Red Cell Folate Status of Children with Sickle Cell Anaemia in Zaria, Nigeria
Keywords:
folic acid, folate, red blood cell, sickle cell anaemiaAbstract
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.
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