RED CELL FOLATE STATUS IN CHILDREN WITH SICKLE CELL ANAEMIA AT AHMADU BELLO UNIVERSITY TEACHING HOSPITAL, ZARIA

Abstract

Background: Sickle Cell Anaemia (SCA) is the commonest and severest form of Sickle Cell
Disease (SCD) in Africa, and affects about 3% of the Nigeria population. It is characterized by
chronic haemolysis and vaso-occlusion resulting in decreased half-lives of erythrocytes.
Increased metabolic rate and protein turnover associated with SCA tends to deplete the body
of micronutrients especially body folate which is necessary for synthesis of ribonucleic acid
(RNA) and deoxyribonucleic acid (DNA). This necessitates folic acid supplementation to meet
the body’s requirement of SCA subject. The level of folate in the body, especially that of red
blood cell (RBC) level of SCA subjects in Zaria is unknown. Determination of RBC folate
level in SCA is hoped may justify or otherwise influence the routine folic acid supplementation
in all SCA.
Objective: This study aimed to determine the status of folate in red blood cells in children with
sickle cell anaemia in Ahmadu Bello University Teaching Hospital, Zaria.
Methodology: Over a period of six months, from June 2015 to December 2015, a hospital
based cross-sectional study involving 170 SCA subjects either in steady or crisis state was
conducted. The same number of controls with haemoglobin AA were enrolled into the study.
A structured interviewer-administered questionnaire was administered and general physical
examination carried out. Blood samples were taken for RBC folate determination using
electrochemiluminiscence immunoassay (ECLIA); full blood count and differentials were also
carried out using standard laboratory procedures.
Results: The mean ± SD of RBC folate level of children with SCA (2005.3±1020.9 ng/ml)
was significantly higher than that of the controls which was 838.3± 256.3 ng/ml (p < 0.001).
There was no significant difference between SCA subjects on folic acid and those who were
not (p = 0.13). There was also no significant difference in the RBC folate level between SCA
subjects in steady or any crises states (p= 0.73). More SCA subjects were stunted and
underweight than the controls. Both groups were from similar socioeconomic background.
Socioeconomic status of the SCA subjects did not significantly affect their RBC folate levels
(p = 0.1) as well as the socioeconomic status of the controls and their mean RBC folate level
(p= 0.64). The mean haematocrit (HCT) was significantly lower in SCA (21.9%) than the
controls (31.7%) (p < 0.001). The RBC folate of the SCA did not significantly influence their
haematocrit levels (p = 0.16). The nutritional status of the SCA subjects did not significantly
affect their red blood cell folate levels. Total white blood cell (WBC) count and red cell
distribution width (RDW) were significantly higher in SCA than the controls (p < 0.0001 and
p <0.001), respectively.
Conclusions: The RBC folate level in SCA subjects was very high irrespective of their crisis
state, folic acid intake, socioeconomic background, haematocrit or nutritional status. The very
high RBC folate levels also found in the controls could suggest that folate intake from the
dietary sources in the community are adequate in this environment and folic acid
supplementation may not be necessary. However further studies are needed to determine actual
levels of folate in the diet. Similar studies from other centres in Nigeria are also needed before
a policy statement can be made on this issue.

RED CELL FOLATE STATUS IN CHILDREN WITH SICKLE CELL ANAEMIA AT AHMADU BELLO UNIVERSITY TEACHING HOSPITAL, ZARIA