COAGULATION PROFILE AMONG CHILDREN WITH SICKLE CELL ANAEMIA IN CRISES AND STEADY STATE ATTENDING UNIVERSITY OF NIGERIA TEACHING HOSPITAL (UNTH) ITUKU-OZALLA ENUGU STATE

Abstract

Sickle cell anaemia (SCA) is a common inherited haematological
disorder and presents with chronic haemolytic anaemia,
thrombocytosis and recurrent infection. Reports now suggest that
coagulation abnormalities also occur. This study was therefore
conducted to determine the coagulation profile of children (aged
between 6 months and 18 years) with sickle cell anaemia in crises and
steady state.
The prospective observational study was conducted among 50 children
with sickle cell anaemia in steady state and 50 of affected children
during crises who met the study criteria. Fifty children (Age and sex
matched) who had normal haemoglobin genotype were used as
controls.
Blood samples of subjects with SCA and controls were assayed for
prothrombin time (PT), activated partial thromboplastin time (aPTT)
and thrombin time (TT). Bleeding time (BT), haemoglobin (Hb)
concentration and platelet count were also determined. Their ages,
sex, weight, height, and vital signs were obtained.
The results showed that the mean PT (12.5+1.2secs), aPTT
(41.6+1.0secs), and TT (12.3+1.2secs) of subjects with sickle cell
anaemia in steady state as well as coagulation profile of those during
crises, PT;(12.6+1.8secs), aPTT (45.6+1.3secs), TT (12.5+1.7secs)

were significantly prolonged when compared to those with HBAA
genotype who had mean PT , aPTT and TT of (11.2+0.8 secs), (38.8
+7.7 secs), (9.9 + 1.5 secs) respectively (P< 0.05).
The mean bleeding time (3.4+1.0 mins) was significantly shorter in
children with sickle cell anaemia in steady state when compared to
that of children with normal haemoglobin AA genotype (3.7+1.1 mins),
(P<0.038). The mean bleeding time value of 3.2+0.7 mins among
subjects in crises was even much shorter (P< 0.004).
The mean haemoglobin concentration(g/dl) of children with
sickle cell anaemia in steady state (7.2+1.2) and crises
(6.8+1.7),were significantly lower than those with normal
haemoglobin genotype(10.8 +1.2); (P < 0.001).
The mean platelet counts of sickle cell anaemia children in
crises and steady state were significantly higher than that for children
with normal haemoglobin genotype (213.7 +81.4), (P = 0.001).
Among subjects with SCA, both in crises and steady state,
coagulation variables were noted to increase with age. However no
such observation was noted in the HbAA group.
Amongst subjects with SCA in crises and steady state, a positive
correlation exists between haemoglobin concentration and platelets.
However a negative correlation was noted between haemoglobin
concentrations and mean PT, aPTT, TT and BT among children with
sickle cell anaemia in crises and steady state.
It is concluded that children with sickle cell anaemia have
prolonged coagulation profiles (which is accentuated during crises)
when compared to those with normal haemoglobin genotype. In
addition, one should have a high index of suspicion of possible
thrombo-embolic episodes and cerebrovascular accidents among these
children especially when they are prepared for surgical procedures.
This makes it expedient for screening for such coagulation variables.
It is therefore recommended that children with SCA be assessed
for coagulation profile especially during crises and before surgical
procedures.

COAGULATION PROFILE AMONG CHILDREN WITH SICKLE CELL ANAEMIA IN CRISES AND STEADY STATE ATTENDING UNIVERSITY OF NIGERIA TEACHING HOSPITAL (UNTH) ITUKU-OZALLA ENUGU STATE