ABSTRACT
Background: Sickle cell disease (SCD) patients have mechanisms that are thought to protect them more than apparently normal individuals from iron deficiency. However, evidence exists that in SCD, hypoferritinaemia may be more prevalent than hyperferitinaemia, especially in developing countries. Methods: Serum ferritin (SF) levels were measured - using an ELISA based kit (Biocheck, USA), and disease severity calculated in fifty- two asymptomatic steady state (ASS) SCD patients; who were iron chelation naive and both parameters correlated. Erythrocyte morphology and malaria parasitaemia were assessed, patients with parasitaemia were excluded. 64 apparently normal individuals in the same environment and socioeconomic group were also assessed as above and served as controls. Statistical analysis was done using SPSS version 20. Results were expressed as means and standard error of mean. Level of significance was set at p= 0.05. Results: 30.7% and 7.6% of the test subjects had hypoferritinaemia and hyperferritinaemia respectively compared to controls, where 56% had hypoferritinaemia and none had hyperferritinaemia. Erythrocyte morphology showed hypochromia and microcytosis to different degrees in all test subjects assessed: 1+ (10.5%), 2+ (63.2%) and 3+ (26.3%), while only 5% of controls had hypochromia and microcytosis. Blood transfusion and age did not seem to significantly affect SF levels (p= 0.65 and 0.93) respectively. SF levels increased progressively with disease severity but didn’t reach statistical significance (p=0.29). Conclusion: The results suggest that hypoferritinaemia is more prevalent than hyperferitinaemia, and that SF levels may be a useful index for computing an objective severity score in SCD management. Anaemia of chronic inflammation may cause a significant part of the anaemia in SCD.
ABSTRACT
Background: Diabetes mellitus (DM) and its complications are on the increase especially in the developing countries with significant negative economic consequences on individuals, families and health systems. Objective: We, therefore compared albumin/creatinine ratio, microalbuminuria, and HbA1c among subjects of varying degree of complications with controls to ascertain if they can serve as markers of diabetic chronic complications to enhance early detection of chronic complications amongst diabetes mellitus patients in developing countries. Methods: 109 type 2 DM subjects (47 males and 62 females) and 100 non-DM controls of the same age range (40-80 yrs) were recruited for this study. The chronic complications found were: nephropathy, retinopathy, coronary artery disease, cerebrovascular disease, peripheral vascular disease and diabetic foot. These were further classified into micro vascular complications (nephropathy and retinopathy) and macrovascular complications (Coronary Artery Disease, Cerebrovascular Disease, Peripheral Vascular Disease and diabetic foot).Out of these 109 DM subjects, 36 were without chronic complications, 37 have microvascular complications only and 36 have a combination of microvascular and macrovascular complications. HbA1c, Urine microalbumin and creatinine were analysed using standard methods. Results: The mean levels of HbA1c, Microalbuminuria and albumin-creatinine ratio were significantly higher in DM subjects when compared to the control (p<0.05). Microalbumin, albumincreatinine ratio, and HbA1c were significantly higher in DM subjects with chronic complications than those without complications (p<0.05). However, DM subjects with both macro and micro complications had significant higher level of urine microalbumin, albumin-creatinine ratio, and HbA1c than those with microvascular complications only (p<0.05). Subjects aged 40-45 years had significant (p<0.01) albumin/creatinine ratio than subjects aged 51-55yrs as well as those >60 years. The male subjects had a significant (p<0.01) albumin/creatinine ratio and microalbumin respectively on comparing to their female counterpart Conclusion: Albumin-creatinine ratio is a simple, and less cumbersome tool which could serve as a predictor of complications in type 2 diabetes mellitus.