Haematological values in a healthy adult population in Yaoundé, Cameroon

Background: Haematological values derived from local populations are useful in laboratories to improve diagnoses for local patients. In Cameroon, these data are not yet available. Moreover, there is great variation in baseline parameters pertaining to full blood cell count among medical laboratories.Objectives: This study aimed to determine values for the complete blood cell count of a healthy adult Cameroonian population for use in locally derived ranges in our medical laboratories.Methods: A cross-sectional study was conducted among blood donors attending three blood banks in Yaoundé from November 2015 to September 2016. We expected to obtain at least 120 venous blood samples from both men and women. Tests were performed for (1) HIV, (2) complete blood cell count, (3) hepatitis B virus, (4) malaria, (5) syphilis, (6) C-reactive protein and (7) hepatitis C virus.Results: We enrolled 294 healthy participants (161 men, 133 women) aged 18 to 55 years. The median haemoglobin concentration was 135 g/L in men and 114 g/L in women (p < 0.001). The median reticulocyte count was 60 × 109/L in men and 40 × 109/L in women (p < 0.001).Significant variation by sex was observed for the platelet count. The median white blood cell count was 4.1 × 109/L in men and 4.6 × 109/L in women (p = 0.008). Conclusion: This study provides locally derived ranges for complete blood cell and reticulocyte counts for a healthy adult population in Yaoundé, Cameroon. These results can be used pending larger studies

The cost of time: A randomised, controlled trial to assess the economic impact of upfront, point-of-care blood tests in the Emergency Centre

Introduction Time and cost constraints abound in the Emergency Centre (EC). These resource-constraints are further magnified in low- and middle-income countries (LMIC). Almost half of all patients presenting to the EC require laboratory tests. Unfortunately, access to laboratory services in LMIC is commonly inadequate. Point-of-Care (POC) tests may assist to avert this shortcoming. The aims of this study were to evaluate the cost effectiveness of upfront POC blood tests performed prior to doctor assessment compared to the standard EC workflow.Methods A secondary analysis was performed on data from a prospective, randomised, controlled trial where patients with abdominal/chest symptoms or generalised body pain/weakness followed either the normal EC workflow pathway or one of two enhanced workflow pathways with POC tests (i-STAT with and without a complete blood count (CBC)) prior to doctor evaluation. The incremental cost effectiveness ratio (ICER) was used to perform the cost effectiveness analysis.Results :There were 248 patients enrolled in the study. The use of the two upfront, POC test pathways significantly exceeded the primary outcome measure of a 20% reduction in treatment time. In the i-STAT + CBC group, the 31 min. time-saving translated into cost-saving of US$14.96 per patient (IECR 0.27) whereas the 21 min. time-saving in the i-STAT only group only had an additional net cost of US$3.11 per patient (IECR 0.90).Conclusion Upfront, POC blood tests can be utilised in the resource-constrained EC to manage patients more efficiently by saving time. This time-saving can, in fact, be more cost effective than traditional EC workflow making it an economically viable option for implementation in LMIC

Anti-Bacterial Susceptibility Patterns of Blood Culture Isolates at a Referral Hospital in Eldoret

Background: Hospital treatment guidelines are often guided by scientific evidence of efficacy of the anti-microbial agents. In developing countries; most of the treatment guidelines are adopted from the World Health Organisation (WHO). However; local data is often needed to confirm or adjust these guidelines to suit a local situation. In resource limited settings there is scarce data on blood culture isolates and their antimicrobial sensitivity patterns to guide anti-biotic prescription in these settings.Objectives: To assess the bloodstream bacterial isolates and their anti-biotic sensitivity patterns in patients admitted at a tertiary teaching and referral hospital. Design: Hospital based laboratory retrospective study Setting: Moi Teaching and Referral Hospital (MTRH); Eldoret; Kenya. Subjects: All blood culture specimens received from inpatients at MTRH over a 12 year period from 2002 to 2013.Results: The median age was 13.4yrs (IQR 0.7-29).Most of the blood samples were from female patients (51.8%). A total of 4046 blood culture samples were analysed of which 29.9% (n=1356) yielded positive growths. Majority of the positive blood cultures were from the New Born Unit (62.4%). Staph epidermidis was the most common organism isolated (43.1% n=531) followed by Klebsiella pneumoniae (22.8% n=281). Resistance to commonly used anti-biotics (penicillin; cephalosporin) was high among gram positive as well as gram negative organisms. No trend in bacterial isolates was observed over the study period.Conclusions: Staph epidermidis and Klebsiella pneumoniae were the most common organisms isolated with higher growth rates occurring in the neonatal and paediatric age groups than in adults. There was no trend in bacterial isolates over the study period. Resistance to commonly used anti-biotics was prevalent

Comparative Study of Intradermal Smear Microscopy in the Diagnosis of Malaria in Symptomatic Pregnant Women

Objectives: A comparative study of intradermal smear in the diagnosis of malaria in symptomatic pregnant women. Venous blood served as the control. Patients and methods : Fifty consecutive symptomatic pregnant women were recruited. Thick films of both venous and intradermal blood were examined. Questionnaires were used to determine patients' preference for the two techniques. Tests of statistical significance were done with Fisher exact and Yates correlation coefficient at 95confidence interval. Sensitivity specificity and accuracy rates were used to assess the validity of intradermal smear. Results: Intradermal smear more frequently diagnosed malaria parasitaemia than peripheral venous blood (66vs 56). This was statistically significant (P value: 0.0065). The sensitivity of intradermal smear was 85.7while the positive predictive value was 77.4. The accuracy rate was 76.7. The technique of intradermal blood collection was preferred by 28of women. Conclusion: Intradermal smear is useful in malaria diagnosis in pregnancy and may be an additional evaluation tool for persistent fever in pregnancy

Population Based Reference Intervals for Common Blood Haematological and Biochemical Parameters in the Akuapen North District

Objectives : To estimate the reference intervals for commonly used blood haematology and biochemical parameters in an adult (18-55yrs) population of residents of Mampong Akuapem. Design: This was a population based cross sectional study of a randomly selected sample of the adult population of Mampong. The sample was selected from an updated census list of the Mampong area. Results: Median values (95 range) for measured parameters were established as follows: Haemoglobin; (males) 14.2 g/dl (females) 12.0 g/dl Alanine aminotransferase (ALT); (female) 19.6 U/L (males) 26.1 U/L and Creatinine; (males) 108 mmol/L (females) 93 mmol/L. Conclusion: In comparison to reference values that are commonly used in Ghana; the haemoglobulin levels from this study were lower; and liver function parameters higher. This could be a result of genetic or environmental differences and calls for the need to establish site specific reference values applicable to our population