Rh Blood Group Antigens and Alloimmunization Risk of Pregnant Women in South Western, Nigeria.

BACKGROUND: Rh blood group antigens are the second most important blood group antigens in clinical transfusion due to their immunogenicity and prevalence. Childbirth, miscarriage, and other obstetrics events are risk factors for alloimmunization in women which increases the likelihood of haemolytic blood transfusion reaction and hemolytic disease of the fetal/newborn (HDNF/B). Even though there are several data on the RhD status of our populations. However, there is a dearth of data on pregnant women's C, E, c, and e status, their alloimmunization risk, and rates in Nigeria. OBJECTIVES: This study aims to provide information on the distribution of the Rh major antigens and risk factors for alloimmunization in pregnant women in southwestern Nigeria. MATERIALS AND METHODS: This was a descriptive cross-sectional study of 133 pregnant women attending routine ante-natal clinics. Questionnaires were administered to collect biodata and obstetrics history. ABO blood grouping and Rh phenotyping were carried out on their blood samples using RAPID LABS Monoclonal Rhesus Typing Reagent. RESULTS AND DISCUSSION: Rh blood group antigen c was present in 100% of the women, followed by e (98.5%) and D (95.5%). C and E are the least prevalent antigens and probably the ones to which antibodies may be formed. The commonest Rh phenotype was Dce. Of all the pregnant women, alloimmunization was present in 0.8%. Of those who were RhD negative, alloimmunization was present in 16.7%. Pregnant women are more likely to be alloimmunized against C and E antigens than c and e antigens due to their low and high frequencies respectively.

CONTEXTE: Les antigènes du groupe sanguin Rh sont les seconds plus importants en transfusion clinique en raison de leur immunogénicité et de leur prévalence. L'accouchement, la fausse couche et d'autres événements obstétriques sont des facteurs de risque d'alloimmunisation chez les femmes, augmentant ainsi la probabilité de réactions hémolytiques lors de transfusions sanguines et de maladies hémolytiques du fœtus/nouveau-né (HDNF/B). Bien qu'il existe plusieurs données sur le statut RhD de nos populations, il y a un manque de données sur le statut des antigènes C, E, c et e chez les femmes enceintes, leur risque d'alloimmunisation et les taux associés au Nigéria. OBJECTIFS: Cette étude vise à fournir des informations sur la distribution des principaux antigènes Rh et les facteurs de risque d'alloimmunisation chez les femmes enceintes dans le sud-ouest du Nigéria. MÉTHODOLOGIE: Il s'agit d'une étude descriptive transversale de 133 femmes enceintes fréquentant les cliniques prénatales de routine. Des questionnaires ont été administrés pour collecter des données biodémographiques et des antécédents obstétriques. La détermination des groupes sanguins ABO et le phénotypage Rh ont été réalisés sur leurs échantillons de sang à l'aide du réactif de typage Rh monoclonal RAPID LABS. RÉSULTATS ET DISCUSSION: L'antigène c du groupe sanguin Rh était présent chez 100 % des femmes, suivi de e (98,5 %) et D (95,5 %). Les antigènes C et E sont les moins prévalents et probablement ceux contre lesquels des anticorps peuvent être formés. Le phénotype Rh le plus courant était Dce. Parmi toutes les femmes enceintes, l'alloimmunisation était présente chez 0,8 %. Parmi celles qui étaient RhD négatives, 'alloimmunisation était présente chez 16,7 %. Les femmes enceintes sont plus susceptibles de développer une alloimmunisation contre les antigènes C et E que contre les antigènes c et e en raison de leurs fréquences respectives faibles et élevées. MOTS-CLÉS: Antigènes du groupe sanguin Rh, Phénotype, Alloanticorps érythrocytaires, Femmes enceintes.

HYPERTENSION AND DIABETES MELLITUS ARE ASSOCIATED WITH DEEP VENOUS THROMBOEMBOLISM: A CASE CONTROL STUDY.

Introduction: Identifying risk factors for venous thromboembolism (VTE) is useful in deciding thromboprophylaxis for VTE. A retrospective study had shown an association between hypertension and diabetes mellitus with VTE in our population. The objective of this study was to confirm these findings and to determine if the complete blood count and coagulation tests can also be useful parameters in stratifying VTE patients for prophylaxis. Methods: This is a gender and age matched prospective case-control study of 45 Doppler's confirmed DVT and 43 apparently healthy controls. Results: Identified risk factors included history of hypertension, diabetes mellitus, previous DVT, recent surgery, recent trauma, malignancy, sepsis, and immobility. The cases had a significantly lower mean haematocrit (33±7.4% vs 38±4.6%, p<0.001). Though no differences were observed in leucocyte and platelet counts between cases and controls but stratification as leucocytosis vs leucopaenia (P=0.003) and thrombocytosis vs thrombocytopaenia (P=0.045) differed between both groups. Also, the International normalized ratio (INR) was higher in cases (1.1±0.2 vs 1.0±0.1;P=0.001), hypercoagulable state (INR<0.9) and hypocoagulable state (INR>1.2) were observed in 4.4% and 28.9% of cases respectively but not in controls (P <0.001). Also, aPTT>40 seconds was seen in 4.4% vs 4.7% of cases and controls respectively and aPTT< 30 seconds in 22% of cases but not in controls (P =0.004). Conclusion: Hypertension and diabetes mellitus are identified risk factors not traditionally associated with DVT. These in addition to a complete blood count and coagulation tests can be useful in stratifying patients for prophylaxis in our population and other similar communities.

Protein C Deficiency in a Patient with Anomalous Hemiazygous Vein and Portal Vein Thrombosis.

Protein C deficiency increases the risk of an individual to develop thromboembolism and its complications. Clinical presentation of the complication of thrombosis in an unusual site may becloud clinical judgment resulting in missed diagnosis. We present an unusual case of protein C deficiency presenting with symptoms referable to the gastrointestinal system. A 34-year-old male with recurrent abdominal discomfort and bloating, managed as a case of gastro-oesophageal reflux disease with poor clinical outcome. Physical examination was unremarkable. Upper gastrointestinal endoscopy showed varices. Abdominal ultrasound scan and CT scan of the abdomen revealed thrombus in the portal vein. Functional assays of protein C and S revealed reduce protein C activity at 65 % (70 - 140%). This case emphasizes the need for extensive investigations in patients with common, sometimes neglected abdominal symptom such as bloating. It has also contributed in expanding the differential diagnosis of bloating and manifestations of protein C deficiency.

Une carence en protéine C augmente le risque pour un individu de développer une thromboembolie et ses complications. La présentation clinique de la complication de la thrombose dans un site inhabituel peut brouiller le jugement clinique entraînant un diagnostic manqué. Nous présentons un cas inhabituel de carence en protéine C présentant des symptômes liés au système gastro-intestinal Un homme de 34 ans avec une gêne abdominale récurrente et des ballonnements, pris en charge comme un cas de reflux gastro-œsophagien avec un mauvais résultat clinique. L'examen physique n'était pas remarquable. L'endoscopie gastro-intestinale haute a montré des varices. Une échographie abdominale et une tomodensitométrie de l'abdomen ont révélé un thrombus dans la veine porte. Les dosages fonctionnels des protéines C et S ont révélé une réduction de l'activité de la protéine C à 65% (70 à 140%). Ce cas souligne la nécessité d'investigations approfondies chez les patients présentant des symptômes abdominaux courants, parfois négligés, tels que des ballonnements. Il a également contribué à élargir le diagnostic différentiel des ballonnements et des manifestations de carence en protéine C.

The Evolving Application of DNA-Based Genotyping of Red Blood Cells in Blood Grouping: A Narrative Review.

Blood grouping system is made of diversities of inherited specific antigen markers located on the red cell membrane. Exposure to foreign antigens not present in individual genetic make-up stimulates the production of the corresponding alloantibodies which often times is detrimental to health. The high throughput, specific and cost-effective DNA-based red cell genotyping has improved health care delivery in blood transfusion science by enhancing our understanding of the genetic variations which control the expression of red cell antigens. It improves efficiency, accuracy of test, and enhances personalized therapy especially in transfusion dependent patients. This review aims to evaluate the evolving application of DNA-based red cell genotyping in determining blood group. It has helped to resolve discrepancies encountered with the conventional serological testing especially in difficult-to-type patients. Rare cell phenotypes with no commercially available antisera or weakly reacting antigens are easily detected. Furthermore, in-utero fetal DNA genotyping for identifying fetus at risk of haemolytic disease of fetus and newborn (HDFN), selection of donors for bone-marrow transplant and monitoring haemopoietic progenitor cells after ABO mismatch are other important applications of DNA-based genotyping.

Le système de groupage sanguin est composé de diversités héréditaires marqueurs antigéniques spécifiques situés sur la membrane des globules rouges. Exposition à des antigènes étrangers non présents dans la génétique individuelle le maquillage stimule la production de la les alloanticorps qui sont souvent préjudiciables à la santé. Le rouge à base d'ADN à haut débit, spécifique et économique le génotypage cellulaire a amélioré la prestation des soins de santé dans le sang la science transfusionnelle en améliorant notre compréhension de la variations génétiques qui contrôlent l'expression des globules rouges antigènes. Il améliore l'efficacité, la précision du test et améliore thérapie personnalisée en particulier chez les transfusionnels les patients. Cette revue vise à évaluer l'application evolutive du génotypage des globules rouges à base d'ADN dans la détermination du groupe sanguin. Il a permis de résoudre les écarts rencontrés avec le tests sérologiques conventionnels, en particulier dans les cas difficiles à taper les patients. Phénotypes de cellules rares sans les antisérums ou les antigènes faiblement réactifs sont facilement détectés. De plus, le génotypage de l'ADN fœtal in utero pour identifier fœtus à risque de maladie hémolytique du fœtus et du nouveau-né (HDFN), sélection de donneurs pour greffe de moelle osseuse et surveillance des cellules progénitrices hémopoïétiques après mésappariement ABO sont d'autres applications importantes du génotypage basé sur l'ADN.

Comparative Analysis of Rapid Test and Enzyme Linked Immunosorbent Assay for Screening of Blood Donors for Hepatitis B Surface Antigen Seropositivity.

BACKGROUND: The Hepatitis B surface Antigen (HBsAg) is the most utilized indicator marker of hepatitis B infection. This study assesses the accuracy of the two most common screening assays used to detect HBsAg among blood donors. MATERIALS AND METHODS: A total of 350 eligible blood donors were screened for HBsAg using both Bio-Check HBsAg Rapid screening kit (BioCheck Inc, South San Francisco, USA) and a fourth-generation Enzyme-Linked Immunoassays (ELISA) kit, MonolisaTM HBs Ag Ultra (Bio-Rad Laboratories, Marnes-la-Coquette-France). Questionnaires were used to inquire about risk factors for HBV infection among blood donors. The calculation of sensitivity, specificity, negative predictive and positive predictive values were carried out by comparing the performance of the rapid kit with ELISA test as the reference standard. RESULTS: The prevalence of HBV infection using Rapid Diagnostic Test (RDT) was 5.7% but was 14.6% by ELISA. Using ELISA as a reference, the sensitivity and specificity of RDT were 31.4% and 98.7% respectively. The positive predictive value and negative predictive value for RDT were 80.0% and 89.4% respectively. Overall non-compliance with transfusion-transmitted infection (TTI) risk-related deferral criteria was 38%. CONCLUSION: The low sensitivity of RDT kits precludes its continuous use in high HBV endemic regions where many donors fail to disclose full and truthful information about their risk for TTI. It is suggested that blood banks should complement the use of RDT with a more sensitive assay such as ELISA.

Haematological Changes Associated with Hepatitis B Virus Infection in Individuals with and without Sickle Cell Disease.

BACKGROUND: Hepatitis B virus infection, a major public health problem that primarily affects the liver, may cause reduction in the levels of haemoglobin, haematocrit and in the extreme, could cause aplastic anaemia. The haematological characteristics could be detected with a complete blood count which could provide invaluable information for diagnosis and management of the disease. AIM: To determine the effect of HBV infection on the blood count of individuals with sickle cell disease (SCD) and apparently normal healthy (Non-SCD). SETTING: Non-SCD participants were recruited from the community while SCD patients in steady state were recruited from SCD routine clinics. METHODS: The study was a cross - sectional study carried out on 1017 non-SCD and 1017 SCD individuals. Haematology Autoanalyzer was used to determine the complete blood count. Granulocyte-to-lymphocyte ratio (GLR), platelet to white blood cell count ratio (PWR) and platelet-to-lymphocyte ratio (PLR) were calculated. ELISA for HBsAg and HBV core antigen IgM antibodies were used to identify participants with HBV. RESULTS: The non- SCD individuals infected with HBV had significantly higher WBC (7.51 ± 5.8 X109/L)) compared to a WBC (6.1 ± 3.4 X109/L) in uninfected individuals (p =0.001). PWR for HBV negative (49.9±28.6) was higher than that for HBV positive participants (41.4±17.6) (p=0.034). Mean platelet volume (MPV) of 9.93 ± 1.1fl in SCD individuals with HBV was significantly higher than 8.30 ± 0.95fl in SCD individuals without HBV (p=.001). CONCLUSIONS: PWR and MPV may be useful as surrogate marker for detection of HBV disease progression in apparently normal healthy non - SCD and SCD populations to institute prompt appropriate ancillary investigation and treatment.

CONTEXTE: L'infection par le virus de l'hépatite B, un problème majeur de santé publique qui affecte principalement le foie, peut entraîner une réduction des taux d'hémoglobine et d'hématocrite et, dans l'extrême, peut provoquer une anémie aplastique. Les caractéristiques hématologiques peuvent être détectées par un hémogramme complet qui pourrait fournirdes informations précieuses pour le diagnostic et la et la gestion de la maladie. OBJECTIF: Déterminer l'effet de l'infection par le VHB sur sanguine complète d'individus atteints de drépanocytose (SCD) et d'individus apparemment normaux en bonne santé (non-SCD). SITE: Les participants de non-SCD ont été recrutés dans la communauté tandis que les patients drépanocytaires en état stable ont été recrutés dans les cliniques de routine de la drépanocytose. MÉTHODES: L'étude était une étude transversale menée sur 1017 personnes non-SCD et 1017 personnes SCD. sur 1017 personnes nonSCD et 1017 personnes SCD. Un autoanalyseur hématologie a été utilisé pour déterminer la formule sanguine complète. Le rapport granulocytes/ lymphocytes (GLR), le rapport plaquettes/blancs (PWR) et le rapport plaquettes/lymphocyte (PLR). ont été calculés. Les tests ELISA pour les anticorps IgM de l'Ag HBs et de l'antigène central du VHB ont été utilisés pour identifier les participants atteints du VHB. RÉSULTATS: Les individus non atteints de DSC et infectés par le VHB présentaient les caractéristiques suivantes un nombre significativement plus élevé de GB (7,51 ± 5,8 X109/L) par rapport à une WBC (6,1 ± 3,4 X109/L) chez les individus non infectés (p =0,001). Le TPM pour lesparticipants négatifs pour le VHB (49,9±28,6) était plus élevé que celuipour les participants positifs au VHB (41,4±17,6) (p=0,034). Le volume moyen des plaquettes Le volume plaquettaire moyen (VPM) de 9,93 ± 1,1fl chez les personnes atteintes de MCS avec VHB était significativement plus élevé que celui des personnes atteintes de MCS sans VHB (8,30 ± 0,95fl) (p=0,001). sans VHB (p=0,001). CONCLUSIONS: Le PWR et le MPV peuvent être utiles comme marqueurs de substitution pour la détection de la progression de la maladie VHB chez population de SCD et Non-SCD apparemment normale, en bonne santé afin d'instituer rapidement les examens complémentaires et le traitement appropriés.

HAEMATOLOGICAL PROFILE AND BLOOD TRANSFUSION PATTERN OF PATIENTS WITH SICKLE CELL ANAEMIA VARY WITH SPLEEN SIZE.

BACKGROUND: The spleen serves critical haematological and immunological functions in the body. However it is also the first organ to be affected by the effects of sickling in sickle cell anaemia. While the splenic size has been evaluated in sickle cell anaemia, the spleen sizes of these patients has not been associated with any specific haematological pattern. OBJECTIVES: To determine the haematological parameters of patients with sickle cell anaemia (SCA) in relation to spleen size. METHODS: The full blood count (FBC), the irreversibly sickled cells and blood transfusion use amongst SCA patients in steady state was evaluated. Abdominal ultrasound was also performed for all patients and HbAA control for splenic size categorization. RESULTS: Forty patients with SCA and 22 controls with HbAA were studied with mean age of 29.28 ± 8.10 years 28.23 ± 8.14 years respectively. The mean splenic longitudinal lengths in patients and controls were 6.3 ± 4.3cm and 8.9 ± 1.5 cm respectively (p-value < .05). The mean haematocrit and haemoglobin value were significantly lower in SCA cases than in controls (p < 0.001). Though the red cell indices were similar but the white blood cell and platelet count were significantly higher in patients than in controls. Among SCA cases, the spleen size showed significant positive correlation with haematocrit (r = 0.371, p = 0.019) and the age at 1st transfusion (r = 0.447, p = 0.013) but significant negative correlation with MCV, MCH, MCHC and platelet count. Above 80% of patients with severe, moderate and mild autosplenectomy had been transfused compared to 25% of patients with splenomegaly. CONCLUSION: Similarities in red cell indices between patients and controls suggests an identical factor influencing the red cell indices which could be genetic such as thalassemia or environmental such as iron deficiency. The negative correlation of the spleen size with red cell indices, white cell count and platelet count and positive correlation with haematocrit suggest that spleen size can be used to determine clinical course of the disease. Earlier age at first transfusion, significantly higher frequency of blood transfusion and MCHC in patients with severe autosplenectomy suggest a more severe clinical course when compared with patients with splenomegaly, normal spleen, mild and moderate autosplenomegaly.

Morbidity pattern and interferon gamma level in sickle cell anemia patients with autosplenectomy.

INTRODUCTION: In sickle cell anemia patients (SCA), the spleen suffers multiple occlusion of its microvasculature causing ischemia and subsequently autosplenectomy. Among the functions of the spleen is the production of gamma interferon (IFN-γ) which has several immunological roles. This function could be impaired in these patients. Therefore, this study aimed at determining the extent to which autosplenectomy affects the immunity of SCA patients as reflected by the level of IFN-γ, frequency of infections, and crises (vaso-occlusive, hemolytic, aplastic) in these patients. MATERIALS AND METHODS: Forty SCA patients in steady state condition were recruited into the study. A self-administered questionnaire was completed by all patients, and venous blood sample was analyzed for IFN-γ levels. All patients underwent abdominal ultrasound scan. RESULTS: Autosplenectomy was observed in 20% of the sickle cell patients. Bone pain was the most frequent type of crisis in the study population; this occurred in 100% and 85% of patients with autosplenectomy and those without autosplenectomy, respectively. Infection rates of more than once a year was reported in 87.5% of SCA patients with autosplenectomy compared with 50% of SCA patients without autosplenectomy. There was no significant difference in IFN-γ plasma levels between SCA patients with autosplenectomy and those without autosplenectomy. CONCLUSION: This study showed a higher prevalence of infection and bone pain crisis among SCA patients with autosplenectomy than in SCA patients without autosplenectomy. It also showed comparable level of IFN-γ in the 2 groups of patients. Patients with autosplenectomy may benefit from early institution of drugs such as hydroxyurea to improve quality of life.

Hypereosinophilic atopic transverse myelitis.

Atopic transverse myelitis is a rare disorder that is defined as a localized myelitis of an unknown cause in patients with either high immunoglobulin E (IgE) level or mite-specific IgE or coexistent atopic disease. It is a cause of intramedullary cord lesions, but its diagnosis does not need tissue confirmation. We report a case of a patient who presented with bladder and anal incontinence, paresthesia, and lower limb weakness. Neither IgE level nor mite-specific IgE level could be determined due to lack of fund; however, magnetic resonance imaging (MRI) of the thoracolumbar region showed hypotense-isotense lesion within the spinal cord at T4 vertebral level, suggestive of transverse myelitis. Blood cell count showed hypereosinophilia. Therefore, a diagnosis of atopic transverse myelitis based on high eosinophil count and MRI was made. Patient was commenced on prednisolone and had good response to treatment. Complete blood count is a cheap simple diagnostic tool in resource-poor country to distinguish atopic transverse myelitis from other causes of intramedullary cord lesions.

A revisit of venous thromboembolism.

OBJECTIVE: To determine the effect of the introduction of Doppler ultrasonography to the management of venous thromboembolism in a health care facility in Nigeria. METHOD: A descriptive study of cases of venous thromboembolism (VTE) over a five year period (March 2007-February 2012) was compared with a five year review done two decades ago before the introduction of Doppler ultrasonography. RESULTS: This review showed an increase of VTE cases from 60 to 178 with a median age of 53 yrs, median age of female patients was 5 yrs younger than male patients with Male/female ratio of 1:1.2. There was an even distribution of patients seen over the five year period with a mean prevalence of 35.6 patients per year. Patients with distal deep vein thrombosis (DVT) were in the majority (76%) compared with proximal DVT and PE which were 21% Vs 3%. About 4% of the patients had a recurrence of the VTE with male patients having twice the likelihood of a re-thrombosis. Common comorbid states observed are cerebrovascular disease (14.5%), cancers (12.2%), retroviral disease (6.7%) and diabetes (6.2%). Prostatic cancer was more common than other cancers while patients with retroviral disease are more likely to have an extensive DVT. CONCLUSION: The introduction of Doppler ultrasonography increased the awareness and diagnosis of VTE, we suggest that patients with associated disease conditions are placed on prophylactic anticoagulation, it is also necessary to determine the prevalence of inherited causes of VTE in the population.

An investigation of the prevalence of iron overload in Nigerian women.

BACKGROUND: Iron overload has been recognized to be a risk factor for numerous acute and chronic illnesses. It is generally assumed to be rare and acknowledgment of iron toxicity is difficult for some nutritional scientists, clinicians and laypersons. There is also a heightened interest to raise body iron through universal iron "fortified" foods. OBJECTIVE: This study investigated the need to examine the policy of unselective iron supplementation in a sub-Saharan African community. METHODS: This is a descriptive study carried out on 98 apparently healthy women attending a Papanicolaou (PAP) smear clinic for routine cervical cancer screening. Information on demographic data and diet were obtained with structured questionnaires and serum samples were analyzed for serum iron (SI) and total iron binding capacity (TIBC) which were used to derive the values for tranferrin saturation (TS%). Iron overload was defined by tranferrin saturation greater than 50%. RESULTS: The prevalence of iron overload was 8.2% in women aged 26-71 years. Skilled workers constituted 44.9% of the population while semi-skilled and housewives were 50% and 5.1% respectively. Eighty four percent of the women had been on iron vitamin supplement at one time or the other. Mild anaemia was present in 25% of the women with iron overload. The prevalence of iron overload between women who were actively reproducing and those who were not was not statistically different. CONCLUSIONS: Iron overload is common, therefore, iron studies may be included in routine investigation and selective iron supplementation should be encouraged. Moreso, iron loading anaemia should be ruled out in patients with anaemia before prescribing iron therapy.

Renal status of multiple myeloma patients in ibadan, Nigeria.

INTRODUCTION: The spectrum of clinical manifestation in multiple myeloma (MM) ranges from asymptomatic disease to severely debilitative state. Unexplained renal disease is an indication for the investigation of patients for MM. This study is a retrospective analysis of the renal profile of patients with multiple myeloma in relation to management strategy in our institution. METHODS: Medical records of 64 patients with multiple myeloma seen between 2000 and 2008 were retrospectively reviewed at an 850-bed tertiary hospital in South-Western Nigeria. The Mahn-Whitney test was used to compare laboratory features between patient with renal failure and those without renal failure. Subjects with serum creatinine ≥2mg/dL were regarded to have renal failure. Overall survival was calculated from diagnosis to death or lost to follow-up. RESULTS: A total of forty three patients were eligible. The renal status was categorized into three according to serum creatinine level; those with normal serum creatinine level (0.5-1.5mg/dl) were 26 (60.5%), serum creatinine level (>1.6-1.9mg/dl), and creatinine level ≥2mg/ dl were 3(7%) and 14(32.5%) respectively. Hyperuricaemia was observed in 6(42.9%) of MM patients with renal failure compared with 7(26.9%) of patient without renal failure (p<0.05). Twenty-one percent of those with renal failure had hypercalceamia. Thirty-six percent of the renal failure patients had haemodialysis. The average survival for all patients with renal failure was 18 months after diagnosis. CONCLUSION: The outcome in patients with renal failure remained poor with early mortality despite supportive management. Hyperuricaemia and dehydration, given the hot climate might have worked in concert with other factors to worsen the renal status in these patients.

Depressed antioxidant status in pregnant women on iron supplements: pathologic and clinical correlates.

Iron (Fe) remains a commonly prescribed supplement in pregnancy. Its possible pathologic potential is either uncommonly considered or ignored. We determined the antioxidant status in pregnant women with and without Fe supplements. Fifty-eight apparently healthy pregnant women on Fe supplements were selected for the study from the antenatal clinic of the University College Hospital, Ibadan, Nigeria. Fifty-five aged matched pregnant women who were not on Fe from various parishes of the Christ Apostolic Church, Ibadan (non-drug using Christian sect) were randomly selected as controls. Both groups were classified according to the trimesters of pregnancy. The gestational age in both pregnant women on Fe supplements and non-supplement pregnant women was similar. Fruit and vegetables consumption was higher in the supplement than in the non-supplement group (57.2% vs. 37.3%). Anthropometric indices, weight, height, and BMI, were also similar. But while the weight of the Fe supplement group decreased by nearly 3% in the third trimester, it increased by over 10% (p < 0.00) in the non-supplement group in the same period. Serum Fe level was significantly higher in the supplement than the non-supplement group (p < 0.001). In contrast, the levels of the antioxidants, ascorbic acid, copper (Cu), zinc (Zn), and bilirubin were all significantly decreased (p < 0.05, p < 0.001, p < 0.05, and p < 0.05, respectively). Uric acid level though also lower in the supplement group did not reach statistical significance (p > 0.05), while vitamin E was similar in both groups. There was relative stability of all antioxidants except uric acid, which declined from the first to the last trimester in the non-supplement group. The significantly higher Fe level in the second trimester was sustained in the third trimester though to a lesser degree (p < 0.05) and associated with significant decreases in the following antioxidant levels in the supplement group, ascorbic acid, bilirubin, Cu, and Zn (p < 0.02, p < 0.02, p < 0.02, and p < 0.001, respectively). Uric acid and vitamin E though lower in the supplement group were not significantly different. Remarkably, percentage changes between the first and third trimesters revealed that serum Fe increased by over 116% in the Fe supplement group, while it only increased by over 50% in the non-supplement group. This was associated with 23.50% decrease in ascorbate level (p < 0.003) in the supplement group, while it decreased by only 3.70% in the non-supplement group (p > 0.05). Again vitamin E decreased by 17.22% in the supplement group, while it decreased by only 7.30% in the non-supplement group during the period. Uric acid and bilirubin levels decreased by similar proportions during the period, while Zn decreased by 18.55% in the supplement group and by 14.86% in the non-supplement group. In contrast Cu increased by 7.20% in the supplement group, while it increased by only 2.96 in the non-supplement group. Additionally, all the antioxidants in the supplement group except vitamin E, viz, ascorbic acid, bilirubin, Cu, uric acid, and Zn, were significantly inversely correlated with serum Fe level (r - 0.299, p < 0.05, r - 0.278, p < 0.05, r - 0.383, p < 0.05, and r - 0.0369, p < 0.05). These data imply markedly depressed antioxidant status in the Fe supplement pregnant group with attendant oxidative stress (most probably pro-oxidant Fe-induced). This is associated with molecular and cellular damage as well as a number of pathologic and clinical correlates that underlie the exacerbation of morbidity and mortality in maternal and child populations, particularly in the developing countries. This appears to call for serious caution and prior evaluation of antioxidant and Fe status and during the use of Fe supplements in pregnancy for monitoring and prognostic purposes and to avert or ameliorate oxidative stress-induced pathologies in maternal and fetal systems.

Audit of the red cell units supply of a busy hospital blood bank in Nigeria.

BACKGROUND/OBJECTIVE: Blood bank audit embraces all procedures from blood procurement to the long -term consequences of transfusion which helps to identify opportunities for improvement. We have therefore looked at red cell transfusion in our hospital to identify areas that will require improvement. METHOD: Data was collected retrospectively from the hard copy record of the blood bank for a period of one month. RESULTS: Request was made for 1210 red cell units; crossmatch was made for 64% of the request. All units crossmatched were issued, of these 4.15% were returned unutilized. 5.1% were issued as uncrossmatched. The Obstetrics/Gynaecology unit recorded the highest blood usage and the medical unit the least. The use of blood by the emergency and paediatric were the same. The crossmatch:transfusion ratio for the hospital was 0.9:1. This study has shown that the crossmatch and transfusion rates are almost equal and only a small percentage was returned unused. CONCLUSION: This showed that there is inadequate supply of blood. There is a need to assess the reason for transfusion and establishing a blood transfusion advisory committee by the hospital. This will ensure interaction and collaboration between blood suppliers and users to improve the quality of transfusion practice. The new policy establishing a national transfusion service will also improve the transfusion service but emphasis has to be put on donor recruitment and donor care.

Prevalence of hepatitis B surface and e antigens, risk factors for viral acquisition and serum transaminase among blood donors in Ibadan, Nigeria.

The objective of this study was to determine the prevalence of hepatitis B e antigen (HBeAg) in blood donors with hepatitis B surface antigen (HBsAg), and alaninine transaminases (ALT) levels and possible risk factors for the transmission of hepatitis B virus (HBV). Over a 6-month period, consecutive blood donors were screened for HBsAg, HBeAg, ALT and risk factors for HBV transmission. One hundred seventy-five adults (158 males, 17 females) were screened. Thirty-seven (21.3%) were HBsAg positive, 4 (2.3%) were HBeAg Positive and 17 (9.7%) had a raised ALT level, which ranged between 42-126 IU/L. All the HBeAg-positive subjects had raised ALT levels. The main risk factors among others, were scarification and indiscriminate injections. Twenty of the 37 HBsAg-positive subjects (54%) had no identifiable risk factor. The present study revealed that, HBeAg positivity among HBsAg positive blood donors was infrequent and whenever present was associated with active liver disease indicated by raised ALT value.

Leukaemia cutis in a patient with acute myelogenous leukaemia: case report.

Leukaemia cutis is a specific lesion of leukaemia in which there is leukaemic cell deposit in the skin. There are few reports of this condition in our environment. Several mechanisms have been postulated for the pathogenesis of the disease. One of which is the tissue selective homing of a unique sub-population of malignant clone of cells. The presence of leukaemia cutis does not seem to worsen the prognosis as the acute myeloid leukaemia is an equally lethal disease. The fatality of the disease is compounded by the unavailability of the right regimen in our patient. This paper documents a case of leukaemia cutis in a patient initially diagnosed to have AML who developed skin lesion in remission. A skin biopsy was found helpful in diagnosing the first sign of relapse in a patient in haematological remission.

Hepatitis B and C viral markers in patients with sickle cell disease in Ibadan, Nigeria.

Serum samples from 180 Sickle Cell Disease (SCD) patients attending Medical Out patients (MOP) clinic of the Department of Haematology, UCH, Ibadan, Nigeria were tested for the presence of HbsAg and anti-HCV in their blood samples. The result showed that HBV infection was slightly higher (not significant) than HCV infection among SCD patients (P>0.05). In addition, the result showed that the mean number of transfusion was higher among patients who were sero-positive for both HbsAg (5.0 +/- 6.6) and anti-HCV (4.6 +/- 6.7) when compared to patients who were negative for both viruses (2.7 +/- 3.0 and 2.9 +/- 3.2) for HBsAg and anti-HCV respectively. These observations is an indication that there is an urgent need to screen blood units for hepatitis B and C virus infections prior to transfusion in order to reduce HCV infection among SCD patients in Nigeria. Furthermore, it suggests the need to vaccinate SCD patients against HBV in this environment.

Factors determining the outcome of management of patients with Burkitt's lymphoma at the University College Hospital Ibadan, Nigeria--an eleven year review.

In recent times, our experience in the chemotherapy of Burkitt's lymphoma patients in Ibadan, Nigeria has been that of poor outcome, hence this study was undertaken to determine the factors leading to the poor results of chemotherapy of Burkitt s lymphoma in Ibadan. A retrospective analysis of Burkitt s Lymphoma patients seen over eleven year period, between January 1987 to December 1997 at the Paediatrics and Haematology Departments of the University College Hospital, Ibadan was carried out. There were 67 patients, mean age 11+5 years (range 4 to 30 years), 42 males, 25 female giving M:F ratio of 1.7:1. Majority of the patients (76.2%) were stage D, only 4.5% were stages A and of the 67 patients, only 57 (83.6%) had chemotherapy, 40 of whom had COAP, 8 had COMP and 9 patients had either cyclophosphamide or cytosar as monotherapy. Only 22.8% of patients that received chemotherapy went into complete remission. In this study, we observed a declining overall complete remission rate of 22.8% (compared to 47% in 1979) in Burkitt s Lymphoma patients. The presence of large amount of fake drugs in the Nigerian market may imply that some of the cytotoxic drugs used in these patients could have been fake drugs. We suggest that the government should subsidize the therapy of these patients as well as eradicate the presence of fake drugs in the market, thereby increasing the chances of a cure.

Quality assessment of platelet concentrate prepared at a tertiary centre in Nigeria.

The need for platelet transfusion has increased at the University College Hospital (U.C.H.) Ibadan, Nigeria because of improved patient care and use of intensive therapeutic regimen associated with bone marrow aplasia. Therefore there is a need to assess the quality of the platelet concentrate prepared in our environment with a view to improving the quality of services available, consequently this study was carried out. Fifty platelet concentrates were assessed for pH, swirling index, volume, platelet count, WBC count and red cell count. All the concentrate preparations were within acceptable pH value of 7.25. The average volume was 18.52 mls/bag. The average platelet count per concentrate was 41.7+/-39.5 x 10(9)/L. Thirty-five percent (35%) of the platelet concentrates had a value > 55 x 10(9)/L. White blood cell count (WBC) < 12 x 10(9)/L was seen 49% of the platelet concentrates prepared. Forty percent (40%) of the platelet concentrate had a red blood cell count (RBC count) > 12 x 10(9)/L with 30% not having red cell contamination. Swirling test was positive in 72% of the platelet concentrate units. The results from this study point to the need to improve the quality of the platelet concentrates being prepared in our blood bank in order to get maximum therapeutic values. There is also a need for regular quality control of the platelet concentrate being prepared in our blood bank.

Hodgkin's disease after treatment for Burkitt's lymphoma: case report.

Hodgkin's disease and non-Hodgkin's lymphomas are interrelated disorders which have been reported to occur either simultaneously or sequentially in the same patient. We report here the development of nodular sclerosing type Hodgkin's disease in a patient two decades after successful treatment for Burkitt's lymphoma with cyclophosphomide and abdominal resection (AR). While the onset of symptoms after treatment for Burkitt's lymphoma was seven years definitive diagnosis of Hodgkin's disease was only made 22 years after the initial diagnosis of Burkitt's lymphoma. The recurrent and solitary nature ofthe lymphadenopathy and the fact that it was initially reported as reactive hyperplasia is typical of nodular lymphocyte predominant Hodgkin's disease. We believe that there was a transitory period of the malignancy as nodular lymphocyte predominant Hodgkin's disease.