SERUM IRON STATUS OF CHILDREN WITH SICKLE CELL ANAEMIA AGED 1 TO 18 YEARS IN UNIVERSITY OF NIGERIA TEACHING HOSPITAL, ENUGU

Abstract

Sickle cell anaemia is a genetic haematological disorder characterized by life-long chronic
haemolytic anaemia. Many children with sickle cell disease are at risk for micronutrient
deficiencies due to unusual losses, increased nutrient demand and poor dietary intake. For those
who repeatedly receive blood transfusions, iron overload rather than iron deficiency is a
concern. In children with sickle cell anaemia (SCA) who do not require transfusions, the
adaptation of increased intestinal iron absorption in response to chronic anaemia is generally
considered protective against iron deficiency anaemia and would suggest that iron deficiency
is unlikely in SCA. In view of all of these, this study aimed to determine the iron status of
children with SCA in University of Nigeria Teaching Hospital (UNTH) Enugu.
This was a cross sectional study carried out at UNTH, between December 2012 and April 2013
to evaluate the serum iron status of children between 1 to 18 years with SCA.
Serum iron status was assessed using biochemical indicators such as serum iron, serum ferritin,
transferrin saturation and total iron binding capacity (TIBC). Haematological indicators such
as haemoglobin, mean corpuscular volume (MCV) and reticulocyte count/index were also
done.
The mean serum iron was significantly lower among subjects when compared to the controls
in both males and females (p = 0.000 in each case). Male and female subjects also had
significantly lower transferrin saturation when compared with the controls (p = 0.000 for each
gender). Irrespective of gender, the mean serum ferritin was significantly higher among
subjects compared to the controls (p = 0.000 respectively). Similarly a higher but not
significantly different, TIBC was observed among male and female subjects compared to the
controls (p = 0.667 and 0.291 respectively).
Irrespective of gender, the mean haemoglobin concentration and red blood cell count were
lower in subjects (p =0.000 in each case). In both male and female subjects, the mean
corpuscular volume values were lower compared to the controls (p = 0.000 and 0.025

respectively). The mean reticulocyte count of subjects was significantly higher when compared
to those of controls of similar gender (p = 0.000 respectively).
The overall prevalence of IDA was 5.3% in subjects as against 1.3% in controls. The difference
however, was not significant (2 = 1.862, p = 0.367). In the present study none of the study
population had iron overload [0 (0.0%)] . Three (75.0%) out of the four subjects with IDA were
in the older age bracket (> 5 years) just as all the ones among the controls. No significant
association was observed between age and IDA among the study population (2 = 0.078, p =
0.780).
Overall, only 36 (48%) of the subjects had previously received blood transfusion. None of the
controls had had blood transfusion. Two (40%) of the five study subjects with IDA have history
of previous blood transfusion as against 34(23.4%) of the study subjects without IDA but the
observed differences were not statistically significant (2 =3.47, p = 0.065).
In conclusion, IDA and iron overload is uncommon in SCA children in our setting. In addition
blood transfusion did not confer any protection against IDA. There is a need for a multicentre
collaborative study to draw conclusions from a larger pool of patients.

SERUM IRON STATUS OF CHILDREN WITH SICKLE CELL ANAEMIA AGED 1 TO 18 YEARS IN UNIVERSITY OF NIGERIA TEACHING HOSPITAL, ENUGU