Gestational thrombocytopenia among pregnant Ghanaian women

Background: Thrombocytopenia is a common problem during pregnancy that is not frequently detected and as a result is often inappropriately managed. The obvious concern with thrombocytopenia during pregnancy is the risk of significant bleeding at the time of delivery. This study was designed to determine the prevalence of gestational thrombocytopenia in pregnant women reporting for ante-natal care at a Ghanaian primary health care centre. Methods: Platelet count was evaluated in 300 blood samples from pregnant women and 100 non pregnant female blood donors. The platelet counts were performed using Sysmex KX-21N automated hematology analyzer. The study design was cross sectional. Proportions were analyzed for statistical significance with the Chi square, Odds ratio was also calculated Results: The prevalence of thrombocytopenia in pregnant women in this study was 15.3% compared with 4% in controls. This was statistically significant with a P value of 0.003. Odds ratio was 4.31 (95% CI : 1.52 - 12.04). Most cases of thrombocytopenia were mild (76%), only 4% of the women with thrombocytopenia had severe thrombocytopenia. Conclusion: The frequency of thrombocytopenia in this study was higher than that reported from more developed parts of the world. This may be due to undetected malaria infection in our patients. Pregnant women should be routinely screened for thrombocytopenia. Those found to be thrombocytopenic should have both thick and thin blood films done to exclude the presence of malaria parasites.Pan African Medical Journal 2012; 12:3

Evaluation of request forms submitted to the haematology laboratory in a Ghanaian tertiary hospital

Background: Laboratory request forms provide information about the laboratory test being requested for. They carry demographic data and other information such as location of patient, laboratory number, doctor’s name, signature of the doctor, telephone number of the requesting doctor. Omission of information on the forms may lead to laboratory errors. The aim of this study was to evaluate the level of completion of laboratory request forms at the haematology department of a Ghanaian tertiary hospital. Methods: Three thousand request forms submitted to the haematology department between January and April 2010 were retrieved and studied. The information provided on each request form was recorded in a spread sheet and analyzed. Results: The patient’s age and sex were missing in 25.6% and 32.7% of the forms respectively. About half of the request forms did not have the patient’s location. No clinical detail was provided on 22.7% of the forms. Doctors were more likely to sign their request forms and provide a name but they all failed to provide an address or a contact telephone number. Conclusion: This study demonstrates that, the standard of completion of request forms was poor. Essential information required on the forms was often missing. This can lead to limited advice given by laboratory physicians and may increase the potential for errors. Conversely, provision of all the information needed on the forms will aid laboratory diagnosis and enhance patient care and save time and resources. There should be closer interaction between clinicians and laboratory personnel to improve quality of services.Key words: Evaluation, request forms, haematology Unit, Ghana, Tertiary Hospita

Plasma levels of some coagulation parameters in Steady State HbSC disease patients

Introduction: sickle cell disease is a collection of autosomal recessive genetic disorders. It includes homozygous HbSS and double heterozygote combinations such as HbSC. Central and West Africa bears a significant burden of HbSC disease. Methods: prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen concentration (FC) and platelet count (PC) were determined in 41HbSC and HbSS patients in steady state along with 40 apparently healthy HbAA controls. One way ANOVA test was used to compare means; p values< 0.05 were considered statistically significant. Results: there was no significant difference in mean PT for the study groups (p = 0.192). Mean PC was highest in HbSS patients: 445.7 +/- 128.3 X 10 9/ L compared to HbSC: 330.0 +/- 97.7 X 10 9/ L andHbAA:245 +/- 77.7 X 10 9/ L (p= 0.000).Mean APTT was 28.1 +/- 3.8 seconds in controls,24.1+/- 66 seconds in HbSS patients and 21.8 +/- 3.8 seconds in HbSC patients (p = 0.000). Mean FC in HbSS was 1.6 +/- 0.7 g/L , 3.2 +/- 0.6 g/L in HbSC and 2.9 +/- 0.4 g/L in HbAA (p =0.000). Conclusion: a significant difference exists in PC, APTT and FC in HbSC patients compared to HbSS patients and HbAA controls. Elevated FC and shortened APTT may play a role in complications more characteristic of HbSC such as retinopathy and osteonecrosis. These suggestHbSC is not merely a milder form of HbSS; both diseases should be seen as different entities with regards to approaches for management

Awareness of venous thromboembolism among patients with cancer: Preliminary findings from a global initiative for World Thrombosis Day

BACKGROUND Cancer-associated venous thromboembolism (CAT) has detrimental impact on patients' clinical outcomes and quality of life. Data on CAT education, communication, and awareness among the general cancer population are scanty. METHODS We present the preliminary results of an ongoing patient-centered survey including 27 items covering major spheres of CAT. The survey, available in 14 languages, was promoted and disseminated online through social networks, email newsletters, websites, and media. RESULTS As of September 20, 2022, 749 participants from 27 countries completed the survey. Overall, 61.8% (n = 460) of responders were not aware of their risk of CAT. Among those who received information on CAT, 26.2% (n = 56) were informed only at the time of CAT diagnosis. Over two thirds (69.1%, n = 501) of participants received no education on signs and symptoms of venous thromboembolism (VTE); among those who were educated about the possible clinical manifestations, 58.9% (n = 119) were given instructions to seek consultation in case of VTE suspicion. Two hundred twenty-four respondents (30.9%) had a chance to discuss the potential use of primary thromboprophylaxis with health-care providers. Just over half (58.7%, n = 309) were unaware of the risks of bleeding associated with anticoagulation, despite being involved in anticoagulant-related discussions or exposed to anticoagulants. Most responders (85%, n = 612) valued receiving CAT education as highly relevant; however, 51.7% (n = 375) expressed concerns about insufficient time spent and clarity of education received. CONCLUSIONS This ongoing survey involving cancer patients with diverse ethnic, cultural, and geographical backgrounds highlights important patient knowledge gaps. These findings warrant urgent interventions to improve education and awareness, and reduce CAT burden

Multiple choice questiones as a tool for assessment in medical education

Background Assessment is an ongoing process aimed at understanding and improving student learning. The goal of assessment in medical education is usually to support learning and ⁄ or to establish the competence of individual doctors; it helps the person being assessed identify and respond to his or her own learning needs. Assessments could be formative or summative; should be able to discriminate between good and poor candidates and have high fidelity. MCQ is one of the objective assessment methods. Methods For this review, a PuBMed online search was carried out for English language publications between 1990 and 2008 using the following keywords or their combinations: Assessment, multiple choice questions, medical education, and academic medicine. To identify additional publications, bibliographies of identified articles, relevant library journals and other publications were searched manually. Articles identified were checked for relevance. Results MCQs are considered an efficient and reliable testing tool and could yield valid information of clinical reasoning skills. Though some investigators claim they may not be ideal for the evaluation of higher-order thinking skills. Advantages and disadvantages of MCQs in medical education are discussed along with possible alternatives. Conclusion Though poorly written MCQs can encourage students to learn isolated facts by memorizing them, a well-constructed peer-reviewed multiple-choice question meets many of the educational requirements for an assessment method. The use of automation for grading and low costs makes it a viable assessment tool for use in a resource poor environment. To further extend the use of MCQs, teachers and item writers should be trained and the questions they write must be reviewed both before and after administration. Keywords: Assessment, medical education, multiple choice question

A Ghana–UK haematology “heparin” partnership

Several recent articles in the British Journal of Haematology have highlighted the crucial role that anticoagulation plays in the management of hospitalized patients with COVID‐19 infection. For the last few years our haematology unit in Liverpool has been sending low‐molecular‐weight heparin (LMWH) to colleagues in Ghana’s largest teaching hospital in Accra, to supplement their supplies. Other UK colleagues have expressed an interest in setting up similar schemes so we thought it would be useful to describe the process we have developed from the perspectives of our coordinators in Liverpool and Accra. We describe some of the challenges and, in particular, the impact of the COVID‐19 pandemic on both partners in the collaboration

Presence of lupus anticoagulant in an asymptomatic Nigerian

Background:The lupus anticoagulant (LA) is one of the antiphospholipid antibodies (aPL), which prolong phospholipid- dependent coagulation tests by interfering with coagulation reactions that depend on protein - phospholipid complexes in vitro. Method:A 25 year old \'healthy\' male Nigerian was screened for the presence of any coagulation abnormality using the KCT, PT and platelet count; after volunteering for his plasma to be used in the preparation of normal pooled plasma in a study. Results: He was discovered to have a prolonged KCT, PT and normal platelet count. Based on the prolonged KCT his plasma was subjected to mixing studies with various concentration of normal pooled plasma; the KCT index was calculated and a curve was plotted. His KCT index was 1.6 and the curve convex in the left axis suggesting the presence of LA. His past medical history and physical examination were not remarkable.Three months after the initial study, a repeat KCT index was 1.4 and the subject asymptomatic. Conclusion: From literature review this is the first report of LA in an asymptomatic adult Nigerian; the importance of this finding is discussed. African Health Sciences Vol. 7 (3) 2007: pp. 182-18

Enhanced Hypercoagulability in Sickle Cell Anaemia Patients with Chronic Leg Ulcers

Sickle Cell Anaemia (SCA) is associated with a hypercoagulable state resulting in a predisposition to venous thromboembolism. With improvements in the quality of care, more patients with SCA survive into adulthood with an associated increase in the frequency of end-organ damage and chronic complications such as chronic leg ulcers (CLUs). These ulcers rarely occur in the first decade of life and are recurrent, painful, and slow-to-heal. This study tested the hypothesis that coagulation is enhanced in SCA patients with CLU. 145 participants (50 SCA with CLU, 50 SCA without CLU, and 45 with haemoglobin AA) were assessed to determine their coagulation profile using selected tests of coagulation. The SCA with the CLU group had the lowest mean haemoglobin (Hb) concentration. SCA patients with and without CLUs had elevated mean platelet counts, shorter mean aPTT, and marginally prolonged mean PT  compared to HbAA patients. SCA with CLUs patients had a significantly shortened aPTT than those without CLUs (p = 0.035) and HbAA (p = 0.009). There were significant differences in the mean PT between SCA with CLUs patients and HbAA (p = 0.017); SCA without CLU and HbAA (p = 0.014). SCA with and without CLUs patients had higher mean D-dimer levels compared to HbAA. There was a negative correlation between Hb concentration and duration of CLU (r = -0.331, p = 0.021). In conclusion, our study demonstrates a heightened hypercoagulability in SCA patients with CLUs. We did not test for platelet activation, and it is not clear what role, if any, the enhanced hypercoagulability plays in the pathogenesis of CLUs in SCA. It will be useful to ascertain if antiplatelet agents or/and anticoagulants quicken the healing of CLUs in SCA patients