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Iron deficiency is the most widespread nutritional disorder. Anaemia during pregnancy is common in developing countries. The purpose of this study was to check iron levels during pregnancy by evaluating laboratory indicators of iron deficiency. Our study was conducted in the Department of Obstetrics and Gynaecology of the Mohamed V Military Training Hospital (MVMTH) and included 66 patients monitored during three trimesters of pregnancy. Biochemical tests including ferritin, serum iron, CRP and blood counts were performed. The average age of patients was 28.3 years, with a standard deviation of 5.2. The prevalence of iron deficiency was 15.2% (n = 10), 25.8% (n = 17) and 42.2% (n = 28) in the first, second and third trimester, respectively. Anemia progressed from 10% (n = 7), 24% (n = 16) to 42% (n = 28). ANOVA test was used to compare the means for the parameters serum ferritin and iron, hemoglobin and hematocrit within the three trimesters. This showed a significant difference with p = 0.001. This study highlights a high prevalence of iron deficiency during pregnancy, especially in the third trimester, that would justify a systematic iron supplementation. [ABSTRACT FROM AUTHOR]

Early detection of sickle cell disease is crucial to improve people's survival. Both financial and geographic accessibility to sickle cell disease tools are barriers to universal screening in developing countries. The purpose of this study was to determine the hospital prevalence of sickle cell disease and to assess the reliability of a rapid diagnostic tool, HemoTypeSC, in a resource-limited environment. We conducted a prospective cross-sectional descriptive study in the Department of Pediatrics of 5 health facilities in the city of Kindu, Maniema province, DRC, over a period of 10 months. The study consisted of HemoType SC rapid test screening for sickle cell disease and then diagnostic confirmation by hemoglobin electrophoresis. A total of 448 children less than 5 years of age were enrolled in the study. The overall hospital prevalence of patients with sickle cell disease was 31.9%, of whom 12.7% were homozygous (SS) and 19.2% trait carriers; the level of suspicion for sickle cell disease in hospitals was 6%; the clinical presumption regarding sickle cell disease was 8%; HemoType SC rapid test had good indicators of validity for the detection of hemoglobins A and S. The study shows that the hospital prevalence of major sickle cell disease is higher in children under 5 years of age with respect to clinical suspicion in the absence of laboratory tests. HemoTypeSC rapid test seems to be a reliable tool for the screening of the disease in the city of Kindu, a resource-limited environment. [ABSTRACT FROM AUTHOR]

The objective of this study is to evaluate the impact of organic extracts of Bunium incrassatum seeds (Talghouda) on the evolution of some hematological parameters. The study was conducted on rabbits of the local population Oryctolagus cuniculus) the animals were divided into five groups and given daily orally at doses of 0.25, 50, 100 and 200 mg/kg/day. Dose 0 was taken as a control. After treatment, the rabbits were sacrificed, the organs were removed and fixed in 10% formalin and then stained with hematoxylin and eosin and the blood was collected in two tubes, one containing anticoagulant EDTA, and the other dry for the measurement of the different parameters. The obtained results show that treatment with the organic extract of Bunium incrassatum induced an increase in the body weight of treated rabbits compared to the control, as well as effects on the hematological parameters, characterized mainly by a significant increase in the rate of lymphocytes, hemoglobin. This result coincides with the increase in the relative weight of the kidney and liver target organs. We conclude that the components of this medicinal plant may, at specific doses, have a positive effect on certain hematological parameters. [ABSTRACT FROM AUTHOR]

The therapeutic management of sickle cell disease is based on several strategies, in which red blood cell transfusion plays an essential role in acute complications such as vaso-occlusive crisis, acute chest syndrome and stroke. However, it is important to weigh the benefit/risk before transfusion in children with sickle cell disease and not to rely solely on the value of hemoglobin. Indeed, it is important to remember that a negative antibody screen as well as a negative serological crossmatch test do not totally eliminate alloimmunisation or the risk of post-transfusion haemolysis. Sickle cell patients demonstrate multiple immunohaematological features: variant phenotypes (especially in the Rh andMNSsystems), rare blood groups, allo- and auto-immunisation favored because of the inflammatory state. The presence of an alloimmunisation can lead to a significant delay to obtain compatible red blood cell units, a supply difficulty or even a genuine blood transfusion deadlock. About 30 % of the requests for rare blood in France concerns sickle cell patients. Any vaso-occlusive crisis occurring within 3 to 15 days after a transfusion should be suspected to be a delayed haemolytic posttransfusion reaction; whenever necessary, the child should be referred to a reference center and any further transfusions should be avoided. The so-called hyperhaemolysis syndrome, corresponding to a major delayed haemolysis with concomitant destruction of autologous red blood cells, constitutes a major complication of the transfusion and may be potentially fatal. It is essential to educate patients and physicians on the recognition of the clinical signs of delayed haemolytic post-transfusion reactions, in order to rapidly implement measures to limit their immediate effects and avoid their occurrence in case of future transfusion. [ABSTRACT FROM AUTHOR]

We here report the case of a 42-year-old female patient presenting with alopecia areata that had progressed over the past month. The anamnesis revealed no psychoaffective irritative stimulus or atopy. Clinical examination was normal. The patient weighed 65kg with a BMI of 22kg/m². Haemoglobin level was 12.5g/dL. Fasting blood glucose was 1.01g/L, TSHus and T4L were normal; 0.23 pmol/L and 13.32 pmol/L, respectively. Anti-nuclear and Anti-electroconvulsive Therapy (ECT) antibodies were negative. The diagnosis of isolated alopecia areata was retained. The patient was treated with intramuscular injections of 80mg of triamcinolone every ten days for 4 sessions (total dose of 320mg). Hair loss treatment topical spray was applied (12 sprays a day). Patients's outcome was marked by a spectacular regrowth of hair assessed at day 30 and day 60. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: L’hémorragie du post-partum (HPP) reste l’une des premières causes de mortalité maternelle en France. Le but de notre étude était de mettre en évidence des facteurs prédictifs de gravité ou de guérison, permettant une prise en charge adaptée la moins invasive possible en cas d’HPP grave. Patientes et méthodes: Étude rétrospective de cohorte incluant les 310 patientes prises en charge dans notre structure pour une HPP grave entre avril 2007 et avril 2009. Résultats: Les facteurs significatifs retrouvés prédictifs d’une prise en charge invasive (chirurgie ou embolisation) sont : la fréquence cardiaque (88 versus 100 battements par minute), l’importance du saignement et la tonicité du globe utérin, ainsi que les taux d’hémoglobine (9 versus 8,2g/dL), de fibrinogène (3 versus 2g/L) et le TP (76 versus 63 %). Les facteurs de guérison identifiés correspondent aux facteurs de gravité. En analyse multivariée, les facteurs à l’admission, indépendants, prédictifs d’un traitement invasif sont : la tonicité du globe utérin (OR=0,14), la fréquence cardiaque (OR=1,3) et le TP (OR=0,76). Discussion et conclusion: En cas d’hémorragie grave peut se poser la question d’un transfert. La difficulté de cette décision est d’éviter un transport inutile, mais sans retard ni perte de chances pour la suite. Très peu d’études ont cherché à mettre en évidence des critères de gravité ou de guérison. Notre étude a retrouvé, comme facteurs prédictifs de prise en charge invasive, des éléments de l’examen clinique (pouls et tonicité du globe utérin), ainsi que des facteurs biologiques (hémoglobine et facteurs d’hémostase). [ABSTRACT FROM AUTHOR]

Résumé: Introduction: Cette étude a pour objectif d’évaluer les effets de la cadence de pédalage (40 et 100rpm) sur le niveau d’oxygénation musculaire lors d’exercices à puissance constante. Les variations de l’hémoglobine déoxygénée (HHb) ont été mesurées par la technique de spectroscopie dans le proche infrarouge (NIRS). Méthodes et résultats: Douze sujets masculins actifs ont effectué une session comprenant deux exercices rectangulaires sur ergocycle à deux cadences différentes (40 et 100rpm). Les valeurs de HHb n’étaient pas significativement différentes lors des tests à 100rpm et à 40rpm, indiquant que l’extraction de l’O2 n’était pas modifiée par la cadence de pédalage. Conclusion: L’augmentation de la cadence de pédalage ne semble pas modifier l’équilibre entre la demande et l’apport d’O2 au niveau de la microcirculation. [ABSTRACT FROM AUTHOR]

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: Introduction: Management of the perioperative hemorrhagic risk is of major interest in patients undergoing total arthroplasty of the lower limb. Anemia in the postoperative period of that increasingly performed surgery carries its own morbidity and mortality. Better anticipation of its occurrence could be done with a refined knowledge of bleeding kinetics. Patients and methods: We conducted a retrospective study in a single centre on 451 consecutive patients undergoing elective unilateral primary total hip or knee arthroplasty for osteoarthritis. Volume of total blood loss according to Mercuriali''s formula and variations of haemoglobin levels were calculated between day 0 (D0) and postoperative day 8 (D8), and during subdivided periods between D0–D1, D1–D3 and D3–D8. Frequency and volume of autologous and homologous blood transfusions were also analyzed. Comparisons were done taking into account the use of intraoperative tranexemic acid (TA). Results: Seventy to 75% of blood loss occurred between D0 and D1. Bleeding occurred mostly between the end of surgery and morning of D1, and tended to stop at D3. TA significantly reduced blood loss in the first 3days, mostly after knee prosthesis surgery. However, the bleeding kinetics were the same with or without TA. Conclusion: Loss of haemoglobin occurred mostly in the early postoperative period. To avoid transfusion delays, haemoglobin levels should be monitored regularly until the third postoperative day after total arthroplasty, especially when D1 haemoglobin is close to the transfusion threshold. Furthermore, our results support the routine use of TA. [Copyright &y& Elsevier]

Abstract: About 60% of body iron is associated with hemoglobin in circulating red blood cells and daily erythropoiesis requires about 25 to 30mg iron per day. This iron is provided by macrophages through recycling of heme iron following phagocytosis of senescent red blood cells and heme catabolism. Intestinal iron absorption (1 to 2mg per day) only compensates for daily iron losses. Hepcidin, a 25 amino-acid peptide synthesized in hepatocytes, secreted in plasma and rapidly removed in urines, is a negative regulator of both intestinal iron absorption and heme iron recycling by macrophages. Hepcidin synthesis is stimulated by iron or by inflammation (mostly by IL-6) and is repressed by iron deficiency and by all conditions that stimulate bone marrow erythropoiesis such as anemia, bleeding, hemolysis, dyserythropoiesis or erythropoietin injections. A defect in the activation of hepcidin normally triggered by iron excess is the underlying mechanism for all juvenile or adult forms of hemochromatosis whereas a defect in hepcidin repression is responsible for an iron deficiency iron refractory anemia (IRIDA). Reduced hepcidin filtration in renal insufficiency contributes to the associated anemia and stimulation of hepcidin synthesis by inflammation is a major determinant of the anemia of chronic disorders. New therapeutic perspectives are currently underway such as the development of agonists or antagonists of hepcidin or siRNA approaches aiming at reducing hepcidin synthesis. The validation of hepcidin assays in a near future will allow identifying the patients most likely to benefit from intravenous iron therapy. [Copyright &y& Elsevier]

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: This case report shows a rare cardiac complication of sickle cell anemia in a young African patient which was an acute paroxysmal atrio-ventricular block. Acute paroxysmal atrioventricular block is a rare complication of polymerization of hemoglobin S during sickle cell disease. Hence, sickle cell anemia should be considered as a cause of auriculoventricular block in black African patients. Cardiac complications of sickle cell anemia are presented in this article. [Copyright &y& Elsevier]

Abstract: Objective: The study''s objective was to determine the CD4 count and laboratory abnormalities in adults infected with HIV at initiation of antiretroviral therapy (ART) in Togo. Methods: A retrospective and descriptive study was made of all patients on HAART in 2009 in Togo. Results: A total of 5106 patients were included with a median age of 35 years. 68.6% were female patients. HIV1 infection was predominant (97.5%). The mean CD4 count at treatment initiation was 134 cells/μl. Among these patients, 22.1% had a CD4 count below 50 cells/μl and 73.8% had a CD4 count below 200 cells/μl. The median hemoglobin level was 10.4g/dl. Transaminase level was elevated (grade 1 and above) in 55.9% of patients for AST, and in 29.8% of patients for ALT. Mean serum creatinine was 9.6±5mg/l. Conclusion: Initiation of ART is late in Togo, consequently a significant proportion of patients present with severe immunosuppression on initiation of treatment. Improving strategies for mass screening should increase the number of patients treated early to better meet WHO 2009 recommendations. [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]

Summary: Objective: This experimental study aims at analyzing the parameters associated with the renal function before and after a basketball game, in female players of the elite division of Benin. Methods: Blood and urine samples were drawn from antecubital veinus in 16 players of two teams from Porto-Novo, at rest, at the end, one hour and 24hours after a basketball game, in order to determine the absolute glomerular filtration rate (GFR) and that reported to the standard of body surface area (GFRc), the urinary sodium/potassium ratio (Na/K), serum albumin and the haemoglobin concentrations. Results: At rest, all the winners and losers presented abnormal decreased values of GFRc, while 13 of them (81.25%) are weakened, with a mean haemoglobin concentration of 10.57±0.22g/100mL. At the end of the game, GFRc decreased significantly in the winners (−27.32%, p =0.046) and the losers (−35.45%, p =0.020). During the following 24hours, the GFRc gradually increased in the winners, up to a value that is significantly higher than that of the rest (+11.75%, p =0.02). Only the Na/K ratio registered 24hours after the game in the winners, is significantly higher (p <0.001) than preceding measures. Conclusion: A basketball game, played in the hot and wet environment of Porto-Novo (Benin Republic), induced a decrease of GFRc, suggesting a transitory failure of the renal function in these weakened girls at rest. [Copyright &y& Elsevier]

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: Faecal occult blood tests (FOBT) have been established as the most relevant procedure for colorectal cancer screening in the general average risk population. Immunochemical FOBT consists in monoclonal antibodies reacting with the globin of the haemoglobin. These tests provide higher performances than traditional guaiac tests. They do not need any diet restriction and their analytic sensitivity is higher. An increasing number of papers suggest that their acceptance and clinical performances in the general population are more satisfactory than the guaiac test. The use of automated reading allowed to cut the process price making it similar to the guaiac test. The providing of quantitative measure of haemoglobin allows to choose the positivity threshold associated with the best balance between sensitivity, specificity and positivity rate. Comparative studies conducted in France suggest the use of a positivity threshold allowing an increase in both sensitivity and specificity compared to the guaiac tests. [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: Purpose: Erythropoietin is the treatment of the anaemia in chronic kidney disease. A target rate of haemoglobin higher than 11g/dl was usually proposed, but recent recommendations stated that higher limit of haemoglobin was to be reached, with the aim to improve the quality of life of the patients and to reduce their risks of cardiovascular diseases. These objectives are to be revised, according to the results of recently published clinical trials. Current knowledge and key points: Patients treated to reach a high rate of haemoglobin (between 13 and 14,5g/dl) have an improved quality of life, but a 30% higher mortality rate, compared to patients treated with a lower objective of haemoglobin rate (10–12g/dl). Hypertension and vascular access thromboses were also more frequent in the patients with the highest haemoglobin rate. Two to three times more erythropoietin was necessary to reach the higher rate of haemoglobin. These results favour a target rate of haemoglobin not higher than 12g/dl. A polemic followed the results of these clinical trials, mostly in the United States, questioning the way in which the higher limit had been fixed whereas precise data were unavailable. The role of pharmaceutical industry and of for profit dialysis centres was underlined. Future prospects and projects: The next step is now to explain if the excess in cardiovascular morbimortality is related to the haemoglobin rate or to a direct effect of the erythropoietin. Such an understanding is important, the more so as new erythropoiesis-stimulating agents are being developed. [Copyright &y& Elsevier]

Abstract: Objectives: The main objective of this study was to compare the efficacy of three regimens of malaria prevention during pregnancy for the reduction of anemia between the first and third antenatal consultations. The first treatment arm was the classical weekly chemoprophylaxis with chloroquine; the other two were the intermittent preventive treatment using either three doses of chloroquine or sulfadoxine–pyrimethamine. Design: We conducted an open, randomized, three-arm study in a rural district of Burkina Faso. A cohort was constituted by 648pregnant women of any parity. Results: The hemoglobin gain was more significant with the intermittent preventive treatment using sulfadoxine–pyrimethamine compared to the other treatment arms. The hemoglobin increased from 10.3g/dl (at the first antenatal consultation) to 11.4g/dl (at the third antenatal consultation). In the three arms of treatment, the chemoprophylaxis reduced the prevalence of moderate anemia and severe anemia. The reduction of moderate anemia was more substantial in the sulfadoxine–pyrimethamine arm (65.6 to 36.7%) at second antenatal consultation (p =0.069) and third antenatal consultation (p =0.014). Conversely, in the two chloroquine arms, there was no significant reduction either at second antenatal consultation (p =0.72) or third antenatal consultation (p =0.55). The prevalence of peripheral parasitemia decreased in all treatment groups. However, it was significantly higher in the sulfadoxine–pyrimethamine group (44.3%). Conclusions: Intermittent preventive treatment with three doses of sulfadoxine–pyrimethamine is a more effective strategy to prevent maternal anemia during pregnancy in Burkina Faso. [Copyright &y& Elsevier]

Abstract: Objectives: The aims of this review are to point out the determinants of oxygen saturation of the haemoglobin of mixed venous blood (SvO2), to specify the correlations existing between SvO2 and central venous saturation in superior vena cava (ScvO2), to determine and finally to locate the current place of venous oximetry in clinical practice. Data sources: A PubMed® database research in English and French languages published until December 2006. The keywords were mixed venous blood oxygen saturation; oxygen consumption; oxygen delivery; oxygen extraction; tissue hypoxia; central venous oxygen saturation. Data extraction: Data in selected articles were reviewed, clinical and basic science research relevant information was extracted. Data synthesis: The SvO2 reflects the peripheral extraction of oxygen (O2), O2 delivery and consumption. Its value is related to four determinants: the O2 consumption (VO2), cardiac flow (CF), haemoglobin level (Hb) and O2 saturation of the haemoglobin of arterial blood (SaO2). ScvO2 is more easily measurable than SvO2. Under physiological conditions its value is 2 to 3% lower than that of SvO2. In the critically ill patient, its value is 5% higher than that SvO2. In most patients, changes in ScvO2 values parallel those in SvO2. The clinical interest of the monitoring of venous oximetry was underlined in cases of severe sepsis and septic shock, and during the perioperative period of major surgery. Conclusion: The management of patients in critical states with therapeutic goals integrating the monitoring of venous oximetry may reduce the morbidity and mortality of patients undergoing major surgery or hospitalised in the intensive care unit. [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]

Abstract: In the last decade, four fast- and long-acting insulin analogues have been created. Due to the pharmacokinetic characteristics of insulin analogues, they provide an insulin profile closer to normal physiology than can be achieved with human insulins. However, they do not necessarily improve glycated haemoglobin, but they allow better quality of life. In the two daily insulin injection regime, fast-acting analogues are very useful to rapidly correct hyperglycaemia, to allow sleeping in and eating something sweet. In the basal-bolus regime (≥4 insulin injections), long-acting analogues reduce nocturnal hypoglycaemias and improve fasting blood glucose. In the two insulin regime (2 or≥4 injections), rapid-acting human insulin must not be systematically replaced by a fast-acting analogue. On the other hand, insulin dose alteration must be triple: • retrospective, according to numerous previous experiments, in order to enjoy more freedom for meals, sports, etc.; • prospective according to programmed changes in meals and sports; • with only a “touch” of compensatory adaptation according to actual glycaemia. [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: Introduction. – Acute splenic sequestration, a well-recognized complication of sickle cell syndromes, is characterized by a sudden decrease in haemoglobin concentration and marked painless splenomegaly. We report a case illustrating the outcome and the treatment options of this complication. Case report. – A 45-year old homozygous woman developed acute splenic sequestration with severe anemia. Red blood cells transfusion led to transient improvement but a relapse-required splenectomy. Long-term outcome was favorable. Conclusion. – Acute splenic sequestration is a severe complication mainly observed in children. Despite the severity of this complication, prompt diagnosis and appropriate therapy, and particularly red blood cells transfusions, led to a complete recovery. Splenectomy is required in the more severe form of the disease. [Copyright &y& Elsevier]

Abstract: Aim of the study. – To analyze the predictive value of computed tomography (CT) and initial physiologic and laboratory data findings in the immediate operative (OP) or non-operative (NOP) management of blunt liver injury (BL). Methods. – Eighty-eight BL, grade III (51), grade IV (28) and nine grade V (9), aged 26.2 years (16–75) were identified. Hemoperitoneum on CT, hemodynamic status, physiologic and laboratory data &#60;24 hours or preoperative (transfusion, vascular filling) and follow-up >48 hours were analyzed. Results. – Data of 71/88 (80%) NOP and 17/88 (20%) OP patients were reviewed. A secondary laparotomy or laparoscopy was necessary in 11/71 TNO. Six OP (35%) and 1 NOP patients died. Blood units transfused were 1.33 (0–10) vs 5.9 (0–22) and vascular filling 1.45 (0.5–5.5) vs 3.6L (2–12) (P &#60;10–6, P &#60;4.10–3 respectively). NOP patients had less severe hemoperitoneum (31 vs 94%, P &#60;10–5) and hemodynamic instability (8.5 vs 94%, P &#60;10–4). But, there was an overlap of values of blood units transfused, amount of vascular filling and initial haemoglobin levels between NOP and OP patients and among CT grades of liver injury. No cut-off values could be determined: 33% NOP received >4 blood units and >3 L vascular filling; 30% had severe hemoperitoneum. In OP group 23.5% patients had lower values and no severe hemoperitoneum. Conclusion. – In the management of BL, vascular filling and blood transfusion increased with the grade of CT liver injury and were globally more elevated in the operative group but did not individually correlate with hemodynamic stability and did not authorize, by themselves, to decide between operative versus non-operative management. [Copyright &y& Elsevier]

Populations and methods. – In order to analyze epidemiological and clinical characteristics of enuresis in children with sickle cell disease, and identify risk and aetiological factors, 987 subjects (aged 5–20 years) took part in a cross-sectional study. These children were divided into two groups: group 1 consisted of 456 homozygous children with sickle cell disease (haemoglobin SS), while group 2 consisted of 531 normal children. These groups were paired according to age and sex.Results. – The prevalence of enuresis was 50.9% in group 1 and 16.4% in group 2, and was significantly higher (P < 0.05) in the girls. The frequency decreased significantly between the ages of 5–20. At age 16, frequency of enuretic children with sickle cell disease remained statistically greater (15.9% vs. 8.0%). The frequency of wet nights was higher (P < 0.05) in group 1. In addition, anaemia crisis and painfull crisis were related to prevalence of enuresis. There was a significant (P < 0.01) negative correlation between haemoglobin F percentage and prevalence of enuresis.Conclusion. – Enuresis is frequent in children with sickle cell disease and its intensity is linked to severity of disease. [Copyright &y& Elsevier]

Objectives. – Postpartum anaemia is a very frequent pathology concerning from 4% to 27% of patients. The purpose of this study was to estimate clinical practice in front of acute postpartum anaemia and to value a new treatment: intravenous iron.Patients and methods. – Retrospective study over a period of 2 years (April 2001–March 2003) realised in the Department of Gynaecology and Obstetrics of Belfort Regional Hospital. Two hundred and seventeen patients were included (5% of deliveries in the same period) with immediate postpartum period haemoglobin <8 g/dl. Two groups were individualised according to the availability or not of an intravenous iron therapy. Clinical and biologic elements concerning deliveries were analysed.Results. – Average haemoglobin values, from delivery to 48 h after it, were 5.81 g/dl for blood-transfused patients, 6.88 g/dl for intravenous iron treated patients and 7.43 g/dl for oral iron treated patients. Fifteen patients were transfused during the year before the launch of intravenous iron as a possible therapy and only five patients the next year. The benefit of haemoglobin values with an intravenous iron therapy was 1.9 g/dl on 7 days and 3.1 g/dl on 14 days.Discussion and conclusion. – These results suggest a real efficiency of intravenous iron therapy for acute postpartum anaemia (haemoglobin values <8 g/dl) with a good tolerance. Patients with haemoglobin values <7 g/dl treated by intravenous iron tend to show that some blood transfusions would be thereby avoided even though blood transfusion remains the urgency treatment. [Copyright &y& Elsevier]

Fatigue and anemia are the symptoms most frequently reported by patients undergoing chemotherapy. The efficacy of curative treatments is often delayed and insufficient and the treatment cost is not insignificant. Our strategy was to propose an early treatment of anemia for any patient undergoing chemotherapy and using reduced doses with a simplified regimen. Patients and methods: Any patient over 18 years of age treated for a solid tumor or lymphoma with an hemoglobin equal to or less than 12 g/dL received a treatment with erythropoietin (EPO). Treatment was rH-EPO 20,000 IU SC once a week. Patients over 70 years of age received arbitrarily darbepoietin 150 U SC once every 15 days. The assessment focused on the number of patients treated, transfused and the overall cost of EPO prescriptions. Results: The study duration was 12 months from October 2002 to October 2003. The number of patients treated each month was 363 [317-415], i.e. three times more than in 2001. The number of patients transfused decreased significantly and was 13%, which represents a 30% reduction in transfusions over the first 6 months of the year 2003. The overall cost of EPO prescriptions remained stable despite the increase in the number of patients treated. Conclusion: The early treatment of anemia with reduced dosages and simplified regimens, and patients treated with chemotherapy, makes it possible to treat more patients and to reduce transfusions without increasing the overall treatment cost for society. [ABSTRACT FROM AUTHOR]

Purpose. – The majority of polycythemias occurs sporadically without any other familial case. Very occasionally polycythemia finds a familial support. This work is a review of the actual knowledge about inherited polycythemias.Current knowledge and key points. – Although polycythemias linked to a anomaly of the haemoglobin affinity for oxygen are well understood (haemoglobin mutants with high oxygen affinity, 2-3 Diphosphoglycerate deficiency and methemoglobinemia), so called primary polycythemias (above all primary familial and congenital polycythemias) just begin to find an explanation for ten years (erythropoietin receptor gene mutation).Future prospects and projects. – Progressively, the part of really idiopathic polycythemias is smaller and smaller. Although most of mechanisms to explain congenital polycythemias are understood, some of them are still unresolved (Chuvash polycythemia, the majority of primary familial and congenital polycythemias). [Copyright &y& Elsevier]

Aim of the study. – To evaluate a policy of treatment with human recombinant erythropoietin (rhEPO) and to describe factors related to red blood cell transfusions (RBCTs) in treated neonates.Study. – Prospective, observative study.Patients and methods. – One-hundred and sixty-five neonates with gestational age (GA) < 30 weeks and/or birthweight < 1000g admitted between may 1998 and october 1999. Ninety were excluded (congenital malformations n = 6, deaths n = 16, referral to a general hospital before discharge n = 67, ECMO n = 1). Data about the characteristics of the population, the severity of the neonatal period, hemoglobin at birth, blood loses, treatment with rhEPO, number of red blood cells transfusions (RBCTs) and donors were recorded in all infants.Results. – Thirty-eight in seventy-five (51%) neonates received 112 blood transfusions. Eighty-eight were prescribed after day 15. In most of the cases (n = 68), RBCTs were done according to the protocol. In 20 cases (23%) infants were transfused during a late-onset infection. No difference was observed between the non-transfused (group I) and the transfused neonates (group II) with regards to the drug administration: first dose on day 3 ± 2, number of injections (17 ± 4 vs 18 ± 1, ns). The start of oral supplementation with iron was late (12j ± 8 vs 19j ± 10, ns). Infants in group II had a lower birthweight (850 ± 240 vs 1050 ± 160g, p < 0,01) for a similar GA (28 ± 1SA vs 28 ± 2SA, ns) in association with an increased number of small for date babies (p = 0.03). Antenatal steroi¨ds administration (89 vs 74%, ns), administration of surfactant (59 vs 81%, ns) were similar in the two groups. The Clinical Risk Index for Babies was higher in group II: 5 ± 3 vs 2 ± 1 (p < 0,001) as was the duration of oxygen delivery (53 ± 44 vs 14 ± 20 days, p < 0,01) and postnatal administration of corticosteroi¨ds ( 38% vs 3%, p < 0.01).Conclusion. – The quality of iron administration, RBCTs and the limitation of donors could be improved in our population. Transfusions among neonates born before 30 weeks and/or with a birthweight of less than 1000g and treated with rhEPO are associated with intrauterine malnutrition and a worse clinical condition on admission. Early identification of at risk neonates could improve prevention of RBCTs and the efficacy of rhEPO administration to preterm infants. [Copyright &y& Elsevier]

Objective. – To determine perioperative variables for predicting allogenic transfusion in adult cardiac surgery.Study design. – Prospective study.Patients. – We included 335 consecutive patients undergoing cardiac surgery between February and April 2001.Methods. – Perioperative variables were prospectively collected in a database. For each patient who received transfusion, hemoglobin threshold for transfusion and total number of units of red cell concentrates were collected. Univariate and multivariate analysis were performed.Results. – The two strategies for blood conservation which were predominantly used were aprotinin therapy (78%) and blood salvage from the extracorporeal circuit (68%). During perioperative period, 42% of patients [95% CI: 37–47%] received allogenic transfusion. The haemoglobin threshold for transfusion was 7.4 ± 1.1 and 8.0 ± 0.7 g dl–1 in operating room and in intensive care unit, respectively. On average, 3.4 ± 2.7 units of red cell concentrates were transfused perioperatively per patient. Using multivariate analysis, perioperative allogenic transfusion was significantly associated with the following variables: preoperative haemoglobin level < 12 g dl–1 (odds ratio 8.9; p = 0.001), emergency procedure (odds = 3.7, p = 0.01), reoperation (odds ratio = 3.3; p = 0.002), chronic obstructive pulmonary disease (odds ratio = 2.5; p = 0.03) and complex surgery (odds ratio = 2.4; p = 0.01). The age, the gender, and body mass index were only independent risk factors by univariate analysis.Conclusion. – In despite of techniques to limit requirement of allogenic transfusion, a large proportion of cardiac surgical patients remains transfused. Independent risk factors of perioperative transfusion are haemoglobin level < 12 g dl–1, emergency procedure, reoperation, chronic obstructive pulmonary disease and complex surgery. [Copyright &y& Elsevier]

Haemoglobins from unicellular organisms, plants or animals, share a common structure, which results from the folding, around the heme group, of a polypeptide chain made from 6–8 helices. Nowadays, deciphering the genome of several species allows one to draw the evolutionary tree of this protein going back to 1800 millions of years, at a time when oxygen began to accumulate in the atmosphere. This permits to follow the evolution of the ancestral gene and of its product. It is likely that, only in complex multicellular species, transport and storage of oxygen became the main physiological function of this molecule. In addition, in unicellular organisms and small invertebrates, it is likely that the main function of this protein was to protect the organism from the toxic effect of O2, CO and NO•. The very high oxygen affinity of these molecules, leading them to act rather as a scavenger as an oxygen carrier, supports this hypothesis. Haemoglobins from microorganisms, which may probably be the closest vestiges to the ancestral molecules, are divided into three families. The first one is made from flavohaemoglobins, a group of chimerical proteins carrying a globin domain and an oxido-reduction FAD-dependant domain. The second corresponds to truncated haemoglobins, which are hexacoordinated with very high oxygen-affinity molecules, 20–40 residues shorter than classical haemoglobins. The third group is made from bacterial haemoglobins such as that of Vitreoscilla. Some specific structural arrangements in the region surrounding the heme are cause of their high oxygen affinity. In plants, two types of haemoglobins are present (non-symbiotic and symbiotic), that arose from duplication of an ancestral vegetal gene. Non-symbiotic haemoglobins, which are probably the oldest, are scarcely distributed within tissues having high energetic consumption. Conversely, symbiotic haemoglobins (also named leghaemoglobins) are present at a high concentration (mM) mostly in the rhizomes of legumes, where they are involved in nitrogen metabolism. In some species, haemoglobin was proposed to be an oxygen sensor bringing to the organism information to adjust metabolism or biosynthesis to the oxygen requirement. Elsewhere haemoglobin may act as final electron acceptors in oxido-reduction pathways. Evolution of haemoglobin in invertebrates followed a large variety of scenarios. Some surprising functions as sulphide acquisition in invertebrates living near hydrothermal vents, or a role in the phototropism of worm need to be mentioned. In invertebrates, the size of haemoglobin varies from monomers to giant molecules associating up to 144 subunits, while in vertebrates it is always a tetramer. In some species, several haemoglobins, with completely different structure and function, may coexist. This demonstrates how hazardous may be to extrapolate the function of a protein from only structural data. [Copyright &y& Elsevier]

Purpose. – To describe the main characteristics and outcome of adult’s acquired immune hemolytic anemias (AIHA). To analyse the relevance of the complementary tests performed for the search of an underlying disease.Methods. – Retrospective (1980–2000) monocentric study. Inclusion criteria: age above 16, AIHA defined by an hemoglobin level below 12 g/dl in men and 11 g/dl in women, with hemolysis and/or a positive direct Coombs test and/or the presence of cold agglutinins (threshold 1/500) and/or in the absence of any other cause.Results. – Eighty three patients included (56 women and 27 men), with a mean age of 56 years (± 22) at AIHA onset including: 72 patients (87%) with warm antibody AIHA and 11 (13%) with cold agglutinin disease. The mean follow-up was 48 months (median 22 months). Among the 72 patients with warm antibody AIHA, the specificity of autoantibodies was : IgG + complement (43%), IgG (32%) or complement alone (25%) ; cold agglutinins (titre from 1/60 to 1/512) were detected in 15 (20%) of the patients. Antinuclear antibodies were detected (threshold : 1/80) in 33% of the cases. Hypogammaglobulinemia on serum protein electrophoresis (SPE) was significatively associated with the presence of an underlying non-Hogkin lymphoma (NHL). The CT-scan of the the chest and abdomen which was performed in 50% of the patients, showed abnormalities other than a spleen enlargement in 25% of the cases. The medullar biopsy (MB) was abnormal in 7 of 26 cases (27%) but lead by itself to the diagnosis of NHL in a single case. Thrirty seven (51%) of warm antibody AIHA cases were finally considered to be « secondary » to an underlying disease namely : NHLs (n = 14), Hogkin''s disease (n = 1) connective tissue disease (CTD) (n = 14), drug-induced AIHA (n = 3), miscellanous (n = 5). In 6 out of 14 cases (43%) of NHL''s associated AIHA, the onset of AIHA precedes the NHL from 22 to 66 months. The response rates to different therapeutic regimens did not significatively differ when « secondary » and « idiopathic » AIHA were compared. Overall, 13 patients (15.6%) died mainly from infectious complications (n = 5) or an underlying NHL (n = 5).Conclusions. – In more than half of the cases AIHA are associated with an underlying disease and AIHA may precede the onset of a NHL for a long period. In the absence of a clinically apparent underlying disorder, testing for the presence of antinuclear antibodies, a SPE and a CT-scan must be systematic. Conversely, if no abnormalities are found , the relevance of a systematic MB at AIHA onset seems very low. [ABSTRACT FROM AUTHOR]

The study involved a 54-year old female patient admitted with severe renal failure. She had a 1-month history of progressive stage II dyspnoea associated with chest pain, bone pain and anuria. Clinical examination showed hypertension (160/80mmHg), glomerular disease (urinary protein excretion 2+, blood 2+ and diuresis 300 cc). Pleuropulmonary examination showed diffuse bilateral lower-chest crackling sounds. Laboratory tests objectified severe renal failure with creatinine level 107mg, urea 1.65g/l, hyperkalaemia 7.8 mmol/l, CRP value 78mg/l, normochromic normocytic anemia with hemoglobin concentration 5.7g/dl and leukocytosis 13570 without thrombocytopenia, hyperprotidemia 144g/l, normal serum albumin concentration 33g/l, hypercalcemia 116mg/l and hyperphosphataemia 120mg/l. Serum protein electrophoresis showed monoclonal gamma globulin peak 60 g/l. Immunoelectrophoresis of plasma proteins showed IgG kappa gammapathy. Bence-Jones protein urine test was negative. Myelogram showed plasmocytosis 10%. Profile skull x-rays objectified multiple pre-existing geodes. The patient underwent CDT1 protocol with dexamethazone thalidomide 100 mg and oral endoxan. [ABSTRACT FROM AUTHOR]

Summary: The case of a newborn with isolated neonatal cyanosis on day 1 is reported. The basic investigations were sufficient to reach the diagnosis. A rare abnormal fetal hemoglobin was isolated. The prognosis of this disease is excellent and self-resolving. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The aim of the study is to assess the effects of a short-term therapeutical prednisolone intake on erythropoietin (EPO) secretion. Synthesis: We studied, according to a double-blind, randomized cross-over protocol, the effects of a 7 day prednisolone intake (60 mg/day) in 10 healthy male subjects on hematocrit, EPO and hemoglobin concentrations. No significant change was found between the treatments (prednisolone/placebo) in the parameters investigated. Conclusion: In view of the results obtained, short-term therapeutic glucocorticoid intake did not induce any enhancement of erythropoiesis via EPO stimulation that can result in ergogenic advantage during submaximal exercise. [Copyright &y& Elsevier]

Abstract: Introduction: Nephrotic syndrome (NS) is characterized by an excessive urinary protein excretion. Case record: A woman, followed-up for NS, present progressive anemia, with no simple explanation. Plasma EPO is low with significant urinary EPO excretion. Treatment with EPO corrects hemoglobin level. Conclusion: EPO deficiency due to excessive urinary excretion is an underestimated cause of anemia during NS. [Copyright &y& Elsevier]

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]

Abstract: Hemoglobin variant with high oxygen affinity is an uncommon, often misdiagnosed, etiology of erythrocytosis. We report two cases of erythrocytosis. Their hemoglobin–oxygen dissociation curve showed a P50 value (the oxygen tension at which hemoglobin is 50% saturated) below the normal range. Globin chains electrophoresis and DNA analysis evidenced hemoglobin Olympia and hemoglobin Malmö, respectively. More than 200 variants of hemoglobin with increased oxygen affinity have been described, that are in about one-third responsible of secondary erythocytosis because of tissular hypoxia. Such abnormal haemoglobin identification should be routinely included in the diagnostic work-up of unexplained erythocytosis, particularly in young people. [Copyright &y& Elsevier]

Abstract: Neurological manifestations in polycytemia vera are common. However, chorea is an exceptionally revealing feature of this disease. We report a 78-year-old man who presented with headache and an abnormal movement disorder corresponding to chorea. Laboratory findings showed increased levels of hemoglobin at 20g/dl and hematocrit at 62.3%. An elevated erythrocyte mass to twice the normal value demonstrated the absolute erythrocytosis. A JAK2 V617F gene mutation was identified. A diagnosis of polycytemia vera-associated chorea was obtained. Clinical and biological outcomes were favorable after therapeutic phlebotomy and treatment with hydroxyurea. We recommend a complete blood cell count in elderly patient presenting with chorea to eliminate a diagnosis of polycytemia vera. [Copyright &y& Elsevier]

Introduction: La β thalassémie est une anémie hémolytique autosomale récessive, caractérisée par un déficit total ou partiel de la chaine β de l’hémoglobine. Elle pose un problème de santé publique en Algérie par sa fréquence (3 %) et sa gravité. Le seul traitement curatif est la greffe de moelle. Les autres moyens symptomatiques : la transfusion, la chélation et la splénectomie. Il a été rapporté dans la littérature une augmentation significative du taux d’HbF permettant parfois un sevrage transfusionnel chez des thalassémiques intermédiaires traités par l’hydroxyurée (hydréa). Sujet: 40 patients âgés de 9 mois à 18 ans sont pris en charge de façon régulière (14 splénectomisés). Nous avons introduit depuis 05 ans, dans la prise en charge de 21 patients l’hydréa d’abord chez les splénectomisés puis d’autres patients sont recrutés mais pas avant trois ans d’âge. Résultats: Un sevrage a été obtenu chez 12 malades et une réponse partielle chez 06 patients. Les patients bénéficient d’une chélation soit par: [-] Desferal (desférioxamine) soit en perfusion continue ou en bolus de 30minutes en sous- cutanée deux fois par jour. [-] per os : Kelfer ; Exjad. Conclusion: malgré le bénéfice de l’hydréa chez certains malades nous appréhendons les effets secondaires à distance. [ABSTRACT FROM AUTHOR]