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.

Prognostic impact of iron parameters in patients undergoing allo-SCT.

Iron overload contributes to increased transplant-related mortality, and serum ferritin is typically used to detect iron overload. Other iron parameters have received limited attention. We studied serum ferritin, transferrin, transferrin saturation, iron, soluble transferrin receptor (sTfR) and C-reactive protein (CRP) levels in 230 consecutive patients undergoing myeloablative allo-SCT. All iron parameters were significantly associated with survival. When analyzed individually, both sTfR and transferrin saturation were superior in prognostic power to ferritin (areas under the curve in receiver operating characteristic analysis: 0.670, 0.715, and 0.657, respectively). A combination of ferritin and transferrin saturation had the highest prognostic power: Patients with ferritin below the 30th percentile (<802 ng/mL) showed excellent survival (70±6% at 5 years), while transferrin saturation above the 80th percentile (≥69%) pointed to a high risk of transplant failure (5-year survival 5±5%). The remaining patients showed an intermediate outcome (5-year survival 52±5%). The prognostic impact of iron parameters was independent of other factors such as stage, conditioning regimen and CRP level, and operated similarly across diseases. Iron overload strongly influenced the outcome of allo-SCT. Low pre-transplant ferritin levels indicate a population at low risk, high transferrin saturations and a subgroup of patients with very poor outcome.

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

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.

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.