|Year : 2018 | Volume
| Issue : 3 | Page : 182-186
Sonographic determination of liver and spleen sizes in patients with sickle cell disease at Gombe, Nigeria
Anthony Chukwuka Ugwu1, Suleiman Tanimu Saad2, Emmanuel Ayuba Buba2, Saleh Yuguda2, Alhaji Modu Ali3
1 Department of Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi, Nigeria
2 Department of Radiology, Federal Teaching Hospital Gombe, Maiduguri, Borno, Nigeria
3 Department of Radiology, Federal Neuro-Hospital, Maiduguri, Borno, Nigeria
|Date of Web Publication||17-Jul-2018|
Emmanuel Ayuba Buba
Department Radiology, Federal Teaching Hospital Gombe, P. M. B 0037 Gombe, Gombe State
Source of Support: None, Conflict of Interest: None
Background: Ultrasonography is a safe, reproducible, and accurate diagnostic imaging modality in the evaluation of the effects of sickle cell anemia (SCA) on the sizes of liver and spleen. The study is aimed at determining the size of liver and spleen in SCA patients compared with that of healthy age-matched known normal hemoglobin genotype (HbAA) volunteers and also to correlate with some hematological parameters. Materials and Method: This is a prospective cross-sectional study conducted over a period of 1 year. A total number of 237 SCA patients attending the outpatient sickle cell clinic of Federal Teaching Hospital, Gombe and an equal number of apparently healthy known age-matched HbAA from the general public were recruited by a convenient sampling technique. Results: The mean size of liver span and spleen length in SCA patients was 13.12 ± 2.05 cm and 6.50 ± 1.75 cm, respectively, while that of the controls was 11.77 ± 1.491 cm and 7.62 ± 1.827 cm, respectively (P = 0.00 for both liver and spleen). The liver span in SCA patients was higher among all the ages, while the spleen length reduces after the first 10 years of age. There was a strong positive correlation between liver span and the age, weight, and height (r = 0.767, 0.830, and 0.826, respectively) in SCA patients. The liver span showed a significant relationship with packed cell volume, red blood cell, white blood cells, mean corpuscular hemoglobin (MCH), MCH concentration, and mean corpuscular volume (r = −0.181, −0.266,−0.299, 0.316, 0.206, and 0.309). There was no correlation between spleen size and hematological parameter. Conclusion: Ultrasound is a veritable tool in the estimation of liver and spleen sizes in SCA patients.
Keywords: Liver span, sickle cell anemia, spleen length, ultrasonography
|How to cite this article:|
Ugwu AC, Saad ST, Buba EA, Yuguda S, Ali AM. Sonographic determination of liver and spleen sizes in patients with sickle cell disease at Gombe, Nigeria. CHRISMED J Health Res 2018;5:182-6
|How to cite this URL:|
Ugwu AC, Saad ST, Buba EA, Yuguda S, Ali AM. Sonographic determination of liver and spleen sizes in patients with sickle cell disease at Gombe, Nigeria. CHRISMED J Health Res [serial online] 2018 [cited 2019 Oct 21];5:182-6. Available from: http://www.cjhr.org/text.asp?2018/5/3/182/236902
| Introduction|| |
Ultrasonography has now become the most common imaging modality used in the measurement and assessment of intra-abdominal organs. It is a noninvasive, nonionizing, reproducible, safe, and accurate method for the measurement of liver and spleen, superior to the less accurate and reliable clinical method of percussion and palpation., Sickle cell anemia (SCA) is frequently associated with liver disease, with the liver generally enlarged throughout the lifespan of many SCA patients. Thus, it is essential to assess for evidence of liver involvement in these patients even when they are asymptomatic. The spleen, on the other hand, is commonly enlarged only in early life as it may undergo atrophy due to repeated episode of vaso-occlusion and infarction, leading to autosplenectomy later in adult life. Other Studies conducted in Nigeria, Saudi Arabia, Senegal, and India; however, reported splenomegaly persisting even in much older age group of SCA patients.
Sickle cell anemia (SCA) is due to the substitution of adenine with thymine in the glutamic DNA codon (GAG→GTG), which results in the substitution of β6 valine for glutamic acid  giving rise to the rigid sickling of the cell, leading to vascular occlusion and ischemia in multiple organs. SCA is one of the most commonly inherited hemoglobinopathies  accounting for 60% of world's major hemoglobinopathies and constituting a major health problem in Nigeria., By virtue of its population, Nigeria stands out as the most sickle cell endemic country in Africa with an annual infant death of 100,000 with SCA accounting for 8% of the total infant mortality in the country. It is also estimated that about 24% of Nigerian adults have sickle cell trait.
Several studies suggested ultrasound evaluation of the liver and spleen to be employed as routine for both screening procedures and follow-up measures in SCA patients.,,, The aim of this study is to determine the size of liver and spleen in SCA patients using B-mode ultrasound, to compare the sizes with healthy controls in the study area, and to assess for possible correlation with some hematological parameters.
| Materials and Methods|| |
This is a prospective cross-sectional study conducted over a period of 1 year (July 2016–August, 2017) at Radiology Department, Federal Teaching Hospital (FTH), Gombe. A total number of 474 participants (age range 1–49 years) comprising 237 SCA (HbSS) patients attending the outpatient sickle cell clinic of FTH Gombe and an equal number (237) of healthy known age-matched hemoglobin genotype (HbAA) volunteers drawn from staff and clients undergoing medical checkups were recruited. Both verbal and written informed consent was obtained from all participants. Ethical approval was obtained from the hospital's Ethical Committee. Participants with a previous history of splenectomy and ultrasound findings of echogenic liver or intrahepatic mass were excluded from this study. Subjects' biometric and anthropometric data were obtained and recorded. Weight was measured using a weighing (Bathroom) scale (Model H 89 LT Blue), while height was measured with subjects standing erect in Frankfurt position using a metal tape measuring instrument.
All participants underwent B-mode real-time transabdominal ultrasound scan using a 3.5–5 MHz curvilinear transducer of Philips HD9 diagnostic ultrasound machine (Bothell, WA, 98021 USA; Manufacture date; 2010/05/31). Subjects were examined in a supine position and on quiet respiration during the ultrasound procedure. Measurement of the liver span was taken at the right midclavicular line with the demonstration of the right kidney in profile. The measurement of the splenic craniocaudal length was also taken in the left MCL at the level of the hilum. Three sequential measurements of the liver span and the splenic length were obtained by a single sonographer and the mean value recorded. All ultrasonographic measurements were taken on a static-freeze screen image capability using the electronic caliber.
Blood samples (5 ml) of SCA participants were collected through venipuncture into commercially prepared concentrations of sequestrene ethylenediaminetetraacetic acid bottles and a full blood count analysis was performed using an auto-hematology analyzer (Sysmex Kx-21N, Kobe, Japan; 2008). Obtained values of packed cell volume (PCV), red blood cell (RBC), white blood cells (WBC), Hb, mean corpuscular hemoglobin (MCH), MCH concentration (MCHC), mean corpuscular volume (MCV), and platelet were obtained and recorded against each participant's biometric data.
Statistical analysis of the data was done using SPSS software version 22 for windows (IBM, Chicago, Illinois, USA). The Pearson's correlation coefficient was used to correlate the liver and splenic measurement with age and anthropometric and hematological values, while the Student's t-test was used to compare mean sonographic measurements of the two study groups. Statistical significance was considered at P < 0.05. Descriptive statistical methods were also used.
| Results|| |
Two hundred and thirty-seven SCA patients and equal number of apparently healthy and known HbAA volunteers were studied (age range and median of 1–49 and 9.83 years, respectively). The age group of 1–10 years (53.6%) and 11–20 years (35.9%) represent the highest and second highest SCA participants in this study, respectively [Table 1]. The mean liver span and splenic size in SCA group were significantly higher than that of the control group (P = 0.000). However, there was no statistical significance in splenic sizes among the age group of 1–10 years in this study (P = 0.797) [Table 2]. [Table 3] shows the correlation between age and anthropometrical parameters on the liver span and splenic length among the control and the SCA subjects. There was a strong positive correlation between liver span and the variables of age, weight, and height with a coefficient of correlation (r) of 0.767, 0.830, and 0.826, respectively, for age, weight, and height. Weak statistical positive correlation was, however, noted between splenic length and weight (P = 013, r = 186). The study also revealed a weak correlation between the liver span and all the hematological parameters with the exception of Hb and platelet with r = −0.181, −0.266, −0.299, 0.316, 0.206, and 0.309 for PCV, RBC, WBC, MCH, MCHC, and MCV, respectively. There was, however, no statistically significant correlation between the splenic length and all the hematological parameters [Table 4].
|Table 2: Mean sonographic sizes of liver and spleen according to age group in study subjects|
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|Table 3: Correlation of liver and splenic sizes by age and anthropometrical variable in control and sickle cell anemia groups|
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|Table 4: Comparison of the effect of hematological parameters on the sonographic sizes of liver and spleen in sickle cell anemia subjects|
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| Discussion|| |
Abnormal abdominal organ changes result from vaso-occlusive and hemolytic pathological processes, characterizing the clinical manifestations in SCA patients.
The mean age of SCA patients in this study was 11.59 ± 8.31 years with most of the participants below 21 years of age. This is, however, not unexpected considering the already documented short lifespan in these patients, especially in Africa.
The mean (±standard deviation) liver span of SCA patients in our study was 13.12 ± 2.05 cm. The liver span remains significantly higher than that of the control among all the age groups in our study affirming documented literature reports of the liver being generally enlarged throughout life in most SCA patients. A recent study by Oguntoye et al. in Ile-Ife , as well as that of Yusuf et al. and Ibinaiye et al. in Zaria and Ma'aji et al. in Sokoto, Nigeria also reported hepatomegaly as a common finding in these patients. Similar findings with different frequencies and prevalence were reported in other countries and races.,,,,, Vascular occlusion, viral hepatitis, iron overload, and drug reactions may contribute to the SCA-related liver disease. Intrasinusoidal sickling and engorgement of Kupffer cells, however, were reported to be possibly responsible for the majority of liver enlargements in these patients  and that this morphological change may not necessarily cause hepatic dysfunction. There was a strong positive relationship between the liver span of SCA patients with age and anthropometrical parameters in our study agreeing with various reports conducted on several normal populations.,, Furthermore, Yusuf et al. found no correlation between liver span and biochemical parameters in their study; there was a statistically significant association between liver span and all the hematological parameters except with hemoglobin concentration and platelet of SCA patients in our study. Oguntoye et al. in their study “Chronic Liver Disease among Adult Patients with Sickle Cell Anaemia in Steady State in Ile-Ife, Nigeria” reported that there was no statistically significant difference in the mean hemoglobin concentration, serum albumin, alanine transaminase, and aspartate transaminase of the patients with hepatomegaly when compared with those without hepatomegaly. They, however, reported a significant relationship between hepatomegaly and frequency of hemolytic crisis but not veno-occlusive crisis.
The spleen has a combined function of immune defense and quality control of senescent or altered red cells, and the first organ injured in SCA. It is commonly enlarged during the first decade of life but then undergoes progressive atrophy as a result of repeated attacks of vaso-occlusion and infarction, leading to autosplenectomy later in life. The mean spleen length of SCA patients in this study was 6.50 ± 1.75 cm being enlarged in the age group of 1–10 years, while a progressive decrease was observed with each successive age group in this study in consistent with a study by Attalla  Persistent splenomegaly was, however, reported by many authors,,,,, but its mere presence in these patients does not imply functional asplenia. The weak positive correlation between splenic length in the SCA group and variables of age, weight, and height observed in our study was similar to report of a study by Olatunji et al. on SCA subjects and also Dhingra et al. on normal populations. Furthermore, our study did not establish a relationship between splenic length and hematological parameters consistent with earlier study. Abdullahi et al. reported the relationship between spleen size and PCV in their study of SCA children. The differences observed could arise from the different sample sizes, age of participants as well as quality of health care and educational status of the study populations.
| Conclusion|| |
Despite recent reports suggesting improved health status of SCA patients, the generally held view in most SCA patients were confirmed in this study with the liver being increased in size throughout life and the spleen shrinking after the first decade of life. Ultrasound has proven to be a veritable tool for the measurements of liver and spleen in SCA patients; however, there is a need for further studies on the relationship between sonographic liver span and hematological parameters in these patients to find out the causes of short life expectancy among the SCA group.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]