[Etiological profile of pancytopenia in adults in Marrakesh, Morocco]. / Profil etiologique des pancytopénies chez l'adulte a Marrakech (Maroc).

This retrospective study evaluated the frequency of different causes of pancytopenia in all adult patients with pancytopenia presenting to the Department of Haematology of Mohamed VI Hospital, Marrakesh from 1 January 2008 to 31 December 2010. A total of 118 cases of pancytopenia were found (average of 39 cases per year). The mean age of patients was 52 years (range 18-82 years) and 52.5% were male. The main clinical signs were pallor (100%), asthenia (100%) and fever (30.5%). Mean haemoglobin was 6.5 g/dL (range 2.9-9.2 g/dL), mean white blood cell count was 2360/mm3 (range 840-3360/mm3) and platelet count 66 000/mm3 (range 3000-123 000/mm3). Bone marrow aspiration was performed in 112 patients; megaloblastosis was found in 32.2% and marrow blasts in 23.7%. Anaemia due to vitamin B12 deficiency (32.2%), acute leukaemia (23.7%) and aplastic anaemia (15.2%) were the main causes of pancytopenia. Given the incidence of acute leukemia among our cases, patients presenting with pancytopenia require urgent diagnosis and treatment.

[Jugal swelling revealing acute lymphoblastic leukemia]. / Tuméfaction jugale révélant une leucémie aiguë lymphoblastique.

INTRODUCTION: Acute lymphoblastic leukemia (ALL) is the most common hematologic malignancy in children. The clinical presentation at diagnosis is due to bone marrow infiltration or extra-medullary involvement. Maxillofacial localization is very rare in ALL. We report a case of T-ALL revealed by right cheek swelling in a 14-year-old boy. CASE PRESENTATION: A 14-year-old boy had presented with a 6 cm right cheek swelling for two months, complicated by pyrexia, cervical adenopathy, and splenomegaly. CT scan revealed a 3×7×8 cm swelling surrounded by voluminous sub chin, subclavicular, mediastinal, and paratracheal bilateral adenopathies. The biological analyses revealed normocytic anemia, hyperleukocytosis with 83.6% blast cells, neutropenia, and thrombopenia. The biopsy histology and the immuno-histochemical analysis suggested a diffuse small-cell Non-Hodgkin lymphoma (NHL). The myelogram identified a type 1 ALL and immunophenotyping on bone marrow cells suggested phenotype T ALL. The patient was treated according to the MARALL-06 protocol and died on the 17th day of induction, in septic shock. DISCUSSION: Despite their rare occurrence, ALL should be included in the differential diagnosis of jugal swelling. The evident hematological context should suggest the diagnosis and a myelogram should be performed as soon as possible because the outcome is rapidly fatal.

[Prevalence of pica in iron deficiency anemia in Marrakech (Morocco)]. / Prévalence du pica au cours de l'anémie ferriprive à Marrakech (Maroc).

INTRODUCTION: Pica is an eating disorder, defined by long-term ingestion of non-nutritive substances. PURPOSE: To determine the frequency of pica in patients with iron deficiency anemia and to describe the population with both iron deficiency anemia and pica. PATIENTS AND METHODS: This retrospective study examined records from the department of hematology at the Mohammed VI University Hospital Center in Marrakech of all adult patients seen from January 1, 2005, through December 31, 2010 who met both criteria. Results: During the 6-year study period, 320 patients with iron deficiency anemia were seen: 256 women and 64 men (sex-ratio F/M: 4). The prevalence of pica among the patients with iron deficiency anemia was 17.5% (56/320). All the patients with pica were women, for a prevalence of 21.8% (56/256); their average age was 23 years; 40 were white (71.4%) and 16 black (28.6%). The clinical signs were primarily pallor (100%) and asthenia (100%). The mean level of hemoglobin was 7.6 g/dL and of ferritin, 6.4 mg/L. Geophagia was the most common form of pica (75%). Iron supplementation induced regression of pica in 64.3% of patients. CONCLUSION: Our study shows a high prevalence of pica in patients with iron deficiency anemia.

[Assessment of transfusion practice: assessing nurses' knowledge in transfusion medicine at Mohamed VI Hematology and Oncology Center of Marrakesh, Morocco]. / Évaluation de la pratique transfusionnelle : enquête au sein du personnel infirmier du centre d'oncologie-hématologie du CHU Mohammed VI de Marrakech, Maroc.

UNLABELLED: Blood transfusion is a complex activity, involving many actors. It is a high-risk activity which could not be controlled without the use of specific methods. Health care workers beliefs and organizational factors are two major issues for the blood transfusion safety. PURPOSE: In our medical center, transfusion medicine care practices were evaluated by testing the nursing staff with a list of questions. We carried out a cross-sectional study. The information was gathered by using an anonymous questionnaire. The latter was developed by foreign teams and adapted to the local context. Forty-two nurses have participated to study. Only 25% have appropriate knowledge and practice with no negative consequences for the patient safety. In our sample, poor knowledge and practice concerned mainly (1) pre-transfusion compatibility check when receiving blood units (30%); (2) delay in preservation of blood unit in the ward (65%); and (3) recognition of abnormal reactions after transfusion (40%). These results showed on which topics the teaching program should emphasize so as to improve the quality of blood transfusion in the medical centers according to legal obligations.

[Catheter fracture and pulmonary embolization of the distal fragment: a rare complication of the totally implantable venous access port]. / Rupture du cathéter et migration du fragment distal vers les artères pulmonaires : une complication rare des chambres à cathéter implantables.

INTRODUCTION: Totally implantable venous access port plays a crucial role in the treatment of patients in oncology. However, its use can result sporadically in catheter fracture with catheter tip embolization into pulmonary arteries. CASE REPORTS: We report this unusual but potentially serious complication in four patients. In these patients, the port had been inserted percutaneously into the subclavian vein using the infra-clavicular approach. This side effect occurred late in three patients. In all patients, the catheter fracture was asymptomatic or pauci-symptomatic and was caused by the pinch-off syndrome. The retrieval of the embolized fragments was successfully performed by transcatheter procedure in the cardiac catheterisation laboratory. CONCLUSION: We reviewed the literature and the newest guidelines and recommendations to detail the clinico-radiological features, the possible causes of this complication and discussed means to recognize, manage and prevent it.

[Circumcision in patients with hemophilia A in the Marrakech region (Morocco)]. / Circoncision chez les hémophiles A dans la région de Marrakech (Maroc).

Circumcision is a ritual in the Jewish and Muslim religions. It is the most common surgical procedure in the world and one of the oldest. Hemophilia A is an inherited, X-linked, recessive disorder caused by a deficiency of functional plasma clotting factor VIII. Circumcision in patients with hemophilia A is a major challenge, and its consequences can be fatal for this particular type of patient. The aim of this study is to evaluate our experience in circumcision of hemophilia patients and assess the safety of our protocol and the complications associated with it.

[Clinical, biological and therapeutic profile of anemia by vitamin B12 deficiency in the department of hematology of Marrakech (Morocco)]. / Profil clinique, biologique, et thérapeutique de l'anémie par carence en vitamine B12 dans le service d'hématologie de Marrakech (Maroc).

The aim of this study is to examine retrospectively the clinical, biological and treatment features of anemia by vitamin B12 deficiency in the Hematology department of CHU Mohamed VI Marrakech. We report the results of a retrospective study conducted during six years (2005-2010). It included all patients with anemia (with or without thrombocytopenia or leukopenia) associated with vitamin B12 levels <200 pg / ml. One hundred twenty one cases were analyzed. The average age of patients was 62 years (38-89 years) with a female predominance (sex ratio F/M: 1.3). The clinical symptomatology is dominated by pallor (97.5%), cardiovascular signs (46%) and digestive symptoms (34.7%). Neurological signs were noted in 17.3% of cases. The blood count showed anemia (hemoglobin: mean= 6.9 g/dl), macrocythemia (MCV: mean= 109 fl). Leukopenia was noted in 35 patients (29%), thrombocytopenia in 34 patients (28%) and pancytopenia in 21 patients (17,3%). The average vitamin B12 was 72 pg/ml. The causes of B12 deficiency are pernicious anemia (43%), food-cobalamin malabsorption (43%), and in 14% of cases no etiology was found. Gastritis was found in 82.7% of our patients and Helicobacter pylori (HP) infection in 72.7% of cases. Reticulocyte crisis was observed after parenteral administration of hydroxocobalamine within an average of 8 days and normalization of blood counts, in all patients, within an average of 51 days. In patients with HP infection, eradication therapy of HP was performed. The cure rate of the HP is 90%.

[Complementary medicine in cancer patients under treatment in Marrakech, Morocco: a prospective study]. / Les médecines alternatives et complémentaires chez les patients cancéreux en cours de traitement à Marrakech, Maroc : étude prospective.

Use of complementary and alternative medicine (CAM) is very frequent in cancer patients. The aims of this study were to analyze the frequency, the reasons of use of CAM in patients with a cancer treated in a Moroccan oncology department. We included in this study 400 patients. An anonymous questionnaire was proposed to patients during treatment. Over 384 analyzable questionnaires, 71% of patients were using CAM. The most frequent method was religious therapy (60%). The second one was herbal medicine (36%). The main reason for using CAM was reducing psychic pain in 53%, and boosting the immune system in 32%. Adverse effects were reported in 2% of cases. Only 5% of patients discussed CAM with their doctors. The cost of CAM was less than 100 Euros in 88% of cases. To optimize the patient-physician relationship and to avoid a propensity to unproved treatments, accurate and adequate communication is necessary.

[Short and medium term cardiotoxicity of anthracyclins: a prospective study]. / Cardiotoxicité à court et à moyen terme des anthracyclines : étude prospective.

There is evidence that anthracyclins may affect the heart and ventricular function. This cardiac toxicity is frequent and serious. It is the first study in Morocco to investigate the frequency of anthracyclins cardiotoxicity. It has for objective to analyze the cardiotoxicity connected to anthracyclins, these risk factors as well as the echocardiographic parameters, which deteriorate prematurely. We led a forward-looking study between October 2008 and December 2009. With 90 patients followed in the service of oncology-radiotherapy and put under chemotherapy with anthracyclins. We conducted a study of various ultrasound parameters of cardiac function, before with anthracyclins, the third cure of chemotherapy, then in the 6th cure of treatment. Only 70 patients have been assessable. Average age was of 47 years (20-68 years); 91% were female. The cardiac function was preserved in 40% of the cases. Among our patients, 56% developed a decrease moderated in light of the cardiac function and 4% of cases developed a severe cardiotoxicity. The echocardiographic parameter most significant in our series was LVEF, followed by TEI index. We found a cardiotoxicity was strictly correlated with the cumulative dose, anthracyclins type and associated comorbidity. The anthracyclins cardiotoxicity is quite common in our series, which requires more thorough preventive measures including monitoring by echocardiography.

Monoclonal antibodies in hematological malignancies: past, present and future.

Much progress has been made during the last few decades in the treatment of hematological malignancies. Monoclonal antibodies (MoAbs) represent a major advance toward a targeted therapy that can dramatically improve the antitumor effect with a substantial reduction of toxicity derived from therapy. Unlike many small molecules, MoAbs offer unique target specificity. Several MoAbs are now in clinical use for hematologic malignancies therapy, and many others are currently undergoing clinical evaluation. This review summarizes the state-of-the-art MoAbs treatment, beginning with an overview of the scientific background to their synthesis, mechanism of action and choice of target antigen, mainly focusing on those antibodies that are currently in use in clinical practice. Despite these advances, significant challenges remain in the identification of optimal cellular targets, antibody forms and treatment schedules for therapeutic applications.