Intestinal helminthiasis and its impact on haematological parameters of patients with endemic Burkitt ‘s lymphoma in northern Nigeria: clinical implications on cancer chemotherapy

Abstract

Background: Endemic Burkitt’s Lymphoma (eBL) and intestinal helminthiasis are common morbidities in Nigeria and share similar epidemiology with respect to age, tropical climate, underdevelopment and poverty. Hence, we predicted that eBL patients with helminthiasis will have a higher risk of anaemia than their counterparts without helminthiasis. Objective: To study the prevalence of intestinal helminthiasis among eBL patients, and determine relative risk of anaemia in eBL patients with and without helminthiasis before commencing cancer chemotherapy.

Methodology: Retrospective analysis of haematological parameters and stool microscopy data of eBL patients diagnosed in an aggregate period of 36 years at different time intervals between 1995-2013 in five northern Nigerian tertiary hospitals.

Result: Out of 312 eBL patients, 233(74.7%) had helminthiasis. Soil transmitted helminths were predominant. Compared to their counterparts without helminthiasis, eBL patients with helminthiasis had higher mean eosinophil count (0.48 vs. 0.3x10⁹/l, p=0.01), higher mean platelet count (405 vs. 236x10⁹/l, p=0.007), lower mean corpuscular volume (77.2 vs. 83.3fl, p=0.02) and higher prevalence of anaemia (65.2% vs. 13.9%, p=0.008). Patients with helminthiasis have high relative risk of anaemia (RR=3.4, CI_95%: 2.3-4.5, p=0.006).

Conclusion: Prevalence of helminthiasis in eBL patients is high and strongly associated with microcytic anaemia. Helminthiasis and anaemia are undesirable in eBL patients because cancer chemotherapy would potentially depress marrow and immunity, disseminate helminthiasis, aggravate anaemia and increase risk of transfusion. Hence, there is need for mandatory pre-chemotherapy stool screening for helminthiasis among eBL patients. Infected patients should be de-wormed before commencing chemotherapy, while nutritional and iron supplementation should be offered to anaemic patients.

Keywords: Gastrointestinal Parasites, Prevalence, Malignancy, Iron Deficiency, Anaemia