Pattern of abnormal liver enzymes in HIV patients presenting at a Nigerian Tertiary Hospital.

AIM: To demonstrate the pattern of abnormal liver enzymes in HIV patients presenting at the University of Port Harcourt Teaching Hospital, Port Harcourt. BACKGROUND: Abnormalities of liver function tests (LFT) have been shown to be common in HIV/AIDS in developed countries. Studies have shown that these abnormalities may be due to direct inflammation induced by the HIV virus on the liver cell. It may also be due to gall bladder disease and infection with bacterial, viral or other opportunistic agents. PATIENTS AND METHODS: We reviewed the clinical notes and biochemistry results of HIV positive patients presenting at the HIV clinic from January 2003 to October 2003. Efforts were made to elicit symptoms suggestive of hepatobiliary disease. Their hepatitis B surface antigen status and their hepatitis C status were obtained. Attempts were made to determine the pattern of liver injury in each patient seen. RESULTS: A total of one hundred and twenty -nine (129) cases were recruited. The mean age was 35.6 +/- 9.0 years with a male to female ratio of 1.1 : 1. One hundred and thirteen patients (87.6%) had abnormalities of their LFT'S. Sixteen of these (14.5%) were classified as cholestatic liver injury while ninety-four (85.5%) were classified as having hepatocellular injury. Three patients (2.3%) were HbSAg positive while one (0.8%) was hepatitis C antibody positive. None of the patients was on anti retroviral drugs at the time of recruitment. CONCLUSION: We therefore conclude that abnormalities of liver enzymes are common in patients with HIV in this environment. It is therefore important to characterise the nature of this abnormality and to institute appropriate management. However further studies are required in this field of HIV related liver disease in our locality.

Epidemiology and management of occupational exposure to blood borne viral infections in a resource poor setting: the case for availability of post exposure prophylaxis.

OBJECTIVES: The aim of this study was to demonstrate the epidemiology and risk of occupational exposure to HIV, HBV and HCV among health care workers (HCWs) and highlight areas where greater training is required. METHODS: The study population included 13 health care workers; 5 males (38.5%) and 8 females (61.5%), mean age 34.15 +/- 6.8 years including 3 doctors (23.1%), 2 laboratory scientist (15.4%), 1 laboratory technician (7.7%), 6 medical students (46.2%) and 1 trainee laboratory assistant (7.7%). The care and follow-up provided to the health care workers in the 500 -bed tertiary health hospital that had percutaneous exposure to patient's blood between June 2002 and June 2005 were analyzed. All exposed health care workers were evaluated and offered follow up counseling. Five milliliters of blood from each of the HCWs and the source patients were screened by immmuno-enzymatic testing for HIV, HBV, and HCV. RESULTS: Exposures were concentrated in few areas of the hospital; pediatrics (46.2%); surgery (15.4%); obstetrics and gynecology (7.7%) and laboratory unit (30.8%) (divided by 2 = 7.72, p = 0.05). Risk of exposure was significantly higher among females (61.5%) compared to males (38.5%) (divided by 2 = 29.96, p = 0.001). All exposed HCWs were seen and offered post exposure prophylaxis within 24 hours of exposure. All the exposed health care workers were sero-negative to HIV, HBsAg and anti-HCV at exposure. The source patients were known in all cases. Evidence of HIV was present in 5 (38.5%); 1 (7.7%) had HBV while none had HCV infection. Of all the HCWs who completed the follow-up, only 1(7.7%) confirmed case of HBV seroconversion occurred in a HCW who was not previously vaccinated against HBV but who received post exposure HBV vaccination. Exposure rate was significantly higher among house officers 7 (53.9%) followed by registrars 3 (23.1%) and laboratory scientist 3 (23.1) (divided by 2 = 74.79, p = 0.0001). CONCLUSIONS: There is need to address the issue of occupational exposure in Africa by providing training on universal precaution, phlebotomy, modifying procedures that have high risk, developing institutional policy for handling of sharps and post-exposure management of health care workers, provision of protective HBV vaccine for all HCWs coupled with the provision of post exposure prophylaxis for exposed HCWs.

The risk of transfusion-acquired hepatitis-C virus infection among blood donors in Port Harcourt: the question of blood safety in Nigeria.

OBJECTIVE: This study was undertaken to establish the sero-epidemology of Hepatitis C Virus (HCV) antibodies among blood donors in Port Harcourt, Nigeria. METHODS: One Thousand Five Hundred consecutive blood donors presenting to the blood transfusion unit of the University of Port Harcourt Teaching Hospital between January and April, 2003 comprising of 1481 males and 19 females were screened for hepatitis C antibodies using the commercially available Clinotech anti-HCV test strips. All initially positive samples were subsequently tested using a second-generation Trinity Biotec enzyme linked immunosorbent assay. RESULTS: HCV antibodies were detected in 7 (0.5%) of donors. Although statistically not significant, the overall sero prevalence of HCV antibodies was higher in males 7 (0.5%) compared to zero prevalence among females. (chi-squared = 1.94, p = 1.000). Commercial remunerated donors had a higher prevalence of anti-HCV anti-bodies 5 (0.8%) compared to family replacement donors (0.2%) (chi-squared = 1.25, p = 0.26). The highest infection rate occurred in the 18 - 27 years age group 7 (0.7%). CONCLUSION: This study shows a 0.5% prevalence of HCV antibodies among blood donors and describes their demographic characteristics. This calls for urgent implementation of a universal donor screening for HCV antibodies and setting up of a national blood transfusion service run on the basis of voluntary, non-remunerated low risk donors.

Seroprevalence of hepatitis C virus in the Niger Delta of Nigeria.

The objective of this cross-sectional survey was to determine the prevalence of anti bodies to hepatitis C virus in 366 consecutively recruited individuals comprising 209 males and 157 females. Anti-HCV was detected in 11 (3.0% ) of the subjects tested. The highest prevalence was found in the 30-39 year age group (3.8% ) while the lowest prevalence occurred in the 40-49 year group (2.2% ). Anti-HCV infection prevalence was higher in less educated subjects (4.6% ) compared to highly educated (1.4% ), in females (3.8% ) compared to males (2.4% ) and was found to be almost two times higher among unmarried (4.1% ) compared to married subjects (2.2% ). This study confirms a high prevalence of anti-HCV and calls for urgent health education and awareness in the Niger Delta area of Nigeria to check further spread of the virus.

Splenic changes in sickle cell anaemia.

BACKGROUND: The spleen is one of the most frequently affected organ in Sickle cell anaemia (SCA). This has been attributed to its complex anatomy and prominent reticuloendothelial functions which include clearance of unwanted particulate matter in blood ( culling), defense against infection and reservoir for blood cells. This paper aims to highlight the current information on the changes that occur in the spleen of Sickle Cell Disease patients in this environment. METHOD: A review of relevant literature on the subject of splenic changes in Sickle Cell Disease sourced by manual library and medline search. RESULTS: The essential splenic change in SCA is splenomegaly and subsequent shrinkage in size (autosplenectomy), which maybe due to several factors. These include: high levels of irreversible sickle cells, decreased HbF associated with increased intravascular sickling and chronic Malaria infection secondary to hyperplasia of the reticulo-endothelial system and increased antibody production especially IgG and IgM. Finally, the clinical complications of these splenic changes such as increased susceptibility to infection, acute splenic sequestration and hypersplenism are also reviewed in this paper. CONCLUSION: In view of the above changes, it is important to ensure regular monitoring and follow-up in order to prevent complications, recurrent crisis and death.

The effects of highly active antiretroviral therapy (HAART) of stavudine, lamivudine and nevirapine on the CD4 lymphocyte count of HIV-infected Africans: the Nigerian experience.

OBJECTIVES: The objective of this study was to investigate the short-term effect of highly active antiretroviral therapy on the CD4 lymphocyte count of HIV-infected Nigerians. DESIGN: A case control study of 70 HIV-infected subjects placed on highly active antiretroviral therapy. Thirty HIV-infected yet to start therapy due to unaffordability were observed as controls. SETTING: This study was carried out at the Hematology Department of the University of Port Harcourt Teaching Hospital a 500 bed tertiary hospital and one of the designated antiretroviral therapy pilot centers. METHODS: CD4 lymphocyte count was determined at baseline for subjects and controls. Subjects were placed on HAART for 12 weeks while controls that were yet to start therapy were monitored as controls. CD4 lymphocyte count was repeated after 12 weeks and the differences compared statistically. RESULTS: We observed that subjects and control patients did not differ significantly in their CD4 lymphocyte count at baseline (p>0.05), but after 12 weeks HAART in subjects and untreated control there was a mean increase in CD4 count of (39 cells/microL) in subjects, while untreated controls showed a mean decline of (12 cells/microL) p< 0.05. There was a statistically significant variation in the therapy dependent increases in CD4 count of HAART treated subjects based on pre-therapeutic baseline CD4 count (divide2 = 180.39, p<0.05). The HAART dependent increase in CD4 counts was higher in younger subjects 19-28 years (31 cells/microL) compared to older subjects 49-58 years (21 cells/microL) (p = 0.01). Similarly CD4 response was found higher in females compared to males (p = 0.01). CONCLUSION: This study indicates the importance of accessing the CD4 lymphocyte count of HIV infected patients before the initiation of HAART, its use as a prognostic maker in predicting the initial response to HAART and in determining the optimal time to initiate therapy.

Adherence to Antiretroviral Therapy among HIV-infected Subjects in a Resource-Limited Setting in the Niger Delta of Nigeria

Since the early days of antiretroviral therapy; adherence has emerged a milestone to success. The objective of this study was to evaluate the factors militating against adherence to antiretroviral therapy among HIV-infected individuals in the resource - limited setting of the Niger Delta of Nigeria. A structured interviewer- administered questionnaire from consecutively recruited 187 HIV-infected patients on combination antiretroviral therapy of two-nucleoside analogue; stavudine and lamivudine and one non-nucleoside (nevirapine) was used. Association between the independent variables and adherence were analyzed using chi square analysis. This study observed an adherence level of 49.2and identified the following as factors associated with nonadherence: cost of antiretrovirals; educational status; medication adverse effect; occupational factors; and high pill burden of prescribed regimen (p 0.05). There is an urgent need for universal access and sustainability of antiretroviral therapy particularly in resource - limited settings. There is need for supervised medication delivery. Efforts should be made towards simplifying the therapeutic regimen to reduce the pill burden and substitution with treatment combination and strategies that minimize negative adverse effects; coupled with the re-intensification of patient's education and counseling

Seroprevalence of HIV infection among blood donors in Port Harcourt, Nigeria.

BACKGROUND: This study was undertaken to determine the seroprevalence of human immunodeficiency virus infection among blood donors living in the Niger Delta area of Nigeria. METHODS: A total of 1500 consecutive donors comprising 1481 males and 19 females were screened for HIV-I and HIV-II antibodies using the World Health Organization (WHO) approved Immunocomb HIV I and II test kit. All initially reactive samples were confirmed using the Genscreen HIV I and II test kit. RESULTS: The overall prevalence of HIV was 1.0%. The highest prevalence occurred in the 20 - 29 years age group (60%), followed by 30 - 39 years age group (21.5%). Commercial remunerated donors had the highest infection burden (1.4%) followed by the family replacement donors (0.7%) (p < 0.05). HIV-I accounted for the more predominant strain (0.8%). CONCLUSION: This study has shown an overall prevalence of 1% among blood donors in the Niger Delta area of Nigeria with the highest prevalence amongst donors in the 20 to 29 years age group. We advocate for the mandatory screening of donor units intended for transfusion and the immediate take off of the national blood transfusion service. Furthermore, there is an urgent need for the health education of the people of the Niger Delta area on preventive measures aimed at arresting the spread of HIV.

Seroprevalence of HIV among unemployed individuals undergoing pre-employment medical examination in Port Harcourt, Nigeria.

BACKGROUND: Human immunodeficiency virus (HIV) infection is highly endemic in Nigeria, particularly with the prevalence in 2001 at 5.8%. This study was undertaken to determine the prevalence of HIV among unemployed individuals undergoing pre-employment medical examination in Port Harcourt. METHOD: HIV screening was performed on 868 individuals comprising 373 males and 495 females presenting to the University of Port Harcourt for the purpose of pre-employment medical examination using a double ELISA confirmatory test of Immunocomb and Genscreen HIV 1 & 2 kits. RESULTS: The sero-prevalence rate was 27/868 (3.19%) among the total population. HIV seroprevalence was relatively higher among females 18/495 (3.6%) compared to males 9/373 (2.4%). The highest prevalence was found in the <19 years age group 7/135 (5.1%) and lowest in the 40-49 years age group 3/130 (2.3%), although the difference was not statistically significant (chi2 = 4.86, p = 0. 09). The highest prevalence occurred among separated subjects 2/26 (7.7%) compared to singles 18/460 (3.9%) and married subjects 7/382 (1.8%). CONCLUSIONS: This study indicates a 3.1% prevalence of HIV infection among unemployed individuals studied and calls for urgent and concerted efforts aimed at promoting behavioural, cultural and social changes that will reverse the current trend in the prevalence of HIV among Nigerians.

An evaluation of the Beckman-Coulter AcT 3-part differential haematology analyzer in a tertiary hospital laboratory.

BACKGROUND: The Beckman-Coulter AcT differential haematology analyzer was evaluated to compare its haemoglobin (HGB), haematocrit (HCT), platelet (PLT), total white cell count (WBC) values and differential leukocyte count (DLC) with the reference manual methods used in our laboratory. METHODS: Samples drawn into 5 millilitres k3 EDTA bottles were selected on a random basis from our routine workload over a 4-week period. Fifty patient samples were analyzed on the AcT diff Coulter analyzer. The same patient samples were then reanalyzed using the reference manual method for comparison. Haemoglobin (cyanmethhaemoglobin method), haematocrit (micro-haematocrit method), total WBC (Turk's Method), platelet (Brecker-Cronkite method) were carried out and blood films were stained with leishman stain, and a 100-cell manual differential count was performed under oil immersion. RESULTS: The Beckman Coulter AcT 3 diff haematology analyzer was shown to have excellent precision and accuracy for HGB and HCT with coefficient of correlation > 0.974. WBC and PLT had low coefficient of correlation of 0.208 and 0.034 respectively. The DLC parameters was shown to have good correlation coefficients for neutrophils > 0.876 and lymphocytes > 0.84. Monocytes showed a low correlation of 0.082 without clinical significance. CONCLUSION: The clinical sensitivity of the instrument in relation to the population evaluated was good. In all, the study results indicate that the AcT 3-part haematology analyzer could improve the overall laboratory productivity with flagged abnormal results being confirmed by the manual reference method.

The influence of foetal haemoglobin on the frequency of vaso-occlusive crisis in sickle cell anaemia patients.

OBJECTIVE: Several biological and environmental factors are presumed to account for the morbidity pattern in patients with sickle cell anaemia. Foetal haemoglobin is one of the biological factors thought to decrease morbidity in these patients. We studied the relationship between the foetal haemoglobin levels and vaso-occlusive crisis (VOC) as a measure of the morbidity pattern in this category of patients. RESULTS: The mean foetal haemoglobin level was 6.4+0.40% (SEM). Vaso-occlusive crisis was more common at lower levels of foetal haemoglobin particularly when lower than 12% (P=0.01). There was a negative correlation between foetal haemoglobin and vaso-occlusive crisis (r=0.561). These variables were also associated in linear regression and both showed statistical significance (p=0.001). CONCLUSION: We conclude that higher levels of foetal haemoglobin positively influence the occurrence of vaso-occlusive crisis in sickle cell anaemia patients.

Some haematological parameters in human immunodeficiency virus (HIV) infected Africans: the Nigerian perspective.

BACKGROUND: Haematologic abnormalities are among the most common manifestations of advanced human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). A specific diagnosis of cause, severity and mechanism of cytopenia should be sought because of specific treatments or intervention may be indicated for its correction. This study was to determine some haematological parameters in HIV/AIDS infected Nigerians. METHOD: One hundred HIV/AIDS infected previously antiretroviral naïve adult Nigerians, aged 18-58 year (males 47 and females 53) consisting of 88 symptomatic and 12 asymptomatic patients recruited into the antiretroviral pilot project in the Haematology department of the University of Port Harcourt Teaching Hospital between June 2002 to July 2003 were studied. Haematological parameters of hemoglobin, white cell count, platelet count, erythrocyte sedimentation rate and differential leucocyte count were determined. Data was analyzed using a multipurpose statistical package version 9 SPSS. RESULT: The mean haemoglobin was 10.25 +/- 1.97 g/dl (range 6.31-14.2 g/dl), severe anaemia occurred in 80% of subjects while 20% were non-anaemic. Haemoglobin values was found positively correlated to lymphocyte count (r = .319, P = 0.01) and inversely correlated to ESR (r = -.343, P = 0.01) and neutrophil count (r = -.343, P = 0.01). Red cell morphology was variable with majority normochromic and normocytic (64%) and 36% showing hypochromia and anisopoikilocytosis. The mean total WBC count was 4.51 +/- 1.82 x 10(9)/l (range 0.9-8.2 x 10(9)/l). Leucopaenia occurred in 10/100 (10%) of study population. Total white cell count showed a significant inverse correlation to lymphocyte count (r = -.326, P = 0.01). The mean neutrophil count was 2.32 +/- 1.58 x 10(9)/l (range 0.00-5.48). Neutropaenia occurred in 24% of subjects. Neutrophil count showed a significant positive correlation with total white cell count (r = .314, P = 0.01) and a negative correlation with lymphocyte count (r = -.982, P = 0.01). Striking eosinophilia occurred in 3% of subjects. The mean platelet count was 170.07 +/- 49.03 x 10(9)/l (range 72-158 x 268 x 10(9)/l). Thrombocytopaenia occurred in 10/100 (10%) of subjects. The mean erythrocyte sedimentation rate was higher than that in healthy Africans (mean 78.87 +/- 39.33mm fall/hour (range 0.2-158mm fall/hour). CONCLUSION: Observation from this study will serve as a guide to clinicians caring for HIV patients in taking rational decision on haematological complications of HIV infection. This constitutes further evidence of the need for routine monitoring of some haematological parameters of HIV/AIDS infected Africans and before commencement of highly active antiretroviral therapy to ensure that mortality and morbidity are minimized and quality of life optimized.

The prevalence of hepatitis B surface antigen (HBsAg) among prospective blood donors and patients in Port Harcourt, Nigeria.

BACKGROUND: HBV infection with its associated sequelae is a disease of major public health importance worldwide. This study analyzed the results of HBsAg screening at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, over a five-year period (1996-2000), with a view to establishing the prevalence rate in this area of the Niger Delta of Nigeria. METHODS: RESULTS from the Hepatitis Laboratory of the Hospital for the five-year period (1996-2000) were reviewed. The subjects consisted of two (2) main groups, i.e. blood donors and hospital patients. Screening was done using latex agglutination kits manufactured by Biotec Laboratories, USA. RESULTS: A total of 7226 samples were screened for HBsAg over the five-year period. The overall sero-positivity rate was found to be 4.98%. The carrier rate among blood donors was 1.57%, while among hospital patients, the prevalence rate was 28.37%. CONCLUSION: Hepatitis B surface antigenaemia is common in Port Harcourt and its environs. Therefore adequate screening of patients and blood donors and the institution of adequate public health measures is advocated in order to reduce the transmission of this virus.

ABO and rhesus antigens in a cosmopolitan Nigeria population.

BACKGROUND: Port Harcourt is a cosmopolitan city consisting of several ethnic groupings such as Ikwerre, Ijaw, Igbo, Ogonis, Efik-Ibibio, Edo, Yoruba, Hausa and foreign nationals. ABO and Rhesus D antigens were screened in this cross-sectional study with the aim of generating data that would assist in the running of an efficient blood transfusion service for a cosmopolitan city as Port Harcourt. METHOD: Blood donors were sampled and screened for ABO and Rhesus D antigens at three Health facilities within Port Harcourt: University of Port Harcourt Teaching Hospital, Braithwaite Memorial Hospital and Orogbum Health centre. RESULTS: A total of 936 blood donors were tested in this study. The results of the ABO screening shows that blood group O was the highest with 527 (56.30%) followed by blood group A, B and lastly AB with 212 (22.65%), 178 (19.02%) and 18(2.10%) respectively. The highest contribution to blood group O was from the Ibos with 220 (23.50%) while the Ijaws gave the highest contribution of Rhesus "D" antigen with 370 (39.53%), closely followed by the Igbos with 334 (0.43%). Rhesus negativity values in this study was 7.26% of which the highest contributors were also the Ijaws with 33 (3.53%) and Igbos with 27(2.89%). CONCLUSION: The increased demand for safe blood calls for an efficient Blood, Transfusion Service at the local, state and national levels. It is hoped that the data generated in this study would assist in the planning and establishment of a functional Blood service that would not only meet the ever increasing demand for blood products, but also play a vital role in the control of HIV/AIDS and . Hepatitis B global scourge.

Determination of paternity disputes in the Niger delta region of Nigeria.

Results of paternity test, among disputants, carried out in our hospital between May 1992 and May 2002 were analysed. The cases were referred from Social Welfare Office, the Court and the Police. A total of twenty-four (24) cases consisting of 22 (91.7% ) groups of three each, including the disputed child, the mother, and the alleged father; and 2 (8.3% ) groups of four each, with one group consisting of the disputed child, the mother and two alleged fathers, while the other consisting of the mother, the alleged father and the disputed female twins. All the disputed victims were children (10 males and 14 females) in the age group 6 months to 8 years. The total cumulative paternal exclusion rate with our routine techniques was only 16.7% , all with the ABO blood group system. This is a far cry from the exclusion rates of about 97% for HLA testing, and 99.9% for DNA analysis. The available screening package in our hospital is therefore inadequate, and we advocate for the provision of more sophisticated and reliable techniques in designated centres across the country. This will go a long way in resolving the medicolegal and social problems encountered by the disputants and the victims.

The prevalence of hepatitis B surface antigenaemia in HIV positive patients in the Niger Delta Nigeria.

BACKGROUND: Both hepatitis-B virus (HBV) and human immunodeficiency virus (HIV) infections are common in Nigeria and are a significant cause of mortality and morbidity. This study was undertaken to determine the prevalence of hepatitis B surface antigen (HBsAg) in HIV infected patients and to highlight the need to pay attention to the recognition of potentially severe concurrent illness that may increase morbidity and mortality of HIV infected patients. METHODS: Three hundred and forty-two HIV positive patients recruited into the antiretroviral therapy pilot project at the University of Port Harcourt Teaching Hospital comprising 192 males and 150 females between June 1995 to February 2003 constituted subjects for this study. HIV status of subjects was confirmed using the WHO approved Immunocomb (Organics, Israel) and Recombigen HIV I and II kits (Cambridge diagnostics, Ireland). HBsAg was assayed using the commercially available Clinotech HBsAg kits based on the chromatographic immunoassay technique (Clinotech diagnostics, Canada). RESULTS: HBsAg was detected in 33 (9.7%) of patients infected with HIV. Co-infection rate was highest in the 33-39 years age group. Single/unmarried patients constituted the highest proportion of those with HIV/HBV co-infection 21/195 (10.8%) followed by widowed/separated 4/47 (8.5%) and married (8.0%). Commercial sex workers had the highest prevalence among the occupational groups 4/30 (13.3%) followed by applicants 8/75 (10.7%) and drivers 4/40 (10.0%) while the lowest occupational prevalence occurred among farmers. Chi-square analysis indicated that age was an independent risk factor for HBV co-infection in HIV infected patients (P<0.05). CONCLUSIONS: This study demonstrates a high prevalence (9.7%) of HBsAg in HIV infected patients. This calls for a more intensive prevention and surveillance measures to control the HIV/AIDS scourge and co-infection with HBV.

Lupus anticoagulant in Nigerian women with preeclampsia.

OBJECTIVE: The Lupus Anticoagulant (LA) which used to be known for its interference with coagulation studies in the 1950s, has now been recognised to be associated also with diverse disease conditions in the developed countries. Our aim therefore was to determine the prevalence of the lupus anticoagulant (LA) in women with pre-eclampsia and controls. SUBJECT AND METHODS: A total of seventy-six pregnant women, were studied, twenty-six pre-eclampsia and fifty who were apparently healthy served as controls. The Kaolin clotting time test (KCT) was performed in duplicates on plasma samples from subjects and controls. Mixing ratio was calculated in order to determine the presence of the lupus anticoagulant, Kaolin clotting time ratio of greater than or equal to 1.2 was taken to signify the presence of the lupus anticoagulant. RESULTS: Eleven (42.3%) of the women with pre-eclampsia had prolonged KCT as against 2(4%) of the pregnant control. The clotting time of 7 of the '11 pre-eclampsia with prolonged KCT, were correctd by normal plasma, while 4 were not corrected. The KCT ratio of all 4 were greater than 1.2 signifying the presence of LA (15.4% prevalence). One (2%) of the pregnant control had KCT ratio greater than 1.2 (2%) prevalence of LA). CONCLUSION: A number of Nigeria women with pre-eclampsia also have the lupus anti-coagulant therefore African women with pre-eclampsia should be screened for the presence of lupus anticoagulant.

Prevalence of lupus anticoagulant in multiparous women in Benin City, Nigeria.

Lupus anticoagulant which in the past was regarded as a laboratory nuisance is now known to be associated with numerous clinical conditions including thrombosis and recurrent foetal loss, however, no work has been done to assess its prevalence in non-pregnant healthy multiparous women. Our aim therefore was to determine the prevalence of lupus anticoagulant in non-pregnant multiparous Nigerian women of childbearing age. Fifty non-pregnant multiparous women who were considered healthy following verbal interviews were studied. An eligibility criterion was used. Coagulation studies were performed on plasma samples from all the women using the Kaolin clotting time. Mixing experiments were conducted on samples with prolonged clotting time to detect the presence of the lupus anticoagulant. The Kaolin clotting time ratio of greater than or equal to 1.2 was considered positive for the lupus anticoagulant. Forty-four (88%) of the 50 women had a normal cloning time, 2(4%) had subnormal clotting time while 4(8%) of them had a prolonged Kaolin clotting time. Mixing experiments on these 4 samples revealed Kaolin clotting time ratios of over 1.2, signifying the presence of the lupus anticoagulant (i.e. 8 per cent prevalence) among the population of women studied Multiparous women with the lupus anticoagulant may not be symptomatic therefore the anticoagulant should be screened for in women with unexplained prolongation of cloning time. We recommend that these women should be followed up especially in pregnancy to forestall any of the obstetric complications that have been associated with the lupus anticoagulant.

Prevalence of D(u) phenotype amongst rhesus negative females in Port Harcourt, Nigeria.

The prevalence of D(u) phenotype was investigated among rhesus negative women of childbearing age (15-45 years) in Port Harcourt, Nigeria, over a period of 17 months. A total of 1,108 women were randomly sampled, out of which 1,003 (90.5%) were rhesus positive and 105 (9.5%) rhesus negative. Only one (0.95%) of the Rh-negative women was D(u) positive while 104 (99.05%) were D(u) negative (true thesus negatives). The results show that the incidence of D(u) phenotype in Nigeria may not be uniform--it is high among the Yorubas (7.5%) and rare among the Ijaws and Efik-Ibibios of the south-east. The results also suggest that D(u) testing may not be indicated in all individuals initially typed as rhesus negative while being strongly indicated only in areas of high prevalence. More studies are required in other parts of Nigeria to provide data that may facilitate the adoption of a comprehensive nationwide policy on appropriate management of rhesus negative women in the country. This will include the D(u) testing of all rhesus negative mothers in areas of high D(u) phenotype prevalence before the prophylactic administration of anti-human immunoglobulin (Rhogam).