[Difficulties of the care of public antigen alloimmunization]. / Difficultés de la prise en charge de l'allo-immunisation anti-public.

Alloimmunization against high-frequency erythrocyte antigens is a problematic situation in terms of laboratory diagnosis, transfusion and obstetrical management. We report the case of a pregnant woman alloimmunized against public Ag. We detail the difficulties of alloantibody (Ab) identification and transfusion management of the deliveries. A 29-year-old pregnant woman was hospitalized in gynecology and obstetrics departments at 36 weeks of gestation for assessment of hydrops fetalis. Antibody identification test revealed the presence of a pan-reactive antibody. Investigations realized in CNRGS (Paris) concluded in anti-GE2+anti-RH3+autoantibody. The red cell phenotype was GE: -2,3. A therapeutic interruption of the pregnancy was indicated. A program of autologous transfusion was organized with withdrawal of 2 units of blood. The 2nd pregnancy took place normally. Before delivery, an autologous blood reserve consisting of 2 red cell packs and 2 fresh frozen plasma was withdrawn and transfused after delivery. The management of anti-public alloimmunization poses several problems. The first one is of diagnostic nature with, on the one hand, the difficulty of Ab identification by the available red cell panels and, on the other hand, the possible presence of alloantibodies of transfusional or obstetric interest masked by anti-public Ab. The second is represented by transfusional care of these patients. In the absence of a national reserve of frozen rare blood, the autologous transfusion remains the only alternative. However, it can answer only a limited number of indications and only in case of moderate blood loss.

[Motivation and sociology of blood donors in Tunisia: reality and perspectives]. / Motivation et sociologie des donneurs de sang en Tunisie : réalités et perspectives.

In Tunisia, blood donation is voluntary, anonymous and non-remunerated. The aim of the study is to analyze donor motivation and sociology in the regional center of transfusion of Sfax. Between 14 May 2007 and 23 June 2007, a total of 903 Tunisian blood donors filled a questionnaire. Among the donors, 81.8% were men and have a mean age of 34.2 years and the majority of them have an age between 18 and 29 years. The middle social class was majority (77.8%) as well as the liberal profession (65.1%). Primary and secondary education were dominant (79.3%). Among the blood donors, 41.6% were new donors and 28.6% had a history of a single donation, 50.3% were voluntary and 49.7% replacement donors. The reasons motivating the voluntary donation were solidarity (69.9%), religion (21.2%), health benefit (3.6%) and insurance for the family (5.2%). The replacement donors refuse the voluntary donation for not obvious reasons (51%), lack of availability (13.3%), difficulties of accessibility of the sites of collection (7.6%), phobia of the blood and the stings (4.02%) or by refusal of blood donation (1.79%). The information and the raising awareness of the replacement donors could change in a near future their attitudes to become voluntary and regular donors. The implication of donor associations in the organization of the collections and the promotion of the blood donation would be of considerable contribution.

[Red blood cell immunization in haemoglobinopathie: about 84 cases]. / Immunisation anti-érythrocytaire dans les hémoglobinopathies : à propos de 84 cas.

AIMS: To estimate the rate of red cell immunization in hemoglobinopathies. PATIENTS AND METHODS: Prospective study (1990-2009) about 84 patients: 44 homozygous sickle cell anemia, one heterozygous sickle cell anemia S/C, 30 thalassemia and nine sickle cell anemia-thalassemia. The mean age was 10.13 years (extremes: 1-45). The red cell units transfused were ABORH1 compatible, then RH-KELL phenotyped after 2006 and phenocompatible after alloimmunisation. The cross-match was realized using indirect antiglobuline test. Irregular red cell antibody screening was realized before every transfusional episode and the direct antiglobuline test was done when there was a poor transfusional efficiency. RESULTS: The number of red blood cells units transfused was 3545 (42.2/patient). The number of red cell antibody screening and the number of direct antiglobulin test were respectively 1474 (17.5/patient) and 272 (3.2/patient). Twenty-seven antibodies were identified (32.1%): 14 alloantibodies (16.6%, 16.6% in sickle cell disease, 16.6% in thalassemia, P=1), 16 antoantibodies (19.04%, 11.1% in sickle cell disease, 33.3% in thalassemia, P=0.018). There were three cases of association of allo- and autoantibodies. The most frequent alloantibodies were anti-RH3 and anti-KEL1 and were developed after transfusion of standard red cell units. There was no significant relation, neither between sex and risk of immunization, nor between the number of red cell units transfused and alloimmunization. On the other hand, there was a significant relation between autoimmunization and the number of red cell units transfused in thalassemia (P<0.001). CONCLUSION: This study proves the interest of using RH-KELL red cell units compatible in patients with hemoglobinopathies in order to reduce alloimmunisation rates.

[Fulminant pneumonia during varicella in an immunocompetent 16-month-old girl]. / Pneumopathie fulminante au cours de la varicelle chez une fillette de 16 mois immunocompétente.

Varicella is a cosmopolitan communicable disease caused by varicella-zoster virus (VZV) characterized by papulovesicular rash and fever. Management of fever and pruritus and prevention of bacterial infection are the main aspects of treatment. Severe complications and death may occur in pregnancy, in newborns, in adults, and in immunocompromised children. Contrary to immunocompetent adults in whom pneumonia occurs in 50% of cases during varicella, this complication in children is rare. We report a fatal case of pneumonia with severe hypoxemia during varicella in an immunocompetent 16-month-old child. Based on a literature review, we discuss the main aspects of diagnosis, treatment, and prognosis of varicella. Active immunization of children after 12 months of age is the primary prevention of varicella.

[Irregular antibody testing during pregnancy in Tunisia: clinical study of 5369 women]. / Recherche des agglutinines irrégulières en milieu obstétrical en Tunisie: étude à propos de 5369 femmes.

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

[Hemogram reference values: study of 1000 healthy adults from Sfax]. / Valeurs de référence de l'hémogramme: étude chez 1000 adultes sains de la region de Sfax.

The aims of this study is to determine the hemogram reference values in a population of healthy adults of the region of Sfax, to compare our results with those from the literature, to estimate the age and sex variations in the blood count. The hemogram parameters were analyzed in 1000 blood donors. Hemogram was performed using Coulter ACT10's analyser. The differential leukocyte count was manually performed. The means of erythrocyte count, hemoglobin, haematocrit and red cell indices were significantly lower in women than in men. There was a significant variation in the red blood cell count, hemoglobin and haematocrit with age. There is also sex and age differences of the leukocyte count. The neutrophil and eiosinophil counts were higher in women than in men. The lymphocytes decreased with age in both sexes. The platelet count was significantly higher in women than in men. These results can be applied only to our local population of adults. The definition of reference values for the Tunisian population requires a study on a more diversified population, including more important number of individuals from various regions of the country.

Comparison of hepatitis A seroprevalence in blood donors in South Tunisia between 2000 and 2007.

The aim of the study was to assess hepatitis A virus (HAV) seroprevalence in blood donors from South Tunisia in two periods 2000 and 2007. Serum samples collected from 376 blood donors in each period aged 18 to 30 years from different regions of South Tunisia were analysed for anti-HAV IgG. The global seroprevalence of HAV infection was 85.9% in 2007 as compared with 94.9% in 2000. The seroprevalence in the 18-20 years age group was 91.9% in 2000 vs 80.6% in 2007, and increased to 99% in 2000 and 92% in 2007 in the subjects over 26. Taking account of geographic area, the HAV seroprevalence in Sfax city decreased from 88.9% in 2000 to 62.7% in 2007 (p < 0.001), but it is still approximatively the same in rural areas (98.4% and 96%) and in the governorates of South Tunisia (97.6% and 99.2%). In conclusion, the number of adults in the city of Sfax which are not immunized against HAV is increasing. Thus, adolescents and young adults are at risk to develop symptomatic and potentially severe hepatitis A.

[Evaluation of a prospective therapeutic protocol in adult patients with nonsevere aplastic anemia in South Tunisia]. / Evaluation d'un protocole thérapeutique prospectif des aplasies médullaires acquises non sévères de l'adulte dans le Sud tunisien.

INTRODUCTION: Immunosuppressive drugs are usually used in the treatment of acquired aplastic anemia (AAA). The aim of this study was to evaluate the efficiency of a prospective therapeutic protocol using cyclosporine and androgens in the treatment of adult patients with nonsevere AAA. METHODS: Twenty-nine patients diagnosed and treated at the University Hospital of Sfax (Tunisia), during a 10-year period (1991-2000) were included. In addition to symptomatic treatment (transfusion, antibiotics), all the patients received a specific treatment including two drugs: cyclosporine 5mg/kg per day and androgens 0,5mg/kg per day. RESULTS: The response rate at three, six and 12 months were 48, 75, and 87%, respectively. Survival rate was 52% at one year, and 37% at five and 10 years. The main toxicities were hepatic, renal, and hypertension, observed in 53, 16 and 15%, respectively. These toxicities were reversible in 65, 87 and 100% of the cases, respectively. CONCLUSION: The response and survival rates in our series are quite satisfactory when compared to those obtained with other immunosuppressive drugs (cyclosporine and antilymphocyte serum) in the literature. The addition of androgens in our patients seemed to potentiate the immunosuppression induced by ciclosporin, but secondary toxic effects were more common.

[Spontaneous perirenal urinoma during nephritic colic]. / Urinome périrénal spontané survenant au cours d'une colique néphrétique.

A case has been reported of the spontaneous rupture of the kidney during an attack of nephritic colic. This rare complication is due to excessive pressure in the renal cavities caused by an obstructive ureteral calculus. Complete resolution of the urinoma was obtained after endoscopic fragmentation of the calculus and double J stenting.

[Repair of urethrocutaneous fistula with double skin flap. Report of 32 cases]. / Réparation des fistules uréthrocutanées par double lambeau cutané. A propos de 32 cas.

OBJECTIVES: Urethro-cutaneous fistula constitutes the main complication of urethroplasty for hypospadias. The frequency of this complication ranges from 12 to 90%. The multiplicity of fistula closure techniques, reflects the difficulty involved in repairing these lesions. The authors evaluated fistula repair by a double pedicle skin flap according to the Wise technique. MATERIAL AND METHODS: 32 patients were treated: 18 had already undergone 34 attempted repairs of urethro-cutaneous fistulas complicating urethroplasties (9 Mathieu, 17 Duplay and 6 Leveuf) for anterior penile (9), middle penile (14) and penoscrotal hypospadias (9). In 14 cases, the Wise technique was the first procedure used to repair the fistula. RESULTS: The authors obtained 29 successes. The 3 failures concerned fistulas after Duplay urethroplasties to correct penoscrotal hypospadias. The overall success rate of this technique in our series (90%) was therefore close to that reported by Wise (5 out of 6 successes), who described this technique in 1977. CONCLUSION: The Wise technique is a good technique for repair of large, recurrent urethro-cutaneous fistulas after several attempts of repair.

[Prevalence of anti-CMV antibodies in blood donors in the Sfax region (value in blood transfusion)]. / Prévalence des anticorps anti-CMV chez les donneurs de sang de la région de Sfax (intérêt en transfusion sanguine).

Detection of anti-CMV antibodies was carried out in sera of healthy blood donors, divided into groups of 20 according to age and sex. Sera were tested for anti-CMV by an ELISA test (Enzygnost anti-CMV/IgG-Behring). Among 280 sera, 272 were positive for IgG to CMV (97.14%). The prevalence of those antibodies was high in all age stratum (95-100%) but was higher in women than in men (98.57% versus 95.71%). The titre of IgG to CMV was superior to 12 Ul/ml in 56.43% of CMV positive donors. So, the leucocyte removal is the only alternative for the prevention of post-transfusional CMV infection. The high percentage of donors with anti-CMV antibodies level more than to 12 Ul/ml allow to consider the use of plasmapheresis for preparing specific immunoglobulins to CMV.

[Markers of viral hepatitis in blood donors. Study apropos of 300 donors]. / Les marqueurs des hépatites virales chez les donneurs de sang. Etude à propos de 300 donneurs.

In order to locate the rate of positivity of the different markers of hepatitis that can be transmitted through blood (Ag HBs, anti-HBc Ab, anti-HCV Ab and transaminases (ALAT)), we have conducted a study over 300 blood donors and who are sale, equally shared between the parts of age and of sex. The ALAT were superior to the normalcy in 10.66% of the cases, the male sex being 3 times more affected than that of the female. The Ag HBs was positive in 4.66% of the cases. The male sex is twice as affected as the female sex. One of three persons who donated blood (37.33%) had anti-HBc Ab. Finally none of the 300 blood donors has the anti-HCV Ab. There's a very weak recovering between the presence of Ag HBs and of ALAT superior to the normalcy, a weak recovering between Ag HBs and anti-HBc Ab and a certain recovering between ALAT superior to the normalcy and the présence of anti-HBc Ab. There is no recovering between the anti-HCV Ab and the indirect markers. Eventually, the systematization of all these tests over each donation engenders the elimination of more than 2/5 of the collected products.