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
Date
2022-03
Authors
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Publisher
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.
Description
MSc. Clinical Trials
Keywords
Haematological, Clinical Parameters, Adult Sickle Cell Patients, Hydroxyurea, Non-Experimental Retrospective Study