Hypofibrinolysis resulting from the up-regulation of plasminogen activator inhibitor-1 (PAI-1) usually occurs in patients with type 2 diabetes mellitus (T2DM), rendering them hypercoagulable. This ...study assessed the plasma antigen and activity levels of the PAI-1 enzyme in T2DM patients in a district hospital in Ghana.
This was a hospital-based case-control study conducted from December 2018 to May 2019 at Nkenkaasu District Hospital. Sixty subjects with T2DM (30 T2DM subjects with good glycemic control and 30 with poor glycemic control), and 30 apparently healthy blood donors were recruited into the study. Blood specimens were collected for complete blood count, lipid profile, PAI-1 Ag and PAI-1 activity levels. A pre-tested questionnaire was used to obtain demographic and clinical information. The data was analyzed using SPSS version 22.0.
Elevated PAI-1 Ag and activity levels were observed in the T2DM subjects compared to the healthy controls, with the levels and activity significantly higher (PAI-1 Ag; p< 0.001, PAI-1 activity level; p = 0.004) in the T2DM subjects with poor glycemic control in comparison to those with good glycemic control. A significant positive correlation was observed between HbA1c and PAI-1 enzymes. PAI-1 Ag levels significantly increased along with increased total cholesterol (Β = 0.262, p = 0.033), triglyceride (Β = -0.273, p = 0.034) and HbA1c (Β = 0.419, p = 0.001). Similarly, PAI-1 activity level was associated with total cholesterol (Β = 0.325, p = 0.009), triglyceride (Β = -0.262, p = 0.042), HbA1c (Β = 0.389, p = 0.003) and VLDL-c (Β = -0.227, p = 0.029).
PAI-1 antigen/activity is enhanced in poorly controlled Ghanaian T2DM subjects. The hypercoagulable state of the affected individuals put them at higher risk of developing cardiovascular diseases. Good glycemic control to regulate plasma PAI-1 levels is essential during T2DM lifelong management. Markers of fibrinolysis should be assessed in these individuals and appropriate anticoagulants given to prevent thrombosis and adverse cardiovascular diseases.
Anaemia in pregnancy is common in underdeveloped countries, and malaria remains the predominant cause of the condition in Ghana. Anti-erythropoietin (anti-EPO) antibody production may be implicated ...in the pathogenesis of Plasmodium falciparum malaria-related anaemia in pregnancy. This study ascertained the prevalence of anti-EPO antibody production and evaluated the antibodies' relationship with Plasmodium falciparum malaria and malaria-related anaemia in pregnancy.
This hospital-based case-control study recruited a total of 85 pregnant women (55 with Plasmodium falciparum malaria and 30 controls without malaria). Venous blood was taken from participants for thick and thin blood films for malaria parasite microscopy. Complete blood count (CBC) analyses were done using an automated haematology analyzer. Sandwich enzyme-linked immunosorbent assay (ELISA) was used to assess serum erythropoietin (EPO) levels and anti-EPO antibodies. Data were analyzed using IBM SPSS version 22.0.
Haemoglobin (p<0.001), RBC (p<0.001), HCT (p = 0.006) and platelet (p<0.001) were significantly lower among pregnant women infected with Plasmodium falciparum. Of the 85 participants, five (5.9%) had anti-EPO antibodies in their sera, and the prevalence of anti-EPO antibody production among the Plasmodium falciparum-infected pregnant women was 9.1%. Plasmodium falciparum-infected pregnant women with anti-EPO antibodies had lower Hb (p<0.001), RBC (p<0.001), and HCT (p<0.001), but higher EPO levels (p<0.001). Younger age (p = 0.013) and high parasite density (p = 0.004) were significantly associated with Plasmodium falciparum-related anti-EPO antibodies production in pregnancy. Also, younger age (p = 0.039) and anti-EPO antibody production (p = 0.012) related to the development of Plasmodium falciparum malaria anaemia in pregnancy.
The prevalence of anti-EPO antibodies among pregnant women with Plasmodium falciparum malaria was high. Plasmodium falciparum parasite density and younger age could stimulate the production of anti-EPO antibodies, and the antibodies may contribute to the development of malarial anaemia in pregnancy. Screening for anti-EPO antibodies should be considered in pregnant women with P. falciparum malaria.
Background and Aim
Impaired coagulation and fibrinolysis have been implicated in thromboembolism in human immunodeficiency virus (HIV)‐infected individuals. This study evaluated the plasma levels of ...plasminogen activator inhibitor‐1 (PAI‐1) and coagulation biomarkers in HIV‐infected individuals on highly active antiretroviral therapy (HAART).
Methods
This matched case‐control study from March to December, 2020 comprised 76 participants: 38 HIV‐positive individuals on HAART and 38 apparently healthy HIV‐negative individuals as controls. Blood samples were collected for prothrombin time (PT), activated partial thromboplastin time (aPTT), D‐dimers, PAI‐1, and soluble fibrin monomer complex (SFMC) estimations. The data were analysed using SPSS version 22.0 and statistical significance was set at p < 0.05.
Results
Activated partial thromboplastin time was significantly lower in HIV seropositive individuals on HAART compared with HIV seronegative controls (25.90 s vs. 29.0 s, p = 0.030); however, PT, SFMC, D‐dimers, and PAI‐1 were significantly higher among the HIV‐seropositive individuals compared with the controls: PT: (16.29 s ± 2.16 vs. 15.15 s ± 2.60, p = 0.010), SFMC: 8.53 ng/mL (8.03–9.12) vs. 7.84 ng/mL (7.32–8.58), p = 0.005), D‐Dimer: 463.37 ng/mL (402.70–526.33) vs. 421.11 ng/mL (341.11–462.52), p = 0.015, and PAI‐1: 12.77 ng/mL (10.63–14.65) vs. 11.27 ng/mL (10.08–12.95), p = 0.039. PAI‐1 showed a moderate positive correlation with D‐Dimer (r = 0.659, p < 0.001) and SFMC (r = 0.463, p = 0.003) among HIV‐positive individuals on HAART. There was a strong positive correlation between the plasma PAI‐1 concentration and the HIV viral load (r = 0.955, p < 0.001).
Conclusion
HIV‐seropositive individuals on HAART have deranged coagulation and fibrinolytic markers. Higher HIV viral load correlates strongly with elevated plasma levels of PAI‐1 antigens. Periodic assessment of markers of coagulation and fibrinolysis be included in the management of HIV/AIDS in Ghana.
Background Anaemia in pregnancy is common in underdeveloped countries, and malaria remains the predominant cause of the condition in Ghana. Anti-erythropoietin (anti-EPO) antibody production may be ...implicated in the pathogenesis of Plasmodium falciparum malaria-related anaemia in pregnancy. This study ascertained the prevalence of anti-EPO antibody production and evaluated the antibodies’ relationship with Plasmodium falciparum malaria and malaria-related anaemia in pregnancy. Methods This hospital-based case-control study recruited a total of 85 pregnant women (55 with Plasmodium falciparum malaria and 30 controls without malaria). Venous blood was taken from participants for thick and thin blood films for malaria parasite microscopy. Complete blood count (CBC) analyses were done using an automated haematology analyzer. Sandwich enzyme-linked immunosorbent assay (ELISA) was used to assess serum erythropoietin (EPO) levels and anti-EPO antibodies. Data were analyzed using IBM SPSS version 22.0. Results Haemoglobin (p<0.001), RBC (p<0.001), HCT (p = 0.006) and platelet (p<0.001) were significantly lower among pregnant women infected with Plasmodium falciparum. Of the 85 participants, five (5.9%) had anti-EPO antibodies in their sera, and the prevalence of anti-EPO antibody production among the Plasmodium falciparum-infected pregnant women was 9.1%. Plasmodium falciparum-infected pregnant women with anti-EPO antibodies had lower Hb (p<0.001), RBC (p<0.001), and HCT (p<0.001), but higher EPO levels (p<0.001). Younger age (p = 0.013) and high parasite density (p = 0.004) were significantly associated with Plasmodium falciparum-related anti-EPO antibodies production in pregnancy. Also, younger age (p = 0.039) and anti-EPO antibody production (p = 0.012) related to the development of Plasmodium falciparum malaria anaemia in pregnancy. Conclusion The prevalence of anti-EPO antibodies among pregnant women with Plasmodium falciparum malaria was high. Plasmodium falciparum parasite density and younger age could stimulate the production of anti-EPO antibodies, and the antibodies may contribute to the development of malarial anaemia in pregnancy. Screening for anti-EPO antibodies should be considered in pregnant women with P. falciparum malaria.
Background and Aims
Type 2 diabetes mellitus (T2DM) individuals are at a higher risk of developing diabetes complications, with approximately 80% complication‐related mortality. The increased ...morbidity and mortality among T2DM patients are partly due to dysregulated hemostasis. This study determined the quality of glycemic control in T2DM and its association with markers of coagulation and inhibitors of fibrinolysis.
Methods
This case–control study recruited 90 participants involving: 30 T2DM patients with good glycemic control, 30 with poor glycemic control, and 30 nondiabetic subjects as controls at a Municipal Hospital in Ghana. Fasting blood glucose, glycated hemoglobin, activated partial thromboplastin time (APTT), prothrombin time (PT), calculated international normalized ratio (INR), and full blood count (FBC) were determined for each respondent. Plasma levels of plasminogen activator inhibitor‐1 (PAI‐1) and thrombin activatable fibrinolysis inhibitor (TAFI) were determined using the solid‐phase sandwich enzyme‐linked immunosorbent assay method. Data were analyzed using R language software.
Results
Plasma PAI‐1 antigen levels were significantly higher in the participants with poor glycemic control as compared to participants with good glycemic control (p < 0.0001). There was no significant difference in plasma TAFI levels between the participants with poor glycemic control as compared to participants with good glycemic control (p = 0.900). T2DM patients had significantly shorter APTT, PT, and INR than controls (p < 0.05). At a cut‐off of ≥161.70 pg/μL, PAI was independently associated with increasing odds (adjusted odds ratio = 13.71, 95% confidence interval: 3.67–51.26, p < 0.0001) of poor glycemic control and showed the best diagnostic accuracy for poor glycemic control (area under the curve = 0.85, p < 0.0001).
Conclusion
PAI‐1 levels were significantly increased in T2DM with poor glycemic control and emerged as the best predictor for poor glycemic control. Good glycemic management to control the plasma levels of PAI‐1 is required to prevent hypercoagulability and thrombotic disorders.
Blood cell abnormalities may occur among COVID-19 patients and could be detrimental during the disease’s progression. This study assessed complete blood count (CBC) parameters and determined abnormal ...changes in the peripheral blood of COVID-19 patients receiving care at Komfo Anokye Teaching Hospital (KATH), Ghana. This hospital-based descriptive cross-sectional study conducted at KATH, Kumasi, Ghana, recruited seventy-three (73) RT-PCR-confirmed COVID-19 participants. Venous blood was taken from participants into EDTA tubes and used for CBC analyses and the preparation of a thin blood film for blood cell morphological examination. Data obtained were analyzed with SPSS version 22.0, and p< 0.05 was considered statistically significant. Females were predominant (45/61.6) and had a higher COVID-19 cycle threshold (CT) value than males (p=0.027). The overall prevalence of anaemia among the study participants was 56.2% (65.5% in males and 50% in females). Geriatrics (>70 years old) had relatively lower Hb compared to other age groups in the study. Erythrocytopaenia (18/73), leucocytosis (28/73), lymphopaenia (9/73), and thrombocytopaenia (21/73) were common among the COVID-19 participants. Red cell morphological abnormalities were seen in the study participants: echinocytes (11/73), elliptocytes (6/73), stomatocytes (1/73), acanthocytes (4/73), pencil-shaped cells (5/73), schistocytes (15/73), ovalocytes (2/73) and target cells (1/73). Moreover, the acanthocytes were significantly higher in males compared to females (4 vs. 0, p=0.019). Again, reactive lymphocytes (8/73), neutrophil toxic granulation (18/73), neutrophil cytoplasmic vacuolation (42/73), smear cells (8/73), and one each of atypical lymphocyte and Dohle body were present among the COVID-19 participants. The COVID-19 CT value was lower among male participants. The overall prevalence of anaemia among COVID-19 participants was high, with males and the aged (>70 years) predominantly affected. COVID-19 patients have abnormal blood cell counts and significant morphological abnormalities in peripheral blood. Early detection of haematological abnormalities would be beneficial in the management of COVID-19 patients. Further study to assess the haematopoietic activities of COVID-19 patients is recommended. Doi: 10.28991/SciMedJ-2023-05-01-02 Full Text: PDF
Background: The ABO blood antigens may influence the levels of vWF: Ag and put individuals at risk of coagulopathies. This study assessed the plasma vWF: Ag and its relation with ABO blood antigens ...among healthy adults in northern Ghana. Methods: This cross-sectional study recruited 84 blood donors, aged 18–50 years, at Tamale Teaching Hospital. Blood groups were determined using the standard tube method, and a complete blood count was measured with an automated haematology analyzer. Sandwich ELISA was used to assess plasma vWF: Ag levels. The data obtained were analyzed using SPSS version 22. Results: The frequencies of O, A, B, and AB blood groups were 34 (40.5%), 25 (29.8%), 20 (23.8%), and 5 (6.0%), respectively. vWF: Ag levels were higher among the non-O than group O individuals (p = 0.008). Plasma vWF: Ag levels were lower in group O compared to AB (p = 0.015) and A (p = 0.013) individuals. Males had higher vWF: Ag levels than females (p = 0.002). A moderately positive correlation was observed between age and vWF levels (r = 0.497, p<0.001). Blood group O participants had lower absolute neutrophil counts (p = 0.039), but higher RDW-SD (p = 0.045). Conclusion: The predominant blood group was O, followed by other groups in the order: O>A>B>AB. Plasma vWF: Ag levels were higher in non-group O compared with group O individuals. Males had higher vWF: Ag levels, and a positive correlation between age and vWF: Ag was observed. Again, blood group O participants had lower neutrophil counts, but higher RDW-SD. The relationship between ABO blood phenotypes and plasma vWF: Ag should be considered in clinical practice. The establishment of separate reference intervals of vWF: Ag for the various phenotypes of ABO is recommended. Also, the study recommends further multicenter studies to assess the link between ABO phenotypes and all the endothelial cell parameters. Doi: 10.28991/SciMedJ-2022-04-02-02 Full Text: PDF
Introduction: The burden of hernia is disproportionately high in low-to-middle-income countries, due to the lack of fundamental resources needed to effectively diagnose and manage cases. The patterns ...of hernia, the haematological profile, and the predictive ability of blood cell indices were all investigated in this study. Methods: Fifty-four subjects: 27 hernia patients and 27 healthy controls were included in this single-centre, unmatched case-control study. Hernia was diagnosed using physical examination and ultrasound scan. Haematological indices of each subject were measured with an automated blood cell counter. Results: Herniae recorded were 92.59% inguinal, and 3.27% each epigastric and uterine prolapse. Hernia was prevalent in males (85.2%, p=0.008) and older subjects ≥53 years (48.1%, p=0.004). HgB (p=0.006), MCHC (p≤0.001), and RDW-CV (p=0.042) levels were significantly elevated in strangulated than non-strangulated hernia and controls respectively, while Abs GRAN (p=0.024) was decreased in non-strangulated than strangulated hernia and control groups respectively. MCHC (AUC=0.947 0.895-0.999, p≤0.001) was the most sensitive predictor for herniation followed by age (AUC=0.750 0.610-0.889, p=0.002); HgB (AUC=0.718 0.580-0.857, p=0.006); and RDW-CV (AUC=0.700 0.559-0.840, p=0.012). Also, MCHC (AUC=0.831 0.723-0.938, p≤0.001); HgB (AUC=0.738 0.590-0.887, p=0.005); and RBC (AUC=0.671 0.502-0.840, p=0.045) respectively, were significant predictors of strangulation. Conclusion: Gender and age were significantly associated with hernias. Inguinal hernia and strangulation were common in the study setting, especially, among males. Also, there were significant variations in erythrocyte- and leucocyte indices across the groups, but not platelets. Erythrocyte indices were significant predictive biomarkers for hernia and strangulation. The CBC is a useful test for the early detection of herniation and strangulation. Doi: 10.28991/SciMedJ-2022-0401-1 Full Text: PDF
Background: The study evaluated the effects of regular blood donation on serum transferrin and soluble transferrin receptor levels at Wenchi Methodist Hospital. Methods: This was a hospital-based ...cross-sectional study conducted at the Medical Laboratory Department of the Wenchi Methodist Hospital in the Bono Region of Ghana. A total of eighty-nine (89) venous blood samples from apparently healthy blood donors were analyzed. Complete blood count parameters were analyzed using an automated haematology analyzer and serum transferrin and transferrin receptor using ELISA. The data were analyzed using SPSS version 22.0. Results: Haemoglobin (p<0.001) and HCT (p=0.004) were significantly lower among the regular blood donors compared with the first-time donors. Regular blood donors had relatively higher serum transferrin (p<0.001) and soluble transferrin receptor levels (p<0.001). A negative correlation was observed between Hb and serum transferrin (r=-0.552, p<0.001), as well as Hb and serum soluble transferrin receptor (r=-0.552, p<0.001). Remunerated donors had lower Hb (p=0.001) and HCT% (p=0.001) but a higher transferrin receptor (p=0.041) than non-remunerated donors. Conclusion: Regular blood donors had relatively lower erythrocyte parameters but higher serum transferrin and soluble transferrin receptors, indicating a possible reduction in serum iron and iron stores. Moderate negative correlations exist between Hb and both transferrin and soluble transferrin receptors. Again, remunerated donors had lower erythrocyte parameters but higher transferrin and soluble transferrin receptors than non-remunerated donors. Periodic assessment of iron parameters among regular blood donors is recommended. A future longitudinal study to assess the entire iron profile of regular blood donors is recommended. Doi: 10.28991/SciMedJ-2022-04-03-01 Full Text: PDF
Individuals with COVID-19 experience thrombotic events probably due to the associated hypofibrinolysis resulting from the upregulation of plasminogen activator inhibitor-1 (PAI-1) antigen. This study ...evaluated plasma PAI-1 antigen levels and haematological parameters before treatment and after recovery from severe COVID-19 in Ghana.
This cross-sectional study was conducted at Sunyani Regional Hospital, and recruited 51 patients who had RT-PCR-confirmed SARS-CoV-2. Participants' sociodemographic data and clinical characteristics were taken from the hospital records. Venous blood was taken before COVID-19 treatment commenced for FBC, PAI-1 and ferritin assays. FBC was assessed using an automated haematology analyzer, whilst plasma PAI-1 Ag and serum ferritin levels were assessed with sandwich ELISA. All the tests were repeated immediately after participants recovered from COVID-19.
Of the 51 participants recruited into the study, 78.4% (40) had non-severe COVID-19 whiles 21.6% (11) experienced a severe form of the disease. Severe COVID-19 participants had significantly lower haemoglobin (g/dL): 8.1 (7.3-8.4) vs 11.8 (11.0-12.5), p<0.001; RBC x 1012/L: 2.9 (2.6-3.1) vs 3.4 (3.1-4.3), p = 0.001; HCT%: 24.8 ± 2.6 vs 35.3 ± 6.7, p<0.001 and platelet x 109/L: 86.4 (62.2-91.8) vs 165.5 (115.1-210.3), p<0.001, compared with the non-severe COVID-19 group. But WBC x 109/L: 11.6 (9.9-14.2) vs 5.4 (3.7-6.6), p<0.001 and ferritin (ng/mL): 473.1 (428.3-496.0) vs 336.2 (249.9-386.5), p<0.001, were relatively higher in the participants with severe COVID-19 than the non-severe COVID-19 counterparts. Also, the severely ill SARS-CoV-2-infected participants had relatively higher plasma PAI-1 Ag levels (ng/mL): 131.1 (128.7-131.9) vs 101.3 (92.0-116.8), p<0.001, than those with the non-severe form of the disease. Participants had lower haemoglobin (g/dL): 11.4 (8.8-12.3 vs 12.4 (11.5-13.6), p<0.001; RBC x 1012/L: 3.3 (2.9-4.0) vs 4.3 (3.4-4.6), p = 0.001; absolute granulocyte count x 109/L: 2.3 ± 1.0 vs 4.6 ± 1.8, p<0.001, and platelet x 109/L: 135.0 (107.0-193.0) vs 229.0 (166.0-270.0), p<0.001 values at admission before treatment commenced, compared to when they recovered from the disease. Additionally, the median PAI-1 Ag (ng/mL): 89.6 (74.9-100.8) vs 103.1 (93.2-128.7), p<0.001 and ferritin (ng/mL): 242.2 (197.1-302.1) vs 362.3 (273.1-399.9), p<0.001 levels were reduced after a successful recovery from COVID-19 compared to the values at admission.
Plasma PAI-1 Ag level was higher among severe COVID-19 participants. The COVID-19-associated inflammation could affect red blood cell parameters and platelets. Successful recovery from COVID-19, with reduced inflammatory response as observed in the decline of serum ferritin levels restores the haematological parameters. Plasma levels of PAI-1 should be assessed during the management of severe COVID-19 in Ghana. This will enhance the early detection of probable thrombotic events and prompts Physicians to provide interventions to prevent thrombotic complications associated with COVID-19.
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