Prevalence and specificity of red blood cell antibodies in patients transfused in tertiary hospitals in Burkina Faso.

BACKGROUND: Sub-Saharan African countries face the challenge of immunological transfusion safety that puts many patients at risk of post-transfusion hemolytic reactions. This is because pre-transfusion testing for irregular/unexpected antibodies that helps to prevent these risks are neither universally available nor accessible. The aim of our study was to determine the prevalence of red blood cell alloantibodies and their specificity in patients transfused in Burkina Faso. MATERIALS AND METHODS: This was a cross-sectional study including patients who had received at least one blood transfusion. Indirect antiglobulin testing using LISS-enhanced medium gel column agglutination technique was used for antibodies screening and identification. Enzymatic technique with papain-treated red cell reagent was performed in attempt to solve some difficulties if necessary as well as auto-control test and RH-KEL phenotyping when possible to help antibodies identification. RESULTS: A total of 832 patients were included, 51.6% of whom were female, and the median (IQR) age was 34 (20-49) years. Of these, 43.7% had chronic kidney disease and 20.4% were sickle cell patients. The median (IQR) number of immunisation episodes (blood transfusion and pregnancies) was 3 (2-6) with the median (IQR) number of blood units received per patient of 2 (1-5). The proportion of patients with RBCs antibodies was 6.4% (53/832), with mainly anti-Rh antibodies. A combination of 2 antibodies was found in 7 patients and a combination of 3 antibodies in one patient. Antibodies of unknown specificity (AUS) were encountered in 29%. Independent factors associated with antibody positivity were age (OR = 1.02; p = 0.026), sickle cell disease (OR = 3.23; p = 0.017) and receiving more than 10 blood units (OR = 7.33; p = 0.01). CONCLUSION: In this study, the proportion of patients with RBC antibodies was quite similar to that observed in Sub-Saharan African countries. However, the availability and accessibility of pre-transfusion compatibility tests as well as the quality of methods used should be improved to ensure the safety of blood transfusions.

Public Health Program for Decreasing Risk for Ebola Virus Disease Resurgence from Survivors of the 2013-2016 Outbreak, Guinea.

At the end of the 2013-2016 Ebola virus disease outbreak in Guinea, we implemented an alert system for early detection of Ebola resurgence among survivors. Survivors were asked to report health alerts in their household and provide body fluid specimens for laboratory testing. During April-September 2016, a total of 1,075 (88%) of 1,215 survivors participated in the system; follow up occurred at a median of 16 months after discharge (interquartile range 14-18 months). Of these, 784 acted as focal points and reported 1,136 alerts (including 4 deaths among survivors). A total of 372 (91%) of 408 eligible survivors had >1 semen specimen tested; of 817 semen specimens, 5 samples from 4 survivors were positive up to 512 days after discharge. No lochia (0/7) or breast milk (0/69) specimens tested positive. Our findings underscore the importance of long-term monitoring of survivors' semen samples in an Ebola-affected country.

Seroprevalence and factors associated with IgG anti-DENV positivity in blood donors in Burkina Faso during the 2016 dengue outbreak and implications for blood supply.

OBJECTIVES: Our study aimed to update the seroprevalence and factors associated with anti-dengue virus (DENV) antibody positivity among blood donors and to discuss their implications for blood supply. BACKGROUND: Questions on the potential transmission of DENV by transfusion increased after the documentation of the risk of transmission of the West Nile virus. This risk was estimated after transfusion of DENV RNA-positive blood units of up to 37.5%. In Burkina Faso, very few studies on DENV in blood donors have been conducted. As a result, there were no reliable data on DENV to allow the implementation of appropriate measures to control the risk of transmission of the dengue virus by blood transfusion. METHODS: We conducted a 4-week cross-sectional study from December 4 to 30, 2016. Blood donors of both genders, aged 18-60 years, accepted for blood donation after medical selection were consecutively enrolled. RESULTS: Our study included a total of 1007 blood donors, in which donors living in urban areas represented 78.2%. The mean age was 26.1 ± 8.1 years. After adjustment in a multiple regression logistic model, the odds of having IgG anti-DENV increased as age increased. The odds of DENV was 53% lower in rural areas (OR = 0.47; P = .000) compared to urban settings and 42% lower in mobile sites (OR = 0.58; P = .03) compared to fixed ones. CONCLUSION: Our study provides new and useful insights for future research on the risk of TT-DENV throughout blood transfusion.

Distribution of ABO and RHD blood group antigens in blood donors in Burkina Faso.

Geographical distribution of ABO and RHD antigens is important for blood transfusion services and population genetics studies. There are few data on this topic in Burkina Faso, a multi-ethnic country. Our study aims at reporting phenotypic and allelic frequencies of ABO and RHD blood groups among voluntary blood donors from various ethnical regions of Burkina Faso. We conducted a cross-sectional study including 81,486 blood donors. ABO allelic frequencies were determined using the Bernstein method. Differences in phenotypic distribution of blood groups were assessed using the chi-square test; a p value <0.05 being considered as statistically significant. We noticed that O+>B+>A+>AB+>O->B->A->AB- in our population. Phenotypic frequencies of blood groups A, B, O and AB were respectively 22.54%, 28.56%, 43.30% and 5.60%. RHD+was 92.24%. The allelic frequencies of A, B, O and D were respectively 0.1524; 0.1887; 0.6590 and 0.7214. We noticed statistical differences (p < 0.05) between these administrative regions which corresponded roughly to some natural ethnic areas. Indeed, the phenotype O was more frequent in the Central-west, Central and East regions corresponding to "Mossi," "Gourounsi," "Gourmantché" areas while the phenotype A and AB were more reported in "Boucle du mouhoun" and "Hauts-Bassins" regions where we have "Bwaba" and "Bobo." The phenotype O negative was less frequent in "Bwaba." Our study provides interesting information to blood services that will allow them to better refine their donor recruitment strategies.

Hepatitis B and C virus seroprevalence, Burkina Faso: a cross-sectional study.

OBJECTIVE: To estimate population-wide hepatitis B and C seroprevalence using dried blood spot samples acquired for human immunodeficiency virus (HIV) surveillance as part of the 2010-2011 Demographic and Health Survey in Burkina Faso. METHODS: We used the database acquired during the multistage, clustered, population-based survey, in which 15 377 participants completed questionnaires and provided dried blood spot samples for HIV testing. We extracted sociodemographic and geographic data including age, sex, ethnicity, education, wealth, marital status and region for each participant. We performed hepatitis B and C assays on 14 886 HIV-negative samples between March to October 2015, and calculated weighted percentages of hepatitis seroprevalence for each variable. FINDINGS: We estimated seroprevalence as 9.1% (95% confidence interval, CI: 8.5-9.7) for the hepatitis B surface antigen and 3.6% (95% CI: 3.3-3.8) for hepatitis C virus antibodies, classifying Burkina Faso as highly endemic for hepatitis B and low-intermediate for hepatitis C. The seroprevalence of hepatitis was higher in men than in women, and varied significantly for both with age, education, ethnicity and region. Extremely high HCV-Ab seroprevalence (13.2%; 95% CI: 10.6-15.7) was identified in the Sud-Ouest region, in particular within the youngest age group (15-20 years), indicating an ongoing epidemic. CONCLUSION: Our population-representative hepatitis seroprevalence estimates in Burkina Faso advocate for the inclusion of hepatitis serological tests and risk factor questionnaire items in future surveys, the results of which are crucial for the development of appropriate health policies and infection control programmes.

[Prognostic factors and survival in adult acute leukemia in Burkina Faso]. / Facteurs pronostiques et survie des leucémies aiguës de l'adulte au Burkina Faso.

Introduction: Acute leukemia is both a diagnostic and therapeutic emergency. Our study aimed to describe the prognostic factors and survival of adults with acute leukemia in Burkina Faso. Patients and methods: Cross-sectional descriptive study with retrospective data collection covering a period of 4.5 years (2018-2022) in two university hospitals in Burkina Faso. Were included all patients over 18 years hospitalized for acute leukemia in these sites with a usable medical record. Results: A total of 42 cases were collected, of which 45% suffered from acute lymphoblastic leukemia and 43% from acute myeloid leukemia. In 12% of cases, acute leukemia was not classified. The average age was 35 ± 15 years, with extremes of 19 and 72 years. 12% of the patients presented an age of poor prognosis. Comorbidities were present in 14% of patients. The deterioration in general condition was fairly constant with 95% of patients at WHO stages 3 and 4. All patients presented with bone marrow failure syndrome and tumor syndrome was found in 45%. Anemia and thrombocytopenia were present in almost all cases. Hyperleukocytosis at diagnosis was present in 28 patients (67%); among them 18 patients (64%) had leukocytes greater than 50 G/L. Death in hospital was found in 38% of patients and loss of sight in 31%. The median survival was 3 months. Survival was 30% at 6 months and 0% at 12 months. Conclusion: Acute leukemias are in our practice conditions of poor prognosis with a fairly short survival.

Establishment of reference values for prothrombin time, activated partial thromboplastin time and fibrinogen in adults in Burkina Faso.

The ordering of clinical haemostasis tests is increasing in Burkina Faso due to the newly emergence of cardiovascular and metabolic diseases. However, appropriate local reference values (RV) are lacking. Our study aimed to establish RV for prothrombin time (PT), activated partial thromboplastin time (aPTT) and fibrinogen assays. In 2020, we carried out a cross-sectional study at the transfusion centre of Ouagadougou and included 280 healthy blood donors (140 males and 140 females) as reference subjects (RS) according to CLSI guidelines (C28 A3). From each RS a 5 mL blood sample had been withdrawn in citrated tubes. We performed PT, aPTT and fibrinogen assays using the Sysmex™ CA660 coagulometer and Siemens™ reagents. RV were calculated using the "central 95 percentile" method. Reference values of PT, aPTT and Fibrinogen were respectively [73.84%-117.50%], [20,01-29.45] seconds and [2.04-3.83] g/L for females and [58.81%-112,31%] seconds, [20,9-29,98] seconds and [1.58-3.35] g/L for males. We report for the first time locally appropriate haemostasis RV for the Burkina Faso adult's population. They will be of clinical use to our health care professionals.

[Alloimmunisation in polytransfused patients with non-phenotyped red blood cells at the University Hospital Souro Sanou of Bobo Dioulasso (Burkina Faso)]. / Allo-immunisation chez les patients polytransfusés avec des concentrés de globules rouges non phénotypés au Centre Hospitalier Universitaire Souro Sanou de Bobo Dioulasso (Burkina Faso).

Introduction: in Burkina Faso, blood transfusion is carried out with only ABO and RHD compatibility between the donor and the recipient. Such a practice carries risks of alloimmunisation, which can lead to clinical complications especially in polytransfused patients. The objective is to determine the prevalence and factors associated with alloimmunisation in polytransfused patients with non-phenotyped red blood cells at Souro Sanou University Hospital. Methods: we conducted a cross-sectional study in polytransfused patients in the clinical departments of the University Hospital Souro Sanou over a 3-month period (March to May 2019). In each of the 141 patients included, 5 ml of whole blood was collected in an ethylenediaminetetraacetic acid (EDTA) tube for testing for irregular antibodies. Irregular antibody testing was performed using the indirect Coombs gel filtration technical. Results: in total, the frequency of alloimmunisation obtained was 5.67%. The majority of the antibodies identified belonged to the Rhesus systems and Kell. We found no statistically significant relationship between age, sex, disease history, number of bags transfused and the positivity of the Irregular Antibody test (p = 0.37, p = 0, 75, p = 0.96). Conclusion: we found that the risk of alloimmunisation is major. Additional measures should be taken to strengthen the immunological safety of transfusions in Burkina Faso. We propose that in Burkina Faso, anti-globulin compatibility testing should be performed systematically in patients with a high risk of immunisation.

Red blood cell alloimmunisation in multi-transfused patients from an haemodialysis service in Burkina Faso.

Background: In Burkina Faso, red blood cell (RBC) transfusion remains the crucial anaemia treatment following chronic renal failure (CRF) as erythropoietin and its analogues are unavailable. However, blood group matching beyond the ABO and Rhesus is not common in Burkina Faso. Thus, alloimmunisation is a potential issue for transfused patients. Objective: Our study aimed to identify anti-erythrocyte antibodies in multi-transfused CRF patients at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso. Methods: This cross-sectional study, conducted from October 2018 to November 2019, included CRF patients who had received at least two RBC units. We screened patients for the presence of RBC antibodies using three commercial Cells panels and identified antibody specificities for positive screenings using 11 Cells panels for an indirect antiglobulin test (IAT) in a low ionic strength microcolumn gel-card system. Results: Two hundred and thirty-five patients (45.1% female; average age: 41.5 years) were included. The median number of blood units received per patient was 10 (interquartile range: 5-20). The overall alloimmunisation rate was 5.9% (14/235). Antibodies identified included: anti-D (1 case), anti-C (1 case), anti-D+C (4 cases), anti-CW (1 case), anti-E (1 case), anti-S (1 case) and anti-Lea (1 case). In four positive patients, the specificity of the antibodies was indeterminate. No risk factors were associated with alloimmunisation. Conclusion: In Burkina Faso, screening for RBC alloantibodies should be mandated for patients at risk. The high rate of indeterminate antibodies suggests the need to develop a local RBC antibody panel adapted to the local population.

Poor procedures and quality control among nonaffiliated blood centers in Burkina Faso: an argument for expanding the reach of the national blood transfusion center.

INTRODUCTION: The World Health Organization (WHO) recommends the creation of national blood transfusion services. Burkina Faso has a CNTS (Centre National de Transfusion Sanguine-National Blood Transfusion Center) but it currently covers only 53% of the national blood supply versus 47% produced by independent hospital blood banks. STUDY DESIGN: To evaluate blood collection, testing, preparation, and prescription practices in the regions of Burkina Faso that are not covered by the CNTS, a cross-sectional survey was conducted. METHODS: Data were collected by trained professionals from May to June 2009 at 42 autonomous blood centers not covered by the CNTS. RESULTS: Blood collection was supervised in all sites by laboratory technicians without specific training. There was no marketing of community blood donation nor mobile collection. Donation was restricted to replacement (family) donors in 21.4% of sites. Predonation screening of donors was performed in 63.4% of sites, but some did not use written questionnaires. Testing for HIV, hepatitis B virus, and syphilis was universal, although some sites did not screen for hepatitis C virus. In 83.3% of the sites, blood typing was performed without reverse ABO typing. In 97.6% of the sites, nurses acted alone or in conjunction with a physician to order blood transfusions. CONCLUSION: Shortcomings in non-CNTS blood centers argue for the development of a truly national CNTS. Such a national center should coordinate and supervise all blood transfusion activities, and is the essential first step for improving and institutionalizing blood transfusion safety and efficacy in a developing country.

Recruitment of blood donors in Burkina Faso: how to avoid donations from family members?

Burkina Faso is a continental West African country of approximately 16 M people whose transfusion needs were covered by 66,210 blood units collected mostly in 4 regional transfusion centers part of a national network but also from hospital-based smaller blood centers. The first group of blood centers relies almost exclusively on volunteer, non-remunerated, blood donors and only approximately 32.7% of them are repeating donation. In contrast, hospital-based blood centers rely nearly exclusively on family/replacement donors. The general strategy of the national blood transfusion network was to base the system exclusively on volunteer donors, which was nearly accomplished overall and completely at Bobo-Dioulasso, the largest center. However, despite considerable increase in blood collection, the overall blood supply remains low (4.7 units/1000 inhabitants) and worsens during the secondary school recesses since young student blood constitutes the most part of volunteer donors. To overcome such shortages, mobile blood collection sessions are organized in alternate sites such as military barracks or places of worship but with limited success. Another critical issue is that despite considerable efforts and help from community advocates, only 32.7% of volunteers repeat donation limiting the considerably safety advantage of a pool of regular donors.

Blood transfusion requirements among children with severe malarial anemia: a cross-sectional study in a second level reference hospital in Burkina Faso.

INTRODUCTION: blood transfusion (BT) is an important part of pediatrics healthcare in sub-Saharan Africa because of anemia due to malaria, malnutrition and hereditary anomalies of red blood cells. However, BT services experienced chronic blood shortage, unsafe blood products and poor procedures of clinical use of blood. This results in inadequate management of severe anemia. METHODS: to assess the quality of BT requirements in severe malarial anemia at the regional hospital center of Koudougou in Burkina Faso, we carried out a cross-sectional study including 402 children with severe malaria (WHO 2000 criteria). RESULTS: over the study period, severe malaria represented 45.6% (402/882) of pediatric admissions. Anemia was observed in 97.5% (392/402) of cases and BT was required for 78.4% (315/402). The median age was 16 months (IQR 9-27) and the average hemoglobin was 51.4±22.2 g/L. The prescriptions were in accordance with WHO and national guidelines respectively in 63.8% and 92.7%. Blood units were issued in 99.4% (350/352) of blood orderings. Out of 350 blood units delivered, blood was administered in 98% (343/350). The median actual time to transfusion was 65 minutes (IQR: 45-100) and median transfusion duration was 73.8 minutes (IQR: 47.5-110). The signs of intolerance to anemia disappeared in 134/138 cases (97.1%) and the average haemoglobin increased of 37.9±17.6 g/L. Death occurred in 23 cases (5.7%). CONCLUSION: the management of severe malaria requires blood transfusion in almost half of cases. Blood was available to meet most requests. However, efforts are still required for proper use of the blood.

Residual risk of HIV, HCV, and HBV transmission by blood transfusion between 2015 and 2017 at the Regional Blood Transfusion Center of Ouagadougou, Burkina Faso.

INTRODUCTION: In sub-Saharan Africa, the high endemicity of blood-borne infections is a serious threat to transfusion safety. In order to improve transfusion safety, Burkina Faso has undertaken in recent years a reorganization of its blood-transfusion system through the creation of a National Blood Transfusion Center, which is the only blood operator in the whole country. This study aimed to estimate the residual risk of transmission of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) by blood transfusion at the Regional Blood Transfusion Center (RBTC) of Ouagadougou. METHODS: This was a retrospective study conducted at the RBTC of Ouagadougou between 2015 and 2017. Prevalence of infectious markers was calculated for first-time donors and incidence rates calculated for repeat donors who had made at least two donations of blood over the study period. Residual risks were estimated for the three viruses (HIV, HBV, and HCV) by multiplying the incidence rate per 100,000 person-years by the respective durations of serological windows. RESULTS: Between 2015 and 2017, of a total of 84,299 blood donors, 68,391 (81.13%) were first-time donors compared to 15,908 (18.87%) repeat donors. The seroprevalence of HBV (8.56%) was twice that of HCV (4.40%) and fourfold that of HIV (1.80%). Incidence rates were 1,215, 2,601, and 1,599 per 100,000 donations for HIV, HCV, and HBV, respectively. In contrast, the estimated residual risk for HCV (1 in 213 donations) was double that of HBV (1 in 408 donations) and four times that of HIV (1 in 1,366). CONCLUSION: The residual risk of transmission of these viruses by blood transfusion remains high in repeat donors. An effective donor-retention and education policy could help to reduce this residual risk.

Subsequent mortality in survivors of Ebola virus disease in Guinea: a nationwide retrospective cohort study.

BACKGROUND: A record number of people survived Ebola virus infection in the 2013-16 outbreak in west Africa, and the number of survivors has increased after subsequent outbreaks. A range of post-Ebola sequelae have been reported in survivors, but little is known about subsequent mortality. We aimed to investigate subsequent mortality among people discharged from Ebola treatment units. METHODS: From Dec 8, 2015, Surveillance Active en ceinture, the Guinean national survivors' monitoring programme, attempted to contact and follow-up all survivors of Ebola virus disease who were discharged from Ebola treatment units. Survivors were followed up until Sept 30, 2016, and deaths up to this timepoint were recorded. Verbal autopsies were done to gain information about survivors of Ebola virus disease who subsequently died from their closest family members. We calculated the age-standardised mortality ratio compared with the general Guinean population, and assessed risk factors for mortality using survival analysis and a Cox proportional hazards regression model. FINDINGS: Of the 1270 survivors of Ebola virus disease who were discharged from Ebola treatment units in Guinea, information was retrieved for 1130 (89%). Compared with the general Guinean population, survivors of Ebola virus disease had a more than five-times increased risk of mortality up to Dec 31, 2015 (age-standardised mortality ratio 5·2 [95% CI 4·0-6·8]), a mean of 1 year of follow-up after discharge. Thereafter (ie, from Jan 1-Sept 30, 2016), mortality did not differ between survivors of Ebola virus disease and the general population. (0·6 [95% CI 0·2-1·4]). Overall, 59 deaths were reported, and the cause of death was tentatively attributed to renal failure in 37 cases, mostly on the basis of reported anuria. Longer stays (ie, equal to or longer than the median stay) in Ebola treatment units were associated with an increased risk of late death compared with shorter stays (adjusted hazard ratio 2·62 [95% CI 1·43-4·79]). INTERPRETATION: Mortality was high in people who recovered from Ebola virus disease and were discharged from Ebola treatment units in Guinea. The finding that survivors who were hospitalised for longer during primary infection had an increased risk of death, could help to guide current and future survivors' programmes and in the prioritisation of funds in resource-constrained settings. The role of renal failure in late deaths after recovery from Ebola virus disease should be investigated. FUNDING: WHO, International Medical Corps, and the Guinean Red Cross.

Traceability of Blood Transfusions and Reporting of Adverse Reactions in Developing Countries: A Six-Year Postpilot Phase Experience in Burkina Faso.

Traceability is an essential tool for haemovigilance and transfusion safety. In Burkina Faso, the implementation of haemovigilance has been achieved as part of a pilot project from 2005 to 2009. Our study aims to evaluate the traceability of blood transfusions and reporting of adverse reactions over the 6-year postpilot phase. A cross-sectional study including all blood units ordered between 2010 and 2015 has been conducted in public and private health care facilities supplied with blood products by the transfusion center of Bobo-Dioulasso. The complete traceability was possible for 83.5% of blood units delivered. Adverse reactions were reported in 107 cases representing 2.1/1,000 blood units per annum. Transfusions of wrong blood to wrong patient were reported in 13 cases. Our study shows that the haemovigilance system in Burkina Faso must be improved. Healthcare workers have to be sensitized on how traceability and haemovigilance could impact the quality of care provided to patients.