ArticlePDF Available

Abstract and Figures

Background: Effective treatment and management of sickle cell disease (SCD) has been a challenge in Africa over the years. Hematological parameters are very useful profiles in the effective management of the disease. However, there is scarcity of studies on the hematological parameters of SCD in Ghana. This study aimed at determining hematological parameters among SCD patients with vaso-occlusion, those in the steady state as well as healthy controls at a teaching hospital in Ghana. Methodology: This was a cross-sectional study involving a total of 628 subjects, including 148 HbAA controls, 208 HbSS patients in steady state, 82 HbSC patients in steady state, 156 HbSS patients in vaso-occlusive crises (VOC), and 34 HbSC patients in VOC. Venous blood sample was collected from all study participants. A full blood count was done within 2 hours of collection, and hemoglobin (Hb) concentration, packed cell volume, red blood cell (RBC) concentration, mean corpuscular Hb, mean cell volume, mean corpuscular Hb concentration, and white blood cells (WBC) and platelet (PLT) counts were recorded. Results: WBC and PLT counts were significantly higher in both female and male patients with SCD, compared with their healthy counterparts (P<0.05). The level of WBC was, however, significantly higher in patients with HbSS VOC among the SCD patients (P<0.001). Levels of Hb, RBC, and hematocrit were significantly higher in the controls (P<0.001). There was no significant difference in mean cell Hb among male patients with SCD (P=0.274) and female patients with SCD (P=0.5410). Conclusion: The SCD patients had lower Hb and RBC than the controls; however, higher PLT and WBC are noted in various status of SCD, possibly reflecting spleen effect in these patients. Further studies are needed to confirm these findings.
Content may be subject to copyright.
© 2018 Antwi-Boasiako et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.
php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work
you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For
permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
Journal of Blood Medicine 2018:9 203–209
Journal of Blood Medicine Dovepress
submit your manuscript | www.dovepress.com
Dovepress 203
ORIGINAL RESEARCH
open access to scientific and medical research
Open Access Full Text Article
http://dx.doi.org/10.2147/JBM.S169872
Hematological parameters in Ghanaian sickle
cell disease patients
Charles Antwi-Boasiako1
Ivy Ekem2
Mubarak Abdul-Rahman3
Frederika Sey4
Alfred Doku5
Bartholomew Dzudzor6
Gifty B Dankwah1
Kate Hagar Otu7
John Ahenkorah8
Robert Aryee1
1Department of Physiology, School
of Biomedical and Allied Health
Sciences, University of Ghana, Accra,
Ghana; 2Department of Haematology,
School of Medical Sciences, College of
Health and Allied Sciences, University
of Cape Coast, Cape Coast, Ghana;
3Department of Pathology, School of
Biomedical and Allied Health Sciences,
University of Ghana, Accra, Ghana;
4Sickle Cell Clinic, Korle-Bu Teaching
Hospital, Accra, Ghana; 5Department
of Internal Medicine, School of
Medicine and Dentistry, University
of Ghana, Accra, Ghana; 6Department
of Medical Biochemistry, School
of Biomedical and Allied Health
Sciences, University of Ghana, Accra,
Ghana; 7Department of Nursing and
Midwifery, Greenhills School of Health
Sciences, Accra, Ghana; 8Department
of Anatomy, School of Biomedical and
Allied Health Sciences, University of
Ghana, Accra, Ghana
Background: Effective treatment and management of sickle cell disease (SCD) has been a
challenge in Africa over the years. Hematological parameters are very useful profiles in the
effective management of the disease. However, there is scarcity of studies on the hematologi-
cal parameters of SCD in Ghana. This study aimed at determining hematological parameters
among SCD patients with vaso-occlusion, those in the steady state as well as healthy controls
at a teaching hospital in Ghana.
Methodology: This was a cross-sectional study involving a total of 628 subjects, including
148 HbAA controls, 208 HbSS patients in steady state, 82 HbSC patients in steady state, 156
HbSS patients in vaso-occlusive crises (VOC), and 34 HbSC patients in VOC. Venous blood
sample was collected from all study participants. A full blood count was done within 2 hours
of collection, and hemoglobin (Hb) concentration, packed cell volume, red blood cell (RBC)
concentration, mean corpuscular Hb, mean cell volume, mean corpuscular Hb concentration,
and white blood cells (WBC) and platelet (PLT) counts were recorded.
Results: WBC and PLT counts were significantly higher in both female and male patients with SCD,
compared with their healthy counterparts (P<0.05). The level of WBC was, however, significantly
higher in patients with HbSS VOC among the SCD patients (P<0.001). Levels of Hb, RBC, and
hematocrit were significantly higher in the controls (P<0.001). There was no significant difference in
mean cell Hb among male patients with SCD (P=0.274) and female patients with SCD (P=0.5410).
Conclusion: The SCD patients had lower Hb and RBC than the controls; however, higher PLT
and WBC are noted in various status of SCD, possibly reflecting spleen effect in these patients.
Further studies are needed to confirm these findings.
Keywords: sickle cell disease, hematological parameters, full blood count, anemia, Ghana
Introduction
Sickle cell disease (SCD) is the most common inherited disease in Africa, which leads
to public health issues at places with populations of African ancestry or descent.1 It
is a major cause of morbidity and mortality in Africa.2 Two percent of all births in
Ghana are born with SCD.3 The disease refers to varied genetic disorders associated
with structurally abnormal hemoglobin (Hb), which results in the episodic formation
of sickle-shaped red blood cells (RBCs) and several clinical manifestations.4 The
common characteristic features in the pathophysiology of SCD are vaso-occlusion
and chronic hemolytic anemia.5 SCD is often characterized by marked inflammation,
leukocytosis, leukocyte activation, and potentially increased leukocyte adhering to
the vascular endothelium.6 This leukocyte adhesion to the endothelium could itself
promote vaso-occlusion,7 which is the hallmark of SCD.4
Correspondence: Charles
Antwi-Boasiako
Department of Physiology, School of
Biomedical and Allied Health Sciences,
College of Health Sciences, University
of Ghana, PO Box DC 754, Dansoman,
Accra, Ghana
Email antwiboasiako@gmail.com
Journal name: Journal of Blood Medicine
Article Designation: Original Research
Year: 2018
Volume: 9
Running head verso: Antwi-Boasiako et al
Running head recto: Haematological parameters in Ghanaian sickle cell disease patients
DOI: http://dx.doi.org/10.2147/JBM.S169872
Journal of Blood Medicine downloaded from https://www.dovepress.com/ by 158.46.218.63 on 31-Oct-2018
For personal use only.
Powered by TCPDF (www.tcpdf.org) 1 / 1
This article was published in the following Dove Press journal:
Journal of Blood Medicine
Journal of Blood Medicine 2018:9
submit your manuscript | www.dovepress.com
Dovepress
Dovepress
204
Antwi-Boasiako et al
A previous report indicated that SCD patients have
elevated white blood cell (WBC) counts,6,8,9 activated
granulocytes, monocytes, and endothelial cells, enhanced
expression of endothelial cell adhesion molecules, elevated
cytokine levels and elevated acute-phase reactants.7 More-
over, another study has reported that the use of drugs, such
as Hydroxyurea, lowers WBC count and thus improves
the clinical outcome of SCD patients.10 Anemia, which is
generally observed in SCD patients, is a reflection of an
overall severity of SCD.11 While higher counts or values
of Hb are linked with higher rates of severe pain in SCD
patients,12 lower steady-state Hb usually accounts for higher
risk of stroke in these same patients.11 Previous reports have
demonstrated that high leukocyte count appears to be a risk
factor for several severe complications of SCD, such as rates
of severe pain,12 acute chest syndrome,13 and mortality.14
The study by Balkaran et al15 established an association
of increased WBC with cerebrovascular accident. Another
study among SCD children in Nigeria reported that leuko-
cytosis and neutrophilia are related to disease severity.16
The hematological profile of Ghanaian SCD patients has
not been studied extensively in recent years. Findings from
such work may provide a predictive data of SCD patients’
hematological parameters in Ghana as well as contribute to
the improvement of SCD management. The current study
aimed at determining hematological parameters among
SCD patients with vaso-occlusion, those in the steady state
as well as healthy controls at a teaching hospital in Ghana.
Materials and methods
The study was conducted at the Korle Bu Teaching Hos-
pital (KBTH), Accra, Ghana after the study protocol was
approved by the Ethical and Protocol Review Committee of
University of Ghana Medical School. Written informed con-
sents were obtained from subjects. Consent was also sought
from the parents/guardians of the children recruited into the
study by signing a written informed consent agreement. The
study involved 628 male and female HbSS and HbSC SCD
patients in vaso-occlusive crises (VOC) and steady states
receiving care at the Center for Clinical Genetics (Sickle
Cell Clinic) and healthy HbAA controls, from February
2013 to May 2015. This clinic attends to sickle cell individu-
als aged 13 years and above. The control group (HbAA) was
recruited from voluntary blood donors at the Accra Area
Blood Center for National blood transfusion at the Korle-
Bu Teaching Hospital, Accra, who consented to participate
in the study. An established laboratory diagnosis of SCD
was necessary for eligibility for enrollment. Steady state
was clinically defined as a patient who has been well and
has not been in crisis for at least 2 weeks.17 Vaso-occlusive
crisis was clinically defined as pains in the bones, muscles,
and joints not attributable to any other cause and requiring
parenteral analgesia and hospitalization at the Center for
some hours.17 Patients with other conditions that may affect
hematological indices such as renal failure, pregnancy, and
recent blood transfusion 3 months prior to the study were
excluded from the study.2 Five milliliters of venous blood
sample was collected from the antecubital veins of par-
ticipants by venepuncture into EDTA tubes. Samples were
thoroughly mixed to prevent cell lysis and coagulation. A
full blood count (FBC) was done within 2 hours of collec-
tion using labsystem Multiskan MS (Amisham Bioscience
Ltd., Chalfont, UK). This is a three-part autoanalyzer which
runs 19 parameters per sample including Hb concentration,
packed cell volume, RBC concentration, mean corpuscular
Hb, mean cell volume, mean corpuscular Hb concentration,
WBCs, and platelet (PLT) parameters.
Statistical analysis
The data were entered into SPSS version-20 software.
Frequency tables were generated for nominal and ordinal
variables. The results were expressed as mean±SD. Student’s
t-test was used to compare means differences between males
and females. ANOVA with a Bonferroni post hoc test was
used to compare the values between more than two groups.
Statistical significance was considered at P<0.05.
Results
Characteristics of study subjects
A total of 628 subjects were recruited for this study. This
was made up of 148 HbAA controls (93 males, 55 females)
with a mean age of 31.9±10.0 years, 208 HbSS patients in
steady state (110 males, 98 females) with a mean age of
25.5±9.7 years, 82 HbSC patients in steady state (30 males,
52 females) with a mean age of 34.9±14.1 years, 156 HbSS
patients in VOC (64 males, 92 females) with a mean age of
26.2±9.4 years, and 34 HbSC patients in VOC (12 males, 22
females) with a mean age of 32.4±12.0 years.
Hematological parameters of male and
female HbSS in steady state
Females had significantly higher mean cell volume (MCV;
P=0.0411), mean cell hemoglobin (MCH; P=0.0145), and
mean cell hemoglobin concentration (MCHC; P=0.0205)
than males in steady state; however, red cell distribution
width (RDW; P=0.0431) and WBC counts (P=0.0016) were
significantly higher in males compared with females. The
mean differences in Hb, hematocrit (HCT), RBC, mean
Journal of Blood Medicine downloaded from https://www.dovepress.com/ by 158.46.218.63 on 31-Oct-2018
For personal use only.
Powered by TCPDF (www.tcpdf.org) 1 / 1
Journal of Blood Medicine 2018:9 submit your manuscript | www.dovepress.com
Dovepress
Dovepress
205
Haematological parameters in Ghanaian sickle cell disease patients
platelet volume (MPV), platelet distribution width (PDW),
platelet (PLT) count, and plateletcrit (PCT) were not signifi-
cant between males and females (P>0.05; Table 1).
Hematological parameters of male and
female HbSS in VOC
There were significantly lower Hb (P=0.0035), HCT
(P=0.0034), RBC (P=0.0015), RDW (P=0.0048), and WBC
(P=0.0012) in females than males except MCV (P<0.001).
However, the mean differences in MPV, MCV, MCH, MCHC,
PDW, PLT, and PCT were not significant (P>0.05) between
both genders in VOC (Table 2).
Hematological parameters of male and
female HbSC in steady state
There were significantly lower Hb (P0.001), HCT
(P<0.001), RBC (P=0.0001), and PDW (P=0.0117) in
females than males except WBC (P=0.0219) in steady state
(Table 3). In VOC, differences in means of hematological
parameters were not significant (P>0.05) between males
and females (Table 3).
A comparison of hematological
parameters between healthy controls,
HbSS, and HbSC male patients with sickle
cell disease in steady state and in VOC
The mean Hb, HCT, RBC, MCHC, RDW, and MPV were
significantly higher in HbAA than in HbSS and HbSC in
steady state and VOC (P<0.001). However, PLT, PCT, and
Table 1 Hematological parameters of male and female HbSS
patients in steady state
Parameters Male (n=110)
(mean±SD)
Female (n=98)
(mean±SD)
P-value
Hb (g/dL) 8.53±1.61 8.31±1.57 0.3128
HCT (%) 25.82±5.15 24.84±5.18 0.1705
RBC (106/mm3)3.06±0.71 2.89±0.77 0.0892
MCV (µm3)84.97±8.47 87.44±8.83 0.0411*
MCH (pg) 28.20±3.51 29.42±3.60 0.0145*
MCHC (g/dL) 33.12±1.46 33.59±1.44 0.0205*
RDW (%) 18.56±2.54 17.82±2.68 0.0431*
MPV (µm3)7.47±0.69 7.32±0.70 0.1197
PDW (%) 13.92±2.26 14.10±1.96 0.5275
PLT (103/mm3)466.33±121.39 461.95±160.55 0.8236
PCT (%) 0.35±0.10 0.33±0.11 0.3045
WBC (103/mm3)12.18±3.56 10.69±3.11 0.0016*
Note: *Signicant.
Abbreviations: HCT, hematocrit; Hb, hemoglobin; MCH, mean cell hemoglobin;
MCHC, mean cell hemoglobin concentration; MCV, mean cell volume; MPV, mean
platelet volume; PCT, plateletcrit; PDW, platelet distribution width; PLT, platelets;
RBC, red blood cell; RDW, red cell distribution width; WBC, white blood cells.
Table 2 Hematological parameters of male and female HbSS
patients in VOC
Parameters Male (n=64)
(mean±SD)
Female (n=92)
(mean±SD)
P-value
Hb (g/dL) 9.24±1.67 8.42±1.68 0.0035*
HCT (%) 28.37±6.01 25.58±5.74 0.0034*
RBC (106/mm3)3.50±0.89 3.05±0.87 0.0015*
MCV (µm3)82.59±9.45 85.50±9.45 <0.001*
MCH (pg) 27.50±6.95 28.40±4.02 0.3078
MCHC (g/dL) 33.03±4.92 33.11±1.69 0.8848
RDW (%) 18.56±2.89 17.39±2.20 0.0048*
MPV (µm3)7.65±0.81 7.62±0.70 0.8213
PDW (%) 13.19±3.01 13.53±2.74 0.4707
PLT (103/mm3)439.34±158.77 459.09±193.64 0.5019
PCT (%) 0.34±0.12 0.35±0.14 0.6394
WBC (103/mm3)16.24±7.37 13.01±4.83 0.0012*
Note: *Signicant.
Abbreviations: HCT, hematocrit; Hb, hemoglobin; MCH, mean cell hemoglobin;
MCHC, mean cell hemoglobin concentration; MCV, mean cell volume; MPV, mean
platelet volume; PCT, plateletcrit; PDW, platelet distribution width; PLT, platelets;
RBC, red blood cell; RDW, red cell distribution width; WBC, white blood cells;
VOC, vaso-occlusive crises.
Table 3 Hematological parameters of male and female HbSC
patients in steady state
Parameters Male (n=30)
(mean±SD)
Female (n=52)
(mean±SD)
P-value
Hb (g/dL) 12.51±1.33 10.74±1.73 <0.001*
HCT (%) 39.83±4.63 33.02±7.08 <0.001*
RBC (106/mm3)4.82±0.49 4.04±0.94 0.0001*
MCV (µm3)82.90±5.15 81.96±8.53 0.5860
MCH (pg) 26.02±1.83 26.61±2.26 0.4225
MCHC (g/dL) 30.02±1.83 31.86±1.15 0.308
RDW (%) 14.97±1.35 15.01±2.58 0.9367
MPV (µm3)8.32±1.01 8.23±1.01 0.9657
PDW (%) 14.23±2.23 12.66±2.89 0.0117*
PLT (103/mm3)289.64±18.31 322.87±20.70 0.2492
PCT (%) 0.23±0.08 0.26±0.09 0.1980
WBC (103/mm3)6.87±1.77 9.32±2.56 0.0219*
Note: *Signicant.
Abbreviations: HCT, hematocrit; Hb, hemoglobin; MCH, mean cell hemoglobin;
MCHC, mean cell hemoglobin concentration; MCV, mean cell volume; MPV, mean
platelet volume; PCT, plateletcrit; PDW, platelet distribution width; PLT, platelets;
RBC, red blood cell; RDW, red cell distribution width; WBC, white blood cells.
WBC were significantly higher in HbSS and HbSC male
patients than in HbAA (P<0.001). The mean differences in
MCV, MCH, and PDW were not significant between SCD
patients and healthy controls (P>0.05; Table 4).
A comparison of hematological parameters
between healthy controls, HbSS, and HbSC
female patients with sickle cell disease in
steady state and in VOC
The mean Hb, HCT, RBC, MCV, RDW, and MPV were sig-
nificantly higher in HbAA female patients than in HbSS and
Journal of Blood Medicine downloaded from https://www.dovepress.com/ by 158.46.218.63 on 31-Oct-2018
For personal use only.
Powered by TCPDF (www.tcpdf.org) 1 / 1
Journal of Blood Medicine 2018:9
submit your manuscript | www.dovepress.com
Dovepress
Dovepress
206
Antwi-Boasiako et al
HbSC patients in steady state and VOC (P<0.001). However,
PLT, PCT, and WBC were significantly higher in the HbSS
and HbSC females in VOC and steady state than the controls
(P<0.001). The mean differences in MCH and MCHC were
not significant between the SCD patients and healthy controls
(P>0.05; Table 5).
Discussion
Hematological features and clinical severity of SCD are influ-
enced by gender, genetic, and environmental factors. The pres-
ence of α-thalassemia, variation in Hb F level, and the specific
Table 4 A comparison of hematological parameters between healthy controls, HbSS, and HbSC male patients with sickle cell disease
in steady state and in VOC
Parameters Control
(n=93)
(mean±SD)
HbSS steady
state (n=110)
(mean±SD)
HbSC steady
state (n=30)
(mean±SD)
HbSS VOC
(n=64)
(mean±SD)
HbSC VOC
(n=12)
(mean±SD)
P-value
Hb (g/dL) 15.38±3.68 8.53±1.61 12.51±1.33 9.24±1.67 12.10±1.63 <0.001*
HCT (%) 42.20±6.51 25.82±5.15 39.83±4.63 28.37±6.01 38.35±4.37 <0.001*
RBC (106/mm3)5.14±0.82 3.06±0.71 4.82±0.49 3.50±0.89 4.45±0.53 <0.001*
MCV (µm3)82.62±6.09 84.97±8.47 82.90±5.15 82.59±9.45 84.42±6.20 0.185
MCH (pg) 27.44±2.67 28.20±3.51 26.02±1.83 27.50±6.95 27.20±2.04 0.274
MCHC (g/dL) 33.18±1.36 33.12±1.46 30.02±1.83 33.03±4.92 32.24±0.58 <0.001*
RDW (%) 18.91±13.25 18.56±2.54 14.97±1.35 18.56±2.89 15.43±1.16 <0.001*
MPV (µm3)9.09±1.38 7.47±0.69 8.32±1.01 7.65±0.81 7.88±0.77 <0.001*
PDW (%) 13.76±1.92 13.92±2.26 14.23±2.23 13.19±3.01 13.42±2.22 0.0900
PLT (103/mm3)224.22±61.17 466.33±121.39 289.64±18.31 439.34±158.77 238.56±109.94 <0.001*
PCT (%) 0.18±0.07 0.35±0.10 0.23±0.08 0.34±0.12 0.19±0.07 <0.001*
WBC (103/mm3)5.31±1.11 12.18±3.56 6.87±1.77 16.24±7.37 9.78±2.09 <0.001*
Note: *Signicant.
Abbreviations: HCT, hematocrit; Hb, hemoglobin; MCH, mean cell hemoglobin; MCHC, mean cell hemoglobin concentration; MCV, mean cell volume; MPV, mean platelet
volume; PCT, plateletcrit; PDW, platelet distribution width; PLT, platelets; RBC, red blood cell; RDW, red cell distribution width; VOC, vaso-occlusive crises; WBC, white
blood cells.
Table 5 A comparison of hematological parameters between healthy controls, HbSS, and HbSC female patients with sickle cell disease
in steady state and in VOC
Parameters Control
(n=93)
(mean±SD)
HbSS steady
state (n=110)
(mean±SD)
HbSC steady
state (n=30)
(mean±SD)
HbSS VOC
(n=64)
(mean±SD)
HbSC VOC
(n=12)
(mean±SD)
P-value
Hb (g/dL) 13.19±3.32 8.31±1.57 10.74±1.73 8.42±1.68 11.26±1.50 <0.001*
HCT (%) 40.91±10.94 24.84±5.18 33.02±7.08 25.58±5.74 35.21±4.66 <0.001*
RBC (106/mm3)4.97±1.26 2.89±0.77 4.04±0.94 3.05±0.87 4.28±0.56 <0.001*
MCV (µm3)82.62±5.29 87.44±8.83 81.96±8.53 85.50±9.45 82.50±7.61 <0.001*
MCH (pg) 26.68±2.05 29.42±3.60 26.61±2.26 28.40±4.02 26.43±2.87 0.5410
MCHC (g/dL) 32.29±0.90 33.59±1.44 31.86±1.15 33.11±1.69 31.96±1.03 0.4588
RDW (%) 18.59±13.25 17.82±2.68 15.01±2.58 17.39±2.20 14.86±1.16 <0.001*
MPV (µm3)8.15±1.08 7.32±0.70 8.23±1.01 7.62±0.70 7.94±0.78 <0.001*
PDW (%) 14.91±1.970 14.10±1.95 12.66±2.89 13.53±2.74 12.79±2.22 <0.001*
PLT (103/mm3)250.82±80.77 461.95±160.55 322.87±20.70 459.09±193.64 319.00±114.88 <0.001*
PCT (%) 0.19±0.06 0.33±0.11 0.26±0.09 0.35±0.14 0.25±0.08 <0.001*
WBC (103/mm3)5.793±1.28 10.69±3.11 9.32±2.56 13.01±4.83 8.25±1.52 <0.001*
Note: *Signicant.
Abbreviations: HCT, hematocrit; Hb, hemoglobin; MCH, mean cell hemoglobin; MCHC, mean cell hemoglobin concentration; MCV, mean cell volume; MPV, mean platelet
volume; PCT, plateletcrit; PDW, platelet distribution width; PLT, platelets; RBC, red blood cell; RDW, red cell distribution width; VOC, vaso-occlusive crises; WBC, white
blood cells.
haplotype background that is linked to the β globin gene
play an important role in the severity of disease.18 This study
highlights the association of hematological parameters with
SCD vaso-occlusion in Ghana. Several reports indicate that
changes in hematological parameters may account for clinical
complications observed in patients with SCD.10,12,15 Therefore,
good management of SCD can be achieved when hematologi-
cal parameters are regularly evaluated and the causes for the
changes in the hematological parameters rectified.
As expected, it was observed that WBC and PLT counts
were generally higher in SCD patients compared with their
Journal of Blood Medicine downloaded from https://www.dovepress.com/ by 158.46.218.63 on 31-Oct-2018
For personal use only.
Powered by TCPDF (www.tcpdf.org) 1 / 1
Journal of Blood Medicine 2018:9 submit your manuscript | www.dovepress.com
Dovepress
Dovepress
207
Haematological parameters in Ghanaian sickle cell disease patients
healthy counterparts. A similar study in Ghana reported
elevated levels of PLTs among SCD patients.19 Elevated WBC
has been linked with SCD patients in previous studies.2,6
Therefore, WBC and PLT counts are expected to increase in
all patients who may present with any form of complication
associated with SCD,2 as observed in the current study. In
particular, a significant part of this study was the inclusion of
patients with VOC (HbSS VOC and HbSC VOC), which is the
hallmark of SCD, as well as the greater sample size of sub-
jects. The higher PLT count seen in patients with SCD could
be attributed to a possible splenic sequestration, reduction or
absence of spleen resulting from hyposplenism in SCD20 or
autosplenectomy,6 as well as the underlying chronic inflam-
mation. Reports indicate that, there is a correlation between
PLT count and SCD,21,22 which corroborates the higher counts
of PLTs among SCD patients in this study, although a cor-
relation was not determined in this study.
Findings from the current study on increased steady PLT
count in SCD patients agree with the work of Freedman and
Karpatkin23 who followed eight adult SCD patients over a
period of 6 months and found an elevation in steady-state
PLT counts. Omoti,2 in his study, also recorded high PLT
counts among SCD patients with vaso-occlusion as well as
those in the steady state. Although WBC counts were gen-
erally elevated in SCD patients, it is worth noting that the
difference in counts was significantly higher in patients with
HbSS VOC. Therefore, as the condition of SCD progresses
from mild to severe with hemolysis, an elevated WBC count
is expected in such patients.24,25 Asymptomatic bacteriuria
is known in SCD patients in Ghana, compared with their
healthy counterparts.26 Several reports indicate that high
WBC counts usually observed in SCD population are mainly
due to bacterial infections.8,9,27–29 The current study, however,
did not establish a relationship between bacterial infections
and WBC counts among the SCD patients. The results from
this study revealed that people with the severer form of the
SCD have higher counts of WBC and PLTs. Even with larger
sample size, the current findings are similar to other results
obtained elsewhere. It is interesting that among the SCD
patients, WBC and PLT counts were higher in males. Thus,
gender may, in part, play a role in levels of WBC and PLTs
in SCD patients.
One of the characteristic features in the pathophysiology
of SCD is chronic hemolytic anemia.5 In SCD, there is an
increased tendency for RBC lysis and adhesion.30 Total Hb
level vary in SCA patients according to the βS haplotypes.18
The lower levels of Hb and HCT among SCD patients in
the current study agree with the work of Tshilolo et al31 and
Omoti.2 Chronic hemolysis,32 shortened red cell survival,33
as well as low erythropoietin response34 associated with SCD
might have been involved in the reduced Hb and HCT levels
observed in the present study. The Hb levels in this study are
similar to the finding of Nagose and Rathod.35 The ongoing
chronic hemolytic anemia in the patients may explain the
reduced RBC counts observed in the current study. A lower
Hb level in SCD patients with complication (a positive his-
tory of leg ulcers) has been reported in a previous study.36
Although vaso-occlusion is known to be a complication
of SCD, the Hb level was observed to be higher, compared
with those at the steady state. The higher levels of Hb in these
patients could, in part, be related to higher blood viscosity and
could further increase VOC. A study conducted by Omoti2
among SCD patients with VOC and those at the steady state
found higher levels of Hb in patients with VOC, although
the difference was not significant. As expected, the level of
Hb was lower in SCD patients at the steady state, probably
due to a reduced ongoing hemolysis compared with those in
crisis. These SCD patients in their steady state might have
adapted well to the anemic state.
In line with other studies, the mean MCV was higher
in females, among the SCD patients compared with the
controls.37–40 A study conducted by Nagose and Rathod,35
however, found higher MCV in males than females. The
difference could possibly be due to the lower sample size
of Nagose and Rathod’s study. One limitation of this study
was the inability to screen for Plasmodium infection, as the
presence of Plasmodium parasites may also lead to hemoly-
sis. We also could not gather information on patients treated
with hydroxyurea. More studies in other regions of Ghana
should be done to validate previous reports and provide a
baseline hematological profile and what to do in the form
of an algorithm to assist clinicians in the management of
SCD patients.
Conclusion
The present study found elevated levels of WBC and PLT,
as well as lower counts of Hb, RBC, and HCT concurrently
among the SCD patients. The cases had lower Hb and RBC
than the control; however, higher PLTs and WBC are noted
in various status of SCD, possibly reflecting spleen effect
in these patients. These hematological parameters present
a more descriptive data on SCD patients in Ghana and may
as well provide a useful tool and assist clinicians (in a form
of algorithm) in the management of SCD patients in Ghana.
Journal of Blood Medicine downloaded from https://www.dovepress.com/ by 158.46.218.63 on 31-Oct-2018
For personal use only.
Powered by TCPDF (www.tcpdf.org) 1 / 1
Journal of Blood Medicine 2018:9
submit your manuscript | www.dovepress.com
Dovepress
Dovepress
208
Antwi-Boasiako et al
Acknowledgments
The authors are thankful to the Office of Research, Innova-
tion and Development (ORID), University of Ghana, and the
University of Ghana-Carnegie Next Generation of Academ-
ics in Africa Project for funding the research. The authors
are also grateful to the staff and patients of the Center for
Clinical Genetics (Sickle Cell Clinic) who took part in the
study. Also, the authors would like to thank the volunteers
who donated blood and consented to take part in the study as
control subjects at the Accra Area Blood Center for National
Blood Transfusion at the Korle-Bu Teaching Hospital, Accra,
Ghana. The research was funded by the ORID, University of
Ghana, and the University of Ghana-Carnegie Next Genera-
tion of Academics in Africa.
Disclosure
The authors report no conflicts of interest in this work.
References
1. Roberts I, de Montalembert M. Sickle cell disease as a paradigm of
immigration hematology: new challenges for hematologists in Europe.
Haematologica. 2007;92(7):865–871.
2. Omoti CE. Haematological values in sickle cell anemia in steady state
and during vaso-occlusive crisis in Benin City, Nigeria. Ann Afr Med.
2005;4(2):62–67.
3. Baah ATD, Azumah DE, Ampiah C, Boampong J, Nuvor SV. Incidence
of human immunodeficiency virus in sickle cell patients in the Cape
Coast Metropolis, Ghana. World J AIDS. 2014;4(3):338–345.
4. Stuart MJ, Nagel RL. Sickle-cell disease. Lancet. 2004;364(9442):
1343–1360.
5. Kato GJ, Gladwin MT, Steinberg MH. Deconstructing sickle cell dis-
ease: reappraisal of the role of hemolysis in the development of clinical
subphenotypes. Blood Rev. 2007;21(1):37–47.
6. Okpala I. The intriguing contribution of white blood cells to sickle cell
disease: a red cell disorder. Blood Rev. 2004;18(1):65–73.
7. Brittain JE, Parise LV. Cytokines and plasma factors in sickle cell
disease. Curr Opin Hematol. 2007;14(5):438–443.
8. Ahmed SG, Ibrahim UA, Hassan AW. Hematological parameters in
sickle cell anemia patients with and without priapism. Ann Saudi Med.
2006;26(6):439–443.
9. Ahmed AE, Ali YZ, Al-Suliman AM, et al. The prevalence of abnormal
leukocyte count, and its predisposing factors, in patients with sickle cell
disease in Saudi Arabia. J Blood Med. 2017;8:185–191.
10. Zimmerman SA, Schultz WH, Davis JS, et al. Sustained long-term
hematologic efficacy of hydroxyurea at maximum tolerated dose in
children with sickle cell disease. Blood. 2004;103(6):2039–2045.
11. Ohene-Frempong K, Weiner SJ, Sleeper LA, et al. Cerebrovascu-
lar accidents in sickle cell disease: rates and risk factors. Blood.
1998;91(1):288–294.
12. Platt OS, Thorington BD, Brambilla DJ, et al. Pain in sickle cell disease.
Rates and risk factors. N Engl J Med. 1991;325(1):11–16.
13. Castro O, Brambilla DJ, Thorington B, et al. The acute chest syndrome
in sickle cell disease: incidence and risk factors. The Cooperative Study
of Sickle Cell Disease. Blood. 1994;84(2):643–649.
14. Platt OS, Brambilla DJ, Rosse WF, et al. Mortality in sickle cell dis-
ease. Life expectancy and risk factors for early death. N Engl J Med.
1994;330(23):1639–1644.
15. Balkaran B, Char G, Morris JS, et al. Stroke in a cohort of patients with
homozygous sickle cell disease. J Pediatr. 1992;120(3):360–366.
16. Ademola AS, Kuti BP. Evaluation of clinical severity of sickle cell
anemia in Nigerian children. J Appl Hematol. 2013;4(2):58–64.
17. Antwi-Boasiako C, Frimpong E, Ababio GK. The role of nitric oxide in
vaso-occlusive crisis in sickle cell disease patients in Ghana. Donnish
J Med Med Sci. 2015;2(4):52–55.
18. Oner C, Dimovski AJ, Olivieri NF, et al. Beta S haplotypes in various
world populations. Hum Genet. 1992;89(1):99–104.
19. Vercellotti GM. PlGF: a link between inflammation and angiogenesis
in sickle disease. Blood. 2003;102(4):1153.
20. de Franceschi L, Cappellini MD, Olivieri O. Thrombosis and sickle cell
disease. Semin Thromb Hemost. 2011;37(3):226–236.
21. Kenny MW, George AJ, Stuart J. Platelet hyperactivity in sickle-
cell disease: a consequence of hyposplenism. J Clin Pathol.
1980;33(7):622–625.
22. Francis RB. Platelets, coagulation, and fibrinolysis in sickle cell disease:
their possible role in vascular occlusion. Blood Coagul Fibrinolysis.
1991;2(2):341–353.
23. Freedman ML, Karpatkin S. Elevated platelet count and megathrom-
bocyte number in sickle cell anemia. Blood. 1975;46(4):579–582.
24. Krishnan S, Setty Y, Betal SG, et al. Increased levels of the inflammatory
biomarker C-reactive protein at baseline are associated with childhood
sickle cell vasocclusive crises. Br J Haematol. 2010;148(5):797–804.
25. Al-Basheer G, Abdelgadir O, Mustafa MEA, Muddathir MRA, Abdel-
gadir ER. C: reactive protein level and WBC count as biomarkers for
vaso-occlusive crisis among patients with sickle cell disease. Am J Med
Med Sci. 2015;5(6):283–286.
26. Donkor ES, Osei JA, Anim-Baidoo I, Darkwah S. Risk of asymptomatic
bacteriuria among people with sickle cell disease in Accra, Ghana.
Diseases. 2017;5(1):4.
27. Buchanan GR, Glader BE. Leucocyte counts in children with sickle cell
disease. Comparative values in the steady state, vaso-occlusive crisis
and bacterial infection. Am J Dis Chil. 1987;132:396–398.
28. Bagul R, Chandan S, Sane VD, Patil S, Yadav D. Comparative evalu-
ation of C-reactive protein and WBC count in fascial space infections
of odontogenic origin. J Maxillofac Oral Surg. 2017;16(2):238–242.
29. Augustina Ii AEF, Marcellinus NU. Some hematological and biochemi-
cal changes associated with blood transfusion in sickle cell anaemia
patients. J Mol Immunol. 2016;2:1.
30. Embury SH, Hebbel RP, Mohandas N, Steinberg MH. Sickle cell dis-
ease: Basic Principles and Clinical Picture. New York: Raven Press.
1994:311–311.
31. Tshilolo L, Wembonyama S, Summa V, Avvisati G. Haemogram findings
in Congolese children with sickle cell disease in remission. Med Trop.
2010;70:459–463.
32. Ashutosh L, Elliot PV. Sickle cell disease. In: Hoffbrand AV, Catovsky D,
Tuddenham EGD, editors. Postgraduate Haematology. 5th ed. Hoboken:
Wiley Blackwell; 2005:104–118.
33. Iheanacho O. Haematological parameters of adult and paediatric subjects
with sickle cell disease in steady state, in Benin City, Nigeria. Int Blood
Res Rev. 2015;3(4):171–177.
34. Sherwood JB, Goldwesser E, Chilcoat R, et al. Sickle cell anaemia
patients have low erythropoietin levels for their degree of anaemia.
Blood. 1987;67:46–49.
35. Nagose V, Rathod S. Hematological profile of sickle cell anemia sub-
jects in central India: a cross-sectional analysis. Ann Pathol Lab Med.
2018;5(1):A87–A91.
36. Lamar re Y, Lalanne-Mistrih ML, Romana M, et al. Male gender,
increased blood viscosity, body mass index and triglyceride levels are
independently associated with systemic relative hypertension in sickle
cell anemia. PLoS One. 2013;8(6):e66004.
37. Serjeant GR, Grandison Y, Lowrie Y, et al. The development of hae-
matological changes in homozygous sickle cell disease: a cohort study
from birth to 6 years. Br J Haematol. 1981;48(4):533–543.
Journal of Blood Medicine downloaded from https://www.dovepress.com/ by 158.46.218.63 on 31-Oct-2018
For personal use only.
Powered by TCPDF (www.tcpdf.org) 1 / 1
Journal of Blood Medicine 2018:9 submit your manuscript | www.dovepress.com
Dovepress
Dovepress
Journal of Blood Medicine
Publish your work in this journal
Submit your manuscript here: http://www.dovepress.com/journal-of-blood-medicine-journal
The Journal of Blood Medicine is an international, peer-reviewed, open
access, online journal publishing laboratory, experimental and clinical aspects
of all aspect pertaining to blood based medicine including but not limited to:
Transfusion Medicine; Blood collection, Donor issues, Transmittable diseases,
and Blood banking logistics; Immunohematology; Artificial and alternative
blood based therapeutics; Hematology; Biotechnology/nanotechnology of
blood related medicine; Legal aspects of blood medicine; Historical perspec-
tives. The manuscript management system is completely online and includes
a very quick and fair peer-review system. Visit http://www.dovepress.com/
testimonials.php to read real quotes from published authors.
Dovepress
209
Haematological parameters in Ghanaian sickle cell disease patients
38. Diop S, Thiam D, Cisse M, et al. New results in clinical severity of
homozygous sickle cell anemia, in Dakar, Senegal. Hematol Cell Ther.
1999;41(5):217–221.
39. Mouélé R, Boukila V, Fourcade V, Feingold J, Galactéros F. Sickle-cell
disease in Brazzaville, Congo: genetical, hematological, biochemical
and clinical aspects. Acta Haematol. 1999;101(4):178–184.
40. Akodu AK, Tella BA, Olujobi OD. Effect of stabilization exercise on
pain and quality of life of patients with non-specific chronic low back
pain. A JPARS. 2015;7:7–11.
Journal of Blood Medicine downloaded from https://www.dovepress.com/ by 158.46.218.63 on 31-Oct-2018
For personal use only.
Powered by TCPDF (www.tcpdf.org) 1 / 1
... The overall low hemoglobin level of 7.8 ± 1.1 g/dl throughout this study is coherent with the findings in another study conducted in south of Nigeria that reported a mean hemoglobin level of 7.93 ± 1.47 g/dl but lower than the 8.53 ± 1.6 g/dl (male) or the 8.31 ± 1.57 g/dl (female) reported from Ghana [27]. ...
... Monocyte series of the white blood cells are hardly reported in the hematological profiles of SCD in sub-Saharan Africa [27,31,33]. Monocytes play a vital role in scavenging dead cells and sickled red cells. ...
... The reaction mixture consisted of template DNA 5 μl, premix (i-Taq) 3 μl, each of primer 1 μl and distilled water10 μl. Thermocycling conditions consisted of initial denaturation at 95°C for 2 minutes, 14 ...
... Hematological features and clinical severity of SCD are influenced by gender, genetic, and environmental factors. It was observed that WBC and PLT count are generally higher in SCD patients compared with healthy counterparts [14]. ...
Article
Full-text available
Abstract Background: Sickle cell anemia (CSA) is one of a group of hemoglobin disorders known as sickle cell disease in which the sickle β-globin gene is inherited. The pathophysiology of sickle cell disease (SCD) is based on the chronic hemolysis, vaso-occlusive episodes, infection and chronic inflammatory conditions. The CCR5 gene which encodes CCR5,Th5,cell associated chemokine receptor act as pro-inflammatory mediator, the presence of mutant allele known as CCR5 delta 32 makes it non- functional, and lower inflammatory picture. Thus it could confer a selective advantage on patient with sickle cell disease because it induce less efficientTh1 response (decrease inflammation and morbidity) its effect on the inflammatory response and morbidity in patients with sickled cell disease. Objective: This study aimed at the detection of the frequency of CCR5delta 32 polymorphism among Sudanese patients with SCA. Materials and Methods: This is a case control study, conducted in Alneelain University –khartoum state during the period from August to December 2018. A total of study population, 60 participants (30 patients with SCA and 30 normal controls), were enrolled in this study. 2.5 milliliter of EDTA anticoagulated blood was collected from each subject. DNA was extracted by salting out method, and target DNA regions of the CCR5 delta 32 gene were amplified using allele specific polymerase chain reaction (AS-PCR). Results: The frequency of CCR5 delta32 polymorphism in study populations was 0%. Conclusion: There is no any CCR5 delta32 among Sudanese patients with sickle cell anemia. Keywords: Sickle cell anemia CCR5-delta32 mutant alleles Sudan.
... At a high dose, hydroxyurea can cause suppression of the bone marrow. [10][11][12] There was a remarkable improvement with 21 days treatment at home only in Covid-19. There were no standard therapeutic guidelines available at that time for children infected with Covid-19. ...
... Total white blood cells, eosinophils, and monocytes subpopulations were significantly elevated in the comorbidity state. In a steady state, the leukocytes count of SCD patients in Ghana was reported to be 12.1 x10 9 /L whereas those in vasoocclusive crisis (VOC) was reported as 16.2 x10 9 /L [17]. In this study, the leucocyte count in malaria-SCD was 18.3 x10 9 /L, a value slightly higher than the count previously reported for SCD in VOC. ...
Article
Full-text available
In Ghana, uncomplicated malaria and sickle cell disease (SCD) is common, hence comorbidity is not farfetched. However, the extent of oxidative stress and the array of clinical manifestations in this comorbidity (presence of both malaria and SCD) has not been fully explored. This study highlights the impact of uncomplicated malaria on SCD. The level of isoprostane, 8-iso-prostaglandin F2α (8-iso-PGF2α) was used to assess oxidative stress while plasma biochemistry and urinalysis was used to assess renal function. Hematological profiling was also done to assess the impact of comorbidity on the hematological cell lines. Of the 411 study participants with malaria, 45 (11%) had SCD. Mean body temperature was significantly higher in comorbidity compared to malaria and SCD cohorts, while a lower parasite density range was obtained in comorbidity compared to malaria cohorts. Furthermore, in comorbidity, the 8-iso-PGF2α oxidative stress biomarker was significantly elevated in all ages, parasite density ranges and gender groups. Comorbidity affected both leukocytic and erythrocytic cell lines with significant eosinophilia and monocytosis coexisting with erythrocytic parameters consistent with severe anemia. Biochemically, while plasma creatinine and bilirubin were significantly elevated in comorbidity, spot urinary creatinine was significantly reduced. Additionally, urine samples in the comorbid state were slightly acidic and hypersthenuric with significant hematuria, proteinuria, and bilirubinemia. Finally, 80% or more malaria-SCD presented with chills, fever, anorexia, headache, joint pains, lethargy, and vomiting. In conclusion, malaria could induce vaso-occlusive crisis in sickle cell disease, therefore, prompt management will alleviate the severity of this comorbidity.
... Hematological parameters assessment in recent years concerning Iraqi patients with sickle cell anemia is lacking. The association of significant morbidity and mortality of sickles cell patients with leukocyte count and severity of anemia in previous reports [11] justify the characterization of such hematological parameters in our patients in order to direct treatment goals toward strategies reducing such morbidity and mortality rate, thus the current study aim was at evaluating the hematological parameters in a subset of Iraqi patients with sickle cell anemia living in Baghdad province. ...
Article
Background: Characterization of hematological parameters in patients with sickle cell anemia can direct treatment goals toward strategies reducing morbidity and mortality rate.Objective: To evaluate the hematological parameters in a subset of Iraqi patients with sickle cell anemia in relation to age and gender. Patients and Methods: This cross-sectional study was included 30 patients with sickle cell anemia who were known to be at a steady clinical state with no vaso-occlusive crises. About 5 ml of venous blood was collected in EDTA tube from each participant. The complete blood count was conducted according to standard protocol. Results: The mean age was 7.93 ±2.43 years and the age range was 4 to 12 years. The study included 17 males and 13 females. 29 (96.7 %) were anemic and there was no significant difference in mean hemoglobin levels between males and females (p = 0.838). Males demonstrated higher frequency of low mean cell volume (MCV) and mean cell hemoglobin (MCH) (64.7% and 58.8%, respectively) than females (7.7% and 7.7%, respectively) with highly significant differences. Conclusion: Some hematological parameters in patients with sickle disease are affected by gender but show no significant correlation to age. Keywords: Hematological characteristics, Sickle cell anemia, Iraq
... 33 White blood cell count (WBC) and platelet count (PCT) have been documented to be higher in patients with SCD compared with their healthy counterparts. 34 This is consistent with the findings in our study with mean WBC and platelet count of 10.5x10 9 /L and 331.0 x 10 9 /L respectively in SCD compared to 5.30x10 9 /L and 233x10 9 /L in the non-SCD controls. There are multiple causes for leukocytosis in SCD. ...
Article
Full-text available
Background: Sickle cell disease is a protean disease with limited data on Nigeria's phenotypic and genetic variants. This study was conducted to provide baseline data on these variants by characterising the existing forms of sickle cell disease and correlating these with basic haematological parameters. Methods: Adult and paediatric patients with SCD were recruited from a tertiary health centre in Nigeria. Patients were age and sex-matched with healthy controls. Blood samples were obtained for Full Blood Count, phenotyping by High-Performance Liquid Chromatography, and genotyping for alpha thalassemia by multiplex Gap-polymerase chain reaction. Data analysis was done using IBM SPSS statistics version 23. Results: A total of 130 patients with sickle cell disease and 117 controls were studied. Alpha thalassemia in the study population was due to a 3.7kb deletion in the alpha-globin gene cluster at a prevalence of 45.4% in the patients and 47% in the controls. The prevalence of the various existing forms of SCD genotype was: Homozygous S without alpha gene deletion (HbSS)- 39.2%; HbSC - 10.8%; HbSSα+1- 35.4%; HbSSα+2 - 6.9% and HbSF- 7.7%. In the control population, HbAA without alpha gene deletion had a prevalence of 42.7%, HbAAα+1 was 25.6%, HbAA α+2 was 6%, HbAS- 7.7%, HbAS α+1 - 11.1%, HbAS α+2 - 2.6%, HbAC - 2.6% and HbAC α+1 - 1.7%. HbA2 was significantly elevated in HbSS individuals with two alpha gene deletions but reduced in normal controls (HbAA) with alpha gene deletions. HbF and HbA2 were negatively correlated with each other (r= -0.587, p < 0.001). Individuals with the HbSC genotype followed by HbSSα+2 had the best haematological parameters. Conclusions: Haematological parameters vary with haemoglobin genotype. The C haemoglobin and homozygous alpha-thalassemia deletion had a better ameliorating effect on SCD haematological parameters than the F haemoglobin in this population. The effect of alpha thalassemia on some haematological parameters in SCD patients are reversed in normal controls.
... 9 11 17 18 Low Hb has been attributed to chronic haemolysis and shortened red cell lifespan and this further reduces RCCs . 18 On the other hand, the higher platelet count and WCC are attributed to a possible splenic sequestration and serious bacterial infection, respectively. 19 20 There is paucity of data on the spectrum of SCD among hospitalised Malawian children. ...
Article
Full-text available
ABSTRACT Introduction Sickle cell disease (SCD) remains a major cause of childhood mortality and morbidity in Malawi. However, literature to comprehensively describe the disease in the paediatric population is lacking. Methods A retrospective review of clinical files of children with SCD was conducted. Descriptive statistics were performed to summarise the data. χ2 or Fisher’s exact test was used to look for significant associations between predictor variables and outcome variables (case fatality and length of hospital stay). Predictor variables that were significantly associated with outcome variables (p≤0.05) in a χ2 or Fisher’s exact test were carried forward for analysis in a binary logistic regression. A multivariable binary logistic regression was used to identify covariates that independently predicted length of hospital stay. Results There were 16333 paediatric hospitalisations during the study period. Of these, 512 were patients with SCD representing 3.1% (95% CI: 2.9%- 3.4%). Sixty-eight of the 512 children (13.3%; 95%CI: 10.5% - 16.5%) were newly diagnosed cases. Of these, only 13.2% (95% CI: 6.2% - 23.6%) were diagnosed in infancy. Anaemia (94.1%), sepsis (79.5%) and painful crisis (54.3%) were the most recorded clinical features. The mean values of haematological parameters were as follows: haemoglobin (g/dL) 6.4 (SD=1.9), platelets (×109 /L) 358.8 (SD=200.9) while median value for white cell count (×109 /L) was 23.5 (IQR: 18.0–31.2). Case fatality was 1.4% (95% CI: 0.6% - 2.8%)and 15.2% (95% CI: 12.2% -18.6%) of the children had a prolonged hospital stay (>5days). Patients with painful crisis were 1.7 (95% CI: 1.02 - 2.86) times more likely to have prolonged hospital stay than those without the complication. Conclusion Anaemia, sepsis and painful crisis were the most common clinical features paediatric patients with SCD presented with. Patients with painful crisis were more likely to have prolonged hospital stay. Delayed diagnosis of SCD is a problem that needs immediate attention in this setting. Although somewhat encouraging, the relatively low in-hospital mortality among SCD children may under-report the true mortality from the disease considering community deaths and deaths occurring before SCD diagnosis is made.
Article
Full-text available
Background: Sickle cell anemia a dangerous genetic disorder in which the erythrocytes of the body caused by a mutation in the HBB gene in the sixth position of the β chain, there is a change in the composition of hemoglobin due to the presence of sickle hemoglobin (Hbs). Aim of the study: Is to evaluate the hematological parameters levels in sickle cell anemia condition of patients with sickle cell anemia in the governorates Al- Diwaniyah and Al-Najaf Al-Ashraf. Methods: A total of one hundred and twenty-four subjects were recruited for this study which consists of eighty four sickle cell anemia subjects who (48 males and 36 females) and Forty healthy (20 male and 20 female) subjects as control who matched by age and sex of the patients groups. Conclusion: The outcomes indicated decrease in the level of RBC, Hb, MPV and HCT, while observed increased in the level of WBC, PLT, RDW-SD, RDW-CD, MCV, MCHC and PDW in sickle cell anemia patients compared with the control groups, however observed no significant in level of MCH in sickled patients compared with the control groups.
Article
Full-text available
Objective Patients with sickle cell disease (SCD) are prone to multiple episodes resulting in frequent hospital visits. We determined the time trends, sociodemographic and health factors associated with length of stay (LoS) for patients with SCD in Ghana. Design, participants, setting We retrospectively analysed SCD hospitalisation records of 22 680 patients from a nationwide database of the Ghana Health Service from 2012 to 2017. Outcome measures Factors associated with LoS were estimated using Cox regression, while the cumulative incidence of being discharged alive was estimated with in-hospital death as a competing risk. Results Patients admitted for SCD over 6 years constituted 22 680 (0.8%) of nearly 3 million admissions. The median age and LoS for the patients were 16 years (IQR=8–24) and 3 days (IQR=2–4), representing 14 202 (62.6%) of the patients discharged alive by the third day. Patients with sickle cell anaemia (6139, 52.6%) with a crisis were more frequent than those without a crisis. Increasing age was associated with shorter LoS when comparing age groups 10–14 years (HR=1.08, 95% CI 1.01 to 1.14) and 25–29 years (HR=1.27, 95% CI 1.17 to 1.37) to patients aged 0–4 years. Patients with comorbidities had a longer LoS compared with those without (HR=0.88, 95% CI 0.86 to 0.90). Conclusion This is the largest study to date documenting factors associated with LoS for patients admitted for SCD. The association of younger age with increased LoS supports recent calls for early SCD screening, especially newborns. The emerging trends and factors accounting for SCD admission require a multisector approach as these patients already experience frequent episodes of pain and hospital visits.
Article
Full-text available
Introduction Sickle cell disease (SCD) remains a major cause of childhood mortality and morbidity in Malawi. However, literature to comprehensively describe the disease in the paediatric population is lacking. Methods A retrospective review of clinical files of children with SCD was conducted. Descriptive statistics were performed to summarise the data. χ ² or Fisher’s exact test was used to look for significant associations between predictor variables and outcome variables (case fatality and length of hospital stay). Predictor variables that were significantly associated with outcome variables (p≤0.05) in a χ ² or Fisher’s exact test were carried forward for analysis in a binary logistic regression. A multivariable binary logistic regression was used to identify covariates that independently predicted length of hospital stay. Results There were 16 333 paediatric hospitalisations during the study period. Of these, 512 were patients with SCD representing 3.1% (95% CI: 2.9%- 3.4%). Sixty-eight of the 512 children (13.3%; 95% CI: 10.5% - 16.5%) were newly diagnosed cases. Of these, only 13.2% (95% CI: 6.2% - 23.6%) were diagnosed in infancy. Anaemia (94.1%), sepsis (79.5%) and painful crisis (54.3%) were the most recorded clinical features. The mean values of haematological parameters were as follows: haemoglobin (g/dL) 6.4 (SD=1.9), platelets (×10 ⁹ /L) 358.8 (SD=200.9) while median value for white cell count (×10 ⁹ /L) was 23.5 (IQR: 18.0–31.2). Case fatality was 1.4% (95% CI: 0.6% - 2.8%)and 15.2% (95% CI: 12.2% -18.6%) of the children had a prolonged hospital stay (>5 days). Patients with painful crisis were 1.7 (95% CI: 1.02 - 2.86) times more likely to have prolonged hospital stay than those without the complication. Conclusion Anaemia, sepsis and painful crisis were the most common clinical features paediatric patients with SCD presented with. Patients with painful crisis were more likely to have prolonged hospital stay. Delayed diagnosis of SCD is a problem that needs immediate attention in this setting. Although somewhat encouraging, the relatively low in-hospital mortality among SCD children may under-report the true mortality from the disease considering community deaths and deaths occurring before SCD diagnosis is made.
Article
Full-text available
Introduction High white blood cell (WBC) count is an indicator of sickle cell disease (SCD) severity, however, there are limited studies on WBC counts in Saudi Arabian patients with SCD. The aim of this study was to estimate the prevalence of abnormal leukocyte count (either low or high) and identify factors associated with high WBC counts in a sample of Saudi patients with SCD. Methods A cross-sectional and retrospective chart review study was carried out on 290 SCD patients who were routinely treated at King Fahad Hospital in Hofuf, Saudi Arabia. An interview was conducted to assess clinical presentations, and we reviewed patient charts to collect data on blood test parameters for the previous 6 months. Results Almost half (131 [45.2%]) of the sample had abnormal leukocyte counts: low WBC counts 15 (5.2%) and high 116 (40%). High WBC counts were associated with shortness of breath (P=0.022), tiredness (P=0.039), swelling in hands/feet (P=0.020), and back pain (P=0.007). The mean hemoglobin was higher in patients with normal WBC counts (P=0.024), while the mean hemoglobin S was high in patients with high WBC counts (P=0.003). After adjustment for potential confounders, predictors of high WBC counts were male gender (adjusted odds ratio [aOR]=3.63) and patients with cough (aOR=2.18), low hemoglobin (aOR=0.76), and low heart rate (aOR=0.97). Conclusion Abnormal leukocyte count was common: approximately five in ten Saudi SCD patients assessed in this sample. Male gender, cough, low hemoglobin, and low heart rate were associated with high WBC count. Strategies targeting high WBC count could prevent disease complication and thus could be beneficial for SCD patients.
Article
Full-text available
Asymptomatic bacteriuria (ASB) is benign except in certain medical conditions such as pregnancy and immunosuppression. In Ghana, there are hardly any studies on urinary infections among sickle cell disease (SCD) patients, and the few studies carried out in Africa focused on pediatric SCD populations. The current study aimed to investigate the risk of ASB among SCD patients at a tertiary hospital in Ghana. This was a cross-sectional study involving 110 SCD patients and 110 age and sex matched healthy controls. Urine specimens were collected from all the study subjects and analyzed by standard microbiological methods. Demographic information were also collected from the study subjects. The overall ASB prevalence was significantly higher among SCD patients (17.2%) than among the control group (8.2%), and the relative risk was 2.11 (p = 0.0431; CI = 1.00–4.45). Being female was as a predictor of ASB among the SCD patients (OR = 14.76; CI = 11.23–18.29; p = 0.0103). The most common organism isolated from the study participants was coagulase negative Staphylococcus species (4.1%), followed by Escherichia coli (2.7%); etiology of ASB in the SCD patients was more diverse compared to healthy people. All the E. coli isolates were susceptible to amikacin, sparfloxacin and norfloxacin but resistant to ampicillin.
Article
Full-text available
Patients with chronic low back pain have lower quality of life compared to patients with other chronic diseases and the general population. This study was designed to assess the effect of stabilization exercises on the quality of life of patients with non-specific chronic low back pain (NSCLBP). A total of 23 patients with NSCLBP, aged 27-65 years, participated in this study. They were recruited from the Orthopaedic Clinic of Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. They were put through core stabilization exercises twice weekly for 4 consecutive weeks and assessed with the World Health Organization Quality of Life (WHO QoL) questionnaire and Verbal Rating Scale (VRS) at baseline and at four weeks post-treatment intervention. Ethical approval was sought and obtained from the Health Research and Ethics Committee of LUTH. Data was analysed using the Statistical Package for Social Science (SPSS) version 17, and the level of significance was set at p < 0.05. Patients recorded significant reduction in pain severity following intervention (p= 0.01). There was also significant improvement in the quality of life domains (psychological health and social relationship) (p=0.01) post intervention, and only age correlated directly with social relationship of the quality of life domain (r=0.59, p=0.01). This study concluded that stabilization exercises reduced pain and improved the psychological health as well as social relationship domains of the quality of life of patients with non-specific chronic low back pain. Keywords: stabilization, quality of life, non-specific low back pain
Article
Full-text available
Background: Recent clinical and experimental data suggest that nitric oxide (NO) may play a role in the pathogenesis and therapy of sickle cell disease (SCD) by maintaining the normal vasomotor tone. However, limited data exist in Ghana and it is therefore imperative that data is collated in that regard. Aim and objectives: To determine the levels of NO in HbSS and HbSC patients in steady state, in VOC, and in the immediate post-crisis period. Materials and method: A cross-sectional study was done on 111 SCD patients at steady state, 112 SCD patients in VOC and 67 SCD patients at the immediate post crisis period, all aged 15 to 65 years, with a laboratory diagnosis of SCD at the Sickle Cell Clinic of the Korle-Bu Teaching Hospital with age-matched 102 healthy controls (HbAA) blood donors recruited from the Center for Clinical Genetics and Accra Area Blood Centre at the Korle-Bu Teaching Hospital, Accra. Results: The mean NO value of (8.66 ± 0.75μm) in control subjects were not significantly different from the mean level of (7.62 ± 0.06μm) in steady state (P>0.05). During VOC however, there was a significant reduction in mean NO levels to (2.08 ±0.81μm) (P<0.05). Mean NO levels rose significantly to (11.97 ± 1.68μm) (P<0.05) in the immediate post crisis period. Conclusion: Nitric oxide levels were diminished during VOC and rebound significantly during the immediate post crisis period in SCD patients
Article
Full-text available
Context: Human immunodeficiency virus (HIV) is a well-known pathogen that causes acquired immunodeficiency syndrome (AIDS). The course of HIV infection and progression may be influenced by sickle cell traits. Objectives: The aim of this study was to determine the incidence of HIV among sickle cell patients in the Cape Coast metropolis. Methods: A cross sectional study was conducted among patients who visited the Central Regional Hospital, Cape Coast. About 2 ml of blood sample was drawn from each participant for sickle cell test using sodium metabisulphite solution. Sickle cell positive samples were selected and tested for the presence of HIV using Alere Determine TM HIV-1/2. Results: A total of 75 patients made up of 25 males and 50 females were enrolled. Their age ranges between 4 to 59 years (27, 1-15 years; 24, 16-30 years; 17, 31-45 years; 7, 46-60 years). Fifteen (15) (20%) had received at least a single blood transfusion while the remaining 60 (80%) had never received blood transfusion before the study. Thirty-six patients (48.0%) were married and the other 39 patients (52.0%) were single. Five patients (6.7%) had antibodies to HIV whereas 70 patients (93.3%) were not with the virus. Conclusion: The incidence rate of HIV among sickle cell trait children and the youths of Cape Coast metropolis were found to be 6.7%. This may suggest that sickle cell traits in children and the youth may be associated with HIV transmission.
Article
PurposeTo assess efficacy of C-reactive protein levels as monitoring tools for patients with fascial space infections of odontogenic origin. Material and MethodA randomized prospective study was conducted on 20 patients suffering from fascial space infection of odontogenic origin, in the department of Oral and Maxillofacial Surgery Bharati Vidyapeeth dental college and hospital, Pune, Patients between 18 and 60 years of age of both the sexes were selected. All patients were treated and observed by the same surgeon. Patient’s venous blood sample was collected pre-operatively and on 2nd and 5th post-operative days for evaluation of WBC count and C-reactive protein (CRP). All patients were encouraged for strict follow-up protocol. ResultWhere the results of WBC count and CRP when compared it was seen that the mean values of WBC were normal in 15 cases and abnormal in 5 cases on day 0, day 2 and day 5; whereas the mean values of CRP were abnormal on day 0 and day 2 and were within normal limit on day 5 in all cases. Conclusion The findings of this prospective analysis indicate that White blood cells and C-reactive protein are effective markers for determining severity of infection, efficacy of treatment regime for patients with fascial space infections of odontogenic origin. Thus the markers also help in making treatment of patients with fascial space infections of odontogenic origin more cost effective and they also help protecting patients from side effects of excess drugs usage. Thus we conclude that CRP should be incorporated as monitoring tools for managing patients with fascial space infections of odontogenic origin.
Article
Sickle cell anemia (SCA) in children exhibits wide clinical diversity. SCA’s variable and unpredictable phenotypic expressions pose significant management challenges to caregivers and physicians alike. We therefore introduced a scoring system to evaluate the clinical severity of SCA in Nigerian children using simple clinico-laboratory parameters, and related the severity to their sociodemographic, hematological, and biochemical profiles. The total severity score of the 115 children ranged from 1 to 24, with mean ± standard deviation of 9.85 ± 5.22. Approximately one-third, 33.9% had mild disease, 55.7% moderate disease, and 10.4% severe disease, according to our severity score grading system. Age was positively correlated with disease severity score (r = 0.61; 95% confidence interval [CI] = 2.1–3.7; P = 0.001). Also, presence of dactylitis/hand-foot syndrome at first presentation, total white blood cell count, absolute neutrophil count, platelet count, and serum bilirubin concentration were significantly higher among those with severe disease. Conversely, hemoglobin F (HbF) percentage was significantly higher in those with mild disease (5.4 ± 3.2% vs. 3.1 ± 1.3%; P = 0.001). On multivariate analysis, dactylitis/hand-foot syndrome as first manifestation (odd ratio [OR] = 0.4; 95% CI = 1.7–3.5; P = 0.043 and HbF% (OR = 0.6; 95% CI = 0.2–0.7; P = 0.013) were the only independent predictors of severe disease. Routine evaluation of disease severity in children with SCA will help to prospectively identify children at higher risk for a turbulent clinical course who may need more active management and monitoring.