Micronutrient levels and haemato-biochemical status of patients with sickle cell anaemia at a tertiary hospital in Abakaliki, south-eastern Nigeria: a cross-sectional study.

Introduction: nutritional status is an under-studied environmental factor that can impact the phenotypic manifestations of patients with Sickle Cell Anaemia (SCA). This study aimed to define hemato-biochemical parameters and micronutrient status in patients with SCA. Methods: this was a cross-sectional study of patients with SCA and hemoglobin genotype HBAA controls at a tertiary health facility in Abakaliki, from 2nd December 2020 to 31st March 2021. Plasma micronutrient levels, haemato-biochemical parameters were analyzed and anthropometric measurements obtained from all participants. Results: sixty participants with SCA had 58.3% females (mean age of 24.77±7.39 years) while controls had 50% females (mean age of 26.23 ± 8.44 years). The SCA group had significantly lowered calcium (2.733 ± 1.593 vs 1.846 ± 1.123 mmol/l; p=0.009) and magnesium (19.38 ± 6.37 vs 9.65 ± 1.38 mg/dl; p= < 0.001) levels but higher plasma iron (1.70 ± 0.89 vs 1.06 ± 0.53; p=0.001). Zinc and Copper did not reveal significant differences between the two groups. Chloride ion levels was significantly lower in the SCA patients (107.50 ± 17.42 vs 100.19 ± 12.92; p=0.026) while Alkaline phosphatase (ALP), bilirubin, total white blood cell (WBC) and platelets (PLT) count were higher compared with the HBAA group (255.72 ± 124.52 vs 134.56 ± 39.67; p= <0.001, 46.86 ± 25.03 vs 25.63 ± 18.80; p = 0.001, 13.21± 6.57 vs 6.10 ± 1.35; p= < 0.001 and 369.25 ± 138.11 vs 209.36 ± 47.85; p= <0.001). Conclusion: Copper and zinc deficiency was not present in our population of SCA patients but, they had lower plasma calcium and magnesium levels and elevated levels of blilirubin, ALP, WBC and platelets PLT counts. These parameters can be explored in designing better management for patients with SCA.

Diagnostic Challenges of Anaplastic Large Cell Lymphoma in a Resource-Limited Setting: A Case Report and Literature Review.

Anaplastic large cell lymphoma (ALCL) is a rare variety of non-Hodgkin's lymphoma with diverse morphologic variants. Due to the similarity of the different variants with other lymphoma entities, misdiagnosis may be inevitable when immunohistochemical and cytogenetic techniques are not available and histology alone is employed. We report a case of a 43-year-old woman with a seven-month history of neck swelling which was complicated by ulceration of the mass and pathological fracture of the right clavicle after two months delay in arriving at a correct diagnosis. Several attempts to arrive at definitive diagnosis using histology alone gave divergent reports which all misdiagnosed the case until it was sent to a facility outside the country. Our report highlights the limitations and challenges of histology in making a definitive diagnosis of ALCL and the overt importance of immunohistochemical and cytogenetic techniques which are largely unavailable in resource-constrained environment typical of tertiary centers in Nigeria and most sub-Saharan Africa countries.