Multiple transfusions for sickle cell disease in the Democratic Republic of Congo: the importance of the hepatitis C virus.

BACKGROUND AND OBJECTIVES: Improvement of transfusion security in sub-Saharan countries requires the determination of priorities taking into account the specific context. PATIENTS AND METHODS: One hundred and forty patients with sickle cell disease (SCD) from one clinical centre for SCD in Kisangani, DRC were tested for HBsAg, anti-HIV antibodies, anti-HCV antibodies and for alloantibodies against red blood cells and human leucocyte antigens (HLA). RESULTS: Thirteen patients had not been transfused and were free of HBV, HIV or HCV infection. HBV, HIV and HCV infections were detected in 2/127 (1.6%), 1/127 (0.9%) and 10/127 (7.9%) transfused patients, respectively. All ten cases of HCV infection were associated with patients who had transfusions prior to the introduction of HCV testing in 2004 (P=0.043). Red blood cells and HLA alloantibodies were detected in 13/127 (10%) and 2/127 (1.6%), respectively. CONCLUSION: HCV testing should be a priority. The rhesus (Rh) phenotype, mainly the RhD antigen and the Kell antigen should be assessed in SCD patients. Further extended phenotyping and deleucocytation should not be considered as priorities.

[Infectious markers among blood donors in Democratic Republic of Congo (DRC)]. / Marqueurs infectieux chez les donneurs de sang en République Démocratique du Congo (RDC).

In sub-saharian Africa, two factors account for the difficulties encountered to reach optimal blood safety: high frequency in the general population of various infections of which some are transmissible by blood transfusion and a still insufficient proportion of voluntary donors which constitute the safest group. The Kisangani transfusion center in DRC does not escape from this rule since in addition to voluntary blood donors (29.2%), its blood supply is mainly assured by family (or replacement) donors (69.2%). Persistence of a few remunerated donors (1.6%) was also noted at the period of the study. In this study, we determined seroprevalence of HIV, HBV and of syphilis infections in these three categories of donors and defined their characteristics by a retrospective analysis carried out on 3.390 subjects between January 2003 to December 2004. It revealed that 4.7% of the donors were positive for HIV, 5.4% for HBV and 3.7% for syphilis. There were significant differences according to studied groups : voluntary blood donors (n=989; HIV+ = 2.2%; VHB+ =3%; syphilis+ = 1.1%), family donors (n = 2.345; HIV+ = 4.6%; HBV+ = 4.9%; syphilis+ = 3.6%) and remunerated donors (n=56; HIV=50%; HBV+ = 64.3%; syphilis+ = 53.6%). These results indicate that it is necessary to intensify promotion of voluntary donation by a policy of information and education and to abolish practice of remunerated donation. Within the limits of possible, family donation should be gradually discouraged.