Estudo de Hemoglobinopatias Estruturais em recém-nascidos de uma maternidade pública de Manaus-Amazonas.

Abstract

ABSTRACT

Early diagnosis of hemoglobin’s variants reduces clinical complications frequently found in neonates (RNS) such as jaundice and severe anemia. Objective: To estimate the prevalence of structural hemoglobinopathies in newboRNs from a public maternity of the city of Manaus-AM. Our study design was descriptive type survey involving 825 samples of newboRNs and their mothers from the Women's Institute Dona Lindu (MDLI) from March 2014 to January 2015. Materials and Methods: Samples were collected from RNS umbilical cord blood, while mothers by venipuncture. Screening for structural hemoglobinopathies was performed only in the RNS technique High Performance Liquid Chromatography (HPLC). Results: We observed 22 (2.7%) samples with hemoglobin variants, 16 FAS (2%) and six (06) FAD (0.7%). The age of patients was 23 years with 80% of term deliveries and 19.4% premature. Primiparity was 45.9% and the prenatal care was performed in 88% of pregnant women. Those who did not undergo prenatal showed 31% increased risk for preterm birth. The main clinical symptoms in pregnant women were Hypertensive Disease Specific Pregnancy (HDP) (5.1%) and gestational diabetes (3.4%). Anemia in the family was reported in 75 (9.15%) with a predominance in the brothers and mothers of pregnant women. The mean levels of hemoglobin in pregnant women were 12.3 g / dl considered normal. NewboRNs showed distribution of 53% for males with predominance of mulattos (81.2%), followed by white (16.4%). Nutrition administered in 80.3% of newboRNs was breast milk, infant formula then (6.4%), parenteral (2.8%) and enteral (2.4%). The average weight of newboRNs with FAA profile was 3257,15g, FAS 3168,76g and FAD 3433,37g. Significant correlations in RNS to mean platelet volume (MPV) higher (p = 0.010) and serum iron (p = 0.025) decreased when vaginally. Decreases in the absolute number of neutrophils and segmented binding capacity of serum iron (p = 0.042) in newboRNs when they were premature. When enteral nutrition was, a reduction in the absolute number of lymphocytes (p <0.001), segmented neutrophils (p = 0.04). When RNs needed intensive hospital in utineonatal, these showed reduced hematocrit values (HT), hemoglobin (Hb) and red blood cells (RBC) (p <0.001). Reduced number of red blood cells (p = 0.004) and hemoglobin (0.016) lower than 13.5g / dL (p = 0.04) were demonstrated in the black race. Not association was between hematological data and hemoglobin profile did not show statistical differences, however increased levels of urea (p = 0.045) were demonstrated between the FAS and FAD profiles when compared to the FAA. NewboRNs weighing less than 2500g were associated s mothers who had preeclampsia (p = 0.029). Low birth weight and pregnant women who did not undergo prenatal were significantly correlated with prematurity, p <0.001 and p = 0.046, respectively. miscarriages were significantly associated with elevated bilirubin (p <0.001) and LDL (p = 0.040). Conclusion: We conclude that despite the absence of positive correlations between the variants found hemoglobins (FAS and FAD) with haematological, biochemical data and clinical manifestations investigated, studies on the identification of hemoglobin variants and alpha thalassemia prenatal monitoring pregnant women and their newboRNs are made necessary in our population, since the real impact of structural hemoglobinopathies and synthesis have not yet actual data in our population. We emphasize that further studies should be followed aiming to the possibility of being found descendants in pregnant women and RNS homozygous for these changes, thus increasing the risk of serious medical complications in pregnancies and newboRNs. We conclude that the realization of this study and the inclusion of molecular techniques help to confirm possible interactions with thalassemia therefore possible knowledge of the real prevalence of these hematologic diseases, contributing to the early diagnosis and clinical monitoring during the prenatal. Keywords: Structural Hemoglobinopathies. Newborns. Manaus.