RELATIONSHIP BETWEEN SICKLE CELL NEPHROPATHY AND SOME BIOCHEMICAL MARKERS OF HAEMOLYSIS AMONGST PATIENTS WITH SICKLE CELL ANAEMIA IN KANO, NORTHWESTERN NIGERIA

Introduction

Advancements in the care of patients with sickle cell anaemia have led to significant improvement in survival with many patients reaching adulthood. As they age, long-term complications of the disease manifest in them, notable amongst which is nephropathy which is one of the leading causes of morbidity and mortality in them. There is limited information about sickle cell nephropathy and some biochemical markers of haemolysis that can detect it early in our setting. This study aimed to determine the relationship between some indirect markers of haemolysis and sickle cell nephropathy.

Methodology

The study was a descriptive cross-sectional one where 204 adolescent and adult patients with sickle cell anaemia attending the clinic of AKTH Kano were recruited. An interviewer-administered questionnaire was utilized. Blood samples were taken for determination of serum bilirubin, LDH, and reticulocyte count. Spot urine was used to quantitatively determine albumin to creatinine ratio. Data collated was analyzed using SPSS version 22.0. P-value <0.05 was considered significant.

Result

Two hundred and four (204) participants were enrolled in to the study. Their mean age was 19.6±5years. Females were the majority 131/204 (64.2%). The median (IQR) serum lactate dehydrogenase, bilirubin, direct bilirubin, and reticulocyte count were 607.0(487.3-758.5) U/L, 54.5(37.0-119.0) umol/L, 16.0(11.3-29.0) umol/L and 4.0(3.0-8.4%) respectively. Sickle cell nephropathy was found in 29/204 (14.2%). There were positive significant associations between sickle cell nephropathy with raised serum bilirubin and serum lactate dehydrogenase (p-value = 0.02 and 0.032 respectively).

Conclusion

Sickle cell nephropathy is common amongst patients with sickle cell anaemia and raised serum bilirubin and lactate dehydrogenase are predictors of sickle cell nephropathy.

Correlation between Red Cell Distribution Width and Glycaemic Control among Adults with Type II Diabetes Mellitus at Aminu Kano Teaching Hospital, North-Western Nigeria

BACKGROUND

Red Blood Cell Distribution Width (RDW) measures the degree of variation in red blood cell size and it is a good predictor of complications in many conditions such as diabetes mellitus (DM). This study aimed to determine the relationship between RDW and glycaemic control in patients with type II DM.

MATERIALS AND METHODS

It was a cross-sectional comparative study where patients with type II DM and apparently healthy non-DM volunteers were recruited. Blood samples were collected and analysed for RDW, Fasting Plasma Glucose (FPG) level and Glycated Haemoglobin (HbA1c). Data were analyzed using Statacorp version 13.

RESULTS

A total of 180 participants were enrolled (90 cases, 90 controls). The mean (±SD) ages of cases and controls were 42 (± 11.94) and 34 (± 9.5) years, respectively. Females constituted the majority (49/90; 54.4%) in both groups. The cases had higher RDW than the controls (15.5 ± 1.0% versus 14.3 ± 1.7 %, p=0.630). The correlation between RDW and HbA1c revealed a weak statistically significant relationship (r=0.096, p=0.03) while a weak negative relationship was observed between the RDW and FPG (r = -0.006, p=0.956) which was not statistically significant. However, a negative finding showed a positive correlation between RDW and MCH (p-value = 0.003) and MCHC (p-value = 0.0002).

CONCLUSION

Red cell distribution width has a direct relationship with HbA1c in patients with DM. Therefore, we recommend that clinicians pay attention to this detail while evaluating patients with DM.

Risk Factors and Pattern of Lower Limb Deep Venous Thrombosis in Gombe, North-Eastern Nigeria

BACKGROUND

Deep venous thrombosis (DVT) is one of most common causes of morbidity and mortality among hospitalized patients. Many risk factors ranging from inherited to acquired are associated with increased risk of DVT.

AIMS

The aim of the study was to review the pattern and risk factors of DVTs in Gombe.

METHODS

This study was a retrospective review of Doppler ultrasound confirmed lower limb DVT that were managed in the Department of Haematology, Federal Teaching Hospital Gombe, North-eastern Nigeria over a 4-year period (January 2018 to December 2021). Data obtained was analyzed using SPSS version 28.

RESULTS

Ninety (90) patients were seen and managed during the study period, most were females, (56.7%; n =51) with an age range of 18 to 92 years and mean of 47.3±17.8 years. Young adults (18-45 years) were in the majority (n=45; 50%), followed by the middle aged (46-60 years) (n=28; 31.1%) and then elderly (>60 years) (n=17; 18.9%). Twenty-five patients (27.8%) had proximal DVT, thirteen (14.4%) distal while 49 (57.8%) had extensive DVT. The most affected side is the left lower limb (64.4%; n=58). Most of the patients had provoked DVT (n=65; 72%) with immobilization, recent surgery, bone fracture and stroke as the leading provoking factors. Among those with provoked DVT, young adults were the majority (n=34; 38%), followed by those in the middle-aged group (n=21; 23%) and then the elderly (n=10; 8%).

CONCLUSION

Our study showed the preponderance of left sided DVT and the majority of the cases were provoked affecting young adults.

Acute Leukaemias in Bauchi State, Northeastern Nigeria: Pattern of Presentations and Clinical Entities

BACKGROUND

Acute leukaemias are very aggressive diseases that run a rapidly fatal course if not promptly diagnosed and appropriately treated. The clinical presentations range from bone marrow failure such as anaemia, neutropenia or thrombocytopenia to features of organ infiltrations such as lymphadenopathy, splenomegaly, etc, but presentations may be non-specific. Misdiagnosis is very common with delay in diagnosis and prompt treatment being the causes of high morbidity and mortality in acute leukaemias. This study aims to determine the pattern of presentation and various clinical entities of acute leukaemias in Bauchi State, North-Eastern Nigeria.

SUBJECTS, MATERIALS AND METHODS

This was a three year retrospective study in which records of cases of acute leukaemias diagnosed in the Haematology Department of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi from the bone marrow aspiration cytology register from 1st January, 2018 to 31st December, 2020 were collected. Data on socio-demographic characteristics of the patients that include age, gender, diagnosis as well as subtypes of some of the malignancies diagnosed were also collated. The collated data were analyzed using SPSS Version 20.0. A p-value of < 0.05 was considered significant.

RESULTS

Twenty-nine cases of acute leukaemias were diagnosed during the period under review. Majority of cases had acute lymphoblastic leukaemia (ALL) 19/29 (65.5%) while acute myeloid leukaemia (AML) was seen in 10/29 (34.5%). The mean ± SD age of the patients was 22.2±9.2 years with a range 6 months to 60 years. Males constituted 75.9% (22/29) of the cases of acute leukaemias diagnosed. The male to female ratios for AML and ALL were 2:1 and 2.6:1 respectively. The mean±SD ages for AML and ALL were 27±9.2years and 17.3±11.3 years respectively. The most common form of presentation of acute leukaemia in this study is recurrent anaemia necessitating blood transfusion while proptosis and epistaxis were the least forms of presentation.

CONCLUSION

Acute lymphoblastic leukaemia is the commonest form of acute leukaemias while recurrent anaemia is the commonest form of clinical presentations in our setting. Early referral of patients with clinical features suggestive of acute leukaemias is recommended.

Burden and Correlates of Anaemia among Patients with Diabetes Mellitus in a Tertiary Health Facility in Northwestern Nigeria

BACKGROUND

Anaemia is a common disorder occurring in about 33% of the global population. It is an important cardiovascular risk factor and a key indicator of some chronic complications of Diabetes Mellitus (DM). This study aimed to determine the burden of anaemia and its correlation with some clinical and biochemical parameters among patients with DM attending a tertiary health facility in Zaria, Northwestern Nigeria.

SUBJECTS, MATERIALS AND METHODS

This was a case-control study in which 168 participants were enrolled (84 DM patients, 84 controls). It was conducted in the Endocrinology and Metabolic clinics of Ahmadu Bello University Teaching Hospital, Zaria. Consenting DM patients were enrolled consecutively and subsequently, sex- and age-matched with non-diabetic controls. Data on age, gender and Haemoglobin (Hb) concentrations were collated for all study participants. Additional data on type of DM, duration of DM once diagnosis, treatment, type of treatment, history of hypertension, chronic kidney disease, peripheral neuropathy, and Fasting Blood Sugar (FBS) were collated for all cases. Data were collated and analyzed using SPSS version 21. Level of significance was set at <0.05. Ethical approval for the study was obtained from the Institutional Health Research Ethics Committee and informed consent was obtained from the all the participants.

RESULTS

Females constituted 39/84(46.4%) of each arm of the study. The mean ± SD of age for both cases and controls was 53.7 ± 8.9 years. The mean ± SD duration of DM, treatment for DM and FBS were 8.4 ± 5.7 years, 5.0 ± 3.6 years and 6.1 ± 2.5mmol/L respectively. Cases had significantly lower Hb concentration compared to controls (12.1±2.2g/dl vs. 13.1 ± 1.4g/dl, t= -3.446, p = 0.001). Overall prevalence of anaemia among cases and controls was 36/84(42.9%) vs. 26/84(31.0%) Z = 1.6, p = 0.110. Among cases, haemoglobin concentration had very weak, inverse and non-statistically significant relationships with age, duration of DM diagnosis, duration of therapy and FBS levels. There was a significant relationship between anaemia on one hand and type of DM and treatment on the other. The odds of DM patients with history of CKD or uncontrolled FBS having anaemia were OR= 0.600 (95% CI 0.196, 1.836) and OR=1.755 (95% CI 0.737, 4.181) respectively.

CONCLUSION

The burden of anaemia amongst patients with DM is high in Zaria, Northwestern Nigeria, and it is associated with poor glycaemic control. Hence, the need to include haematological assessment as part of routine care of patients with DM.