Compatibility testing between the blood of donors and recipients in Nigerians.

5163 consecutive units of group O donor blood or donor blood of the same ABO and Rh (D) blood group as the recipient (patient) crossmatched for 2500 patients between 1981 and 1983 were analysed for the occurrence of incompatibility due to agglutinating antibodies. A surprisingly low percentage (1.76%) of all the donor/recipient crossmatches were incompatible, with the frequency of incompatibility being 1.83% when the donors are of same blood group as the recipients (intra-group crossmatches) compared to a frequency of incompatibility of 0.7% when group O donors are crossmatched for group A, B or AB recipients or group A or B donors are crossmatched for group AB patient (inter-group crossmatches). There were only 5 out of 2500 recipients (0.2%) with positive "Auto Control' against whom 16 units of donor blood were unsuccessfully cross matched. Contrary to popular belief, the uses of Group O as a "universal donor' was very infrequent, involving only 225 out of 5163 (4.35%) donor units. The clinical significance of these findings are discussed and explanations are offered.

Assessment of auditory function in sickle cell anaemia patients in Nigeria.

The auditory function of 30 patients with homozygous sickle cell disease (sicklers) was compared to a control group of 20 patients with a normal haemoglobin AA (non-sicklers). The sicklers exhibited a relatively higher mean pure tone hearing threshold at most frequencies than the control group, the difference at 4000 cps being statistically significant. The sicklers and non-sicklers (control group) did not show any significant differences in the pattern of tympanograms, static middle ear compliance and mean acoustic reflex thresholds, suggesting essentially normal middle ear mechanisms in both groups. The higher mean pure tone hearing threshold in sicklers may be due to inner ear sensori-neural deafness due to lifelong vaso-occlusion of some of the micro-vasculature supplying the inner ear apparatus in sicklers. Clinical implications are discussed and the need for periodic assessment of auditory function in Nigeria sicklers for preventive management of auditory problems is emphasized.

Oral and dental complications of sickle cell disease in Nigerians.

A clinical evaluation of the oral and dental complications of sickle cell disease in Nigerians was carried out in 37 consecutive patients with homozygous sickle cell disease Hb-SS (Sicklers) compared to a control group of 24 persons with normal haemoglobin Hb-AA (control group) matched for age and sex. The significant abnormalities found in sicklers included intrinsic opacity of the teeth in 67.5% of sicklers compared to 28.83% in the control group; malocclusion of the teeth with over-jet and over-bite in 35% of sicklers compared to 16.66% in the control group; dental caries is present in 35.13% of sicklers which was less than its occurrence in 54% of the control group due to widespread avoidance of sweets by most local sicklers. Diastemata (gaps between the teeth) was present in approximately equal frequency in sicklers (27%) and control group (25%). In view of the aesthetic and medical implications of these abnormalities, it is recommended that sicklers should receive regular dental check-up with a view to ameliorating or preventing these complications by prophylactic measures including the use of orthodontic appliances such as braces, etc. The above findings are discussed in relation to the other complications of sickler cell disease in other organs of the body.

Tibial and fibular angles in homozygous sickle cell disease.

Measurements of the tibial and fibular angles made on ankle radiographs of 34 patients with sickle cell disease were compared with those of 36 normal Nigerians. Widening of the fibular angle, which is an indication of tibiotalar slant, was demonstrated in about 79% of sickle cell disease patients. By using fibular angle measurements as an objective method of assessing subtle tibiotalar slant, it is concluded that the incidence of this deformity is much higher among sickle cell disease patients than previously reported. The mean values of tibial and fibular angles in normal Nigerians are higher than has been reported amongst Caucasians.

Tissue damage in sickle cell disease as assessed by serum acid phosphatase.

The extent of tissue damage caused by vaso-occlusion in sickle cell disease in those organs rich in acid phosphatase was assessed by measuring serum acid phosphatase in 33 patients with homozygous sickle cell disease Hb-SS (sicklers) and comparing the result with that of 31 persons with normal haemoglobin-AA (non-sicklers) matched for age and sex. The result showed a decrease in the level of total, labile and tartrate-resistant serum acid phosphatase in sicklers compared to non-sicklers, though the decrease is not statistically significant (p greater than 0.1). Though serum acid phosphatase is unlikely to be a useful index for the assessment of organ damage, the result is in consonance with reported decreases in other body secretions such as serum testosterone or aldosterone due to organ damage by vaso-occlusion of the micro-circulation by sickled red cells in sickle cell disease.

Blood transfusion in obstetrics and gynaecology: pattern, problems and prospects.

PIP: Despite a severely inadequate supply of blood in African countries, the misuse or overuse of blood exists in many countries, particularly Nigeria, and compromises the efficiency of blood transfusion services. The aim of this retrospective study was to find out the problems of blood usage and to make recommendations for the improvement of blood transfusion services in the Obstetrics/Gynecology Department of the University of Benin Teaching Hospital. The department is the largest user of blood in this hospital. The records of 500 consecutive patients who received 1,264 units of blood in the department over a 3-year period (1979-1982) were analysed. 1 major problem identified was "single unit transfusion" in 23.2% of the patients, (needless transfusion of only 1 unit of blood). The next problem, in 15.2% of non-bleeding patients with chronic anemia, was the excessive reliance on the level of packed cell volume rather than on the clinical indications to justify the need for blood transfusion. The 3rd problem was the preponderance of emergency requests for blood, 53.8% of all cases, as compared to 48.2% of all cases, thereby depriving other departments in the hospital of blood reserved for elective procedures. The impact of these problems on the blood bank and on blood transfusion services in general are discussed, and the propoer indications for blood transfusion reviewed.^ieng

Cholelithiasis in sickle cell disease: a cholecystographic and ultrasonographic evaluation in Nigerians.

A prospective study designed to establish the incidence of gallstones among 48 Nigerian homozygous sickle cell disease patients was made using oral cholecystography and grey-scale ultrasonography. The age range was 2 to 35 years with a mean of 16 years. The youngest patient with gallstones was a 51/2-year-old boy. Gallstones were demonstrated on cholecystosonography in 12 of 48 patients (25%). The incidence of cholelithiasis was 7.7% in children 10 years or younger and 31.4% in patients above this age. There was no correlation between the incidence of cholelithiasis and serum bilirubin on one hand and positive history of abdominal pain on the other. Screening of patients over 15 years for gallstones is suggested with a view to performing elective cholecystectomy in patients who subsequently become symptomatic.

Ocular manifestations of sickle cell disease in Nigerians; experience in Benin City, Nigeria.

The ocular findings in 50 cases of homozygous sickle cell disease are reported. Ocular abnormalities were found in 45 (90%) of them. Conjunctival vascular anomalies, tortuosity of the retinal vessels, particularly the veins and pigmented chorioretinal lesions were the commonest ocular manifestations; central retinal artery occlusion was found in one patient. Angioid streaks, retinitis proliferans and retinal detachment were not observed. Visual acuity was normal in 49 out of 50 patients; the exception was the patient with central artery occlusion.

Anti-A and anti-B haemolysins, dangerous universal blood donors and the risk of ABO antagonism in a Nigerian community.

Blood samples from 509 volunteers from a Nigerian community were tested for the presence of anti-A and anti-B hemolysins. Among the group 0 individuals in the study, 53.6% had anti-A hemolysins, 62.7% had anti-B hemolysins and 47.9% had both anti-A and anti-B hemolysins. Of the group A individuals 35.7% had anti-B hemolysins and none had anti-A hemolysins; 8.8% of the group B individuals had anti-A hemolysins and none had anti-B hemolysins. The high level of anti-A and anti-B hemolysins compared to the low levels in Europeans is discussed, particularly in relation to the preponderance of ABO incompatibility over Rh(D) incompatibility as a cause of hemolytic disease of the newborn in Nigerians in contrast to Europeans. The physiology of anti-A and anti-B hemolysins is reviewed and the fact that, unlike Europeans, many group O individuals in Nigeria are 'dangerous' rather than 'safe' universal blood donors is highlighted.

Bone marrow status of anaemic pregnant women on supplemental iron and folic acid in a Nigerian community.

The bone marrow status of 31 consecutive pregnant women who had been on supplemental oral iron and folic acid since early pregnancy at the University of Benin Teaching Hospital was assessed later in pregnancy to test the efficacy of oral iron and folic acid in preventing iron deficiency and/or megaloblastic anaemia in our community. Only those pregnant patients with haemoglobin genotype AA or AS took part in the study. Nobody was excluded except those with CC or SC. 96.77% (30 out of 31 patients) had iron deficiency with no stainable iron in the bone marrow. 35.4% (11 out of 31 patients) had megaloblastic changes in the bone marrow. 32.2% (10 out of 31 patients) had a combined iron deficiency and megaloblastic anaemia while only one out of 31 patients (3.23%) had megaloblastic anaemia without concurrent iron deficiency. 60.4% (20 out of 31 patients) had iron deficiency alone without concomitant megaloblastic changes in marrow. The bone marrow in all the patients were normal in other respects except with regards to iron-deficiency and/or megaloblastic status. The significance of this high incidence of iron-deficiency and/or megaloblastic anaemia in patients already on routine pre-natal drugs is discussed.

Urographic changes in homozygous sickle cell disease.

A prospective urographic study of 40 Nigerian homozygous sickle cell patients is presented. The age range was 13-51 years with a mean of 20. The excretory urogram was normal in 30% of the patients. There is a very high incidence of renal papillary necrosis (40%). The other abnormalities observed are non-obstructive caliectasis (47.5%), poor excretion of contrast medium (40%) and renal enlargement. The incidence of urographic abnormality was neither age- or sex-related. There is also no relationship between abnormality and urinary symptoms.

An evaluation of cellularity in various types of bone marrow specimens.

Comparisons of marrow cellularity determinations in needle biopsy sections, aspirated smears of marrow particles, and aspirated clot sections were made using the point-counting and standard visual methods of measurement. Good correlations of cellularity between biopsies and smears were obtained with the point-counting method. This occurred with either single- or multiple-observer measurements, and differed from the wide observer-to-observer variation obtained in the other comparisons. Although the optimal method for cellularity measurements is point counting by biopsy sections, the findings indicate that aspirated smears of marrow particles can be a suitable substitute for needle biopsy sections when point counting is used. This would be particularly useful in clinical settings necessitating frequent cellularity assessments. The results also show that the standard visual method of cellularity measurement is satisfactory when specimens are evaluated by one observer. The point-counting method of measurement, although the most accurate, is not as reproducible among observers as previously considered.

Stainable iron in aspirated and needle-biopsy specimens of marrow: a source of error.

Marrow iron was assessed in needle biopsy sections and in simultaneously obtained aspirated smears and aspirated clot sections from 251 patients. Significantly different amounts of stainable iron were observed in needle biopsy sections and aspirated smears in 15% of the specimens. The usual difference consisted of significantly less stainable iron in needle biopsy sections as compared to the aspirated smears (13%). Of clinical importance was the finding of absent stainable iron in 8% of the needle biopsy sections, in contrast to the definite deposits observed in the corresponding aspirated smear. Of similar interest was the observation that 6% of the needle biopsy sections had significantly less stainable iron than corresponding hemosiderotic smears. The amounts of stainable iron in needle biopsy sections were similar to the amounts observed in the corresponding aspirated clot sections. Evaluation of marrow iron using needle biopsy sections as well as aspirated clot sections differs from results observed in aspirated smears and could be a source of significant error in the assessment of iron stores.