Browsing by Author "Zuniga, Pamela"

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    American Society of Hematology, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panamena de Hematologia, Sociedad Peruana de Hematologia, and SVH 2023 guidelines for diagnosis of venous thromboembolism and for its management in special populations in Latin America
    (2023) Neumann, Ignacio; Izcovich, Ariel; Aguilar, Ricardo; Basantes, Guillermo Leon; Casais, Patricia; Colorio, Cecilia C.; Esposito, Maria Cecilia Guillermo; Lazaro, Pedro P. Garcia; Pereira, Jaime; Garcia, Luis A. Meillon; Rezende, Suely Meireles; Serrano, Juan Carlos; Valle, Mario L. Tejerina; Altuna, Diana; Zuniga, Pamela; Vera, Felipe; Karzulovic, Lorena; Schunemann, Holger J.
    Background: Implementation of international guidelines in Latin American settings requires additional considerations (ie, values and preferences, resources, accessibility, feasibility, and impact on health equity).Objective: The purpose of this guideline is to provide evidence-based recommendations about the diagnosis of venous thromboembolism (VTE) and its management in children and during pregnancy. Methods: We used the GRADE ADOLOPMENT method to adapt recommendations from 3 American Society of Hematology (ASH) VTE guidelines (diagnosis of VTE, VTE in pregnancy, and VTE in the pediatric population). ASH and 12 local hematology societies formed a guideline panel comprising medical professionals from 10 countries in Latin America. Panelists prioritized 10 questions about the diagnosis of VTE and 18 questions about its management in special populations that were relevant for the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context. Results: In comparison with the original guideline, there were significant changes in 2 of 10 diagnostic recommendations (changes in the diagnostic algorithms) and in 9 of 18 management recommendations (4 changed direction and 5 changed strength). Conclusions: This guideline ADOLOPMENT project highlighted the importance of contextualizing recommendations in other settings based on differences in values, resources, feasibility, and health equity impact.
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    High prevalence of bleeders of unknown cause among patients with inherited mucocutaneous bleeding. A prospective study of 280 patients and 299 controls
    (FERRATA STORTI FOUNDATION, 2007) Quiroga, Teresa; Goycoolea, Manuela; Panes, Olga; Aranda, Eduardo; Martinez, Carlos; Belmont, Sabine; Munoz, Blanca; Zuniga, Pamela; Pereira, Jaime; Mezzano, Diego
    Background and Objectives
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    Monitoring of anticoagulant treatment with Unfractionated Heparin in pediatrics
    (2022) Aguirre, Noemi; Rivera, Carolina; Munoz, Gonzalo; Valle, Patricio; Panes, Olga; Zuniga, Pamela
    Unfractionated heparin (UFH) is the most widely used anticoagulant in hospitalized patients. The therapeutic range (TR) was defined in adults according to the prolongation of the activated Partial Thromboplastin Time (aPTT). However, the recommendation is to maintain a therapeutic range with anti-factor Xa assay (antiFXa). As this technique is more complex to perform and less available, it is recommended to make local correlation curves of aPTT with antiFXa. Objective: to determine the correlation between the values of aPTT and antiFXa in patients treated with UFH. Patients and Method: 52 patients between 2 days to 14 years of age hospitalized in the Pediatric Critical Patient Unit were recruited. They received treatment with UFH in continuous infusion for at least 24 hours. aPTT and antiFXa tests were performed according to the moment of anticoagulation. To evaluate the concordance of the levels of aPTT with those of antiFXa, the Kappa statistical coefficient of Landis and Koch was used. Results: 105 samples were collected from 52 patients. The overall concordance was 0.452 (moderate correlation). In patients aged < 1 month (n = 40), a considerable correlation was evident (r = 0.617); in those from 1 month to < 6 months (n = 18) and 6 months -< 12 months with aPTT < 120 seconds (n = 11), also showed a considerable correlation (r = 0.636 and 0.615, respec-tively), while in those aged > 12 months (n = 37) with aPTT < 120 seconds, a moderate correlation was evident (r = 0.454). Conclusion: In our population, there is a moderate correlation between the values of aPTT and antiFXa.
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    Validation of the ISTH/SSC bleeding assessment tool for inherited platelet disorders: A communication from the Platelet Physiology SSC
    (2020) Gresele, Paolo; Orsini, Sara; Noris, Patrizia; Falcinelli, Emanuela; Alessi, Marie Christine; Bury, Loredana; Borhany, Munira; Santoro, Cristina; Glembotsky, Ana C.; Rosa Cid, Ana; Tosetto, Alberto; De Candia, Erica; Fontana, Pierre; Guglielmini, Giuseppe; Pecci, Alessandro; Melazzini, Federica; Falaise, Celine; Casonato, Alessandra; Podda, Gianmarco; Kannan, Meganathan; Jurk, Kerstin; Sevivas, Teresa; Castaman, Giancarlo; Grandone, Elvira; Fiore, Mathieu; Zuniga, Pamela; Henskens, Yvonne; Miyazaki, Koji; Dupuis, Arnaud; Hayward, Catherine; Zaninetti, Carlo; Abid, Madiha; Ferrara, Grazia; Mazzucconi, Maria Gabriella; Tagariello, Giuseppe; James, Paula; Fabris, Fabrizio; Russo, Alexandra; Bermejo, Nuria; Napolitano, Mariasanta; Curnow, Jennifer; Vasiliki, Gkalea; Zieger, Barbara; Fedor, Marian; Chitlur, Meera; Lambert, Michele; Barcella, Luca; Cosmi, Benilde; Giordano, Paola; Porri, Claudia; Eker, Ibrahim; Morel-Kopp, Marie-Christine; Deckmyn, Hans; Frelinger, Andrew L., III; Harrison, Paul; Mezzano, Diego; Mumford, Andrew D.
    Background Careful assessment of bleeding history is the first step in the evaluation of patients with mild/moderate bleeding disorders, and the use of a bleeding assessment tool (BAT) is strongly encouraged. Although a few studies have assessed the utility of the ISTH-BAT in patients with inherited platelet function disorders (IPFD) none of them was sufficiently large to draw conclusions and/or included appropriate control groups. Objectives The aim of the present study was to test the utility of the ISTH-BAT in a large cohort of patients with a well-defined diagnosis of inherited platelets disorder in comparison with two parallel cohorts, one of patients with type-1 von Willebrand disease (VWD-1) and one of healthy controls (HC). Patients/Methods We enrolled 1098 subjects, 482 of whom had inherited platelet disorders (196 IPFD and 286 inherited platelet number disorders [IT]) from 17 countries. Results IPFD patients had significantly higher bleeding score (BS; median 9) than VWD-1 patients (median 5), a higher number of hemorrhagic symptoms (4 versus 3), and higher percentage of patients with clinically relevant symptoms (score > 2). The ISTH-BAT showed excellent discrimination power between IPFD and HC (0.9 < area under the curve [AUC] < 1), moderate (0.7 < AUC < 0.9) between IPFD and VWD-1 and between IPFD and inherited thrombocytopenia (IT), while it was inaccurate (AUC <= 0.7) in discriminating IT from HC. Conclusions The ISTH-BAT allows to efficiently discriminate IPFD from HC, while it has lower accuracy in distinguishing IPFD from VWD-1. Therefore, the ISTH-BAT appears useful for identifying subjects requiring laboratory evaluation for a suspected IPFD once VWD is preliminarily excluded.