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Potere N, Mahé I, Angchaisuksiri P, Cesarman-Maus G, Tan CW, Rashid A, AlGahtani FH, Imbalzano E, van Es N, Leader A, Olayemi E, Porreca E, Ní Áinle F, Okoye HC, Candeloro M, Mayeur D, Valerio L, Clark RC, Castellucci LA, Barco S, Di Nisio M. Unmet needs and barriers in venous thromboembolism education and awareness among people living with cancer: a global survey. J Thromb Haemost 2024:S1538-7836(24)00177-6. [PMID: 38582384 DOI: 10.1016/j.jtha.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/02/2024] [Accepted: 03/21/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major preventable cause of morbidity, disability, and mortality in subjects with cancer. A global appraisal of cancer-associated VTE education and awareness is not available. OBJECTIVES To evaluate VTE-related education, awareness, and unmet needs from the perspective of people living with cancer using a quantitative and qualitative approach. METHODS This cross-sectional study used data from an online-based survey covering multidimensional domains of cancer-associated VTE. Data are presented descriptively. Potential differences across participant subgroups were explored. RESULTS Among 2262 patients with cancer from 42 countries worldwide, 55.3% received no VTE education throughout their cancer journey, and an additional 8.2% received education at the time of VTE diagnosis only, leading to 63.5% receiving no or inappropriately delayed education. When education was delivered, only 67.8% received instructions to seek medical attention in case of VTE suspicion, and 36.9% reported scarce understanding. One-third of participants (32.4%) felt psychologically distressed when becoming aware of the potential risks and implications connected with cancer-associated VTE. Most responders (78.8%) deemed VTE awareness highly relevant, but almost half expressed concerns about the quality of education received. While overall consistent, findings in selected survey domains appeared to numerically differ across age group, ethnicity, continent of residence, educational level, metastatic status, and VTE history. CONCLUSION This study involving a large and diverse population of individuals living with cancer identifies important unmet needs in VTE-related education, awareness, and support across healthcare systems globally. These findings unveil multilevel opportunities to expedite patient-centered care in cancer-associated VTE prevention and management.
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Affiliation(s)
- Nicola Potere
- Department of Medicine and Ageing Sciences, School of Medicine and Health Sciences, "G. D'Annunzio" University, Chieti, Italy.
| | - Isabelle Mahé
- Innovative Therapies in Haemostasis, INSERM UMR_S1140, INNOVTE-FRIN Université Paris Cité, Assistance Publique des Hôpitaux de Paris, Hôpital Louis Mourier, Paris, France
| | - Pantep Angchaisuksiri
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Chee Wee Tan
- Department of Hematology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Anila Rashid
- Section of Haematology, Department of Pathology & Laboratory Medicine/Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Farjah H AlGahtani
- Division of Hematology-Oncology, Oncology Center, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Nick van Es
- Department of Vascular Medicine, Amsterdam UMC - University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
| | - Avi Leader
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | | | - Ettore Porreca
- Department of Innovative Technologies in Medicine and Dentistry, School of Medicine and Health Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Fionnuala Ní Áinle
- Department of Hematology, Mater Misericordiae University Hospital and Rotunda Hospital, Dublin, Ireland; School of Medicine, University College, Dublin, Ireland
| | - Helen C Okoye
- Department of Hematology and Immunology, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Matteo Candeloro
- Department of Innovative Technologies in Medicine and Dentistry, School of Medicine and Health Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Didier Mayeur
- Medical Oncology, Transversal Department of Supportive Care, Association Francophone des Soins Oncologiques de Support, Centre Georges-François Leclerc, Dijon, France
| | - Luca Valerio
- Centers for Thrombosis and Hemostasis and Cardiology, University Hospital Mainz, Mainz, Germany
| | - R Cary Clark
- Programs and Education, International Society on Thrombosis and Haemostasis, Carrboro, North Carolina, USA
| | - Lana A Castellucci
- Department of Medicine, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Stefano Barco
- Centers for Thrombosis and Hemostasis and Cardiology, University Hospital Mainz, Mainz, Germany; Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, School of Medicine and Health Sciences, "G. D'Annunzio" University, Chieti, Italy
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Okoye HC, Korubo KI, Omunakwe HE, Efobi CC, Onodingene NM, Ugwu NI. Survey on the Knowledge and Management of Cancer-Associated Thrombosis (CAT) in Haemato-Oncology Patients with Thrombocytopenia among Haematologists and Haematology Residents in Nigeria. West Afr J Med 2023; 40:956-961. [PMID: 37767996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Arterial or venous thrombosis can complicate cancer, and 20% of cancer patients may develop venous thromboembolic disorders. Venous thromboembolism (VTE) is common in some haematologic malignancies and may coexist with thrombocytopenia in those haematologic malignancies. We carried out this survey to assess the knowledge and practice of haematologists and resident doctors in haematology in Nigeria regarding the management of thrombocytopenia and cancer-associated thrombosis. METHODS This was a survey that was shared electronically with participants who were consultant haematologists and resident doctors in haematology in Nigeria.. RESULTS There were 106 respondents, 70 (66%) of which were consultant haematologists. About a third (30.2%) of the respondents saw 6-10 patients with blood malignancies monthly. Fifty-seven (53.8%) of the respondents carried out risk assessment in their patients for cancer-associated thrombosis (CAT); 63 (59.4%) of the respondents saw 1-2 cancer patients with thrombosis in 3 months. The most common mode of treatment was pharmacological - 94 (88%) respondents used low molecular weight heparin. The most common haematologic malignancies associated with thrombocytopenia were acute leukaemias (69; 67%). The most common decision taken by respondents was to stop anticoagulants and transfuse platelets because the most frequent concern was the risk of bleeding in this group of patients. CONCLUSION Many haematologists and haematology residents had a high level of awareness, knowledge and good practice regarding thrombocytopenia with CAT in haematooncology patients; however, there is a need for improved knowledge and unified protocols for treatment in line with newer management guidelines.
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Affiliation(s)
- H C Okoye
- University of Nigeria Teaching Hospital, Nsukka, Nigeria
| | - K I Korubo
- University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - H E Omunakwe
- Rivers State University Teaching Hospital, Rivers State, Nigeria.
| | - C C Efobi
- Department of Haematology, Faculty of Basic Clinical Sciences, Nnamdi Azikiwe University, Nnewi Campus
| | | | - N I Ugwu
- Department of Haematology & Immunology, Ebonyi State University, Abakaliki, Nigeria
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Okoye HC, Othman M, Nwagha TU, Onwusulu DN, Onoh RC, Chigbu CO. Evaluating the hemostatic effects of tranexamic acid in women with pre-eclampsia. Int J Gynaecol Obstet 2023; 162:931-936. [PMID: 37067045 DOI: 10.1002/ijgo.14779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE To evaluate the hemostatic effects of tranexamic acid (TXA) ex vivo in women with pre-eclampsia. METHODS This was an ex vivo study involving 45 normal pregnant women and 45 women with pre-eclampsia (nine with mild and 36 with severe features) matched for age, gestational age, and body mass index. Blood samples were collected and divided into two parts. The first served as the pre-TXA sample, while the second was spiked with TXA and served as the post-TXA sample. Plasma levels of D-dimer and plasmin-antiplasmin complex (PAP) were determined using enzyme-linked immunosorbent assay. RESULTS The mean D-dimer and PAP values in the pre-TXA samples differed significantly between groups. Following spiking with TXA, the mean D-dimer and PAP levels did not differ significantly in the pre-TXA and post-TXA samples (P = 0.560 and P = 0.500, respectively) in the pre-eclampsia cohort. In normal pregnancy, the mean D-dimer and PAP levels in the post-TXA samples did not differ significantly (P = 0.070 and P = 0.050, respectively) from the pre-TXA samples following TXA spiking. CONCLUSION TXA did not significantly affect D-dimer and PAP levels in pre-eclampsia, suggesting that TXA may not increase the thrombotic risks in patients with pre-eclampsia.
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Affiliation(s)
- Helen C Okoye
- Department of Hematology and Immunology College of Medicine, University of Nigeria Ituku-Ozalla campus, Enugu, Nigeria
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
- School of Baccalaureate Nursing, St Lawrence College, Kingston, Ontario, Canada
- Department of Clinical Pathology, School of Medicine, Mansoura University, Mansoura, Egypt
| | - Theresa U Nwagha
- Department of Hematology and Immunology College of Medicine, University of Nigeria Ituku-Ozalla campus, Enugu, Nigeria
| | - Daniel N Onwusulu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Robinson C Onoh
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi, Nigeria
| | - Chibuike O Chigbu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Nigeria
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Nnachi OC, Umeokonkwo AA, Okoye HC, Ekwe AN, Akpa CO, Okoye AE. Acceptability of Newborn Screening for Sickle Cell Disease among Post-Partum Mothers in Abakaliki, South East Nigeria. West Afr J Med 2023; 40:298-304. [PMID: 37017939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
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.
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Affiliation(s)
- O C Nnachi
- Department of Haematology, Alex Ekwueme Federal University Teaching Hospital Abakaliki / Ebonyi State University, Ebonyi State, Nigeria.
| | - A A Umeokonkwo
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - H C Okoye
- Department of Haematology, University of Nigeria Teaching Hospital Ituku Ozalla, Enugu State, Nigeria
| | - A N Ekwe
- Department of Haematology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - C O Akpa
- Department of Haematology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - A E Okoye
- Department of Haematology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
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Ugwu GC, Okoye HC, Nnachi OC, Nwani E, Nnachi OA, Ezenwenyi IP, Ugwu NI, Okoye AE. Platelet Yield and Some Donor-Related Predictors in a Single Donor Apheresis: Report from a Nigerian Tertiary Hospital. West Afr J Med 2022; 39:1280-1284. [PMID: 36583368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- G C Ugwu
- Department of Haematology and Blood Transfusion, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - H C Okoye
- Department of Haematology and Blood Transfusion, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.,Department of Haematology and Immunology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu State, Nigeria
| | - O C Nnachi
- Department of Haematology and Blood Transfusion, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - E Nwani
- Department of Haematology and Blood Transfusion, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - O A Nnachi
- Department of Haematology and Blood Transfusion, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - I P Ezenwenyi
- Department of Haematology and Blood Transfusion, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - N I Ugwu
- Department of Haematology and Blood Transfusion, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - A E Okoye
- Department of Haematology and Blood Transfusion, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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Potere N, Barco S, Mahé I, Cesarman‐Maus G, Angchaisuksiri P, Leader A, Okoye HC, Olayemi E, Ay C, Carrier M, Connors JM, Farmakis IT, Fumagalli RM, Jing Z, Lee LH, McLintock C, Ní Ainle F, Giannakoulas G, Goto S, Guillermo Esposito MC, Jara‐Palomares L, Szlaszynska M, Tan CW, Van Es N, Wang T, Hunt BJ, Di Nisio M. Awareness of venous thromboembolism among patients with cancer: Preliminary findings from a global initiative for World Thrombosis Day. J Thromb Haemost 2022; 20:2964-2971. [PMID: 36201366 PMCID: PMC9828201 DOI: 10.1111/jth.15902] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cancer-associated venous thromboembolism (CAT) has detrimental impact on patients' clinical outcomes and quality of life. Data on CAT education, communication, and awareness among the general cancer population are scanty. METHODS We present the preliminary results of an ongoing patient-centered survey including 27 items covering major spheres of CAT. The survey, available in 14 languages, was promoted and disseminated online through social networks, email newsletters, websites, and media. RESULTS As of September 20, 2022, 749 participants from 27 countries completed the survey. Overall, 61.8% (n = 460) of responders were not aware of their risk of CAT. Among those who received information on CAT, 26.2% (n = 56) were informed only at the time of CAT diagnosis. Over two thirds (69.1%, n = 501) of participants received no education on signs and symptoms of venous thromboembolism (VTE); among those who were educated about the possible clinical manifestations, 58.9% (n = 119) were given instructions to seek consultation in case of VTE suspicion. Two hundred twenty-four respondents (30.9%) had a chance to discuss the potential use of primary thromboprophylaxis with health-care providers. Just over half (58.7%, n = 309) were unaware of the risks of bleeding associated with anticoagulation, despite being involved in anticoagulant-related discussions or exposed to anticoagulants. Most responders (85%, n = 612) valued receiving CAT education as highly relevant; however, 51.7% (n = 375) expressed concerns about insufficient time spent and clarity of education received. CONCLUSIONS This ongoing survey involving cancer patients with diverse ethnic, cultural, and geographical backgrounds highlights important patient knowledge gaps. These findings warrant urgent interventions to improve education and awareness, and reduce CAT burden.
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Affiliation(s)
- Nicola Potere
- Department of Medicine and Ageing Sciences“G. D'Annunzio” UniversityChietiItaly
| | - Stefano Barco
- Department of AngiologyUniversity Hospital ZurichZurichSwitzerland
- Center for Thrombosis and HemostasisJohannes Gutenberg UniversityMainzGermany
| | - Isabelle Mahé
- Université Paris CitéHôpital Louis MourierParisFrance
- Innovative Therapies in HaemostasisINSERM UMR_S1140Saint‐EtienneFrance
| | | | | | - Avi Leader
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva; Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Helen C. Okoye
- Department of Haematology and Immunology, College of MedicineUniversity of NigeriaEnuguNigeria
| | | | - Cihan Ay
- Department of Medicine I, Clinical Division of Haematology and HaemostaseologyMedical University ViennaViennaAustria
| | - Marc Carrier
- Department of Medicine, University of Ottawa at The Ottawa HospitalOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Jean Marie Connors
- Brigham and Women's Hospital, Hematology DivisionHarvard Medical SchoolBostonUSA
| | - Ioannis T. Farmakis
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany; Department of Cardiology, AHEPA University HospitalAristotle University of ThessalonikiThessalonikiGreece
| | | | - Zhi‐Cheng Jing
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College HospitalChinese Academy of Medical SciencesBeijingChina
| | - Lai Heng Lee
- Department of HaematologySingapore General HospitalSingapore
| | - Claire McLintock
- National Women's HealthAuckland City HospitalAucklandNew Zealand
| | | | - George Giannakoulas
- Department of Cardiology, AHEPA University HospitalAristotle University of ThessalonikiThessalonikiGreece
| | - Shinya Goto
- Department of MedicineTokai University School of MedicineIseharaJapan
| | | | - Luis Jara‐Palomares
- Unidad Médico‐Quirúrgica de Enfermedades Respiratorias, Hospital Virgen del Rocío, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES)Instituto de Salud Carlos IIIMadridSpain
| | | | - Chee Wee Tan
- Department of Haematology, Royal Adelaide Hospital, SA Pathology, Adelaide, South Australia, AustraliaUniversity of AdelaideSouth AustraliaAustralia
| | - Nick Van Es
- Amsterdam UMC location University of Amsterdam, Vascular Medicine, Amsterdam, Netherlands; Amsterdam Cardiovascular SciencesPulmonary Hypertension & ThrombosisAmsterdamthe Netherlands
| | - Tzu‐Fei Wang
- Department of Medicine, University of Ottawa at The Ottawa HospitalOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Beverley J. Hunt
- St Thomas' Hospital Thrombosis and Haemophilia Centre and Thrombosis and Vascular Biology GroupGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences“G. D'Annunzio” UniversityChietiItaly
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Efobi CC, Okoye HC, Korubo KI, Ezebialu IU, John OC. Evaluation of Obstetricians' Opinion of Thrombocytopenia in Pregnancy: A Cross-Sectional Study. West Afr J Med 2022; 39:657-662. [PMID: 35921687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Thrombocytopenia occurs in about 8-10% of pregnancies. Thrombocytopenia may be incidental in pregnancy and could point to medical or gestational conditions that may pose a morbidity and mortality risk to both mother and foetus. AIM To determine Obstetricians' view/opinion about thrombocytopenia in pregnancy. METHODS A pre-tested structured questionnaire was distributed amongst consultant and resident obstetricians during their antenatal clinics in 3 tertiary hospitals over a period of one month. Analysis was descriptive and results were expressed as frequencies in words, tables and charts. RESULTS A total of 91 responders were studied of which 24 were consultants (26.4%), 57 (62.6%) senior registrars and 10 (11%) were registrars. There were 20 (22.7%) responders who were unaware of incidental thrombocytopenia in pregnancy. Most obstetricians (n=83, 91.2%) requested for only packed cell volume (PCV) at antenatal booking, only 2 (2.9%) routinely requested for full blood count (FBC). At booking; only 10 (11.1%) obstetricians asked for a history of thrombocytopenia. Majority (n=87, 98.9%) never requested for platelet counts. If they encountered thrombocytopenia, up to 89 (97.8%) would investigate further with a repeat FBC (n=77, 86.5%), coagulation screen (n=54, 61.4%) or bone marrow aspiration (n=20, 24.7%). Most of the obstetricians (n=82, 96.5%) would transfuse patients with thrombocytopenia and 34 (43.6%) of them would do so when the count is <50 X 109/L. CONCLUSION Obstetricians have the capacity to investigate symptomatic thrombocytopenia in pregnancy but do not routinely screen for asymptomatic thrombocytopenia. Routine FBC if done at booking may identify missed cases of asymptomatic thrombo-cytopenia for adequate management.
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Affiliation(s)
- C C Efobi
- Department of Haematology and Blood Transfusion, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus
| | - H C Okoye
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Ituku Ozalla Campus, Enugu State, Nigeria
| | - K I Korubo
- Department of Haematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - I U Ezebialu
- Department of Obstetrics and Gynaecology, College of Medicine, Chukwuemeka Odumegwu Ojukwu University, Awka Campus
| | - O C John
- Department of Obstetrics and Gynaecology. University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
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C Okoye H, U Nwagha T, O Ugwu A, E Menuba I, N Duru A, O Ugwu E, U Ezebialu F, C Eze S, O Ugwu A. Diagnosis and treatment of obstetrics disseminated intravascular coagulation in resource limited settings. Afr Health Sci 2022; 22:183-190. [PMID: 36032500 PMCID: PMC9382527 DOI: 10.4314/ahs.v22i1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Disseminated intravascular coagulation (DIC) is one of the commonest causes of abnormal bleeding during pregnancy and puerperium. Its successful management is a challenging feat in resource limited settings (RLS).
Aim: To determine Obstetricians’ approach in diagnosing and treating obstetrics DIC in a RLS
Method: A semi-structured pre-tested 4-sectioned questionnaire was used to collect demographic data of Nigerian obstetricians and data on their practice in the diagnosis and treatment of obstetrics DIC.
Results: A total of 171 obstetricians responded. Preeclampsia was the most frequent cause identified (70.2%) followed by postpartum haemorrahge (58.3%). Platelet count determination was the test mostly used (95.9%) to make a diagnosis of DIC whereas, antithrombin assay was the least (20.6%) requested investigation. While about two-third would monitor the evolution of DIC, a little less than half of the obstetricians would not repeat laboratory testing more than every 2 days, reason mainly (61.8%) due to patient’s financial constraint. Almost three-quarter of them preferred fresh whole blood as the first line of treatment of DIC.
Conclusion: DIC remains a challenge in the obstetrics practice in RLS especially in investigations, monitoring and index of suspicion for non-overt DIC.
Keywords: Investigations; DIC; Obstetrician; diagnosis; treatment.
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Nwagha TU, Okoye HC, Udo CE, Yuguda S, Korubo KI, Adeyemo TA. Clinical Audit of Low Dose Prophylaxis Programme for Nigerian Children with Haemophilia. West Afr J Med 2022; 39:11-15. [PMID: 35156361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The evidence of benefits for prophylaxis especially low dose prophylaxis is incontestable yet most children in developing countries as Nigeria do not have access to this treatment protocol. AIM The aim was to audit the low dose prophylaxis treatment in Nigerian children with haemophilia. METHODOLOGY A multicentre clinical audit of five haemophilia treatment centres; University of Nigeria Teaching Hospital Enugu, Lagos University Teaching Hospital, National Hospital Abuja, University of Port Harcourt Teaching Hospital Port Harcourt, and Federal Teaching Hospital Gombe. Eighteen children with mild-severe haemophilia were enrolled into low-dose prophylaxis treatment programme. The reduction of joint bleeding, improvement of joint function and Quality of Life (QoL) during prophylaxis were analysed. RESULTS In total 18 children - 17males and 1 female (median age 8 years) were enrolled. The median duration of observation was 7 months (range 3-15months). Seven of the children were on primary prophylaxis (41%) while 10 of the children (59%) were on secondary prophylaxis. The number of joint bleeds decreased from a total of 162 (individual range 5-20, mean 10.3) to 42 (range 0-7, mean 3.0) during the observation period with an overall reduction of 74%. Joint function improved in 94.1% of disease joints, while only 5.6% reported no improvement (due to poor compliance). School attendance improved in all subjects, sports participation and daily activity improved moderately. CONCLUSION Low dose prophylaxis was beneficial in reduction of joint bleeds, improvement of joint function and improvement of QoL of Children with haemophilia in Nigeria.
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Affiliation(s)
- T U Nwagha
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Ituku Ozalla Campus, Enugu, Nigeria
| | - H C Okoye
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Ituku Ozalla Campus, Enugu, Nigeria
| | - C E Udo
- Department of Haematology, University of Abuja, Abuja, Nigeria
| | - S Yuguda
- Department of Haematology and Blood Transfusion, Gombe State University/Federal Teaching Hospital, Gombe, Nigeria
| | - K I Korubo
- Department of Haematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - T A Adeyemo
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
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Ugwu NI, Nna EO, Ugwu CN, Ogah OE, Okike C, Ikeagwulonu RC, Nnadozie UU, Madu AJ, Okoye HC, Uzoma IC, Alo C, Ugwu GC, Ekpeagu VN, Okeke UI. Evaluation of Foetal Haemoglobin Status among Nigerian Patients with Sickle Cell Anaemia Using High Performance Liquid Chromatography. West Afr J Med 2021; 38:222-227. [PMID: 33765368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sickle cell anaemia (SCA, HbSS) is a genetic disorder of haemoglobin with marked variation in clinical manifestation. The aim of this study was to determine the foetal haemoglobin (HbF) status of patients with HbSS, compared with that of individuals with HbAS and HbAA control as well as to establish the relationship between HbF level and age and gender of the participants. METHODS This was a cross-sectional study in which HbF values of known HbSS patients along with HbAS and HbAA controls were analysed using High Performance Liquid Chromatography. Socio-demographic and other information were obtained with the use of questionnaire. Data was analyzed using SPSS software, version 20.0. Ethical approval was obtained for the study. RESULTS One hundred and two (102) participants were recruited for the study, comprising 60 patients with HbSS, 22 HbAS and 20 HbAA controls, with mean age of 11.0 years±9.6, 11.7 years ±8.8 and 12.3 years±8.1 respectively. There were 30 (61.2%) males and 30 (56.6%) females for HbSS group, 9 (18.4%) males and 13(24.5%) females for HbAS group and 10(20.4%) males and 10(18.9%) for HbAA group. Mean HbF level among HbSS participants was 8.0 ±6.1% and was significantly higher than that of HbAS (3.0 ±3.4%) and HbAA (2.2 ±4.1%) control (P<0.05). Mean HbF level was higher in children (<18 years) than adults (e"18 years) among HbSS, HbAS and HbAA participants, though not statistically significant (p >0.05). Mean HbF level was also higher among female HbSS, HbAS and HbAA groups compared to corresponding male groups, though only HbSS female group was significant (p = 0.031). CONCLUSION Patients with HbSS have significantly higher HbF level than individuals with HbAS and HbAA. Foetal haemoglobin level tend to decrease with advancing age and higher in females. Increased HbF level may play a compensatory mechanism in sickling in HbSS, thus the use of agent that increase HbF level may improve clinical outcome.
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Affiliation(s)
- N I Ugwu
- Departments of Haematology & Immunology, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - E O Nna
- Safety Molecular Pathology Laboratory, The Molecular Pathology Institute, Enugu, Nigeria
| | - C N Ugwu
- Internal Medicine, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - O E Ogah
- Paediatrics, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - C Okike
- Paediatrics, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - R C Ikeagwulonu
- Chemical Pathology, Alex Ekwueme Federal Teaching Hospital, Abakaliki, Nigeria
| | - U U Nnadozie
- Division of Plastic Surgery, Department of Surgery, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - A J Madu
- Haematology, Faculty of Health Sciences, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - H C Okoye
- Haematology, Faculty of Health Sciences, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - I C Uzoma
- Medical Laboratory Science, University of Nigeria, Enugu Campus. Nigeria
| | - C Alo
- Community Medicine, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - G C Ugwu
- Haematology and Transfusion Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - V N Ekpeagu
- Haematology and Transfusion Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - U I Okeke
- Nigerian Navy Reference Hospital Calabar, Cross River State, Nigeria
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11
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Okoye HC, Efobi CC, Ugwu AO, Ugwu EO, Nwagha TU. ABO blood group as a biomarker of preeclampsia among antenatal clinic attendees in Nigeria. Niger J Clin Pract 2020; 23:729-733. [PMID: 32367883 DOI: 10.4103/njcp.njcp_48_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The clinical application of the ABO blood group is not limited to transfusion medicine but extends to other aspects of medicine. Its impact on preeclampsia is controversial. Aim To determine the association of ABO blood group type with preeclampsia. Subjects and Methods This was a cross-sectional analytical study of 66 women with preeclampsia and 81 apparently healthy women controls carried out in a tertiary health institution. The case and control groups were consecutively recruited during antenatal clinic visits and matched for age, parity, and gestational age. Data on demographics and the ABO blood group of the two groups of individuals were obtained. The analysis was both descriptive and inferential using the statistical package for social sciences (SPSS) version 21 (Chicago Il, USA). A P value of <0.05 was considered statistically significant. Results The mean age of the participants was 30.6 (4.9), 95% CI: 27.76-33.95. The majority of the women were ≤40 years (98.5%) and multigravidae constituted 81.8%. Forty-six (69.7%) women with preeclampsia had blood group O and 20 (30.3%) had a non-O blood group. Forty-nine (60.5%) of the controls had blood group O and 32 (39.5%) had a non-O blood group. The observed difference was not statistically significant (OR 1.50; 95% CI: 0.75-3.0; P = 0.26). The odds ratio for developing preeclampsia was 0.83 (95% CI: 0.37-1.91; P = 0.67) for the primigravidae. The non-O blood groups were more likely to present with symptoms than the O group (P < 0.01). Twenty-six (39.4%) women with preeclampsia had a mild disease while 40 (60.6%) had severe disease. Conclusion Women with non-O blood groups are not at increased risk of developing preeclampsia but are more likely to be symptomatic than the O group.
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Affiliation(s)
- H C Okoye
- Department of Haematology and Immunology, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla Campus, Enugu, Nigeria State, Nigeria
| | - C C Efobi
- Department of Haematology and Immunology, Chukwuemeka Odumegwu Ojukwu University, Awka, Anambra State, Nigeria
| | - A O Ugwu
- Department of Haematology and Immunology, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla Campus, Enugu, Nigeria State, Nigeria
| | - E O Ugwu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla Campus, Enugu, Nigeria State, Nigeria
| | - T U Nwagha
- Department of Haematology and Immunology, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla Campus, Enugu, Nigeria State, Nigeria
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12
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Okoye HC, Efobi CC, Korubo K. Evaluation of laboratory investigative methods of diagnosing clonal hematological disorders in a resource-poor setting. Niger J Clin Pract 2020; 23:33-40. [PMID: 31929204 DOI: 10.4103/njcp.njcp_580_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The successful treatment of patients with clonal hematological disorders (CHDs) depends largely on making an accurate diagnosis, which is, in turn, is dependent on performing specific diagnostic tests that are necessary. Objectives This study assessed the laboratory investigative methods of diagnosing CHDs with regard to the specific required tests (SRTs) that were needed to make a final diagnosis in a center with limited resources. Methods This is a descriptive hospital-based retrospective study. For the study, data about laboratory investigation details of adults diagnosed with CHDs from 1995 to 2015 were retrieved. The SRTs were determined and data analyzed using SPSS version 20. Results A total of 129 case notes of adults in the age range of 18-80 years, diagnosed with CHDs, were used. Out of the 671 SRTs needed for diagnosis, only 304 (45.3%) were conducted. When an SRT was requested to be done within the treatment facility, the patients were significantly more likely to do it in comparison with when they were requested to get it done from an external referral laboratory. All the patients with aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH) had all (100%) their SRTs done while patients with non-Hodgkin's lymphoma (NHL) had the least (15.3%) of their SRTs done. Full blood count (FBC) was the most frequently used (n = 129; 100%) SRT for diagnosis while immunophenotyping (IMPT) was the least (n = 4; 8.3%) used SRT. Conclusion Most of our patients had CHD diagnosis without the complete SRT, and this may cast doubt on the accuracy of diagnosis. Therefore, there is a crucial need for availability of more comprehensive laboratory services, especially in government-owned hospitals.
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Affiliation(s)
- H C Okoye
- Department of Hematology and Immunology, College of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
| | - C C Efobi
- Department of Hematology and Immunology, College of Medicine, Chukwuemeka Odumegwu Ojukwu University, Awka Campus, Awka, Nigeria
| | - K Korubo
- Department of Hematology and Immunology, College of Medicine, University of Port Harcourt, Nigeria
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Abstract
Background Most resource-poor countries are yet to develop standard hemophilia treatment center (HTC) despite improved outcome of health status of persons with hemophilia (PWH). Aim This study aimed to evaluate the health status of PWH in Nigeria. Methodology In this descriptive, cross-sectional study, modified prevalidated and pretested questionnaire (National health and Nutrition examination survey (NHANES) 2013 Health Status questionnaire (HSQ)) was consecutively administered to consenting PWH (pediatric and adult) attending the 2018 Annual General Meeting of the Haemophilia Foundation of Nigeria. The study's measurable outcome variables were calculated health status and its determinants. Association between the outcome variables and clinical characteristics of PWH was done using SPSS software version 22, and P < 0.05 was considered statistically significant. Results Of the 36 PWH who participated in the survey, 50% had good health status, 38.9% had poor health status, while only 11.1% had excellent health status. A majority (88.9%) had access to HTC with <6 consultations in the past year. Nearly 47.2% were hospitalized for disease-related problem in the past year. There was nonsignificant difference between health status and disease type (P = 0.751) and severity (P = 0.086), treatment plan (0.496), type of treatment facility (P = 0.152), and access to a doctor (P = 0.67). Conclusion Several PWH in resource-poor settings still suffer serious morbidity that impacts negatively on their health status. More robust (multicenter) research is needed to ascertain the true picture of health status of PWH in resource-poor countries.
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Affiliation(s)
- Helen C Okoye
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Benedict Nwogoh
- Department of Haematology, School of Medicine, University of Benin, Benin City, Edo, Nigeria
| | - Megan Adediran
- Haemophilia Foundation of Nigeria Headquarters, Kaduna, Nigeria
| | - Theresa U Nwagha
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
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Korubo KI, Okoye HC, Efobi CC. The economic burden of malignant and premalignant hematological diseases in Southern Nigeria. Niger J Clin Pract 2018; 21:1396-1402. [PMID: 30417835 DOI: 10.4103/njcp.njcp_278_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Hematological malignancies are a significant cause of morbidity and mortality. They constitute an economic burden for the patients, their relatives, and the society because of the cost associated with their management, which is usually long term. We aimed to determine the total direct cost of managing patients with premalignant hematological disorders (PMHDs) and malignant hematological disorders (MHDs). Materials and Methods A hospital-based retrospective study was carried out between 1997 and 2015. Data were retrieved from the case notes of adult patients diagnosed with either PMHD or MHD. The total cost of medical care was calculated as the sum of in-patient and out-patient direct cost associated with their management. Data were analyzed using Statistical Package for Social Sciences. Results There was a total of 129 patients; 74 (57.4%) males and 55 (42.6%) females with mean age of 45.7 ± 16.3 years and the majority (n = 76, 58.9%) being employed. Males were more affected than the females except in chronic lymphocytic leukemia, myelodysplastic syndrome, and paroxysmal nocturnal hemoglobinuria. The commonest MHD was chronic myeloid leukemia with 37 (28.7%) patients. Full blood count was the commonest investigation done, whereas free light chains were the least (n = 2; 1.6%). The total cost of care for the 129 patients was N30,041,900.00 ($82,306.58) with an average total cost of care per patient of N232,882.95 ($638.04). Patients with non-Hodgkin lymphoma had the highest mean cost of care per patient (N373,196.30; $1,022.46). The average monthly expenditure per patient was about N70,000 ($190). Conclusion In our setting, management of CHDs constitutes an economic burden.
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Affiliation(s)
- K I Korubo
- Department of Haematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - H C Okoye
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Ituku Ozalla, Enugu, Enugu State, Nigeria
| | - C C Efobi
- Department of Haematology, Chukwuemeka Odumegwu Ojukwu Teaching Hospital, Awka, Anambra, Nigeria
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Abstract
PURPOSE Novel therapy has dramatically changed the outcome of patients with myeloma. Current National Comprehensive Cancer Network guidelines give bortezomib-based combinations a central role in the management of multiple myeloma (MM). The aim of this survey is to assess the use of bortezomib for the treatment of MM by hematologists practicing in Nigeria. MATERIALS AND METHODS This is a cross-sectional observational survey. A structured, prevalidated questionnaire was self-administered to different cadres of hematologists. Data collected were analyzed using SPSS software version 21 (IBM, Chicago, IL). RESULTS There were 54 respondents from 24 centers across the country. The most frequently used drugs for first-line therapy were thalidomide (66.7%), dexamethasone (54.2%), and bortezomib (48%), and a combination of bortezomib, thalidomide, and dexamethasone (16.7%) was the most frequently used first-line regimen. Of the 54 hematologists, 39 (72.2%) had prescribed bortezomib previously; no one had used bortezomib as monotherapy. Drug unavailability (86.7%) and cost (46.7%) were the major reasons for those who had not prescribed bortezomib. Approximately 56.4% of responders had patients who had experienced adverse effects, of which neuropathy was the most common (86.3%). CONCLUSION Bortezomib, thalidomide, and dexamethasone was the most frequently used first-line regimen to treat myelomatosis. Thalidomide and dexamethasone were the most frequently used drugs in myeloma treatment. Despite poor access to health care, coupled with the high cost and poor availability of bortezomib in our low- or middle-income country, those who prescribed bortezomib did so frequently (in more than half of their patients).
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Affiliation(s)
- Kaladada I. Korubo
- Kaladada I. Korubo, University of Port Harcourt, Rivers;
Anazoeze J. Madu and Helen C. Okoye, University of
Nigeria Nsukka, Enugu; and Benedict Nwogoh, University of Benin,
Benin City, Edo, Nigeria
| | - Anazoeze J. Madu
- Kaladada I. Korubo, University of Port Harcourt, Rivers;
Anazoeze J. Madu and Helen C. Okoye, University of
Nigeria Nsukka, Enugu; and Benedict Nwogoh, University of Benin,
Benin City, Edo, Nigeria
| | - Helen C. Okoye
- Kaladada I. Korubo, University of Port Harcourt, Rivers;
Anazoeze J. Madu and Helen C. Okoye, University of
Nigeria Nsukka, Enugu; and Benedict Nwogoh, University of Benin,
Benin City, Edo, Nigeria
| | - Benedict Nwogoh
- Kaladada I. Korubo, University of Port Harcourt, Rivers;
Anazoeze J. Madu and Helen C. Okoye, University of
Nigeria Nsukka, Enugu; and Benedict Nwogoh, University of Benin,
Benin City, Edo, Nigeria
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Abstract
Background Bleeding disorders (BDs) are characterized by abnormal bleeding for which effective management requires a combination of skill, workforce, diagnostic facilities, and adequate therapeutic options. Objectives The objectives of this study were to determine the capacity of Nigerian hematologists to handle BDs and to assess availability of required infrastructure, equipment, and treatment options. Materials and Methods This descriptive study was conducted during the 2016 scientific conference of the Nigerian Society for Hemetology and Blood Transfusion. A structured questionnaire was distributed to hematologists in attendance. Data were analyzed with SPSS version 21. Results A total of 55 (76.4%) hematologists from 27 centers responded. The most frequently carried out tests to assess bleeding were hemoglobin or packed cell volume (100%), full blood count (96.3%), and prothrombin time/international normalized ratio and activated partial thromboplastin time (77%). Many centers did not have a coagulometer (47.8%) or cold centrifuge (43.4%) and none had thromboelastography or rotational thromboelastometry. Fresh whole blood was the most accessible (88.5%) and up to one-third of the centers did not have access to component therapy. Only 39.1% centers had factor concentrates available. Conclusion Facilities required for diagnosing and treating BD are significantly deficient in most centers in Nigeria. Funding to provide facility and training is required to improve on this inadequacy.
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Affiliation(s)
- H C Okoye
- Department of Hematology and Immunology, College of Medicine, University of Nigeria, Ituku Ozalla, Enugu, Nigeria
| | - K I Korubo
- Department of Hematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - B Nwogoh
- Department of Hematology, University of Benin, Benin City, Edo State, Nigeria
| | - C C Efobi
- Department of Hematology, Chukwuemeka Odumegwu Ojukwu University Awka, Anambra,, Nigeria
| | - N I Ugwu
- Department of Hematology, Federal Teaching Hospital, Abakaliki, Nigeria
| | - A J Madu
- Department of Hematology and Immunology, College of Medicine, University of Nigeria, Ituku Ozalla, Enugu, Nigeria
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Okoye HC, Nielsen BI, Lee K, Abajas YL, Key NS, Rollins-Raval MA. DDAVP trial in discrepant non-severe haemophilia A patients. Haemophilia 2018; 24:e152-e154. [PMID: 29732646 DOI: 10.1111/hae.13485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 11/27/2022]
Affiliation(s)
- H C Okoye
- Haematology and Immunology, University of Nigeria, Enugu, Nigeria
| | - B I Nielsen
- Harold R Roberts Haemophilia and Thrombosis Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K Lee
- Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Y L Abajas
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - N S Key
- Harold R Roberts Haemophilia and Thrombosis Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M A Rollins-Raval
- Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Okoye HC, Eweputanna LI, Okpani AOU, Ejele OA. Associations between pre-eclampsia and protein C and protein S levels among pregnant Nigerian women. Int J Gynaecol Obstet 2017; 137:26-30. [PMID: 28092096 DOI: 10.1002/ijgo.12085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 11/01/2016] [Accepted: 12/13/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate levels of protein C and free protein S among women with pre-eclampsia, and determine whether there is a relationship between deficiencies and pre-eclampsia. METHODS A cross-sectional study was conducted at a hospital in Nigeria from July 2013 to March 2014 among 90 pregnant women with pre-eclampsia (blood pressure ≥140/90 mm Hg, proteinuria ≥300 mg in 24 hours) and 90 normotensive pregnant women (control group). Plasma levels of protein C and free protein S were analyzed by enzyme-linked immunosorbent assay, and protein C activity by a chromogenic method. RESULTS Mean protein C antigen and activity levels did not differ between groups (P=0.639 and P=0.444, respectively). The incidence of protein C antigen and activity deficiency also did not differ (P=0.288 and P>0.99, respectively). The mean free protein S antigen level was higher among women with pre-eclampsia (54.48%±19.58%) than in the control group (47.23%±10.27%; P=0.004). No woman in the control group had protein S deficiency, as compared with 2 (2%) of the women with pre-eclampsia (P=0.497). No association was found between deficiencies of these proteins and pre-eclampsia. CONCLUSION Deficiencies of protein C and free protein S are unlikely to be etiopathogenetic for pre-eclampsia; therefore, therapeutic intervention should focus on other potential pathogenetic pathways.
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Affiliation(s)
- Helen C Okoye
- Department of Hematology and Immunology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Lisa I Eweputanna
- Department of Radiology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Anthony O U Okpani
- Department of Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Oseikhuemen A Ejele
- Department of Hematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
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Okoye HC, Eweputanna LI, Korubo KI, Ejele OA. Effects of maternal hypertension on the neonatal haemogram in southern Nigeria: A case-control study. Malawi Med J 2016; 28:174-178. [PMID: 28321281 PMCID: PMC5348610 DOI: 10.4314/mmj.v28i4.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hypertension in pregnancy is a leading cause of maternal and neonatal morbidity and mortality. This study aimed to compare the hematological parameters in neonates of hypertensive mothers with those of normotensive mothers, and also to compare the incidence of polycythaemia, neutropenia and thrombocytopenia in both groups. METHODS This was a hospital-based case control study. Three milliliters of cord blood from neonates of women with hypertension in pregnancy and those of normotensive pregnant women were sampled for haemogram parameters using a 3-part autoanalyser. Haematocrit and white blood cell differentials were done manually. Data were analysed using SPSS version 16. RESULTS A total of 200 neonates were recruited, comprising 100 neonates of mothers with hypertensive disorders of pregnancy and 100 neonates of normotensive mothers. The mean haematocrit was significantly higher in neonates of hypertensive mothers than those of normotensive mothers. The neutrophil and platelet counts of neonates of hypertensive mothers were significantly lower than those of normotensive mothers. The incidences of polycythaemia, neutropenia, and thrombocytopenia were found to be 8%, 15%, and 38% among neonates of hypertensive mothers and 0%, 2%, and 8% among neonates of normotensive mothers, respectively. These incidences were significantly different between the groups. CONCLUSIONS There was a positive association between hypertension in pregnancy and neonatal polycythaemia, neutropenia, and thrombocytopenia. Haematological parameters of neonates of mothers with hypertension in pregnancy should be properly evaluated and monitored to reduce the chances of developing complications associated with these abnormalities.
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Affiliation(s)
- Helen C Okoye
- Department of Haematology and Immunology, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Lisa I Eweputanna
- Department of Radiology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Kaladada I Korubo
- Department of Haematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Oseikhuemen A Ejele
- Department of Haematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
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