Annals of Tropical Medicine and Public Health
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Year : 2018  |  Volume : 11  |  Issue : 4  |  Page : 133-139

Fetal hemoglobin level and its relationship with spleen size and malaria parasite density in Nigerian children with sickle cell anemia

1 Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals' Complex, Ile Ife, Osun State, Nigeria
2 Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
3 Department of Radiology, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria

Correspondence Address:
Dr. Morenike Agnes Akinlosotu
Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, P. M. B. 013, Ile-Ife
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ATMPH.ATMPH_393_17

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Background: Sickle cell anemia (SCA) is a major global public health concern. Fetal hemoglobin level (HbF) is a major modulating factor of the clinical manifestation of the disease. In Nigeria, data on HbF level of children with SCA and its relationship with the spleen, a major reticuloendothelial organ, are scanty. Methods: In this cross-sectional comparative study, we determined steady-state HbF levels of children with SCA aged 1–15 years by high-performance liquid chromatography and compared with their age-, sex-, and socioeconomic class-matched HbAA controls. The spleen size was determined clinically and sonographically. Relationships between HbF level and spleen size and malaria parasite density were also determined. Results: About two-thirds of children with SCA had HbF level of <10%. However, they had significantly higher mean HbF level (9.6% ± 5.9%) compared with matched controls (0.5% ± 0.7%; P< 0.001). Higher proportion (9.8%) of children with SCA who were ≥8 years developed autosplenectomy compared to none of those <8 years (P = 0.012). There was no significant relationship between HbF levels and spleen size, although children with autosplenectomy had significantly lower mean HbF levels compared with those without autosplenectomy (3.5% ± 1.4% vs. 8.3% ± 3.5%, 95% confidence interval = 1.1–8.4, P = 0.012). HbF levels had no significant correlation with malaria parasite density, P > 0.05. Conclusion: Children with SCA had higher HbF levels compared with matched controls. Furthermore, patients with autosplenectomy had significantly lower HbF levels. Further studies exploring the roles of foetal haemoglobin on spleen functions in children with SCA are advocated, since spleen dysfunction is central to morbidity and mortality in this group of patients.

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