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Ayogu CI, Valluru B. Septic arthritis of the native hip joint and septic pulmonary embolism in an adult with sickle cell trait after a complicated dental extraction. BMJ Case Rep 2024; 17:e254945. [PMID: 38802256 DOI: 10.1136/bcr-2023-254945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Septic arthritis (SA) is a serious infection of the joint which can lead to irreversible destruction of the joint.We report a case of right hip SA with septic pulmonary embolism following a complicated dental extraction in a woman in her early 40s with sickle cell trait (SCT).The patient presented with severe right thigh pain and left jaw pain.Initial workup revealed raised C reactive protein and positive blood cultures. Right hip joint SA was confirmed following intraoperative joint aspiration. The patient had right hip debridement with long-term intravenous antibiotics.The incidence of SA in adults with sickle cell disease is low: 0.3% in a study in France and Brazil and 10.3% incidence of haematogenous osteoarticular infection in children with SCT in West Africa.
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Noulsri E, Lerdwana S. Blood Donors with Thalassemic Trait, Glucose-6-Phosphate Dehydrogenase Deficiency Trait, and Sickle Cell Trait and Their Blood Products: Current Status and Future Perspective. Lab Med 2023; 54:6-12. [PMID: 35943550 DOI: 10.1093/labmed/lmac061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The use of blood products for different medical purposes has increased in recent years. To meet increasing demand, some blood centers allow volunteer donors with thalassemic trait, glucose-6-phosphate dehydrogenase deficiency (G6PD) trait, and sickle cell trait (SCT) to donate blood if their hemoglobin values fall within acceptable ranges and show no signs of hemolysis. Currently, there are no standard guidelines or policies regarding the use or management of blood products obtained from these donors. However, in recent years, there has been advanced research on eligible donors who have these underlying conditions. In this review, we summarize the current knowledge from in vitro and in vivo studies regarding donor characteristics, changes in physical and biochemical parameters in blood products during processing and storage, and posttransfusion efficacy of blood products. In addition, we discuss some unresolved issues concerning blood products from thalassemic trait, G6PD-deficiency trait, and SCT donors.
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Affiliation(s)
- Egarit Noulsri
- Research Division, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Surada Lerdwana
- Biomedical Research Incubator Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Ojinnaka U, Ahmed Z, Kannan A, Quadir H, Hakobyan K, Gaddam M, Mostafa JA. A Traditional Review of Sickle Cell Disease and the Associated Onset of Dementia: Hematological and Neurocognitive Crossroads. Cureus 2021; 13:e18906. [PMID: 34703679 PMCID: PMC8530004 DOI: 10.7759/cureus.18906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022] Open
Abstract
Sickle cell trait and disease are potential risk factors for dementia and cognitive dysfunction in African Americans, as are genetic variants. This illness affects around 300 million people globally. Due to its ability to defend against severe malaria, it represents an evolutionary survival advantage. It has been shown that sickle cell disease and trait are independent risk factors for the prevalence and incidence of albuminuria and chronic renal disease. Sickle cell anemia impairs cognitive performance in people with minimal or mild manifestations of the genetic blood disorder, owing mostly to its cerebrovascular implications. Similarly, various cerebral minor vascular disorders, such as silent cerebral infarcts, have been linked to the sickle cell trait, which is associated with impaired cognitive ability. It has been found that patients with sickle cell disease have a significantly decreased subcortical and cortical brain volume. Adults and children with sickle cell disease have been documented to have attention-related issues, particularly reduced sustained attention.
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Affiliation(s)
- Ugochi Ojinnaka
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Zubayer Ahmed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Amudhan Kannan
- Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
- General Surgery, Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Huma Quadir
- Internal Medicine, Family Medicine, Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Knkush Hakobyan
- Diagnostic Radiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mrunanjali Gaddam
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jihan A Mostafa
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Akinbodewa AA, Ogunleye A, Adejumo OA. Prevalence of sickle cell trait and its association to renal dysfunction among blood donors at University of Medical Sciences Teaching Hospital, Ondo, Nigeria. Afr Health Sci 2021; 21:1237-1242. [PMID: 35222587 PMCID: PMC8843258 DOI: 10.4314/ahs.v21i3.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Prospective blood donors are routinely screened for blood borne infections but medical illnesses and haemoglobin genotype are overlooked despite a high prevalence of haemoglobin AS among Nigerian donors. Objective To determine the prevalence of haemoglobin AS and its association to renal function, if any. Method Apparently healthy donors were studied between February and December 2018. Their haemoglobin genotype and, estimated glomerular filtration rates were determined. Results There were 96 males (94.1%) and 6 (5.9%) females with mean age of 26.7±4.5 years (range 19–44 years) and mean eGFR of 103.97±19.00ml/min/1.73m2. Eighty one (79.4%) and 21 (20.6%) subjects had haemoglobin AA and AS genotypes respectively. The mean eGFR for subjects with haemoglobin AA and AS were 105.2±18.6ml/min/1.73m2 and 99.9 ± 21.2ml/min/1.73m2 respectively (p value = 0.270). Eighty one (79.4%), 20 (19.6%) and 1 (1.0%) subjects had renal function at >90ml/min/1.73m2, 60–89ml/min/1.73m2 and 30–59ml/min/m2 respectively. There was no significant difference in the mean eGFR between subjects with haemoglobin AA and AS (mean difference 5.3, p = 0.265, 95%CI = -4.07 to 14.60). Conclusion The prevalence of sickle cell trait among Nigerian blood donors is high. There is no significant difference in the renal function status of blood donors with SCT and normal haemoglobin genotype.
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Affiliation(s)
| | - Adeyemi Ogunleye
- Department of Medical Laboratory Services, University of Medical Sciences Teaching Hospital, Ondo State
| | - Oluseyi Ademola Adejumo
- Kidney Care Centre, department of Medicine, University of Medical Sciences Teaching Hospital, Ondo State
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Badawi M, Garoot S, Tahlawi M, Hindawi S, Adam S. Evaluation of a point-of-care method for screening blood donors for sickle cell status. Transfusion 2021; 60 Suppl 1:S10-S14. [PMID: 32134127 DOI: 10.1111/trf.15586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 10/12/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Turbidity tests are commonly used for screening blood units for the presence of sickle cell trait (SCT) before transfusion to specific patient populations, based on recommendations of the AABB. In this pilot study, we evaluate a new method for screening blood donors and blood units for the presence of sickle hemoglobin. STUDY DESIGN AND METHODS This study was based at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. Study participants were approached consecutively between July 24, 2016, and August 8, 2016. Blood donors, control individuals, and known patients with sickle cell disease (SCD) were tested using both a point-of-care testing technology (Sickle SCAN, Biomedomics, Inc.) and hemoglobin capillary electrophoresis (HEP). Corresponding blood units were also tested using Sickle SCAN. RESULTS A total of 200 donors, 13 blood units, and 57 patients and controls were included. Sensitivity and specificity of Sickle SCAN for detection of SCT and SCD was 100%, when compared to HEP as the gold standard. CONCLUSION Sickle SCAN is a rapid test that shows high sensitivity and specificity for identification of hemoglobin S among blood donors and when used for testing blood units.
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Affiliation(s)
- Maha Badawi
- Department of Hematology, King Abdulaziz University, Jeddah, Saudi Arabia.,King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Mofida Tahlawi
- King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Salwa Hindawi
- Department of Hematology, King Abdulaziz University, Jeddah, Saudi Arabia.,King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Soheir Adam
- Department of Hematology, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medicine, Duke University, Durham, North Carolina
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Molecular detection of Mycobacterium tuberculosis in blood stained sputum samples using GeneXpert PCR assay. Diagn Microbiol Infect Dis 2021; 100:115363. [PMID: 33743471 DOI: 10.1016/j.diagmicrobio.2021.115363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/21/2022]
Abstract
This study investigated the possibility of detecting Mycobacterium tuberculosis (MTB) in blood-stained sputa with GeneXpert assay (Xpert MTB/Rif G4 v.5) using appropriate blood lysing (distilled water and distilled water/carbon tetrachloride) and protein denaturing (guanidinium chloride and heat) agents. Blood free sputa were collected from individuals infected with MTB. Various levels of blood-spiked sputa (0%-50%) were prepared and subsequently assayed with GeneXpert analyzer. GeneXpert was found to be reproducible at less than 2% blood contamination. However, beyond 5% blood contamination, GeneXpert was unreliable with absolute PCR inhibition at 20% of blood contamination. Boiling at 95°C for 5 minutes was able to recover MTB DNA in previously undetectable levels as well as in 57% of patients' sputa with blood stains with previous negative GeneXpert results.
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Kroger FL, Ernesto IC, Silva MS, Santos OFD, Medeiros RLD, Rodrigues DDOW. Hemoglobin S identification in blood donors: A cross section of prevalence. Hematol Transfus Cell Ther 2021; 44:336-340. [PMID: 33839080 PMCID: PMC9477770 DOI: 10.1016/j.htct.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 10/21/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction In Brazil, the sickle cell trait (SCT) has an average prevalence of 4% in the general population and 6–10% among Afro-descendants. Although SCT is highly prevalent, a large segment of the population ignores their status. The Therapeutic Guidelines prohibit the transfusion of SCT red blood cells into patients with hemoglobin disorders or severe acidosis and newborns. Methods This was a cross-sectional study with data from 37,310 blood donation candidates. The study included only eligible first-time donors qualified to be tested for the presence of hemoglobin S (HbS) at the Fundação Hemominas Juiz de Fora, Brazil. The variables studied were gender, skin color, age, type of donation, place of birth, blood type, result of the solubility test for hemoglobin S (HbST) and hemoglobin electrophoresis (HbEF). Statistical analysis was performed using the Q square test and the Kappa index of agreement for comparing biochemical methods. This project was approved by the National Research Ethics Committee. Results The analysis of first-time donor data showed that 7166 were considered eligible. A total of 127 of the 7166 donors were carriers of SCT (1.77%). Among the blood donors, 73.23% were from the local area. The HbST and HbEF were found to be 100% in concordance. Sensitivity was not tested in the present study. Conclusions The HbST is highly specific for identifying the HbS, but sensitivity was not tested in this study. The screening of blood donors for abnormal hemoglobins is useful, helping to detect and counsel heterozygous people. The study seeks to identify the prevalence of SCT in a region of Brazil.
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Affiliation(s)
| | - Ianka Cristina Ernesto
- Faculdade de Medicina da Universidade Presidente Antônio Carlos (UNIPAC), Juiz de Fora, MG, Brazil
| | - Marina Schuffner Silva
- Faculdade de Medicina da Universidade Presidente Antônio Carlos (UNIPAC), Juiz de Fora, MG, Brazil
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Ngwengi NY, Fon PN, Mbanya D. Distribution of haemoglobin genotypes, knowledge, attitude and practices towards sickle cell disease among unmarried youths in the Buea Health District, Cameroon. Pan Afr Med J 2021; 37:109. [PMID: 33425142 PMCID: PMC7757270 DOI: 10.11604/pamj.2020.37.109.17864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/26/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction sickle cell disease (SCD) is one of the commonest genetic causes of morbidity and mortality in the world. In resource-limited settings, SCD prevention through public education and screening could be a significant strategy to curb its prevalence. The study aimed at determining the distribution of haemoglobin genotypes among unmarried youths in Buea, Cameroon as well as their knowledge, attitude and practices towards SCD. Methods a community-based, analytic, cross-sectional study was conducted within the city of Buea. Data was collected from 410 youths using self-administered questionnaires. Of the 410 youths, 100 were selected by purposive random sampling and their haemoglobin genotyping was done using haemoglobin electrophoresis. The data was analysed using the statistical software Epi Info Version 7. Results the majority (51.5%) of the 410 respondents were females. The modal age range was 18- 21 years (46.8%) and 60.4% had tertiary education. Less than one quarter (20.5%) had good knowledge of SCD. Only 13.2% knew their genotype and 59.3% were willing to avoid carrier marriages. Out of the 100 participants for genotyping, 84.0% had normal haemoglobin (HbAA) and 16.0% had the sickle cell trait (HbAS). Conclusion most of the respondents had moderate knowledge of SCD. Only a few knew their haemoglobin genotype and more than half were willing to avoid carrier marriages. The prevalence of sickle cell trait is high in Buea. The promotion of preventive methods like public education and genetic screening is recommended to reduce the burden of SCD in Cameroon.
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Affiliation(s)
- Nini Yesih Ngwengi
- Department of Medicine, Faculty of Health Sciences, University of Buea, Buea, South West Region, Cameroon
| | - Peter Nde Fon
- Department of Medicine, Faculty of Health Sciences, University of Buea, Buea, South West Region, Cameroon
| | - Dora Mbanya
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroun.,Haematology & Blood Transfusion Service, Yaoundé University Teaching Hospital, Yaoundé, Cameroon
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Oppong M, Lamptey H, Kyei-Baafour E, Aculley B, Ofori EA, Tornyigah B, Kweku M, Ofori MF. Prevalence of sickle cell disorders and malaria infection in children aged 1-12 years in the Volta Region, Ghana: a community-based study. Malar J 2020; 19:426. [PMID: 33228681 PMCID: PMC7684914 DOI: 10.1186/s12936-020-03500-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Alterations in the structure of haemoglobin (Hb) are usually brought about by point mutations affecting one or, in some cases, two codons encoding amino acids of the globin chains. One in three Ghanaians are said to have sickle cell disorders, whereas malaria continues to be one of the leading causes of mortality among children. This study determined the prevalence of sickle cell disorders and malaria infection among children aged 1–12 years in the Volta Region. Methods This was a community-based cross-sectional survey that involved 938 children aged 1–12 years selected from three districts, one each from the 3 geographical zones of the Volta Region using a multistage sampling method. Demographic information was collected using a standard questionnaire and anthropometric indices were measured. Isoelectric focusing (IEF) electrophoresis was used to determine the Hb genotypes and sub-microscopic parasites were determined by PCR. Results The prevalence of sickling screening positive was 16.0% with an overall prevalence of sickle cell disorders being 2.0%. Among the individual genotypes making up the sickle cell disorders, genotype HbSF was the highest (0.9% as compared to 0.2%; HbSS, 0.6%; HbSC and 0.3%; HbSCF). Microscopic Plasmodium falciparum parasitaemia was detected among 5.5% of the children and 14.2% sub-microscopic prevalence by PCR. Children with sickle cell disorders were more likely to have sub-microscopic parasitaemia (AOR = 5.51 95%CI (2.15, 14.10), p < 0.001) as well as anaemia (AOR = 3.03 95% CI (1.04, 8.82), p = 0.042), compared to those with normal genotypes. There was no significant difference observed between sickle cell disorders and growth and development of the children screened. Conclusions Sickle cell disorders were significantly associated with sub-microscopic parasitaemia as well as anaemia in this study. Establishment of sickle cell clinics in the district and regional hospitals will help in the management of children with the disorder and also generate a national database on sickle cell disorders. National neonatal screening policies must also be put in place to help in early detection and management of these disorders.
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Affiliation(s)
- Mavis Oppong
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Helena Lamptey
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Eric Kyei-Baafour
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Belinda Aculley
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ebenezer Addo Ofori
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Bernard Tornyigah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Margaret Kweku
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Michael F Ofori
- Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana.
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Batina‐Agasa S, Kambale‐Kombi P, Kabamba P, Tonen‐Wolyec S, Kayembe Tshilumba C, Marini Djang'eing'a R, Kabinda Maotela J. Sickle cell trait among blood donors in the democratic republic of the Congo: which transfusion policy for Sickle cell patients? ACTA ACUST UNITED AC 2020. [DOI: 10.1111/voxs.12580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Salomon Batina‐Agasa
- Department of Internal medicine Faculty of Medicine and Pharmacy University of Kisangani Kisangani Democratic Republic of the Congo
| | - Paul Kambale‐Kombi
- Department of Internal medicine Faculty of Medicine and Pharmacy University of Kisangani Kisangani Democratic Republic of the Congo
| | - Paul Kabamba
- Centre National de Transfusion Sanguine Kinshasa Democratic Republic of the Congo
| | - Serge Tonen‐Wolyec
- Department of Internal medicine Faculty of Medicine and Pharmacy University of Kisangani Kisangani Democratic Republic of the Congo
| | - Charles Kayembe Tshilumba
- Department of Internal medicine Faculty of Medicine and Pharmacy University of Kisangani Kisangani Democratic Republic of the Congo
| | - Roland Marini Djang'eing'a
- Department of Pharmaceutical Sciences Laboratory of Analytical chemistry Faculty of Medicine University of Liège Liège Belgium
| | - Jeef Kabinda Maotela
- Centre National de Transfusion Sanguine Kinshasa Democratic Republic of the Congo
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Fenomanana J, Rakotoniaina I, Manantsoa SN, Randriamahenina H, Randriamanantany ZA. [Prevalence of sickle cell trait in blood donors at the regional blood transfusion center in the Haute Matsiatra Region, Madagascar]. Pan Afr Med J 2020; 36:329. [PMID: 33193983 PMCID: PMC7603814 DOI: 10.11604/pamj.2020.36.329.21478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/11/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION sickle cell trait is the heterozygous form of sickle-cell disease. Patients with sickle cell trait can synthesize normal hemoglobin A and hemoglobin S. This condition has no recognizable clinical signs; then subjects with sickle cell trait, ignoring their genetic status, can be found among blood donors. This can have severe impact on donors´ health status and on that of recipients, especially if these have sickle-cell trait. The purpose of our study is to determine the prevalence of sickle cell trait in blood donors. METHODS we conducted a 4-month descriptive prospective study (January-May 2017) at the Haute Matsiatra Regional Blood Transfusion Center (RBTC). All donors were screened by Emmel test and positive cases were confirmed by hemoglobin electrophoresis. RESULTS the study involved 427 donors, of whom 332 were men and 95 women (sex ratio 3.4). The average age of blood donors was 32.72, ranging from 18 to 64 years. Emmel test was positive in 5 donors (1.17%). These patients had the AS genotype confirmed by hemoglobin electrophoresis. CONCLUSION the results of this study reveal the presence of sickle cell trait among blood donors at the CRTS. Most of them ignore their sickle cell status before blood donation. Quality and safety of blood and blood products are mandatory, hence the importance of screening among blood donors is a current relevant issue.
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Kehinde TA, Osundiji MA. Sickle cell trait and the potential risk of severe coronavirus disease 2019-A mini-review. Eur J Haematol 2020; 105:519-523. [PMID: 32589774 PMCID: PMC7361772 DOI: 10.1111/ejh.13478] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022]
Abstract
Coronavirus Disease 2019 (COVID‐19) pandemic is a rapidly evolving public health problem. The severity of COVID‐19 cases reported hitherto has varied greatly from asymptomatic to severe pneumonia and thromboembolism with subsequent mortality. An improved understanding of risk factors for adverse clinical outcomes may shed some light on novel personalized approaches to optimize clinical care in vulnerable populations. Emerging trends in the United States suggest possibly higher mortality rates of COVID‐19 among African Americans, although detailed epidemiological study data is pending. Sickle cell disease (SCD) disproportionately affects Black/African Americans in the United States as well as forebearers from sub‐Saharan Africa, the Western Hemisphere (South America, the Caribbean, and Central America), and some Mediterranean countries. The carrier frequency for SCD is high among African Americans. This article underscores the putative risks that may be associated with COVID‐19 pneumonia in sickle cell trait as well as potential opportunities for individualized medical care in the burgeoning era of personalized medicine.
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Affiliation(s)
| | - Mayowa Azeez Osundiji
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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13
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Blood Donors' Age, Haemoglobin Type, G6PD Status, and Blood Group Impact Storability of CPDA-1 Banked Whole Blood: A Repeated-Measure Cohort Study in Cape Coast, Ghana. Adv Hematol 2020; 2020:4959518. [PMID: 32550847 PMCID: PMC7277056 DOI: 10.1155/2020/4959518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/21/2020] [Accepted: 04/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background The high prevalence of haemoglobin variants and glucose 6-phosphate dehydrogenase disorder (G6PDd) in sub-Saharan Africa means that substantial proportions of donor blood units carry these red cell abnormalities. Aim This study investigated the impact that inherited haemoglobin variants and/or G6PD status have on whole blood banked at 4–6°C for 35 days. Method This repeated-measure cohort study was undertaken on 103 donor blood units collected into blood bag containing CPDA-1 anticoagulant. On days 0, 7, 14, 21, and 35, full blood count, osmotic-induced haemolysis, and plasma K+ levels were estimated. Also, on day 0, G6PD status, haemoglobin variants, % foetal haemoglobin, and blood group of donor units were determined using methaemoglobin reductase, cellulose acetate electrophoresis, modified Bekte alkali denaturation assay, and slide haemagglutination test, respectively. Result Overall, although plasma K+ levels increased during storage, donor units from individuals ≥20 years, G6PD normal, Hb AC, or blood group B had comparatively higher percentage change in plasma K+ during storage. Osmotically induced haemolysis of donor units was significantly decreased in Hb AC (compared with Hb A or AS) donor units on days 7, 14, 21, and 35 (p < 0.0001 in each case). G6PDd donor units had comparatively reduced osmotic-induced lysis compared with G6PD normal units, reaching a statistical significance on day 35 (p = 0.043). Also, Hb AC units had comparatively nonstatistically higher plasma K+ at all time points (compared with Hb A or AS). Furthermore, whereas donor units from individuals ≥20 years showed significantly higher median free haemoglobin on day 21 (compared to donor <20 years), when donor units were stratified per Hb variants, only Hb AS units had median free haemoglobin below the 0.8% threshold after 35 days' storage. Conclusion Age of donor, blood group, Hb AC variant, and G6PD status may be important considerations in the storability of whole blood.
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Uyoga S, Mpoya A, Olupot-Olupot P, Kiguli S, Opoka RO, Engoru C, Mallewa M, Kennedy N, M'baya B, Kyeyune D, Wabwire B, Bates I, Gibb DM, Walker AS, George EC, Williams TN, Maitland K. Haematological quality and age of donor blood issued for paediatric transfusion to four hospitals in sub-Saharan Africa. Vox Sang 2019; 114:340-348. [PMID: 30838664 PMCID: PMC6563499 DOI: 10.1111/vox.12764] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/28/2018] [Accepted: 01/28/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Paediatric blood transfusion for severe anaemia in hospitals in sub-Saharan Africa remains common. Yet, reports describing the haematological quality of donor blood or storage duration in routine practice are very limited. Both factors are likely to affect transfusion outcomes. MATERIALS AND METHODS We undertook three audits examining the distribution of pack types, haematological quality and storage duration of donor blood used in a paediatric clinical trial of blood at four hospitals in Africa (Uganda and Malawi). RESULTS The overall distribution of whole blood, packed cells (plasma-reduced by centrifugation) and red cell concentrates (RCC) (plasma-reduced by gravity-dependent sedimentation) used in a randomised trial was 40·7% (N = 1215), 22·4% (N = 669) and 36·8% (N = 1099), respectively. The first audit found similar median haematocrits of 57·0% (50·0,74·0), 64·0% (52·0,72·5; P = 0·238 vs. whole blood) and 56·0% (48·0,67·0; P = 0·462) in whole blood, RCC and packed cells, respectively, which resulted from unclear pack labelling by blood transfusion services (BTS). Re-training of the BTS, hospital blood banks and clinical teams led to, in subsequent audits, significant differences in median haematocrit and haemoglobins across the three pack types and values within expected ranges. Median storage duration time was 12 days (IQR: 6, 19) with 18·2% (537/2964) over 21 days in storage. Initially, 9 (2·8%) packs were issued past the recommended duration of storage, dropping to 0·3% (N = 7) in the third audit post-training. CONCLUSION The study highlights the importance of close interactions and education between BTS and clinical services and the importance of haemovigilance to ensure safe transfusion practice.
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Affiliation(s)
- Sophie Uyoga
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ayub Mpoya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Peter Olupot-Olupot
- Mbale Clinical Research Institute, Mbale, Uganda
- Faculty of Health Sciences, Busitema University, Mbale Campus, Mbale, Ugandas
| | - Sarah Kiguli
- Department of Paediatrics, Mulago Hospital, Makerere University, Kampala, Uganda
| | - Robert O Opoka
- Department of Paediatrics, Mulago Hospital, Makerere University, Kampala, Uganda
| | - Charles Engoru
- Department of Paediatrics, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Macpherson Mallewa
- Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Neil Kennedy
- Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
- School of Medicine, Dentistry and Biomedical Science, Queen's University, Belfast, UK
| | | | | | | | - Imelda Bates
- Liverpool School of Tropical Medicine and Hygiene Pembroke Place, Liverpool, UK
| | - Diana M Gibb
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Ann Sarah Walker
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Elizabeth C George
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Thomas N Williams
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Medicine, St Mary's Campus Imperial College, London, UK
| | - Kathryn Maitland
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Medicine, St Mary's Campus Imperial College, London, UK
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15
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Aninagyei E, Doku ET, Adu P, Egyir-Yawson A, Acheampong DO. Storage related haematological and biochemical changes in Plasmodium falciparum infected and sickle cell trait donor blood. BMC HEMATOLOGY 2018; 18:30. [PMID: 30450212 PMCID: PMC6220467 DOI: 10.1186/s12878-018-0128-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/28/2018] [Indexed: 01/05/2023]
Abstract
Background In sub-Saharan Africa where sickle cell trait (SCT) and malaria is prevalent, significant proportions of blood donors may be affected by one or more of these abnormalities. The haemato-biochemical properties of SCT and asymptomatic malaria in donor blood have not been evaluated. This study evaluated the haemato-biochemical impact of SCT and asymptomatic malaria infections in citrate-phosphate-dextrose-adenine (CPDA-1) stored donor blood units. Methods Fifty-milliliters of sterile CPDA-1 anti-coagulated blood were drained into the sample pouch attached to the main blood bag. Ten units each of sickle cell/malaria negative, sickle cell and malaria positive blood were analyzed. Baseline and weekly haematological profiling and week 1, 3 and 5 concentrations of plasma haemoglobin, % haemolysis, sodium, potassium and chloride and lactate dehydrogenase (LDH) were assayed. Differences between baseline and weekly data were determined using one-way analysis of variance (ANOVA) and Kruskal-Wallis test, whereas differences between baseline parameters and week 1-3 data pairs were determined using paired t-test. P-value < 0.05 was considered statistically significant. Results Storage of SCT and malaria infected blood affected all haematological cell lines. In the SCT donors, red blood cells (RBC) (4.75 × 1012/L ± 1.43baseline to 3.49 × 1012/L ± 1.09week-5), haemoglobin (14.45 g/dl ± 1.63baseline to 11.43 g/dl ± 1.69week-5) and haematocrit (39.96% ± 3.18baseline to 33.22% ± 4.12week-5) were reduced. In the asymptomatic malaria group, reductions were observed in RBC (5.00 × 1012/L ± 0.75baseline to 3.72 × 1012/L ± 0.71week-5), haemoglobin (14.73 g/dl ± 1.67baseline to 11.53 g/dl ± 1.62week-5), haematocrit (42.72% ± 5.16baseline to 33.38% ± 5.80week-5), mean cell haemoglobin concentration (35.48 g/dl ± 1.84baseline to 35.01 g/dl ± 0.64week-5) and red cell distribution width coefficient of variation (14.81% ± 1.54baseline to 16.26% ± 1.37week-5). Biochemically, whereas plasma LDH levels significantly increased in asymptomatic malaria blood donors (319% increase at week 5 compared to baseline), SCT blood donors had the most significant increase in plasma potassium levels at week 5 (382% increase). Sodium ions significantly reduced in SCT/malaria negative and sickle cell trait blood at an average rate of 0.21 mmol/L per day. Moreover, elevations in lymphocytes-to-eosinophils and lymphocytes-to-neutrophils ratios were associated with SCT and malaria positive blood whilst elevation lymphocytes-to-basophils ratio was exclusive to malaria positive blood. Conclusion Severe storage lesions were significant in SCT or malaria positive donor blood units. Proper clinical evaluation must be done in prospective blood donors to ensure deferral of such donors.
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Affiliation(s)
- Enoch Aninagyei
- 1Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | - Patrick Adu
- 3Department of Medical Laboratory Technology, University of Cape Coast, Cape Coast, Ghana
| | - Alexander Egyir-Yawson
- 1Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Desmond Omane Acheampong
- 1Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
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16
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Significantly elevated foetal haemoglobin levels in individuals with glucose 6-phosphate dehydrogenase disease and/or sickle cell trait: a cross-sectional study in Cape Coast, Ghana. BMC HEMATOLOGY 2017; 17:16. [PMID: 29021902 PMCID: PMC5613503 DOI: 10.1186/s12878-017-0088-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/15/2017] [Indexed: 12/02/2022]
Abstract
Background Previously published data have demonstrated that sickle red blood cells produce twice as much reactive oxygen species (ROS) suggesting that co-inheritance of sickle cell disease (SCD) and glucose 6-phosphate dehydrogenase (G6PD) enzymopathy could lead to more severe anaemia during sickling crises. Elevated foetal haemoglobin (Hb F) levels have been shown to have positive modulatory effects on sickling crises and disease outcomes. This study sought to assess how inheritance of G6PD enzymopathy affects the level of Hb F and haemoglobin concentration in adults in steady state. Methods This cross-sectional study selected 100 out-patients (41 males and 59 females) visiting the University of Cape Coast hospital, between January, 2016 and May, 2016. Cellulose acetate electrophoresis (pH 8.2–8.6), methaemoglobin reductase test, modified Betke alkaline denaturation methods were used to investigate haemoglobin variants, qualitative G6PD status, and %Hb F levels in venous blood samples drawn from these participants. Data was analysed with GraphPad Prism 6 and SPSS and significance set at p < 0.05. Results Forty one percent of the participants demonstrated qualitative G6PD enzymopathy whereas only 10% demonstrated Hb AS type (Sickle cell trait, SCT). 5% of the participants co-inherited SCT and G6PD enzymopathy. %Hb F levels in G6PD deficient males was significantly higher than in G6PD deficient females [(p = 0.0003, 2.696% (males) vs 1.975% (females)], although the %Hb F levels was comparable in non-G6PD deficient individuals. %Hb F levels were significantly elevated in males with SCT only (p < 0.05), or G6PD enzymopathy only (p < 0.0001), or SCT + G6PD enzymopathy (p < 0.0001) compared to males with none of these pathologies even though their respective haemoglobin levels were comparable. Male participants with G6PD enzymopathy + SCT co-inheritance had significantly elevated %Hb F when compared to their counterparts with only G6PD enzymopathy (p < 0.001). Male gender [(p = 0.001, OR: 6.912 (2.277–20.984)] partial defective G6PD enzyme [(p = 0.00, OR: 7.567E8 (8.443E7–6.782E9)] SCT [(p = 0.026, OR: 4.625 (1.196–17.881)] were factors associated with raised %Hb F levels ≥2.5. Conclusion The inheritance of G6PD defect and/or SCT significantly elevate %Hb F levels in the steady state even though haemoglobin levels are not affected.
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17
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Adu P, Simpong NL, Kontor K, Ephraim RK. Misleading presentation of haemoglobin electrophoresis data. Ghana Med J 2017; 51:36-38. [PMID: 28959071 DOI: 10.4314/gmj.v51i1.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Haemoglobinopathies are common in sub-Saharan Africa. As such haemoglobin electrophoresis are required to inform clinical decision making. However, haemoglobin electrophoresis is an assay that detects protein at either alkaline or acidic pH. Such assays do not interrogate gene sequences but rather the product of a gene. As many post-transcriptional and post-translational modifications impact the final output of the gene (i.e. protein), presentation of such protein-based assay must accurately reflect the technique employed. It is grossly misleading and scientifically inaccurate to report cellulose acetate and/or citrate agar haemoglobin electrophoresis results as 'haemoglobin genotype'. We propose a new paradigm in which haemoglobin electrophoresis data would be presented as 'haemoglobin phenotype' at a specified pH. FUNDING None declared.
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Affiliation(s)
- Patrick Adu
- Department of Medical Laboratory Technology, School of Allied Health Sciences, University of Cape Coast, Ghana
| | | | - Kate Kontor
- Medical OPD, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Richrd Kd Ephraim
- Department of Medical Laboratory Technology, School of Allied Health Sciences, University of Cape Coast, Ghana
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18
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Glucose-6-Phosphate Dehydrogenase Deficiency and Sickle Cell Trait among Prospective Blood Donors: A Cross-Sectional Study in Berekum, Ghana. Adv Hematol 2016; 2016:7302912. [PMID: 27703480 PMCID: PMC5039272 DOI: 10.1155/2016/7302912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/04/2016] [Accepted: 08/25/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Blood transfusion is a therapeutic procedure usually undertaken in patients with severe anaemia. In Ghana, severe anaemia is mostly due to malaria caused by severe Plasmodium falciparum infection, road traffic accidents, and haemoglobinopathy-induced acute haemolysis. Method. This cross-sectional study evaluated coinheritance of sickle cell haemoglobin variant and G6PD enzymopathy among individuals that donated blood at the Holy Trinity Hospital, Berekum, in the Brong-Ahafo Region, Ghana. Demographic data and other pertinent information were captured using questionnaire. Sickle cell haemoglobin variants were determined using cellulose acetate electrophoresis (pH 8.6). Qualitative G6PD status and quantitative G6PD enzyme activity were determined using methaemoglobin reduction and Trinity Biotech G6PD test kit, respectively. Results. Prevalence of sickle cell trait (SCT) and G6PD enzymopathy coinheritance was 7%. In addition, 19.5% of the donors had 10%–60% of normal G6PD enzyme activity suggesting that these donor units are prone to stressor-induced acute haemolysis when given to recipients. Mild G6PD activity (p = 0.03, OR: 2.410 (CI: 1.049–5.534)), commercial (p = 0.020, OR: 5.609 (CI: 1.309–24.035)), and voluntary (p = 0.034, OR: 2.404 (CI: 1.071–5.397)) donors were significantly associated with SCT. Conclusion. Screening for red cell pathologies must be incorporated into existing protocols for populations with high incidence of haemoglobinopathies to protect high-risk recipients.
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