1
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Jayaram A, Dutta R, Kim EK, Mahajan A, Pendleton A, Nathani P, Veetil DK, Stossberger R, McClain CD, Grewal M, Gadgil A, Roy N, Raykar NP. Alternative strategies for emergency blood transfusion in low-resource settings: A scoping review. Transfusion 2024; 64:1350-1361. [PMID: 38742837 DOI: 10.1111/trf.17838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/13/2024] [Accepted: 03/28/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Anusha Jayaram
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eric K Kim
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Alaska Pendleton
- Division of Vascular Surgery, University of Rochester, Rochester, New York, USA
| | - Priyansh Nathani
- Hinduhridaysamrat Balasaheb Thackeray Medical College, Mumbai, India
| | | | | | - Craig D McClain
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Anita Gadgil
- The George Institute for Global Health, New Delhi, India
| | - Nobhojit Roy
- The George Institute for Global Health, New Delhi, India
- Department of Public Health Systems, Karolinska Institute, Stockholm, Sweden
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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2
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Halawani SH, Khan SA, Al Zughaibi TA, Khan SA. Attitude and Behavior of Parents of Children With Sickle Cell Disease Toward the Disease: An Observational Study in Saudi Arabia. Cureus 2024; 16:e55552. [PMID: 38576648 PMCID: PMC10993756 DOI: 10.7759/cureus.55552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a significant hematological disorder affecting populations worldwide, with a notable prevalence in certain regions of Saudi Arabia. Despite extensive screening programs, there is a critical need for improved public health education to enhance understanding and management of SCD. This study examines the relationship between the attitudes and behaviors of parents toward their children's disease and its management. METHODS We conducted a cross-sectional observational study at the King Fahd Medical Research Center in Jeddah. This research encompassed children aged 5-16 years with SCD and their parents. Comprehensive questionnaires assessed sociodemographic data, attitudes toward SCD, and behavioral responses to the illness and treatment. RESULTS The study included 66 parents, predominantly in the age range of 30-39 years and earning below 5000 Saudi Riyals, who exhibited varying attitudes towards SCD, with a majority questioning the availability of a cure and expressing caution towards new treatments. Despite a cautious approach to invasive treatments, parents relied on information from healthcare providers. Attitudes towards treatment showed significant differences based on gender and education level, with females and less-educated parents exhibiting more hesitancy towards new treatment and blood transfusions. CONCLUSION The study indicates that while parents show a positive and proactive attitude toward SCD, there is hesitancy towards new and invasive treatments, reflecting the need for continued educational support. The results underscore the importance of tailored healthcare communication strategies to address the diverse needs of families affected by SCD.
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Affiliation(s)
- Saeed H Halawani
- Department of Hematology and Immunology, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Shahida A Khan
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, SAU
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, SAU
| | - Torki A Al Zughaibi
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, SAU
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, SAU
| | - Sarah A Khan
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, SAU
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3
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Charlotte EE, Edgar MML, Yolande PD, Daniele-Christiane KMK, Betoko MR, Patricia E, Iyawa H, Ngenge MB, Abigaelle M, Diomède NN, Dominique E, Gaelle NK, Juliana J, Karen E, Georgette MEJ, Margaret EM, Doriane E, Penda CI. Comparison of in-hospital mortality in children and adolescents with sickle cell disease in a resource-limited setting before and during the COVID-19 pandemic. Arch Pediatr 2024; 31:38-43. [PMID: 37989661 DOI: 10.1016/j.arcped.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 09/18/2023] [Accepted: 10/08/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND COVID-19 in children and adolescents with sickle cell disease (SCD) has variable presentations (from mild to severe disease), and the main symptoms are vaso-occlusive crises (VOC) and acute chest syndrome (ACS). We hypothesized that the desertion of hospitals due to the pandemic would lead to late arrival at the emergency room and an increased mortality. In this study, we sought to measure and compare the mortality of children with sickle cell disease before and during the COVID-19 pandemic. MATERIAL AND METHODS We conducted a retrospective cohort study at the sickle cell disease management center of Laquintinie Hospital in Douala (Cameroon). The study period was divided into two, i.e., from March 2019 to February 2020 (Pre-COVID-19) and from March 2020 to February 2021 (COVID-19). All administrative and ethical considerations were fully respected. Data were analyzed using SPSS 20.0. RESULTS Overall, 823 patients were admitted during the study period. Males represented 52.4% of the overall population, giving a sex ratio of 1.1:1. We admitted 479 patients during the pre-COVID-19 period versus 344 patients during the COVID-19 period, which is a 28.2% drop in admissions during the COVID-19 period. The mortality rate was 3.5% during the pre-COVID-19 period and 3.2% during the COVID-19 period (p>0.05). The most common causes of death were ACS (39.3%, n = 11), severe anemia (25.0%, n = 7), and VOC (17.9%, n = 5). ACS (adjusted odds ratio [aOR]=3.628, 95% confidence interval [CI], [1.645-7.005], p<0.001) was significantly associated with mortality. CONCLUSION During the COVID-19 pandemic, although the consultation frequency decreased, the mortality rate of sickle cell disease patients remained unchanged.
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Affiliation(s)
- Eposse Ekoube Charlotte
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon; Laquintinie Hospital of Douala, Douala, Cameroon
| | - Mandeng Ma Linwa Edgar
- Laquintinie Hospital of Douala, Douala, Cameroon; Faculty of Health Sciences, University of Buea, Buea, Cameroon.
| | | | | | - Mbono Ritha Betoko
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon; Laquintinie Hospital of Douala, Douala, Cameroon
| | - Epee Patricia
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Hassanatou Iyawa
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon; Laquintinie Hospital of Douala, Douala, Cameroon
| | | | - Megoze Abigaelle
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Noukeu Njinkui Diomède
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Enyama Dominique
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | | | | | - Ekotto Karen
- Laquintinie Hospital of Douala, Douala, Cameroon
| | | | | | - Ekoe Doriane
- Laquintinie Hospital of Douala, Douala, Cameroon
| | - Calixte Ida Penda
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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4
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Piel FB, Rees DC, DeBaun MR, Nnodu O, Ranque B, Thompson AA, Ware RE, Abboud MR, Abraham A, Ambrose EE, Andemariam B, Colah R, Colombatti R, Conran N, Costa FF, Cronin RM, de Montalembert M, Elion J, Esrick E, Greenway AL, Idris IM, Issom DZ, Jain D, Jordan LC, Kaplan ZS, King AA, Lloyd-Puryear M, Oppong SA, Sharma A, Sung L, Tshilolo L, Wilkie DJ, Ohene-Frempong K. Defining global strategies to improve outcomes in sickle cell disease: a Lancet Haematology Commission. Lancet Haematol 2023; 10:e633-e686. [PMID: 37451304 DOI: 10.1016/s2352-3026(23)00096-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Frédéric B Piel
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - David C Rees
- Department of Paediatric Haematology, King's College London, King's College Hospital, London, UK
| | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence for Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Obiageli Nnodu
- Department of Haematology and Blood Transfusion, College of Health Sciences and Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Brigitte Ranque
- Department of Internal Medicine, Georges Pompidou European Hospital, Assistance Publique-Hopitaux de Paris Centre, University of Paris Cité, Paris, France
| | - Alexis A Thompson
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Russell E Ware
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Miguel R Abboud
- Department of Pediatrics and Adolescent Medicine, and Sickle Cell Program, American University of Beirut, Beirut, Lebanon
| | - Allistair Abraham
- Division of Blood and Marrow Transplantation, Children's National Hospital, Washington, DC, USA
| | - Emmanuela E Ambrose
- Department of Paediatrics and Child Health, Bugando Medical Centre, Mwanza, Tanzania
| | - Biree Andemariam
- New England Sickle Cell Institute, University of Connecticut Health, Connecticut, USA
| | - Roshan Colah
- Department of Haematogenetics, Indian Council of Medical Research National Institute of Immunohaematology, Mumbai, India
| | - Raffaella Colombatti
- Pediatric Oncology Hematology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Nicola Conran
- Department of Clinical Medicine, School of Medical Sciences, Center of Hematology and Hemotherapy (Hemocentro), University of Campinas-UNICAMP, Campinas, Brazil
| | - Fernando F Costa
- Department of Clinical Medicine, School of Medical Sciences, Center of Hematology and Hemotherapy (Hemocentro), University of Campinas-UNICAMP, Campinas, Brazil
| | - Robert M Cronin
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Mariane de Montalembert
- Department of Pediatrics, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris Centre, Paris, France
| | - Jacques Elion
- Paris Cité University and University of the Antilles, Inserm, BIGR, Paris, France
| | - Erica Esrick
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Anthea L Greenway
- Department Clinical Haematology, Royal Children's Hospital, Parkville and Department Haematology, Monash Health, Clayton, VIC, Australia
| | - Ibrahim M Idris
- Department of Hematology, Aminu Kano Teaching Hospital/Bayero University Kano, Kano, Nigeria
| | - David-Zacharie Issom
- Department of Business Information Systems, School of Management, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland
| | - Dipty Jain
- Department of Paediatrics, Government Medical College, Nagpur, India
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zane S Kaplan
- Department of Clinical Haematology, Monash Health and Monash University, Melbourne, VIC, Australia
| | - Allison A King
- Departments of Pediatrics and Internal Medicine, Divisions of Pediatric Hematology and Oncology and Hematology, Washington University School of Medicine, St Louis, MO, USA
| | - Michele Lloyd-Puryear
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leon Tshilolo
- Institute of Biomedical Research/CEFA Monkole Hospital Centre and Official University of Mbuji-Mayi, Mbuji-Mayi, Democratic Republic of the Congo
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Kwaku Ohene-Frempong
- Division of Hematology, Children's Hospital of Philadelphia, Pennsylvania, USA; Sickle Cell Foundation of Ghana, Kumasi, Ghana
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5
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Kabuyi PL, Mbayabo G, Ngole M, Zola AL, Race V, Matthijs G, Van Geet C, Tshilobo PL, Devriendt K, Mikobi TM. Hydroxyurea treatment for adult sickle cell anemia patients in Kinshasa. EJHAEM 2023; 4:595-601. [PMID: 37601858 PMCID: PMC10435708 DOI: 10.1002/jha2.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/20/2023] [Accepted: 06/08/2023] [Indexed: 08/22/2023]
Abstract
Background: Despite a high incidence of sickle cell anemia, hydroxyurea (HU) treatment is rarely used in the DR Congo. This study aims to assess the efficacy of HU, the incidence of side effects that may limit its use in adults and to determine the dose needed for clinical improvement in patients. Methods: In a prospective study, patients received an initial dose of 15 mg/kg/day which was increased by 5 mg/kg every 6 months, up to a maximum of 30 mg/kg/day. The response and side effects to HU were evaluated biologically and clinically every 3 months during a 2-year period. Results: Seventy adult patients with a moderate or severe clinical phenotype initiated treatment. Only minor side effects were reported. At the end of the 2-year treatment phase, 45 (64.3%) had dropped out, of whom 33 were without a clear reason. Clinical and biological improvement was more marked during the first year. There was a reduction in severe vaso-occlusive crises (p < 0.001), need for transfusion (p < 0.001), and hospitalization days (p = 0.038). Fetal hemoglobin (HbF) levels increased on average 2.9 times after 12 months (p < 0.001). The increase in mean corpuscular volume was greater in the first year (p < 0.001) than in the second year (p = 0.041). The decrease in leukocytes (p < 0.001) was significant during the first year. In 70% of patients, the 20 mg/kg/day dose was needed to reach the 20% HbF threshold. Conclusion: HU is effective and well tolerated. The magnitude of the response varies from one patient to another. Improvement of clinical manifestations is achieved in most patients with a relatively low dose. Effective implementation of HU treatment will require improved adherence to treatment.
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Affiliation(s)
- Paul Lumbala Kabuyi
- Department of PediatricsUniversity of KinshasaKinshasaDemocratic Republic of the Congo
- Center of Human GeneticsFaculty of MedicineUniversity of KinshasaKinshasaDemocratic Republic of the Congo
- Center for Human GeneticsKatholieke Universiteit Leuven and University Hospitals LeuvenLeuvenBelgium
| | - Gloire Mbayabo
- Department of PediatricsUniversity of KinshasaKinshasaDemocratic Republic of the Congo
- Center of Human GeneticsFaculty of MedicineUniversity of KinshasaKinshasaDemocratic Republic of the Congo
- Center for Human GeneticsKatholieke Universiteit Leuven and University Hospitals LeuvenLeuvenBelgium
| | - Mamy Ngole
- Center of Human GeneticsFaculty of MedicineUniversity of KinshasaKinshasaDemocratic Republic of the Congo
- Center for Human GeneticsKatholieke Universiteit Leuven and University Hospitals LeuvenLeuvenBelgium
- Department of Clinical BiologyUniversity of KinshasaKinshasaDemocratic Republic of the Congo
| | - Aimé Lumaka Zola
- Center of Human GeneticsFaculty of MedicineUniversity of KinshasaKinshasaDemocratic Republic of the Congo
| | - Valerie Race
- Center for Human GeneticsKatholieke Universiteit Leuven and University Hospitals LeuvenLeuvenBelgium
| | - Gert Matthijs
- Center for Human GeneticsKatholieke Universiteit Leuven and University Hospitals LeuvenLeuvenBelgium
| | - Chris Van Geet
- Department of Cardiovascular SciencesCenter for Molecular and Vascular BiologyKatholieke Universiteit LeuvenLeuvenBelgium
| | - Prosper Lukusa Tshilobo
- Center of Human GeneticsFaculty of MedicineUniversity of KinshasaKinshasaDemocratic Republic of the Congo
| | - Koenraad Devriendt
- Center for Human GeneticsKatholieke Universiteit Leuven and University Hospitals LeuvenLeuvenBelgium
| | - Tite Minga Mikobi
- Center of Human GeneticsFaculty of MedicineUniversity of KinshasaKinshasaDemocratic Republic of the Congo
- Departement des sciences de base, Laboratory of Biochemistry and Molecular Biology, Faculty of MedicineUniversity of KinshasaKinshasaDemocratic Republic of the Congo
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6
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Gadji M, Cobar G, Thiongane A, Senghor AB, Seck R, Faye BF, Seck M, Guéye YB, Sy D, Sall A, Toure AO, Diéye TN, Diop S. Red blood cell alloantibodies in paediatric transfusion in sub-Saharan Africa: A new cohort and literature review. EJHAEM 2023; 4:315-323. [PMID: 37206261 PMCID: PMC10188460 DOI: 10.1002/jha2.645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 05/21/2023]
Abstract
Blood transfusion support predisposes transfused children to the risk of erythrocyte alloimmunization in Sub-Saharan Africa. A cohort of 100 children receiving one to five blood transfusions were recruited for screening and identification of irregular antibodies using gel filtration technique. The mean age was 8 years and the sex-ratio at 1.2. The retrieved pathologies were: major sickle cell anaemia (46%), severe malaria (20%), haemolytic anaemia (4%), severe acute malnutrition (6%), acute gastroenteritis (5%), chronic infectious syndrome (12%) and congenital heart disease (7%). The children presented with haemoglobin levels ≤6 g/dl, and 16% of them presented positive irregular antibodies directed against the Rhesus (30.76%) and Kell (69.24%) blood group systems. A literature review shows that irregular antibody screenings vary from 17% to 30% of transfused paediatric patients in Sub-Saharan Africa. These alloantibodies are in particular directed against the Rhesus, Kell, Duffy, Kidd and MNS blood group and generally found in sickle cell disease and malaria. This study highlights the urgent need of extended red blood cell phenotyping including typing for C/c, E/e, K/k, and Fya/Fyb, and if possible Jka/Jkb, M/N, and S/s for children before transfusion in Sub-Saharan Africa.
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Affiliation(s)
- Macoura Gadji
- Service of Haematology and Oncology‐Haematology (HBOH)Department of Biology and Applied Pharmaceutical SciencesFaculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
- National Centre of Blood Transfusion (CNTS)DakarSenegal
| | - Guéda Cobar
- Service of Haematology and Oncology‐Haematology (HBOH)Department of Biology and Applied Pharmaceutical SciencesFaculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
- National Centre of Blood Transfusion (CNTS)DakarSenegal
| | - Alioune Thiongane
- Service of PaediatricsDepartment of Medicine, Hospital Albert Royer of FannFaculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
| | | | - Rose Seck
- National Centre of Blood Transfusion (CNTS)DakarSenegal
| | - Blaise Félix Faye
- National Centre of Blood Transfusion (CNTS)DakarSenegal
- Service of HaematologyDepartment of Medicine, Faculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
| | - Moussa Seck
- National Centre of Blood Transfusion (CNTS)DakarSenegal
- Service of HaematologyDepartment of Medicine, Faculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
| | | | - Diariétou Sy
- National Centre of Blood Transfusion (CNTS)DakarSenegal
| | - Abibatou Sall
- Service of HaematologyDepartment of Medicine, Faculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
| | - Awa Oumar Toure
- Service of HaematologyDepartment of Medicine, Faculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
- Service of BiologyHospital Aristide le DantecDakarSenegal
| | - Tandakha Ndiaye Diéye
- National Centre of Blood Transfusion (CNTS)DakarSenegal
- Service of ImmunologyDepartment of Biology and Applied Pharmaceutical Sciences Faculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
| | - Saliou Diop
- National Centre of Blood Transfusion (CNTS)DakarSenegal
- Service of HaematologyDepartment of Medicine, Faculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
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7
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Pirenne F, Floch A, Diop S. Alloimmunisation against red blood cells in sickle cell disease: transfusion challenges in high-income and low-income countries. Lancet Haematol 2023:S2352-3026(23)00066-2. [PMID: 37060916 DOI: 10.1016/s2352-3026(23)00066-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 04/17/2023]
Abstract
Sickle cell disease is the most frequent inherited disorder in sub-Saharan Africa and in many high-income countries (HICs). Transfusion is a key element of treatment, but it results in high rates of alloimmunisation against red blood cell antigens and post-transfusion haemolysis, which can be life-threatening in severe cases. The prevention of alloimmunisation is, therefore, an important issue in both HICs and in low-income countries (LICs). In HICs, the main reason for high alloimmunisation rates is blood group disparity between blood donors, who are mostly of European descent, and the patients, who are mostly of African descent. However, alloimmunisation rates also remain high in sub-Saharan Africa despite the homogeneity of blood group antigen frequencies between donors and patients; this occurrence is probably due to matching strategies limited to ABO blood group and RhD. However, other possible underlying causes of alloimmunisation have also been suggested, with each cause affecting HICs and LICs in different ways-eg, the immunogenetic and inflammatory status of the patient and the characteristics of the red blood cell products. In this Viewpoint, we discuss the available data and hypotheses that potentially account for the association of sickle cell disease with high rates of alloimmunisation in both settings, HICs and LICs (focusing particularly on sub-Saharan Africa), and the challenges faced by HICs and LICs to improve prevention of alloimmunisation.
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Affiliation(s)
- France Pirenne
- Transfusion and Red Blood Cell Diseases, INSERM U955, The Mondor Institute for Biomedical Research, University Paris-Est Créteil, Paris, France; Établissement Français du Sang Ile de France, Paris, France.
| | - Aline Floch
- Transfusion and Red Blood Cell Diseases, INSERM U955, The Mondor Institute for Biomedical Research, University Paris-Est Créteil, Paris, France; Établissement Français du Sang Ile de France, Paris, France
| | - Saliou Diop
- Department of Haematology, National Center Transfusion Sanguine, Cheikh Anta Diop University, Dakar, Senegal
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8
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Hydroxyurea and stroke prevention in sickle cell anaemia: the challenge of application in sub-Saharan Africa. Lancet Haematol 2023; 10:e237-e238. [PMID: 36870359 DOI: 10.1016/s2352-3026(23)00003-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 03/06/2023]
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9
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Quirino MG, Neto QADL, Zacarias JMV, Góis KS, Maria Sell A, Visentainer JEL. Low-cost molecular methodology for blood group antigens identification and genotyping contribution to transfusion efficacy in multiple transfused patients. Expert Rev Mol Diagn 2022; 22:1-9. [PMID: 36333936 DOI: 10.1080/14737159.2022.2144236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Blood transfusions usually result in the production of alloantibodies, complicating subsequent transfusions. Many blood group systems, in addition to ABO and Rh, can lead to the production of irregular antibodies in multiple transfused patients. OBJECTIVES The aim of this work was to standardize a molecular biology methodology for identified some alleles of KEL, FY, JK and DI blood group system; the transfusion efficacy of chronically transfused patients with phenotype-matched blood was also evaluated. METHODS A PCR-SSP was developed and validated using Sanger sequencing. The genotype and frequencies of 141 multiple transfused patients treated at blood banks of Maringá were compared with the blood donor's population to assess the availability of compatible blood bags. The clinical history of 29 patients on a phenotype-compatible transfusion regimen was followed to assess pre- and post-genotyping alloimmunization. RESULTS The PCR-SSP was effective in identifying the genotypes under study. Significant differences were observed in genotype and allele frequencies for FY and JK. Compatible bags were identified for all patients. Most patients (93.1%) did not develop new alloantibodies after erythrocyte genotyping. CONCLUSION Erythrocyte genotyping proved to be important both in the search for positive blood bags for rare alleles and in the prevention of alloimmunization.
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Affiliation(s)
| | - Quirino Alves de Lima Neto
- Department of Clinical Analysis and Biomedicine, Maringá State University, Maringá, Brazil
- Department of Basic Health Sciences, State University of Maringá, Maringá, Brazil
| | - Joana Maira Valentini Zacarias
- Department of Clinical Analysis and Biomedicine, Maringá State University, Maringá, Brazil
- Department of Basic Health Sciences, State University of Maringá, Maringá, Brazil
| | - Kelly Silvério Góis
- Department of Clinical Analysis and Biomedicine, Maringá State University, Maringá, Brazil
| | - Ana Maria Sell
- Department of Clinical Analysis and Biomedicine, Maringá State University, Maringá, Brazil
| | - Jeane Eliete Laguila Visentainer
- Department of Clinical Analysis and Biomedicine, Maringá State University, Maringá, Brazil
- Department of Basic Health Sciences, State University of Maringá, Maringá, Brazil
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10
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Seck M, Ba O, Faye BF, Touré SA, Guèye YB, Dieng N, Sall A, Gadji M, Touré AO, Diop S. Homozygous sickle cell disease related mortality in Senegal (2011–2020). EJHAEM 2021; 2:711-715. [PMID: 35845188 PMCID: PMC9176000 DOI: 10.1002/jha2.273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
Homozygous sickle cell disease (HSCD) is characterized by multiorgan morbidity and an increased risk of early death. We aim to describe the mortality rate, causes, and risk factors of death in HSCD between 2011 and 2020. We conducted a retrospective study with a duration of 10 years in the cohort of 2348 HSCD patients. The mortality rate was determined by reporting the number of deaths to the total number of patients followed in the year. Sociodemographic, clinical, biological data and causes of death were studied. Death risk factors were determined by a bivariate analysis comparing deceased and living HSCD patients. The mean age of death was 26 years (3–52). The sex ratio was 1.2. The mortality rate was 2.76%. The death rate was high in 2011 (3.2%) and low in 2020 (0.17%). We observed a significant reduction of mortality of 94.6%. Most of the common causes of death were acute anemia (40%), acute chest syndrome (24.6%), and infections (20%). Risk factors of death were age, vaso‐occlusive crises ≥3, acute chest syndrome, blood transfusion, and chronic complications. Mortality among HSCD has significantly decreased over the past 10 years in Senegal, and the main causes of death were acute anemia, acute chest syndrome, and infections.
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Affiliation(s)
- Moussa Seck
- Hematology Department Cheikh Anta Diop University Dakar Senegal
| | - Oumou Ba
- Hematology Department Cheikh Anta Diop University Dakar Senegal
| | | | | | | | - Nata Dieng
- Hematology Department Cheikh Anta Diop University Dakar Senegal
| | - Abibatou Sall
- Hematology Department Cheikh Anta Diop University Dakar Senegal
| | - Macoura Gadji
- Hematology Department Cheikh Anta Diop University Dakar Senegal
| | - Awa Oumar Touré
- Hematology Department Cheikh Anta Diop University Dakar Senegal
| | - Saliou Diop
- Hematology Department Cheikh Anta Diop University Dakar Senegal
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11
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Esoh K, Wonkam-Tingang E, Wonkam A. Sickle cell disease in sub-Saharan Africa: transferable strategies for prevention and care. Lancet Haematol 2021; 8:e744-e755. [PMID: 34481550 DOI: 10.1016/s2352-3026(21)00191-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/27/2021] [Accepted: 06/10/2021] [Indexed: 12/22/2022]
Abstract
Sickle cell disease can be life-threatening or chronically debilitating for both children and adults. Worldwide, more than 300 000 children are born with sickle cell disease every year, over 75% of whom in sub-Saharan Africa. Increased awareness and early interventions, such as neonate screening and comprehensive care, have led to considerable reductions in mortality in children younger than 5 years in high-income countries. However, sickle cell disease prevention and care have largely been neglected in Africa. Without intervention, 50-90% of affected children in many sub-Saharan African countries die before their fifth birthday. Fortunately, increasing initiatives in sub-Saharan Africa are piloting interventions such as neonate screening and comprehensive care, and as mortality declines, quality of life and increased life expectancy become major targets for interventions. Hydroxyurea (hydroxycarbamide) and haematopoietic stem-cell transplantation have already been shown to be effective therapies in high-income countries, but are either not widely accessible or too expensive for most African populations. These challenges are being alleviated by numerous networks evolving through international collaborations that are positively changing the outlook of sickle cell disease management in sub-Saharan Africa. In this Series paper, we describe the epidemiology, pathophysiology, clinicobiological profile, and psychosocial effects of sickle cell disease in sub-Saharan Africa. We highlight transferable strategies already used for the successful management of the condition and key strategies and recommendations for affordable and comprehensive care on the continent. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Kevin Esoh
- Division of Human Genetics, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Edmond Wonkam-Tingang
- Division of Human Genetics, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Pathology, University of Cape Town, Cape Town, South Africa; Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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12
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Rankin A, Darbari D, Campbell A, Webb J, Mo YD, Jacquot C, Delaney M, Luban NLC, Nickel RS. Screening for new red blood cell alloantibodies after transfusion in patients with sickle cell disease. Transfusion 2021; 61:2255-2264. [PMID: 34002408 DOI: 10.1111/trf.16444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) are frequent recipients of red blood cell (RBC) transfusions and are at risk for RBC alloimmunization. RBC alloimmunization is diagnosed by identifying RBC alloantibodies as part of pre-transfusion testing, but this testing fails to detect alloantibodies that have evanesced. It may be beneficial to screen for new RBC alloantibody development after transfusion before possible antibody evanescence. STUDY DESIGN AND METHODS Our institution started a new initiative for episodically transfused patients with SCD to obtain at least one antibody screen 2-6 months after transfusion as part of their clinical care. A database was created to prospectively track all transfused patients for 1 year and their post-transfusion antibody screen results. Patients received prophylactically CEK-matched RBC units. RESULTS During the study year, 138 patients with SCD received a total of 242 RBC transfusions. Patients with a history of an RBC alloantibody (n = 13, 9.4%) had previously received more RBC units than non alloimmunized patients (median 11 vs. 2 RBC units, p = .0002). A total of 337 post-transfusion antibody screens were obtained in 127 patients (92.0%) with 110 patients (79.7%) having at least one antibody screen 2-6 months post-transfusion. With this prospective testing, two new RBC alloantibodies (anti-C and -M) were identified in two patients. CONCLUSION It is feasible to test for new RBC alloantibody development in most episodically transfused patients with SCD as part of their routine care. The yield of this screening appears low with CEK matching, but it could still provide important information for individual patients.
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Affiliation(s)
- Alexander Rankin
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Pediatric Hematology-Oncology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Deepika Darbari
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Andrew Campbell
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Jennifer Webb
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Yunchuan Delores Mo
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Cyril Jacquot
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Meghan Delaney
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Naomi L C Luban
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Robert Sheppard Nickel
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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