Objective: To describe the haematologic features of the HIV infection in adult Zimbabweans and compare the features in the different clinical stages of the disease. Design: Descriptive cross sectional study. Setting: Parirenyatwa Hospital, a tertiary and referral medical centre in Harare, and the blood donor clinics of the Blood Transfusion Service in Harare. Subjects: Patients attending HIV outpatients clinics or receiving inpatient care at Parirenyatwa Hospital and asymptomatic persons donating blood at the BTS Harare. Main Outcome M easures: Full blood counts and bone marrow cell counts and morphology. Results: Blood cytopenia was found in 47.5% of adults with HIV infection. The most frequent abnormalities were lymphopenia (31.5%); anaemia (30.8%); neutropenia (29.6%); thrombocytopenia (24.7%); eosinophilia (23.5%) and leucopenia (11.7%). Frequency of anaemia in the AIDS and symptomatic groups (43.4% and 24.5% respectively) was greater than in the carriers (6.7%), while the frequency of other cytopenias and of eosinophilia was about the same in all groups. There was also a general lack of association between the severity of haematologic abnormalities and the clinical stage of the disease. Conclusion: Severe haematologic changes occur frequently in HIV infection and AIDS but routine full blood count may not be helpful in the monitoring of the disease or the prediction o f onset of AIDS.

SUMMARYObjective: To determine whether or not pre-donation testing of blood donors affords substantial cost savings without compromise to blood transfusion safety. Predonation testing of blood donors for Transfusion Transmissible Infections (TTIs) is done in most developing countries because substantial cost savings are made from resources, materials and man-hours which would have been spent to procure infected blood units. Simple rapid test kits used in pre-donation testing is not as sensitive as the Enzyme Linked Immuno-sorbent Assay (ELISA) method used in post-donation screening in a quality assured manner. Design: It is a retrospective study where records of pre-and post-donation tests done in donor clinic of University of Ilorin Teaching Hospital, between January and December 2010 were retrieved. All processes and inputs were evaluated and costs calculated for predonation testing by simple rapid techniques and post donation screening by ELISA. Results: 5000 prospective donors were tested in the study period. The cost of single rapid Pre-donation testing was less than that of single ELISA Postdonation screen. The cost of double rapid Pre-donation and Post donation ELISA screen exceeded the cost of single post donation ELISA screen. Substantial cost savings were made when single rapid Pre-donation testing is relied on. More blood units were found reactive for the TTIs with the more expensive Postdonation ELISA. Conclusion: Pre-donation testing of blood donors was not cost effective. Although, there is an apparent savings if pre-donation testing is not followed by postdonation ELISA testing, it is done at a compromise to blood transfusion safety.

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Sera from young, black, group 0 Zimbabwean blood donors were screened for anti-A and anti-B haemolysins. Nearly one fifth of the sera were found to be strongly haemolytic for either A or B cells or both. Some of the sera were titrated for agglutination in saline before and after treatment with dithiothreitol. Serum dilutions beyond the endpoint of agglutination were further tested by the indirect antiglobulin technique using specific anti-IgM and anti-IgG sera. More than 60% of the strongly lytic sera had high titres of IgG (≥ 64). The IgM and IgG concentrations both of anti-A and anti-B were correlated and these levels were in turn correlated with haemolytic activity.

To document the pattern of presenting clinical and haematological features of chronic myeloid leukaemia (CML) in central Africans and evaluate the clinical consequences of treating the disease with chemotherapy. Design: Prospective descriptive analysis of clinical and haematological data. Setting: Departments of Haematology of tertiary referral centres and teaching hospitals. Materials and Methods: Prospective clinical and haematological data were collected on 150 central Africans (90 Zimbabweans and 60 Malawians) using modern Coulter counters and standard up-to-date haematological procedures and the results analysed using predetermined criteria and the top-desk Scientific Calculator Model HP 48GX, Texas Instruments, USA. Results: There were 150 CML patients studied. Males predominated in a ratio of 1:5:1. The youngest patient was 10 years and the oldest 77 years with a mean ± s.d. of 38.9 ± 14.7 years. The peak age incidence of 47.3% occurred between 21 to 40 years. The Ph chromosome was found in 19 of the 20 patients studied. Although complaints attributed to splenic enlargement were the most common symptoms, several unusual clinical features were encountered viz: hepatomegaly (26%), bleeding (12%), significant Iymphadenopathy (11.3%), purpura (3.3%), skin infiltration (2.7%), cardiac failure (2.7%) and 14.7% were diagnosed incidentally. Symptoms such as fatigue, headaches and weight loss were associated with greater degrees of leucocytosis, severe to gross splenomegaly and lower haemoglobin levels. The severe to gross splenomegaly which occurred in 68(45.3%) suggests that patients in this part of the world seek medical advice rather late in the disease. The median survival times of 65,47 and 39 months respectively for alpha interferon, hydroxyurea and busulphan are in agreement with those of previous larger series from other parts of the world. Conclusions: The study has revealed that the presenting pattern of clinical and haematological features of CML is changing probably due to the advent of modern clinical practice coupled with increased physician density, greater awareness of disease among clinicians besides other reasons. However, optimal treatment is not possible for the majority of patients due to lack of chemotherapeutic agents and supportive care. Recommendation: Referral centres in African health systems should be equipped for better management of CML patients.