Haematology Consultations in a Tertiary Health Care Centre in Nigeria.

BACKGROUND AND OBJECTIVES: The ease with which investigations are done in this technological age increases the possibility of finding abnormal haematological values, which inevitably leads to haematologic consultations. The Department of Haematology at the University College Hospital (UCH), Ibadan provides a busy consultative service for in-patients and out-patients suspected of having a haematological disorder. This study reviewed the consultations received from different clinical departments to Consultant Haematologists at our tertiary hospital. METHODS: Analysis of consultation requests on in-patients received in the Haematology department, UCH between June 2015 and January 2016 was done. During this period, the department had six Haematologists and nine resident doctors. SPSS version 22 was employed for the statistical analysis. RESULTS: A total of 285 consultation requests were received during the study period, with an average of 36 consults per month. The highest number was received in July 2015. The patients reviewed had a mean age of 36.9±19 years, and requests on female patients exceeded those on males, with a M:F ratio 1:1.5. Consultation for a presumptive diagnosis of sickle cell disease (SCD) were the commonest indication (17%). The highest consultation was from Obstetrics and Gynaecology (O&G) (25%) while the least was from Radiation Oncology (0.4%). CONCLUSION: There is an increasing role for the Haematologist in sub-Saharan Africa as evidenced by the high frequency of consultations observed in this review. The management team of each teaching hospital should bear in mind the need to have adequate number of Haematologists so as to ensure optimal haematological services.

Changes in mediators of inflammation and pro-thrombosis after 12 months of dietary modification in adults with metabolic syndrome.

OBJECTIVE: This study evaluated the effects of a 12-month dietary modification on indices of inflammation and pro-thrombosis in adults with metabolic syndrome (MS). MATERIALS AND METHODS: This longitudinal study involved 252 adults with MS recruited from the Bodija market, Ibadan and its environs. Participants were placed on 20%, 30% and 50% calories obtained from protein, total fat and carbohydrate respectively and were followed up monthly for 12 months. Anthropometry and blood pressure were measured using standard methods. Fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), high density lipoprotein-cholesterol (HDL-C), fibrinogen, plasminogen activator inhibitor-1 (PAI-1)], interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured using spectrophotometric methods and ELISA as appropriate. Data was analysed using ANCOVA, Student's t-test, Mann-Whitney U and Wilcoxon signed-rank tests. P-values less than 0.05 were considered significant. RESULTS: After 6 months of dietary modification, there was a significant reduction in waist circumference (WC), while the levels of HDL-C, fibrinogen and PAI-1 were significantly increased when compared with the corresponding baseline values. However, WC and fibrinogen reduced significantly, while HDL-C and IL-10 significantly increased after 12 months of dietary modification as compared with the respective baseline values. CONCLUSION: Long-term regular dietary modification may be beneficial in ameliorating inflammation and pro-thrombosis in metabolic syndrome.

Therapy Outcome of a T-Cell-Rich-B-Cell Lymphoma (TCRBCL) Patient with R-CHOP in Ibadan, Nigeria: a Case Report.

T-cell-rich B-cell lymphoma (TCRBCL) is considered a rare variant of aggressive B cell lymphoma characterized by few neoplastic B cells and a large reactive infiltrate with striking similarities to nodular lymphocyte predominant Hodgkin's lymphoma.A case of a 46 year old man referred with a 5 months history of generalized lymphadenopathy, weight loss, low grade pyrexia and two separately reported lymph node histology consistent with TCRBCL is described.The clinical course was indeed aggressive because in spite of initial treatment with four cycles of CHOP combination chemotherapy, followed by R+CHOP(x 6 cycles), signs of tumor re-growth/infiltration were frequently observed. Also, recurrent infection was frequent, troublesome and eventually became overwhelming resulting to the loss of the patient.This case, being the first case of TCRBCL diagnosed by immunohistochemical confirmation and managed at this centre with R-CHOP, is presented to highlight the dilemma in making diagnosis, clinical challenges faced and rituximab therapy outcome especially in resource poor country. It will also serve to increase our index of suspicion and the need reinforce immunohistochemistry in the diagnosis of lymphoma.

Richter's syndrome: a case report.

OBJECTIVE: To report a case of Richter's syndrome found in one of the teaching hospitals in Nigeria in the context of sparse earlier reports of Richter's syndrome in western Africa. CLINICAL PRESENTATION AND INTERVENTION: A 52-year-old male had been diagnosed earlier as having chronic lymphocytic leukaemia (CLL) and treated for 6 months with chlorambucil, although compliance was poor and the patient eventually stopped treatment. He presented to our hospital 18 months later with clinical features in keeping with Richter's syndrome. The blood and bone marrow smear review, together with fine-needle aspiration cytology of the masses, showed diffuse large cells of non-Hodgkin lymphoma consistent with the Richter's syndrome stage of CLL. There was significant improvement in response to the first 4 cycles of CHOP chemotherapy (consisting of cyclophosphamide, doxorubicin, vincristine and prednisolone) instituted, but then there were features of relapse. CONCLUSION: The case report serves to increase awareness and improve the index of suspicion about the terminal phase of CLL and low-grade lymphoma. It equally emphasizes the great need to strengthen further the laboratory diagnosis of haematological malignancies in developing countries.

An Acute Leukaemia Masquerading as Immune Thrombocytopaenic Purpura (ITP)? A Case Report.

This is a case report of a 35 year old female with diagnosed Immune Thrombocytopaenic Purpura (ITP) that was strangely followed by acute myeloid leukaemia at 10 months post diagnosis of ITP. She was managed as ITP using prednisolone 45 mg daily for 10 months with good response. She also synchronously carried a pregnancy to term and safe delivery. Shortly after delivery, she represented with gingival bleeding and peripheral film review and subsequent bone marrow cytology was in keeping with AML-M4 subtype. She died shortly after diagnosis without being able to receive chemotherapy.

Bone marrow findings in patients with pulmonary tuberculosis.

The cytology and culture of bone marrow aspirate in sixty-two newly diagnosed patients with pulmonary tuberculosis were studied. The findings were depressed erythroid activity in 69% of the patients, micronormoblastic changes in 18% and megaloblastic changes in 16.6%. Myeloid activity was increased in 65% of the patients. Normal looking plasma cells above 5% was found in 17.7% of the bone marrow aspirates while 12.9% had eosinophilic precursors above 5% in the marrow. None of the marrow smears showed granuloma formation or caseation necrosis. The bone marrow cultures yielded no growth of Mycobaterium tuberculosis while stainable iron in the marrow was found to be low or negative in 88.8% of the patients.