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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 3  |  Page : 163-165

Correlates and predictors of frequency of blood transfusions among sickle cell anemia patients in a Tertiary hospital in Nigeria


Department of Haematology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Date of Submission21-Jul-2016
Date of Acceptance01-Sep-2016
Date of Web Publication19-Sep-2016

Correspondence Address:
Sani Awwalu
Department of Haematology, Ahmadu Bello University Teaching Hospital, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2384-5147.190861

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  Abstract 

Context: Blood transfusion is a central modality in the management of sickle cell anemia (SCA) patients. However, blood remains relatively scarce and the provision of safe, adequate, and timely transfusion services is still a challenge in Nigeria. Aims: To determine correlates and predictors of frequency of blood transfusions in SCA patients. Settings and Design: A cross-sectional, descriptive study was conducted. Convenience sampling technique was used to recruit 51 SCA patients attending the sickle cell clinic of ABUTH, Zaria Nigeria. Subjects and Methods: Age, sex, hematocrit, reticulocyte percentage, and 12-month recall of number of blood transfusions, pain episodes, and hospital admissions were assessed. Data were analyzed using SPSS version 20.0. Statistical Analysis Used: Results were summarized as median (interquartile range [IQR]) or mean ± standard deviation (SD). Spearman correlation and multiple regression analyses were carried out. Level of significance was set at P < 0.05. Results: Out of the 51 participants, 40 (78.43%) were females. The median (IQR) for age, number of pain episodes, number of hospital admissions, number of blood transfusions, and reticulocyte percentage was 23.00 (9.00) years, 2.00 (5.00), 0.00 (1.00), 0.00 (1.00), 8.60% (3.10%), respectively. Mean ± SD for hematocrit was 0.23 ± 3.41 L/L. Using frequency of blood transfusions as a reference, Spearman correlation analyses were performed for age (ρ = 0.206, P = 0.148), pain episodes (ρ = 0.270, P = 0.055), hospital admissions (ρ = 0.373, P = 0.007), hematocrit (ρ = 0.055, P = 0.704), and reticulocyte percentage (ρ = 0.122, P = 0.395). Backward multiple regression model to predict frequency of blood transfusions produced: F (2, 48) = 11.780, P < 0.001, adjusted R2 = 0.301. Only number of hospital admissions added statistically significant to the prediction (β = 0.542, P ≤ 0.001). Conclusions: Number of hospital admissions predicted frequency of blood transfusions in SCA patients in this study.

Keywords: Blood transfusion, correlates and predictors, sickle cell anemia


How to cite this article:
Awwalu S, Mamman AI, Hassan A, Ibrahim IN, Kusfa IU, Suleiman AM, Dachi RA, Pindiga KM. Correlates and predictors of frequency of blood transfusions among sickle cell anemia patients in a Tertiary hospital in Nigeria. Sub-Saharan Afr J Med 2016;3:163-5

How to cite this URL:
Awwalu S, Mamman AI, Hassan A, Ibrahim IN, Kusfa IU, Suleiman AM, Dachi RA, Pindiga KM. Correlates and predictors of frequency of blood transfusions among sickle cell anemia patients in a Tertiary hospital in Nigeria. Sub-Saharan Afr J Med [serial online] 2016 [cited 2023 May 31];3:163-5. Available from: https://www.ssajm.org/text.asp?2016/3/3/163/190861


  Introduction Top


Sickle cell anemia (SCA) is a genetic disorder of the beta globin gene, resulting in qualitative defects of the hemoglobin molecule. [1] This condition predisposes to chronic hemolysis in addition to other varied manifestations. [2],[3] Blood transfusions, especially red cells, remains the mainstay of management of SCA. In developed countries, the indications for blood transfusions have been increasing due to availability of elaborating technology to prevent certain complications associated with this form of management. [4] However, in a developing country like Nigeria, availability of safe blood and facilities is in short supply. The routine and emergent care of SCA have attendant cost implications. With advances in care, this group of patients live longer and thus cumulative cost of care increases. [4]

A central modality of care in SCA is blood transfusion. [5] Utilization of this modality is often limited by availability, technical limitations, and complications. It has been shown that 78% of hospitals in Nigeria are unable to transfuse SCA patients due to nonavailability of blood. The same study also revealed that no hospital in Nigeria offers extended phenotyping and routine monitoring of iron overload is not feasible. [6] It has therefore been suggested that proactive measures to reduce blood transfusion be adopted. This study was to determine the correlates and predictors of number of blood transfusions in SCA patients in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria.


  Subjects and methods Top


This was a cross-sectional, descriptive study using semi-structured interviewer-administered questionnaires. Following the acquisition of institutional ethical clearance, convenience sampling technique was used to recruit 51 adult SCA patients in the Sickle Cell Clinic of the Haematology Department of ABUTH Zaria, Nigeria. Age, sex, hematocrit, reticulocyte percentage, and 12-month recall of number of blood transfusions, number of pain episodes, and number of hospital admissions were assessed. Data were analyzed using IBM SPSS Statistics for Windows Version 20.0. Results were summarized as median (interquartile range [IQR]) or mean ± standard deviation (SD) where appropriate. Spearman correlation and multiple regression analyses were carried out. Level of significance was set at P < 0.05.


  Results Top


Out of the 51 participants, 40 (78.43%) were females. Shapiro-Wilk test of normality returned P ≤ 001 for all parameters, except hematocrit (P = 0.788). The median (IQR) for age, number of pain episodes, number of hospital admissions, number of blood transfusions, and reticulocyte percentage was 23.00 (9.00) years, 2.00 (5.00), 0.00 (1.00), 0.00 (1.00), and 8.60% (3.10%), respectively. Mean ± SD for hematocrit was 0.23 ± 3.41 L/L [Table 1].
Table 1: Summary statistics

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Using frequency of blood transfusions as a reference, Spearman correlation analyses were performed for age (ρ = −0.206, P = 0.148), pain episodes (ρ = 0.270, P = 0.055), hospital admissions (ρ = 0.373, P = 0.007), hematocrit (ρ = 0.055, P = 0.704), and reticulocyte percentage (ρ = −0.122, P = 0.395) [Table 2].
Table 2: Spearman correlation analyses with number of blood transfusions as a reference

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Backward multiple regression model to predict frequency of blood transfusions produced: F (2, 48) = 11.780, P < 0.001, adjusted R2 = 0.301. Only number of hospital admissions added statistically significantly to the prediction (β =0.542, P ≤ 0.001).


  Discussion Top


With increasing awareness and quality of care, SCA patients are beginning to live longer; thus, more now live beyond 20 years. [7],[8] This development laudable as it is also challenging for physicians to be ready to deal with the consequences. Since SCA patients may require blood transfusion at one time or the other, this is an important area in the care of these patients.

This study revealed a weak positive but insignificant relationship between number of pain episodes and blood transfusion. This may be because uncomplicated pain in SCA patients is not an indication for blood transfusion. [9] Hence, the usual first line of managing such conditions in addition to treating the underlying or predisposing causes include rehydration, analgesia, and bed rest. [3] Blood transfusions are resorted to when pain has become intractable or is associated with other factors such as hyperhemolysis, acute chest syndrome, or acute cerebral syndromes. [9]

This study revealed a significant positive relationship between hospital admission and blood transfusion in SCA patients. This is likely due to the reason that blood transfusion is usually given in inpatient setting. This, of course, is without prejudice to the hematology day care setting where patients can be transfused and allowed to go home on the same day. Delays and logistic challenges before getting appropriate safe blood often will make the hematologists resort to admitting patients in the ward for blood transfusions. In addition, frequent admissions are indicative of severe phenotypes, who ordinarily may require more blood transfusions.

This study relied on patients' 12-month recall because not all cases of pain episodes, blood transfusions, or admissions are carried out in tertiary hospitals. Thus, relying on hospital records may greatly underestimate these parameters. However, this does not preclude recall bias on the part of the patients.

The significant role played by hospital admissions in this study explained only 30.1% of the variations in the frequency of blood transfusions. This implies that other factors have important roles in predicting the frequency of blood transfusions in this population. These factors may include duration of illness, dependence on analgesics, and availability of blood donors among others. In addition, specific indications for admissions may determine whether a patient will be transfused or not. Hence, further research will be required to determine the roles of these factors. The foregoing notwithstanding, it may be suggested that proactive efforts aimed at reducing total number of hospital admissions could reduce the frequency of blood transfusions.

Although blood transfusion remains a life-saving procedure in SCA patients, it is not without its problems which range from the infectious to the noninfectious complications. [10],[11] Similarly, the high cost of getting safe blood and risk of alloimmunization is ever present. [4],[12],[13] This study therefore recommends that hematologists must take proactive measures to avoid blood transfusion in SCA patients, except when it is inevitable. [14]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kaur M, Dangi CB, Singh M. An overview on sickle cell disease profile. Asian J Pharm Clin Res 2013;6:25-37.  Back to cited text no. 1
    
2.
Chen J, Hobbs WE, Le J, Lenting PJ, de Groot PG, López JA. The rate of hemolysis in sickle cell disease correlates with the quantity of active von Willebrand factor in the plasma. Blood 2011;117:3680-3.  Back to cited text no. 2
    
3.
Adewoyin AS. Management of sickle cell disease: A review for physician education in Nigeria (Sub-Saharan Africa). Anemia 2015;2015:791498.  Back to cited text no. 3
    
4.
Kauf TL, Coates TD, Huazhi L, Mody-Patel N, Hartzema AG. The cost of health care for children and adults with sickle cell disease. Am J Hematol 2009;84:323-7.  Back to cited text no. 4
    
5.
Aliyu ZY, Tumblin AR, Kato GJ. Current therapy of sickle cell disease. Haematologica 2006;91:7-10.  Back to cited text no. 5
    
6.
Diaku-Akinwumi IN, Abubakar SB, Adegoke SA, Adeleke S, Adewoye O, Adeyemo T, et al. Blood transfusion services for patients with sickle cell disease in Nigeria. Int Health 2016. pii: Ihw014. [Epub ahead of print].  Back to cited text no. 6
    
7.
Chijioke A, Kolo PM. The longevity and clinical pattern of adult sickle cell anaemia in Ilorin. Eur J Sci Res 2009;32:528-32.  Back to cited text no. 7
    
8.
Isoa EM. Current trends in the management of sickle cell disease: An overview. Benin J Postgrad Med 2009;11:50-64.  Back to cited text no. 8
    
9.
Danielson CF. The role of red blood cell exchange transfusion in the treatment and prevention of complications of sickle cell disease. Ther Apher 2002;6:24-31.  Back to cited text no. 9
    
10.
Wanko SO, Telen MJ. Transfusion management in sickle cell disease. Hematol Oncol Clin North Am 2005;19:803-26.  Back to cited text no. 10
    
11.
Nouraie M, Gordeuk VR. Blood transfusion and 30-day readmission rate in adult patients hospitalized with sickle cell disease crisis. Transfusion 2015;55:2331-8.  Back to cited text no. 11
    
12.
Olujohungbe A, Hambleton I, Stephens L, Serjeant B, Serjeant G. Red cell antibodies in patients with homozygous sickle cell disease: A comparison of patients in Jamaica and the United Kingdom. Br J Haematol 2001;113:661-5.  Back to cited text no. 12
    
13.
Natukunda B, Schonewille H, Ndugwa C, Brand A. Red blood cell alloimmunization in sickle cell disease patients in Uganda. Transfusion 2010;50:20-5.  Back to cited text no. 13
    
14.
Otaigbe B. Prevalence of blood transfusion in sickle cell anaemia patients in South-South Nigeria: A ten-year experience. Int J Med Med Sci Res 2013;1:13-8.  Back to cited text no. 14
    



 
 
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