Long-Term Ovarian Function Assessment After Haematopoietic Stem Cell Transplantation in Female Sickle Cell Anaemia Survivors.

BACKGROUND: Haematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for sickle cell anaemia (SCA). While HSCT offers the possibility of disease remission, it can also lead to long-term complications, including gonadal dysfunction and premature menopause. METHODS: We conducted a retrospective cohort study of female survivors who had hydroxyurea therapy and those who underwent post-HSCT follow-up for SCA at a teaching hospital in Lagos, Nigeria, between January 2019 and December 2022. Participants were eligible if they were at least five years post-HSCT or hydroxyurea treatment and had available serum samples for markers of ovarian function measurement. Demographic and clinical data were collected from the hospital register and patients' medical records. Serum levels of oestradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and anti-Müllerian hormone (AMH) were measured using the Abbott Architect i1000SR chemiluminescent immunoassay analyzer (Abbott Diagnostics, Abbott Park, IL). Descriptive statistics and inferential analyses were used to assess the relationship between markers of ovarian function (FSH and AMH) and clinical parameters. RESULTS: There were statistically significant differences in the median serum levels of all the assessed endocrine hormones between the HSCT and non-HSCT (hydroxyurea) groups of SCA survivors. Up to 82.6% of the SCA survivors experienced ovarian dysfunction after HSCT treatment. Impaired ovarian function in SCA survivors was associated with a longer median follow-up duration than in SCA survivors who had normal ovarian function (12.0 vs. 7.5 years, p = 0.048). There were higher odds of impaired ovarian function in the SCA survivors who had myeloablative regimens than in those who had reduced intensity conditioning regimens (94.1% vs. 50.0%, p = 0.040). CONCLUSION: Our study highlights the significant impact of HSCT on long-term ovarian function in female SCA survivors. However, further prospective studies with larger sample sizes and longer follow-up periods are required to confirm our findings and elucidate the factors influencing ovarian function in SCA survivors of HSCT. In addition, studies are also needed to further elucidate the optimal transplant protocols and fertility preservation strategies to minimize gonadal toxicity and preserve reproductive potential in female SCA patients undergoing HSCT.

Prevalence and determinants of moderate-to-severe anaemia in the third trimester of pregnancy: a multicenter cross-sectional study in Lagos, Nigeria.

The high burden of anaemia during pregnancy underscores the urgent need to gain a comprehensive understanding of the factors contributing to its widespread occurrence. Our study assessed the prevalence and the trends of moderate-to-severe anaemia (MSA) in late pregnancy (28 to 36 weeks) and then investigated the key determinants driving this prevalence among women in Lagos, Nigeria. We conducted a secondary data analysis involving 1216 women enrolled in the Predict-PPH study between January and March 2023. We employed a multivariate binary logistic regression model with a backward stepwise selection approach to identify significant predictors of MSA. The study revealed a 14.5% prevalence of MSA during pregnancy. Independent predictors of MSA included having given birth to two or more children (adjusted odds ratio = 1.46, 95% confidence interval: 1.03-2.07), having a maternal body mass index (BMI) of 28 kg/m2 or higher (adjusted odds ratio = 1.84, 95% confidence interval: 1.29-2.61), having less than tertiary education (adjusted odds ratio = 1.51, 95% confidence interval: 1.08-2.11), and being unemployed (adjusted odds ratio = 1.97, 95% confidence interval: 1.19-3.26). It is crucial for pregnant women, particularly those with higher parities and elevated BMI, to be monitored regularly for anaemia and its consequences during their antenatal care. Additionally, addressing the link between low education, unemployment, and anaemia necessitates comprehensive strategies that empower women in terms of education and economic status to enhance the overall well-being of individuals and communities, ultimately reducing the prevalence of anaemia and associated health issues in pregnancy.

Prenatal anaemia and risk of postpartum haemorrhage: a cohort analysis of data from the Predict-PPH study.

BACKGROUND: Most previous clinical studies investigating the connection between prenatal anaemia and postpartum haemorrhage (PPH) have reported conflicting results. OBJECTIVES: We examined the association between maternal prenatal anaemia and the risk of PPH in a large cohort of healthy pregnant women in five health institutions in Lagos, Southwest Nigeria. METHODS: This was a prospective cohort analysis of data from the Predict-PPH study that was conducted between January and June 2023. The study enrolled n = 1222 healthy pregnant women giving birth in five hospitals in Lagos, Nigeria. The study outcome, WHO-defined PPH, is postpartum blood loss of at least 500 milliliters. We used a multivariable logistic regression model with a backward stepwise conditional approach to examine the association between prenatal anaemia of increasing severity and PPH while adjusting for confounding factors. RESULTS: Of the 1222 women recruited to the Predict-PPH study between January and June 2023, 1189 (97·3%) had complete outcome data. Up to 570 (46.6%) of the enrolled women had prenatal anaemia while 442 (37.2%) of those with complete follow-up data had WHO-defined PPH. After controlling for potential confounding factors, maternal prenatal anaemia was independently associated with PPH (adjusted odds ratio = 1.37, 95% confidence interval: 1.05-1.79). However, on the elimination of interaction effects of coexisting uterine fibroids and mode of delivery on this association, a sensitivity analysis yielded a lack of significant association between prenatal anaemia and PPH (adjusted odds ratio = 1.27, 95% confidence interval: 0.99-1.64). We also recorded no statistically significant difference in the median postpartum blood loss in women across the different categories of anaemia (P = 0.131). CONCLUSION: Our study revealed that prenatal anaemia was not significantly associated with PPH. These findings challenge the previously held belief of a suspected link between maternal anaemia and PPH. This unique evidence contrary to most previous studies suggests that other factors beyond prenatal anaemia may contribute more significantly to the occurrence of PPH. This highlights the importance of comprehensive assessment and consideration of various maternal health factors in predicting and preventing this life-threatening obstetric complication.

Incidence and Antepartum Risk Factors of Severe Postpartum Haemorrhage in Anaemic Pregnant Women in Lagos, Nigeria: A Secondary Cohort Analysis.

BACKGROUND: The magnitude and risk factors for postpartum haemorrhage (PPH) have been extensively investigated, although little is currently known about the incidence and predictors of severe PPH, specifically among women affected by prenatal anaemia in Nigeria. OBJECTIVES: The study determined the incidence and antepartum risk factors of severe PPH in anaemic pregnant women in five health institutions in Lagos, Southwest Nigeria. METHODS: A secondary analysis was performed using the data of pregnant women with anaemia from the "Predict-PPH" study that was conducted between January and June 2023. This study included n=570 pregnant women affected by anaemia who gave birth in five hospitals in the Lagos metropolis of Nigeria. The study outcome was severe PPH, defined as an estimated blood loss of at least 1000 mL within 24 hours of childbirth. A backward stepwise conditional approach in a multivariable logistic regression model was utilised to identify the independent risk factors for severe PPH in anaemic pregnant women. RESULTS: Of the 570 women with prenatal anaemia enrolled in the primary study, 42 (7.4%) had severe PPH. The identified independent risk factors for severe PPH were maternal obesity (adjusted OR = 3.85, 95% CI = 1.85-8.02), antepartum haemorrhage in index pregnancy (adjusted OR = 2.98, 95% CI = 1.29-6.90), uterine fibroids (adjusted OR = 6.10, 95% CI = 2.39-15.52), delivery gestational age ≥39 weeks (adjusted OR = 2.62, 95% CI = 1.23-5.56), and delivery by caesarean birth (adjusted OR = 16.75, 95% CI = 5.81-48.31). CONCLUSION: About one in 13 anaemic pregnant women enrolled in the study developed severe PPH during childbirth. Maternal obesity, antepartum bleeding in the current pregnancy, co-existing uterine fibroids in pregnancy, delivery gestational age beyond 38 weeks, and caesarean birth in the current pregnancy were factors that were significantly associated with severe PPH in anaemic pregnant women. These findings underscore the importance of increased vigilance during both the antenatal and peripartum periods to identify women with these risk factors for the initiation of timely interventions to prevent severe PPH.

Knowledge, attitude and premarital screening practices for sickle cell disease among young unmarried adults in an urban community in Lagos, Nigeria.

Introduction: sickle cell disease (SCD) refers to a group of inherited blood disorders that are life-long and affect many people globally. An estimate of 2.3% of the Nigerian population suffer from SCD and about 25% of adults have the sickle cell gene. Premarital screening for sickle cell gene is considered one of the methods of preventing new births of children with SCD among the young adults. The study assessed the knowledge, attitude, willingness to take premarital screening test for SCD and factors influencing knowledge among young unmarried adults in an urban community in Lagos, Nigeria. Methods: the study was cross-sectional descriptive among 300 respondents who were selected using multistage sampling technique. Data were collected using a pre-tested, interviewer-administered questionnaire and analyzed using SPSS software, version 25. Univariate and bivariate analysis were conducted with level of significance at p ≤ 0.05. Results: the mean age of respondents was 21.2± 3.5 years, and most 188 (62.7%) were males. About 139 (46.3%) and 165 (55.0%) of the respondents respectively had good knowledge and positive attitude towards SCD and premarital screening. Only 43% of the respondents knew their haemoglobin phenotype, however, majority (92.4%) were willing to have Hb phenotype test done. Knowledge of SCD and premarital screening was statistically significant with age, level of education and occupation of respondents (p<0.001). Conclusion: this study found less than half of the respondents with good knowledge, about half had positive attitude and poor premarital screening practices of SCD. Therefore, community-based health education and awareness programs on SCD and premarital screening among young adults is recommended.

Outcome of acute myeloid leukaemia in Nigeria: clinician's perspective.

The outcome of acute myeloid leukaemia (AML) has remained a major concern even in developed countries. In resource poor countries, it is envisaged that the outcome will be far worse because of late presentations, lack of appropriate diagnostic facilities and supportive care. However, data to validate this is lacking and many of these countries lack an effective cancer registry. This study determined the clinician's perspective of the outcome of care of AML patients in Nigeria and their attitudes to the care of these patients. Structured self-administered questionnaire was used to assess the clinician's perception of outcomes of care, contributory factors and attitude to care of AML patients. Ninety-eight percent of clinicians reported that the outcome of care was suboptimal; 73.3% and 90.6% of the clinicians reported having less than 31% of AML patients surviving induction and post-induction therapies, respectively. Sixty-six-point one percent (66.1%), 50% and 62.7% of the clinicians have never used immunophenotyping, cytogenetic or molecular studies, respectively, in the management of AML patients under their care. Access to blood components other than Red cells was low; 23.3% had access to apheresis platelets and 55% to fresh frozen plasma. Forty-six percent of clinicians will either give half dose of chemotherapy or offer only supportive care. This reported early death rate is three times higher than that reported in developed countries with only 9% likely to survive the first year of induction compared to about 32.9% in Ontario. Approximately 28 units of pooled or apheresis derived platelet may be required in course of therapy but just 10% of clinicians have access to platelet apheresis. Lack of diagnostic facilities, blood components and clinicians' attitudes are contributing factors to the extremely poor outcomes of patients with AML in Nigeria.

Awareness and practice of cord blood donation by pregnant women in Lagos Nigeria: Practice implication for future cord blood transplantation in Nigeria.

Background: Poor awareness remains a substantial limitation to harnessing the benefits of umbilical cord blood (UCB) in sub-Saharan Africa. The aim of this study was to determine the level of awareness and factors influencing intention to donate cord blood to blood bank among antenatal clinic attendees at a tertiary hospital in Nigeria. Methods: We conducted a questionnaire-based cross-sectional study of 400 women attending the antenatal clinic of a tertiary hospital in Lagos, Nigeria, between February and June 2018. The data were analyzed using Stata version 13; comparisons were conducted with Chi-square, Student's t-test, and Mann-Whitney U-test. Univariable and multivariable binary logistic regression was conducted with "willingness to donate" as the outcome variable. Results: Majority (n = 287/331 [86.2%, 95% confidence interval [CI]: 76.4-84.9]) of the participants had some knowledge of UCB, almost half intended future donation of UCB (n = 161/333, [48.3%, 95% CI: 42.9-53.6]). Based on our findings, factors such as religion (P = 0.001), education (P = 0.03), information from health-care provider (P < 0.001) appear to influence awareness, and the decision to donate UCB. Conclusion: Although the awareness of the clinical uses of UCB is very limited in Nigeria, the intent to participate in UCB donation is high. Factors such as religion, education, and prior information about UCB donation by health-care providers have been identified in this study to have an influence on the decision to donate UCB.

RésuméContexte: La faible sensibilisation demeure une limitation substantielle à l'exploitation des avantages du sang de cordon ombilical (UCB) en Afrique subsaharienne. Le but de cette étude était de déterminer le niveau de sensibilisation et les facteurs influençant l'intention de donner du sang de cordon à une banque de sang parmi Les participants à une clinique prénatale dans un hôpital tertiaire au Nigéria. Méthodes: Nous avons mené une étude transversale basée sur un questionnaire auprès de 400 femmes fréquentant la clinique prénatale d'un hôpital tertiaire à Lagos, au Nigeria, entre février et juin 2018. Les données ont été analysées à l'aide de Stata version 13; des comparaisons ont été effectuées avec le chi carré, le test t de Student et le test U de Mann-Whitney. Binaire univariable et multivariable une régression logistique a été effectuée avec la "volonté de donner" comme variable de résultat. Résultats: Majorité (n = 287/331 [86,2%, confiance à 95% intervalle [IC]: 76,4­84,9]) des participants avaient une certaine connaissance de l'UCB, près de la moitié des dons futurs prévus de l'UCB (n = 161/333, [48,3%, IC à 95%: 42,9-53,6]). Des facteurs tels que la religion (P = 0,001), l'éducation (P = 0,03), les informations fournies par le prestataire de soins de santé (P <0,001) ont influence la sensibilisation et la décision de faire un don d'UCB. Conclusion: Bien que la connaissance des utilisations cliniques de l'UCB soit très limitée au Nigéria, la l'intention de participer au don UCB est élevée. Facteurs tels que la religion, l'éducation et les informations préalables sur le don d'UCB par les soins de santé les prestataires ont été identifiés dans cette étude comme ayant une influence sur la décision de faire un don d'UCB.

A Comparative Study of Serum Ferritin Levels Among Unfit and Fit Blood Donors.

BACKGROUND: Cheap methodologies are being utilized by low-resource countries to determine blood donors' fitness. Important hematological biomarkers might have to be evaluated to enhance the use of these methods. AIMS: The study evaluated the pattern of serum ferritin in 18-24 fit and unfit prospective blood donors (PDBs) and the prevalence of iron store deficiency. SETTINGS AND DESIGN: This study was a cross-sectional, comparative study which was conducted at the blood donor clinic of the Lagos University Teaching Hospital. MATERIALS AND METHODS: Blood samples were collected by venipuncture into sodium-ethylenediaminetetraacetic acid and plain bottles. The latter was centrifuged and used for ferritin determination via human ferritin enzyme-linked immunosorbent assay test kit, while the former was used for red cell indices analysis using an autoanalyzer. STATISTICAL ANALYSIS: Data were analyzed using SPSS version 20, values were presented as mean ± standard deviation, and P ≤ 0.05 was considered statistically significant. RESULTS: A total of 263 PDB were recruited into the study consisting of 210 (79%) males and 53 (21%) females, with a mean age of 32.88 ± 8.22. Only 110 (41.8%) of the participants were considered fit, while 153 (58.2%) were unfit using copper sulfate specific gravity. There was no statistically significant difference (P = 0.301) in the mean level of serum ferritin in unfit blood donors (74.5 ± 90.8 µg/L) compared to that of the fit blood donors (61.5 ± 54.5 µg/L). The prevalence of iron store depletion among blood donors in Lagos state was 11.8% (31 of 263) with a higher proportion (7.6%) occurring among unfit donors. However, low levels of serum ferritin (<15 µg/L) were significantly associated with the occurrence of anemia (hemoglobin < 12.5 g/gl) among unit donors (19%; P = 0.05). CONCLUSION: Although serum ferritin depletion appears to be higher in the unfit blood donors, the use of serum ferritin as an index for the screening and determination of PDBs' fitness requires further evaluation.

Correction to: Population data of 21 autosomal STR loci in the Hausa, Igbo and Yoruba people of Nigeria.

In the original paper author Alani Sulaimon Akanmu was erroneously omitted from the author list. Prof. Akanmu has now been added as 4th author. Prof. Akanmu acted as an academic supervisor of the study and additionally contributed to the publication by reading, commenting and editing the manuscript.

Population data of 21 autosomal STR loci in the Hausa, Igbo and Yoruba people of Nigeria.

The three major ethnic groups of Nigerian population namely the Hausa, Igbo and Yoruba make up 29, 21 and 18% of the total population, respectively. To provide genetic information necessary for forensic analysis, this study was carried out to determine STR allele frequencies in 102 Hausa, 128 Igbo and 134 Yoruba individuals in Nigeria using 21 STR loci including the 20 CODIS (Combined DNA Index System) loci plus SE33.

Clinicopathologic review of polyps biopsied at colonoscopy in Lagos, Nigeria.

INTRODUCTION: Colorectal polyps are known precursors of colorectal cancers. The increase in utilization of colonoscopy in Nigeria has meant a rise in the recently reported incidence of these lesions. The aim of this study is to evaluate the clinicopathological profile of colorectal polyps biopsied during the inaugural 12 month period of colonoscopy from a private endoscopy suite in Nigeria. METHODS: This is a retrospective review of all the clients who had polyps diagnosed at colonoscopy over a 12 month period (August 2014 -July 2015) at a private endoscopy suite in Lagos, Nigeria. This analysis of prospectively collected data was performed using clinical information from the endoscopy logs and pathology database system of a private endoscopy suite based in Lagos, Nigeria. RESULTS: A total of 125 colonoscopies were carried out over the stated period. Of these, 14 individuals had a total of 18 polyps- 4 clients (28.6% of the persons with polyps) had two polyps each. The polyp detection rate was 11.2% while the polyp per colonoscopy rate was 14.4%. Of these clients, males were 10 in number; giving a male to female ratio of 2.5:1. Their ages ranged from 37 to 77 years (mean= 57.3 years). The presenting complaint at colonoscopy was hematochezia in 11 (78.6%), new onset constipation in 2 (14.2%) and peri-anal pain in 1 patient (7.1%). The polyps were distributed as follows; 2 (11.1%) in the ascending colon, 1 (5.6%) each in the transverse and descending colons, 8 (44.4%) in the sigmoid colon, 6(33.3%) located in the rectum. Hence, there was left sided (15 of 18= 83.3%) preponderance. Pathologically, tubular (adenomatous) polyp with or without low grade dysplastic changes was diagnosed in 6 of the 18 polyps (giving an adenoma detection rate of 4.8%), 4 (22.2%) were inflammatory polyps, 1 (5.6%) was malignant and another had the rare inflammatory fibroid polyp. Five (27.8%) of the specimens were reported as non-specific colitis. CONCLUSION: The study supports the present wisdom that polyps are clearly less prevalent in our environment when compared to the Western world. The increased prevalence with advancing age, in male subjects and of left sided lesions, is also in keeping with previous results from our environment. A case is also advanced for the increased deployment of endoscopy as a tool for the detection of these polyps and ultimately, the reduction of colorectal cancer in our population.

Pattern of haematologic abnormalities in incident dialysis patients and the effect of using locally derived haematologic reference ranges.

Background: The aim of the study was to compare the prevalence of haematologic abnormalities seen in incident haemodialysis patients using standard laboratory reference ranges with reference ranges derived locally. Study Design and Method: This was a retrospective study of 97 patients with renal failure who received haemodialysis at a single dialysis unit in Lagos, Nigeria. All patients were 18 years of age or older, had renal failure requiring dialysis, and had not previously dialyzed. Patients with a history of haemoglobinoapthy or other red cell disorders, recent history of overt blood loss or blood transfusion and pregnancy were excluded. Results: Fifty six (57.7%) of the patients were males; and 55 (56.7%) had chronic kidney disease. There were no significant differences in baseline characteristics between males and females, however, patients with CKD had significantly higher mean systolic and diastolic blood pressures, mean serum creatinines and lower mean haemoglobin concentrations. Overall, anaemia was the most common haematologic abnormality (97.9%), followed by leukocytosis (34.0%). Leukopenia, thrombocytosis and thrombocytopenia were less common (3.1%, 7.2% and 10.3% respectively). The use of locally derived reference ranges was associated with significantly higher frequencies of occurrence of majority of the haematologic abnormalities studied. Conclusion: Haematological abnormalities occurred frequently in the study population. Use locally derived haematologic reference ranges was associated with significant differences in the frequency and pattern of some of the haematologic abnormalities. Further studies are needed to determine the clinical implications of these findings.

Estimating the Risk of ABO Hemolytic Disease of the Newborn in Lagos.

Background. ABO hemolytic disease of the newborn is the most common hemolytic consequence of maternofetal blood group incompatibility restricted mostly to non-group-O babies of group O mothers with immune anti-A or anti-B antibodies. Aim. We estimated the risk of ABO HDN with view to determining need for routine screening for ABO incompatibility between mother and fetus. Materials and Methods. Prevalence of ABO blood group phenotypes in blood donors at the donor clinic of the Lagos University Teaching Hospital and arithmetic methods were used to determine population prevalence of ABO genes. We then estimated proportion of pregnancies of group O mothers carrying a non-group-O baby and the risk that maternofetal ABO incompatibility will cause clinical ABO HDN. Results. Blood from 9138 donors was ABO typed. 54.3%, 23%, 19.4%, and 3.3% were blood groups O, A, B, and AB, respectively. Calculated gene frequencies were 0.1416, 0.1209, and 0.7375 for A, B, and O genes, respectively. It was estimated that 14.3% of deliveries will result in a blood group O woman giving birth to a child who is non-group-O. Approximately 4.3% of deliveries are likely to suffer ABO HDN with 2.7% prone to suffer from moderately severe to severe hemolysis.

An audit of request forms submitted in a multidisciplinary diagnostic center in Lagos.

INTRODUCTION: Request forms are important means of communication between physicians and diagnostic service providers. Pre-analytical errors account for over two thirds of errors encountered in diagnostic service provision. The importance of adequate completion of request forms is usually underestimated by physicians which may result in medical errors or delay in instituting appropriate treatment. The aim of this study was to audit the level of completion of request forms presented at a multidisciplinary diagnostic center. METHODS: A review of all requests forms for investigations which included radiologic, laboratory and cardiac investigations received between July and December 2011 was performed to assess their level of completeness. The data was entered into a spreadsheet and analyzed. RESULTS: Only 1.3% of the 7,841 request forms reviewed were fully completed. Patient's names, the referring physician's name and gender were the most completed information on the forms evaluated with 99.0%, 99.0% and 90.3% completion respectively. Patient's age was provided in 68.0%, request date in 88.2%, and clinical notes/ diagnosis in 65.9% of the requests. Patient's full address was provided in only 5.6% of requests evaluated. CONCLUSION: This study shows that investigation request forms are inadequately filled by physicians in our environment. Continuous medical education of physicians on the need for adequate completion of request forms is needed.