Anti-HPA-1b Mediated Posttransfusion Purpura: A Case Report.

Posttransfusion purpura (PTP) is an uncommon, but potentially fatal, transfusion reaction characterized by profound thrombocytopenia and bleeding. PTP is caused by alloimmunization to human platelet specific antigens following blood component transfusion. Although there is evidence of a wide serological spectrum of culprit antibodies implicated, Anti-human-platelet-antigen- (HPA-) 1a is the most common antibody in cases reported. We report a case of posttransfusion purpura in an African American. The patient was negative for HPA-1a antibodies, but anti-HPA-1b was identified with a platelet phenotype of HPA-1a/HPA-1a. Although less common, HPA-1b antibody may be an important consideration in posttransfusion purpura diagnosed in patients of African descent.

Human immunodeficiency virus associated with haemophagocytic syndrome in pregnancy: a case report.

BACKGROUND: Haemophagocytic syndrome (HPS) is a rare condition that has been documented in association with viral, bacterial, fungal and parasitic infections as well as a wide spectrum of malignant neoplasms and autoimmune diseases. Whereas HPS is a known cause of anaemia in HIV infection, its occurrence is uncommon. Its occurrence in pregnancy is even rarer and very few such cases have been reported. METHODS: Full clinical evaluation and investigations including bone marrow aspiration cytology were done to elucidate the cause of the anaemia. RESULTS: Evaluation revealed severe anaemia, increased serum bilirubin HIV positivity and a low CD4 count. The final diagnosis confirmed the case to be haemophagocytic syndrome in pregnancy. A 31-year-old primigravida presented at 21 weeks of gestation with a two-week history of fever, jaundice and abdominal pain. She responded to treatment. CONCLUSION: Although a rare condition, this case highlights the importance of a high index of suspicion for the syndrome in HIV positive pregnant women with persistent Coombs negative haemolytic anaemia. Full recovery could be expected following prompt institution of HAART and delivery.

The evolution of CD4+ T cell cytometry in perspective: challenges for resource poor settings.

CD4+ T cell cytometry antedated the Human Immunodeficiency Virus (HIV) epidemic. However it was in the wake of the HIV scourge that CD4+ T cell counting technology gradually evolved from a pure cellular research assay technique into a routine clinical diagnostic test. In the more than two and half decades of the HIV/AIDS pandemic, this cell based diagnostic test has undergone several phases of technological improvements in the efforts to produce cheaper and more robust equipment for the monitoring of patients. The evolution however, is still very much in progress. Resource poor countries that remain the worst hit by the scourge of HIV/AIDS are paradoxically usually the last to benefit from the impact of the technological advancements in CD4+ T cell cytometry. This review highlights the progress and the scientific milestones so far attained in the development of improved techniques for CD4+ T cells count as a major cornerstone of patient care, as well as the emerging future directions in the evolution of this important cellular diagnostic test. Some of the challenges for developing economies are highlighted.

Improving supply of safe blood and reducing cost of transfusion service through haemovigilance.

Availability of safe blood remains a major challenge for many developing countries. Unnecessary discontinuation of scarce blood is a major conduit of wastage of scarce blood, as well as man hours and funds. Haemovigilance is a national system of surveillance and alarm, from blood collection to the follow-up of the recipients, gathering and analysing all untoward effects of blood transfusion in order to correct their cause and prevent recurrence. A prospective study to audit discontinuation of blood transfusion at the Obafemi Awolowo University Teaching Hospital Ile-Ife over a period of one and half years was done. Simple febrile non-haemolytic transfusion reaction (FNHTR) was the leading indication for such discontinuation (66.7%). More than half of discontinued transfusion due to FNHTR (58%) was successfully completed on review by trained personnel in transfusion medicine. A system of haemovigilance if incorporated into the blood transfusion service will promote effective monitoring of blood transfusion and reduce wastage of scarce blood/blood products.

Blood transfusion reactions; evaluation of 462 transfusions at a tertiary hospital in Nigeria.

The immuno-haematological safety of blood remains an important and recurring issue in blood transfusion practice. Data concerning morbidity and mortality from blood transfusion is sparse in Nigeria however and while the current efforts at reduction in the incidence of adverse consequence of blood transfusion is encapsulated in the concept of Haemovigilance, the Nigerian blood transfusion service is yet to institute the practice. A prospective study of 462 transfusions at the Obafemi Awolowo University Teaching Hospital was done to evaluate the incidence and pattern of transfusion reactions in the hospital. The overall incidence of transfusion reactions is 8.7% (40 cases), with febrile nonhaemolytic transfusion reactions (FNHTR) constituting 65% of these. The incidence of adverse reaction is significantly related to a positive history of previous transfusion (p = 0.0039). Efforts must be sustained at evolving a system to minimize the incidence and consequences. The development of a haemovigilance system in which data regarding all transfusions carried out in Nigerian hospitals is collated and analyzed is necessary. The advent of the National Blood Transfusion Service (N.B.T.S) in Nigeria with Zonal centres in the six geopolitical zones of the country offers an opportunity for setting up a national haemovigilance programme.

Survival in primary a plastic anaemia; experience with 20 cases from a tertiary hospital in Nigeria.

BACKGROUND: Aplastic anaemia is a condition characterized by pancytopenia and unexplained bone marrow hypocellularity. Without treatment, it is invariably fatal. However with the currently available treatment options, patient survival is improving in the developed countries. METHODS: The study is a retrospective study. We reviewed the cases of primary aplastic anaemia managed in our hospital over a period of fifteen years. RESULTS: A total of twenty five cases were seen; out of which twenty had complete analyzable data. Management consisted of transfusion support with packed red cells, platelet concentrates and freshly collected unbanked blood; immunosuppressive therapy was with methyl prednisolone. None of the patients had the benefit of bone marrow/stem cell transplantation. Overall median survival was 6.5 weeks. CONCLUSIONS: There is a clear need to ensure the availability of proven therapeutic options for patients such as bone marrow/stem cell transplantation and drugs such as cyclosporine and antithymocyte globulin to improve on the present situation.

One year clinical audit of the use of blood and blood components at a tertiary hospital in Nigeria.

BACKGROUND: The appropriate use of blood and blood components remains a formidable challenge faced by clinicians particularly in a developing country like Nigeria. The inadequate supply of safe blood implies that measures aimed at ensuring judicious use of the available supply should be continually identified and explored. STUDY DESIGN: Aprospective study to evaluate all blood and blood component transfusions over a period of one year from January to December 2004 was done. The appropriateness of the transfusion with respect to the clinical state and the transfusion needs of the recipient was assessed by a Haematologist. RESULTS: A total of 682 transfusion episodes were reviewed and analyzed. The commonest indication for use blood/blood component was severe anaemia in 38% of cases. Twenty nine percent of transfusions for moderate anemia, and 36% of fresh frozen plasma transfusions were found to be unnecessary. Inappropriate transfusion is most marked in the setting ofplatelet transfusion with 81% of platelet transfusion being inappropriate. CONCLUSION: Enhanced capacity for component preparation, regular auditing of transfusion practices as well as improved communication between the clinicians and laboratory physicians will lead to more judicious use of blood component therapy. The need for the development of guidelines for blood component use in hospitals in line with the national blood transfusion policy is highlighted.

Allergic Transfusion Reactions in a Tertiary Hospital in Southwest Nigeria

Background: Allergic reaction is a recognized cause of morbidity in clinical blood transfusion. Few studies have characterised the presentation of this adverse reaction in the general population of transfusion recipients in Nigerians. Aim: To determine the patterns of presentation of allergic transfusion reactions in both adult and paediatric blood /blood products recipients in this environment. Methods: Using a haemovigilance report form; we prospectively evaluated the presentation of allergic transfusion reactions among transfusion recipients. Information obtained include: age; sex; blood component transfused; history of atopy in the patient or family. Detailed clinical examination and review of the recipients was done from the commencement of the transfusion episode up till 24 hrs after the completion of the transfusion. Results: A total of 462 consecutive transfusion episodes were evaluated for allergic events. Including 101 children and 157 adults. The results show that allergic transfusion reactions are not uncommon in the population. The overall incidence of allergic transfusion reactions was 2.8. The commonest allergic symptom seen was pruritus. There was no significant statistical difference in the overall incidence of allergy between adult and paediatric transfusion recipients. Pattern of the specific allergic symptoms differ between the two subpopulations with peri-orbital oedema seen exclusively in children. Atopic paediatric transfusion recipients are at higher risk of allergic reactions than adults ( p=0.05). Conclusion: Incidence of allergic transfusion reactions is similar in black adult and paediatric transfusion recipients. Improvement in blood transfusion practice through enhanced component transfusion will reduce the incidence in transfusion recipients