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Article: Aetiology of pancytopenia: Experience of a South African tertiary academic centre.

Nell, Erica-Mari / Chapanduka, Zivanai C

2022 Volume 11, Issue 1, Page(s) 1645

Abstract: Background: Pancytopenia is a manifestation of numerous disease entities. The causes of pancytopenia differ with geographic region, socio-economic factors and HIV prevalence. Awareness of the common causes of pancytopenia may aid timely diagnosis.: ... ...

Abstract	Background: Pancytopenia is a manifestation of numerous disease entities. The causes of pancytopenia differ with geographic region, socio-economic factors and HIV prevalence. Awareness of the common causes of pancytopenia may aid timely diagnosis. Objective: This study aimed to determine the aetiology of pancytopenia in a South African population. Methods: A retrospective observational study of adult patients presenting with pancytopenia at Tygerberg Academic Hospital, South Africa, from January 2016 to December 2017 was performed. Data on pancytopenia cases were obtained from the laboratory information system and utilised to determine the causes of pancytopenia. Results: A total of 673 cases of pancytopenia were identified. The most common causes of pancytopenia were chemoradiation therapy (25%), sepsis (18%), haematological malignancy (9%), advanced HIV (7%), and megaloblastic anaemia (6%). The diagnostic yield of bone marrow examinations (BME) was 57% ( Conclusion: Several easily recognisable and treatable conditions can manifest as pancytopenia. Prompt management of such conditions, notably sepsis and megaloblastic anaemia, can result in the resolution of the cytopenias and negate the need for a BME. However, haematological malignancy and unexplained pancytopenia strongly rely on a BME to establish a diagnosis. Pancytopenia investigations, when guided by appropriate clinic-laboratory findings, can promptly identify the underlying aetiology, while also identifying cases where an expedited BME is required. This is valuable in resource-conscious medicine.
Language	English
Publishing date	2022-05-31
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	2708535-1
ISSN	2225-2010 ; 2225-2002
ISSN (online)	2225-2010
ISSN	2225-2002
DOI	10.4102/ajlm.v11i1.1645
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Article ; Online: The impact of laboratory staff training workshops on coagulation specimen rejection rates.

du Toit, Marcel / Chapanduka, Zivanai C / Zemlin, Annalise E

PloS one

2022 Volume 17, Issue 6, Page(s) e0268764

Abstract: Background: Pre-analytical variables can have a significant adverse impact on the quality and credibility of coagulation test results. Therefore, correct and consistent identification of pre-analytical variables that compromise coagulation specimen ... ...

Abstract	Background: Pre-analytical variables can have a significant adverse impact on the quality and credibility of coagulation test results. Therefore, correct and consistent identification of pre-analytical variables that compromise coagulation specimen quality is of paramount importance. Lack of standardization and heterogeneity among laboratory staff when assessing coagulation specimens can lead to inconsistent identification of these variables. Failure to recognize such pre-analytical variables results in the analysis of poor quality specimens and the authorization of spurious test results. Objectives: To determine the impact of a laboratory staff training workshop on coagulation specimen rejection rates and to ascertain the level of knowledge of laboratory personnel concerning coagulation specimen rejection criteria before and after the workshop. Methods: A retrospective three-month audit was performed with rejection data of incorrect blood to additive ratio, clotted, aged and haemolysed specimens collected. Training workshops and evaluation sessions were subsequently presented. A revised standard operating procedure delineating coagulation specimen rejection criteria was implemented and a repeat three-month audit was conducted. Results: In total, 13 162 coagulation specimens were received during the initial audit with 1 104 specimens (8.39%) rejected. Following the workshops, the rejection rate increased by 3.49% to 11.88% with 12 743 coagulation specimens received and 1 514 specimens rejected. Evaluation sessions performed before and after the workshops revealed that 95.2% of attendees attained improved knowledge. Conclusion: This study demonstrated the pivotal importance of regular laboratory staff training. The increase in specimen rejection following the workshops signifies their success in educating laboratory personnel regarding the correct identification of pre-analytical variables. Since most pre-analytical variables occur outside the laboratory, educational workshops need to be extended to non-laboratory personnel responsible for specimen collection and transport.
MeSH term(s)	Aged ; Blood Coagulation ; Blood Specimen Collection/methods ; Humans ; Laboratories ; Retrospective Studies ; Specimen Handling
Language	English
Publishing date	2022-06-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0268764
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Article ; Online: A study of patient-reported pain during bone marrow aspiration and biopsy using local anesthesia alone compared with local anesthesia with intravenous midazolam coadministration at a tertiary academic hospital in South Africa.

Alzanad, Fatima / Feyaza, Merga / Chapanduka, Zivanai C

Health science reports

2022 Volume 5, Issue 6, Page(s) e902

Abstract: Introduction: During the bone marrow aspiration and biopsy (BMAB) procedure, patients report pain of widely variable intensity. There is limited literature on the factors associated with the pain. The use of local anesthesia (LA) only is still ... ...

Abstract	Introduction: During the bone marrow aspiration and biopsy (BMAB) procedure, patients report pain of widely variable intensity. There is limited literature on the factors associated with the pain. The use of local anesthesia (LA) only is still widespread although it does not abolish the pain. Midazolam is the most commonly used benzodiazepine for conscious sedation. Our center introduced universal midazolam sedation unless there is a contraindication to its use, 4 years ago. This study assessed the impact of the universal use of intravenous midazolam for BMAB compared to use of LA only. The factors associated with the pain of BMAB, were analyzed. Methods: A retrospective cross-sectional study was performed on adult patients who had a BMAB procedure from July 1, 2018 to March 30, 2019. A questionnaire incorporating a visual analog pain scale, was used for data collection. Results: A total of 182 BMAB procedures were included in the study. Pain was reported in all procedures performed under LA and only in 29.1% of procedures performed with midazolam. Age, sex, race, level of education, body mass index (BMI), indication and diagnosis had no influence on pain. Patients who had previous BMAB experienced less pain. Experience of operator had a significant effect on pain. Midazolam dose showed a negative correlation with pain. Conclusion: LA only is not enough to abolish pain of BMAB. Midazolam conscious sedation used with LA reduces pain to acceptable levels. Patients with previous experience of BMAB under midazolam premedication reported less pain. Furthermore, the experience of operator reduced the pain significantly.
Language	English
Publishing date	2022-10-31
Publishing country	United States
Document type	Journal Article
ISSN	2398-8835
ISSN (online)	2398-8835
DOI	10.1002/hsr2.902
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Article ; Online: The impact of physician education regarding the importance of providing complete clinical information on the request forms of thrombophilia-screen tests at Tygerberg hospital in South Africa.

Abdullah, Ibtisam / Jafta, Andrea D / Chapanduka, Zivanai C

PloS one

2020 Volume 15, Issue 8, Page(s) e0235826

Abstract: Background: Thrombophilia-screen tests are specialised haemostasis tests that are affected by numerous unique patient variables including the presence of acute thrombosis, the concomitant use of medication and patient demographics. Complete information ... ...

Abstract	Background: Thrombophilia-screen tests are specialised haemostasis tests that are affected by numerous unique patient variables including the presence of acute thrombosis, the concomitant use of medication and patient demographics. Complete information on the request form is therefore crucial for the haematological pathologist to make patient-specific interpretation of patients' results. Objectives: To assess the completeness of thrombophilia-screen test request forms and determine the impact of provision of incomplete information, on the interpretive comments generated by reporting haematological pathologists. To assess the impact of an educational session given to clinicians on the importance of providing all the relevant information on the request forms. Method: Two retrospective audits, each covering 3 months, were performed to evaluate the completeness of demographic and clinical information on thrombophilia-screen request forms and its impact on the quality of the interpretive comments before and after an educational intervention. Results: One hundred and seventy-one request forms were included in the first audit and 146 in the second audit. The first audit revealed that all 171 thrombophilia-screen request forms had complete patient demographic information but none had clinical information. Haematological pathologists only made generic comments which could not be applied to a specific patient. The second audit, conducted after a physician educational session, did not reveal any improvement in the clinical information provision by the test-ordering physicians. This was reportedly due to the lack of space on the request form. The interpretive comments therefore remained generic and not patient-specific. Conclusion: Physicians' failure to provide relevant clinical information made it impossible for pathologists to make patient-specific interpretation of the results. A single physician education session did not change the practice, reportedly due to the inappropriate design of the test request form. Further studies are required to investigate the impact of an improved request form and the planned electronic test requesting.
MeSH term(s)	Education, Medical, Continuing ; Forms and Records Control/statistics & numerical data ; Humans ; Mass Screening/standards ; Mass Screening/statistics & numerical data ; Medical Audit/statistics & numerical data ; Medical Records/standards ; Medical Records/statistics & numerical data ; Physicians/standards ; Physicians/statistics & numerical data ; Program Evaluation ; Retrospective Studies ; South Africa ; Thrombophilia/diagnosis
Language	English
Publishing date	2020-08-06
Publishing country	United States
Document type	Journal Article
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0235826
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Article ; Online: Hematological findings in adult patients with SARS CoV-2 infection at Tygerberg Hospital Cape Town South Africa.

Abdullah, Ibtisam / Cornelissen, Helena M / Musekwa, Ernest / Zemlin, Annalise / Jalavu, Thumeka / Mashigo, Nomusa / Chetty, Carissa / Nkosi, Nokwazi / Chapanduka, Zivanai C

Health science reports

2022 Volume 5, Issue 3, Page(s) e550

Abstract: Background: Coronavirus disease 2019 (COVID-19) is associated with hematological abnormalities of variable severity. The full blood count (FBC) and leukocyte differential count (DIFF) could facilitate the prediction of disease severity and outcome in ... ...

Abstract	Background: Coronavirus disease 2019 (COVID-19) is associated with hematological abnormalities of variable severity. The full blood count (FBC) and leukocyte differential count (DIFF) could facilitate the prediction of disease severity and outcome in COVID-19. This study aimed to assess the hematological parameters in early severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their correlation with disease outcome. Methods: A retrospective cross-sectional descriptive study was performed. Adults with a FBC and positive SARS-CoV-2 polymerase chain reaction results between March 1, and June 31, 2020 were reviewed. Basic hematological parameters (FBC, DIFF) and human immunodeficiency virus (HIV) status were recorded. Outcome measures were admission to a general ward or intensive care unit (ICU), recovery or death. Results: Six hundred and eighty-five cases median age 51 years, were analyzed. Forty-four percent were males and fourteen percent were HIV-positive with no association between death and/or ICU admission ( Conclusion: Evidence-based interpretation of routine laboratory parameters, readily available in resource-constrained settings, may identify patients at increased risk of mortality. The FBC, DIFF, NLR, and MLR should form part of the early COVID-19 investigation.
Language	English
Publishing date	2022-04-13
Publishing country	United States
Document type	Journal Article
ISSN	2398-8835
ISSN (online)	2398-8835
DOI	10.1002/hsr2.550
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Article ; Online: Peripheral-blood cytopenia, an early indicator of inborn errors of immunity.

Cornelissen, Helena M / Musekwa, Ernest M / Glashoff, Richard H / Esser, Monika / Zunza, Moleen / Abraham, Deepthi R / Chapanduka, Zivanai C

British journal of haematology

2022 Volume 198, Issue 5, Page(s) 875–886

Abstract: Inborn errors of immunity (IEI) are inherited monogenic disorders resulting in defective immune response. Non-infectious presentations are increasingly more apparent. Widely available, cost-effective early indicators are needed. Peripheral-blood ... ...

Abstract	Inborn errors of immunity (IEI) are inherited monogenic disorders resulting in defective immune response. Non-infectious presentations are increasingly more apparent. Widely available, cost-effective early indicators are needed. Peripheral-blood cytopenia may be a presenting laboratory feature or an observed secondary phenomenon. This retrospective review of the South African Primary Immunodeficiency Registry (SAPIDR) aimed to assess the haematological indices at presentation and their association with the International Union of Immunological Societies (IUIS) 2019 IEI classification and mortality. Of 396 patients on the SAPIDR, 66% (n = 257) had available haematological results. Sixty percent were males and 85% under 18 years. A majority (53%) had predominantly antibody deficiency. At presentation, infection was prominent (86%) followed by cytopenia (62%). Neutropenia was associated with IUIS III [odds ratio (OR) 3.65, confidence interval (CI) 1.44-9.25], thrombocytopenia with IUIS II (OR 14.39, CI 2.89-71.57), lymphopenia with IUIS I (OR 12.16, CI 2.75-53.73) and pancytopenia with IUSI I (OR 12.24, CI 3.82-39.05) and IUIS II (OR 5.99, CI 2.80-12.76). Cytopenia showed shorter overall survival (OR 2.81, CI 1.288-4.16). Cytopenias that are severe, persistent, unusual and/or recurrent should prompt further investigation for IEI. The full blood count and leucocyte differential may facilitate earlier identification and serve as an adjunct to definitive molecular classification.
MeSH term(s)	Adolescent ; Anemia ; Female ; Humans ; Lymphopenia ; Male ; Neutropenia ; Pancytopenia ; Thrombocytopenia
Language	English
Publishing date	2022-07-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80077-6
ISSN	1365-2141 ; 0007-1048
ISSN (online)	1365-2141
ISSN	0007-1048
DOI	10.1111/bjh.18337
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Article: Infection and myelodysplasia: A case report of GATA2 deficiency in a South African patient.

Nell, Erica-Mari / Cornellissen, Helena / Hodkinson, Katherine / Urban, Michael F / Bassa, Fatima Cassim / Fazel, Fatima Bibi / Wiggill, Tracey / Irusen, Semira / Chapanduka, Zivanai C

Clinical case reports

2023 Volume 11, Issue 3, Page(s) e7075

Abstract: Rare diseases often result in delays in diagnosis. It is important to recognize conditions that have features of both inborn errors of immunity and predispose to myeloid neoplasia. Here we report a patient with GATA2 deficiency that presented with ... ...

Abstract	Rare diseases often result in delays in diagnosis. It is important to recognize conditions that have features of both inborn errors of immunity and predispose to myeloid neoplasia. Here we report a patient with GATA2 deficiency that presented with disseminated non-tuberculous mycobacterial infection and pancytopenia secondary to myelodysplastic syndrome.
Language	English
Publishing date	2023-03-14
Publishing country	England
Document type	Case Reports
ZDB-ID	2740234-4
ISSN	2050-0904
ISSN	2050-0904
DOI	10.1002/ccr3.7075
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Article ; Online: The clinical and epidemiological characteristics of a series of patients living with HIV admitted for COVID-19 in a district hospital.

Mnguni, Ayanda Trevor / Schietekat, Denzil / Ebrahim, Nabilah / Sonday, Nawhaal / Boliter, Nicholas / Schrueder, Neshaad / Gabriels, Shiraaz / Sigwadhi, Lovemore N / Zemlin, Annalise E / Chapanduka, Zivanai C / Ngah, Veranyuy / Yalew, Anteneh / Jalavu, Thumeka / Abdullah, Ibtisam / Tamuzi, Jacques L / Tembo, Yamanya / Davies, Mary-Ann / English, Rene / Nyasulu, Peter S

BMC infectious diseases

2023 Volume 23, Issue 1, Page(s) 123

Abstract: Background: The coronavirus disease 2019 (COVID-19) pandemic continues to evolve. Globally, COVID-19 continues to strain even the most resilient healthcare systems, with Omicron being the latest variant. We made a thorough search for literature ... ...

Abstract	Background: The coronavirus disease 2019 (COVID-19) pandemic continues to evolve. Globally, COVID-19 continues to strain even the most resilient healthcare systems, with Omicron being the latest variant. We made a thorough search for literature describing the effects of the COVID-19 in a high human immunodeficiency virus (HIV)/tuberculosis (TB) burden district-level hospital setting. We found scanty literature. Methods: A retrospective observational study was conducted at Khayelitsha District Hospital in Cape Town, South Africa (SA) over the period March 2020-December 2021. We included confirmed COVID-19 cases with HIV infection aged from 18 years and above. Analysis was performed to identify predictors of mortality or hospital discharge among people living with HIV (PLWH). Predictors investigated include CD4 count, antiretroviral therapy (ART), TB, non-communicable diseases, haematological, and biochemical parameters. Findings: This cohort of PLWH with SARS-CoV-2 infection had a median (IQR) age of 46 (37-54) years, male sex distribution of 29.1%, and a median (IQR) CD4 count of 267 (141-457) cells/mm3. Of 255 patients, 195 (76%) patients were discharged, 60 (24%) patients died. One hundred and sixty-nine patients (88%) were on ART with 73(28%) patients having acquired immunodeficiency syndrome (AIDS). After multivariable analysis, smoking (risk ratio [RR]: 2.86 (1.75-4.69)), neutrophilia [RR]: 1.024 (1.01-1.03), and glycated haemoglobin A1 (HbA1c) [RR]: 1.01 (1.007-1.01) were associated with mortality. Conclusion: The district hospital had a high COVID-19 mortality rate among PLWH. Easy-to-access biomarkers such as CRP, neutrophilia, and HbA1c may play a significant role in informing clinical management to prevent high mortality due to COVID-19 in PLWH at the district-level hospitals.
MeSH term(s)	Humans ; Male ; Middle Aged ; COVID-19/epidemiology ; COVID-19/mortality ; Glycated Hemoglobin ; HIV ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Hospitals, District ; Leukocytosis ; SARS-CoV-2 ; South Africa/epidemiology ; Female ; Adult
Chemical Substances	Glycated Hemoglobin
Language	English
Publishing date	2023-02-28
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2041550-3
ISSN	1471-2334 ; 1471-2334
ISSN (online)	1471-2334
ISSN	1471-2334
DOI	10.1186/s12879-023-08004-6
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Article ; Online: An investigation of the correlation of vitamin D status and management outcomes in patients with severe COVID-19 at a South African tertiary hospital.

Jalavu, Thumeka P / Sigwadhi, Lovemore N / Kotze, Maritha J / Yalew, Anteneh / Ngah, Vera / Tamuzi, Jacques L / Chapanduka, Zivanai C / Allwood, Brian W / Koegelenberg, Coenraad F / Irusen, Elvis M / Lalla, Usha / Matsha, Tandi E / Erasmus, Rajiv T / Zumla, Ali / Zemlin, Annalise E / Nyasulu, Peter S

IJID regions

2023

Abstract: Background: Severe COVID-19 has a poor prognosis, and biomarkers may predict disease severity. This study aimed to assess the effect of baseline Vitamin D (VitD) inadequacy on outcome of patients with severe COVID-19 admitted to intensive care unit (ICU) ...

Abstract	Background: Severe COVID-19 has a poor prognosis, and biomarkers may predict disease severity. This study aimed to assess the effect of baseline Vitamin D (VitD) inadequacy on outcome of patients with severe COVID-19 admitted to intensive care unit (ICU) in a tertiary hospital in South Africa. Methods: Patients with confirmed SARS-CoV-2 were recruited during wave II of the pandemic in Cape Town. Eighty-six patients were included in the study. They were categorized into three groups "VitD deficient, VitD insufficient and VitD sufficient". We combined the VitD deficient with insufficient group to form "VitD inadequate'' group. Cox regression analysis was done to assess the association between VitD status and mortality. Factors with p< 0.05 in adjusted multivariable cox regression were considered statistically significant. Results: The proportion of VitD inadequacy was 64% (55/86), with significantly higher proportion of hypertension (66%; p 0.012). Kaplan Meir curve showed no significant difference in the probability of survival among the COVID-19 patients admitted in the ICU with or without VitD inadequacy. However, patients with elevated serum creatinine were significantly more at risk of dying (Adjusted Hazard Ratio 1.008 (1.002 - 1.030, p<0.017). Conclusion: Our study found a high prevalence of VitD inadequacy (combined deficiency and insufficiency) in COVID-19 patients admitted to the ICU. This may indicate a possible risk of severe disease. Whilst there was no statistically significant relationship between VitD status and mortality in this cohort, baseline VitD may be an important prognostic biomarker in COVID-19 patients admitted to the ICU, particularly in those with comorbidities that predispose to VitD deficiency.
Language	English
Publishing date	2023-06-01
Publishing country	England
Document type	Journal Article
ISSN	2772-7076
ISSN (online)	2772-7076
DOI	10.1016/j.ijregi.2023.05.007
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Article ; Online: Immunologic and vascular biomarkers of mortality in critical COVID-19 in a South African cohort.

Shaw, Jane Alexandra / Meiring, Maynard / Snyders, Candice / Everson, Frans / Sigwadhi, Lovemore Nyasha / Ngah, Veranyay / Tromp, Gerard / Allwood, Brian / Koegelenberg, Coenraad F N / Irusen, Elvis M / Lalla, Usha / Baines, Nicola / Zemlin, Annalise E / Erasmus, Rajiv T / Chapanduka, Zivanai C / Matsha, Tandi E / Walzl, Gerhard / Strijdom, Hans / du Plessis, Nelita /

Zumla, Alimuddin / Chegou, Novel / Malherbe, Stephanus T / Nyasulu, Peter S

Frontiers in immunology

2023 Volume 14, Page(s) 1219097

Abstract: Introduction: Biomarkers predicting mortality among critical Coronavirus disease 2019 (COVID-19) patients provide insight into the underlying pathophysiology of fatal disease and assist with triaging of cases in overburdened settings. However, data ... ...

Abstract	Introduction: Biomarkers predicting mortality among critical Coronavirus disease 2019 (COVID-19) patients provide insight into the underlying pathophysiology of fatal disease and assist with triaging of cases in overburdened settings. However, data describing these biomarkers in Sub-Saharan African populations are sparse. Methods: We collected serum samples and corresponding clinical data from 87 patients with critical COVID-19 on day 1 of admission to the intensive care unit (ICU) of a tertiary hospital in Cape Town, South Africa, during the second wave of the COVID-19 pandemic. A second sample from the same patients was collected on day 7 of ICU admission. Patients were followed up until in-hospital death or hospital discharge. A custom-designed 52 biomarker panel was performed on the Luminex® platform. Data were analyzed for any association between biomarkers and mortality based on pre-determined functional groups, and individual analytes. Results: Of 87 patients, 55 (63.2%) died and 32 (36.8%) survived. We found a dysregulated cytokine response in patients who died, with elevated levels of type-1 and type-2 cytokines, chemokines, and acute phase reactants, as well as reduced levels of regulatory T cell cytokines. Interleukin (IL)-15 and IL-18 were elevated in those who died, and levels reduced over time in those who survived. Procalcitonin (PCT), C-reactive protein, Endothelin-1 and vascular cell adhesion molecule-1 were elevated in those who died. Discussion: These results show the pattern of dysregulation in critical COVID-19 in a Sub-Saharan African cohort. They suggest that fatal COVID-19 involved excessive activation of cytotoxic cells and the NLRP3 (nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3) inflammasome. Furthermore, superinfection and endothelial dysfunction with thrombosis might have contributed to mortality. HIV infection did not affect the outcome. A clinically relevant biosignature including PCT, pH and lymphocyte percentage on differential count, had an 84.8% sensitivity for mortality, and outperformed the Luminex-derived biosignature.
MeSH term(s)	Humans ; COVID-19 ; South Africa/epidemiology ; SARS-CoV-2 ; HIV Infections ; Pandemics ; Hospital Mortality ; Biomarkers ; Cytokines ; Procalcitonin
Chemical Substances	Biomarkers ; Cytokines ; Procalcitonin
Language	English
Publishing date	2023-07-03
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2023.1219097
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