[Anti-RH1 (anti-D) alloimmunization after transfusion of platelet concentrates from RH :1 donors]. / Allo-immunisation anti-RH1 (anti-D) après transfusion de concentrés plaquettaires issus de donneurs RH :1.

Anti-erythrocyte alloimmunization may occur following the transfusion of platelet concentrates, in response to the presence of residual erythrocytes. Immunization against RH1 (D) antigen is the most frequent, but transfusion of RH1 compatible platelet concentrates is not always possible because of supply constraints. We report here three cases of anti-RH1 (anti-D) alloimmunization in RH :-1 patients after transfusion of platelet concentrates from RH :1 donors. Criteria for selection of platelet concentrates are numerous and difficult to achieve in practice. Respect of RH1 compatibility is not obligatory, but in case of transfusion of RH1 incompatible platelet concentrates, anti-RH1 immunoprophylaxis must be made for RH :-1 women of child-bearing age and without profound immunosuppression, as recommended by Afssaps (Agence française de sécurité sanitaire des produits de santé). These data point out the need to perform post-transfusional screening test for irregular erythrocyte antibodies as part of the transfusion of platelet concentrates.

[Identitovigilance and its impact on the results ensuring the transfusion security]. / Identitovigilance et son impact sur les résultats d'immuno-hématologie érythrocytaire assurant la sécurité transfusionnelle.

Errors on identity of patients during their registration may lead to non-compliance with a transfusion procedure, a non-issue adjusted blood and thus a transfusion risk. The main mistake is the misknowledge of an antibody, secondarily a loss of transfusion information and a redundancy of examinations. The creation of a working group "identitovigilance" helped sensitize the staff of health establishments and clinical chemistry laboratories. In this area of computerization of medical and transfusion records, shared folders and networking, identification of patients is a real issue of risk management hospital.

Amotosalen-inactivated plasma is as equally well tolerated as quarantine plasma in patients undergoing large volume therapeutic plasma exchange.

A retrospective - single center - survey compared tolerance of individual donor therapeutic plasma in a series of 88 patients principally presenting with thrombotic microangiopathy; all patients underwent therapeutic plasma exchange (TPE) performed with more than 90% of either of two types of plasma preparations. One plasma type used in TPE was prepared with pathogen reduction by amotosalen addition and UVA illumination, and the other one was non-manipulated (quarantine plasma). Both types of plasma were single donor. Occurrences of adverse reactions were equally low in either arm (amotosalen: 9 in 4689 bags of ∼200mL [0.019] versus quarantine: 2 in 828 bags [0.024]), confirming the safe use of amotosalen inactivated therapeutic plasma for TPE.

Plateletpheresis concentrates produced with the COMTEC cell separator: the French experience.

The latest generation of cell separators such as Trima (Gambro), Amicus (Baxter) and AS-TEC 204 (Fresenius), allow the collection of leucocyte-reduced platelet concentrates without secondary filtration. Fresenius has recently developed the COMTEC cell separator whose performance has been evaluated by several teams in France. This new cell separator is an improved version of the Fresenius AS-TEC 204 cell separator, designed to allow more efficient platelet collections. This study reports on the experience of six French teams (from Bordeaux, Clermont-Ferrand, Creteil, Dijon, Lille and Nancy) who obtained 696 leucocyte-reduced plateletpheresis concentrates in the course of collection using the new Fresenius COMTEC cell separator. All healthy volunteer donors fulfilled French selection criteria for platelet apheresis. Donors were eligible if they had suitable venous accesses, if their bodyweight was *50 kg and if their pre-apheresis platelet count was >150 x 10(9) l(-1). Between 4606 and 5229 ml of blood were processed. The mean volume of the platelet concentrates was between 439 and 493 ml (mean 460 +/- 63 ml). The platelet yield was of the order of 5.18 +/- 1.02 x 10(11) with only one platelet concentrate below the norm of 2 x 10(11) platelets (0.91 x 10(11)). No plausible explanation for this was found. The residual leucocyte levels conform to current norms. The platelet concentrates contained less than 1 x 10(6) leucocytes per concentrate (mean 0.233 +/- 0.150 x 10(6) leucocytes) in more than 97% of the components produced with >95% statistical confidence. The efficacy of the cell separator (52.44 +/- 7.35%) is comparable to that of other separators. The Fresenius COMTEC cell separator makes it possible to obtain leucocyte-reduced platelet concentrates which comply with current standards both in terms of platelet content and residual leucocyte level.

[Identification of alloantibodies and their associations: balance sheet of a year at the Auvergne-Loire French Blood Establishment]. / Identification d'allo-anticorps et leurs associations : bilan d'une année à l'Établissement français du sang Auvergne-Loire.

OBJECTIVES: Some alloantibodies and their combinations can lead to delays or even an impasse in a transfusion, owing to the necessity of finding compatible red blood cell concentrates. The aim of this study was to determine the specificities of the most common alloantibodies, as well as the most common combinations of alloantibodies. METHODS AND MATERIALS: A retrospective study analysed erythrocyte alloantibodies identified in 2008 in the immunohematology laboratories at the Auvergne-Loire French Blood Establishment. The following data were studied: frequency, specificities of the alloantibodies, date of discovery, and patient age and sex. RESULTS: One thousand eight hundred and fifteen alloantibodies were identified in 1575 patients (median age: 63.5years, female/male ratio: 3.03). The most common alloantibodies were directed against the following antigens: RH3/E (18.7%), KEL1/K (17.3%), RH1/D (16.4%), MNS1/M (9.4%), FY1/Fya (6.9%), RH2/C (6.1%), KEL3/Kpa (4.7%), JK1/Jka (4.3%) and RH4/c (4.1%). In 13.1% of patients, at least two alloantibodies were identified. The pairs most frequently combined were anti-RH1/RH2, anti-RH3/RH4 and anti-RH3/KEL1. CONCLUSION: Specific associations of paired alloantibodies were identified. The main combinations provide indications on the choice of red cell concentrates in the inventory for a given patient. The data collected in our study show that when an antibody is identified, it is recommended for subsequent transfusion episodes to respect the phenotype RH 1-5 (D, C, E, c, e) and KEL1 (K) of the patient, and if possible antigens JK1 (Jka) and FY1 (Fya), and to a lesser extent MNS3 (S). Detailed knowledge of the immunological mechanisms leading to the formation of these alloantibodies and their combinations would allow better prevention of erythrocyte alloimmunization.

Functional treatment of intra-articular fractures of the calcaneus.

Fifty-one adult patients with 54 intra-articular fractures of the calcaneus have been reviewed from one to 11 years after the injury. Treatment consisted in immediate active exercises of the foot without any attempt at reduction or immobilization. The patients resumed full weight-bearing, on the average, three months after injury. The overall results were excellent in 19, good in 24 and unsatisfactory, objectively and subjectively, in 11 feet. In this consecutive series, the majority of the fractures had a marked degree of displacement. Excluding undisplaced fractures which had a good result, no clear cut relation between the type and degree of displacement and the final result could be found. However, there were more unsatisfactory results in fractures in which the tuber-joint angle was equal to or less than 10 degrees.