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Master Thesis

Profil épidémiologique de la maladie de Biermer en Guadeloupe : étude observationnelle au CHU de Pointe-à-Pitre de 2009 à 2014

Abstract : Background: The increased morbidity of pernicious anemia, its neoplastic risk and its coexistence with autoimmune diseases such as type 1 diabetes, have motivated the study of the epidemiological profile in Guadeloupe. Aims: The main objective of this work was to describe the epidemiological profile of pernicious disease in Guadeloupe. Secondary objectives were to identify the discriminating factors by age, as well as predictors of severity. Methods: This is a retrospective study in 5 services at hospital of Pointe-à-Pitre, from 2009 to 2014 with the following inclusion criteria: a vitamin B12 deficiency and / or macrocytic aplastic anemia, presence of anti intrinsic factor antibodies (IFA) and / or gastric parietal anticellules (PCA) and / or atrophy in fundic histology. Sociodemographic, clinical, laboratory, endoscopic, histological data, treatment and follow-up results were collected and analyzed. Results: 52 patients, median age 65.5 years [15-95] with a sex ratio to 0.52 were included. Of these, 41 (78.8%) showed clinical signs of anemia, 39 (75.0%) had digestive signs and 25 (48.1%) had neuropsychiatric signs. Two (3.8%) patients remained asymptomatic and 15 (30.6%) patients had poor clinical safety signs. The median value of B12 was estimated at 90 pg / mL [53-964], hemoglobin at 5.4 g / dL [2.1-16.3], the white blood cell count at 3.95 G / L [1.6-23] and the wafers at 117 G / L [31-614]. The hemoglobin was below 8 g / dL in 42 (80.8%) cases, pancytopenia was found in 15 (28.8%) cases and pseudo thrombotic microangiopathy in 2 (3.8%) cases. The positivity rate of IFA and anti PCA were 84.4% (n = 38/45) and 52.2% (n = 24/46) respectively. The histological fundic atrophy was found in 87.5% (n = 28/32) of cases and metaplasia in 74.3% of cases (n = 26/35). Among 51 cases: a transfusion was performed in 36 (70.6%) cases, treatment with B12 vitamin in 50 (98.0%) cases with clinical improvement in 35 (70%) cases. Complications were observed in 13 (25%) cases responsible for one death (1.9%). The less than 65 years patients had more clinical anemia (p = 0.025), more severe disease (p = 0.024) low levels of vitamin B12 and low white blood cell count (p = 0.000 and 0.003 respectively). Clinical anemia was a predictor of severity in univariate analysis (p = 0.000). Conclusion: The clinical presentation of pernicious anemia in Guadeloupe, is comparable to the literature although his expression is more severe in less than 65 years patients.
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Master Thesis
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Submitted on : Friday, March 11, 2016 - 4:52:28 PM
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Nadine Gerion. Profil épidémiologique de la maladie de Biermer en Guadeloupe : étude observationnelle au CHU de Pointe-à-Pitre de 2009 à 2014. Médecine humaine et pathologie. 2015. ⟨dumas-01287043⟩

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