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Master Thesis

Problématiques immuno-hématologiques transfusionnelles des patients drépanocytaires de Guyane

Abstract : TITLE : Immunohematologic transfusions problems of sickle cell patients in French Guiana. BACKGROUND : Blood transfusion is a cornerstone of treatment of sickle cell disease. Alloimmunization represents a major complication, which may itself lead to delayed hemolytic transfusion reaction, that is life-threatening. This study attempts to characterize this risk of allo-immunization. METHODS : This cross-sectional study looked at the patients which were followed on october the first, 2016 to the centre « intégré de drépanocytose » (a department of the hospital of Cayenne). The clinical and biological data came from the department records and the immuno-hematological data came from the medico-technical software of the Etablissement Français du Sang of Cayenne. The red blood cells units (RBCs) received were also studied. RESULTS : 451 patients were included among whose 58 % were SS SCD. 298 patients (66%) were transfused with 6834 RBCs. The rate of alloimmunization of transfused patients was 23 % along with a high occurence of Lewis antibodies. 21 patients (7 % of transfused patients) had an antibody known to be dangerous, namely the anti-Jkb (JK2), the anti-S (MNS3) and the anti-Fya (FY1). There were neither significant differencies between alloimmunised patients and others on the gender, the age when the data were collected, nor on the hemoglobine phenotype. The average number of RBCs transfused was significantly higher for allo-immunised patients (p=0,02), and so the average number of RBCs they received in emergency (p=0,01) and the average number of RBCs at simple transfusion occasions (p=0,01). A multivariate analysis of these factors showed a significant difference for the simple transfusion only. 13 transfused patients developped a DHTR (4,4%), 9 were women and 5 were pregnant during this episode. CONCLUSION : The alloimmunization rate is partially explained by the metropolitain and guadeloupeen origin of the RBCs. The high occurence of anti-Lewis might be due to the identification techniques used. Finally, the proportion of pregnant women during the DHTR requires a thinking on the management of this risky situation.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03181311
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Submitted on : Thursday, March 25, 2021 - 3:10:12 PM
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Salomé Conrath. Problématiques immuno-hématologiques transfusionnelles des patients drépanocytaires de Guyane. Médecine humaine et pathologie. 2019. ⟨dumas-03181311⟩

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