Blood use in sub‐Saharan Africa: a systematic review of current data

Dhabangi, Aggrey; Dzik, Walter H.; Idro, Richard; John, Chandy C.; Butler, Eric; Spijker, René; Hensbroek, Michaël Boele van

doi:10.1111/trf.15280

Cited by 7 publications

(15 citation statements)

References 47 publications

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“…It is obvious that children constitute a group at risk of alloimmunization due to frequent use of transfusion, despite that simple transfusions are dosed by volume (i.e.,10-15 mL/kg) in paediatric patients [23][24][25][26].…”

Section: Ias In Transfused Paediatric Patients In Ssamentioning

confidence: 99%

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Red blood cell alloantibodies in paediatric transfusion in sub‐Saharan Africa: A new cohort and literature review

Gadji

Cobar

Thiongane

et al. 2023

eJHaem

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Blood transfusion support predisposes transfused children to the risk of erythrocyte alloimmunization in Sub‐Saharan Africa. A cohort of 100 children receiving one to five blood transfusions were recruited for screening and identification of irregular antibodies using gel filtration technique. The mean age was 8 years and the sex‐ratio at 1.2. The retrieved pathologies were: major sickle cell anaemia (46%), severe malaria (20%), haemolytic anaemia (4%), severe acute malnutrition (6%), acute gastroenteritis (5%), chronic infectious syndrome (12%) and congenital heart disease (7%). The children presented with haemoglobin levels ≤6 g/dl, and 16% of them presented positive irregular antibodies directed against the Rhesus (30.76%) and Kell (69.24%) blood group systems. A literature review shows that irregular antibody screenings vary from 17% to 30% of transfused paediatric patients in Sub‐Saharan Africa. These alloantibodies are in particular directed against the Rhesus, Kell, Duffy, Kidd and MNS blood group and generally found in sickle cell disease and malaria. This study highlights the urgent need of extended red blood cell phenotyping including typing for C/c, E/e, K/k, and Fya/Fyb, and if possible Jka/Jkb, M/N, and S/s for children before transfusion in Sub‐Saharan Africa.

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Section: Ias In Transfused Paediatric Patients In Ssamentioning

confidence: 99%

“…Early recognition and management of haemolytic transfusion reactions can avert poor clinical outcomes [24,25,35,37,48].…”

Section: Frequencies and Specificities Of Ias In Paediatric Patients ...mentioning

confidence: 99%

Red blood cell alloantibodies in paediatric transfusion in sub‐Saharan Africa: A new cohort and literature review

Gadji

Cobar

Thiongane

et al. 2023

eJHaem

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“…SCA is most common in sub-Saharan Africa [9] where mortality is extremely high [10], and the consequences of stroke are more severe [11, 12]. Blood supply and transfusion services in Africa are currently inadequate to support a safe and effective chronic transfusion program for SCA [13, 14]. Hydroxyurea is an attractive alternative for both primary and secondary stroke preventions.…”

Section: Introductionmentioning

confidence: 99%

Stroke Prevention with Hydroxyurea Enabled through Research and Education: A Phase 2 Primary Stroke Prevention Trial in Sub-Saharan Africa

Smart¹,

Ambrose²,

Balyorugulu³

et al. 2022

Acta Haematol

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Introduction: Stroke is a severe complication of sickle cell anemia (SCA), with devastating sequelae. Transcranial Doppler (TCD) ultrasonography predicts stroke risk, but implementing TCD screening with suitable treatment for primary stroke prevention in low-resource environments remains challenging. SPHERE (NCT03948867) is a prospective phase 2 open-label hydroxyurea trial for SCA in Tanzania. Methods: After formal training and certification, local personnel screened children 2-16 years old; those with conditional (170-199 cm/sec) or abnormal (≥200 cm/sec) time-averaged mean velocities (TAMV) received hydroxyurea at 20 mg/kg/day with dose escalation to maximum tolerated dose (MTD). The primary study endpoint is change in TAMV after 12 months of hydroxyurea; secondary endpoints include SCA-related clinical events, splenic volume and function, renal function, infections, hydroxyurea pharmacokinetics, and genetic modifiers. Results: Between April 2019 and April 2020, 202 children (average 6.8±3.5 years, 53% female) enrolled and underwent TCD screening; 196 were deemed eligible by DNA testing. Most had numerous previous hospitalizations and transfusions, with low baseline hemoglobin (7.7±1.1 g/dL) and %HbF (9.3±5.4%). Palpable splenomegaly was present at enrollment in 49 (25%); average sonographic splenic volume was 103 mL (range 8-1045 mL). TCD screening identified 22% conditional and 2% abnormal velocities, with hydroxyurea treatment initiated in 96% (45/47) eligible children. Conclusion: SPHERE has built local capacity with high-quality research infrastructure and TCD screening for SCA in Tanzania. Fully enrolled, participants have a high prevalence of elevated baseline TCD velocities and splenomegaly. SPHERE will prospectively determine the benefits of hydroxyurea at MTD for primary stroke prevention, anticipating expanded access to hydroxyurea treatment across Tanzania.

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“…1 Severe anaemia is a common clinical consequence of malarial disease, especially among children, and is the primary indication for blood transfusion in sub-saharan Africa. 2 However, anaemia is not the only consequence, and an accompanying thrombocytopenia can not only be diagnostic in febrile patients but is also associated with poor disease outcome. 3 The role of platelet involvement in the pathogenesis of P. falciparum infection is not completely understood.…”

Section: Introductionmentioning

confidence: 99%

“…Erythrocytes are the primary host cells for replication of the malaria parasite Plasmodium falciparum and the parasite takes advantage of many cell membrane proteins and glycoproteins to adhere to and invade these cells 1 . Severe anaemia is a common clinical consequence of malarial disease, especially among children, and is the primary indication for blood transfusion in sub‐saharan Africa 2 . However, anaemia is not the only consequence, and an accompanying thrombocytopenia can not only be diagnostic in febrile patients but is also associated with poor disease outcome 3 .…”

Section: Introductionmentioning

confidence: 99%

Platelets inhibit erythrocyte invasion by Plasmodium falciparum at physiological platelet:erythrocyte ratios

Jongruamklang

Rebetz

Kapur

et al. 2021

Transfusion Medicine

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Objective: To evaluate the effect of platelet:erythrocyte (P:E) ratios on Plasmodium falciparum erythrocyte invasion.Background: Recent reports have shown that platelets are directly involved in the immune response towards P. falciparum during erythrocyte invasion. However, the literature both supports and conflicts with a role for platelets in limiting invasion.Also, the effect of platelet numbers on invasion (parasitemia) has not been thoroughly investigated.Methods/materials: The P. falciparum strains FCR3S1.2 and W2mef were cultured with group O erythrocytes. The cultures were synchronised and supplemented with pooled platelets at P:E ratios ranging from 1:100 to 1:2. Parasitemia was measured at 40 h by flow cytometry and by microscopy of blood smears.Results: A linear relationship was observed between reduced invasion and increased platelet numbers at P:E ratios ranging from 1:100 to 1:20. However, this effect was reversed at lower ratios (1:10-1:2). Microscopic evaluation revealed aggregation and attachment of platelets to erythrocytes, but not specifically to parasitised erythrocytes. Conclusion:We have shown that under physiological P:E ratios (approx. 1:10-1:40), platelets inhibited P. falciparum invasion in a dose-dependent manner. At ratios of 1:10 and below, platelets did not further increase the inhibitory effect and, although the trend was reversed, inhibition was still maintained.

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Blood use in sub‐Saharan Africa: a systematic review of current data

Cited by 7 publications

References 47 publications

Red blood cell alloantibodies in paediatric transfusion in sub‐Saharan Africa: A new cohort and literature review

Red blood cell alloantibodies in paediatric transfusion in sub‐Saharan Africa: A new cohort and literature review

Stroke Prevention with Hydroxyurea Enabled through Research and Education: A Phase 2 Primary Stroke Prevention Trial in Sub-Saharan Africa

Platelets inhibit erythrocyte invasion by Plasmodium falciparum at physiological platelet:erythrocyte ratios

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