Quality assessment of platelet concentrate prepared at a tertiary centre in Nigeria.

The need for platelet transfusion has increased at the University College Hospital (U.C.H.) Ibadan, Nigeria because of improved patient care and use of intensive therapeutic regimen associated with bone marrow aplasia. Therefore there is a need to assess the quality of the platelet concentrate prepared in our environment with a view to improving the quality of services available, consequently this study was carried out. Fifty platelet concentrates were assessed for pH, swirling index, volume, platelet count, WBC count and red cell count. All the concentrate preparations were within acceptable pH value of 7.25. The average volume was 18.52 mls/bag. The average platelet count per concentrate was 41.7+/-39.5 x 10(9)/L. Thirty-five percent (35%) of the platelet concentrates had a value > 55 x 10(9)/L. White blood cell count (WBC) < 12 x 10(9)/L was seen 49% of the platelet concentrates prepared. Forty percent (40%) of the platelet concentrate had a red blood cell count (RBC count) > 12 x 10(9)/L with 30% not having red cell contamination. Swirling test was positive in 72% of the platelet concentrate units. The results from this study point to the need to improve the quality of the platelet concentrates being prepared in our blood bank in order to get maximum therapeutic values. There is also a need for regular quality control of the platelet concentrate being prepared in our blood bank.

Septicaemia in sickle cell anaemia patients: the Ibadan experience.

OBJECTIVE: To describe the pattern of septicaemia among sickle cell anaemia patients. DESIGN: Descriptive study. SETTING: Haematology Day Care Unit of the University College Hospital, Ibadan, Nigeria. SUBJECTS: 269 patients with sickle cell anaemia who presented with fever greater than 38 degrees C. RESULTS: The blood of 97 of the patients exhibited positive growth with isolation of bacteria thereby confirming the diagnosis of septicaemia in them. Fifty seven (59%) of the isolates were gram negative while 40 (41%) were gram positive pathogens. Klebsiella sp. was the predominant gram negative bacteria while Staphylococcus aureus was the predominant gram positive bacteria. The sensitivity tests on the isolates confirmed Ceftozidine (Fortum) was the most effective antibacterial agent for the gram negative and gram positive pathogens. The 172 patients, who had no bacteria pathogens isolated did well with prophylactic broad spectrum antibiotics. Thirty one patients with positive malarial parasites had full anti-malarial therapy. CONCLUSION: The incidence of gram negative septicaemia is high in patients with sickle cell anaemia. Klebsiella spp. is the predominant gram negative bacterium while Staphylococcus aureus is the predominant gram positive bacterium. Ceftozidine appears to be the most effective antibiotic against both the gram positive and gram negative bacterial infection.

Haematological values in pregnancy in Ibadan, Nigeria.

Haematological values were studied in 495 apparently healthy pregnant Nigerian women receiving antenatal care in a maternity hospital in Ibadan, Nigeria. Means, standard deviations and ranges of haematrocrit, total and differential white cell counts, absolute platelet count, erythrocyte sedimentation rte, prothrombin time (PT) and partial thromboplastin time (PTTk) were determined. The mean haematrocrit was 0.311 (SD 0.033), mean total leucocyte count was 5.765 x 10(9)/L (SD 1.753 x 10(9)/L) and mean platelet count was 193 x 10(9)/L (SD 46 x 10(9)/L). The mean erythrocyte sedimentation rate was 18.6 (SD 7.4) mm/hour, mean prothrombin time was 12.3 (SD 2.5) seconds and mean partial thromboplastin time was 38.4 (SD 2.0) seconds. There were significant differences between the second and third trimesters of pregnancy in nay of the haematological values studied. The study has presented the range of variations in haematological values (including those that measure coagulation) in apparently healthy pregnant Nigerian women. It would appear that in the population studied, there were no significant differences in these haematological values between the second and third trimesters in otherwise healthy women receiving regular antenatal care.

Coagulation profile in healthy Nigerian neonates.

A study of some coagulation factors were carried out in preterm and term infants on the first day of life. Screening coagulation tests--prothrombin time (PT), partial thromboplastin time with kaolin (PTTK) and the concentrations of Factors VIII: C and fibrinogen were determined in 100 normal newborn infants classified into three groups according to their gestational ages: 28 to 30 weeks, 31 to 36 weeks, 37 to 42 weeks. The respective values were compared with those of six-month-old infants as well as adults. The mean values of the screening coagulation tests, PT and PTTK, Factor VIII: C and fibrinogen were significantly different in all the three gestational age groups of nonates when compared with those of six-month-old infants and adult Nigerians. This suggests that a relative hypocagulable state exists among newborn infants and could be responsible for increased bleeding tendencies in these groups of infants. This is the first documented report of coagulation profile in Nigerian neonates, and the range obtained in this study can thus be regarded as standard for healthy Nigerian neonates. The body of data should therefore provide a basis for evaluating newborn noenates with bleeding problems.

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.

Neurological manifestations of chronic myelogenous leukaemia.

Neurological manifestations occur in about one-quarter of patients with chronic myelogenous leukaemia (CML), usually as a result of hyperleukocytosis, predisposing to intravascular thrombus formation. We report the clinical and pathological findings in a 16-year-old female with CML who presented with deafness, blindness and paraplegia, and discuss possible aetiopathogenetic mechanism.

Bacterial causes of acute osteomyelitis in sickle cell anaemia: changing infection profile.

The bacterial causes of osteomyelitis were reviewed on 25 patients with sickle cell anaemia using blood culture and direct wound swab. Age range was 2 to 45 years with a median of 23 years. Klebsiella species were cultured in 45% of the blood samples. Staphylococcus aureus was responsible in 20%, Salmonella species in 8% and Streptococcus pyogenes was cultured in 4% of the samples. From direct wound swab culture, Klebsiella was responsible for 36%, Staphylococcus aureus 28% and coagulase Negative Staphylococcus 24%. Proteus species were responsible for 8% and Salmonella was cultured in 4%. The highest number of patients presenting with osteomyelitis occurred in the second decade. From (culture) sensitivity tests, ceftazidine and Ofloxacine were found to be the most effective antibacterial drugs. The preponderance of Klebsiella indicates a change in the previously accepted pattern of infection in which Salmonella species were considered to be the main causative organism.

Acceptability of prenatal diagnosis of sickle cell anaemia (SCA) by female patients and parents of SCA patients in Nigeria.

The acceptability of prenatal diagnosis (PND) of sickle cell anaemia (SCA) as a means of controlling sickle cell disorder in Nigeria was examined using a structured questionnaire. The respondents were comprised of 92 adult female patients with SCA, aged 15-20 (23 +/- 6) years; 53 HbAS mothers, aged 20-61 (37 +/- 11) years and 48 HbAS fathers, aged 33-65 (46 +/- 8) years. More than 85% of the respondents would like PND to be offered in Nigeria and 92% of the HbAS mothers as well as 86% of the fathers would like to have the investigation or allow their wives to go through the procedure, respectively. Only 35% of the patients as compared to 63% of the mothers and 51% of the fathers would opt for termination of an affected pregnancy. Fear of the complications of abortion and religious convictions were the two most frequently cited reasons for opposing pregnancy termination. The high percentage of parents who would opt for termination of an affected pregnancy was associated with the societal emphasis on perfection and on previous experience in management of SCA patients. It is interesting that most of the respondents still favoured effective genetic counselling as the best means of controlling SCA.

A review of cephalhaematoma in adult sickle cell disease patients.

Twelve patients with sickle cell disease (SCD), eleven males within the age range 21 to 24 years and one female, fourteen years old presenting with cephalhaematoma at the Haematology Day Care Unit (H.D.C.U.) of the University College Hospital, Ibadan during a three year period were reviewed. Only one patient was sickle cell haemoglobin SC (HbSC) while others were homozygous (HbSS). They all presented with a triad of symptoms consisting of fever, headaches and scalp swelling. Significant findings include the exclusive male preponderance and the almost exclusive presentation in HbSS patients. Treatment include analgesic and intravenous fluids.

Aplastic anaemia: a review of cases at the University College Hospital, Ibadan, Nigeria.

Thirty male and 27 female patients were treated at the University College Hospital, Ibadan, over a 20 year period (January, 1971 to December, 1990) for aplastic anaemia. Age range was three months to 52 years with a median of 19 years. In 26 patients the aplasia could not be linked with a particular cause. Most patients in this category were students in secondary and tertiary institutions, office workers and casual labourers. Nineteen patients were automobile and factory workers who are exposed to lead while two were dealers in petroleum products. In two patients aplasia was linked to chloramphenicol ingestion while in three, the aplasia linked to the use of hair dye. Another three linked the aplasia to a past history of viral hepatitis. One patient had congenital aplasia of the marrow and one was a radiographer. Treatment included oxymethalone 100 mg given three times daily (tds) or intramuscular (i.m.) Durabolin 500 mg weekly. When these drugs were unavailable prednisolone 60 mg daily was administered. No patient had the benefit of bone marrow transplantation (BMT) or the superior drugs, e.g. anti-thymocyte globulin and cyclosporin A. This might have contributed to the poor prognosis as revealed by the survival pattern in which 24 patients died within six months of diagnosis while 19 survived 12 months. Seven patients died within 18 months and four others died within three years. Three patients were alive five years after presentation. Death generally resulted from complications of the aplastic anaemia with gastro-intestinal bleeding, cerebro-vascular accidents and overwhelming infections.

Prognosis of acute lymphoblastic leukaemia in Ibadan, Nigeria.

Patients with acute lymphoblastic leukaemia (ALL) seen in University College Hospital, Ibadan, Nigeria, still have low rates of complete remission and relatively short survival. Yet the overall prognosis was expected to have improved because the proportions of adults, males and people of low socio-economic class among the patients have decreased steadily over the past three decades. Possible causes of the persistent poor performance were sought for in 30 new ALL patients seen in the hospital over a period of 2 years and 9 months. Unfavourable prognostic factors, lack of standard cytotoxic drugs, inadequate supportive care and absence of modern facilities for therapy combined to make their disease outcome worse than expected.