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OBJECTIVE: To determine whether or not pre-donation testing of blood donors affords substantial cost savings without compromise to blood transfusion safety. Pre-donation testing of blood donors for Transfusion Transmissible Infections (TTIs) is done in most developing countries because substantial cost savings are made from resources, materials and man-hours which would have been spent to procure infected blood units. Simple rapid test kits used in pre-donation testing is not as sensitive as the Enzyme Linked Immuno-sorbent Assay (ELISA) method used in post-donation screening in a quality assured manner. DESIGN: It is a retrospective study where records of pre- and post-donation tests done in donor clinic of University of Ilorin Teaching Hospital, between January and December 2010 were retrieved. All processes and inputs were evaluated and costs calculated for pre-donation testing by simple rapid techniques and post donation screening by ELISA. RESULTS: 5000 prospective donors were tested in the study period. The cost of single rapid Pre-donation testing was less than that of single ELISA Post-donation screen. The cost of double rapid Pre-donation and Post donation ELISA screen exceeded the cost of single post donation ELISA screen. Substantial cost savings were made when single rapid Pre-donation testing is relied on. More blood units were found reactive for the TTIs with the more expensive Post-donation ELISA. CONCLUSION: Pre-donation testing of blood donors was not cost effective. Although, there is an apparent savings if pre-donation testing is not followed by post-donation ELISA testing, it is done at a compromise to blood transfusion safety.

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Objective: To determine whether or not pre-donation testing of blood donors affords substantial cost savings without compromise to blood transfusion safety. Predonation testing of blood donors for Transfusion Transmissible Infections (TTIs) is done in most developing countries because substantial cost savings are made from resources; materials and man-hours which would have been spent to procure infected blood units. Simple rapid test kits used in pre-donation testing is not as sensitive as the Enzyme Linked Immuno-sorbent Assay (ELISA) method used in post-donation screening in a quality assured manner. Design: It is a retrospective study where records of pre- and post-donation tests done in donor clinic of University of Ilorin Teaching Hospital; between January and December 2010 were retrieved. All processes and inputs were evaluated and costs calculated for predonation testing by simple rapid techniques and post donation screening by ELISA. Results: 5000 prospective donors were tested in the study period. The cost of single rapid Pre-donation testing was less than that of single ELISA Postdonation screen. The cost of double rapid Pre-donation and Post donation ELISA screen exceeded the cost of single post donation ELISA screen. Substantial cost savings were made when single rapid Pre-donation testing is relied on. More blood units were found reactive for the TTIs with the more expensive Postdonation ELISA. Conclusion: Pre-donation testing of blood donors was not cost effective. Although; there is an apparent savings if pre-donation testing is not followed by postdonation ELISA testing; it is done at a compromise to blood transfusion safety

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In many developing countries where hepatitis B is endemic, positivity rate for HBsAg in donor blood is high, and in some places, up to 20% of donated blood has to be discarded for being HBsAg positive. This degree of wastage may be financially crippling for some developing countries. Pre-donation testing may be useful, so that donors who test HBsAg positive are deferred and wastage of costly blood bags is reduced. The study is to evaluate the suitability of the AMRAD kit, for pre-donation testing for HBsAg. One hundred and one (101) healthy blood donors were screened for HBsAg/eAg using the test kit. The same specimens were screened using Monolisa (ELISA) kits for HBsAg and eAg as the standard. True positive (TrP), False negative (FN), True negative (TrN) and, false positive (FP) values were then found, from which, sensitivity and specificity, were derived. The AMRAD test kit detected 93 specimens as negative and 8 specimens as positive for HBsAg as against 94 negatives (TrN) and 7 positives (TrP) by monolisa. Thus, one false positive (FP) result was found in using the kit while no false negative (FN) occurred. The findings in this preliminary study suggest that AMRAD kit may be a useful predonation screening test for HBsAg.

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OBJECTIVE: To document the clinical and haematological features of chronic lymphocytic leukaemia (CLL) in Central Africans. DESIGN: Prospective descriptive analysis. SETTING: Tertiary referral teaching hospitals. SUBJECTS: 48 Zimbabweans and 27 Malawians formed the basis of this analysis. RESULTS: There were 75 patients (40 males and 35 females) studied and their ages ranged from 32 to 78 years with a mean +/- s.d. of 56.8 +/- 10.1 years. The peak age incidence of 26.7% occurred between 60 to 64 year old and 21.3% were below 50 years. The major clinical findings included: splenomegaly (68%); hepatomegaly (37.3%); anaemia (34.7%); lymphadenopathy (33.3%) and nine (12%) patients were diagnosed incidentally. The majority of patients (78.7%) had Rai stage III and IV and only seven (9.3%) patients were in stage 0. Of the 32 patients treated with chemotherapy, 25.9% and 59.3% achieved complete or partial remissions respectively. Six patients were still alive after a follow up period of a mean +/- s.d of 39.3 +/- 24.4 months; five were lost to follow up after a mean +/- s.d period of 28.6 +/- 18.8 months and 16 were dead after a mean +/- s.d. period of 25.7 +/- 19.1 months. The main causes of death in the treated group were septicaemia in six, pneumonia in four and tuberculosis in three. In the untreated group of 43 patients, two refused therapy, four died shortly after diagnosis and 37 were lost to follow up. CONCLUSIONS AND RECOMMENDATIONS: Although the study has disclosed that CLL is not rare in central Africans and its presentations are similar to cases reported in the literature, the majority of patients seek medical treatment late. Optimal therapy is impossible due to lack of chemotherapy and supportive services..Therefore, it is recommended that tertiary referral centers in African health systems should be equipped for better management of CLL patients.

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OBJECTIVES: To document the pattern of presenting clinical and haematological features of chronic myeloid leukaemia (CML) in central Africans and evaluate the clinical consequences of treating the disease with chemotherapy. DESIGN: Prospective descriptive analysis of clinical and haematological data. SETTING: Departments of Haematology of tertiary referral centres and teaching hospitals. MATERIALS AND METHODS: Prospective clinical and haematological data were collected on 150 central Africans (90 Zimbabweans and 60 Malawians) using modern Coulter counters and standard up-to-date haematological procedures and the results analysed using predetermined criteria and the top-desk Scientific Calculator Model HP 48GX, Texas Instruments, USA. RESULTS: There were 150 CML patients studied. Males predominated in a ratio of 1:5:1. The youngest patient was 10 years and the oldest 77 years with a mean +/- s.d. of 38.9 +/- 14.7 years. The peak age incidence of 47.3% occurred between 21 to 40 years. The Ph chromosome was found in 19 of the 20 patients studied. Although complaints attributed to splenic enlargement were the most common symptoms, several unusual clinical features were encountered viz: hepatomegaly (26%), bleeding (12%), significant lymphadenopathy (11.3%), purpura (3.3%), skin infiltration (2.7%), cardiac failure (2.7%) and 14.7% were diagnosed incidentally. Symptoms such as fatigue, headaches and weight loss were associated with greater degrees of leucocytosis, severe to gross splenomegaly and lower haemoglobin levels. The severe to gross splenomegaly which occurred in 68(45.3%) suggests that patients in this part of the world seek medical advice rather late in the disease. The median survival times of 65,47 and 39 months respectively for alpha interferon, hydroxyurea and busulphan are in agreement with those of previous larger series from other parts of the world. CONCLUSIONS: The study has revealed that the presenting pattern of clinical and haematological features of CML is changing probably due to the advent of modern clinical practice coupled with increased physician density, greater awareness of disease among clinicians besides other reasons. However, optimal treatment is not possible for the majority of patients due to lack of chemotherapeutic agents and supportive care. RECOMMENDATION: Referral centres in African health systems should be equipped for better management of CML patients.

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Race is thought to be one of the factors determining the level of ABO antibodies. The objective of this study was to compare the haemolytic activity of anti-A and anti-B in two racial groups, Black and White Zimbabweans, living under similar conditions. Serum haemolytic activity was assessed by comparing spectrophotometrically, released haemoglobin when known A1 and B red cells were incubated in equal volumes of subjects' serum and water. Serum from Black subjects showed greater haemolytic activity of anti-A and anti-B than serum from White subjects. Within each racial group, anti-B showed greater haemolytic activity than anti-A. Race may be an important factor in the haemolytic activity of ABO antibodies.

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OBJECTIVES: To determine the patterns of leukaemias seen in Malawians at Queen Elizabeth Central Hospital (QECH) and to compare the findings with those from elsewhere. An overview of the problems encountered in the management of leukaemia in developing countries especially those in sub-Saharan Africa are highlighted. DESIGN: Retrospective descriptive analysis of consecutive leukaemia cases seen from January 1994 through December 1998. RESULTS: Of the 95 leukaemia patients diagnosed during the study period, childhood (0-15 years) leukaemia occurred in 27 (28.4%) patients while adulthood (above 15 years) leukaemia accounted for 68 (71.6%) patients. The main leukaemia types were: acute lymphoblastic leukaemia (ALL) 14 (14.7%), acute myeloblastic leukaemia (AML) 25 (26.3%), chronic myeloid (granulocytic) leukaemia (CML) 32 (33.7%), chronic lymphocytic (lymphatic) leukaemia (CLL) 22 (23.2%) and hairy cell leukaemia (HCL) two (2.1%) patients. Most of the acute leukaemia (AL) cases occurred in the six to 15 year age bracket with a male preponderance. In ALL, lymphadenopathy was the commonest presenting feature followed by pallor (92.9%) while in the AML group, pallor occurred in 80% of cases. Abdominal swelling (87.5%) due to splenomegaly (81.3%) were the main clinical features in the CML group whereas lymphadenopathy (63.6%) followed by splenomegaly (59.1%) were the dominant presenting features in CLL. Haematologically, although leucocytosis characterised both acute and chronic leukaemias, most cases of acute leukaemia presented with more severe anaemia (Hb < 7 g/dl) and marked thrombocytopenia (Platelet count < 50 x 10(9)/l) than the chronic leukaemias. CONCLUSIONS AND RECOMMENDATIONS: The study shows that leukaemias are not rare in Malawi and cases which were diagnosed in this series probably only represent the tip of the iceberg. While there is need to increase diagnostic awareness among clinicians and laboratory staff, the severe chronic shortage of cytotoxic drugs and lack of supportive care facilities commonly encountered in developing countries should be realistically addressed through cost-sharing, cost recovery, adequate government subvention and donations from charitable organisations.

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Six hundred and ten new graduates of Nigerian tertiary institutions were studied for their knowledge of and attitude to sickle cell disorders. A questionnaire was administered to assess knowledge and attitudes. Then a two-hour educational seminar on the basic genetics, transmission, and implications for the affected individuals and their families, of sickle cell disease (SCD) and carrier states was conducted. Sickle carrier screening was undertaken by cellulose acetate haemoglobin electrophoresis. A sickle carrier frequency of 21.6% was found and the questionnaires revealed severely deficient knowledge of the transmission of SCD among the 20-32 year old graduates. After the seminar there was eagerness among the graduates to know their sickle status. It is concluded that unmarried youths in, or graduating from, higher educational institutions may be a most suitable target for information, carrier detection and genetic counselling in the prevention and control of sickle cell disorders.

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OBJECTIVES: To document the current pattern of packed red cell (PC) usage and the crossmatch to transfusion ratio (C/T ratio) in a major city teaching hospital in Harare, Zimbabwe. DESIGN: Restropective, (audit). SETTING: Harare Central Hospital, a 1,200 bed multidisciplinary hospital located in Harare, Zimbabwe. MAIN OUTCOME MEASURES: Amount of PC ordered and proportion collected for the year 1995. Quantity of PC used by different medical specialties. RESULTS: In 1995 a total of 8,292 PC were collected from Harare Hospital blood bank. This translates to an average PC usage for a 1,200 bed hospital of seven units per hospital bed per year. Only 48.5% of PC crossmatched was collected with a C/T ratio of 2.1:1. Revenue loss of Z$478,434 is estimated to have occurred due to expired units and resource wastage from uncollected crossmatched units. The largest consumer of PC was the Department of Gynaecology, followed by Surgery and Paediatrics. CONCLUSION: Regular auditing of blood usage is recommended to promote the efficient use of PC in accordance with accepted international standards and local guidelines and practice.

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OBJECTIVE: To describe the haematologic features of the HIV infection in adult Zimbabweans and compare the features in the different clinical stages of the disease. DESIGN: Descriptive cross sectional study. SETTING: Parirenyatwa Hospital, a tertiary and referral medical centre in Harare, and the blood donor clinics of the Blood Transfusion Service in Harare. SUBJECTS: Patients attending HIV outpatients clinics or receiving inpatient care at Parirenyatwa Hospital and asymptomatic persons donating blood at the BTS Harare. MAIN OUTCOME MEASURES: Full blood counts and bone marrow cell counts and morphology. RESULTS: Blood cytopenia was found in 47.5% of adults with HIV infection. The most frequent abnormalities were lymphopenia (31.5%); anaemia (30.8%); neutropenia (29.6%); thrombocytopenia (24.7%); eosinophilia (23.5%) and leucopenia (11.7%). Frequency of anaemia in the AIDS and symptomatic groups (43.4% and 24.5% respectively) was greater than in the carriers (6.7%), while the frequency of other cytopenias and of eosinophilia was about the same in all groups. There was also a general lack of association between the severity of haematologic abnormalities and the clinical stage of the disease. CONCLUSION: Severe haematologic changes occur frequently in HIV infection and AIDS but routine full blood count may not be helpful in the monitoring of the disease or the prediction of onset of AIDS.

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OBJECTIVE: To determine the prevalence of HBsAg among blood donors in Ilorin, in the middle belt area of Nigeria. DESIGN: Cross sectional. SETTING: University of Ilorin Teaching Hospital. SUBJECTS: 100 patients from antenatal clinic, 100 patients from STD clinic and 295 healthy blood donors from UITH. MAIN OUTCOME MEASURES: Prevalence of HBsAg. RESULTS: One hundred and sixteen (23.4pc) of the subjects were positive for HBsAg. These included 16pc of ANC patients, 36pc of STD patients and 21.7pc of blood donors. The positivity rate among STD patients was significantly higher than among ANC patients (p < 0.01) and blood donors (p < 0.01). The positivity rate among patients above 34 years of age was higher than in those of 15 to 34 years. CONCLUSION: The above positivity rates are higher than those previously reported in Nigeria and may indicate increasing prevalence. The highest rate found among STD clinic patients may have identified them as a reservoir group to which control programmes need to be targeted.

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OBJECTIVE: To review haemophilia care in Zimbabwe. DESIGN: Retrospective study. SETTING: Cases seen in both central hospitals and health centres in Harare. MAIN OUTCOME MEASURES: Home treatment hospital admission and HIV seroconversion. RESULTS: Of the expected 500 haemophilicacs in a Zimbabwean male population of five million, only 190 had been registered by mid 1993. Home treatment is effective. CONCLUSION: Haemophilia care in Zimbabwe has a good foundation. Home care is effective and needs to be expanded simultaneously with health education for the cases.

PIP: A retrospective study was conducted to evaluate the status of hemophilia care in Zimbabwe. Parirenyatwa Hospital in Harare has the only hemophilia clinic in Zimbabwe. This monthly clinic facilitates diagnosis, registration, and long-term management of hemophilia. In mid 1993, there were 190 registered hemophilia cases in Zimbabwe. During 1991-1993, only 70 patients were seen more than once in the clinic. The National Blood Transfusion Service (NTSB) supplies blood products for hemophiliacs. Solvent-detergent treated Factor VIII and IX (FVIII and FIX, respectively) concentrates are imported from South Africa. They are the most common blood products used in Harare. Laboratory staff screen fresh frozen plasma and cryoprecipitate for HIV antibody and hepatitis B surface antigen. Five NTSB branches also distribute blood products. Blood products are expensive. Most hemophiliacs are covered by a social welfare program. 45 hemophiliac cases had been receiving home care since 1987. 67% of 24 home care patients receiving FVIII did not store FVIII packs in a refrigerator. Most home care patients injected blood products 0-6 hours from onset of symptoms (e.g., nosebleed). About 33% did not know how to calculate the dose required. All home care patients were satisfied with treatment. In 1992, Parirenyatwa Hospital registered 3 deaths of hemophiliacs. When considering only the 70 regular clinic attenders, the mortality rate for 1992 was 5.7%. Of the 73 hemophiliac cases tested for HIV infection, 32% tested positive. All HIV-positive hemophiliac cases began treatment for hemophilia before 1986, the year before HIV testing of hemophiliacs started. So far, about 33% of hemophiliacs tested positive for hepatitis C. The only social support system for hemophiliacs is the Zimbabwe Hemophilia Association. None of the 38 hemophiliacs screened for coagulation factor inhibitors had any inhibitors. Hemophilia care in Zimbabwe has a good start and can be used as a model for other developing countries. Expansion and close supervision of the effective home treatment program is advised.

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Studies in Southern Africa have shown that whites have significantly greater morbidity and mortality from coronary heart disease than blacks. This study investigated the distribution of some haemostatic variables known or suspected to be correlated with greater risk for coronary heart disease in healthy black and white Zimbabwean men. Factor VII, antithrombin III, leukocyte and platelet counts were measured in 56 blacks and 29 whites aged between 20 and 50 years. We found significantly greater factor VII and leukocyte counts in the whites compared to the blacks. The other variables measured were similar in the two ethnic groups. These results suggest that the greater prevalence of coronary heart disease in whites is consistent with high levels of factor VII and white blood cell counts previously identified as risk factors for this condition.

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The sickle haemoglobin gene (Bs gene) frequency in Zimbabwe was determined by haemoglobin electrophoresis of cord blood samples in a discontinuous alkaline buffer system on cellulose acetate strips. Samples were collected from different regions of the country including malaria-endemic and malaria-free areas and, predominantly Shona and Ndebele speaking areas respectively. 868 samples were analysed and the Bs gene frequency at birth was found to be 0.012. This value was lower than expected probably due to the peculiar topography of Zimbabwe. There was no significant difference in haemoglobin genotype distribution between malarious and non-malarious areas and between ethnic regions. The only exception was for haemoglobin Barts of which there seemed to be an excess in an area of predominantly Ndebele-speaking people.

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Sera from young, black, group 0 Zimbabwean blood donors were screened for anti-A and anti-B haemolysins. Nearly one fifth of the sera were found to be strongly haemolytic for either A or B cells or both. Some of the sera were titrated for agglutination in saline before and after treatment with dithiothreitol. Serum dilutions beyond the endpoint of agglutination were further tested by the indirect antiglobulin technique using specific anti-IgM and anti-IgG sera. More than 60% of the strongly lytic sera had high titres of IgG (> or = 64). The IgM and IgG concentrations both of anti-A and anti-B were correlated and these levels were in turn correlated with haemolytic activity.

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Plasma fibrinogen levels, leucocytes and platelets are among the many factors known to influence haemostasis. Impaired haemostatic processes in hypertension are thought to contribute to the other cardiovascular diseases seen in this condition. This study compares the level of plasma fibrinogen, and leucocyte and platelet counts between 17 male hypertensives and 24 male normotensives. The results for the hypertensives were: leucocyte count mean 5.45 x 10(9)/L, platelet count mean 234.7 x 10(9)/L, and plasma fibrinogen 4.13 g/L. The results for the normotensives were: leucocyte count mean 4.83 x 10(9)/L, platelet count mean 222.9 x 10(9)/L, and plasma fibrinogen 3.27 g/L. The hypertensives had higher plasma fibrinogen levels, and leucocyte and platelet counts compared to the normotensives, but this only reached statistical significance for the plasma fibrinogen levels (p < 0.025).

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Disorders of both coagulation and fibrinolysis contribute to the development of cardiovascular diseases such as coronary artery disease, essential hypertension, ischaemic stroke and deep vein thrombosis. Different ethnic groups, in particular Blacks, Whites and Asians have different prevalences for the above diseases. Comparisons of these haemostatic processes in different ethnic groups have contributed greatly to the understanding of the pathogenesis of many of these diseases. Such studies, in particular those conducted in Africa, are reviewed below.

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The current prevalence of anaemia was determined among children in the age group half to fourteen years in one urban and two rural communities in the middle belt region of Nigeria. A total of 1,775 apparently healthy and 660 sick children were investigated using capillary packed cell volume, PCV, as the diagnostic index. Packed cell volume of healthy children was found to vary between 23 pc and 48 pc. The mean PCV for the whole group was 35.90 pc but the relatively better economic and educational status of urban elite children was reflected in the higher PCV levels. Using the WHO recommended cut-off values for anaemia in children, prevalence of anaemia in the healthy children study was found to be 35.8 pc. When compared with figures recorded in Nigerian children in earlier studies, this finding represents a deterioration and occurs at a time of declining national economy. There were significant differences between groups when classified by age and socio-economic status, with the highest prevalence of 55 pc being found in the rural school-age group and the lowest of 20 pc in the economically better-off urban pre-school children. The overall prevalence of anaemia among sick children was 55 pc with the school age group having the worst value of 70 pc. In most cases, the anaemia was associated with nutritional and infectious conditions.

PIP: The prevalence of anaemia was determined among children aged 6 months to 14 years in one urban and two rural communities in Kwara State, an area within the middle belt of Nigeria. 1775 apparently healthy and 660 sick children who reported ill at Rural Health Centers or at a district hospital were investigated using capillary packed cell volume (PCV) for diagnosis determined by the microhaematocrit centrifugation method. PCV of healthy children varied from 23 to 48%. The mean PCV for the whole group was 35.90%, but the children of the urban elite had a mean PCV of 36.4% while rural children had a mean PCV of 34.5%. There was a general rise of PCV with age. According to analysis of variance (ANOVA) and Duncan grouping, 1 tier comprised children aged 6 months to 2 years with a mean PCV of 33.90 +or- 3.53% while the 2nd tier included children who were aged 2 to 6-7 years with a mean PCV of 35.60 +or- 3.63% +or- 3.83%. The difference between the first group and the other two groups was statistically significant (p .05), while the difference between the pre school and school-age groups was not. Using the WHO recommended cut-off values for anaemia in children, prevalence of anaemia in healthy children was 35.8%, a deterioration when compared with earlier studies. The anaemia prevalence was 28.0% for the 1st group, and 24.0% for pre school, and 40.4% for school-age groups, respectively. There were significant differences between groups: the highest prevalence (55%) was found in the rural school-age group and the lowest (20%) in the economically better-off urban pre school children. The overall prevalence of anaemia among sick children was 55%, and the school age group had the worst value of 70%. In contrast tot he healthy children (mean PCV 35.90%), the sick children had a mean PCV of 31.70 +or- 6.95%. The prevalence of anaemia in the group of sick children was 55.7%.

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Changes in filterability during 28-day bloodbank storage of normal, sickle trait, and sickle cell anaemia red cells were investigated. The technique used involved constant positive-pressure filtration of red cell-saline suspensions through cellulose nitrate membrane filters of 8-microns pore size for 2 min. Erythrocyte filtration rate was expressed as the number of red cells filtered per minute; calculated from the volume and red cell count of the filtrates. This was a departure from the commonly used filtrate volume measurements alone, and seemed to permit a clearer definition of changes in filterability during storage of red cells. It was found that changes in filterability during storage followed an exponential pattern for normal and sickle trait red cells but not for sickle cell anaemia cells. Filterability is known to correlate well with deformability which in turn is an important determinant of in-vivo survival of red cells. It may therefore be concluded that sickle trait red cells do not manifest any peculiar deformability or other changes during storage which might affect their post-transfusion in-vivo survival more adversely than normal red cells.

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