Browsing by Author "Opie, Jessica"

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    Open Access
    Burkitt and Burkitt-like lymphoma/leukaemia at Groote Schuur Hospital from 2005 to 2014: a retrospective review
    (2018) Koller, Anna J; Opie, Jessica
    Introduction: South Africa has the highest global burden of human immunodeficiency virus (HIV). The HIV seropositive population is at increased risk of developing non-Hodgkin lymphoma, particularly high grade aggressive subtypes such as Burkitt- and Burkittlike lymphoma (also known as B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma). Methods: Ten year retrospective review of clinico-pathological features and survival of adults with newly diagnosed Burkitt- and Burkitt-like lymphoma at a tertiary hospital in South Africa. Results: Burkitt lymphoma (BL) (n=109) was more frequent than Burkitt-like lymphoma (BLL) (n=41) and at presentation there were no significant differences in HIV prevalence (86% vs 78%); median CD4 count (213 vs 207 cells/μL); bone marrow involvement (49% vs 34%), leukaemic dissemination (37% vs 27%) and most frequent site of diagnosis (abdomen/pelvis; 26% vs 29%), respectively. There were significant differences in median age (34 vs 41 years, p=0.0319), median lactate dehydrogenase levels (2052 vs 869 U/l, p=0.0011) and cerebrospinal fluid involvement (12% vs 0%, p=0.046). 43% of patients with an available HIV viral load result showed virological supression defined as lower than detectable limit (LDL) with the median value also being LDL. The patients that received high dose chemotherapy including high dose methotrexate (112/150; 75%) showed a one-year survival of 62% with no significant difference between Burkitt and Burkitt-like lymphoma (66 months versus 51 months, respectively; p=0.267). Patients with leukaemic presentation showed a significantly lower mean survival of 24 months compared to those without (72 months; p< 0.001). The 2 year survival for the whole group, regardless of type of treatment received, was 40% (95% CI, 32-48%) with a median survival of 7.5 months. Conclusion: This is the largest cohort of Burkitt- and Burkitt-like lymphoma patients described in South Africa. There was a high HIV prevalence. The majority received intensive chemotherapy and survival was comparable to certain well-resourced countries. Leukaemic presentation was frequent and associated with less favourable survival.
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    The diagnostic utility of bone marrow biopsies performed for the investigation of fever and/or cytopenias in HIV-infected adults at Groote Schuur Hospital.
    (2009) Van Schalkwyk, Willem Adendorff; Opie, Jessica
    This is a retrospective review of the results of consecutive bone marrow biopsies performed at our institution over a three year period on HIV positive patients for the investigation of fever and cytopenias. Clinical data, haematological parameters, morphology of bone marrow biopsy, Ziehl-Neelsen staining and microbiological culture results were analyzed. The aim of the study was to determine the diagnostic yield of this investigation.
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    Establishing locally derived reference intervals for full blood count parameters and white cell differential counts in the Western Cape region of South Africa
    (2019) DeKoker, Annemarie; Opie, Jessica; Bird, Arthur
    Background: The recognised variation observed in normal haematological parameters in different populations and geographic locations, emphasizes the need to establish locally derived reference intervals (RIs) with appropriate representation of the various ethnic groups. Accurate RIs are essential to distinguish between health and disease. Objective: To establish locally derived RIs for full blood count (FBC) and white blood cell (WBC) differential count parameters in healthy adults in the Western Cape region of South Africa. Methods: A prospective, descriptive study was performed, utilizing blood samples of healthy first-time blood donors, presenting voluntarily for blood donation to the Western Cape Blood Service (WCBS) between November 2016 and October 2017. African, Coloured and Caucasian participants aged between 18 and 60 years of age were included based on convenience sampling. Participants testing positive for human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV, HCV) and syphilis, and those with serum ferritin levels outside the reference range were excluded. Donors with an elevated serum ferritin were also excluded. Reference intervals were derived using non-parametric statistical methods and expressed to include the central 95% of the sample population (2.5th to 97.5th percentiles). Outliers for individual parameters were identified and excluded from the analysis. Results: A total of 376 females and 244 males were included for analysis; 31.61% were African, 39.68% Coloured and 28.71% Caucasian. For all race groups combined, gender-based differences were found in most FBC parameters, including the haemoglobin (Hb), WBC count, neutrophil count and platelet count. When comparing RIs for males and females in the three ethnic groups, statistically significant differences were found for parameters including the Hb, WBC count and red cell indices. There were no significant differences in the absolute eosinophil counts and mean cell volume (MCV) in females, and platelet counts in males. The ranges differed for a number of FBC variables compared to the National Health Laboratory Service (NHLS) coastal reference ranges in current use. Conclusion: Locally established and population-specific RIs are essential for accurate interpretation of blood counts. Implementation of separate RIs for the main ethnic groups in the Western Cape should be considered and would have implications for the diagnosis of anaemia and other blood count abnormalities as well as decision rules on haemoglobin levels for blood donor deferral.
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    From the marrow to the blood: Optimising the diagnosis of iron deficiency in the setting of inflammation
    (2024) Richardson, David; Opie, Jessica; Louw, Vernon
    Iron deficiency (ID) is a common condition with readily available treatment but can be challenging to diagnose. Traditional biomarkers of ID are acute phase reactants, which complicates diagnosis in patients with co-existent inflammation. This study aimed to establish optimal biomarker diagnostic thresholds for ID diagnosis using bone marrow (BM) iron stores as the gold standard and the Creactive protein (CRP) as an inflammatory marker. A cross-sectional study was carried out in the haematology department of a tertiary academic hospital. Patients undergoing BM biopsies for any reason were recruited for inclusion. Retrospective case finding was used to enrich the data for cases with confirmed BM ID. Laboratory markers including red cell indices, reticulocyte haemoglobin and iron studies were evaluated to establish optimal cut-offs for ID diagnosis. A CRP of >5 mg/L was used as a marker of inflammation. The study included 139 patients. Forty-two patients had BM ID with a median serum ferritin (SF) of 48.5 μg/L. 96/134 (72%) had inflammation with a CRP > 5 mg/L. A SF of < 80 μg/L had optimal sensitivity (69%) and specificity (94%) for ID diagnosis in the whole group (OR 23.5; CI 4.3-129). In patients without inflammation, a SF 80 cut-off had high sensitivity (93%) and specificity (96%). A SF < 200 μg/L indicated ID in those with inflammation (sensitivity 78%, specificity 74%). A transferrin saturation of <13% in those with inflammation increased the diagnostic specificity (92%). The reticulocyte haemoglobin was unhelpful in diagnosing ID in this setting. In this hospital population, SF was the best parameter to diagnose ID, even in the presence of inflammation, albeit at a higher cut-off level. The CRP was useful to identify populations in whom a higher SF threshold could be used together with the transferrin saturation to accurately diagnose ID.
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    HIV-associated Hodgkin lymphoma at Groote Schuur Hospital, Western Cape, South Africa
    (2017) Swart, Luhan; Opie, Jessica; Novitzky, Nicolas
    Background: Human immunodeficiency virus (HIV) is associated with an increased risk of developing Hodgkin lymphoma (HL). South Africa (SA) has the highest HIV prevalence rate in the world. There is currently no 5-year overall survival (OS) outcome based data for HIV-associated HL from SA. Methods: A bone marrow database was compiled of all bone marrow biopsies (BMB) reported at National Health Laboratory Service (NHLS) Groote Schuur Hospital (GSH) between January 2005 and December 2012. Patients who had a BMB performed for staging of HL or where HL was diagnosed on the BMB were included for further analysis. Clinical and laboratory data was extracted from medical and laboratory records. Primary outcome measures included histological subtype, bone marrow infiltration (BMI) by HL, CD4 count, HIV-viral load (HIV-VL), tuberculosis (TB) data, treatment with chemotherapy and 5-year overall survival (OS). Results: The database included 6569 BMB and 219 patients of these had HL and were included for analysis. The median age at presentation (32 years) was similar in the HIV+ and HIV-populations. While males predominated in the HIV-group, females predominated in the HIV+ group (male:female ratio of 1.5:1 vs 0.7:1, respectively). The majority of patients (71%) were HIV negative (HIV-) and 29% were HIV positive (HIV+). The diagnosis of HL was made on BMB in 17% of cases. BMI was seen in 37%(82/219) overall, and was found in more HIV+ patients (61%; 39/64) than HIV-patients (28%; 43/155; p= 0.03). The histological subtype varied according to HIV status with nodular sclerosis classical Hodgkin lymphoma (NSCHL) being most frequent in the HIV-group and classical Hodgkin lymphoma (CHL)-unclassifiable the most frequent in the HIV+ group. HIV+ patients had a median CD4 count of 149 x106/L and 39% were anti-retroviral therapy (cART) naive at HL diagnosis. HIV+ patients had received anti-TB therapy more frequently than HIV-patients (72% vs 17%; p= 0.007). More HIV+ patients did not receive chemotherapy than HIV-patients (31% vs 3%; p= 0.001). The 5-year OS was 56%. HIV+ patients with BMI had a 5-year OS of 18%. BMI, HIV status, low CD4 count, histological subtype and TB therapy had a statistical significant impact on 5-year OS (p< 0.01). Conclusion: BMB provided the diagnosis of HL in 17% of cases, confirming its diagnostic utility in our setting. BMI by HL was more common in HIV+ patients and was associated with significantly worse survival. Our cohort showed similar survival outcomes to other countries in Africa, Asia and Central America with comparable socio-economic constraints to SA.
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    The burden of imported malaria in Cape Town, South Africa
    (2014) Opie, Jessica; Freeks, Roschelle; Du Pisani, Louis Almero
    BACKGROUND: The Western Cape Province of South Africa (SA) is not malaria endemic; however, a considerable number of patients present with malaria to our healthcare services. OBJECTIVES: To establish the frequency of patients presenting with malaria at Groote Schuur Hospital (GSH), Cape Town, SA, and to describe their demographics, clinical outcomes and laboratory findings. METHODS: An observational, retrospective, descriptive study was conducted, which included all patients presenting with smear-positive malaria to GSH over a 4-year period between 1 April 2008 and 31 March 2012. RESULTS: During the study period, 134 malaria patients presented to GSH for management; 85% (n=114) were male, median age was 27 years. Of the total smear-positive tests, 96% (n=128) were Plasmodium falciparum, 3% (n=4) P. ovale, and in 1% (n=2) the species was not identified. The number of malaria patients increased markedly, from 6 cases in 2008 to 50 cases in 2012. Of the patients, 48.3% (n=57) were from Somalia, 8.5% (n=10) from SA and 29% (n=30) from other African countries. One SA patient acquired transfusion-transmitted malaria from a pooled platelet product, and the other SA patients had travelled to malaria-endemic areas. The remaining cases were from countries outside of Africa, including 13% (n=15) from Bangladesh. Almost two-thirds (62%; n=72) were admitted to hospital with a median length of stay of 3 days (range 1 - 32). Clinical outcomes were good with only one death and the remaining patients being discharged. CONCLUSION: Imported malaria is imposing a significant burden on health resources. The costs of medical care for the emergency treatment of foreign nationals needs to be recognised, and adequately budgeted for.