients who died, respectively (3.7 ± 3.2 vs. 2.5 ± 2.3; p = 0.03; and 3.7 ± 3.1 vs. 1.7 ± 0.6; p = 0.002; Mann-Whitney U test). The receiver operating characteristic (ROC) curve analysis for detecting bacterial infection and predicting survival with the CD64 index showed an area under curve (AUC) of 0.66 (95% CI, 0.52-0.8; p = 0.03) and 0.71 (95% CI, 0.57-0.85; p = 0.01), respectively. Diagnostic accuracy and prognostic value of CD64 expression was good in adult patients with fever.