Cardiovascular abnormalities in children and adolescents with sickle cell anaemia at Muhimbili National Hospital,Dar es Salaam,Tanzania.

Abstract

cardiovascular abnormalities in children and adolescents with sickle cell anaemia attending sickle cell clinic at Muhimbili National Hospital. Design: Cross -sectional hospital based descriptive study Methodology: Children aged six months to seventeen years, attending sickle cell clinic were randomly selected. History was taken, physical examination was done and haemoglobin level was measured. Then chest radiography, electrocardiography and echocardiography were done. Outcome: Magnitude and pattern of cardiovascular disorders among patients with sickle cell anaemia. Results: Ninety-nine patients met the criteria for inclusion and were subject for final analys is. Males were 54 and females were 45, male to female ratio was 1: 1.7. Mean haemoglobin level was 7.2g/dl (range 4.9-10) The overall prevalence of cardiac abnormalities in this study was 28 %. Prevalence according to individual diagnostic parameters was ECG; 50.5%, CXR; 69.7%, cardiac signs 76.8% and ECHO; 83.3%.

Vlll Tachycardia was common in children aged 6 years or below (P=0.005), cardiomegaly, presence of cardiac murmurs and abnormal ST- T changes were significant in children above 6 years (p= 0.0009,0.012 and 0.013 respectively). Patients with haemoglobin of 8g/dl or less frequently had tachycardia (P=O.OOl), cardiac murmurs (P=O.OOOOl), prominent pulmonary vasculature (P=0.04) and upper lobe blood redistribution (P=O. 014). Cardiac chamber dilatation and left ventricular hypertrophy were inversely related to haemoglobin level. Systolic dysfunction was significantly reduced in 23.3% of patients with haemoglobin of 8g/dl and below. Diastolic dysfunction was found in 51 % of patients, this was about four times common in patients with haemoglo bin of 8g/d I and below. Conclusions and recommendations: Cardiomegaly was the most common cardiovascular abnormality found in sickle cell anemia patients above six years, in particular those with chronic anemia and hemoglobin :s 8gmld1. These patients need to have their hemoglobin maintained above 8gmldl and those with hemoglobin below 8gmldl plus cardiovascular signs would need cardiovascular evaluation.