Normocytic anaemia and associated diseases in Kenyatta National Hospital
Background: Normocytic anemia is probably the most frequently encountered type of anemia in clinicalpractice because it is usually associated with several diseases. In spite of this no study has been conducted in the Kenyatta National Hospital (KNH) to find out not only its status but also the associated diseases. Therefore this study was set to provide information on the normocyticanaemia and also the associated diseases in the KNH. Objective: To determine the normocytic anaemia and associated diseases in KNH. Study design: This was a cross-sectional descriptive study. Setting: Hematology laboratory and wards at the KNH. Methods: The recruitment of the cases involved daily perusal of all haemograms request forms and reports in the haematology laboratory and tracking the patients to the wards. All the request forms with Haemoglobin levels less than 11.5g/dl were selected. The selected forms were then scrutinized and the ones with normocytic anaemia (MCV 76-96£1) were set aside for further evaluation. The patients' address as stipulated in the forms enabled tracing the patients in the wards. Once identified, each case was then informed about the study upon which informed consent was obtained and singed. This was followed by clinical evaluation of the patient including history and physical examination. Other clinical data were retrieved from the patient's file. Blood was then drawn from the patient for the required laboratory tests. The blood samples was put in the bottle with Ethylene Diamine Tetra Acetic Acid (EDTA), and transported to the laboratory. Haematological test were performed as requested and noted in the investigation form The tests included making of the blood films for peripheral blood smear (PBF), which was stained using Romanowsky stain, and performing erythrocyte sedimentation rate (ESR) and Complete blood count (CBC) using cell dyne 3200.The PBF, ESR and haemograms print outs were further examined for the study details by, the principal investigator and reviewed by the supervisors. All the data were entered in a proforma questionnaire data sheets. Outcome measures: For every case of the age above 13 years, the following were sought and documented; age in years ,sex, residence (province ), occupation, the diagnosis, Hb levels, MeV, total WBC count, WBC differential count (neutrophil ,lymphocyte , monocyte, eosinophil,basophils) platelet count and peripheral blood film, ESR and HIV status. Results: A total of 637cases were evaluated out of whom 62 %( 395) had normocytic anaemia. Overall the age characteristics were as follows; range 13-89years, mode age 32 years and median 37 years. Female and males constituted 63% (n-250) and 37% (n-145) respectively .Of the provinces Nairobi and neighboring provinces of Central and Eastern constituted the major proportions. The results also showed that the ten disease associated with normocytic anaemia were, infections (40.4%) mainly HIV infection, malignancies (20.5%) ,genitourinary 6.6%), cardiovascular (6.3%), central nervous system (5.8%), endocrine (5.6%), gastrointestinal tract (4.6%), unc1assified(4.1%), haematological (3.8%), and connective tissue (2.3%). Of those with infections diseases the majority had HIV infection as shown by sero -positive tests by ELISA which is the KNH current testing technique. The level of anaemia in the majority the studied cases were mild to moderate while the WBC counts were within the normal range in most of the patients. The white cells differential count; Neutrophil, lymphocyte, eosinophil and monocytes were found to be within the normal ranges. However in those who were HIV seropositive, most had low lymphocyte count. Total platelet count was within the normal range in most of the patients. However, the ESR was raised in 98.7% of the cases this is consistent with the majority being infections among whom HIV the major component. The occupation of the majority of the study cases was in the transport industry the matatu industry however the major portion of the females in the study were housewives. Conclusions: This study showed that of the anaemic patients aged above 13 years old in the KNH; normocytic anaemia constituted 62% and is the commonest type of anaemia. The anaemia in the majority was of mild to moderate level. Females were more than males and the overall mean age was 37 and mode 32 years. The main occupation of the study cases were; housewives, and the unemployed while those employed were in the transport industry matatu and teachers being the majority and minority respectively.