[Maternal anaemia: effect on the newborn]

Pregnancy increases considerably iron needs in mother and her foetus. The purpose of our study is to measure the effect of maternal anaemia on the foetus and the effect of iron supplementation on the maternal and foetal reserves. Therefore, we conducted a three-month cross sectional study at the gynaecological and obstetrics clinics of Aristide Le Dantec Hospital. Ninety-five women aged 16 to 43 years old and having an haemoglobin rate < 11 g/dl were recruited. Most of them were primipares. Among them 69 had a low ferritinemia (< 50 ng/ml), 36, a ferritinemia collapsed (< 30 ng/ml) and 13 virtually non-existent reserves (< 12 ng/ml). All newborns were born in terms with an apgar score >/= in 93 of them. Among them 24 had anemia (rate of haemoglobin < 14 g/dl) and 54.7% a low ferritinemia. There is no relationship between the maternal and foetal rates of haemoglobin; 74% of newborn had a normal rate of haemoglobin. Among 36 women with low ferritinemia only two gave birth to a newborn without iron reserves. In our study, among 68 women who received iron regularly, 41 had normal reserves and 43 gave birth to a newborn with high ferritinemia. There is significant difference between the women having received iron during their pregnancy and those not supplemented as regards the effect on newborn (p = 0.00001). The prevention of iron deficiency and anaemia can be done by the iron systematic and premat supplementation.

[Portal and splenic veins thrombosis reveling a miliary tuberculosis of the liver]

The etiologies of the portal vein trombosis are dominated by the neoplasic forms with hepatocellular carcinoma; we report a rare case of portal and splenic veins thrombosis revealing a liver military tuberculosis occuring in a HIV 1 infected patient. A 42 years old senegalese woman with no personal or family history of thrombosis was admitted for abdominal upper right quadran, and epigastric pain, with fever and important weight loss. Ultrasound identified endoluminal echogenic images in the portal and splenic veins. There were no lymph nodes or liver tumor. Evaluations of proteins C and S were normal and there was no anticardiolipin antibody. In searching the aetiology of the thrombosis, a liver biopsy was performed, and showed a miliary tuberculosis. an HIV 1 infection was later on diagnosed. The antituberculosis treatment associated with heparine therapy was successful, the thrombosis resolved entirely. This portal and splenic veins thromboses occuring on a miliary tuberculosis of the liver seems to be an exceptional situation. We did not found in the literature a similar case.lt points out the interset of liver biopsy in searching the aetiology and the early heparine therapy set up

[Homozygous drepanocytosis in Dakar: effect of the hemoglobin F level, and sociocultural and economic factors]

Sickle cell anemia exhibits significant variations in clinical presentation in different populations despite the homogeneity of the genetic defect which is involved. Genetic modulation of this disease is known but cannot explain alone such observations. Our objectives were to determine the effects of Hb F level, sociocultural and economic factors on disease severity in Dakar. Sixty homozygous sickle cell patients were followed up between october 1996 and April 1998 during which period the severity of the disease was assessed and a "severity index" was calculated for each patient. The factors which were identified with proved benefit were: Hb F > 15%, a high socioeconomic level, a good understanding of the disease, at least 4 medical visits per year. These results allow us to identify some potential targets to improve preventive and curative care of this disease.

[Evaluation of thrombotic risk in type 2 diabetes: determination of platelet factor 4 and beta thromboglobulin]

We achieved the dosage of platelet factor 4 (PF 4) and beta thromboglobulin (B-TG), two proteins stored in platelet alpha granules and released from the platelets when activated. These proteins were studied by ELISA technics in patients with type 2 diabetes without any complications (n = 32), with thrombotic complication (n = 32) and in a healthy control group (n = 32). The diabetic patients with complications had significantly elevated plasma levels of PF4 and B-TG compared with diabetic patients without complications, whereas levels of these proteins where normal in control group. These high rates of PF4 and B-TG were significantly related to a disturbance of lipidic balance. Our data suggest that platelet hyperactivation may be a reliable element in the pathogenesis of thrombotic complications in type 2 diabetes.

New results in clinical severity of homozygous sickle cell anemia, in Dakar, Senegal

Despite the unicity of its genetic mutation, Sickle cell homozygosity presents different clinical features. Our objectives were to evaluate disease severity in Senegalese patients. Sixty (60) homozygous sickle cell patients were followed up monthly during one year and disease severity was assessed using the "severity index" (SI) which is resulting from epidemiologic, clinic and biological data. Mean age was 20.13, sex ratio was 0.87 and mean age of diagnosis was 9.8 years. 90% of patients presented vaso-occlusive crisis (2.53 per patient), 73.3% had infectious episodes (1.9 per patient), 69.3% had never been transfused and 25% of patients had presented chronic complications linked to anemia or ischemia. Mean hemoglobin value was 8.1 g/dl and mean Hb F was 8.2%. Low seric ferritin was found in 1.7% of patients. Benign form of homozygous sickle cell anemia (SI< or =6) was found in 48.3% of patients. Our data confirm the relative good tolerance of homozygous sickle cell disease in Senegal. The haplotype Senegal may play an important role but others host and environmental factors operate certainly because some severe cases were identified in our patients. The identification of all these factors might contribute to a better follow up of sickle cell disease.