Red Cell Folate Status of Children with Sickle Cell Anaemia in Zaria, Nigeria
Keywords:folic acid, folate, red blood cell, sickle cell anaemia
Background: Sickle Cell Anaemia (SCA) is the commonest and severest form of Sickle Cell Disease (SCD) affecting about 3% of the Nigerian population. Increased metabolic rate and protein turnover associated with SCA tends to deplete the body of micronutrients especially, body folate which is necessary for the synthesis of ribonucleic acid (RNA) and deoxyribonucleic acid (DNA). This necessitates folic acid supplementation to meet the body’s requirements in SCA patients.
Aim and Objective: To determine the red cell folate status of children with SCA and the effects of folic acid supplementation.
Materials and Methods: This was a cross-sectional study carried out at the Paediatric clinic of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria – Nigeria over a six months period (June – December 2015). One hundred and seventy (170) SCA patients in steady state or in crisis state and 170 controls were recruited. A structured intervieweradministered questionnaire was administered. Socioeconomic status and folic acid intake and frequency of crisis were assessed and a general physical examination was carried out on each study participant. Blood samples were taken for RBC folate determination usingelectrochemiluminescence immunoassay (ECLIA); full blood count and differentials and blood films were also carried out using standard laboratory procedures.
Result: Ninety-one percent of the SCA patients were taking daily 5mg of folic acid and 99.4% were regular on it. The mean RBC folate level of children with SCA (2005.3±1020.9 ng/ml) was significantly higher than that of the controls which was 838.3± 256.3 ng/ml (P = 0.001) and was also higher than the normal range (106531ng/ml). There was no significant difference in RBC folate levels between SCA patients on folic acid and those who were not (P = 0.13). There was also no significant difference in the RBC folate level between SCA patients in steady or crises states (P = 0.73). The socioeconomic status of the SCA patients or the controls did not significantly affect their RBC folate levels (P = 0.1) and (P = 0.64) respectively. The mean haematocrit (HCT) was significantly lower in SCA (21.9%) in than the controls (31.7%), (P = 0.001). The RBC folate levels of the SCA did not significantly influence their haematocrit levels (P = 0.16).
Conclusion: The red cell folate levels of patients with SCA were very high irrespective of their crisis state, folic acid intake, socioeconomic background, or haematocrit levels. The high red cell folate levels also found in the controls could suggest that folate intake from the dietary sources in the community might be adequate in this environment and routine folic acid supplementation may not be necessary. However, further studies, preferably multicentre, are needed before a policy on the routine use of folic acid supplementation in patients with SCA could be made.
Adeodu OO, Alimi T, Adekile AD. A comparative study of perception of sickle cell anaemia by married Nigerian rural and urban women. West Afr J Med. 2000;19(1):1-5.
WHO. Prevalence of Sickle Cell Anaemia. Secretariate 2006. Report No.: A59/9.
Okpala I. Epidemiology, genetics and pathophysiology of SCD. In: Okpala I, editor. Practical management of haemoglobinopathies. Oxford: Blackwell; 2004. p. 20-25.
Adekile AD, Adeodu OO. Haemoglobinopathies. In: Azubuike JC, Nkanginieme KE, editors. Paediatrics and Child Health in Tropical Region. 2nd ed ed. Owerri: African Educational Services; 2007. p. 373-390.
Mustapha O, Abubakar F. Study of the prevalence of sickle cell disease in Kano metropolis and its suburbs in northern Nigeria. Niger J Basic App Sci. 2001;10:219225.
Ambe JP, Mava Y, Chama R, Farouq G, Y. M. Clinical features of sickle cell anaemia in northern nigerian children. West Afr J Med. 2012;31:81-85.
Galloway-Blake K, Reid M, Walters C, Jaggon J, MG. L. Clinical Factors Associated with Morbidity and Mortality in Patients Admitted with Sickle Cell Disease. West Indian Med J.; 63 (7): 711. 2014;63:711.
Bensinger TA, Gillette PN. Haemolysis in sickle cell disease. Arch Intern Med. 1974;133:624-631.
Chanarin I, Dacie JV, Mollin DL. Folic acid deficiency in haemolytic anaemia. Brit J Haematol. 1959;5:245-256.
Jonsson U, Roath OS, Kirkpatrick C. Nutritional megaloblastic anaemia associated with sickle cell states. Blood. 1959;14:535-547.
Maclver J, Went LN. Sickle cell anaemia complicated by megaloblastiic anaemia in infancy. Br Med J. 1960;1:775-779.
Lindenbaun J, Klipstein F. Folic acid deficiency in sickle cell anaemia. N Eng J Med. 1963;269:875-882.
Akinsulie AO. Serum and red cell folate levels of paediatric sicklers in painful and anaemic crises in Lagos University Teaching Hospital. Niger Quart J Hosp Med. 1999;9(3):202-4.
Rodriguez-Cortes HM, Griener JC, Hyland K, Teodoro B, Michael JB, Barton AK, et al. Plasma homocysteine levels and folate status in children with sickle cell anaemia. J Pediatr Hematol Oncol. 1999;21(3):219-23.
Valentina M, Francesca M, Luca B, Elena B, Giovanni P, Lorenzo L. Effects of nutritional intake on disease severity in children with sickle cell disease. Nutrition Journal 2016;15(46):1-6. 16.Yates JR. Folic Acid. Altern Med Rev. 2005;10:222-9.
Gregory J, Bhandari SD, Bailey L B. Relative Bioavailability of deuterium-labelled monoglutamyl tetrafolates and folic acid in human subjects. Am J Clin Nutri. 1992;55:1147-53.
Chandrika JP, Constance B, Philip C. Approach to red blood cell folate analysis. Chem Insights. 2007;2:107-10.
Omoti CE. Haematological values in sickle cell anaemia in steady state and vasoocclusive crises in Benin, Nigeria. Ann Afr Med. 2005;4:62-7.
Ogunlesi TA, Dedeke IOF, Kuponiyi OT. Socio-economic classification of children attending specialist paediatric centres in Ogun State, Nigeria. Nig Med Pract. 2008;54:21-5.
WHO. WHO Anthroplus software. [Available from: http://www.who.int/growthref/tools/en.
WHO. World Health Organization Child growth standards: Training course on child growth assessment. Geneva 2008.
Wang WC. Role of nutritional supplemnt in sickle cell disease. J Pediatr Haematol Oncol. 1999;21(3):176-8.
Bain BJ, Lewis SM, Imelda B. Basic Haematology Techniques. In: Bain BJ, Lewis SM, Imelda B, editors. Dacie and Lewis Practical Haematology. 10 ed ed. Philadelphia: Churchill Livinstone; 2007. p. 25-57.
Sysmen Corporation Kobe J. Operator's manual. XT -2000i Automated Hematology Analyzer. 2004.
Adewuyi JO. Investigation of Haemoglobinopathies. In: Adewuyi JO, editor. Companion to Practical Haematology A manual for the practical haematology course in the medical undergraduate programme in developing countries. Ilorin: Klobex Academic 2007. p. 47-48.
Roche D. Elecyscs Folate RBC 2010 [Available from: www.rochediagnostic.ch/dam/rbcfolate.
Flour F, Initiative. Foods with folic acid expected to decrease Nigeria birth defect prevalence: Enhanced online news; 2012 [Available from: www.enhancedonlinenews.com/eon/folicacid/Nigeria/Birth-defects.
Kennedy TS, Ellen BF, Deborah AK, Kawchak RD, Zemel RD, Babette S, et al. Red blood cell folate and serum vitamin B12 status in children with sickle cell disease. J Pediatr Hematol Oncol. 2001;23(3):165-169.
Schnog JB, van der Dijs FPL, Fokkenna MR, Muskiet FD, Muskiet FA. Folate status assessment and folic acid supplementation in sickle cell disease. J Pediatr Haematol Oncol. 2001;23(8):548-550.
Akinsulie AO. Folate status of paediatric patients with sickle cell anaemia in Lagos University Teaching hospital. Niger Quart J Hosp Med. 1999;9(4):285-286.
Herbert V. Drugs effective in megaloblastic anemias. In: Goodman LS, Gilman A, editors. The pharmacological basis of therapeutics. 5 ed: MacMillan Co; 1975. p. 1324-1349.
Rabb L, Grandison Y, Mason K, Hayes RJ, Sergeant B, Sergeant GR. A Trial of folate supplementation in children with homozygous sickle cell disease. Br J Haematol. 1983;54(4):589-594.
Odutola I O, Josephat M C, Kingsley I A, Eberechukwu O A. Body Mass Index and other anthropometric variables in children with sickle cell anaemia. Pak J Med Sci 2016;32(2):341-346.
Akinsete FI, Boyo AE. Studies on folic acid in Nigerian infants and pre-school children. J Trop Pediatr. 1977;23:202-205.
Liu YK, Augusta G. Folate deficiency in children with sickle cell anemia. Am J Dis child. 1974;127:389-393.
Aneke JC, Adekoke AO, Oyekunle AA, Osho PO, Okocha EC, Okokwo KU, et al. Haematological and clinical profile of Nigeria sickle cell disease patient with or without chronic kidney disease. Orient J of Med. 2014;26:3-4.
Sanjeev SR, Jagdish PG, Raghunath SV, S VB. Hematological profile of sickle cell disease from South Gujarat, India. Gujurat: Department of Pediatrics, Govt Medical College, Surat, Gujarat, India; 2012.
Sharon E C, Julie M, Anthony J F, Albert N K, Soka D, Thomas N W, et al. Nutritional status, hospitalization and mortality among sickle cell anaemia in Tanzania. Haematologica. 2011;96:948-953.
Iheanacho OE. Haematological parameters of adult and paediatric subjects with sickle cell disease in steady state in Benin city, Nigeria. Int Blood Res and Rev. 2015;3(4):171-177.
Ajay WM, Priyanka AB, Ruchir K, Komal P. Haematological indices and electrolyte status in SCD at rural hospital in central Maharashtra. Int J Med Sci and Pub health. 2014;3(11):1410-1412.
Copyright (c) 2023 Nigerian Journal of Haematology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.