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Submitted

Rajab, JA.  Submitted.  The role of trephine needle bone marrow biopsy in the evaluation of various haematological and non-haematological diseases At Kenyatta National Hospital, Nairobi. Abstract

This is a descriptive retrospective and prospective
study of 101 patients admitted to Kenyatta National Hospital
(KNH) between 1st October, 1985 and 30th January, 1990 and
had bone marrow examination done by aspiration and trephine
needle biopsy. At KNH trephine needle bone marrow (TNBM)
biopsy has been performed over the years when aspiration
results in 'dry tap'. It is only available for the use by a
few specialists (haematologists) and it is rarely performed
in staging malignant lymphomas or as a routine diagnostic
technique in various other diseases. The study was done to
evaluate the role of the technique in patient care at this
hospital. The relevant data and the diagnostic outcome of
50 patients admitted to the hospital between 1st October,
1985 and 30th June, 1989 were collected retrospectively.
Trephine needle biopsies were performed by the investigator
on 51 patients during the last 7 months of the study. Data
collected included: the age and sex, the indications for
bone biopsy, the quality of the specimen, the reporting
format and the final diagnosis on the trephine biopsies.
The 101 patients studied were between 2 and 75 years of
age. The mean age was 23.9 years. There were 62 males and
39 females. A 'dry tap' aspirate, the commonest indication
for TNBM biopsy was reported in 37 (36.6%) cases. In twelve
cases, the aspirate and needle biopsy were performed at the
same time using the same needle. Ten of these were in the
staging of malignant lymphomas. Good or satisfactory
specimens were obtained in at least 86% of the biopsies

performed. Aplastic anaemia, the commonest abnormality
detected was found in 28 (27.7%) of the patients studied. A
review of the reporting format showed that in only 20% cases
in the retrospective study was a full report of the biopsy
given by the haematologist.
This study shows that TNBM biopsy is a simple and safe
procedure yielding a good or satisfactory specimen in most

instances. The biopsy will most likely provide a diagnosis
when bone marrow aspirate fails due to 'dry tap' or scanty
yield. The procedure may be of value in routine
investigation of various diseases such as aplastic anaemia
and in staging of malignant lymphomas although larger
studies need to be done in this area (only ten cases in this
study). A standard format should be formulated and adhered
to by haematologists and pathologists reporting on the TNBM
biopsies in this hospital.

2010

Kitonyi G W, Duncan A, GRNIJAEAJ.  2010.  Congenital Afibrinogenaemia in a Kenyan child. EAMJ. 87(2) AbstractWebsite

Congenital afibrinogenaemia (CA), is a rare inherited bleeding disorder characterised by complete deficiency of fibrinogen in the plasma. Blood clotting tests are indefinitely prolonged in patients. Themode of inheritance is autosomal recessive. Typically patients present with excessive cord bleeding after birth with intracerebral haemorrhages reported in childhood. Other manifestations include musculoskeletal haemorrhages, mucocutaneous bleeds with poor wound healing reported occasionally. In females, menorrhagia, repeated early pregnancy loss and post-partum haemorrhages are common. We present a four year old female who initially presented with severe cord bleeding after birth, warranting a blood transfusion. Currently she experiences recurrent epistaxis, easy bruising and excessive post -traumatic haemorrhages. All her clotting times are markedly prolonged. Her plasma fibrinogen and fibrinogen antigen are undetectable. An older sibling died from excessive cord haemorrhage after birth. Bleeds in CA respond very favourably to fibrinogen concentrates, cryoprecipitate and fresh plasma. To date, 242 cases of CA have been reported worldwide, none of them in Kenya. Our aim in reporting this case is to document the disorder, and also to raise the index of suspicion of the condition

Pamnani P, Rajab J.A, G’a KJNR.  2010.  Disseminated Histoplasmosis diagnosed on Bone Marrow Aspirate Cytology. EAMJ. 86:102-105.

2009

Kitonyi G.W, Githang’a J.N, RMJAWO.  2009.  Paediatric Thrombosis in Kenya . Journal of Haemostasis and Thrombosis. 7(Supplement 2):452.

2008

Murila F., RGJA.  2008.  Disease at a National Referral Hospital – A Ten Year Review. EAMJ. 85(9)

2005

A, DRRAJABJAMILLA.  2005.  Rajab JA, Muchina WP, Orinda DA, Scott CS. Blood donor haematology parameters in two regions of Kenya.East Afr Med J. 2005 Mar;82(3):123-7.. East Afr Med J. 2005 Mar;82(3):123-7.. : VDM Verlag Abstract
Department of Haematology and Blood Transfusion, College of Health Sciences, University of Nairobi, P. O. Box 19676, Nairobi, Kenya. OBJECTIVES: To determine the status of blood donor haematology in two regional sites in Kenya and to assess the potential role of automated haematology in National blood bank process control. DESIGN: A cross sectional descriptive study. SETTING: Two regional blood banks–Nairobi and its environs (Blood Transfusion Services, Nairobi) and Western Region (National Blood Transfusion Services, Kisumu). MAIN OUTCOME MEASURES: Distribution, mean, median, and 95% percentile ranges of haemoglobin (Hb), red cell parameters (red cell count, haematocrit, MCV, MCH and MCHC), total and differential white blood cell (WBC) counts, and platelet counts in the two donor populations. RESULTS: A significant number of donations (16.5% in Kisumu and 3.4% in Nairobi) showed haemoglobin levels below the recommended National Blood Transfusion Service (NBTS) guideline of 42g/unit. Compared to Kisumu, Nairobi donors had significantly (p < 0.001) higher Hb, MCV and MCH values while the red blood cell counts and MCHC values were similar (p > 0.05). A low MCV (< 78 fl) was observed in 12.4% and 3.4% of Kisumu and Nairobi donors respectively. Both populations showed similar but significant frequencies (Kisumu, 21.3%; Nairobi, 18.7%) of mild neutropenia (< 1.5 x 10(9)/1), while eosinophilia (> 0.5 x 10(9)/1 in the tropics the cut off is > 0.6 x 109) was more prominent in Kisumu donors (18.8% versus 8.5%). Platelet counts were also significantly lower in Kisumu donors, with the prevalence of thrombocytopenia (< 150 x 10(9)/1) being considerably higher (15.9% versus 3.7%). CONCLUSIONS: A significant number of Kenyan donors showed abnormal haematology profiles that may indicate underlying pathology. Such abnormalities are not detected by current blood transfusion services screening practices and there may be a need to strengthen donor selection criteria to protect both donors and recipients.
O, PROFORINDADA, A DRRAJABJAMILLA, S PROFKIGONDUCHRISTINE.  2005.  Rajab JA, Waithaka PM, Orinda DA, Scott CS. Analysis of cost and effectiveness of pre-transfusion screening of donor blood and anti-malarial prophylaxis for recipients. East Afr Med J. 2005 Nov;82(11):565-71.. East Afr Med J. 2005 Nov;82(11):565-71.. : VDM Verlag Abstract
OBJECTIVES: To determine the prevalence of malaria in donor units in a low and a high endemic region in Kenya and evaluate the cost effectiveness of recipient anti-malarial prophylaxis and pre-transfusion screening (using an automated method) as options to prevent post transfusion malaria. DESIGN: A descriptive cross-sectional study. SETTING: Two regional blood banks, Nairobi and its environs (National Blood Transfusion Services, Nairobi) a low malaria endemic region and western region (National Blood Transfusion Services, Kisumu) high malaria endemic region. SUBJECTS: All the donated units were included in the study for analysis, during the duration of study, from the two study sites. MAIN OUTCOME MEASURES: Prevalence of malaria in donor units in low endemic area (Nairobi) and high endemic area (Kisumu). Cost per case prevented for the two options, Option I Prophylactic administration of anti-malarial (sulfadoxine pyrimethamine SP) drugs to recipients, and Option II pre-transfusion screening using an automated technique. RESULTS: A malaria prevalence of 0.67% was found in Nairobi and its environments (low endemic) and 8.63% for Kisumu and its environments (high endemic area). The cost analysis showed a cost per case prevented of Ksh.105 (US$1.4) adult, Ksh.52.5 (US$0. 69) and paediatric for the option of recipient prophylaxis using an SP based drug. The cost escalated to Ksh.592 (US$7.79) adult Ksh.444 (US$5.84) paediatric if the prophylaxis was upgraded to the recommended artemisinin derivative (ACT-artemisinin based combination) and for the option of pre-transfusion screening using an automated technique the cost was Ksh.2.08 (US$0.03). CONCLUSION: The prevalence of malaria in donors showed the expected regional variation in the low and high endemic areas and was comparable to data obtained elsewhere. If malaria positive donor units were to be excluded from the national blood supply, an estimated 5% (compared to 1.3% for human Immunodeficiency virus, 3.6% for hepatitis B virus and 1.3% for hepatitis C virus) would be wasted. The cost per case prevented of transfusion-associated malaria is considerably higher for recipient antimalarial prophylaxis than pre-transfusion screening using an automated technique. The cost escalates by five to seven times if the newer artemesinin based combination antimalarial drugs are adopted.

1999

A, DRRAJABJAMILLA.  1999.  Mwanda WO, Rajab JA. Granulocytic sarcoma: report of three cases.East Afr Med J. 1999 Oct;76(10):594-6.. East Afr Med J. 1999 Oct;76(10):594-6.. : VDM Verlag Abstract
Department of Haematology and Blood Transfusion, College of Health Sciences, University of Nairobi. Granulocytic sarcoma (GS) is a rare extramedullary solid tumour composed of malignant immature cells of the granulocytic series. It may herald, accompany or signal acute myeloid leukaemia (AML) or chronic granulocytic leukaemia (CGL). GS may also occur in patients with myelodysplastic syndromes (MDS) where it is a sign of imminent disease progression. Three cases of GS are presented; the first one involving the pancreas and preceding AML, the second case affecting uterine cervix in stable phase CGL and the third case is GS of the breast accompanying AML. Any site of the body may be involved by the GS, and morbidity depends on the local organ/tissue affected in addition to the attending primary leukaemia or MDS. Treatment of GS involves surgery, radiotherapy and chemotherapy. The objective of this communication is to enhance awareness in personnel providing health care. Further, early diagnosis and treatment affects overall outcome.
A, DRRAJABJAMILLA.  1999.  Safe blood transfusion module 4 STI control and prevention manual for postgraduate diploma. East Afr Med J. 2005 Mar;82(3):123-7.. : VDM Verlag Abstract
Rajab J.A. Unit 4: Safe blood transfusion module 4 STI control and prevention manual for postgraduate diploma in the control and management of sexually transmitted infections by distance learning. Ministry of Health and the Belgian Development Cooperation, 1999.

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