von Willebrand factor activity and activated partial thromboplastin time as proxy biomarkers for coagulopathies in women with menorrhagia in Zambia: a case-control study

Introduction

von Willebrand Disease (vWD) is the most prevalent bleeding disorder. Women are more likely to manifest abnormal bleeding symptoms due to physiologic events and menorrhagia is the most common presenting symptom.

Methods

this case-control study included 168 women aged between 18 and 45. The cases had menorrhagia whilst the controls did not. Blood grouping, activated partial thromboplastin time and von Willebrand factor activity tests were performed on samples collected from consenting study participants.

Results

the mean age was 29.96 ± 7.37. Mean vWF activity of cases was 66.6% and of controls 97.8%. The mean activated Partial ThromboplastinTime (aPTT) of cases was 31.09s and of controls was 30.40s. There was no difference in the vWF activity between blood group O (86.3%) and non-blood group O (88.0%) participants. Eight women were diagnosed with von Willebrand disease, 6 cases and 2 controls. Higher odds of von Willebrand disease were seen in the cases (OR = 6.6). Epistaxis, von Willebrand and factor activity levels and family history of menorrhagia were associated with an increased risk for menorrhagia.

Conclusion

von Willebrand factor activity levels were associated with menorrhagia while activated partial thromboplastin time was not. vWF activity levels did not depend on any specific blood group. The prevalence of von Willebrand disease was significantly higher in participants with menorrhagia and repeated epistaxis and family history of menorrhagia pointed to a higher risk of menorrhagia.

Seroprevalence of parvovirus B19 in blood donors: the risks and challenges of blood transfusion in Zambia in the era of HIV/AIDS at the Kitwe Central Hospital, blood bank

BACKGROUND

Human Parvovirus (B19V) is a small, single-stranded, non-enveloped DNA virus which is pathogenic to humans causing a wide array of clinical complications which include erythema infectiosum, aplastic crisis and hydrops foetalis. It is generally harmless in healthy individuals but may be life threatening in immunocompromised individuals such as patients with sickle cell disease, cancer, HIV and pregnant women. It has been shown to be transmissible by blood transfusion but donor screening for the virus is not yet mandatory in most sub-Saharan African countries including Zambia.

MATERIALS AND METHODS

This was a cross-sectional study undertaken at the Kitwe Central Hospital, blood bank and Tropical Diseases Research Centre at Ndola Central Hospital. A total of 192 blood samples were screened for Ig M antibodies against parvovirus B19 by ELISA.

OBJECTIVES

The general objective of the study was to determine the seroprevalence of parvovirus B19 infections among healthy blood donors at the Kitwe Central Hospital blood bank. Specific Objectives were to detect parvovirus B19 Ig M antibodies in donor blood using serology and to analyse the age and sex distribution of parvovirus among blood donors.

RESULTS

The prevalence of parvovirus B19 Ig M in this study was 15.6%. The majority of the positive cases were in the age group 15-22 years (17.8%) but there was no statistical significance between occurrence of parvovirus and age ( p value=0.703). Prevalence in males was higher than in females that is 16.4% and 13.8%, respectively. The relationship between gender and parvovirus B19 occurrence was however not significant either (p value=0.516).

CONCLUSION

This study showed a 15.6% prevalence rate of acute Parvovirus B19 infections in blood donors at the Kitwe Central Hospital, blood bank. Studies with larger sample sizes are needed to validate these results.

Evaluation of hepcidin as a biomarker for the differential diagnosis of iron deficiency anaemia and anaemia of chronic disease

Background: Anaemia affects approximately 1.62 billion people globally corresponding to 24.8% of the world’s population. Iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) are the most common forms of anaemia. A hormone produced by the liver, hepcidin, is the primary regulator of iron homeostasis and its production increases in ACD and decreases in IDA. Usually, ACD and IDA coexist and sometimes look identical on peripheral blood smears.Aims and Objectives: The current study aims to evaluate the diagnostic value of hepcidin to predict ACD from IDA as well as the diagnostic value of hepcidin to predict ACD from a combination of IDA and ACD.Materials and Methods: Specimens presenting with haematological indices suggestive of IDA and/or ACD following World Health Organisation (WHO) standard case definitions were identified among samples coming to the Haematology laboratory for routine investigations. Serum hepcidin, serum ferritin, serum iron and total iron binding capacity (TIBC) were assessed. Demographic data was obtained from specimen requisition forms.Results: Of the 66 participants, 62.1% (n = 41) were females. IDA was more common among females (36.4%) than males (6.1%) while ACD was more common in males (19.7%) than females (12.1%). Iron Deficiency Anaemia participants had significantly lower hepcidin levels than ACD (p<0.001). There was a significant positive correlation between serum hepcidin and serum ferritin levels (p < 0.001).Conclusion: We found that IDA participants had significantly lower hepcidin levels than ACD and IDA/ACD combined. Therefore, serum hepcidin could be considered in diagnosing and distinguishing ACD from IDA or IDA/ACD as it also had high diagnostic sensitivity and specificity compared to other markers.Asian Journal of Medical Sciences Vol.9(1) 2018 15-20

The Use of Dried Blood Spots: A Potential Tool for the Introduction of a Neonatal Screening Program for Sickle Cell Anemia in Zambia

Context

Sickle cell disease is a group of hemoglobin (Hb) disorders resulting from the inheritance of the sickle β-globin gene. It is the most common pathological Hb mutation worldwide with 75% being born in Sub-Saharan Africa.

Aims

This study aims to determine if dried blood spots (DBSs) can be used for diagnosis of sickle cell in newborns. In Zambia, there is no neonatal screening program for sickle cell anemia (SCA), yet it has been proved that early diagnosis by newborn screening (NBS) using DBSs and access to comprehensive care results in survival to adulthood of over 96% of sickle cell patients.

Settings and Design

A cross-sectional study was carried out at the University Teaching Hospital to determine whether DBSs can be used to diagnose sickle cell using Hb electrophoresis.

Subjects and Methods

Results from DBSs stored for 2 weeks were then compared to those obtained using freshly collected whole blood.

Statistical Analysis Used

To evaluate performance characteristics, the following values were used: true positive, false positive, true negative, and false negative.

Results

Ninety-seven participants were included in this study. DBSs had a sensitivity of 100%, a specificity of 94.7%, positive predictive value of 96.7%, negative predictive value of 100%, overall efficiency of 97.9%, and a Kappa r², P < 0.0001 in comparison to fresh whole blood which we used as the gold standard.

Conclusions

The use of DBSs can be recommended for NBS of SCA in Zambia due to its high sensitivity, specificity, and stability of hemoglobin.

Performance Characteristics of Kidney Injury Molecule-1 In Relation to Creatinine, Urea, and Microalbuminuria in the Diagnosis of Kidney Disease

Context:

The diagnosis and evaluation of impaired renal function remains a challenge owing to lack of reliable biomarker for assessment of kidney function. The existing panel of biomarkers currently displays several limitations, and recently kidney injury molecule-1 (KIM-1) has been suggested as a sensitive biomarker of renal function and proposed to enter clinical practice.

Aims:

This study was conducted to determine the diagnostic value of serum creatinine, urea, and microalbuminuria (MAU) in relation to the novel biomarker, KIM-1.

Materials and Methods:

Serum creatinine, urea, MAU, and KIM-1 were measured in forty individuals with and forty without kidney disease. Data were analyzed using multivariate methods of assessing diagnostic efficiency, test agreement, condition effects, and variability.

Results:

The area under the receiver-operator characteristic curve revealed a diagnostic advantage of creatinine (0.924 ± 0.0066) and urea (0.925 ± 0.0068) over MAU (0.880 ± 0.078) and KIM-1 (0.35 ± 0.124). Overall diagnostic efficiency was higher for creatinine and urea (89.5% and 90.9%, respectively), followed by MAU (85.7%) and then KIM-1 (56.3%). Logistic regression analysis showed that creatinine and urea (R² = 0.75 and R² = 0.72, respectively, P < 0.001 for both) were better predictors of kidney disease than MAU (R² = 0.64, P < 0.001) and KIM-1 (R² = 0.046, P = 0.116). Further analysis of agreement showed that urea had an excellent agreement with creatinine (kappa r = 0.835, P < 0.001), with KIM-1 (kappa r = –0.198, P = 0.087) showing a poor agreement with creatinine.

Conclusion:

Our results indicate that elevated serum creatinine and urea above specific cutoff points reliably identifies patients with acute kidney injury or chronic kidney disease. However, more researches are warranted to further validate the diagnostic efficiency and application of MAU and for KIM-1 before its implementation in clinical practice.