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Routine haemoglobin electrophoresis screening in day case herniotomy in Nigerian children: Is it evidence-based?
Adesoji O Ademuyiwa1, C O Bode1, I Desalu2
1Department of Surgery, Paediatric Surgery Unit, College of Medicine, University of Lagos, Lagos, Nigeria.
Insights
Routine screening for sickle cell trait (HbAS) and sickle cell disease (HbSS) in children undergoing day case herniotomy is not routinely necessary. While 27.4% had haemoglobinopathies, only 1.1% had sickle cell disease.
Area of Science:
- Pediatric Surgery
- Hematology
- Genetics
Background:
- Haemoglobinopathies are inherited blood disorders.
- Day case herniotomy is a common pediatric surgical procedure.
- Prevalence of haemoglobinopathies varies geographically.
Purpose of the Study:
- To determine the prevalence of haemoglobinopathies in children undergoing day case herniotomy.
- To assess the necessity of routine haemoglobinopathy screening in these patients.
Main Methods:
- Retrospective analysis of 95 pediatric patients undergoing herniotomy over 12 months.
- Data collected included age, sex, diagnosis, haemoglobin electrophoresis results, surgical outcome, and hospital stay.
Main Results:
- 27.4% of patients had haemoglobinopathies.
- Sickle Cell Trait (HbAS) found in 23.2%, HbAC in 3.2%, and Sickle Cell Disease (HbSS) in 1.1%.
- All patients survived; most discharged same-day, except the HbSS patient.
Conclusions:
- The prevalence of sickle cell trait and disease aligns with Nigerian population data.
- Routine haemoglobinopathy screening for all herniotomy patients may not be indicated.
- Screening should be based on clear clinical indications.
Background:
To determine the prevalence of haemoglobinopathies in children who require day case herniotomy in our centre and ascertain if routine screening is necessary in all patients who require herniotomy.
Materials And Methods:
A 12-month retrospective analysis of patients requiring herniotomy in our centre. Data including age, sex, diagnosis, haemoglobin electrophoresis status, surgical outcome and hospital stay were analysed.
Results:
Ninety-five patients had complete records. There were 84 boys and 11 girls. M:F ratio: 7.6:1. The mean age was 3.2 ± 0.6 years. Fifty-five point eight per cent of the patients had right inguinal hernias while 35.8% had left inguinal hernias. Eight patients (8.4%) had bilateral inguinal hernias. Twenty-six patients (27.4%) had haemoglobinopathies while 69 patients (72.6%) had homozygous Haemoglobin A. The Sickle Cell trait (HbAS) was found in 22 patients (23.2%) while the HbAC was found in three patients (3.2%). One patient (1.1%) had Sickle Cell disease (Haemoglobin SS). He had had blood transfusion and previous history of jaundice. All patients survived and all patients were discharged on the day of surgery (mean hospital stay: 4hrs (range: 2.5 hrs-12 hrs)) except the patient with Sickle Cell disease who was admitted a day before surgery and discharged a day after the operation.
Conclusion:
One in four children coming for day case herniotomy in our centre had the Sickle Cell trait while only 1% had the Sickle Cell disease. These findings are in keeping with the prevalence in the Nigerian population. Routine screening may not be necessary for all patients coming for herniotomy in our centre. Clear indication(s) should be outlined for screening.
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