Hematinic Research Articles

Maternal predictors of blood transfusion among neonates in the Neonatal Intensive Care Unit of Ahmadu Bello University Teaching Hospital Zaria, Nigeria

Background: Maternal health and healthcare accessibility are important determinants of neonatal survival. Pregnancy-related complications may lead to maternal anemia and, maternal micronutrient deficiency, conditions which could result in neonatal anemia necessitating transfusion. Objectives: To determine maternal predictors of neonatal blood transfusion. Methods: We conducted a case–control study on mother–infant pairs of cases and controls. A semi-structured questionnaire was used to collect information. Logistic regression was used on maternal predictors, and the level of significance was set at ≤0.05. Results: The overall mean (±standard deviation) age of mothers in both case and control groups was 21.79 ± 10.71 years, respectively. The likelihood of neonatal transfusion was increased by parity of ≥5 [odds ratio (OR): 3.1, 95% confidence interval (CI) = 1.26–7.39], while age of ≥18 years at first marriage, attainment of at least secondary school, four antenatal care (ANC) visits before delivery, birth interval of ≥2 years, and hematinics use during pregnancy were associated with reduced neonatal blood transfusion (OR: 0.36, 95% CI = 0.14–0.96), (OR: 0.66, 95% CI = 0.32–1.37), (OR: 0.70, 95% CI = 0.25–1.99), (OR: 0.55, 95% CI = 0.19–1.62), and (OR: 0.63, 95% CI = 0.17–2.36), respectively. Conclusion: We found that high parity, teenage mothers, inadequate ANC visits, short birth interval, and hematinics noncompliance during pregnancy were all associated with increased need of blood transfusion among neonates.

Resolution of blood group discrepancy and transfusion support to a nontransfusion-dependent thalassemia patient with anti-C and anti-N alloantibodies

Nontransfusion-dependent thalassemia (NTDT) patients generally do not require regular blood transfusion, but may be transfused before surgery. Blood group discrepancy exists when forward grouping and reverse grouping do not match. Pretransfusion testing includes ABO/Rh typing, antibody screening, and cross-matching. Forward grouping and reverse grouping were done using monoclonal anti-A, anti-B, and anti-D (Tulip Diagnostics, Goa, India) and in-house prepared 5% A, B, and O cell by conventional tube test method, respectively. Antibody screening and identification were done using 3-cell panel and 11-cell panel (Ortho Clinical Diagnostics, USA), respectively. In our case, we found a discrepancy in reverse grouping and incompatibility due to anti-c and anti-N alloantibodies. Three units of O positive, c and N antigen negative blood units were transfused to this patient. The patient was also managed by hematinics, antibiotic, and bed rest. Antiglobulin cross-matching must be done in all types of compatibility testing of RBC units. Rh and K phenotype-matched PRBC reduced the chances of alloimmunization. Proper coordination between the physician and specialist in transfusion medicine is required in case of alloantibody formation.

A study of prescription pattern in the drug therapy of chronic kidney disease

Objectives: a) To analyze the pattern of drug prescription for chronic kidney disease and its co-morbid conditions, if exist. b) To study the rationality of drug therapy.Methodology: Over a period of 1 year, the discharge-summary records of 188 patients with CKD, admitted to nephrology wards of Justice K. S. Hegde Charitable Hospital, Mangaluru, were scrutinized and the data collected in a specially designed proforma. Descriptive analysis of the data was done.Results: Of the total 188 patients, 101(53.7%) were males and 87 (46.3%) females. Highest numbers of patients were in the age group of 58-67 years (29.3%). Hypertension was the most common co-morbidity (82%) observed, followed by anaemia (54.8%) and type 2 diabetes (43%). A total of 1436 drugs were prescribed to 188 CKD patients. Each patient received an average of 7.6 drugs. Polypharmacy was seen in all patients. Drugs acting on the cardiovascular system constituted the bulk of the prescriptions (31%) followed by nutritional Supplements (15.3%), haematinics (10.7%) and the drugs acting on gastrointestinal system (10.3%). Other important categories of drugs prescribed included antimicrobials (5.8%), antiplatelets and hypolipidaemic agents (5%), antidiabetic drugs (4.7%) and phosphate binders (4%).Conclusion: This study shows that the management of chronic kidney disease in the nephrology department of Justice K. S. Hegde Charitable Hospital, is in congruity with the rational utilization of medicines which is based on the clinical knowledge, expertise and the guidelines accessible in the field of nephrology practice.

Evaluation of factors influencing precision in the analysis of samples taken from blood spots on filter paper.

Dried blood spots (DBS) on filter paper have potential as a collection method in screening for haematinic deficiencies. Factors influencing the volumetric precision of uniform 'centre' punches (6.35 mm diameter) removed from dried blood spots have been evaluated. The volume of blood in each DBS punch (n = 234) was greatly influenced by both sample haematocrit (r = 0.63) and haemoglobin concentration (r = 0.63). The volume in identical punches (n = 57) also differed significantly when measured independently using either 125I human serum albumin or haemoglobin relative to the original blood sample. DBS punch volumes should be predetermined for individual batches of filter paper using the specific analyte of interest.

Protective response to Sulfadoxine-pyrimethamine during intermittent presumptive treatment of malaria in pregnant women in Sagamu, Nigeria

We study the protective response to sulfadoxine-pyrimethamine (SP) during intermittent presumptive treatment (IPT) of malaria in pregnant women. Pregnant women attending the antenatal service of the primary health centre in Sagamu, Nigeria were enrolled into the study. In addition to the usual treatment with haematinics, participants were randomized into two treatments; SP treated (SPTG) and no SP treated (NSPTG) groups. Information on methods of protection against malaria infection and previous use of IPT was obtained from the participants. All participants were followed up for eight weeks and monitored for peripheral parasitaemia using microscopy. Of the 242 pregnant women enrolled 165(68.2%) pregnant women used at least one form of anti-vector measure; insecticide spray was most common. 186 (76.9%) of these participant had no knowledge of the IPT. Parasite Suppression and malaria pigment-clusters clearance were similar in the two groups. Although knowledge of IPT among pregnant women in the area remains low, use of high anti-vectors in pregnant women population may complement, but blur, the effect of IPT on malaria parasite. Key words: Intermittent presumptive treatment, malaria, pregnant women, sulfadoxine-pyrimethamine, insecticide.

Influence of Antenatal Care on the Haematocrit Value of Pregnant Nigerian Igbo Women

Context: Antenatal care is generally believed to influence the outcome of any pregnancy. Haematocrit values are important in the assessment of anaemia in pregnancy. A good antenatal care is expected to be associated with good haematocrit values, prevent anaemia in pregnancy, and result in an overall good pregnancy outcome. Objective: To determine the prevalence of anaemia in pregnancy and the effect of antenatal care, especially iron and folate supplementation on the blood build-up in pregnancy. Study Design, Setting and Subjects: Single arm clinical study of 186 consecutive booked pregnant women with singleton fetuses attending antenatal clinic at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. The biosocial characteristics (age, parity and social class); gestational age at booking; and compliance with antenatal medication were obtained and analysed. Results: At booking, 66(35.5%) of the women were anaemic, with haematocrit value being less than 30%. At the onset of labour, the number dropped to 32(17.2%) [p Conclusion: The results suggests that antenatal iron and folate supplementation and antenatal care in general promote blood build-up in the pregnant women, thereby reducing the incidence of anaemia before parturition. Key Words: Antenatal Care, Haematinics, Iron, Folate, Anaemia. [Trop J Obstet Gynaecol, 2002, 19: 68-70]

Pernicious anaemia in Africans.

Summary Ten cases of pernicious anaemia seen over a 15-year period (1973–1988) in a Lagos hospital are presented. Their ages ranged from 34 to 67 with a mean of 53.6 years. Females outnumbered males 6 to 4. Complications seen include gastric carcinoma, myelopathy, peripheral neuropathy, skin hyperpigmentation, hair depigmentation and diarrhoea. Reluctance to consider the diagnosis owing to firmly held notions of its rarity and a penchant for empirically treating chronic anaemias with all available haematinics and blood transfusion are probably contributory to its underdiagnosis. The fact that seven of the patients presented were seen in the last three years and three of them in the last one year raises the possibility of an increasing incidence of pernicious anaemia in Africans. The disease may be much less rare in Africans than once believed, and medical education should emphasize its existence and advocate greater care in the management of chronic anaemias.