Open Access Original Research Article

Aplastic Anaemia: Experience with Management in a Resource Limited Setting

I. O. George, G. K. Eke, C. Okechukwu

Asian Hematology Research Journal, Page 1-6

Background: Aplastic anaemia is syndrome of bone marrow failure characterized by peripheral pancytopenia and loss of haemopoietic stem cells in the bone marrow. It is a relatively rare disease with high risk of death if untreated.

Objective: To evaluate the incidence, management and outcome of aplastic anaemia in children, over a four-year period, at the University of Port Harcourt Teaching Hospital(UPTH), Nigeria.

Subjects and Methods: This was a retrospective study of case notes of all children with anaemia and bone marrow aspiration reports suggestive of aplastic anaemia in the Haematology and Oncology Units of the Department of Paediatrics, UPTH, from 1st January 2015 to 31stDecember 2018.Data retrieved included bio data, clinical and laboratory profile, and outcome. Data entry and analysis were done using the Statistical Package for Social Sciences (SPSS) version 22. Data analysis were done using descriptive statistics (proportions and frequencies) and presented in prose and frequency tables. Mean and standard deviations of quantitative data were obtained.

Results: A total of six children were treated for a plastic anaemia during the period under review, giving an annual incidence of 0.0049 cases per year. Their ages ranged from 3 to 11 years (mean 8.2±3.7), with a male to female ratio of 2:1.At presentation, they had a mean (±SD) packed cell volume of 15± 3.2%, white cell count of 2.72± 0.76x 109/L, Absolute neutrophil count (ANC) of 0.25± 0.17 x 109/L, and platelets count of 17.33± 21.36 x 109/L. They all (100%) had severe aplastic anaemia at diagnosis. Among others, they received transfusion support with unbanked fresh whole blood, platelet concentrates, antibiotics, antifungal and antiviral, oral cyclosporine and intravenous methyl-prednisolone. They were all blood transfusion dependent. The mean survival from diagnosis was 7.3± 3.08 months.

None of the patients benefited from bone marrow transplantation and anti-thymocyte immunoglobulin. Mortality rate was 83.3% and major cause of death was sepsis with thrombocytopaenic bleeding.

Conclusion: Aplastic anaemia is rare with short survival rate. There is need for the Federal Government to ensure that bone marrow/stem cell transplantation centres are available and accessible across the country, and to make drugs such as cyclosporine and anti-thymocyte immunoglobulin affordable to ameliorate the condition.

Open Access Original Research Article

When to Transfuse? Identification of Transfusion Triggers in Anaemic Patients

Humaira Rehman, Madeeha Rehan, Sehar Khaliq

Asian Hematology Research Journal, Page 7-10

Aims/ Objectives: To identify the transfusion triggers in hospitalized patients for judicial use of blood products.

Study Design: Cross-sectional study.

Place and Duration of Study: Department of Haematology, Ali Medical Centre Islamabad, The duration of the study was from November 2018 to June 2019.

Methodology: In this study total number of transfusion events and the Hb transfusion triggers were analyzed for 265 patients. The threshold for transfusion was according to patient's clinical condition, the indication for admission and generally varied according to the situation and discretion of physician.

Results: Total 265 admitted patients were included in the study. The threshold for transfusion was 8.6 ± 1.7.

Conclusion: Liberal transfusion regimen can be safely used for surgical patients, severe hypoxic patients and patients with medical emergencies. However patients admitted with medical ailments that are otherwise stable should be given transfusion following restrictive transfusion regimen.

Open Access Original Research Article

Assessment of Some Haemo-rheological Parameters in Descent of Rumuche, Emohua, Rivers State, Nigeria with Rheumatoid Arthritis Disease

Serekara Gideon Christian, Ransome Baribefii Jacob, Mercy Eberechi Onu

Asian Hematology Research Journal, Page 11-17

Aims: This study assessed some haemo-rheological parameters on individuals with Rheumatoid Arthritis disease.

Study Design: A cross sectional, case-control field based design was employed with a total of eighty-six subjects consisting of thirty-one males and fifty-five females aged between 20- 80 years. Thirty-nine positive subjects for rheumatoid arthritis served as test while forty-seven negative subjects were used as control.

Methodology: Samples obtained were screened using latex agglutination method for the presence of rheumatoid factor, fibrinogen estimation was done using ELISA method, packed cell volume was determined using microhaeamatocrit method, erythrocyte sedimentation rate was determined using Westergren method and haemoglobin concentration was determined using cyanmethaemoglobin method. Data obtained were analyzed using Graph-pad prism 8.2 version.

Results: Result showed that 45.3% of the studied population were positive for rheumatoid arthritis (females: 31.4%; males: 13.9%). Gender based percentage in relation to positivity for rheumatoid arthritis showed that females (49.0%) were more affected than males (38.7%). Between those without rheumatoid arthritis (control) and those with rheumatoid arthritis (test), there was statistically significant increase in mean values of erythrocyte sedimentation rate in test group when compared to the control group (p < 0.0001); there was no statistical significant difference (p > 0.05) in other parameters. Gender based comparison of studied parameters based on positivity and negativity of rheumatoid arthritis showed a statistically significant increase in erythrocyte sedimentation rate: 36.67 ± 14.87 mm/hr versus 10.79 ± 11.00 mm/hr(p < 0.0001) in test group for males while packed cell volume, haemoglobin and fibrinogen showed no statistically significant difference (p > 0.05). In females, there was statistical significant increase in packed cell volume: 36.56 ± 3.896% versus 33.96 ± 4.501% (p < 0.05) and erythrocyte sedimentation rate: 50.07 ± 28.73 mm/hr versus 25.43 ± 21.77 mm/h (p = 0.0007) in rheumatoid positive females; haemoglobin and fibrinogen concentration showed no statistically difference (p > 0.05).

Conclusion: The percentage positivity for rheumatoid arthritis in the studied subjects was 45.3% with females affected more than males. No statistical significant difference was observed in fibrinogen and haemoglobin concentrations based on the presence of the disease and in-gender comparison. Rheumatoid arthritis is significantly associated with increased erythrocyte sedimentation rate in both male and female with attendant increased packed cell volume in females. This confirms the high rate of inflammation at the joint (synovium) around the microvasculature in patients with rheumatoid arthritis. The arthritis in this study is non-anaemic with respect to mean values of packed cell volume.

Open Access Original Research Article

Cost and Financial Challenges of Accessing Bone Marrow Transplantation: Opinion Survey in a Nigerian Tertiary Institution

Nwagu Marcellinus Uchechukwu, Adeyemi Oluwafemi, Nwaopara O. Anthony

Asian Hematology Research Journal, Page 18-26

Background: Bone Marrow Transplantation is a procedure that involves infusion of bone marrow cells to a recipient to treat bone marrow diseases like leukemia, sickle cell disease and autoimmune diseases. This medical intervention was first done in the early sixties and has since become popular in many countries. However, same cannot be said of African countries especially resource poor nations like Nigeria due to the expensive nature of the procedure. This study is aimed at seeking the opinion of Nigerians in a university community concerning the cost of Bone Marrow Transplantation and how to subsidize the cost and make the treatment accessible for Nigerians.

Materials and Methods: A questionnaire was used to collect information from participants at Edo University Iyamho, Edo State, Nigeria. Data was analyzed using SPSS version 23.

Results: A total of 196 respondents were interviewed out of which 85.2% said the Bone Marrow Transplantation is very expensive and same percentage of respondents said government’s intervention would reduce the cost.  One hundred and sixty-five (84.2%) agreed that the role of National Health Insurance Scheme will also reduce the cost.  Corruption was identified by 86.3% of participants as the major impediment towards subsidizing the cost of the procedure.

Conclusion/Recommendation: We conclude that the cost of Bone Marrow Transplantation is very expensive to Nigerians and government need to play vital role towards subsidizing the cost. Activating the National Health Insurance Scheme and tackling corruption are the main ways the cost would be subsidized.

Open Access Original Research Article

Relationship between HAS-BLED Score & Major Bleeding Events in Patients with Non-valvular Atrial Fibrillation on Warfarin: A Study at a Tertiary Care Teaching Hospital

Vishwa Lokuhettige, Prabath Chathuranga, Chandima Kulathilake, Nishadya Ranasinghe, Sampatha Goonewardena, Vindya Kumarapeli

Asian Hematology Research Journal, Page 27-34

Background: Prevention of stroke and thrombo-embolism in patients with atrial fibrillation(AF) using oral vitamin K antagonists is closely related to risk of bleeding. The HAS-BLED score has been evaluated as a predictor of major bleeding risk in various populations. The present study was conducted to evaluate the usefulness of the HAS-BLED score for predicting 1-year major bleeding risk in a cohort of Sri Lankan patients with non valvular atrial fibrillation on warfarin.

Materials and Methods: This was a retrospective cohort study conducted at anticoagulation outpatient clinics of a tertiary care teaching hospital, which included ninety one patients with non valvular atrial fibrillation on warfarin for at least 18 months. The relevant data were collected using an interviewer administered questionnaire and medical records of the patient. HAS-BLED score was calculated 6 months after the initial diagnosis and start of warfarin, using the retrospective information. The occurrence of major bleeding events during the period of following 01year was documented. The results were analyzed by obtaining a p value through Fisher exact test and using logistic regression analysis to assess the independent risk factors.

Results: Out of 91 patients, 47.25% (43/91) were males and 52.74% (48/91) were females. The median HAS-BLED score was 2. In this cohort, 06(6.6%) were in a low risk, 59(64.8%) were in an intermediate risk and 26(28.6%) were in a high risk of bleeding according to HAS-BLED score. There were 2 major bleeding events in the one year period with one each occurring in intermediate and high risk groups. But, the association was not statistically significant(Fisher exact test is 1.000, P=1.000). Logistic regression analysis did not show any significance of individual components of the score as independent risk factors for bleeding.

Conclusion: The data of our study showed a limited value of HAS-BLED score, as it had no statistically significant relationship with the major bleeding events in patients in our cohort. However, further studies using greater samples are recommended to draw further conclusions in our population.