Patterns of hernia, haematological profile, and predictive ability of blood cell indices in pre-surgery patients; A case-control study in a district hospital in Ghana

Abstract

Introduction: The burden of hernia is disproportionately high in low-to-middle income countries, due to the lack of fundamental resources needed to effectively diagnose and manage cases. This study explored the patterns of hernia, haematological profile, and predictive ability of blood cell indices. Methods: Fifty-four subjects: 27 hernia patients and 27 healthy controls were included in this single-centre, unmatched case-control study. Hernia was diagnosed using physical examination and ultrasound scan. Haematological indices of each subject were measured with an automated blood cell counter. Results: Herniae recorded were 92.59% inguinal, and 3.7% each of epigastric and uterine prolapse. Hernia was prevalent in males (85.2%, p = 0.008) and older subjects ≥ 53 years (48.1%, p = 0.004). HgB (p = 0.006), MCHC (p ≤ 0.001), and RDW-CV (p = 0.042) were significantly elevated in strangulated than non-strangulated hernia and controls, while Abs GRAN (p = 0.024) was decreased in non-strangulated than strangulated hernia and controls. MCHC (AUC = 0.947 [0.895–0.999], p ≤ 0.001) was the most sensitive predictor of herniation followed by age (AUC = 0.750 [0.610–0.889], p = 0.002); HgB (AUC = 0.718 [0.580–0.857], p = 0.006); and RDW-CV (AUC = 0.700 [0.559–0.840], p = 0.012). Also, MCHC (AUC = 0.831 [0.723–0.938], p ≤ 0.001); HgB (AUC = 0.738 [0.590–0.887], p = 0.005); and RBC (AUC = 0.671 [0.502–0.840], p = 0.045) respectively, were significant predictors of strangulation. Conclusion: Gender and age were significantly associated with hernia. Inguinal hernia and strangulation were common in the study setting, especially, among males. Also, there were significant variations in erythrocyte- and leucocyte indices among hernia patients. Erythrocyte indices were significant predictive biomarkers for hernia and strangulation. CBC is a useful test for early detection of herniation and strangulation.