Use Of Hematin Research Articles

Prevalence of Anaemia among Antenatal Clinic Attendees at A Tertiary Hospital in South West, Nigeria

Introduction: Anaemia in pregnancy is a global public health problem causing both maternal and perinatal morbidities and mortalities. Prevalent rates vary from one geopolitical region to the other. Efforts have been made to reduce this condition during pregnancy through the use of haematinics and other interventions. However, despite all the efforts put in place, pregnant women still present with this condition. This study was carried out to find out its prevalence rate and the factors responsible for it. Materials and Methods: It was a cross-sectional institutional based study carried out at the antenatal clinic of the University of Medical Sciences Teaching Hospital Complex, Akure, Ondo State, South West, Nigeria. The study used a systematic sampling to recruit 400 antenatal clinic patients over a period of 16weeks starting from the 16th of August to 16th of December 2022.The women were interviewed with copies of a structured questionnaire administered by trained research doctors who also helped in the collection of the blood samples. About 3mls of venous blood was collected from the antecubital vein using plastic disposable syringes into sample bottles containing ethylene diamine-tetra acetic acid (EDTA) and the bottles labelled accordingly. Packed cell volume and red cell morphology were done for the women at the time of recruitment. Data obtained were analysed using the Statistical Package for Social Sciences (SPSS Version 22). Descriptive statistics were computed for all relevant variables, Chi Square test and Multivariate logistic regression were used to test for association and possible risk factors for anaemia. The level of significance was set at ???? < 0.05. Results: Most of the women were within 30years- 39years (51.2%, 205) with a mean age of 31.61years±5.37years. Most of them were married (97.3%, 389), were Christians (94.5%, 378), were Yorubas (82.8%, 331), were traders (40.3%, 161), had tertiary level of education (68.8%, 275) and lived in the urban areas of Ondo State (89.5%,358). Most had their first menses between the ages of 10 to 15 years (79.2%, 317) with a mean age of 14.24 ± 2.12 years. Majority had inter- pregnancy interval of ≤ 2 years (53.7%, 215). There was no history of bleeding in most of the women (91.5%, 366), many of them were in the third trimester of their pregnancy (64.1%, 257) with a mean gestational age of 28.83 ± 6.91 weeks. The prevalence of anaemia among the study participants was 40.0% (160/400) while 60% (240/400) were not anaemic. Among the participants who were anaemic, 77.5% (124/160) had mild anaemia, 22.5% (36/160) had moderate anaemia while none had severe anaemia. The only risk factors identified to be responsible for anaemia among the women were high parity and being in the third trimester of pregnancy. Conclusion: This study showed that the prevalence of anaemia is still high among our women mostly occurring among women of high parity and in the third trimester of pregnancy. Efforts must be intensified to address this condition through the use of haematinics which can be started pre-conception and adequate counselling on the need to fully recover from the effects of one pregnancy before embarking on another.

PATTERN OF RED CELL MORPHOLOGY AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC IN AKURE, SOUTH WEST, NIGERIA

Background: Anaemia in pregnancy is a global health problem especially due to poor dietary intake. This study was carried out to ascertain the morphological pattern of anaemia among women and the factors associated with it. Method: It was a cross sectional study conducted at the antenatal clinic of the University of Medical Sciences Teaching Hospital Complex in Akure, Ondo State, Nigeria. A total number of 400 pregnant women were recruited by systematic sampling and interviewed with structured questionnaires with their blood samples taken for red cell indices. Data was analysed using SPSS Version 22. Descriptive statistics were done for relevant variables and a Chi square test was used to nd an association between the variables and anaemia. Signicance was set at p<0.05. Results: Most of the women had normocytic hypochromic anaemia 2 2 especially among those with less intake of animal products (X = 69.9, p=0.013) and green vegetables (X = 25.9 , p=0.039). Conclusion: The reported normocytic hypochromic anaemia in this study showed that efforts must be intensied in counselling our women on the intake of iron rich diets which should be complemented by the routine use of haematinics.

Prevalence and risk factors for anaemia among pregnant women attending antenatal clinic at Benue State University Teaching Hospital, North-central Nigeria.

In developing countries such as Nigeria, anaemia in pregnancy is thought to be one of the most common complications of pregnancy accounting for a significant level of maternal morbidity and mortality. The aim of this study was to determine the prevalence of anaemia in pregnancy among women attending the booking Antenatal Clinic (ANC) in Benue State University Teaching Hospital (BSUTH), North-Central, Nigeria. A cross-sectional descriptive study was conducted from May 2019 to January, 2020 on 299 women. A structured interviewer administered questionnaire was used to obtain socio-demographic, clinical, and nutritional information from pregnant women attending the clinic who consented to participate in the study. Haematocrit levels were stratified according to the World Health Organisation's (WHO) classification as follows: <7mg/dL - severe, 7-8.99mg/dL - moderate, 9-10.99mg/dL - mild anaemia and ≧ 11mg/dL - non-anaemic. Data were analysed using SPSS version 25.0. Chi-square test was conducted to determine relationships. Multivariate logistic regression model was used to identify the risk factors for anaemia among pregnant women. P-value <0.05 and odds ratio with a 95% confidence interval were used to assess the association. The mean age of respondents was 29.9, ranging from 18 - 40 years. One hundred and twenty-three (41.1%) women were anaemic (haemoglobin [Hb] < 11.0 g/dL). The majority (95.1%) of these anaemic patients were mildly anaemic, whereas 4.9% were moderately anaemic. There was no case of severe anaemia (Hb < 7.0 g/dL). The prevalence of anaemia was significantly higher in those within the age group of 20-24 years and those with lower levels of education (P < 0.05). The patient's gestational age, number of miscarriages and birth interval had no significant relationship with the haemoglobin concentration among the pregnant women in this study (P > 0.05). However, parity, clinical features such as fever, and practices like use of haematinics and non-consumption of meat, poultry and fish were significantly related to anaemia (P < 0.05). The pregnant women who did not take haematinics were 5.8 times likely to develop anaemia (OR=5.8, 95%CI [2.3, 14.5]) while pregnant women who did not eat meat, poultry or fish were 9 times more likely to become anaemic than pregnant women who ate (OR=9.0, 95%CI [1.0, 79.5]). The prevalence of anaemia in pregnancy is high among women attending booking antenatal clinic at BSUTH, North-Central, Nigeria, and requires specific intervention that address the identified risk factors.

The clinical effect of experimental infection with Trypanosoma congolense on Dutch belted rabbits.

The clinical effect of Trypanosoma congolense infection on Dutch belted (does) rabbits was investigated. Sixteen Dutch belted rabbits weighing between 1.6 and 1.8kg were grouped into two groups of eight each. Animals were accessed for packed cell volume (PCV), total leucocyte count (TLC), rectal temperature (RT), heart rate (HR), and body weight (BW) before infection as well as 18, 25, and 58days post inoculation (PI). The level of parasitaemia was estimated on a weekly basis and was graded by number of parasites/field. There was a significant difference (P < 0.05) in the mean PCV between treatment and control groups of the rabbits on all days PI. The other parameters were not significantly different between uninfected controls and treatment group although the rectal temperature fluctuated. The mean PCV of infected rabbits was 36.0 ± 0.53%, 35.3 ± 0.19%, and 28.0 ± 0.89% at days 18, 25, and 58 PI, while for uninfected, the mean PCV was 40.8 ± 0.11%, 41.8 ± 0.19%, and 41.3 ± 0.08% across the same time periods. Parasitaemia was detected at 6th day PI and remained high to the end of the study. The study suggests that the use of haematinics and anti-pyrexia treatments as part of disease management for rabbits would be useful.

Prevalence, density and predictors of malaria parasitaemia among ill young Nigerian infants.

Introductioninfants in the first six months of life are relatively protected from malaria. Emerging reports from endemic regions however are showing increasing malaria susceptibility in this age group. This study set out to determine the prevalence, parasite density and predictive factors for malaria parasitaemia in ill young infants at the Wesley Guild Hospital (WGH), Ilesa, Nigeria.Methodsill infants aged one to six months were consecutively recruited over an 11-month period in a hospital based cross-sectional study. History of illness, sociodemographic and perinatal history were obtained; clinical examination and results of venous blood for thick and thin film malaria parasite examinations were recorded and analyzed.Resultsthe mean (SD) age of the 350 infants was 3.4 (1.6) months with male: female (M: F) of 1.2: 1. The prevalence of malaria parasitaemia (all plasmodium falciparum) was 19.1% while parasite density ranged from 24.0 to 400,000 parasites/µl, median (IQR) 900 (250-4,588)/µl. Sixteen (4.6%) had heavy malaria parasitaemia (>5000/µl). Low social class (OR=2.457; 95%CI 1.404-4.300; p=0.002), suboptimal antenatal care (OR=2.226; 95%CI 1.096-4.522; p=0.027), low birth weight infants (OR=4.818; 95%CI 2.317-10.018; p=<0.001) and injudicious use of haematinics (OR=3.192; 95%CI1.731-5.886; p=<0.001) were predictors of malaria parasitaemia among the infants.Conclusionone-in-five ill young infants had malaria parasitaemia with heavy parasitaemia in 23.8% of infected infants. Malaria parasitaemia was associated with modifiable factors, high index of suspicion in endemic region and optimal maternal and child care services may assist to reduce the burden of malaria in this age group.

Indications for blood and blood products transfusions among children in a semi-urban tertiary hospital in Nigeria

Background: Anaemia is prevalent among children in our environment, often necessitating blood transfusions. The knowledge of the common indications for blood transfusion and the required preventive measures is likely to reduce the transfusion rates. Objective: To determine the disease conditions requiring blood transfusion in post-neonatal age children at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Methods: The hospital records of all children aged 1 month to 18 years admitted into the post-neonatal ward who received blood transfusions over 18 months (1st July 2015to­31st December 2016) were reviewed. Results: There were 710 paediatric admissions out of which 82 (11.6%) received blood transfusions. Ninety transfusions were carried out amongst 82 children, at a ratio of 1.1 transfusions per child. Severe malaria (28.1%), sickle cell anaemia (19.5%) and septicaemia (18.3) were the most common disease conditions requiring blood transfusions. The leading blood products transfused included packed red cells (64.5%) and whole blood (30.0%). Conclusion: Blood transfusion is frequently indicated in the paediatric population in our setting, largely due to severe malaria and sickle cell anaemia problems. Intensifying efforts on the use of long-lasting insecticide-treated nets and environmental control may reduce the prevalence of severe malaria, while improved nutrition, adequate hydration, regular malaria prophylaxis, prompt treatment of infections and regular use of haematinics may minimize the need for blood transfusions among children with sickle cell anaemia.

Prevalence, Morphological Classification, And Factors Associated With Anemia Among Pregnant Women Accessing Antenatal Clinic At Itojo Hospital, South Western Uganda.

PurposeThe study aimed to determine the prevalence, morphological classification, and risk factors of anemia among pregnant mothers attending antenatal clinic at Itojo hospital, Ntungamo district, southwestern Uganda.Patients and methodsAfter obtaining an informed consent, 5mL of blood was collected from the vein of each participant for complete blood count (CBC) and peripheral film report. The CBC was performed using HumaCount 80 hematology analyzer (HUMAN Gesellschaft für Biochemica und Diagnostica mbH Max-Planck-Ring 21 65,205 Wiesbaden Germany). Peripheral blood smears were made and stained using Wright’s Romanowsky stain and examined under ×1000 magnification for morphological classification of anemia. Structured questionnaires were administered to each participant to collect information on patients’ demography and risk factors of anaemia in pregnancy. The data generated were prepared in EXCEL and later transferred to SPSS version 20 for analysis. Univariate logistic regression and multivariate logistic regression were used to evaluate the association of socio-demographic characteristics of the participants with anemia. A 95% confidence level was used and statistical significance was reached at p<0.05.ResultsOne hundred and sixty-three participants (n=163) were recruited for the study with the median age of 25 years and range of (17 to 40 years). The overall prevalence of anemia was 12 (7.4%), the morphological classification was 1 (8.3%) normocytic normochromic anemia, 6 (50%) microcytic hypochromic anemia, and 5 (41.7%) macrocytic anemia. Spouse occupation (p=0.03), household income (p=0.04), use of insecticide-treated mosquito nets (p=0.001), history of urinary tract infection (p=0.002), use of haematinics (p≤0.001), and history of postpartum hemorrhage (p=0.03) were significantly associated with anemia in pregnancy.ConclusionDespite the reported high prevalence of anemia in pregnancy in other areas within the country, anemia prevalence was low in this study. Routine screening for anemia at all antenatal care clinics countrywide is recommended.

Nutrition knowledge and food consumption practices and barriers in rural Ghana: The case of foods for preventing vitamin A and iron deficiencies

Food-based approaches such as dietary diversification, nutrient retention and biofortification combined with nutrition education can be effective in eliminating micronutrient deficiencies. The objective of this study was to assess the nutrition knowledge and consumption practices as well as barriers to consumption with specific focus on food-based approaches to vitamin A and iron deficiencies prevention and to identify individual, community and governmental level strategies that may facilitate the adoption of these approaches. Using qualitative methods, one focus group (FG) discussion each was conducted with members of the Cocoa Farmers’ Cooperatives in each of the 25 rural communities in the Amansie West and Asunafo North Districts in Ghana. Findings showed participants in only 3 FGs had knowledge of vitamin A and its deficiency diseases while only 2 FGs had knowledge of foods that could prevent vitamin A deficiency. Participants in 23 FGs were aware of the occurrence of iron deficiency anaemia especially in pregnant women; however, only 8 FGs had knowledge of the causes of anaemia. Furthermore, all the 25 FGs mentioned the use of haematinics in the treatment and prevention of anaemia but only 4 FGs knew about the use of food-based approaches. Various types of animal products, vegetables, fruits, and legumes, which are useful in preventing vitamin A and iron deficiencies, were found to be available in the communities. However, participants in all the 25 FGs indicated that the consumption of these foods particularly dark-green leafy vegetables has been dwindling with time. The FG participants mentioned a number of barriers to consumption of these foods and they include inadequate knowledge of nutritional value of the foods, lack of cooking skill, low production levels, laziness, conflicting media reports, lack of storage facilities, and contamination with agrochemicals. Findings imply that nutrition interventions should focus on education and awareness creation and implementation of strategies that can remove consumption barriers and facilitate the adoption of food-based approaches for managing micronutrient deficiencies. Key words : Vitamin A deficiency, iron deficiency, nutrition knowledge, consumption practices, barriers

Preoperative Anaemia and Associated Postoperative Outcomes in Noncardiac Surgery Patients in Central Region of Ghana.

Introduction Several studies suggest that preoperative anaemia (PA) is associated with adverse postoperative outcomes, but little is known about these outcomes in the Central Region of Ghana. This study aims to determine the prevalence of PA among noncardiac surgical patients and its implications for their postoperative outcomes. Methods This study was designed as an observational study; data including demographics and clinical and laboratory results were collected from the patients' records and through interviews. Results A total of 893 inpatient surgical cases undergoing elective and emergency operations, aged 15 years and above with mean age of 44.2 ± 17.0 yrs, were enrolled. The prevalence of PA was 54.3%, mostly microcytic with or without hypochromia (57.2%). The prevalence was higher in females than males (p ≤ 0.001). Preoperative anaemia was significantly associated with prolonged length of hospital stay (OR: 2.12 (95% CI: 1.49–3.10)). Allogeneic blood transfusion significantly prolonged the length of hospital stay (OR 4.48 (95% CI: 2.67–7.51)). 15.5% of the anaemic patients received oral iron supplements compared to 2.2% of nonanaemic patients (p ≤ 0.001). Conclusion Preoperative anaemia is common among noncardiac surgical patients. It is independently and significantly associated with prolonged hospital stay leading to the use of increased healthcare resources. It is also the main predictor for perioperative allogeneic blood transfusions and the use of haematinics.

The Effect of Eltrombopag (Promecta) on Thrombocytopenia in Egyptian Patients with Chronic Hepatitis C

Background and aim: Chronic hepatitis C is the leading cause of chronic liver disease and cirrhosis in Egypt. Thrombocytopenia is one of its complications which may postpone or interfere with diagnostic and therapeutic procedures. One of the treatment options of thrombocytopenia is Eltrombopag, Eltrombopag is an orally bioavailability, low molecular weight non-peptide growth factor that is a selective c-Mpl agonist. We aimed to evaluate the ability of Eltrombopag to increase platelet counts in patients with HCV-related thrombocytopenia and to compare it with the use of haematinics. Study population: The study was conducted on 54 patients with HCV related chronic liver disease and thrombocytopenia (platelet count ˂75.000 /µL). All patients were subjected to complete history taking, clinical evaluation, laboratory investigations and abdominal ultrasonography. Patients were divided into three groups, group (I) twenty four patients received Eltrombopag, group (II) received vitamin B₁₂ and folic acid and group (III) who did not receive any haematenics and considered as a control group. Results: There was a significant rise in the platelet count in the Eltrombopag group after one and two weeks of treatment when compared to the other groups and more than half of the patients reached the target platelet count (>100,000/μL) after two weeks of treatment with Eltrombopag. There was also a significant negative correlation between AST level and the dose of the drug and a significant positive correlation between the splenic size and the total grams of Eltrombopag needed to reach the target platelet count (p< 0.01). So they may be used as predictors for the response to treatment. Other blood elements did not exhibit any changes during Eltrombopag treatment. Conclusion: Eltrombopag causes significant selective elevation of platelet count in patients with HCV related thrombocytopenia; this can facilitate diagnostic and therapeutic interventions in such patients.

Eriochrome Blue Black R and Fluorescein degradation by hydrogen peroxide oxidation with horseradish peroxidase and hematin as biocatalysts

Abstract We describe an UV–vis study of Eriochrome Blue Black R and Fluorescein elimination by chemical transformation and oligo/polymerization using the horseradish peroxidase enzyme (HRP) and the biomimetic hematin as catalysts in aqueous solution. Using HRP/H2O2 and Eriochrome Blue Black R a decolorization of 92.5% was achieved at the highest dye concentration (150 mg/L). In the case of the hematin/H2O2 system, the decolorization of Eriochrome Blue Black R solutions decreased with the increase of the dye concentration reaching only a removal of 30.2% at the highest dye concentration tested. Fluorescein decolorization in the presence of HRP was very good at 25 mg/L (near 85%) but decreased to 35.7% as the dye concentration increased to 150 mg/L. On the other hand, hematin was poorly active as catalyst for Fluorescein elimination. The use of hematin as catalyst instead of HRP has advantages from the technological and economical points of view for Eriochrome Blue Black R. Hematin can be considered an adequate alternative to the use of enzymatic catalysts based on peroxidases.

A stable biomimetic redoxcatalyst obtained by the enzyme catalyzed amidation of iron porphyrin

Hematin, a hydroxyferriprotoporphyrin, is the more stable oxidized form of the free heme. The use of hematin as a catalyst for oxidative polymerization reactions has been restricted due to its limited aqueous solubility at low pH conditions. While there have been reports on the functionalization of hematin with poly (ethylene glycol), the esters formed are not very stable at low pH conditions. We report here the design and synthesis of hematin tethered with methoxypolyethylene glycol amine chains as a novel stable biomimetic catalyst. This one step amidation was performed under solventless conditions and catalyzed by a hydrolase (Novozyme-435). The amidation greatly improved the stability of hematin at low pH. Further, this catalyst was soluble in water and was able to catalyze the polymerization of aniline based monomers. The amide functionalized hematin serves as a robust cost-effective alternative to HRP, active even at lower pH conditions.

Biocatalytic Modification of Naturally Occurring Iron Porphyrin

Hematin, a hydroxyferriprotoporphyrin, is the stable, oxidized form of heme. Heme has been reported to be the active catalytic center of naturally occurring peroxidases such as horseradish peroxidase (HRP). While there have been reports on the use of hematin as a catalyst for oxidative polymerization reactions, these reactions could be carried out only at high pH conditions due to limited aqueous solubility of hematin at lower pH conditions. We report here the biocatalytic modification of hematin using a lipase, Novozyme-435. Hematin has been modified by tethering monomethoxy polyethylene glycol (mPEG) chains which provide aqueous solubility over a fairly wide range of pH conditions. This pegylated Hematin (PEG-Hematin) is synthesized via a one-step solventless reaction and the products formed can be isolated with minimal purification. The PEG-Hematin synthesized serves as a robust alternative to HRP for the polymerization of aniline and phenol.

Transfusion of blood products in paediatrics

The evidence base for transfusion in children is scanty, but all blood products should be used judiciously, regardless of age. Minimize transfusion by appropriate use of haematinics, antifibrinolytic agents and avoid excessive blood sampling. Children tolerate anaemia well and a postoperative haemoglobin of 6 g/dl is usually adequate in the normovolaemic patient, with a threshold of 7 g/dl for most patients in intensive care. Appropriate thresholds for neonates are less clear as this relates in part to gestational/post-gestational age and recent transfusion history. Red cells in additive solutions are suitable for most circumstances but not advised in massive transfusions in those under 6 months. Avoid the use of red cells that have been stored for more than a few days when large volumes will be given rapidly, for example priming of extracorporeal circuits or massive blood loss as hyperkalaemic cardiac arrest can occur. Fresh frozen plasma (FFP) should be used to correct a significant coagulopathy (coagulation times 1.5 or more times normal) in association with bleeding or an intended invasive procedure. In the UK, virus-inactivated FFP is provided for this age group. Suggested thresholds for prophylactic platelet transfusion include 30 × 109/litre for preterm infants or neonates with sepsis, 10 × 109/litre for older stable patients with marrow failure, and 50 × 109/litre for all children who are to undergo invasive procedures (100 × 109/litre for brain or eye surgery). Donor exposure can be reduced by the sequential use of aliquoted components form one donor and by recognizing that the plasma in a platelet unit may preclude the need for the additional administration of FFP.

Hematin as a peroxidase substitute in hydrogen peroxide determinations.

Hematin can substitute for horseradish peroxidase (HRP) as the catalyst in the determination of hydrogen peroxide using phenolic substrates such as p-hydroxyphenylacetate or p-cresol. Although the peroxidatic activity of hematin from bovine blood is not as great as HRP in terms of unit iron content, the activity per unit weight is substantially greater. Hematin is 500 times less expensive than HRP per unit peroxidatic activity. In hematin-catalyzed systems, reaction development and fluorescence measurement can both be conducted optimally in the same ammoniacal buffer. Hydroxyalkyl hydroperoxides are rapidly hydrolyzed to H2O2 at this pH and are also determined. On the other hand, for methyl hydroperoxide, hematin exhibits only approximately 10% of the sensitivity exhibited by HRP. Hematin is significantly more stable in solution than HRP. The use of hematin as catalyst and p-cresol as the substrate leads to a particularly inexpensive and sensitive system, permitting a limit of detection (LOD) of 7 nM H2O2 in a flow-injection configuration.

Hematin Therapy in Acute Porphyria

To the Editor.— I was interested to read Dr Bissell's answer to the challenging question concerning the use of hematin in the patient with acute intermittent porphyria (AIP) and pregnancy, which would also apply in hereditary coproporphyria (HCP) and variegate porphyria (VP). 1,2 We recently have had clinical experience with this difficult situation. Our quadraparetic patient with AIP had cyclic attacks coupled to her menses, despite trials of hormonal manipulation and glucose feedings. In fact, we came to expect her "crises" on this very predictable basis until she suddenly came to us with a severe midcycle attack. We searched diligently for a cause and found an early pregnancy that, for lack of any other new problem, was presumed to have been the precipitant. Claus Pierach, MD, who first suggested hematin as the drug of choice in attacks of AIP, and I considered the use of hematin in the setting of

Hematin toxicity in rats

The toxicity of intravenously administered hematin (3.4 and 6 mg 100 g ) was investigated in rats, where an LD 50 of 4.32 mg 100 g was computed, with 95% confidence limits of 5.40 and 3.46 mg 100 g . At toxic levels (4 mg 100 g ) the rats showed a drop of blood pressure, hemorrhages and renal failure, whereas lower doses were well tolerated. This study indicates a possibly wide therapeutic margin of safety, when compared to the therapeutic use of hematin on porphyric patients.