Elevated unidentified antibodies in sickle cell anaemia patients receiving blood transfusions in Cape Town, South Africa

Background. Sickle cell disease (SCD) is an inherited haemoglobinopathy in which homozygous individuals suffer from numerous complications including vaso-occlusion, infection and haemolytic anaemia. Patients therefore often require blood transfusions, which may lead to elevated levels of allogeneic antibodies. In South Africa (SA), the number of patients with SCD has risen significantly owing to migration and changing demographics, leading to an increased need for blood products.Objectives. Against the above background, to determine the incidence of alloimmunisation and the presence of clinically significant antibodies in SCD patients requiring transfusions in Cape Town, SA.Methods. Information on SCD patients receiving blood products between 2010 and 2012, including demographics, number of units transfused and the presence and type of alloantibodies, was collected. The results were compared with those for non-SCD controls who had received a similar number of transfusions.Results. Of 182 patients analysed, 91 had SCD. Twenty-two percent of the SCD patients and 13.2% of the controls had become alloimmunised (p=0.12), while the proportions of those receiving transfusions and acquiring clinically significant antibodies were similar between the two groups (p=0.17 and p=0.19, respectively). However, the total number and amount of unidentified antibodies were significantly increased in patients with SCD (p=0.02 and p<0.001, respectively).Conclusions. This study concluded that patients with SCD develop increased numbers of unidentified antibodies, which may be important in the selection of suitable donors

An assessment of mother-to-child HIV transmission prevention in 16 pilot antenatal clinics in Jamaica

OBJECTIVES: This study aims to determine the number and age distribution of pregnant women testing positive for HIV at 16 selected clinics in Jamaica between 2001 and 2002; the utilization of therapeutic interventions to minimize the risk of mother-to-child transmission (MTCT) and the current status of the HIV-exposed infants and, finally, the number of children who received testing for detection of HIV and to calculate the incidence of MTCT in these children. METHODS: A retrospective study was carried out at sixteen pilot clinic sites by examining the patient records for all confirmed HIV-positive pregnant mothers and the resultant infants at these facilities for the period January 2001 to December 2002. RESULTS: One hundred and twenty-three of 8116 pregnant women newly tested positive during the period January 2001 to December 2002; however, 176 HIV+ women delivered. Fifty-three (30) knew their HIV status prior to participating in the programme. Sixty-two (1.4) and 61 (1.6) tested positive in 2001 and 2002, respectively. One hundred and ten (77) and 113 (83) mothers and infants, respectively, received ARV therapy, (92 - nevirapine, 8 - zidovudine). Twenty-three per cent of pregnant women received no ARV Forty-four (25.0) of the 176 infants had a documented ELISA HIV test before eighteen months of age, none had a PCR test. The health status of 40 (23) of these children was known: 30 (75) were alive and well, five of whom did not receive any ARV, one (2.5) was alive and ill and nine (22.5) were reported dead, five of whom received ARV; 28.6 of infants who did not receive ARV were reported as either dead or ill compared to 13.8 of those receiving ARV CONCLUSION: Though the majority of pregnant women discovered their HIV status during pregnancy, a significant number got pregnant knowing that they were HIV+. The majority of mothers and infants received ARV but the follow-up and testing of infants was limited. Nevirapine is clearly protective in the prevention of MTCT of HIV and should be made universally accessible. All infants delivered to HIV+ mothers should be identified and tested for HIV

Lid surgery to reduce discomfort produces an unexpected improvement in visual acuity--a case presentation.

A significant cause of blindness in leprosy is corneal scarring secondary to corneal anaesthesia and lagophthalmos (Brand & ffytche 1985). Such patients may continue to experience considerable ocular discomfort, particularly when there is associated ectropion of the lower lid, with inflammation of the exposed tarsal conjunctiva (Courtright & Johnson 1991). Where visual outcome is no longer the primary consideration, one may hesitate to subject patients to surgery, particularly in relatively unsophisticated field conditions, attempting instead to relieve the patient's discomfort by conservative treatment such as frequent topical ocular lubricants, use of protective spectacles or eye shades etc. A case is presented here in which minor surgery aimed solely at relieving ocular discomfort resulted in an unexpected improvement in visual acuity. This suggests that there are instances where a more aggressive approach to treatment of even severely damaged eyes could prove more rewarding than anticipated.