{"id":12264,"date":"2025-04-22T09:54:00","date_gmt":"2025-04-22T13:54:00","guid":{"rendered":"https:\/\/live-ssi-pfas.pantheonsite.io\/resource-hub\/medical-screening-guidance-for-clinicians\/"},"modified":"2025-11-03T14:06:03","modified_gmt":"2025-11-03T19:06:03","slug":"medical-screening-guidance-for-clinicians","status":"publish","type":"post","link":"https:\/\/pfas-exchange.org\/pt-br\/resource-hub\/medical-screening-guidance-for-clinicians\/","title":{"rendered":"Orienta\u00e7\u00e3o de triagem M\u00e9dica \u2014 para m\u00e9dicos"},"content":{"rendered":"\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"791\" height=\"1024\" src=\"https:\/\/pfas-exchange.org\/wp-content\/uploads\/2025\/07\/PFAS-REACH-Medical-screening-guidance_clinicians_PT-1-pdf-791x1024.jpg\" alt=\"\" class=\"wp-image-10827\" srcset=\"https:\/\/pfas-exchange.org\/wp-content\/uploads\/2025\/07\/PFAS-REACH-Medical-screening-guidance_clinicians_PT-1-pdf-791x1024.jpg 791w, https:\/\/pfas-exchange.org\/wp-content\/uploads\/2025\/07\/PFAS-REACH-Medical-screening-guidance_clinicians_PT-1-pdf-232x300.jpg 232w, https:\/\/pfas-exchange.org\/wp-content\/uploads\/2025\/07\/PFAS-REACH-Medical-screening-guidance_clinicians_PT-1-pdf-768x994.jpg 768w, https:\/\/pfas-exchange.org\/wp-content\/uploads\/2025\/07\/PFAS-REACH-Medical-screening-guidance_clinicians_PT-1-pdf.jpg 1088w\" sizes=\"auto, (max-width: 791px) 100vw, 791px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<h2 class=\"wp-block-heading\">&nbsp;Sobre este documento de orienta\u00e7\u00e3o<\/h2>\n\n\n\n<p>A orienta\u00e7\u00e3o aqui reunida busca informar a discuss\u00e3o e a tomada de decis\u00f5es para os m\u00e9dicos e seus pacientes. Muitos destes exames e triagens fazem parte das consultas anuais de aten\u00e7\u00e3o b\u00e1sica. Em 2019, a American Medical Association (AMA) decidiu apoiar pesquisas e pol\u00edticas que abordam os efeitos da exposi\u00e7\u00e3o a PFAS.<\/p>\n<\/div>\n<\/div>\n\n\n\n<p>Baseamos as seguintes sugest\u00f5es para exames de triagem m\u00e9dica naquelas previamente desenvolvidas e implementadas em uma comunidade impactada pelo PFAS, bem como pesquisas revisadas por pares e avalia\u00e7\u00f5es cient\u00edficas, usando abordagens de peso da evid\u00eancia de:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Agency for Toxic Substances and Disease Registry (2021)<\/li>\n\n\n\n<li>Centers for Disease Control and Prevention (2019)<\/li>\n\n\n\n<li>C8 Science and Medical Panels (2005-2013)<\/li>\n\n\n\n<li>European Environment Agency (2019)<\/li>\n\n\n\n<li>International Agency for Research on Cancer (2017)<\/li>\n\n\n\n<li>National Toxicology Program (2016)<\/li>\n<\/ul>\n\n\n\n<p>Essas recomenda\u00e7\u00f5es s\u00e3o para aqueles que vivem em comunidades com \u00e1gua contaminada, ou que est\u00e3o expostos a outras fontes de PFAS, aumentando substancialmente sua carga interna de PFAS. Essas recomenda\u00e7\u00f5es n\u00e3o s\u00e3o direcionadas \u00e0queles com n\u00edveis m\u00e9dios de exposi\u00e7\u00e3o a PFAS.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">&nbsp;Orienta\u00e7\u00e3o para pacientes adultos<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">PFAS blood and water tests <\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>PFAS blood tests.<\/strong> A 2022 NASEM report recommended making PFAS blood tests available to people who likely had elevated PFAS exposures and offering additional medical screening for those with elevated levels. The PFAS-REACH Exchange provides resources for obtaining PFAS blood tests (<a href=\"http:\/\/bit.ly\/pfas-blood-test\">bit.ly\/pfas-blood-test<\/a>).<\/li>\n\n\n\n<li><strong>Water testing. <\/strong>PFAS water testing is advisable in areas with known or suspected water contamination. PFAS water filtration is recommended when PFAS levels exceed drinking water guidelines.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Exames laboratoriais<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Perfil lip\u00eddico (colesterol, LDL, HDL, triglicer\u00eddeos). <\/strong>A exposi\u00e7\u00e3o ao PFAS tem sido associada a maiores n\u00edveis de colesterol total e LDL e esteatose hep\u00e1tica.<\/li>\n\n\n\n<li><strong>Exames de fun\u00e7\u00e3o hep\u00e1tica<\/strong>, como ALT, AST e GGT. A exposi\u00e7\u00e3o a PFAS tem sido associada a testes de fun\u00e7\u00e3o hep\u00e1tica acima do normal, bem como hepatotoxicidade, incluindo danos nos hepat\u00f3citos e na estrutura do f\u00edgado.<\/li>\n\n\n\n<li><strong>Creatinina s\u00e9rica, prote\u00edna e albumina urin\u00e1rias<\/strong>. A exposi\u00e7\u00e3o a PFAS est\u00e1 associada \u00e0 doen\u00e7a renal cr\u00f4nica e c\u00e2ncer renal. Uma observa\u00e7\u00e3o importante para os pesquisadores \u00e9 que h\u00e1 maior excre\u00e7\u00e3o de PFAS na doen\u00e7a renal moderada a grave, especialmente se houver albumin\u00faria. Concentra\u00e7\u00f5es s\u00e9ricas reduzidas de PFAS para esses indiv\u00edduos apresentaram vi\u00e9s para o nulo, se n\u00e3o forem controlados para estudos epidemiol\u00f3gicos.<\/li>\n\n\n\n<li><strong>Exames de tireoide<\/strong>, como TSH com ou sem FT4. A exposi\u00e7\u00e3o a PFAS tem sido associada a doen\u00e7as da tireoide.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Exames cl\u00ednicos<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Exame f\u00edsico dos test\u00edculos<\/strong>. A exposi\u00e7\u00e3o a altos n\u00edveis de PFAS tem sido associada ao aumento do risco de c\u00e2ncer testicular.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">T\u00f3picos de aconselhamento<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Resposta vacinal.<\/strong> A exposi\u00e7\u00e3o a PFAS tem sido associada \u00e0 diminui\u00e7\u00e3o da resposta de anticorpos \u00e0s vacinas. Atualmente, n\u00e3o h\u00e1 consenso sobre a revacina\u00e7\u00e3o de pacientes com baixo teor de vacina quando testado um m\u00eas ap\u00f3s a vacina\u00e7\u00e3o (por exemplo, Tdap, MMR); mais pesquisas s\u00e3o necess\u00e1rias.<\/li>\n\n\n\n<li><strong>Monitoramento domiciliar da press\u00e3o arterial durante a gravidez<\/strong>. PFAS est\u00e3o associados \u00e0 press\u00e3o arterial elevada durante a gravidez e \u00e0 pr\u00e9-ecl\u00e2mpsia.<\/li>\n\n\n\n<li><strong>Amamenta\u00e7\u00e3o<\/strong>. Os beb\u00eas podem ser expostos ao PFAS durante a gravidez, j\u00e1 que PFAS pode atravessar a placenta. Os produtos qu\u00edmicos PFAS tamb\u00e9m se acumulam no leite materno. No entanto, os benef\u00edcios da amamenta\u00e7\u00e3o s\u00e3o evidentes e incluem benef\u00edcios para a sa\u00fade materna e infantil. N\u00e3o h\u00e1 evid\u00eancias suficientes para n\u00e3o recomendar a amamenta\u00e7\u00e3o com base na exposi\u00e7\u00e3o materna ao PFAS.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">&nbsp;Orienta\u00e7\u00e3o para pacientes pedi\u00e1tricos<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Exames laboratoriais<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Perfil lip\u00eddico (colesterol, LDL, HDL, triglicer\u00eddeos)<\/strong>. A exposi\u00e7\u00e3o ao PFAS tem sido associada a maiores n\u00edveis de colesterol total e LDL e esteatose hep\u00e1tica.<\/li>\n\n\n\n<li><strong>Exames de fun\u00e7\u00e3o hep\u00e1tica<\/strong>, como ALT, AST e GGT. A exposi\u00e7\u00e3o a PFAS tem sido associada a testes de fun\u00e7\u00e3o hep\u00e1tica acima do normal, bem como evid\u00eancia de hepatotoxicidade, incluindo danos nos hepat\u00f3citos e na estrutura do f\u00edgado.<\/li>\n\n\n\n<li><strong>Exame de tireoide<\/strong>, como TSH com ou sem FT4. A exposi\u00e7\u00e3o a PFAS tem sido associada a doen\u00e7as da tireoide.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Exames cl\u00ednicos<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Exame f\u00edsico dos test\u00edculos<\/strong>. As crian\u00e7as t\u00eam uma dura\u00e7\u00e3o de exposi\u00e7\u00e3o mais extensa, portanto correm maior risco de desenvolver supostos efeitos da exposi\u00e7\u00e3o prolongada a PFAS, como c\u00e2ncer testicular.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">T\u00f3picos de aconselhamento<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Resposta vacinal<\/strong> A exposi\u00e7\u00e3o a PFAS tem sido associada \u00e0 diminui\u00e7\u00e3o da resposta de anticorpos \u00e0s vacinas. Atualmente, n\u00e3o h\u00e1 consenso sobre a revacina\u00e7\u00e3o de pacientes com baixo teor de vacina quando testado um m\u00eas ap\u00f3s a vacina\u00e7\u00e3o (por exemplo, DTaP, MMR); mais pesquisas s\u00e3o necess\u00e1rias.<\/li>\n\n\n\n<li><strong>Disfun\u00e7\u00e3o end\u00f3crina<\/strong>. PFAS t\u00eam sido associados a n\u00edveis mais baixos de horm\u00f4nios sexuais em crian\u00e7as pequenas.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Reconhecer o estresse e lidar com a incerteza<\/h2>\n\n\n\n<p>A incerteza sobre os efeitos a longo prazo na sa\u00fade pode causar estresse entre os pacientes que foram expostos \u00e0 contamina\u00e7\u00e3o por PFAS.<\/p>\n\n\n\n<p>Estudos anteriores mostraram que fornecer resultados de testes de exposi\u00e7\u00e3o qu\u00edmica com informa\u00e7\u00f5es contextuais e etapas de a\u00e7\u00e3o, pode fazer as pessoas se sentirem capacitadas (Brody et al., 2006).<\/p>\n\n\n\n<p>A ATSDR desenvolveu recursos para profissionais de sa\u00fade lidarem com \u00e0s preocupa\u00e7\u00f5es dos residentes em comunidades afetadas pela contamina\u00e7\u00e3o: <a href=\"https:\/\/www.atsdr.cdc.gov\/community-stress-resource-center\/hcp\/tips-for-clinicians\/supporting-patients.html\">https:\/\/www.atsdr.cdc.gov\/community-stress-resource-center\/hcp\/tips-for-clinicians\/supporting-patients.html<\/a><\/p>\n\n\n\n<details class=\"wp-block-details is-layout-flow wp-block-details-is-layout-flow\"><summary>Refer\u00eancias<\/summary>\n<p>Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological Profile for Perfluoroalkyls. U.S. Department of Health and Human Services. 2021. https:\/\/www.atsdr.cdc.gov\/ToxProfiles\/tp200.pdf. <\/p>\n\n\n\n<p>American Medical Association. Memorandum from the Speaker of the House of Delegates. Resolutions 901 and 922. 2019. https:\/\/www.ama-assn.org\/system\/files\/2019-11\/i19-handbook.pdf <\/p>\n\n\n\n<p>C8 Medical Panel. Information on the C-8 (PFOA) Medical Monitoring Program Screening Tests Prepared by the Medical Panel for the C-8 Class Members. 2013. http:\/\/www.c-8medicalmonitoringprogram.com\/docs\/med_panel_education_doc.pdf. <\/p>\n\n\n\n<p>Centers for Disease Control and Prevention (CDC). CDC Public Health Grand Rounds: PFAS and Protecting Your Health. 2019. https:\/\/www.cdc.gov\/grand-rounds\/pp\/2019\/20191119-pfas-health.html. <\/p>\n\n\n\n<p>European Environment Agency. Emerging chemical risks in Europe \u2013 \u2018PFAS.\u2019 2019. http:\/\/dx.doi.org\/10.2800\/486213. <\/p>\n\n\n\n<p>International Agency for Research on Cancer (IARC). IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Some Chemicals Used as Solvents and in Polymer Manufacture. Lyon (FR): International Agency for Research on Cancer; 2017. PMID: 31829531. <\/p>\n\n\n\n<p>National Academies of Sciences, Engineering, and Medicine (NASEM). 2022. Guidance on PFAS Testing and Health Outcomes. https:\/\/nap.nationalacademies.org\/read\/26156\/chapter\/1 <\/p>\n\n\n\n<p>National Toxicology Program (NTP). 2016. Systematic Review of Immunotoxicity Associated with Exposure to Perfluorooctanoic Acid (PFOA) or Perfluorooctane sulfonate (PFOS); Office of Health Assessment and Translation, Division of the National Toxicology Program, National Institute of Environmental Health Sciences: Research Triangle Park, NC. https:\/\/ntp.niehs.nih.gov\/ntp\/ohat\/pfoa_pfos\/pfoa_pfosmonograph_508.pdf.<\/p>\n<\/details>\n\n\n<div class=\"wp-block-post-date\"><time datetime=\"2025-04-22T09:54:00-04:00\">April 22, 2025<\/time><\/div>\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Um guia para ajudar profissionais de sa\u00fade a avaliar e tratar pacientes com problemas relacionados a PFAS.<\/p>\n","protected":false},"author":5,"featured_media":12452,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"resource-type":[93],"audience":[83],"class_list":["post-12264","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","resource-type-orientacao-medica","audience-medicos"],"acf":[],"_links":{"self":[{"href":"https:\/\/pfas-exchange.org\/pt-br\/wp-json\/wp\/v2\/posts\/12264","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pfas-exchange.org\/pt-br\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pfas-exchange.org\/pt-br\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pfas-exchange.org\/pt-br\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/pfas-exchange.org\/pt-br\/wp-json\/wp\/v2\/comments?post=12264"}],"version-history":[{"count":5,"href":"https:\/\/pfas-exchange.org\/pt-br\/wp-json\/wp\/v2\/posts\/12264\/revisions"}],"predecessor-version":[{"id":12970,"href":"https:\/\/pfas-exchange.org\/pt-br\/wp-json\/wp\/v2\/posts\/12264\/revisions\/12970"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pfas-exchange.org\/pt-br\/wp-json\/wp\/v2\/media\/12452"}],"wp:attachment":[{"href":"https:\/\/pfas-exchange.org\/pt-br\/wp-json\/wp\/v2\/media?parent=12264"}],"wp:term":[{"taxonomy":"resource-type","embeddable":true,"href":"https:\/\/pfas-exchange.org\/pt-br\/wp-json\/wp\/v2\/resource-type?post=12264"},{"taxonomy":"audience","embeddable":true,"href":"https:\/\/pfas-exchange.org\/pt-br\/wp-json\/wp\/v2\/audience?post=12264"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}