An unusual case of a spurious, transfusion-acquired haemoglobin S

Prevalence of sickle cell trait and its association to renal dysfunction among blood donors at University of Medical Sciences Teaching Hospital, Ondo, Nigeria

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.

[Prevalence of sickle cell trait in blood donors at the regional blood transfusion center in the Haute Matsiatra Region, Madagascar]

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.

Glucose-6-Phosphate Dehydrogenase Deficiency and Sickle Cell Trait among Prospective Blood Donors: A Cross-Sectional Study in Berekum, Ghana

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.

Prevalence of hemoglobin S trait among blood donors: a cross-sectional study

Background

Sickle cell trait (SCT) or Hemoglobin S (HbS) trait which is due to inheritance of an abnormal hemoglobin (Hb) gene from one parent and a normal gene from the other has been known to be common among people of African descent. Individuals with SCT may find themselves in the blood donor population without knowing their ‘carrier’ status and this may have severe consequences on their health as well as that of a recipient, particularly if they happen to be a sickle cell disease patient. The aim of the study was to determine the prevalence of HbS trait among blood donors.

Results

This cross-sectional study employed convenience sampling method to recruit subjects. A total of 150 prospective and healthy blood donors comprising 138 males and 12 females were involved in the study. Two (2) ml of venous blood was collected from each donor into K₃EDTA tubes and analyzed using the sodium metabisulphite slide test and cellulose acetate Hb electrophoresis at alkaline pH (8.6) for Hb genotypes. Statistical Package for Social Sciences version 20.0 (SPSS 20.0) and Chi square were used to analyse the data obtained. Out of the 150 blood donors, 133 (88.7 %) tested negative for sickling (131 were genotype AA and 2 were AC) and 17 (11.3 %) tested positive for sickling, all of whom were genotype AS.

Conclusion

The results of the study showed the existence of SCT among the blood donor population sampled. Taking blood from such people can harm their health as well as that of the recipient if they happen to be sickle cell disease (SCD) patients. It is therefore recommended that blood donors as well as donated blood units should be screened for SCT to avoid causing any harm to both the donor and recipient.

Transfusion associated peak in hb HPLC chromatogram - a case report

High performance liquid chromatography (HPLC) and electrophoresis are commonly used to diagnose various hemoglobinopathies. However, insufficient information about the transfusion history can lead to unexpected and confusing results. We are reporting a case of Juvenile myelomonocytic leukemia (JMML) in which HbHPLC was done to quantify fetal hemoglobin (HbF). The chromatogram showed elevated HbF along with a peak in the HbD window. A transfusion acquired peak was suspected based on the unexpectedly low percentage of HbD and was subsequently confirmed using parental HbHPLC.