Publication year: 2015
Resumo:
Este estudo objetivou identificar o perfil sociodemográfico e clínico de crianças em pós-transplante de células-tronco hematopoiéticas imediato em cuidado ambulatorial. Pesquisa quantitativa, transversal e retrospectiva, realizada no Serviço de Transplante de Medula Óssea do Complexo Hospital de Clínicas da Universidade Federal do Paraná. Dentre os critérios de inclusão estão prontuários de crianças com idade entre 0 e 12 anos incompletos, transplantadas no período de 2009 a 2013. Os dados foram coletados por meio de instrumento estruturado, com início em janeiro e término em julho de 2015, e analisados por métodos estatísticos simples com auxílio do programa Software Statistical Package for the Social Sciences® 19.0. Para avaliação da associação entre variáveis categóricas foi aplicado o Teste do qui-quadrado, sendo considerados os valores de p<0,05 com significância estatística. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa do Setor de Ciências da Saúde da Universidade Federal do Paraná, parecer 742.621, 07 de agosto/2014. A amostra foi composta por 138 prontuários, dos quais 66,7% do sexo masculino, 58,5% com idade igual ou superior a seis anos, 51,4% estudantes, 68,1% brancos e 68,1% católicos. Houve prevalência das síndromes de falência medular (51%), dentre as quais a Anemia de Fanconi (30,4%). Todos os transplantes foram alogênicos, sendo 51,4% não aparentados. A medula óssea foi a fonte de células-tronco mais utilizada (80,4%), seguida do sangue de cordão umbilical (19,6%). Os transplantes com doadores aparentados incompatíveis somaram 12,3%. Dos transplantes, 69,6% foram compatíveis, prevaleceu o condicionamento de intensidade reduzida (50,7%) e a mucosite apresentou prevalência de 92,8%. Colonização por microrganismos multirresistentes esteve presente em 26,1%. As perdas do cateter de Hickman somaram 8% e o uso de sonda nasoenteral 11,6%. A alta hospitalar ocorreu, em 61,6%, entre 21 e 30 dias após o transplante. As reinternações somaram 34,8%, sendo a febre a principal causa (23,9%). Quanto às intercorrências clínicas, as mais prevalentes foram dor (60,9%), tosse (57,2%), coriza e febre (47,1% cada), vômito (46,4%), náusea (35,5%), diarreia (39,1%) e infecção viral (37%). Esta última esteve relacionada a sintomas como tosse, coriza e febre, bem como com a incompatibilidade do antígeno leucocitário humano (p<0,05). Houve associação entre transplantes com sangue de cordão umbilical e infecção viral; e transplantes não aparentados e infecções fúngicas e virais. A doença do enxerto contra hospedeiro representou 26,8%, sendo a pele o órgão mais acometido (11,6%). Um total de 68,1% de participantes necessitou de antibiótico e a causa mais comum foi a febre (43,5%). Quanto aos antivirais, 51,4% utilizaram e a principal causa foi o Citomegalovírus (45,7%). A rejeição do enxerto aconteceu em 13%. Dos participantes, 42,8% realizaram até 5 transfusões e a reação transfusional somou 8,6%. A alta ambulatorial aconteceu após os 100 dias do transplante em 56,5%. Almeja-se que estes dados possam corroborar o desenvolvimento de estratégias de cuidado, criação de protocolos e capacitação da equipe para atender a essa população de crianças, a partir das necessidades identificadas, bem como contribuir com o desenvolvimento da prática profissional em transplante de células-tronco hematopoiéticas.
Abstract:
This study aimed to identify the sociodemographic and clinical profile of children in post-hematopoietic stem cells transplantation in outpatient care. This is a quantitative, transversal, and retrospective research, carried out at the Bone Marrow Transplant Service of the Clinics Hospital Complex of the Federal University of Paraná, Paraná State, Brazil. Records of children aged from 0 to incomplete 12 years old, transplanted from 2009 to 2013, were among the criteria of inclusion. Data were collected using a structured instrument, beginning in January and ending in July 2015, and were analyzed using Statistical Package for the Social Sciences® (SPSS) software, version 19. Chi-square test was applied to evaluate the association among categorical variables, and p<0.05 values were considered as statistical significance. This study was approved by the Research Ethics Committee of the Health Sciences Sector of the Federal University of Paraná, under Opinion n. 742,621 of 7 August 2014. One hundred thirty-eight medical records composed the sample; among them, 66.7% were male patients, 58.5% were equal or greater than six years old, 51.4% were students, 68.1% were white, and 68.1% were Roman Catholic. There was prevalence of bone marrow failure syndromes (51%), and the Fanconi anemia (30.4%) was among them. All of the transplants were allogeneic, and 51.4% were unrelated. The bone marrow was the most used source of stem cells (80.4%), followed by umbilical cord blood (19.6%). Transplants with mismatched related donors were 12.3%. Compatible transplants were 69.6%; reduced intensity conditioning (50.7%) was prevailed; and mucositis showed a prevalence of 92.8%. Colonization by multi-resistant microorganisms was present in 26.1% of the cases. Losses of the Hickman catheter were 8% and the use of nasogastric probe was 11.6%. The hospital discharge occurred in 61.6% in the period of 21 to 30 days after transplantation. Hospitalizations accounted for 34.8%, and the main cause was fever (23.9%). Regarding clinical complications, the most prevalent were pain (60.9%), cough (57.2%), runny nose and fever (47.1% each one), vomiting (46.4%), nausea (35.5%), diarrhea (39.1%), and viral infection (37%). Viral infection was related to symptoms such as coughing, runny nose and fever, as well as related to the incompatibility of the human leukocyte antigen (p<0.05). There was association among umbilical cord blood transplants and viral infection; and unrelated transplants were associated with fungal and viral infections. The graft-versus-host disease accounted for 26.8%, and the skin is the most affected organ (11.6%). A total of 68.1% of participants needed antibiotic and the most common cause was fever (43.5%). The main cause of viral infections was the Cytomegalovirus (45.7%), and antivirals were used in 51.4% of the cases. The graft rejection occurred in 13% of the transplants. A total of 42.8% of participants had up to five blood transfusions and 8.6% had transfusion reaction. The outpatient discharge of 56.5% took place after hundred days of transplant. It is expected that this data can confirm the development of care strategies, creation of protocols, and staff training to address this children population, considering the identified needs; it is expected also that it can contribute to the development of professional practice in hematopoietic stem cell transplantation.
