ABSTRACT
Background: Sickle cell anaemia (SCA) patients are prone to require long-term frequent blood transfusion because of chronic haemolysis and overlapping hyper-haemolysis. Hence, they become vulnerable to iron overload and its complications. On the other hand, iron deficiency has been documented among un-transfused SCA cases. Thus, there is a need to effectively and efficiently determine iron status of SCA patients. Objective: We investigated whether adult SCA patients in steady state (SSt) or those with vaso-occlusive crisis (VOC) have significantly different iron status viz-a-viz Serum Iron (SI), Serum Ferritin (SF), Total Iron Binding Capacity (TIBC), Transferrin (TRF), percentage TFS and haematological parameters when compared with age and sex-matched controls. Materials and Methods: Ninety subjects, comprising 30 SCA patients in SSt, 30 SCA patients with VOC and 30 HbAA, ethnicity, age and sex-matched controls (NC), were consecutively recruited. Serum samples were analysed for SF, TRF and TIBC using ‘WATER’ HPLC 616 and 626; SI was determined using the Atomic Absorption Spectroscopic (AAS) method. Haematological parameters were determined using a Sysmex Kx21 auto-analyser. Results: The SCA groups (VOC and SSt) had significantly lower SI, SF, TRF and TIBC compared to the control group. The VOC group had a significantly lower mean ferritin level but higher SI, TRF and percentage TFS levels compared to SSt group. The MCV, MCH (in SSt group) were significantly lower while MCHC was significantly higher in the SCA groups compared to the NC group. Using the normal ranges for all parameters, all parameters were within normal for the controls while TIBC was below normal and percentage TFS was higher in SCA groups. Percentage TFS was significantly higher in VOC compared to SSt group. Conclusions: The study reported lower SI and TRF, lower MCV and MCH, below normal TIBC, within normal Ferritin but elevated WBC and platelet counts, elevated percentage TFS (more elevated in VOC than SSt) and higher MCHC in SCA patients. The use of percentage TFS as a marker of VOC is suggested.
ABSTRACT
Aims: To compare the mean levels of plasma total Homocysteine (tHct), Meth ylm alonic ac id ( MMA), vitamin B12, folate and haematological parameters(PCV, WBC, Platelet counts, MCV, MCH, MCHC) among adult SCA patients in steady state (SS), SCA in (VOC) and age and sex matched controls in order to determine significant differences. Study Design: Case-control study. Place and Duration of Study: Department of Haematology and Department of Chemical Pathology, University College Hospital, Ibadan, Nigeria between March 2012 and July 2012. Methodology: We included 60 SCA patients (30 in VOC, 30 in Steady State; and 30 age and sex matched controls. Plasma tHct, MMA, folate and vitamin B12 were assessed using HPLC and haematological parameters were determined using haematological autoanalyzer (Syxmex Kx21). Results: The mean plasma tHct, MMA, vitamin B12 of SCA patients (VOC and SS) were significantly lower (p=0.000) compared to control population but the mean folate levels were comparable (p=0.085). The SCA (in VOC) had significantly lower (p=0.000) MMA and folate levels compared to SS group but the SS group had significantly lower (p=0.001) tHct level compared to VOC group. While the PCV, Hgb, MCV, and MCH were significantly lower; the WBC, platelet count and the MCH were significantly elevated in SCA patients compared to controls. Conclusion: A larger, better controlled, multicenter study is required to confirm lower tHct and MMA found in SCA groups compared to control group and higher tHct in SCA (VOC) but higher MMA level in SCA (SS) when VOC and SS groups were compared. The haematological parameters in SCA groups were not in keeping with macrocytic anaemia but were indicative of chronic haemolytic and inflammatory process.