African Journal of Laboratory Haematology and Transfusion Science

High pre-and post-treatment Platelet-Neutrophil to Lymphocyte ratio is linked to high mortality risk in Epithelial Ovarian Cancer patients in Southeastern Nigeria

JO Okoye, TJ Ado-Okoye, CM Emeka, GU Eleje, IO Uduchi, UL Okoye — Mon, 01 Apr 2024 00:00:00 +0000

Introduction: To identify risk factors and prognostic tools for epithelial ovarian cancer (EOC), an aggressive ovarian cancer, this study assessed the frequency of BRCA2 mutation in early-onset (£ 50 years old) and late-onset (> 50 years old) EOC and variation of systemic immune-inflammatory indices, especially among herbal medicine- and chemotherapy-experienced patients.

Methods: This study included 100 patients diagnosed with EOC from Jan. 2016 to Dec. 2021. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelets-neutrophils-to-lymphocytes ratio (PNLR), and neutrophils-to-lymphocytes platelets ratio (NLPR) were assessed and analyzed accordingly. Significance was set at p< 0.05.

Result: The frequency of early menarche, serous adenocarcinoma, in-hospital death, and late-stage disease was 3.3, 1.6, 1.7, and 1.4 times higher among patients with early-onset EOC compared with their late-onset counterparts (p= 0.001, 0.025, 0.063, and 0.397, respectively). The frequency of BRCA2 mutation, hypertension, and diabetes was 2.5, 2.5, and 5.7 times higher among the latter than among the former (p= 0.001, 0.006, and 0.064, respectively). The pre-/post-treatment PNLR were 1.7/2.3 times significantly higher in cases of in-hospital death (1016.0 ± 169.4/ 750.5 ± 193.2) than in patients who were stable on discharge (591.60 ± 25.3/325.3 ± 35.3 at p= 0.044 and 0.013, respectively. There was a significant decline of pre-to-post-chemotherapy PNLR in the Stages I/II cases and an insignificant decline in Stages III/IV cases (p= 0.003 and 0.433, respectively). The post-treatment PNLR, PLR, and TWBC of herbal medicine-experienced patients were 5.6, 1.6, and 1.5, higher than the post-treatment values of naïve counterparts, respectively (p< 0.05).

Conclusion: This study revealed a high frequency of aggressive early-onset EOC and a higher frequency of BRCA2 mutation in late-onset EOC. It also revealed better treatment outcomes among patients who received at least four courses of chemotherapy and poor treatment outcomes among patients with a history of herbal medicine uptake. It suggests that NLR, PNLR, and PLR could be used to monitor disease progression.

Knowledge of Healthcare Professionals on Full Blood Count Histogram Interpretation: a cross-sectional study from Ghana

R Duku-Takyi, MA Essuman, S Daud, F Osei-Boakye — Mon, 01 Apr 2024 00:00:00 +0000

Introduction: The full blood count (FBC) is a routine assay that provides information on all the blood cells, such as erythrocytes, leucocytes, and platelets. The FBC results are usually accompanied by histograms which are applicable for making a preliminary prediction of many disease states. In this study, we assessed the utility of FBC histograms among health workers and their knowledge of its interpretation.

Methods: An online quantitative cross-sectional survey designed using Google forms were conducted from April to May 2022. The convenience sampling method was used to invite health workers to the survey that demanded that they answer questions that assessed their levels of utility and knowledge on the interpretation of FBC histograms. Data collected was analysed using the IBM SPSS version 26 using descriptive and inferential statistics.

Results: The final analysis involved responses from 206 health workers who were made up of 133 (64.4%) males and 73 (35.4%) females. The results indicated that a greater portion of respondents makes use of FBC results (94.7%), 73.8% use FBC analyzers that produce histograms. However, only a small number (30.6%) use FBC histograms in diagnosing patients. A large majority of respondents (80.6%) demonstrated poor knowledge of the FBC histogram with the remaining demonstrating average (14.6%) and good (4.9%) knowledge.

Conclusion: The level of knowledge on FBC histograms is highly inadequate among Ghanaian healthcare professionals and requires urgent attention. We recommend that relevant healthcare professionals should be given continual refresher training on the interpretation of FBC and its histograms to aid in patient management.

The Trajectory of Haptoglobin in Haemolysis, Inflammation and Transfusion Reaction

N Ihua, BW Moore-Igwe, BE Echonwere-Uwikor — Mon, 01 Apr 2024 00:00:00 +0000

Introduction: Haptoglobin is an acute-phase α₂-glycoprotein produced in the liver with the major biological function of binding free haemoglobin with very high affinity to prevent the loss of iron following hemolysis. Haptoglobin has an anti-inflammatory property and is raised during inflammation whereas, low level is associated with haemolysis. Transfusion is linked with haemolysis thereby increasing the level of free haemoglobin due to anti-haptoglobin and storage effect. Studies have revealed interplay of haptoglobin in haemolysis, inflammation and transfusion reaction although, the underlying mechanism is not well understood. Besides, its utilization as a diagnostic biomarker and therapeutic advantage have not been well explored hence, this study.

Method: In this review 20 primary studies from various electronic databases such as Google scholar, Semantic scholar and PubMed were obtained on the basis that they were focused on haptoglobin, haptoglobin in haemolysis, inflammation and transfusion. This was made possible by the use of Boolean function.

Results: Haptoglobin, is measured in blood due to its complex formation with hemoglobin, forming a protective non-covalent complex with CD63 as receptor. The finding from this review shows that, haptoglobin plays a crucial role in scavenging surplus hemoglobin, iron and heme in haemolysis with antioxidant function and immunomodulatory effect in transfusion reactions. The concept of the trajectory of haptoglobin explored the multi-dimensional course of this acute phase scavenger protein in the course of clinical conditions of haemolysis, inflammation and transfusion reaction. The review confirmed specific roles of haptoglobin such as physiologic-antioxidant, prognostic, diagnostic biomarker, immunologic and therapeutic. Additionally, an inverse relationship exists between haptoglobin and haemolysis as well as transfusion reaction consequent to hypohaptogloinaemia whereas, direct relationship exists with inflammation resulting to hyperhaptoglobinaemia observed in those clinical conditions respectively. Haptoglobin synthesis is elevated by the liver in response to inflammation, countering oxidative damage and inflammation by neutralizing free hemoglobin. When there is an immunological mismatch, haemolytic transfusion reactions can occur and transfusion of prolonged stored blood potentiate same effect.

Conclusion: The role of haptoglobin cannot be overemphasized. Based on the widespread roles and clinical relevance of haptoglobin, it is vital that haptoglobin be utilized.

Neonatal Blood Transfusion in Africa; Towards Optimizing Scarce Resource

Mon, 01 Apr 2024 00:00:00 +0000

Neonatal transfusion is a common practice in Africa, where many infants are born with low birth weight and require blood transfusions. The use of paediatric packs for neonatal blood transfusions has been recommended. However, the optimal use of these packs in Africa is not clearly understood by some healthcare practitioners. This review aims to provide insights into the optimal use of paediatric packs in neonatal transfusion in Africa.The World Health Organization (WHO) recommends restrictive transfusion practices for paediatric patients, including neonates, based on expert opinion. Transfusion triggers in neonates are controversial and mainly based on expert clinical opinion, although recent randomized controlled trials of ‘liberal’ versus ‘restrictive’ red cell transfusion policies in very low birth weight preterm babies are starting to influence clinical guidelines. Many neonatal red cell transfusions are given to replace losses from frequent blood sampling. This can be reduced by avoiding non-essential tests, using low-volume sample tubes, validated near patient testing, micro-techniques in the laboratory, and non-invasive monitoring where possible.The use of CMV-seronegative blood products for transfusion in low birth weight neonates is not deemed necessary. The primary rationale is that the risk of transfusion-transmitted infections should be reduced by stringent screening of donors, restrictive transfusion practice and certain interventions like irradiation of blood units before transfusion. A recent international survey of transfusion practices for extremely premature infants showed that factors considered “very important” regarding the need to administer blood transfusions included degree of oxygen requirement and need for respiratory support. Donor exposure can also be reduced by allocating single donor units, split into paedipacks, to babies predicted to need more than one transfusion episode within the expiry date of the donation. Implementing a program to improve compliance with neonatal intensive care unit transfusion guidelines was accompanied by a reduction in transfusion rate. The implementation of guidelines to improve compliance with neonatal intensive care unit transfusion guidelines can also reduce the transfusion rate.

Selected Indicators of Immunothrombosis in Apparently Healthy Nigerian Women of Different Reproductive Status

EC Akwiwu, CE Esedeke, GU Ndukwe, SB Egbe, DA Abunimye, JO Akpotuzor — Mon, 01 Apr 2024 00:00:00 +0000

Introduction: Women are considered to be vulnerable with regards to immunothrombotic conditions. Exploring this bidirectional susceptibility across the different female reproductive phases is important for effective maternal healthcare delivery. This study assessed selected indicators of immunothrombosis between premenopausal and postmenopausal women.

Methods: Equal numbers of premenopausal and postmenopausal women totaling one hundred were recruited for this comparative study. Blood sample was collected from each participant into appropriate sample bottles. Blood cell counts were carried out by haemocytometry and microscopic blood film reading. Standard manual methods were also employed for prothrombin time, activated partial thromboplastin time and relative plasma viscosity tests, while blood cell ratios were calculated. Results are expressed as Mean ±SD following student t-test analysis of data on SPSS version 22.0. Statistical significance was drawn at a p≤ 0.05.

Results: The eosinophils count (0.42±0.31x10⁹/l), monocyte count (0.05±0.05x10⁹/l) and platelets count (150.04±46.88x10⁹/l) were significantly higher in premenopausal women than postmenopausal women (0.29±0.27x10⁹/l, 0.03±0.03x10⁹/l and 132.62±38.37x10⁹/l respectively), while a significantly higher value was observed in the relative plasma viscosity of postmenopausal women (1.74±0.17mPa/s) than the premenopausal women (1.59±0.10mPa/s). The two derived indicators of inflammation (NLR) and thrombosis (PLR) correlated positively in both premenopausal (r=0.397, p=0.004) and postmenopausal (r=0.293, p=0.039) women.

Conclusion: Immune and thrombotic parameters are largely comparable in apparently healthy adult females irrespective of their reproductive phase. However, eosinophil, monocyte and platelet counts were observed to be significantly higher in premenopausal women compared to postmenopausal women.

Prevalence of Anaemia and Iron Requirement in Women Across Reproductive Phases in Calabar, Nigeria

EC Akwiwu, UE Nwabia, EE Okon, SB Egbe, JO Akpotuzor — Mon, 01 Apr 2024 00:00:00 +0000

Introduction: Maternal healthcare takes into consideration the immediate state of an individual woman with regards to health status and subsequent management. Anaemia is a common maternal health challenge that is affected by hormonal shifts in women. Thus, this study focused on prevalence of anaemia and iron requirement across women of premenopausal and postmenopausal phases.

Methods: This study enrolled apparently healthy 100 females with equal numbers of premenopausal and postmenopausal subjects. Blood sample was appropriately obtained from each subject for assessment of red cell and iron parameters. Microhaematocrit and cyanmethaemoglobin methods were employed for the measurement of packed cell volume and haemoglobin concentration respectively, while the iron parameters were assayed by colorimetric methods. Transferrin saturation was mathematically derived. Results are expressed as Frequencies and Mean ±SD, while student t-test was used for analysis of data on SPSS version 22.0. Statistical significance was drawn at a p≤ 0.05.

Results: Postmenopausal women had significantly higher values of packed cell volume (0.38 ± 0.03 l/l), haemoglobin concentration (125.50 ± 9.30 g/l), serum iron (23.17 ± 0.93 µmol/l) and transferrin saturation (36.88 ± 2.00 %) than the premenopausal women (0.37 ± 0.02 l/l, 121.44 ± 7.83 g/l, 15.53 ± 2.60 µmol/l and 20.70 ± 3.60 % respectively) while the premenopausal women had significantly higher values in total iron binding capacity (75.24 ± 3.32 µmol/l) than the postmenopausal women (62.97 ± 1.88 µmol/l. Whereas 30% of the premenopausal women were anaemic and 10% had low transferrin saturation, anaemia in postmenopausal women occurred at a prevalence of 18% and the indicators of iron need were adequate.

Conclusion: This study has shown that among apparently healthy individuals, prevalence of anaemia and iron requirement are lower in postmenopausal women than premenopausal women.

Study of Hemoglobins C and S in Pregnant Women in the Eastern Health District of Abobo

Mon, 01 Apr 2024 00:00:00 +0000

Introduction : Hemoglobinosis C and S are the most common structural abnormalities in West Africa. They worsen the overall health of carriers, particularly in pregnant women, leading to high-risk pregnancies and contributing to maternal and fetal morbidity and mortality. The objective of this study was to investigate hemoglobinopathies C and S in pregnant women.

Methods: This cross-sectional study was conducted from February to December 2022. It focused on pregnant women attending consultations at five health care facilities in the Abobo-East health district. Hemogram analysis was performed using the Sysmex XT 2000i, and hemoglobin electrophoresis at alkaline pH was conducted on the Helena system. Data were collected and analyzed using Microsoft Excel® 2016.

Results: Among the 500 selected patients, the mean age was 28 ± 6 years. 32.8% of women were anemic. 78.2% had normal hemoglobin, while 21.8% had hemoglobinopathies. Qualitative hemoglobinosis accounted for 21.2%, and suspected thalassemias were 0.6%. The prevalence of hemoglobin S and hemoglobin C was 15.2% and 6%, respectively. Healthy AS and AC carriers represented 20% of the study population.

Conclusion: The results of this study show a high prevalence of hemoglobinopathies C and S in community settings. A mandatory national strategy for the screening and management of hemoglobinosis in maternity wards throughout the country would be desirable.

Pre-transfusion compatibility tests in Malagasy sickle cell patients

EE Batavisoaniatsy, AH Razafinarivo, FAM Tsatoromila, ZA Randriamanantany — Mon, 01 Apr 2024 00:00:00 +0000

Introduction: Blood transfusion is a key component of sickle cell disease management. However, iterative transfusions of labile blood products for sickle cell patients increase the risk of anti-erythrocyte alloimmunization. It is usual to perform pre-transfusion compatibility tests in order to check ABO compatibility and to detect the possible existence of irregular antibodies in patients against the donor's antigens.

Methods: This is a prospective and descriptive study dealing with pre-transfusion compatibility tests over a 3-month period, from September 2018 to November 2018, at the Regional Blood Transfusion Centre (CRTS) of Analamanga Region, the capital of Madagascar.

Results: We included 33 out of 113 patients during the study period. Compatibility test was positive in 21.21%, of all tested samples. Major and minor compatibility tests were positive alone respectively in 6.25% and 12.50%. And both were positive in 3.12%. The self-test was positive in 3.03% with a positive direct antiglobulin test. Positive compatibility tests were more frequent in patients who received more than two transfusions. Compatible blood bag for the patient was found after testing 2 donor pockets in 27.27% of cases, and after testing 3 pockets in 3.03%.

Conclusion: Pre-transfusion compatibility tests are essential and have to be performed systematically on each blood bag before any transfusion. They are used to identify the presence of alloantibodies and provide compatible blood products to patients.