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Efficacy and Safety of Manual Partial Red Cell Exchange in the Management of Severe Complications of Sickle Cell Disease in a Developing Country. Adv Hematol 2017; 2017:3518402. [PMID: 28584527 PMCID: PMC5443989 DOI: 10.1155/2017/3518402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/24/2017] [Accepted: 04/11/2017] [Indexed: 12/22/2022] Open
Abstract
Introduction The realization of red cell exchange (RCE) in Africa faces the lack of blood, transfusion safety, and equipment. We evaluated its efficacy and safety in severe complications of sickle cell disease. Patients and Method Manual partial RCE was performed among sickle cell patients who had severe complications. Efficacy was evaluated by clinical evolution, blood count, and electrophoresis of hemoglobin. Safety was evaluated on adverse effects, infections, and alloimmunization. Results We performed 166 partial RCE among 44 patients including 41 homozygous (SS) and 2 heterozygous composites SC and 1 S/β0-thalassemia. The mean age was 27.9 years. The sex ratio was 1.58. The regression of symptoms was complete in 100% of persistent vasoocclusive crisis and acute chest syndrome, 56.7% of intermittent priapism, and 30% of stroke. It was partial in 100% of leg ulcers and null in acute priapism. The mean variations of hemoglobin and hematocrit rate after one procedure were, respectively, +1.4 g/dL and +4.4%. That of hemoglobin S after 2 consecutive RCE was −60%. Neither alloimmunization nor viral seroconversion was observed. Conclusion This work shows the feasibility of manual partial RCE in a low-resource setting and its efficacy and safety during complications of SCD outside of acute priapism.
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Factors Associated with Growth Retardation in Children Suffering from Sickle Cell Anemia: First Report from Central Africa. Anemia 2017; 2017:7916348. [PMID: 28250985 PMCID: PMC5303847 DOI: 10.1155/2017/7916348] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background. The aim of this study was to investigate and determine the risk factors associated with poor growth among SCA children. Methods. A cross-sectional study was conducted in Kinshasa, the capital's country. The nutritional status was assessed using the Z scores of the anthropometric indices. Results. We gathered data on the 256 patients, 138 females (53.9%), who entered the study. The mean age at presentation was 8.4 ± 4.9 years of age. Underweight, stunting, and wasting were found, respectively, in 47.7%, 10.5%, and 50.3% of SCA children. A history of hand-foot syndrome, more than 3 blood transfusions, being less than 12 months of age when receiving the first transfusion, more than two severe sickle crises per year, a medical history of severe infections, and the presence of hepatomegaly were associated with poor growth. When comparing sickle cell patients under 12 years of age (n = 159) to a group of 296 age-matched children with normal Hb-AA, a significantly higher proportion of subjects with stunting and underweight were found among SCA. Conclusion. Nutritional status encountered in Congolese sickle cell children has been described for the first time in this study. A high prevalence of poor growth in SCA children was found in our study.
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Diakité SAS, Ndour PA, Brousse V, Gay F, Roussel C, Biligui S, Dussiot M, Prendki V, Lopera-Mesa TM, Traoré K, Konaté D, Doumbia S, Cros J, Dokmak S, Fairhurst RM, Diakité M, Buffet PA. Stage-dependent fate of Plasmodium falciparum-infected red blood cells in the spleen and sickle-cell trait-related protection against malaria. Malar J 2016; 15:482. [PMID: 27655345 PMCID: PMC5031340 DOI: 10.1186/s12936-016-1522-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/06/2016] [Indexed: 01/07/2023] Open
Abstract
Background Sickle-cell trait (HbAS) reduces falciparum malaria risk and suppresses parasitaemia. Although several candidate mechanisms have been proposed, their epidemiological, clinical and experimental correlates have not been adequately explained. To explore the basis for generally lower parasitaemias and delayed malaria episodes in children with HbAS, it is hypothesized here that their spleen-dependent removal of ring-infected red blood cells (RBCs) is more efficient than in children with normal haemoglobin A (HbAA). Methods The mechanical splenic retention of Plasmodium falciparum-infected RBCs from subjects with HbAS or HbAA was investigated using two physiologically relevant methods: microsphiltration and ex vivo spleen perfusion. P. falciparum-infected RBCs obtained from in vitro cultures and from patients were used in either normoxic or hypoxic conditions. The effect of sickling in ring-infected HbAS RBCs was also investigated. Results When a laboratory-adapted parasite strain was analysed, ring-infected HbAA RBCs were retained in microsphilters at similar or greater levels than ring-infected HbAS RBCs, under normoxic (retention rate 62.5 vs 43.8 %, P < 0.01) and hypoxic (54.0 vs 38.0 %, P = 0.11) conditions. When parasitized RBCs from Malian children were analysed, retention of ring-infected HbAA and HbAS RBCs was similar when tested either directly ex vivo (32.1 vs 28.7 %, P = 0.52) or after one re-invasion in vitro (55.9 vs 43.7 %, P = 0.30). In hypoxia, sickling of uninfected and ring-infected HbAS RBCs (8.6 vs 5.7 %, P = 0.51), and retention of ring-infected HbAA and HbAS RBCs in microsphilters (72.5 vs 68.8 %, P = 0.38) and spleens (41.2 vs 30.4 %, P = 0.11), also did not differ. Retention of HbAS and HbAA RBCs infected with mature P. falciparum stages was greater than 95 %. Conclusions Sickle-cell trait is not associated with higher retention or sickling of ring-infected RBCs in experimental systems reflecting the mechanical sensing of RBCs by the human spleen. As observed with HbAA RBCs, HbAS RBCs infected with mature parasites are completely retained. Because the cytoadherence of HbAS RBCs infected with mature parasites is impaired, the very efficient splenic retention of such non-adherent infected RBCs is expected to result in a slower rise of P. falciparum parasitaemia in sickle-cell trait carriers. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1522-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seidina A S Diakité
- INSERM U1134, Paris 5, Paris 7, Institut National de la Transfusion Sanguine, 75015, Paris, France.,Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Odontostomatology, University of Bamako, Bamako, BP, 1805, Mali.,Laboratoire d'Excellence du Globule Rouge (GR-Ex), 75115, Paris, France
| | - Papa Alioune Ndour
- INSERM U1134, Paris 5, Paris 7, Institut National de la Transfusion Sanguine, 75015, Paris, France.,Laboratoire d'Excellence du Globule Rouge (GR-Ex), 75115, Paris, France
| | - Valentine Brousse
- Centre de Référence de la Drépanocytose, Hôpital Universitaire Necker Enfants Malades, 75012, Paris, France
| | - Frederick Gay
- INSERM U1134, Paris 5, Paris 7, Institut National de la Transfusion Sanguine, 75015, Paris, France
| | - Camille Roussel
- INSERM U1134, Paris 5, Paris 7, Institut National de la Transfusion Sanguine, 75015, Paris, France
| | - Sylvestre Biligui
- INSERM U1134, Paris 5, Paris 7, Institut National de la Transfusion Sanguine, 75015, Paris, France
| | - Michaël Dussiot
- Laboratoire d'Excellence du Globule Rouge (GR-Ex), 75115, Paris, France.,INSERM U1163/CNRS ERL 8254, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Institut Imagine, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Virginie Prendki
- INSERM U1134, Paris 5, Paris 7, Institut National de la Transfusion Sanguine, 75015, Paris, France
| | - Tatiana M Lopera-Mesa
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20852, USA
| | - Karim Traoré
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Odontostomatology, University of Bamako, Bamako, BP, 1805, Mali
| | - Drissa Konaté
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Odontostomatology, University of Bamako, Bamako, BP, 1805, Mali
| | - Saibou Doumbia
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Odontostomatology, University of Bamako, Bamako, BP, 1805, Mali
| | - Jérôme Cros
- Department of Chirurgie Digestive et Viscérale, Hôpital Beaujon, AP-HP, 92110, Clichy, France
| | - Safi Dokmak
- Department of Chirurgie Digestive et Viscérale, Hôpital Beaujon, AP-HP, 92110, Clichy, France
| | - Rick M Fairhurst
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20852, USA
| | - Mahamadou Diakité
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Odontostomatology, University of Bamako, Bamako, BP, 1805, Mali
| | - Pierre A Buffet
- INSERM U1134, Paris 5, Paris 7, Institut National de la Transfusion Sanguine, 75015, Paris, France. .,Laboratoire d'Excellence du Globule Rouge (GR-Ex), 75115, Paris, France.
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