Liver function tests profile of sickle cell anaemia patients in steady state of health: Zaria experience

Abstract

Background: Several reports across the world suggest that liver and biliary tract dysfunctions are common complications of sickle cell anaemia (SCA). However, there is paucity of data on the pattern of liver function tests profile in SCA patients in Zaria. Most of the  reported studies were carried out elsewhere.

Objective: The overall objective of this study was therefore to evaluate the liver function status in patients with SCA in Zaria, northern  Nigeria with a view to recommend or otherwise the inclusion of liver function tests in the routine investigation of SCAin Nigerian  hospitals.

Subjects and methods: The study was conducted in the Departments ofChemical Pathology and Haematology of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, northern Nigeria. Serum levels of total bilirubin (TB), alanine amino transferase (ALT),  aspartate amino transferase (AST), alkaline phosphatase (ALP), total protein (TP), albumin (ALB) and AST/ALT (De Ritis) ratio were  determined in sixty (60) each of SCA patients and age- and sex-matched control individuals. These consisted of thirty (30) each of male  and female patients and controls, respectively. The mean age of these patients was 21 years (ranged 13-40 years). Both the patients and  controls were partitioned according to age groups, as groups I (13-20 years), II (21-30 years) and III (31-40 years) with thirty three (33),  fifteen (15) and twelve (12) subjects, respectively. The data obtained were analysed using Microsoft Office Excel 2003. Two-tailed  student's t- test for matched samples and one way analysis of variance (ANOVA) statistical methods were employed for the analyses. A  p-value of equal to or less than 0.05 (p = 0.05) was considered as statistically significant.

Results: The results of serum TB, ALT, AST, ALP,  TP, ALB and AST/ALT ratio in SCA patients were 24.33±0.21 µmol/L, 47.17±1.51, 27.85±0.63, 145.05±6.45 IU/L, 75.35±0.97, 43.40±0.98 g/L  and 0.7±0.06 respectively, while those in controls were respectively 16.09±0.79 µmol/L, 27.78±1.48, 15.78±0.90, 72.32±3.57 IU/L, 72.58±0.87, 50.48±2.26 g/L and 0.6±0.03. These results show that the levels of serum TB, ALT, AST and ALP were significantly higher in patients than in controls (p < 0.001), while serum ALB concentrations were significantly lower (p < 0.002) in patients than in control individuals. The results  of serum TP and AST/ALT ratio in patients and controls were not statistically different (p>0.05). These results therefore,  demonstrate that LFTs are mildly deranged in SCA patients. There were no gender variations in LFTs profile in both patients and controls.  Serum TB and ALP in patients decrease significantly with advancing age, while serum ALT, AST, TP, ALB and AST/ALT ratio levels at  different age groups were statistically similar. All the components of LFTs at different age groups in controls were statistically similar.

Conclusion: It can be concluded from the findings of this study that there is a minor derangement in LFTs profile in SCA patients and that  the extent of the abnormalities decreases with advancing age. This therefore, suggests that liver functions are impaired in SCA  patients, most especially below twenty years of age. Therefore, it can be recommended from this study that routine evaluation of liver  function status be considered in the management of SCA patients in Nigerian hospitals. This could assist in early detection of liver  dysfunction and hence reduce morbidity and mortality from SCA in Nigeria.