RESUMO
To investigate fetal outcomes in pregnant women with sickle cell disease [SCD], and to analyze the impact of baseline variables on those outcomes. This is a retrospective cohort study carried out over 5 years [June 2006 to August 2011] investigating fetal outcomes at Sultan Qaboos University Hospital, Muscat, Oman. Sixty-eight consecutive pregnant women with SCD [62 women with hemoglobin sickle cell anemia [SS] genotype] were included and analyzed in the study. Multivariable logistic regression was used to estimate the impact of baseline variables on major fetal complications [intrauterine growth restriction, intrauterine fetal death, and low birth weight babies, perinatal mortality, and admission to the neonatal unit]. The mean maternal age was 30 years +/- 3.8. Mean gestational age at delivery was 37 weeks +/- 1.8. The initial mean hemoglobin was 9.5 g/dl [standard deviation [SD] 1.1, range 7.2-11.9]. The mean baseline hemoglobin F was 10.2 [SD 6.6, range 0.7-29]. There were 11 cases [16.2%] of intrauterine growth restriction [95% confidence interval [CI]: 7.2-25.2], and 19 cases of fetal distress [27.9%; 95% CI: 17.0-38.9]. Low birth weight was seen in 22 cases [32.4%, 95% CI: 20.9-43.8] with a mean weight of 2.6 Kg [SD: 0.47, range 1.2-3.9]. There were 2 neonatal deaths. On multivariate logistic regression for a composite of fetal outcomes, none of those variables were of statistical significance. The adverse fetal outcomes in pregnant women with SCD are high compared with the general population. There is no significant difference in fetal outcome between SCD, SS genotype versus others
RESUMO
This study aimed to validate pulse CO-oximetry-based haemoglobin [Hb] estimation in children and adults with thalassaemia major [TM] and to determine the impact of different baseline variables on the accuracy of the estimation. This observational study was conducted over a five-week period from March to April 2012. A total of 108 patients with TM attending the daycare thalassaemia centre of a tertiary care hospital in Muscat, Oman, were enrolled. Spot [Sp] Hb measurements were estimated using a Pronto-7 [Registered Sign] pulse CO-oximetry device [Masimo Corp., Irvine, California, USA]. These were compared to venous samples of Hb using the CELL-DYN Sapphire Hematology Analyzer [Abbott Diagnostics, Abbott Park, Illinois, USA] to determine the reference [Ref] Hb levels. A multivariable linear regression model was used to assess the impact of baseline variables such as age, gender, weight, height, Ref Hb and blood pressure on the Hb estimations. Of the 108 enrolled patients, there were 54 males and 54 females with a mean age of 21.6 years [standard deviation [SD] = 7.3 years; range: 2.5-38 years]. The mean Ref Hb and Sp Hb were 9.4 g/dL [SD - 0.9 g/dL; range: 7.5-12.3 g/dL] and 11.1 g/dL [SD = 1.2 g/dL; range: 7.5-14.7 g/dL], respectively. The coefficient of determination [R[2]] was 21% with a mean difference of 1.7 g/dL [SD = 1.1 g/dL; range: -0.9-4.3 g/dL]. In the multivariable model, the Ref Hb level [P = 0.001] was the only statistically significant predictor. The Pronto-7 [Registered Sign] pulse CO-oximetry device was found to overestimate Hb levels in patients with TM and therefore cannot be recommended. Further larger studies are needed to confirm these results