[Improvement and process optimization transfusion in Morocco: proposal of a new organization]. / Amélioration et optimisation du processus transfusionnel au Maroc : proposition d'une nouvelle organisation.

PURPOSE OF THE STUDY: Propose a new organization for the Moroccan blood transfusion system. MATERIALS AND METHODS: Through an analysis of several aspects of the current organization, both qualitatively and quantitatively (Statistics 2011), it was found that several failures of the current system prevent them from achieving it's objectives and ensuring its responsibilities. Using multiple-criteria decision analysis (ELECTRE III), a new organization based on resources pooling is proposed. This new organization concerns the status of the National Blood Transfusion Center, donor management, the geographical location of the various regional centers, logistics, inventory management and the information system. RESULTS: Within the new organization proposed, the number of regional Centers for blood transfusion is reduced from 16 to 7 in accordance with the existing constraints, while redefining the roles of each site. The aspects of inventory management, the information system, increasing the number of donors, the policy communication and marketing and cycle of blood collection and distribution are also redefined. CONCLUSION: This proposed new organization will provide decision makers with the necessary assistance for decision making, whit respect to the improvement of the entire system Moroccan blood transfusion system. And so help achieving the desired objectives on ensuring blood availability and it' maximum safety. The simulation of this proposal should confirm the choice that was made. Further analysis of complementary aspects such as the financial aspect or human resources, would moreover contribute to refining this proposal.

Pathways controlling the superoxide response during phagocyte differentiation: involvement of arachidonic acid and Ca2+ in the response to bacterial endotoxin.

In contrast to the phorbol ester oxidative response, which only develops during dimethylsulphoxide (DMSO)-induced differentiation of the human leukemic myeloblast HL-60 cell-line, the endotoxin response was observed in undifferentiated and differentiated cells. The Ca2+ response to endotoxin, detected in both differentiated and undifferentiated HL-60 cells, consisted of a transient 10-50 nM increase in intracellular Ca2+. A very slow, irreversible increase in intracellular Ca2+ was detected at high 1-100 micrograms/ml endotoxin concentrations, and this effect, and the inositol phosphate response, correlated with the surfactant activities of various endotoxins and Lipid A. Arachidonic acid and sodium arachidonate 1-50 microM stimulated a large 200-500 nM and transient Ca2+ response in undifferentiated HL-60 cells, which was significantly greater than that elicited by 1-50 microM eicosapentaenoic acid, and was not observed at similar concentrations of arachidonic acid methyl ester or myristic acid. These concentrations (1-50 microM) of arachidonic acid were observed to have surfactant activities on the plasma membrane. At lower arachidonic acid concentrations a marked potentiation of both Ca2+ and oxidative responses to the chemotactic peptide fMet-Leu-Phe was detected. It is possible that the arachidonic acid released during phospholipase A2 activation of neutrophils may be involved in cellular cross-talk and, at higher concentrations, in directly activating Ca2+ and superoxide production. It is also possible that previously reported effects of endotoxin at high concentrations are an in vitro artefact of surfactant properties of endotoxin.

The regulatory role of external cations on human polymorphonuclear phagocyte chemiluminescence.

The effect of the external cations Na+ and Ca2+ on polymorphonuclear chemiluminescence was investigated. Both Ca2+ in the range of 0.2-2 mM and Na+ in the range of 114-143 mM showed a dose dependent increase in polymorphonuclear chemiluminescence, irrespective of the concurrent increase in osmolality. The Na+/H+ antiport inhibitor Amiloride decreased the response significantly. These effects were observed using buffers commonly used for chemiluminescence studies and indicate the importance of defining the Ca2+ and Na+ composition of the buffers used in chemiluminescence assays.

Human immunoglobulin G stimulates human adipocyte lipogenesis.

The effect of human IgG on human adipocytes has been investigated. Polyclonal IgG prepared from sera of normal subjects, monoclonal IgG from sera of patients with myeloma and IgG harvested from lymphocytes cultures were equally potent in stimulating lipogenesis in human adipocytes. Fc fragments prepared from IgG fractions also stimulated lipogenesis, whereas Fab fractions were inactive. Pre-incubation of IgG and Fc fragments with gamma-chain specific anti-IgG and anti-Fc antisera neutralised the stimulatory activity of both IgG and Fc fractions. The stimulatory effect of IgG on lipogenesis was demonstrated both on adipocyte suspensions and on adipose tissue. These data demonstrate that human IgG has a specific stimulatory effect on lipogenesis by human adipocytes and that this effect is mediated through the Fc moiety.

Insulin-like stimulatory effect of human immunoglobulin G on adipocyte lipogenesis.

An investigation into the possible effect of thyroid stimulating immunoglobulin G on lipogenesis by adipocytes led to the discovery that all human IgGs exerted an insulin-like stimulatory effect of lipogenesis by rat adipocytes in vitro. Highly purified polyclonal IgGs prepared from normal subjects had stimulatory potencies similar to those of monoclonal IgGs obtained from patients with IgG myeloma. However, whole sera from myeloma patients with elevated IgG concentrations had a significantly higher stimulatory effect on adipocyte lipogenesis than control sera. These observations provide the first evidence that human IgG has an insulin-like metabolic effect, and that this effect is probably exerted by a nonspecific nonvariable portion of the IgG molecule. IgG may thus contribute to the non-suppressible insulin-like activity in the serum.