NEWSCLICK NIGERIA INTERVIEW: Unveiling medical facts behind circumstances some Nigerians push to ‘village people’; Blood Group, Genotype, Sickle Cell, others – Dr Caleb Nwaneri

Dr Caleb Nwaneri is a renowned medical professional with years of experience in both public and private practice in Nigeria.

In this interview with Newsclick Nigeria’s Toyibat Ajose, he explained in details medical facts behind what most Nigerians tag ‘hand work of village people’. From the basics of Blood Group, Genotype and other complex medical issues like sickle cell disease, Dr Nwaneri unbundled all saying what is lacking in most cases is knowledge of the situation at hand and how to tackle same or avoid it entirely in the first place.

Excerpts from the interview below:

Can you please introduce yourself sir?

I am Dr Caleb Nwaneri, Senior Medical Officer TOFAN hospital, Fertility consultant, Optimal care fertility solutions, and the Bridge hospital, Ikeja.

Can you differentiate between Blood Group and Genotype for a layman?

Blood grouping constitutes a set of groups different blood types have. The most important feature in blood grouping is compatibility as regards transfusion and mixing of bloods. The major concern for blood group is strictly for compatibility and viability of blood products for different persons. There are four major classes of blood group which includes blood group A, B, AB and O. They all have different ways they operate such that when the need for blood transfusion arises, you cannot just be given any blood, it as to be compatible.

Genotype is another type of grouping which has nothing to do with the blood group or transfusion. It has to do with reproduction, creatin an offspring. Here there are different arrangement for the blood types that determines how they will be replicated when they are passed to the offspring.

From time immemorial, the blood group have always been constant (i.e A,B, AB and O) but for the genotype, when God made man, he made man has AA. There was no variants. Malaria was the singular factor that caused man to evolve and getting other kinds of genotype. That is why Paris people do not have AS, AC, SS and SC. Societies were malaria is not endemic do not have to grapple with the sickle cell traits. Over the years in Africa, the Mediterranean, Asia, South America where malaria was endemic, the human body began to support to be able to cope with malaria parasite. Part of what the body did was to cause a mutation to occur in one of the hemoglobin chains. That mutation will create abnormal red blood cells that the body will destroy over time. These abnormal cells were sticky and due to their stickiness, they will pack all the parasites to their surface so that they destroy the parasites together with the abnormal cells.

The variants was a coping mechanism for the population to be able to withstand malaria. That is where the sickle cell traits came from. People that were AA began to develop abnormal S genes, so they pass it to their offspring. Soit would be A and S or A and C. Everybody was happy and those people were able to withstand malaria for years. It became problematic when those offspring started getting married to each other now creating SS. It became Homozygous. The plan was not to have an A, the plan was to have an A which will continue the normal body functioning and process then the S which will help in eradicating the parasite. That’s why till date AA always have malaria and AS rarely have malaria. For most AS or AC before the parasite gets to levels it will cause problems, the body already destroy the S cells alongside the parasites, so they rarely come down on malaria. For offspring of with SS, when the body destroys the S cells, the carrier falls into crisis because they do not have any normal blood cells again. So, evolution is the beam of this problem.

For intending couples, what are the major medical tests to conduct before marriage?

The first test will be genotype to avoid giving birth to offsprings of sickle cell. The type of genotype we have includes; AA, AS, AC, SS, SC and CC. All these are different variants of AA, AS and AC.  In recent times we have also seen another phenomenon called the Thalassaemia Phenomenal. It’s actually not common, its majorly between Mediterranean, Asia and Caribbeans. It was very uncommon in Africa but now we are seeing more of those things in Africa now. This is now in Africa due to mix marriage and the traits are now being passed down to the offspring. That is why we now have AA and AS having SS. It is not SS, it is thalassaemia phenomenal but it has the same features with SS and the machine we have in this part of the world don’t recognize it, they present it as SS and SC. So thalassaemia phenomenal should be considered too. The test that reveals this is High Performance Liquid Chromatography (HPLC).

The blood group is also important because there is something called Rhesus factor (Rh factor). It is the positive (+) or negative (-) at the end the blood group. Positive is Rhesus factor Positive and Negative is Rhesus factor negative. If Rh positive lady getsmarried to Rh positive man there is no problem, but if Rh negative lady marries Rh positive man, then there is a problem. Although the problem is minimal and can be solved. In this situation, if the lady gets pregnant and the first child is positive, it will sensitize the mother’s cell and makes them aggressive, noting happens to the first pregnancy but subsequent ones become a problem, the mother can lose other pregnancies and she may give birth to still births and blue babies that dies on the spot and it can continue to happen over and over again. It’s not village people, its lack of knowledge. This was common in the days of our forefathers whereby miscarriages and stillbirths were rampant. This tragedy can be avoided with a shot of an injection called Rhogam which will be administered to the mother.

Another test to look out for is Venereal Disease Research Laboratory (VDRL). This test for syphilis and other venereal diseases. The woman’s blood levels should also be checked because labour process can come with bleeding. So, it is better to know the blood level and boost it before it gets to that stage.

Can you define Sickle Cell in a layman’s language?

Sickle cell disease is a group of disorder that cause red blood cell to become mis-shapened and broken down. Incidentally, that name Sickle was gotten from a farm equipment called sickle. It’s a special kind of knife that looks like a pair of scissors that farmers used to harvest certain type of crops. The normal red blood cell is round/oval in shape but the abnormal sickle cell is S shaped like a sickle. Because of their shape, they tend to get stuck wen blood is flowing, that what bring about their painful crisis. Apart from the abnormal shape, their intercity is not as good as the normal A blood cells, so they tend to be destroyed easily. An average red blood cell lives to about 120 days while the abnormal sickle cells live for about 30 days or less. So for a sickle cell patient they have their all their cells destroyed in 30 days or less without having a normal A to function when the S is down.

Symptoms of Sickle cell disease before a crisis?

Dizziness, breathing very fast, pains from the blockages in many areas most especially in the long bones.

Factors that predispose sickle cell disease patient to crisis?

Dehydration

Stress

Malaria

Sepsis

Sudden change of weather

Dirty Environment or exposure to bacteria.

Is sickle cell very expensive to manage for a poor person?

That question is tricky, if you do the normal things you are supposed do it may not be very expensive. But if the patient in question has frequent hospital admission, then it can be reallyexpensive. Prevention is just the best thing because it can be very burdensome. The financial implications, the opportunity cost, the emotional stress. So, when we talk about the finances, it’s not straight forward, its not just how much you spend in the hospital its encompasses more than that. In 2022, I do not expect anybody to still have sickle cell based on all the information available to us.

Is there any age a sickle cell disease carrier outgrows the disease?

It is not true, there is nothing like that. I have had a 40-year-oldwho die from sickle cell. What happens is children tends to put their hands in their mouth often and as kids, they do not understand what is happening. One may need to force them to use their drugs and they are more prone to infections. Adults on the other and tends to take responsibility of their health. They are more mindful and take hygiene more seriously, so this tends to reduce the number of crises an adult gets. Sometimes even when you follow the rules, shits still happen.

General features of Sickle cell disease carrier

Frontal Bossing: the shape of most carriers’ head tends to be wide. This is because the bone marrow is overworking itself trying to replace the blood cells being destroyed. This causes the skull to expand to accommodate the extra work.

Jaundice: a lot of time, they tends to have yellowish coloration of the eyes.

Pale: most of them are pale.

What is the difference between SS and SC?

Between SS and SC, SS are the Sickler, they tend to get sickerand more crisis. When you meet SC, most times one can’t tell that they have sickle cell disease because they do not have the general features. SC get to live relatively normal life but they have more splenii sequestration. This is the biggest problem in Sickle cell. I don’t know which to prefer between SS and SC. Although I prefer a healthy child but if I am to choose, I will choose SS because they sick everytime and get one prepared and always on your toes. SC may go years without being sick, but one splenii sequestration can bring them down. Once it happens, you need about 3 to 4 pints of blood to even stand any chance of surviving. This is because the spleen has just swallowed all their blood at once. The persons PCV can o from 35 to 10 and the person is already in heart failure. SC doesn’t prepare its carries and caregivers before splenii sequestration happens.

Is there any life expectancy rate for someone with sickle cell disease?

Two weeks ago, I was with a patient, I think she is 72 or 75, she has sickle cell disease. She is SS. It all depends on the quality of care. On the average even non sickle cell patients in Africa life expectancy is 55-60 for men while women are it longer.

For sickle cell they are for different stages, we have the life expectancy of 7 years for the first group, another one is 25 years, if they survive that it now depends on what they do with their life, they can live as long as they want. All they need to do is keep to instructions, don’t miss your clinic visits, and do not indulge in anything tat will cause problems for your health.

For women, they have it bad when they need to give birth. A pregnant sickle cell patient is a ticking time bomb, all hands have to be on deck, its not easy. Pregnancy itself for non-sickle cell its not easy and its worse in sickle cell. The maternal mortality rate in sickle cell patients can be as high as 50 percent.

What is the survival rate for someone that has sickle cell in Nigeria?

In Nigeria we have to divide it into two groups; the haves and the have-not. For the haves, they can actually live a normal life. But the have-not, the survival rate is actually quite low. Money has a role to play. The support from the family and caregivers too is important.

How frequent do we have sickle cell cases in Nigeria?

I do not have the figures because we are not a country that values data.