Multiple Blood Transfusion may contribute to Abnormal Liver and Endocrine Functions in Adults with Sickle Cell Anaemia.

BACKGROUND: The study evaluated the effect of multiple blood transfusions on the prevalence of iron load and its effects on organ functions in patients with sickle cell anaemia (SCA). METHODOLOGY: Sixty-seven multiply transfused SCA subjects and 58 non-multiply transfused SCA controls were investigated. Serum ferritin, insulin, growth hormone (GH), thyroid stimulating hormone (TSH), triiodothyronine (T3) and thyroxine (T4) were measured by the ELISA method while plasma alanine transaminase (ALT) was measured spectrophotometrically. RESULTS: The median serum ferritin level was 364.97 (142.5-579.3) ng/ml and that of ALT was 12.20 (7.4-16.7) IU/l in the subjects and were significantly higher compared with 115.31 (81.3-285.6) ng/ml and 7.74(5.9-9.9) IU/l obtained in the controls (p <0.001 in each case). TSH was significantly lower 1.45 (0.4-2.9) µIU/ml in subjects compared with 2.12 (0.7-3.6) µIU/ml obtained in the controls (p = 0.034). The mean values for T4 in the subjects was 10.19 ± 1.5 µg/dl and was significantly higher compared with that of the controls of 9.57 ± 1.5 µg/dl (p = 0.026). However, there were no significant differences in the mean values of T3, GH and Insulin between the cases and the controls. There was a strong correlation between serum ferritin level and the number of units of blood transfused in the subjects (r = 0.575, p < 0.001). CONCLUSION: The study found high serum ferritin level in multiply transfused SCA patients and which also correlated with the number of blood units transfused.

CONTEXTE: L'étude a évalué l'effet des transfusions sanguines multiples sur la prévalence de la charge ferreuse et sur les fonctions fonctions organiques chez les patients atteints d'anémie falciforme (ACS). MÉTHODOLOGIE: Soixante-sept sujets atteints d'anémie falciforme transfusés à plusieurs reprises et 58 témoins SCA non multitransfusés ont été étudiés. Le serum ferritine, de l'insuline, de l'hormone de croissance (GH), de la thyréostimuline (TSH), la triiodothyronine (T3) et la thyroxine (T4) ont été mesurées par la méthode ELISA, tandis que l'alanine transaminase (ALT) du plasma a été mesurée par spectrophotométrie. RÉSULTATS: Le taux médian de ferritine sérique était de 364,97 (142,5-579,3) ng/ml et celui de l'ALT était de 12,20 (7,4-16,7) UI/l chez les sujets et étaient significativement plus élevés par rapport aux 115,31% (81,3-285,6) ng/ml et 7,74(5,9-9,9) UI/l obtenus chez les témoins (p <0,001 dans chaque cas). La TSH était significativement plus basse : 1,45 (0,4-2,9) µUI/ml chez les sujets par rapport aux 2,12 (0,7-3,6) µUI/ml obtenus chez les témoins (p = 0,034). Les valeurs moyennes de la T4 chez les sujets étaient de 10,19 ± 1,5 µg/ dl et était significativement plus élevée comparée à celle des contrôles de 9,57 ± 1,5 µg/dl (p = 0,026). Cependant, il n'y avait pas de différences significatives différences significatives dans les valeurs moyennes de T3, GH et Insuline entre les cas et les témoins. Il y avait une forte corrélation entre le taux de ferritine sérique ferritine et le nombre d'unités de sang transfusées chez les sujets (r = 0,575, r = 0,575). (r = 0,575, p < 0,001). CONCLUSION: L'étude a révélé un taux de ferritine sérique élevé chez patients atteints de SCA ayant reçu des transfusions multiples et qui était également en corrélation avec le nombre d'unités de sang transfusées. MOTS CLÉS: Anémie drépanocytaire, Transfusion sanguine multiple, Sérum transferrine, surcharge en fer, dysfonctionnement des organs.

Platelet Indices and Erythrocyte Sedimentation Rate are useful Parameters in the Assessment of a Cohort of Nigerian Women with Preeclampsia.

BACKGROUND: The study compared some haematological parameters in normotensive pregnant women with those of women with pre-eclampsia (PE) to identify those parameters that may reinforce the occurrence and severity of PE. METHODS: The study was a case-control study involving 40 pre-eclamptic women as subjects and 40 normotensive pregnant women as controls. The subjects were classified into mild and severe based on their blood pressure of >140/90 mmHg and >169/100 mmHg, respectively. Full blood count (FBC) was done using a haematology autoanalyzer, D-dimer and fibrinogen were assessed by enzyme-linked immunosorbent assay (ELISA) method, while Prothrombin Time (PT) and activated plasma thromboplastin time (aPTT) were done manually. RESULTS: The mean PCV was higher while the mean WBC was lower in PE but the differences were not statistically significant. The ESR was significantly higher (50.48 ± 2.90mm/hr vs 41.05 ± 3.74mm/hr, p < 0.049). The mean neutrophil (59.38 ± 7.77% vs 64.95 ± 6.68%; p < 0.001) and lymphocyte (31.35±7.67% vs 7.63±7.47%, p = 0.031) counts were significantly lower and higher, respectively, in PE. Although the mean platelet count in PE was lower, the plateletcrit, mean platelet volume (MPV), and platelet distribution width (PDW) were significantly higher in PE (p = 0.01, 0.04, 0.001, respectively). The D-dimer was significantly higher in the women with PE (p < 0.001), while the PT, aPTT and fibrinogen concentrations were not statistically different between the two groups. CONCLUSION: It may be concluded that low platelet count, high MPV, PDW, PCT and ESR in PE women may reinforce the diagnosis while a high MPV may, in addition, discriminate between severe and mild Pre-eclampsia.

CONTEXTE: L'étude a comparé certains paramètres hématologiques chez des femmes enceintes normotendues à ceux de femmes atteintes de pré-éclampsie (PE) afin d'identifier les paramètres qui peuvent renforcer l'occurrence et la gravité de la PE. MÉTHODES: Il s'agissait d'une étude cas-témoins impliquant 40 femmes pré-éclamptiques comme sujets et 40 femmes enceintes normotendues comme témoins. Les sujets ont été classés en légers et sévères sur la base de leur pression artérielle de > 140/90 mmHg et >169/100 mmHg respectivement. La formule sanguine complète (FBC) a été réalisée à l'aide d'un auto-analyseur d'hématologie, les D-dimères et le fibrinogène ont été évalués par la méthode ELISA (enzymelinked immunosorbent assay), tandis que le temps de prothrombine (PT) et le temps de thromboplastine plasmatique activé (aPTT) ont été réalisés manuellement. RÉSULTATS: Le VPC moyen était plus élevé tandis que le nombre moyen de globules blancs était plus faible dans l'EP, mais les différences n'étaient pas statistiquement significatives. L'ESR était significativement plus élevé (50.48 ± 2.90mm/hr vs 41.05 ± 3.74mm/hr, p < 0.049). Les numérations moyennes des neutrophiles (59,38 ±7,77 % contre 64,95 ± 6,68 % ; p < 0,001) et des lymphocytes (31,35±7,67 % contre 27,63±7,47 %, p = 0,031) étaient respectivement plus faibles et plus élevées de manière statistiquement significative dans l'EP. Bien que la numération plaquettaire moyenne dans l'EP soit plus faible, le critère plaquettaire, le volume plaquettaire moyen (VPM) et la largeur de distribution plaquettaire (LDP) étaient significativement plus élevés dans l'EP (p = 0,01, 0,04, 0,001 respectivement). Le D-dimère était significativement plus élevé chez les femmes atteintes d'EP (p < 0,001), tandis que les concentrations de PT, aPTT et fibrinogène n'étaient pas statistiquement différentes entre les deux groupes. CONCLUSION: On peut conclure qu'une faible numération plaquettaire, un VPM élevé, un PDW, un PCT et un ESR chez les femmes atteintes d'EP peuvent renforcer le diagnostic, tandis qu'un VPM élevé peut, en outre, faire la distinction entre une pré-éclampsie grave et une pré-éclampsie légère. Mots clés: Prééclampsie, Numération plaquettaire, Indices plaquettaires, ESR, D-Dimères, Gravité.

PREVALENCE AND ASSOCIATED CHARACTERISTICS OF CYTOMEGALOVIRUS (CMV) IMMUNOGLOBULIN ANTIBODIES AMONG BLOOD DONORS AT A UNIVERSITY TEACHING HOSPITAL IN NIGERIA.

BACKGROUND: The screening for cytomegalovirus (CMV) specific antibodies is not routine in our setting, thus the transfusion of blood portends high risk for susceptible individuals. OBJECTIVE: To determine the prevalence of IgG and IgM specific antibodies and associated characteristics in blood donors seen at a referral teaching hospital in Nigeria. DESIGN: Prospective, cross-sectional and descriptive study. SETTING: Blood Bank and Serology Unit of the Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Nigeria. SUBJECTS: One hundred and eighty four blood donors negative for human immunodeficiency virus, hepatitis B and C viruses and syphilis were assessed for their levels of CMV specific IgG and IgM antibodies (AccuDiagTM ELISA, DIAGNOSTIC AUTOMATION INC, USA) using the enzyme linked immunosorbent assay technique (ELISA). RESULTS: Ninety six percent of the donors were males while those with secondary education and below (61.3%), unmarried (70%), artisans and unemployed including students (82.5%) were in the majority. The prevalence of CMV IgG and IgM antibodies were 97.4% and 52.6%, while CMV IgG antibody range from 94.7% to 100% in all types of donation. All female donors (3.8%) were positive for IgG and IgM antibodies. The level of education of the donors predicts IgM antibody positivity, those with secondary education or less are more likely than others to be positive (p < 0.05; X2 = 15.98). Linear logistic regression showed that male donors and those in the artisan group are more likely to be positive for IgM antibody (p < 0.05). CONCLUSION: The prevalence of CMV antibodies is very high (IgG = 97.4%; IgM = 52.6%) in our setting. Donors with low educational status and artisans are more likely to be IgM positive. Therefore, a more stringent donor selection, adoption of leukodepleted blood and blood products for uninfected patients especially the immuno-compromised and adoption of a national policy on CMV infected blood is advocated.

Haemophilic arthropathy; a case report.

AIMS AND OBJECTIVES: The objective of this article is to report a rarely encountered case of haemophilic arthropathy which should be considered in the differential diagnosis of knee swelling. PATIENTS AND METHODS: The history. physical findings and results of investigations of a patient presenting with haemophilic arthropathy and the past medical records of the patient were reviewed with relevant literature. RESULTS: This is a report of the existence of this condition in this environment and the management of this rarely encountered condition in a I0 year old boy, known haemophiliac who presented at the orthopaedic clinic with features of right knee arthropathy. He was co-managed with the haematologist with the available Fresh frozen plasma and physical therapist with good response. CONCLUSION: Haemophilia is rare in this environment. Haemophilic arthropathy is rarely considered a differential diagnosis of knee swelling. There is little experience with the presentation and the management of this condition.

Preliminary report of HLA (DNA) typing of Nigerians using sequence-specific primer technique.

AIMS AND OBJECTIVES: This communication is an attempt to present the experience and a preliminary report of results over a one-year period. PATIENTS AND METHODS: From December 2011 to December 2012, a prospective determination of the HLA types of 20 individuals referred to the Tissue Typing Laboratory of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife was done. These consisted of prospective transplant recipients, their donors, and a migrant pair for kinship determination. DNA was extracted from the client's peripheral blood sample, using the QIAmp Blood DNA Mini kit, (Qiagen). PCR was done using OlerupR low-resolution PCR-SSP typing kit. The PCR product was resolved in 2% agarose gel, and the bands visualised under UV light. The HLA types were determined using provided tables and/or Helmberg software. Data were presented using descriptive statistics whileHLA antigen frequency (AF) was expressed in percentage and gene frequency (GF) was determined using square root method (1-(1-AF)1/2). RESULTS: A total of 20 individuals (13males and 7females) consisting of seven renal transplant recipients and seven prospective donors; a stem cell recipient and three donors and a migrant pair for kinship determination were typed. Age ranged from 4-65 years. 44 HLA alleles were detected, while HLA-A, B, C, DRB1 and DQB1 were 7, 10, 11, 8, 8 alleles respectively. The alleles were heterogeneous in distribution while 6 antigens (HLA-A*02, B*30, C*15, DRB1*03, DRB1*08 and DQB1*06) were having frequencies e"25%. CONCLUSION: This report confirms that DNA-based HLA typing is feasible locally, andit was observed that renal transplantation procedure is the most frequent indication. The HLA antigens observed to have very high frequencies (e"25% frequency) in this population were HLA-A*02, B*30, C*15, DRB1*03, DRB1*08 and DQB1*06. There is a strong need to develop a broad-based HLA data bank for Nigeria to further strengthening her transplantation programmes.

Imatinib (Glivec) and gastrointestinal stromal tumours in Nigerians.

BACKGROUND: To assess the response and the impact on the overall survival (OS) on c-KIT-positive (CD117+) gastrointestinal stromal tumours (GISTs) patients treated with imatinib mesylate. METHODS: Between July 2003 and December 2012, consenting patients with advanced c-kit-positive GISTs were enrolled to receive imatinib mesylate therapy at a dose of 400mg - 800mg daily, supplied gratis by Novartis Pharma (Basel, Switzerland) under its GIPAP initiative. Disease severity was based on tumour site, size and mitotic index at diagnosis. Clinical features together with drug toxicity, haematological and biochemical parameters were monitored. Overall survival (OS) reviewed at 12 months intervals over 5 years was computed using Kaplan-Meier RESULTS: There were 27 patients in all (17 males and 10 females with a median age of 52 years (range 26 - 83). Twenty three patients, 15 males and 8 females that have been followed up for at least 6 months were evaluated, aged 26-83 years (median = 56). There were 17 (73.9%) gastric tumours and 6 extragastric including 3 cases of peritoneum and 1 each of small gut, colon and rectum. At diagnosis, 21 (91.3%) cases were high risk, and 1 each fell into the intermediate and low risks, respectively. Ten patients (43.4%) including 5 with metastases presented with unresectable lesions. Five patients (21.7%) had complete tumour resection, 5 (3 with metastases) had partial resections and 3 others with non-bulky, nonmetastatic diseases underwent no surgery. Imatinib was used as the primary therapy for all patients, except the 5 patients that underwent complete tumour resection. Nine (39.1%) patients were lost to disease progression with a median survival of 16.7 +/- 10.7 (+/- SE) (95% CI = 0-37.6) months. The overall survival at 2 years for all patients was 71.9%, which dropped to 65.9% at 4 years. CONCLUSIONS: Although a small number of GISTs, imatinib induced an extended remission in patients with advanced disease, most of whom would have been dead within a few months of diagnosis.

An appraisal of kidney dysfunction and its risk factors in patients with sickle cell disease.

Sickle cell disease (SCD), a genetically inherited disease of blacks, often presents with disabling acute complications which can occasionally be fatal. Its renal manifestations are increasingly being recognized as affected patients now survive to middle and rarely old age. We set out to determine the magnitude of kidney dysfunction in our SCD patient population and evaluate its predictive factors. We reviewed the available case records of SCD patients managed in our hospital. Information on socio-demographic, clinical and laboratory data were retrieved and collated. A total of 374 (99.46%) were reviewed with complete data; the median age was 23 years (range 7-62), while median age at diagnosis of SCD was 4 years (range 0.25-31). 235 patients (68.2%) had no kidney disease while the remaining 139 (37.2%) had proteinuria, hematuria or reduced glomerular filtration rate (GFR) <60 ml/min. The age of patients was a significant predictor of kidney disease (p = 0.002) and correlated with the level of serum creatinine (r = 0.188, p < 0.001), GFR (r = 0.245, p < 0.0001) and the degree of proteinuria (r = 0.174, p = 0.006). Patients with kidney disease had a significantly higher number of crises/hospitalizations (p < 0.001). Seven patients died in all and 4 (57%) of them had end-stage renal disease. We concluded that kidney disease is a common complication of SCD and significantly contributes to mortality. The age of the patients, duration of SCD and frequency of crises/hospitalizations are strong predictors of development of kidney disease.

Hepatitis B viral markers in surface antigen negative blood donors: the need to look beyond antibody negativity.

BACKGROUND: The presence of Hepatitis B Virus (HBV) in blood that is Hepatitis B Surface Antigen (HBsAg) negative is considered a potential risk for transmission of hepatitis B virus infection. OBJECTIVE: To determine prevalence of antibodies to markers of hepatitis B virus infection in HBsAg negative prospective blood donors. METHODS: A structured questionnaire to assess prospective donor's demographic data and past medical history was administered to 457 consenting HBsAg negative subjects. All the subjects were also negative for antibodies to hepatitis C virus (HCV), human immunodeficiency virus (HIV) and syphilis. Their serum samples were tested for the presence of anti-HBc, anti-HBe, anti-HBs and HBeAg. RESULTS: Of the 457 samples tested, 20 (4.37%), 58 (12.69%), 1 (0.22%), and 1 (0.22%) were positive to anti-HBc, anti-HBs, anti-HBe, and HBeAg antibodies, respectively. Ten (50%) of those who were positive for HBc antibody were also positive to anti-HBe and anti-HBs. Similarly, two (3.4%) donors who were positive for anti-HBs were also positive for HBeAg and anti-HBe. Of the 20 who were anti-HBc positive, seven had tattoo/traditional marks on their body and one had previous history of blood transfusion. CONCLUSION: This study has shown that some potential blood units containing HBV are being transfused to patients unknowingly by screening for HBsAg only. Screening for other markers of hepatitis B virus may increase the rejection rate, but will reduce HBV transmission.

HELLP syndrome: the experience at Ile-Ife, Nigeria.

Between 1 January and 31 December, 2006, 34 consecutive cases of severe pre-eclampsia (12), imminent eclampsia (10) and eclampsia (12) who were admitted at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife in the south-western part of Nigeria, were investigated for the development of HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome in a prospective study. The ages of the women ranged from 18 to 38 years, parity 0-5 and the estimated gestational age from 18-41 weeks at presentation. A total of 26 (76.5%) of the patients were unbooked, six (17.6%) of the 34 cases developed HELLP syndrome. Four (33%) of the 12 eclamptics developed HELLP syndrome, while only one (10%) of the cases of imminent eclampsia and 1 (8.3%) of severe pre-eclamptic cases developed the syndrome. Using the Mississippi Triple class system, none of the HELLP syndrome cases belonged to Class I; 4 were categorised in Class II while 2 were in Class III. All of the four eclamptic cases with HELLP syndrome died giving a 100% fatality rate while none of the imminent eclamptic and severe pre-eclamptic patients with the syndrome died. Furthermore, there were six (15.8%) perinatal deaths among the 38 infants delivered by the 34 mothers with severe pre-eclampsia/eclampsia. Our data suggest that the development of HELLP syndrome is more likely in eclamptic patients and when it occurs in them, it is highly fatal. Most of the cases in this study were unbooked. Substandard care may have contributed to the progression of the disease state and consequently, to maternal mortality. It is imperative to draw up an action plan for the identification of the risk factors for the development of pre-eclampsia/eclampsia at peripheral hospitals and maternity centres and for prompt referral of such cases afterwards. Efforts should also be geared towards the minimising of treatment delay in all phases, so as to minimise both perinatal and maternal morbidity and mortality.

Relation between erythrocyte sedimentation rate, clinical and immune status in HIV-infected patients.

BACKGROUND: The objective of this study was to determine the clinical and immunologic implications of an elevated ESR in HIV-infected patients. METHOD: One hundred and four consecutive HAART naïve human immunodeficiency virus (HIV)-infected adult patients and fifty one controls were studied. Detailed history was taken and full physical examination was conducted. Erythrocyte sedimentation rate (ESR), CD4+ T lymphocyte count, and complete blood count were performed. RESULTS: The mean (+/- SD) of ESR in the patients was 84.5 +/- 36.8 mm/1st one hour and that for the controls was 20.4 +/- 17.6 mm/1st one hour. The patients' ESR was significantly higher than those of the controls (p < 0.0001). There was a significant difference between the mean ESR of symptomatic (87.6 +/- 37.0 mm/1st hr) and asymptomatic patients (61.0 +/- 26.1 mm/1st hr) (p = 0.018), and between asymptomatic patients (mean +/- SD = 61 +/- 26.1 mm/1st one hour) and controls (mean +/- SD = 20.4 +/- 17.6 mm/1st one hour) (p = 0.000).The mean (+/- SD) CD4+ lymphocytes count of the patients and controls were 155.4 +/- 90.6 cells/microL, and 655.7 +/- 17.6 cells/microL, respectively. The CD4+ cells count was significantly lower in the patients than in the controls (p < 0.0001). CONCLUSION: ESR may be useful in monitoring HIV/AIDS disease.

Blood transfusion reactions; evaluation of 462 transfusions at a tertiary hospital in Nigeria.

The immuno-haematological safety of blood remains an important and recurring issue in blood transfusion practice. Data concerning morbidity and mortality from blood transfusion is sparse in Nigeria however and while the current efforts at reduction in the incidence of adverse consequence of blood transfusion is encapsulated in the concept of Haemovigilance, the Nigerian blood transfusion service is yet to institute the practice. A prospective study of 462 transfusions at the Obafemi Awolowo University Teaching Hospital was done to evaluate the incidence and pattern of transfusion reactions in the hospital. The overall incidence of transfusion reactions is 8.7% (40 cases), with febrile nonhaemolytic transfusion reactions (FNHTR) constituting 65% of these. The incidence of adverse reaction is significantly related to a positive history of previous transfusion (p = 0.0039). Efforts must be sustained at evolving a system to minimize the incidence and consequences. The development of a haemovigilance system in which data regarding all transfusions carried out in Nigerian hospitals is collated and analyzed is necessary. The advent of the National Blood Transfusion Service (N.B.T.S) in Nigeria with Zonal centres in the six geopolitical zones of the country offers an opportunity for setting up a national haemovigilance programme.

Relation between erythrocyte sedimentation rate, clinical and immune status in HIV-infected patients.

BACKGROUND: The objective of this study was to determine the clinical and immunologic implications of an elevated ESR in HIV-infected patients. METHOD: One hundred and four consecutive HAART naïve human immunodeficiency virus (HIV)-infected adult patients and fifty one controls were studied. Detailed history was taken and full physical examination was conducted. Erythrocyte sedimentation rate (ESR), CD4+ T lymphocyte count, and complete blood count were performed. RESULTS: The mean (+/- SD) of ESR in the patients was 84.5 +/- 36.8 mm/1st one hour and that for the controls was 20.4 +/- 17.6 mm/1st one hour. The patients' ESR was significantly higher than those of the controls (p < 0.0001). There was a significant difference between the mean ESR of symptomatic (87.6 +/- 37.0 mm/1st hr) and asymptomatic patients (61.0 +/- 26.1 mm/1st hr) (p = 0.018), and between asymptomatic patients (mean +/- SD = 61 +/- 26.1 mm/1st one hour) and controls (mean +/- SD= 20.4 +/- 17.6 mm/1st one hour) (p = 0.000).The mean (+/- SD) CD4+ lymphocytes count of the patients and controls were 155.4 +/- 90.6 cells/microL, and 655.7 +/- 17.6 cells/microL, respectively. The CD4+ cells count was significantly lower in the patients than in the controls (p < 0.0001). CONCLUSION: ESR may be useful in monitoring HIV/AIDS disease.

Pre-donation screening of intending blood donors for antibodies to infectious agents in a Nigerian tertiary health institution: a pilot study.

Large pools of blood donors are difficult to get in most donor centres in Nigeria; donors come in trickles and only when there is pressing need. Predonation screening for transmissible agents, using induvidualised rapid screening techniques is often employed to avoid wastage of blood bags and reagents. The aim is to compare the relative prevalences of serum markers of infectious diseases in intending blood donors before blood donation for the purpose of elimination. Both paid and volunteer blood donors were screened for HIV, HbsAg, and HCV antibodies using the rapid test kits. The presence of microfilaria in blood and low haematocrit were also checked for. Prospective donors were initially sorted using a structured questionnaire on risk behaviour and were physically examined. Screenings were done before bleeding them. A total of 1259 donors were screened during the six-month duration of the study and 151 (12%) were rejected. Seropositivity for HBsAg in 69 (5.48%), HCV in 56 (4.45%), HIV in 9 (0.71%) were responsible for the rejection. Fourteen (1.1%) were rejected because of low haematocrit, while two (0.16%) others were not bled because of circulating microfilaria. We conclude that hepatitis viruses were responsible for most cases of donor rejection in Nigeria, post-donation screening for infectious agents lead to wastage of blood bags, problems of decontaminating and discarding infectious blood, and the loss to treatment and follow-up of infected persons who are likely to continue to spread the infectious agents. We therefore suggest pre-donation screening of prospective donors in blood banks.

Clinical and prognostic features of Nigerians with chronic myeloid leukemia.

AIMS AND OBJECTIVES: Chronic myeloid leukemia (CML). PATIENTS AND METHODS: CML patients confirmed at the OAUTHC, Ile-Ife between June 1986 and December 1999 were studied prospectively until death or the last visit to the clinic. Stages of the disease at diagnosis, presenting clinical features and laboratory parameters, as well as the drug history were noted for each patient. Survival of each patient was computed from the date of diagnosis until the date of death. Kaplan-Meier statistical technique was used for analysis of survival. Factors were compared with log rank test. Student's t-test was used for comparing means of presenting clinical and laboratory parameters between groups. P-value of <0.05 was considered significant. SPSS for windows Release 10 (Real Stats, Real Easy, 1989-1999) was used for all calculations. RESULTS AND CONCLUSION: There were 42 patients (27 males and 15 females, ratio of 1.8:1) with ages ranging from 12-74 (median=38.0) years. Philadelphia chromosome was positive in the five patients (12.0%) that underwent cytogenetic analysis. Thirty-three of the patients (78.6%) presented in treatable chronic phase and the other 9 (21.4%) were seen in advanced stages (7 in accelerated & 2 in blastic phase). The median survival of patients that presented in chronic phase was 31.7 months compared to 0.16 months in patients presenting in advanced stages, the difference was statistically significant (log rank=7.8, p-value=0.005). Significant positive correlation was obtained between spleen size and total white cell count at diagnosis (r=0.36, p=0.02). Univariate regression analysis showed negative relationship between survival and ages of patients at diagnosis, haematocrit value, spleen and liver sizes, and blast count. The relationships were statistically significant for only liver and spleen (b=-0.63, p=0.004 and b=-0.51, p=0.026, respectively). Regression of both the liver and spleen with survival, still confirms the significant negative relationship between hepatomegaly and survival.

Head and neck manifestations of myeloma in Nigerians.

A study on the clinicopathologic features of myeloma as it manifests in the head and neck region was conducted over a 15-year period. A total of six patients were seen and they constituted 20% of all myeloma cases. The mean age was 41.5 years, three were males and three were females. Clinical presentation was varied and included swelling, epistaxis and gingival bleeding. The duration of symptom ranged from 3 months to 6 years. Definitive diagnosis was extramedullary myelomatosis in three patients, multiple myeloma in two patients while one patient had solitary plasmacytoma of bone. Chemotherapy alone was the treatment modality in two patients, one had surgery combined with chemotherapy and one patient had only supportive therapy. Two patients did not receive treatment, as they requested for discharge against medical advice. One patient followed up for a period of 1 year recovered with residual neurological deficits. This study confirms the rarity of myeloma in the head and neck region and where it occurs; it is most likely multiple myeloma or extramedullary myelomatosis. In this part of the world, mortality rate is aggravated by late presentation and inability to afford chemotherapy.

Myelomatosis: clinical and laboratory features in Nigerians.

BACKGROUND: The objective was to investigate the factors influencing survival of Nigerians with Myelomatosis. MATERIALS AND METHODS: The pre-therapy clinical and laboratory features of patients managed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, between June 1986 and May 2001 were studied. Diagnosis was based on history of bone pain, marrow plasmacytosis, osteolytic bone lesions, serum biochemical profile, monoclonal (M) band, and/or Bence-Jones proteinuria. RESULTS: Twenty-seven patients (22 males, 5 females) aged 15 to 81 (median, 60) years were managed within the study period. Of the 27, 5 (18.5%) were 40 years or younger while 14(51.8%) were 60 years or older. Multiple myeloma (MM) is the main sub-type seen (81.5%). Majority presented with bone pain, weakness, fatigue and inability to walk. Anaemia, high erythrocyte sedimentation rate and bone marrow plasmacytosis were the significant haematological findings. Serum protein electrophoresis showed M-band in 6 cases of MM, with 3 of them also having Bence-Jones proteinuria. Renal function impairment and hypercalcaemia occurred mainly in those with MM. Multiple osteolytic lesions and pathological fractures were recorded in 44% of those with MM and Solitary Myeloma of Bone. Twelve patients were already dead at the time of analysis, with renal failure being the cause in 8 and anaemia in the rest. The median survival was 1.2 months. CONCLUSIONS: We could conclude that the presenting features of Nigerian patients with myelomatosis are not different from reports elsewhere, but high default rate and short survival are particularly noted.

Immunoglobulin classes (IgG, IgA and IgM) and acute phase proteins in pregnant women with urinary schistosomiasis.

BACKGROUND: S. haematobium have been implicated in female genital schistosomiasis (FGS), ectopic pregnancy and infertility. The presence of schistosome eggs in urine has been reported to correlate with FGS but host immune response in FGS is yet to be determined. This gap in knowledge is addressed by this study. MATERIALS AND METHODS: Serum levels of three immunoglobulin classes (IgG, IgA and IgM) and three acute phase proteins (transferrin, alpha 2-macroglobulin, and haptoglobin) were determined by using single radial immunodiffusion technique in one hundred and eight Nigerian women aged between 15 and 30 years. They were made up of thirty pregnant women with urinary schistosomiasis (P+USS), thirty-six pregnant women without USS (P-USS), eighteen non-pregnant women with USS (NP+USS) and twenty-four healthy non-pregnant women without urinary schistosomiasis (NP-USS). RESULTS AND CONCLUSIONS: IgG, IgA and IgM were significantly raised in pregnant women with urinary schistosomiasis compared with non-pregnant women without urinary schistosomiasis (p < 0.01 in each case). The level of transferrin was significantly increased in non-pregnant subjects with urinary schistosomiasis compared with non-pregnant women without urinary schistosomiasis (p <0.01) suggesting the possibility of iron deficiency in these subjects. Alpha-2 macroglobulin was significantly elevated in pregnant subjects with urinary schistosomiasis compared with non-USS subjects, while the mean serum haptoglobin level was significantly higher in pregnant women without urinary schistosomiasis compared to pregnant subjects with urinary schistosomiasis. The results indicate that USS or pregnancy changes different aspects of humoral immunity, thus the co-existence of pregnancy and S. haematobium infection may influence each other.

Haematological parameters in sickle cell anaemia patients with and without splenomegaly.

BACKGROUND: The aim is to investigate the clinical and haematologic effects of persistent splenomegaly (PS) and splenectomy in a population of Nigerians with sickle cell anaemia (SCA). MATERIALS AND METHODS: SCA patients attending the Haematology clinic of the OAUTHC, Ile-Ife, were examined physically and haematologically. Patients with PS were compared with age and sex-matched controls without splenomegaly. Foetal haemoglobin (HbF), packed cell volume (PCV), reticulocyte count and the frequency of blood transfusion were noted for both groups. The clinical effects of splenectomy were documented in three patients who underwent the procedure because of symptomatic massive splenomegaly (> or = 10 cm). RESULTS: Seventy-one patients, 40 males and 31 females, aged 16-48 (median, 21) years were studied. Nineteen (26.8%) had PS ranging from 3-22 cm (mean +/- SD = 9.4 +/- 4.4 cm; median = 7 cm). Ten of these had massive splenomegaly (spleen > or = 10 cm) varying from 10-22 cm (mean +/- SD = 12.3 +/- 3.8 cm; median = 12 cm). No significant differences were found between the mean values of HbF, PCV, reticulocyte count, frequencies of pain crisis, transfusion requirement, weights and heights in SCA with PS and age-sex matched controls without PS. Annual transfusion requirement showed a mild negative correlation with splenic size (r = -0.06), which was not statistically significant (p = 0.882). Significant haematologic improvement was confirmed in the 3 patients who underwent elective splenectomy for splenomegaly-induced hypersplenism. CONCLUSIONS: We conclude that massive persistent splenomegaly is a recognised cause of significant morbidity in SCA patients as evident in the patients that underwent splenectomy. However, where it is mild to moderate, PS may not have significant adverse effect on the overall clinical picture of the disorder.

Erythrocyte rate and plasma viscosity in health and disease.

Erythrocyte sedimentation rate(ESR) and plasma viscosity (PV) were assessed in patients with the following disorders: pulmonary tuberculosis (PTB); malignant lymphomas (ML) and sickle cell anaemia (SCA). Normal healthy individuals (controls) and pregnant women were also investigated. The degree of correlation between erythrocyte sedimentation rate and plasma viscosity was assessed in each case. The mean ESR values for the controls, pregnant subjects, sickle cell anaemia, pulmonary tuberculosis and malignant lymphomas patients were 14.02 +/- 16.15, 50.26 +/- 32.56, 9.12 +/- 8.84, 102.54 +/- 27.64 and 79.73 +/- 51.75 mm/hr, respectively. Similarly, their relative PV were found to be 1.69 +/- 0.13, 1.72 +/- 0.16, 1.86 +/- 0.18 2.01 +/- 0.52 and 0.24 +/- 2.18, respectively. The ESR was significantly higher in pulmonary tuberculosis, malignant lymphomas and in pregnancy but lower in SCA when compared with the control. With the exception of SCA patients, regression analysis showed that haematocrit and sex significantly influenced ESR values but not PV values. Erythrocyte sedimentation rate correlated positively with PV in patients with pulmonary tuberculosis and malignant lymphomas but not in pregnant women, SCA and normal controls. Therefore PV cannot reliably replace ESR as a routine laboratory test either in health or in disease conditions such as SCA.

Autoimmune haemolytic anaemia: pattern of presentation and management outcome in a Nigerian population: a ten-year experience.

Autoimmune haemolytic anaemia (AHA) is one of the commonest autoimmune disorders of man. It is characterised by the binding of anti-erythrocyte autoantibodies to red blood cells and destruction of the coated cells in the reticulo-endothelial system. Autoimnmune disorders are said to be rare in indigenous African population, probably due to the widespread infectious diseases, which impair host's T-cell immunity. This study is therefore aimed at investigating the pattern of presentation and management outcome of patients with AHA seen over a period of 10 years (June 1988 to May 1998) at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. We retrospectively analysed the records of patients with respect to the clinical, haematological, biochemical and serological features of AHA seen within the study period. Diagnosis was based on laboratory features of haemolytic anaemia and/or a positive direct anti-human globulin (Coombs') test after excluding other causes of haemolytic anaemia. Treatment protocol and outcome were noted in all cases. We identified 13 patients with AHA (7 females, 6 males) aged 6-70 (median, 42) years. Six (42%) had secondary AHA and the remaining 8 presented with primary (idiopathic) AHA. Laboratory evidence of haemolysis (bone marrow erythroid hyperplasia and hyperbilirubinaemia) was found in all cases, while the direct Coomb's test was positive in 10 (76.9%) cases. All the patients had moderate-severe anaemia within the course of the disease, requiring blood transfusion. Remission was induced with prednisolone in all except three cases with secondary AHA who died of the primary disease before AHA could be controlled. Follow-up period post-remission ranged between 1 and 78 months. However, 2 (20%) are still being followed-up till the time of this report. This study agrees with the view that autoimmune disorders are not common in Nigerians, as documented for other Africans. It also shows that steroid therapy (prednisolone) is quite effective, especially, in idiopathic AHA, and that red cell transfusion could be useful in life-threatening anaemia.