Evaluation of Complete Blood Count in Liver Disease Patients Attending Khartoum Teaching Hospital

Abstract

This is an analytical case-control study, conducted at Khartoum Teaching Hospital during the period from January to June, 2010. The aim of this study was to determine complete blood haemogram in Sudanese patients with liver diseases attending Khartoum Teaching Hospital. Eighty five patients with different liver diseases were informed about the study and expected outcome, agreement of the participants was obtained. A questionnaire was used to collect data about sex, age, tribe, residence, alcohol consumption or medication administered, history of past diseases, blood transfusion, symptoms of splenomegally, hepatomegally and jaundice, the type of liver disease was obtained from clinical diagnosis. Fifteen healthy participants (neither affected by liver diseases nor submitted to any kind of therapy for the two months proceeding sample collection) were also informed and blood samples were collected and used as control. Blood samples (2.5 ml) were taken from patients in non- evacuated K3 EDTA anticoagulant containers. A fully automated Sysmex KX 21 (Sysmex Corporation; Mundelein, IIIinois, Sysmex America, Inc) was used for complete blood counting. Computerized statistical package for social science (SPSS) version (11.5) was used to determine the sample size and subsequent data processing. Clinical investigations indicated that all acute liver disease patients were suffering from stress, abdominal pain, jaundice, fever, anorexia, hepatomegally and splenomegally. Chronic liver disease patients were suffering from all the mentioned symptoms in addition to weight loss, ascites and bleeding manifestations. Statistical analysis showed that the mean age of patients included in the study was 47.16 year range (16 to 80) years. The most affected group was (40 - 60) forming 38% of patient. The prevalence of chronic liver diseases was higher (64%) than acute liver diseases (36%).The mean age in chronic liver diseases was high e.g.: liver cirrhosis 53.1year and acute liver diseases was low HAV 23year. the results showed that HBV patients was most common among liver diseases followed by liver cirrhosis then obstructive jaundice including gallbladder stones, liver metastasis and HCV, hepatocellular carcinoma and alcoholic liver diseases, liver abscesses and lastly HAV. HGB, RBCs count and HCT were decreased in the majority of liver disease patients. This reflected anaemia and 78.8% of the patients were anaemic (49.4% mild, 29.4% severe). Normocytic normochromic anaemia was recorded in 71.8% of the patients. The means of HGB, RBCs count, HCT, MCV, MCH, MCHC, TWBCs and platelets count were 9.6, 3.5, 30.0, 87.8, 28.1, 31.1, 8.4, and 196.1, respectively for all liver diseases. The means of HGB, RBCs count and HCT showed highly significant variation between patients and control and were significant at 0.000, 0.000, 0.000 respectively at (P.value = 0.05). There was no significant variation for means of MCV, MCH, MCHC between the patients and control the significance was 0.476, 0.319,0 .380, respectively. The TWBCs count showed no significant variation (P.value = 0.051), and for platelets count there was significant variation (P.value = 0.005) as compared with control. The means of CBC for all types of liver diseases when compared with the means of CBC of healthy individuals (control) showed that liver diseases affected blood cells as follows: Leukocytosis was found in cases of amoebic and pyogenic liver abscesses, cholangitis, gallbladder stones and liver cancer. Leukopenia was found in cases of liver cirrhosis associated with splenomegally and liver failure. Erythrocytosis was found in case of hepatocellular carcinoma (due to ectopic secretion of erythropoietin hormone). High MCV was found in cases of alcoholic liver diseases and some cases of liver cirrhosis this reflected folic acid deficiency anaemia. Low MCV and MCH were found in cases of liver cancer, liver cirrhosis and some chronic liver diseases and this reflected iron deficiency anaemia. Thrombocytosis was found in case of hepatocellular carcinoma and liver metastasis (due to ectopic secretion of thrombopoitin hormone). Severe thrombocytopenia was found in cases of liver cirrhosis, splenomegally and liver failure. The RBCs morphology were of the normocytic normochromic type in most cases of liver diseases, and acanthocytosis found in case of liver cirrhosis, target cell found in cases of obstructive jaundice and acute hepatitis . Atypical lymphocytes found in cases of acute hepatitis and severe liver diseases. In conclusion; blood cells and its parameters were extremely affected (decreasing or increasing) as a result of liver diseases when compared with control group.