CONCLUSION
Les variations physiopathologiques des leucocytes sont
particulières chez le drépanocytaire SS (grande
variabilité des leucocytes) : leucopénie, intervalle
adéquat des leucocytes et hyperleucocytose avec des implications
biocliniques.
L'hyperleucocytose détermine la
sévérité et le caractère létal de la
drépanocytose SS. Mais elle renforce la protection des
drépanocytaires SS vis-à-vis du paludisme grave et du
neuropaludisme. Le taux des leucocytes >15.000
éléments/mm3 est le seuil létal chez le
drépanocytaire SS.
En dépit du moindre risque de mortalité
liée à la leucopénie chez les drépanocytaires SS,
la leucopénie et l'hyperleucocytose constituent des facteurs de risque
de paludisme grave. Mais l'hyperleucocytose et l'intervalle adéquat des
leucocytes renforcent la protection des drépanocytaires SS
vis-à-vis du paludisme grave.
L'extrême variabilité des leucocytes est
significativement associée au paludisme grave et à la
mortalité hospitalière des drépanocytaires SS.
Ce travail ouvre des nouveaux horizons dans la prise en charge
des drépanocytaires SS.
RECOMMANDATIONS
Les recommandations suivantes sont formulées au terme
de ce travail :
· le Gouvernement de la République
Démocratique du Congo est invité à soutenir le Programme
National de Lutte contre la Drépanocytose et les Organisations Non
Gouvernementales à renforcer l'évaluation et le traitement de la
drépanocytose à la lumière du comportement biologique des
leucocytes ;
· les professionnels de santé en charge des
drépanocytaires devraient avoir à l'esprit les variations
physiopathologiques des leucocytes : un taux de leucocytes >
15.000/mm3 signifie l'hyperleucocytose, la
leucopénie pour un taux < 4000/mm3 et le taux
adéquat « normal » égal à 4001 -
14999/mm3. Ils ne devront donc plus prescrire abusivement
l'antibiothérapie devant l'hyperleucocytose sans infection chez les
drépanocytaires ;
· les chercheurs congolais sont invités à
identifier les conditions environnementales capables de maintenir les
leucocytes des drépanocytaires dans l'intervalle adéquat.
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