Aspects périopératoires de la transfusion sanguine en pédiatrie

In pediatric elective surgery, the main indications of blood transfusion are cardiac surgery, neurosurgery and abdominal tumors. Blood saving techniques are also available. The transfusion threshold has to take into account the physiological age-related particularities. Underestimation of blood loss and delayed transfusion are associated with a severe morbidity. In the absence of specific literature, the management of hemorrhagic shock is based on extrapolation of the adult recommendations.     

Gestion des évènements indésirables receveurs : le point de vue de l’hémovigilant d’un établissement de santé

The French haemovigilance system designates a physician in charge of haemovigilance in each hospital. She/he collects the adverse reactions and events reported by medical staff or nurses. In 2010, 7360 (2.42/1000 units) adverse reactions and 518 adverse events (excepted donors) were reported. These results mean that the system is particularly effective in hospitals. This study collected the opinion of physicians in charge of haemovigilance about this organization.     

Recherche des agglutinines irrégulières en milieu obstétrical en Tunisie : étude à propos de 5369 femmes

Purpose of the studyTo evaluate the prevalence of alloimmunization in women followed in an obstetrical environment in Tunisia, to identify the specificities of antibodies found and to determine factors that could influence the appearance of this immunization.MethodsWe proceeded to a retrospective analysis of search for irregular antibodies at women followed up in obstetrical environment over nine consecutive years (2000–2008). The panel was officially defined and produced by the Regional Centre for Blood Transfusion in Sfax (Tunisia).ResultsOverall 5369 women benefited from 6575 antibody testing (average: 1.22; extremes: 1–14). The results were positive for 278 women (5.17 %), allowing to identify 216 antibodies or associations of antibodies. Among identified antibodies, those immune were found in 198 women. The rate of alloimmunization was 3.68 % (198/5369). The majority of the antibodies found was anti-Rh1, isolated or associated with another antibody, in 84.3 % of the total immunized women. The immunization of women according to the number of gestations showed a significant increasing rate ranging from 2.34 % for a first gestation to 5.27 % for four gestations or more. In addition, a significant difference was also noted between the rate of immunization in women who had received anti-Rh1 immunoglobulin and those who had not.ConclusionAnti-Rh1 immunization is the most frequent in the population of studied women. This could denote of an insufficiency in pregnancies follow-up and immunoprophylaxis protocols.     

Résultats des échanges transfusionnels partiels chez 42 patients drépanocytaires homozygotes au CHU de Brazzaville

The standard of care for major sickle cell diseases in crisis is based on blood transfusion, but this remains a risky therapy in sub-Saharan Africa. The objective of this retrospective and prospective study was to assess exchange transfusion (ET) in homozygous sickle cell disease between 1st July 2005 and 30th June 2008 at the transfusion centre of university hospital of Brazzaville. The ET technique used was manual and made of three stages: bleeding, infusion of solution, and infusion of red cell concentrate. Clinical and biological assessments were done before and after exchanges. The indication for ET were: pregnancy (19 cases); strokes (seven cases); vaso-occlusive crisis (five cases), priapism (four cases), cardiac failure (three cases) and miscellaneous (four cases), the values of hematocut in red cell blood bag between 0.55 and 0.70 (median 0.65). The median haemoglobin level before exchange was about 5.8 g/dl (4.1–7.4 g/dl), that of HbS from haemoglobin electrophoresis about 98.4 % (94.6–100 %). Before the exchanges, viral serological tests were done with the following results: two patients with HBV antigen positive and one patient antibodies to HCV. In acute situation interval between exchanges is 3 to 10 days, whereas during chronic situation is between 14 to 28 days. No major immediate complications have been observed. Clinical situation after exchange characterized by stabilization of cerebral vascular stroke and over and control of one case of priapism complications. Assessment after exchange showed the following results: medium rate of Hb level: 9.5 g/dl (an increase of 3.7 g/dl); medium percentage of HbS reduced to 46.8 % (approximately a decrease of 51.6 %). Patient's serological status to HCV changed for one patient. This study illustrates the benefit and the limitations of the transfusion exchange during sickle cell disease in sub-Saharan Africa.     

Les effets indésirables receveurs inconnus de cinq régions françaises : analyse,résultats,propositions

ObjectiveAdverse transfusion effects with “unidentified diagnosis” are yearly notified on the French national database “e-FIT” in various numbers and with high interregional discrepancies. The aim of this work was to analyse them in order do reach a better understanding of these notifications.ResultsOn a total of 2499 “Fiches d’Effets Indésirables Receveurs” (FEIR) registered in 2006 in five French regions, 416 with “unidentified diagnosis” were analysed. Fifty-seven percent of them were kept classified in “unidentified diagnosis”. Forty-three per cent of FEIR were reclassified, some in already proposed diagnostic categories (100 EIR), some in new proposed diagnostic categories (80 EIR) as: pathological context of the patient, pains linked to transfusion, hypotension.ConclusionThe study confirms the necessity to re-examine the French notification system. It underlines the insufficiency of clinical and biological investigations, which could allow to reach accurate diagnosis. It gives prominence the necessity of taking into account the patient's pathology and targets at least two diagnoses of transfusion adverse effects which are not yet proposed on the FEIR model. This work brings an overture about evolution of the French haemovigilance database which will involve further developments.     

Aspect clinique et profil évolutif de la carence en thiamine en milieu carcéral en Guinée : étude de trente-huit observations

Cardiovascular and neurological manifestations associated with thiamine deficiency in Guinean prisons are common but not reported.We performed a prospective study of 38 cases related to vitamin B1 deficiency over a period of 4 years. In this population, the literature of traditional data gathered: frequency peak after thirty (92.6%) and clear representation male (sex ratio M/F: 18/1). The clinical symptomatology remains essentially dominated by sensorimotor polyneuropathy and pure sensory (52.2%), overall heart failure (31.5%) and to a lesser degree by Gayet Wernicke’s encephalopathy (7.8%) and shoshin beriberi with severe evolution (5.2%). The study of nutritional status by body mass index (BMI) of the World Health Organization, by the criteria of Detsky and biological markers including albumin, shows that these patients are severely malnourished.