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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 43  |  Issue : 2  |  Page : 85-87

Correlation between splenic size and CD4+ T lymphocytes in sickle cell anaemia patients in a Tertiary Hospital


1 Department of Haematology and Blood Transfusion, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
2 Department of Haematology, Federal Teaching Hospital, Ido Ekiti, Nigeria
3 Department of Haematology, University College Hospital, Ibadan, Nigeria
4 Department of Chemical Pathology, University College Hospital, Ibadan, Nigeria

Date of Submission06-Mar-2017
Date of Acceptance06-May-2017
Date of Web Publication7-Aug-2018

Correspondence Address:
Omotola T Ojo
Olabisi Onabanjo University Teaching Hospital, Hospital Road, Sagamu, Ogun State, 121101
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejh.ejh_15_17

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  Abstract 


Background Impaired leucocyte function, loss of both humoral and cell-mediated immunity and splenic dysfunction are partly responsible for increased susceptibility to infection in patients with sickle cell anaemia (SCA) with resultant increased morbidity and mortality.
Objective This study was carried out to determine the correlation between splenic size and CD4 T lymphocytes, which are two of the parameters highly involved in immunological status of an individual, among patients with SCA.
Materials and methods A comparative cross-sectional study of 40 SCA patients in steady state and 40 age-matched and sex-matched healthy Haemoglobin A controls was carried out. The blood samples were analysed for CD4+ T lymphocytes by flow cytometry, whereas spleen size was determined by ultrasonography. Data were analysed using statistical package for the social sciences version 17, and level of significance was put at P less than 0.05.
Result There was a negative correlation (r=−0.150) between CD4 T lymphocyte count and splenic size in sickle cell haemoglobin; however, the relationship is weak, and also not statistically significant (P=0.36).
Conclusion The importance of the spleen in immunity has been widely proven with consequent increased susceptibility to infection following the absence of spleen or splenic dysfunction. This study shows that CD4 T lymphocyte count may not be of prognostic value in the course of the disease. However, functionality of CD4 T lymphocytes vis-à-vis cytokine expression in relation to spleen size and function should be studied in patients with SCA.

Keywords: autosplenectomy, CD4+ T lymphocytes, sickle cell anaemia, spleen ultrasonography


How to cite this article:
Ojo OT, Ibijola AA, Shokunbi WA, Busari OE, Olatunji PO, Ganiyu A. Correlation between splenic size and CD4+ T lymphocytes in sickle cell anaemia patients in a Tertiary Hospital. Egypt J Haematol 2018;43:85-7

How to cite this URL:
Ojo OT, Ibijola AA, Shokunbi WA, Busari OE, Olatunji PO, Ganiyu A. Correlation between splenic size and CD4+ T lymphocytes in sickle cell anaemia patients in a Tertiary Hospital. Egypt J Haematol [serial online] 2018 [cited 2018 Oct 21];43:85-7. Available from: http://www.ehj.eg.net/text.asp?2018/43/2/85/238762




  Introduction Top


Sickle cell haemoglobin (HbS) is the most common abnormal haemoglobin with a worldwide distribution [1]. Vaso-occlusive crisis, which is the most common sickle cell crisis and the hallmark of the disease, presents as an acute-onset episode of pain, which is often severe and can affect any tissue in the body [2]. Repeated infarction of the spleen leads to fibrosis, calcification and functional autosplenectomy, thereby impairing the role of the spleen in host immune defence [3].

Thymus-derived (T) lymphocytes play an important role in cellular immunity. In the blood, T lymphocytes constitute 60–70% of peripheral lymphocytes [4]. They are also found in the paracortical areas of lymph nodes and in the periarteriolar sheath of the spleen. About 60% of mature T cells express CD4 (helper) and 30% express CD8 (cytotoxic) [5].

Increased morbidity and mortality in patients with sickle cell anaemia (SCA) is reported to be partly because of increased susceptibility to infection, which has been attributed to impaired leucocyte function, loss of both humoral and cell-mediated immunity and splenic dysfunction [6].

There are various studies on splenic size but few on the level of CD4 T lymphocytes among patients with SCA. Even rarer are the studies on the correlation between splenic size and level of CD4 T lymphocytes (which are two of the parameters highly involved in immunological status of an individual) among patients with SCA − hence the need for this study.

The aim of this study is to determine the correlation between splenic size and CD4 T lymphocytes in patients with SCA.


  Materials and methods Top


A total of 80 participants comprising 40 participants with SCA aged 18–40 years in steady state attending Haematology Clinic of the University College Hospital (UCH), Ibadan, Oyo state, South West of Nigeria, and 40 HbA controls from members of the staff were recruited.

Three millilitres of venous blood was collected aseptically from each participant after obtaining informed consent. The blood sample from each participant was transferred into sodium EDTA bottle, which was used in the analysis for CD4+ T lymphocytes by flow cytometry using the Partec CyFlow counter by Sysmex , Am Flugplatz 1302828 Görlitz, Germany. All participants were HIV negative.

Abdominal ultrasound was done for the determination of splenic size by the Radiologist, in the Department of Radiology, UCH, Ibadan. Ultrasound scan using a 3.5–5 MHz curvilinear transducer was performed on the patients in supine or right lateral position for complete visualisation of the spleen. The splenic length was measured in centimeters on longitudinal scan from the dome of the diaphragm to the inferior splenic margin ([Figure 1]). The spleen was considered nonfunctioning and atrophic if it was less than 6 cm [7],[8]. A spleen size of 6–12 cm was taken as normal, and a length exceeding 12 cm was considered to be evidence of splenomegaly [7],[8].
Figure 1: Correlation between spleen size and CD4+ T lymphocyte count in sickle cell haemoglobin patients

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Data were analysed using statistical package for the social sciences, version 17 (SPSS Inc., Chicago, Illinois, USA). The results were summarised as mean, SD, frequencies, percentages and ranges. χ2-Test was used to investigate the association between categorical variables. Difference in mean between two groups was compared using Student’s t-test, whereas analysis of variance was used to compare the mean among three groups. The inferential analyses were carried out using parametric methods such as Pearson’s correlation to test for the significance of the relationship and association between variables. Statistical significance was defined as P-value is 0.05 or more.


  Ethical consideration Top


Ethical approval was obtained from UI/UCH Ethics Committee, UCH, Ibadan.


  Results Top


Demographic characteristics of the study participants

The mean age of the SCA patients was 25.5±2.2 years, ranging from 16 to 40 years, whereas the mean age of HbA patients was 27±3.4 years, ranging from 18 to 38 years. There was no statistically significant difference in mean age in both the study and the control groups (P=0.38).

There was a slightly higher number of female patients among both HbS patients and the control population. There were 22 (55%) female participants in the HbS group and 25 (62.5%) in the control group, whereas there were 19 (45%) male participants in the study group and 15 (37.5%) in the control group. However, there was no statistically significant difference in the proportion of male and female participants in both the study and the control groups (P=0.50).

Relationship between CD4+ T lymphocyte count and spleen size in sickle cell haemoglobin patients

As shown in [Table 1], the mean of CD4+ T lymphocyte count was highest in HbS with normal spleen size − 1030±565 cells/μl − and lowest in HbS with splenomegaly − 762±370 cells/μl. The mean in HbS with autosplenectomy was 865±324 cells/μl. There was no significant difference in the mean CD4+ T lymphocyte count of the HbS patients with autosplenectomy, normal spleen size and splenomegaly when compared with the control (P=0.53, 0.77 and 0.21, respectively). Within the groups of HbS, there was no significant difference in the mean of the CD4+ T lymphocyte count in the three groups (P=0.54).
Table 1 Mean comparison of CD4+ T lymphocyte count in relation to spleen size in both sickle cell haemoglobin and HbA individuals

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Correlation between spleen size and CD4+ T lymphocyte count in sickle cell haemoglobin patients

The scatter plot of the relationship between the spleen size of the HbS patients and their CD4+ T lymphocyte count is shown by [Figure 1]. There was a negative correlation (r=−0.150) between CD4+ T lymphocyte count and splenic size; however, the relationship was weak, and also not statistically significant (P=0.36).


  Discussion Top


In this study, the mean CD4 T lymphocyte count in HbS patients with autosplenectomy was lower than HbS patients with normal size spleen but did not differ significantly. This is in contrast with the report by Koffi et al. [7], who indicated a significant decrease in CD4 T cell in sickle anaemia patients with asplenia when compared with those with normal spleen size. Sixty-five per cent of the HbS patients in this study had normal spleen size, which may explain why they have similar mean CD4 T-cell value compared with control. This may also be related to few number of asplenic patients. A larger population size might make the difference clear.Studies have shown that most HbS patients do not have palpable spleen beyond the eighth year of life [9] when the spleen is expected to have undergone autosplenectomy, from repeated vaso-occlusion and infarction. However, this is not always the case with some HbS patients living in the tropics, where the spleen remains palpable in the older age group (adolescent and adult) [10]. Factors such as high levels of foetal haemoglobin, chronic malaria infection and co-inheritance of alpha thalassaemia have been associated with the persistence of splenomegaly in older HbS patients [11]. In Nigeria, persistence of the spleen in some HbS patients has been attributed to chronic malaria infection [12]. However, the effect of chronic malaria infection was not part of this study.

There was no significant correlation between splenic size and CD4 T cell in HbS patients in this study.


  Conclusion Top


The importance of the spleen in immunity has been widely proven with consequent increased susceptibility to infection following the absence of spleen or splenic dysfunction. This study shows that CD4 T lymphocyte count may not be of prognostic value in the course of the disease. However, functionality of CD4 T lymphocytes vis-à-vis cytokine expression in relation to spleen size and function should be studied in patients with SCA.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hoffbrand AV, Moss MPAF, editors. Genetic disorders of haemoglobin. In: Essential haematology. 6th ed. London: Blackwell Publishing Limited; 2011. pp. 78–82.  Back to cited text no. 1
    
2.
Beutler E. Tisorders of hemoglobin structure: sickle cell anemia and related abnormalities. In: Lichtman MA, Beutler E, Kipps TJ, Seligsohn U, Kaushansky K, Prchal JT, editors. Williams’ haematology. 7th ed. New York: McGraw-Hill, Medical Publishing Division 2006. pp. 667–683.  Back to cited text no. 2
    
3.
Lal A, Vichinsky EP. Sickle cell disease. In: Hoffbrand AV, Catovsky D, Tuddenham EGD, editors. Postgraduate haematology. 5th ed. London: Blackwell Publishing Limited; 2005. pp. 104–118.  Back to cited text no. 3
    
4.
Kumar V, Abbas AK, Fausto N, Aster JC, editors. Diseases of the immune system. In: Robbins ad cotran pathologic basis of disease. 8th ed. Philadelphia: Saunders Elsevier; 2010. pp. 184–186.  Back to cited text no. 4
    
5.
Rastogi SC. Elements of immunology. The T-lymphocytes. 1st ed. New Delhi: CBS Publishers and Distributors; 2002. pp. 24-25:84–94.  Back to cited text no. 5
    
6.
Battersby AJ, Knox-Macaulay HH, Carol ED. Susceptibility to invasive bacterial infections in children with sickle cell disease. Pediatr Blood Cancer 2010; 55:401–406.  Back to cited text no. 6
    
7.
Koffi KG, Sawadogo D, Meite M. Reduced levels of T-cell subsets CD4+ and CD8+ in homozygous sickle cell anaemia patients with splenic defects. Hematol J 2003; 4:363–365.  Back to cited text no. 7
    
8.
Parulekar SG, Balachandra A. Ultrasound measurements of the Spleen. In: Goldberg BB, MaGhan JP, editors. Atlas of ultrasound measurement. 2nd ed. Philadephia: Mosby Elsevier; 2006. p. 429–443.  Back to cited text no. 8
    
9.
Al-Salem AH. Indications and complications of splenectomy for children with sickle cell disease. J Pediatr Surg 2006; 41:1909–1915.  Back to cited text no. 9
    
10.
Haricharan RN, Roberts JM, Morgan TL, Aprahamian CJ, Hardin WD, Hilliard LM et al. Splenectomy reduces packed red cell transfusion requirement in children with sickle cell disease. J Pediatr Surg 2008; 43:1052–1056.  Back to cited text no. 10
    
11.
Lubega I, Ndugwa CM, Mworozi EA, Tumwine JK. Alpha thalassemia among sickle cell anaemia patients in Kampala. Uganda Afr Health Sci 2015; 15:682–689.  Back to cited text no. 11
    
12.
Adekile AD, McKie KM, Adeodu OO, Sulzer AJ, Liu JS, McKie VC et al. Spleen in sickle cell anemia: comparative studies of Nigerian and US patients. Am J Hematol 1993; 42:316–321.  Back to cited text no. 12
    


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    Tables

  [Table 1]



 

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