Serum Iron Status and Haematological Profiles in Adult Nigerian Sickle Cell Anaemia Patients

Background: Sickle cell anaemia (SCA) patients are prone to require long-term frequent blood transfusion because of chronic haemolysis and overlapping hyper-haemolysis. Hence, they become vulnerable to iron overload and its complications. On the other hand, iron deficiency has been documented among un-transfused SCA cases. Thus, there is a need to effectively and efficiently determine iron status of SCA patients.
Objective: We investigated whether adult SCA patients in steady state (SSt) or those with vaso-occlusive crisis (VOC) have significantly different iron status viz-a-viz Serum Iron (SI), Serum Ferritin (SF), Total Iron Binding Capacity (TIBC), Transferrin (TRF), percentage TFS and haematological parameters when compared with age and sex-matched controls.
Materials and Methods: Ninety subjects, comprising 30 SCA patients in SSt, 30 SCA patients with VOC and 30 HbAA, ethnicity, age and sex-matched controls (NC), were consecutively recruited. Serum samples were analysed for SF, TRF and TIBC using ‘WATER’ HPLC 616 and 626; SI was determined using the Atomic Absorption Spectroscopic (AAS) method. Haematological parameters were determined using a Sysmex Kx21 auto-analyser.
Results: The SCA groups (VOC and SSt) had significantly lower SI, SF, TRF and TIBC compared to the control group. The VOC group had a significantly lower mean ferritin level but higher SI, TRF and percentage TFS levels compared to SSt group. The MCV, MCH (in SSt group) were significantly lower while MCHC was significantly higher in the SCA groups compared to the NC group. Using the normal ranges for all parameters, all parameters were within normal for the controls while TIBC was below normal and percentage TFS was higher in SCA groups. Percentage TFS was significantly higher in VOC compared to SSt group.
Conclusions: The study reported lower SI and TRF, lower MCV and MCH, below normal TIBC, within normal Ferritin but elevated WBC and platelet counts, elevated percentage TFS (more elevated in VOC than SSt) and higher MCHC in SCA patients. The use of percentage TFS as a marker of VOC is suggested.