Red blood cell alloimmunizations in beta-thalassemia patients in Casablanca/Morocco: Prevalence and risk factors.

Red blood cell alloimmunization is one of the major challenges to regular transfusions in ß-thalassemic patients. In Morocco, rare studies have focused on this hemoglobinopathy. OBJECTIVE: We aimed to study the prevalence and risk factors of red cell alloimmunization in ß-thalassemic patients. PATIENTS AND METHODS: Retrospective study during 9 years (2009-2018) was conducted on 160 ß-thalassemic patients transfused regularly in pediatric department of children's hospital in Casablanca, Morocco. The main clinical, demographic and transfusional characteristics of alloimmunized and non-alloimmunized patients were compared. Red blood cells units transfused were leukodeplated and phenotypically matched for RH-KELL systems and for other systems after immunization. Screening and antibody identification were performed by gel-filtration method on BIO-RAD caseds using 3 and 11 red blood cells panels. To detect autoantibodies, autocontrol and direct antiglobulin tests were carried out using polyspecific coombs (IgG/C3d) gel cards. RESULTS: The prevalence of alloimmunizations was 8.75% during the study period. Seventeen alloantibodies identified were directed mainly against antigens of KELL and RH systems: KEL 1 (35.29%), RH 3 (23.52%), RH1 (11.76%), Kpa (11.76%), RH2 (5.88%). Red blood cells autoantibodies had been detected in 6 of 14 (42.85%) of alloimmunized patients versus 12 of 146 (11.76%) of non-alloimmunized patients (P<0.01). Presence of autoantibodies, transfusional interval<3weeks and gender were associated with high rate of red cells alloimmunization. CONCLUSION: This study proves the data of literature. The presence of red cell autoantibodies appears to be a major risk factors for alloimmunization in thalassemic children, and could advocate specific transfusion guidelines.

[Hemogram profile and interest of pre-donation hemoglobin measurement in blood donors in the northwest region of Morocco]. / Profil de l'hémogramme et intérêt de la mesure de l'hémoglobine pré-don chez des donneurs de sang de la région Nord-Ouest du Maroc.

BACKGROUND: Blood donation in Morocco and more particularly in the northwest region is carried out without prior determination of the pre-donation hemoglobin. In addition, we note the lack of scientific research that reports data on the red blood cells, leukocytes and platelet lines in donated blood at the regional or even national level. AIMS: To study hemogram profile in blood donors taken from the Northwest region of Morocco in order to provide decision makers of the National Center of Blood Transfusion and Hematology with valid scientific arguments to complete the criteria to donate whole blood, by the hemogram. METHODS: Prospective study, conducted in 15797 volunteer blood donors (BD) aged between 18 and 60 years, collected during mobile or fixed collections carried out by the Regional Blood Transfusion Center of Tangier and Tetouan from November 2014 to May 2016. The hemogram was performed using a Sysmex KX21N® and the analysis of the data was done by the software SPSS 20.0. RESULTS: According to the World Health Organization, anemia corresponds to a hemoglobin level less than 12g/dL in women and less than 13g/dL in men. We found that 14.5 % of women (n=1054) and 3.0 % of men (n=245) were anemic and anemia was hypochromic microcytic in 58,66 % of these BD. Analysis of the white line showed leucopenia in 2.05 % of BD and 807 cases of leukocytosis (5.27 % of BD). Platelet study showed thrombocytopenia in 3.97 % of BD and thrombocytosis in 151BD (0.99 % of cases). CONCLUSION: This study shows the interest of systematic pre-donation hemoglobin measurement and periodic realization of the hemogram among BD in the Northwest region of Morocco.

Novel intronic RHD variants identified in serologically D-negative blood donors.

BACKGROUND: Blood group genotyping is used to predict RhD phenotype in transfusion and obstetric medicine. Prediction of antigen D is based on molecular techniques which targets most common RHD-specific polymorphism. However, inactive RHD variants can suggest false-positive RhD phenotype. Their types and frequencies vary among ethnicities. Our study aimed to identify RHD variants among Moroccan blood donors who are serologically D negative. STUDY DESIGN AND METHODS: DNA from 53 blood donors who are serologically D negative RhC and/or RhE positive were screened for RHD exon 10 by PCR-SSP. RHD-positive samples were further tested by multiplex PCR covering exons 3, 4, 5, 6, 7 and 9 and then sequenced by targeted next-generation sequencing method. Mutations' impact on mRNA splicing was predicted using alamut software version 2·0. RESULTS: PCR-SSP revealed 9 of 53 (16·9%) RHD-positive samples. Five of nine samples were positive for all tested exons, two of nine were positive for exon 9, and two of nine were undetermined. Sequencing revealed four novel RHD variants based on six mutations in introns 1, 3, 5 and 6. In silico analysis revealed aberrant splicing of three mutations (RHD c.487-1024delG, RHD c.487-256T>G and RHD c.940-187_940-188del), while three other mutations (RHD c.149-682C>A, RHD c.802-37delA and RHD c.939 + 1151dup) had no effect on splicing compared to wild type. CONCLUSIONS: All identified RHD variants contain at least one mutation that probably affects splicing to generate D-negative phenotype. Hence, ethnic RhD antigen background must be considered when developing transfusion and obstetric strategies.

[Identification of alloantibodies and their associations: Balance sheet of 3 years at the Regional Center of Blood Transfusion in Rabat/Morocco and difficult in transfusion management]. / Identification des allo-anticorps seuls et associés : bilan de trois années au centre régional de transfusion sanguine de Rabat/Maroc et difficultés de prise en charge transfusionnelle.

Red blood cell immunization can lead to delays or even an impasse in a transfusion. OBJECTIVES: Determine the specificities of the most common of alloantibodies and their associations to correct management of red blood cell transfused. METHODS AND MATERIALS: A retrospective study between 2013 and 2015 in immunohematology laboratories at the Blood Transfusion Center of Rabat in Morocco. The following data were studied: frequency, specificities of alloantibodies, blood group involved in alloimmunization and difficult of management of transfusion in case with association of alloantibodies. RESULTS: Five hundred of alloantibodies were identified in 425 people (372 patients/pregnant women and 53 blood donors). The alloantibodies were directed against the following antigen: RH1 (50.8 %), RH3 (11.4 %), KEL 1 (8.2 %), RH2 (7.6 %), RH4 (4.6 %), MNS1 (4 %), MNS3 (2.6 %), Jka (2.4 %) and Fya (2.2 %). Only one alloantibody was identified in 85 % of cases. In 15 %, at least, two alloantibodies were found. The most common associations were directed against: anti-(D+C) (25), anti-(E+K) (4), anti-(E+c) (3) and anti-(D+C+E) (3). The rhesus system is the most involved in alloimmunization. Frequency of specific associations of alloantibodies was identified: Fya-/Jkb- (18.23 %), Fyb-/Jkb- (11.7 %), Jka-/S- (8.70 %), Jka-/Fyb- (5.20 %), Fyb-/s- (3.40 %) and Fyb-/Jkb-/s- (0.85 %). CONCLUSIONS: Red blood cell immunization is a serious problem in transfused patients. This study proves the data of literature, the interest of using RH-Kel1 red cell units compatibles among women in age to procreate and for the transfused patients to reduce the rate of immunization. Associations of antibodies with low frequency suggest a promotion of donation.

Testing for Partial RhD with a D-Screen Diagast Kit in Moroccan Blood Donors with Weak D Expression.

The aim of this study was to search for the partial D phenotype in Moroccan blood donors with weak D expression. The study included 32 samples with weak D phenotype, and partial D category red blood cells were detected with the D-Screen Diagast kit, which consists in 9 monoclonal anti-D antibodies specific for the most common categories of partial D. Among the 32 samples studied, we identified 13 specific reactions to a partial D antigen (3 DVI, 2 DVa, 2 DIII((a,b,c)), and 6 DVII), with 8 reactions suggesting a weak D and 11 reactions providing no formal argument in favor of a partial D antigen. This work can be used to validate the performance of the anti-D reagent and to improve the safety of transfusion of red blood cells from donors expressing the partial D antigen by integrating the finding into the recipient file with a recommendation concerning the appropriate care.

Mapping rare erythrocyte phenotypes in morocco: a tool to overcome transfusion challenges.

The aim of this research is to search for the distribution of blood groups in all the regions of Morocco. This study, done for the first time, aimed to provide the frequency of the Rhesus system and Kell (K) in more than 55000 blood donors from nine different regions around the country. In addition, the frequency of the Cellano, Duffy, Kidd, and MNS blood antigens was searched for 500 blood donors from the Rabat's region. Frequency of blood donors with rare blood groups was characterized for the first time in the country and compared to results found from other populations.

Epidemiology and molecular identification of Anisakis pegreffii (Nematoda: Anisakidae) in the horse mackerel Trachurus trachurus from northern Morocco.

Anisakis infection parameters were studied in horse mackerel (Trachurus trachurus) taken from two areas of northern Morocco (Tetouan and Tangier), which showed a mean prevalence of 54.9%. Identification of the ITS1-5.8S-ITS2 fragment by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) showed A. pegreffii to be the dominant species; no A. simplex s.s. were detected. The presence of A. pegreffii in horse mackerel was not influenced by the sex (P = 0.46) or catch area (Atlantic versus Mediterranean, P = 0.52) of the fish, but was significantly related to their length, weight, liver weight and gonad weight, and to the season of their capture (P < 0.05). A low prevalence (8.6%) and mean intensity (1.0) was detected in the muscle, probably related to the reduced ability of A. pegreffii to penetrate muscle. The risk of the presence of A. pegreffii in the muscle was fivefold higher in fish caught during the summer than during any other season. Susceptible members of the human population can minimize the risk of infection by avoiding the consumption of larger horse mackerel specimens during the summer.

[Optimization of inventory levels in the blood transfusion centers in Morocco]. / Optimisation des niveaux de stock dans les centres de transfusion sanguine au Maroc.

PURPOSE OF THE STUDY: Improve the flow of quantities of blood products between the different centers to restore the ideal quantities at low cost. MATERIALS AND METHODS: The problem addressed in this work concerns the balancing inventory levels between blood transfusion centers in Morocco. This problem is characterized by a number of constraints to be taken into account: safety stock, stock ideal proportional balancing of stocks, etc. An integer linear model has been proposed to determine the optimal allocation between different centers. Two variants are examined; the first which aims to minimize the level of inventory loss, the second is to balance the different levels of stock, so that all centers have a level of surplus stock and/or loss proportional to the ideal stock. RESULTS: Two variants of an integer linear model that determine the optimal allocation between different centers has been proposed and their performance was evaluated by experimental results obtained using a solver commercial. CONCLUSION: The results of this study allow us to meet the goal of PSL availability of sufficient and subsequently the quality of service required blood transfusion.

Hepatitis B in Moroccan blood donors: a decade trend of the HBsAg prevalence in a resources limited country.

OBJECTIVES: To calculate the hepatitis B surface antigen (HBsAg) reactive rate for 2011 blood donors (BD) across Morocco. In addition, to monitor the profile of donors bearing the HBsAg during 2000 and 2011, we calculated the percentage of the prevalence in both sexes, in different age groups and in first-time replacement and regular BD from the Rabat Regional Blood Transfusion Centre. BACKGROUND: Hepatitis B is a viral infection that spreads through blood and other biological fluids. The hepatitis B virus remains one of the most common serious complications of transfusion. No information exists on the real prevalence of hepatitis B in Moroccan BD. METHODS: For the 2011 national HBsAg reactive rate, the percentage was calculated based on enzyme-linked immunosorbent assay (ELISA) results of the 232 190 blood donations collected around the country. For the Rabat blood Centre, we calculated the hepatitis B sero-prevalence from donations made at the donors' suite during 2000 and 2011. RESULTS: The national prevalence of HBsAg was 1·34%. The HBsAg variations among different regions was between 0·43 and 2·86%. The Rabat donors' suite hepatitis B prevalence decreased from 2·47% in 2000 to 0·91% in 2011 (P < 0·001). In both years, family/replacement donors were found as safe as first-time BD and female donors were the safest. CONCLUSIONS: These results, presented for the first time in the country, mapped the hepatitis B distribution across Morocco in a healthy population. The findings of this study could be of great importance in setting up strategies for the recruitment of the BD and keeping blood safety at the highest level.

[Improvement and process optimization transfusion in Morocco: proposal of a new organization]. / Amélioration et optimisation du processus transfusionnel au Maroc : proposition d'une nouvelle organisation.

PURPOSE OF THE STUDY: Propose a new organization for the Moroccan blood transfusion system. MATERIALS AND METHODS: Through an analysis of several aspects of the current organization, both qualitatively and quantitatively (Statistics 2011), it was found that several failures of the current system prevent them from achieving it's objectives and ensuring its responsibilities. Using multiple-criteria decision analysis (ELECTRE III), a new organization based on resources pooling is proposed. This new organization concerns the status of the National Blood Transfusion Center, donor management, the geographical location of the various regional centers, logistics, inventory management and the information system. RESULTS: Within the new organization proposed, the number of regional Centers for blood transfusion is reduced from 16 to 7 in accordance with the existing constraints, while redefining the roles of each site. The aspects of inventory management, the information system, increasing the number of donors, the policy communication and marketing and cycle of blood collection and distribution are also redefined. CONCLUSION: This proposed new organization will provide decision makers with the necessary assistance for decision making, whit respect to the improvement of the entire system Moroccan blood transfusion system. And so help achieving the desired objectives on ensuring blood availability and it' maximum safety. The simulation of this proposal should confirm the choice that was made. Further analysis of complementary aspects such as the financial aspect or human resources, would moreover contribute to refining this proposal.

Assessment of butyltin and phenyltin pollution in the sea mullet, Mugil cephalus, along the Moroccan and Spanish coasts (Mediterranean Sea).

Levels of three butyltin (BTs) compounds, monobutyltin (MBT), dibutyltin (DBT) and tributyltin (TBT), and three phenyltin (PTs) compounds, monophenyltin (MPhT), diphenyltin (DPhT), and triphenyltin (TPhT), were determined in the sea mullet, Mugil cephalus, collected along the northern Mediterranean coast of Morocco, and the south Mediterranean coast of Spain. Also, sediment samples from the Guadalquivir River (Spain) near to its mouth in the Mediterranean Sea were analysed. TBT and TPhT were the predominant compounds in the analyzed samples, and TBT concentrations were higher in liver than in muscle. In general, the total content of BTs in these samples was higher than PT levels. In the Moroccan coast, the highest value of BTs (18.00 mg/Kg wet weight) was found in the west harbour of the Tangier site, while the lowest concentration (0.01 mg/Kg wet weight) was detected in the Oued Laoue site. Concerning PTs compounds, the highest value (4.00 mg/Kg wet weight) was found in the harbour of the M'diq Site and the lowest value (0.01 mg/Kg wet weight) was detected in the Oued Laoue site. On the other hand, organotin (OT) residues were not detected in the water samples of the Spanish coast although TBT was identified in four of the nine sediment samples from the Guadalquivir River at concentrations between 15.45 and 245.07 mg/Kg wet weight.

Ultrastructural data on the sporogenesis of Myxidium giardi, cépède 1906 (Myxozoa, Myxosporidia), parasite of Anguilla anguilla (Teleostea).

Ultrastructural study of Myxidium giardi showed that pluricellularity is maintained by the formation of septate desmosomes. The polar capsule is formed from helicoidal depositions of banded material in the initial vacuole. This process makes possible not only the formation of the rigid capsular body but also of the flexible polar filament which is evaginable and reversed in the capsule. The special feature of the genus Myxidium is the ornamentation of the valvogenic cells of the spores in the form of longitudinal ribs. An ultrastructural study showed that the morphogenesis of this cell relief in Myxidium giardi involves a special process based on the development of fusiform macrovesicles whose bases are connected to a cytoskeleton formed of special microtubules 14 nm in diameter. The latter seem to determine the future rigidity of the valvar epicyte.