Prevalence and Factors Associated With Pulmonary Hypertension in Sickle Cell Anemia Patients Attending Outpatient Clinic at Bugando Medical Centre, Mwanza, Tanzania
- Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : 2019
- xiv; 68 Pages Includes References and Appendices
Abstract:
Background: The greatest burden of sickle cell anemia is in sub-Saharan Africa (SSA) with 75% of the 300,000 global births of affected children. The World Health Organization estimates 70% of sickle cell anemia deaths in Africa are preventable with simple, cost-effective interventions such as early diagnosis and the subsequent provision of comprehensive care. Pulmonary hypertension is now recognized to be a common complication in sickle cell anemia and associated with increased morbidity and mortality. Recurrent hemolytic, vaso-occlusive crises, chest syndrome and aging are among the associated factors of pulmonary hypertension in sickle cell anemia patients. Cardiac catheterization is the gold standard for the diagnosis of pulmonary hypertension; however, it is not available in most health care in sub-Saharan Africa and many other parts of the developing world. Doppler echocardiography is an excellent validated screening tool for pulmonary hypertension and associated right heart dysfunction.
Objectives: To determine the prevalence and factors associated with pulmonary hypertension in sickle cell anemia patients aged twelve years and above attending Bugando hospital in Mwanza - Northwestern Tanzania.
Methodology: A cross-sectional study was conducted. Clinical history for symptoms and physical examination for pulmonary hypertension were performed. Full blood picture, echocardiography, and NT-pro-brain natriuretic peptide were performed.
Results: A total of 171 sickle cell anemia patients were included in the final analysis with the median (IQR) age of 14 (13-17), females formed majority 94(54.97%) of the study participants. The prevalence of pulmonary hypertension was 11.11% and was significantly associated with; increase in age [OR=7.9 (2.21-28.25)] and a loud second heart sound [OR=47.32(6.74-332.14) p<0.001].
Conclusion: Pulmonary hypertension is an alarming complication among sickle cell anemia patients with a prevalence of 11.11%. Older age and loud second heart sound on physical examination are found to be strongly associated factors.
= OPERATIONAL DEFINITIONS Elevated N-Terminal-pro-Brain Natriuretic Peptides. NT-pro-BNP level of >164pg/ml OPERATIONAL DEFINITIONS Pulmonary hypertension Defined as TRV of 2.5-2.9m/sec plus elevated NT-pro-BNP or TRV≥3m/sec OPERATIONAL DEFINITIONS Sickle cell anemia. Abnormal sickle red blood cell confirmed by Hemoglobin electrophoresis.
= LIST OF ABBREVIATIONS NT-pro-BNP N-Terminal-pro-Brain Natriuretic Peptides HbA Adult hemoglobin HBB Hemoglobin better chain LDH lactate dehydrogenase MNH Muhimbili National Hospital NO Nitric oxide PH Pulmonary hypertension PYO Persons Year of Observation SCA Sickle cell anemia SCD Sickle cell disease TRV Tricuspid regurgitant velocity
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz