Abstract

AIM: To determine if Autoimmune Haemolysis plays a role in the aetiology of anaemia in patients with Malignancies in Port Harcourt, Nigeria

OBJECTIVES:

1. To determine the prevalence of anaemia in cancer patients in Port Harcourt. 2. To determine the prevalence of Autoimmune Haemolysis in patients diagnosed with cancer. 3. To determine if the strength of a positive Direct Antiglobulin Test correlates with clinical picture of Haemolytic anaemia and bilirubin levels.

STUDY DESIGN: This was a case-control study conducted on patients with malignancies either on admission in the wards or attending follow up clinics in University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Healthy age/sex matched subjects were used as controls. Cases with and without chemotherapy were analyzed as a sub groups.

MATERIALS AND METHODS Three hundred and seventy six (376) participants (188 cancer patients and 188 controls) who satisfied the inclusion criteria were enrolled into the study. FBC, reticulocyte count, blood film, DAT, IAT and bilirubin assays were conducted on anticoagulated blood samples of all the patients and controls. The DAT was performed on fresh sample not more than 6 hours after collection using Polyspecific AHG.

RESULTS Anaemia was found in 124 (66%) of the total cancer population. Three (1.6%) of the 188 patients with malignancies were found to have a positive DAT of which 2 had strongly positive DAT with features of haemolysis and therefore had autoimmune haemolytic anaemia (AIHA). The two patients with AIHA had chronic lymphocytic leukaemia. The third case was a weak positive DAT with malignant teratoma but did not have features of haemolysis. The cases of both AIHA and DAT were found in the group without chemotherapy. AIHA was the aetiology of the anaemia in 2 (2%) of the 98 cases who had anaemia and not on chemotherapy. The group receiving chemotherapy recorded no case of positive DAT or AIHA. There were 5 (2.7%) participants with anaemia out of 188 patients in the control group, but no positive DAT or AIHA was recorded.

CONCLUSION The data generated in this study suggests that AIHA plays a role in the aetiology of anaemia of cancer, though patients with lymphoid malignancies are more predisposed. A positive DAT may occur without features of haemolysis.