45
CHAPTER 4
46
Figure 4.1 Age distribution of the study group.
0 .02 .04 .06 .08
0 20 40 60 0 20 40 60
Control group HbS patients
Density Normal AGE Densit
AGE
Graphs by GROUP
47
Table 4.2 Median comparison of Protein C, Coagulation profile and Liver function tests of the HbS patients and Controls.
Variables HbS patients HbA subjects (control) Median test
median median chi-square p-value
Age (years) 24.5 26.0 0.802 0.370
PT (s) 15.0 15.0 0.000 1.000
APTT (s) 48.5 44.0 5.051 0.025
INR 1.2 1.2 0.000 1.000
Total protein (mg/dl) 7.4 7.2 0.800 0.371
Albumin (mg/dl) 3.7 3.9 2.452 0.117
ALT (i.u/L) 11.5 11.0 0.050 0.823
Protein C (%) activity 62.8 74.6 45.00 0.000
Table 4.2 presents the median estimates (25-75percentile) of the Age, Prothrombin time, Activated Partial Thromboplastin Time (APTT), International Normalizes Ratio (INR), Total protein, Albumin, Alanine
48
Transaminase (ALT) and Protein C of the HbS patients and control HbA subjects. The median age estimates of the HbS patients and the control subjects which stood at 24.5 and 26years respectively were not significantly different from each other (p=0.370). Similarly, the median Prothrombin time of the HbS patient (15s) was the same (p=1.000) as that of the control HbA subjects (15s).The two groups had similar INR (P=1.000), Albumin (P=0.117), Total protein (P=0.371) and ALT (p=0.823).
However, the APTT and Protein C on the other hand, differed significantly between the groups; the HbS patients significantly had longer APTT (48.5s) than the control HbA subjects (44.0s) (P=0.025) and the control group had significantly higher median estimate of Protein C (74.6%) than the HbS patients had (62.8%)(p=0.000)
49
Coagulation profile of the HbS patients and the control HbA subjects.
The coagulation profile of the Subjects was assessed by Prothrombin Time (seconds), International Normalized Ratio (INR), (seconds) and Activated Partial Thromboplastin Time (APTT).
50
Figure 4.2 Prothrombin time of the HbS patients versus controls (HbA subjects)
As shown in Figure 4.2, male HbS patients had higher median (25-75 percentiles) Prothrombin Time, 15s (14-17s) than their counterparts in the control group, 14s (14-16s). Meanwhile, the female HbS patients 15s (14-17s) had similar median Prothrombin Time, 15s (14-16s) with the control subjects.
However, the median test (Table 4.2) shows no significant difference in the prothrombin time between the HbS patient and the control HbA (P=1.000)
1 1 1 16 17 18
MALE FEMALE
Control subjects HbS patients Control subjects HbS patients Prothrombin time (sec)
51
Figure 4.3 Activated partial thromboplastin time of the HbS patients and controls (HbA subjects)
Figure 4.3 shows the median APTT of the HbS patients and control HbA subjects. Both male (49.5s, 42-53s) and female (48s, 38-52s) members of the HbS patients had relatively higher median APTT than their male (43s, 41-45s) and female (44s, 43-46s) counterparts in the control subjects. However, there was an outlier among the female patients in the control group.
The median test (Table 4.2) however shows that the HbS patient had significantly higher APTT than the control HbA (P=0.025).
30 40 50 60
MALE FEMALE
Control subjects HbS patients Control subjects HbS patients APTT (sec)
52
Figure 1.4 INR of the HbS patients versus Controls (HbA)
The male HbS patients had relatively higher median (25-75 percentiles) INR 1.2(1.1-1.5) than the male control subjects 1.1 (1.0-1.3), meanwhile the female HbS patients had median INR, 1.2 (1.1-1.3) which was similar to that of the median INR 1.2 (1.2-1.4) of female in the control HbA subjects.
According to the median test (Table 4.2), there is no significant difference in the INR between HbS and the Controls (p-value =1.000)
1 1.2 1.4 1.6
Control subjectsl HbS patients Control subjects HbS patients
MALE FEMALE
INR
Graphs by gender
53
Liver function tests of HbS patients and Control HbA subjects.
Three parameters (Total protein, ALT, and Albumin) were used in assessing the liver function of the study subjects.
Figure 4.5 Total protein profiles by gender in the HbS group versus controls (Hb A subjects)
4 6 8 10 12
Total protein (mg/dl)
MALE FEMALE
Control group HbS patients Control group HbS patients
54
Although, there was an outlier among the male subjects with a total protein of 5.7mg/dl in the control group as depicted in Figure 4.5, the median estimate, 7.25mg/dl (5.7-7.6mg/dl) of the Total protein of the male subjects in the HbS patients was similar to the median estimate 7.2mg/dl (6.7-7.6mg/dl) of the control subjects. On the other hand, the median estimate, 7.4mg/dl (6.5-8.2mg/dl) of Total protein of the female subjects in the HbS patients was marginally higher than the median estimate, 7.1mg/dl (6.4-8.0mg/dl) of the control subjects.
The median test (Table 4.2) shows no significant difference between the HbS total protein and the control HbA.
Figure 4.6 ALT of the HbS patients versus controls (HbASubjects).
0 10 20 30 40
ALT
MALE FEMALE
Control subjects HbS patients Control subjects HbS patients
55
The median ALT estimates of the male HbS patients (12 i.u/L, 10-16 i.u/L) and the control male subjects (13u.i/l, 11-18 i.u/L) were relatively higher than that of the female HbS patients (11 i.u/L, 10-15 i.u/L) and control female subjects (10 iu/L, 8-11 i.u/L) . However, male subjects in the control group still had relatively higher median estimate of ALT than their male counterparts in the HbS patients. In converse, the female HbS patients had marginally higher median estimate than their counterparts female control subjects. However, there were outliers among two HbS patients and two control subject. Median test (Table 4.2) shows no significant difference in the ALT between HbS patients and the control HbA (P value =0.823)
56
Figure 4.7 Albumin profiles of the HbS patients versus control (HbA) subjects.
Figure 4.7 depicts the albumin estimates of the HbS patients and the control HbA subjects by sex. Male control subjects had a relatively higher median Albumin concentration of 4mg/dl (3.6-4.1mg/dl) than the median estimate, 3.6mg/dl (3.2-4.2mg/dl) of the male HbS patients. The female control subjects and the female HbS patients however had relatively similar median estimates of Albumin concentration of 3.7mg/dl (3.3-4.2mg/dl) and 3.7mg/dl (3.5-4.1mg/dl) respectively. The median test (Table 4.2) shows no significant difference between the HbS patients and the control HbA. (P=0.117)
2 4 6 8
MALE FEMALE
Control subjects HbS patients Control subjects HbS patients Albumin (mg/dl)
57
Protein C profile of the HbS patients and the control HbA subjects.
Figure 4.8 Protein C of the HbS patients and the control HbA subjects.
The Protein C level of the HbS patients and the control HbA subjects is summarized in Figure 4.8. The male control subjects had higher median protein C, 72.6% (68.8-78.2%) than the median estimate of 63.9% (61.3-65.1%) of their male counterparts HbS patients. Similarly, the female control subjects had higher median protein C estimate, 74.7% (71.3-75.7%) than the female HbS patients 60.7% (57.3-64.6%). There were outliers among female patients in the control group.
50 60 70 80 90
Protein C (%)
MALE FEMALE
Control subjects HbS patints Control subjects HbS patients
58
The median test (Table 4.2) shows that The HbS patients had significantly lower protein C than the control HbA (p=0.000).
Disaggregating the correlation analysis between protein C and the other biochemical parameters by gender, Table 4.3 presents the estimates of
coefficients of the relationship between the Protein C and the parameters. Yet, none of the parameters had significant relationship with the level of Protein C in the HbS patients (p>0.05).
Table 4.3 Correlation coefficients of the relationship between Protein C activity (%) and other characteristics of the patients by gender.
HbS patients Control HbA
Parameter
male (n=18) female (n=22) male (n=23) female (n=17) Rho P-value Rho P-value Rho P-value rho P-value
Age (years) 0.174 0.490 -0.303 0.171 0.003 0.988 -0.461 0.062 Prothrombin time (s) -0.391 1.084 -0.405 0.062 0.329 0.125 -0.011 0.967 APTT (s) 0.248 0.322 0.067 0.767 0.193 0.377 0.153 0.557
INR -0.391 0.108 -0.405 0.062 0.361 0.091 0.038 0.886
Total protein (mg/dl) -0.292 0.239 0.279 0.209 0.077 0.726 0.174 0.505 Albumin (mg/dl) -0.453 0.059 0.014 0.952 0.051 0.814 0.085 0.745
rho: Spearman rank correlation coefficient
59
Figure 4.9 Correlation between Protein C activity (%) and Prothrombin time(s) in HbS patients.
The scatter plot of the relationship between the protein C of the patients and their
prothrombin time is shown by figure above. The spearman correlation coefficient (rho= -0.30, n=40, p=0.06) value of the relationship showed that there was no significant relationship between the two parameters.
50 55 60 65 70
13 14 15 16 17 18
Prothrombin time (s) Protein C activity (%)
60
Figure 4.10 Correlation between Protein C and prothrombin time in HbS patient by gender.
The relationship between the Protein C and the Prothrombin time was further disaggregated by sex as shown by the figure above. Similarly, neither the protein C of the male patients (rho=-0.39, n=18, p=0.11) nor that of the female patients (rho=-0.40, n=22, p=0.06) had any significant association with their prothrombin time.
5 5 60 65 70
12 14 16 18 12 14 16 18
MALE FEMALE
Prothrombin time Protein C activity (%)
61
Figure 4.11 5055606570
Protein C activity (%)
1 1.2 1.4 1.6
INR
Correlation between Protein C activities (%) and INR of HbS patients
Figure 4.11 shows the scatter plot of the relationship between the protein C of the patients and their INR. The spearman correlation coefficient (rho=-0.30, n=40, p=0.06) of the relationship depicts that there was no significant relationship between the two parameters.
62
Figure 4.12 Correlation between Protein C and INR by gender of the HbS patients.
Figure 4.12 therefore shows the disaggregation of the relationship between protein C and INR. The results of the correlation analysis showed that neither the Protein C of the male patients (rho=-0.39, n=18, p=0.11) nor that of the female patients (rho=-0.40, n=22, p=0.06) had significant relationship with their INR.
5 5 60 65 70
1 1.2 1.4 1.6 1 1.2 1.4 1.6
MALE FEMALE
INR Protein C activity (%)
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Protein C activity (%)
30 40 50 60
APTT
Correlation between Protein C activities (%) and APTT(s) of HbS patients
Figure 4.13
The relationship between the Protein C and the APTT of the patients is shown by figure 4.13.
The spearman correlation coefficient (rho=-0.21, n=40, p=0.19) of the relation implies that there was no significant relationship between the two parameters.
64
Figure 4.14 Correlation between Protein C and APTT of the HbS patients by gender.
As similarly shown by Figure 4.14, there was no significant relationship between the Protein C and APTT of the male (rho=-0.25, n=18, p=0.32) and of the female patients (rho=-0.07, n=22, p=0.77).
5 5 60 65 70
30 40 50 60 30 40 50 60
MALE FEMALE
APTT Protein C activity (%)
65
Figure 4.15
Figure 4.15 shows that the Protein C of the patients did also not have any relationship with the Total protein concentration of the patients (rho=-0.02, n=40, p=0.92).
50 55 60 65 70
Protein C activity
4 6 8 10 12
TOTAL PROTEIN
Correlation between Protein C activity (%) and Total protein (mg/dL) of HbS patients
66
Figure 4.16 Correlation of Protein C and total Protein of the HbS patients by gender.
Furthermore, neither the Protein C of the male patients (rho=-0.29, n=18, p=0.24) nor that of the female patients (rho=-0.28, n=22, p=0.21) had any significant relationship with their respective total protein concentrations (Figure4.16).
5 5 60 65 70
4 6 8 10 4 6 8 10
MALE FEMALE
Total Protein Protein C activity (%)
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Protein C activity (%)
2 4 6 8
ALBUMIN
Correlation between Protein C activities (%) and Albumin (mg/dL) of HbS patients
Figure 4.17
As shown by the Scatter plot above (Figure 4.17), the protein C of the patients had no significant relationship (rho=-0.23, n=40, p=0.16) with the Albumin level of the patients.
68
Figure 4.18 Correlation of Protein C and Albumin of the HbS patients by gender.
Figure 4.18 shows that neither the Protein C of the male patients (rho=-0.45, n=18, p=0.06) nor that of the female patients (rho=-0.01, n=22, p=0.95) had any significant relationship with the Albumin level of the patients.
5 5 60 65 70
2 4 6 8 2 4 6 8
MALE FEMALE
Albumin Protein C activity (%)
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Protein C activity (%)
5 10 15 20 25 30
ALT
Correlation between Protein C activities (%) and Alanine Transferase Enzyme (i.u/L) of HbS patients
Figure 4.19
The spearman correlation coefficient (rho=-0.10, n=40, p=0.54) of the relationship between the protein C and the ALT of the patients shows that there was no significant relationship between the two parameters.
70
Fig 4.20 Correlation between Protein C and ALT of the HbS patients by gender.
The disaggregation of the relationship by sex had no significant influence as neither the Protein C of the male patients (rho=-0.07, n=22, p=0.77) had significant relationship with their respective ALT ,nor that of the female patients. (rho=0.20, n=18, p=0.42)
5 5 60 65 70
10 20 30 10 20 30
MALE FEMALE
ALT Protein C activity (%)
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CHAPTER 5