Second Trimester Anaemia in Pregnant Ghanaians.

BACKGROUND: Anaemia is considered a severe public health problem by WHO and is seen as such in Ghana. Its prevalence in pregnancy has remained high despite improved antenatal care. The main purpose of this study was to determine the current anaemia prevalence and aetiology other than iron deficiency. METHODS: This was a cross-sectional study. A total of 214 pregnant women were studied. Women were administered a questionnaire related with the subject and blood samples were drawn. Full blood count was performed within four hours and serum iron, folate and vitamin B12 were studied. Other tests done included sickling and Hb electrophoresis , stool routine examination for hookworm infestation, thick and thin film for malaria parasitaemia. Dietary intake was also looked at to determine whether it contributed to anaemia seen in these subjects. RESULTS: Anaemia was detected in 150 (70%) of the 214 pregnant women studied. Using the World Health Organisation criteria for anaemia, 81 subjects had mild, 66 moderate and 3 had severe anaemia. Anaemia was more prevalent in young adults (82%) than in teenagers and subjects above 35years (p=0.018). Primigravidae (21%) and multigravidae (67%) were more likely to be anaemic than grandmultigravidae (12%). Anaemia was more prevalent in the low social class group (94%). Nutritional intake of both anaemic and non-anaemic subjects was found to be adequate and thus iron deficiency anaemia, which was found to be the commonest cause of anaemia, was probably due to intake of diet low in bioavailable iron. There was very little consumption of fruits and vegetables that facilitate iron absorption. Twenty seven anaemic subjects had low serum iron levels. Transferrin saturation was low in 39 subjects; 24 of these also had low serum iron, which was suggestive of iron deficiency. Folate and vitamin B12 deficiency did not play significant role in the aetiology of anaemia. Malaria and hookworm infestation were also not found to be significant in the causation of anaemia. CONCLUSIONS: The prevalence of anaemia (70%) in pregnant Ghanaians in their second trimester is unacceptably high. Twenty seven (18%) of the 70% anaemic subjects had low serum iron and six (4%) had low serum folate levels. None of the subjects had vitamin B12 deficiency. Generally dietary intake in pregnant women in this study was adequate, but significant proportion of their meals was of the type low in bioavailable iron as more cereals and tubers were consumed. The kind of diet, which most people can afford in Africa is low in proteins and vitamins, but high in carbohydrate with high phytate contents and this reduces iron absorption. Iron and folic acid prophylaxis for all women of child bearing age is recommended and emphasis on a more balanced nutritional intake at antenatal clinics should be encouraged.

Laboratory diagnosis of homozygous alpha thalassaemia.

BACKGROUND: Alpha-thalassaemia is one of the most prevalent haemoglobinopathies in the world. The molecular basis of the condition is mainly due to deletion of one or more alpha genes and occasional point mutations. The diagnosis and treatment of microcytic hypochromic anaemia is at times a problematic medical issue in Ghana due to co-existence of a-thalassaemia traits and iron deficiency anaemia (IDA) since there is no routine laboratory procedure for the diagnosis of the former. OBJECTIVE: To identify the alpha thalassaemias and determine a simple laboratory method of differentiating them from other causes of microcytic hypochromic, anaemia. METHODS: Venous blood samples of random 216 adult OPD patients at the Central Laboratory of Korle-Bu Hospital were taken for full blood count, iron studies, PCR and restriction enzyme analysis to tag -a3.7-thalassaemia variants. RESULTS AND CONCLUSION: Of the 200 accepted subjects, 114 (57.0%) were -a/aa, 11 (5.5%) were -a/-a and 75(37.5%) áá/áá. Differences among the entire red cell indices and serum iron measurements between -a/-a and aa/aa, and-a/-a and -a/-aa were found to be statistically significant (P<0.05 in each case) and consistent with previous studies, but there were no significant (P>0.05) differences between -a/aa and aa/aa RBC parameters. However, selective analysis based on Hb<13.0 g/dl for males and <12.0 g/dl for females indicated that combination of RBC indices with iron studies can be used to differentiate -a/-a from IDA. Calculation of RBC/PCV ratios of anaemic aa/aa, and -a/-a was yet another tool as the latter was found to have higher ratio.

Frequency of hepatitis C virus antibodies and elevated serum alanine transaminase levels in Ghanaian blood donors.

The objective of the study was to determine the frequency of Hepatitis C Virus (HCV) positivity in blood donors and investigate the possibility of using serum alanine transaminase (ALT) elevation as a surrogate marker. Blood samples from 1300 healthy blood donors were screened for HCV antibodies by an ELISA technique. The serum ALT was also assayed in 725 of them. 68 (5.2%) were positive for HCV antibodies. In the ALT assay 23 (3.2%) had elevated values and only 13 of this number had ALT values of 80 I.U and above. Only two positive HCV donors had elevated serum ALT. It is concluded that 5.2 per cent of blood donors had HCV antibodies and ALT assay cannot be used as a surrogate marker.

A preliminary study of serum ferritin reference range in the adult Ghanaian.

Serum ferritin levels were determined in 85 Healthy Ghanaian adults (45 men and 39 women) with a Ciba Corning 125I-Ferritin procedure. Concentrations showed a non-guassian distribution. Values for males ranged from 5.6-273 ng/ml and from 0.74-135 ng/ml for females. The non-guassian nature of the distribution necessitated a logarithmic transformation of the data in order to calculate the serum ferritin reference range (Mean +/- 2SD) for the subjects. The reference range for the males (antilogarithm) was 8.5-306.5 ng/ml (mean = 51.0 ng/ml). The reference range for the Ghanaian women was 3-112 ng/ml (mean = 18.0 ng/ml). The reported reference range for the Caucasian male is 7-350 ng/ml (mean -51.0 ng/ml) and for the Caucasian female, 5-135 ng/ml (mean = 22.0 ng/ml). These Ghanaian reference ranges agree closely with the caucasian values. Data from this preliminary study suggest serum ferritin values of < 8.5 ng/ml and < 3 ng/ml could serve as cut-off points below which iron deficiency may be said to be present in the adult Ghanaian male and female respectively when the same method of analysis is used. A further study of ferritin levels in the Ghanaian is recommended. Pending further work, continued use of the conventional cut-off points of 20 ng/ml for males and 10 ng/ml for females to identify iron-deficient individuals is in order. These conventional cut-off points enhance chances for identifying iron-deficient individuals.

Blood demand in a teaching Hospital in Ghana.

The blood requirement per acute hospital bed and the pattern of the supply were determined using the number of units of blood supplied to the various wards of the Korle Bu Teaching Hospital between 1987 to 1993. The mean yearly supply and mean monthly supply and their standard deviations were determined. The former was used to calculate the blood needs per bed in the clinical departments and also per adult and paediatric bed respectively. The rainfall figures in mm per month and year were used to determine the mean rainfall for the various months and years under study. This was superimposed over the blood requirement. There were 1143 adult acute beds with blood requirement of 5.16 units per bed compared with 231 paediatric beds needing 9.2 units per bed. The mean blood requirement per acute hospital bed which is found to be applicable also to regional hospitals is 5.5. Paediatric blood usage was extremely high in July to September after the April to July rains and also very high in the years with the highest rainfall.

Some aspects of blood transfusion practice in West Africa

It is agreed that safe blood transfusion is achieved only through the joint implementation of safe donation; quality in testing and processing and transfusion only when essential. The article throws light on current transfusion practice in West Africa and suggests ways to implement the above three components which together make blood transfusion safe

Hepatitis B viral markers in Ghanaian pregnant women.

Seven hundred pregnant women referred for blood grouping were studied for the presence of some markers of Hepatitis B virus. After collection of personal data including place of permanent residence the sera were tested for the presence of HBs Ag and anti HBs. The sera positive for HBs Ag were tested for the "e" antigen and antibody. The results were analysed according to parity, age and geographical location. Six hundred and ninety-two results were available for analysis showing 464 (67.1%) to have antibodies. 215 (31.1%) had no marker whatsoever. 44 (6.4%) of the women were HBs Ag carriers. Eight of these had the e antigen indicating that 1.16 percent were therefore infective. Calculation was made to determine the extent of vertical transmission using the prevalence of the e antigen. 15% of HBV carrier rate in the population is due to perinatal transmission and this is significant. Parity, age and geographical location did not influence the prevalence of the various markers.

Screening of blood donors for antibody to human immunodeficiency virus type 1.

29,575 blood donors of whom about 20% were voluntary were screened for HIV 1. During the three years period 1988 to 1990 four different tests kits were used. Three were ELISA methods and one an agglutination method. Comparison of the monthly seropositivity for each year showed variations of 0.9 to 4.4% for the first year, 1.4 to 10% for the second year and 0.2 to 6.9% for the third year. The differences in the standard errors were found to be significant. These wide differences are suggested to be due to many factors including the use of different screening kits, many first time donors and inability to perform repeat tests on positive samples.

PIP: Between January 1988 and December 1990, the National Blood Transfusion Service in Ghana tested the blood of 29,575 blood donors for HIV-1 antibodies to examine the significance in variations in monthly seropositivity. More than 90% of the blood donors were first-time donors. 20% were voluntary donors and the remaining donors were family donors. Over the study period, the Service used 4 different test kits: Wellcome ELISA (January 1988-November 1989), hemagglutination method ( December 1989-February 1990), Wellcome recombinant ELISA (February-October 1990), Elavia ELISA (November-December 1990). It screened 9739, 9279, and 10,557 blood donors in 1988, 1989, and 1990, respectively. The monthly HIV-1 seropositivity rates were 0.9-4.4%, 1.4-10.1%, and 0.2-6.9% in 1988, 1989, and 1990, respectively. When the Service used just Wellcome recombinant ELISA (April-October 1990), the range was only 0.2-2%. Differences in the standard errors between the HIV-1 seropositivity rate for that month and that of the rest of the year were significant, especially in the 7-month period in which the Service used just the recombinant ELISA method. Contributing factors to the wide deviations included changes in testing kits, inability to repeat tests on all positive samples, and many first-time donors.

Prevalence of thalassaemias in ethnic Saudi Arabians.

A study of the prevalence of alpha- and beta-thalassaemia and the sickle cell gene was carried out on 840 healthy adult male Saudi Arabians of different tribal origins. Complete blood count, haemoglobin electrophoresis and HbA2 estimation were carried out on all. Globin biosynthetic analysis was carried out on all 85 subjects with microcytic red cells and on 180 randomly selected subjects with normal red cell indices. The results showed prevalence of beta-thalassaemia of 3.0%, alpha/beta thalassaemia of 0.9%, alpha-thalassaemia of 43.3% and sickle trait of 5.7%. There were tribal variations in the prevalence of both alpha-thalassaemia and the sickle gene.

Association of red cell glucose-6-phosphate dehydrogenase with haemoglobinopathies.

A total of 1,112 randomly selected Saudi Arabs, of both sexes, living in Jeddah and the surrounding areas were screened for the phenotypic distribution of red cell glucose-6-phosphate dehydrogenase (G6PD) and 6-phosphogluconate dehydrogenase (6PGD). They were also investigated for haemoglobin and for thalassaemia. Phenotyping of the haemoglobins and the red cell enzymes was carried out by starch gel electrophoresis and the dye-decolouration screening test, while the investigation for thalassaemia was carried out by globin-chain biosynthesis, followed by column chromatography. The red cell Gd- alleles were significantly associated with the sickle-cell gene in both the males (chi 2(1): AS-28.80; SS-4.89) and females (chi 2(1): AS-10.99; SS-13.16). A similar association was also observed between G6PD deficiency and thalassaemias in males (chi 2(1): alpha-thalassaemia - 3.13; beta-thalassaemia - 11.06) and females (chi 2(1): alpha-thalassaemia - 6.63). However, no such association was detected between red cell 6PGD types and haemoglobin genes. The results suggest that the red cell G6PD deficiency, sickle-cell and thalassaemia genes might have evolved as a result of the same ecological factor, probably malaria.

Non-benign sickle cell anaemia in western Saudi Arabia.

Seventy-one Saudi and Yemeni Arabs with sickle cell anaemia from western Saudi Arabia aged between 1 1/2 and 42 years were studied. The mean steady state haemoglobin concentration of 8.1 g/dl was lower than that of 10.7 g/dl reported previously for sickle cell anaemia in eastern Saudi Arabia. The patients were divided into an SSLF group with fetal haemoglobin (HbF) of 10.0% or below (44 patients) and an SSHF group having HbF above 10.0% (27 patients). No significant differences were found in the haemoglobin concentrations, haematological indices and incidences of bone changes of the two groups. SSLF patients were significantly more prone to infections (P less than 0.01), however. Also, there was an overall high incidence of hepatomegaly (69.0%) and splenomegaly (54.9%) and hepatomegaly was significantly more common in the SSLF group (P less than 0.02). Many of the patients, even with HbF levels over 10.0%, did not follow a benign course and suffered from severe anaemia, infections of the respiratory and urinary tracts, bone pains and infarcts, or bossing of the skull. Rarer complications included hepatic crisis, chest syndrome, retinal haemorrhage, epistaxis and hemiplegia. It is therefore apparent that Saudi Arabian sickle cell anaemia, even in patients with raised haemoglobin F levels, may be as clinically severe as in African patients.