Relevance of fibrinolytic protein (D-dimer) and fibrinopeptide A as markers of sickle cell anaemia vaso-occlusive crisis.

AIMS AND OBJECTIVES: To determine the plasma concentration of fibrinolytic protein (D-dimer) and Fibrinopeptide A(FPA) in sickle cell anaemia (SCA) patients in steady state and vaso-occlusive crisis(VOC) for the purpose of determining their clinical value in assessing/or predicting the onset of VOC Subjects and Methods: A total of 25 (14 Males: 11Females) HbSS subjects in VOC , 24 (13M:11F) HbSS subjects in steady state between the ages of 10-40 years old and 30 (17M:13F) healthy HbAA volunteers, of the same age and sex with the subjects were recruited for the study. Haematological parameters{Haemoglobin (Hb), Haematocrit(HCT), White blood cell count(WBC) and Platelets(Plt)}, prothrombin time(PT), activated partial thromboplastin time(APTT), plasma concentrations of D-dimer and FPA were determined. RESULTS: Haemoglobin concentration of 6.22±1.75 g/dl and HCT of 18.45±6.43% for SCA subjects in VOC; Hb of 7.42±1.36 g/dl and HCT of 22.83 ±4.68% in steady state were significantly decreased(p <0.01) compared with Hb(13.0±1.04 g/dl and HCT( 41.09±3.50%) for HbAA controls. However, plasma FPA of 680.99 ± 411.37 ng/ml, WBC of 19.44±14.88 x109/L, Plt of 292.72±148.57 x109/L, APTT of 52.24±5.34sec. for SCA subjects in VOC and Plasma FPA of 449.67 ± 310.01 ng/ml, WBC of 11.84±7.67 x109/L, Plt of 292.72±148.57 x109/L, APTT of 47.76±4.80secs in steady state were significantly increased when compared with FPA(163.52 ± 86.26ng/ml), WBC(5.15±1.24 x109/L), Plt(173.44±59.90 x109/ L), APTT( 37.75±1.41secs) for HbAA controls. CONCLUSION: Fibrinolysis is not significantly increased in SCA either in the steady state or during VOC. Fibrinopeptide A assay appears to be of value in the assessment of VOC in sickle cell anaemia.

Acid ingestion in a 2-day old baby.

The incidence of chemical burns is low when compared to thermal burns. It can occur in little children accidentally if chemicals are left within their reach. A case is presented of a 2-day old male child who ingested a corrosive substance in unknown circumstances. He developed severe respiratory problems necessitating endotracheal intubation, and later died from acute necrotizing oesophago-gastritis and lung collapse. The severity of damage caused by corrosive chemicals is discussed and the role of the anaesthetist in the initial management is highlighted.