Pattern of blood donation and characteristics of blood donors in Enugu, Southeast Nigeria.

BACKGROUND: Despite increasing need for blood donation in medical practice, little is known about pattern of blood donation and characteristics of blood donors in some African populations like Nigeria. This information is necessary in designing strategies and policies for improving blood transfusion services in Africa. AIM: The aim of this study is to determine the pattern of blood donation and characteristics of blood donors in Enugu, Southeast, Nigeria. MATERIALS AND METHODS: A cross-sectional study of 3377 blood donors at a tertiary hospital in Enugu, Nigeria from May 1, 2016 to April 30, 2017. Information sought included donors' sociodemographic characteristics; type of blood donor: Voluntary nonremunerated donor (VNRD), family replacement donor (FRD), or paid donor (PD); willingness to become VNRD in the future after counseling and education (at point of entry to blood bank) on its benefits to clinical practice; hemoglobin (Hb) level; and transfusion transmissible infections (TTIs). RESULTS: Mean age of blood donors was 28.8 ± 8.5 years, majority were male (3011, 89.2%) and students (1289, 32.8%). FRDs were the highest in number (1998, 59.2%), followed by PDs (746, 22.1%) and finally VNRDs (633, 18.7%). Of the 3377 persons that came for blood donation, 2537 (75.1%) were found eligible to donate while 840 (24.9%) were deferred on account of low Hb (602/3377, 17.8%) or positive infectious screening test (238/3377, 7.0%). The odds of a male donor being a VNRD were about one and half times that of a female donor (582/3011 [19.3%] vs. 51/366 [13.9%]; odds ratio: 1.48; 95% confidence interval: 1.09-2.02; P = 0.01). After counseling of FRDs and PDs, majority (54.3%) were willing to become VNRDs in the future. Donors' age >30 years, being of male sex, having tertiary level of education, and being employed were strongly associated with willingness to become VNRDs in the future (P < 0.001). CONCLUSION: VNRD made up <20% of the total number of donors in Enugu, Nigeria. There is a need for improvement in public enlightenment on the need for VNRDs and employment opportunities of the populace to improve voluntary blood donation.

Frequency and clinical impact of ETV6/RUNX1, AF4-MLL, and BCR/ABL fusion genes on features of acute lymphoblastic leukemia at presentation.

BACKGROUND: Variations in disease presentation and outcome of leukemia treatment has been associated with the presence of certain mutant genes. Three major translocations (ETV6-RUNX1, BCR-ABL, and AF4-MLL) in acute lymphoblastic leukemia (ALL) have been shown to affect treatment outcome. This study is aimed at assessing the relationship between these translocations and the presence of other indicators of disease severity (white cell count, hemoglobin concentration, platelet count, and hematocrit) in ALL. PATIENTS AND METHODS: Forty chemotherapy naïve patients aged between 9 months and 54 years had their marrow samples analyzed for the prevalent mutations. Their clinical and laboratory details on presentation were also obtained. RESULTS: Abnormal genes detected were BCR/ABL1 major transcript in 5 (12.5%), ETV6/RUNX1 in 2 (5.0%), MLL/AF4 none and none of the patients had more than one fusion gene. There was no relationship between the presence of these fusion genes and the clinical and laboratory features of ALL. An association exists between the fusion genes and ethnic origin of the patients (P = 0.005). There is no significant association between the abnormal fusion genes detected and some laboratory features of prognostic importance, which include total white blood cell count (P = 0.416) and FAB subtype (P = 0.576). CONCLUSION: Presence of fusion the genes BCR/ABL1, ETV6/RUNX1, and MLL/AF4 does not have any impact on the clinical and laboratory features of ALL at presentation.

Important clinical and laboratory correlates of glomerular filtration rate in sickle cell anemia.

BACKGROUND: Renal impairment is routinely assessed using the estimated glomerular filtration rate (eGFR) and it may be helpful to obtain certain clinical or laboratory markers, which show relationship with glomerular filtration rate (GFR) in sickle cell disease (SCD). AIM: To assess the relationship between important clinical and laboratory parameters in SCD, and the eGFR. PATIENTS AND METHODS: Steady state clinical and laboratory data were obtained from 228 homozygous SCD patients seen over a 7-year period. The GFR was estimated using (isotope dilution mass spectrometry) traceable modification of diet in renal disease (MDRD) and Cockroft-Gault methods. The correlation coefficient and independent t-test were done to assess the level of significance between the eGFR_MDRD and the known indicators of disease severity. RESULTS: The serum alkaline phosphatase (ALP) and serum direct bilirubin levels both showed significant inverse relationship with eGFR_MDRD P = 0.012 and P = 0.24, respectively. The patients' age, Hb, leukocyte count, platelet count, serum direct bilirubin and aspartate transaminase did not show a significant correlation. The eGFR_MDRD was more discriminatory revealing that 20.3% of the patients had suboptimal GFR. Proteinuria in steady state was observed in 20.3% of the patients. CONCLUSION: High serum direct bilirubin and ALP are associated with a deteriorating eGFR_MDRD. Other clinical and laboratory indicators of disease severity in SCD do not show the relationship with the GFR. MDRD_GFR estimation seemed to be a more appropriate method of estimating GFR in SCD.

Multiple myeloma in Nigeria: an insight to the clinical, laboratory features, and outcomes.

AIM: In developing African nations, late presentation and occurrence of complications adversely affects survival. This study aims at identifying initial clinical and basic laboratory features of multiple myeloma (MM), which will aid the physician to entertain a high index of suspicion and therefore target his investigations in order to prevent late presentation and avert complications. MATERIALS AND METHODS: A retrospective analysis of 32 patients diagnosed and managed in Nigeria, West Africa was done. Information on the clinical, laboratory, and radiological data as well as response to treatment was obtained at presentation, 3, 6, 12, and 24 months and analyzed. RESULTS: The median age at diagnosis was 62 years, 17 (53.1%) males and 15 (46.9%) females. The median duration of follow-up was 24 weeks (range, 2-288 weeks). The average percentage of bone marrow plasmacytosis at diagnosis was 38%. Clinical features at presentation were anemia (71.9%) and bone pains (78.1%), while pathological fractures were found in 69%, and nephropathy in 13.8%. The longest duration of survival of 288 and 252 weeks were recorded in patients on melphalan and prednisolone with or without thalidomide. CONCLUSION: Presence of bone pain and anemia in elderly patients should alert the clinician to investigate along the lines of MM. Majority of patients have osteolytic lesions on X-ray and pathological fractures, and benefit from melphalan based combinations in situations where facilities for transplant are not available.

Electrocardiographic findings in sickle cell cardiovascular autonomic neuropathy.

BACKGROUND: There is a lack of data on the relationship between cardiovascular autonomic neuropathy (CAN) and electrocardiographic parameters in sickle cell anaemia. AIMS AND OBJECTIVES: The purpose of the study was to compare the electrocardiographic findings in adult sickle cell anaemia patients with CAN with those of patients without this complication. METHODS: A cross sectional study was done using 62 consecutively recruited sickle cell anaemia patients who met the inclusion criteria for the study. Cardiovascular autonomic dysfunction was determined based on abnormal values in at least two of five non-invasive tests: Valsalva manoeuver, heart rate variation during deep breathing, heart rate response to standing, blood pressure response to sustained hand grip, and blood pressure response to standing. The subjects were subsequently evaluated with electrocardiography. RESULTS: Sickle cell anaemia patients with CAN had statistically significantly increased P-wave duration (p < 0.001), PR-interval (p < 0.05) and QTc dispersion (p < 0.05) compared with patients without CAN. Significantly increased frequencies of Q waves and first degree atrio-ventricular block were found in patients with CAN than in those without CAN (p = 0.026, p = 0.014, respectively). Significant correlations were noted between the severity of CAN [number of abnormal autonomic function tests (AFT)] and (1) P-wave duration (p = 0.008), (2) PR- interval (p = 0.013). Significant association was found between the number of abnormal AFT and (1) presence of Q-waves, and (2) degree of anaemia (haematocrit class). CONCLUSION: Electrocardiographic features consistent with atrio-ventricular and ventricular repolarization abnormalities are associated with CAN in sickle cell anaemia. Further studies are required to evaluate the prognostic implications of these findings in sickle cell patients with cardiovascular autonomic dysfunction.

The prevalence of Rhesus negativity among pregnant women in Enugu, Southeast Nigeria.

BACKGROUND: Hemolytic disease of the newborn, secondary to rhesus D (Rh D) iso-immunization, contributes significantly to perinatal morbidity and mortality. Prevalence data in Nigeria, and Southeast Nigeria in particular, is very scanty. This study was carried out to provide our experience in this preventable clinical condition in Enugu, Southeast Nigeria. OBJECTIVE: To determine the prevalence and trends of Rh D negativity among pregnant women in Enugu, Southeast Nigeria. MATERIALS AND METHODS: A 5-year retrospective study of rhesus negative women was carried out at the University of Nigeria Teaching Hospital, Enugu, Nigeria, between 1 st January 2000 and 31 st December 2004. RESULT: The prevalence rate of Rh D negative women in Enugu, Nigeria, is 4.5%. Out of 6306 women who booked for antenatal care, 282 (4.5%) were Rh D negative women. One hundred and eighty-two (182) (64.5%) of the Rh D negative women were of blood group O followed by blood group A 20%, blood group B 12.1%, and blood group AB 3.2%, respectively. CONCLUSION: There is a need for adequate counseling of pregnant women on the importance of Rh D negative factor during the antenatal period in order to prevent hemolytic disease of the newborn.

Haemogram pattern at diagnosis of malignant disorders and variations post-chemotherapy.

A total of eighty patients with various malignancies seen between September 2008 and April 2009 at the University of Nigeria Teaching Hospital, (UNTH) Ituku-Ozalla Enugu Nigeria had their haemogram values done at Days 0 and 12 of the first cycle of their various chemotherapeutic regimens. They were adult patients who had been diagnosed of various malignancies, consisting of Breast cancer 36 patients (45%), Non-Hodgkin's iymphoma 8 (10%), Hodgkin's lymphoma 13 (16.25%), Colorectal carcinoma 6 (7.5%), Multiple myeloma 7 (8.75%), Cervical carcinoma 1 (1.25%) and other malignancies 9 (11.25%). Haematological indices evaluated include: packed cell volume, haemoglobin concentration; total white blood cell count, platelet count and erythrocyte sedimentation rate. The socio demographic data of the patients were assessed from a questionnaire. There were 27 males (33.75%) and 53 females (66.25%). The age of the patients ranged from 18-80 years with a median of 45 years. Haematological parameters which were found to be significantly reduced include: haemoglobin concentration, packed cell volume and total white cell count.

Absolute neutrophil values in malignant patients on cytotoxic chemotherapy.

A total of eighty patients with various malignancies seen between September 2008 and April 2009 at the University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla, Enugu, Nigeria, had their absolute neutrophil counts, done at Days 0 and 12 of the first cycle of their various chemotherapeutic regimens. They were adult patients who had been diagnosed of various malignancies, consisting of Breast cancer 36 (45%), Non-Hodgkin's lymphoma 8 (10%), Hodgkin's lymphoma 13 (16.25%), Colorectal carcinoma 6 (7.5%), Multiple myeloma 7 (8.75%), Cervical carcinoma 1 (1.25%) and other malignancies 9 (11.25%), Manual counting of absolute neutrophil count was done using Turks solution and improved Neubauer counting chamber and Galen 2000 Olympus microscope. The socio demographic data of the patients were assessed from a questionnaire. There were 27 males (33.75%) and 53 females (66.25%). Their ages ranged from 18 - 80 years with a median of 45 years. The mean absolute neutrophil count of the respondents pre-and post chemotherapy was 3.7 +/- 2.1 x 10(9)/L and 2.5 +/- 1.6 x 10(9)/L respectively. There were significant differences in both the absolute neutrophil count (p=0.00) compared to the pre-chemotherapy values. Chemotherapeutic combinations containing cyclophosphamide and Adriamycin were observed to cause significant reduction in absolute neutrophil.

Changing pattern of childhood malignancies in Eastern Nigeria.

BACKGROUND: Childhood cancers constitute important causes of morbidity and mortality in Nigeria. There is a need for us to continue to analyse the patterns of these neoplasms. OBJECTIVE: To review the major studies on childhood malignancies in Enugu, Nigeria and identify trends in paediatric malignancies in this environment. METHODS: We compared the results of four major studies on childhood malignancies in Enugu, Eastern Nigeria between 1976 and 2004 and assessed the patterns in the frequencies of paediatric cancers in this environment. RESULTS: Lymphomas were the most common childhood malignancy in this environment with Burkitt's lymphomas being the most common specific paediatric cancer. Nephroblastomas and sarcomas have been on the increase. The pattern of changes in the relative percentage frequencies of leukaemias, retinoblastoma and neuroblastomas has not been consistent. Leukaemias appear to be on the decline but occurrences of retinoblastomas and neuroblastomas have been fluctuating. CONCLUSION: Since Burkitt's lymphoma is associated with high prevalence of malaria, Epstein Barr Virus infection, and malnutrition, its persistent high rates suggest strongly that the control of these infections and malnutrition should be intensified.

Pregnancy outcomes in patients with sickle cell disease in Enugu, Nigeria.

BACKGROUND: Pregnancy in patients with sickle cell disease (SCD) is associated with increased maternal and foetal morbidity and mortality. The objective of this study was to review the pregnancy outcomes in patients with SCD as seen at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-eastern Nigeria. METHODS: This is a retrospective study. The data extracted from the patients' case files include the age, parity, gestational age at booking and complications of disease and pregnancy during the antenatal period, labour and puerperium. Fetal outcomes were also reviewed. RESULTS: During the 30-year period under study (1975-2004), only 10 pregnant women with sickle cell disease were documented to have been attended to. Pregnancies were characterized by high maternal and fetal morbidity and mortality. Maternal complications identified were maternal mortality, lobar pneumonia, HIV and recurrent malaria infections, candidiasis, bone pain crises, haemolytic crises, pseudotoxaemia and pre-eclampsia. Fetal complications included intra-uterine fetal deaths, still births, low birth weights, and breech presentation. CONCLUSION: From this study, it seems that female SCD patients present more rarely with pregnancy in South-eastern compared to South-western Nigeria. However, the spectrum of complications seen is similar to that recorded in other studies.

Pregnancy outcomes in patients with sickle cell disease in Enugu, Nigeria.

BACKGROUND: Pregnancy in patients with sickle cell disease (SCD) is associated with increased maternal and foetal morbidity and mortality. The objective of this study was to review the pregnancy outcomes in patients with SCD as seen at the University of Nigeria Teaching Hospital(UNTH), Enugu, South-eastern Nigeria. METHODS: This is a retrospective study. The data extracted from the patients' case files include the age, parity, gestational age at booking and complications of disease and pregnancy during the antenatal period, labour and puerperium. Fetal outcomes were also reviewed. RESULTS: During the 30-year period under study (1975-2004), only 10 pregnant women with sickle cell disease were documented to have been attended to. Pregnancies were characterized by high maternal and fetal morbidity and mortality. Maternal complications identified were maternal mortality, lobar pneumonia, HIV and recurrent malaria infections, candidiasis, bone pain crises, haemolytic crises, pseudotoxaemia and pre-eclampsia. Fetal complications included intra-uterine fetal deaths, still births, low birth weights, and breech presentation. CONCLUSION: From this study, it seems that female SCD patients present more rarely with pregnancy in South-eastern compared to South-western Nigeria. However, the spectrum of complications seen is similar to that recorded in other studies.

Spectrum of childhood malignancies in Enugu, Nigeria (1999-2004).

A retrospective analysis of childhood malignancies in Enugu, Nigeria was carried out using data obtained from the Cancer Registry of the University of Nigeria Teaching Hospital (UNTH), Enugu between 1st January 1999 and 30th June 2004. A total of 79 childhood cancers were recorded during the period. There were 48 males (60.8%) and 31 females (39.2%) with a male female ratio of 1.5:1. The three commonest malignancies were lymphomas 33 (41.2%), sarcomas 12 (15.2%) and nephroblastomas 12 (15.2%). The less common tumours included the leukaemias 6(7.6%), retinoblastomas 6 (7.6%), neuroblastomas 4 (5.1%), and carcinomas 2 (2.5%). Burkitt's lymphoma remains the commonest specific childhood malignancy in this environment constituting 19 (57.6%) of all the lymphomas and 24.1% of all the cancers seen.

Clinical and electrocardiographic evaluation of sickle-cell anaemia patients with pulmonary hypertension.

Pulmonary hypertension is an emerging complication of sickle cell anaemia with associated increased risk of mortality. In order to evaluate the clinical and electrocardiographic findings in adult sickle-cell patients with pulmonary hypertension, a cross sectional study was conducted on sixty two sickle cell anaemia patients and sixty two age and sex matched normal controls. Elevated pulmonary artery pressures (PAP), defined by PAP ≥ 30 mm Hg on echocardiography, was demonstrated in 41.9% of patients with sickle cell anaemia and in 3.2% of the controls; χ(2) = 26.571, P < 0.001. Right ventricular hypertrophy, increased P-wave duration, QTc interval, and QTc dispersion were significantly associated with pulmonary hypertension. Significant correlation was found between mean PAP and (1) Frequency of crisis (Spearman correlation = 0.320; P = 0.011), (2) body mass index (Pearson's correlation = -0.297; P = 0.019), and (3) QTc interval (Pearson's correlation 0.261; P = 0.040). Pulmonary hypertension in adult sickle anaemia patients is associated with electrocardiographic evidence of right ventricular hypertrophy, and correlates significantly with frequency of vaso-occlusive crisis, and QTc interval. The observations by this study tend to suggest that these parameters could be useful for early detection and prevention of pulmonary hypertension in patients with sickle cell anaemia.

An evaluation of ankle-brachial blood pressure index in adult Nigerians with sickle cell anaemia.

AIM: There are few studies to be found in the literature on ankle-brachial index in sickle cell disease. The aim of this study was to compare ankle-brachial index of steadystate adult sickle cell anaemia patients with that of normal controls. METHODS: A descriptive cross-sectional study of 62 sickle cell anaemia patients and 62 age- and gender-matched normal controls was carried out in the adult outpatient sickle cell clinics and the cardiac centre of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria from February to August 2007. The supine brachial and ankle blood pressures were measured separately with the cuff of the mercury sphygmomanometer applied to the right arm and right calf, respectively. RESULTS: The ankle systolic blood pressure was lower in patients with sickle cell anaemia than in the controls (p < 0.001). The mean indices for ankle-brachial index were 0.88 ± 0.09 and 1.03 ± 0.06, respectively for patients and controls. This difference was statistically significant (p < 0.001). Seventy three per cent of the patients had ankle-brachial index less than 0.9 compared with controls (5%). This was also significant (p < 0.001).

P-wave dispersion: relationship to left ventricular function in sickle cell anaemia.

BACKGROUND: The prognostic implications of P-wave dispersion in patients with a variety of cardiac disease conditions are increasingly being recognised. The relationship between P-wave dispersion and left ventricular function in sickle cell anaemia is unknown. OBJECTIVE: This study was aimed at evaluating the relationship between P-wave dispersion and left ventricular function in adult Nigerian sickle cell anaemia patients. METHODS: Between February and August 2007, a total of 62 sickle cell anaemia patients (aged 18-44 years; mean 28.27 ± 5.58) enrolled in the study. These were drawn from patients attending the adult sickle cell clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. An equal number of age- and gender-matched normal subjects served as controls. All the participants were evaluated with electrocardiography and echocardiography. P-wave dispersion was defined as the difference between the maximum and minimum P-wave duration measured in a 12-lead electrocardiogram. RESULTS: P-wave duration and P-wave dispersion were significantly higher in patients than in controls. Significant correlation was demonstrated between P-wave dispersion and age in the patients (r = 0.387; p = 0.031). A comparison of subsets of sickle cell anaemia patients and controls with comparable haematocrit values (30-35%) showed significantly higher P-wave duration and P-wave dispersion in the patients than in the controls. The P-wave duration in patients and controls, respectively, was 111.10 ± 14.53 ms and 89.14 ± 16.45 ms (t = 3.141; p = 0.006). P-wave dispersion was 64.44 ± 15.86 ms in the patients and 36.43 ± 10.35 ms in the controls (t = 2.752; p = 0.013). Significant negative correlation was found between P-wave dispersion and left ventricular transmitral E/A ratio (r = -0.289; p = 0.023). CONCLUSION: These findings suggest that P-wave dispersion could be useful in the evaluation of sickle cell patients with left ventricular diastolic dysfunction. Further prospective studies are recommended to evaluate its prognostic implication on the long-term disease outcome in sickle cell disease patients.

Electocardiographic findings in adult Nigerians with sickle cell anaemia.

BACKGROUND: Cardiovascular system abnormalities are common causes of morbidity and mortality in sickle cell anaemia. OBJECTIVES: The study aims at determining the pattern of electrocardiographic changes in adult Nigerian sickle cell anaemia patients. METHODS: A descriptive cross sectional study was done on sixty sickle cell anaemia patients seen at the adult sickle cell clinic of University of Nigeria Teaching Hospital (UNTH) Enugu, and sixty age and sex matched normal controls. All the subjects had clinical evaluation as well as electrocardiographic examination. RESULTS: The mean heart rate, P-wave duration, P-wave dispersion, PR interval, QRS duration, QRS dispersion, QTc interval and QTc dispersion were significantly higher in the patients than in the control group. Electrocardiographic abnormalities identified by this study were: left ventricular hypertrophy (75%; 1.7%), left atrial enlargement (40%; 0%), biventricular hypertrophy (11%; 0), ST-segment elevation (10%; 0%) and increased P-wave and QTc dispersions. ST segment elevation was found more in patients with moderate and severe anaemia (P= 0.02, Spearman correlation r= 0.342; P= 0.007), CONCLUSION: Sickle cell anaemia is associated with significant electrocardiographic abnormalities. Further prospective studies are recommended to evaluate the prognostic significance of the electrocardiographic intervals dispersion on the long term disease outcome in sickle cell anaemia.

Arterial blood pressure in adult Nigerians with sickle cell anemia.

AIM AND OBJECTIVE: This study was aimed at comparing the arterial blood pressures in steady state adult sickle cell patients with those of age- and sex-matched healthy controls. METHODS: A descriptive cross-sectional study of 62 sickle cell anemia patients and 62 age- and sex-matched healthy controls was carried out in the adult outpatient sickle cell clinics and the cardiac center of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Brachial blood pressures were measured in the right arm in all subjects. RESULTS: Significant increase in pulse rate was found in the study subjects (87.68 ± 8.91 bpm) compared with the controls (72.13 ± 6.79 bpm) (p<0.05). The mean systolic blood pressure was comparable in the two groups. However, the patients had significantly lower diastolic blood pressure, lower mean arterial blood pressure, as well as a higher pulse pressure than the control subjects. Significant correlations were found between blood pressure indices and hematocrit, body mass index, frequency of crisis, and body surface area. CONCLUSION: Relatively lower arterial blood pressure is a significant finding in patients with sickle cell anemia. Hematocrit, frequency of crisis, body mass index, and body surface area are significant determinants of blood pressure indices in sickle cell anemia.

Usefulness of oral corticosteroid in Rosai-Dorfman disease.

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a benign self-limiting disorder of unknown aetiology, which is frequently mistaken for lymphoma. There is no consensus as to the proper management of this disorder. In the past, potentially harmful treatments, such as antineoplastic drugs, have been advocated. We describe a 25-year-old woman with RDD who has had a remarkably favourable response to oral prednisolone therapy. Our observation strengthens the conclusions of previous case reports as to the effectiveness of corticosteroids in this condition. This article is aimed at creating awareness among clinical oncologists about this pseudolymphomatous disorder and emphasizing the therapeutic role of corticosteroids.