editor’s note note de l’editeur - afsbt

(i)

December 2015, Volume 18, no. 1Africa Sanguine

After about a decade of existence of the AfSBT, it was observed that the impact of the Society was not being uniformly felt in all the countries of Africa where there are members of AfSBT. Also, many members do not feel a sense of belonging to the Society, except when a Congress is being held in their area. Although it helps that continental Congresses are held in rotation between Anglophone and Francophone countries, only handfuls of members, from non-hosting countries, are able to attend Congresses due to funding difficulties. The idea therefore arose that the countries of Africa be divided into regional blocks along the geo-political groupings of the Continent, and members allocated to Regions where they reside. This proposal was approved by the General Assembly of Delegates (GAD) at the Nairobi Congress in 2009. Five Regions were then created, namely, the EAC, the ECOWAS, the MAGHREB, the RAFTS, and the SADC. The composition and nomenclature of some of the Regions were recently amended in 2016. The current delineation and nomenclature of the Regions are shown in the Appendix. The policy of Regionalisation was not meant to create governance sub-units, but rather operational arms of the Society. The governance and authority of the Society remain centralized, and membership remains individual, with payment of membership dues direct to the Society headquarters in RSA. The Terms of Reference (TOR) of the Regions include the promotion and actualization of the objectives of the Society within the countries of their Region, and the recruitment of more members into the Society. Regional activities are to be organized to attract participation by more members from the Region than would continental activities elsewhere. These may include Regional conferences, and advocacy and local training programmes. For this purpose a Regional Committee is elected, in line with the electoral policy of the Society, and the Regional Chairman becomes a member of the AfSBT Board, with the designation of Vice President. While there are no official country branches of AfSBT, the Chairman may appoint focal persons in each country in the Region to coordinate AfSBT activities in the country.However, from reports being sent from the Regions, through the Board, to the GAD at each continental Congress, the Regions have not been active enough to effectively fulfill the mandate for their creation. Regional conferences are not being held, except in the ECOWAS Region, where two conferences, exclusively of AfSBT, have been held in 2011 and 2014 with good effect. Chairpersons of other Regions may wish to emulate the ECOWAS example, and, for a start, organize Regional conferences in their areas, even if they have to piggy-back on some other national or regional meetings in their locality. A good example may be the 18-monthly SA National Blood Transfusion Conference in RSA, for the SADC Region. The timing of regional sconferences must however not be close to, or clash with continental Congresses. Conferences have been known to be a fertile ground for raising awareness about AfSBT, recruiting new members and making local impact for the Society. Encouragement and support by the parent body, represented by the Board and the Management, will be helpful to the Regions in organizing their activities.

APPENDIX - LIST OF AfSBT REGIONS BY COUNTRIESCENTRAL AFRICA (ECCAS) Burundi, Cameroon, Central African Republic, Chad, Congo Brazzaville, Democratic Republic of the Congo, Equitorial Guinea, Gabon, Sao Tome and Principe

EAST AFRICA (EAC) Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Mayotte, Reunion, Rwanda, Somalia, Tanzania, South Sudan, Uganda.

NORTH AFRICA (MAGHREB) Algeria, Egypt, Libya, Mauritania, Morocco, Sudan, Tunisia, Western Sahara.

SOUTHERN AFRICA (SADC) Angola, Botswana, Lesotho, Malawi, Mauritius, Mozambique, Namibia, Seychells, South Africa, Swaziland, Zambia, Zimbabwe.

WEST AFRICA (ECOWAS) Benin, Burkina Faso, Cape Verde, Cote d’Ivoir, Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Siesrra Leone, Togo

EDITOR’S NOTE

Après une dizaine d’années d’existence de la SATS, on a observé que l’impact de la Société n’a pas été ressenti de manière uniforme dans tous les pays d’Afrique où il y a des membres de la SATS. En outre, de nombreux membres ne ressentent pas une appartenance à la Société, sauf si un congrès est organisé dans leur région. Bien que les congrès continentaux soient organisés de façon rotative entre les pays francophones et anglophones, seule une poignée de membres des pays n’accueillant pas le congrès sont en mesure de participer en raison des difficultés d’obtention de financement. L’idée a donc été de regrouper les pays d’Afrique en blocs régionaux selon l’organisation géopolitique sur le continent, et d’affecter les membres dans les régions où ils résident. Cette proposition a été approuvée par l’Assemblée Générale des Délégués (AGD) au Congrès de Nairobi en 2009. Cinq régions ont ensuite été créées, à savoir, la CEDEAO l’EAC, le MAGHREB, le RAFTS et la SADC. La composition et la nomenclature de certaines des régions ont récemment été modifiées en 2016. La délimitation actuelle et la nomenclature des régions sont présentés en annexe. La politique de régionalisation ne visait pas à créer des sous-unités de gouvernance, mais plutôt des bras opérationnels de la Société. La gouvernance et l’autorité de la Société restent centralisées, et l’adhésion reste individuelle, avec le paiement des cotisations directement au siège de la Société en République Sud-africaine. Les termes de référence (TDR) des régions comprennent la promotion et l’actualisation des objectifs de la Société dans les pays de leur région, et le recrutement de plusieurs membres. Les activités régionales doivent être organisées pour attirer la participation de plusieurs membres de la région mieux que le ferait les activités continentales. Celles-ci peuvent inclure des conférences régionales, le plaidoyer et les programmes de formation locaux. A cet effet, un comité régional est élu, conformément à la politique électorale de la Société, et le Président régional devient membre du Conseil d’Administration de la SATS, en tant que du Vice-Président de la SATS. Bien qu’il n’y ait pas de branches officielles dans les pays de SATS, le président peut nommer des points focaux dans chaque pays dans la région pour coordonner les activités de la SATS dans le pays.Cependant, à partir des rapports envoyés par les régions, par l’intermédiaire du Conseil, à l’AGD lors de chaque Congrès continental, les régions n’ont pas été suffisamment actives pour remplir efficacement le mandat de leur création. Les conférences régionales ne sont pas tenues, sauf dans la région de la CEDEAO, où deux conférences, exclusivement de la SATS, ont eu lieu en 2011 et 2014 avec de bons résultats. Les présidents des autres régions peuvent souhaiter suivre l’exemple de la CEDEAO, et, pour commencer, organiser des conférences régionales dans leurs zones, même si elles empiètent sur d’autres réunions nationales ou régionales de leur localité. Un bon exemple peut être la conférence nationale mensuelle sur la transfusion sanguine en Afrique du Sud, pour la région de la SADC. Le calendrier des conférences régionales ne doit cependant pas être proche de, ou en conflit avec le congrès continental. Des conférences sont connues pour être un terrain fertile pour la sensibilisation à l’adhésion à la SATS, le recrutement de nouveaux membres et l’impact local de la Société. L’encouragement et le soutien de la société mère, représentée par le Conseil et la direction, seront utiles aux régions dans l’organisation de leurs activités.

ANNEXE - LISTE DES RÉGIONS DE LA SATS AFRIQUE CENTRALE (CEEAC) Burundi, Cameroun, République Centrafricaine, Tchad, Congo Brazzaville, République démocratique du Congo, Guinée équatoriale, Gabon, Sao Tomé-et-Principe.

AFRIQUE DE L’EST (EAC) Comores, Djibouti, Érythrée, Éthiopie, Kenya, Madagascar, Mayotte, La Réunion, le Rwanda, la Somalie, la Tanzanie, le Soudan du Sud, en Ouganda.

AFRIQUE DU NORD (MAGHREB) Algérie, Egypte, Libye, Maroc, Mauritanie, Soudan, Tunisie, Sahara Occidental.

AFRIQUE AUSTRALE (SADC) Angola, Botswana, Lesotho, Malawi, Maurice, Mozambique, Namibie, Seychelles, Afrique du Sud, Swaziland, Zambie, Zimbabwe.

AFRIQUE DE L’OUEST (CEDEAO) Bénin, Burkina Faso, Cap-Vert, Côte d’Ivoire, Gambie, Ghana, Guinée, Guinée Bissau, Libéria, Mali, Niger, Nigeria, Sénégal, Sierra Leone, Togo

AFSBT : WITHER REGIONALISATION

NOTE DE L’EDITEUR

SATS : OU EN SOMMES NOUS AVEC LA REGIONALISATION ?

1


TRANSFUSION OF THE DANGEROUS UNIVERSAL DONOR BLOOD LEADING TO MATERNAL MORTALITY: A Case Report

Suleiman AM1, Mamman Aisha I1, Akanmu AS2

1. Department of Haematology and Blood Transfusion, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.2. Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Nigeria.

CORRESPONDENCEDr AM SuleimanEmail: [email protected]

KEYWORDSTransfusion, maternal, mortality, blood

ABSTRACTBACKGROUNDIn a health-care se ng in which group-iden cal donor blood is not always available for transfusion, group O whole blood, in theobsolete concept of its being a universal donor, is some mes givento group A and B recipients without necessary precau ons.

OBJECTIVES The objec ve is to draw a en on to the danger of transfusing groupA or B recipients with group O blood.

MATERIALS AND METHODSThe case is presented of a mul parous blood group A pregnantwoman who was transfused with whole blood group O. The womandeveloped a haemoly c blood transfusion reac on, which led tointravascular haemolysis, disseminated intravascular coagula on,mul ple organ failure and death.

CONCLUSION AND RECOMMENDATIONWhenever group-iden cal compa ble blood is not available, andgroup O blood has to be given to a group A or B recipient, haemolysintest must be included in the pre-transfusion tests, and blood shouldbe given preferably as red cell concentrate.

SCIENTIFIC ARTICLES

RESUMECONTEXTEDans un environnement sanitaire ou le sang de donneur isogroupe n’est pas toujours disponible pour la transfusion, le groupe sanguin O du sang total, dans le concept obsolète de don universel, est parfois donné aux receveurs des groupes A et B sans les précau ons nécessaires.

OBJECTIFL’objec f est d’a rer l’a en on sur le danger de la transfusion des receveurs du groupe A ou B avec du sang du groupe O.

MÉTHODE ET RÉSULTATIl s’agit du cas d’une femme enceinte mul pare qui a été transfuséavec du sang total de groupe sanguin O. La femme a développé une réac on aigue hémoly que, qui a mené à l’hémolyseintravasculaire, une coagula on intravasculaire disséminée, l’échec de mul ples organes et la mort.

CONCLUSION ET RECOMMANDATIONChaque fois que le sang compa ble avec le groupe du receveur n’estpas disponible et que le sang du groupe O doit être administré à unreceveur du groupe A ou B, un test de recherche des hémolysines doit être inclus dans les tests pré-transfusionnels et le sang doit être administré de préférence sous forme de concentrés de globules rouges.

TRANSFUSION DU DANGER UNIVERSEL DONATEUR SANG CONDUISANT À LA MORTALITÉ MATERNELLE: un dossier

2


INTRODUCTION

Blood transfusion has for a long time been a modality for thetreatment of severe anaemia in pregnancy with consequent reduc onof maternal morbidity and mortality.1,2 This benefi t may, however turnharmful when incorrect blood is transfused.2 In a sub-Saharan Africancountry like Nigeria, where there is perennial shortage of donorblood, the concept of group O donors being universal donors is s llbeing applied, and group O blood is some mes given to group A orB recipients.3 However, the presence, some mes, of haemolysinsA and/or B in group O blood makes this prac ce very dangerous.3

Haemolysins are the potent immune IgG an -A and an -B which occur in the ABO blood group system.4 The occurrence, distribu on and potency of haemolysins vary with ABO blood group, ethnicity,geographical loca on, previous exposure through transfusion andobstetric and other incidents.4 In Zaria, group O individuals cons tute between 46.9% and 49.2% of blood donors, of whom 32.3% havevery strong an -A and an -B haemolysins.5,4 Okafor and Enebe fromEnugu, reported a blood group O haemolysin rate of 53.6%, 62.7%, and 47.8% for an -A, an -B and an -A,B respec vely among blooddonors6. Haemolysins were also detected in non-group O personswith an -B haemolysins occurring in 35.7% of group A individuals while an -A haemolysins were found in 8.8% of group B individuals.6

Anyanwu et al in Calabar reported an occurrence of an -A (15.2%),lan -B (12.1%) and an - A,B (30.3%) haemolysins among group Oindividuals with Haemoglobin SS (HbSS).7 Some mes, health-careproviders in rural areas may be caught in the dilemma betweensaving life in emergency situa ons by transfusing so-called universaldonor blood on the one hand, and on the other, wai ng for the correct group-identical blood which may not be immediatelyavailable.8 Where such blood is not routinely screened forhaemolysins, a signifi cant propor on of group A or B recipients of group O blood may be at risk of haemoly c transfusion reac ons.What happens in such cases is that the IgG an -A and/or an -Ban bodies in the donor plasma cause intravascular lysis of recipientA and B cells, and lead to haemoglobinaemia, haemoglobinuria,disseminated intravascular coagula on, (DIC), and acute renal, andother organ failure, with a high fatality index. We describe a case of fatal haemoly c transfusion reac on following transfusion of groupO whole blood to a group A recipient.

CASE REPORT

HA was a pregnant 29 year old housewife in a rural area in NorthernNigeria. She was G6P4+1 with 3 living children. She presented at a secondary health care facility, where a diagnosis of placenta praeviawas made. She was also found to be severely anaemic with a packedcell volume of 18%. She was transfused with two units of group O RhD posi ve whole blood, even though she herself was blood groupA Rh D posi ve. Six days a er blood transfusion, she developedbruising at injec on and venepuncture sites, and was passing dark-coloured urine. Nine days post-transfusion, there was loss of foetalmovement, which prompted an induc on of labour with oxytocin.She was later delivered of a macerated foetus weighing 2.7 kg and was referred to the teaching hospital for further management. Onpresenta on, the pa ent was found to be severely pale, jaundiced,and febrile to touch with a body temperature of 38.5 oC. She hadecchymoses on the trunk and generalised exfolia on of the skin.

There was and mild ankle oedema, Bilateral fi ne basal crepita ons were heard in the lung fi elds, The heart rate was 160 beats per minute with a moderate-volume but regular peripheral pulse. Her blood pressure was 100/70 mmHg. The abdomen was distended, but abdominal organs were not palpably enlarged. The pa ent wasdisorientated in place and me. The bladder catheter was draining dark-coloured urine, while vaginal examina on revealed a lochial fl ow with clots, from an empty uterus. Results of inves ga ons on admission revealed a haematocrit of 0.19, total leucocyte count of 11.2 x 109/L, and platelet count of 45x109/L. The blood fi lm showed marked hypochromic microcytosis, with some macrocytosis, few target cells and fragmented red cells. The re culocyte count was 6%. Her blood group was confi rmed to be A RhD posi ve, and she had aposi ve direct an -human globulin test, and an -A haemolysin tre of 2. The donors of the blood with which she was earlier transfused were traced, and their blood groups rechecked. Both were blood group O Rh D posi ve, but one had an an -A haemolysin tre of 128. The thrombin, prothrombin, and ac vated par al thromboplas n mes were indefi nitely prolonged. The hepa c enzyme levels were

126 IU/L and 314IU/L for alanine transaminase, and aspartate transaminase respec vely. The urea level was 63.5mmol/L while serum crea nine was 874umol/L and serum bicarbonate 20mmol/L The urine was posi ve for protein and urobilinogen, and the urine sediment was posi ve for haemosiderin by Pearls method. The chest x-ray was essen ally normal, and urine, stool and blood cultures yielded no pathogens. A diagnosis of intravascular haemolysis with disseminated intravascular coagulopathy and renal failure was made. Therapeu c management included transfusion with 2 units of compa ble blood group A fresh whole blood, intravascular injec on of frusemide at a dose of 40mg, and hydrocor sone 100mg stat.intravascular course of amoxicillin-clavulanate at a dose of 375mg 8 - hourly was commenced. She had one session of haemodialysis. Oedema worsened, with development of anasarca, along features of uraemic encephalopathy. In spite of the management, the pa ent’s condi on deteriorated, and she died 5 days later.

DISCUSSION

The decision of the referring hospital to transfuse the pa ent wasdictated by severe anaemia in late pregnancy, probably due to the combina on of mul parity, micronutrient defi ciency and chronic blood loss, termed “maternal deple on syndrome”.9 The choice of group O donor blood for transfusion to a group A pa ent was probably made in the absence of compa ble donor blood group A, and in the no on that group O blood could be given to a group A person under the circumstances. However, there was failure to check the group O donor blood for haemolysin A. in spite of thereported high frequency of haemolysins in the blood of Nigerians, and black Africans in general.4,6,7,10,11 Treatment of severe anaemia in late pregnancy with whole blood transfusion was ill-advised, butmay have been done for lack of plasma reduc on facility at the primary and secondary levels of health establishments in Nigeria.The consequence was the development of a delayed haemoly c transfusion reac on, in which the an bodies in the donor plasma destroyed the recipient’s own red cells. This led to intravascular haemolysis, disseminated intravascular coagula on, mul ple organ failure and ul mately death. The unavailability of appropriate blood components to treat DIC, even at the ter ary health facility, probably contributed to the rapid clinical deteriora on.

3


CONCLUSION AND RECOMMENDATIONS

The concept that blood group O can serve as a universal donor isdangerous, and is now obsolete (refs).There is need for greaterawareness of this fact among all levels of healthcare facili es inAfrica, where blood transfusion is prac ced. Screening of groupO donor blood for haemolysins should always be done, and morepar cularly when group O blood is to be transfused to group A orB recipients. Such group-compa ble, but uniden cal transfusionshould preferably be in form of red cell concentrate, to reducerecipient exposure to ABO haemolysins. Finally, blood servicesin Africa should be improved to make safe and adequate bloodavailable always for transfusion, and appropriate blood componentsavailable for treatment of special cases.

REFERENCES

1. Malcolm D. Black, Blood transfusion in obstetrics, BMJ 1937; 903-6

2. Bates I, Chapotera GK, McKew S, van den Broek N Maternal mortality in sub-Saharan Africa: the contribu on of ineff ec veblood transfusion services. BJOG 2008; 115 (11): 1331-39.

3. Donald M. Ervin, Lawrence E. Young, Dangerous Universal Donors Blood, 1950; 5(1): 61-73

4. Kulkarni AG, Ibazebe R, Fleming AF: High frequency of an -A and an -B-haemolysins in certain ethnic groups in Nigeria. Vox sang 1985; 48(1): 39-41.

5. Hassan A, Babadoko AA, Ahmed AJ, Ahmed AJ Isa HA, Suleiman AM, The pa ern of of distribu on of ABO blood groups in North Western Nigeria, Annals of Nigerian Medicine, 2005; 1(2): 17-8.

6. Okafor LA Enebe S, An -A and an -B haemolysins, dangerous universal blood donors and the risk of ABO antagonism in a Nigerian community, Trop Geogr Med 1985; 37(3): 270-2.

7. Anyanwu R. A., Emeribe A O, Igwe C U, Ajayi I, Akpotuzor J, Lele KC Emelike FO, Occurrence of haemolysin an bodies among sickle cell anaemia pa ents within Calabar metropolis of Nigeria. African Journal of Biotechnology 2007; 6 (10):1217-1220.

8. Olawumi HO, Olatunji PO. Prevalence and tre of alpha and beta Haemolysins in blood group ‘O’ donors in Ilorin, Afr .J.Med.Sci 2001; 30: 319-321.

9. Ugwuja EI, Akubugwo EI, Ibiam UA, Obodoa Onyechi, Impact of Maternal Iron Defi ciency and Anaemia on Pregnancy and its outcomes in a Nigerian Popula on. The Internet Journal of Nutri on and Wellness, 2010; Vol 10(1).

10. Adewuyi JO, Gwanzura Chris ne and Mvere D. Characteris cs of an -A and an -B in Black Zimbabweans. Vox Sanguinis 1994,67 :307-309

11. Adewuyi JO and Gwanzura Chris ne. Racial diff erence between White and Black Zimbabweans in the haemoly c ac vity of ABO an bodies. Afr J Med Med Sci 2001; 30;71-74

4


Kouamenan S1, Sekongo YM1, Konan S, Toure CP, Kassogue K1, N’Guessan P1, Siransy-Bogui L1, Konate S1, Abisse A1, Sanogo I2

1. Centre Na onal de Transfusion Sanguine, Abidjan, Côte d’Ivoire2. Service d’Hématologie Clinique, Centre Hospitalier et Universitaire, Yopougon, Côte d’Ivoire

CORRESPONDANCESekongo Yassongui Mamadou,Unité de Recherche et de Thérapeu que Transfusionnelle, Centre Na onal de Transfusion Sanguine, Abidjan, Côte d’Ivoire BP V15 km 4 Bd de MarseilleE-mail : [email protected]

MOTS CLÉSCiné que, Hémolyse, Trait drépanocytaire

Confl it d’intérêt Les auteurs déclarent ne pas avoir de confl it d’intérêt concernant ce manuscrit transmis à la revue Africa Sanguine.

ETUDE DE LA CINÉTIQUE DE L’HÉMOLYSEdans les poches de concentrés érythrocytairesdes donneurs de sanghétérozygotes AS et son implication transfusionnelle

RESUMEINTRODUCTIONLe don de sang par le sujet drépanocytaire hétérozygote AS cons tue un champ d’inves ga on peu exploré.

OBJECTIFContribuer à la défi ni on des condi ons du don de sang par lessujets AS.

METHODOLOGIEIl s’agissait d’une étude prospec ve horizontale qui s’est déroulée auCentre Na onal de Transfusion Sanguine (CNTS) à Abidjan-Treichvillesur une durée de 02 mois d’octobre 2010 à novembre 2010. Nous avons sélec onné 11 donneurs AS dans une popula on de donneursde sang réguliers et 11 donneurs témoins AA. Tous répondaientaux critères d’ap tude au don. Une Numéra on Formule Sanguine(NFS) et un dosage de la kaliémie ont été réalisés à Jour 0 Jour 10Jour 20 et Jour 30. Les dosages ont été faits de façon compara ve.

RESULTATSLe taux d’hémoglobine moyen de nos donneurs avant le don était supérieur ou égal à 12g/dl. On observait une diminu on du tauxd’hémoglobine dans le temps à par r de Jour 10 chez les AS. Chez lesAA, après une diminu on brève à Jour 10, le taux restait stable dans le temps. Le poids moyen en hémoglobine des poches issues de donneursAS était proche des normes de produc on des Concentrés de GlobulesRouges à Jour 0 et Jour 10 mais le poids baissait à par r de Jour 20.

ABSTRACTStudy of the kine cs of hemolysis in red cell concentrated blood units from heterogenous AS sickle cell blood donors and its transfusion implica on.

INTRODUCTIONBlood dona on from heterogeneous AS sickle cell donors represents a li le explored fi eld of research.

OBJECTIVETo contribute to defi ne of blood dona on condi ons by AS subjects.

METHODOLOGYThis was a prospec ve and cross-sec onal study held at the Na onal Blood Transfusion Center (CNTS) Abidjan-Treichville over a period of 02 months from October 2010 to November 2010. We selected 11 AS donors in a popula on of repeat blood donors and 11 AA donorswho served as controls. All met the suitability criteria for dona on. A full blood count (FBC) and a monitoring of serum potassium were done at Day 0, Day 10 Day 20 and Day 30. The results of assays were done compared.

RESULTSThe mean hemoglobin levels of our donors before dona on wasgreater than or equal to 12g / dl. We observed a decrease in hemoglobin levels over the me from Day 10 in AS. In AA, a er a brief decline at Day 10, the rate remained stable over the me.

5


INTRODUCTION

La drépanocytose est une hémoglobinopathie caractérisée parune anomalie de structure située au niveau de la chaine β del’hémoglobine. L’acide aminé en posi on 6 qui y est l’acide glutamiqueest remplacé par la valine. Ce e anomalie va entraîner la gélifi ca onde l’hémoglobine, la falciforma on de l’héma e et une accentua onde l’hémolyse physiologique lorsque la pression partielle del’oxygène baisse. Il existe plusieurs phénotypes hémoglobiniques.Les formes décrites sont les formes anémiques (SSFA2 et SFA2)et les formes non anémiques (SAFA2 et SC). Il existe également letrait drépanocytaire AS qui est en général asymptoma que et dedécouverte fortuite.1,2,3 Les pa ents AS ne nécessitent en général pas de traitement, et ils se retrouvent au cours des dons de sang.Une étude antérieure réalisée au CNTS a montré que 28% d’individuissus d’un groupe de donneur avaient un phénotype AS4. Le donde sang par le sujet drépanocytaire hétérozygote AS cons tue un champ d’inves ga on peu exploré. Quelques données parcellairessont cependant retrouvées dans la li érature. Les études réaliséesont montré la polymérisa on de l’hémoglobine S avec obstruc ondes fi ltres lors de la déleucocyta on.5,6,7 Les lésions de stockage se traduisent plus ou moins par une grande détérioration de certains composants du sang. Il apparait des produits indésirables et une perte de qualité fonc onnelle pendant la prépara on et laconserva on des composants sanguins. Les produits du catabolismedes CGR sont le potassium extracellulaire, le 2,3DPG, les lactates.8

Le nombre de globule rouge, le taux d’hémoglobine et l’hématocritesont des refl ets indirects de l’hémolyse. A travers ce e étude, nousavons voulu savoir si l’importance de l’hémolyse dans les poches desang de donneur AS dans ce contexte de plus en plus désoxygénéest élevé au point que l’hémoglobine résiduel soit insuffi sante pourla transfusion. La surveillance de ce e hémolyse progressive avecle temps devrait perme re de préciser jusqu’à quel moment lapoche de sang AS est encore apte à être transfuser, ce qui permet de déterminer la durée de conserva on de la poche AS. L’objec f général de ce travail était de contribuer à la défi ni on des condi onsdu don de sang par les sujets AS.

PATIENTS ET METHODES

Il s’agit d’une étude de cohorte prospec ve qui s’est déroulée auCNTS à Abidjan-Treichville sur une durée de 02(deux) mois d’octobre 2010 à novembre 2010. La sélec on des donneurs AS a été faite àpar r de la base de données de l’étude de Legbedji. Nous avonssélec onné onze donneurs AS dans une popula on de donneursde sang réguliers et onze donneurs témoins AA. Ils répondaienttous aux critères d’ap tude au don c’est-à-dire âge entre 18 et65 ans, la tension artérielle normale, le taux d’hémoglobine>11g/dl. Ils ont tous été testés vis-à-vis des agents pathogènessuivants : VIH, VHC, VHB et syphilis et se sont révélés néga fs.

Un prélèvement de sang total de 450cc +/-50 ml a été eff ectué surpoche avec comme an coagulant SAGM. Après décanta on avecextrac on du plasma, nous avons obtenu une poche de concentré érythrocytaire standard conservés sur SAG-mannitol entre 4° et 6°C. Après stripage du cordon, plusieurs boudins ont été réalisés etont été conservés pendant 30 jours entre 4° et 6°C. Les poches de concentré érythrocytaire ont été distribuées.Un prélèvement sur tube EDTA et tube sec a été fait également afi nd’eff ectuer les examens sérologiques et immuno-hématologiques pour la valida on biologique du don.Une numéra on globulaire et un dosage de la kaliémie ont été réalisés à J0 J10 J20 et J30.• La numéra on globulaire a été réalisée grâce un automate

d’hématologie de type SYSMEX. Cela permet la détermina on du nombre de globules rouges, de l’hématocrite, et du taux d’hémoglobine.

• Détermina on de la kaliémie Le dosage du potassium sérique a été réalisé grâce à un automate

de biochimie par la méthode spectrophotométrique.

RESULTATS

Figure 1:g évolu on du taux d’hémoglobinemoyen chez les donneurs AA et AS

L’analyse des courbes d’évolu on du taux d’hémoglobine dans les poches de sang des donneurs AS et AA montre une diminu on progressive dans les deux groupes en fonc on du temps. Le taux d’hémoglobine diminue aussi bien chez le donneur AA que chez le donneur AS mais ce e diminu on est plus importante chez ledonneur AS après J10. (Figure1)

Le poids en hémoglobine des poches AS était inférieur à celui des poches AA. La kaliémie augmentait dans le temps, ceci traduisaitindirectement l’hémolyse. Ce e augmenta on de la kaliémie étaitparadoxalement plus importante chez les AA que les AS.

CONCLUSIONCe e étude montre une ciné que de l’hémolyse plus importantedans les poches AS à par r de Jour 10.

The average weight of hemoglobin AS donors in blood bags was close to those of standards of Red Cell Concentrates on Day 0 and Day 10 but the weight felt from Day 20. Weights of hemoglobin AS blood bags were lower than those of AA. Serum potassium levels increased over the me, it indirectly refl ected hemolysis. The increase in serum potassium was paradoxically higher in the AA than in AS blood units.

CONCLUSIONThis study shows that hemolysis kine c is more important in AS blood units from Day 10.

05

1015

20

J0J10

J20J30

taux

d'H

b en

g/d

l

temps en jours

Taux d'hémoglobine moyen donneurs AA et AS

AS

AA

6


Tableau1: Comparaison du poids moyen en hémoglobine despoches de sang issus de donneurs AS et AA

Temps en jours

Poids moyen en Hb en g J0 J10 J20 J30

Donneurs AA 75,06 72,12 67,03 64,16

Donneurs AS 65,43 60,60 51,74 48,98

Concernant le poids en hémoglobine des poches de sang dans letemps des deux groupes, on observe une diminu on plus importantechez les sonneurs AS. (Tableau 1)

Tableau 2: Comparaison du pourcentage de la chutedu poids en hémoglobine du sujet AA et du sujet AS

Temps en jours

Chute du poids enHb en % J0 J10 J20 J30

Donneurs AA 0 6,7% 20,22% 27,3%

Donneurs AS 0 5,33% 11,18% 14,69%

Concernant la chute du poids en hemoglobine des poches de donneurs AS et AA par rapport au poids ini al, lachute du poids en hémoglobine des donneurs AS est le double de celle des donneursAA après J10. (Tableau 2)

Figure 2:g évolu on de la kaliémie chez les donneurs AS et AA

La comparaison de la kaliémie des donneurs AS et AA montre une augmenta on plus importante de la kaliémie lors de la conserva on des poches chez le donneurs AA que chez le donneur AS (Figure 2)

DISCUSSION

Le taux d’hémoglobine moyen de nos donneurs avant le don est supérieur ou égal à 11g/dl. Compte tenu du fait de la prépara on de concentré de globules rouges, le taux d’hémoglobine de la poche est supérieur à ce taux. On observe une diminu on du taux d’hémoglobine dans le temps. Ce e diminu on s’observeaussi bien chez le donneur AA que chez le donneur AS, mais elle est plus importante à par r de J10 chez les donneurs AS.

Chez les donneurs AA après une diminu on brève à J10, le taux reste stable dans le temps. Selon Timothy5 cette diminution du taux d’hémoglobine ne permet pas une bonne oxygéna on des ssus surtout chez les pa ents qui sont dans un état grave. Les lésions observées lors du stockage des CGRS sont d’ordre biochimique et mécanique et réduisent leur survie et leur capacitéfonc onnelle.5 Dans l’étude de Jin YS,6 le taux d’hémoglobine dansles poches de sang des donneurs AS était inférieur à celui des donneurs AA. Ould, dans une série de 10 pa ents AS, a montré que les CGRS AS conservaient un bon taux d’hémoglobine dans le temps ainsi que le taux en 2,3DPG.4 Le poids en hémoglobine des poches issues des donneurs AS et AA diminue dans le temps. Le poids moyen en hémoglobine des poches issues de donneurs de phénotypes AS est proche des normes de produc on des CGRS à J0 et J10 mais le poids baisse à par r de J20. Le poids en hémoglobine des poches de donneurs AS est inférieur à celui des donneurs AA. Ce poids varie chez les diff érents donneurs AS, cela est probablement liée à des variables endogènes ou exogènes à iden fi er, probablement le pourcentage en hémoglobine S. La baisse du poids en hémoglobineà par r de J10, fait que ces poches issues de dons AS pourraient être proposées pour la transfusion que dans les 10 jours suivants le prélèvement. Ces résultats sont sensiblement égaux à ceux de Ould4 qui dit que le donneur AS ne peut être exclu du don de sang. Etant donné la forte demande en produit sanguin chez nous, les poches sont distribuées dans les 15 jours suivants le prélèvement. Selon Ackley7 des poches issues de donneurs AS conservent leurscapacités jusqu’à 6 jours après ladéglycérolisation. Il a même suggéré l’opportunité de la réalisa on d’une autotransfusion chez les sujets drépanocytaires dans certaines situa ons pathologiques.7

On observe une diff érence de la chute du poids en hémoglobineentre le sujet AA et le sujet AS. Ce e chute est plus accentuée chez le sujet AS que chez le sujet AA. Ce e diff érence ne peut être interpréter de façon sta s que compte tenu de notre échan llon. Néanmoins ce e observa on nous amène à dire que la chute en hémoglobine est plus importante chez le sujet AS après 10 jours de conserva on. Le poids en hémoglobine des poches issues de don AS ne répond plus aux critères de qualifi ca on. Dans notre étude,on observe une augmenta on de la kaliémie en fonc on du temps, ceci montre indirectement l’hémolyse. Ce e augmenta on est plus importante chez le donneur AA que chez le donneur AS. Cesobserva ons sont comparables à ceux de Noizat2 et Isola8 qui trouveune augmenta on de la kaliémie lors du stockage des CGR. Ce ekaliémie augmente parfois pour a eindre 30 mEq/l après 3semaines de conserva on. Dans notre série, nous avoisinons ces chiff res à J30.Toutefois, la supériorité de la kaliémie chez le sujet AA par rapport à celle du sujet AS est paradoxale car la durée de vie des globules rouges de phénotypes S est plus réduite par rapport à celle des globules rouges de phénotypes A. Ce e observa on nous amènera à faire une prochaine étude sur la kaliémie dans les popula ons chez les donneurs de sang. Ces résultats nous perme ent de dire qu’il faut distribuer le sang avant J10 aux pa ents qui sont dans un état grave. Ould4 dans sa série a trouvé qu’il y avait des désordres biochimiques, mais cela n’altérait pas la qualité des CGRS. Ces mêmes observa ons concernant la kaliémie ont été faite sur lespoches de sang irradiées.6,9

Castro,10 dans son étude s’est basée sur les modifications biochimiques surtout le 2,3DPG. Il a évalué l’eff et du stockage desCGRS sur le 2,3DPG qui permet le transport de l’oxygène. Il a trouvé que la diminu on du 2,3DPG dans les CGRS SS est similaire à celledes CGRS AA.

0

10

20

30

J0J10

J20J30

kalié

mie

en

mEq

/l

temps en jours

evolution de la kaliémie chez les donneurs AS et AA

AS

AA

7


CONCLUSION

L’étude de l’hémolyse chez le donneur AS et son implicationtransfusionnelle réalisée au CNTS, bien qu’étant une étudepréliminaire permet de soulever la probléma que de la réalisa onde l’électrophorèse de l’hémoglobine chez les donneurs de sang. L’hémolyse s’observe aussi bien chez le donneur AA que chez ledonneur AS, mais elle est accentuée dans les poches de sang desdonneurs AS. Le poids moyen en hémoglobine des poches issues des donneurs AS répond aux normes jusqu’à J10. A par r de J10,le pouvoir thérapeu que de ces poches de sang AS est altéré.Etant donné qu’il y a une insuffi sance en produit sanguins en Côted’Ivoire due à un nombre insuffi sant de donneurs de sang, les sujetshétérozygotes (AS) ne sont pas exclus du don de sang.Il paraît donc judicieux au vue de ces résultats préliminaires depoursuivre ce travail surtout in vivo afi n d’évaluer le rendementtransfusionnel des CGRS issus des donneurs AS et de proposer desindica ons transfusionnelles par rapport au don du sujet AS. Auterme de ce travail, nous pouvons dire qu’il est important de réaliserl’électrophorèse de l’hémoglobine chez les donneurs de sang afi nd’assurer une meilleure sécurité transfusionnelle.

REFERENCES BIBLIOGRAPHIQUES

1. Bégué P. Le centenaire de la drépanocytose : quel bilan, quelavenir ? Méd Trop, 2010, 70, 421-422.

2. Labie D., Elion J. La drépanocytose, problème de l’Afrique. Med Trop, 2010, 79, 449-453.

3. Encyclopédie Orphanet Grand Public. La drépanocytose. Anémie falciforme, Anémie à héma es falciformes. Mars 2011, 26 p

4. Legbedji A. Etude hémotypologique des donneurs de sang à AbidjanMémoire de medecine 2008F.

5. Noizat-Pirenne F, Bierling P . Drépanocytose et transfusion sanguine : la poli que de l’établissement français du sang. Feuillet de Biologie, 2014 ; LV(314) : 74-77.

6. Stroncek DF, Rainer T, haron V, Byrne KM, Noguchi CT, Klein HG, Schechter AN, Leitman SF. Sickle Hb polymeriza on in RBC components from donors with sickle cell trait prevents eff ec ve WBC reduc on by fi ltra on. Transfusion. 2004; 44(9):1293-9.

7. Ould Amar AK, Kérob-Bauchet B, Robert P, Leconte C, Maier H, Bera O, Plumelle Y, Hyronimus JC, Césair R. Assessment of qualita ve func onal parameter of stored red cell from donors with sickle cell trait (AS) or with heterozygote (AC) status. Transfusion clinique biologique1996;3(4):225-33.

8. Isola H. Capacité de technique transfusionnelle. Paris déc 20089. Timmouth A, Fergusson D, Yee I C.Clinical consequences of red

cell storage in the cri cally Transfusion. 2006; 46(11); 2014-27

REMERCIEMENTS

Nous remercions le Directeur Général, le personnel du laboratoire de contrôle qualité et de la distribu on du CNTS de Côte d’Ivoire pour leur contribu on à la réalisa on de ce e étude.

8


Nuako Isaac,1 Bedu Addo George,2 Ansong Daniel3

1. Physiotherapy Department, Komfo Anokye Teaching Hospital2. Department of Medicine, Komfo Anokye Teaching Hospital3. Department of Child Health, Komfo Anokye Teaching Hospital

CORRESPONDENCEIsaac NuakoDepartment of PhysiotherapyKomfo Anokye Teaching HospitalP O Box1934 Kumasi, [email protected]

KEYWORDSknowledge, a tude, prac ce, nurses, blood dona on

KNOWLEDGE, ATTITUDE AND PRACTICE on blood donation among nurses in Komfo Anokye Teaching Hospital, Kumasi

ABSTRACT

BACKGROUNDThere is some evidence to suggest that the greater one’s knowledgein the blood dona on process and the need to donate blood,the more likely one would donate blood. Generally, the lack of knowledge among par cipants in most studies on blood dona onissues seems to be a major concern. There is a percep on thatamong health professionals, nurses are in the group that donatefewer units of blood on yearly basis and this has been blamed onseveral factors that have not been scien fi cally verifi ed.

OBJECTIVESThe objec ves of the study were to determine the knowledge,a tudes and prac ces regarding blood dona on among Nurses inKomfo Anokye Teaching Hospital (KATH); and to iden fy the factorsthat prevent nurses from dona ng blood.

METHODOLOGYA cross-sec onal study was conducted which made use of a close-ended ques onnaire to ascertain the knowledge, a tude and prac ces of nurses in eight clinical directorates at KATH. The dataobtained were entered into a database which was designed usingEpiData v3.1. The data were then analysed using StataIC 12.

CONNAISSANCE, ATTITUDE ET PRATIQUE sur le don du sang chez les infirmières de l’Hôpital d’Enseignement de Komfo Anokye, Kumasi

RESUME

CONTEXTEIl y a des preuves qui indiquent que plus la connaissance du processus de don de sang et de la nécessité de faire un don de sang sont grandes, plus il est probable qu’une personne donne dusang. En général, les connaissances limitées chez les par cipants de la plupart des études portant sur les ques ons de dons de sangsemblent être une préoccupa on majeure. On a l’impression que parmi les professionnels de la santé, les infi rmières font par e du groupe qui donne le moins d’unités de sang sur une base annuelle et cela a été a ribué à plusieurs facteurs qui n’ont pas été scien fi quement vérifi és.

OBJECTIFSLes objec fs de l’étude étaient de déterminer les connaissances, les a tudes et les pra ques concernant le don de sang chez les infi rmières de l’Hôpital d’enseignement Komfo Anokye (KATH); Et d’iden fi er les facteurs qui empêchent les infi rmières de donner du sang.

9


RESULTS170 nurses took part in the study. Females formed 85.3% of the respondents and the rest were males. The Regular voluntary non-remunerated donor was affi rmed as having the highest chance of dona ng safe blood. The most frequently men oned importance of blood dona on was to save lives (87%). Out of the 27.1% of therespondents who have donated blood before, only 1.6% were regulardonors. The results showed that the nurses had limited knowledgeabout blood dona on, but a rather posi ve a tude towards blooddona on. There was however poor prac ce of actual blood dona onamong the nurses.

CONCLUSION The knowledge and prac ce of blood dona on among the nurses inKATH are limited. There is need for more specifi c training of nursesand other health workers on blood dona on.

INTRODUCTION

Voluntary non-remunerated donors account for only 41% of the totalblood dona ons in Ghana.1 The demand for whole blood and blood products is increasing at a rate higher than the collec on rate.2 Itis known that more than 75% of blood in the rural areas and 50%in urban areas in Ghana is transfused to children under fi ve years and women of child-bearing age.1 People have diff erent reasonswhy they donate blood. Whilst some think it is their religious andmoral duty others think it is good for their health,3, 4 In Ghana, mostpeople donate blood because a rela ve or friend is in need of it.1

Response to blood dona on campaign largely depends on the levelof educa on, knowledge, and a tudes of individuals and groups targeted. Generally, the lack of knowledge among par cipantsin most studies on blood dona on issues seems to be a majorconcern. This could not only be seen in students and teachers,6 army personnel7 and the general public who are frequent donors, butalso in health personnel.8 However, in contrast to these fi ndings, astudy among medical personnel showed an increase in knowledgeon blood and blood dona on issues among them but this did not translate to the increase in the number of voluntary blood dona onsby the medical personnel.8 In a study involving health sciencestudents including nurses, the overall knowledge on blood dona onwas good, but majority of the students never donated blood.9 It isknown that 60.2% of clinical personnel in Ghana are nurses.10 There isa percep on that among health professionals nurses are in the groupthat donate fewer units of blood on yearly basis and this has beenblamed on several factors that have not been scien fi cally verifi ed.The objec ves of the study were to determine the knowledge,a tudes and prac ce regarding blood dona on among nurses in ater ary hospital in Ghana; and to iden fy the factors that preventnurses from dona ng blood.

MÉTHODOLOGIEUne étude transversale a été menée et a u lisé un ques onnaire étroit pour déterminer les connaissances, l’a tude et les pra ques des infi rmières dans huit direc ons cliniques au KATH. Les données obtenues ont été saisies dans une base de données qui a été conçue avec EpiData v3.1. Les données ont ensuite été analysées à l’aide de StataIC 12.

RÉSULTATS170 infi rmières ont par cipé à l’étude. Les femmes représentaient 85,3% des répondants. Les par cipants ont affi rmé que le donneurvolontaire non rémunéré régulier avait la plus grande chance de donner du sang sans risque. La raison la plus souvent men onnéepour le don de sang était pour sauver des vies (87%). Sur les 27,1% des répondants qui ont donné du sang précédemment, seulement 1,6% étaient des donneurs réguliers. Les résultats ont montré que les infi rmières avaient des connaissances limitées sur le don de sang, mais une a tude plutôt posi ve envers le don de sang. Il y avait cependant une mauvaise pra que de don de sang réel parmi les infi rmières.

CONCLUSIONLes connaissances et la pra que du don de sang chez les infi rmières du KATH sont limitées. Il est nécessaire de former plus précisément les infi rmières et les autres travailleurs de la santé au don de sang.

MATERIALS AND METHODS

The study was conducted at Komfo Anokye Teaching Hospital. The one thousand fi ve hundred (1500) bed capacity hospital receives referrals from all district and private hospitals in the Ashan region, as well as hospitals from other regions and neighbouring countries.The staff strength of the hospital stands at 3472 and nurses makeup about 36.5% of the total staff popula on. A cross-sec onal study was conducted. Par cipants completed a self-administered ques onnaire to assess their Knowledge, A tude and Prac ce about blood dona on. Stra fi ed sampling method was used to group thenurses. The sample size for the cross sec onal study was calculated using a confi dence level of 95% and margin of error of 7%. The sample size required for the study was 170.11 Nurses including midwives and other specialist nurses who work in the Komfo Anokye Teaching Hospital were recruited for the study a er consent was obtained from the hospital. Only nurses who consented were admi ed to the study. A structured close-ended ques onnaire assessing the knowledge, a tude and prac ce of the nurses was used to collect the data. The ques onnaire was adopted from the Pan American Health Organiza on’s (PAHO) Methodological guidelines for socio-cultural studies on issues related to blood dona on12 and modifi ed to suit the study. This was fi rst pre-tested with twenty (20) nurses to ensure that the ques ons were clear and provided the relevant informa on that was needed to achieve the desired results in the study. The necessary changes and adjustments were made, a er which the fi nal ques onnaire was administered to the nurses who met the inclusion criteria. The ques onnaire also included the demographic data of the par cipants. The data obtained were used for the purposes of this study only. The names of par cipants were not required in the ques onnaire for confi den ality reasons. Ethical clearance was obtained from the ethical review commi ee of Kwame Nkrumah University of Science and Technology and KATH.

10


RESULTS

Data collected were entered into database which was designed usingEpiData 3.1 so ware. StataIC 12 so ware was used in analysing thedata to extract the desired informa ons. The results obtained werealso presented in Tables. Percentages were used for descrip veparameters.

• Demographics of RespondentsA total of 170 nursing staff took part in the study between April 2012 and July 2012. The mean age of the respondents was29.63 (SD: 8.32) years. Females (85.3%) formed majority of the respondents whiles the males (14.7%) formed the minority. Nurses from eight clinical directorates responded to the ques onnaire. The directorates were Accident and Emergency(A & E), Anaesthesia, Dental Eye Ear Nose and Throat (DEENT),Medicine, Obstetrics and Gynaecology (O & G), Child Health,Surgery and Polyclinic. 93.5% of the respondents knew their blood groups whilst 6.5% did not know. For those who knewtheir blood groups, O+ blood group was the highest amongthe par cipants. This was followed by B+ (20.1%), A+ (18.9%),O- (7.6%), AB+ (5%), B- (3%) and A- (0.6%) respec vely. Table 1shows the demographics of par cipants.

• Knowledge of Nurses on Blood Dona onThe greatest chance of dona ng safe blood was thought bythe nurses to be by regular voluntary non-remunerated donors(45.3%), Professional donors (21.2%), Family replacement donors (20%) and Commercial donors (12.9%). Table 2 shows other responses from par cipants on their knowledgeconcerning blood dona on.

• A tude of Nurses towards Blood Dona onA total of 131 nurses gave responses of their opinion on theimportance of blood dona on. The most frequently men onedimportance of blood dona on was, to save lives 114 (87%) insuch condi ons as excessive bleeding in childbirth and trauma,severe anaemia, and other emergencies. Other reasons given for blood dona on were, to get blood test 9 (6.9%), and to replenishone’s blood 7 (5.4%). Other importance also men oned was, to stock the blood bank, and to serve as a surety for the donor. Onerespondent (0.85) did not think blood dona on was important.The responses on incen ves for blood dona on, and the factorsinfl uencing and encouraging peoples’ willingness to donate blood are presented in a table.

• Nurses’ Prac ce on Blood Dona onOf the respondents, only 27.1% have ever donated blood.Moreover, the last me the donors donated blood was 1-3 months (20%), 1-3 years (55.6%), 4-6 years (13.3%), and 8-10 years (11.1%). Thus it can be seen that 1.6% of the respondentsdonate blood regularly, 7.7% occasionally and 19.1% seldomly.Majority of donors (67.4%) were mo vated to donate bloodby blood bank staff , while 28.3% was by friends or rela ves,and 4.4% by radio/television. The reasons given by the donorsfor dona ng blood were to save lives 84.8%, to get a bloodtest 13.0% and for other reasons, 2.2%. Blood was donated by37.2% of the donors in the hospital whilst 58.1% donated duringa mobile collec on. The rest (4.7%) did not state where theydonated blood.

Of the 72.9% who have never donated blood, the reasons given for non-dona on are presented in table 4. Major among them is“ No one has ever asked me to donate ”

DISCUSSION

Studies on the knowledge, a tude and prac ce on blood dona on among nurses are limited. The results from this study showed that all the respondents were poten al donors since their age range (21 - 56 years) was within the range of eligibility for blood dona on. Though the age range varies with each country.13 according to the Na onal Blood Service, Ghana, the minimum age for donors should be 17 years.14 Females dominate their male counterparts in terms of numbers, in the nursing profession.15 However, the male donors were more than the female donors; thus confi rming that males generally donate more than females. 4, 16, 17 Majority of the nurses (93.5%) knew their blood groups and blood group O (Rh) posi ve was the commonest (44.7%) among the blood groups. Some studies have also found blood group O (Rh) posi ve as being the commonest blood group.18

Regular voluntary non- remunerated donors are the most preferred since they are known to be most likely to donate safe blood.19

However, a fi h of our respondents thought other donors like the family replacement donor would rather be preferred. This may suggest why some nurses may prefer to donate for their rela ves when they are in need, rather than donate voluntarily. Generally, the nurses showed good knowledge on the risk factors that can aff ect the safety of blood transfusion as well as the contraindica ons for blood dona on. One’s blood being replenished a er dona on seemed tobe an importance of blood dona on by a very small propor on of the nurses;(5.4%) but a report showed that this was actually one of the major benefi ts of blood dona on.20 Moreover, only one-sixth of nurses could actually state the age range for donors. Again, lessthan half could also give the right minimum body weight for donors and the inter-dona on interval. It can therefore be stated that, the nurses have limited knowledge on blood dona on, though it was expected that their background in health knowledge should have translated into be er knowledge in blood dona on. Several incen ves for voluntary blood dona on have been evaluated in other studies. Issuance of Blood Donor Cer fi cate was seen as the most appropriate incen ve for voluntary dona on in this study. 10.6% of the respondents required money as an appropriate incen ve. However, in most researches majority of respondents do not agree to money as an appropriate incen ve for donors.21 One-tenth of nurses thought an extra day off from work would be an appropriate incen ve. A larger propor on of nurses stated that saving lives wasthe major importance of blood dona on. A study conducted at King Husein Medical Centre, in Jordan also showed a higher percentage of par cipants asser ng to the fact that saving lives was the major importance of blood dona on.22 On the other hand others thought ge ng blood test (6.9%) and replenishing one’s blood (5.4%) was more important. According to the South African Na onal Blood Service,23 ge ng blood test was one of the reasons why people donate blood. However, 0.8% of the nurses thought blood dona on is not important. Furthermore, almost all the nurses were willing to donate blood for someone in case of emergency as well as encourage people to donate blood. A study in India also showed a posi ve a tude towards blood dona on among health science students.9 Ingeneral, it could be stated that the a tude of nurses towards blood dona on was good since a larger percentage of them gave posi veresponses on their a tude towards dona on. Only 27.1% of the nurses have ever donated blood. Studies from some countries found that only a few health workers were donors. 24, 25 This suggests thathealth workers form a small percentage of blood donors in many popula ons. Among those who have donated, majority (48%) have donated blood only once, whilst very few (6.5%) have donated blood up to four mes. Similar result was seen in a community survey in northern Nigeria where 43.4% of the public had donated blood once

11


and 9% have donated four mes.26 It is therefore not a surprise thatonly 1.8% of our nurses donate blood regularly. A study conducted among doctors and paramedics also showed them to be only 3.4% of regular donors.8 However, majority of nurses who donated blood did so for altruis c reasons- which is the most preferred reason fordona ng blood.27 Blood bank staff were a major mo vator for blood dona on, while mobile collec on (58.1%) was, ironically, the place where most nurses donated blood, in contrast to the hospital bloodbank, where only 37.2% of donated blood. This could mean that most nurses actually join the public during mobile collec ons or whilst they were in school, church or other programmes. The main reason for non-donors was ‘no one has ever asked me to donate’ (33.6%).A study conducted by Maqbool et al,4 showed a similar reason whypeople do not donate. Other reasons (19.20%) such as low blood pressure, low body weight, nursing mother, diseases (such as fi broid,skin diseases etc.) were also men oned.

CONCLUSION AND RECOMMENDATIONS

The knowledge on blood dona on among the nurses in KATH islimited. Nurses must not be presumed to have good knowledge of blood dona on, and there is the need to educate nurses and otherhealth professionals on issues specifi cally rela ng to blood dona on.While the a tude of the nurses towards blood dona on appearedposi ve, there was disconnect between a tude and prac ce, as nurses were not frequent blood donors. The posi ve a tude,probably based on clinical experiences, must be worked upon totranslate to actual prac ce. This requires training programmestargeted at nurses and other health workers, and feedback fromsuch programmes could be used to develop be er strategies forrecrui ng and retaining them as regular blood donors.

Table 1: Demographics of Study par cipants

Variable N=170 Percentage (%)Age mean (SD) 29.63 (8.32) years N/AGender

Male 25 14.7Female 145 85.3Marital status

Single 105 61.8Married 65 38.2Knowledge on blood group

Yes 159 93.5No 11 6.5

Table 2: Knowledge of nurses concerning blood dona on

Variable Response (n) Percentage (%)

Benefi t of dona ng blood

One’s blood is replen-ished a er dona on

97 57.1

Low weight and appe te 0 0

None of the above 67 39.4

No response 6 3.5

Age range of blood donors (Years)

18 and above 38 22.4

18-45 35 20.6

13-55 5 2.9

17-60 25 14.7

Don’t know 59 34.7

No Response 8 4.7

Minimum weight of blood donors (Kg)

Less than 50 24 14.1

50-60 77 45.3

61-70 5 2.9

Greater than 70 2 1.2


No Response 8 4.7

Quan ty of blood taken for each dona on

<500ml 117 68.8

650ml 9 5.3

1000ml 8 4.7


Table 3: A tude of nurses on blood dona on

Variable Response (n) Percentage (%)Incen ve for voluntary dona on

Money 18 10.6Extra off day from work 16 9.4Blood donor cer fi cates 108 63.5Nothing 12 7.1Others 14 8.2No response 2 1.2Willingness to donate blood

Yes 153 90No 17 10Encouraging someone to donate

Yes 155 91.2No 14 8.2No response 1 0.6

equent blood donors The posi ve a tude 61-70 5 2 9

12


Table 4: Prac ce of nurses on blood dona on

Variable Response (n) PercentageHistory of Blood Dona on

Yes 46 27.1No 124 72.9Number of blood dona ons

Once 22 48Twice 15 32.6Three mes 6 13Four mes 3 6.5Reason for Dona on

Save lives/ voluntary 39 84.8Get blood test 6 13.0Other 1 2.2Why par cipants do not donate blood

Fear of needles 15 12Not interested 35 28No one has asked 41 33.6Fear of disease transmission 4 3.2Fear of blood tests 3 2.4Others 24 19.2No response 2 1.6

REFERENCES

1. Ministry of Health-Republic of Ghana. Preface. In: Na onal Blood Policyfor the Health Sector. 2006. p. 3.

2. Gillespie, T. W., Hillyer CD. Blood donors and factors impac ng the blooddona on decision. Transfusion Medicine Reviews. 2002;16(2):115-130.

3. Glynn, S.A., Schreiber, G.B., Murphy EL et al. Factors influencingthe decision to donate: racial and ethnic comparisons. Transfusion. 2006;46:980–990.

4. Shahshahani HJ, Yavari MT, A ar M, Ahmadiy MH. Knowledge , a tudeand prac ce study about blood dona on in the urban popula on of Yazd, Iran. Transfusion Medicine. 2006;16:403-409.

5. Olaiya, M.A., Alakija, W., Ajala, A. & Olatunji R. Knowledge, a tudes, beliefs and mo va ons towards blood dona ons among blood donorsin Lagos, Nigeria. Transfusion Medicine. 2004;14:13–17.

6. Vásquez M, Ibarra P MM. Blood dona on: Knowledge and A tudes of aUniversity popula on in Chile. Rev Panam Salud Publica. 2007;22(5):323-8.

7. Maqbool Alam, Mohammad Talha SA. Percep ons About Blood Dona onamong Army Personnel. Pakistan Armed Forces Medical Journal.2006;56(3):311-5.

8. Gilani I, Kayani ZA AM. Knowledge A tude and Prac ces (kap) regarding Blood Dona on prevalent in Medical and Paramedical Personnel. J Coll Physicians Surg Pak. 2007;17(4):473-6.

9. Sabu KM, Remya A, Binu VS VR. Knowledge, A tude and Prac ce on Blood Dona on among Health Science Students in a University campus, South India. Online J Health Allied Scs. 2011;10(2):6.

10. WHO AFRO. Africa Health Workforce Observatory HRH Fact Sheet Ghana. 2006.

11. The Research Advisors. Sample Size Table. h p://research-advisors.com/tools/SampleSize.htm[10/12/2011 3:33:12 PM]. 12-14.

12. Pan American Health Organiza on’s (PAHO). Methodological Guidelines for Socio-cultural Studies on Issues Related to Blood Dona on. 2005. p. 35-65.

13. WHO. World Blood Donor Day: Celebra ng the Gi of Blood. In: h p://www.who.int/worldblooddonorday. 2006. p. 10.

14. Na onal Blood Service-Ghana. The Ghana Club / Pledge 25. www.nbsghana.org.Tuesday, November 29, 2011, 7:07:24 AM.

15. Saillour-Glenisson F, Tricaud S, Mathoulin-Pelissier S, Bouchon , Galperine I, Fialon P and SL. Factors associated with nurses ’ poor knowledge and prac ce of transfusion safety procedures in Aquitaine , France. Interna onal Journal for Quality in Health Care. 2002;14(1):25-32.

16. Sinha K. Only 6% of blood donors are women - Times Of India. h p://www. mesofi ndia.com/.

17. Allain, J.P., Sarkodie, F., Boateng, P., Asenso, K., Kyeremateng, E. & Owusu-Ofori S. A pool of repeat blood donors can be generated with li le expense to the blood centre in sub-Saharan Africa. In: Transfusion. 2008. p. 735–741.

18. Benedict N, Usimenahon A, Alexander NI, Isi A. Knowledge , a tude and prac ce of voluntary blood dona on among physicians in a ter aryhealth facility of a developing country. Interna onal Journal of BloodTransfusion and Immunohematology. 2012;2:4-10.

19. Poel CLVD, Seifried E, Schaasberg WP. Paying for blood dona ons : s ll a risk? Vox Sanguinis. 2002;83:285-293.

20. Evidence suggests that giving blood has health benefi ts, June 27, 2012. www.nbsghana.org/category/featured-ar cles: Content Courtesy: CNN Health [Thursday, August 09, 2012, 5:11:06 PM].

21. Abdel Gader AM, Osman AA, Al Gahtani FH, Farghali MN, Ramadan AHA-MA. A tude to blood dona on in Saudi Arabia. Asian J Transfus Sci. 2011;5(2):121-126.

22. Samar A, Ahmad S, Mansour A, Yahiya AQ MA. Knowledge and A tude About Blood Dona on Among Blood Donors at King Hussein Medicalcenter. Asian J. Exp. Biol. 2012;3(2):435-438.

23. SANBS. Donors. www.sanbs.org.za. [Saturday, August 20, 2011, 12:20:40 PM]. 1-2.

24. Sojka BN SP. The blood dona on experience: self-reported mo ves andobstacles for dona ng blood. Vox Sanguinis. 2008;94:56–3.

25. William AK, Susanne J GW. An academic-based hospital donor site: Do Physicians Donate Blood? Annals of Clinical & Laboratory Science. Annals of Clinical & Laboratory Science. 2009;39:339– 44.

26. Salaudeen AG, Musa OI, Awoyemi AO, Bolarinwa AO, Adegboye AO, Samuel SO. Community survey on blood dona on prac ces in a northern state of Nigeria. Knowledge Crea on Diff usion U liza on. 2011;:21-25.

27. World Health Organisa on. Key global fact and fi gures in June 2011. In: Blood safety. 2011. p. 1-9.

13


Rachel Githiomi,1 Kennedy M. Kuria2

1. Kenya Na onal Blood Transfusion Service (KNBTS)2. Mount Kenya University (MKU)

[email protected] /[email protected]

KEYWORDSWeak RhD an gen, Du Test, Micro tre, An Human Globulin (AHG), Monoclonal an -D

PREVALENCE OF WEAK RhD PHENOTYPE in the blood donor population of Nairobi Regional Blood Transfusion Centre - Kenya

ABSTRACT

BACKGROUNDThe weak RhD phenotype is a form of RhD antigen that, in rou ne RhD typing, does not react by agglu na on with potentmonoclonal an -D serum, but requires addi on of an globulinserum to demonstrate the presence of the an gen. However, theweak D an gen can cause immuniza on or sensi za on when atruly D-nega ve recipient is exposed to it. It is therefore crucial tocorrectly determine the RhD status of units in the blood donor poolof a transfusion service.

STATEMENT OF THE PROBLEMThe prevalence of the weak RhD phenotype is known to varybetween races and countries, and the documented prevalence inone race or country is not applicable to others. The prevalence of the weak Rh-D phenotype has not been well documented in theKenya popula on.

OBJECTIVES The objec ve of the study was to determine the prevalence of theweak RhD an gen in blood donors at the RBTC in Nairobi. The studywas also to explore the weak RhD an gen in rela on to the genderand age of the donors in the popula on.

PRÉVALENCE DU PHÉNOTYPE DIFFÉRENTIEL dans la population de donneurs de sang du Centre Régional de Transfusion du sang de Nairobi - Kenya

RESUME

CONTEXTELe phénotype RhD faible est une forme d’an gène RhD qui, lors du typage RhD habituel, ne réagit pas par agglu na on avec un puissant sérum an -D monoclonal, mais nécessite l’addi on de sérum an globuline pour démontrer la présence de l’an gène. Cependant, l’an gène D faible peut provoquer une immunisa on ou une sensibilisa on lorsqu’un receveur réellement D-néga f y est exposé. Il est donc crucial de déterminer correctement le statut RhD des unités dans le pool de donneurs de sang d’un service de transfusion.

ÉNONCÉ DU PROBLÈMEOn sait que la prévalence du phénotype RhD faible varie selon les races et les pays, et la prévalence documentée dans une race ou un pays n’est pas applicable aux autres. La prévalence du phénotype Rh-D faible n’a pas été bien documentée dans la popula on kenyane.

OBJECTIFSL’objec f de l’étude était de déterminer la prévalence de l’an gène RhD faible chez les donneurs de sang au RBTC à Nairobi. L’étudevisait également à explorer la rela on entre l’an gène RhD faible, le sexe et l’âge des donneurs dans la popula on.

14


INTRODUCTION

The weak RhD phenotype is a variant form of the RhD an gen thatin rou ne RhD typing does not react by agglu na on with potent monoclonal an - RhD serum, but requires addi on of an globulin serum to demonstrate the presence of D an gen. This weak formof RhD an gen was described in 1944 by Wiener and was formallyreferred to as Du an gen.1,2 In 1946 Stra on termed this form of D asa weak expression of the RhD an gen.3 The abnormality on the weakD red cells appears to be a quan ta ve varia on. Weak RhD red cellshave fewer D an gen sites per cell than normal RhD posi ve cells.The number of RhD an gen sites on the Rh (D)-posi ve red blood cellis normally in the range of 9900 to 33000, but the weak D red blood cell has about 110 to 9000 an gen sites.4,5 However, the an gens onthe weak D red cells can cause sensi za on or allo-immuniza onwhen a truly RhD nega ve person is exposed to them. This makesit very crucial to correctly iden fy this weakened form of D an genin the blood donor pool to ensure recipient safety. The frequency of the weak RhD phenotype varies between races, and also dependson the method of determina on.6 The higher the frequency of the Du phenotype in a donor popula on, the higher is the risk of mismatches. The frequency of the weak D phenotype in whites isapproximately 0.3% (3 in 1000).7 It has also been established thatthe frequency of weak D among Blacks is higher than in Whites.7

The purpose of this study was to determine the point prevalence of weak RhD phenotype in donated blood at the Regional BloodTransfusion Centre Nairobi (RBTC Nairobi).


Blood samples from voluntary non- remunerated donors who hadconsented to par cipate in the study were collected in 6mls EthyleneDiamine Tetra-chloral ace c Acid (EDTA) tubes and delivered to theNa onal Blood grouping laboratory. The samples were fi rst typedby a micro tre method Those found to be RhD nega ve were thentyped by tube method to confi rm their D status. Samples confi rmedas RhD nega ve by the two methods were then tested by the indirectan globulin method in a Du test. Posi ve and nega ve controls wereincluded in all tests.

METHODS Donor blood samples were typed by mixing monoclonal an D withred cell saline suspensions in micro tre plates which were thenspun at 2000 rpm for 1 minute. RhD nega ve samples were furthertested by a tube agglu na on method. Samples confi rmed nega veby the two methods were then tested by the indirect an globulintechnique (IAT) in a Du test.

RESULTSOf the 384 donor samples tested, 26 (6.8%) reacted nega vely with an D in the micro tre and tube tests. Eight (30.8% of nega ves,and 2.1 % of total) of the 26 “nega ve” samples reacted posi velyby the IAT or Du test. There was no rela onship between gender orage and weak RhD posi vity.

CONCLUSION AND RECOMMENDATIONThe prevalence of weak RhD was found to be 2.1 % in the donor popula on of the RBTC Nairobi Kenya. The Du test should be appliedto all blood donor samples found to be RhD nega ve in rou neblood typing.

MÉTHODESDes échantillons sanguins de donneurs ont été préparés en mélangeant des suspensions monoclonales anti-D avec des suspensions salines de globules rouges dans des plaques de micro trage qui ont ensuite été centrifugées à 2000 tr / min pendant 1 minute. Les échan llons néga fs de RhD ont été en outre testés par un procédé d’agglu na on par tube. Les échan llons confi rmés négatifs par les deux méthodes ont ensuite été testés par la technique an globuline indirecte (IAT) dans un test Du.

RÉSULTATSSur les 384 échan llons de donneurs testés, 26 (6,8%) étaient néga fs à l’an D dans les tests de micro tra on et de tube. Huit (30,8% des néga fs et 2,1% du total) des 26 échan llons «néga fs» ont réagi posi vement au test IAT ou Du. Il n’y avait aucune rela on entre le sexe ou l’âge et la faible posi vité du RhD.

CONCLUSION ET RECOMMENDATIONLa prévalence du RhD faible était de 2,1% chez les donneurs du RBTC de Nairobi au Kenya. Le test Du doit être appliqué à tous les échan llons de donneurs de sang trouvés RhD néga f dans des analyses de rou ne.

RhD typing

• Micro tre procedure The micro tre plates were labeled appropriately with donor

numbers. One drop of monoclonal an -D was dispensed into all wells, and one drop of a 2% saline suspension of donor cells was added to respec ve wells. The plates were placed in the micro tre centrifuge and spun at 2000rpm for 1 minute. The plates were shaken for 1 minute, and the wells were examinedvisually with aid of magnifying mirror viewers. Samples not showing agglu na on were regarded as RhD nega ve, and later retyped by tube agglu na on method.

• Tube agglu na on procedure Two drops of monoclonal IgG an -D were placed in labeled

tubes. Two drops of donor 5% red cell suspension in saline were added to respec ve tubes. All tubes were spun in a centrifuge at 1000 rpm for 1 minute. Absence of agglu na on was taken as RhD nega ve.

• Du test (IAGT) procedure All tubes showing no agglutination in the tube test were

incubated at 37 OC for 60 minutes and washed in saline 3 mes.The supernatant from the last wash was gently discarded, andthe cell bu on gently mixed. One drop of an -human globulin (AHG) was added and gently mixed. Tubes were centrifuged at 1000rpm for 1 minute, and the contents were examined for haemolysis in the supernatant. The cell deposit was examined macro- and microscopically for agglu na on. Samples showing agglu na on, and or haemolysis were regarded as Du posi ve .

RESULTS

Of the 384 blood donor samples grouped using monoclonal an - D reagents 358 agglu nated directly with the an -D in the ini al micro-titre typing. When the 26 samples which did not react directly with an - D in the fi rst test were retyped using the tube method, there was no agglu na on in any of the samples. When an indirect an human globulin test (the Du test) was performed on these samples, 8 of the 26 tubes showed agglu na on. (Tables 1 and 2, and Figure 1).

15


Table 1: RhD an gen typing results (micro- tre plate method)

Frequency Percent(%)

Cumula ve Percent

RhD an genPosi ve 358 93.23 93.23RhD an genNega ve 26 6.80 100.00

Total 384 100.00 -

Table 2: RhD an gen typing results (IAT/ DU Test)

Frequency Percent Cumula vePercent

RhD an gen Nega ve 18 69.2 69.2Weak RhD an gen Posi ve 8 30.8 100.0

Total 26 100.0 -

Figure 1:g Weak RhD An gen Prevalence

When the Du posi ve donors were segregated by gender, there wasno signifi cant diff erence in prevalence between males and females.(Table 3 and Figure 2)

Table 3: Weak RhD an gen Posi ve in rela on to gender

Gender Frequency Percent Cumula ve Percent

Male 4 50 50

Female 4 50 100

Total 8 100 -

Figure 2:g Weak RhD in rela on to gender

When the weak D posi ve donors were segregated by age no correla on was found between age and Du status (Table 4 and Figure 3)

Figure 3:g Weak RhD an gen Posi ve in rela on to Age

Table 4: Correla on between Age and Weak RhD an gen

Weak RhD an gen

Age of Blood donor

Weak RhD an gen

Pearson Correla on (a) (a)

Sig. (2-tailed)N 8 8

Age of Blood donor

Pearson Correla on (a) 1

Sig. (2-tailed)N 8 8

a Cannot be computed because the weak RhD an gen is a constant variable.

DISCUSSION

Extensive analysis has been done on Rh an gens, and presently, over 200 variants have been described.8,9 Many of these may not be serologically dis nguishable, and may require molecular analysis.10 Many may also not be clinically important The D is the most immunogenic of the Rh an gens. It has been es mated that 20-30 % of RhD nega ve persons who receive signifi cant volumesof RhD posi ve red cells make an -D.11,12 Transfusion of red cellsbearing the weak D , which is a variant of the RhD an gen, may pose a risk of sensi za on or allo-immuniza on in RhD nega ve recipients. Haemoly c disease of the newborn and of the fetus can also occur in pregnant RhD nega ve women carrying weak RhD posi ve babies.13 Prevalence of weak RhD phenotype is known tovary between races,6 and the documented prevalence in one race or country may not be applicable to others.In general it has been observed that Blacks have higher prevalence of weak RhD than Whites.7 While the prevalence of weak RhD phenotype has not been well documented in the Kenyan popula on, our study has revealed a prevalence of 2.1% for weak RhD phenotype in the Nairobi donor popula on. This fi gure is much lower than the 6.4% found in Ghana.14 It is however higher than the 0.2-1%quoted for Caucasians,7 as well as the 0.01%for Indians15 and the 0.14% for Albanians.16

Age of Blood donor

Perc

ent

16


CONCLUSION AND RECOMMENDATION

The prevalence of weak RhD phenotype was found to be 2.1% in the donor popula on at the Regional Blood Transfusion Centre in Nairobi Kenya. It is recommended that all blood samples found to be Rh nega ve on rou ne saline grouping should be retyped in a Du

test to avoid RhD mismatches. It is also recommended that similarstudies to ours be carried out in other centres in Kenya to establish a na onal prevalence for Kenya, and in other parts of Africa to confi rmthe higher prevalence of weak RhD phenotype in Blacks.

ACKNOWLEDGMENTS

I would like to thank Mount Kenya University for the role of mentorship, Kenya Na onal Blood Transfusion Service & RegionalBlood Transfusion Centre Nairobi, for allowing me to conduct the research in their facilities. Dr.Margaret Oduor, Director KenyaNa onal Blood Transfusion Service, Mr. D Macharia, Ms C.Yego, Mr.Abdi Nassir, and Ms B Rukenya for the permission and support theyoff ered me during the research period. I thank Prof. J.O. Adewuyifor help in the write up of this ar cle, and fi nally, my family for theircon nued unwavering support all the me.

REFERENCES

1. Agre PC, Davies DM, Issi PD, Lamy BM et al. Aproposal to standardize terminology for weak D an gen Transfusion 1992; 32(1):86-7

2. Storry JR, Tani Y, Yu LC, et al. Interna onal Society of Blood Transfusion working party on red cell immunogene cs and blood group terminology: Berlin report Vox Sanguinis 2011;101:77-82.

3. Daniels G. The molecular gene cs of blood group polymorphisms. Transplant immunology 2005; 14:143-153.

4. Wagner FF et al Molecular basis of weak D phenotypes Blood 1999; 93 (1) :385-395.

5. Flegel WA, and Wagner FF. Molecular biology of par al D, and weak D: Implica ons for blood bank prac ce Clin Lab 2002; 48 (1-2):53-9.

6. Denomme GA, Wagner FF, Fernades BJ, et al. Par al D, weak D types and novel RHD alleles among 33,864 mul -ethnic pa ents: implica ons for an -D alloimmunisa on, and preven on. Transfusion 2005; 45(10):1554-60.

7. Daniels G and Reid ME. Blood groups: the past 50 years. Transfusion 2010; 50(2):281-9

8. Sco ML The complexity of the Rh system. Blood Transfusion 2004; 87(1):58-62

9. Wagner FF,Frohmajer A, Landewig B,Eicher NI, et al. Weak D alleles express dis nct phenotype. Blood 2000 April 15, 95(8):2699-708

10. Connie WM. Rh complexi es: serology and DNA typing. Transfusion 2007; 47:17s-22s

11. Flegel WA. Molecular genetics of RH and its clinical application. Transfusion: Clin Biol: 2006; 13(1-2): 4-12

12. Daniels G. Variants of RhD; current tes ng and clinical consequences. Bri sh Journal of Haematology 2013; 161: 461-470

13. Daniels G. Human blood groups 2002, 2nd edn, Blackwell Sci Ltd, Oxford14. Opoku-Okrah C, Amidu N,Amoah-Sakyi. Detection of weak D (Du)

phenotype among RhD nega ve males and females in Kumasi GhanaJournal of Science and Technology 28 (3) 203-7

15. Makroo R, Vimarsh R, Mohit C, Bha a A, Gupta R and Rosamma N. Weak D prevalence among the Indian blood donors. Asian J of Transfusion Science 2010; 4(2): 137-39

16. Xhetani MM and Seferi I et al. Distribu on of Rh blood group an gens, and weak D alleles in the popula on of Albania. Blood Transfusion 2014; 12(4):565-69

17


ABSTRACT

BACKGROUNDKnowledge of RH variants in African populations is critical toimproving transfusion safety in countries with popula ons of Africanancestry and to providing valuable informa on and direc on forfuture development of transfusion in Africa. The purpose of thisreport is to describe RH diversity in individuals from Mali.

STUDY DESIGN AND METHODSBlood samples collected from 147 individuals self-iden fi ed asDogon and Fulani were analyzed for Rh an gens and alleles.

RESULTSThe most common RHD allele variant was RHD*DAU0. Five predicted par al-D phenotypes were a ributed to RHD*DAU3 or RHD*DIVa. Neither RHD*DAR nor RHD*DIIIa was found. Investigation of RHCE revealed three predicted partial-e antigens encoded byRHCE*ce(254G) in trans to RHCE*cE. Regarding C an gen, 28 Fulanityped as C1 and 16 of 28 harbored at least one RHCE*Ce-D(4)-ce,

two being homozygous and predicted to show a rare RH:32,246 phenotype. A new RHCE*ceTI with replacement of Exon 2 by RHD(RHCE*ceTI(D2)) was iden fi ed in Dogon and was iden fi ed byinheritance study to be in cis to RHD*DIVa. These samples typed C– with an -C polyclonal an body and monoclonal an bodies (MoAbs) MS24, P3X25513681MS24, and MS273, but posi ve with an -RhCe MoAb-BS58. The same pa ern was observed in sample with RHD*DIVa/RHCE*ceTI.

CONCLUSIONOur survey indicated an uneven distribution of RH variant alleles between Dogon and Fulani, sugges ng that study in well-documented cohorts is warranted. A high incidence of predicted par al-C phenotype encoded by RHCE*Ce-D(4)-ce was found in Fulani. Further study will also be needed to clarify the clinical signifi cance of the new DIVa/ceTI(D2) haplotype encoding par al D and variant ce an gens.

RH DIVERSITY IN MALI: Characterization of a new haplotype RHD*DIVa/RHCE*ceTI(D2)

(Reprinted with permission from ‘Transfusion’, Vol 55, June 2015)

Alhassane Ba,1,3 Sophie Beley,2,3 Jacques Chiaroni,2,3 Pascal Bailly,2,3 and Monique Silvy2,3

1 Centre Na onal de Transfusion Sanguine (CNTS), Bamako, Mali2 Etablissement Français du Sang Alpes Méditerranée3 UMR 7268 ADÉS, Aix-Marseille Université- EFS-CNRS, Marseille, France.

CORRESPONDENCEMonique Silvy, PhD Laboratoire d’Hématologie Moléculaire, EFS Alpes Méditerranée, 207Boulevard Sainte Marguerite, 13009, Marseille, FranceEmail: [email protected]

ABBREVIATIONSSCD = sickle cell disease;SNP(s) = single-nucleo de polymorphism(s).

Disclosure: The authors have disclosed no confl icts of interest.

ACKNOWLEDGMENTSWe acknowledge the contributions of Thomas Granier for his technical assistance and Elisabeth Durieux-Roussel for her contribu on in serologic tes ng. We also thank Andrew Corsini for proofreading the manuscript.

18


The RH blood group is one of the most polymorphic and immuno-genic blood group systems. An bodies directed against Rh an genshave been implicated in hemoly c disease of the fetus and newborn,hemolytic transfusion reactions, and autoimmune hemolyticanemia. Rh an gens are encoded by the homologous RHD and RHCEgenes that share 93.8% homology over all introns and coding exons.These two genes consist of 10 exons each and are closely linked inopposite orienta on on chromosome 1p36.11.1

The complexity of the RH blood group is related to the high diversityof Rh an gens (n 5 54) and RH variant alleles.2 RH alleles originatefrom a variety of molecular mechanisms including single-nucleo depolymorphism (SNP), genetic conversion, crossing over, andinser on- dele on. Most RH allele variants have been encounteredin people of African ancestry. Some variants such as RHD*DAU3, RHCE*ceTI, and RHCE*Ce-D(4)-ce (also known as RHCE*CeRN)encode proteins considered as par al due to their associa on withan body produc on.3-5 Other variants are referred to as weak sinceno immuniza on has been described. Interlinkage between RHDand RHCE can lead to phenotypes with both par al D and c and/orEe an gens as observed for RHD*DIIIa/RHCE*ce(1025T),4 RHD*DIVa/RHCE*ceTI,4 and RHD*DOL/RHCE*ceBI haplotype.6

Amino acid changes encoded by DNA polymorphisms can induce expression of low-prevalence an gens or lack of expression of high-prevalence an gens. Accordingly, Rh proteins encoded by RHD*DIIIa, RHD*DOL, or RHCE*Ce-D(4)-ce express the low-prevalence RH:54an gen that is presumed to be of clinical signifi cance.2 Several rare phenotypes have been observed. RH:218 is encountered inindividuals who are apparent homozygous for RHD*DAR in cis toRHCE*ceAR or *ceEK (or compounds heterozygous). RH:234 has been linked to homozygosity for the (C)ceS Type 1, (C)ceS Type 2, or RHD*DIIIa/RHCE*- ce(733G,1006T) haplotypes. RH:46 islacking in individuals who are homozygous for RHCE*Ce-D(4)-ceallele.7-9 Produc on of an -RH18, an -RH34, or an -RH46 can beclinically signifi cant requiring special precau ons for pregnancy andtransfusion, for example, use of equivalent rare an gen-nega vered blood cells (RBCs).7

In a recent editorial in TRANSFUSION, it was suggested tes ng of large cohorts of selected ethnic groups to assess allele and phenotype prevalence is essen al to allow future evidence-based decisions10 to op mize transfusion safety, especially for sickle cell disease (SCD) pa ents who undergo chronic transfusions. The purpose of this report is to describe gene c diversity observed bysequencing RHD and RHCE alleles in a random survey of individuals Efrom two ethnic groups in Mali.


Serologic studyEthylenediaminetetraacetate (EDTA) blood samples were collected from 147 individuals self-iden fi ed as Dogon (n 5 101) and Fulani (n = 46) in Region V of Mali (Mop ; Fig. 1). Par cipants provided wri en informed consent. Study and consent protocols were approved by the Comité d’Ethique Ins tu onnel de la Faculté de Médecine, de Pharmacie et d’Odontostomatologie in Mali.

All blood samples were phenotyped for D, C, E, c, and e an gens using the gel column agglutination method (Ortho Clinical Diagnostics, Illkirch, France) with the following monoclonal antibodies (MoAbs): D7B8 for anti-D, MS24 for anti-C, C2 for anti-E, MS42 for anti-c, and MS16 + MS21 + MS63 for anti-e. Addi onal tes ng for C expression was performed on one sample with RHD*DIVa/ RHCE*ceTI(D2) haplotype and samples with theRHD*DIVa/ RHCE*ceTI haplotype. Direct agglu na on test (DAT) in gel matrix, test tube, and microplate was performed using an - C MoAbs MS24 (Ortho Clinical Diagnos cs), MS273 (Eurobio, Courtaboeuf, France), P3X2551368+MS24 (Diagast, Loos, France), respec vely. Indirect an globulin tests (IATs) were performed with an -Ce MoAb BS58.11

Sequencing of RHD and RHCEGenomic DNA was isolated from 200 μl of whole blood using a blood DNA mini-kit (QIAmp, Qiagen, Courtaboeuf, France) according to the manufacturer’s instruc ons. Polymerase chain reac on (PCR) assay was performed on the 10 exons of the RHD and RHCE genes Eas previously described.12 Briefl y, amplifi ca on was performed with 100 ng of genomic DNA in a fi nal volume of 50 μL containing PCR buff er, 2 mmol/L MgCl2, 80 ng/μL bovine serum albumin, 0.2 mmol/Lof each dNTP, 0.05 unit of Taq DNA polymerase, and 200 nmol/L of each primer. Touchdown PCR included a 5 minute denatura on step at 94 oC followed by amplifi ca on cycles consis ng of 30 seconds at 94 oC, 30 seconds at the annealing temperature, and 1minute at 72 oC. Hybridiza on temperature was lowered 1 oC every2 cycles from 66 to 61 oC and then a 30-cycle annealing step was performed at 60 oC. Determina on of the presence or absence of each exon of RHD and RHCE genes was performed on 2% agarose gel and visualized using DNA stain (Sight, Euromedex, Strasbourg, France). PCR products were sequenced using the Sanger technique (GATC Biotech, Konstanz, Germany). Sequence alignment to iden fy polymorphisms was performed using computer so ware (SeqMan Pro, DNASTAR, Inc., Madison, WI). The presence of the RHCE*Ce-D(4)-ce allele was confi rmed by allelic discrimina on using probes (TaqMan, Life Technologies, Carlsbad, CA) as previously described.5

Allele frequencies were determined by coun ng. Since no RHDzygosity determina on was performed, results were based on equencing data. We assumed that any sample with heterozygouspolymorphism (SNP or STR in coding or noncoding sequence) was dizygous. When no informa on on zygosity was available (apparent homozygous), RHD allele frequency was calculatedin the two extreme conditions (hemizygous and dizygous).

Figure 1: g Geographic localiza on of Mali. The eight administra ve regions (I to VIII) and Bamako district

are shown. Dogon and Fulani were from Region V (Mop ).

19


Any polymorphism compared to conventional sequence wasconsidered as defi ning a variant allele independently of clinicalrelevance (Table 2). Par al predicted c and e phenotypes were deduced from published data showing an -e alloimmuniza on ine+ pa ent or an -c in c+ pa ent.

RESULTS

D and CE phenotypesA total of 147 blood samples collected from two ethnic groups(Dogon and Fulani) in Mali were phenotyped for D, C, E, c, and e an gens. Analysis of phenotype frequency in the overall cohortindicated a typical African profi le with a predominance of D+C-c+E-e+(52.4%) and D+C+c+E-e+ (23.8%; Table 1). Comparison of Dogon and Fulani demonstrated a number of diff erences. The D+C+c-E-e+phenotype was absent in Dogon and frequent in Fulani (10.9%)while the D+C-c+E+e+ phenotype was uncommon in Fulani (2.2%)but frequent in Dogon (16.8%).

RHD allele variantsEight samples, that is, six Dogon and two Fulani, were typed asD-. This phenotype was linked to homozygous RHD dele on infour Dogon and one Fulani or the presence of RHD pseudogene (RHD*DPsi) and/or (C)ceS Type 1 haplotype. One Fulani was homo-or hemizygous for RHD*DPsi. One Dogon had (C)ceS Type 1 in trans to RHD dele on and another was heterozygous for RHD*DPsi and(C)ceS Type 1.

No variant RHD allele was observed in 35 Dogon and 34 Fulani. Inthe remaining 78 samples, a variety of variant alleles were found(Table 2). The most common RHD allele variant was RHD*DAU0with a frequency of 0.217 to 0.247 in Dogon and 0.076 in Fulani.The RHD*DAU0.1 allele was iden fi ed in six Dogon. Four RHD alleles encoding D par al phenotype were found with the most frequentbeing RHD*DIVa in Dogon (frequency, 0.029) and RHD*DAU3in Fulani (frequency, 0.043). Four samples with RHD*DIVa or RHD*DAU3 allele homo- or hemizygous (or in trans to silent allele) were predicted to express a par al D phenotypes, that is, three inDogon (2.9%) and one in Fulani (2.2%). All samples with predicted par al D phenotypes were typed D1 by hemagglu na on.

RHCE allele variantsA total of 11 RHCE*ce variant alleles and one RHCE*Ce variant allelewere iden fi ed in this popula on study. In addi on, two samples carried a RHCE*cE allele with 48G>C transversion. The most frequent RHCE*ce variant allele was RHCE*ce(48C) with a frequency of 0.227 in Dogon and 0.152 in Fulani. Four alleles encoding par al e an gen, that is, RHCE*ce(48C,254G), RHCE*ce(254G), RHCE*- ceMO, and RHCE*ceTI, were iden fi ed. The most frequent allele encoding par al e an gen was RHCE*ce(254G), occurred in 20 Dogon and 11Fulani. One Dogon sample exhibited RHCE*ceTI characterized by a 48G>C and 1025C>T transi ons and fi ve Dogon samples exhibited a new allele (see below). Altogether, three samples were predicted to be par al for e an gen.

Twenty-eight of the 47 Fulani in this cohort were typed as C1 including 16 bearing at least one RHCE*Ce- D(4)-ce allele. Two ampleswere predicted to exhibit a rare RH:32,246 phenotype featuring a RHCE*Ce-D(4)-ce allele in homozygous state. Altogether, fi ve Dogon and 15 Fulani exhibited a predicted par al C phenotype based on the presence of either (C)ceS Type 1 haplotype in Dogon or RHCE*Ce-D(4)-ce in Fulani.

Comparison of phenotype and genotype revealed that three out of fi ve samples with the new allele as well as two samples with RHCE*Ce-D(4)-ce allele were C-. No other discrepancies were observed.

New RHCE*ceTI(D2) alleleSequencing of genomic DNA revealed a new RHCE allele in fi ve EDogon. This allele displayed 48C, 150T, 178A, 201G, 203G, 307T (Table 3), and 1025T. The 48C and 1025T SNPs are characteris c of the RHCE*ceTI allele. The remaining are common to Exon 2 of the RHD gene and RHCE*C allele. Since the new allele did not exhibitCthe 109-bp inser on characteris c feature of the RHCE*C allele C(data not shown), we assume that the new allele was a RHCE*cevariant with Exon 2 being replaced by its RHD counterpart. The presence of heterozygous SNPs in exons and introns ascertains the amplifi ca on of two alleles for RHCE Exons 1 to 3. Two samplesE(Table 3, Samples 1 and 5) showed 186T in Exon 2 of RHD because of RHD*DIVa in trans to RHD*DIIIa-CE(3-7)-D. Therefore the Exon 2 with 150T, 178A, 201G, 203G, and 307T amplifi ed during RHCE analysisEis not carried by RHD locus. Altogether, DNA sequencing showedthat the new RHCE allele was a RHCE*ce-D(2)-ce hybrid allele with 48C and 1025T, which is therea er referred to as RHCE*ceTI(D2).

TableTT 1: Rh phenotypes in Dogon and Fulani

Dogon (n = 101) Fulani (n = 46) Total (n = 147)Rh phenotype Number Frequency (%) Number Frequency (%) Number Frequency (%) Frequency in Africa2 (%)

D+C-c+E-e+ 61 60.4 16 34.8 77 52.4 45.8

D+C+c+E-e+ 14* 13.9 21 45.7 35 23.8 21.0

D+C-c+E+e+ 17 16.8 1 2.2 18 12.2 18.6D-C-c+E-e+ 4 4.0 2 4.3 6 4.1 6.8

D+C+c+E+e+ 3* 3.0 1 2.2 4 2.7 4.0D+C+c-E-e+ 0 0 5 10.9 5 3.4 2.0

D+C-c+E+e- 0 0 0 0 0 0.7 0.2D-C+c+E-e+ 2* 2.0 0 0 2 1.4 RareD-C-c+E+e+ 0 0 0 0 0 0 Rare

* C+ phenotype was due to (C)ceS TypeTT 1 haplotype in two samples with D+C+c+E-e+ phenotype, one sample with D+C+c+E+e+phenotype, and two samples with D-C+c+E-e+ phenotype.

20

December 2016, Volume 18, no. 2Africa SanguineTa

ble

TT2:

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21


Study of intron sequence also revealed that, like RHCE*ceTI, this allele also bore three polymorphisms in Introns 2 and 6, that is,IVS2-91a>g, IVS2-32C>T, and IVS6 1 52C>T.

To support the molecular basis of the new allele, an inheritance testwas carried out to study transmission in two families. As shown inFigure 2, the RHCE*ceTI(D2) allele is in cis to the RHD*DIVa allele and the haplotype RHD*DIVa/RHCE*ceTI(D2) was integrally transmi ed.

Based on the nucleo de sequence observed in coding regions,samples bearing RHCE*ceTI(D2) might express all or part of C antigen. Thus, hemagglutination to detect C expression wasperformed in one sample bearing RHD*DIVa/RHCE*ceTI(D2)

and in samples with RHD*DIVa/RHCE*ceTI. In all cases, DAT in gel matrix, tube, and microplate using an -C MoAbs MS24, MS273, and P3X2551368+MS24, respec vely consistently showed a C- phenotype (Table 4). As previously reported,11 MoAb BS58 showed no reac vity on C-c+E+e- sample, a weak reac vity on C-c+E-e+ sample, and a strong one on C+c-E-e+ sample. IAT with an -Ce MoAb BS58 showed reac vity similar to that observed in the C+c-E-e+ control sample and sample with RHD*DIVa/RHCE*ceTI haplotype (Fig. S1, available as suppor ng informa on in the online versionof this paper). Unfortunately, because of paucity of blood sample neither RNA analysis nor further serologic inves ga ons using a larger an -C panel were achieved.

Table 3: Relevant nucleo de polymorphisms in samples with RHD*DIVa/RHCE*ceTI(D2) haplotype*

RHD RHCE

Sample Genotype Intron1/Exon 2 Exon 1 Intron 1/Exon 2 Intron 2/Exon 31 DIVa ceTI(D2) IVS1-485g/a 48C IVS1-204c/t IVS2-91a/g

(C)ceS Type 1 IVS-376g IVS1-29g/c IVS2-32c/t186T IVS1-20a/g

150C/T178C/A201A/G203A/G307C/T

2 DIVa ceTI(D2) IVS1-376a/g 48G/C IVS1-204c/t IVS2-91a/gWeak D Type 4.0 ce IVS-29c IVS1-20a/g IVS2-32c/t

186G/T 150C/T178C/A201A/G203A/G307C/T

3 DIVa ceTI(D2) IVS1-376a/g 48G/C IVS1-204c/t IVS2-91a/gDAU0.1 ce(254G) 186G/T IVS1-20a/g IVS2-32c/t

150C/T178C/A201A/G203A/G254C/G307C/T

4 DIVa ceTI(D2) IVS1-766g/a 48C IVS1-204c/t IVS2-91a/gDAU0 ce(48C) IVS1-376a/g IVS1-20a/g IVS2-32c/t

186G/T 150C/T178C/A201A/G203A/G307C/T

5 DIVa ceTI(D2) IVS1-485g/a 48C IVS1-204c/t IVS2-91a/g(C)ceS Type 1 IVS1-376a/g IVS1-20a/g IVS2-32c/t

IVS1-29c 150C/T186T 178C/A

201A/G203A/G307C/T

* Heterozygous SNPs are in italics.

22


DISCUSSION

An bodies against Rh an gens have been implicatedin transfusion reac ons and hemoly c disease of thefetus and newborn. The high incidence of variantRHD or RHCE alleles in African black persons has beendeduced from clinical experience and screening forcertain variant RH alleles.12-17 However, data on largecohorts of selected ethnic groups are lacking. Only onestudy inves ga ng RHD variants has been performedin Mali in blood donors.13 The purpose of this report isto describe a comprehensive study of RHD and RHCEvariants in Dogon and Fulani in Mali. This approach wasused because Mali is a mul ethnic country and some RH variants repeatedly occur in a single ethnic group.8

Phenotyping demonstrated a profi le comparable tothose reported previously in African populations.2

However, a number of frequency differences wereobserved between the two ethnic groups. Ethnicdiff erences have already been noted in Nigeria.18,19

Figure 2:g Inheritance study of RHD*DIVa/RHCE*ceTI(D2) haplotypein two families

Table 4: DAT characterization of DIVa/ceTI(D2)and comparison with DIVa/ceTITT

Reac vityTechnique An -C clone RHD*DIVa/

RHCE*ceTI(D2)RHD*DIVa/RHCE*ceTI

Tube MS273 - -Plate P3X2551368 + MS24 - -Gel matrix MS24 - -

BS58* + +

* Reac vi es using an -Ce MoAb BS58 are shown in Fig. S1(available as suppor ng informa on in the online version of this paper).

Results of RH genotyping were roughly similar to those of previousdata.12,16,17,20 The most common RHD alleles were belonging tothe usual three African D clusters, that is, DAU, DIVa, and weak DType 4.21 As expected, alleles from the DAU cluster were the most frequent12,22 and three out of fi ve par al predicted D phenotypeswere related to the RHD*DAU3 allele. This supports the sugges onof Wagner and colleagues3 that DAU cluster is a major source of Dvariability and an -D immuniza on in pa ents of African ancestry.The frequency of the RHD*DAU0.1 allele was 0.029 to 0.039 in Dogon compared to 0.017 in blood donors from Mali.13 Thefrequency of RHCE alleles was broadly similar to previous reportsEwith a high frequency of RHCE*ce(48C).12,20,23 However, frequenciesof RHCE*ceMO and RHCE*ceTI were lower than that reported byGranier and coworkers12 who inves gated 220 African samples from six ethnic groups. The most likely explana on for this discrepancy iscohort size. Our data showed that the frequency of RHCE*ce(254G)was around 10% in both ethnic groups and that it accounted for allthe par al predicted e phenotypes (3/3); lower frequencies (around5%) were noted in SCD pa ents.16,17

Neither RHD*DIIIa allele nor RHD*DAR/RHCE*ceAR/*ceEKhaplotype was detected in this study. This fi nding was surprisingsince the frequency of these alleles and haplotypes ranged from3% to 5% in other studies12,15 and indicated that African popula ons may be more heterogeneous than previously suggested.12

The frequency of the RHD*DIVa allele (today considered to be the same allele as RHD*DIVa.224) in Dogon was 3%. This is interes ng since this allele was absent in samples from Congo-Brazzaville and Kenya whereas it showed a frequency of approximately 10% in two West African ethnic groups (Mandenkas and Yorubas).12

This observa on supports the no on that the RHD*DIVa allele is specifi c to or at least morefrequent in West Africa. The geographic origin of inves gated samples could at least par ally explain the wide range of RHD*DIVa frequenciespreviously reported which were 0.018 and 0.019 in French blood donors from African origin andSCD from France, respec vely compared to 0.009 in both sub-Saharan Africa and SCD from the United States.12,16,17,20

Several diff erences were observed between Dogon and Fulani. The frequency of RHD*DAU0 was 0.217 to 0.247 in Dogon compared to 0.076 in Fulani. The RHCE*Ce-D(4)-ce allele was found exclusivelyin Fulani with a high frequency (0.195). Moreover, two of 46 samples were homozygous for this allele leading to the predicted RH:246 phenotype.10 Surprisingly, two samples with RHCE*Ce-D(4)-ce in trans to RHCE*ce and RHCE*-ce(254G), respec vely,were typed C- with MS24 an -C which reacts usually 31 in Ortho column agglu na on technique. Unfortunately, no blood sample compa ble with immunohematologic tests was available to confi rm the typing a er molecular inves ga ons. The fi nding that 53.6% of C1 Fulani had a par al predicted C phenotype supports systema c search for RHCE*Ce-D(4)-ce allele in this popula on especially inhos ng countries. This is also supported by the fi nding that 7.3%of C1 SCD pa ents from unknown ethnic group harbored RHCE*Ce-D(4)-ce.5

Another approach would be to consider all C1 pa ents from African ancestry as poten ally being par al C and straightaway transfuse them with C-RBC units. However, such an approach would requirethe use of already scarce resources since most donors are from Caucasian ethnicity and only 32% are C-.

23


This study also iden fi ed the new RHCE*ceTI(D2) allele characterized by seven SNPs in Dogon. An inheritance study showed thattransmission of this new allele was part of a haplotype withRHD*DIVa. Two of the polymorphisms, that is, 48G>C and 1025C>T,were in common with the RHCE*ceTI allele that encodes a par al e phenotype.4 Since these alleles shared three intronic SNPs, that is, IVS2-91a>g, IVS2-32C>T, and IVS6 1 52C>T, it seems reasonableto think that they have the same origin. It is likely that the newallele arose from a rearrangement between RHCE*ceTI and RHD. Based on the nucleo de sequence observed in coding regions aswell as on previously published data showing that the expressionof C an gen is related to the exofacial serine 103 resul ng from the 307C>T transi on,25,26 it can be thought that samples bearing RHCE*ceTI(D2) express all or part of C-an gen. Surprisingly, fi ve of the seven samples bearing RHCE*ceTI(D2), that is, fi ve fromthe Dogon popula on in this study plus the two from childrenincluded in the inheritance study, typed C- with MoAb MS24 whilethe two remaining carried (C)ceS Type 1 in trans to RHCE*ceTI(D2). In the light of fi ndings showing that RHD*DIVa expresses weak,variable, and unstable posi ve RBC reac ons with some an -C,4

addi onal immunohematologic tests were carried out on samples with either RHD*DIVa/RHCE*ceTI(D2) or RHD*DIVa/ RHCE*ceTIhaplotypes. Since an -C yielded similar results on both samples, itwas not possible to demonstrate specifi c C reac vity encoded byRHCE*ceTI(D2) allele. Use of a larger an -C panel will be needed to clearly determine the C profi le associated with this allele. SinceRHCE*ceTI was shown to encode partial phenotypes for bothan gens,4 study of par al c and e an gen expression encoded by RHCE*ceTI(D2) would also have been useful but c and e inves ga onwas rendered impossible because RHCE*ceTI(D2) was in trans to the RHCE*ce allele in all samples.

Taken together, our results revealed an uneven distribu on of someRH variant alleles in Mali Africa, sugges ng the need for furtherstudy in well-documented cohorts. A wider study in donors of African descent will also be required to determine the frequency of the new haplotype RHD*DIVa/RHCE*ceTI(D2) associa ng an alleleencoding par al D, variant ce an gens, and aberrant reac vity withan -C and to evaluate its poten al impact on transfusion strategy.

REFERENCES

1. Flegel WA. Molecular gene cs and clinical applica ons for RH.Transfus Apher Sci 2011;44:81-91.

2. Reid ME, Lomas-Francis C, Olsson ML. The blood group an gensFactsBook. 3rd ed. San Diego: Academic Press; 2012.

3. Wagner FF, Ladewig B, Angert KS, et al. The DAU allele clusterof the RHD gene. Blood 2002;100:306-11.

4. Westhoff CM, Vege S, Halter Hipsky C, et al. RHCE*ceTI encodes par al c and par al e and is o en in cis to RHD*DIVa. Transfusion2013;53:741-6.

5. Tournamille C, Meunier-Costes N, Costes B, et al. Par al C an genin sickle cell disease pa ents: clinical relevance and preven on of alloimmuniza on. Transfusion 2010;50:13-19.

6. Roussel M, Poupel S, Nataf J, et al. RHD*DOL1 and RHD*DOL2 encode a par al D an gen and are in cis with the rare RHCE*ceBIallele in people of African descent. Transfusion 2013;53:363-72.

7. Noizat-Pirenne F, Lee K, Le Pennec PY, et al. Rare RHCEphenotypes in black individuals of Afro-Caribbean origin:iden fi ca on and transfusion safety. Blood 2002;100:4223-31.

8. Le Pennec PY, Rouger P, Klein MT, et al. A serologic study of red cells and sera from 18 Rh:32,-46 (RN/RN) persons. Transfusion 1989;29:798-802.

9. Pham BN, Peyrard T, Juszczak G, et al. Heterogeneous molecularbackground of the weak C, VS1, hr(B)-, Hr(B)- phenotype in black persons. Transfusion 2009;49:495-504.

10. Nance ST, Lomas-Francis C. Where are we in eff orts to unravel the complexity of Rh to guide transfusion decisions? Transfusion 2013;53 (11 Suppl 2):2840-3.

11. Sonneborn HH, Ernst M, Tills D, et al. Comparison of the reac ons of the Rh-related murine monoclonal an bodies BS58 and R6A. Vox Sang 1990;58:219-23.

12. Granier T, Beley S, Chiaroni J, et al. A comprehensive survey of both RHD and RHCE allele frequencies in sub-Saharan Africa.Transfusion 2013;53(11 Suppl 2):3009-17.

13. Wagner FF, Moulds JM, Tounkara A, et al. RHD allele distribu on in Africans of Mali. BMC Genet 2003;4:14.

14. Grootkerk-Tax MG, van Wintershoven JD, Ligthart PC, et al. RHD(T201R, F223V) cluster analysis in fi ve diff erent ethnic groups and serologic characterization of a new Ethiopian variant DARE, the DIII type 6, and the RHD(F223V). Transfusion 2006;46:606-15.

15. Hemker MB, Ligthart PC, Berger L, et al. DAR, a new RhD variant involving exons 4, 5, and 7, o en in linkage with ceAR, a new Rhce variant frequently found in African blacks. Blood 1999;94:4337-42.

16. Chou ST, Jackson T, Vege S, et al. High prevalence of red blood cell alloimmuniza on in sickle cell disease despite transfusion from Rh-matched minority donors. Blood 2013; 122:1062-71.

17. ilvy M, Tournamille C, Babinet J, et al. Red blood cellimmuniza on in sickle cell disease: evidence of a large responder group and a low rate of an -Rh linked to par al Rh phenotype. Haematologica 2014;99:e115-7.

18 Jeremiah ZA, Buseri FI. Rh an gen and phenotype frequencies and probable genotypes for the four main ethnic groups in Port Harcourt, Nigeria. Immunohematology 2003;19:86-88.

19. Jeremiah ZA, Odumody C. Rh antigens and phenotype frequencies of the Ibibio, Efi k, and Ibo ethnic na onali es in Calabar, Nigeria. Immunohematology 2005;21:21-4.

20. Kappler-Gra as S, Auxerre C, Dubeaux I, et al. Systema c TH genotyping and variant iden fi ca on in French donors of African origin. Blood Transfus 2014;12 Suppl 1:s264-72.

21. Flegel WA, von Zabern I, Doescher A, et al. D variants at the RhDves bule in the weak D type 4 and Eurasian D clusters. Transfusion 2009;49:1059-69.

22. Touinssi M, Chapel-Fernandes S, Granier T, et al. Molecular analysis of inac ve and ac ve RHD alleles in na ve Congolese cohorts. Transfusion 2009;49:1353-60.

23. Silvy M, Di Cristofaro J, Beley S, et al. Iden fi ca on of RHCE and KEL alleles in large cohorts of Afro-Caribbean and Comorian donors by multiplex SNaPshot and fragment assays: a transfusion support for sickle cell disease pa ents. Br J Haematol 2011;154:260-70.

24. Reid ME, Ripaux M, Auxerre C, et al. DIVa and DIVa-2 are encoded by the same RHD allele [abstract]. Transfusion 2012;52:34A.

25. Noizat-Pirenne F, Mouro I, Pennec L, et al. Evidence that serine at posi on 103 is not suffi cient for complete C an gen expression [abstract]. Transfusion 1999;39:103S.

26. Vege S, Johnson NC, Vellique e RW, et al. A novel allele with nucleo de 307C > T (Pro103Ser) on RHCE*ceAG (254C > G) encodes robust C an gen [abstract]. Transfusion 2013;53: 30A.

24


DELEGATE QUESTIONNAIRE ANALYSIS – Post Congress

Beryl Armstrongy gCommunica ons & Marke ng Manager, Africa Society for Blood Transfusion (AfSBT)

INTRODUCTIONDelegates were invited to complete and submit a ques onnaire at the conclusion of the congress. The ques onnaire is available from the author, on request. This survey was conducted in order to enable AfSBT to assess and evaluate the various aspects of the congress with a view to ini a ng appropriate improvements for future congresses.The number of countries represented in the ques onnaire responses was 18: Belgium (2), Cameroon (2), DRC (1), Eritrea (1), Ethiopia (1), Ghana (2), Kenya (1), Madagascar (1), Namibia (1), Niger (1), Nigeria (3), Rwanda (16), South Africa (9), Sudan (3), Uganda (4), United Kingdom (2), Zambia (1), and Zimbabwe (3).

METHODS Due to the rela vely low number of ques onnaires submi ed (55) in comparison with the es mated total a endance (350) at the congress, the fi gures used to illustrate the outcomes have been retained as absolute numbers rather than percentages. The values allow direct comparisons to be made between the op ons selected by respondents.

RESULTS & DISCUSSIONThe questions posed within the survey were independently consolidated and the results follow in chronological order. Some scores are highlighted for par cular a en on.

Financial assistance in a ending the congressOf those who submi ed a ques onnaire, most were fully or par ally funded to a end. Support was provided either by the country (state) or by a sponsor or employer. Figure 1 illustrates the spread.

Figure 1:g Funding to a end congress in Kigali

Supportedby state 23

Supportedby sponsor 21

Fully funded 32

Par allyfunded 12

8th INTERNATIONALBLOOD TRANSFUSION CONGRESS

KIGALI, RWANDA 2016

AFRICA SOCIETY FOR BLOOD TRANSFUSION

MembershipRespondents provided information on their membership of various socie es, including AfSBT. Membership of local socie es was rela vely low, and this raises further ques ons that would be interes ng to pursue, including the sugges on that perhaps there are countries which do not have na onal socie es? Figure 2 illustrates membership of AfSBT, the Interna onal Society of BloodTransfusion (ISBT), AABB as well as na onal socie es.

Figure 2:g Membership of Socie es

AfSBT 34

ISBT 16

AABB 9

Na onalsociety 10

Professional speciality Respondents were asked to provide their professional speciali es and more than one answer could be given such as being a nurse and also being a manager. Figure 3 shows the spread of professional occupa ons of respondents. It is noted that most respondents were doctors, and / or managers. It is also apparent that technologists / scien sts were in higher numbers than those from other fi elds of work.

Figure 3:g Professional speciality of respondents

Student 2

Nurse 5

Recruiter 4

Technologist 8

Scien st 9

Doctor 18

Educator 3

Marke ng 0

Manager 17

Other 3

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Work environmentAs expected, most respondents were employed at a blood service,some in a blood bank, and some within the hospital environment.Figure 4 illustrates the diversity of the work environment.

Figure 4:g Work environment of respondents

Hospital 14

Blood bank 11

University 7

Industry 1

BTS 33

Management 5

Other 1

How did you hear about this Congress?Respondents were asked how they got to know that therewas an AfSBT congress in Kigali, and the three major routes of communica on are shown in Figure 5 - website, email or invita on.

Figure 5:g Manner is which respondents were made aware of theKigali Congress

Website 16

Email 15

Publica on 3

Verbal 11

Invita on 22

Other 1

AfSBT congresses a endedAfSBT has held seven interna onal congresses prior to the congress in Kigali. The fi rst four congresses were held in conjunc on with partners, and the last three were independently arranged byAfSBT. Respondents indicated their a endance at these, as shownin Figure 6.

Figure 6g : AfSBT congress a endance

Durban1999 0

Tunis 2002 0

Lagos 2004 1

Cape Town2006 7

Nairobi2009 7

Mauri us 2012 12

Victoria Falls 2014 12

Other interna onal scien fi c mee ngs a endedTo establish whether respondents had a ended other congresses,the next ques on queried a endance at other mee ngs, i.e.ISBT, AABB, na onal mee ngs, and also those arranged by theWorld Health Organiza on. Figure 7 shows a endances at thesefunc ons.

Figure 7g : A endance at other congresses

ISBT 17

AABB 12

WHO 12

Other 12

Major reasons for a endance Respondents indicated their mo va ons for a endance as illustrated in Figure 8. Not surprisingly, most respondents wantedto gain knowledge and stated that their a endance was due to scien fi c interest; what is strange is that not all replies included gaining knowledge. What was par cularly pleasing to see, was the number who were interested in educa onal aspects, and innetworking.

Figure 8g : Major reasons for a ending the congress in Kigali

Training/educa on 24

Donor recruitment 8

Scien fi cinterest 36

Networking 25

Present of studies 19

Sightseeing 3

To gainknowledge 33

Other 2

Which sessions par cularly interested you?Respondents demonstrated a variety of interests that prompted or mo vated their a endance, as shown in Figure 9. Par cularly popular responses are highlighted.

Figure 9g : Diversity of interest that mo vated a endance at the congress

Educa on and training 26

Donor recruitment 17

Blood dona on 14

Blood components 15

Laboratory studies 13

TTIs 28

Emerging technologies 16

Transfusion hazards 15

Haemovigilance 26

Clinical transfusion 13

Appropriate use 17

Sustainability 27

Research 27

Computers 11

Quality 23

Accredita on 29

Leadership/ management 24

Other 2

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Which type of presenta ons did you prefer?Most respondents preferred plenary sessions, workshops and symposia. Conversely, concurrent sessions also proved to bepopular. Disappoin ngly, poster sessions and breakfast mee ngsscored poorly. No addi onal types of presenta ons, from thoselisted and illustrated in Figure 10, were suggested in responses.

Figure 10g : preferred types of presenta on

Plenary 37

Concurrent 15

Posters 8

Workshops 16

Symposia 18

Breakfast 8

Other 0

Ques ons related to language of presenta onRespondents were asked to score the dual English/French languagepresenta ons, and whether or not they could adequately followpresenta ons that were given in their second language. Figure11 illustrates score; it shows that presenta ons were largelyunderstood. However, 15 of the 55 respondents s ll maintainedthat they did not sa sfactorily understand the presenta ons.

Figure 11g : Scoring related to dual language presenta ons being adequate (10 is high)

I couldunderstand adequately

30

I had diffi culty understanding

15

Ques on related to the Trade Exhibi onRespondents were asked to score the exhibitor facili es. Figure 12illustrates score; it shows that in the opinion of most respondents,exhibitor facili es were good.

Figure 12g : Scoring related to exhibitor facili es (10 is high)

Ques on related to communica onA challenge at any congress is eff ec ve communica on with delegates. Respondents scored communica on as shown in Figure 13. Although the outcome was more than acceptable,the organisers should do their best to improve communica onin future, such as be er signage, be er informa on on line andin the congress book, and more frequent announcements. Inall communica on given, there should be improved use of both English and French.

Figure 13g : Scores related to communica on

StandardsWith regard to all aspects of the congress, respondents were asked to rate whether they felt that the standard off ered was good, average, poor, or did not apply to them. The outcome is illustrated in Figure 14. Of special note is the poor ra ng received with regard to presenta on facili es – this was due to the size of the screens and less than adequate visibility experienced by some respondents si ng at the back of the room, as reinforced by general comments submi ed.

Figure 14g : Ra ng of standards at Kigali congress

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Finally, respondents were invited to comment on their congress experience. The comments provided are listed hereunder,verba m, and in no par cular order except that the fi ve commentsin French were google translated making presump ons toovercome challenges related to reading the wri ng.

GENERAL COMMENTS• Just try to speak loud to make sure everyone hears your voice

and make the PowerPoint presenta on bigger because people behind do not see very well.

• Very well organised. Very enjoyable experience.

• Congratula ons and hold on.

• Bilingual/transla on service must be considered forsubsequent congresses.

• Very good and instruc ve congress and well organised. Anissue was with the IT in the halls (and no pointers) - only one inthe ballroom hall, and none anywhere else.

• It was really good.

• The congress was well organised and the team was vigilant.Transla ons however were not adequately met. Bravo!!Congress organisers!

• The congress was very well organised and there was a lot tolearn to take back to our various countries.

• The conference was very interes ng. I wish it to be organisedannually because we gained too many things.

• The congress was wonderful. Keep it up!

• Good work done. Nice and beau ful country.

• Congress well organised. Interes ng scien fi c presenta ons.Agenda was respected.

• Although the fi rst me for me to a end this AfSBT but I amso proud with this event and I hope to a end all the coming AfSBT’s.

• The dual language presenta on should be organised wherepersonal transla on devices so that you listen to your preferred language to minimise the delays and miss out on transla ons.

• The dual language made it diffi cult to follow some of thepresenta ons.

• You do miss informa on when slides are discussed e.g.when a table or graph needs discussion. Otherwise very well presented.

• Well prepared mee ng.

• It has been a good interac ve congress.

• As a fully paid up member of AfSBT in good standing I was denied vo ng rights because the badge given to me did not have access rights to the AGM (comment from Uganda).

• Indicate which language the presenta ons will be presented in. The French presenta ons are not really helpful.

• Slides were o en out of sync – many could not be seen (too small) except from the fi rst few rows.

• Excellent presenta ons and very well organised. The sessions were so well a ended.

• Loved the experience. Gained valuable knowledge. This is a good pla orm for our profession.

• Fabulous congress and well organised – pleasant coordinators. There must be direct transla on.

• What an amazing congress! Extremely well organised. Fantas c venue, great facili es. Congratula ons Beryl and team.

• In view of the status of conference venue, the screens for ppt were too small for people sea ng behind. Next me you shall need to rearrange the rooms maybe then control in order tohelp not to tease our eyes.

• La qualité de slides de certain présenta on déviâted. Les présenta ons simultanées étaient insuffi santes.

• Le congrès était une nécessité, bien organisé, avec un processus de réplica on pour comprendre les points. Comment traiter l’accès à l’améliora on des résumés des besoins.

• La conférence était très bonne; Je propose d’augmenter le nombre d’études rela ves à l’organisa on de la Société.

• Très bonne organisa on dans l’ensemble.

• Inscrip on: pas facile de trouver les noms des par cipants (eu à a endre longtemps). Présenta on: Il manquait lepointeur laser, les diaposi ves français / anglais ne sont pas synchornised. Toutes mes félicita ons aux organisateurs du Congrès

CONCLUSIONThe congress in Kigali was the 8th congress of AfSBT. What hasbecome evident, over the years, is that this congress, which is ideally held every two years, a racts African scien sts and other professionals related to the fi eld of blood transfusion medicine, as no other African mee ng does. As such, AfSBT has a responsibility to con nue to address the needs of the profession, and to get be er each me, at doing so. Ques onnaires, such as this one, are valuable tools in discovering what was done right, what were the shortcomings and how best to meet challenges and make improvements in order to con nue to add value in the future.

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AfSBT CONGRESS ABSTRACTSZIMBABWE 2014

EPIDEMIOLOGY OF HEPATITIS B VIRUSINFECTION in Africa

EPIDEMIOLOGIE DE L’INFECTION DU VIRUSDE L’HEPATITE B en afrique

Prof Jean-Pierre AllainEmeritus professor of Transfusion Medicine, Dept of Haematology,University of Cambridge, Cambridge, UK

Professeur émérite de médecine transfusionnelle, Département d’Hématologie, Université de Cambridge, Cambridge, Royaume-Uni

Le virus de l’hépa te B a infecté l’homo sapiens pendant plus de 35,000 ans. Le virus génotype d’origine A répandu en Afrique a été remplacé par le génotype D dans la région nord méditerranéenne et par le génotype E dans les par es occidentale et centrale durant les 300 dernières années. Ce dernier génotype a connu une expansionrapide à travers le con nent probablement à cause de l’infec osité plus élevée, liée à la charge virale plus élevée chez les jeunes enfants nouvellement infectés et responsable du mode d’infec on horizontal largement dominant.

Le génotype A du VHB ini al s’est diversifi é en trois sous génotypesprincipaux : A1 dominant en Afrique de l’Est, en Ethiopie et en Afrique du sud ; A2 présent dans certaines par es du centre et del’Ouest de l’Afrique, mais surtout en Europe de l’Ouest et A3 trouvé dans les poches des souches minoritaires dans les zones dominées par le génotype E. On suppose que le génotype D répandu comme sous génotype D2 et D7 de l’Egypte au Maroc a probablement été importé du Moyen-Orient après les invasions arabes /turques autour du bassin de la Méditerranée et en Europe de l’Est. Plusieurs études concordantes ont déterminé l’appari on du génotype E il y’a environ 300ans en Afrique de l’Ouest. Ce e es ma on basée sur la phylogéné que est corroborée par les données historiques depuis que les Afro-Américains testés aux Etats-Unis, aux Caraïbes et au Brésil portent le génotype A1 importé avec le commerce des esclaves du 16ème au 19ème siècle, et qui a été interrompu audébut du 19èmesiècle, avant l’expansion massive du génotype E. En outre, dans les zones où les génotypes A1, A3, D et E se chevauchent géographiquement, les infec ons par le génotype double peuvent conduire à une recombinaison géné que entre génotypes. Les virus recombinants circulants A3/E, A1/D, D/E ont été iden fi és comme composants minoritaires du spectre géné que VHB en Afrique. Le Génotype semble faire des diff érences cliniques depuis la prévalence des maladies chroniques par infec on par le VHB (HBsAg+) de la

Hepa s B virus has been infec ng homo sapiens for more than-35,000 years. The original genotype A virus prevalent in Africa hasbeen replaced by genotype D in the northern Mediterranean areaand by genotype E in the western and central part in the last 300years. The la er genotype has been rapidly expanding throughoutthe con nent probably because of higher infec vity related to higherviral load in newly infected young children responsible for the largelydominant horizontal mode of infec on.

The ini al HBV genotype A has diversifi ed in three main subgeno-types: A1 dominant in East Africa Ethiopia to South Africa, A2 foundin some from parts of central and west Africa but mostly in WesternEurope and A3 found in pockets of minority strains in genotype E dominated areas. It is hypothesized that genotype D prevalent as subgenotype D2 and D7 from Egypt to morocco has likely been imported from the Middle East following the Arab/Turkish invasionsaround the Mediterranean basin and Eastern Europe. Severalconcordant studies determined the occurrence of genotype Eapproximately 300 years ago in West Africa. This phylogene cally-based es ma on is corroborated by historical data since African Americans tested in the USA, the Caribbean and Brazil carrygenotype A1 imported with the 16-19th century slave trade thatwas interrupted in early 19th century before the massive expansion of genotype E. In addi on, in areas where A1, A3, D and E genotype overlap geographically, dual genotype infec ons may lead to gene crecombina on between genotypes. Circula ng recombinant virusesA3/E, A1/D, D/E have been iden fi ed as minority components of the HBV gene c spectrum in Africa.

Genotype appears to make clinical diff erences since the prevalence of chronic HBV infec on (HBsAG+) in general adult popula on aswell as fi rst- me blood donors ranges between 11-25% in genotypeE areas, 5-10% in A1 areas and 2-5% in genotype D areas. In parallel,

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the prevalence of exposure to HBV indicated by the presence of an -HBc is > 80%, about 50% and 30% in genotype E, A1 and Dgenotype dominance areas, respec vely. The distribu on of viralload in chronic infec on, the percentage of HBV DNA nega veHBsAg+samples and the frequency of occult HBV infec on (OBI)also vary according to genotype.

The elements reported above play a significant role in blooddona on tes ng, the sensi vity of the HBsAg screening assays playing a prominent role in determining HBV blood safety. The residual risk of HBV transmission is higher in genotype E areasbut most patients having been previously exposed and youngchildren being systema cally vaccinated decreases the poten alfrequency of transfusion-transmission. Even in genotype D areas,an -HBc screening is not cost-eff ec ve for improving HBV bloodsafety because the high percentage of deferred dona ons it wouldrequire would be expensive and would further deplete an alreadyprevalent blood shortage. HBV NAT already in place in South Africa,Nambia and Egypt is beyond the economic and technical reach of most other African countries although its impact on blood safetymight be signifi cant.

popula on adulte en générale c’est ainsi que chez les donneurs desang pour la première fois, elle se situe entre 11-25% dans les zones à génotype E, 5-10% dans les zones à génotype A1 et 2-5% dans les zones à génotype D. En parallèle, la prévalence de l’exposi on au VHB indiqué par la présence d’an corps an -HBc est>80%, environ 50% et 30% dans les zones de dominance des génotypes E, A1 et D respec vement. La répar on de la charge virale dans les infec ons chroniques, le pourcentage des échan llons HBsAg+ADN néga fs de HBV et la fréquence des infec ons occultes par le VHB (OBI) varient également selon le génotype.

Les éléments présentés ci-dessus jouent un rôle important dans lestests de don de sang, la sensibilité des tests de dépistage de l’HBsAg joue un rôle de premier plan dans la détermina on du VHB pour la sécurité transfusionnelle. Le risque résiduel de transmission du VHB est plus élevé dans les zones à génotype E, mais la plupart despa ents ayant été préalablement exposés et les jeunes enfants systéma quement vaccinés diminuent la fréquence poten elle de transmission par transfusion. Même dans les zones à génotype D, le dépistage an HBc n’est pas rentable pour l’améliora on de la sécurité du VHB dans le sang en raison du pourcentage élevé de dons diff érés, il serait coûteux et contribuerait à la pénurie du sang. LeDGV pour le VHB a été déjà introduit en Afrique du Sud, la Namibie et l’Egypte est au-delà de la portée économique et technique de la plupart des autres pays africains, bien que son impact sur la sécurité du sang pourrait être important.

BLOOD UTILIZATION IN HOSPITALS IN TANZANIA,June-September 2013

UTILISATION DES PRODUITS SANGUINS DANS LES HOPITAUX EN TANZANIE, Juin – Septembre 2013

Ibironke Apatap , Anindya De, Magdalena Lyimo, AbduJuma, Regina Kutaga, Mwanakheir Mahmud, Sonal Pathak, EfesperNkya, Ma hew Kuehnert, Naomi Bock Anthony Marfi n

INTRODUCTIONBlood transfusion can be a lifesaving treatment but blood is an expensive and scarce resource. The World Health Organiza onrecommends that national government develop polices andstrategies to decrease the need for transfusions and promote the appropriate use of blood. For a given popula on, the orderingprac ces of healthcare providers and the prevalence of clinicalcondi ons that require blood transfusions are factors that aff ectblood demand. Understanding blood u liza on in a country caninform na onal blood transfusion guidelines and strategies, whichcan ul mately help to increase the availability of blood to pa entswho need it.

INTRODUCTIONLa transfusion sanguine peut être un traitement de sauvetage mais le sang est une ressource rare et chère. L’Organisa on mondiale de la Santé recommande que les gouvernements na onaux élaborent des politiques et des stratégies visant à réduire le besoin en transfusions et à promouvoir l’u lisa on appropriée du sang. Pour une popula on donnée, les pra ques de commande des fournisseurs de soins de santé et la prévalence des condi ons cliniques qui nécessitent des transfusions sanguines sont des facteurs qui infl uent sur la demande de sang. Comprendre l’u lisa on du sang dans un pays peut avoir une infl uence sur les lignes directrices et les stratégies de transfusion sanguine na onales et peuvent fi nalement contribuer à accroître la disponibilité du sang pour les pa ents qui en ont besoin.

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AIMS AND OBJECTIVESThis study was designed to describe the clinical u liza on of bloodand the clinical characteris cs of blood recipients in Tanzania tobe er understand the rela onship between blood demands andblood needs in the country.

METHODSFrom June to September 2013, we conducted a na onal prospec vesurvey of blood transfusion prescrip ons and prac ces acrossTanzania. Probability-propor onal-to-size (size=number of beds)sampling was used to randomly select 42 hospitals in the country.From each hospital, data on all requested units during the surveyperiod were collected and pa ent data were abstracted from medicalrecords. Our analysis focused on transfusion of whole blood and redcell units for pa ents with anemia as the clinical indica on. Causes of anemia were grouped under seven broad categories: infec ousdisease, non-maternal hemorrhage, trauma, non-trauma surgery,pregnancy (pregnancy – related haemorhage and anemia), chronicdisease and other. Clinical variables including pre-transfusion hemoglobin level, age group (i.e., adults versus children <18years) and gender were also described.

RESULTS Anemia was the clinical indica on for 83% (11, 660/14,902) of the requests for whole blood and red cell units. Of these requests,7,050 (60%) were for adults and 4,483 (38%) for children. Amongadults, 72% (5,109/7,050) of the requests were for females. The median (interquar le range) adult age was 34 (26 – 46) years andthe median pre-transfusion hemoglobin was 6 (4-8) g/dL, femalepa ents accounted for 47% (2,098/4483) of transfusion requestsin children. In children the median age was 3(1-7) years and thepre-transfusion haemoglobin was 5(4-6) g/dl

Pregnancy (33%) infec ous disease (28%) and chronic disease (14%) were the most common causes of anaemia requiring transfusionsin adults, while infec ous disease (71%) and chronic disease (13%)were the most common causes in children. Among female adultspregnancy accounted for 45% of transfusion, due to anemia, whileit accounted for 5% of transfusion in female < 18 years old. Overall, infec ous disease accounted for the lowest median pre-transfusionhaemoglobin of 5 (4-6) g/dl, while non-trauna surgery accountedfor the highest of 9 (7-12) g/dl.

DISCUSSIONStrategies to address the underlying causes of anemia in Tanzania could be an eff ec ve blood conserva on approach. Such strategiesinclude improvement of material and child health services, early diagnosis and treatment of common causes of anemia, suchas infectious and chronic diseases and use of alternatives totransfusions.

BUTS ET OBJECTIFSCe e étude a été conçue pour décrire l’u lisa on clinique du sang et les caractéris ques cliniques de receveurs de sang en Tanzanie afi n de mieux comprendre la rela on entre les exigences et les besoins de sang dans le pays.

MÉTHODESDe juin à septembre 2013, nous avons mené une enquête prospec ve nationale sur les prescriptions et les pratiques de transfusion sanguine à travers la Tanzanie. La probabilité propor onnelle à lataille (taille = nombre de lits) a été u lisé pour l’échan llonnage et pour choisir au hasard 42 hôpitaux dans le pays. De chaque hôpital, les données sur toutes les unités de sang demandées au cours de la période d’enquête ont été recueillies et les données des pa ents ont été extraites des dossiers médicaux. Notre analyse a porté sur la transfusion du sang et des globules rouges des unités en ères pour les pa ents souff rant d’anémie comme indica on clinique. Les causes de l’anémie ont été regroupées sous sept grandes catégories : les maladies infec euses, hémorragies non maternelle, traumatologie, chirurgie non-trauma que, la grossesse (hémorragie et anémie liée à la grossesse), les maladies chroniqueset d’autres. Les variables cliniques y compris le taux d’hémoglobine avant transfusion, le groupe d’âge (à savoir adultes par rapport aux enfants de <18ans) et le sexe ont également été décrits.

RÉSULTATSL’anémie était l’indication clinique pour 83% (11 660/14 902) des demandes de sang total et des unités de globules rouges. Parmi ces demandes, 7050 (60%) étaient pour les adultes et 4483 (38%) pour les enfants. Chez les adultes, 72% (5109/7050) des demandes concernaient les femmes. L’âge moyen des adultes (intervalle interquar le) était de 34 (26-46) ans et la moyenne de l’hémoglobine avant transfusion était de 6 (4-8) g/DL. Les pa entsde sexe féminin représentaient 47% (2098/4483) des demandes de transfusion chez les enfants. Chez les enfants, l’âge moyen était de 3 (1-7) ans, et le taux d’hémoglobine avant transfusion était de 5 (4-6) g/dL. La grossesse (33%), les maladies infec euses (28%) et les maladies chroniques (14%) étaient les causes les plus courantes d’anémie nécessitant des transfusions chez les adultes, tandis que les maladies infec euses (71%) et les maladies chroniques (13%) étaient les causes les plus courantes chez les enfants. Parmi les adultes de sexe féminin, l’anémie due à la grossesse représentait45% des transfusions, alors qu’elle représentait 5% des transfusions chez les femmes <18 ans. Dans l’ensemble, les maladies infec euses représentent le plus faible taux d’hémoglobine avant transfusion (5(4-6) g/dL), tandis que la chirurgie non-trauma que représentait le plus grand taux (9(7-12)g/dL).

DISCUSSIONLes stratégies visant à s’attaquer aux causes sous-jacentes de l’anémie en Tanzanie pourraient être une approche effi cace de meilleure conservation du sang. Ces stratégies comprennent l’améliora on du matériel et des services de santé de l’enfant ; Le diagnos c précoce et le traitement des causes les plus courantes d’anémies, telles que les maladies infec euses et chroniques et l’u lisa on des alterna ves aux transfusions.

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REDUCTION OF VON WILLEBRAND FACTOR LEVELS in HIV/AIDS patients on antiretroviral (ARV) treatment in Zimbabwe

REDUCTION DES TAUX DE FACTEUR DE VON WILLEBRAND CHEZ les pa ents VIH/SIDA sous traitement an retroviral (AVR) au Zimbabwe

Arthur Mandisodza,, O Tapera, C Gwanzura, E Chidziva, C Musshoperi

KEYWORDSHIV infec ons, von Willebrand factor, an retroviral treatment, thrombosis, viral loads

INTRODUCTIONvon Willebrand factor (vWF) is a mul mer protein that facilitatesplatelet adhesion to the injured blood vessel and subsequent plateletaggrega on. Levels of vWF are kept to a minimum by ADAMTS – 13which breaks down unwanted vWF to prevent clo ng. High levels of von Willebrand factor are associates with HIV infec on endothelialactivation and damaged and are noted to decease with ARVtreatment. ADAMTS – 13 levels are also decreased due to presenceof autoan bodies. Measurement of vWF has both diagnos c andprognos c benefi ts to the HIV/AIDS pa ents and it may be usefulas a monitoring tool for ARV treatment.

AIMS AND OBJECTIVESThe aim of the study was to fi nd out if there was a diff erence in vonWillebrand concentra on in HIV pa ents on an retroviral (ARV)and those pa ents not on treatment. The objec ve of the study isto suggest inclusion of measurement of vWF level as an aff ordablemonitoring tool for Arv treatment.

STUDY DESIGN AND METHODSA prospec ve cross-sec onal study was carried out at Na onal BloodService Zimbabwe (NBSZ) and CIMAS medical Laboratories. VonWillebrand factor was measured using the Grad pore ELISA methodon 50 normal, 44 HIV pa ents on ARV treatment and 36 HIV pa entsnot on treatment at the CIMAS Serology Department. Sta s calanalysis was done using the Microso Minitab programme.

RESULTSThere was sta s cally signifi cant diff erence in the concentra onof vWF between regular donors (normal subjects) and HIV/AIDS pa ents not on ARvs (p= 0.0001). There was also a sta s callysignifi cant diff erence in the concentra on of vWF between those on ARV treatment and those not on treatment (p=0.0014). Therewas an associa on between HIV infec on without treatment andhigh vWF levels (X2 test, P=031). There was no sa s cally signifi cantdiff erence in vWF between normal subjects and those on ARVtreatment (p=0.58). Mean vWF concentra ons: regular donors= .9U/ml; on ARVs = 2.1 U/ml and not on Arv = 2.8U/ml (normalreference range = 0.5 – 2.5 U/ml).

INTRODUCTIONLe facteur de vonWillebrand (vWF) est une protéine mul mère, quifacilite l’adhésion des plaque es aux vaisseaux sanguins blessés et l’agréga on plaque aire subséquente. Le taux de vWF est réduit au minimum par ADAMTS-13 qui décompose le vWF indésirablepour empêcher la coagula on. Les niveaux élevés de facteurs devonWillebrand sont associés avec l’ac va on endothéliale de l’infec on à VIH, endommagés et sont amenés à diminuer avec un traitement ARV. Le taux ADAMTS-13 va diminuer en raison de la présence d’auto-an corps. La détermina on du taux de vWF adeux avantages diagnos que et pronos que pour les pa ents du VIH/SIDA et il peut être u le comme ou l de surveillance pour letraitement ARV.

OBJECTIFSL’objectif de l’étude était de savoir s’il y avait une différence de concentra on de vonWillebrand chez les pa ents VIH sous traitement antirétroviral (ARV) et les patients non traités. L’objec f de l’étude est de proposer l’inclusion de la mesure de la concentra on de vWFcomme un ou l de surveillance abordable pour le traitement ARV.

CONCEPTION MÉTHODES ET ETUDEUne étude transversale prospec ve a été réalisée au Service Na onal de transfusion sanguine du Zimbabwe (NBSZ) avec les laboratoiresmédicaux CIMAS. Le facteur vonWillebrand a été mesuré en u lisant la méthode ELISA Grad pores 50, au Département sérologie CIMAS. L’étude a concerné 44 pa ents a eints du VIH sous traitement ARV et 36 pa ents VIH sans traitement. L’analyse sta s que a été eff ectuée à l’aide du programme Microso Minitab.

RÉSULTATSIl y avait une diff érence sta s quement signifi ca ve de la concentra on en vWF entre les donneurs réguliers (sujets normaux) et les pa ents ayant contracté le VIH/SIDA et sous ARV (p= 0,0001). Il y avait aussi une diff érence sta s quement signifi ca ve de la concentra on en vWF entre ceux sous traitement ARV et ceux qui n’ont pas de traitement (p = 0,0014). Il y’ avait une associa on entre l’infec on à VIH sans traitement et les niveaux élevés de vWF (test X2, P = 0,031).

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DISCUSSION AND CONCLUSIONSHIV virus is known to damage the endothelium, releasing largeamounts of mul mer vWF resul ng in thrombo c tendencies.Normally, mul mer vWF is cleaved by ADAMTS – 13 to preventexcessive clot forma on. Reduc on of vWF levels to within normalwith ARV treatment confi rms studies that ARV treatment reducesendothelial ac va on and damage. Measurement of vWF levels inblood may help in monitoring the treatment of HIV/AIDS.

REFERENCES• Aukrust P, et al (2000). Persistently elevated levels of von

Willebrand factor in HIV infec on. Down regula on duringhighly ac ve an retroviral therapy. Journal of Thrombosis andHaemostasis, 84(2): 83-187.

• Cole. JW (2004). Acquired immunodefi ciency syndrome and therisk of stroke. Stroke, 35 (1) 51-56.

• Saif MW (2001). AIDS and Thrombosis: A retrospec ve studyof 131 HIV infected pa ents AIDS pa ent Care STDs, 15 (6):311 – 320.

Il n’y avait aucune différence statistiquement significative en concentra on de vWF entre sujets normaux et les pa ents sous traitement ARV (p = 0,58). Les concentra ons moyennes de vWF : les donneurs réguliers = .9U/ml ; sous ARV = 2,1 U/ml et sans ARV = 2,8 U/ml (intervalle de référence normal = 0,5 à 2,5 U/ml).

DISCUSSIONS ET CONCLUSIONSLe virus VIH est connu pour endommager l’endothélium, libérantde grandes quan tés de mul mères VWF entraînant une tendancethrombo que. Normalement, les mul mères du vWFsontclivées par ADAMTS-13 pour empêcher la forma on de caillots de manière excessive. La réduc on du taux de vWFchez les individus normaux et chez ceux avec un traitement ARV confi rme les études que le traitement ARV réduit l’ac va on endothéliale et les dommages. La mesure du taux de vWF dans le sang peut aider à surveiller le traitement du VIH/SIDA.

INTRODUCTIONEn février 1995, un programme d’exposi on limitée aux donneursde sang (LDEP) a été lancé par le Service de transfusion sanguine dela Province de l’Ouest et le professeur Gert Kirsten du département de néonatologie à l’Hôpital Tygerberg, Cape Town.

OBJECTIFL’objec f de ce programme était de s’assurer que les volumes corrects de globules rouges étaient transfusés, et qu’il y’avait une exposi on minimale aux diff érents donneurs de sang résultant à une meilleure réponse immunitaire et l’u lisa on plus effi cace d’une ressource rare à savoir le sang issu d’un don. En février 1994, les concentrés de globules rouges pédiatriques (PRBC1, 2 pré-fi ltrés), de volume de 180m (x2), provenant de la division d’une unité deglobules rouges ont été u lisé.

INTRODUCTIONIn February 1995, a limited Donor Exposure programme (LDEP) was ini ated by the Western Province Blood Transfusion Serviceand Professor Gert Kirsten of the Department of Neonatology atTygerberg Hospital, Cape Town.

OBJECTIVE The objec ve of this programme was to ensure that the correct volumes of red cells were transfused, and that there was minimalexposure to diff erent donors resul ng in a be er immune responseand more effi cient u liza on of a scarce resource i.e. donated blood.Pre-February 1994, Paediatric Red Blood Cell Concentrate (PRBCI,2 pre-fi ltered), volume of 180ml (x2), split from one cell dona onwas used.

THE EFFICIENT USE OF RED CELL DONATIONS RESULTING IN DECREASE IN PAEDIATRIC IMMUNE EXPOSURE. Then and now, winning the war on our limitedblood resources

L’UTILISATION EFFICACE DES DONS DE GLOBULES ROUGESENTRAINANT UNE DIMINUTION DE L’EXPOSITION IMMUNITAIRE PEDIATRIQUES. Hier et aujourd’hui, gagner la guerre sur nos ressources limitees de sang

Caren Overall

KEYWORDSpaediatric, neonatal, effi ciency, donor, exposure, limited donor exposure

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It was noted in a study by (Kirsten et al., 1996:1462) that pa ents require an average red blood cell transfusion volume of 21+/-12.2ml,with the larger infants requiring 34.5ml = /-12.7ml Therea er, a 3pack infant Red blood cell (IRBCI 1,2,3 pre-fi ltered volume of 75ml +/-20ml (x3) system was introduced and followed by a 4 pack infantred blood cell (IRBC 1,2,3,4 pre-fi ltered volume of 55ml +/-20ml(x4) system

METHODA retrospective study of the LDEP request, usage, expiry andexposure was done, by consul ng computer records u lizing theLDEP selec on criteria in the neonatal crossmatch programme, onour in-house Blood Bank computer system.

RESULTSThe results obtained indicated that implemen ng the LDEP (3 to 4pack system) an increase in issues and re-usage from 53% to 60% and 6% to 20% respec vely, as well as a decrease in expiries from41% to 20% was evident.

Provincial hospitals (local and regional) were more ac ve in thisprogramme as opposed to the private hospitals in the ra o 60%: 40%.

CONCLUSIONThe 4, as opposed to the 3 red cell pack system worked the best. It allowed for the more effi cient use of the volunteer dona on, i.e.4 packs (2 per pa ent) split between two pa ents, where at most1 pack was used, rather than 3 red cell packs being set aside for 1pa ent and only 1 being transfused.

Consequently there were less expiries on comple on of the LDEPand an increase in re-usage of the red cell packs was evident.The clinical impact was the decrease exposure to mul ple donors(foreign antigens), thus allowing for a reduced likelihood of alloimmuniza on and therefore a be er immune response being mounted in the neonatal and paediatric pa ents.

Essentially, refining the training of Blood Bank staff as wellspecifi c marke ng, aimed at clinicians and nursing staff workingin the paediatric fi eld, is required at both private and provincialinstruc ons.

REFERENCESKirsten, G.F. Kirsten, C.L. Faber, M., Collect, C., Mitchell, C.A., & Bird,A.R. 1996. Introduc on of a donor exposure reduc on programmefor mul ple-transfused very–low-birth-weight infants. SAMj, Cri calCare 86 (11) 1462.

Il a été noté d’après une étude de [Kirsten et al, 1996 :1462.] que les pa ents ont besoin en moyenne d’un volume de globules rouges pour la transfusion de 21+/-12.2ml, et que les enfants représentantle grand nombre nécessitent 34.5ml +/-12.7ml.Par la suite, un système de 3 pack de globules rouges pourenfant (CGR N 1, 2, 3 pré-fi ltré), de volume de 75ml +/- de 20ml (3x) a été introduit et suivi d’un système de 4 pack de globules rouges, (CGR N 1, 2, 3, 4 pré-fi ltrée), de volume de 55ml +/-20ml de (x4).

MÉTHODEUne étude rétrospective de la demande de LDEP, l’utilisation, l’expira on et l’exposi on a été réalisée, en consultant les dossiers informa ques, en u lisant des critères de sélec on des LDEP dans le programme de compa bilité de croisée néonatale, sur notre système informa que de la Banque de sang en interne.

RÉSULTATSLes résultats obtenus indiquent que la mise en œuvre de la LDEP(pack de 3 à 4 ), une augmenta on des demandes et réu lisa on de 53% à 60% et de 6% à 20%, respec vement, ainsi que d’unediminu on de poches expirées de 41% à 20% étaient évidents. Les hôpitaux provinciaux (locaux et régionaux) étaient plus ac fs dans ce programme plutôt que les hôpitaux privés dans le ra o de 60% : 40%.

CONCLUSIONLe système 4, par opposi on au 3 fonc onne mieux. Il a permisune u lisa on plus effi cace du don bénévole. C'est-à-dire 4 pack (2 par personne), répar s entre deux pa ents, dont au plus 1 pack aété u lisé, plutôt que 3 packs de globules rouges étant mis de côté pour 1 pa ent et seulement 1 transfusé. Par conséquent, il y avait moins de possibilité d’expira on à la fi n de la LDEP et évidemment une augmenta on de la réu lisa on des packs de globules rouges.L’impact clinique était ce e diminu on d’exposi on à de mul ples donneurs de sang (an gènes étrangers), perme ant ainsi une probabilité réduite de l’allo-immunisa on et donc une meilleure réponse immunitaire retrouvée chez les pa ents des services de pédiatrie et de néonatologie. Il est essen el d’affi ner la forma on du personnel de la banque de sang ainsi que le marke ng spécifi que, visant les cliniciens et le personnel infi rmier travaillant dans les services de pédiatrie, dans les deux établissements privés et provinciaux.

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CONTEXTELa recherche clinique en médecine transfusionnelle a des avantages de grande envergure, y compris la capacité à éclairer la prise de décisions et la poli que opéra onnelle et de procéder à la surveillance des maladies. Cela sert à assurer la sécurité du sang, et une provision suffi sante en sang. La recherche est par culièrement importante en Afrique étant donné les défis actuels : haute prévalence des infec ons transmissibles par transfusion, défi cit du bon de sang volontaire et une demande clinique élevée pour la transfusion sanguine.

MÉTHODESDans le cadre du programme US Na onal Heart, Lung and Blood Ins tute REDS-III, nous avons développé une infrastructure de recherche clinique avec le Service Na onal de transfusion sanguine sud-africain (SANBS). Une base de données sur les donneurs de sang et de don a été crée comportant des informa ons sur toutes les dons : la démographie des donneurs de sang, le type de don premier/régulier et les résultats des tests des marqueurs infec eux. Suite à une évalua on des besoins, trois protocoles cliniques ont été élaborés pour répondre à des ques ons contemporaines, de recherche per nente à la pra que de la transfusion locale :1. une étude de la transfusion sanguine et du VIH dans le cadre

obstétrical ;2. une étude des facteurs de risque pour une infec on récente par

le VIH et le VHB ; et 3. une étude visant à iden fi er les facteurs de mo va on et de

dissuasion pour le don de sang chez les Sud- Africains noirs etde l’impact sur le risque de transmission du VIH.

Enfi n, le programme REDS-III sou en la forma on et le mentorat de jeunes médecins et des scien fi ques dans les méthodes de recherche clinique.

BACKGROUNDClinical research in transfusion medicine has wide-ranging benefi tsincluding the ability to inform opera onal decision – making and policy and to conduct disease survelliance. This serves to toassure blood safety, and adequate provision of blood. Researchis particularly important in Africa given ongoing challenges of high prevalence of transfusion transmissible infec ons, shor allin voluntary blood dona on and a high clinical demand for blood transfusion.

METHODSUnder the US Na onal Heart, Lung and Blood Ins tute REDS-IIIprogram, we have developed a clinical research infrastructurewith the South African Na onal Blood Service (SANBS). A researchdonor and dona on database was established including informa on about all dona ons: donor demographics, fi rst/repeat status andinfec ous marker test results. Following a needs assessment, threeclinical protocols were developed to address contemporary researchques ons relevant to local transfusion prac ce: • A study of blood transfusion and HIV in the obstetric se ng• A study of risk factors for recent HIV and HBV infec on; and• A study to iden fy mo vators and deterrents to blood dona on

among Black South Africans and impact on HIV risk.Finally, the REDS-III program supports training and mentorship of junior physicians and scien sts in clinical research methods.

RESULTSFrom January 2012 through June 2013, 1,461,458 dona ons from564,826 donors were recorded in the research donor dona ondatabase. Males and females were equally represented, 53% of donors were aged between 16 and 29 years and Black and Coloreddonors were under-represented with respect to the generalpopula on.

DEVELOPING RESEARCH CAPACITY IN TRANSFUSION MEDICINE IN AFRICA:The REDS-III study in South Africa

DEVELOPPER LES CAPACITES DE RECHERCHE EN MEDECINE TRANSFUSIONNELLE EN AFRIQUE : l’etude REDS-III en Afrique du Sud

Edward Murphyp y, E.M. Bloch, C. Ingram, R. Crookes, B. Custer, R. Reddy, S. Ngcobo, K. van den Berg, M. Vermeulen, T. Multhivhi, ,yyyyR. Swanevelder, T. Mokoena, L. Courtesy, E.L. Murphy

For the Interna onal Component of the NHLBI Recipeint Epidemology and Donor Evalua on study-III (REDS-III)South Africa Na onal Blood Service, Johannesburg, South AfricaRTI, Rockvile, Maryland, USAUniversity of Calfornia san Francisco, San Francisco, Calfonia, USA.

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A pilot study demonstrated similar rates of obstetric hemorrhage(OH) to those reported in Europe and the United States; however,the observed incidence of transfusion (2.8%) in obstetric pa entswas up to tenfold higher. Signifi cant contribu ng factors for the hightransfusion incidence include OH, prenatal anemia and HIV infec on.A planned study of recent HIV and HBV infec ons will take advantageof HIV nucleic acid tes ng (NAT) as well as an body avidity tes ng to iden fy recent infec ons.

A focus group study iden fi ed promo onal communica ons, smallincen ves and altruism as the primary mo vators for blood dona onwhile fear (of needles, of learning test results) is the primarydeterrent against dona on. A planned prospec ve cohort studywill iden fy which specifi c pa erns of mo vator and deterrentsare associated with actual return for second dona on among fi rst– me Black blood donors at lower risk of HIV. Finally, several Juniorinves gators from SANBS have completed two – week, in – countrycourses on protocol development and manuscript wri ng and arereceiving ongoing mentorship by senior SANBS and US inves gators.This has resulted in the successful submission of a number of abstracts and manuscripts for publica on.

CONCLUSIONSA large program of transfusion medicine research has begun togenerate data which will inform future policy decisions regardingblood transfusion in South Africa. The program makes allowancefor development of human capital in clinical research to ensuresustainability or research a er funding has ended. Finally, it is hopedthat collabora ons between SANBS and other African countries willensure that benefi ts extend beyond South Africa.

RÉSULTATSDe janvier 2012 à juin 2013, 1,461.458 dons provenant de 564 826 donateurs ont été enregistrés dans la base des données des donneurs et des dons. Hommes et femmes étaient également représentés, 53% des donneurs étaient âgés entre 16 et 26ans. Les Noirs et les personnes de couleur étaient sous-représentés par rapport à la popula on générale. (1) Une étude pilote a démontré des taux similaires d’hémorragie obstétricale (OH) à ceux rapportés en Europe et aux Etats-Unis. Toutefois, l’incidence observée de la transfusion (2,8%) chez les pa ents obstétriques était jusqu’à dix fois plus élevée. Les Facteurs contribu fs importants pour la forte incidence de la transfusion sont l’HO, l’anémie prénatale et l’infec on à VIH.(2) Une étude planifi ée des infec ons récentes au VIH et VHB profi tera du dépistage du VIH par la technique du test d’acide nucléaire, ainsi que des tests an corps d’avidité pour iden fi er les infec ons récentes.(3) Une étude de groupe de réfl exion a iden fi é les éléments de communica on promo onnelle à savoir les pe tes incita ons et l’altruisme comme les principaux facteurs de mo va on pour le don de sang alors que la peur (des aiguilles, d’apprendre les résultats des tests) est le principal facteur de dissuasion contre le don. Une étude de cohorte prospec ve planifi ée perme ra d’iden fi er quels modèles spécifi ques des facteurs de mo va on et de dissuasion sont associés à un deuxième don chez les donneurs de sang de race noire à faible risque du VIH donnant du sang pour la première fois. Enfi n, plusieurs jeunes chercheurs du SANBS ont terminé deux semaines, de cours dans le pays sur l’élabora on de protocole et de rédac on d’ar cle et ont reçu un mentorat con nu par les seniors du SANBS et des chercheurs américains. Cela a abou à la présenta on réussied’un certain nombre de résumés et manuscrits pour publica on.

CONCLUSIONSUn grand programme de recherche en médecine transfusionnelle a commencé à générer des données qui éclaireront les décisions poli ques futures concernant la transfusion sanguine en Afrique du Sud. Le programme prend en compte le développement du capital humain dans la recherche clinique pour assurer la durabilité de la recherche après la fi n du fi nancement. Enfi n, il est à espérer que les collabora ons entre SANBS et d’autres pays africains feront en sorte que les avantages vont au-delà de l’Afrique du Sud.

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FROZEN PLATELETS as an Available Alternative in Blood Bank

PLAQUETTES CONGELES comme une alterna ve disponibledans la banque de sang

Milos Bohonek, Eva Staskova, Eliska Sladkova,k

INTRODUCTIONMassive bleeding and massive transfusion are associated withincreased morbidity and mortality in severely injured pa ents. Earlyand aggressive use of blood products in these pa ents may correct coagulopathy, control bleeding, and improve outcomes. Majorityis preventable if red cells, plasma and platelets are available assoon as possible. Due to their very short shelf life, having a dailystockpile of fresh platelets is not possible for many hospital bloodbanks. The alterna ve solu on is a stock of frozen platelets whichare successfully used in military medicine.

CHALLENGEFollowing up on Netherlands Military Blood Bank’s experiences, weput into prac ce a produc on and use of frozen platelets.

BODY WORKApheresis, Lecodepleted, platelets, with >280 x 109 thrombocytes/unit, are (a er a removal of supernatant) frozen in -80oC, with 5%DMSO, and stored in the same temperature for up to 2 years. For clinical use, there are thawed platelets, group O, recons tuted in thawed plasma, group AB. The recons tu on is a sample processwhich consists of thawing platelets and plasma in water bath and adding plasma into platelets under mixing. The whole proceduretakes 30 minutes at most. Shelf life of recons tuted frozen plateletsis 6 hours, during storage in 20 – 24oC and agita on. Before therou ne use, we performed a valida on study with 15 produced unitsof frozen platelets. All 15 units of checked platelets meet specifi edcriteria a er recons tu on: Plt 200 – 420 x 109/unit, le -<1 x106/unit, RBCs – <6.8 x 109/unit, sterile, posi ve swirling, no aggregates,pH – >6.4. Compared to fresh apheresis platelets, frozen plateletsare (par ally) ac vated, clot strength measured by TEG with citratedkaolin is reduced, and onset of clo ng and clot amplifi ca on is faster.

CLOSING REMARKSFrozen platelets are a benefi cial alterna ve not only for militaryblood banks, but also for civilian blood banks which do not havea permanent stock of fresh platelets available. Due to rela velyeasy prepara on, the cost of frozen platelets is not high and theirstoring in small portable deep freezers does not bring any signifi cantaddi onal expenses. Procedure of thawing and recons tu on of frozen platelets is very simple and fast, and it allows for havingquality platelets products when dealing with massive bleedings andother urgent situa ons.

INTRODUCTIONUne hémorragie massive et une transfusion massive sont associées à une morbidité et une mortalité accrues chez les pa ents gravement blessés. L’u lisa on agressive et précoce des produits sanguins chez ces patients peut corriger la coagulopathie, contrôler le saignement, et améliorer les résultats. La mortalité est évitable si les globules rouges, le plasma et les plaque es sont disponibles dès que possible. En raison de leur durée de vie très courte, avoir uneréserve journalière de plaque es fraîches n’est pas possible pour de nombreuses banques de sang de l’hôpital. La solu on alterna ve est un stock de plaque es congelées qui est u lisé avec succès dans la médecine militaire.

DEFISuite à l’expérience de la banque de sang militaire des Pays-Bas, nous me ons en pra que une produc on et l’u lisa on de plaque es congelées.

CORPS DU SUJETPlaquettes d’aphérèse, déleucocytées, avec un nombre de thrombocytes >280 x 109/unité, sont (après sépara on et élimina on du surnageant) congelées à-80°C, avec 5% de DMSO, et stockées à la même température pendant 2ans. Pour une u lisa on clinique, il y a les plaque es décongelés, groupe O, recons tués dans du plasma décongelé, de groupe AB. La recons tu on est un processus simple qui consiste à décongeler les plaque es et le plasma au bain-marie et à ajouter le plasma aux plaque es en procédant au mélange. Toute la procédure prend 30 minutes tout au plus. Durée de vie des plaque es congelées recons tuées est de 6 heures, avec stockage entre 20-24°C et l’agita on. Avant l’u lisa on de rou ne, nous avons réalisé une étude de valida on avec 15 unités produites de plaque es congelées. Les 15 unités de plaque es vérifi ées sa sfont aux critères spécifi és après recons tu on : Plt 200-420 x 109/unit, globules rouges <6,8 x 109/unit, stérile, tourbillonnement posi f, aucun agrégats, pH>6,4. Par rapport aux plaque es d’aphérèse fraîches, les plaque es congelées sont (par ellement) ac vées, la rétrac on du caillot mesuré par TEG avec kaolin citraté est réduite, et l’appari on du caillot de coagula on et de l’amplifi ca on est plus rapide.

MOT DE LA FINLes plaquettes congelées sont une alternative bénéfique non seulement pour les banques de sang militaires, mais aussi pour les banques de sang civiles qui n’ont pas un stock permanent de plaque es fraîche disponibles. Grâce à une prépara on rela vement facile, le coût des plaque es congelées n’est pas élevé et leur stockage

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dans de pe ts congélateurs portables n’apporte pas de dépenses supplémentaires importantes. La Procédure de décongéla on et de recons tu on des plaque es congelées est très simple et rapide, et permet d’avoir des produits de plaque es de qualité lorsqu’il s’agit de saignements massifs et d’autres situa ons d’urgence.

A POLICY REVIEWof national blood transfusion polices in Africa

UN EXAMEN DES POLITIQUES na onales de tranfusion sanguine en Afrique

Veena Sharma,1 Oliver Hassali1, Alex owusu-ofori 1, 2, Imelda Batest2 1

1. Liverpool school of tropical medicine, Liverpool, UK 1. Liverpool School of Tropical Medicine, Liverpool, Royaume-Uni2. Kwame Nkrumah university of sciences and technology, 2. Université Kwame Nkrumah des sciences et de la technologie,

Kumasi, Ghana Kumasi, Ghana

KEY WORDSAfrica; blood transfusion; health policy; evidence-based; policy and prac ce; blood transfusion; health policy; evidence-based; policy and prac ce; blood safety.

MOTS CLÉSAfrique ; transfusion sanguine ; la poli que de santé ; fondées sur des preuves ; la poli que et la pra que ; la sécurité du sang.

INTRODUCTIONThe world health organization (WHO) programme on bloodtransfusion safety advocates the development and implementa onof na onal blood policies, but there has been limited research onblood transfusion policies in Africa. Policies must be evidence-basedand context-specifi c to ensure local needs are met, but it is unclearto what extent local evidence informs African blood policies.

AIMS AND OBJECTIVESTo review African na onal blood policies and WHO guidelines, andiden fy their strengths and weaknesses.

STUDY DESIGN AND METHODSForty-two countries from the WHO African region were included.Polices were iden fi ed and obtained by conduc ng a web search inFrench and English, and contac ng representa ves of na onal bloodservices. Policies were analyzed qualita vely, and a list of commonlyaccepted policies and discrepancies between policies generated andcompared with the evidence.

INTRODUCTIONLe programme de l’Organisa on mondiale de la santé (OMS) surla sécurité transfusionnelle préconise le développement et la mise en œuvre des poli ques na onales de transfusion sanguine, mais il y’a eu peu de recherches sur les poli ques de transfusion sanguine en Afrique. Les poli ques doivent être fondées sur des preuves et s’assurer que les besoins locaux sont sa sfaits en tenant compte du contexte local, mais on ne sait dans quelle mesure les éléments de preuves locales s’informent sur les poli ques na onales de transfusion en Afrique.

OBJECTIFSExaminer les poli ques na onales de transfusion sanguine africaine et les direc ves de l’OMS, et iden fi er leurs forces et leurs faiblesses.

CONCEPTION DE L’ÉTUDE ET MÉTHODESQuarante-deux pays de la Région africaine de l’OMS ont été inclus. Les poli ques ont été iden fi ées et obtenues en eff ectuant une recherche sur le Web en français et en anglais, et en contactant les représentants des services na onaux de transfusion sanguine. Les poli ques ont été analysées qualita vement et une liste des poli ques communément admise et des divergences générées, entre les poli ques ont été comparés par rapport aux éléments de preuve.

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RESULTSNa onal blood transfusion polices from fi een countries and threeWHO policy document were obtained for review. Eleven of thena onal polices referenced the WHO directly or acknowledged theirsupport and infl uence. Twelve items were common to more than half of na onal policies. These were: strict donor criteria; recruitment of exclusively voluntary donors; prohibi on of paid donors maintainingdonor confi den ality; provision of pre-dona on counseling fordonors; ABO and Rh grouping as a minimum; ensuring blood can be traced to its donor; screening for transfusion transmi ed infec ons(TTIs); proper disposal of infected blood; appropriate clinical use of blood; standardized blood request forms and obtaining informedconsent from pa ents prior to blood transfusion. Two thirds of theseitems were also present in one or more of the WHO documents.Conversely, there were fi ve areas of signifi cant diff erences betweenpolicies. These were: specifi c donor selec on criteria; the TTIsfor which blood should be screened; blood storage condi ons,informa on required for blood transfusion requests and transfusionmonitoring criteria. Blood donor and pa ent safety were emphasizedin most policies. Some policies were imprecise or lacked evidence,par cularly in a local context. The exclusive recruitment of voluntarydonors was common to nearly every policy and directly confl icts withevidence from several studies from Africa illustra ng no signifi cantdiff erence in the seroprevalence of hepa s B and replacementdonors dona ng for the fi rst me.

DISCUSSION AND CONCLUSIONSSome blood transfusion policies in Africa are underpinned byevidence and ethics, and positively contribute to the region’sblood services. However, the imprecise policies leave room forinterpreta on and may not be carried out as intended. When context–specifi c evidence is lacking, exis ng policies may not address local needs and further research is required in these cases. Na onal bloodservices should take this into account when referring to external policies, including those of the WHO, and modify recommenda onsas necessary. The presence of policy confl ic ng with evidencedindicates that research alone is insuffi cient and more eff orts shouldbe made to ensure policy and prac ce and more eff orts should be made to ensure policy and prac ce and prac ce are evidence-based.

RÉSULTATSLes poli ques na onales de quinze pays et trois documents sur la poli que de l’orienta on sanguine de l’OMS ont été obtenus et examinés. Onze des poli ques na onales se référent aux documents de l’OMS directement ou reconnaissent leur infl uence. Douze ar cles sont communs à plus de la moi é des poli ques na onales.Ce sont : critères strictes pour les donneurs de sang ; le recrutement de donneurs volontaires exclusivement ; l’interdic on d’avoir recours aux donneurs rémunérés ; le main en de la confi den alité pour les donneurs de sang, le fait de prodiguer des conseils aux donneurs avant le don; pra quer au minimum un groupage sanguin ABO et Rh, s’assurer de la traçabilité don-donneur ; le dépistage des infec ons transmises par transfusion (ITT), l’élimina on appropriée du sang infecté ; l’u lisa on clinique appropriée du sang ; les deux ers de ces éléments sont retrouvés dans un ou plusieurs des documents de l’OMS. Inversement, il y avait cinq domaines de diff érence signifi ca ve entre les poli ques ? Ce sont : les critères de sélec ondes donneurs spécifi ques ; les ITT pour lesquels le sang soit êtreanalysé, les condi ons de stockage du sang, les informa ons requises pour les demandes de transfusion sanguine ; et les critères de surveillance de la transfusion. Le sang, les donneurs et la sécuritédes patients ont été soulignée dans la plupart des politiques. Certaines poli ques étaient imprécises où n’avaient pas de preuve, en par culier dans le contexte local. Le recrutement exclusif de donneurs volontaires est commun à presque toutes les poli ques et diverge avec la preuve apportée par plusieurs études sur l’Afrique illustrant aucune diff érence signifi ca ve dans la séroprévalence del’hépa te B et du VIH entre les bénévoles et les donneurs familiauxde remplacement qui font un don de sang pour la premier fois.

DISCUSSION ET CONCLUSIONCertaines politiques de transfusion sanguine en Afrique sont soutenues par des éléments de preuve et par l’éthique, et contribuent posi vement aux services de transfusion sanguine de la région. Cependant, les poli ques imprécises laissent placeà l’interpréta on et ne peuvent pas être menées comme prévu. Lorsque des données spécifi ques au contexte local font défaut, lespoli ques existantes ne peuvent pas répondre aux besoins locauxet d’autres recherches sont nécessaires dans ces cas. Les services na onaux de transfusion sanguine doivent en tenir compte lorsqu’ils font référence aux poli ques extérieures, y compris celles de l’OMS, en apportant les modifi ca ons nécessaires aux recommanda ons. L’existence d’une poli que en contradic on avec les éléments de preuve indique que la recherche ne suffi t pas et davantage d’eff orts doivent être déployés pour assurer que la poli que et la pra que soient fondées sur des éléments de preuves.

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BLOOD DEMAND AND ESTIMATION of unmet Transfusion needs Tanzania 2013

LES DEMANDES DE SANG ET L’ESTIMATION des besoins non sa sfaits enma ere de Transfusion, en Tanzanie

Bakary Drammehy , Sonal Pathak, Anindya De, Abdu Juma, Regina Kutaga, Mwanakheir Mahmoud, Dunstan Haule, Senga Sembusa, ,Karen Chang, Efespar Nkya, Naomi Bock, Anthony Mar n

KEYWORDSblood demand, transfusion, na onal blood services, Tanzania.

BACKGROUNDNa onal blood transfusion services in Africa o en have challengesmee ng pa ent demand, even with a small number of transfusion facili es. Blood collec on targets using a threshold of 10 dona onsper 1,000 popula ons are o en not achievable, and the actualunmet demand for blood is unknown. Es mates of how much bloodis needed to meet blood transfusion requests are lacking. The goal of this prospec ve study was to determine blood demand at theseven zonal blood centers in Tanzania, based on the total numberof blood components requested.

STUDY DESIGN AND METHODSA total of 42 transfusion hospitals (out of 266 na onally) wereprobabilis cally selected and stra fi ed by type and loca on. Bloodbank registers and pa ents fi les were reviewed daily from June17-September 27, 2013. Pa ents histories and demographics; the numbers of blood component units (i.e., whole blood, red cells,platelets, fresh frozen plasma) requested/issued/transfused; pre-transfusion tests, signs, symptoms and vital signs were abstractedusing a ques onnaire. The primary outcome measures were thenumber of units requested and issued. The unmet blood demandwas defi ned as units requested but not issued due to unavailableblood components.

RESULTS (see a ached table)Table 1: requested, issued and transfused blood and componentsfor 42 Tanzanian hospitals by zone from June 17 2013 September27th 2013A total of 14,706 blood transfusion hospitals requests were reviewedduring the 3.5 month study period. These records included 21,409 units of blood components requested; 16,728 units issued; 4681units not issued. Of the units issued, 93.5% were transfused; easternzone had a lower transfusion rate of 89%. Blood components wererequested as a whole blood (80.2%), adult red cells (11.5%), pediatricred cells (5.4%), platelets (1.4%) and fresh frozen plasma (1.5%); foradults (72%) and children (28%). Unmet prescrip ons accounted for21.9% of all requests, 25.8% and 11.5% respec vely for requests foradults and children. Eastern zone had the most blood requests (8432units), highest unmet need (40.5%) and underu liza on (11.3%).Lake zone reported the lowest unmet need (0.3%). On average, 1.5units of blood components were ordered per request.

CONTEXTELes services na onaux de transfusion sanguine en Afrique doivent souvent relever des défi s quant à la demande des pa ents, mêmeavec un pe t nombre d’établissements de transfusion. Les objec fs de collecte de sang en u lisant un seuil de 10 dons pour 1000 habitants ne sont pas souvent réalisables, et la demande non sa sfaite réelle pour le sang est inconnue. Les es ma ons de la quan té de sang nécessaire pour répondre aux demandes de transfusion sanguine font défaut. Le but de ce e étude prospec ve était de déterminer la demande de sang dans les sept centres de transfusion des zones en Tanzanie, sur la base du nombre total de composants sanguins requis.

CONCEPTION ET LES MÉTHODES D’ÉTUDEUn total de 42 hôpitaux de transfusion (sur 266 à l’échelle na onale) a été sélec onné et stra fi é selon le type et l’emplacement. Les registres des banques de sang et les dossiers des pa ents ont été examinés tous les jours pendant la période allant du 17 juin au 27 septembre 2013.L’historique et les données démographiques des pa ents, Le nombre d’unités de produits sanguins (par exemple, le sang total, les CGR, plaque es, plasma frais congelé) demandé/distribué/transfusé ; les tests de pré-transfusion, les signes, les symptômes et les signes vitaux ont été extraites à l’aide d’un ques onnaire. Les principales données de résultat ont été le nombre d’unités demandées et délivrées. La demande de sang non sa sfaite a été défi nie comme étant les unités demandées mais non reçues du fait de l’indisponibilité des produits sanguins.

RÉSULTATS DE L’ÉTUDELes processus ont été classés en cinq ac vités principales : Le recrutement, la collecte de sang, la produc on de composants du sang, qualifi ca on des dons, stockage/distribu on. Les coûts directs représentent 59% des coûts totaux. Le facteur de coût majeur est la collecte de sang à 22% des coûts et l’ac vité de moindre coût est la produc on de composants de sang à 4%. La main-d’œuvre directe représente 10,5% des coûts totaux. La main-d’œuvre indirecte 12,8% des coûts totaux. La qualifi ca on cons tue 14%. Ces résultats sont en moyenne valables sur une période de trois ans. Pour les ac vités combinées, le travail reste l’élément de coût important et représente 36% des coûts totaux.

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CONCLUSIONOverall, among the 42 transfusion hospitals surveyed, almost 80%of the blood demand was met during the 3.5 months of the study.This informa on can be used to set blood collec on targets basedon current hospital demand. Regional varia ons and blood demandoutside transfusion hospitals require further explora on.

CONCLUSIONLe coût du sang et produits sanguins varie par des alterna ves et des interven ons de la direc on. La direc on doit iden fi er et analyser les diff érents facteurs qui infl uent sur les coûts associés aux ac vités menées dans le recrutement, la sélection et la production de composants sanguins. Cela permet d’évaluer la ges on des pilotes d’ac vités alterna ves qui pourraient être plus rentable en termes d’heure machine, de travail, de matériel, etc. L’analyse des facteurs de coûts devrait être u lisée comme une base pour évaluer un coût et disposer d’un modèle de fi nancement du sang.

THE IMPACT OF A DECADE OF PEPFAR SUPPORTon blood safety in Kenya

L’IMPACT D’UNE DECENNIE DE SOUTIEN DU PEPFAR a la securitetransfuionnelle au Kenya

Daniel Kimani,,1 Jane Mwang,1 Sanuel Mwalili,1 Mercy Njeru1

1. US Centres for Disease Control and Preven on (CDC), Division of Global HIV/AIDS (DGHA), Nairobi, Kenya1. Etats-Unis Centers for Disease Control and Preven on (CDC), Division de la surveillance mondiale du VIH/Sida (DGHA), Nairobi, Kenya

KEYWORDSBlood, PEPFAR, Transfusion – Transmissible Infec ons, Kenya Na onal Blood Transfusion Service

MOTS CLÉSSang, PEPFAR, les infec ons transmissibles par transfusion, Kenya Na onal Blood Transfusion Service.

INTRODUCTIONThe President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Centres for Disease Control and Preven on (CDC) has been suppor ng the Kenya Na onal Blood Transfusion Service (KNBTS) tomeet its mandate of providing safe and suffi cient blood to Kenyans for a decade. This is a part of eff orts in HIV preven on. The supporthas included policy, infrastructure, and human capacity developmentand quality management systems.

METHODOLOGYNa onal programma c data from KNBTS were reviewed from 2004to 2013. Data were collected on the number of blood units collectedannually and on prevalence of HIV, Hepa s B Virus (HBV), Hepa sC Virus (HCV) and Syphillis. A trend analysis was done to test for theannual percentage change (APC).

RESULTSBlood collec on was 37,734 blood units in 2003 and increased to156,891 units in 2013 an increase of 316%.Data for prevalence of transfusion – transmissible infec ons (TTls)among blood donors was available for the later 6 years. The TTl prevalence declined between 2007 and 2012 as follows: HIV: 1.2%to 0.5%; HBV: 2.8% to 1.4%; HCV: 0.9% to 0.5%. There was no changein syphilis prevalence remaining at 0.3% both in 2007 and 2012.

INTRODUCTIONLe plan d’urgence du Président pour la lu e contre le sida (PEPFAR)à travers le centre américain, Centerfor Disease Control and Preven on (CDC) a soutenu le Service Na onal de transfusion sanguine du Kenya (KNBTS) à s’acqui er de son mandat pour ce qui est de l’approvisionnement en sang sûr et suffi sant aux Kenyans pour une décennie. Cela fait par e des eff orts de préven on du VIH. Lesou en ainclu la poli que, les infrastructures et le développementdes capacités humaines et des systèmes de ges on de la qualité.

MÉTHODOLOGIELes données na onales telles que programmées, du KNBTS ont été examinés pour la période allant de 2004 à 2013. Ces données ont été recueillies sur le nombre d’unités de sang collecté chaque année et sur la prévalence du VIH, de l’hépa te B (VHB), du virus de l’hépa te C (VHC) et de la syphilis. Une analyse des tendances aété réalisée pour tester la varia on annuelle en pourcentage (APC).

RÉSULTATSLa collecte de sang a été de 37734 unités de sang en 2003 et estpassée à 156 891 unités en 2013, soit une augmenta on de 316%.Les données sur la prévalence des infec ons transmissibles par transfusion (ITT) chez les donneurs de sang étaient disponibles pour les 6 dernières années. La prévalence des ITT a diminué entre 2007

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The APC for: HIV was -17.3% (95% Cl; -59 to 184.6% ) , HBV was -14.4% (95% Cl; -38.6 to 19.1%), HCV was -10.4% (95% Cl; - 50.7to 63%) and Syphilis was 8.1% (95% CL; -59 to 184.6%). All the TTlswith the excep on of syphilis had nega ve APC, though none of theAPCs was shown to be sta s cally signifi cant.

CONCLUSIONThese fi ndings indicate that a decade of PEPFAR has led to anincrease in the number of blood units collected and a decrease in TTlprevalence. Access to safer blood for pa ents needing transfusionhas improved.

et 2012 comme suit : VIH de 1,2% à 0,5% ; VHB de 2,8% à 1.4% ; HCV de 0,9% à 0,5%. Il n’y avait pas de changement dans la prévalence de la syphilis qui est restée à 0,3% en 2007 et pareil en 2012. Pour cequi est de l’APC. Le VIH était -17,3% (IC à 95% -49,2 à 34,8%), le VHB était -14,4% (IC à 95% -38,6 à 19,1%), le VHC était -10,4% (IC à 95% -50,7 à 63%) et de la syphilis a été de 8,1% (IC à 95% -59 à 184,6%).Toutes les ITT à l’excep on de la syphilis avaient une APC néga ve, aucune des APC ne s’est avérée sta s quement signifi ca ve.

CONCLUSION Ces résultats indiquent que le sou en de PEPFAR pendant une décennie a conduit à une augmenta on du nombre d’unités de sang collecté et une diminu on de la prévalence des ITT. La transfusion s’est améliorée avec un accès à un sang plus sûr pour les personnes nécessitant une transfusion.

PREVALENCE OF BACTERIA CONTAMINATION IN BLOOD AND BLOOD PRODUCTSat National Blood Service Zimbabwe

PREVALENCE DE LA CONTAMINATION BACTERIENNE DANSLE SANG ET DANS LES PRODUITS SANGUINS au service na onal de transfusion sanguine du Zimbabwe

Ngonidzashe Makuni,g , Prof C. Simango, Dr. R.T. Mavengwa

KEYWORDSBacterial contamina on, blood/blood products, blood safety

MOTS CLÉSContamina on bactérienne, sang/produits sanguins, la sécurité transfusionnelle.

INTRODUCTIONThe safety of donated blood from transfusion transmissible infec ons(TTIs) has always been the top priority in transfusion prac ce.Technological advantages in screening for viral TTIs have greatlyimproved the safety of blood. However, bacterial contamina onof blood products is emerging as a new threat to blood safety andthe commonest cause of transfusion related fatality. In Zimbabwe,the demand for blood products is rising whilst data on bacterialcontamina on of blood products is scare. Although the prevalenceof transfusion related bacterial sepsis has not been established inZimbabwe, reports on transfusion related complica ons suggest thatprevalence of bacterial contamina on of blood components is of clinical relevance. We set out this study to determine the prevalenceof bacterial contamina on as well as to iden fy bacterial species contamina ng blood products in an urban blood service centre inHarare, Zimbabwe.

INTRODUCTIONLa sécurité des dons de sang pour éviter les infec ons transmissibles par transfusion (ITT) a toujours été la priorité dans la pra que de la transfusionnelle. Les avancées technologiques en ma ère de dépistage des ITT virales ont considérablement amélioré la sécurité du sang. Cependant, la contamina on bactérienne des produitssanguins est entrain de devenir une nouvelle menace pour la sécurité du sang et une des causes les plus fréquentes de mortalité liée à la transfusion. Au Zimbabwe, la demande en produits sanguins est en hausse alors que les données sur la contamina on bactérienne des produits sanguins sont rares. Bien que la prévalence de sep cémies bactériennes liées à la transfusion n’ait pas été établie au Zimbabwe, des rapports sur des complica ons transfusionnelles, suggère que la prévalence de la contamina on bactérienne des composants sanguins est de per nence clinique. Ce e étude a été eff ectuée pour déterminer la prévalence de la contamina on bactérienne ainsi que pour iden fi er les espèces bactériennes à l’origine de la contamina on des produits sanguins dans un centre urbain de service de transfusion sanguine à Harare, Zimbabwe.

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AIMS AND OBJECTIVESThis study was designed to es mate the prevalence of bacterialcontamina on in blood products and iden fy implicated bacteria.We also set to iden fy blood products mostly aff ected with a viewof advocating for improved infection control and appropriateinterven on measures.

STUDY DESIGN AND METHODSThis cross-sec onal study was conducted in Harare, Zimbabwe between April and August 2013. Random samples were collectedfrom screened blood and blood products consis ng of packed cells,whole blood and platelets. Samples were collected using asep c techniques, inoculated into Typton soy Broth and incubated for 7days at 37 oC. Sub-culturing was done onto blood Agar, chocolateAgar and MacConkey Agar; Isolated bacteria were identifiedusing standard microbiological techniques and suscep bility toan microbial agents was done using the disc diff usion and KirbyBauer methods.

RESULTS196 samples were randomly collected and cultured. From thesesamples, the overall prevalence of bacterial contamina on was3%(6/196, packed cells 1.3%, {2/149}, whole blood 0% {0/8} andplatelets 10.3%,{4/39} ). Isolated bacteria included staphylococcusaurues 2/6(33%), coagulase negative staphylococci 1/6(17%),bacillus sp 2/6(33%) and Escherichia coli 1/6(17%). The isolatedgram posi ve bacteria were sensi ve to erythromycin, gentamicin,and clindamycin while resistant to tetracycline.

DISCUSSION AND CONCLUSION The high prevalence of bacterial contamina on in blood products suggests that pa ents who receive blood products suggests that pa ent who receive blood products, especially platelets are at riskof developing infec on. Clinical outcome following contaminatedproducts is however dependent on a range of factors which includecurrent medica on and virulence of implicated bacteria. There isneed for introduc on of approved methods to reduce bacterialcontamina on in donated blood to ensure improved pa ent safety.

BUTS ET OBJECTIFSCette étude a été menée pour estimer la prévalence de la contamina on bactérienne des produits sanguins et iden fi er les bactéries impliquées. Nous avons également cherché à iden fi er les produits sanguins les plus touchés en vue de plaider pour un meilleur contrôle de l’infec on et me re en place les mesures d’interven on appropriées.

ETUDES ET MÉTHODESIl s’agit d’une étude transversale menée à Harare, au Zimbabwe entre Avril et Août 2013. Des échan llons aléatoires ont été prélevés à par r du sang testé parmi les produits sanguins, comprenant des concentrés de globules, du sang total des plaque es. Les échan llons ont été recueillis à l’aide de techniques asep ques, inoculés dans du Typton bouillon de soja et incubés pendant 7 jours à 37°C. Une sous-culture a été eff ectuée sur gélose au sang, gélose MacConkey. Les bactéries isolées ont été iden fi és en u lisant des techniques microbiologiques standard et la sensibilité aux agents an microbiens a été réalisée en u lisant la méthode de diff usion sur disques et la méthode Kirby Bauer.

RÉSULTATS196 échan llons ont été prélevés au hasard mis en culture. A par r de ces échan llons, la prévalence globale de la contamina on bactérienne était de 3% (6/196), 1,3% pour les concentrés de globules rouges (2/149), 0% pour le sang total (0/8) et pour les plaque es 10,3%, (4/39)). Parmi les bactéries isolées on trouve,Staphylococcie aureus 2/6 (33%), des staphylocoques à coagulasse néga ve 1/6 (17%), Bacillus sp 2/6 (33%) et Escherichia coli 1/6 (17%). Les bactéries Gram positives isolées étaient sensibles à l’érythromycine, la gentamicine, la clindamycine cependant résistantes à la tétracycline.

DISCUSSION ET CONCLUSIONLa forte prévalence de contamina on bactérienne des produits sanguins suggère que les patients qui reçoivent des produits sanguins, en particulier les plaquettes présentent un risque pour développer une infec on. Les résultats cliniques suite à la transfusion de produits contaminés dépendent cependant d’une série de facteurs qui comprennent les médicaments et la virulencedes bactéries impliquées. Il est nécessaire d’introduire des méthodes approuvées pour réduire la contamina on bactérienne des produits sanguins transfusés pour assurer une meilleure sécurité des pa ents.

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DISCREPANCIES IN IMMUNUOHEMATOLOGY in immunuohematology

LES DISCORDANCES en immunohematologie

L. Siransy-Bouguiy g , B. Dembele, A. Abisse, S. Konate ,

1. Na onal centre for Blood Transfusion-Abidjan 2. Unit Training and Research (UFR) Medical sciences Department of Immunology-Abidjan 3. Unit Training and Research (UFR) Pharmaceu cal sciences Department of Immunology-Abidgan4. Centre Hospitalier universitaire de Cocody(CHU)

1. Centre Na onal de Transfusion sanguine-Abidjan2. Unité de Forma on et de recherche (UFR) Sciences médicales département d’immunologie-Abidjan.3. Unité de Forma on et de recherche (UFR) sciences pharmaceu ques département d’immunologie-Abidjan.4. Centre Hospitalier Universitaire de Cocody (CHU)

KEYWORDSABO-RH, blood safety, discrepancies, immunohematology, typing errors.

MOTS CLÉSGroupes sanguins ABO-RH, sécurité transfusionnelle, discordances, immunohématologie, erreurs de groupage.

SUMMARYImmunohematology is a rela vely complex biological discipline.However the error is unacceptable because it can have seriousconsequences in a transfused pa ent. Unfailing rigor should beapplied to the sampling and its iden fi ca on then, when performing,valida on and interpreta on of immunohematology tests. Reagents, consumables and equipment used must be validated throughinternal and na onal controls. The errors of the donor iden fi ca onare poten ally serious in blood groupings if the results are used forthe delivery of blood products.

OBJECTIVEIn this study we iden fy challenges encountered when performingthe determina on of ABO-RH grouping, in order to determine theirfrequency and to iden fy the main causes.

MATERIALS AND METHODSThis is a prospec ve study in the laboratory of biological qualifi ca onof dona ons (QBD) of the blood transfusion centre of Abidjancovering the period May 2011 to march 2012 on the discrepanciesobserved between plasma and erythrocyte test blood grouping.After performing blood grouping, each technician records theresults in the so ware donor management progress maksystem.ABO discrepancies and/ or HR is reported when the results of current donor specimens are diff erent from each other or diff erentfrom previous known results. Discrepancies were confi rmed a errestar ng grouping by another couple of technicians on specimensof the day and on the tubes of blood bags. To iden fy the various causes we checked the iden fi ca on of samples examined the recordsheets, and records of consulta on and sampling.

RÉSUMEL’immunohématologie est une discipline biologique rela vement complexe. Toutefois l’erreur est inadmissible car elle peut avoir des conséquences gravissimes chez un pa ent transfusé. Une rigueur sans faille doit donc être appliquée au prélèvement, à son identification puis à la réalisation, à la validation et à l’interpréta on des analyses en immunohématologie. Les réac fs, les consommables et les équipements u lisés doivent être validés grâce à des contrôles internes et na onaux.Les anomalies d’iden fi ca on des donneurs lors des groupages sanguins sont poten ellement graves si les résultats sont u lisés pour la délivrance de produits sanguins.

OBJECTIFNos travaux présentent ici les diffi cultés rencontrés notamment dans la détermina on des groupes sanguins ABO –RH, en vue de déterminer leurs fréquences et d’iden fi er les principales causes.

MATÉRIEL ET MÉTHODESIl s’agit d’une étude prospec ve au laboratoire de qualifi ca on biologique des dons (QBD) du Centre de transfusion sanguine d’Abidjan de mai 2011 à mars 2012 portant sur les discordances observées entre l’épreuve globulaire et l’épreuve plasma que du groupage sanguin.Après le groupage, chaque technicien enregistre ses résultats dans le logiciel de ges on des donneurs Progesa de Maksystem. Les discordances ABO et/ou RH sont signalées lorsque les résultats des spécimens actuels du donneur sont diff érents entre eux ou diff érents des résultats connus antérieurs. Les discordances ont été confi rmées après reprise du groupage par un autre couple de techniciens sur les spécimens du jour et sur les boudins des poches de sang.

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RESULTS210 discrepancies were detected, which means 4-5 errors per week.The frequency of detectable cases is 21cases/10000.190 errorsconcern the ABO system and the 20 the RH system.• 55.30% of errors are related to the iden fi ca on and registra on

of donors at the recep on,• 34.20% related to technical and data entry due to laboratory.• 6.38% related to the labeling of tubes and bags during the

sampling, 4.60% unexplained,• 20 discrepancies are observed during the Rh grouping and due

to technical errors in detec on of weak D an gen.

CONCLUSIONImmunohematology testing is based on simples’ principles.Interpreta on of results can however present some diffi cul es.The majority of problems encountered require the training of thediff erent actors involved in the process and precise and rigorousformal approach.

Pour iden fi er les diff érentes causes, nous avons vérifi é l’iden fi ca on des échan llons, examiné les fi ches d’enregistrement, et les registres des services de consulta on et de prélèvement.

RÉSULTATS210 déterminations de groupe incohérentes vis-à-vis de leurs antériorités ont été détectées, soit 4 à 5 erreurs d’iden fi ca on par semaine. La fréquence des cas détectables était de 21cas/1000.190 erreurs dans le système ABO et 20 dans le système RH :• 55,30% lié à l’iden fi ca on et l’enregistrement des donneurs

à l’accueil,• 34,20% lié aux techniques et à la saisie imputable au laboratoire.• 6,38% lié à l’é quetage de tubes et poches lors du prélèvement,• 4,60% non expliqué,• Les 20 discordances RH observées étaient dues à des erreurs

techniques de détec on de l’an gène D faible.

CONCLUSIONLa réalisa on technique des analyses d’immunohématologie repose sur des principes simples. L’interprétation des résultats peut toutefois présenter quelques diffi cultés. La majorité des diffi cultés rencontrées impose la forma on des diff érents acteurs impliqués dans le processus et une démarche rigoureuse précise et formalisée.

Tel: 011 430 7000 Sharecall: 086 111 7736 Website: www.ssemmthembu.co.za Email: [email protected]

Quality You Can TrustDistributors of Blood Bags, Blood Collection & Processing Equipment

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GENERAL INFORMATIONAFRICA SOCIETY FOR BLOOD TRANSFUSION

GLOBAL BLOOD FUND extracted from website

Global Blood Fund is a not-for-profi t charity established in 2008. It is run by prac cing professionals working in blood dona on management in the US and Europe. The aim is simple; to save lives by improving the availability and safety of blood in some of the world’s poorest na ons. GBF focuses par cularly on enabling blood services in developing countries to nurture that most precious of resources – their blood donors. GBF has provided money, equipment and other forms of support to countries in Africa, Asia, the Caribbean and South America.

GBF recognized that blood centres in North America and Europe rou nely dispose of usable equipment. These items, which are in good condi on, can however be used to advantage by blood services in Africa. GBF recognises that the donors of equipment may not know which African blood services could benefi t from this equipment. Also, poten al recipients do not know what equipment is available. To facilitate the communica on between donors and recipients of equipment GBF has created EqXchange.

EqXchange is a free-to-use, online portal that makes it possible for:• Donors to register equipment or services they would like to donate to in-need blood services.• Registered users to view what is available and request that the equipment be donated to their blood transfusion service.• Blood collectors in Africa to post their needs for review by be er-resourced services. This can be equipment, but requests for technical

exper se can also be made. It is a way for developing blood services to get support from blood banking experts across all disciplines.

The link takes you through to the EqXchange portal where there is further informa on and the opportunity to register. If you do have any queries, please contact [email protected]

EDITORIAL BOARD OF THE AFRICA SANGUINE

Editor-in-Chief fBanji Adewuyi (Nigeria)French Editor Claude Tayou Tagny (Cameroon) Produc on Editor Leesha Raman (South Africa)

Other EditorsLudovic Anani (Benin)Jus na Ansah (Ghana)Kamel Boukef (Tunisia)David Chama (Zambia)John Eggington (United Kingdom)Olivier Garraud (France)Isaac Kajja (Uganda)Robin Knight (United Kingdom)Malcolm Needs (United Kingdom)Jean-Bap ste Tapko (Cameroon)Tracy Thurgood (United Kingdom)Mark Williams (United Kingdom)

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AABB INFORMATION extracted from AABB website

AABB MembershipMembership is a great way to stay up-to-date, build your technical skills and professional knowledge while networking with your peers – on a global scale, go to: h p://www.aabb.org/about/join/Pages/individual.aspx

AABB ProgrammesPrograms & Services content encompasses the major program areas within AABB. Included within this sec on is informa on on transfusion, cellular therapies and pa ent blood management; a sec on devoted to the why, where and how of blood dona on; consul ng services, a division of AABB that provides managerial and technical assistance to facili es worldwide; disaster response, which provides background on ac vi es and resources intended to help facili es be be er prepared in the event of a disaster or pandemic aff ec ng the blood supply; AABB publica ons such as newsle ers and the offi cial journal; and the Na onal Blood Exchange, a resource-sharing program.

AABB publica onsThis sec on provides access to all AABB publica ons, including Associa on Bulle ns as well as the associa on’s journal, Transfusion; monthlymagazine, AABB News; weekly e-newsle er, AABB Weekly Report; daily e-newsle er, AABB SmartBrief; and several quarterly e-newsle ers on specifi c topics or ini a ves related to transfusion medicine and cellular therapies.h p://www.aabb.org/programs/publica ons/Pages/default.aspx

AABB SmartBrief link (free sign up)Free daily email newsle er with summaries of the latest news stories.www.aabb.org/programs/publica ons/Pages/smartbrief.aspx

ACKNOWLEDGEMENTSAfSBT acknowledges with gra tude the support of the Na onal Bioproducts Ins tute in covering the cost of produc on of the journal, Africa Sanguine.

DISCLAIMERThe AfSBT and Editors cannot be held responsible for errors or any consequences arising from the use of informa on contained in this journal; the view and opinions expressed do not necessarily refl ect those of the AfSBT and Editors, neither does the publica on of adver sements cons tute any endorsement by the AfSBT and Editors of the products adver sed.

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Submissions for considera on may include original scien fi c ar cles (which will be peer reviewed), short reports, le ers to the Editor, reviews, congress proceedings, and reprints of published ar cles (with permission).

ORIGINAL SCIENTIFIC WORK MUST MEETTHE FOLLOWING REQUIREMENTS:

1. Be a report of original study by the Author(s)

2. Be wri en in English or French

3. Not have been published elsewhere or submi ed to anotherJournal for publica on. If submission had been presented as aConference Abstract or paper, which must be acknowledged. Itmust not have been published as full ar cle in the Proceedings

4. The Title page must show the names of all Authors, followedby Ins tu onal affi lia ons in lower font, with superscript Arabnumerals to iden fy Authors. The main or corresponding Authormust be indicated, and contact details including e-mail, andtelephone number provided where applicable. A short runningTitle, and 3-5 Keywords should be provided on the Title page.

5. A structured ABSTRACT of not more than 250 words must beprovided under the following subheadings:a. Background/Introduc onb. Aims and Objec vesc. Study design / Materials and Methodsd. Resultse. Conclusion.

Le ers to the Editor and Brief Reports do not require Abstracts, and will be published at the discre on of the Editor.

6. The Manuscript should not exceed 10,000 words, including Tables and Figures. The forma ng requirements of the text are: Font Arial, size 10. Abbrevia ons in the text must be preceded by full expression of the term(s) the fi rst me of appearance, followed by the abbreviation in parenthesis. Standard abbrevia ons and units of measurement must be used wherever applicable. Tables and Figures must be kept simple, with Titles above and Legends below. The same data should be represented by either a Table or a Figure as preferred by the Author, not both.

7. References must be checked for accuracy by the author(s), and befully indexed. References, which must be in the Vancouver style,must be represented by super-script Arab numerals in the text,and be listed in the order of appearance, a er the Conclusion.Where there are many Authors in the Reference, at least thefi rst three must be listed fully, before the use of the words ‘et al’.llCommas should be used to separate Authors’ names, without fullstops between or a er ini als, except at the end.

Examples of References:a. Egah DZ, Banwat EB, Audu ES, Iya D, Mandong BM, Anele AA, et

al. Hepa s B surface an gen, hepa s C and HIV an bodies ina low-risk blood donor group in Nigeria. East Mediterr Health J.2007;13:961-6

b. Ferrera C, Monet D. Clinical Use of Blood. 2e ed. Paris: LocktBlackwell, 1997.

c. Beide ET Indica ons for Fresh Frozen Plasma, In: Fererra C,Monet D. Clinical Use of Blood 2e ed, Paris: Lockt Blackwell,1997: p 1-15

d. Telly G Blood donor in Africa In: ISBT, State of the Art LecturesXXIIIrd Congress of the ISBT, Basel, Karger, 1994, p25-6.

8. Report of research on human subjects must comply with theprinciples of the Declara on of Helsinki (1964), and must include evidence of ethical approval by the Authori es of the Ins tu onor Country. Evidence or statement must also be shown of informed consent of the Subjects. The Editors reserve the rightto reject any submission with ques onable ethical jus fi ca on.Views expressed in a published ar cle belong to the Authors,and the Journal will not be held responsible.

9. Evidence must be provided of the consent of all Authors topublish submissions in Africa Sanguine.

10. Produc on of ManuscriptsManuscripts should be produced in Microso Word format.Basic text should be used, and complex forma ng avoided,especially in Tables and Figures. Manuscripts should be easy to update/change to comply with the forma ng of theJournal. Authors must provide the en re manuscript in a single submission.

11. Manuscripts should be submi ed to the Editor-in-Chief, and/orthe Produc on Editor as an a achment to email.


CONTRIBUTION GUIDELINES: Instructions to Authors

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GUIDE POUR CONTRIBUTION Instructions aux Auteurs

Les soumissions de manuscrits pour publica on peuvent être destravaux scien fi ques originaux (qui seront relu par les pairs), descourtes notes, des le res à l’éditeur, des revues, des présenta onsde congrès, des réédi ons d’ar cles publiés (avec permission).

LES TRAVAUX SCIENTIFIQUES ORIGINAUX DOIVENT REMPLIR LES CONDITIONS SUIVANTES :

1. Etre un rapport d’un travail original par l(es) Auteur(s)

2. Etre écrit en français ou en anglais

3. N’avoir pas été publié dans un journal ou soumis dans un autrepour publica on. Si la soumission avait été présentée commeun abstract ou un papier au cours d’une conférence, elle ne doit pas avoir été publiée comme un ar cle en er

4. La page Titre doit montrer le nom de tous les Auteurs, suiviepar les affi lia ons ins tu onnelles en pe ts caractères, avec deschiff res arabes en exposant pour iden fi er les Auteurs. L’Auteurprincipal ou correspondant doit être indiqué, et les détails de son contact dont l’email, le numéro de téléphone fournis lorsquedisponibles. Un court Titre et 3-5 Mots clés devraient fi gurersur la page Titre.

5. Un ABSTRACT structuré de moins de 250 mots doit être fourniet comporter les sous- tres suivants :a. Contexte/Introduc onb. But et objec fsc. Type d’étude, matériels et méthodesd. Résultatse. Conclusions.

Les le res à l’éditeur et des courtes notes ne requièrent pasd’abstracts, et seront publiées à la discré on de l’éditeur.

6. Le manuscrit ne doit pas dépasser 10.000 mots y compris les tables et fi gures. Les exigences de formatage du texte sont : Arial, taille 10. Les abrévia ons dans le texte doivent êtreprécédées par une expression complète des termes lors de leur première appari on, suivie par l’abrévia on entre parenthèses. Les abrévia ons standards et les unités de mesure doivent être u lisées quand c’est nécessaire. Les tables et fi gures doivent être simples, avec les tres au dessus et les légendes en dessous. Les mêmes données devront être représentées soit dans la table, soit dans la fi gure selon la préférence de l’Auteur mais pas dans les deux.

7. Les références doivent être vérifi ées correctement par les Auteurs et être entièrement indexées. Les références, qui doivent être dans le style Vancouver, doivent être représentées dans le texte par un chiff re arabe en exposant, et être listéesdans leur ordre d’appari on, après la conclusion. Lorsqu’il ya plusieurs Auteurs dans la référence, au moins les 3 premiers doivent être listés en èrement avant l’u lisa on des mots “et al”. Les virgules devront être u lisées pour séparer les noms des Auteurs, sans les points entre et après les ini ales, sauf à la fi n. Exemples de Références:a. Egah DZ, Banwat EB, Audu ES, Iya D, Mandong BM, Anele

AA, et al. Hepa s B surface an gen, hepa s C and HIV an bodies in a low-risk blood donor group in Nigeria. East Mediterr Health J. 2007;13:961-6

b. Ferrera C, Monet D. Clinical Use of Blood. 2e ed. Paris: Lockt Blackwell, 1997.

c. Beide ET Indica ons for Fresh Frozen Plasma, In: Fererra C,Monet D. Clinical Use of Blood 2e ed, Paris: Lockt Blackwell, 1997: p 1-15

d. Telly G Blood donor in Africa In: ISBT, State of the Art Lectures XXIIIrd Congress of the ISBT, Basel, Karger, 1994, p25-6.

Contact details for all Submissions and Correspondence

For more details visit website: www.afsbt.orgf g

Prof Banji ADEWUYI,Editor-in-Chief, (Nigeria)Email: [email protected] @yTelephone +2348037135170

Mrs Leesha RAMAN,Production Editor (South Africa)C/O National Bioproducts InstitutePrivate Bag X9043 Pinetown 3600Republic of South Africa.Email: [email protected]@g

Dr Claude Tayou TAGNY, French Editor (Cameroon)Faculty of Medicine and Biomedical Sciences, University of YaoundeP.O. Box 4806 Yaounde CAMEROONEmail: [email protected] @y f

49


8. Le rapport de la recherche sur les humains doit correspondre auxprincipes de la Déclara on d’Helsinki (1964), et doit inclure une évidence d’approba on éthique par les autorités de l’ins tu onou du pays. Une évidence ou une déclara on doit égalementêtre apportée sur le consentement éclairé des Sujets. Les éditeurs se réservent le droit de rejeter toute soumission avec justifi cation éthique douteuse. Les opinions exprimées dans un article publié appartiennent aux Auteurs, et le journal ne sera pas tenu pour responsable.

9. La preuve doit être fournie sur le consentement de tous les Auteurs pour les contributions à publier dans AfricaSanguine

10. La Production de Manuscrits Les manuscrits doivent être produits au format Microsoft

Word. Le texte de base doit être utilisé, et la mise en forme complexe doit être évitée, en particulier dans les tableaux et fi gures. Les manuscrits doivent être faciles à mettre à jour, à modifi er pour se conformer à la mise en forme de la Revue. Les Auteurs doivent fournir l’ensemble du manuscrit en un seul envoi.

11. Les manuscrits doivent être adressés aux éditeurs, et / ou le directeur de la production dont les adresses se trouvent ci-dessous.

Détails de contact pour toute soumission ou correspondance

Pour plus de détails, visiter le site web: www.afsbt.orgf g

Prof Banji ADEWUYI,Editeur en Chef (Nigeria)Email: [email protected] @yTelephone: +2348037135170

Mrs Leesha RAMAN,Editeur chargée de la produc on(République d’Afrique du Sud)C/O Na onal Bioproducts Ins tutePrivate bag X9043, Pinetown, 3600République d’Afrique du [email protected]@g

Dr Claude Tayou TAGNY, Editeur de langue française (Cameroun)Faculty of Medicine and Biomedical Sciences, Université de Yaoundé [email protected] @y f

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editor’s note note de l’editeur - afsbt

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