Zaccheaus Awortu Jeremiah

Sero-epidemiology of transfusion-transmissible infectious diseases among blood donors in Osogbo, south-west Nigeria

BACKGROUND Transfusion-transmissible infectious agents such as hepatitis B virus (HBV), human immunodeficiency virus (HIV), hepatitis C virus (HCV) and syphilis are among the greatest threats to blood safety for transfusion recipients and pose a serious public health problem. This cross-sectional study was undertaken with the aim of determining the seroprevalence of HIV, HCV, hepatitis B surface antigen (HBsAg) and syphilis and correlates the findings with sex and age to ascertain the associations, if any, in the occurrence of the pathogens. MATERIALS AND METHODS HBsAg, antibodies to Treponema pallidum and HCV were determined using Clinotech test strips. Antibodies to HIV types 1 and 2 were screened with Determine and Immunocomb. All the reactive samples were confirmed using enzyme-linked immunosorbent assays. Antibodies to Treponema pallidum were confirmed with a Treponema pallidum haemagglutination test. RESULTS A total of 1,410 apparently healthy prospective blood donors aged between 18 and 64 years (mean+/-SD, 32.58 +/- 10.24 years) who presented for blood donation at the Ladoke Akintola University of Technology Teaching Hospital Blood Bank, Osogbo were studied. The male:female ratio was 6:1. Of the prospective blood donors, 406 (28.8%) had serological evidence of infection with at least one infectious marker and 36 (2.6%) had dual infections. The overall seroprevalence of HBsAg, HIV, HCV and syphilis was found to be 18.6%, 3.1%, 6.0% and 1.1%, respectively. The highest prevalences of HBsAg, HIV, HCV and syphilis infections occurred among commercial blood donors and those aged 18 to 47 years old, the most sexually active age group. There were no significant associations between pathogens except for syphilis and HIV (p > 0.001). CONCLUSION The high seroprevalence of blood-borne pathogens among prospective blood donors in Osogbo, Nigeria calls for mandatory routine screening of blood donors for HBV, HIV, HCV and syphilis.

Anaemia, iron deficiency and iron deficiency anaemia among blood donors in Port Harcourt, Nigeria

BACKGROUND There is paucity of information on the effect of blood donation on iron stores in Port Harcourt, Nigeria. The present study was, therefore, designed to assess, using a combination of haemoglobin and iron status parameters, the development of anaemia and prevalence of iron deficiency anaemia in this area of Nigeria. MATERIALS AND METHODS Three hundred and forty-eight unselected consecutive whole blood donors, comprising 96 regular donors, 156 relatives of patients and 96 voluntary donors, constituted the study population. Three haematological parameters (haemoglobin, packed cell volume, and mean cell haemoglobin concentration) and four biochemical iron parameters (serum ferritin, serum iron, total iron binding capacity and transferrin saturation) were assessed using standard colorimetric and ELISA techniques. RESULTS The prevalence of anaemia alone (haemoglobin <11.0 g/dL) was 13.7%. The prevalence of isolated iron deficiency (serum ferritin <12 ng/mL) was 20.6% while that of iron-deficiency anaemia (haemoglobin <11.0 g/dL + serum ferritin <12.0 ng/mL) was 12.0%. Among the three categories of the donors, the regular donors were found to be most adversely affected as shown by the reduction in mean values of both haematological and biochemical iron parameters. Interestingly, anaemia, iron deficiency and iron-deficiency anaemia were present almost exclusively among regular blood donors, all of whom were over 35 years old. CONCLUSION Anaemia, iron deficiency and iron-deficiency anaemia are highly prevalent among blood donors in Port Harcourt, Nigeria. It will be necessary to review the screening tests for the selection of blood donors and also include serum ferritin measurement for the routine assessment of blood donors, especially among regular blood donors.

Prevalence of antibodies to hepatitis C virus in apparently healthy Port Harcourt blood donors and association with blood groups and other risk indicators

BACKGROUND Testing for hepatitis C virus (HCV) is not yet mandatory in blood transfusion laboratories in Port Harcourt, Nigeria, so the current prevalence rate of this infection in our locality is unknown. The aim of this study was to determine the prevalence of HCV among apparently healthy blood donors in our area and also to assess some of the risk factors associated with the infection. MATERIALS AND METHODS The presence of anti-HCV antibodies was determined in the serum of 300 blood donors in Port Harcourt, Nigeria. A second-generation rapid screening test, the HEP C SPOT HCV assay was used. Initial reactive results were confirmed by repeat testing with UBI HCV EIA 4.0 enzyme immunoassay. The ABO and Rh blood groups of donors were also determined using standard serological procedures. RESULTS The majority of our blood donor population was constituted of males (88%) and commercial donors (63%). The blood group distribution of the donors was as follows: O RhD-positive (73%), AB RhD-positive. (4.0%), A RhD-positive (10.0%), B RhD-positive (3.0%), O RhD-negative (4.0%), A RhD-negative (3.0%), AB RhD-negative (1.0%) and B RhD-negative (2.0%). Fifteen of the 300 donors were positive for HCV, giving a prevalence rate of 5.0% in this study population. The age group 21-30 years was identified as the highest risk group with 60% of the subjects with HCV infection being in this group, compared to 20% each in the age groups 31-40 years and 41-50 years old. Twelve of the 15 (80%) HCV-positive subjects were commercial donors. The prevalence of HCV was statistically significantly higher among female donors than among male donors (chi2 = 81.000, p < 0.01). With regards to the distribution of HCV-positivity according to blood group, 4.1% of the O RhD-positive subjects, 10% of the A RhD-positive subjects and 25% of the AB RhD-positive were HCV-positive. No cases of HCV-positivity were found among the donors with other blood groups. No statistically significant relationship was found to exist between blood groups and HCV prevalence (p > 0.05). CONCLUSION There was a moderate prevalence of HCV infection (5%) in apparently healthy blood donors in Port Hartcourt, Nigeria. The prevalence was higher among commercial donors and in donors in the age bracket of 21-30 years of age.

Elevation in D-dimer concentrations is positively correlated with gestation in normal uncomplicated pregnancy

Background D-dimer levels have been reported to increase progressively during pregnancy, but how this affects Nigerian women is not well known. Objective This study aims to determine the D-dimer concentration and its relationship to other coagulation parameters among pregnant women in Port Harcourt, Nigeria. Method In a cross-sectional observational study conducted in Port Harcourt, Nigeria, 120 pregnant women and 60 nonpregnant controls, drawn from a tertiary health institution in the Niger Delta, Nigeria, were assessed, using the standard procedures, for the following parameters: D-dimer concentration, prothrombin time, activated partial thromboplastin time, platelet count, hemoglobin, and packed cell volume. Results The median D-dimer concentration of 153.1 ng/mL in the pregnant group was found to be significantly elevated when compared with the control value of 118.5 ng/mL (t = 2.348, P = 0.021). Conversely, there was a marked depression in the platelet count among pregnant women (193.5 × 109/L) when compared with 229.0 × 109/L in the control group (t = 3.424; P = 0.001). There was no statistically significant difference in the values for the prothrombin time and the activated partial thromboplastin time between pregnant and nonpregnant women. D-dimer values correlated positively and significantly with gestation (r = 0.36; P < 0.01) and negatively with international normalized ratio values (r = −0.281; P < 0.05). About 63.3% of the pregnant women had normal D-dimer values (0–200 ng/mL), 26.7% of the pregnant women had elevated D-dimer levels (201–499 ng/mL), while 10.0% of the pregnant women were found to be at risk of thrombosis (D-dimer > 500 ng/mL). A linear relationship was found to exist between D-dimer and gestation (y = 8.355x + 36.55; R2 = 0.130; P < 0.005). Conclusion 10% of the pregnant women in this population had elevated D-dimer levels over 500 ng/mL, and through comparison with what has been reported in the literature, there is the possibility that this group may be at risk of thrombosis. Further studies, incorporating other diagnostic parameters, may be needed before a more logical conclusion can be drawn, since the D-dimer is not a specific test.

The prevalence of human immunodeficiency virus infection among TB patients in Port Harcourt Nigeria.

The joint statement by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America recommends that all patients with tuberculosis (TB) undergo testing for human immunodeficiency virus (HIV) infection after counseling. In this study, we investigated the prevalence of HIV infection among 120 patients diagnosed with microbiologically proven TB aged 18 to 54 years with a mean age of 39.5 years (standard deviation 6.75). The subjects studied were 36 male (30%) and 84 females (70%). Enzyme-linked immunosorbent assay methods were used to screen for HIV infection among the subjects. Of the 120 TB patients tested 30 (25%) were positive for HIV infection. The prevalence of HIV was higher in females 24 (80%) compared to males 6 (20%) and among singles (66.7%) compared to married subjects (33.3%) (χ2 = 83.5 and χ2 = 126.2, respectively P = 0.001). HIV-1 was the predominant viral subtype. HIV prevalence was significantly higher in subjects in the 38–47 year and 28–37 year age groups (both 40%) followed by the 18–28 year age group (20%) (χ2 = 42.6, P = 0.05). The mean CD4 lymphocyte count of the HIV-infected TB subjects was significantly lower (195 ± 40.5 cells/μL) compared to the non-HIV infected (288 ± 35.25 cells/μL P = 0.01). This study has shown a high prevalence of HIV among TB patients. Reactivation of TB among people living with HIV can be reduced by TB preventive therapy and by universal access to antiretroviral therapy.

Distribution of antibodies to Salmonella in the sera of blood donors in the south-western region of Nigeria

BACKGROUND There are currently no reports of a multicentre assessment of the presence of antibodies to Salmonella in donated blood in Nigeria. MATERIALS AND METHODS Blood specimens from blood donors presenting at six selected public blood collection centres in the south-western region of Nigeria were analysed for the presence of Salmonella antibodies. RESULTS Out of the 200 specimen analysed, 106 (53%) were found to be Widal-positive with a minimum titre of 160. Among the positive cases, reactivity was most common to S. typhi (D) antigens (48.6%). The most frequently recorded titre of reactive specimens (i.e., the modal titre) was 160, with 71 donors (35.5%) of the total sample population from the different centres reacting at this level. Thirty-one donors had elevated titres of = 320 and nine donors had a titre of 640. The percentages of Widal-positive cases among donors with A positive and O positive blood groups were 58.7% and 64.2%, respectively; the percentage of Widal-positive cases was lowest among B positive blood donors (26.7%). The p-value for these differences (p<0.05) shows that blood group has a statistically significant impact on Widal reaction in donors. CONCLUSION.: This study confirms that salmonellosis is endemic in Nigeria and that many of our blood donors may be Salmonella carriers. This study also revealed a positive association between blood groups and typhoid fever.

Storage Related Haematological and Biochemical Changes of CPDA-1 Whole Blood in a Resource Limited Setting

Majority of the blood banks in Nigeria still practice whole blood banking. The changes associated with the storage of blood in our blood banks have not been reported. This study was aimed at bridging this gap. Blood (450 ml) was drawn from ten healthy volunteer donors into CPDA-1 anticoagulant and placed on the quarantine shelf of the blood bank refrigerator maintained at 2-8°C. Blood bags were screened for HCV, HBsAg, Syphilis and HIV 1&2 and were confirmed negative. Samples were collected at 1, 7, 14, 21 and 28 days and tested for hematological and biochemical using the PE-600 fully auto Haematology analyzer (China) for hematological parameters, Excite -40 ESR analyzer and Prestige 24i automated clinical analyzer for biochemical parameters. Comparison of day 1 versus day 7 revealed that the granulocytes were drastically reduced from 1.93 × 109 /L on day 1 to 0.33 × 109/L on day 7 (F=48.79, p=0.000, ESR values increased from 2.90 mm/hr on day 1 to 6.60 mm/hr on day 7 (F=7.45, p=0.013. For biochemical parameters, there was a significant decrease in Na value from 137.38 mEq/L on day 1 to 135 mEq/L on day 7 (F=43.66, p=0.000). Analysis of variance (ANOVA) showed that at the end of 28 days, there was significant changes in WBC, differential and absolute leucocytes, MPV, PDW, and ESR, albumin and potassium were significantly affected among the biochemical parameters. No significant changes were observed in Hb, PCV and other hematological parameters throughout the study. Rapid degeneration of leukocytes could lead to immunodulation related to blood transfusion. Whole blood should be leukodepleted before storage if it must be used beyond one week.

Frequencies of maternal red blood cell alloantibodies in Port Harcourt, Nigeria.

Background: Alloantibodies of clinical importance can cause transfusion reactions or hemolytic disease of the fetus and newborn (HDFN). The frequencies of these antibodies have not been reported in our locality. Aims: To determine the frequency of occurrence of alloantibodies among pregnant women in Port Harcourt, Nigeria. Settings and Design: This is a prospective study, which was carried out in the Braithwaite Memorial Specialist Hospital, Port Harcourt, Nigeria. Materials and Methods: Screening and identification of red blood cell alloantibodies was done on the sera of 500 pregnant women using the DiaMed, DiaCell, and DiaPanel reagents (Cressier, Switzerland). ABO and Rh blood groups were done using antisera bought from Biotec (Ipswich, UK). Results: Alloantibodies were identified in the serum of 17 of the 500 (3.4%) pregnant women. The specificity of the antibodies was as follows: anti-C 6 (1.2%), anti-E 3 (0.6%), anti-Jsb 3 (0.6%), and anti-K 5 (1.0%). No anti-D was identified despite 8.6% of the study population being Rhesus D (Rh D) negative. The distribution of the antibodies was found to be independent of the blood groups of the participants (χ2 = 4.050, P = 0.670). Blood group O constituted the highest percentage (48.0%). Conclusion: This study has identified the presence of non-Rh D antibodies to the proportion of 3.4%. Rh D antibody was absent in this population irrespective of the relatively high percentage of Rh D negative women. There is a need to determine the actual risk these antibodies may pose to the antenatal women and to include antibody screening and identification in routine antenatal care.

Pattern and prevalence of neonatal thrombocytopenia in Port Harcourt, Nigeria

Correspondence: Zaccheaus Awortu Jeremiah P.O. Box 1437, Diobu, Port Harcourt, 500001, Nigeria Tel +234803 4045636 Email zacjerry@yahoo.com Background: In Port Harcourt, evidence-based guidelines for platelet transfusion therapy in neonatal patients are yet to be defined and the prevalence and pattern of neonatal thrombocytopenia has not yet been reported. Methods: Platelet counts of 132 neonatal patients admitted into the special care baby unit (SCBU) at the University of Port Harcourt Teaching Hospital in Nigeria were assessed using the International Committee on Standards in Hematology (ICSH) approved manual procedures for hemocytometry. Study design: This is a cross sectional study carried out on neonates to determine the prevalence and pattern of neonatal thrombocytopenia. Results: The median platelet count of the neonates was 97.0 × 10/L (interquartile range [IQR] 50–152) while the mean age was 61.7 hours (range 1–336 hours). The overall prevalence of neonatal thrombocytopenia was 53.0%. Mild thrombocytopenia (platelet count 51–100 × 10/L) was found in 39.4% of the neonates, 12.1% had moderate thrombocytopenia (platelet count 30–50 × 10/L), while severe thrombocytopenia (platelet count 30 × 10/L) was detected in 1.5% of the neonates. Of these, 84.84% of the cases occurred within 72 hours (early onset). The most common clinical diagnosis among the neonates was severe birth asphyxia (33.3%), followed by neonatal jaundice (19.7%), neonatal sepsis (16.7%), low birth weight (13.6%), anemia and bleeding (6.1%), and other clinical conditions (10.6%). There was no association between clinical diagnosis and thrombocytopenia (Fisher’s exact test = 10.643; P = 0.923). Conclusion: There is a high prevalence of early onset neonatal thrombocytopenia cases in this region of Nigeria, the majority of which are mild in nature. There is a need to define a safer lower limit for platelet count and to determine which neonates will benefit from treatment.

Isolated anti-HBc-IgM antibody among blood donors in the semi-arid region of Nigeria.

Laboratory screening for the diagnosis of hepatitis B virus (HBV) infection in blood donors currently consists of testing for hepatitis B surface (HBsAg) antigen alone. The prevalence of isolated anti-HBc-IgM is not yet known in the semi arid region of Nigeria. The major objective of this study was to determine the sero-prevalence of antibody to hepatitis B core antigen (anti-HBc-IgM) and other infectious agent markers; HBsAg, HCV, HIV and Syphilis among blood donors in the North Eastern region of Nigeria. In a cross sectional study from October 2010 to January 2011, 266 blood donors were tested for the infectious disease markers using standard ELISA procedures as contained in the manufacturers standard operating procedures. The prevalence of various infectious markers obtained were as follows: HBsAg (8.6%); anti-HCV (1.5%); HIV (2.6%) and anti-HBc-IgM(18.4%). There was a zero percent prevalence of Syphilis in this donor population. The proportion of isolated anti- HBc-IgM antibody obtained was 18.1%. Performance indices for HBsAg were as follows: Sensitivity (10.2%), specificity (91.7%), positive predictive value (PPV) (21.7%), Negative predictive value (81.9%), and efficiency (76.7%). The prevalence of anti-HBc- IgM antibody was higher among first time blood donors (21.4%), and in some ethnic groups. There is a high prevalence of isolated anti-HBc-IgM antibody among blood donors in Maiduguri. The sensitivity of HBsAg was found to be very low and as such many recent HBV infections may be missed during pre-transfusion screening. The use of anti-HBc-IgM screening as a mandatory pre-transfusion screening test is hereby advocated.