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SERUM IMMUNOGLOBULIN LEVELS IN NIGERIAN PATIENTS WITH SICKLE CELL ANAEMIA DURING BONE PAIN CRISIS AND STEADY STATE
Abstract
Sickles cell aneamia (SCA) patients are prone to unpredictable recurrent episodes of vaso-occlusive crisis (VOC). VOC is the hall mark of clinical manifestation of sickle cell disease (SCD). Bone pain crisis (BPC) is the most common acute form of VOC, infection is the most common precipitating factor. Immunoglobulin are serum glycoprotein produced by plasma cell that help fight infection. They are important effectors of specific humoral immunity. This study was designed to measure the level of serum immunoglobulin (IgG, IgA, and IgM) in Nigerian sickle cell aneamia patients during BPC and steady state and to ascertain if it has any association on the severity of SCA when compared with other known prognostic factors such as leucocytosis. A total of 100 participants were recruited into the study: subject-50 SCA patients in BPC, 35 of the SCA patients were seen again in steady state four weeks after the initial BPC (served as Auto-control subjects). Control subjects-50 apparently healthy HbA individuals.
The participants were included in the study after an informed consent was obtained. The mean serum IgG level during BPC 19.96g/l compared with 15.92g/l in steady state was statistically significant (p = 0.001). The mean serum immunoglobulin (IgG and IgA) in SCA patients during BPC were higher (19.81g/l, 5.23g/l) respectively compared with mean serum levels of 11.28g/l and 3.4g/l respectively among HBA control subject (P< 0.001).
The mean total WBC count was 12,097/cmm during BPC and 9.097 in steady state. The mean haematocrit (HCT) in SCA during BPC was 0.24 and 0.25 during steady state. The mean neutrophil count was 5.5 x 109/l during BPC and 4.5 x 109/l during steady state. There was no significant correlation between the mean serum immunoglobulin levels, total WBC count and neutrophil count. When separated into BPC severity groups, 55% of the patient with severe bone pain crisis (pain score 7-10) had a significant higher serum IgG level. Markedly raised levels of IgG may be predictive of bone pain crisis severity in SCA.
