Anemia in HIV Patients Attending Highly Active Antiretroviral Therapy Clinic at Hoima Regional Referral Hospital: Prevalence, Morphological Classification, and Associated Factors

Purpose

To determine the prevalence of anemia, the morphological classification and to assess the factors associated with anemia among HIV patients attending Highly Active Antiretroviral Therapy (HAART) clinic at Hoima Regional Referral Hospital.

Methods

This was a cross-sectional study among 340 participants attending the HAART clinic at Hoima Regional Referral Hospital. Participants were recruited using a simple random sampling technique. A complete blood count (CBC) was performed using the Sysmex XN-550 hematology analyzer. Thick films were made and examined for malaria parasites, while thin films were examined for the morphological classification of anemia. Bivariate and multivariate logistic analyses were conducted using SPSS (version 23).

Results

Out of the 340 study participants, 255 (75%) were females, and the median age was 39 years (range: 6-76 years). The overall prevalence of anemia among the study participants was 16.8% (95% CI 13.1-21.1). Normocytic normochromic anemia was the most prevalent form of anemia (47.4%). The logistic regression at multivariate analysis showed that age groups (18-27 years, p = 0.017; 28-37 years, p = 0.005; and ≥38 years, p = 0.009), divorced marital status (p = 0.024), the presence of chronic disease (p = 0.010), a family history of anemia (p = 0.007), and the presence of malaria in the past one month (p = 0.001), presence of opportunistic infection (OR = 58, p = 0.000), use of antihelminthic drug in the past 3 months (OR = 0.10, p = 0.003) and unsuppressed viral load (OR = 10.74, p = 0.000) had a significant association with anemia.

Conclusion

Anemia is prevalent in HIV/AIDS patients who receive treatment at Hoima Regional Referral Hospital. Age, marital status, the presence of chronic illnesses, a family history of anemia, experiencing malaria in the past 3 months, the presence of opportunistic infections, the use of antihelminthic drugs in the past 3 months, and an unsuppressed viral load were significantly associated with anemia.

Association Between Helicobacter pylori Infection and Anemia Among Adult Dyspeptic Patients Attending Kiryandongo General Hospital, Uganda

Purpose

To determine the prevalence of anemia and its association with Helicobacter pylori infection among adult dyspeptic patients.

Patients and Methods

A cross-sectional study was conducted among 283 dyspeptic patients at Kiryandongo General Hospital, in Uganda. A structured questionnaire was administered to capture demographic and clinical characteristics of study participants. Four milliliters of blood were then collected into an EDTA vacutainer for Complete Blood Count (CBC) and analyzed using HUMA COUNT 30^TS, and peripheral blood smears were made and stained using Giemsa stain. Anemia was defined as hemoglobin levels <12g/dl in females and <13g/dl in men according to the World Health Organization (WHO). Helicobacter pylori (H. pylori) stool antigen test was performed using Whole power H. pylori Ag rapid test device, and saline stool preparation was examined for intestinal parasites. Chi-squared test and Logistic regression were performed to determine association, and a p-value of ≤0.05 was considered statistically significant.

Results

The overall prevalence of Helicobacter pylori infection was 42.4% (120/283). The prevalence of anemia among H. pylori-infected patients was 25.8% (31/120) and 15.3% (25/163) among H. pylori-negative counterparts. H. pylori infection was significantly associated with anemia (p-value 0.042), age (p-value 0.02, 0.009), water sources (p-value 0.0049,) and intestinal parasitic infestation (p-value 0.02), respectively.

Conclusion

This study has shown that the prevalence of H. pylori infection and anemia is high among dyspeptic patients at Kiryandongo General Hospital. H. pylori infection was found associated with anemia, age, water sources, and intestinal parasitic infestation. Routine screening of anemia in H. pylori-infected individuals and further studies to explore the relationship between anemia and H. pylori disease is highly recommended.

Anaemia, Morphological Classification and Its Associated Risk Factors Among Lactating Mothers at Mbarara City Council Health Centre IV, Southwestern Uganda

Purpose

The objectives of this study were to determine the prevalence of anaemia, morphological classification and its associated risk factors among the lactating mothers accessing postnatal care at Mbarara City Health Centre IV, Southwestern Uganda.

Patients and Methods

A cross-sectional study was conducted at Mbarara City Health Centre IV among 264 participants. A structured questionnaire was used to capture characteristics of study participants. 4 mL of venous blood was collected from each participant for complete blood count (CBC) and peripheral blood smear (PBS). CBC was done using hematology analyzer (BC-2800 Mindray Hematology Analyzer) while PBS were taken for participants with hemoglobin (Hb) <12.0g/dl and stained using Giemsa–Maygrunwald stain. Bivariate analysis and multivariate logistic regression were used to determine the associations between factors and anaemia. A p-value of <0.05 was considered significant.

Results

The overall prevalence of anaemia was 65 (24.6%), with mean hemoglobin (Hb) concentration of 12.5g/dL. Out of the anaemic participants (24.6%), morphological classifications of anaemia were as follows: normocytic normochromic 27 (41.5%), microcytic hypochromic 20 (30.8%), normocytic hypochromic 16 (24.1%) and macrocytic normochromic 2 (3.1%). According to the severity of anaemia, majority had mild anaemia 52 (80%), moderate anaemia was 11 (16.9%), and severe anaemia was 2 (3.1%). The following risk factors were significantly associated with anaemia: duration of lactation (between 5 to 8 months, p-value 0.017, 95% CI (0.12–0.82) and alcohol consumption (p-value 0.032, 95% CI (1.12–12.16). The rest of the variables had no association with anaemia.

Conclusion

The prevalence of anaemia among lactating mothers is high and it is a moderate public health problem as defined by WHO. Nutrition promotion, and health education, may be the ideal way to reduce the prevalence of anaemia in this region.

The utility of 'home-made' reagent red blood cells for antibody screening during pre-transfusion compatibility testing in Uganda

Background

The WHO recommends that pre-transfusion testing should include ABO/RhD grouping followed by screening for red blood cell (RBC) alloantibodies using the indirect antiglobulin test (IAT). However, in Uganda, current practice does not include RBC alloantibody screening.

Objective

To assess the utility of ‘home-made’ reagent RBCs in alloantibody screening.

Materials and Methods

In a laboratory-based study, group O RhD positive volunteer donors were recruited and their extended phenotype performed for C, c, E, e, K, Fya, Fyb Jkb, S and s antigens. These ‘home-made’ reagent RBCs were preserved using Alsever's solution and alloantibody detection tests performed. For quality assurance, repeat alloantibody screening of patients' samples was done at Bloodworks Northwest Laboratory in Seattle, United States.

Results

A total of 36 group O RhD positive individuals were recruited as reagent RBC donors (median age, 25 years; range, 21 – 58 years; male-to-female ratio, 1.6:1). Out of the 311 IATs performed, 32 (10.3%) were positive. Confirmatory IAT testing in the United States was in agreement with the findings in Uganda.

Conclusion

Use of ‘home-made’ reagent RBCs during pre-transfusion testing in Uganda is feasible. We recommend the introduction of pre-transfusion IAT alloantibody screening in Uganda using ‘home-made’ reagent RBCs to improve transfusion safety.

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

PURPOSE

The 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 METHODS

After 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.

RESULTS

One 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.

CONCLUSION

Despite 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.

Prevalence of cryptosporidiosis and hygiene practices among HIV/AIDS patients in southwest Uganda

Purpose: To determine the prevalence of Cryptosporidium by age, sex, and duration on antiretroviral therapy (ART) and establish hygienic malpractices that may predispose to infection.

Methods: We enrolled 138 HIV/AIDS patients on ART from June to October 2018. Stool samples were collected from study participants, wet saline preparations made and examined, stool samples concentrated using formal ether concentration, and smears stained using the modified Ziehl–Neelsen technique. Structured questionnaires were used to collect demographic data and hygienic malpractices that predisposed study participants to cryptosporidiosis infection.

Results: Of 138, 99 (71.7%) were females and 39 (28.7%) males. The age range was 9–69 years and mean age 37 years. The overall prevalence of cryptosporidiosis was three (2.17%). The most affected age-groups were 31–40 years (3.85%) and 21–30 years (3.22%), and only females (3.03%) were affected. The distribution of cryptosporidiosis according to the duration spent on ART showed that those who had spent <1 year on ART were the most affected (11.1%), followed by those who had spent 1–5 years 1 (2.2%), while those patients on ART for 6-10 years were 1 (1.7%) and those on ART for more than 10 years were not affected. There was no significant association between cryptosporidiosis and sex (P=0.272), educational background (P=0.670), handwashing (P=0.853), drinking boiled water (P=0.818), duration on ART (P=0.263), occupation (P=0.836), and age (P=0.723).

Conclusion: The prevalence reported in this study is low; however, it is still vital for clinicians to proceed to have cryptosporidiosis as the main differential in HIV/AIDS patients with gastrointestinal infections.

Biochemical changes in stored donor units: implications on the efficacy of blood transfusion

Background

Blood transfusion with allogeneic blood products is a common medical intervention to treat anemia or prepare patients for surgical procedures. Generally, the blood units are secured and stored prior to expected transfusion. During storage, a number of biochemical changes occur (generally known as storage lesion), which can affect the efficacy of blood transfusion. The aim of the study was to evaluate the biochemical changes that occur in blood units during storage and to project the impact of these changes on transfusion.

Methods

The study protocol was approved by the Faculty of Medicine Research Ethics committee of Mbarara University of Science and Technology. A total of 200 blood recipients were categorized into two study arms: group I received fresh blood (n=100) and group II received old blood (n=100), who were formally consented and recruited consecutively. A total of 2 mL of venous blood was collected from each participant in EDTA tubes before transfusion (for pre-transfusion hemoglobin [Hb] estimation) and after transfusion (for post-transfusion Hb estimation). Each crossmatched unit was sampled to collect plasma for pH, lactate and potassium assays. Data were analyzed with STATA version 12.0.

Results

A total of 200 blood transfusion recipients aged 1–60 years were enrolled in the study. Up to 60% of the participants were females. The pH of the stored blood dropped from 7.4 to 7.2 in the first 3 days to ~7.0 by day 11 and to <7.0 by day 35 (p=0.03). The average rise in lactate level was 25 g/dL in blood stored for 0 to 11 days and 32.4 g/dL in blood stored for 21–35 days. The highest increase was encountered in blood stored beyond 28 days: 40–57 g/dL by 35 days (p=0.001). Potassium levels equally increased from ~4.6 mmol/L in the first 5 days of storage to ~14.3 mmol/L by 11 days. From the third week of blood storage and beyond, there was exponential increase in potassium levels, with the highest record in blood units stored from 30 to 35 days (p=0.068).

Conclusion

Whole blood stored for >14 days has reduced efficacy with increased markers of red cell storage lesion such as increased potassium level, lactate and fall in pH. These lesions increase the length of hospital stay.