Systemic T Cell Subsets and Cytokines in Patients With Homozygous Sickle Cell Disease and Asymptomatic Urinary Tract Infections in Togo.

Background: In sickle cell disease (SCD), cytokine expression influences the pivotal pathways that contribute to disease pathogenesis. Additional infection could affect the immune profile of patients with SCD and increase disease mortality. The aim of this study was to investigate the cytokines and T helper cells profile in patients with asymptomatic urinary tract infection and homozygous SCD (HbSS). Methods: From July to September 2018, 22 HbSS subjects were recruited at Centre Hospitalier Universitaire Campus in Lomé, Togo, 12 of whom had urinary tract bacterial infections and 10 of whom were uninfected. Cytokines from plasma were measured by the enzyme-linked immunosorbent assay (ELISA) sandwich method, and immune cell profiles were performed by flow cytometry. The immunogenicity of bacteria-derived antigens isolated from the urine of HbSS subjects with asymptomatic urinary tract infections was studied in a cell culture system, and the induction of the cytokines was measured. Results: The mean age of HbSS subjects with urinary tract infections was 20.33 ± 3.58 years, and the male/female ratio was 0.09 (1:11). HbSS subjects with asymptomatic urinary tract infections had elevated plasma levels of interferon gamma (IFN-γ) and interleukin (IL)-10. CD4+Tbet+IFN-γ+ and CD4+FoxP3+IL-10+ T cell populations were decreased in HbSS subjects with asymptomatic urinary tract infections. Bacterial antigens from HbSS subjects induced the production of IL-10 but not IFN-γ in uninfected volunteer donors (HbAA). Conclusion: Our study demonstrated that patients with SCD and asymptomatic urinary tract infections had elevated IFN-γ and IL-10 levels. This chronic inflammatory condition could be a risk for this group of patients in terms of vaso-occlusive crisis. Systematic cytobacteriologic examination of the urine of HbSS subjects would be of interest.

[Quality control of red blood cell pockets produced at Centre National de Transfusion Sanguine de Lomé]. / Evaluation de la qualité des concentrés de globules rouges produits au Centre National de Transfusion Sanguine de Lomé.

INTRODUCTION: at the National Center for Blood Transfusion (NCBT) in Lomé, whole blood is systematically separated into its various labile blood products. This study aims to assess the quality of the red blood cell concentrates (RBCC) produced. METHODS: we conducted a cross-sectional study on 260 RBCCs (204 adult units and 56 paediatric units) from January to March 2018. The bags were weighed to determine the volume of their content. Hemoglobin and hematocrit levels were determined using the Horiba Medical Pentra XLR device. We evaluated the fidelity and precision of the device in order to ensure the accuracy of the measurements of the variables analyzed. Statistical analyses were performed using the R software. RESULTS: adult units assessment showed that 79.90%; 81.86% and 43.13% bags were consistent with respect to the volume and haemoglobin and haematocrit levels. Paediatric units assessment showed that 98.21%; 69.64% and 37.50% bags were consistent with respect to the volume and haemoglobin and haematocrit levels. Simultaneous analysis of the three parameters showed a compliance rate of 42.16% for RBCCs in adults against 35.71% for pediatric RBCCs. CONCLUSION: we recommend to expand the interval between two blood donations and to perform hemoglobin test before blood donation in compliance with the eligibility criteria for giving blood at the National Center for Blood Transfusion in Lomé.

Intrauterine Growth Retardation Complicated by Biermer's Disease: An Observation in Togo.

OBJECTIVE: To report the first case in Togo of Biermer's disease associated with intrauterine growth retardation (IUGR) in a 39-year-old pregnant woman. OBSERVATION: The patient with phenotype AA, born on 20/02/1978, G2P0 (a spontaneous abortion at 3 months), was referred to hematology on 17th March 2017 for anemia at 26 weeks of amenorrhea (WA). She had received martial treatment with ferrous fumarate 66 milligrams daily. At 26 weeks, the uterine height was 16 centimeters, and there was good fetal vitality. During ultrasound, there was a harmonious development of the fetus, but it was lower than that for the gestational age at 10th percentile based on fetal biometry, and anemia was at 65 g/l. She was then referred to hematology where she was found to have pancytopenia with macrocytic aregenerative anemia at 47 g/l (MCV at 109 fl), neutropenia at 1.02 g/l, and thrombocytopenia at 58 g/l. The myelogram found megaloblastosis at 53%, collapsed serum B12 vitamin at 61.7 pg/ml, normal serum folate at 9.9 ng/ml, increased serum homocysteine to 51.44 µmol/l, and elevated LDH. The search for intrinsic anti-factor antibodies was positive. Digestive endoscopy noted fundal atrophy. The patient was given vitamin B12 injection; at the 7th day, hemoglobin was observed at 94 g/l, then a normalization of the blood count after 3 weeks, and a good evolution of the pregnancy with delivery at 38 WA of a newborn, female, weighing 1960 g with 500 grams of placenta, with a size of 40 cm, and a cranial perimeter of 29 cm. The child had stunted weight growth (at 16 months; weight = 7 kg; height = 69 cm). CONCLUSION: Biermer's disease as a maternal cause of IUGR and infantile hypotonia is a reality in Togo. It requires management in patients and especially during pregnancy to avoid neurological complications in children born from mothers with this disease.

[Prevalence of albuminuria in sickle cell disease patients at the Campus university hospital of Lome, Togo]. / Prévalence de l'albuminurie chez les drépanocytaires au Centre hospitalier universitaire Campus de Lomé au Togo.

OBJECTIVES: The objective of this study was to assess the prevalence of albuminuria in sickle cell disease patients at the Campus University Hospital of Lome. PATIENTS AND METHOD: Albuminuria was assessed by the urinary albumin-to-creatinine ratio (UACR) in sickle cell disease individuals who attended the outpatient consultation in their steady state. RESULTS: The prevalence of albuminuria was 21% (14/67). Albuminuria was more frequent (32% vs 13%, p=0,054) and occurred earlier (6 years vs 21 years) among the 28 SS/Sß0-thalassemia sickle-cell diseases individuals than the 39 SC ones. Albuminuria was associated with high counts of leukocytes (p=0.033) and neutrophils (p=0.008). It was negatively correlated with hemoglobin level (p=0.032) and positively with LDH (p=0.002), SGOT (p=0.002), leukocytes (p=0.003), neutrophils (p< 0.001) and thrombocytes (p=0.010) counts for all sickle cell patients without statistical confirmation for each sickle cell phenotype apart from neutrophils in SS/Sß0-thalassemia. Defining albuminuria as an UACR greater than 20 mg/g had a specificity of 100% and a sensibility and 90% when the UACR was compared to the 24-hours urines albumin quantification. CONCLUSION: The assessment of albuminuria should begin at age 5 years in SS/Sß0-thalassemia sickle-cell anemia patients and from 20 years old in SC patients by the UACR.

[Characteristics of chronic lymphocytic leukemia in Togo]. / Caractéristiques de la leucémie lymphoïde chronique au Togo.

The epidemiological, clinical and biological characteristics of chronic lymphocytic leukemia (CLL) are little studied in Togo. The purpose of this study was to describe these characteristics at the time of diagnosis. We conducted a retrospective and descriptive study of patients diagnosed at the University Hospital Campus from January 1999 to December 2018. Over the past two decades, 87 patients were seen for CLL (20% of patients with hematological malignancies) with an annual prevalence of 4.35 new cases. The average age of patients was 61 +/- 12,48 years (ranging from 17-85 years); 55 women and 32 men (sex ratio M/F 0.58) were enrolled. Clinically, 16 patients (18%) had no tumor syndrome, 33 patients (38%) had lymphadenopathy, 62 patients (71%) splenomegaly and 23 patients (26%) hepatomegaly. Biologically, the mean blood and medullary lymphocyte count was 87188/mm3 (ranging from 7000-481780/mm3) and 75.75% +/- 12,88 (ranging from 44,5-96,5%) respectively; 65 patients (75%) had haemoglobin less than 10g/dl and 20 patients (23%) had platelet count below 100000/mm3. At the time of diagnosis, 67 patients (77%) had Binet stage C, 7 patients (8%) stage B and 13 patients (15%) stage A. The study of biological prognostics factors showed that 66% of cases had ß2-microglobulin level higher than normal and 95% of cases had LDH higher than normal. CLL is a reality in Togo with a predominance of women and an average age of 61 years. Most patients are seen at Binet stage C and their assessment has revealed huge tumor mass with increased LDH and ß2-microglobulin. The current follow-up of these patients will enable us to assess their overall survival.

[Types of bcr-abl and their correlations with the blood count in chronic myeloid leukemia (CML) in Togo]. / Les transcrits bcr-abl et leurs corrélations avec l'hémogramme au cours de la leucémie myéloïde chronique (LMC) au Togo.

This study aims to describe the different bcr-abl gene transcript variants in order to determine their frequency and to study their influence on CBC diagnostic test. We conducted a cross-sectional study of 34 patients with chronic myeloid leukemia in Togo. The search for fusion transcripts was performed in the laboratory of biological haematology at the Henri Mondor Hospital, Créteil (France). The average age of patients was 42,32±14,87 years ranging between 9 and 65 years. Most patients were male, with a sex- ratio of 1.61 (21 men and 13 women). Molecular examination showed b3-a2 transcript and b2-a2 transcript. Nineteen patients (55.88%) expressed b3-a2 transcript, 13 patients (38.24%) b2-a2 transcript (32.10%) and two patients expressed both b3-a2 and b2-a2 transcripts (5.88%). At diagnosis, mean hemoglobin level, the average number of white blood cells and the average number of platelets in patients expressing b3-a2 transcript were 99,2g/L; 207,63g/l and 451,28g/l respectively. In patients expressing b2-a2 transcript values were 104,6g/l, 114,32g/l and 486,11g/l. In patients with both transcripts, values were 67g/L, 867g/l and 780g/l respectively. CBC parameters are more significantly altered in patients with both transcripts b3-a2 and b2-a2.

Blood typing profile of a school-aged population of a North Togo township.

The aim of this study was the determination of hemoglobin (Hb) variants and ABO blood groups in a school population aged 6 to 9 years in the township of Agbandé-Yaka in North Togo. A cross-sectional study was carried out on 570 children of four primary schools at Agbande-Yaka, between March and July 2010. Hemoglobin characterization was done by alkaline buffer electrophoresis and the blood types ABO-Rhesus (Rh) D by immuno-hematological methods. A Hb variant was detected in 37.0% of the schoolchildren. Among them, the AS trait accounted for 11.9% and the AC trait for 20.2%. Homozygous Hb S (HBB: c.20A>T) was not found but Hb C (HBB: c.19G>A) appeared at a frequency of 3.3%, while compound heterozygotes carrying Hb SC were seen at a frequency of 1.6%. The O, B and A blood groups accounted for 49.0, 26.8 and 21.9%, respectively. The Hb anomalies reached a high prevalence in this school population. These results are remarkable by the absence of homozygous Hb S individuals compared to homozygous Hb C individuals, which were as numerous as expected. The frequencies of the ABO blood groups are similar to what has been found in other West African populations.

Performance d'Hemocue Hb 201+ dans le diagnostic de l'anémie de l'enfant dans les structures sanitaires du niveau périphérique au Togo.

Performance of HemoCue Hb201+ in the diagnosis of anaemia in children in health facilities at the peripheral level in Togo. BACKGROUND: Anaemia is a global public health problem, especially in developing countries. Anaemia has major repercussions on health status, as well as on the economic and social development of a country. Effective care of anaemic patients requires a reliable and precise diagnostic test that can determine haemoglobin levels. OBJECTIVE: To evaluate the diagnostic performance of the Hemocue test Hb201+®. METHOD: This study compared haemoglobin levels measured using the photometer Hemocue Hb201+® with those measured by analysers of haematology. Children aged 6 to 59 months who suffered from uncomplicated malaria were eligible for inclusion. Haemoglobin levels determined by the analysers were considered the reference for evaluation of the levels measured using Hemocue Hb201+®. RESULTS: 72.8% of the values obtained by Hemocue Hb201® were within ±1g/dl of the reference value. The Pearson correlation coefficient was 0.80. The prevalence of anaemia was 79.3% using the reference method and 77.9% using Hemocue 201+®. The sensitivity and the specificity of Hemocue Hb201+® were 95.1% and 65.3% respectively. CONCLUSION: The study results showed that the Hemocue Hb201 test+® provided good sensitivity, average specificity and average precision, both for the diagnosis of anaemia and for the determination of haemoglobin levels. It may be used in peripheral centres to facilitate the laboratory diagnosis of anaemia and its management in populations that live in areas with difficult accessibility.

[Myeloproliferative disorders "Philadelphia negative" and JAK2V617F mutation: study of 15 cases in Togo]. / Syndromes myéloprolifératifs « Philadelphie négatif ¼ et mutation JAK2V617F : étude des 15 premiers cas ayant bénéficié de cette recherche au Togo.

The goal of our study is to document the prevalence of change JAK2V617F among patients reached of myeloproliferative syndromes (MPS) in Togo in order to evaluate frequencies. This descriptive study included 15 patients followed with the CHU Campus for a SMP. The research of JAK2 change by PCR was carried out with the APHP Henri Mondor of Creteil (France). During the study period, 15 patients followed for MPS (9 cases of polycythemia Vera, 5 cases of essential thrombocytemia and a case of primitive myelofibrosis) profited from the research of JAK2 change. The Middle age of the patients was respectively of 45±18 years; of 55±6 years for the PV and the essential thrombocytemia. The patient followed for primitive myelofibrosis was 72 years old. Sex-ratio (H/F) was of 2. JAK2 Change was positive in 5 cases out of 9 (55.5%) of the polycythemia Vera, at 3 patients out of 5 (60%) followed for essential thrombocytemia but negative for patient reached of primitive myelofibrosis. In conclusion, JAK2 Change has an interest diagnosis and forecast in the MPS negative Chromosom Philadelphia and can be systematic even in Africa Sub-saharian.

Clonal hypereosinophilic syndrome: two cases report in black men from sub-saharan Africa and literature reviews.

The first case is about a man of 60 years old suffering of hypereosinophilic syndrome (HES) developed since 1998. He presented chronic cough, insomnia, and negative parasitical test. We observed hypereosinophilia and fibroblastic hyperplasia at the bone marrow biopsy. Initially, hydroxyurea and α-interferon treatment failed. We proposed to him imatinib mesylate in May 2003. The FIP1L1-PDGFRA gene was detected. The second case is about a man of 34 years old seen in March 2002. First investigation concluded to CML. Progressively, eosinophil cells increased, and complications occurred as oedema syndrome, dyspnoea, and parietal chronic endocarditic fibrosis associated with pericarditis. In addition, a bowel obstruction happened and was cured by surgery. Bcr-abl fusion was negative, and FIP1L1-PDGFRA gene was detected after and imatinib mesylate was given. Actually, endocarditic fibrosis decreased. The two patients are in haematological and cytogenetic remission. We concluded that clonal HES is present in Africa, and imatinib mesylate is effective.

Hematological reference values for healthy adults in togo.

The hematological reference values are very important for diagnostic orientation and treatment decision. The aim of this study was to establish hematological reference values for healthy adults in Togo. A total of 2571 voluntary blood donors participated to this study. Only 1349 subjects negative for HIV, HBV, HCV, malaria, and without hemoglobin abnormalities in electrophoresis and hypochromia on blood smear, were definitively retained for the study. Median hemoglobin level was higher in males than females (15.1 g/dL versus 13.0 g/dL, p = 0.000). Median total WBC (4.2×10(9)/L) and absolute neutrophil counts (1.6×10(9)/L) were similar by gender. The median lymphocyte counts in males and females were, respectively, 2.1×10(9)/L and 2.2×10(9)/L (p = 0.11). The median platelet count was lower in males than females (236×10(9)/L versus 247×10(9)/L, p = 0.004). Our median values for RBC parameters differ from those of African countries probably because of our inclusion criteria which eliminate most cases with iron deficiency and/or thalassemia.

Effect of Tectona grandis on phenylhydrazine-induced anaemia in rats.

Traditional oral report indicates that Tectona grandis is used in the treatment of anaemia in Togo. For this purpose, the extract of T. grandis leaves is evaluated on anaemia model of rat induced by intraperitoneal injection of phenylhydrazine at 40 mg/kg for 2 days. Oral administration of T. grandis extract at 1 g/kg/day and 2 g/kg/day, to the rats previously treated with phenylhydrazine, increased the concentration of haemoglobin, red blood cells number, haematocrit and reticulocytes rate. Moreover, the extract of T. grandis enhanced the osmotic resistance of the red blood cells that confirm the important presence of young red blood cells. These results support partially the traditional use of T. grandis in the treatment of anaemia.