Haematological manifestations in cyanotic heart diseases at Kenyatta National Hospital And Mater Hospital, Nairobi
Abstract
Background: Cyanotic heart disease results in inadequate tissue oxygenation.
This in turn triggers increased erythropoietin release from the kidneys in an effort
to increase the red cell mass so as to increase oxygen delivery to the tissues.
Polycythemia results and often iron deficiency develops as the iron stores are
depleted as a result of the sustained erythropoiesis. Polycythemia and iron
deficiency both lead to increased blood viscosity and a tendency to bleeding
diathesis. The objective of this study was to examine the haematological profile of
children with cyanotic heart disease in Kenyatta National Hospital and Mater
Hospital, and to document the prevalence of abnormal coagulation and iron
deficiency in these children.
Method: A cross-sectional descriptive study was carried out at Kenyatta National
Hospital and Mater Hospital from August to December 2007. A total of 112
children meeting the eligibility criteria were recruited into the study.
Haemoglobin level, Mean corpuscular volume, Mean corpuscular haemoglobin,
Peripheral blood film report, serum ferritin levels, Prothrombin time, Activated
partial thromboplastin time, Platelet counts and D-dimer levels were determined
and recorded.
Results: The prevalence of iron deficiency was found to be 16.9% (95% CI 9.8-
24.1%). Abnormalities in the coagulation tests were as follows: Prolonged APTT-
9
32.1% (95% CI 23.5-40.7%) of the study population, prolonged PT-3.6% (95%
CI 1.4-8.8%), low platelets-7.1 % (95% CI 3-11 %), and raised D-dimer - 60%
(95% CI 50.9-69.1%).
The sensitivity of Low MCV in detecting iron deficiency was 58.8% with
specificity of 51.2%. For Low MCH the sensitivity was 52.9% with a specificity
of 50.6%. Findings of microcytic hypochromic cells on peripheral blood film
gave a sensitivity of 50%% and specificity of73.4%.
Conclusion: There is a high prevalence of iron deficiency among patients with
congenital heart disease with cyanosis in Kenyatta National Hospital and Mater
Hospital. Mild to moderate coagulation abnormalities were also noted.
Recommendation: Screening for iron deficiency using biochemical methods is
recommended for patients with congenital cyanotic heart disease, and routine
screening for coagulopathy is recommended prior invasive procedures.
Citation
Master of science in Pathology, University of Nairobi,2008Publisher
Universty of Nairobi