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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 20  |  Issue : 1  |  Page : 80-83

Methemoglobin levels among malaria parasite-infected blood donors in Nnewi, Southeastern, Nigeria


1 Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Anambra State, Nigeria
2 Department of Haematology, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Anambra State, Nigeria
3 Department of Immunology, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Anambra State, Nigeria

Date of Web Publication11-Jan-2017

Correspondence Address:
Okeke Chizoba Okechukwu
Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, P.M.B. 5001, Anambra State
Nigeria
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DOI: 10.4103/1119-0388.198133

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  Abstract 

Background: Safety of blood and blood products is of immense concern in transfusion medicine. Malaria parasite (MP) which is known to be endemic in the tropics has been shown to disrupt hemoglobin molecule converting it to nonfunctional methemoglobin which is unable to transport oxygen effectively. Objective: This study was aimed at determining the prevalence of malaria parasitemia and methemoglobin level among blood donors attending Nnamdi Azikiwe University Teaching Hospital (NAUTH). Subjects and Methods: A total of 100 apparently healthy blood donors aged 18-60 years were recruited and tested for MP, methemoglobin level, and packed cell volume (PCV), after obtaining ethical approval from the Ethics Committee of NAUTH and informed consent of the participants. Methemoglobin was assayed by cyanmethemoglobin method, and MP was tested using thick and thin blood film and PCV by microhematocrit method. Statistical Package for Social Sciences (SPSS) version 20 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Results: Among the 100 blood donors screened, 75 of the participants representing 75% were positive for MP and 25 representing 25% tested negative. Plasmodium falciparum was responsible for all cases of parasitemia. The mean values of methemoglobin were significantly higher in asymptomatic MP infected blood donors than in noninfected donors, while PCV was significantly reduced in malaria infected donors compared to noninfected donors (P < 0.05). Conclusion: This study identified a high rate of malaria parasitemia in blood donors and an elevated methemoglobin level in asymptomatic MP infected donors. Screening of blood donors for MP is advocated and exclusion of infected donors may be necessary.

Keywords: Blood donors, malaria parasite, methemoglobin, packed cell volume


How to cite this article:
Okechukwu OC, Nneka AF, Grace AI, Martin IO. Methemoglobin levels among malaria parasite-infected blood donors in Nnewi, Southeastern, Nigeria. Trop J Med Res 2017;20:80-3

How to cite this URL:
Okechukwu OC, Nneka AF, Grace AI, Martin IO. Methemoglobin levels among malaria parasite-infected blood donors in Nnewi, Southeastern, Nigeria. Trop J Med Res [serial online] 2017 [cited 2017 Jun 28];20:80-3. Available from: http://www.tjmrjournal.org/text.asp?2017/20/1/80/198133


  Introduction Top


Malaria remains one of the most complex and overwhelming health problems facing humanity,[1] with 300-500 million cases and 2-3 million deaths/year.[2] It destroys red blood cells and interferes with the hemoglobin (the red cell pigment) by disrupting and converting it to methemoglobin leading to methemoglobinemia.[3] Majority of the infection is caused by Plasmodium falciparum which is the most dangerous and the most infective of the four human malaria parasites (MPs).[2] The transfusion of blood to a patient is a potentially lifesaving procedure and the demand of blood has greatly increased over the years.[4] Although transfusion therapy helps save lives, blood can nonetheless be a vehicle for transmission of infections including parasitic diseases such as malaria.[1] Malaria infection has become of more interest to blood banking and blood transfusion, following discoveries that malaria infection may cause methemoglobinemia, as hemoglobin taken up by parasites into their acid food vacuole leads to the spontaneous oxidation of ferrous (Fe2+ ) to ferric (Fe3+ ) iron. It is an altered state of hemoglobin in which the ferrous of heme is oxidized to ferric form, thus making the heme moiety unable to bind oxygen.[5] Studies have shown that MP disrupts hemoglobin pigment converting hemoglobin to nonfunctional methemoglobin.[6] In healthy subjects, the level of methemoglobin is low, typically < 2% of the total hemoglobin in the blood. When methemoglobin concentrations are increased, there is less available functional hemoglobin to carry oxygen for systemic delivery,[7] leading to varying complications from skin discoloration, cyanosis, weakness, confusion, seizures, and death.

In Nigeria, screening for MP is not stipulated in the current National blood transfusion guidelines and is not routinely done in blood banks.[8] However, Nigeria like many other tropical developing countries has a high level of occurrence of blood-demanding conditions such as road traffic accidents, pregnancy-related hemorrhage, armed robbery attacks, communal clashes, and violent events with an amplified possibility of the transmission of blood-borne diseases.[3] The study was therefore designed to determine the prevalence of malaria parasitemia and the methemoglobin levels in MP infected blood donors in a tertiary hospital in Nigeria.


  Subjects and Methods Top


Study site

The study was carried out at Haematology and Blood Transfusion Unit of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Southeastern, Nigeria. NAUTH is a tertiary health institution serving patients of high, low, and middle socioeconomic status and majority of blood donors in the hospital are family replacement donors as well as some commercial donors. Nnewi is a populated commercial town located in Nnewi North Local Government. A greater number of the population is traders, students, and health workers.

Study subjects

A total of 100 apparently healthy blood donors aged 18-60 years visiting the Haematology and Blood Transfusion Unit for blood donation purposes were recruited by simple random sampling technique for the study.

Ethical consideration

The ethical approval was obtained from the Ethics Committee of NAUTH, Nnewi. Informed consent of the donors was obtained before being recruited for the study.

Inclusion and exclusion criteria

The study included blood donors who were screened and found fit to donate. Prospective donors who were not eligible for blood donation for any reason (such as those positive for transfusion transmissible infections such as HIV, syphilis, and hepatitis B and C) were excluded as well as donors who refused to give their consent to be used in the study.

Sample collection

Four milliliters of whole venous blood was collected into ethylene diamine tetraacetic acid (EDTA)-anticoagulated specimen containers, following standard protocol for venesection. It was used for malaria testing, packed cell volume (PCV), and methemoglobin estimation.

Laboratory investigations

Malaria testing was done using thick and thin blood films prepared from EDTA-anticoagulated blood as described by Dacie and Lewis (2006).

PCV was done using the microhematocrit method as described by Dacie and Lewis (2006).

Methemoglobin estimation was carried out by cyanmethemoglobin method using test kits manufactured by Teco Diagnostics Co. (Cat. No: H526-480, Lot: 57104).

Statistical analysis

Data were analyzed using the Statistical Package for Social Sciences, version 20.0 computer software (SPSS Inc., Chicago, IL, USA). Results were expressed as mean ± standard deviation. Comparison of parameters among groups was done using ANOVA, while comparison between groups was carried out using Student's t-test. Level of statistical significance was set at P < 0.05.


  Results Top


Out of the total of 100 blood donors screened for MP, 75 of the participants representing 75% were positive and 25 participants representing 25% of screened donors tested negative. Plasmodium falciparum was responsible for all cases of parasitemia.

The mean values of methemoglobin were significantly higher in asymptomatic MP infected subjects compared to the uninfected subjects (P < 0.05). Conversely, PCV was significantly decreased in MP infected donors compared to the uninfected donors (P < 0.05) [Table 1].
Table 1: Comparison of parameters between malaria infected and noninfected blood donors


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There was no significant difference in methemoglobin level and PCV when compared among the age groups (P > 0.05) [Table 2].
Table 2: Comparison of parameters among the patients based on age group of donors


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  Discussion Top


The safety of blood and blood products is a global goal of blood transfusion. In this study, we investigated the prevalence of MP infection, methemoglobin level, and PCV among blood donors. We observed a malaria infection prevalence of 75% among blood donors tested. This prevalence is very much high compared to what was obtained in studies carried out in other parts of Nigeria, viz., 28% in Lagos University Teaching Hospital,[4] 10% in Port Harcourt,[9] 23.4% in Sokoto,[10] 32.5% in Sokoto,[3] 40.9% in Southeastern Nigeria,[11] and 51.5% in Abakaliki,[12] while a similar prevalence of 74.1% was obtained in Onitsha Urban area[1] which is a nearby commercial town in the state. This variation in prevalence obtained in various studies could be explained by earlier assertions that differences in geographical zone affect the transmission of malaria with a constant minimum temperatures of 16°C-18°C (optimum: 20°C-30°C) and high humidity for several weeks as preconditions for vectoral transmission of malaria.[13] Our finding could be attributed to the fact that malaria is endemic in our environment and donors are not screened for malaria as exclusion criteria for recruiting blood donors in transfusion laboratory in the study area. The implication of this is that there is a high probability of malaria transmission through blood transfusion of asymptomatic donor units. Furthermore, the predominance of family replacement and remunerated donors as against voluntary nonremunerated low-risk donors in the study area could also account for the high prevalence as transfusion-transmitted malaria has been described as particularly common in countries where blood donation has become a commercial transaction and where the blood donors come from less affluent social classes.[14]

Our finding that P. falciparum was predominant is consistent with the findings of some previous studies.[9],[14],[15],[16] Maharaj et al.[17] also reported that P. falciparum has been and remains the causative agent in over 90% of malaria cases in South Africa.

In our study, the mean value of methemoglobin was significantly higher in MP infected blood donors than in noninfected donors. This could be due to the fact that malaria imposes serious effect on the blood, destroying red blood cells, interfering with the hemoglobin by disrupting the red blood cells pigment, and converting hemoglobin to methemoglobin leading to methemoglobinemia. Methemoglobin is formed when the heme part of hemoglobin is oxidized by accepting an electron from free radicals in the blood. This finding agrees with previous study that also showed a significantly higher methemoglobin levels in MP infected than in uninfected individuals.[7],[3],[18] According to Behera et al.[19] based on a finding similar to ours, routine methemoglobin estimation may be used as a prognostic indicator in the management of malaria patients. Zama et al.[3] also observed a significant positive correlation between the level of malaria parasitemia and methemoglobin level among parasitized donors.

Malaria is usually associated with anemia especially in tropical Africa. In this study, PCV was significantly decreased in MP infected donors compared with MP uninfected donors, and this could result from hemolyses of the red cells by the MP which can result to anemia. Potential causes of hemolysis include loss of infected cells by rupture or phagocytosis, removal of uninfected cells due to antibody sensitization or other physicochemical membrane changes, and increased reticuloendothelial activity, particularly in organs such as the spleen.[20] This is in line with the findings of previous studies.[21]


  Conclusion and Recommendation Top


The concentration of methemoglobin is significantly higher in asymptomatic MP infected blood donors than in noninfected donors, while PCV is decreased in MP infected donors than in noninfected donors.

Therefore, universal screening of donors for MP, particularly in high endemic regions such as Sub-Saharan Africa, will further enhance blood transfusion safety and ensure high quality of transfused blood. It is therefore recommended that screening of blood donors for MP be incorporated into routine screening tests before blood donation and because of the endemicity of MPs, malaria parasitemia should be considered as exclusion criteria for blood donation in our locality. However, as a prophylactic measure, recipients of blood transfusion, particularly children and pregnant women in malaria-endemic regions, may be treated with antimalarial drugs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ekwunife CA, Ozumba NA, Ezeanyi CI, Nwaorgu OC. Malaria infection among blood donors in Onitsha urban Southeast Nigeria. Sierra Lone J Biomed Res 2011;3:21-6.  Back to cited text no. 1
    
2.
World Health Organization. The African Malaria Report. Geneva: World Health Organization/UNICEF; 2003.  Back to cited text no. 2
    
3.
Zama I, Yakubu A, Okwesili AN, Ishaku E, Erhabor O, Mainasara AS, et al. Prevalence of malaria parasitemia and methemoglobin levels among blood donors in Sokoto, Nigeria. Intern Med Insid 2013;1:4.  Back to cited text no. 3
    
4.
Agboola TF, Ajayi MB, Adeleke MA, Gyang PV. Prevalence of malaria parasite among blood donors in Lagos State University Teaching Hospital. Ann Biol Res 2010;1:72-5.  Back to cited text no. 4
    
5.
Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: etiology, pharmacology, and clinical management. Ann Emerg Med 1999;34:646-56.  Back to cited text no. 5
    
6.
Belcher JD, Mahaseth H, Welch TE, Otterbein LE, Hebbel RP, Vercellotti GM. Heme oxygenase-1 is a modulator of inflammation and vaso-occlusion in transgenic sickle mice. J Clin Invest 2006;116:808-16.  Back to cited text no. 6
    
7.
Ash-Bernal R, Wise R, Wright SM. Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals. Medicine (Baltimore) 2004;83:265-73.  Back to cited text no. 7
    
8.
Attah EB. Malaria and other blood parasites. Hum Physiol 2000;13:203-10.  Back to cited text no. 8
    
9.
Erhabor O, Ok O, Awah I, Uko KE, Charles AT. The prevalence of plasmodia parasitaemia among donors in the Niger delta of Nigeria. Trop Doct 2007;37:32-4.  Back to cited text no. 9
    
10.
Abdullahi AU, Abubakar T, Adamu AI. Malaria in Sokoto, North Western Nigeria. Afr J Biotechnol 2009;8:7101-5.  Back to cited text no. 10
    
11.
Uneke CJ, Ogbu O, Nwojiji V. Potential risk of induced malaria by blood transfusion in South-Eastern Nigeria. Mcgill J Med 2006;9:8-13.  Back to cited text no. 11
    
12.
Epidi TT, Nwani CD, Ugorji NP. Prevalence of malaria in blood donors in Abakaliki Metropolis, Nigeria. Acad J 2008;3:162-4.  Back to cited text no. 12
    
13.
Fritz HK, Kurt AB, Johannes E, Rolf MZ. Medical Microbiology. 10 th ed. New York: Thieme; 2005. p. 520-38.  Back to cited text no. 13
    
14.
Adewuyi JO. The challenge of blood safety in Africa. Afr Sanguine 2001;4:1-5.  Back to cited text no. 14
    
15.
Chikwem JO, Mohammed I, Okara GC, Ukwandu NC, Ola TO. Prevalence of transmissible blood infections among blood donors at the University of Maiducuri Teaching Hospital, Maiduguri, Nigeria. East Afr Med J 1997;74:213-6.  Back to cited text no. 15
    
16.
Erhabor O, Azuonwu O, Frank-Peterside N. Malaria parasitaemia among long distance truck drivers in the Niger delta of Nigeria. Afr Health Sci 2012;12:98-103.  Back to cited text no. 16
    
17.
Maharaj R, Raman J, Morris N, Moonasar D, Durrheim DN, Seocharan I, et al. Epidemiology of malaria in South Africa: from control to elimination. S Afr Med J 2013;103 (10 Pt 2):779-83.  Back to cited text no. 17
    
18.
Uko EK, Udoh AE, Etukudoh MH. Methaemoglobin profile in malaria infected children in Calabar. Niger J Med 2003;12:94-7.  Back to cited text no. 18
    
19.
Behera GC, Behera SK, Jena RK, Bharati VS. Study of Methaemoglobin in Malaria Patients. Indian J Hematol Blood Transfus 2016;32:100-3.  Back to cited text no. 19
    
20.
Meraiyebu A, Akintayo CO, Nenchi DY. Evaluation of Pcv and hemoglobin variations among malaria positive and malaria negative patients, at the Ecwa Community Health Centre Bukuru, Jos Nigeria. IOSR J Pharm 2012;2:65-9.  Back to cited text no. 20
    
21.
Okafor UE, Tsoka-Gwegweni JM, Bibirigea A, Irimie A, Tomuleasa C. Parasitemia and haematological changes in malaria-infected refugees in South Africa. S Afr Med J 2016;106:413-6.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2]



 

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