DRUG MANAGEMENT AND MICRONUTRIENT LEVELS IN ADULT PATIENTS WITH SICKLE CELL DISEASE IN AHMADU BELLO UNIVERSITY TEACHING HOSPITAL SHIKA, ZARIA
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ABSTRACT
Sickle cell diseases (SCD) have numerous complications which vary widely among patients making drug treatment difficult. In addition, SCDs are associated with deficiencies in some micronutrients; supplementation of which may ameliorate some of the complications and contribute to existing drug management strategies. The drug utilisation of 45 SCD patients in crises and 45 SCD patients in steady state in a Nigerian Teaching Hospital (Ahmadu Bello University Teaching Hospital, Shika, Zaria-ABUTH) was evaluated. 45 HbAA volunteers acted as controls. The medication and clinical history was obtained via questionnaire and interview of patients and their care givers. Plasma magnesium, zinc, copper and iron levels of the SCD patients and 45 age and sex matched HbAA controls was determined using spectrophotometric methods (Beckman Coulter DU 520 Colorimeter). Genotype was determined using haemoglobin electrophoresis following sickle test. While, full blood count was determined using standard methods. The drug management was in line with standard treatment guidelines (2008). The SCD crises group had a higher percentage of analgesic use than the steady state group; however their routine drug use was similar with the exception of liberal fluid intake which was more in the steady state group. Further analysis of the drug utilisation patterns with respect to haemoglobin variants (HbSS, HbSS+F and HbSC) showed a variation, with the HbSS having the highest analgesic utilisation. Non opioid analgesics were more commonly used than opioid analgesics. Amoxicillin was the first drug of choice for treatment of infection. The SCD patients on amoxicillin had a significantly higher (p<0.05) white blood cell count than SCD patients who were not on amoxicillin. Full blood counts of the HbAA controls fell within normal limits. There was a statistically significant difference between these values and those found in both SCD groups. The mean plasma magnesium of the SCD patients was significantly lower (p<0.05) than that of the HbAA; with the mean plasma magnesium levels of the SCD in crises being significantly lower (p<0.05) than that of the SCD in steady state. Although, the mean plasma zinc levels of the SCD patients was lower than that of the HbAA, it was not significant (p<0.05). The mean plasma iron levels of the SCD patients was significantly higher (p<0.05) than the mean plasma iron levels of the HbAA controls. In conclusion, the drug management strategies in the Haematology department of ABUTH conformed to the standard treatment guidelines. Individualised care will be needed in patients on chronic analgesia in other to prevent co morbid gastrointestinal, hepatic and renal associated toxicities, as well as tolerance and addiction. viii Plasma magnesium levels were significantly lower in crises group than other groups suggesting low magnesium levels may be a contributor to the severity of crises. Plasma zinc levels of both SCD groups were also low, suggesting there may be greater zinc utilization in the SCD patients. Plasma micronutrient levels significantly differed from HbAA controls and may present a possible mode for therapeutic intervention
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