Bolarinwa RA, Akinola NO, Aboderin OA, Durosinmi MA
About 2-3% of the over 100 million Nigerian population carries the homozygous HbS gene. Crises, especially vaso-occlusive crisis (VOC) remain an important cause of morbidity and often time mortality in this cohort. Sixty patients with HbSS and HbSC phenotype attending the haematology clinic of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife presenting with vaso-occlusive crisis over a 16 month-period were studied for the role of malaria infection in the development of vasoocclusion. Associated clinical features, full blood count, reticulocyte count, platelet count, percentage sickle cell count, and the malaria parasite density were also evaluated. Of those studied (52 HbSS and eight HbSC), sixty-five vaso-occlusive episodes were evaluated with moderate to severe pains in 51%. Malaria parasite was detectable in 55% of patients, with a mean malaria parasite density of 671parasites/µl (±1087; CI = 315.9-1026). Observed symptoms include fever (40%), jaundice (35.4%), headache (23.1%), and vomiting (13.8%). Severe anaemia occurred in 12.2% of patients, and malaria parasitaemia was found in 61% of patients with fever, 73.9% of patients with jaundice and 75% of patients with severe anaemia. Malaria parasite density did not correlate with the haematocrit level, platelet count, and total white cell count or with pain severity. Malaria infection is a significant cause of VOC in more than fifty percent of patients with sickle cell disease. It is associated with fever, and moderate to severe pains. In malaria endemic area, and in the context of sickle cell disease, acute malaria infection should be considered a medical emergency.
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