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Résumé: La drépanocytose est une pathologie héréditaire de l'hémoglobine qui atteint essentiellement les populations d'origine africaine et antillaise. Son incidence augmente en France métropolitaine. La transfusion reste un traitement majeur de cette pathologie. En fonction de l'indication, elle peut prendre plusieurs formes allant de la transfusion simple à l'érythraphérèse. Les protocoles transfusionnels en termes de qualifications des produits sont adaptés au statut de polytransfusés de ces patients, mais aussi à la forte incidence d'allo-immunisation dans cette population, conséquence des différences importantes avec les donneurs d'origine européenne au niveau des groupes sanguins. Des axes d'amélioration de la sécurité transfusionnelle de ces patients doivent être envisagés, ceux-ci passent en premier lieu par la promotion du don au sein des individus d'origine africaine et antillaise. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To estimate the rate of red cell immunization in hemoglobinopathies. Patients and methods: Prospective study (1990–2009) about 84 patients: 44 homozygous sickle cell anemia, one heterozygous sickle cell anemia S/C, 30 thalassemia and nine sickle cell anemia-thalassemia. The mean age was 10.13 years (extremes: 1–45). The red cell units transfused were ABORH1 compatible, then RH-KELL phenotyped after 2006 and phenocompatible after alloimmunisation. The cross-match was realized using indirect antiglobuline test. Irregular red cell antibody screening was realized before every transfusional episode and the direct antiglobuline test was done when there was a poor transfusional efficiency. Results: The number of red blood cells units transfused was 3545 (42.2/patient). The number of red cell antibody screening and the number of direct antiglobulin test were respectively 1474 (17.5/patient) and 272 (3.2/patient). Twenty-seven antibodies were identified (32.1%): 14 alloantibodies (16.6%, 16.6% in sickle cell disease, 16.6% in thalassemia, P =1), 16 antoantibodies (19.04%, 11.1% in sickle cell disease, 33.3% in thalassemia, P =0.018). There were three cases of association of allo- and autoantibodies. The most frequent alloantibodies were anti-RH3 and anti-KEL1 and were developed after transfusion of standard red cell units. There was no significant relation, neither between sex and risk of immunization, nor between the number of red cell units transfused and alloimmunization. On the other hand, there was a significant relation between autoimmunization and the number of red cell units transfused in thalassemia (P <0.001). Conclusion: This study proves the interest of using RH-KELL red cell units compatible in patients with hemoglobinopathies in order to reduce alloimmunisation rates. [Copyright &y& Elsevier]

Abstract: Transfusion occupies an important part of medical care in the palliative phase of paediatric malignancies with major bone marrow involvement. The aim of transfusion is to improve the quality of life. Fatigue is a frequent symptom in palliative phase, in children as well as in adults; anaemia is one of the responsible factor. Transfusion of red blood cells may contribute to the improvement this symptom. Specific pediatric recommendations are lacking, but studies in adults and clinical experience allow thinking that we should take into account the evaluation of this fatigue, more than a threshold value of haemoglobin. Platelets transfusion indication depends on the preserved activity and mobility of the child. The possibility of transfusion at home should reduce the constraints of this care. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this retrospective observational multicenter study was to assess appropriateness of red blood cell (RBC) transfusion, according to the French national guidelines (Agence française de sécurité sanitaire des produits de santé) published in 2002. Six hundred and thirty-nine RBC transfusions from nine institutions have been randomly selected and analysed. The data collected are issued from different specialities. Patients’ characteristics, occurrences of transfusion, admission, pre-transfusion, post-transfusion and discharge haemoglobin concentrations have been collected. Two physicians (who are in charge) must evaluate the appropriateness of pre-transfusion, discharged haemoglobin concentrations, quantity and quality of transfused RBC. The mean pre-transfusion haemoglobin concentration was 7.89±1.24, the median number of transfused RBC was two (extremes: 1–16), the mean discharge haemoglobin concentration was 10.14±1.30 (−5 days after the end of transfusion). The pre-transfusion and discharge haemoglobin concentrations were higher if the patient presented a co-morbidity factor. Ninety-three percent of pre-transfusion and 79% of discharge haemoglobin concentrations are in accordance with the guidelines. According to the physicians, the RBC transfusions are too “precocious” when pre-transfusion haemoglobin concentration is above nine and the anaemia is asymptomatic. 50% of RBC transfusion with discharge haemoglobin concentration above 10 is not excessive. In case of acute anaemia, the pre-transfusion and discharge haemoglobin concentrations are higher and RBC transfusion excessive. In this study, the trigger haemoglobin concentration is “restrictive”, but the target haemoglobin concentration is “liberal” with a high-discharge haemoglobin concentration. Inappropriate RBC transfusions are mainly due to over-transfusion. [ABSTRACT FROM AUTHOR]

Abstract: Homozygous, sickle-cell disease (SCD) is responsible for acute complication, especially anaemic crisis and special situation such as acute chest syndrome, stroke and acute priapism. Pregnancy sickle-cell disease presents high risk for the mother and the fetus. In these indications, blood transfusion is the main therapy aiming to reduce anaemia in order to restore hemoglobin''s rate or to increase normal Hb proportion. This study aims to assess the short-term efficiency of the red cell transfusion in SCD homozygous form. One hundred and twelve homozygous sickle-cell patients were enrolled in this prospective study: 59 females and 53 males, median age is 21,8 years (extremes: 2 and 45 years). These patients are mostly with very low income. Two groups of patients are included in this study. In the first group, patients present acute anemia crisis caused by infections disease (malaria, bacterial infections). In the second group (20 cases), SCD patients have particularly situations: pregnancy (10 cases); stroke (six cases); cardiac failure (two cases) and priapism (two cases). Transfusion treatment in first group is simple regimen. Transfusion of EC increased median Hb level at 2,9g/dl (extremes: 1,1 and 4,7). In the second group of patients, 16 cases were transfused by manual partial exchange (1–3) and four patients received simple regimen of transfusion. Median Hb level was 3,1g/dl (extremes: 2,4–4,9g/dl). HbS percentage reduction was after PTE between –30 and −66,8% (median: −52,6%). According to our diagnostic possibilities (blood serologic test), we have not found any contamination by HIV, HBV and HCV (virus). [Copyright &y& Elsevier]

Abstract: Uncontrolled hemorrhage is the most common cause of potentially preventable death in massive trauma. In addition to the early identification of potential bleeding sources and angiographic embolisation or surgical bleeding control, in-hospital management will aim at maintain tissue oxygenation with volume replacement using crystalloids, colloids and RBC. In general, RBC transfusion is recommended to maintain hemoglobin between 7–10g/dL. The complex combination of clotting factors and platelets consumption, loss and dilution, shock, hypothermia, acidosis and colloid-induced hemostatic alterations leads to coagulopathic bleeding. Most guidelines recommend the use of FFP in significant bleeding complicated by coagulopathy (PT, aPTT >1.5 times control). Platelets should be administered to maintain a platelet count above 50×109/L (100×109/L in patients with traumatic brain injury). However, standard laboratory tests have poor correlation with in vivo coagulopathy and the test results are not rapidly available. Empiric guidelines derived from mathematical hemodilution models developed in elective surgery settings may not be appropriate for trauma settings where significant bleeding may have already occurred. Moreover, coagulopathy is frequently present on admission in severely injured patients. Recent litterature suggests that FFP and platelets should be given early and more often to injured patients requiring massive transfusion. The place of adjunctive hemostatic therapy is discussed. [Copyright &y& Elsevier]

Abstract: As part of a quality assurance process in the transfusion service of a hospital blood bank of Yaoundé, Cameroon, a selection of units of red cell concentrates (RCC) were evaluated for volume, haemoglobin, and haematocrit levels as well as blood cell content. Blood samples were all collected into standard double blood bags containing an anticoagulant, citrate-phosphate-dextrose and adenine. During a three-month period, 35 bags intended for the preparation of the RCC were analysed. After relevant screening for transfusion transmissible infections ,and ABO and rhesus (RH1) blood grouping, the bags were centrifuged to obtain RCC. The resultant red cell bags were weighed and the volumes estimated. Full blood counts were performed on samples of the RCC using an electronic particle counter (DIANA 5, HYCEL Diagnostics, Reims, France). The results obtained showed that, based on ISO 9001: 2000 norms, there were 57, 66 and 80% of RCC respectively with volumes, hemoglobin levels as well as hematocrit that were in conformity with the norms. When the data was analysed based on the Algerian norms, 83, 66 and 95% respectively conformed. The significance of these findings and the need for establishing local norms for quality assurance in our community are discussed. [Copyright &y& Elsevier]

Abstract: In order to identify a rapid feasible and adaptable method of haemoglobin measurement for use in a blood bank, two methods were evaluated against the automated method in 204 blood donors in Yaoundé, Cameroon. Anaemia was defined as Haemoglobin<12 g/dl. Using the World Health Organisation (WHO) haemoglobin colour scale (HCS), the Hemocue method (HemoCue AB, Angelhom, Suède) and the Celly Electronic counter (Hycel Diagnostics, Reims, France), anaemia was found in 27.5, 29.4 and 31.9% of donors respectively (P <0.05). The sensitivity and specificity of the HCS was 75.38 and 94.96% respectively compared to 86.15 and 97.13%respectively in the HemoCue method. Correlation studies between each method compared to automated method showed r =0.70 for the WHO. colour scale method and 0.91 for the Hemocue method. Using the Bland and Altman statistical method, the haemoglobin distribution around the mean was wider in the WHO scale (–2.74;+2.96) than in the Hemocue method (–2.06; +1.38). We conclude that while the two methods can be used to detect anaemia in the blood bank, that the Hemocue method is more sensitive and more specific. [Copyright &y& Elsevier]

Le don de sang en Algérie se fait sans réalisation préalable de l'hémoglobine (Hb) pré-don. Par ailleurs, nous notons l'absence de travaux scientifiques qui rapportent des données sur les lignées érythrocytaires, leucocytaires et plaquettaires chez les donneurs de sang (DDS). Notre étude de profil de l'hémogramme chez des DDS prélevés dans le Centre de Wilaya de Transfusion Sanguine (CWTS) de Sétif a pour but de fournir des arguments scientifiques permettant de montrer la nécessité de la détermination de l'hémoglobine comme examen pré-don et de compléter, par l'hémogramme, les critères d'aptitude au don de sang total. Cette étude réalisée chez 396 DDS volontaires âgés de 18 à 57 ans, prélevés lors des collectes mobiles ou fixes effectuées par le CWTS du CHU de Sétif. L'hémogramme a été réalisé à l'aide d'un automate type MEDONIC M32 séries. Selon l'étude de Troussard et al., 2014, l'anémie correspond à un taux d'hémoglobine (HB) inférieur à 11,5 g/dl chez la femme et 13 g/dl chez l'homme. En adoptant ces références, nous avons remarqué que 10,11 % des femmes (n = 9) et 8,47 % des hommes (n = 26) étaient anémiques, et l'anémie était normocytaire normochrome chez 48,57 % de ces DDS anémiés. L'analyse de la lignée blanche a montré l'existence d'une leucopénie chez 0,8 % des DDS (n = 3), 6,3 % des donneurs présentaient une hyperleucocytose (n = 25). L'étude de la lignée plaquettaire a révélé l'existence d'une thrombopénie chez 4,8 % des DDS (n = 19) et une thrombocytose chez 3 des DDS (soit 0,8 % des cas). Cette étude modeste consolide l'intérêt de la mesure systématique de l'Hb pré-don et la réalisation périodique de l'hémogramme chez les DDS. [ABSTRACT FROM AUTHOR]

Abstract: Indications for transfusions of red blood cells (RBC) are anemias, which can occur after trauma, in surgery, in obstetrics or oncohematology wards. The main criteria to administer RBC transfusion are hemoglobin level and clinical features. Transfusions are rare when the hemoglobin level is above 10 g/dL and are frequent when it is below 6 g/dL. However clinical setting, patient age, associated diseases, cardiovascular complications are taken into account. Immunocompatibility should always be tested and the transfusion consequences checked immediately and on the long term. Platelet transfusions are performed when the platelet count is low and patients suffered from hemorrhage. In oncohematology patients, platelet transfusion are administered with prophylaxis when the platelet count is lower than 10 g/L. Fresh frozen plasma has now a limited use, only in complex haemostatic disorders and in hemolytic uremic syndrome. [Copyright &y& Elsevier]