Hematological parameters among kidney transplant recipients on follow up at Kenyatta National Hospital renal unit

Abstract

Background Kidney transplantation is the best and most cost effective renal replacement therapy modality for patients in stage 5 chronic kidney disease. The kidney transplantation program in Kenyatta National Hospital (KNH) is located at the KNH renal unit (KNH-RU). The program has grown tremendously since the year 2010 with about 70 kidney transplant recipients (KTRs) on follow up at the transplant clinic. Hematological abnormalities are common in the KTRs. They include post renal transplant erythrocytosis (PTE), post transplant !nemia

(PTA), leukopenia and thrombocytopenia. These abnormalities have severe consequences if undiagnosed or untreated. While these abnormalities have been widely studied in other parts of the world, no study has been conducted on the Kenyan cohort on follow up at KNH-RU hence the need for this study. Objective of the study The main objective of this study was to determine the hematological parameters among KTRs on follow up at KNH-RU. Specifically, the study sought to describe the prevalence of anemia, post renal transplant erythrocytosis, leukopenia and thrombocytopenia. A secondary objective ofthe study was to identify patient factors associated with these abnormalities. Methods A cross-sectional descriptive study was carried out on KTRs attending the transplant clinic at KNH-RU. Sixty three consecutive KTRs were screened for eligibility between zo' December 2011 and 6th March 2012; of these sixty one were recruited and enrolled into the study. Clinical and social demographic data was captured and recorded in a pre-designed questionnaire. Subsequently, two millilitres of blood was collected for measurement of a complete blood count and peripheral blood film examination. The tests were undertaken at the KNH Department of Human Pathology, Unit of Haematology and blood transfusion using a CELL-DYN 3700 automated blood counter. Results Sixty one eligible renal transplant recipients were recruited into the study. The mean (SD) age was 42.5 ﾱ 13.0 years. There were 39 (63.9%) males and 22 (26.1 %) females. The prevalence of abnormalities were; anaemia 21.3%, PTE 11.5%, leukopenia 4.9% and thrombocytopenia 1.6%. Male gender was significantly associated with PTE, p=0.035, OR 1.219 (1.052-1.411). Conclusion Haematological abnormalities are prevalent among KTRs on follow-up at KNH-RU affecting fifty-three (86.9%) of the KTRs. The abnormalities predominantly involved the red and white cell lines with relative sparing of the platelets. Recommendations We recommend further evaluation of patients noted to have haematological abnormalities to elucidate the cause and offer treatment especially for anemia and PTE which are known to confer adverse outcomes if untreated.