[Anemia in blood donors and criteria of hemoglobin level control at the national blood transfusion center (NBTC) of Lomé, Togo]. / Anemie chez les donneurs de sang et criteres de controle du taux d'hemoglobine au centre national de transfusion sanguine de Lome (Togo).

INTRODUCTION: The aim of this study was to evaluate the prevalence of anemia among blood donors at Lomé national blood transfusion center (NBTC) and to identify criteria for controlling hemoglobin level in blood donation candidates. METHODS: We determined the hemoglobin level using HemoCue® 201+. To identify the hemoglobin level control criteria, the judgment parameters were the proportion of anemic donors based on the number of blood donations in the last 12 months and the staining of the conjunctiva. One parameter is considered "critical" and used as a control criterion when more than 30% of donors meeting this parameter are anemic. RESULTS: A total of 1 291 blood donor candidates, predominantly male (89.70%), were included in this study. The prevalence of anemia was 28.12%. This prevalence was 38.71% among women who made 2 donations and 32.27% among men who made 3 donations and who came for a new donation in the year. Anemia was observed in 59.45% of men and 51.56% of women who had slightly colored conjunctiva. CONCLUSION: The prevalence of anemia was high among blood donors at NBTC Lomé. Hemoglobin control is indicated in blood donation candidates with conjunctiva judged to be slightly colored and / or on their 2nd donation (female) and 3rd blood donation (male) within 12 months.

INTRODUCTION: Cette étude avait pour buts d'évaluer la prévalence de l'anémie parmi les donneurs de sang au centre national de transfusion sanguine (CNTS) de Lomé et d'identifier les critères de contrôle du taux d'hémoglobine chez les candidats au don de sang. MÉTHODES: Nous avons déterminé le taux d'hémoglobine (THb) à l'aide de HemoCue® 201+. Pour identifier les critères de contrôle du THb, les paramètres de jugement étaient la proportion de donneurs anémiés en fonction du nombre de dons de sang dans les douze derniers mois et la coloration des conjonctives. Un paramètre est jugé « critique ¼ et retenu comme critère de contrôle du THb lorsque plus de 30 % des donneurs répondant à ce paramètre sont anémiés. RÉSULTATS: Au total 1291 candidats au don de sang, à prédominance masculine (89,70%), étaient inclus dans cette étude. La prévalence de l'anémie était de 28,12%. Cette prévalence était de 38,71% parmi les femmes qui avaient fait 2 dons et de 32,27% parmi les hommes ayant effectué 3 dons et qui étaient revenus pour un nouveau don de sang en l'espace de 12 mois. L'anémie était observée chez 59,45% des hommes et 51,56% des femmes qui avaient des conjonctives peu colorées. CONCLUSION: La prévalence de l'anémie est élevée parmi les donneurs de sang au CNTS de Lomé. Le contrôle du taux d'hémoglobine est indiqué chez les candidats au don de sang ayant des conjonctives jugées peu colorées et/ou qui sont à leur 2ème don (femme) ou 3ème don de sang (homme) en l'espace de douze mois.

Therapeutic phlebotomy during major sickle cell disease in Togo.

To determine the influence of therapeutic phlebotomy on the reduction of vaso-occlusive crises (VOCs) and of hospital admissions of patients with sickle cell disease and to describe how they experience this practice. Descriptive cross-sectional study of 27 patients with sickle cell disease who underwent phlebotomies. We estimated the number of VOCs, hemoglobin levels, and patient response. Among 27 sickle cell patients (24 SC and 3 SS) who underwent phlebotomies, there were 22 men (81.5 %) men and 5 (18.5 %) women, with an average age of 34.6 ±10.9 years (range: 21-56 years). Before the phlebotomies, 23 (85.2 %) had showed signs of hyperviscosity, they had a mean of 5.3 ± 1.02 (range: 3-8) VOCs annually, and their mean hemoglobin level was 14.3 ±1.5g/dl (range: 10.4 g/dl-16.8 g/dl). The mean number of phlebotomies was 4.9±4.11 (range: 1-13). After this treatment, 21 (91.3 %) reported that their signs of hyperviscosity disappeared, and the mean number of VOCs annually decreased to 0.9 ±0.07 (range: 0-2). The mean change in hemoglobin was 1.9 ±0.8 g/dl (range: 0.9-3.2 g/dl). Nine patients (6SC and 3SS), 7 under anti-anemic treatment, initially refused phlebotomy, mainly because they did not understand how it could be useful to reduce the amount of blood in patients with a potentially anemic disease. Phlebotomy has resulted in a decrease in the frequency of VOCs and hospitalizations. It is essential to further popularize it and increase patients' aware of its value in combatting sickle cell disease and thus improve their willingness for and adherence to this treatment.

[Biermer's disease in the hematology service of campus teaching hospital of Lomé: 13 cases from January 2013 to December 2014]. / La maladie de biermer, a propos de 13 cas colliges du 1er Janvier 2003 au 31 Decembre 2014 au CHU campus de Lome.

AIMS: To study the epidemiological, clinical, paraclinical and therapeutic aspects of Biermer's disease in the hematology service of campus teaching hospital of Lomé. METHOD: This retrospective study was conducted in the laboratory service of the University Hospital campus in which there is a unit of clinical hematology. This study took place over a period of twelve years and has identified 13 patients (5 men, 8women). Patients were selected on the basis of clinical, paraclinical (blood cells count, bone marrow, dosage of vitamin B12 and the intrinsic factor antibody) and the therapeutic test. RESULTS: The mean age was 53 years ranging from 32 to 68 years. There was a female predominance with a sex ratio of 0.6. Clinically, there was conjonctival palor and asthenia (92% each) followed by paresthesia (62%). The blood cell count essentially showed profound anemia (7g/dl on average), macrocytic (84,6%), normocytic (15,3%), bicytopenia (61,5%) and pancytopenia (23% ). In all patients, the bone marrow study showed megaloblasts, the dosage of the vitamin showed a collapse of vitamin B12 (76,9%), and intrinsic factor antibody was positive (92,3%). The fibroscopy showed atrophic gastritis (76,9%), intestinal metaplasia (69,2%) and an absence of Helicobacter pylori. The evolution was favorable with parenteral B12 vitamin therapy for all patients. CONCLUSION: We recommend looking for iron deficiency during the follow-up and gastric biopsy even if no macroscopic lesions are found.

OBJECTIF: Etudier les aspects épidémiologiques, cliniques, paracliniques et thérapeutiques de la maladie de Biermer dans le service d'hématologie du CHU Campus de Lomé. MÉTHODE: Il s'agissait d'une étude rétrospective réalisée dans l'unité d'hématologie clinique du service des laboratoires du CHU Campus de Lomé. Cette étude s'est déroulée sur une période de douze ans et a permis de recenser 13 patients (5 hommes et 8 femmes). Les patients ont été retenus sur la base des arguments cliniques, paracliniques (hémogramme, myélogramme, dosage de la vitamine B12 et la recherche des anticorps anti-facteur intrinsèque) et le test thérapeutique. RÉSULTATS: L'âge moyen des patients était de 53 ans avec des extrêmes de 32 et 68 ans. Il y avait une prédominance féminine avec une sex-ratio de 0,6. Le tableau clinique était dominé par la pâleur conjonctivale et l'asthénie (92%) suivies de la paresthésie (62%). L'hémogramme avait montré essentiellement une anémie profonde (7g/dl en moyenne) macrocytaire (84,6%), normocytaire (15,3%), une bicytopénie (61,5%) et une pancytopénie (23%). Chez tous les patients, le myélogramme montrait des mégaloblastes, le dosage vitaminique montrait un effondrement de la vitaminémie B12 (76,9%), et l'anticorps anti-facteur intrinsèque était positif (92,3%). La fibroscopie digestive haute associée à l'examen anatomo-pathologique avait montré une gastrite atrophique (76,9%), une métaplasie intestinale (69,2%) et une absence d'hélicobacter pylori. L'évolution a été favorable sous vitaminothérapie B12 par voie parentérale chez l'ensemble des patients. CONCLUSION: Nous recommandons la recherche d'une carence martiale au cours de l'évolution et la biopsie gastrique même en l'absence de lésion macroscopique à la fibroscopie digestive haute.

[Rare hemoglobins in Togo: a 15-year study at the Lomé University Campus Hospital Center]. / Les hémoglobines rares au Togo : à propos d'une étude réalisée sur quinze ans au CHU Campus de Lomé (Togo).

OBJECTIVES: To identify the rare hemoglobins (Hbs) encountered in Togo and characterize their geographical and ethnic distribution and hematologic expression. MATERIAL AND METHOD: This retrospective descriptive study covers 27,530 hemoglobin electrophoresis tests performed in the department of Hematology of the Lomé Campus teaching hospital from January 1996 through December 2010, the national reference laboratory. The anomalies identified were studied with both alkaline and acid electrophoresis and high performance liquid chromatography (HPLC), all performed in Lome. Any other specialized examinations were conducted mainly at the biochemistry laboratories of either Robert Debre Hospital in Paris or Henri Mondor Hospital in Creteil (France). RESULTS: During the study period, 20 cases of a rare Hb were identified, i.e., 0.07% of all Hb analyses. These rare mutants were: HbK Woolwich (10 cases, 50% of the rare Hbs); HbD Korle-Bu (7 cases, 35%); HbJ Lome, G Philadelphia, and Hb Lepore (1 case each, 5% for each). Eighteen cases were associated with Hb A. Two cases of composite rare Hb were found: HbS/HbK Woolwich and HbC/Hb D Korle-Bu. Carriers of Hb Lepore and of HbC/HbD Korle-Bu had hypochromic and microcytic anemia. HbK Woolwich was found in the Adja-Ewé and Tem-Kabyé ethnic groups, in the Maritime and Kara regions; HbD Korle-Bu, HbJ Lome, and Hb Lepore were also identified among the Adja-Ewé, and HbG Philadelphia in the Akposso ethnic group of the Plateau zone. CONCLUSION: This study although limited to Lome, allowed us to identify the rare Hb forms observed in Togo. Other studies on a national scale will specify their real frequency.

[White blood cells counts and parasite density in malaria in children aged 6 to 60 months in urban areas of Togo]. / Numération leucocytaire et densité parasitaire dans le paludisme simple chez les enfants âgés de 6 mois à 5 ans en milieu urbain au Togo.

Rational use of the artemisinin-based combination therapies in Togo requires laboratory parasitemia values to confirm suspected malaria. This study was conducted to determine the impact of the measured white blood cell (WBC) count on the determination of malaria parasite density among children younger than 5 years old infected with uncomplicated Plasmodium falciparum in Togo. This cross-sectional study of 267 children from four pediatric centers diagnosed malaria with both thick and thin blood smears and counted WBCs with a hematology analyzer. The parasite densities, calculated with the number of WBCs and estimated with an assumed count of 8,000/µL, were compared with the Wilcoxon matched pairs signed-rank test. The children's median age was 35 months (interquartile range [24-48]), with a sex ratio of 1.32. The median WBC value was 8,300 cells/µL (range: 1,300-24,900 cells/µL). The median parasitemia value calculated with the absolute WBC count was 35,714 (range: 139-48,860 parasites/µL) was not statistically different from that estimated with the assumed value of 8,000 cells/µL - 33 125 parasites/µL (p = 0.564). This study shows that malaria parasite density obtained by assuming 8000 cells/µL does not result in overestimations for children aged 6-59 months.

[Chronic myeloid leukemia and imatinib: Experience at the Lome Campus teaching hospital (Togo)]. / Leucémie myéloïde chronique et imatinib, expérience du CHU Campus de Lomé au Togo.

BACKGROUND: Chronic myeloid leukemia (CML) is a clonal malignant myeloproliferative disorder characterized by the expansion of hematopoietic cells carrying the Philadelphia chromosome (t 9.22). Our main objective was to assess the efficacy of imatinib in CML patients, measured by their survival. METHODS: Over a six-year period (June 2003 through May 2009), 25 patients were seen regularly for CML at the Lomé Campus teaching hospital. Patients received imatinib after diagnosis and underwent regular laboratory monitoring (quantification of BCR-ABL ratio by RT-PCR). Patients' survival and treatment response were evaluated. RESULTS: Patients' mean age at diagnosis was 40 years (range: 9 to 72 years). Men predominated (17 compared with 7 women). Splenomegaly was found in 80% of cases. The mean leukocyte level was 188.71 g/L (24.4-350). Six patients (24%) had thrombocytosis with a mean platelet count of 491.15 g/L (108-2000). Six patients (24%) died after developing accelerated-phase CML or blast crisis. Estimated overall survival of patients at 6 years was 60%. Molecular biology monitoring detected a secondary G250E mutation with resistance to imatinib in one patient. Standard hematological side effects led to reduction in imatinib doses. The principal nonhematological side effects were weight gain and transient digestible disorders. CONCLUSIONS: At six years after diagnosis, imatinib was effective in treating patients with CML, even in sub-Saharan Africa. Mutation-induced resistance required regular molecular biological monitoring to determine the need to switch to later-generation tyrosine kinase inhibitors.

[Evolution of cardiovascular diseases' admissions in cardiology departments of Lomé hospitals: a cross-sectional study on 7959 patients from June 2004 to May 2009]. / Évolution des admissions pour maladies cardiovasculaires en milieu cardiologique à Lomé : étude transversale de 7959 patients de juin 2004 à mai 2009.

BACKGROUND: To determine the frequency of cardiovascular diseases, their risk factors as well as their evolution in two cardiology departments of Lomé. METHODS: This cross-sectional study was carried out among patients attending two cardiology departments of Lomé, from June 2004 to May 2009, who had a diagnosis of cardiovascular disease. RESULTS: A total of 7959 patients were included. Female gender predominated. The mean age was of 49.5 ± 17.2 years. The number of admissions increased from 958 in 2004 to 2399 in 2009. Arterial hypertension (62.7%) and ischemic heart diseases (10.6%) were the most frequent diagnoses. Among patients with a diagnosis of heart failure, the etiology was not recorded for 12.2%. Overweight and dyslipidemia were significantly more frequent in women (P<0.001), while smoking and physical inactivity were significantly more frequent in men (P<0.001). During the period, there was a moderate rise of the prevalence of overweight, dyslipidemia, and physical inactivity, whereas the prevalence of diabetes and smoking remained almost unchanged. CONCLUSION: Admissions for cardiovascular diseases increased from 2004 to 2009. This epidemiological transition may be related to poor awareness of cardiovascular disease among the low-income population and the financial burden of health care.