[Anemia in blood donors and criteria of hemoglobin level control at the national blood transfusion center (NBTC) of Lomé, 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.

Inflammatory and regulatory CCL and CXCL chemokine and cytokine cellular responses in patients with patent Mansonella perstans filariasis

Mansonella perstans (Mp) filariasis is present in large populations in sub-Saharan Africa, and to what extent patent Mp infection modulates the expression of immunity in patients, notably their cellular cytokine and chemokine response profile, remains not well known. We studied the spontaneous and inducible cellular production of chemokines (C-X-C motif) ligand 9 (CXCL9) [monokine induced by interferon (IFN)-γ (MIG)], CXCL-10 [inducible protein (IP)-10], chemokine (C-C motif) ligand 24 (CCL24) (eotaxin-2), CCL22 [macrophage-derived chemokine (MDC)], CCL13 [monocyte chemotactic protein-4 (MCP-4)], CCL18 [pulmonary and activation-regulated chemokine (PARC)], CCL17 [thymus- and activation-regulated chemokine (TARC)] and interleukin (IL)-27 in mansonelliasis patients (Mp-PAT) and mansonelliasis-free controls (CTRL). Freshly isolated peripheral mononuclear blood cells (PBMC) were stimulated with helminth, protozoan and bacterial antigens and mitogen [phytohaemagglutinin (PHA)]. PBMC from Mp-PAT produced spontaneously (without antigen stimulation) significantly higher levels of eotaxin-2, IL-27, IL-8, MCP-4 and MDC than cells from CTRL, while IFN-γ-IP-10 was lower in Mp-PAT. Helminth antigens activated IL-27 and MCP-4 only in CTRL, while Ascaris antigen, Onchocerca antigen, Schistosoma antigen, Entamoeba antigen, Streptococcus antigen, Mycobacteria antigen and PHA stimulated MIG release in CTRL and Mp-PAT. Notably, Entamoeba antigen and PHA strongly depressed (P < 0·0001) eotaxin-2 (CCL24) production in both study groups. Multiple regression analyses disclosed in Mp-PAT and CTRL dissimilar cellular chemokine and cytokine production levels being higher in Mp-PAT for CCL24, IL-27, IL-8, MCP-4, MDC and PARC (for all P < 0·0001), at baseline (P < 0·0001), in response to Entamoeba histolytica strain HM1 antigen (EhAg) (P < 0·0001), Onchocerca volvulus adult worm-derived antigen (OvAg) (P = 0·005), PHA (P < 0·0001) and purified protein derivative (PPD) (P < 0·0001) stimulation. In Mp-PAT with hookworm co-infection, the cellular chemokine production of CXCL10 (IP-10) was diminished. In summary, the chemokine and cytokine responses in Mp-PAT were in general not depressed, PBMC from Mp-PAT produced spontaneously and selectively inducible inflammatory and regulatory chemokines and cytokines at higher levels than CTRL and such diverse and distinctive reactivity supports that patent M. perstans infection will not polarize innate and adaptive cellular immune responsiveness in patients.

Chemokine levels and parasite- and allergen-specific antibody responses in children and adults with severe or uncomplicated Plasmodium falciparum malaria

Chemokine and antibody response profiles were investigated in children and adults with severe or uncomplicated Plasmodium falciparum malaria; the aim was to reveal which profiles are associated with severe disease, as often seen in nonimmune children, or with mild and uncomplicated disease, as seen in semi-immune adults. Blood samples were obtained from children under 5 years of age as well as adults with falciparum malaria. Classification of malaria was performed according to parasite densities and hemoglobin concentrations. Plasma levels of chemokines (IL-8, IP-10, MCP-4, TARC, PARC, MIP-1δ, eotaxins) were quantified, and antibody responses (IgE, IgG1, and IgG4) to P. falciparum, Entamoeba histolytica-specific antigen, and mite allergen extracts were determined. In children with severe malaria proinflammatory, IL-8, IP10, MIP-1δ, and LARC were at highly elevated levels, suggesting an association with severe disease. In contrast, the Th2-type chemokines TARC, PARC, and eotaxin-2 attained in children the same levels as in adults suggesting the evolution of immune regulatory components. In children with severe malaria, an elevated IgG1 and IgE reactivity to mite allergens and intestinal protozoan parasites was observed. In conclusion, exacerbated proinflammatory chemokines together with IgE responses to mite allergens or E. histolytica-specific antigen extract were observed in children with severe falciparum malaria.

[Knowledge of sickle cell disease and prevention methods in an urban district of Lomé, Togo]

Despite the important frequency of the gene "S" in Togo, essential information remains insufficient to elaborate a prevention campaign on this affection. In order to assess the knowledge on sickle cell diseases as well as the prevention practices in the Togo population in one of the five districts of the township of Lomé, a cross sectional study was conducted in the third district of the township of Lomé from January 21, 2004 to January 26, 2004 in 210 natives from Togo aged of 15 and over, through a semi-structured questionnaire. The variables studied were: - the socio-demographic features and the knowledge of sickle cell disease characteristics (symptoms, biological diagnosis, treatment and means). Data collected were analysed through software Statically Package for Social Science (SPSS) version 10.0 of Windows using the chi2 test with 5% significance in the comparison of some variables. 117 women and 93 men were interviewed. Sickle cell disease was known in almost all ethnic groups but incompletely: 79.5% of the individuals knew about premarital check up but only 12.4% knew about haemoglobin electrophoresis check up. 74,8% of the people had a good knowledge of the cause of sickle cell disease, 78.6% had a fairly good knowledge of its symptoms, 57.6% knew the factors inducing attacks, 64.3% the prognosis and 69.5% the prevention methods, but a poor knowledge of the complications (62.4%), biological diagnosis (71%) and treatment (97.2%). The prevention practices were poorly adopted: 12% had an haemoglobin electrophoresis check up and 15% of them had their husband to have one as well. Professional status influenced the level of knowledge of the biological diagnosis (p=0.001) and prevention means (p=0.018). The educational level influenced biological diagnosis knowledge (p = 0.000) and prevention means (p = 0.02). On the whole, sickle disease was linked to marital status (p = 0.00). Sickle cell disease remains quite unknown in spite of the gene "S" important frequency in Togo. These results are to be taken into account to implement information, education and communication program to struggle against sickle cell disease.

[Effect of Morinda lucida Benth. (Rubiaceae) and Newbouldia leavis P. Beauv. (Bignoniaceae) on sickling of red blood cells]

The purpose of this study was to evaluate the In vitro anti-sickling activity of two plants widely used for treatment of sickle cell disease in Togo, i.e., Morinda lucida et Newbouldia leavis. A concentration-dependent decrease in the rate of sickling was observed after incubation of red blood cells with plant extracts and 2% sodium metabisulfite as compared to incubation with 0.9% NaCl. On samples with a SS blood genotype the inhibition rate of Morinda lucida was 17.30% at a concentration of 1 mg/ml and 92.31% at a concentration of 30 mg/ml. On samples with an AS blood genotype, the inhibition rate of Morinda lucida 48.10% at a concentration of 1 mg/ml and 99.34% at a concentration of 30 mg/ml. Using Newbouldia leavis the inhibition rates at concentrations of 1 mg/ml and 30 mg/ml were 15.66% and 90.42% respectively on samples with a SS blood genotype and 64.03% and 99.02% respectively on samples with an AS blood genotype. The study protocol appeared to be adequate for both SS and AS blood genotypes since the Pearson correlation coefficient between rates measured on the two types of samples was 0.92 for Newuboulida and 0.89 for Morinda. These findings show that these two plants have clear-cut in vitro anti-sickling activity and support their use in traditional medicine.

[Hemoglobin anomalies at the university hospital center in Lome, Togo]

Togo is a sub-Saharan African nation with a number of public health problems including endemic tropical disease. The country is also located in the Lehmann sickle cell belt characterized by a high incidence of genetic red blood cell disorders. The purpose of this study was to identify the main hemoglobin variants, evaluate their incidence and discuss diagnostic pitfalls. Data on 5604 subjects was compiled from the 3 studies, i.e., a 405-case prospective study conducted in a rheumatology department, a 5028-case retrospective study using electrophoresis and a 171-case transversal study in newborns. Diagnosis of hemoglobinopathy was based on alkaline electrophoresis. Rare hemoglobins were identified in the Biochemistry Laboratory of the Henri Mondor Hospital in Paris, France. Diagnosis of alpha-thalassemia was checked by PCR. The main abnormal hemoglobins were the S and C variants with respective incidence ranges of 15.8 to 16.7% for the AS trait and 12.1 to 15.8% for AC trait. SS sickle cell disease was observed in 1.2 to 2% of subjects and SC sickle disease in 2.3 to 4.2%. Rare hemoglobulinopathies involved the fast hemoglobulin variant, hemoglobin D, and hereditary persistence of hemoglobin F. Alpha-thalassemia was detected in 47% of the 171 newborns studied with a predominance of the heterozygous form (36.8%), followed by the homozygous form (8%). The incidence of alpha gene triplication in the newborns was about 2.4%. Hemoglobin Barts was not a consistent finding in association with diagnosis of alpha-thalassemia since it was present in 15 newborns with normal alpha genotype (8.8%) and absent in 10 newborns with heterozygous alpha genotype (5.9%). This study demonstrates that molecular biology is the best method for the detection of the alpha-globin gene abnormalities.

[Four case reports of Biermer's anemia in West Africa]

The purpose of this report is to describe 4 cases of Biermer's anemia observed in West Africa over a 7-year period. Severe asthenia was the main clinical manifestation. Laboratory tests consistently demonstrated macrocytic anemia usually with a deep drop in hemoglobin levels ranging from 40 to 84 g/l associated with various degrees of thrombocytopenia or leukopenia. Other consistent findings were bone marrow megaloblastosis, serum vitamin B12 deficiency, and intrinsic factor antibodies. In most cases diagnosis was established on the basis of therapeutic tests with subsequent confirmation. Treatment using vitamin B12 therapy was successful in all cases. The authors recommend iron deficiency testing during the course of the disease and gastric biopsy during fibroscopy of upper digestive tract even if no macroscopic lesions are found.

Priapism in sickle cell anemia in Togo: prevalence and knowledge of this complication

Prevalence of priapism and knowledge on this disease was assessed by interviewing a group of 114 sickle cell anemia patients, 5 years and older, considered to be genotypically homogenous (Benin or #19 haplotype). Prevalence of priapism in homozygous sickle cell patients was 26.3% (30/114) and that of the control group of subjects with Hb AA was 2% (2/102) (the difference was very significant: p = 5.10-7). Actuarial probability of having priapism by 20 years of age was 69 +/- 8.5%. Few homozygous patients without a history of priapism (15.8%) have heard about priapism. This lack of knowledge, added to low accessibility of a health care system, may explain the high rate of impotence (31.6%). The results of this study led us to plan a large program of infonnation about priapism and sickle cell disease in the Togolese population.

[Intracavernous injections of etilefrin: its efficacy in the treatment of priapism in sickle cell patients]

OBJECTIVE

To date, the treatment of priapism in sickle-cell patients has relied on measures aimed at lowering blood viscosity and acidosis and reducing the level of circulating hemoglobin S (hyperhydration, alkalinization, or exsanguinotransfusion...) Surgical cavernous-venous shunt may be proposed if conservative treatment fails. We examined the efficacy of intracavernous etilefrin injections.

PATIENTS AND METHODS

From January 1996 through October 1997 (20 months) we performed 35 consecutive intracavernous injections of an alphastimulant, etilefrin in 7 sickle-cell patients (6 SS, 1 AS) who had experienced one or several episodes of low-flow priapism lasting 2 to 28 hours.

RESULTS

Involution of the tumefaction was rapidly achieved in all cases. Tolerance was satisfactory, although some post-injection undesirable effects were reported by certain patients: moderate transient pain (2-5 min) in the retrosternal area, or intense pain in the penis (more intense than the priapism) which lasted 10 to 30 minutes. This work confirmed the earlier reported efficacy of intracavernous injections of etilefrin and suggests that the autonomous nervous system plays an important role in the genesis of this condition in sickle-cell patients. Patients should be informed about the observed undesirable effects which have not been reported previously in the literature.

CONCLUSION

Etilefrin can be proposed as first line treatment for priapism in sickle-cell patients (at least in cases lasting less than 24 h). The pathogenic mechanism could involve neuromuscular dysfunction.

Hemoglobins in Togolese newborns: Hb S, Hb C, Hb Bart's, and alpha-globin gene status

The gene frequency of the most important hemoglobin (Hb) abnormalities is reported in a population of 171 Togolese newborns. Hb phenotypes, hematological parameters, and the more frequently described alpha-gene deletions were analyzed. Structural abnormalities of beta-globin were observed in 35.7% of the children with a gene frequency of 0.105 for beta(S) and 0.091 for beta(C). The frequency of the different alpha-globin genotypes was alpha alpha/ = 0.71, -alpha/ = 0.28, and alpha alpha alpha/ = 0.01. All of the individuals homozygous for the -alpha genotypes, and most of the heterozygous individuals, carried Hb Bart's. Within the alpha alpha/alpha alpha and the -alpha/alpha alpha groups, several individuals with or without Hb Bart's were found; they did not differ from the others by their red blood cell (RBC) parameters but by their levels of fetal hemoglobin (Hb F). The African alpha2 polymorphism marker, characterized by the replacement of G by TCGGCCC at position 7238 (EMBL HSHBA4, 1993) and of T 7174 by G, was found in 21 newborns. The mean value of Hb F was calculated for each genotype, the mean (G)gamma percentage was 69.4 +/- 4.0%, and the gene frequency of the AgammaT marker was 0.10; this marker was linked to the normal beta-globin cluster.

[Idiopathic thrombopenic purpura in a child in black Africa: a case report in Togo]

Idiopathic thrombocytopenic purpurea (ITP) is an autoimmune disease that occurs frequently in Europe and the US, but has rarely been described in Africa. Case report. An 8-year-old girl was admitted for cutaneous and mucosal bleeding. She had a low platelet count (11 x 10(9)/l). ITP was suspected and the diagnosis was confirmed by bone marrow examination. Corticosteroid treatment was effective.

DISCUSSION

This is the second case reported in Togo since 1982. The diagnosis of the disease is straightforward, so the lack of cases reported in central Africa suggests that the disease is rare in this region. The rarity of the disease may be due to genetic or environmental factors, or it may simply be that physicians overlook this disease when making their diagnosis. Corticosteroids are now the preferred treatment for ITP because of the risk of transmitting Creutzfeldt-Jacob's disease by intravenous administration of immunoglobulin. Splenectomy is the ultimate treatment for chronic forms.

CONCLUSION

Unlike other diseases, the diagnosis and treatment of which require methods unavailable in parts of Africa, ITP treatment, as currently practiced in countries of the northern hemisphere, is within the reach of most African countries. Further studies are required to determine the true frequency of the disease in central Africa.

[Rheumatic diseases and hemoglobinopathies in Lomé (Togo)]

This prospective cross-sectional study was designed to determine the frequency and impact of hemoglobinopathies in rheumatology clinic patients in Lomé (Togo). Among the 405 study patients, 142 (35%) had an abnormal hemoglobin, 22% had hemoglobin S, and 16.8% had hemoglobin C. Sickle cell anemia and sickle cell-hemoglobin C disease (2% and 4.2% of patients respectively) were associated with vasoocclusive crises and necrosis of the femoral head. Presence of AS or AC (heterozygotic forms of hemoglobins S and C) was found in 15.8% and 12.1% of patients, respectively. These proportions were similar to those reported in the population at large. Presence of AS or AC had no detectable influence on degenerative spinal disease, osteoarthritis of the knee, tendinitis or inflammatory joint diseases. Our data suggest that presence of AS or AC has no adverse significance and should be disregarded when evaluating patients with musculoskeletal symptoms.

[Anemia in Third World children]

The number of persons suffering from anaemia in the world is estimated at fifty million to one billion. Most of these are children, since they are more vulnerable than adults as regards nutrition and they constitute the bulk of the population in developing countries. Depending on the region, the prevalence of anaemia among children varies from 15 to 25 p. 100 in Latin America and Indonesia and from 70 to 80 p. 100 in Africa south of the Sahara desert and in India. Anaemia results from multiple deficiencies simultaneously involving iron, folic acid and proteins. The responsibility of each of these deficiencies is difficult to determine and probably varies from one region to another. The causes of these deficiencies are multiple; they include insufficient intake, inadequate absorption, increased needs and excessive losses. The only efficient measure would be an improvement in the level of life.