Hematological profiles of newly diagnosed pulmonary tuberculosis patients in Western Kenya
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20241480Keywords:
PTB, Hematological profiles, Normocytic normochromic anemia, Hematocrit, HemoglobinAbstract
Background: Pulmonary tuberculosis (PTB) mortality remains high despite current availability of effective anti-TB drugs. This could be due to pathophysiological derangements that are not fully understood and managed during anti-TB therapy. The objective of this study was to evaluate the hematological changes in newly diagnosed PTB patients.
Methods: 55 newly diagnosed PTB patients and 55 healthy controls were included in this cross-sectional non-randomized study. Complete hematological profiles were determined using an automatic analyzer. Peripheral blood films were used to evaluate cellular morphology. Data was analyzed using chi-square and Mann-Whitney tests (SPSS version 29.0).
Results: Males constituted 80% (44) of the newly diagnosed PTB patients and 81.8% of the blood donor controls. Compared with the control group, the PTB patients group exhibited significantly lower median red blood cell (RBC) count (4.79×106 µl vs 5.2×106 µl, p=0.001), hemoglobin levels (12.8 g/dl vs 14.3 g/dl, p=0.0001), hematocrit (37.9% vs 42.05%, p=0.0001), mean platelet volume (8.9 fl vs 10.5 fl, p=0.0001) and platelet distribution width (10.4 fl vs 13.0 fl, p=0.0001). The median platelet count for the PTB group was significantly higher relative to controls (314.0×103/µl vs 237.0×103/µl, p=0.0001). Similarly, the PTB group had a significantly higher PCT% compared to controls (0.27% vs 0.25%, p=0.002). Morphological analysis of peripheral blood films revealed normocytic normochromic anemia and microcytic hypochromic anemia in 54.5% (n=30) and 34.6% (n=19) of PTB patients, respectively.
Conclusions: Newly diagnosed PTB patients in Western Kenya present with leukocytosis, elevated platelet count and anemia, suggesting the need for appropriate management and routine monitoring of hematological profiles.
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References
Global tuberculosis report 2021. Available at: https://www.who.int/publications-detail-redirect/9789240037021. Accessed on 8 April, 2024.
Ministry of Health Republic of Kenya annual report. Available at: https://www.nltp.co.ke/reports/annual-reports/,2021. Accessed on 8 April, 2024
Factsheet Global TB report 2021. Available at: https://www.who.int/publications/m/item/factsheet-global-tb-report-2021. Accessed on 8 April, 2024.
Sia JK, Rengarajan J. Immunology of Mycobacterium tuberculosis Infections. Microbiology Spectrum, 2019;7(4):746.
Khan N, Downey J, Sanz J, Kaufmann E, Blankenhaus B, Pacis A, et al. M. tuberculosis reprograms Hematopoietic Stem Cells to Limit Myelopoiesis and Impair Trained Immunity. Cell. 2020;183(3):752-770.
Abaker M, Mohammed. S Some Hematological Parameters among Patients with Pulmonary Tuberculosis Khartoum State. Sch J App Med Sci. 2016;4(1):99-111.
Kirwan DE, Chong DLW, Friedland JS. Platelet Activation and the Immune Response to Tuberculosis. Fronti Immunol. 2021;12:631-96.
Fox KA, Kirwan DE, Whittington AM, Krishnan N, Robertson BD, Gilman RH et al. Platelets Regulate Pulmonary Inflammation and Tissue Destruction in Tuberculosis. Am J Respiratory Crit Care Med. 2018;198(2):245-55.
Minardi ML, Fato I, Di Gennaro F, Mosti S, Mastrobattista A, Cerva C, et al. Common and Rare Hematological Manifestations and Adverse Drug Events during Treatment of Active TB: A State of Art. Microorganisms. 2021;9(7):7.
Ministry of Health Republic of Kenya integrated guideline for tuberculosis, leprosy and lung disease. Available at: https://www.nltp.co.ke/wp-content/uploads/2022/02/Integrated-Guideline.pdf. 2021. Accessed on 8 April 2024
Alamlih L, Albakri M, Ibrahim WH, Khan A, Khan FY. Hematologic Characteristics of Patients with Active Pulmonary, Extra-Pulmonary and Disseminated Tuberculosis: A Study of over Six Hundred Patients. J Tuberculosis Res. 2020;08(02):02.
Batool Y, Pervaiz G, Arooj A, Fatima S. Hematological manifestations in patients newly diagnosed with pulmonary tuberculosis. Pak J Med Sci. 2022;38(7):1968-72.
Shah AR, Desai KN, Maru AM. Evaluation of hematological parameters in pulmonary tuberculosis patients. J Family Med Primary Care. 2022;11(8):4424-8.
Abdelkareem Y, Hashim AM, Abdelazeem H. Hematological changes in pulmonary tuberculosis. Al-Azhar Assiut Med J. 2015;13:4.
Rohini K, Surekha Bhat M, Srikumar PS, Mahesh Kumar A. Assessment of Hematological Parameters in Pulmonary Tuberculosis Patients. Indian J Clin Biochem. 2016;31(3):3325.
Zheng Y, Ma A, Wang Q, Han X, Cai J, Schouten EG, et al. Relation of Leptin, Ghrelin and Inflammatory Cytokines with Body Mass Index in Pulmonary Tuberculosis Patients with and without Type 2 Diabetes Mellitus. plos One. 2013:8(11):e80122.
De Martino M, Lodi L, Galli L, Chiappini E. Immune Response to Mycobacterium tuberculosis: A Narrative Review. Front Pediatr. 2019;7:350.
Ongwae JM, Musyoki SK, Mongare, S. Profile of haematological indices among pulmonary tuberculosis patients attending Kisii teaching and referral hospital, Kenya. Int J Community Med Publ Heal. 2023;10(8):2669-75.
Kahase D, Solomon A, Alemayehu M. Evaluation of Peripheral Blood Parameters of Pulmonary Tuberculosis Patients at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia: Comparative Study. J Blood Med. 2020;11:115-21.
Boxer LA. How to approach neutropenia. Hematology 2010, the American Society of Hematology Education Program Book. 2012(1):174-82.
Shafee M, Abbas F, Ashraf M, AlamMengal M, Kakar N, Ahmad Z, et al. Hematological profile and risk factors associated with pulmonary tuberculosis patients in Quetta, Pakistan. Pak J Med Sci. 2014:30(1):36-40.
Abbas B, Dogara MM, San NM, Gumel AM, Lawal D. Assessment of Haematological Parameters of Pulmonary Tuberculosis Patients with and Without HIV Infection Attending Two Secondary Health Facilities in Jigawa State. Int J Microbiol Biotechnol. 2020;5(3):3.
Van Lettow M, Kumwenda JJ, Harries AD, Whalen CC, Taha TE, Kumwenda N, et al. Malnutrition and the severity of lung disease in adults with pulmonary tuberculosis in Malawi. Int J Tuberculosis Lung Dis. 2004;8(2):211-7.
Erhabor O, Abubakar S, Erhabor T, Mgbere O. EC pharmacology and toxicology EC pharmacology and toxicology Research Article Hematological Manifestations in Patients with Pulmonary Tuberculosis in Sokoto, Nigeria. 2020;8:70-84.
Mukherjee A, Kaeley N, Dhar M, Kumar S, Bhushan B. Prevalence, characteristics, and predictors of tuberculosis associated anemia. J Family Med Primary Care. 2019;8(7):2445-9.
Abay F, Yalew A, Shibabaw A, Enawgaw B. Hematological Abnormalities of Pulmonary Tuberculosis Patients with and without HIV at the University of Gondar Hospital, Northwest Ethiopia: A Comparative Cross-Sectional Study. Tuberculosis Res Treat. 2018;2018:5740951.
Molay Banerjee, BL Chaudhary, Snehanshu Shukla. Hematological Profile Among Pulmonary Tuberculosis Patients in Tertiary Care Hospital. Int J Bioassays. 2015;4(5):3900-2.
De Mendonça EB, Schmaltz CA, Sant’Anna FM, Vizzoni AG, Mendes-de-Almeida DP, de Oliveira R.de VC, et al. Anemia in tuberculosis cases: A biomarker of severity? PloS One. 2021;16(2):e0245458.
Rathod S, Samel DR, Kshirsagar P, Pokar M. Thrombocytosis: Can it be used as a marker for tuberculosis? Int J Res Med Sci. 2017;5(7):3082-6.
