Lupus Anticoagulant in Nigerian Children With Homozygous Sickle Cell Disease

Background: Lupus anticoagulant (LA) is an antiphospholipid antibody (APLA), which recognise combinations of phospholipids or phospholipid -binding proteins or both and interfere with coagulation reactions dependent on protein phospholipid complexes in vitro. LA has paradoxically been associated with thrombosis and a myriad of clinical conditions such as cerebrovascular accidents (CVA). APLA have been described in adult homozygous sickle cell disease (SCD) patients and adults with \u3b2- thalassaemia. Our objective was to determine the presence or otherwise of LA in children with homozygous SCD and to see if they were more prone to developing LA compared to normal HbAA controls. Method: A total of 57 children with homozygous SCD between the ages 1-15 years were prospectively screened for the presence of LA using the kaolin clotting time (KCT), while 52 healthy HbAA children served as controls. KCT was performed in duplicates on all 109 subjects. Kaolin clotting time ratio was calculated to determine the presence of LA. A ratio greater than or equal to 1.2 was taken to signify the presence of LA. Results: One (1.8%) child with homozygous SCD had prolonged KCT, and this was not corrected by normal plasma, the KCT ratio was greater than 1.2, signifying the presence of LA. None of the control subjects had LA (p >0.05). Conclusion: One (1.8%) child in this study had LA; this value was not statistically significant when compared with HbAA controls. In spite of the fact that secondary LA is more common in females, the only patient with LA in our study was male and had no prior history of CVA or thrombosis.Fond : L'anticoagulant de lupus (AL) est un anticorps antiphospholipide (AAPL), qui identifie les combinaisons des phospholipides ou du phospholipide prot\ue9ines liantes ou toutes les deux et qui interf\ue8re avec des r\ue9actions de coagulation qui d\ue9pendent sur les complexes phospholipide de prot\ue9ine en vitro. L'AL a \ue9t\ue9 paradoxalement associ\ue9e \ue0 la thrombose et \ue0 une myriade de conditions cliniques tels que les accidents c\ue9r\ue9brovasculaires (ACV). AAPL ont \ue9t\ue9 d\ue9crits dans des malades adultes de dr\ue9panocytose homozygote et adultes de dr\ue9panocytose homozygote et des adultes avec la thalass\ue9mie de b. Notre objectif \ue9tait de d\ue9terminer la pr\ue9sence ou autrement d'AL chez les enfants avec dr\ue9panocytose homozygote et pour voir s'ils \ue9taient plus en pronation au d\ue9veloppement d'AL en comparaison avec les commandes normales de HbAA. M\ue9thode : Un total de 57 enfants avec dr\ue9panocytose homozygote entre les \ue2ges 1-15 ans \ue9taient prospectivement examin\ue9s pour la pr\ue9sence de l'Al en utilisant le temps de coagulation de kaolin (TCK), tandis que 52 enfants en bonne sant\ue9 de HbAA servaient de commandes. Le TCK a \ue9t\ue9 ex\ue9cut\ue9 en reproductions sur chacun des 109 sujets. La proportion de temps de coagulation de kaolin a \ue9t\ue9 calcul\ue9e pour d\ue9terminer la pr\ue9sence de l'AL. Une proportion sup\ue9rieure ou \ue9gale \ue0 1,2 a \ue9t\ue9 prise pour signifier la pr\ue9sence de l' AL. Les r\ue9sultats : Un (1,8 %) enfant avec dr\ue9panocytose homozogote avait prolong\ue9 le TCK, et ceci n'a pas \ue9t\ue9 corrig\ue9 par le plasma normal, la proportion de TCK \ue9tait plus grande que 1,2, signifiant la pr\ue9sence de l'AL. Aucun des sujets de contr\uf4le n'avait AL (p>0,05). Conclusion : Un (1,8%) enfant dans cette \ue9tude a eu l'AL ; cette valeur n'\ue9tait pas statistiquement significative en comparaison avec des commandes de HbAA. Malgr\ue9 le fait que l'AL secondaire est plus commune dans les femelles, le seul malade avec l'AL dans notre \ue9tude \ue9tait un m\ue2le et n'a eu aucune histoire ant\ue9rieure de ACV ou de thrombose

Sickle Cell Disease (SCD): when is blood transfusion indicated?

This is a review of the literature as regards the indications for blood transfusion in SCD, complications associated with these transfusions and how to reduce these complications in SCD.The objectives of blood transfusion in SCD include the correction of anaemia and the reduction of the circulating Haemoglobin S level to less than 30%.Thus the indications include prophylaxis for the prevention of stroke especially in childhood.The use of exchange blood transfusion is highly advocated inorder to reduce the level of Haemoglobin S to less than 30%. Conditions such as acute chest syndrome and acute exacerbation of severe anaemia in SCD with hepatic and splenic sequestration also benefit from simple transfusion. Elective surgical conditions; aplastic crisis due to parvovirus B19, in which the packed cell volume is marked reduced; and pregnant multigravida all benefit from simple transfusion to correct the anaemia, and restore the value of the steady state packed cell volume.Complications that may occur due to blood transfusion include alloimmunization to minor red cell antigens ( C, E and kell) and iron overload.. Inorder to minimize complications the rational use of blood transfusion is advocated, in addition to having appropriate and extensive crossmatching techniques to detect minor antigens.Also advocated is the need to prevent iron overload in SCD patients, if there is an increasing frequency of transfusion.Keywords: Sickle Cell Disease, Bloodtransfusions, Indication

HEPATITIS B SURFACE ANTIGEN AND ANTIBODY TO HEPATITIS C VIRUS AMONG ACCIDENT AND EMERGENCY PATIENTS

Objective: To determine the sero-prevalence and epidemiology of antibody to hepatitis Cvirus (anti-HCV) and hepatitis B surface antigen in accident and emergency patients.Design: A descriptive study was performed on 150 accident and emergency patients. Serawas screened for anti-HCV and HbsAg, using enzyme linked immunosorbent assay. Personalinformation and risk factors involved were obtained using a questionnaire.Setting: Haematology laboratory of the University of Benin Teaching Hospital, Nigeria.Subjects: One hundred and fifty adults consisting of 122 males and 28 females who wereabove the age of 21 years. Patients were randomly selected from all adults including dentalpatients attending the emergency department for both surgical, dental and medicalemergencies. The age range was between 21 - 58 years. In order to ascertain the epidemiologyof both viruses a questionnaire was used detailing the possible risk factors for transmission.These included history of previous blood transfusion; history of life time occurrence ofmultiple sexually transmitted diseases; history of heterosexual exposure to partners at risk(for example prostitutes); history involving the use of unsterilised blades; presence ofscarification marks and tattooing; low socio-economic status (low annual income orunemployed): history of intravenous drug use and heterosexual activity. Anti-HCV andHBsAg were both assayed using different assay kits, based on the enzyme linked immunoabsorbent assay (ELISA) tests from different manufacturers.Results: The sero-prevalence of anti-HCV was 14% and 29.3% for HBsAg. Anti-HCVpositivity was significantly associated with a past history of blood transfusion and heterosexualexposure to partners at risk. The study also revealed a significant association between HBsAgpositivity and all the risk factors.Conclusion: The high prevalence rate for anti-HCV and HbsAg in accident and emergencypatients increases the likelihood of further spread from patients to health care providersespecially if adequate precautions are not observed

High prevalence of hepatitis B virus among female sex workers in Nigeria Alta prevalência de hepatite pelo vírus B entre trabalhadoras do sexo feminino na Nigéria

Hepatitis B virus (HBV) infection is endemic in Nigeria and constitutes a public health menace. The prevalence of HBV infection in many professional groups has been described in Nigeria. However, literature on HBV infection among female sex workers (FSW) in Nigeria is scanty. FSW in Nigeria are not subjected to a preventive control of HBV infection. This study assesses the extent of spread of HBV among FSW in Nigeria. Seven hundred and twenty (n = 720) FSW (mean age = 26.7 years) were tested for hepatitis B surface antigen (HBsAg) by a double antibody sandwich ELISA method. The overall HBV prevalence among the FSW was 17.1%. FSWs between the ages of 31-35 year (20.5%) and those with 'age-at-first-sex' below 10 years of age (28%) were most affected. This high prevalence of a vaccine preventable disease is unacceptable, therefore, vaccination of this high risk HBV reservoir group should be considered worthwhile.<br>A hepatite pelo vírus B (HBV) é infecção endêmica na Nigéria e constitui problema de saúde pública. A prevalência da infecção HBV em muitos grupos profissionais foi descrito na Nigéria. No entanto, a literatura da infecção HBV entre trabalhadoras do sexo feminino (FSW) na Nigéria é escasso. FSW na Nigéria não são submetidas a um controle preventivo de infecção de HBV. Este estudo avalia a extensão da disseminação de HBV entre FSW na Nigéria. Setecentos e vinte (n = 720) FSW (média de idade = 26,7 anos) foram testadas para antígeno de superfície da hepatite B (HBsAg) pelo método ELISA usando sandwich de duplos anticorpos. A prevalência total de HBV entre o FSW foi 17,1%. FSWs entre as idades de 31-35 anos (20,5%) e abaixo de 10 anos de idade (28%) foram mais afetadas. Esta alta prevalência de doença evitável pela vacinação é inaceitável, portanto, vacinação deste grupo de alto risco de HBV deve ser considerada fundamental