Diagnostic des hépatopathies et de leur sévérité

Diagnosis and prognosis of liver diseases are considered here in the context of surgery. When a chronic liver disease is suspected by clinical signs or abnormal liver function tests, the degree of liver fibrosis has to be evaluated. The most accurate markers to assess clinically significant fibrosis in clinical practice are now prothrombin index and serum hyaluronate. The diagnostic accuracy for cirrhosis approaches 90% using non invasive means. The most accurate signs are in clinics: firm liver, in laboratory tests: thrombopenia, decreased prothrombin index and increased hyaluronate, with ultrasonography-Doppler: increased portal diameter and decreased portal velocity and with endoscopy: esophageal varices (but this not a true non-invasive tool). Improvement by blood fibrosis markers and ultrasonography-Doppler are awaited. Child-Pugh score is the most used prognostic score in clinical practice and trials. This is due to its simplicity but some limitations are known. Therefore, other scores are used: APACHE III ou MELD in surgery or resuscitation, Maddrey's score in alcoholic hepatitis and Mayo Clinic's scores in cholestatic diseases.     

Immunisation anti-érythrocytaire et anti-HLA au cours des hémoglobinopathies

AimEvaluate the anti-erythrocyte and anti-HLA immunization rates in hemoglobinopathies.Patients and methodsCross-sectional study (October 2009–March 2010) on 83 patients followed for hemoglobinopathies. The irregular antibodies research is realized by two techniques: indirect Coombs and enzymatic technique on gel cards. The search for anti-HLA class I antibodies is done by complement dependent lymphocytotoxicity.ResultsThe mean age was 30 years (14–64 years), the sex ratio M/F is 0.84. Our series included 42 cases of sickle cell disease (29 homozygous sickle cell anemia and 13 sickle-thalassemia) and 41 cases of thalassemia syndromes (26 major and 15 intermediate). The anti-erythrocyte alloimmunization rate is 10.84% without difference between thalassemia syndromes and sickle cell disease. The autoimmunization rate (22.89%) is higher in thalassemia syndromes (41.46%) than in the sickle cell disease (7.14%) (P < 0.001). The anti-HLA immunization rate is 31.6% without difference between thalassemia syndromes and sickle cell disease. The young age, transfusion at a young age and the total number of transfusions are the factors that increase the risk of anti-erythrocyte autoimmunization. No clinicobiological parameter does influence the anti-erythrocyte and anti-HLA alloimmunization. There is no significant association between anti-erythrocyte and anti-HLA immunization.ConclusionThe erythrocyte and anti-HLA anti-immunization rates are high in our series. Preventive strategy is needed to ensure optimal blood safety.     

Thérapie génique et cellulaire dans le traitement des pathologies ischémiques des membres inférieurs

Late evolution of peripheral arterial disease consists in the apparition of critical limb ischemia. Surgical treatments allow to treat these patients during long time; however, in most patients, especially the diabetic ones, there a very few options and the clinical evolution is rapidly dramatic. For these reasons, the critical limb ischemia is one of the first diseases treated by genic or cellular therapies aiming to improve blood flow perfusion in the lower-limbs. In this short review, we describe the main clinical trials of genic therapy; most of them have been abandoned because serious side effects, modest effects and major risks. Different types of stem cells are now used for cell therapy: endothelial progenitor cells, early or late, activated or not, mesenchymal stem cells, embryonic stem cells and human induced pluripotent stem cells. Problems of characterization are described and the results of the most important clinical trials are reported.     

Le don bénévole,volontaire, et non rémunéré ; état des lieux et perspectives

The voluntary and unpaid blood donation is recommended by all international authorities (WHO, Council of Europe, ISBT, EBA), because it represents the best way of aiming towards self-sufficiency in blood products of all kinds, while preserving an optimal level of quality and safety for recipients as for donors. Still infrequent in many developing countries it tends to develop. However, the objective assigned by the WHO to reach 100% of unpaid and voluntary blood donations in 2020 appears ambitious, in particular for the collection of plasma intended to the splitting industry. The close evaluation of European directives concerning the donation of human body elements should allow harmonization of practices by Member States.