Changes In Haematological And Clinical Parameters In Adult Sickle Cell Patients On Hydroxyurea: A Before And After Non-Experimental Retrospective Study At The Sickle Cell Clinic, Korle-Bu Teaching Hospital

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2022-03

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University Of Ghana

Abstract

Introduction Sickle cell disease (SCD) is a genetic blood disorder and major public health problem. The haemoglobin polymerizes at low oxygen and pH resulting in a sickled shape of the red cell causing a frequent painful vaso-occlusion crisis, anaemia, acute chest syndrome and organ damage. Hydroxyurea induces the production of haemoglobin F which inhibit sickling of red blood cell hence preventing these painful episodes with its associated complications. However, in Ghana, since the introduction of hydroxyurea, its effect on sickle cell patients have not been evaluated. Thus, this resaerch aims to investigate the changes in the haematological and clinical parameters of adult sickle cell patients on hydroxyurea. Methodology: A pre and post non-experimental retrospective study was conducted on 105 SCD patients who are above 15 years. The data extraction tool, kobocollect was used to collect patients’ socio-demographic information, clinical history and haematological findings from patients’ folders. The primary outcome include changes in six haematological parameters and four clinical parameters 6 months before and after hydroxyurea therapy and the 12th month after being treated with 10-20mg/kg/day. Data analysis was employed using STATA 16/IC 16 software. Continuous variables such as age, Hb, HbF, MCV, WBC, platelet (Plt) and reticulocyte (Rct) count were summarized as mean and standard deviation (SD). Categorical data were summarized as percentages (%). Chi-square test was used to test for association between demographics and clinical parameters and the association between clinical manifestation and dosage. Paired t test was used to compare differences in means of continuous variables to determine changes in haematological parameters before and after hydroxyurea therapy. Differences in proportions was estimated using z test of proportion. A significance level of 5% was adopted. Results: There was a significant increase in haemoglobin (Hb) and mean corpuscular volume (MCV) at 6 months from 8.40±1.52 to 9.11±1.55 and 85.38±9.96 to 94.36± 11.87 respectively. Only Hb increased significantly at 12 months. A significant reduction was observed in white cell count (WBC), platelet count at the 6th month, but was not significant at the 12th month. An increase of 1.56% HbF was observed in one patient (7.4% to 8.96%). HU significantly reduced the frequency of vaso-occlusive crisis (65.4% to 19.6%, p<0.001) and hospitalization (36.5% to 9.6%, p< 0.001). Reduction in blood transfusion (6.7% to 2.9%, p= 0.195) and acute chest syndrome (3.9% to1%, p= 0.174) was not significant. Patients commenced HU on 10mg, 15mg and 20mg/kg/day which was not associated with vaso-occlusive crisis, acute chest syndrome, blood transfusion and hospitalization. Conclusion: Hydroxyurea resulted in a beneficial reduction in WBC, PLT and RET and increases in Hb level, HbF and MCV. Clinically, HU reduced the frequency of vaso-occlusion crisis, acute chest syndrome, blood transfusion and hospitalization. There was no association observed between the dosages of HU and clinical parameters. Recommendations: Based on the findings of this study, hydroxyurea is effective and improves the condition of sickle cell patients. Therefore, sickle cell patients should be encouraged to adopt the use of the medication. Clinicians should educate and recommend hydroxyurea to patients. More research should be conducted on the dosages of HU and clinical outcomes among adult sickle cell patients in Ghana.

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MSc. Clinical Trials

Keywords

Haematological, Clinical Parameters, Adult Sickle Cell Patients, Hydroxyurea, Non-Experimental Retrospective Study

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