By Chioma Obinna
With the rising cases of misdiagnosis in the country, a professor of haematology at the Lagos University Teaching Hospital, LUTH, Prof Sulaimon Akanmu has urged laboratory practitioners to avoid errors while carrying out diagnoses on individuals with haemoglobinopathy, stating that it could ruin lives and families.
Haemoglobinopathy is pathological haemoglobin. Haemoglobin is the molecule that helps to transfer oxygen from the lungs to the tissue and helps to transfer carbon dioxide from the tissue back to the lungs. Haemoglobin that is incapable of doing that is abnormal haemoglobin or pathological haemoglobin, so pathological haemoglobin is what we refer to as haemoglobinopathy.
Akanmu who spoke during a 3-Day Hands-On Workshop organised by the Initiative for Medical Diagnostic Awareness, IMDA, with the theme:: “Haemoglobinopathy: Diagnosis & Misdiagnosis” in Lagos also called for training and retraining of laboratory practitioners as a major strategy to tackling misdiagnosis in laboratories across the country.
Akanmu warned that laboratories easily commit errors in the diagnosis of an individual that has a haemoglobinopathy, particularly, sickle haemoglobinopathy, when standard procedure is not followed.
Akanmu also lamented that despite the fact there are cheaper and easier ways to make a diagnosis of sickling genes which is driving prenatal disputes, many practitioners go for more complex approaches that most times lead to error results.
He said although the standard procedure for such screening is simple, many laboratory scientists find it hard to use it.
Akanmu said: “When we want to make a diagnosis of the sickle haemoglobinopathy, the laboratorians will always believe when they do the procedure that we refer to as haemoglobin electro forensics and they see what we call the S-Band on the electrophoresis paper that was sufficient to make a diagnosis of the sickle gene, it is far from being sufficient, it is just an indicator that sickle gene may be present because what we call the electrophoresis is only referring to the mobility of some proteins depending on the number of electrical charges that are on that protein, so the sickle protein has some charges on it but we have some other type of haemoglobin that have the equal amount of charges that sickle protein has so when you subject them to the mobility they will move the same distance the same band on the electrophoresis mobility test.”
He advised practitioners that the fact that they have seen that S Band does not confirm that a particular type of haemoglobin is S, hence, the need for them to take a further step to confirm that the S gene is truly S gene using the most important property of the S protein.
“It is not sufficient to do haemoglobin electro forensics to make the diagnosis of the sickle gene after they have seen that band, you must carry out a haemoglobin solubility test or what we used to teach in the medical school as a sickling test.
“Sickling test is critical, it is very cheap to do, very easy and takes less than 30 minutes to do but somehow practitioners don’t just value it, once they see the electro forensics band they assume it is the ultimate because that is more complex to do.”
“Laboratory scientists should come for renewal of knowledge, they should be doing competency training and retraining to perfect their skills and improve their knowledge base to be able to do tests correctly and the Laboratory medicine practice is advancing every day.”
Speaking, the Chairman, Board of Trustees, Initiative for Medical Diagnostic Awareness, IMDA, Professor Oyedeji Kolawole said the hands-on workshop which focused on Haemoglobinopathy: Diagnosis and Misdiagnosis” was designed to unravel the controversies over parental disputes.
Kolawole noted that there are increasing cases of parental disputes following laboratory misdiagnosis of the sickle gene and misdiagnosis in such issues could come with numerous complications.
“This workshop is about digging deeper into what we call haemoglobinopathy. We have about 35 participants because it is hands-on training. There is what we call prenatal diagnosis where you can check your baby while you are still carrying the baby invitro to check the haemoglobin of the baby, there are limitations when you use automated machines. We want to teach people how to read films so the basic simple way to look at the theme is about genotyping and the different methods for genotyping are microbiology and molecular diagnosis.”
“We are looking at sickling diagnosis mobility, haemoglobin electro forensics and film reading, a molecular investigation by PCR and high-performance liquid filmography.
Speaking, a retired Medical Laboratory Scientist at the College of Medicine, University of Lagos, Florence Adefelaju said the IMDA workshop was in line with the Laboratory Scientists’ profession to ensure proper diagnosis of disease conditions.
Adefalaju explained that proper diagnosis ensures patients are well managed.
“Proper diagnosis will also prevent labelling someone who is AS as AA. When it is not properly done, it can cause problems in families and society. Many of our laboratory practitioners need to be retrained. Many people have been practising for 20 years without updating their knowledge despite the advancement in the laboratory world as regards evidence-based diagnosis to help patients get the quality care they deserve.”
Source: Vanguard