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LEUKAEMIA AT QUEEN ELIZABETH CENTRAL HOSPITAL IN BI,ANTYRE, MALAWI
Abstract
Objectives: To determine the patterns of leukaemias seen in M rlawians at Queen Elizabeth
Central Hospital (QECH) and to compare the findings wit11 those from elsewhere. An
overview of the problems encountered in the management of leukaemia in developing
countries especially those in sub-Saharan Africa are highlighted.
Design: Retrospectivedescriptive analysis of consecutive leukac ,mia cases seen from January
1994 through December 1998.
Results: Of the 95 leukaemia patients diagnosed during the st1 ~ d y period, childhood (0 - 15
years) leukaemia occurred in 27 (28.4 % )patients while adulthot d (above 15 years) leukaemia
accounted for 68 (71.6%) patients. The main leukaemia typts were: acute lymphoblastic
leukaemia (ALL) 14 (14.7%), acute myeloblastic leukaemia (AML) 25 (26.3%), chronic
myeloid (granulocytic) leukaemia (CMI,) 32 (33.7%), chro lic lymphocytic (lymphatic)
leukaemia (CLL) 22 (23.2%) and hairy cell leukaemia (HCL) two (2.1%) patients. Most of
the acute leukaemia (AL) cases occurred in the six to 15 ythar age bracket with a male
preponderance. In ALL, lymphadenopathy was the commone! t presenting feature followed
by pallor (92.9%) while in the AML group, pallor occurred in 80% of cases. Abdominal
swelling (87.5%) due to splenomegaly (81.3%) were the main clinical features in the CML
group whereas lymphadenopathy (63.6%) followed by splt nomegaly (59.1 % ) were the
dominant presentingfeatures in CLL. Haematologically,altho~ ~gh leucocytosis characterised
both acute and chronic leukaemias, most cases of acute leu naemia presented with more
severe anaemia (Hb<7g/dl) and marked thrombocytopenia (Platelet count
4 0 x 10'A) than the chronic leukaemias.
Conclusions and recommendations: The study shows that leuk remias are not rare in Malawi
and cases which were diagnosed in this series probably only rcspresent the tip of the iceberg.
While there is need to increase diagnostic awareness among clinicians and laboratory staff,
theseverechronic shortageof cytotoxicdrugs and lack of suppc ~rtive care facilities commonly
encountered in developing countries should be realistically ad dressed through cost-sharing.
cost recovery, adequate government subvention and donations From charitable organisations.
Central Hospital (QECH) and to compare the findings wit11 those from elsewhere. An
overview of the problems encountered in the management of leukaemia in developing
countries especially those in sub-Saharan Africa are highlighted.
Design: Retrospectivedescriptive analysis of consecutive leukac ,mia cases seen from January
1994 through December 1998.
Results: Of the 95 leukaemia patients diagnosed during the st1 ~ d y period, childhood (0 - 15
years) leukaemia occurred in 27 (28.4 % )patients while adulthot d (above 15 years) leukaemia
accounted for 68 (71.6%) patients. The main leukaemia typts were: acute lymphoblastic
leukaemia (ALL) 14 (14.7%), acute myeloblastic leukaemia (AML) 25 (26.3%), chronic
myeloid (granulocytic) leukaemia (CMI,) 32 (33.7%), chro lic lymphocytic (lymphatic)
leukaemia (CLL) 22 (23.2%) and hairy cell leukaemia (HCL) two (2.1%) patients. Most of
the acute leukaemia (AL) cases occurred in the six to 15 ythar age bracket with a male
preponderance. In ALL, lymphadenopathy was the commone! t presenting feature followed
by pallor (92.9%) while in the AML group, pallor occurred in 80% of cases. Abdominal
swelling (87.5%) due to splenomegaly (81.3%) were the main clinical features in the CML
group whereas lymphadenopathy (63.6%) followed by splt nomegaly (59.1 % ) were the
dominant presentingfeatures in CLL. Haematologically,altho~ ~gh leucocytosis characterised
both acute and chronic leukaemias, most cases of acute leu naemia presented with more
severe anaemia (Hb<7g/dl) and marked thrombocytopenia (Platelet count
4 0 x 10'A) than the chronic leukaemias.
Conclusions and recommendations: The study shows that leuk remias are not rare in Malawi
and cases which were diagnosed in this series probably only rcspresent the tip of the iceberg.
While there is need to increase diagnostic awareness among clinicians and laboratory staff,
theseverechronic shortageof cytotoxicdrugs and lack of suppc ~rtive care facilities commonly
encountered in developing countries should be realistically ad dressed through cost-sharing.
cost recovery, adequate government subvention and donations From charitable organisations.
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