Symposiums/Transfusion clinique et biologique 12 (2005) S1-$43 more, donors who have stayed in a malarial area for a period of longer than 6 months, or who were born or grew up in such an area, are deferred for 4 years provided a immunological or molecular genomic test proves to be negative. The deferral periods may be omitted for those donors whose plasma is used exclusively for fractionation. Donors with a known history of malaria are not allowed to donate for a period of four years following cessation, however, an additional test is not mandatory. The actual figure in the Red Cross Blood service of BadenWfirttemberg and Hessia shows that 0.15% of all individuals willing to donate blood are deferred because they were born in or lived in a malarial area for a longer period of time. Less than 1 in 10,000 donors are deferred because they report a malarial or other tropical disease or are suspicious to have an undiagnosed febrile illness. Since questioning of the donor as to the country where he/ she originated from is mandatory, each transfusion establishment should have a current map of the world endemic zones of malaria available at all donation sites for reference purposes. Official information is also available via the internet: ww.rki.de.
S08-03
S C R E E N I N G B L O O D D O N A T I O N S F R O M 'RISK D O N O R S ' FOR M A L A R I A - THE EFFECTIVENESS OF A N T I B O D Y SCREENING KITCHEN A. NTMRL, NBS, LONDON, ENGLAND alan.kitchen @nbs.nhs.uk Although not common in most non-endemic countries, transfusion transmitted malaria can have severe clinical consequences if not identified and treated early. Of concern are the increasing numbers of donors defined as 'malaria risk' as individuals travel further, populations move from endemic to non-endemic areas, and as malaria itself spreads into previously non-endemic or eradicated areas. Although this donor loss may appear low in absolute terms, it is cumulative, year on year, with the disturbing potential to carry on increasing as more people travel to malarious areas. In addition, simply deferring anyone with any malaria risk potentially excludes particular population groups from ever giving blood; e.g. those who reside in the UK, and in most cases were born in the UK, but who may regularly visit malarious areas to see family, or for religious reasons. To address this situation, screening of 'malaria risk' donors for the presence of malarial antibodies, as an indicator of current or previous infection, has been adopted in the UK, and by transfusion services in other non-endemic countries.
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The optimum strategy for minimising risk of transfusion transmitted malaria in non-endemic countries without unnecessary donor/donation loss, is a combination of donor selection guidelines with donation screening for malarial antibodies. In the UK, the donor selection guidelines have changed significantly over recent years as malarial antibody screening has been re-introduced, and the current guidelines are based upon the availability of malarial antibody testing to provide maximum effectiveness. Analysis of the 5 identified cases of transfusion transmitted malaria reported in the UK has retrospectively demonstrated the appropriateness and effectiveness of the guidelines in minimising the risks of post-transfusion malaria whilst safeguarding sufficiency,
S08-04
MISE EN PLACE D'UNE N O U V E L L E T E C H N I Q U E DE DEPISTAGE DES ANTICORPS ANTIPALUDI~ENS SUR LES DONS DE SANG EN FRANCE ELGHOUZZI M.H.*, CANDOLFI E.**, ASSAL A.***, BARLET V.****, BEOLET M.*****, BERREBI S.******, CHUTEAU C.*******, GALIAN P.********, VOLLE P.*********, ANDREU G.********** *EFS fLE-DE-FRANCE, RUNGIS, FRANCE ; **INSTITUT DE PARASITOLOGIE DES MALADIES TROPICALES, STRASBOURG, FRANCE ; ***EFS CENTRE ATLANTIQUE, TOURS, FRANCE ; ****EFS RHONEALPES, METZ-TESSY, FRANCE ; *****EFS NORD DE FRANCE, LILLE, FRANCE ; ******EFS REUNION, SAINT DENIS DE LA REUNION, FRANCE ; *******EFS PAYS DE LOIRE, ANGERS, FRANCE ; ********EFS ALPES MEDITIERRANIEE, MARSEILLE, FRANCE ; *********EFS NORMANDIE, ROUEN, FRANCE ; * *********DIRECTION MIEDICALE ET SCIENT1FIQUE, EFS, PARIS, FRANCE
[email protected] Contexte : 4,50 % des dons en France subissent un drpistage des anticorps anti-paludrens (AC Palu) chaque annre par une technique d'immunofluorescence indirecte (IFI) commerciale ou de fabrication <
et 6ventuellement par une recherche
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Symposiums/Transfusion clinique et biologique 12 (2005)S1-$43
d'antig6ndmie et/on PCR ~ l'Institut de Parasitologie du CHU de Strasbourg. Par ailleurs le lieu de naissance ou la zone d'end6mie palustre visit6e ont 6t~ recherch6s pour les donneurs concern6s. R~sultats : Huit EFS r6gionaux ont particip& Cette 6tude en cours de rdalisation montre un pourcentage de discordances IFI+ (douteux)/Elisa - _< 1% et un pourcentage pour IFI - / Elisa + (zone grise h 20 %) de 2,5 % avant confirmation. Le d6tail des r6sultats sera pr6sent6. Conclusion : Apr~s un cas de paludisme post-transfusionnel mortel survenu en 2002, les mesures de d6pistage ont 6t6 renforc6es, provoquant une augmentation importante du nombre de tests ~ r6aliser, et la recherche d'une solution technique automatis6e, sensible et fiable par I'EFS apr~s une 6tude h grande 6chelle. Les rdsultats confortent la strat6gie adopt6e.
2- Le questionnaire m6dical a montr6 ses limites dans sa capacit6 h 61iminer les porteurs asymptomatiques, ce qui justitle de proposer l'introduction du d6pistage. 3- La recherche de 1' Ag du Plasmodium par technique Elisa ou par test rapide nous semble etre le meilleur outil de d6pistage en zone d'end6mie. 4- La strat6gie de d6pistage syst6matique est la plus appropri6e en terme de s6curit6 transfusionnelle mais elle est limit6e par son surcofit.
Greffe de cellules souches hfimatopo'ifitiques Mod6rateurs : G. Semana et T. Lamy
S09-01 S08-05
I~VALUATION DES RISQUES DE T R A N S M I S S I O N DU P A L U D I S M E PAR LA T R A N S F U S I O N SANGUINE EN ZONE D'ENDI~MIE : E X E M P L E DU SI~NI~GAL DIOP S.*, NDIAYE M.*, CHEVALIER B.**, SARR A.***, JAMBOU R.****, THIAM D.*, DIAKHATE L.* * CNTS, DAKAR, SENE,GAL ; **HOPITAL PRINCIPAL, DAKAR, SENEGAL ; ***HOPITAL REGIONAL, THIES, SENEGAL ; ****INSTITUT PASTEUR, DAKAR SENEGAL diop @ cnts-dakar.sn L'objectif 6tait d' 6valuer le risque de transmission du PIasmodium par la transfusion sanguine en zone d'enddmie, de cornparer les outils et discuter des diffdrentes stratdgies. L'6tude a port6 sur 3001 donneurs de sang recrut6s dans sept centres de transfusion sanguine au S6n6gal au cours de deux p6riodes : saison s~che (Juin-Juillet 2003) et salson des pluies (OctobreNovembre 2003). Sur chaque don ont 6t6 effectu6s un d6pistage de l'Ag pLDH et des anticorps du Plasmodium par technique Elisa (DiaMed), la goutte @aisse et le frottis sanguin, ainsi que les d6pistages du VIH, de FAg HBs, du VHC et de la syphilis. L' fige moyen des donneurs de sang'6tait de 29,3 ans. La sdropr6valence des anticorps anti-plasmodiaux a 6t6 de 65,3 % et celle de l'antigene pLDH de 0,53 %, positivit6 confirm6e par microscopie. La pr6valence des autres marqueurs infectieux 6tait de 11,7 % pour FAg HBs, 0,83 % pour la syphilis, 0,49 % pour l'h6patite C et 0,46 % pour le VIII. Les facteurs de risque associ6s hun portage asymptomatique du Plasmodium 6taient : la saison des pluies, le caractere irr6gulier des dons, le nombre 61ev6 d' ant6c6dents d' accas palustre et 1'absence de traitement lors du demier @isode. Conclusion : 1- Le Plasmodiurn repr6sente le troisi~me risque de transmission d'agents infectieux par la transfusion sanguine apras l'h6patite B, la syphilis, et avant le VHC et le VIH.
I M M U N O G E N E T I C S AND I M M U N E R E C O N S T I T U T I O N IN HSCT CHARRON D. INSERM U 662 IUH AND CIB HOG - CENTRE HAYEM, HOPITAL SAINT-LO UIS, PARIS [email protected] Recipients of allogenic hematopoietic stem cell transplantation (HSCT) incur the risk of graft-versus-host disease even when the donor is a sibling who shares the Major Histocompatibility Antigens. Therefore, even the perfect HLA match does not represent the optimal genetic match between donors and recipients in HSCT. In addition to the HLA complex other genetic systems operate and affect the outcome of HSCT. These include minor histocompatibility systems (inducing bona fide allogeneic responses) as well as a series of functional polymorphisms in cytokines and chemokines and receptors genes (ILIO, TNF, INFg...). Among the items affecting the outcome of HSCT the incidence and severity of infections have an important impact. Polymorphisms of genes controlling both arms of the immune responses to pathogens (innate versus cognate) are strong candidates for susceptibility factors to infection in allergenic transplantation. These include the MHC alleles (HLA class I, class II, MIC) CD1, Toll and TLR genes MBP, MPO genes...). In addition to the NK alloreactivity induced by HLA class I epitopes mismatching (a common situation in HSCT) variations in the genotype of the KIR genes may also be encountered between the donor and the recipient leading to potentially harmful or beneficial combinations. An integrated knowledge of the role and hierarchy of the most important genetic factors (MHC and non-MHC) will provide the rationale for a comprehensive matching in HSCT. Impaired T cell immune reconstitution after HSCT is associated with the occurrence of opportunistic infections, GVHD and relapse and is therefore a major cause of morbidity and mortality. Broad T cell repertoire diversity (assessed by CDR 3 sequencing) indicates a favourable long term immune reconstitution after cord blood transplanta-