Possible Risk Factors for Severe Anemia in Hospitalized Sickle Cell Patients at Muhimbili National Hospital, Tanzania: Protocol for a Cross-Sectional Study

Abstract

BackgroundSickle cell disease (SCD) is the most common inherited disorder worldwide, with the highest burden in sub-Saharan Africa. The natural history of SCD is characterized by periods of steady state interspersed by acute episodes. The acute anemic crises may be transient and are precipitated by treatable factors like infections, nutritional deficiencies, and sequestration. Anemia is almost always present, although it occurs at different levels of severity.ObjectiveThis paper describes the protocol of a cross-sectional study to determine the prevalence of severe anemia and associated factors among sickle cell patients hospitalized at the Muhimbili National Hospital.MethodsThis is an ongoing, descriptive, cross-sectional, hospital-based study among individuals with SCD, admitted to the Muhimbili National Hospital in Dares Salaam, Tanzania. A minimum sample size of 369 was calculated based on the previous prevalence of hospitalizations due to severe anemia (20%) in the same cohort. We are using a piloted standardized case report form to document clinical and laboratory parameters following informed consent. Data analysis will be performed using Stata software. Severe anemia is defined as Hb<5g/dL. Chi-square or Fisher’s exact test will be used to ascertain association between categorical variables, and t-test will be used for numerical variables. Regression models for severe anemia against explanatory and confounding variables will be run, and results will be presented as adjusted odds ratio with 95% confidence intervals. A P value of <.05 will be considered significant.ResultsEnrolment commenced in January 2015 and concluded in September 2016. Complete data analysis will begin in February 2018. The study results are expected to be published in May 2018.ConclusionsThis protocol paper will provide a useful and practical model for conducting cross-sectional studies in hospitalized patients that cover a wide ranging of clinical and laboratory variables.

Sickling-preventive effects of rutin is associated with modulation of deoxygenated haemoglobin, 2,3-bisphosphoglycerate mutase, redox status and alteration of functional chemistry in sickle erythrocytes

“…The challenges associated with SCD made the World Health Organization (WHO) to declare Sickle Cell Anaemia a public health priority (Makani et al., 2013). It has been reported that poor nutrition, inadequate health care facilities and high orthodox treatment costs, are factors that further exacerbate anaemia in children with SCD (Tluway et al., 2018).…”

Prevalence and Factors Associated With Human Parvovirus B19 Infection in Sickle Cell Patients Hospitalized in Tanzania

“…This was a nested study investigating factors associated with severe anemia among patients admitted at Muhimbili National Hospital 10. The study population was hospitalized SCD patients with various complications between February and April 2016.…”

“…Patient care and management for recruited study population is well described in the published protocol by Tluway et al10 Inclusion criteria were: 1) aged between 0–45 years 2) confirmed SCD-(SS/Sβ O ) by High-Performance Liquid Chromatography (HPLC), and 3) hospitalized at MNH during the study period. Patients on hydroxyurea, those who had received blood transfusion within the past four weeks and re-admission within the past four weeks were excluded from this study 10. The study was granted ethical approval by Muhimbili University of Health and Allied Science (MUHAS) Institutional Review Board.…”

In-Vitro Effects of Hesperidin on Human Erythrocytes Sickling With Modifications of Functional Chemistry

“…Due to the challenges associated with SCD, WHO has declared Sickle Cell Anaemia as a disease of municipal health concern. Studies have exposed that inadequate nutrition and health care facilities with exorbitant conventional treatment are factors that further exacerbate anaemia in children with SCD [4] SCD is associated to a mutation in a single nucleotide in the βglobin gene leading to sickle shaped haemoglobin whichpredisposes the hemoglobin with altered amino acid sequence to increased polymerization, microscopically evidenced by red blood cells (RBC) [3]. This alteration to RBC shape revisesnot only the structure but also the function of this important protein, resulting in decreased blood flow and lower oxygen supply to tissues and organs [5].…”