Red Blood Cell Alloimmunization in Sickle Cell Disease Patients in Tanzania.

OBJECTIVE: Alloimmunization is a recognized complication of red blood cell (RBC) transfusion and causes delayed hemolytic transfusion reactions and provides problems sourcing compatible blood for future transfusions. The objective of this study was to determine the frequency of RBC alloimmunization in SCD patients in Tanzania where pretransfusion screening for alloantibodies is not practiced. METHODS: In a cross-sectional study, SCD patients at Muhimbili Hospital Sickle Cell Clinic, Dar es Salaam, Tanzania, were investigated. The demographic characteristics and transfusion history were recorded. Blood samples were drawn from consenting, previously transfused patients and RBC alloimmunization was demonstrated using immunohematologic techniques. RESULTS: There were 365 patients (median age, 16 years; 55.3% female) and they had received a median of 2 transfusion episodes. Fifteen patients (4.1%) possessed RBC alloantibodies. A total of 61 alloantibodies was found; 16 (26.2%) and 11 (18.0%), were directed against Kell and Rh blood group antigens, respectively. CONCLUSION: The rate of RBC alloimmunization in Tanzanian SCD patients was 4.1%. The low transfusion load may explain this immunization frequency. Nevertheless, our study confirms the significance of RBC alloimmunization as a complication in Tanzanian SCD patients. Therefore, there is need to improve immunohematologic testing in Tanzania so that RBC alloimmunization and its consequences may be prevented.

Association between anaemia and infections (HIV, malaria and hookworm) among children admitted at Muhimbili National Hospital.

OBJECTIVE: Anaemia is the major cause of morbidity and mortality in paediatric age with much aetiology. The magnitude of childhood anaemia has been inadequately studied at Muhimbili National Hospital (MNH). The study was aimed at determining the frequency of anaemia and associated infections in patients admitted in general paediatric wards at MNH in Dar es Salaam. STUDY DESIGN: This was a descriptive cross-sectional study. STUDY SETTING: This was conducted at MNH in general paediatric wards from 20th August, 2009 to 15th December, 2009. SUBJECTS: Patients, aged 1-84 months, consecutively admitted were recruited in the study. After informed verbal consent from the guardian or parent was obtained, information on demographic and clinical characteristics was collected from the parent or guardian. Physical examination and laboratory tests on blood ; stool samples for hookworm screening; blood slides for malaria parasites; Human Immunodeficiency Virus (HIV) screening; and blood peripheral smears were done on all subjects. Additional information was taken from medical files. Data management: The prevalence of anemia was determined as a percentage of all paediatric patients recruited during the time of data collection. All information was recorded using questionnaires and analysis was done using SPSS version 13.0. A p value of < 0.05 was considered statistically significant. RESULTS: A total of 315 children were assessed. The frequency of anaemia was 79.4%. This is much higher than the WHO prevalence of 67.6% in Africa for anaemia to be taken as a disease of public health importance. The proportion of malaria was 7.9%, HIV seropositive was 10.2% and hookworm was 1.0% of all admissions. There was an increased risk of anaemia in patients with HIV seropositive and or malaria although this was not statistically significant (RR > 1.0, p > 0.05). CONCLUSION: Anaemia in paediatric patients admitted at MNH is a disease of high public health importance in Dar es Salaam and may well carry a high burden in the rest of the country. Other risk factors of anaemia should be investigated with a goal of reducing the burden of anaemia.

Problems and solutions associated with transmission of HIV via donated blood in Tanzania.

Donor-blood from populations with high prevalence of HIV infection carry the risk of transmitting HIV to a significant proportion of recipients. This paper presents a review of experience gained in efforts towards ensuring availability of HIV-free blood for transfusion in tropical Africa, with emphasis on Tanzania. The effect of introducing a countrywide screening programme in averting possible HIV transmission, and the main problems of controlling transfusion associated with HIV infection have been identified. Lack of organized blood transfusion services in tropical Africa, widespread occurrence of transfusion associated diseases, shortage of skilled staff, unreliable electricity supply and communication networks, and absence of a 100% sensitive antibody test for HIV are among the problems encountered in attempts to provide safe blood. To reduce transfusion associated HIV infection, efforts should be directed to; reduction of unnecessary blood transfusions; exclusion of HIV high-risk donors, provision of affordable, rapid and reliable HIV antibody test kits, using heat-treated and HIV-free blood products for treatment of bleeding disorders; and establishment of separate facilities fur voluntary HIV testing and counselling form blood donation centers. With continuing successes globally in the development of simple, rapid, affordable and highly sensitive HIV antibody tests, the control of HIV transmission through blood transfusion should be feasible in all areas of Africa.

Myelodysplastic syndrome

It appears that MDS has not been reported before in Tanzania. We report two patients who were referred to Muhimbili Medical Centre; Dar es Salaam and subsequently diagnosed as MDS type CMML

Ocular granulocytic sarcoma with acute myeloid leukaemia in Dar es Salaam

It appears that granulocytic sarcoma in children has not been reported before in Tanzania. This report describes three cases of granulocytic sarcoma which were associated with otherwise typical acute myeloid leukaemia