Haemostatic disorders in patients with breast cancer at Kenyatta national hospital, Kenya

Abstract

Haemostatic disorders (thrombosis and haemorrhage) are increasingly being investigated and assessed as factors that influence outcome of treatment of solid tumors including breast cancer. There is little data available on prevalence and influence of these disorders in patients with breast cancer locally. Objective To determine and describe haemostatic disorders in patients with breast cancer at Kenyatta National hospital (KNH), Nairobi. Design and Setting A cross-sectional descriptive study conducted at KNH oncology unit and the University of Nairobi (UON) haematology laboratory. Methods One hundred and three (103) eligible patients were studied. Data was obtained by direct interviews, clinical examination and from patient files. Full haemogram (FHG), peripheral blood film (PBF), prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, thrombin time (TT) and d-dimers were assayed at the UON haematology laboratory. Data handling Data collected and that generated from the laboratory tests was analysed using Statistical Package for Social Sciences (SPSS) Version 15 software for analysis and presented as proportions and percentages in form of tables and charts. Correlations between variables were determined where appropriate. Results A total of 103 patients were recruited into the study 93.2% of whom were female and the majority in the 36-45 year age group (31.1%). Ninety three percent (93%) had invasive ductal carcinoma and 6.8% with lobular carcinoma. One patient had lower limb deep venous thrombosis and none had clinical features of haemorrhage (petechiae, purpura, and easy xii bruisability). During the course of treatment, 93.2% had had surgery. Fifty eight percent and 31.1% were on chemotherapy and radiotherapy respectively. Abnormal clotting times were observed in 21.3% and elevated d-dimers in 7.7% of the participants. There was a statistically significant association between abnormal clotting times, elevated d-dimers and elevated fibrinogen levels with advanced disease (stage IV). Conclusions 1. Haemostatic disorders are present in patients on management for breast cancer at KNH at a rate of 21.3% 2. The disorders are present at low prevalence compared to other studies done in other centers 3. Late stage of disease (Stage IV) is associated with likelihood of haemostatic disorder development Recommendations 1. This study demonstrated that there are coagulation disorders (DVT, elevated d-dimers, prolonged clotting time) in patients with cancer with significant association with late stage disease. It is therefore recommended that coagulation disorders be screened for in patients with breast cancer in late stage disease. 2. It is recommended that the study be undertaken where the haemostatic parameters will be assayed on automated equipment to improve accuracy e.g. use of ELISA to identify d-dimers in thrombosis, automated PT, aPTT and thrombin time. 3. Other similar studies enrolled participants who were newly diagnosed and not on treatment. A similar study to be undertaken using similar criteria so as to delineate effect of disease and treatment as independent and related variables on haemostasis. 4. To conduct a prospective study in Kenyan patients with quantifiable objective endpoints such as venography and/or Doppler studies.