Background/Case Studies: In sub-Saharan Africa, where sickle cell anaemia (SCA) is highly prevalent, blood transfusion remains a key therapeutic intervention. However, iron overload—a frequent consequence of repeated transfusions—is rarely monitored, leading to silent organ damage. SCD patients also require folate supplementation due to elevated red blood cell turnover; however, the appropriate dosage may vary by geographical region. It is therefore essential for healthcare providers to tailor folate prescriptions in accordance with established regional guidelines and nutritional standards. This study evaluated iron status among transfused SCA patients at a tertiary facility in Ghana, aiming to guide local transfusion and chelation practices.
Study
Design/Methods: A purposive case-control study enrolled 100 steady-state SCA patients (Hb SS n=26; Hb SC n=14; 5–60 years) at Cape Coast Teaching Hospital. Participants were stratified by transfusion history (none, ≤2, >2). We performed complete blood counts (Sysmex analyzer), serum ferritin via latex-enhanced turbidimetry (Mindray BS-120), and urinary hemosiderin screening. Sociodemographics and transfusion data were collected by questionnaire. Statistical analyses (GraphPad Prism 6) included Mann–Whitney U, Spearman correlations, and Kruskal–Wallis tests; p< 0.05 was significant.
Results/Findings: 62.5% had received multiple transfusions. • Median ferritin was higher in >2 transfusions (177 µg/L; IQR 85–325) versus none (92 µg/L; IQR 40–210), p=0.20. • Females showed an age-related ferritin increase (r=0.53; p=0.77), peaking ≥30 years; males peaked at 20–29 years then declined. • Hb SS patients exhibited higher ferritin than Hb SC (224±245 vs. 78±32 µg/L in males; p=0.68). • Weak correlations existed between ferritin and Hb (r=0.32–0.50) or RDW (r=–0.87–0.32), varying by gender and anaemia severity.
Conclusions: Although not reaching statistical significance, multiple transfusions and Hb SS genotype are associated with elevated ferritin in this Ghanaian SCA cohort, with distinct age- and gender-specific patterns. These data underscore the need for routine iron monitoring and individualized chelation protocols in LMIC transfusion programs to mitigate iron-mediated end-organ injury.
