[Fetal RHD genotyping by PCR using plasma from D negative pregnant women]. / Génotypage RHD fœtal par PCR dans le plasma de femmes enceintes D négatif.

AIM OF THE STUDY: Free fetal DNA in maternal blood offers a non invasive method for prenatal diagnosis. The aim of this study is to perform fetal RHD genotyping by conventional PCR in D negative pregnant women of Moroccan origin. PATIENTS AND METHODS: Plasma sample from 120 D negative pregnant women from 10 to 40 gestational weeks were tested by conventional PCR for the presence of exons 7 and 10 of RHD gene. The results were compared with the RhD phenotype of the newborns. RESULTS: In this study, the positive and the negative predictive value of the fetal RhD status were 98.7 and 96.7%, respectively. CONCLUSION: These results demonstrate de feasibility of fetal RHD genotyping by conventional PCR in D negative pregnant women of Moroccan origin.

[Stem cell transplantation in Morocco: report of 87 cases]. / Greffe de cellules souches hématopoïétiques au Maroc : à propos de 87 cas.

PURPOSE: The autologous peripheral blood stem cells (CSP) are used as a support to the restoration of the hematopoiesis in oncohematology. The objective of this work, carried out in the laboratory of cryobiology at the Center Regional of Blood Transfusion, Casablanca, is to assess the short- and long-term results of this type of autograft. PATIENTS AND METHODS: This retrospective study focused on 87 patients treated for hematological malignancies in services of oncohaematology over a period from June 2004 to March 2009. One hundred and twenty-seven cytapheresis were conducted to collect the CSP. The rate of CD34+ cells ranged from two to 50x10(6) per kilogram. The removal, treatment with 10% DMSO, the characterization, cryopreservation, thawing and washing of grafts on Cobe 2991 were made before the autograft. RESULTS: Forty-nine patients were transplanted for multiple myeloma, 24 for Hodgkin's disease, 13 for a non-Hodgkin lymphoma and one for rabdomyosarcome. The mean age of patients was 35 years. The mean length of hospitalization was 27 days. The average time of release for aplasia is 7 to 49 days, with a mean of 16 days. A blood transfusion was necessary during the aplasia: two to 41 red blood cells per patient and six to 298 platelet units per patient. The short-term complications after autologous transplantation are primarily infectious. Seven times the progressive hematologic malignancies and seven deaths are regrettable. CONCLUSION: The autologous CSP is simple, effective and well tolerated, which should be developed in our context.

[Kidney transplantation in a patient with haemophilia A]. / Transplantation rénale chez un patient hémophile A.

A 37-year-old patient with moderate haemophilia A and end-stage renal disease underwent kidney transplantation in the University Hospital Ibn Rochd of Casablanca (Morocco). He received factor VIII replacement therapy perioperatively and until the 21st day postoperation. So, the activity rates of Factor VIII was higher than or equal to 80 % in the day of intervention and two to three days later, then between 30 and 60 % until healing. The evolution of the patient to 28 months post-transplantation is marked by a good renal function without episode of rejection or bleeding complications. The heavy surgical interventions are possible in patients with haemophilia, but depend on good replacement therapy in peri- and postoperation.

[Systemic lupus erythematosus and Epstein-Barr virus]. / Lupus et virus d'Epstein-Barr.

We determined the prevalence of antibodies to Epstein-Barr virus (EBV) in 44 patients with systemic lupus erythematosus (SLE) and 44 healthy blood donors matched for sex and age as controls. Of the cases, 39 were women; mean age was 33 years. Four cases (9%) and 5 controls (11%) were positive for IgM anti-viral capsid antigen (VCA) (P = 0.9). All the cases were positive for IgG anti-VCA compared with 91% of the controls (P = 0.12). The mean immunity ratio for this antibody was 2.341 in cases and 1.873 in controls (P = 0.068). Forty (91%) cases were positive for IgG anti-EBNA1 (EB nuclear antigen1) compared with 42 (95%) controls (P = 0.6).

[Systemic lupus erythematosus and Epstein-Barr virus]

We determined the prevalence of antibodies to Epstein-Barr virus [EBV] in 44 patients with systemic lupus erythematosus [SLE] and 44 healthy blood donors matched for sex and age as controls. Of the cases, 39 were women; mean age was 33 years. Four cases [9%] and 5 controls [11%] were positive for IgM anti-viral capsid antigen [VCA] [P = 0.9]. All the cases were positive for IgG anti-VCA compared with 91% of the controls [P = 0.12]. The mean immunity ratio for this antibody was 2.341 in cases and 1.873 in controls [P = 0.068]. Forty [91%] cases were positive for IgG anti-EBNA1 [EB nuclear antigen1] compared with 42 [95%] controls [P = 0.6]

Therapeutic plasma exchange in Casablanca.

BACKGROUND: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification method for the treatment of diseases in which pathological proteins have to be eliminated. In the aim to demonstrate our single center activity, we analyzed our data since 2 years. METHODS: Between years 2002 and 2005, 104 TPE procedures were performed on 42 patients. Median age and male/female ratio were 32 (range, 17-56) and 24/18, respectively. Departments those referred the majority of the TPE were neurology (n=32), nephrology (n=5) and intensive care unit (n=5). The most common indications were: polyradiculoneuropathies (53%), myasthenia gravis (17%) and Guillain-Barré syndrome (12%). RESULTS: The median TPE procedure per patient was 2.3 (range, 1-10). In the majority of patients, vascular access was provided by puncture of two large, durable peripheral antecubital veins. The procedures were performed with the "Haemonetic Ultralight" discontinuous flow cell separator devices. Citrate solution was used as an anticoagulant in all cases. The substitution fluids most often used in our unit are Albumin 20% solution (92 times), Albumin 4% (10 times) and fresh frozen plasma (twice). Seventy five percent of the patients showed improvement, 7% remained the same and 18% worsened. Thirteen adverse reactions were recorded. CONCLUSION: The creation of a national registry by the local society is a vital move to improve TPE practice in our country.

Hepatitis B in Moroccan health care workers.

AIM: To evaluate knowledge and perception of hepatitis B, including prevention, among Moroccan health care workers (HCWs) and to estimate seroprevalence of hepatitis B and vaccine coverage (VC). METHODS: Four hundred and twenty HCWs were randomly selected and stratified by site: 120 in Rabat, 140 in Taza and 160 in Témara-Skhirat. The study included an anonymous questionnaire about knowledge of hepatitis B and its prevention and a serological survey. Oral statements and vaccine registers were used to analyse the VC of the HCWs. Serological testing and VC were analysed according to the occupational exposure. RESULTS: Participation rates in the questionnaire and serological tests were 68% (285/420) and 66% (276/420), respectively. Fifteen (5%) HCWs had a history of hepatitis B. All HCWs considered that hepatitis B virus (HBV) infection may be acquired through blood exposure. Vaccination was acknowledged as a necessary means against HBV transmission by 276 (98%) HCWs. Forty-two per cent HCWs had no HBV serological markers. The prevalence of hepatitis B surface antigen was 1%. The mean prevalence of hepatitis B core antibody (anti-HBc) was 28% and was significantly higher (P < 0.05) among nursing auxiliaries (57%), nurses (30%), medical physicians (31%) and midwives (25%) than among laboratory technicians (13%). According to the vaccination registers (available in two sites), VC (> or =3 doses) was 55%. VC was 75% among midwives, 61% among nurses, 53% among nursing auxiliaries and 38% among medical staff. Of the fully vaccinated HCWs without anti-HBc, 51% had serological evidence of protection. CONCLUSION: HBV vaccines should be more readily available for Moroccan HCWs by reinforcing current vaccination programmes.

Iron deficiency in frequent and first time female blood donors.

BACKGROUND: Blood donation has a marked influence on the body iron stores especially in female blood donors. Iron deficiency anaemia is an important limiting factor for the number of donations in female regular blood donors. AIM OF THE STUDY: This study was conducted to evaluate the frequency of iron deficiency and relevant factors in frequent and first time female blood donors at Casablanca blood transfusion centre, Morocco. METHODS: Between November 2005 and April 2006, twenty-one female first time and twenty-one frequent female blood donors were selected randomly. In frequent blood donors, only females with at least 10 donations were included. Haemoglobin concentration. serum ferritin, serum iron and total transferrine binding capacity were measured and analysed. RESULTS: The results of haemoglobin concentration, serum ferritin, serum iron were significant lower in frequent female blood donors when compared with the results of same parameters in first time female blood donors. The results show that the frequency of iron deficiency in frequent female blood donors is 43% and in the first time female blood donors is 14%. CONCLUSION: Iron deficiency is very common in regular female blood donors at Casablanca's transfusion centre. Frequent blood donation has marked influence on the body iron stores in frequent female blood donors. It is therefore recommended that blood transfusion centres focused on maintaining iron balance by measuring serum ferritin and total transferrine binding capacity in frequent female blood donors. They have also to educate the donors about iron supplementation and yearly ferritin checking.

Iron Deficiency in Frequent and First Time Female Blood Donors

Background: Blood donation has a marked influence on the body iron stores especially in female blood donors . Iron deficiency anaemia is an important limiting factor for the number of donations in female regular blood donors. Aim of the study: This study was conducted to evaluate the frequency of iron deficiency and relevant factors in frequent and first time female blood donors at Casablanca blood transfusion centre; Morocco. Methods: Between November 2005 and April 2006; twenty-one female first time and twenty-one frequent female blood donors were selected randomly. In frequent blood donors; only females with at least 10 donations were included. Haemoglobin concentration; serum ferritin; serum iron and total transferrine binding capacity were measured and analysed. Results: The results of haemoglobin concentration; serum ferritin; serum iron were significant lower in frequent female blood donors when compared with the results of same parameters in first time female blood donors. The results show that the frequency of iron deficiency in frequent female blood donors is 43and in the first time female blood donors is 14. Conclusion: Iron deficiency is very common in regular female blood donors at Casablanca's transfusion centre. Frequent blood donation has marked influence on the body iron stores in frequent female blood donors. It is therefore recommended that blood transfusion centres focused on maintaining iron balance by measuring serum ferritin and total transferrine binding capacity in frequent female blood donors .They have also to educate the donors about iron supplementation and yearly ferritin checking

[Pregnancy and delivery in a patient with Willebrand's disease. Apropos of a case]. / Maladie de von Willebrand et grossesse : à propos d'un cas.

Willebrand's disease is the most frequent inborn coagulopathy and type 3 is its most severe form. Pregnancy and delivery are critical events in women with Willebrand's disease of type 3. Prophylactic treatment for delivery and early postpartum period is recommended. We report the management of pregnancy and successful delivery of a 32-year-old woman with type 3. Prophylactic treatment with 2000 IU of Willebrand's disease factor (WdF) was given twice a day during the delivery day and the day after, and 1000 IU per day during the next three days. The patient did not show any spontaneous metrorrhagia but anemia. No bleeding was observed in the newborn.

[Complications of blood donation in Morocco (during and immediately after the donation)]. / Les complications du don du sang au Maroc (pendant et immédiatement après le don).

UNLABELLED: The complications that may arise in connection with a blood donation are usually benign. These complications can lead to disaffection for the donation. The purpose of this study is to determine the incidence of complications occurring during or shortly after blood donation and to identify factors that contribute to its occurrence. MATERIALS AND METHODS: A prospective study of 10 December 2005 to 09 June 2006 is conducted at the Regional Center for Blood Transfusion in Casablanca (Morocco) on the complications seen in 23 745 donors. RESULTS: During the study period, 23 745 samples were made and 122 complications were collected (0.51%). One hundred and sixteen (95%) complications of a general: 81 vagal malaise, 20 syncopations, two syncopations convulsivantes and three tetany. Seventy-three (63%) donors presented hypotension. Complications are more common in men than in women: 71 versus 45 (p < 0.001); patients give for the first time than to Former donors: 82 versus 34 (p < 0.001); donors have age less or egal to 30 years compared with than with age over 30 years: 78 versus 38 (p < 0.001). Eighty-two complications (71%) were observed among donors with weight more than 70 kg. CONCLUSION: In this study, the incidence of the complications for blood donation remains lower. The best choice of the donors by the doctor, taking into consideration the factors involved in these complications, reduces this incidence.

[Knowledge about hepatitis B and C viruses and HIV among blood donors in Casablanca]. / Connaissances sur les virus des hépatites B et C et le VIH chez des donneurs de sang à Casablanca.

A survey was conducted in the Casablanca Regional Blood Transfusion Centre from February to May 2002. A questionnaire was given to 1750 blood donors from different groups of society to asses the knowledge of the public about hepatitis B and C and human immunodeficiency viruses. The responses indicated that the mechanism of HIV transmission was well known to the public: 85% gave correct answers. Hepatitis B and hepatitis C viruses were less well understood: 60% and 54% gave correct answers respectively. Our study suggests that the public needs to be better informed about hepatitis B and C virus transmission.

[New container of sample: role in the reduction of bacterial contamination of standard platelet units]. / Nouveau container de prélèvement : rôle dans la réduction de la contamination bactérienne des unités plaquettaires standard.

BACKGROUND: Bacterial contamination of unstable blood products constitutes today the most frequent infectious risk transmitted by blood transfusion. Platelet concentrates are often incrimineted. As responsible germs are in general of cutaneous origin, a sample procedure with diversion of the first 20 ml during blood donation is studied. The aim of this study is to evaluate the results of this technique on bacterial contamination rate of standard platelet units prepared at the regional blood transfusion center in Casablanca. STUDY DESIGN AND METHODS: A comparative study of two types of sample pockets is made: 500 Standard Platelet concentrates (CPS) are prepared after collection using standard triple bags (Baxter) (group 1) and 560 pockets of CPS were prepared after collection using triple bags with Sample Diversion Pouch sampling system for elimination of the first 20 ml of donation (Macopharma and Terumo) (group 2). The skin was disinfected in two times with alcohol 70%. The bacteriological study was made in the two groups at the third day of conservation. RESULTS: Six CPS of group 1 were contaminated, of which five were staphylococci coagulase negative and one bacillus sp. Six CPS of group 2 were contaminated, of which five were staphylococci coagulase negative and one staphylococcus aureus. The bacteria isolated were those of cutaneous flora at 100%. Diversion of first 20 ml of blood donation results in a 16.6% reduction in bacterial contamination of CPS (P>0.05). CONCLUSION: The non-significant reduction in the prevalence of the bacterial infection of CP formulates the problem of the indication of the sampling devices with derivation of first 20 ml during blood collection.

[Knowledge about hepatitis B and C viruses and HIV among blood donors in Casablanca]

A survey was conducted in the Casablanca Regional Blood Transfusion Centre from to May 2002. A questionnaire was given to 1750 blood donors from different groups of society February to assess the knowledge of the public about hepatitis B and C and human immunodeficiency viruses. The responses indicated that the mechanism of HIV transmission was well known to the public: 85% gave correct answers. Hepatitis B and hepatitis C viruses were less well understood: 60% and 54% gave correct answers respectively. Our study suggests that the public needs to be better informed about hepatitis B and C virus transmission

[ABO polymorphism in blood donors in Morocco]. / Polymorphisme ABO chez les donneurs de sang au Maroc.

Blood grouping were improved since the advent of monoclonal antibodies and the automation of the tests. No comparative study has been done before in Morocco concerning ABO regional genetic frequencies. Hence, the aim of this work is to actualize and to precise them. The ABO blood grouping has been carried out on 344 954 blood donors by micro method in several regional blood transfusion centers. Genetic frequencies were calculated according to the Bernstein's method. The national mean values are A: 0.2141, B: 0.105, O: 0.6777. The regional frequencies show gradients between the north and the south of Morocco.

[A quantitative determination of IgG anti-D subclasses by Elisa in hemolytic disease of the newborn]. / Etude quantitative des sous-classes d'IgG anti-D par Elisa au cours de la maladie hémolytique néonatale.

The quantification of IgG anti-D subclasses is one of the most important parameters considered in the assessment of the severity of hemolytic disease of the newborn. Traditionally IgG subclassing is performed using qualitative haemagglutination methods, difficult to interpret. A quantitative enzyme-linked immunosorbent assay (Elisa) was implemented for measuring IgG anti-D subclasses in 20 sera collected from 14 RhD-immunized pregnant women. All 4 IgG subclasses were detected in the 20 sera tested. The mean proportion of IgG1 was 52.8%. The mean proportion of IgG3 was 30.7%. The mean proportions of IgG2 and IgG4 were 14.5 and 1.9% respectively. A good correlation between the sum of IgG subclasses and the severity of HDN was found. Severe HDN occurred when both IgG1 and IgG3 were present. IgG1 anti-D was the predominant subclass in 4 of the 8 severe cases.

[Production of a new monoclonal anti-AB reagent]. / Production d'un nouveau réactif monoclonal anti-AB.

Techniques of monoclonal antibodies production have well progressed in the developed countries. But, they are still absent in the third world. In this report, the murine hybridoma technology was performed to produce anti-ABH monoclonal antibodies. The anti-AB specificity of several hybridomas was determined by agglutination techniques using phenotyped red cells panels. An anti-AB monoclonal antibody was selected and compared to other reagents for its use as a blood grouping reagent. Its characteristics were in accordance with the international standards. Hybridoma establishment to produce a good monoclonal reagent is henceforth possible in Morocco.