An Evaluation of the Levels of Subclinical Malaria Infection and Haemolysis among Residents of Opobo, Rivers State, Nigeria

Aim: The study was aimed at evaluating the levels of subclinical malaria infection and haemolysis among the residents of Opobo, Rivers State, Nigeria. Study Design: A cross sectional study design was used. The subjects were grouped into males and females and comparisons were made between positive and negative subjects of the same gender and positive subjects of different gender. Place and Duration of Study: The study area was Opobo Town in Opobo/Nkoro Local Government Area of Nigeria. The study was carried out within August 2nd to August 26th, 2019 and a total of 89 apparently healthy subjects were recruited, 35 males and 54 females, aged between 16 – 70 years. Methodology: Malaria parasite identification was done by thick and thin film using Giemsa’s stain, packed cell volume was by microhaematocrit method, plasma haemoglobin concentration and whole blood haemoglobin concentration was determined by cyanmethaemoglobin method. Results: The result revealed a total of 24.72% positivity and 75.28% negativity for malaria parasite infection. Among the males, 17.14% positivity and 82.86% negativity for malaria parasite infection were observed while that of the females was 20.37% positivity and 79.63% negativity. In comparison of the studied parameters made between females infected with malaria parasites and those that were not infected with malaria parasites, there was no statistical significant difference at p<0.05 in plasma haemoglobin and percentage haemolysis. In comparison of the studied parameters between males infected with malaria parasites and those not infected with malaria parasites, there was no statistical significant difference in plasma haemoglobin and percentage haemolysis. On gender based comparison, there was also no statistical significant difference in level haemolysis. Conclusion: The study has revealed a prevalence rate of 24.72% for subclinical malaria infection and the percentage haemolysis of red blood cells in malaria infected subjects residing in Opobo Town compared to subjects without malaria parasite was not statistically significant. Based on gender difference, males were affected more than females, but the level of red blood cell haemolysis was not statistically significant after comparison.

Protocol of a randomised controlled trial in cardiac surgical patients with endothelial dysfunction aimed to prevent postoperative acute kidney injury by administering nitric oxide gas

IntroductionPostoperative acute kidney injury (AKI) is a common complication in cardiac surgery. Levels of intravascular haemolysis are strongly associated with postoperative AKI and with prolonged (>90 min) use of cardiopulmonary bypass (CPB). Ferrous plasma haemoglobin released into the circulation acts as a scavenger of nitric oxide (NO) produced by endothelial cells. Consequently, the vascular bioavailability of NO is reduced, leading to vasoconstriction and impaired renal function. In patients with cardiovascular risk factors, the endothelium is dysfunctional and cannot replenish the NO deficit. A previous clinical study in young cardiac surgical patients with rheumatic fever, without evidence of endothelial dysfunction, showed that supplementation of NO gas decreases AKI by converting ferrous plasma haemoglobin to ferric methaemoglobin, thus preserving vascular NO. In this current trial, we hypothesised that 24 hours administration of NO gas will reduce AKI following CPB in patients with endothelial dysfunction.MethodsThis is a single-centre, randomised (1:1) controlled, parallel-arm superiority trial that includes patients with endothelial dysfunction, stable kidney function and who are undergoing cardiac surgery procedures with an expected CPB duration >90 min. After randomisation, 80 parts per million (ppm) NO (intervention group) or 80 ppm nitrogen (N2, control group) are added to the gas mixture. Test gases (N2or NO) are delivered during CPB and for 24 hours after surgery. The primary study outcome is the occurrence of AKI among study groups. Key secondary outcomes include AKI severity, occurrence of renal replacement therapy, major adverse kidney events at 6 weeks after surgery and mortality. We are recruiting 250 patients, allowing detection of a 35% AKI relative risk reduction, assuming a two-sided error of 0.05.Ethics and disseminationThe Partners Human Research Committee approved this trial. Recruitment began in February 2017. Dissemination plans include presentations at scientific conferences, scientific publications and advertising flyers and posters at Massachusetts General Hospital.Trial registration numberNCT02836899.

Changes in Plasma Haemoglobin Concentration in Citrate Phosphate Dextrose Adenine-1(CPDA-1) Stored Blood

Aim: This study assessed the level of plasma haemoglobin concentration in CPDA-1 stored blood with a view to determine the extent of haemolysis during the 35 days storage period. Study Design: This is an observational and comparative case-control study. Place and Duration of Study: The study was conducted using healthy male donors residing in Port Harcourt. Analysis was carried out at the Blood Bank of Rivers State University Teaching Hospital, formerly Braithwaite Memorial Specialist Hospital (BMSH), Port Harcourt, Nigeria, from February 1st to March 8th, 2017. Methodology: Blood for transfusion was collected from prospective male blood donor found to be in good health, aged between 18 and 52 years, with haemoglobin level within the range of 13.5 g/dl – 16 g/dl, body weight within 55 kg – 75 kg, and body temperature within 37.0 to 37.50C / 99.50F, into plastic bags containing anticoagulant CPDA-1, and handled under strict sterile condition to prevent bacterial contamination. The blood was stored in a blood bank refrigerator with a constant temperature of +2 to +60C under proper inspection at intervals for colour, turbidity, haemolysis and clot formation. Two milliliters of the sample was collected aseptically at different interval days of collection from the blood bag and analyzed using the HemoCue photometer. Results: Results showed no significant changes in plasma haemoglogin from day 1, 5, and 10, while significant increase in haemolysis occurred from day 15, 20, 25, 30, and 35 (p = 0.000), a significant increase (p<0.05) in plasma haemoglobin was observed from day 15 to day 35 of storage. Conclusion: It is pertinent therefore to note that the use of CPDA-1 does not completely stop the changes that occur in RBC as there are several changes occurring in stored blood collectively called “storage lesions”. Therefore, it is advisable that blood should be transfused within 14 days of storage to avoid transfusion of blood products that has lost most of its benefits to recipients, and where possible whole blood should be processed and components separated before storage to reduce the level of non-viable red blood cells.

Lung Function Abnormalities in Sickle Cell Anaemia

Background. Abnormalities in lung function tests have been shown to commonly occur in a majority of patients with sickle cell disease (SCD) even at steady state. The prevalence and pattern of these lung function abnormalities have been described in other populations but this is unknown among our sickle cell cohort. There is generally little information available on risk factors associated with the lung function abnormalities and its relevance in patient care. Method. This was an analytical cross-sectional study involving 76 clinically stable, hydroxyurea-naive adult Hb-SS participants and 76 nonsickle cell disease (non-SCD) controls. A structured questionnaire was used to obtain sociodemographic data and clinical history of the participants. Investigations performed included spirometry, pulse oximetry, tricuspid regurgitant jet velocity (TRV) measurements via echocardiogram, complete blood counts, free plasma haemoglobin, serum urea, and creatinine. Results. Weight, BMI, mean FVC, and FEV1% predicted values were comparatively lower among the Hb-SS patients (p < 0.001). Abnormal spirometry outcome occurred in 70.4% of Hb-SS patients, predominantly restrictive defects (p < 0.001), and showed no significant association with steady-state Hb, WBC count, free plasma haemoglobin, frequency of sickling crisis, chronic leg ulcers, and TRV measurements (p > 0.05). The mean oxygen saturation was comparatively lower among Hb-SS patients (p < 0.001). Conclusion. Measured lung volumes were significantly lower in Hb-SS patients when compared to non-SCD controls and this difference was not influenced by anthropometric variance. Lung function abnormalities, particularly restrictive defects, are prevalent in Hb-SS patients but showed no significant association with recognized markers of disease severity.

Hyperglycaemic Environment: Contribution to the Anaemia Associated with Diabetes Mellitus in Rats Experimentally Induced with Alloxan

Background. Diabetes mellitus characterized by hyperglycaemia presents with various complications amongst which anaemia is common particularly in those with overt nephropathy or renal impairment. The present study has examined the contribution of the hyperglycaemic environment in diabetic rats to the anaemia associated with diabetes mellitus. Method. Sixty male albino rats weighing 175–250 g were selected for this study and divided equally into control and test groups. Hyperglycaemia was induced with 170 kgbwt−1alloxan intraperitoneally in the test group while control group received sterile normal saline. Blood samples obtained from the control and test rats were assayed for packed cell volume (PCV), haemoglobin (Hb), red blood cell count (RBC), reticulocyte count, glucose, plasma haemoglobin, potassium, and bilirubin.Result. Significant reduction (P<0.01) in PCV (24.40±3.87versus40.45±3.93) and haemoglobin (7.81±1.45versus13.39±0.40) with significant increase (P<0.01) in reticulocyte count (12.4±1.87versus3.69±0.47), plasma haemoglobin (67.50±10.85versus34.20±3.83), and potassium (7.04±0.75versus4.52±0.63) was obtained in the test while plasma bilirubin showed nonsignificant increase (0.41±0.04versus0.24±0.06).Conclusion. The increased plasma haemoglobin and potassium levels indicate an intravascular haemolytic event while the nonsignificant increased bilirubin showed extravascular haemolysis. These play contributory roles in the anaemia associated with diabetes mellitus.

Extracellular vesicles in the circulation: are erythrocyte microvesicles a confounder in the plasma haemoglobin assay?

Blood contains a mixture of extracellular vesicles from different cell types, primarily platelets, endothelial cells, leucocytes and erythrocytes. Erythrocytes are the most abundant cell type in blood and could, especially in certain pathologies, represent an important source of vesicles. Since erythrocytes contain the haemoglobin components iron and haem, which are potentially toxic, it is important to investigate the contribution of vesicle-associated haemoglobin to total cell-free haemoglobin levels. To our knowledge, this is the first time that cell-free plasma haemoglobin has been differentiated into vesicle-associated and molecular species. We investigated the contribution of vesicle-associated haemoglobin in residual patient material that was routinely analysed for total cell-free plasma haemoglobin. All patient samples included in the study were haemolytic with total cell-free haemoglobin concentration ranging from 80 to 2500 mg/l. In the majority of the samples, total cell-free haemoglobin concentration was between 100 and 200 mg/l. No haemoglobin could be detected in the vesicle fraction, indicating that the contribution of vesicle-associated haemoglobin to total cell free-haemoglobin levels in plasma is negligible. It is important to investigate whether erythrocyte vesicles are not formed in blood or that their production is not increased during pathologies associated with haemolysis or that the clearance rate of the vesicles surpasses the formation rate.