ESTER CERDEIRA SABINO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Patologia, Faculdade de Medicina - Docente
LIM/46 - Laboratório de Parasitologia Médica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/46 - Laboratório de Parasitologia Médica, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Diversity of RH and transfusion support in Brazilian sickle cell disease patients with unexplained Rh antibodies(2019) DINARDO, Carla L.; KELLY, Shannon; DEZAN, Marcia R.; RIBEIRO, Ingrid H.; CASTILHO, Shirley L.; SCHIMIDT, Luciana C.; VALGUEIRO, Maria do C.; PREISS, Liliana R.; CUSTER, Brian; SABINO, Ester C.; WESTHOFF, Connie M.BACKGROUND Genetic diversity in the RH genes among sickle cell disease (SCD) patients is well described but not yet extensively explored in populations of racially diverse origin. Transfusion support is complicated in patients who develop unexpected Rh antibodies. Our goal was to describe RH variation in a large cohort of Brazilian SCD patients exhibiting unexpected Rh antibodies (antibodies against RH antigens to which the patient is phenotypically positive) and to evaluate the impact of using the patient's RH genotype to guide transfusion support. STUDY DESIGN AND METHODS Patients within the Recipient Epidemiology and Evaluation Donor Study (REDS)-III Brazil SCD cohort with unexpected Rh antibodies were selected for study. RHD and RHCE exons and flanking introns were sequenced by targeted next-generation sequencing. RESULTS Fifty-four patients with 64 unexplained Rh antibodies were studied. The majority could not be definitively classified as auto- or alloantibodies using serologic methods. The most common altered RH were RHD*DIIIa and RHD*DAR (RHD locus) and RHCE*ce48C, RHCE*ce733G, and RHCE*ceS (RHCE locus). In 53.1% of the cases (34/64), patients demonstrated only conventional alleles encoding the target antigen: five of 12 anti-D (41.7%), 10 of 12 anti-C (83.3%), 18 of 38 anti-e (47.4%), and one of one anti-E (100%). CONCLUSION RHD variation in this SCD cohort differs from that reported for African Americans, with increased prevalence of RHD*DAR and underrepresentation of the DAU cluster. Many unexplained Rh antibodies were found in patients with conventional RH allele(s) only. RH genotyping was useful to guide transfusion to determine which patients could potentially benefit from receiving RH genotyped donor units.
conferenceObject Symptoms and Outcomes of Dengue Among Transfusion Recipients in Brazil Who Were RNA plus or Who Received an RNA plus unit Compared to RNA- Recipients(2014) SABINO, E. C.; OLIVEIRA, C. D.; LOUREIRO, P.; LOPES, M.; CAPUANI, L. D.; MCCLURE, C.; CHOWDHURY, D.; KLEINMAN, S.; BUSCH, M.; CUSTER, B.conferenceObject Changes in Gene Expression in Response to Red Blood Cell Transfusions in Chronically Transfused Sickle Cell Disease Patients(2019) KELLY, Shannon; DINARDO, Carla; DENG, Xutao; BELISARIO, Andre; PROIETTI, Anna Carneiro; LOUREIRO, Paula; MOTA, Rosimere Afonso; FLOR-PARK, Miriam V.; MAXIMO, Claudia; SABINO, Ester; CUSTER, Brian- Demographic characteristics and prevalence of serologic markers among blood donors who use confidential unit exclusion (CUE) in Sao Paulo, Brazil: implications for modification of CUE polices in Brazil(2011) ALMEIDA-NETO, Cesar de; LIU, Jing; WRIGHT, David J.; MENDRONE-JUNIOR, Alfredo; TAKECIAN, Pedro L.; SUN, Yu; FERREIRA, Joao Eduardo; CHAMONE, Dalton de Alencar Fischer; BUSCH, Michael P.; SABINO, Ester CerdeiraBACKGROUND: This study evaluated demographic profiles and prevalence of serologic markers among donors who used confidential unit exclusion (CUE) to assess the effectiveness of CUE and guide public policies regarding the use of CUE for enhancing safety versus jeopardizing the blood supply by dropping CUE. STUDY DESIGN AND METHODS: We conducted a cross-sectional analysis of whole blood donations at a large public blood center in Sao Paulo from July 2007 through June 2009, compared demographic data, and confirmed serologic results among donors who used and who have never used CUE (CUE never). RESULTS: There were 265,550 whole blood units collected from 181,418 donors from July 2007 through June 2009. A total of 9658 (3.6%) units were discarded, 2973 (1.1%) because CUE was used at the current donation (CUE now) and 6685 (2.5%) because CUE was used in the past (CUE past). The CUE rate was highest among donors with less than 8 years of education (odds ratio [OR], 2.78; 95% confidence interval [CI], 2.51-3.08). CUE now donations were associated with higher positive infectious disease marker rates than CUE never donations (OR, 1.41; CI, 1.13-1.77), whereas CUE past donations were not (OR, 1.04; CI, 0.75-1.45). CONCLUSION: The CUE process results in a high rate of unit discard. CUE use on an individual donation appears predictive of a high-risk marker-positive donation and, thus, appears to contribute modestly to blood safety. The policy of discarding units from donors who have previously CUE-positive donations does not improve safety and should be discontinued.
conferenceObject Motivation to Donate Among Granulocytes, Apheresis, and Whole Blood Donors in a Brazilian Blood Center(2013) ROCHA, P. C.; SABINO, E. C.; OLIVEIRA, C. D.; PATAVINO, G. M.; CAPUANI, L. D.; ALMEIDA-NETO, C. deconferenceObject T. cruzi PCR Positivity is Associated with Clinical and Laboratory Markers of Severity of Chagas Cardiomyopathy(2012) SABINO, E. C.; RIBEIRO, A. L.; LEE, T.; KEATING, S. M.; CARRICK, D. M.; DENG, X.; OLIVEIRA, C. D.; KAVOUNIS, K.; CUSTER, B.; BUSCH, M. P.conferenceObject Incidence of Chagas Cardiomyopathy and Relative Diagnostic Value of Electrocardiogram (ECG) Versus Echocardiogram (ECHO) Among T. cruzi Seropositive Donors(2012) SABINO, E. C.; RIBEIRO, A.; PATAVINO, G. M.; CAPUANI, L. D.; ALMEIDA-NETO, C. de; OLIVEIRA, C. Di Lorenzo; CARRICK, D. M.; CUSTER, B.; BUSCH, M. P.; MURPHY, E. L.Background/Case Studies: Few studies have prospectively evaluated the natural history of Chagas cardiomyopathy, including disease penetrance, prognostic factors and indications for treatment. Nor has the diagnostic utility of ECHO been compared to the simpler and less costly ECG screening. Study Design/Methods: In a retrospective cohort study, T. cruzi seropositive blood donors with an index blood donation in 1996-2002 in Sao Paulo and Montes Claros, Brazil were matched to seronegative donors on index donation date, age, gender and city. 101 Chagas cardiomyopathy patients served as positive controls. In 2009-2010, all subjects underwent a health history questionnaire, medical examination, standardized ECG and ECHO. Subjects with abnormal screening EKG or ECHO were referred to a blinded panel of 3 cardiologists who adjudicated the outcome of Chagas cardiomyopathy. Diagnostic sensitivity, specifi city, positive predictive value (PPV) and negative predictive value (NPV) were calculated separately for ECHO and ECG. Results/Findings: Mean follow-up time was 10.5 years for the sero-positives and 11.1 years for the seronegatives. The sensitivity of the combined ECHO/ECG and expert panel algorithm was 98%, based on diagnoses of cardiomyopathy in 99 of 101 previously diagnosed Chagas cardiomyopathy patients, of whom 1 (1%) expert referral was triggered by ECHO alone, none by ECG alone and 98 (99%) by both ECHO and ECG. In contrast, 24 (5%) of 488 T. cruzi-seronegative control donors were falsely classifi ed as having Chagas cardiomyopathy (specifi city = 95%). Among the 499 T. cruzi seropositives, 315 (63%) were referred to the expert panel and 120 (24%) had defi nite Chagas-like cardiomyopathy, leading to an incidence difference of 1.85 per 100 person-years attributable to T. cruzi infection. The Table summarizes the sensitivity, specifi city and predictive values of ECHO and ECG screening for cardiomyopathy diagnosis among the T. cruzi seropositive individuals. Conclusion: There is a substantial (~2%) annual incidence of Chagas cardiomyopathy among initially asymptomatic T. cruzi seropositive blood donors. Among seropositives, ECG had better sensitivity and ECHO had better specifi city. Both tests had poor positive predictive value, but ECG had better negative predictive value. Future studies could use a two-step algorithm in which ECG is used to exclude those with a negative test and low likelihood of disease. ECHO would be done to refine the diagnosis only in patients with abnormal ECG fi ndings. Disclosure of Commercial Conflict of Interest M. P. Busch: NIH, Grants or Research Support; Novartis/Gen-Probe, Grants or Research Support; Terumo/Caridian, Grants or Research Support; Gen-Probe, Consulting or Board of Director Fees; Johnson & Johnson/Merck, Ortho, Consulting or Board of Director Fees; Abbott, Travel Support or Honorarium; Novartis, Travel Support or Honorarium; L. D. Capuani: Nothing to disclose; D. M. Carrick: Nothing to disclose; B. Custer: Nothing to disclose; C. de Almeida-Neto: Nothing to disclose; C. Di Lorenzo Oliveira: No Answer; E. L. Murphy: Nothing to disclose; G. M. Patavino: Nothing to disclose; A. Ribeiro: Nothing to disclose; E. C. Sabino: Nothing to disclose Disclosure of Grants Conflict of Interest M. P. Busch: Novartis, Grants or Research Support; Ortho, Grants or Research Support; Terumo/Caridian, Grants or Research Support; L. D. Capuani: Nothing to disclose; D. M. Carrick: Nothing to disclose; B. Custer: Nothing to disclose; C. de Almeida-Neto: Nothing to disclose; C. Di Lorenzo Oliveira: No Answer; E. L. Murphy: Nothing to disclose; G. M. Patavino: Nothing to disclose; A. Ribeiro: Nothing to disclose; E. C. Sabino: Nothing to disclose Expert Panel Diagnosis of Cardiomyopathy in T. cruzi seropositives ECHO YES (N = 120) NO (N = 379) Triggered by ECHO 75 77 PPV = 49% Not Triggered by ECHO 45 302 NPV = 87% Sens = 63% Spec = 80% ECG Triggered by ECG 114 151 PPV = 43% Not Triggered by ECG 6 228 NPV = 97% Sens = 95% Spec = 60%conferenceObject Predictors of Red Blood Cell Alloimmunization in a Brazilian Sickle Cell Disease (SCD) Cohort(2017) KELLY, Shannon; PREISS, Liliana; DINARDO, Carla; CASTILHO, Shirley Lopes de; VALGUEIRO, Maria do Carmo; CAYRES, Luciana; GUO, Yuelong; SABINO, Ester; PAGE, Grier; CUSTER, Brian- Number of recent sexual partners among blood donors in Brazil: associations with donor demographics, donation characteristics, and infectious disease markers(2012) PATAVINO, Giuseppina Maria; ALMEIDA-NETO, Cesar de; LIU, Jing; WRIGHT, David J.; MENDRONE-JUNIOR, Alfredo; FERREIRA, Maria Ines Lopes; CARNEIRO, Anna Barbara de Freitas; CUSTER, Brian; FERREIRA, Joao Eduardo; BUSCH, Michael P.; SABINO, Ester CerdeiraBACKGROUND: Brazilian blood centers ask candidate blood donors about the number of sexual partners in the past 12 months. Candidates who report a number over the limit are deferred. We studied the implications of this practice on blood safety. STUDY DESIGN AND METHODS: We analyzed demographic characteristics, number of heterosexual partners, and disease marker rates among 689,868 donations from three Brazilian centers between July 2007 and December 2009. Donors were grouped based on maximum number of partners allowed in the past 12 months for each center. Chi-square and logistic regression analysis were conducted to examine associations between demographic characteristics, number of sex partners, and individual and overall positive markers rates for human immunodeficiency virus (HIV), human T-lymphotropic virus Types 1 and 2, hepatitis B virus, hepatitis C virus, and syphilis. RESULTS: First-time, younger, and more educated donors were associated with a higher number of recent sexual partners, as was male sex in Sao Paulo and Recife (p < 0.001). Serologic markers for HIV and syphilis and overall were associated with multiple partners in Sao Paulo and Recife (p < 0.001), but not in Belo Horizonte (p = 0.05, p = 0.94, and p = 0.75, respectively). In logistic regression analysis, number of recent sexual partners was associated with positive serologic markers (adjusted odds ratio [AOR], 1.2-1.5), especially HIV (AOR, 1.9-4.4). CONCLUSIONS: Number of recent heterosexual partners was associated with HIV positivity and overall rates of serologic markers of sexually transmitted infections. The association was not consistent across centers, making it difficult to define the best cutoff value. These findings suggest the use of recent heterosexual contacts as a potentially important deferral criterion to improve blood safety in Brazil.
- Prevalence of serologic markers of transfusion and sexually transmitted infections and their correlation with clinical features in a large cohort of Brazilian patients with sickle cell disease(2020) BLATYTA, Paula F.; KELLY, Shannon; SABINO, Ester; PREISS, Liliana; MENDES, Franciane; CARNEIRO-PROIETTI, Anna B.; RODRIGUES, Daniela de Oliveira Werneck; MOTA, Rosimere; LOUREIRO, Paula; MAXIMO, Claudia; PARK, Miriam; MENDRONE-JR, Alfredo; GONCALEZ, Thelma T.; ALMEIDA NETO, Cesar de; CUSTER, BrianBACKGROUND: Patients with sickle cell disease (SCD) often require red blood cell (RBC) transfusion for clinical complications, so may be exposed to transfusion-transmitted infections (TTIs). The prevalence of markers for human immunodeficiency virus (HIV), hepatitis C virus (HCV) and B (HBV), human T-cell lymphotropic virus (HTLV-1/2), Chagas disease, and syphilis in an SCD cohort in Brazil were studied. STUDY DESIGN AND METHODS: Clinical history, interview data, blood samples, and medical chart review data were collected during cohort enrollment from November 2013 to May 2015. Serologic markers of infection were assessed. Standard measures of statistical association were calculated, and multivariable models were developed for the most prevalent infections to identify associated factors. RESULTS: Infectionmarkers were evident in 5.2% (144/2779) of the enrolled cohort. Anti-HCV was detected in 69 (2.5%), syphilis antibodies in 34 (1.2%), anti-HTLV-1/2 in 17 (0.6%), HBV surface antigen in 13 (0.5%), Chagas disease antibodies in 13 (0.5%), and anti-HIV in 8 (0.3%) of participants. Factors associated with increased odds of being anti-HCV reactive were older age, illegal drug use, increasing number of RBCs, more than three pain crises in the previous year, and geographic location. Syphilis was associated with older age, females, and smoking history. CONCLUSION: HCV infection was more common in older patients who may have received RBCs before testing was performed on donations, suggesting possible historic transfusion transmission. The cohort showed decreasing rates of infections and a reduction in transfusion transmission markers in younger patients compared to historical literature except for syphilis, indicating contemporary reduced risk of TTI.