HAEMATOLOGICAL PARAMETERS AMONGST ACUTE STROKE PATIENTS MANAGED AT A TERTIARY HOSPITAL IN ABAKALIKI NIGERIA: A CASE-CONTROL STUDY.

Introduction: Changes in the haematological indices could have implications for stroke risk, management plan, and outcome. There are limited data on the pattern of haematological parameters of acute stroke patients in Nigeria despite its impact on stroke risk, management, and outcome. Objectives: To determine the pattern and the prognostic implications of the haematological parameters in acute stroke patients managed over a nine-year period at a Tertiary Hospital in Abakaliki Nigeria. Methodology: This was a retrospective hospital-based case-control study of the haematological parameters of acute stroke patients seen over a nine-year period at a tertiary hospital in Abakaliki Nigeria. Results: The mean total white blood cell count and percentage neutrophil in the case group were significantly higher than the control group while the mean packed cell volume did not show any significant difference. Further analysis of the case group revealed that the mean PCV was significantly lower among female folks, elderly age group, those with low education attainment, impaired renal status, short admission duration, haemorrhagic stroke, and admitting hypertension. On the other hand, mean total WBC count and differential neutrophils were significantly elevated among female folks, working-class age group, low educational status, longer admission duration, mortality, and haemorrhagic stroke. Conclusions: Elevated total white blood cell count and differential neutrophilia were significantly associated with acute stroke. Changes in haematological parameters have implications for stroke risk and outcome.

Acceptability of Newborn Screening for Sickle Cell Disease among Post-Partum Mothers in Abakaliki, South East Nigeria.

BACKGROUND: Newborn screening (NBS) for sickle cell disease (SCD) has been shown to reduce early childhood morbidity and mortality associated with sickle cell disease (SCD) but the programme is yet to gain universal coverage in Nigeria. The study assessed the awareness and acceptability of NBS for sickle cell disease for newly delivered mothers. MATERIALS AND METHODS: This was a cross-sectional study conducted to assess 780 mothers admitted into the postnatal ward 0-48 hours after delivery at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria. Pre-validated questionnaires were employed for data collection and statistical analysis was performed using the United States' Center for Disease Prevention and Control (CDC) Epi Info 7.1.4 software. RESULTS: Only 172 (22%) and 96 (12.2%) of the mothers were aware of NBS and comprehensive care for babies with SCD respectively. The acceptance of NBS was high, 718 (92%) among the mothers. The reasons for acceptance of NBS were to know how to take care of the baby 416 (57.9%), know the genotype status 180 (25.1%) while the motivating factors for NBS were knowledge of benefits 455 (58%) and the cost is free 205 (26.1%). The majority of the mothers 561(71.6%) agree that SCD can be ameliorated by NBS while 80 (24.6%) do not know if it can. CONCLUSION: There was low awareness of NBS and comprehensive care for babies with SCD among mothers with newborns, however acceptability for NBS was high. There is a considerable need to bridge the communication gap between health workers and parents to increase their awareness.

CONTEXTE: Il a été démontré que le dépistage néonatal de la drépanocytose réduisait la morbidité et la mortalité infantiles associées à cette maladie, mais le programme n'a pas encore atteint une couverture universelle au Nigéria. L'étude a évalué la connaissance et l'acceptabilité du NBS pour la drépanocytose chez les mères qui viennent d'accoucher. MATÉRIEL ET MÉTHODES: Il s'agit d'une étude transversale menée auprès de 780 mères admises dans le service postnatal 0-48 heures après l'accouchement à l'hôpital universitaire fédéral Alex Ekwueme, à Abakaliki, au Nigeria. Des questionnaires pré-validés ont été utilisés pour la collecte des données et l'analyse statistique a été réalisée à l'aide du logiciel Epi Info 7.1.4 des Centres américains de prévention et de contrôle des maladies (CDC). RÉSULTATS: Seules 172 (22%) et 96 (12,2%) des mères connaissaient le NBS et les soins complets pour les bébés atteints de SCD, respectivement. Le taux d'acceptation du NBS était élevé, 718 (92%) parmi les mères. La raison de l'acceptation du NBS était de savoir comment s'occuper du bébé 416 (57,9%) et de connaître le statut du génotype 180 (25,1%) tandis que le facteur de motivation pour le NBS était la connaissance des avantages 455 (58%) et le coût est gratuit 205 (26,1%). La plupart des mères 561 (71,6%) sont d'accord pour dire que le NBS peut améliorer le SCD, tandis que 80 (24,6%) ne savent pas si c'est le cas. CONCLUSION: Les mères de nouveau-nés sont peu sensibilisées au NBS et aux soins complets pour les bébés atteints de DICS, mais l'acceptabilité du NBS est élevée. Il est nécessaire de rétablir la communication entre les professionnels de la santé et les parents afin de les sensibiliser davantage. Mots clés: Dépistage Néonatal, Drépanocytose, Acceptabilité, Sensibilisation, Mère.

Platelet Yield and Some Donor-Related Predictors in a Single Donor Apheresis: Report from a Nigerian Tertiary Hospital.

BACKGROUND: Single-donor platelet transfusion is the preferred therapeutic option for patients with platelet insufficiency and its effectiveness is partly dependent on the yield. AIM: To determine the platelet yield and predictors of platelet yield in single-donor apheresis. MATERIALS AND METHODS: This was a five-year review of the data on single-donor apheresis using the Haemonetics Apheresis machine MCS+ at Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi state. Platelet donor related variable of interest included the pre-donation platelet count, donor's blood group, number of apheresis cycles and yield volume. Analysis was done using Graphpad Prism version 9.1.1. RESULTS: A total of 153 platelet apheresis were studied. The mean (SD) values for pre-donation platelet count, number of cycles, platelet yield and volume of platelet concentrate were 279 ± 47 x 109/L, 6 ± 0.3, 4.5± 0.8 X 10 11/L, and 320 ± 78 mL respectively. In this study, volume of platelet concentrate predicted 61% of platelet yield while platelet count of donor predicted 41%. Neither ABO nor Rh blood groups was a determinant of platelet yield. CONCLUSION: Pre-donation platelet count and volume of platelet concentrate are important predictors of platelet yield. There is need for proper platelet donor selection.

CONTEXTE: La transfusion de plaquettes d'un seul donneur est l'option thérapeutique privilégiée pour les patients souffrant d'insuffisance plaquettaire et son efficacité dépend en partie du rendement. OBJECTIF: Déterminer le rendement plaquettaire et les prédicteurs du rendement plaquettaire dans l'aphérèse à donneur unique. MATÉRIEL ET MÉTHODES: Il s'agissait d'un examen quinquennal des données sur l'aphérèse à donneur unique utilisant l'appareil d'aphérèse Haemonetics MCS+ à l'hôpital universitaire fédéral Alex Ekwueme d'Abakaliki dans l'État d'Ebonyi. Les variables d'intérêt liées au donneur de plaquettes comprenaient la numération plaquettaire avant le don, le groupe sanguin du donneur, le nombre de cycles d'aphérèse et le volume de rendement. L'analyse a été effectuée à l'aide de Graphpad Prism version 9.1.1. RÉSULTATS: Au total, 153 aphérèses plaquettaires ont été étudiées. Les valeurs moyennes (écart-type) de la numération plaquettaire avant don, du nombre de cycles, du rendement plaquettaire et du volume du concentré plaquettaire étaient respectivement de 279 ± 47 x 109/L, 6 ± 0,3, 4,5 ± 0,8 x 1011/L et 320 ± 78mL. Dans cette étude, le volume du concentré plaquettaire prédisait 61 % du rendement plaquettaire, tandis que la numération plaquettaire du donneur prédisait 41 %. Ni le groupe sanguin ABO ni le groupe sanguin Rh n'ont été des facteurs déterminants du rendement plaquettaire. CONCLUSION: La numération plaquettaire pré-don et le volume de concentré plaquettaire sont des facteurs prédictifs importants du rendement plaquettaire. Il est nécessaire de sélectionner correctement les donneurs de plaquettes. Mots clés: Aphérèse plaquettaire, Numération plaquettaire, Volume plaquettaire, Rendement plaquettaire.

Effect of the COVID-19 pandemic on blood donations and transfusions in Nigeria - A multi-facility study of 34 tertiary hospitals.

Background: The coronavirus disease 2019 (COVID-19) pandemic affected blood supplies globally. Mobile blood drive campaigns halted, and voluntary blood donations reduced, challenging available blood supplies. Furthermore, fears of virus transmission led to deferrals of elective surgeries and non-urgent clinical procedures with noticeable declines in blood donations and transfusions. Aims: We aimed to assess the effect of the COVID-19 pandemic on the number of blood donations and transfusions across the country by blood product type across various hospital departments. Materials and Methods: A retrospective descriptive study was conducted to determine the impact of the COVID-19 pandemic on blood services in 34 tertiary hospitals in Nigeria, comparing January to July 2019 (pre-COVID-19) to January to July 2020 (peri-COVID-19). Data were collected from the country's web-based software District Health Information System, Version 2 (DHIS2). Results: A 17.1% decline in numbers of blood donations was observed over the study period, especially in April 2020 (44.3%), a 21.7% decline in numbers of blood transfusions, especially in April 2020 (44.3%). The largest declines in transfusion were noted in surgery department for fresh frozen plasma (80.1%) [p = 0.012] and accident and emergency department transfusion of platelets (78.3%) [p = 0.005]. The least decline of statistical significance was observed in internal medicine transfusions of whole blood (19.6%) [p = 0.011]. Conclusions: The COVID-19 pandemic significantly affected the numbers of blood donations and transfusions in Nigeria. Strengthening blood services to provide various blood components and secure safe blood supplies during public health emergencies is therefore critical.

Chronic Myeloid Leukaemia with Sudden Bilateral Deafness and Leg Ulcer Associated with Hydroxyurea Therapy.

Deafness occurs rarely in patients with chronic myeloid leukaemia. Hydroxyurea-induced leg ulcer has been found in patients on long-term hydroxyurea therapy. We present a 53 year old man who developed spontaneous bilateral deafness shortly after he was diagnosed with chronic myeloid leukaemia and subsequently developed hydroxyurea induced leg ulcer in the course of treatment. A 53 year-old male presented to our clinic with six months history of left abdominal mass, associated with easy satiety, occasional fever, night sweats, loss of appetite, weight loss, easy fatiguability and bilateral leg swelling. Physical examination showed a middle-aged man in no obvious distress, afebrile, anicteric, pale, with no peripheral lympadenopathy but had bilateral pitting pedal edema to the lower third. There was no significant finding on the chest. Abdominal examination showed hepatosplenomagaly. Full blood count showed anaemia, hyperleucocytosis and thrombocytosis. Peripheral blood film and bone marrow aspiration examinations were in keeping with chronic myeloid leukaemia. The BCR/ABL-1 transcript was negative, thus he was started on hydroxyurea in addition to other supportive treatment. Before commencement of hydroxyurea therapy, he spontaneously developed bilateral sensorineural deafness. Subsequently, he also developed leg ulcers, having been on hydroxyurea therapy for seven years which healed within eight weeks on discontinuation of hydroxyurea. Spontaneous deafness can occur in patients with chronic myeloid leukaemia due to hyperleucocytosis and urgent cytoreduction may help to prevent this complication. In addition, leg ulcer due to long-term hydroxyurea therapy can occur and usually do not respond to the conventional treatment but discontinuation of hydroxyurea.

La surdité survient rarement chez les patients atteints de leucémie myéloïde chronique. Un ulcère de jambe induit par l'hydroxyurée a été trouvé chez des patients sous traitement à long terme par hydroxyurée. Nous présentons un homme de 53 ans qui a développé une surdité bilatérale spontanée peu de temps après avoir été diagnostiqué avec une leucémie myéloïde chronique et qui a ensuite développé un ulcère de jambe induit par l'hydroxyurée au cours du traitement. Un homme de 53 ans s'est présenté à notre clinique avec des antécédents de six mois de masse abdominale gauche, associée à une satiété facile, une fièvre occasionnelle, des sueurs nocturnes, une perte d'appétit, une perte de poids, une fatiguabilité facile et un gonflement bilatéral des jambes. L'examen physique a montré un homme d'âge moyen sans détresse évidente, apébrile, anictérique, pâle, sans lympadénopathie périphérique mais présentant un œdème bilatéral de la pédale par piqûres au tiers inférieur. Il n'y avait aucune découverte significative sur la poitrine. L'examen abdominal a montré une hépatosplénomagie. Une formule sanguine complète a montré une anémie, une hyperleucocytose et une thrombocytose. Les examens de frottis sanguin périphérique et d'aspiration de la moelle osseuse étaient conformes à la leucémie myéloïde chronique. Le transcrit BCR / ABL-1 était négatif, il a donc commencé à prendre de l'hydroxyurée en plus d'un autre traitement de soutien. Avant le début du traitement par hydroxyurée, il a développé spontanément une surdité neurosensorielle bilatérale. Par la suite, il a également développé des ulcères de jambe, après avoir été sous traitement à l'hydroxyurée pendant sept ans, qui ont guéri en huit semaines à l'arrêt de l'hydroxyurée. Une surdité spontanée peut survenir chez les patients atteints de leucémie myéloïde chronique due à une hyperleucocytose et une cytoréduction urgente peut aider à prévenir cette complication. De plus, un ulcère de jambe dû à un traitement à long terme par hydroxyurée peut survenir et ne répond généralement pas au traitement conventionnel mais l'arrêt de l'hydroxyurée.

Plasma lipid levels in relation to disease severity in sickle cell anaemia in Abakaliki, Southeast Nigeria

Dyslipidaemia has been implicated in the pathophysiology of sickle cell disease (SCD) complications; hence its role requires further elucidation. Objectives: To investigate the relationship between disease severity and plasma lipid levels of patients with sickle cell anaemia. Methods: A cross-sectional study design was used for the survey. A total of 50 patients with sickle cell anaemia and 50 controls without SCD were recruited for the study. The clinical data and plasma lipid levels of lipids and haemoglobin parameters were analysed. Results: The majority of the participants were aged 18-25 years. Total plasma cholesterol and HDL-C were significantly lower in individuals with SCA compared with the controls (3.3±1.2 vs 4.2±1.2; p<0.001) and (1.3±0.5 vs 1.5±0.4; p = 0.038) respectively. Most patients with SCA had moderate disease severity (24; 48%). There was no statistically significant difference in the plasma levels of total cholesterol and HDL-C across the disease severity groups of SCA (p = 0.694 and 0.262). There was also no significant correlation between total cholesterol, HDL-C, and markers ofhaemolysis, haemoglobin F, and haemoglobin S levels. Conclusion: SCA is characterised by lower mean plasma TC and HDL than controls. However, no relationship was found between TC, HDL levels and SCD disease severity, markers of haemolysis, HbF and HbS levels. Further studies are required to ascertain the implications of plasma lipid levels in SCD

Effect of the COVID-19 pandemic on blood donations and transfusions in Nigeria ­ A multi-facility study of 34 tertiary hospitals

Background: The coronavirus disease 2019 (COVID-19) pandemic affected blood supplies globally. Mobile blood drive campaigns halted, and voluntary blood donations reduced, challenging available blood supplies. Furthermore, fears of virus transmission led to deferrals of elective surgeries and non-urgent clinical procedures with noticeable declines in blood donations and transfusions. Aims: We aimed to assess the effect of the COVID-19 pandemic on the number of blood donations and transfusions across the country by blood product type across various hospital departments. Materials and Methods: A retrospective descriptive study was conducted to determine the impact of the COVID-19 pandemic on blood services in 34 tertiary hospitals in Nigeria, comparing January to July 2019 (pre-COVID-19) to January to July 2020 (peri-COVID-19). Data were collected from the country's web-based software District Health Information System, Version 2 (DHIS2). Results: A 17.1% decline in numbers of blood donations was observed over the study period, especially in April 2020 (44.3%), a 21.7% decline in numbers of blood transfusions, especially in April 2020 (44.3%). The largest declines in transfusion were noted in surgery department for fresh frozen plasma (80.1%) [p = 0.012] and accident and emergency department transfusion of platelets (78.3%) [p = 0.005]. The least decline of statistical significance was observed in internal medicine transfusions of whole blood (19.6%) [p = 0.011]. Conclusions: The COVID-19 pandemic significantly affected the numbers of blood donations and transfusions in Nigeria. Strengthening blood services to provide various blood components and secure safe blood supplies during public health emergencies is therefore critical.