RESUMO
Besides specific organisational requirements, the transfusional chain in French ultra-marine areas has specificities related to the epidemiology of infectious diseases and to population characteristics. We focus on some of these sociodemographic and medical peculiarities: the challenge of autosufficiency in relation to demographic trends; epidemiologic risks associated to emergent viruses such as dengue and Chikungunya, and the strategies that had been implemented to face last outbreaks; inappropriate selection criteria for eligibility to blood donation (biologic characteristics of Afro-Caribbeans not taken into account for the low hemoglobin deferral threshold; absence of guidelines for the screening of hemoglobinopathies AS/AC, present in 8% of the target population); specific indications for transfusion, such as platelet use in dengue fever or RBC transfusion in sickle cell disease. Due to the high polymorphism of erythrocyte antigens in Afro-Caribbeans, intra-ethnic transfusion facilitates compatibility for common antigens, but is responsible for the emergence of allo-antibodies difficult to identify in the absence of specific antisera or panels; molecular typing of erythrocyte antigens would allow detection of those patients at risk for immunization, expressing variant antigens or lacking high frequency antigens, as well as the characterization of RBC expressing immunogenic so called low frequency antigens. In an era of periodic emergence of new viruses in Europe (dengue, Chikungunya, West Nile virus...) and with the spreading of diseases with high transfusional requirements, such as sickle cell disease, ultra-marine services represent laboratories for the study of future trends and problems in transfusion medicine.
Assuntos
Doadores de Sangue , Transfusão de Sangue , Infecções por Alphavirus/epidemiologia , Infecções por Alphavirus/prevenção & controle , Infecções por Alphavirus/transmissão , Anemia Falciforme/etnologia , Doadores de Sangue/estatística & dados numéricos , Antígenos de Grupos Sanguíneos/genética , Incompatibilidade de Grupos Sanguíneos/etnologia , Incompatibilidade de Grupos Sanguíneos/prevenção & controle , Segurança do Sangue/normas , Transfusão de Sangue/estatística & dados numéricos , Patógenos Transmitidos pelo Sangue , Febre de Chikungunya , Surtos de Doenças , Seleção do Doador , Etnicidade/genética , França , Hemoglobinopatias/etnologia , Hemoglobinopatias/terapia , Humanos , Isoanticorpos/biossíntese , Malária/epidemiologia , Malária/prevenção & controle , Malária/transmissão , Reunião , Fatores Socioeconômicos , Índias OcidentaisRESUMO
ABO and Rho(D) blood groups were determined in 3813 males and females affiliated with the Instituto Mexicano del Seguro Social (IMSS) who are residents of the Monterrey Metropolitan Area (MMA) in northeastern Mexico. They were selected by their monophyletic or polyphyletic surnames. The ABO and Rho(D) blood group phenotypes and gene frequencies were determined and based upon these, the risk of incompatibilities was estimated for both marriages (MI) and maternal-fetal incompatibility (MFI). These were compared with those estimated for other populations of residents in the MMA, and in other locations in Mexico, as well as with the two most important ancestral populations, Spanish and Tlaxcaltecan Mexican Indians, with the hypothesis that the percent of risk ABO and Rho(D) MI and MFI are greater in the population with monophyletic surnames than those with polyphyletic surnames. It was found that for persons with nomophyletic and polyphyletic surnames, as well as for the other populations in the MMA and other places in Mexico, their ABO and Rho(D) MI and MFI percent of risk are intermediate to the ones estimated for their ancestry. The percentages of MI and MFI are higher for the persons with monophyletic than for the ones with polyphyletic surnames, other populations from the MMA and those from other locations in Mexico. The risks are higher when the similarity with Spanish increases and are lower when their similarities with the mexican Indians increase