Clinical and Laboratory Predictors of Frequency of Painful Crises among Sickle Cell Anaemia Patients in Nigeria.

INTRODUCTION: The severity of Sickle Cell Anaemia (SCA) in terms of frequency of painful Vaso-Occlusive Crises (VOC) may be affected by clinical and haematological parameters amongst others. Elucidation of these factors in a given disease prevalent environment is necessary for prompt and effective management of patients with frequent painful VOC. AIM: This study aimed at determining the clinical and laboratory predictors of frequency of painful VOC among SCA patients in Enugu, Southeastern Nigeria. MATERIALS AND METHODS: It was a cross-sectional study of 100 consecutive SCA patients receiving care at the University of Nigeria Teaching Hospital, Enugu, Nigeria between May 2012 and February 2014. The eligible patients were categorized into two groups namely; Group A and Group B. Group A/study group (severe disease) comprised SCA patients who had experienced three or more painful crises (≥3 crises) in the last one year preceding the study but, currently in steady state, while Group B/control group (mild-moderate disease), comprised SCA patients matched for age, sex, highest educational status, and occupation but who have had no painful crisis or had only one or two painful crises (0-2 crises) in the last one year preceding the study and currently in steady state. RESULTS: The overall mean age of the patients was 18.4±12.2 (range=2-52) years. The mean values of the haematological parameters including haemoglobin concentration, white cell count, platelet count, and neutrophil count were significantly higher in those with severe crises than mild-moderate crises (p<0.05). Sickle cell related complications including Avascular Necrosis (AVN) and leg ulcers were significantly higher in the study group than the control group (p<0.05). CONCLUSION: There was significant association between the frequency of crises and haemogblobin level, platelet and neutrophil counts and some clinical parameters: AVN, nephropathy and stroke. Future preventive interventions for reduction in frequency of crisis amongst patients with SCA could be targeted at controlling the blood levels of the identified haematological parameters.

Seroprevalence of human T-cell lymphoma/leukemia virus type-1 (HTLV-1) antibodies among blood donors at Enugu, Nigeria.

BACKGROUND: Human T-cell lymphotrophic/leukemia virus (HTLV-1) is a retrovirus implicated in transfusion-transmitted infection. OBJECTIVE: The objective of this study was to determine the seroprevalence of HTLV-1 antibodies among blood donors at the University of Nigeria Teaching Hospital, Enugu, Eastern Nigeria. METHODS: A cross-sectional study was carried out on consented participants over 4 months. A total of 300 blood donors were recruited consecutively from the blood bank. The serum of the collected 5 mL of blood obtained from each participant was stored at -20°C until required for analysis. The serum samples were then analyzed for antibodies to HTLV-1 using a one-step incubation double-antigen sandwich ELISA (enzyme-linked immunosorbent assay) kit. Participants' demographic characteristics and degree of exposure to the risk factors associated with HTLV-1 infection were captured using a questionnaire. Statistical analysis of results was done using SPSS version 17. RESULTS: Of the 300 blood donors, 288 (96%) were male, while 12 (4%) were female. The average age of the blood donors was 26.85±8.52 years. The age group with the highest representation among the blood donors were those aged between 21 and 25 years. Only 22.3% of the blood donors were above 30 years. None of the 300 screened blood donors tested positive to HTLV-1 antibodies. Hence, the seroprevalence of HTLV-1 infection among blood donors was 0%. Of the blood donors, 5% had history of previous sexually transmitted disease, while 34.7% used condoms during sexual intercourse. CONCLUSION: The seroprevalence obtained in this study cannot statistically support the justification of routine screening of blood donors for HTLV-1 infection. More prospective and multicentered studies are required to determine the infectivity of HTLV-1 in blood donors in Nigeria.

Seroprevalence and correlates of human T-cell lymphoma/leukemia virus type 1 antibodies among pregnant women at the University of Nigeria Teaching Hospital, Enugu, Nigeria.

BACKGROUND: Human T-cell lymphoma/leukemia virus (HTLV)-1 is a retrovirus transmitted vertically from mother to child parenterally and sexually by infected lymphocytes. OBJECTIVE: The objective of this study was to determine the seroprevalence of HTLV-1 antibodies and associated risk factors for HTLV-1 infection among pregnant women in University of Nigeria Teaching Hospital, Enugu, southeast Nigeria. MATERIALS AND METHODS: A cross-sectional study was carried out from July to October 2010. Two hundred pregnant women were recruited consecutively from the antenatal clinic. Five milliliters of blood was collected from each of the participants into a plain sterile bottle and allowed to clot. The serum obtained was stored at -20°C until required for analysis. The serum samples were then analyzed for antibodies to HTLV-1 using a one-step incubation double-antigen sandwich enzyme-linked immunosorbent assay kit. Participants' demographic characteristics and degree of exposure to the risk factors associated with HTLV-1 infection were captured using a questionnaire. Statistical analysis of results was done using SPSS version 17. RESULTS: The average age of the pregnant women was 28.94 years (standard deviation 4.17). The age-group with the highest representation was those between the ages of 26 and 30 years. Thirty-six percent of the population was above 30 years old. The result of the tests showed that only one respondent, a 31-year-old pregnant woman tested positive for HTLV-1 antibodies. Therefore, the seroprevalence of HTLV-1 antibodies among pregnant women attending the antenatal clinic at University of Nigeria Teaching Hospital was 0.5%, with a 95% confidence interval of 0%-2.8%. Some of the sociodemographic risk factors of HTLV-1 infection found to be applicable to the 31-year-old woman who tested positive included positive history of previous sexually transmitted diseases, high parity, low socioeconomic status, female sex, and age above 30 years. The pregnant women that participated in this study were exposed to risk factors and behaviors associated with HTLV-1 infection. Some of the pregnant women (17.5%) had contracted sexually transmitted diseases, and 80.5% did not use condoms during coitus. CONCLUSION: The seroprevalence obtained in this study was low, though it is 100% for anyone infected. More prospective and multicenter studies are required to determine the infectivity of HTLV-1 among pregnant women in Nigeria.

Increased prevalence of activated protein C resistance during pregnancy may implicate venous thrombo embolic disorders as a common cause of maternal mortality in Nigeria

Background: Acquired resistance to protein C in pregnancy has been established as one of the factors associated with thromboembolic phenomenon, an important cause of maternal mortality and morbidity. Objectives: To establish the mean levels of PCA ratio (measure of protein C resistance) of among our pregnant women since maternal mortality rate of the country is on the increase despite efforts to reduce this trend. Materials and Methods: A prospective study was carried out in a tertiary institution in Enugu State, Southeastern Nigeria over the 7 months period from May 2010 to November 2010. Two hundred pregnant women and 50 non pregnant female controls were recruited and PCA ratio, (coagulometric assay) were determined. Results: There was a non significant difference between the mean and standard deviation PCA ratio of the female non pregnant controls and pregnant women in 2nd trimester 4.32±0.4 and 4.30±0.4 respectively. A significant difference was noted between the controls and pregnant women in 3rd trimester 4.32±0.4 and 3.87±0.5 respectively also between the pregnant women in their 2nd and 3rd trimester 4.30±0.4 and 3.87±0.5 respectively. Conclusion: There is increased protein resistance C in our pregnant women. This may implicate thromboembolic disorders as one of the leading causes of increase maternal mortality despite a downward trend in the prevalence of post partum haemorrhage

Platelet Function and Other Indices of Hemostasis in Chronic Liver Disease.

BACKGROUND: Bleeding time has been used for a long time as a global test of platelet function. Due to a number of pitfalls the test has been losing popularity. This study was designed to determine the prevalence of prolonged bleeding time in Nigerians with chronic liver disease in relation to other indices of hemostasis. METHODS: Bleeding time, platelet count, prothrombin time (PT) and activated partial thromboplastin time (aPTT) were determined in patients with chronic liver disease seen over a twenty-eight-month period. Liver disease severity was graded using Child's score. RESULTS: Only 14 of 164 (8.5%) patients with chronic liver disease had prolonged bleeding time while 60 patients (36.6%) had significantly prolonged PT. Thirty seven patients (22.6%) had prolonged aPTT. Bleeding time showed positive correlation with PT and aPTT but negative correlation with platelet count. CONCLUSIONS: Bleeding time is not sensitive in detecting disorders of hemostasis in patients with chronic liver disease although it correlates significantly with other indices of hemostasis.