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Some Full Blood Count Parameters among Hypertensive Patients Attending Specialist Hospital, Sokoto, Nigeria

Authors:
  • Federal University Otuoke, Bayelsa State, Nigeria
Open Journal of Blood Diseases, 2019, 9, 77-91
https://www.scirp.org/journal/ojbd
ISSN Online: 2164-3199
ISSN Print: 2164-3180
DOI:
10.4236/ojbd.2019.94008 Oct. 23, 2019 77 Open Journal of Blood Diseases
Some Full Blood Count Parameters among
Hypertensive Patients Attending Specialist
Hospital, Sokoto, Nigeria
Osaro Erhabor1*, Abdullahi Shehu1, Tosan Erhabor2, Teddy Charles Adias3,
Ikechukwu Polycarp Iwueke4
1Department of Haematology, School of Medical Laboratory Science, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
2Medical Laboratory Science Council of Nigeria, Abuja, Nigeria
3Federal University Otuoke, Otuoke, Nigeria
4Pathology Department, Federal Neuro-Psychiatric Hospital, Sokoto, Nigeria
Abstract
Hypertension (HTN) is a major health problem worldwide. It can lead to car-
diovascular disease and functional disturbances including haematological pa-
rameters. Full blood count (FBC) parameters of a total of 60 consecutive-
ly-recruited hypertensive subjects and 30 age-matched non-
hypertensive
controls were studied between June and September, 2018. Ethylene Diamine
Tetra Acetic Acid (EDTA) anticoagulated blood and serum from subjects and
control participants were analyzed for
FBC. The total white cell count
(WBC), packed cell volume (PCV) haemoglobin (Hb), neutrophils and eosi-
nophil
s were significantly lower among hypertensive subjects compared to
non-hypertensive controls (p < 0.01, p = 0.02, p < 0.01, p < 0.01, p < 0.01) re-
spectively. The red cell count, monocyte and lymphocyte count were signifi-
cantly higher among the hypertensive subjects compared to controls (p =
0.00). There was a statistically significant variation in the haemoglobin, plate-
let count and red cell distribution width among the hy
pertensive subjects
based on the stage of the hypertensive disease (p < 0.01, p = 0.01 and p <
0.01) respectively. The haematological
parameters were compared among the
hypertensive subjects based on age, gender and ethnicity. The P
CV and
platelet count were significantly higher among hypertensives >40-year-
old
compared to those <40 years of age (p = 0.02 and 0.01) respectively. The RBC
count was significantly higher among female compared to male hypertensives
(p = 0.05). The haemoglobin and monocyte
count were significantly higher
among male compared to female hypertensives (p = 0.02 and 0.04) respec-
tively. The monocyte count was significantly higher among hypertensive sub-
jects of Hausa ethnic group compared to Fulani (t = 2.79, p < 0.01). The
How to cite this paper:
Erhabor, O., She-
hu, A
., Erhabor, T., Adias, T.C. and Iwueke,
I
.P. (2019) Some Full Blood Count Para-
meters among Hypertensive Patients A
t-
tending
Specialist Hospital, Sokoto, Nige-
ria
.
Open Journal of Blood Diseases
,
9,
77
-91.
https://doi.org/10.4236/ojbd.2019.94008
Received:
July 26, 2019
Accepted:
October 20, 2019
Published:
October 23, 2019
Copyright © 201
9 by author(s) and
Scientific
Research Publishing Inc.
This work is licensed under the Creative
Commons Attribution International
License (CC BY
4.0).
http://creativecommons.org/lic
enses/by/4.0/
Open Access
O. Erhabor et al.
DOI:
10.4236/ojbd.2019.94008 78 Open Journal of Blood Diseases
findings from this study indicates that the WBC, PCV, Hb, neutrophils and
eosinophils were significantly lower among hypertensive subjects compared
to non-
hypertensive controls. Stage of the disease, age, gender and ethnicity
had a significant effect on the FBC parameters of the hypertensive patients.
There is need to step up public enlightenment programme to educate hyper-
tensive patients on the need for attending clinic regularly for effective follow
up. It is recommended that facilities for the routine monitoring of FBC pa-
rameters among hypertensive in the area be provided.
Keywords
Full Blood Count, Hypertension, Specialist Hospital, Sokoto, Nigeria
1. Introduction
Hypertension, also known as high blood pressure or arterial hypertension is a
chronic medical condition in which the blood pressure in the arteries is elevated.
Blood pressure is expressed by two measurements, the systolic and diastolic
pressures, which are the maximum and minimum pressures, respectively, in the
arterial system. The systolic pressure occurs when the left ventricle is most con-
tracted; the diastolic pressure occurs when the left ventricle is most relaxed prior
to the next contraction. Normal blood pressure at rest is within the range of 100
- 140 mmHg systolic and 60 - 90 mmHg diastolic. Hypertension is present if the
blood pressure is persistently at or above 140/90 mmHg for most adults; differ-
ent criteria apply to children [1]. Blood pressure falls during sleep and rises ra-
pidly just before we wake up, which is when the risk of cardiovascular events is
the highest. Therefore, a definition of hypertension is usually taken as that level
of arterial blood pressure associated with doubling of long-term cardiovascular
risk [2].
Hypertension has become a chronic condition and a major public health prob-
lem that adversely affects health status of individuals’ families and communities
[3]. However, globally, the burden of hypertension and other non-communicable
diseases (NCDs) is rapidly increasing, and the African continent may be the
most affected region in the world [4]. It is estimated that hypertension affects
about 1 billion people all over the world and it is the main risk factor for many
other cardiovascular diseases [5] [6] [7]. With an increasing adult population
and changing lifestyle of Nigerians, the burden of hypertension may continue to
increase as time unfolds [8] [9]. The prevalence of hypertension in Nigeria may
form a substantial proportion of the total burden in Africa because of the large
population of the country currently estimated to be over 170 million [5]. In Ni-
geria, the last two decades have seen a rise in the number of prevalence studies
concerning hypertension and other non-communicable diseases [10] [11] [12]
[13] [14].
Hypertension has been documented as a threat to the health of people in
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sub-Saharan Africa and a major contributor to morbidity and mortality in the
sub-region [15]. The awareness of hypertension is low in Nigeria. Previous re-
ports indicated awareness rates of 14.2% in rural areas [16] and 42% among
market workers in Enugu State [17]. Awareness, treatment and control of hyper-
tension were generally low with attendant high burden of hypertension related
complications. The proportion of hypertensives on treatment in Nigeria is re-
ported to be 21% (23.7% men, 17.5% women) [18] and 18.6% (19.0% men,
18.4% women) [16].
Full blood count (FBC) is also known as Complete Blood Count (CBC). It is
one of the most common laboratory tests performed today. It gives information
about the production of all blood cells and identifies the patient’s oxygen carry-
ing capacity through the evaluation of red blood cells (RBC) indices, haemoglo-
bin and haematocrit. It also provides information about the immune system
through the evaluation of white blood cells (WBC) count with differential. This
test is helpful in the diagnosis of anaemia, certain cancers, infection, acute hae-
morrhagic states allergies and immune deficiencies as well as in the monitoring
of side effects of certain drug that causes dyscrasias [19].
Hypertension is a highly prevalent factor for cardiovascular disease. It has be-
come an increasingly common health problem worldwide because of increasing
longevity and prevalence of contributing factors such as obesity, physical inac-
tivity and unhealthy diet [20] [21]. The current prevalence in many developing
countries, particularly in urban societies, is already as high as those seen in the
developed countries [22] [23]. The population of global disease burden attribut-
able to hypertension is substantial. Hypertension plays a major role in the de-
velopment of cerebrovascular disease, cardiac and renal failure. Treating hyper-
tension has been associated with about a 40% reduction in the risk of stroke and
about a 15% reduction in risk of myocardial infection [24]. Hypertension re-
mains a major challenge in Nigeria. The prevalence of hypertension in Nigeria
has increased from 11.2% in the 1990s [25] to 27.9% in 2010 in a rural commu-
nity in the Niger Delta [26] and 22.6% in 2009 among a suburban Christian
community in Port Harcourt was 21.33% [27]. The prevalence of hypertension
in rural communities in Rivers State [26] and Edo State [28] was 27.9% and
20.2% respectively.
There is paucity of data of Full Blood Count Parameters among Hypertensive
patients attending Specialist Hospital, Sokoto, Nigeria. The aim of this study is
to determine the full blood count parameters among hypertensive patient in So-
koto, North Western, and Nigeria.
2. Materials and Methods
2.1. Study Area
The study was conducted in the Medicine Department of Specialist Hospital
Sokoto and the samples were analyzed in the Department of Haematology and
Blood Transfusion Science, Usmanu Danfodiyo University Teaching Hospital
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(UDUTH), Sokoto, Nigeria. The Department and the collaborating Specialist
Hospital Sokoto have enabling environment (human and material endowment)
to carry out this study. Sokoto State is located in the extreme North Western
part of Nigeria, near to the confluence of the Sokoto River and the Rima River.
With an annual average temperature of 28.3˚C (82.9˚F), Sokoto is on the whole,
a very hot area. However, maximum daytime temperatures are for most of the
year is generally under 40˚C (113.0˚F). The rainy season is from June to October
during which showers are a daily occurrence. There two major seasons (wet and
dry) are distinct. Report from the 2007 National Population Commission indi-
cated that the State had a population of 3.6 million [29].
2.2. Study Population
The study enrolled 60 hypertensive patients both men and women attending the
general outpatient clinic of Specialist Hospital Sokoto. Thirty non-hypertensive
healthy aged-matched men and women (students and staff of Usmanu Danfo-
diyo University and Specialist Hospital Sokoto) were included as controls. The
study was carried out between June and September, 2018.
2.3. Inclusion Criteria
All consenting adult patients with confirmed hypertension visiting the general
outpatient clinic of Specialist Hospital Sokoto were consecutively recruited into
the study.
2.4. Exclusion Criteria
All non-consenting and non-adult hypertensive subjects and non-hypertensive
individuals were excluded from the study as subjects.
2.5. Sample Size Determination
Sample size determination for the study was calculated based on the prevalence
reported from a previous study in Nigeria [30] using the following formulae:
2
2
Z pq
nd
=
where;
n
= Number of samples (sample size)
Z
= Standard normal deviate at 95% confidence interval = 1.96
p
= Prevalence from initial studies = 4.8% = 0.048 [30]
d
= degree of confidence at = 5% = 0.05
q
= 1 p = 1 0.048 = 0.952
2
2
1.96 0.048 0.952 3.8416 0.0456 70.07 70
0.0025
0.05
n×× ×
= = = ≈
2.6. Study Design
This research was a case-control study involving confirmed hypertensive pa-
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tients as subjects. The patients were consecutively enrolled into the study. Qua-
litative data was elicited using structured interviewer administered questionnaire
which include age, gender, socio-economic class of the parent and others. The
socio-economic status was assessed based on income, education and occupation.
It is usually broken into three categories (high, middle and low socio-economic
status).
Quantitative data were obtained by estimating the manganese, zinc level and
full blood count parameters which include packed cell volume, total leukocytes,
neutrophil, eosinophil, basophil and monocytes count.
2.7. Subject Selection
The study involved individuals with a confirmed diagnosis of hypertension at
the Internal Medicine Unit of Specialist Hospital Sokoto. The control samples
were obtained from non-hypertensive individual as confirmed by the physician
at the hospital. Following informed consent, a structured interviewer adminis-
tered questionnaire was used to elicit data on subject’s socio-economic and demo-
graphic characteristics. Ethical approval was obtained from the Hospital Ethical
and Research Committee of Specialist Hospital Sokoto before commencement.
2.8. Sample Collection and Processing
About 3.0 ml of venous blood was collected from each subject from a venipunc-
ture site using 70% alcohol under aseptic conditions. One milliliter of blood was
then delivered into sample bottles containing ethylene diamine tetra acetate
(EDTA) and gently mixed immediately to prevent sample from clotting and 2.0
mls into plain sample bottle. The sample was then appropriately labeled. The
EDTA anticoagulated blood was used for determination of complete blood
count.
2.9. Informed Consent
Verbal informed consent was obtained from the parent and guardian prior to
commencement of the study.
2.10. Ethical Consideration
Ethical approval for the study was obtained from Research and Ethical Commit-
tee of Specialist Hospital, Sokoto.
2.11. Questionnaire
A semi-structured interviewer-administered questionnaire was administered to
all consenting participants to obtain information on their socio-demographic,
nutritional and medical history.
2.12. Sample Collection and Method of Analysis
Two milliliters of blood were collected from each participant into EDTA bottle
for full blood count estimation. These samples were tested in Haematology De-
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partments of Usmanu Danfodiyo University Teaching Hospital (UDUTH).
2.13. Full Blood Count Estimation
Full blood count was carried out using the five-part automated haematology
analyser (Mythic 22 CT, 2008 Orphee, Switzerland). The analyzer, when the di-
luent is displayed by blood cells, causes a measurable change in resistance. The
cells are allowed to pass through an aperture through which an electric current
is flowing. Cell passing through the aperture displace the diluents; and being
bad conductors of electricity, increases the resistance which is counted as a vol-
tage pulse, which are converted to digital recording. The cell suspension is
drawn through the aperture with the help of a vacuum pump into a system of
tubing.
2.14. Data Analysis
Data obtained was entered into a statistical package (such as SPSS version 25) on
a computer to define the nature of the distribution of data for each group. Statis-
tical differences of data was analyzed using series of statistical analysis such a
mean, standard deviation, t-test, ANOVA was used to compare the mean ± SD
of the full blood count and zinc and manganese level of hypertensive patients
and the normal control subjects depending on the nature (categorical or conti-
nuous) and distribution of data (normal or non-normal). Probability (p ≤ 0.05)
was used to determine the level of significant for all statistical analysis.
3. Result
The study investigated 60 hypertensive patients both men and women at-
tending the general outpatient clinic of Specialist Hospital Sokoto. Thirty
non-hypertensive healthy aged-matched men and women were monitored as
controls. Table 1 shows the FBC among hypertensive subjects and controls. The
White Cell Count (WBC), haemoglobin (Hb), Packed Cell Volume (PCV), Neu-
trophil and Eosinophil count were significantly lower among the hypertensive
subjects compared to non-hypertensive controls (p < 0.01, p < 0.01, p = 0.02, p <
0.01 and p < 0.01) respectively. The Red cell count (RBC), lymphocyte and mo-
nocyte count were significantly higher among the hypertensive subjects com-
pared to the non-hypertensive controls (p = 0.00). There were no statistically
significant differences in the Red cell distribution width (RDW), platelet and
basophil count of the hypertensive subjects and the non-hypertensive controls
(p > 0.05).
Table 2 shows the effect of the different stages of hypertension on the full
blood count parameters of hypertensive subjects. RBC, Hb, RDW and Platelets
show a statistical significance with difference stages of hypertension (p < 0.05).
There was a statistically significant difference in the RBC, Hb and Monocyte.
Table 3 shows the FBC of hypertensive patients in the study groups based on
Age; (male and female). There was a statistically significant difference in the
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PCV and platelets parameters among hypertensive patients (p < 0.05). There was
no statistical difference in WBC, RBC, Hb, RDW, Monocytes, Basophils among
hypertensive subjects (p > 0.05).
Table 4 shows the FBC parameters among hypertensive patients based on
gender (male and female). There was a statistically significant difference in the
RBC (p < 0.05), Hb (p < 0.02) and Monocyte (p < 0.04) among hypertensive pa-
tients based on gender. There was no statistical difference in WBC, PCV, RDW,
Monocytes, Basophils, Manganese, Neutrophil, lymphocytes, and platelet para-
meters among hypertensive subjects (p > 0.05).
Table 5 shows the FBC of hypertensive patients in the study groups based on
ethnicity. There was a statistically significant difference in the monocytes, para-
meter among hypertensive patients based on ethnicity (p < 0.05). There was no
statistical difference in the other full blood count parameter and trace elements
among hypertensive subjects (p > 0.05).
Table 1. Full blood count parameters among the subjects and controls.
Parameters
Controls (30)
Mean ± SD
t-value
p-value
WBCC (×103/μl) 5.33 ± 1.79 6.96 ± 2.21 3.75 <0.01
RBCC (×106/µl) 4.79 ± 0.97 3.21 ± 0.63 8.08 <0.01
Hb (g/dl) 12.18 ± 2.01 13.95 ± 1.66 4.16 <0.01
PCV (%) 36.45 ± 6.39 39.74 ± 5.85 2.37 0.02
RDW (%) 13.95 ± 1.86 14.03 ± 2.53 0.16 0.87
Platelet (×103/μl) 277.12 ± 90.39 272.03 ± 108.78 0.24 0.82
Lymphocyte (%) 48.07 ± 14.07 38.14 ± 7.12 3.63 <0.01
Monocyte (%) 9.04 ± 4.19 4.82 ± 1.96 5.23 <0.01
Neutrophil (%) 51.03 ± 14.77 60.17 ± 9.68 3.07 <0.01
Eosinophil (%) 1.99 ± 2.11 3.67 ± 1.40 3.95 <0.01
Basophil (%) 0.49 ± 0.42 0.57 ± 0.29 0.89 0.38
Table 2. Effect of the different stages of hypertension on the FBC parameters.
Parameters
Stages
N
Mean ± SD
f-value
p-value
White Blood Cells
Stage 1 2 5.10 ± 0.98
Stage 11 16 5.72 ± 0.87 0.52 0.59
Stage 111 42 5.19 ± 2.06
Red Blood Cells
Stage 1 2 5.50 ± 0.42
Stage 11 16 5.32 ± 0.69 4.78 0.01
Stage 111 42 4.55 ± 0.98
Haemoglobin
Stage 1 2 13.65 ± 0.35
Stage 11 16 10.68 ± 1.50 7.66 <0.01
Stage 111 42 12.68 ± 1.94
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Continued
PCV (%)
Stage 1 2 38.10 ± 6.93
Stage 11 16 37.39 ± 4.37 0.335 0.72
Stage 111 42 36.00 ± 7.07
Platelet
Stage 1 2 216.00 ± 25.46
Stage 11 16 335.50 ± 68.25 5.47 0.01
Stage 111 42 257.79 ± 90.23
Monocyte
Stage 1 2 9.60 ± 5.09
Stage 11 16 8.26 ± 3.99 0.37 0.68
Stage 111 42 9.31 ± 4.30
Lymphocyte
Stage 1 2 44.60 ± 13.58
Stage 11 16 47.38 ± 13.07 0.09 0.90
Stage 111 42 48.49 ± 14.58
Neutrophil
Stage 1 2 61.10 ± 7.07
Stage 11 16 52.49 ± 16.93 0.63 0.53
Stage 111 42 50.00 ± 14.17
Eosinophil
Stage 1 2 0.75 ± 0.21 0.40 0.668
Stage 11 16 2.18 ± 2.17
Stage 111 42 1.97 ± 2.14
Basophil
Stage 1 2 0.75 ± 0.71
Stage 11 16 0.45 ± 0.26 0.46 0.63
Stage 111 42 0.49 ± 0.47
Red Cell Distribution
Width
Stage 1 2 13.00 ± 0.85
Stage 11 16 12.68 ± 1.47 6.82 <0.01
Stage 111 42 14.48 ± 1.79
Table 3. FBC parameters among hypertensive subjects by age.
Parameters
Age (Years)
N
Mean ± SD
t-value
p-value
White Blood Cells
<40 4 5.07 ± 2.24 0.29 0.77
>40 56 5.35 ± 1.78
Red Blood Cells
<40 4 4.37 ± 1.39 −0.88 0.38
>40 56 4.82 ± 0.94
Haemoglobin
<40 4 11.05 ± 3.23 1.16 0.24
>40 56 12.26 ± 1.91
PCV (%)
<40 4 29.50 ± 10.71 2.33 0.02
>40 56 36.94 ± 5.82
Platelet
<40 4 174.00 ± 57.78 2.46 0.01
>40 56 284.48 ± 88.05
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Continued
Monocyte
<40 4 7.87 ± 4.38 0.57 0.56
>40 56 9.12 ± 4.20
Lymphocyte
<40 4 40.90 ± 10.51 1.05 0.29
>40 56 48.57 ± 14.22
Neutrophil
<40 4 58.70 ± 5.62 1.07 0.28
>40 56 50.48 ± 15.19
Eosinophil
<40 4 0.47 ± 0.34 1.50 0.13
>40 56 2.09 ± 2.13
Basophil
<40 4 0.60 ± 0.22 0.52 0.60
>40 56 0.48 ± 0.43
Red Cell Distribution
Width
<40 4 14.23 ± 1.73 0.304 0.76
>40 56 13.93 ± 1.88
Table 4. FBC parameters among hypertensive subjects based on gender.
Parameters
Male (30)
Mean ± SD
Female (30)
Mean ± SD
t-value
p-value
WBCC (×103/μl) 5.52 ± 1.64 5.14 ± 1.94 0.81 0.42
RBCC (×106/µl) 4.54 ± 0.78 5.03 ± 1.08 2.03 0.05
Hb (g/dl) 12.77 ± 1.57 11.58 ± 2.24 2.38 0.02
PCV (%) 35.74 ± 6.52 37.16 ± 6.29 0.86 0.39
RDW (%) 14.02 ± 1.65 13.88 ± 2.07 0.28 0.78
Platelet (×103/μl) 287.03 ± 73.49 267.20 ± 104.96 0.85 0.40
Lymphocyte (%) 49.73 ± 14.96 46.40 ± 13.15 0.92 0.36
Monocyte (%) 10.13 ± 4.23 7.96 ± 3.92 2.06 0.04
Neutrophil (%) 49.70 ± 14.56 52.36 ± 15.10 0.69 0.49
Eosinophil (%) 2.22 ± 2.17 1.76 ± 2.05 0.85 0.40
Basophil (%) 0.57 ± 0.54 0.42 ± 0.23 1.39 0.17
Table 5. FBC parameters among hypertensive subjects by ethnic group.
Haematological
Ethnicity
Parameter
N
Mean ± SD
t-value
p-value
White Blood Cells
Hausa 48 5.21 ± 1.69 0.21 0.83
Fulani 5 5.04 ± 2.31
Red Blood Cells
Hausa 48 4.83 ± 0.76 1.41 0.16
Fulani 5 4.30 ± 1.16
Haemoglobin
Hausa 48 12.20 ± 1.90 0.56 0.58
Fulani 5 11.68 ± 2.67
PCV (%)
Hausa 48 36.57 ± 6.17 0.80 0.42
Fulani 5 34.18 ± 8.19
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Continued
Platelet
Hausa 48 280.06 ± 93.07 1.06 0.29
Fulani 5 233.20 ± 105.92
Monocyte
Hausa 48 9.27 ± 4.22 2.79 <0.01
Fulani 5 3.90 ± 1.92
Lymphocyte
Hausa 48 49.24 ± 13.73 0.18 0.85
Fulani 5 48.04 ± 18.26
Neutrophil
Hausa 48 52.60 ± 14.44 1.37 0.18
Fulani 5 43.16 ± 16.79
Eosinophil
Hausa 48 1.85 ± 2.04 0.86 0.39
Fulani 5 1.05 ± 0.76
Basophil
Hausa 48 0.53 ± 0.45 1.09 0.28
Fulani 5 0.31 ± 0.11
RDW
Hausa 48 13.82 ± 1.79 0.27 0.79
Fulani 5 14.04 ± 1.39
4. Discussion
Hypertension is a major health problem worldwide. It can lead to cardiovascular
disease and also leads to functional disturbances including haematological pa-
rameters. The aim of this study was to assess some haematological parameters of
hypertensive individuals in comparison with normotensive individuals.
In this study the mean value for Hb was shown to be lower among hyperten-
sive compared to normotensive subjects (p > 0.05). Our finding agrees with the
finding in a previous study conducted in São Paulo, Brazil [31]. Our finding is
however at variance with previous report [32] which shows that Hb value was
significantly increased in the hypertensive group compared to normotensive
groups. The association between HTN and Hgb level may be explained by Hgb
and arginase enzyme effects on nitric oxide (NO) bioavailability [32]. Normo-
cytic anaemia is common among hypertensive patients. Lower haemoglobin
concentrations were found in patients with uncontrolled than among those with
well controlled hypertension, indicating a higher cardiovascular risk in uncon-
trolled hypertension. Patients with anaemia had higher nocturnal systolic and
mean blood pressure and a tendency for increased diastolic blood pressure and
lower dipping status compared to patients with normal haemoglobin levels. Lep-
tin, the product of the human obesity gene, might be involved in the regulation
of the rheologic behavior of erythrocytes and the microcirculation in hyperten-
sion. Anaemia is associated with higher cardiovascular risk, higher blood pres-
sure values, and lower dipping status in hypertensive patients, and haemoglobin
should be monitored in hypertensive patients [33]. During HTN, there is a pos-
sibility of haemolysis [34] [35] [36] [37]. Previous studies suggest that hyperten-
sion is a complication of hemolysis and associated with haemolytic anaemia
[38]. During haemolysis, haemoglobin and arginase enzyme are released in to
circulation from erythrocytes. This free haemoglobin is a scavenger of nitric
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oxide which is produced in the endothelial cell that lines the blood vessels which
is important for relaxation of blood vessels. On the other hand, arginase enzyme
depletes the substrate used for NO synthesis by conversion of arginine to orni-
thine, thus reducing NO production [39].
Our finding is consistent with a previous report which indicated that haema-
tological parameters are impaired [40] and may strongly indicate hypertensive
end-organ damage, specifically kidney failure [41] [42]. Specifically, increased
Hb level may cause left ventricular hypertrophy while low Hgb levels causes
anemia and heart failure [43].
We observed that the White Cell Count (WBC) was significantly lower among
the hypertensive subjects compared to non-hypertensive controls. Our finding is
consistent with a previous report which showed a lower mean value of WBC
count in hypertensive individuals when compared to apparently healthy normo-
tensive subjects [44] [45]. In two community studies that adjusted for such co-
ronary risk factors, the WBC count was no longer associated with elevated co-
ronary risk. Elevated WBC count has been associated with high blood pressure
(BP) [46].
We observed that there were no significant differences between the platelet
count of hypertensive subjects and controls. Our finding agrees with findings in
a previous study [47]. During hypertension, there is endothelial dysfunction and
this leads to platelet activation and clot formation. Then platelets will be con-
sumed and the number does not increase as expected [48]. When platelet pro-
duction is induced, there could be increment in platelet count. Evidence suggests
that platelet consumption increase at the site of injured blood vessel. During this
condition larger platelets would be released from the bone marrow because larg-
er platelets are haemostatically more active than mature platelets. Platelets have
central role in pathophysiology of athero-thrombotic cardiovascular diseases.
Increased MPV has been shown in patients with cardiovascular diseases and in
patients’ groups with known coronary artery disease risk factors. Moreover, in-
creased MPV has also prognostic role in cardio-vascular diseases, for example, it
is associated with higher mortality following myocardial infarction [31].
The result obtained from this study showed that the mean value of RDW was
not significantly lower among hypertensive subject compared to non-hypertensive
subject (p = 0.87). Our finding is disagreement with previous report [44] which
shows that the hypertensive groups had significantly higher mean (SD) value of
RDW (p < 0.05). RDW increased significantly in hypertensive groups compared
to normotensive individuals. Most studies suggest that higher RDW, which is a
measure of the variability in the circulating erythrocytes’ size, may result from
ineffective erythropoiesis due to chronic inflammation during hypertension [42].
5. Conclusion and Recommendation
The findings from this study indicate that the (WBC), packed cell volume (PCV)
haemoglobin (Hb), neutrophils and eosinophils are significantly lower among
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10.4236/ojbd.2019.94008 88 Open Journal of Blood Diseases
hypertensive subjects compared to non-hypertensive controls. Stage of the dis-
ease, age, gender and ethnicity have a significant effect on the full blood count
parameters of hypertensive patients. There is need to step up public enlighten-
ment programme to educate hypertensive patients on the need for attending
clinic regularly for effective follow up. It is recommended that routine monitor-
ing of FBC parameters among hypertensive in the area be carried out and used
to monitor the prognosis of the disease and to manage hypertensive related
complications.
Limitations
The main limitation is that a higher number of hypertensive subjects could have
been studied. There may be need to carry out a larger multicenter and regional
study in future.
Conflicts of Interest
Authors confirm that there is no conflict of interest associated with this manu-
script.
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