Prevalence of liver fibrosis and cirrhosis in 699 Moroccan patients with chronic hepatitis C

Introduction

chronic hepatitis C (CHC) can cause severe complications, including fibrosis and cirrhosis. Very little is known about the prevalence of these complications in the Moroccan population.

Methods

the prevalence of liver fibrosis and cirrhosis using a non-invasive blood test (FibroTest and ActiTest) was studied in 699 Moroccan patients with CHC for 4 years (from January 2014 to December 2017). The serum immunological markers: α2-macroglobulin, haptoglobin, apolipoprotein A1 were analyzed nephelometrically on BN ProSpec® System. The serum biochemical markers: γ-glutamyltransferase, alanine aminotransferase, and bilirubin were performed using the VITROS® Chemistry System Ortho Clinical Diagnostic. A 699 patients with CHC were identified.

Results

the overall prevalence of cirrhosis (F4) was estimated at 31.8%. Thirteen point nine percent (13.9%) of patients with cirrhosis had a risk of developing esophageal varices and a 3.3% risk of developing primary liver cancer. The association between cirrhosis and age showed an increase in prevalence after age 55 years old [OR=7.68(95%CI=4.9-12.2); p<0.0001]. No significant association for cirrhosis was found for sex.

Conclusion

according to the results of FibroTest, 32% of patients with CHC had cirrhosis. The older age was independently associated with liver cirrhosis.

Cold agglutinins revealed by abnormalities to the cell blood count: a case report

Cold agglutinin are erythrocyte antibodies which possess the property of agglutinating red blood cells at temperatures of below 37°C, this phenomenon is reversible after heating. This is usually immunoglobulin M (IgM) class. Their pathogenicity is much more related to their temperature range of activity than their title. As we report in this observation, cold hemagglutination makes it difficult to interpret certain immunological tests such as ABO Rh blood grouping or searching for irregular antibodies (SAI). The discovery of cold agglutinins can be fortuitous revealing itself by disturbances and aberrations in the results of blood count or as part of a suggestive clinical or laboratory table cold hemagglutinin disease. The search for a lymphoid hematological at their diagnosis should be systematic.

Rare and unusual case of anti-factor XI antibodies in patient with plasma cell leukemia

Background

The acquired inhibitors of coagulation have been observed in very rare cases of monoclonal gammopathies. We report a very rare case of anti-factor XI antibodies in patient with plasma cell leukemia (PCL).

Case presentation

This is a 59-year-old male patient without pathological history, admitted to the nephrology department for management of renal insufficiency and anemia syndrome. The history and physical examination revealed stigmata of hemorrhagic syndrome including hemothorax and hemoptysis. The hemostasis assessment showed an isolated prolonged activated partial thromboplastin time (APTT) with APTT ratio = 2.0.The index of circulating anticoagulant (37.2%) revealed the presence of circulating anticoagulants. The normalized dilute Russell viper venom time ratio of 0.99 has highlighted the absence of lupus anticoagulants. The coagulation factors assay objectified the decrease of the factor XI activity corrected by the addition of the control plasma confirming the presence of anti-factor XI autoantibodies. In addition, the blood count showed bicytopenia with non-regenerative normocytic normochromic anemia and thrombocytopenia. The blood smear demonstrated a plasma cell count of 49% (2842/mm3) evoking PCL. The bone marrow was invaded up to 90% by dystrophic plasma cells. The biochemical assessment suggested downstream renal and electrolyte disturbances from exuberant light chain production with abnormalities including hyperuricemia, hypercalcemia, elevated lactate dehydrogenase, non nephrotic-range proteinuria and high level of C reactive protein. The serum protein electrophoresis showed the presence of a monoclonal peak. The serum immunofixation test detects the presence of monoclonal free lambda light chains. He was treated with velcade, thalidomide and dexamethasone. The patient died after 2 weeks despite treatment.

Conclusion

Both PCL and anti-factor XI inhibitors are two very rare entities. To the best of our knowledge, this is the first reported case of a factor XI inhibitor arising in the setting of PCL. Factor inhibitors should be suspected in patients whose monoclonal gammopathies are accompanied by bleeding manifestations.

[Seroprevalence of viral markers among blood donors at the Blood Donor Center of Mohammed V Military Teaching Hospital of Rabat, Morocco]

Le but de ce travail était de déterminer la prévalence du virus de l’immunodéficience humaine (VIH), du virus de l’hépatite B (VHB) et C (VHC) sur les dons du sang collectés au Centre de transfusion sanguine(CTS) de l’hôpital militaire d’instruction Mohammed V entre 2010 et 2012. Etude rétrospective menée auprès des donneurs de sang militaires âgés de 18 à 50 ans avec prédominance masculine (95%). L’entretien médical pré-don constitue la première barrière de sélection des sujets à risque. Le dépistage biologique était réalisé par technique immuno-enzymatique en milieu liquide utilisant des anticorps et/ou des antigènes. L’ELISA (enzyme linked immuno-sorbent assay) combiné de quatrième génération pour VHC et VIH a été utilisé. La confirmation a été faite en réalisant la même technique en double au CTS et au laboratoire de virologie. Dans notre série de 25661 échantillons testés, la prévalence du VHB était 3,97‰ (n=102), celle de VHC était 2,45 ‰ (n=63), celle de VIH était 0,15 ‰ (n=4). Un seul cas de coïnfection (0,039 ‰) par le VHB et VHC a été noté, aucune association entre VIH-VHB, VIH-VHC ou VHB, VHC et VIH n’a été enregistrée. Les taux faibles de séroprévalence des marqueurs viraux de notre étude montrent l’amélioration des mesures préventives en ce qui concerne la sélection des donneurs et des tests de dépistage. Cette prévalence constatée incite à maintenir l’utilisation du réactif combiné qui est la seule alternative à la biologie moléculaire pour les pays en voie de développement.

Severe hemolytic disease of the premature newborn due to RH1 incompatibility: a case report

We report a case of dramatic outcome of severe hemolytic disease in a newborn due to RH1 incompatibility. A newborn with A RH1 blood group was admitted in the Mohammed V Military Teaching Hospital for the problem of hydrops fetalis associated with RH1 incompatibility. The blood group of his mother, aged 31, was AB RH1-negative and that of his 37 year old father was A RH1. The mother had a history of 4 term deliveries, 3 abortions, and 1 living child. There was no prevention by anti-D immunoglobulin postpartum. The mother’s irregular agglutinin test was positive and the pregnancy was poorly monitored. The laboratory tests of the newborn showed a high total serum bilirubin level (30 mg/L) and macrocytic regenerative anemia (Hemoglobin=4 g/dL, mean corpuscular volume = 183 fL, reticulocytes count =176600/m³). The blood smear showed 1256 erythroblasts per 100 leukocytes, Howell–Jolly bodies and many macrocytes. The direct antiglobulin test was positive. He was transfused with red blood cell concentrates and treated with conventional phototherapy. The evolution was unfavourable; he died three days after the death of his mother. The monitoring of these high-risk pregnancies requires specialized centers and a close collaboration between the gynaecologist and the blood transfusion specialist to strengthen the prevention, as well as clinico-biological monitoring in patients with a history of RH1 fetomaternal alloimunization.

[Seroprevalence of hepatitis C at the Military Hospital Mohammed V of Rabat]

Introduction

L'hépatite virale C représente un problème majeur de santé publique. L'OMS estime qu'il y'aurait 180 millions de porteurs chroniques de part le monde. L'objectif de cette étude est de connaître la séroprévalence de l'hépatite C virale à l'hôpital militaire d'instruction Mohammed V de Rabat.

Méthodes

À travers cette étude rétrospective, menée entre janvier 2010 et décembre 2012 et qui Concerne les patients hémodialysés chroniques du centre d'hémodialyse (groupe 1, n =152), les donneurs de sang du centre de transfusion (groupe 2, n= 29530) et les jeunes recrues des forces armées royales marocaine en visite d'aptitude (groupe 3, n = 15320). Au total 45002 sérums ont été testés par technique immunoenzymatique au laboratoire de l'HMIMV.

Résultats

La séroprévalence du virus de l'hépatite C est respectivement de 17,8% pour le groupe1, de 0,18% pour le groupe 2 et de 0,25% pour le groupe 3.

Conclusion

La faible prévalence de l'hépatite C enregistrée dans notre étude semble en rapport avec leur faible endémicité au Maroc. Les taux de prévalence retrouvés sont inférieurs à ceux enregistrés dans la population générale traduisant l'efficacité des programmes de surveillance, de prévention et de prise en charge des infections hépatiques adoptés au sein du Service de santé des forces armées royales marocaines.

Range-reference determination of lymphocyte subsets in Moroccan blood donors

BACKGROUND

Information on lymphocyte populations (T, B, and Natural killer cells) and subpopulations (CD4 and CD8) in Morocco is scarce if not inexistent.

OBJECTIVE

To establish a reference value of these cells in 242 Moroccan young adult blood donors by flow cytometry.

RESULTS

Smokers had significantly higher total leukocyte count (p < 0.001), total lymphocyte count (p < 0.0001) and higher CD3+CD4+ cells (p < 0.0001). The percentage of CD3-CD56+ subsets was affected by smoking (p < 0.01). Our analysis positively correlate with previous observations of an increase of absolute CD4+ T cells, with no changes in other lymphocyte subset cells in smokers. The lymphocyte subpopulation distributions for all antigens were found to be similar to those reported in Saudi and Italian adults, while higher levels were reported for the same gender in other countries, especially Ghana and Kuwait.

CONCLUSION

The international classification standards of the HIV-infected subjects according to their rates of CD4 are applicable to the present study's population.

[Seroprevalence of HBV and HCV in blood donors at the Blood Transfusion Center of Mohammed V Military Teaching Hospital in Rabat Morocco]

The purpose of this report is to present the findings of a retrospective study (2008-2009) to determine the seroprevalence of hepatitis B and C virus in blood donors at the Blood Transfusion Center of Military Teaching Hospital Mohammed V in Rabat, Morocco. Samples from 19,801 consecutive blood donors were analyzed by the immuno-enzymatic method (Enzyme Linked Immunosorbent Assay, third generation). The overall seroprevalence of HBV and HCV was 0.8% and 0.2% respectively. A total of 98 units were rejected because of elevated alanine transaminase. No case of co-infection was found. From 1991 to 2010, HBV and HCV seropositivity showed a significant declining trend. In spite of the low prevalence observed, this study confirms that the risk of transfusion transmitted infection exists and thus underlines the need to implement preventive strategies to improve blood transfusion safety.

[Mycotic aneurysm of the abdominal aortic due to Salmonella enterica serotype enteritidis: a case report]

Bacteraemia due to non Typhi Salmonella is frequent in human immunodeficiency virus (HIV infected patients). Focal vascular complications especially in patients with artheriosclerosis are rarely reported. We report the case of patient who presented a mycotic aneurysm of the abdominal aortic due to Salmonella enterica serotype enteritidis. Despite the chirurgical treatment associated with antibiotherapy, the patient evolution was fatal.

[One case report of anti-JK1 antibody undetected on plasma sample]

The sensitivity of the detection of irregular antibodies (DIA) is one of the fundamental bases of transfusion safety. Its implementation is specified in accordance with a very specific framework that allows the use of serum or plasma. The case reported here points out a failure to detect irregular antibodies in plasma sample. Thus a low intensity anti-JK1 antibody detected and identified in serum slipped through unnoticed in plasma. The difficulties to detect and identify this antibody, well-known as a deceptive and dangerous one, are being discussed in order to better assess the limitations of DIA.