Cardiovascular Abnormalities in Children and Adolescents with Sickle Cell Anemia at Muhimbili National Hospital, Dar Es Salaam, Tanzania

Abstract

Background: Cardiac disorders are frequently reported in patients with sickle cell anaemia, but the magnitude among children and adolescents attending sickle cell clinic at Muhimbili National Hospital is unknown. A Cross –sectional study was therefore done to evaluate the magnitude and pattern of cardiovascular disorders among patients with sickle cell anaemia, aged six months to seventeen years. Methodology: A total of 99 patients confirmed to have sickle cell anaemia; aged 6 months to 17 years were randomly recruited during their follow up visit. Children were excluded if they had fever, co-existing congenital heart disease, rheumatic heart disease and chronic respiratory problems. Cardiac evaluation involved physical examination, haemoglobin measurement, chest radiography, electrocardiography and echocardiography. Results: A total of ninety nine eligible patients were recruited of whom 54% were males, 58.6% were aged >6 years, and 75.8% of the study population had haemoglobin ≤8g/dl. Prevalence of cardiac abnormalities detected by presence of abnormalities picked by all four diagnostic methods was 28%. Abnormalities picked by a single diagnostic method were as follows, majority were picked by ECHO (83.3%), followed by cardiac signs (76.8%) then CXR (69.7%) and least (50.5%) by ECG. Tachycardia was common in children aged ≤6 years (p=0.005) and children with haemoglobin ≤8g/dl (p=0.001). Majority of children aged >6 yrs, had cardiomegaly (p=0.0009) and murmurs (p= 0.012). ST-T segment abnormalities were common in patients aged >6 years (p=0.013). More patients with haemoglobin ≤8g/dl had systolic dysfunction (p=0.01), increased left atrial diameter (p=0.00001) and interventricular septal hypertrophy (p=0.017). There was no statistically significant difference ECHO finding for those aged >6 years and those aged ≤6 years, signifying similar magnitude of cardiac abnormalities between young and older children despite different clinical presentation. Conclusion: Prevalence of cardiac abnormalities among children and adolescents with sickle cell anaemia at MNH is relatively small when picked by all parameters but high when single parameter is used. These abnormalities are significantly related to low haemoglobin, with the common presenting sign being tachycardia. Echocardiography detected most of the abnormalities therefore should be considered as an essential investigation for children and adolescents with sickle cell anaemia with presenting with cardiac signs.

Keywords: cardiovascular disorders, children, adolescents, anemia