Red cell alloimmunization in multi-transfused patients with sickle cell anemia in Benin City, Nigeria.

BACKGROUND: Sickle cell anemia (SCA) is an inherited hemoglobin disorder characterized by chronic anemia and occasional crises. Clinical features are variable. While some individuals are relatively stable and rarely require blood transfusion, others often require blood transfusion. Multiple blood transfusion is associated with complications including alloimmunization, infections, and iron overload. AIMS AND OBJECTIVES: The study aimed at determining the prevalence of red cell alloimmunization among multi-transfused patients with SCA. MATERIALS AND METHODS: A cross-sectional study of adult SCA patients who have received multiple blood transfusion and those who have never received blood was done. Antibody screening and identification were carried out using gel technology with commercially made panel of cells. RESULTS: A total of 145 SCA subjects were studied. They were made up of 86 test group (those that had received two or more units of blood) and 59 control group (those that had never received blood transfusion). Prevalence of red cell alloantibody among multi-transfused patients with SCA was found to be 9.3%. Alloantibodies identified were mainly against Rhesus antigens contributing 87.5% (anti-E 37.5%, anti-C 25%, anti-D 12.5%, anti-e 12.5%). A combination of Kell and Lutheran blood group antigens contributed 12.5%. No antibody was detected among the control group. CONCLUSION: Blood transfusion is associated with the development of alloantibodies. Routine blood grouping for multi-transfused patients with SCA should be extended to include other blood group antigens in addition to Rhesus D and ABO antigens.

Awareness of Blood Donation among Tertiary Institution Undergraduates in Southern Nigeria

Background:The increased need of safe blood and blood products and their unavailability in hospitals remain a formidable challenge faced by healthcare providers in developing countries such as Nigeria.Aim: To determine the level of awareness of blood donation among tertiary institution undergraduates in an urban setting of Southern Nigeria. Methodology: Semi-structured questionnaire was used to collect information from undergraduates of the University of Benin and Delta State University both in southern Nigeria. Data analysis was done using SPSS software version 16. Results: A total of 396 people were surveyed. Of these; 370 (93.4) were aware that blood can be donated; while 172 (43.4) were aware of the WHO policy on blood donation. Three hundred and forty-one (86.1) were aware that blood donation should be nationally coordinated while 306(77.3) did not agree that medical workers have created enough awareness on blood donation. Two hundred and twenty-two (56.1) were aware that blood donation should be voluntary and 209(52.8) were willing to donate blood if there is an attached financial reward. Conclusion:This study has revealed a high level of awareness on blood donation among tertiary institution undergraduates in Southern Nigeria and have demonstrated a poor level of awareness of the WHO policy on blood donation

Anthropometric indices as determinants of haemorheological cardiovascular disease risk factors in Nigerian adults living in a semi-urban community.

BACKGROUND: Some epidemiological studies have found anthropometric indices to be related to cardiovascular disease risk factors. Fibrinogen--an acute phase reactant protein--is central in the haemostatic system. Its associations with cardiovascular diseases have been well documented. A possible association between measures of body fat and fibrinogen has been reported. AIMS: To study the relationship of fibrinogen (PFC), plasma viscosity (PV) and haematocrit (HCT) with measures of obesity (body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR)) in apparently healthy Nigerians living in Ilisan-Remo, a semi-urban community. SUBJECTS AND METHODS: The study population comprised of apparently healthy mono-ethnic Nigerians living in Ilisan-Remo town. Obesity was measured using the body mass index, waist circumference, waist-to-hip ratio and waist-to-height ratio. Blood samples were analyzed for rheological parameters (plasma fibrinogen, plasma viscosity, haematocrit and the erythrocyte sedimentation rate (ESR) using standard methods. RESULTS: A total of 122 subjects were studied, 46 males (mean age 57+/-15.7 years) and 76 females (mean age 58.92+/-17.99 years). The mean systolic blood pressure was 138.5 mmHg for males and 135.2 mmHg for females respectively. The independent variables (BMI, waist-to-hip ratio) were divided into 2 groups using the 75th percentile cut off. In the BMI group, the diastolic blood pressure, haematocrit and plasma viscosity were significantly higher in males (p<0.0001) in the >75th percentile group but not in females. Using the waist circumference; plasma viscosity and diastolic blood pressure were higher in males (p<0.0001) in the >75th percentile group. In females the haematocrit and blood viscosity were significantly higher (p=0.0074, p=0.0434) respectively in the >75th percentile group. Using stepwise multiple regression analysis, the waist circumference and BMI were found to be significant determinant for systolic and diastolic blood pressure. The BMI was significant determinant for the haemorheological cardiovascular disease (HCVD) risk factors except fibrinogen. While the waist circumference was a significant predictor of all the haemorheological cardiovascular disease risk factors (p<0.0001). CONCLUSION: While the BMI and the WHR may be good predictors of CVD (cardiovascular disease) risk factors, we have shown that the waist circumference may be a better predictor of haemorheological cardiovascular disease risk factors than the BMI in Nigerians.

Using serial haemorheological parameters to assess clinical status in sickle cell anaemia patients in vaso-occlussive crisis.

In a prospective study using standard methods, haemorheological parameters were assessed in 10 sickle cell anaemia patients in pain crises. Patients were investigated for possible changes in determinants of rheology in the course of painful episodes: blood samples were taken for plasma fibrinogen concentration (PFC); plasma viscosity (PV); haematocrit (Hct), whole blood viscosity (WBV) and the erythrocyte sedimentation rate (ESR) using standard methods. Samples were collected on presentation to the emergency unit and daily for 4 consecutive days. Whole blood viscosity and plasma fibrinogen concentration were significantly higher at onset of crises when compared with baseline values (p<0.01 and p<0.0001), respectively. Plasma fibrinogen and blood viscosity peaked within 24 h of onset of crisis and started declining 48-72 h later. These parameters approached baseline values by the 4th day of painful crisis.There was no significant change in the haematocrit and the erythrocyte sedimentation rate during the period of painful crisis despite change in whole blood viscosity and fibrinogen. In conclusion, this study showed elevated haemorheological parameters in sickle cell anaemia patients in VOC, it also demonstrated an acute rise in these parameters at onset of crisis and a return to almost baseline levels within 96 h of onset of painful episodes.

Autoimmune hemolytic anemia in HIV-infected patients: a hospital based study.

BACKGROUND: The prevalence of anemia in HIV/AIDS patients is high, with a multitude of possible etiologies; autoimmune hemolytic anemia (AIHA) in HIV/AIDS patients has been associated with a poor prognosis when treated with red cell transfusion. Our aim was to demonstrate the frequency of AIHA in a cohort of adult Nigerian HIV/AIDS patients and to see if the presence or not of AIHA is related to the severity of the disease with regards to the CD4 counts and the presence or absence of opportunistic infections. METHOD: Ninety- eight adult patients with HIV infection were screened for the presence of AIHA using the packed cell volume (PCV), direct antiglobulin test (DAT) and reticulocyte count (RC). RESULTS: The frequency of AIHA was 3.06%, 36.74% of our study population were anemic; 11.22% had a positive DAT. Mean RC was 2.22 +/- 0.90 for all the patients. There was no statistically significant difference in the PCV of patients that had positive and negative DAT. There was no correlation between the presence of AIHA, use of ART, presence of opportunistic infections or CD4 counts. CONCLUSION: We conclude that in spite of the low frequency of AIHA in HIV/AIDS patients, the fact that most patients will respond to standard treatment makes it imperative to screen HIV/AIDS patients with anemia for the presence of AIHA. Again since HIV/A IDS patients with AIHA may have a fatal reaction to red cell transfusion, we suggest that anemic patients with HIV/AIDS in non -emergency situations be screened for the presence of AIHA before receiving red cell transfusions when indicated.

Autoimmune Hemolytic Anemia in HIV-infected Patients: a Hospital Based Study

Background: The prevalence of anemia in HIV/ AIDS patients is high; with a multitude of possible etiologies; autoimmune hemolytic anemia (AIHA) in HIV/AIDS patients has been associated with a poor prognosis when treated with red cell transfusion. Our aim was to demonstrate the frequency of AIHA in a cohort of adult Nigerian HIV/AIDS patients and to see if the presence or not of AIHA is related to the severity of the disease with regards to the CD4 counts and the presence or absence of opportunistic infections. Method: Ninety- eight adult patients with HIV infection were screened for the presence of AIHA using the packed cell volume (PCV); direct antiglobulin test (DAT) and reticu- locyte count (RC). Results: The frequency of AIHA was 3.06; 36.74of our study population were anemic; 11.22had a positive DAT. Mean RC was 2.22 +/- 0.90 for all the patients. There was no statistically significant difference in the PCV of patients that had positive and negative DAT. There was no correlation between the presence of AIHA; use of ART; presence of opportunistic infections or CD4 counts. Conclusion: We conclude that in spite of the low frequency of AIHA in HIV/AIDS patients; the fact that most patients will respond to standard treatment makes it imperative to screen HIV/AIDS patients with anemia for the presence of AIHA. Again since HIV/AIDS patients with AIHA may have a fatal reaction to red cell transfusion; we suggest that anemic patients with HIV/AIDS in non-emergency situations be screened for the presence of AIHA before receiving red cell transfusions when indicated

Autoimmune Hemolytic Anemia in HIV-infected Patients: a Hospital Based Study

Background: The prevalence of anemia in HIV/ AIDS patients is high; with a multitude of possible etiologies; autoimmune hemolytic anemia (AIHA) in HIV/AIDS patients has been associated with a poor prognosis when treated with red cell transfusion. Our aim was to demonstrate the frequency of AIHA in a cohort of adult Nigerian HIV/AIDS patients and to see if the presence or not of AIHA is related to the severity of the disease with regards to the CD4 counts and the presence or absence of opportunistic infections. Method: Ninety- eight adult patients with HIV infection were screened for the presence of AIHA using the packed cell volume (PCV); direct antiglobulin test (DAT) and reticulocyte count (RC). Results: The frequency of AIHA was 3.06; 36.74of our study population were anemic; 11.22had a positive DAT. Mean RC was 2.22 +/- 0.90 for all the patients. There was no statistically significant difference in the PCV of patients that had positive and negative DAT. There was no correlation between the presence of AIHA; use of ART; presence of opportunistic infections or CD4 counts. Conclusion: We conclude that in spite of the low frequency of AIHA in HIV/AIDS patients; the fact that most patients will respond to standard treatment makes it imperative to screen HIV/AIDS patients with anemia for the presence of AIHA. Again since HIV/AIDS patients with AIHA may have a fatal reaction to red cell transfusion; we suggest that anemic patients with HIV/AIDS in non-emergency situations be screened for the presence of AIHA before receiving red cell transfusions when indicated

Chronic lymphoid leukaemia: clinico-haematological correlation and outcome in a single institution in Niger Delta region of Nigeria.

Sixty patients were prospectively studied with the aim of analyzing the clinical and laboratory features and outcome of patients diagnosed with chronic lymphocytic leukaemia (CLL) in a major referral center in Niger Delta region of Nigeria for 10 years (1995-2005). The peripheral blood, bone marrow cytology, clinical features and stage at diagnosis were studied. Treatment modalities, response to treatment and survival outcome of the patients were analysed. Sixty patients (15 men and 45 women) were seen, with female preponderance (M : F ratio,1 : 3). The CLL incidence was 36.4% of total leukaemias. The median age was 56 years with peak age group at 51-60 years while 15% were below 40 years. Major clinical findings include lymphadenopathy (91.7%), anaemia (58.3%), abdominal swelling (58.3%), and splenomegaly (50%) with 53 patients (88.3%) presenting as International (Binet) stage B and C while only seven patients (11.7%) were seen in stage A. The least clinical presentation includes Richter's syndrome in 3.3% of cases and herpes Zoster skin manifestations in two patients (3.3%). There was a strong association between the blood counts at diagnosis and outcome of therapy. The 2-year survival for young (<55 years) and older (>55 years) CLL patients was 27.2% and 28.9%, respectively, which is still very poor because of a number of strong limiting factors. CLL is not rare in Southern Nigeria and its presentations are similar to cases seen worldwide. Contrary to existing literature a female predominance was observed in this study with majority of patients seeking medical intervention late. It is therefore recommended that future research into the genetic make up/HLA typing of patients of African descent is needed to clarify some of the differences observed.

Haemorheological variables in Nigeria pulmonary tuberculosis patients undergoing therapy.

Haemorheological changes in response to therapy have not been fully determined in pulmonary tuberculosis patients living in developing countries. This study was aimed at monitoring haemorheological parameters in newly diagnosed pulmonary tuberculosis patients undergoing therapy. Haemorheological parameters were studied in 40 tuberculosis patients (17 males and 23 females, mean age 33.4+/-1.4 years, range 23-45 years) undergoing treatment and 10 newly diagnosed patients (5 males and 5 females mean age 33.0+/-2.1 years) along with 50 apparently healthy controls age and sex matched. There were significantly lower packed cell volume (PCV), platelet count (PC), and total white blood cell count (p<0.0001). Whole blood viscosity (WBV), plasma viscosity (PV), erythrocyte sedimentation rate (ESR), and plasma fibrinogen (PF) were significantly higher in pulmonary tuberculosis patients than controls (p<0.0001). The packed cell volume was significantly increased by the 8th week of therapy (p<0.01), there was a significant reduction in the erythrocyte sedimentation rate from the 4th week of therapy (p<0.0001). There was no significant change in blood viscosity by the 4th week of therapy (p>0.05), while the plasma fibrinogen showed significant reduction from the 4th week of therapy till 8th week of therapy (p<0.01 and p<0.0001 respectively). We conclude that thrombocytopaenia, stasis and hyperfibrinogenemia may predispose African PTB patients to bleeding and thrombotic disorders. Haemorheological parameters may be useful indices in assessing response to therapy and drug compliance in pulmonary tuberculosis patients living in developing countries.

Haemostatic variables and their relationship to body mass index and blood pressure in adult Nigerians with the sickle cell trait.

Several studies had assessed the rheological and haemostatic parameters in both sickle cell anaemia(HbSS) and haemoglobin AA(HbAA) subjects. The effect of the heterogeneous state on these parameters has not been fully determined. Our aim was to assess the haemorheological and haemostatic parameters and there relationship to body mass index in individuals with the sickle cell trait. Fifty eight males (41 HbAA and 17 HbAS) who were neither smokers nor drinkers were studied. Body mass index was calculated as weight in Kg divided by height in m(2), blood samples were analysed for haematocrit, erythrocyte sedimentation rate, platelets, fibrinogen and factor VII by standard methods. There were no significant differences in the levels of haemostatic and cardiovascular risk factors between the HbAA and HbAS individuals. Fibrinogen correlated positively with BMI (r=0.6014, p=0.0107), systolic blood pressure (r=0.4820, p=0.0570), diastolic blood pressure (r=0.4699, p=0.0570) in HbAS individuals. The body mass index also correlated positively with diastolic blood pressure (r=0.5182, p<0.05), and systolic blood pressure (r=0.6189, p<0.01). Positive associations were also found between fibrinogen and body mass index (r=0.5012, p=0.0008), and fibrinogen and haematocrit (r=0.3696, r=0.0174) respectively in HbAA subjects. We conclude that the lack of significant difference in both haemorheological and cardiovascular risk factors in HbAS and HbAA subjects has further supported the observation that HbAS is a benign condition under physiological settings. Also the positive associations of fibrinogen with other cardiovascular risk factors have further underscored the central role of fibrinogen as an independent risk factors in the development of cardiovascular diseases.

The influence of foetal haemoglobin on the frequency of vaso-occlusive crisis in sickle cell anaemia patients.

OBJECTIVE: Several biological and environmental factors are presumed to account for the morbidity pattern in patients with sickle cell anaemia. Foetal haemoglobin is one of the biological factors thought to decrease morbidity in these patients. We studied the relationship between the foetal haemoglobin levels and vaso-occlusive crisis (VOC) as a measure of the morbidity pattern in this category of patients. RESULTS: The mean foetal haemoglobin level was 6.4+0.40% (SEM). Vaso-occlusive crisis was more common at lower levels of foetal haemoglobin particularly when lower than 12% (P=0.01). There was a negative correlation between foetal haemoglobin and vaso-occlusive crisis (r=0.561). These variables were also associated in linear regression and both showed statistical significance (p=0.001). CONCLUSION: We conclude that higher levels of foetal haemoglobin positively influence the occurrence of vaso-occlusive crisis in sickle cell anaemia patients.

Donor blood procurement and utilisation at the University of Benin Teaching Hospital, Benin City.

Banked blood is a limited resource in Nigeria. We sought to evaluate factors that may further limit the effective utilisation of donor blood in a tertiary hospital in Benin City. The records of the blood transfusion unit of the hospital were studied to identify the methods of blood procurement and utilisation from January 1, 2000 to December 31, 2002. A total of 11,021 units of blood were received in the blood transfusion unit within this period out of which 1491 (13.5%) donor blood samples were found unfit for transfusion and, hence, discarded. Commercial blood donation accounted for 95.3%, compared to 4.7% from replacement and volunteer donors. Commercial blood donation was a major risk factor for likely disposal of donor blood (chi2 = 74.3, p < 0.0001, OR = 21.1. 95% CI = 7.8-56.7). Expired units of blood with low PCV were discarded for lack of infrastructure to fractionate and store them. Over 0.8million naira (US$6000.00) is wasted annually on discarded units of donor blood mainly from commercial donors. A policy on blood procurement to include subgroup selection of donors and improved funding of blood banking services may enhance efficient and effective utilisation of donor blood.

Lupus anticoagulant in Nigerian women with preeclampsia.

OBJECTIVE: The Lupus Anticoagulant (LA) which used to be known for its interference with coagulation studies in the 1950s, has now been recognised to be associated also with diverse disease conditions in the developed countries. Our aim therefore was to determine the prevalence of the lupus anticoagulant (LA) in women with pre-eclampsia and controls. SUBJECT AND METHODS: A total of seventy-six pregnant women, were studied, twenty-six pre-eclampsia and fifty who were apparently healthy served as controls. The Kaolin clotting time test (KCT) was performed in duplicates on plasma samples from subjects and controls. Mixing ratio was calculated in order to determine the presence of the lupus anticoagulant, Kaolin clotting time ratio of greater than or equal to 1.2 was taken to signify the presence of the lupus anticoagulant. RESULTS: Eleven (42.3%) of the women with pre-eclampsia had prolonged KCT as against 2(4%) of the pregnant control. The clotting time of 7 of the '11 pre-eclampsia with prolonged KCT, were correctd by normal plasma, while 4 were not corrected. The KCT ratio of all 4 were greater than 1.2 signifying the presence of LA (15.4% prevalence). One (2%) of the pregnant control had KCT ratio greater than 1.2 (2%) prevalence of LA). CONCLUSION: A number of Nigeria women with pre-eclampsia also have the lupus anti-coagulant therefore African women with pre-eclampsia should be screened for the presence of lupus anticoagulant.

Prevalence of lupus anticoagulant in multiparous women in Benin City, Nigeria.

Lupus anticoagulant which in the past was regarded as a laboratory nuisance is now known to be associated with numerous clinical conditions including thrombosis and recurrent foetal loss, however, no work has been done to assess its prevalence in non-pregnant healthy multiparous women. Our aim therefore was to determine the prevalence of lupus anticoagulant in non-pregnant multiparous Nigerian women of childbearing age. Fifty non-pregnant multiparous women who were considered healthy following verbal interviews were studied. An eligibility criterion was used. Coagulation studies were performed on plasma samples from all the women using the Kaolin clotting time. Mixing experiments were conducted on samples with prolonged clotting time to detect the presence of the lupus anticoagulant. The Kaolin clotting time ratio of greater than or equal to 1.2 was considered positive for the lupus anticoagulant. Forty-four (88%) of the 50 women had a normal cloning time, 2(4%) had subnormal clotting time while 4(8%) of them had a prolonged Kaolin clotting time. Mixing experiments on these 4 samples revealed Kaolin clotting time ratios of over 1.2, signifying the presence of the lupus anticoagulant (i.e. 8 per cent prevalence) among the population of women studied Multiparous women with the lupus anticoagulant may not be symptomatic therefore the anticoagulant should be screened for in women with unexplained prolongation of cloning time. We recommend that these women should be followed up especially in pregnancy to forestall any of the obstetric complications that have been associated with the lupus anticoagulant.

Leucocyte counts in pregnant Nigerian women with sickle cell trait.

White blood count (WBC) with differential counts and packed cell volume (PCV) were studied in 100 pregnant and 30 non-pregnant control women aged 18-45 years. Eighty of the pregnant women were homozygous HbAA and 20 heterozygous HbAS. The non-pregnant women's PCV, lymphocyte and eosinophils counts were significantly higher (p < 0.005) while their leucocytes neutrophil counts were significantly lower (p < 0.005) compared with HbAA and HbAS pregnant women. However, HbAS pregnant women had higher leucocyte, lymphocyte and eosinophil counts compared with HbAA, but these were not significant. There were no variations in basophil and monocyte counts. HbAA pregnant women had no change in PCV but significant changes occurred in leucocyte and neurophil counts with increase in the second trimester with decreasing lymphocyte and eosinophil counts in the second and third trimesters. However, HbAS pregnant women had significant increase in PCV in their first trimester, leucocyte and neutrophil counts in their third trimester but no variation in lymphocyte, eosinophil and basophil and monocyte counts. The increased leucocyte and neutrophil counts in the second trimester in HbAA and third trimester in HbAS may be due to genetic factor and/or oestrogen secretion reaching production peak at different periods of pregnancy. The relative increase in these haematological indices in HbAS women may be a protective mechanism against infection during pregnancy.