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La drépanocytose ou anémie falciforme est une maladie héréditaire touchant environ un nouveau-né sur 6 000 et est caractérisée par l'altération de l'hémoglobine, protéine assurant le transport de l'oxygène dans le sang.
Génétiquement parlant
La drépanocytose est liée à une mutation ponctuelle sur le sixième codon du gène de la bêta-globine, porté par le chromosome 11. La substitution d'une adénine par une thymine dans ce codon entraîne la substitution de l'acide glutamique par la valine lors de la traduction. L'hémoglobine anormale qui en résulte, appelée hémoglobine S (pour Sickle-cell disease), acquiert ainsi la propriété de se polymériser lorsqu'elle est désoxygénée. Ceci explique que la falciformation des hématies soit déclenchée par le manque d'oxygène dans le sang (hypoxie).
Médicalement parlant
Le gène responsable de l'anémie falciforme est récessif : il faut que les deux copies de ce gène (porté par le chromosome 11) soient anormaux pour que l'individu soit malade. Ainsi, un individu ne peut donc être atteint que si ses deux parents lui transmettent le gène responsable ; il est alors dit homozygote.
Les symptômes de cette maladie peuvent apparaître dès l'âge de six mois. Les manifestations aiguës habituelles de la drépanocytose sont de 3 ordres :
- Crise vaso-occlusives : des caillots bouchent une artère, ce qui entraîne des douleurs intenses et brutales dans une partie du corps (fréquemment mains, pieds, hanches, abdomen)
- Anémie hémolytique : les globules rouges des drépanocytaires sont de forme anormale (l'hémoglobine S est en effet moins soluble que l'hémoglobine normale (hémoglobine A)), elle précipite, et déforme les hématies. Celles-ci prennent une forme de faux, et sont arrêtées par le filtre que représente la rate, où elles sont détruites. Cette destruction entraîne une baisse du nombre d'hématies et donc une anémie régénérative
- Infections : elles sont plus fréquentes chez les drépanocytaires. Elles peuvent aussi aggraver l'anémie en cas d'infection par le parvovirus B19.
Les manifestations chroniques de la drépanocytose associent un retard de taille et de poids, des déficit nutritionnels (notamment en folates, car cette vitamine est indispensable à la création des hématies qui sont renouvelées très rapidement lors des crises d'anémie, épuisant ainsi le stock de folates), un retard pubertaire fréquent, des troubles cardio-pulmonaires (cardiomégalie, insuffisance respiratoire), une rate hypertrophiée (mais qui avec le temps va devenir au contraire atrophique), des anomalies rétiennes (hémorragies), etc.
Aujourd'hui des tests permettent de dépister les porteurs sains (personnes qui possèdent l'allèle responsable mais qui ne sont pas malades); ils sont alors informés que l'enfant conçu par deux porteurs sains a un risque sur quatre d'être atteint d'anémie falciforme.
Le gène est plus fréquent dans les zones paludéennes car l'altération de l'hémoglobine constitue un avantage sélectif : Plasmodium falciparum étant détruit avec l'hématie, alors trop déformée, les hétérozygotes (porteurs des gènes Hémoglobine A et Hémoglobine S) résistent mieux au paludisme que les homozygotes sains.
Source : encyclopédie wikipedia
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