Aliyu Babadoko

Prevalence and risk factors for pulmonary artery systolic hypertension among sickle cell disease patients in Nigeria

Pulmonary artery systolic hypertension is common and associated with increased mortality among adult sickle cell disease (SCD) patients in the United States. Although the prevalence of SCD is highest in sub‐Saharan Africa, the frequency of pulmonary artery systolic hypertension and the risk factors for the development of pulmonary hypertension have not been reported from Africa. We studied 208 hydroxyurea naïve Nigerian SCD patients at steady state and 94 healthy controls. Pulmonary artery systolic hypertension was defined prospectively as tricuspid regurgitant jet velocity ≥2.5 m/sec. Results were compared with a previously published US prospective SCD cohort. Only 7% of Nigerians compared with 46% of US adults with SCD were >35 years. Tricuspid regurgitant jet velocity was ≥2.5 m/sec in 25% of Nigerian SCD patients. Higher jet velocity was associated with greater serum globulin (P = 0.002), blood urea nitrogen (P = 0.019) and lactate dehydrogenase concentrations (P = 0.026) and with inability to walk >300 m in 6 min (P = 0.042). Compared with the US cohort, Nigerian patients had more hemolysis as indicated by lower hemoglobin and higher lactate dehydrogenase concentrations (P ≤ 0.003). Pulmonary hypertension is common among Nigerian SCD patients. The public health implication of this finding is significant considering the potential number of individuals at risk for this complication. Better understanding of the long term outcome of pulmonary hypertension and causes of death in SCD and the institution of preventive measures are major public health challenges for Africa. The inclusion of African sites in sickle cell pulmonary hypertension clinical trials should be encouraged. Am. J. Hematol., 2008.

Morbidity and Mortality Patterns of Hospitalised Adult HIV/AIDS Patients in the Era of Highly Active Antiretroviral Therapy: A 4-year Retrospective Review from Zaria, Northern Nigeria

Background. This study, undertaken in major tertiary hospital in northern Nigeria, examined the morbidity and mortality patterns of hospitalised adult HIV/AIDS patients in the HAART era. Methods. Between January 2006 and December 2009, admission records and causes of deaths of hospitalised medical HIV-infected patients were retrieved and analysed according to antiretroviral (ART) status. Results. Of the 207 HIV/AIDS patients reviewed, majority were newly diagnosed (73.4%), and most were hospitalised and died from various AIDS-defining illnesses, mainly disseminated tuberculosis and sepsis. Immune-inflammatory-reconstitution-syndrome, ART-toxicity and ART-failure, contributed to morbidity and mortality in patients receiving ART. Sixty six (31.9%) patients died, with higher mortality in males and in those with lower CD4-cell count, lower PCV, and shorter hospital stay. However, hospital stay ≤3 days and severe anaemia (PCV < 24%) were independent predictors of mortality. Conclusion. In the current HAART era, late presentation and tuberculosis continue to fuel the HIV/AIDS pandemic in Africa, with emerging challenges due to ART-related complications.

NT-PROBNP AS A MARKER OF CARDIOPULMONARY STATUS IN SICKLE CELL ANAEMIA IN AFRICA

N‐terminal (NT) pro‐brain natriuretic peptide (proBNP) ≥160 ng/l has a 78% positive predictive value for pulmonary hypertension and is associated with increased mortality in US sickle cell disease patients, but the importance in sickle cell disease patients in Africa is not known. In a cross‐sectional study at Ahmadu Bello University Teaching Hospital, Shika‐Zaria, Nigeria, we studied 133 hydroxycarbamide‐naïve Nigerian sickle cell anaemia patients aged 18–52 years at steady‐state and 65 healthy controls. Twenty‐six percent of patients versus 5% of controls had NT‐proBNP ≥160 ng/l (P = 0·0006). By logistic regression among the patients, human immunodeficiency virus seropositivity, higher serum ferritin and lower haemoglobin or higher lactate dehydrogenase independently predicted elevated NT‐proBNP. After adjustment for haemoglobin concentration, elevated NT‐proBNP concentration was associated with an estimated 7·8‐fold increase in the odds of severe functional impairment, defined as an inability to walk more than 300 m in 6 min (95% confidence interval 1·5–32·6; P = 0·005). Similarly, elevated tricuspid regurgitation velocity was associated with an estimated 5·6‐fold increase in the odds of functional impairment (95% confidence interval 1·5–21·0; P = 0·011). In conclusion, NT‐proBNP elevation is common and is associated with markers of anaemia, inflammation and iron status and with severe functional impairment among sickle cell anaemia patients in Nigeria.

Erythropoietic response to anaemia of dialysis naïve patients with chronic kidney disease in Zaria, north west Nigeria

Introduction: Chronic kidney disease (CKD) is a global health problem with an increasing prevalence worldwide. Anemia is one of its consistent and severe hematological complications although its mechanism is not fully elucidated. The primary defect could manifest as serum erythropoietin (sEPO) deficiency or EPO resistance. We set out to determine the erythropoietic response to anemia of patients with CKD and its relationship with their iron status in a cross-sectional descriptive study of 91 patients in various stages of CKD. Materials and Methods: Soluble transferrin receptor (sTfR), sEpo, and serum ferritin levels were determined using ELISA method (Diagnostic Automation Inc and WKEA med supplies corp.). Data generated were analyzed using Epi Info version 3.5.3 and level of statistical significance was set at ≤0.05. Results: Participants comprised of 50 females (54.9%) and 41 (45.1%) males with an overall mean age of 47 ± 15 years. The major causes of CKD were hypertension (HTN) (50.54%), diabetes mellitus (DM) (6.59%), and HTN + DM (19.78%). The mean hemoglobin (Hb) concentration of the participants was 10.97 ± 2.28 g/dl; the red cell indices were within normal ranges except for Red cell distribution width-Coefficient of variation (%) which was elevated (16.29%). The mean serum ferritin, sTfR, and sEpo were 70.58 ± 46.44 ng/ml (interquartile range [IQR] 82.00), 22.9 ± 49.7 ng/ml (IQR 15.00), and 12.49 ± 33.47 IU/L (IQR 6.00), respectively, with a high variance. Serum ferritin and sTfR are consistently low across the stages of CKD (range between 54.54 ng/ml and 88.64 ng/ml), but sEPO for stage 3 and 4 showed a 2-fold increase when compared to normal level at Hb 10.97 g/dl (29.54 IU/L and 38.83 IU/L, respectively). Correlation between sTfR and sEpo (r2 = 0.96, P = 0.001), while between sEpo and serum ferritin (r2 = 0.02, P = 0.185), and between Hb and stage of CKD undulating (r2 = 0.41, P = 0.001). Conclusion: In contrast to some existing literature, this study has demonstrated that EPO resistance and iron deficiency contributes to anemia in CKD and serum ferritin can be used to assess the iron level of dialysis naïve CKD patients at every stage of the disease.

Prevalence of Lupus Anticoagulant in Women with Spontaneous Abortion in Zaria

Introduction: Spontaneous abortion (SA) is a common complication of pregnancy. Presence of lupus anticoagulant (LA), one of the antiphospholipid antibodies, has been associated with SA in many studies, especially in Caucasians. This study was carried out to determine the prevalence of LA in women with SA in ABUTH, Zaria. Materials and Methods: A cohort of 100 consecutive women presenting with SA with no history of thrombotic episodes were enrolled into the study. Prothrombin time (PT), kaolin clotting time (KCT), and activated partial thromboplastin time (APTT) were conducted on samples of all the participants. Eight patients had prolonged APTT, and after a 50:50 mixture of their plasma with pooled control plasma, four (50%) had uncorrected APTT. Staclot® (a hexagonal-phase phospholipid) test and calculated Rosner index for prolonged KCT were used for the confirmation of LA in samples with uncorrected APTT after mixing studies. Results: We analyzed 100 women with one or more SA with a mean age of 31.0 ± 3.8 years. Nearly 4% and 3% of the participants were LA positive with Staclot® and KCT tests, respectively. Patients with LA were more likely to have had a past history of preeclampsia/eclampsia, small for gestational age deliveries, and previous SA (prevalence odds ratio [95% confidence interval]) of 1.9 (0.2, 20.1), 3.2 (0.3, 34.3), and 1.4 (0.1–13.6), respectively. The PT, APTT, and KCT were significantly prolonged in patients with LA (P ≤ 0.001 for each, respectively). Conclusion: LA may be one of the causes of SA and other adverse pregnancy outcomes such as preeclampsia/eclampsia and small for date deliveries. It is recommended that patients with prolonged APTT, uncorrected with 50:50 mixing study with pooled control plasma, should be evaluated further for LA.

Reproducibility of hematological parameters: Manual versus automated method

Background: The automated hematology analyzer has replaced the traditional manual assay methods and eye count for determination of hematological parameters. Recently, they are widely used in laboratories and hospitals for counting of blood cells necessary for diagnosis and monitoring treatment of various disorders. Objective: To compare the blood count results of automated hematology analyzer with the traditional manual method in the determination of some hematological parameters. Methodology: A total of 100 samples were randomly selected from samples received at the reception of hematology laboratory in June 2014. The anticoagulated blood was collected and subjected to analysis of hematological parameters by automated hematology analyzer (Swelab Alfa) and standard manual methods. Results: The mean hematocrit, total white cell and platelets count, neutrophils, and lymphocytes percentages by manual method were 37.5 ± 7.2%, 7.2 ± 3.7 × 10 9 /L, 244.8 ± 171.8 × 10 9 /L, 53.8 ± 16.0%, and 41.8 ± 28.2%, respectively while that by automation were 37.2 ± 7.3%, 7.9 ± 6.1 × 10 9 /L, 278.1 ± 162.0 × 10 9 /L, 52.6 ± 16.0%, and 41.0 ± 14.3%, respectively. Whereas the mean platelets count was significantly (P < 0.05) higher in the automated method, there was no significant statistical difference between the mean hematocrit, total white cell and platelets count, neutrophils, and lymphocytes percentages of all the study samples (P > 0.05) and this remained so in male gender. The Pearson correlation test showed a positive significant (P < 0.05) correlation between both methods even after gender stratification. Conclusion: Automated analyzers can be used in all laboratories to provide quick and accurate results for patient care. However, it should be accompanied by microscopic blood film examination to provide confirmatory and additional useful diagnostic information.

An evaluation of the gallbladder in adult sickle cell anemia patients in Zaria North-West Nigeria

Background: Sickle cell anemia (SCA) is characterized by a constant state of hemolysis which leads to hyperbilirubinemia. Hyperbilirubinemia may predispose to development of pigment gallstones in these patients. Gallstones in SCA patients increase morbidity and mortality and poses diagnostic dilemma as most patients are asymptomatic. The objective of this study was to evaluate the gallbladder using ultrasonography, biochemical, and hematological parameters among adult SCA patients in steady state at the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Patients and Method: We conducted a case-control cross-sectional study of adult SCA patients attending the hematology clinic of ABUTH, Zaria, Nigeria and HbAA controls. Sixty-seven consenting adult SCA patients in steady state and twenty HbAA controls had abdominal ultrasonography, biochemical, and hematological tests on blood samples. Information obtained was entered and analyzed using Statistical Package for the Social Sciences (SPSS) 17.0. Statistical evaluation consisted of descriptive analysis and comparison of means using student′s t-test. Level of significance was set at P < 0.05. Results: Of the 67 SCA patients, 19 (28.4%) had gallstones, and the prevalence increased with increasing age of the patients. There were significant differences in all laboratory parameters between SCA patients and the HbAA controls except alkaline phosphatase levels. While there were no significant differences in these parameters between SCA patients with gallstone and those without gallstone except the gallbladder volume. All the SCA patients with gallbladder stones were asymptomatic. Conclusion: There is a high prevalence of gallbladder stone in SCA patients, especially after the age of 20 years. Thus, abdominal ultrasonography should be part of the routine care of SCA patients, especially after the second decade of life.

Immuno-hematological abnormalities of human immunodeficiency virus-1 infected highly active antiretroviral naïve adults in Zaria, Northern Nigeria

Background: In HIV-1-infected adults, hematological derangements include peripheral cytopenias and bone marrow abnormalities. The level of the CD4+ T lymphopenia is presently considered as one of the best markers of HIV induced immune impairment. Multiple interacting factors contribute to the hematological manifestations of HIV infection. We compare the prevalence of peripheral cytopenias and the level of immunological deterioration in treatment naïve HIV-1 infected patients. Patients and Methods: Four hundred consecutive HIV-1 infected patients undergoing pre-treatment (Highly active antiretroviral therapy naïve) assessment were recruited at the HIV sub-specialty clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria between May 2003 and October 2004. A cross-sectional study of baseline hematological and immunological parameters was undertaken after confirmation of HIV-1 infection by double ELISA methods; complete blood count and CD4+ T cell count (Dynal ® ) were analyzed by manual techniques. Results: Anemia is the most common peripheral cytopenia, 73% in male and 54% in the females. Neutropenia occurred in 10.8% of the patients while 6.25% had thrombocytopenia. Packed cell volume and Absolute lymphocyte count is associated with a reduction of CD4+ T cell counts but this is not consistent following gender and CDC clinical/immunological staging. CD4+ T cell counts decreases significant from asymptomatic stage A through symptomatic stages B to stage C p < 0.001. Conclusion: This study demonstrates that anemia and low CD4+ T cells are the commonest hematological complication in HIV-1 infected patients and these cytopenias deteriorates with increasing advanced stages of the infection.

Biochemical and ultrasound assessment of the liver in sickle cell anaemia patients in Zaria, Nigeria

Introduction: Sickle cell anemia (SCA) is frequently associated with liver disease. The constant state of hemolysis due to reduced red cell survival; and multiple blood transfusions, places these patients at risk hepatic sinusoidal congestion, viral hepatitis, cholestasis, and hemosiderosis, all of which may contribute to the development of liver disease. Objective: The aim was to assess the pattern of biochemical liver function tests and their relationship with liver size in steady state adult SCA patients in Zaria, North-West, Nigeria. Materials and Methods: Seventy-one adult SCA patients in steady state and 20 hemoglobin AA controls were enrolled into the study. Liver function tests were carried out and liver spans assessed using B-mode ultrasound scan in all subjects. Results: The serum bilirubin, aspartate transaminase (AST) and AST/alanine transaminase (ALT) ratio were significantly higher in SCA patients than in controls, with P values of 0.04, <0.001, and <0.001 respectively. Thirty-four (48%) SCA patients had AST/ALT ratio of >2. Hepatomegaly was present in 67/71 (94%) of the patients, and absent in the controls. The liver span was significantly greater in SCA patients (P < 0.001). There were no significant difference in the mean values of ALT, alkaline phosphatase (ALP), total protein and albumin. There was no correlation between the liver span and the biochemical parameters. Conclusion: Steady state SCA patients in Ahmadu Bello University Teaching Hospital, Zaria, have hepatomegaly associated with minimal elevation of ALT and ALP. There was no correlation between the liver span and the biochemical parameters. It is advisable that liver function tests and liver ultrasound scan be interpreted with caution in these patients.

Renal complications of sickle cell anemia in Zaria, Nigeria: An ultrasonographic assessment

Background: Vaso-occlusion in the kidney is a capillary phenomenon. Renal medullary hyperosmolalrity and low oxygen tension encourage the maximum formation of sickled red cells. In addition, the glomerular loops constitute an aggregating point for the sickled red cells with subsequent obstruction to the blood flow. These factors, together with the large volume of blood flowing through the kidneys make renal complications inevitable in sickle cell anemia (SCA). Aim: The purpose of this prospective study was to report the renal sonographic findings of a sample of patients with hemoglobin electrophoretic pattern consistent with sickle cell anemia Materials and Methods: A cross-sectional prospective study of 74 patients with the diagnosis of SCA, as documented by electrophoresis and who attended the adult sickle cell clinic, Hematology Department of the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria and 20 age-matched controls with a normal hemoglobin (HbAA) phenotype and with no history of renal disease, was carried out between April and December, 2010. None of the patients had any clinical evidence of acute sickle episode (crisis) at the time of ultrasonographic examination. B-mode ultrasonography with Aloka SSD-3500 was used to assess the kidneys. The hematological parameters were determined by multiparameter analyzer Sysmex XT 2000i, whereas creatinine and urea of the patients were also analyzed using the Selectra XL chemistry autoanalyzer. Results: Renal size of the study group was compared with that of the control group and it showed a significant increase in the adult patients with SCA (P<0.05). The mean right renal length in the study group and control group was 10.65±0.97 cm and 9.95±0.80 cm (P<0.001), respectively, whereas the mean left renal length in the study group and control group was 10.70±1.02 cm and 10.00±0.66 cm (P<0.001), respectively. Statistical relationships between renal length and some hematological indices (packed cell volume (PCV), red blood cell count, and reticulocyte count) showed no correlation but renal length was positively correlated with reticulocyte count, especially high reticulocyte count. Other findings documented and discussed include echogenicity of renal parenchyma, hydronephrosis, and papillary necrosis. Conclusion: Renal ultrasound imaging of patients with SCA showed a high incidence of renal abnormalities.