Showing papers in "Transfusion Clinique Et Biologique in 2013"
TL;DR: France is the country worst affected in Europe and the world by this latter form of CJD, before the USA and UK, and is the second country in the world most affected after the UK.
Abstract: France, involved for a long time in the epidemiological surveillance of transmissible spongiform encephalopathy (TSE), created a national network of surveillance in 1991, because of the description of the first cases of Creutzfeldt-Jakob disease (CJD) linked to a treatment by growth hormone of human origin and the observation of cases of cats infected with the agent of the bovine spongiform encephalopathy in the United Kingdom (UK). The French surveillance network is integrated into the European network of surveillance since its creation in 1993. As in other countries, sporadic CJD is the most frequent form of TSE in France with an annual mortality rate of 1.44 per million. Genetic forms are most often associated with a mutation at codon 200. Among the cases of iatrogenic CJD, 13 cases of CJD after duramater grafts were observed and 119 related to treatment with growth hormone. France is the country worst affected in Europe and the world by this latter form, before the USA and UK. Since 1996, 27 cases of variant of CJD (vCJD) has been observed, making France the second country in the world most affected after the UK. No cases of transfusion-associated vCJD have been observed.
26 citations
TL;DR: To face known and emerging threats to public health, all countries have to overcome the challenges of providing sufficient supplies of blood and blood products of the highest quality and safety.
Abstract: To face known and emerging threats to public health, all countries have to overcome the challenges of providing sufficient supplies of blood and blood products of the highest quality and safety. Unfortunately, self-sufficiency is not yet a reality in many countries. In 2011, experts from WHO addressed the urgent need to establish strategies and mechanisms for achieving this goal. A summary of these recommendations is further discussed.
21 citations
TL;DR: Blood transfusion safety in sickle cell anemia patients in Mali should be improved by the introduction of at least the technique for detecting the viral genome in the panel of screening tests and a policy of transfusions of blood units only from regular blood donors.
Abstract: Red cell transfusion is one of the main treatments in sickle cell disease. However there are potential risks of blood transfusions. In order to propose strategies to improve blood safety in sickle cell disease in Mali, we conducted a prospective study of 133 patients with sickle cell anemia recruited at the sickle cell disease research and control center of Bamako, November 2010 to October 2011. The study aimed to determine the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections by serum screening and the frequency of red cell alloimmunization before and after blood transfusion. The diagnosis of sickle cell syndrome was made by HPLC, the detection of markers of viral infection was performed by ELISA, and the diagnosis of alloimmunization was conducted by the Indirect Coombs test. Prevalence of viral infections observed at the time of enrolment of patients in the study was 1%, 3% and 1% respectively for HIV, HBV and HCV. Three cases of seroconversion after blood transfusion were detected, including one for HIV, one for HBV and one another for HCV in sickle cell anemia patients. All these patients had received blood from occasional donors. The red cell alloimmunization was observed in 4.4% of patients. All antibodies belonged to Rh system only. Blood transfusion safety in sickle cell anemia patients in Mali should be improved by the introduction of at least the technique for detecting the viral genome in the panel of screening tests and a policy of transfusions of blood units only from regular blood donors.
19 citations
TL;DR: In the last 10 years, three technologies capable of inactivating pathogens in platelet concentrates have been authorized in Europe although only one based on the addition of amotosalen and illumination with ultraviolet A (UVA) light, has been approved by the National Agency for the Safety of Medicines and Health Products (ANSM) as mentioned in this paper.
Abstract: In the last 10 years three technologies capable of inactivating pathogens in platelet concentrates have been authorized in Europe although only one based on the addition of amotosalen and illumination with ultraviolet A (UVA) light, has been approved by the National Agency for the Safety of Medicines and Health Products (ANSM). An intense debate exists about the implementation of pathogen inactivation technologies for labile blood components in general and for platelet concentrates in particular. In this review, we will analyze some of the most frequently argued reasons for not implementing pathogen inactivation for platelet components, i.e.: current platelet components are safe enough; pathogen inactivation technologies might be toxic for the recipient; and pathogen inactivation technologies affect platelet function and increase the risk of bleeding. The analysis and discussion of the evidence currently available to answer those reservations will be limited to the pathogen inactivation technology based on amotosalen and UVA.
16 citations
14 citations
TL;DR: In this article, the authors describe the overall analysis of risk (AGR), name given by the author to the up-to-date APR method which after several changes of the initial process aims to cover a perimeter of analysis and broader management both at the level of structural that business risks of any kind throughout the system development life cycle, of the study of its feasibility to dismantling.
Abstract: After a reminder on the fundamental concepts of the management of risk, the author describes the overall analysis of risk (AGR), name given by the author to the up-to-date APR method which after several changes of the initial process aims to cover a perimeter of analysis and broader management both at the level of structural that business risks of any kind throughout the system development life cycle, of the study of its feasibility to dismantling.
13 citations
TL;DR: In this paper, the actors of the transfusion must analyze certain parameters: the value of a donation, the meaning of volunteering, the appropriateness of remunerating the act of giving a part of one's self, no longer as a donation or an expression of altruism and solidarity, but as a commercial act regimented by economic laws.
Abstract: Blood donation is an act of solidarity. Most often, this act is done on a volunteer basis and, depending on countries and circumstances, is not remunerated. The increase in need, the always-greater number of deferral criteria, the safety issues and the changes in the structures of our societies are among the many subjects for ethical debates. Taking these into account, the actors of the transfusion must analyze certain parameters: the value of a donation, the meaning of volunteering, the appropriateness of remunerating the act of giving a part of one's self, no longer as a donation or an expression of altruism and solidarity, but as a commercial act regimented by economic laws.
13 citations
TL;DR: Bacterial contamination of blood products (BP) remains the most important infectious risks of blood transfusion in 2013 and platelet concentrates (PC) are the blood products the most at risk, whether CPA or MCPS.
Abstract: Bacterial contamination of blood products (BP) remains the most important infectious risks of blood transfusion in 2013. Platelet concentrates (PC) are the blood products the most at risk, whether CPA or MCPS. In France, the residual risk has been steadily declining since 1994. For the platelets, the frequency of transfusion reaction due to bacterial contamination (TRBC) is now about at one per 50,000 CP distributed. The number of deaths has remained stable since 1994 with one death per year (300,000 distributed CP). The progressive decrease in the number of cases of TRBCs is the result of steady improvement of practices and prevention methods at all stages from collection to the transfusion of BP. But if all these improvements have significantly reduced the incidence of TRBCs, mortality is not changed with the CP and the reduction of this risk is a priority for the French Blood Establishment (EFS). Detection methods of CP contaminated or pathogen inactivation are two approaches available and can provide a significant reduction (for the former) or deletion (for seconds) of the risk of transfused contaminated CP. Currently, the choice is in favor of the detection of bacteria. New detection "rapid tests" methods were added to the panel of candidates and are being evaluated. Inactivation of pathogens remains the safest prospect of eliminating this adverse effect of transfusion. Implementation of one method for bacterial detection is probably a transitional measure.
12 citations
TL;DR: The epidemiology and surveillance of West Nile Virus, dengue and chikungunya and their role in the risk management of transfusions is described and the optimum prevention strategy is the subject of research.
Abstract: Arbovirus infections are increasing in prevalence worldwide. This presents new risks for blood transfusion. This article describes the epidemiology and surveillance of West Nile Virus, dengue and chikungunya and their role in the risk management of transfusions. Arboviruses are RNA viruses and very adaptable by nature. The majority of arbovirus infections are zoonoses. The risk of transmission is multifactorial and concerns the virus, vectors, animal reservoirs, the environment and human behaviour. In recent years, West Nile Virus has become established and widespread in North America, the number of cases of dengue worldwide has increased dramatically, and major epidemics of chikungunya have occurred in the Indian Ocean and Asia. The transmission of dengue and chikungunya is demonstrated in temperate zones. All arboviruses are potentially transmissible by transfusion due to their capacity to induce an asymptomatic viremic phase. The risk of West Nile Virus transmission via transfusion is recognised and prevention measures are well established. The risk of transmission via transfusion of dengue and chikungunya is real but difficult to quantify and the optimum prevention strategy is currently the subject of research. Access to up-to-date epidemiological data is an essential aid to decision-making, especially for donors returning from endemic areas to Europe. The challenge is to define and implement appropriate measures in unpredictable situations.
11 citations
TL;DR: The risk-analysis and measures taken by the French authorities in the period 1990-2010 will be described with the various assumptions and working hypothesis used and revisited as new findings become available.
Abstract: Risk of transmission of Creutzfeldt-Jakob disease (infectious agent, responsible of spongiform encephalopathy) via blood and blood components (including the plasma-derived medicinal products such as coagulation factors and immunoglobulins) have been a subject of concern for Health authorities since the early 1980s, with a regain of interest in the 1990s, with the bovine spongiform encephalopathy outbreak followed few years after with the notification of the first cases of variant Creutzfeldt-Jakob disease in humans. The risk-analysis and measures taken by the French authorities in the period 1990-2010 will be described with the various assumptions and working hypothesis used and revisited as new findings become available.
8 citations
TL;DR: Some technologies are ready for high-throughput blood group genotyping and will be used in the future to obtain a fully typed blood group card of each donor but also to detect blood donors with rare phenotypes to register them to the Banque Nationale de Sang de Phenotype Rare.
Abstract: The molecular basis of almost all antigens of the 33 blood group systems are known. These knowledge and the advent of the PCR technology have allowed the DNA-based genotyping in order to predict the presence or absence of a blood group antigen on the cell membrane of red blood cells. DNA genotyping is required in cases where red blood cells patient cannot be used for serological typing either after a recent transfusion or because of the presence of autoantibodies on the red blood cells. Numerous DNA assays are available to detect any nucleotide polymorphism on the genes encoding blood group antigens. The technologies have improved to answer quickly to any case of transfusion emergency and to limit the risk of DNA contamination in a molecular diagnostic laboratory. Some technologies are ready for high-throughput blood group genotyping. They will be used in the future to obtain a fully typed blood group card of each donor but also to detect blood donors with rare phenotypes to register them to the Banque Nationale de Sang de Phenotype Rare (BNSPR).
TL;DR: Une meilleure connaissance des causes of ces manifestations est en effet indispensable a the mise en place d’actions de prevention efficaces.
Abstract: Transfusion of labile blood products (LBPs) generates occasional inflammatory : type, hazards; for a large part of these, no antigen/antibody conflict is thus, detected. Residual leucocytes used to account for a large part of such incidents - rarely accidents. Since, however, the systematic leukoreduction of LBPs, leucocytes are the less and less incriminated in adverse events. Platelets themselves proved capable of secreting copious amounts of inflammatory mediators, even in the absence of any deliberated stimulation. Meanwhile, even though exceptionally, inflammation can be observed after red blood cell transfusion. It has been noticed that the collection mode of cellular compounds, as well as the preparation and storage conditions are capable of inflicting lesions to the cell membranes and to activate those cells, and thus promoting inflammatory responses. Storage lesions as well as ageing of the stored cells alongside with cell apoptosis contribute to inflammatory responses. This present 'State of the Art' paper aims at encompassing the primary and secondary components of the LBPs, along with the various types of molecules displaying pro-inflammatory properties that can be encountered in transfusion. A better knowledge of causes of inflammatory transfusion-linked hazards is indeed instrumental to the implementation of safety measures aimed at reducing or suppressing these unwanted effects.
TL;DR: The results support the decision to transfuse, ST, preoperatively only if the patient is significantly below their steady-state haemoglobin (Hb) level and/or the blood loss volume.
Abstract: Objectives We conducted a retrospective study to examine the optimal regimen of transfusion and whether preoperative transfusion is needed in patients with Sickle cell anaemia (SCA) undergoing a Total hip arthroplasty (THA). Then, we assessed the incidence of perioperative complications rates among patients assigned to different transfusion regimens to propose finally the safety transfusion protocol. Background Preoperative transfusions are usually given to reduce or prevent perioperative complications to SCA patients undergoing THA. There is no consensus however on the best regimen of transfusion. Study design and methods During the period of 2000 to 2010, 14 patients with SCA (sex-ratio 0.4) with a mean age of 36 years underwent 16 THA (primary or revision). Three groups were differentiated according preoperatively protocol transfusion. Group 1: exchange transfusion (EXT), group 2: simple transfusion (ST), group 3: no transfusion (NT). Results Overall, preoperative transfusion was performed in 43.7% of cases and complications rate was 50%. In the group 1 (EXT) including five patients (31%), severe complications occurred in four patients (80%). in the group 2, including two patients (12.5%), no complications were observed. In the group 3, including nine patients (56%), complications occurred in four procedures (44.5%), the half of them were haemolytic complications. Conclusion Our results support the decision to transfuse, ST, preoperatively only if the patient is significantly below their steady-state haemoglobin (Hb) level. Transfusion can be used intraoperatively according Hb level and/or the blood loss volume. Exchange transfusion appeared mostly to be related to postoperative morbidity rates.
TL;DR: The part concerning donors, as the name suggests, targeted on improvement of donor's safety covers in fact the two points of the transfusion chain with serious adverse events in donor, epidemiologic survey for recipients and post-donation information on the two sides.
Abstract: Since its creation in 1993, hemovigilance has an important place for blood safety. The part concerning donors, as the name suggests, targeted on improvement of donor's safety covers in fact the two points of the transfusion chain with serious adverse events in donor, epidemiologic survey for recipients and post-donation information on the two sides. Organized management and close collaboration between the actors of the transfusion chain are necessary to ensure the effectiveness of the system.
TL;DR: Le facteur VII active recombinant ne devait etre utilise qu’a titre compassionnel, hors AMM et apres echec de l’ensemble des therapeutiques conventionnelles, ainsi que dans les hemorragies du postpartum, et par extension probablement aussi dans the autres situations d’hemorragie grave.
Abstract: The management of massive bleeding has improved, thanks to high-quality blood components and new transfusion strategies. However, it remains controversial and, despite a huge body of literature, randomised control trials are still lacking. However, the therapeutic approach has also evolved, requiring earlier and more active management. If a 'no delay' management is well recognized, its modes are still discussed. Immediate delivery of blood products with ratios close to 1:1:1 for RBC units/fresh frozen plasma/platelet concentrates, through massive transfusion protocol using blood packs, has been advocated, but yet this approach is not evidence-based. Secondly, a targeted strategy to provide fibrinogen concentrates is under evaluation. Tranexamic acid is effective in trauma patients. Recombinant factor VIIa should only be used on a compassionate basis.
TL;DR: The coordination des vigilances trouve avantage dans le partage d'un systeme declaratif commun commun avec la gestion des risques associes aux soins.
Abstract: Resume Les vigilances sanitaires sont apparues au fil du temps. Certaines possedent un echelon regional, et toutes se trouvent regroupees a l’Agence nationale de securite du medicament et des produits de sante. Avec la certification des etablissements de sante (ES), la coordination des vigilances a evolue : son existence semblait facultative dans la premiere version de la certification, puis s’est imposee aux ES dans les versions suivantes, en precisant les actions a entreprendre. En parallele, la gestion des risques au sein d’un etablissement de sante est en plein essor. La coordination des vigilances trouve avantage dans le partage d’un systeme declaratif commun avec la gestion des risques associes aux soins. La collaboration de la coordination des vigilances et de la gestion des risques permet d’elaborer une cartographie a priori des risques, de mettre en place des analyses des evenements indesirables et d’utiliser la notion de criticite dans le cadre d’une culture securitaire globale pour l’etablissement de sante.
TL;DR: Molecular abnormalities associated with decrease of HSP70 expression in the nucleus may result in ineffective erythropoiesis characterized by apoptosis and impaired maturation of erythroid precursors.
Abstract: Erythropoiesis is finely regulated by two major cytokines, stem cell factor (SCF) and erythropoietin (Epo). Decrease levels of Epo result in caspase activation and erythroid progenitors apoptosis. However, normal erythroid cell maturation requests caspase activation and cleavage of various caspase substrates, except the erythroid transcription factor GATA-1, that is protected by interaction with the chaperone HSP70 in the nucleus. Therefore, molecular abnormalities associated with decrease of HSP70 expression in the nucleus may result in ineffective erythropoiesis characterized by apoptosis and impaired maturation of erythroid precursors. These findings open new potential targeted therapies for erythroid disorders.
TL;DR: Cette revue resume les connaissances physiopathologiques actuelles and les principes du diagnostic and de the prise en charge of ces reactions d’hypersensibilite immediate, allergiques ou non.
Abstract: Hypersensitivity or allergic reactions can occur after transfusion of any kind of blood products. They represent the second or third causes adverse events related to labile blood product administration. This review summarizes their physiopathology, and the current guidelines regarding their diagnosis and treatment.
TL;DR: In this paper, the authors present the descriptive analysis of serious adverse reactions in donors (dSAR's), which were notified in 2010 and 2011 in the French national haemovigilance database "e-FIT" (Internet secured haemOVigilance reporting system).
Abstract: This work aim to present the descriptive analysis of serious adverse reactions in donors (dSAR's), which were notified in 2010 and 2011 in the French national haemovigilance database "e-FIT" (Internet secured haemovigilance reporting system). Some data, which are necessary for this analysis, also come from the regional haemovigilance coordinators' reports (RHC). The other parts of haemovigilance in the context of donation, without donors adverse reactions, such as post-donation information (PDI), adverse events occurred in the blood collection steps of the transfusion chain and epidemiology are not subject to this work analysis. This work shows that the quality of the data gradually improved since the setting up of the notification system of dSAR's. These data are particularly rich in learning lessons, but are still improving. It allows us to confirm that donor's safety, blood components quality, while preserving the blood components self-sufficiency in France, remains a priority. For these reasons, it is important to continue this haemovigilance awareness and to implement necessary actions that would be required for the protection of the donor's health and comfort during donation.
TL;DR: La transfusion intra-ethnique fait emerger des allo-anticorps difficiles a detecter les malades exprimant des antigenes partiels et/ou publics negatifs susceptibles of s’immuniser et les CGR porteurs d’antigenes dits de basse frequence potentiellement immunogenes.
Abstract: Resume Outre ses aspects organisationnels, la chaine transfusionnelle dans les DOM comporte des particularites essentiellement liees a l’epidemiologie infectieuse et aux caracteristiques populationnelles. Nous detaillons certaines de ces particularites sociodemographiques et medicales : le defi de l’autosuffisance face aux enjeux demographiques ; les risques epidemiologiques associes aux virus emergents de la dengue et du Chikungunya et les strategies mises en œuvre lors des dernieres epidemies ; le probleme des referentiels de contre-indications medicales au don inadaptes aux populations cibles (seuil d’exclusion pour l’hemoglobine pre-don ne prenant pas en compte les normes biologiques specifiques des populations afro-antillaises, avec un taux normal d’hemoglobine inferieur aux valeurs de reference europeennes ; depistage des hemoglobinopathies AS/AC non impose mais present chez 8 % des donneurs potentiels) ; la typologie des indications transfusionnelles, notamment la transfusion de plaquettes dans la dengue et la transfusion des drepanocytaires. Compte tenu du polymorphisme eleve des antigenes erythrocytaires chez les populations afro-antillaises, la transfusion intra-ethnique facilite la compatibilite vis-a-vis des antigenes courants, mais fait emerger des allo-anticorps difficiles a detecter en l’absence d’anti-sera et de panels informatifs d’ou l’interet potentiel du genotypage erythrocytaire pour detecter les malades exprimant des antigenes partiels et/ou publics negatifs susceptibles de s’immuniser et les CGR porteurs d’antigenes dits de basse frequence potentiellement immunogenes. A une epoque ou les agents pathogenes emergents menacent periodiquement l’Europe (dengue, Chikungunya, West Nile…), et ou certaines pathologies fortement consommatrices de PSL, comme la drepanocytose, y deviennent un enjeu d’avenir, ces etablissements constituent de veritables laboratoires pour l’etude des problematiques futures de la transfusion.
TL;DR: In this paper, the authors evaluated the connaissances des medecins en matiere de securite immunologique en transfusion erythrocytaire avant et apres une lecture d'un CD-ROM d'auto-enseignement.
Abstract: Resume En Tunisie, la transfusion de globules rouges s’inscrit dans un cadre reglementaire mais reste sujette a des defaillances en raison de la meconnaissance de la legislation et des regles de securite. L’objectif de notre travail est d’evaluer les connaissances des medecins en matiere de securite immunologique en transfusion erythrocytaire avant et apres une lecture d’un CD-ROM d’auto-enseignement. Il s’agit d’une evaluation d’une intervention. Quatre-vingts medecins hospitaliers ont repondu a un questionnaire anonyme, comportant sept questions a choix multiple (QCM) de 29 items. Le taux de bonnes reponses (TBR) calcule par question et par item a pris en compte l’impact du CD-ROM sur l’amelioration des reponses apres lecture. La note globale moyenne est de 2,9/7. Les reponses par questions sont variables (25 % a 76 %). Tous les participants ont repondu juste a plus de 50 % des items. Deux participants ont repondu correctement a tous les items. Parmi les participants, 31,3 % ont repondu correctement aux cinq items « importants » concernant les regles de compatibilite dans le systeme ABO et l’epreuve ultime au lit du malade. Quatre-vingt-trois pour cent ont visionne le CD-ROM et accepte de participer a l’evaluation finale. L’impact du CD-ROM a ete statistiquement significatif. La note globale a augmente de 2,9 a 5,8/7, 31,5 % ont repondu correctement a toutes les questions (vs 2 %) et 95,5 % ont repondu correctement aux cinq items importants (vs 31,3 %). Ce travail a revele une meconnaissance des medecins en matiere de securite immunologique erythrocytaire. Le CD-ROM a significativement ameliore les reponses. L’instauration d’une formation continue est imperative dans notre pays.
TL;DR: Une suspicion de paludisme post transfusionnel a Plasmodium falciparum diagnostiquee le 08/11/2012 a ete declaree le 09/11-2012 sous la forme d’une Fiche d”Evenement Indesirable Receveur de grade 3.
Abstract: Introduction Une suspicion de paludisme post transfusionnel a Plasmodium falciparum diagnostiquee le 08/11/2012 a ete declaree le 09/11/2012 sous la forme d’une Fiche d’Evenement Indesirable Receveur de grade 3, chez une patiente transfusee 21 jours auparavant de 2 concentres de globules rouges (CGR). En l’absence de sejour en zone d’endemie palustre, une origine transfusionnelle a donc ete recherchee.
TL;DR: The evaluation of screening assays and prion filters is challenging, time-consuming and costly, but these evaluations are critical to policy making.
Abstract: Three cases of vCJD transmission by blood transfusion have been reported in the UK, and a fourth case discovered at post-mortem. Modelling has been conducted to predict the number of cases that may occur in the future through transfusion, based on estimates of prevalence, infectivity and susceptibility, and a number of steps have been taken to reduce the risk of transmission. These include deferral of previously transfused donors, leucocyte depletion of all components, importation of plasma for certain patient groups and for fractionation, and the collection of the majority of platelets from single donors (by apheresis). However, even with these interventions, some future cases are still predicted. The UK-wide Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) considers the evidence for clinical and cost-effectiveness of any proposed intervention, such as prion assays and filters, and makes recommendations to the governments of the UK. The development of prion assays is challenging as prions do not generate an immune response, do not have nucleic acid and are present in blood in very low concentrations against a high background of normal prion protein. It is critically important that prion assays show high levels of sensitivity and — especially —specificity for a healthy blood donor population. Assessment is impacted by the very short supply of positive human samples, necessitating the use of animal models. Filters that are capable of removing prions from blood components have been developed and CE marked, but it is again necessary to use animal models to study their efficacy. Guidelines have been produced for the assessment of the quality of red cells filtered through these devices, and a clinical safety study has recently been completed. In conclusion, the evaluation of screening assays and prion filters is challenging, time-consuming and costly, but these evaluations are critical to policy making.
TL;DR: Prevalence of TTI markers is high and national strategies for safe blood transfusion have to be strengthened, while females should be encouraged to donate blood.
Abstract: Background. – The study aimed to determine the seroprevalence of transfusion-transmitted infectious (TTI) markers for human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV, HCV) and syphilis among blood donors in Niamey (Niger). The association between seroprevalence of ITT markers and sociodemographic characteristics of blood donors was investigated. Methods. – A cross-sectional study was conducted in 2010 among 3213 blood donors. Data were collected from a pre-donation questionnaire and from laboratory tests results. Results. – The male/female ratiowas 4/1. Up to 18.1% of donations had at least one positive marker, in which 2.7% presented a positive test for two or more agents. A seroprevalence of 1.62% (95%CI: 1.21–2.12) was associated with HIV, 15.4% (13.9–16.7) with HBV, 1.18% (0.84–1.62) with HCV, and 0.47% (0.26–0.77) for blood samples reacted with RPR test for syphilis. The HIV seroprevalence was two-fold higher in family than in volunteer donors (OR = 2.15, 95%CI: 1.24–3.73). It was also higher in Rhesus D negative donors (OR = 2.40, 95%CI: 1.11–5.17). The hepatitis B surface antigen seroprevalence was significantly higher in males than females (OR = 1.85, 95%CI: 1.39–2.45) and in first time than in regular donors (P < 0.0001). The HCV seroprevalence was significantly higher in male donors (OR = 4.41, 95%CI: 1.06–18.4) and in donors from rural areas (OR = 4.09, 95%CI: 1.42–11.8). Syphilis marker was significantly associated with the marital status (higher seroprevalence in divorced donors, P = 0.0085). Conclusion. – Prevalence of TTI markers is high and national strategies for safe blood transfusion have to be strengthened. It is essential to recruit and maintain more volunteer donors, while females should be encouraged to donate blood. # 2013 Elsevier Masson SAS. All rights reserved.
TL;DR: In this paper, a nouvelle organization se basing sur la mutualisation de ressources is proposed, which concerne le statut du Centre national de transfusion sanguine (CNTS), la gestion des donneurs, limplantation geographique des differents centres, la partie logistique, the gestion de stock and le systeme informatique.
Abstract: Resume But de l’etude Proposer une nouvelle organisation pour le systeme transfusionnel marocain. Materiels et methodes A travers une analyse de plusieurs aspects de l’organisation actuelle, sur le plan qualitatif et quantitatif (Statistique 2011), il a ete constate que plusieurs defaillances du systeme actuel empechent de realiser pleinement ces objectifs et d’assurer les responsabilites qui lui sont incombees. A l’aide de l’analyse multicritere pour l’aide a la decision (ELECTRE III), une nouvelle organisation se basant sur la mutualisation de ressources est proposee. Cette nouvelle organisation concerne le statut du Centre national de transfusion sanguine (CNTS), la gestion des donneurs, l’implantation geographique des differents centres, la partie logistique, la gestion de stock et le systeme informatique. Resultats Au sein de la nouvelle organisation proposee, le nombre de centre regionaux de transfusion sanguine (CRTS) passe de 16 a 7 en respectant au mieux les contraintes existantes, avec une redefinition des roles de chaque site. Les aspects de gestion de stock, systeme informatique, l’augmentation du nombre de donneurs, la politique communication et marketing et le circuit de collecte et de distribution de sang ont ete egalement redefinis. Conclusion Cette proposition de nouvelle organisation va permettre de mettre a disposition des decideurs les elements necessaires pour l’aide a la prise de decision par rapport a l’amelioration de l’ensemble du systeme transfusionnel marocain pour atteindre les objectifs souhaites a savoir assurer une disponibilite et une securite maximale des Produits sanguins labiles (PSL). La simulation de cette proposition devrait permettre de confirmer le choix qui a ete fait. L’analyse des aspects complementaires tel l’aspect financier ou ressources humaines par exemple permettra d’affiner davantage cette proposition.
TL;DR: Cette etude montre que des signes cutanes sont majoritairement retrouves lors d’un effet indesirable receveur allergique pediatrique et que le concentre de plaquettes d”apherese est le plus souvent implique.
Abstract: Purpose of the study
In the transfused patients, in France, in 2011, allergy ranked as the third adverse transfusion reaction. In order to evaluate the incidence and symptomatology of allergic adverse transfusion reactions in the paediatric people, a study was performed.
TL;DR: The aim of the study is to analyze donor motivation and sociology in the regional center of transfusion of Sfax and the implication of donor associations in the organization of the collections and the promotion of the blood donation would be of considerable contribution.
Abstract: In Tunisia, blood donation is voluntary, anonymous and non-remunerated. The aim of the study is to analyze donor motivation and sociology in the regional center of transfusion of Sfax. Between 14 May 2007 and 23 June 2007, a total of 903 Tunisian blood donors filled a questionnaire. Among the donors, 81.8% were men and have a mean age of 34.2 years and the majority of them have an age between 18 and 29 years. The middle social class was majority (77.8%) as well as the liberal profession (65.1%). Primary and secondary education were dominant (79.3%). Among the blood donors, 41.6% were new donors and 28.6% had a history of a single donation, 50.3% were voluntary and 49.7% replacement donors. The reasons motivating the voluntary donation were solidarity (69.9%), religion (21.2%), health benefit (3.6%) and insurance for the family (5.2%). The replacement donors refuse the voluntary donation for not obvious reasons (51%), lack of availability (13.3%), difficulties of accessibility of the sites of collection (7.6%), phobia of the blood and the stings (4.02%) or by refusal of blood donation (1.79%). The information and the raising awareness of the replacement donors could change in a near future their attitudes to become voluntary and regular donors. The implication of donor associations in the organization of the collections and the promotion of the blood donation would be of considerable contribution.
TL;DR: Les resultats des sujets D negatif ont montre that the deletion du gene RHD est le mecanisme le plus frequent du phenotype DNegatif dans the population tunisienne.
Abstract: Resume But de l’etude La determination du phenotype RhD est importante en medecine transfusionnelle. Toutefois, la complexite de l’expression de l’antigene D est a l’origine des discordances observees entre deux determinations serologiques et a l’omission par serologie de certains variants qui peuvent entrainer une allo-immunisation. Par consequent, il est important de connaitre dans une population les alleles RHD responsables de phenotypes D partiel et D faible. Le but de ce travail est le depistage de D partiel avec RHD/RHCE gene hybride par PCR-multiplex. Sujets et methodes Notre etude a concerne 308 donneurs de sang du Sahel tunisien (269 D positif et 39 D negatif). Nous avons utilise la technique de PCR-multiplex pour amplifier les exons specifiques du gene RHD 3, 4, 5, 6, 7, 9 et 10. D’autres investigations moleculaires ont ete realisees pour caracteriser les variants RHD depistes par la PCR-multiplex. Resultats Parmi les 269 echantillons D positif, un seul cas a montre l’absence d’amplification des exons 4 et 5 du gene RHD . Ce variant a ete identifie en un D faible type 4 par PCR-SSP. Aucun des exons RHD n’a ete amplifie a partir de l’ADN de 39 echantillons D negatif ce qui est en faveur d’une deletion totale du gene RHD . Conclusion Nous n’avons trouve aucun variant D partiel avec RHD/RHCE gene hybride. Les resultats des sujets D negatif ont montre que la deletion du gene RHD est le mecanisme le plus frequent du phenotype D negatif dans la population tunisienne.
TL;DR: Les recherches actuelles se concentrent donc sur la coagulopathie post-traumatique et sur l’evaluation de nouveaux produits sanguins pouvant etre deployes au niveau des unites les plus avancees.
Abstract: Military conflicts create a dynamic medical environment in which the number of severe trauma cases is compressed in both time and space. In consequence, lessons are learned at a rapid pace. Because the military has an effective organizational structure at its disposal and the logistical capacity to rapidly disseminate new ideas, adoption of novel therapies and protective equipment occurs quickly. The recent conflicts in Iraq and Afghanistan are no exception: more than three dozen new clinical practice guidelines were implemented by the US Armed Forces, with attendant survival benefits, in response to observation and research by military physicians. Here we review the lessons learned by coalition medical personnel regarding resuscitation of severe trauma, integrating knowledge gained from massive transfusion, autopsies, and extensive review of medical records contained in the Joint Theater Trauma Registry. Changes in clinical care included the shift to resuscitation with 1:1:1 component therapy, use of fresh whole blood, and the application of both medical devices and pharmaceutical adjuncts to reduce bleeding. Future research will focus on emerging concepts regarding coagulopathy of trauma and evaluation of promising new blood products for far-forward resuscitation. New strategies aimed at reducing mortality on the battlefield will focus on resuscitation in the pre-hospital setting where hemorrhagic death continues to be a major challenge.
TL;DR: Cette loi definit egalement une categorie particuliere de medicament de therapie innovante prepare ponctuellement dont les conditions d’autorisations des etablissements qui pourront les fabriques et des medicaments ainsi prepares sont precisees par le decret n o 2012-1236 du 6 novembre 2012.
Abstract: The European regulation n(o) 1394/2007/CE published on the 13th of November 2007 defined and harmonized the European regulatory framework for advanced therapy medicinal products. It creates a specialized committee located at the European Medicine Agency, in charge of the assessment of these medicinal products. The consequences of this regulation are introduced in the French regulation by the law n(o) 2011-302 published on the 22nd of March 2011. It detailed notably the possibility for public establishments (except health establishments) and nonprofit organisms to create pharmaceutical establishments. This law defined also a specific category of advanced therapy medicinal products, which fall under the "hospital exemption" framework. The rules regarding the authorizations of the establishments able to prepare these types of medicinal products and the authorization of the products are defined by the n(o) 2012-1236 decree published on the 6th of November 2012.