The prevalence of thrombocytopenia at a primary care HIV clinic in South Africa - possible implications for neuraxial anaesthesia
| dc.contributor.advisor | Smit, Marli | en_ZA |
| dc.contributor.author | Steadman, Carl | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Anaesthetics and Critical Care. | en_ZA |
| dc.date.accessioned | 2017-10-22T08:00:17Z | |
| dc.date.accessioned | 2017-12-11T10:26:40Z | |
| dc.date.available | 2019-01-01T03:00:08Z | |
| dc.date.issued | 2017-12 | |
| dc.description | Thesis (MMed)-- Stellenbosch University, 2017. | en_ZA |
| dc.description.abstract | ENGLISH ABSTRACT: South Africa has a high incidence of Human Immunodeficiency Virus (HIV) infection, and many of these patients will require surgery during their lives. The exact prevalence of thrombocytopenia in South African, HIV-infected patients (naïve/non anti-retroviral therapy naïve) are unknown. The reported global prevalence of thrombocytopenia in HIV positive patients ranges between 5.5 to 50% 17, 18. Neuraxial anaesthesia is contraindicated in patients with platelet counts of <75 x 109/L, due to the risk of neuraxial haematoma. The large variation in practice (in South Africa) in terms of preoperative special investigations (especially platelet count) in this patient population suggests that patients are either under investigated, or that unnecessary investigations are performed; with cost and time implications. This wide range in thrombocytopenia prevalence, together with the anaesthetic implications secondary to thrombocytopenia was the motivation behind us conducting an audit to determine the prevalence of thrombocytopenia in HIV positive patients. Our primary outcome was to determine the prevalence of thrombocytopenia in HIV-positive patients attending a primary care HIV clinic in the Western Cape, South Africa. Secondary outcomes were to: 1. Determine if there is any correlation between CD4 count and platelet count. 2. Determine what the influence of ART on platelet count is. 3. To make informal proposals regarding pre-operative special investigations (specifically platelet count) in the HIV positive patients. Our study, consisting of 1,410 patients, provided the following important results: The median CD4 count was 281 +/- 199 cells / mm3. Thirty-one percent of patients had a CD4 count of < 200 cells / mm3. The median platelet count was 270 +/- 100x109/L. The platelet count was < 150 x 109/L (thrombocytopenia) in 6.5%, and < 75 x 109 /L (severe thrombocytopenia) in 0.7% of participants. Thrombocytopenia was more common in patients with a CD4 count < 200 cells/mm3 (p <0.001) and in ART naïve patients (p = 0.02). However, there was no connection between severe thrombocytopenia and a CD4 count of < 200 cells / mm3 (p = 0.36) or ARV naivety (p = 0.66) Infection and malignancy had no significant impact on thrombocytopenia (p = 0.66, Fischer's exact 0.3) nor severe thrombocytopenia (p = 0.99, Fischer's exact 0.5). Conclusion: In this descriptive study, we found that the prevalence of severe thrombocytopenia to be very low (0.7%). We cannot make statistically supported deductions regarding this result because the prevalence of thrombocytopenia in the general population is unknown, and our study did not have a control group. However, we will propose that the following be kept in mind regarding preoperative special investigation decision making in HIV positive patients: 1. The incidence of neuraxial hematomas has not increased in conjunction with the increase in HIV positive patients, 2. The costs associated with special investigations. 3. The low prevalence of severe thrombocytopenia. 4. The lack of literature to support a safe cut-off for platelet count for neuraxial anaesthesia. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Suid-Afrika het 'n hoë insidensie van Menslike Immuniteitsgebreksvirus (MIV) infeksie, en baie van hierdie pasiënte sal tydens hulle lewe chirurgie benodig. Die presiese prevalensie van trombositopenie in Suid Afrikaanse, MIV geïnfekteerde pasiënte (met of sonder anti-retrovirale behandeling) is onbekend. Die gemelde prevalensie van trombositopenie in MIV positiewe pasiënte wêreldwyd wissel tussen 5.5 en 50%17, 18 Neuraksiale narkose is gekontraindikeerd in pasiënte met erge trombositopenie (75 x 109/L), as gevolg van ‘n neuraksiale hematoom risiko. Daar is ‘n groot variasie in praktyk (in Suid Afrika) in terme van preoperatiewe spesiale ondersoeke (veral plaatjie telling) in díe pasiënt populasie. Dit impliseer dus dat pasiënte potensieël benadeel word of dat onnodige spesiale ondersoeke gedoen word – met koste en tyd implikasies. Die groot reikwydte in die gerapoteerde prevalensie tesame met die kliniese narkose implikasies sekondêr tot trombositopenie, was die motivering om ‘n ouditstudie te doen wat die prevalensie van trombositopenie in MIV positiewe pasiënte beskryf. Ons primêre uitkoms was om die prevalensie van thrombositopenie in MIV-positiewe pasiënte wat n primere HIV kliniek in Wes-Kaap, Suid-Afrika bywoon, te bepaal. Ons sekondêre uitkomste was - 1. Bepaal of daar enige korrolasie tussen CD4 telling en plaaitjie telling is. 2. Bepaal wat die invloed van ART op plaaitjie telling is. 3. ‘n Informele voorstel te maak in terme van pre-operatiewe spesiale ondersoeke (spesifiek plaaitjie telling) in HIV positiewe pasiënte. Ons studie, wat uit 1410 pasiënte bestaan het, het die mees belangrike resultate getoon: Die gemiddelde CD4 telling was 281 +/- 199 selle/mm3. Agt en dertig persent van pasiënte het 'n CD4 telling < 200 selle/mm3 gehad (CI95% 0,36-0,41). Die gemiddelde plaatjie telling was 270 +/- 100x109/L. Die plaatjie telling was <150 x 109/L (trombositopenie) in 6.5%, en < 75 x 109/L (erge trombositopenie) in 0.7% van die deelnemers. Trombositpenie was meer algemeen in pasiënte met 'n CD4 telling <200 selle/mm3 (p <0.001) en in ART naïewe pasiënte (p = 0,02). Daar was egter geen verband tussen erge trombositopenie en ‘n CD4-telling van <200 selle/mm3 (p = 0,36) en/of ARV naïwiteit (p=0,66) gevind nie. Infeksie en maligniteit het geen beduidende impak op trombositopenie (p=0,66, Fischer se presiese 0,3) of erger trombositopenie (p=0,99, Fischer se presiese 0,5) gehad nie. Gevolgtrekking: In hierdie ouditstudie het ons gevind dat die prevalensie van erge trombositopenie baie laag (slegs 0,7%) was. Ons kan geen statisties ondersteunde afleidings maak na aanleiding hiervan nie aangesien die prevalensie van trombositopenie onbekend is in die algemene populasie, en ons studie nie ‘n kontrole groep gehad het nie. Ons sal egter voorstel dat die volgende ingegagte gehou word tydens pre-operatiewe spesiale ondersoek besluitneming in die MIV positiewe pasiënte: 1. Die insidensie van neuraxiale hematome het nie toegeneem tesame met die toename in MIV positiewe pasiënte nie. 2. Die koste verbonde aan spesiale ondersoeke, 3. Die lae prevalensie van erge trombositopenie 4. Die gebrek aan literatuur ter ondersteuning vir die veilige afsny waarde van plaaitjie telling en neuraksiale narkose. | af_ZA |
| dc.embargo.terms | 2019-01-01 | |
| dc.format.extent | 35 pages | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/10019.1/102571 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | en_ZA |
| dc.rights.holder | Stellenbosch University | en_ZA |
| dc.subject | HIV thrombocytopenia neuraxial anaesthesia | en_ZA |
| dc.subject | Thrombocytopenia | en_ZA |
| dc.subject | HIV infections | en_ZA |
| dc.subject | Neuraxial anaesthesia | en_ZA |
| dc.subject | Primary care (Medicine) | en_ZA |
| dc.title | The prevalence of thrombocytopenia at a primary care HIV clinic in South Africa - possible implications for neuraxial anaesthesia | en_ZA |
| dc.type | Thesis | en_ZA |
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