DRUG MANAGEMENT AND MICRONUTRIENT LEVELS IN ADULT PATIENTS WITH SICKLE CELL DISEASE IN AHMADU BELLO UNIVERSITY TEACHING HOSPITAL SHIKA, ZARIA
DRUG MANAGEMENT AND MICRONUTRIENT LEVELS IN ADULT PATIENTS WITH SICKLE CELL DISEASE IN AHMADU BELLO UNIVERSITY TEACHING HOSPITAL SHIKA, ZARIA
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Date
2012-10
Authors
OLORUKOOBA, BASHIRAT ABIMBOLA
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Abstract
Sickle cell diseases (SCD) have numerous complications which vary widely among patients
making drug treatment difficult. In addition, SCDs are associated with deficiencies in some
micronutrients; supplementation of which may ameliorate some of the complications and
contribute to existing drug management strategies. The drug utilisation of 45 SCD patients in
crises and 45 SCD patients in steady state in a Nigerian Teaching Hospital (Ahmadu Bello
University Teaching Hospital, Shika, Zaria-ABUTH) was evaluated. 45 HbAA volunteers acted
as controls. The medication and clinical history was obtained via questionnaire and interview of
patients and their care givers. Plasma magnesium, zinc, copper and iron levels of the SCD
patients and 45 age and sex matched HbAA controls was determined using spectrophotometric
methods (Beckman Coulter DU 520 Colorimeter). Genotype was determined using haemoglobin
electrophoresis following sickle test. While, full blood count was determined using standard
methods. The drug management was in line with standard treatment guidelines (2008). The SCD
crises group had a higher percentage of analgesic use than the steady state group; however their
routine drug use was similar with the exception of liberal fluid intake which was more in the
steady state group. Further analysis of the drug utilisation patterns with respect to haemoglobin
variants (HbSS, HbSS+F and HbSC) showed a variation, with the HbSS having the highest
analgesic utilisation. Non opioid analgesics were more commonly used than opioid analgesics.
Amoxicillin was the first drug of choice for treatment of infection. The SCD patients on
amoxicillin had a significantly higher (p<0.05) white blood cell count than SCD patients who
were not on amoxicillin. Full blood counts of the HbAA controls fell within normal limits. There
was a statistically significant difference between these values and those found in both SCD
groups. The mean plasma magnesium of the SCD patients was significantly lower (p<0.05) than
that of the HbAA; with the mean plasma magnesium levels of the SCD in crises being
significantly lower (p<0.05) than that of the SCD in steady state. Although, the mean plasma
zinc levels of the SCD patients was lower than that of the HbAA, it was not significant (p<0.05).
The mean plasma iron levels of the SCD patients was significantly higher (p<0.05) than the
mean plasma iron levels of the HbAA controls. In conclusion, the drug management strategies in
the Haematology department of ABUTH conformed to the standard treatment guidelines.
Individualised care will be needed in patients on chronic analgesia in other to prevent co morbid
gastrointestinal, hepatic and renal associated toxicities, as well as tolerance and addiction.
Plasma magnesium levels were significantly lower in crises group than other groups suggesting
low magnesium levels may be a contributor to the severity of crises. Plasma zinc levels of both
SCD groups were also low, suggesting there may be greater zinc utilization in the SCD patients.
Plasma micronutrient levels significantly differed from HbAA controls and may present a
possible mode for therapeutic intervention.
Description
A THESIS SUBMITTED TO THE POSTGRADUATE SCHOOL, AHMADU BELLO
UNIVERSITY, ZARIA, NIGERIA IN PARTIAL FULFILMENT FOR THE AWARD OF
MASTERS OF SCIENCE DEGREE IN PHARMACOLOGY
DEPARTMENT OF PHARMACOLOGY AND THERAPEUTICS
AHMADU BELLO UNIVERSITY, ZARIA
NIGERIA
NOVEMBER, 2012
Keywords
DRUG MANAGEMENT, MICRONUTRIENT, LEVELS, ADULT PATIENTS, SICKLE CELL DISEASE, AHMADU BELLO UNIVERSITY TEACHING HOSPITAL SHIKA, ZARIA