Pulmonary Hypertension among Patients with Sickle Cell Anemia in Kano, Northwestern Nigeria: Clinical and Laboratory Correlates

Abstract

Background

Advances in the management of sickle cell anemia (SCA) have significantly improved patient survival. However, as individuals with SCA live longer, chronic complications increasingly emerge. Pulmonary hypertension (PH) is now recognized as one of the leading causes of morbidity and mortality in adult SCA patients. Understanding the burden and correlates of PH is essential for early detection and intervention.

Aim

To determine the prevalence of pulmonary hypertension and its clinical and laboratory correlates among adult SCA patients in Kano, North-Western Nigeria.

Methods

A cross-sectional study was conducted involving 211 adults aged ≥16 years with confirmed SCA.

• Data collection: Demographic and clinical information were obtained using a structured questionnaire and review of clinical records.

• Laboratory evaluation: Complete blood count (CBC) and biochemical markers of hemolysis were measured using standard procedures.

• Assessment of PH: Tricuspid regurgitant velocity (TRV) was measured using 2D echocardiography. PH was defined as TRV ≥ 2.5 m/sec.

• Data analysis: SPSS Version 21.0 was used, with statistical significance set at p < 0.05.

Results

• The prevalence of PH in this SCA cohort was 31.8%.

• Patients with PH were:

  • Significantly older (p = 0.036)

  • Had more blood transfusions (X² = 7, p = 0.003)

  • Had fewer hospitalizations (X² = 8.8, p = 0.001)

  • Experienced fewer vaso-occlusive crises (VOC) (X² = 6.7, p = 0.000)

  • Had higher rates of priapism (X² = 10, p = 0.036)

• Positive correlations with PH:

  • Platelet count (r = 0.416)

  • Reticulocyte count (r = 0.451)

  • Serum LDH (r = 0.682)

  • Serum bilirubin (r = 0.810)

• Negative correlations with PH:

  • Hemoglobin level (r = –0.661)

  • Packed cell volume (PCV) (r = –0.573)

Conclusion

Pulmonary hypertension is common among adults with sickle cell anemia in this setting and is significantly associated with:

• Higher frequency of blood transfusions

• Lower frequency of painful crises

• Elevated markers of hemolysis (LDH and bilirubin)

Routine screening for PH using echocardiography and early intervention is essential to reduce morbidity, prevent early mortality, and improve overall quality of life in patients with SCA.