Adult malignant lymphomas in University of Benin Teaching Hospital, Benin City, Nigeria--incidence and survival.

BACKGROUND: The occurrence of malignant lymphomas is worldwide and its incidence has being increasing, ranked 12th among all, cancers worldwide. We aim to determine the incidence and survival of the lymphoma patients in the Niger Delta region of Nigeria. STUDY DESIGN: A study of 205 cases of lymphoma patients from 1993 to 2003. One-year survival was calculated using simple percentage of those alive and those that died before 1 year of diagnosis. RESULTS: A total of 205 patients aged 18-72 years were studied. Non-Hodgkin's Lymphoma (NHL) was the most frequent (83%) while Hodgkin's Lymphoma (HL) had an incidence of 17%. The 1 year survival for patients with NHL and HL was 35.3% and 42.9% respectively. We found a strong association between haemoglobin (Hb) and white blood cell count (WBC) at presentation and lyear survival in NHL patients (P=0.0003; P=0.0001) and HL patients (P=0.0001; P=0.0104) respectively. Also, the mean Erythrocyte sedimentation rate (ESR) for lymphoma patients alive at lyear was significantly lower than those that died within 1 year (P=0.0001). Duration of illness before presentation was found to influence 1 year survival. CONCLUSION: We conclude that NHL was the most common of the lymphoma seen in young adulthood in the Niger Delta region of Nigeria. A positive correlation between survival and duration of illness at presentation and haematological counts was found. The 1 year survival is still very poor and this may not be unconnected with late presentation and other strong limiting factors.

Antiphospholipid antibodies in medical practice: a review.

BACKGROUND: Antiphospholipid antibodies are autoantibodies that have been associated with . thrombosis and recurrent foetal loss. The purpose of this review is to highlight the history of these antibodies, their epidemiology, to document what is known of their pathogenesis, clinical features, diagnosis and available treatment modalities. METHODS: Literature on the subject was reviewed using manual library search, articles in journals, internet search and conference abstracts. RESULT: Antiphospholipid antibodies have been detected in all age groups; incidence increases with age. They are antibodies to protein-phospholipid complexes and not to phospholipid alone. The most commonly detected antiphospholipid antibodies are lupusanticoagulant (LA), anticardiolipin antibodies and anti--2 glycoprotein-1 antibodies. Apart from thrombosis and recurrent foetal loss, they are also associated with neurologic disorders, cutaneous manifestations and thrombocytopaenia. CONCLUSION: Early detection requires a strong index of suspicion especially when thrombosis is seen at unusual sites. Several modalities of treatment such as anticoagulants and antiplatelet agents have been developed, though it is difficult to monitor level of anticoagulation as the antibodies may interfere with coagulation studies. Grey areas remain in the management of antiphospholipid antibodies; for instance it is not certain if patients with a positive laboratory test without any clinical feature should be treated.

Multiple myeloma : 2 case reports

This is a report of multiple myeloma in first cousins from the Niger delta region of Nigeria.The first patient was a 60-year-old Negroid male with a 3-month history of productive cough; chest pain; fever and 1 month history of weight loss. The diagnosis was confirmed by greater than 50neoplastic plasma cells in the bone marrow; monoclonal band on electrophoresis and lytic bone lesions in the skull. He was treated with cyclophosphamide; prednisolone and allopurinol and received a total of 4 pints of packed cells. His PCV improved subsequently.The second patient was a 54-year-old Negroid housewife. She presented with a six-month history of bone pains and weakness in both lower limbs. She also had cough productive of mucoid sputum. The diagnosis of MM was confirmed by the presence of more than 30neoplastic plasma cells in the bone marrow; a monoclonal band on serum electrophoresis and lytic lesions in the pelvic bones on skeletal survey. She had three 28-day cycles of vincristine; adriamycin and dexamethasone (VAD). She was also transfused with 3 pints of packed cells. We conclude that while we cannot rule out the effect of environmental factors in pathogenesis of MM in our patients; the occurrence of MM in first cousins is suggestive of a possible familial origin. We advocate screening of urine for Bence Jones protein and serum electrophoresis for relatives of patients with MM; especially those from the Niger Delta region

Multiple myeloma : 2 case reports

This is a report of multiple myeloma in first cousins from the Niger delta region of Nigeria.The first patient was a 60-year-old Negroid male with a 3-month history of productive cough; chest pain; fever and 1 month history of weight loss. The diagnosis was confirmed by greater than 50neoplastic plasma cells in the bone marrow; monoclonal band on electrophoresis and lytic bone lesions in the skull. He was treated with cyclophosphamide; prednisolone and allopurinol and received a total of 4 pints of packed cells. His PCV improved subsequently.The second patient was a 54-year-old Negroid housewife. She presented with a six-month history of bone pains and weakness in both lower limbs. She also had cough productive of mucoid sputum. The diagnosis of MM was confirmed by the presence of more than 30neoplastic plasma cells in the bone marrow; a monoclonal band on serum electrophoresis and lytic lesions in the pelvic bones on skeletal survey. She had three 28-day cycles of vincristine; adriamycin and dexamethasone (VAD). She was also transfused with 3 pints of packed cells. We conclude that while we cannot rule out the effect of environmental factors in pathogenesis of MM in our patients; the occurrence of MM in first cousins is suggestive of a possible familial origin. We advocate screening of urine for Bence Jones protein and serum electrophoresis for relatives of patients with MM; especially those from the Niger Delta region

Megaloblastic anaemia: response to Amples A and B (folic acid, vitamin B12 (Cyanocobalamin), niacin and vitamin C)--a case report.

BACKGROUND: Megaloblastic anaemia is prevalent in our society and patients are diagnosed late. METHOD: Case Report of a patient with megaloblastic anaemia and discussion of relevant literature. RESULTS: A 50 year old Nigerian trader with recurrent chronic anaemia and repeated blood transfusions (Eight units in 10 days) was finally diagnosed to have megaloblastic anaemia. He was commenced on intramuscular, Ample A and Ample B (folic acid 0.7mg, vitamin B12 (Cyanocobalamin) 2500g, niacin 12mg and vitamin C 150mg) on alternate days (6 doses) then weekly as maintenance until haematocrit returned to normal. Response was dramatic; haemoglobin was 6.4g/dl before, 7.9g/dl after the second dose and 11.5g/dl after the 6th dose of the drug. The corrected retic was 2.0% before, 4.6% 72hrs after and 8.4% after the 6th dose. The MCV decreased from 105fl before to 79fl after the 6th dose of the drug. His packed cell volume has remained above 35% after completing the 6th dose and during maintenance therapy. CONCLUSION: The combination of Cyanocobalamin, folic acid, niacin, and vitamin C, in Amples A and B is complementary. Treatment with Amples A and B is effective and affordable in the management of megaloblastic anaemia.

Adult lymphomas in Edo state, Niger Delta region of Nigeria--clinicopathological profile of 205 cases.

The clinicopathologic features of malignant lymphomas had not been documented in the Niger Delta region of Nigeria, which is known for its petrochemical industries and gas flare sites. Cases of lymphomas that presented to the University of Benin Teaching Hospital (UBTH), a major referral centre in the region, from January 1990 to December 2003 were reviewed. Demographic and clinical information were obtained from the case files. Diagnosis was established based on the histological examination of an accessible biopsy lymph node and classified according to the Working Formulation (WF). Haematological parameters were done using an automated Coulter counter. Non-Hodgkin's lymphoma (NHL) occurred predominantly in young adults (20-39 years). A majority of the patients presented in the advanced stage of the disease (Stages III-IV) according to the Ann Arbor system and a performance status (PS) scale of 2-4. The intermediate grade NHL (41.2%) formed the largest group of which diffuse large cell lymphoma (DLCL) was the most commonly observed histopathologic type followed by the large cell immunoblastic type.

Haematological alterations in leprosy patients treated with dapsone.

OBJECTIVE: To evaluate the haemoglobin concentration (Hb); total white blood cell count (WBC), differential WBC count; platelet count and reticulocyte count in leprosy patients already treated with dapsone. DESIGN: A case-control study. SETTING: Specialist Hospital Ossiomo, which is a Leprosarium and Haematology laboratory, University of Benin Teaching Hospital (UBTH), Nigeria. SUBJECTS: Seventy six leprosy patients (forty males and thirty six females) age range 13-40 years on single dose dapsone. RESULTS: The haemoglobin concentration showed a marked decrease while the reticulocyte count was markedly elevated which was suggestive of haemolytic anaemia. There was also lymphocytosis in patients during pre and post dapsone therapy. CONCLUSION: Leprosy patients on a dosage of 100 mg dapsone, are prone to haemolytic anaemia. Leprosy patients should routinely have their Hb, WBC, platelet count and reticulocyte count determined, while on dapsone therapy in order to ascertain the presence of haemolysis.

Haematological alterations in leprosy patients treated with dapsone

OBJECTIVE: To evaluate the haemoglobin concentration (Hb); total white blood cell count (WBC), differential WBC count; platelet count and reticulocyte count in leprosy patients already treated with dapsone. DESIGN: A case-control study. SETTING: Specialist Hospital Ossiomo, which is a Leprosarium and Haematology laboratory, University of Benin Teaching Hospital (UBTH), Nigeria. SUBJECTS: Seventy six leprosy patients (forty males and thirty six females) age range 13-40 years on single dose dapsone. RESULTS: The haemoglobin concentration showed a marked decrease while the reticulocyte count was markedly elevated which was suggestive of haemolytic anaemia. There was also lymphocytosis in patients during pre and post dapsone therapy. CONCLUSION: Leprosy patients on a dosage of 100 mg dapsone, are prone to haemolytic anaemia. Leprosy patients should routinely have their Hb, WBC, platelet count and reticulocyte count determined, while on dapsone therapy in order to ascertain the presence of haemolysis.

Hepatitis B surface antigen and antibody to hepatitis C virus among accident and emergency patients.

OBJECTIVE: To determine the sero-prevalence and epidemiology of antibody to hepatitis C virus (anti-HCV) and hepatitis B surface antigen in accident and emergency patients. DESIGN: A descriptive study was performed on 150 accident and emergency patients. Sera was screened for anti-HCV and HbsAg, using enzyme linked immunosorbent assay. Personal information and risk factors involved were obtained using a questionnaire. SETTING: Haematology laboratory of the University of Benin Teaching Hospital, Nigeria. SUBJECTS: One hundred and fifty adults consisting of 122 males and 28 females who were above the age of 21 years. Patients were randomly selected from all adults including dental patients attending the emergency department for both surgical, dental and medical emergencies. The age range was between 21-58 years. In order to ascertain the epidemiology of both viruses a questionnaire was used detailing the possible risk factors for transmission. These included history of previous blood transfusion; history of life time occurrence of multiple sexually transmitted diseases; history of heterosexual exposure to partners at risk (for example prostitutes); history involving the use of unsterilized blades; presence of scarification marks and tattooing; low socio-economic status (low annual income or unemployed): history of intravenous drug use and heterosexual activity. Anti-HCV and HBsAg were both assayed using different assay kits, based on the enzyme linked immuno absorbent assay (ELISA) tests from different manufacturers. RESULTS: The sero-prevalence of anti-HCV was 14% and 29.3% for HBsAg. Anti-HCV positivity was significantly associated with a past history of blood transfusion and heterosexual exposure to partners at risk. The study also revealed a significant association between HBsAg positivity and all the risk factors. CONCLUSION: The high prevalence rate for anti-HCV and HbsAg in accident and emergency patients increases the likelihood of further spread from patients to health care providers especially if adequate precautions are not observed.

Risk factors and seroprevalence of hepatitis C antibody in blood donors in Nigeria.

OBJECTIVE: To determine risk factors and sero-prevalence of hepatitis C virus antibody (anti-HCV) in blood donors in Nigeria. DESIGN: A descriptive study was performed on 260 healthy blood donors. Sera were screened for anti-HCV, using enzyme linked immuno-absorbent assay. Personal information and risk factors associated with positive anti-HCV was volunteered by the study subjects using a questionnaire. SETTING: Blood Bank of the University of Benin Teaching Hospital, Benin, Nigeria. SUBJECTS: Two hundred and sixty healthy volunteer male donors aged 20-54 years. RESULTS: Anti-HCV prevalence rate was 12.3%. Fifty six point six per cent of the anti-HCV positives were in the 41-50 year age group. There was an association between anti-HCV positive and history of exposure to heterosexual partners at risk, history of sexually transmitted disease; low socio-economic status and hepatitis B surface antigen positivity. CONCLUSION: The prevalence rate was 12.3%; this was the highest reported among volunteer blood donors in Nigeria. In order to reduce the spread of hepatitis C virus, we recommend elimination of donors with risk factors identified as being associated with anti-HCV. The introduction of cost effective screening and public education on the epidemiology of anti-HCV, is also recommended.

Acceptability of prenatal diagnosis of sickle cell anaemia by a sample of the Nigerian population.

The acceptability of prenatal diagnosis (PND) as a means of controlling sickle cell anaemia (SCA) in Nigeria was examined using a semi-structured questionnaire. The aim of the study was to examine the attitudes of well-informed, educated Nigerians to the use of PND and abortion of confirmed HbSS pregnancies in the control of SCA. There were 433 respondents comprising 204 males and 210 females (gender was not recorded for 19 respondents). They were aged 15-50 (31 +/- 18) years. Forty percent had HbAA, 15% HbAS, 1.6% HbAC, 2% HbSS, and 0.2% HbSC; 153 (35%) had no knowledge of their haemoglobin electrophoretic patterns "genotypes". The majority of the respondents (69.5%) appreciated the role of both parents in the transmission of the disease. Only 45 (18%) of the respondents heard of SCA for the first time through sickle cell counsellors, 23% through newsmedia, 29% through friends and relations, 21% obtained the information through health workers, while 5% had never heard of sickle cell disease before the interview. As many as 192 (44%) of the respondents were aware that SCA could be diagnosed in pregnancy; 45% would opt for termination of the affected pregnancies. Avoidance of the problems associated with managing SCA children was the most important reason for approving pregnancy termination, whereas 73% of those rejecting pregnancy termination did so for religious and moral reasons. Seventy-eight percent of those interviewed would want PND started in Nigeria. The two approved control measure for SCA by most of the respondents were genetic counselling and PND; both should, therefore, be considered in implementing control measures for SCA in this country.