Hematological, liver and kidney parameters among Ghanaian steady state sickle cell disease patients

Hematological, liver and kidney parameters among Ghanaian steady state sickle cell disease patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Hematological, liver and kidney parameters among Ghanaian steady state sickle cell disease patients Stephen Twumasi, Alfred Effah, Richard Owusu Ansah, Samuel Kwarteng, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5529431/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Sickle cell disease’s ( SCD) clinical hallmarks include hemolysis and vascular occlusive symptoms. In sickle cell disease (SCD), red blood cells are distorted into a sickle shape by the polymerization of deoxygenated hemoglobin S (HbS) molecules, which results in tissue destruction, hemolysis, and vaso-occlusion. Vaso-occlusion can result in organ damage, which may cause changes in blood cells, liver and renal function. This study investigated the complete blood count, liver and kidney profile of steady state sickle cell disease patients in Ghana. Methods This case-control study involved 64 SCD patients and 80 healthy subjects. Participants' information was thoroughly documented using a structured questionnaire and patient case records. Venous blood was drawn from each participant for the estimation of their hematobiochemical parameters. Findings: Majority of SCD patients were under 20 years of age (40.6%) compared to the non-SCD group (33.8%) ( p = 0.062). Hemoglobin and hematocrit levels were significantly lower in HbSS participants (8.50 ± 1.45 g/dL and 24.50%, p < 0.001 respectively) compared to HbSC (10.62 ± 1.76 g/dL and 30.35%, p < 0.001) and non-SCD groups (11.73 ± 2.08 g/dL and 35.40%, p < 0.001). Platelet, white blood cell (WBC), lymphocyte, and neutrophil counts were higher in HbSS participants, compared to HbSC ( p < 0.001). Liver function markers showed significant increase in HbSS participants, with higher aspartate transaminase (AST) and alkaline phosphatase (ALP) levels (52.30 U/L, p < 0.001 and 106.05 U/L, p < 0.001 respectively) compared to HbSC and non-SCD groups. Fibrinogen and fibrinogen-to-albumin ratios (FAR) were higher in HbSS (4.59 g/L and 0.11, p < 0.001 respectively). Moreso, there was high Urine Albumin-to-Creatinine ratio in HbSS 19.84 (6.77–34.97) compared to HbSC 18.44 (6.26–35.64) individuals. Neutrophil Gelatinase Associated Lipocalin (sNGAL) levels were significantly elevated in SCD, particularly HbSS (5.96 ng/mL, p < 0.001), compared to non-SCD (4.35 ng/mL, p < 0.001). Conclusion This study reported reduced levels of hemoglobin and hematocrit as well as high WBC and platelets among HbSS and HbSC patients compared to controls. We also observed normal liver function parameters in our patients and finally we reported normal levels of traditional renal markers but found high levels of NGAL in HbSS and HbSC patients compared to controls. Health sciences/Diseases/Haematological diseases/Anaemia Health sciences/Diseases/Haematological diseases/Sickle cell disease Biological sciences/Biochemistry Biological sciences/Chemical biology Biological sciences/Immunology Biological sciences/Microbiology Health sciences/Diseases Health sciences/Medical research Health sciences/Neurology Sickle cell disease hematological biochemical complete blood count liver and kidney function Introduction Sickle cell disease (SCD) remains a significant public health concern globally. Millions of people worldwide are afflicted by SCD, although sub-Saharan Africans are disproportionately affected ( 1 ). In Ghana, the overall prevalence of SCD remains at 2% of the population. According to Ohene-Frimpong et al ., (2008), SCD affects 1.9% of all babies in Ghana annually and is the cause of a number of premature deaths ( 2 ). The majority of complications in SCD arise from the polymerization (sickling) of HbS in a concentration-dependent manner under conditions of stress and hypoxia. Red blood cells can take on the crescent or sickled form that gives rise to the disease when Hb tetramers containing two of these mutant sickle β-globin subunits (HbS) polymerize in the presence of deoxygenation or when hemoglobin is not bound to oxygen( 3 ). In SCD, a single amino acid substitution in the beta-globin chain causes the mutant hemoglobin S to polymerize, disrupting the flow properties and lifespan of red blood cells (RBC) ( 4 ). Subsequently initiating a series of pathogenic events that include oxidative stress, inflammation, hemolysis, infarction, and hypercoagulability ( 4 ). A mutation in both HBB alleles, at least one of which is the βS allele, results in SCD. The presence of a single beta S allele with another beta S allele leads sickle cell anaemia (HbSS), or another hemoglobin variant (for instance, HbSC) or thalassemia (HbSβ-thalassaemia) constitude sickle cell disease. The presence of the beta S allele with a beta A allele characterizes AS heterozygosity, which is not sickle cell disease. People with sickle cell anemia(HbSS), the most common SCD phenotype, have two βS alleles (βS/βS) ( 5 ). The sickle Hb (HbS) allele, beta S, is an HBB allele in which an adenine-to-thymine substitution results in the replacement of valine for glutamic acid at position 6 in the mature β globin chain The HbSC genotype is characterized by the presence of one beta S allele and one HBB allele (HBB Glu6Lys, or βC allele) with a distinct nucleotide substitution, which results in the production of the HbC structural variant. Anemia is the most indicator in SCD, indicating the necessity for blood transfusion. Low hemoglobin levels are associated with a bad outcome in SCD ( 6 ).Also, patients with SCD have a far lower prevalence of hypertension (2–6% versus 28%, respectively) compared to the general population, and some may exhibit lower-than-normal blood pressure ( 7 ). The following are explanations for this relative hypotension: Waste of water and sodium due to medullary deficit ( 8 ), systemic vasodilation compensates for microcirculatory flow abnormalities ( 7 ), enhanced synthesis of prostaglandins and nitric oxide ( 9 ), reduced vascular reactivity ( 8 ). Renal disease is a common consequence of sickle cell disease (SCD) caused by prolonged anaemia and abnormal medullar capillary circulation ( 10 ). In the latter research, renal failure affected 21 percent of the participants ( 11 ). Acute renal failure (ARF) in sickle cell disease (SCD) might have multiple likely causes. SCD individuals are more vulnerable to intravascular volume depletion-induced prerenal failure due to their reduced capacity for concentration. Among the intrinsic renal causes of ARF are hepatorenal syndrome (hepatic failure due to hemosiderosis), rhabdomyolysis, sepsis, pharmaceutical nephrotoxicity, and renal vein thrombosis. Blood clots obstructing the urinary tract and, less frequently, papillary necrosis are examples of postrenal causes ( 12 ). Creatinine is not a reliable indicator for estimating GFR in SCD ( 13 ). Falsely normal plasma creatinine levels and creatinine clearance brought on by decreased production and enhanced clearance of creatinine can postpone the diagnosis of kidney disease. The most frequent liver condition linked to SCD is biliary issues. These conditions can range from gallstones and biliary sludge to cholangiopathy and cirrhosis. The main cause of gallstones and hyperbilirubinemia is increased hemolysis. There are two types of presentations: mild (bilirubin 80–150 µmol/L, ≥ 50% conjugated, elevated transaminases, without liver failure (or a bilirubin 3–5× the steady state), no liver failure) and severe (bilirubin over 150 µmol/L, ≥ 50% conjugated), high levels of transaminases and conjugated bilirubin (more than 50 µmol/L), with liver failure and no liver failure (normal INR). Iron overload can occur in SCD individuals as a result of frequent blood transfusions. Roughly 10% of patient deaths are related to hepatic iron excess ( 14 ). More than half of asymptomatic people have abnormal serum AST (which also indicates the rate of hemolysis) and, to a lesser extent, ALT, but not at levels higher than 2 times the upper limit of normal (ULN). ALP, which varies with growth, is not a reliable diagnostic of hepatobiliary illness in adults. However, ɣ-GT is more sensitive and specific ( 15 ). Since SCD has a significant impact on the kidneys and liver, among other organs, this study compared the complete blood count, liver, and renal parameters of people with HbSS and HbSC phenotypes with those of healthy controls. Methods Study design, duration and study setting The study was a case-control study conducted from November 25, 2023 to August 31, 2024.The research was carried out at the Komfo Anokye Teaching Hospital (KATH), the Suntreso Government Hospital and the Kumasi South Government Hospital. The KATH is located at Bantama, Kumasi, Ashanti Region, Ghana. It is the sole tertiary healthcare facility in the Ashanti Region and the second-largest hospital in Ghana. Kumasi South Hospital is located in Atonsu Agogo and Suntreso Government Hospital is located at Suntreso. These facilities are situated in the Kumasi Metropolis in the Ashanti Region of Ghana. These are a 24-hour working health facilities that boast of services like laboratory, scan, obstetrics and gynaecology, emergency. These facilities also have a sickle cell clinic from where SCD participants were recruited for the study. Ethical Clearance and Informed Consent This study was conducted based on the Helsinki Declaration and the study protocol, consent forms and participant information material were reviewed and approved by the Committee for Human Research Publication and Ethics of Komfo Anokye Teaching Hospital (KATH IRB/AP/175/23) and Kwame Nkrumah University of Science and Technology's (CHRPE/AP/1037/23). Permission was sought from the research facility of Komfo Anokye Teaching Hospital (KATH), the Suntreso Government Hospital and the Kumasi South Government Hospital before commencement of study. Written informed consent was obtained from participants and confidentiality was maintained. In addition, the privacy rights of human subjects were observed. Study participants The study included known SCD patients who were registered with the sickle cell clinic of the Komfo Anokye Teaching Hospital and Kumasi South Government Hospital, Ghana. They reported at the clinic for a review as and when directed by their physician. Owing to their clinical history, haematology clinicians in both hospitals accessed SCD patients and declared them fit for the study before they were recruited. Normal individuals were recruited from the laboratory units of Suntreso Government hospital and Komfo Anokye Teaching Hospital. SCD participants were individuals who were above eighteen ( 18 ) years without any history of diabetes mellitus, arterial hypertension, neoplastic, cardiovascular, renal, lung or endocrine disease were included in the study. In addition, cancer patients, individuals who have infections, pregnant women, G6PD defects and other known hemolytic disease aside SCD were excluded. Steady-state SCD was clinically defined as SCD participants who have been well for at least two weeks and without symptoms suggestive of sickle cell pain crisis, acute sickness (fever or requiring referral to an urgent care facility) and clinically suspected urinary tract infection or extensive hematuria. The control group involved healthy individuals without any history of SCD, diabetes mellitus, arterial hypertension, neoplastic, cardiovascular, inflammatory, renal, lung and endocrine diseases. Also, they were not supposed to be on any medication. Both SCD and control group were without symptoms of malaria and urinary tract infection. Data collection Demographics such age, gender, marital status and clinical history of participants were recorded using a well-structured questionnaire and patient medical records. Dietary habits were categorized qualitatively as occurring rarely (one per month), irregularly (seven times per month), and regularly (twice per month). Estimates were made for height to the nearest centimeter without shoes and weight to the nearest 0.1 kg when wearing light clothes. A wall-mounted ruler was used to measure height. A Zhongshan Camry Electronic Co. Ltd. bathroom scale (Guangdong, China) was used to assess weight. Blood sampling and analysis Phlebotomy was performed following standard protocol (World Health Organization, 2010). Five ( 5 ) millilitres (ml) (venous blood) were pulled from each participant and collected into K3 EDTA tube, sodium citrate tube and Serum Separator tube (SST) – 1.8ml into sodium citrate tube first, 2.2 ml separated into SST second and 1ml into EDTA tube. Whole blood in EDTA was used for full blood count. Serum in SST was used to analyze Liver function markers, creatinine, urea, electrolytes (sodium, potassium and chloride) and NGAL. Sodium citrate was used for fibrinogen measurement. Participants were directed to collect a mid-stream urine in a cleaned dry urine container. They were told to allow the first part of their urine to fall into the toilet bowl before they collect about 1 to 2 ounces of urine, then urinate the rest into the toilet bowl. The urine sample was used for Urine Albumin-to-Creatine Ratio (UACR). Laboratory assay To confirm the phenotypes in all participants, cellulose acetate electrophoresis at pH 8.9 followed by high-performance liquid chromatography (Bio-Rad variant II dual program hemoglobin testing) were performed and results reported as HbSS, HbSC and HbAA. Full Blood Estimation was done using five ( 5 )- part Automated Hematology Analyzer XN-550 (XN-550; Sysmex Corporation, Kobe Japan). Renal function tests (electrolytes, urea, and creatinine), liver function tests (bilirubin, AST, ALT, ALP, GGT Total Protein and albumin), urine albumin-to-creatinine ratio were determined on Vitros 5600 integrated systems (Ortho-Clinical Diagnostics, UK). Fibrinogen was measured with Wonfo Fibrinogen reagent kit and OCG-102 Coagulation analyzer following approved procedures ( 16 ). Fibrinogen-to-Albumin ratio calculations involved dividing the Fibrinogen (FIB) by Albumin (ALB) to arrive at values. A commercially available ELISA kit (Melson Shanghai Chemical Ltd, China) was used for the sNGAL measurement. Reagent was used in accordance with the manufacturer's instructions to measure samples from the controls and the participants using the solid phase ELISA technique. 5.68 ± 1.34µg/L is the commonly accepted reference value for serum. Statistical analysis The study's data was entered into Microsoft Excel (2016), and IBM Statistical Package for Social Sciences (version 26.0) were used for statistical analysis. Continuous variables were presented as mean ± standard deviation or median (interquartile range) depending on the normality, whilst categorical variables were expressed as frequencies (%) and compared using the chi-square test or Fisher Exact test where appropriate. Depending on the normality, One-way ANOVA or Kruskal-Wallis test was also computed to assess the mean or median differences between three or more independent variables and it was followed by pairwise comparison test to determine the significant pairs within the group using the Bonferroni correction for multiple test. All computations of statistical significance were performed using a 95% confidence interval and a p value of 0.05. Results Sociodemographic Characteristics of Study Participants Majority of SCD patients were under 20 years of age (40.6%) compared to the non-SCD group (33.8%) ( p = 0.062). Most of the male participants were in the SCD group (39.1%) compared to non-SCD (25.0%) ( p = 0.070). Considering marital status, most SCD participants were single (75.0%), while non-SCD participants had a higher proportion of married individuals (38.8%) ( p = 0.079). Residence was predominantly urban for both groups, though more pronounced in the SCD group (90.6%) compared to the non-SCD group (73.8%) ( p = 0.010). SCD participants had more secondary education (50.0%) compared to non-SCD participants, who had a higher basic education rate (37.5%) ( p = 0.011). Moreover, participants with SCD had a significantly lower body mass index (BMI) (22.97 ± 3.00 kg/m²) compared to non-SCD participants (25.22 ± 1.97 kg/m²) ( p < 0.001). Diastolic blood pressure was also lower in the SCD group [71.00 (64.25–76.00) mmHg] compared to the non-SCD group [76.00 (4.00–79.00) mmHg], whilst systolic blood pressure was slightly higher in SCD participants [119.00 (114.00–122.00) mmHg] compared to non-SCD participants [113.50 (109.00–119.00) mmHg] (both p < 0.001). (Table 1 ). Table 1 Baseline characteristics of SCD and non-SCD participants Variable Non-SCD (n = 80) SCD (n = 64) p -value Age(years) 29.5 (24.0–40.0) 25.5 (22.3–33.0) 0.074 b Age group 0.062 Less than 21 27 (33.8) 26 (40.6) 21–25 21 (26.3) 24 (37.5) Greater than 25 32 (40.0) 14 (21.9) Gender 0.070 Male 20 (25.0) 25 (39.1) Female 60 (75.0) 39 (60.9) Marital Status 0.079 Single 47 (58.8) 48 (75.0) . Married 31 (38.8) 16 (25.0) Divorced 2 (2.5) 0 (0.0) Residence 0.010 Rural 21 (26.3) 6 (9.4) Urban 59 (73.8) 58 (90.6) Education Level 0.011 No formal Education 1 (1.3) 0 (0.0) Basic 30 (37.5) 9 (14.1) SHS 27 (33.8) 32 (50.0) Tertiary 22 (27.5) 23 (35.9) Occupation 0.217 Unemployed 31 (38.8) 20 (31.3) Formal 13 (16.3) 18 (28.1) Informal 36 (45.0) 26 (40.6) Ethnicity 0.375 Akan 60 (75.0) 54 (84.4) Fante 7 (8.8) 3 (4.7) Others 13 (16.3) 7 (10.9) Religion 0.897 Christian 73 (91.3) 58 (90.6) Muslim BMI (Kg/m 2 ) 7 (8.8) 6 (9.4) 25.22 ± 1.97 22.97 ± 3.00 < 0.001 a Diastolic BP 76.00 (74.00–79.00) 71.00 (64.25–76.00) < 0.001 b Systolic BP 113.50 (109.00–119.00) 119.00 (114.00–122.00) < 0.001 b Categorical variables were summarized as frequency (%), while continuous variables were reported as mean ± standard deviation for parametric data and median (interquartile range) for non-parametric data. The chi-square test, a independent sample t-test, and b Mann-Whitney U test were used for comparisons. A p-value < 0.05 was considered statistically significant, with significant values presented in bold. Lifestyle Characteristics of Study Participants Egg consumption was higher among SCD participants, with 78.1% consuming eggs regularly compared to 72.5% of non-SCD participants ( p = 0.562). Similarly, fruit and vegetable consumption was more frequent in the SCD group, with 56.3% reporting regular intake compared to 47.5% in the non-SCD group ( p = 0.147). Alcohol intake also differed significantly, with a greater proportion of non-SCD participants reporting irregular (16.3%) and regular (3.8%) alcohol consumption, whilst 93.8% of SCD participants rarely consumed alcohol ( p = 0.045). Salt intake also differed significantly, with 15.0% of non-SCD participants rarely consuming salt, in contrast to none of the SCD participants ( p = 0.003). However, lifestyle factors, including vigorous exercise, activity level, animal protein consumption, portion control, and tobacco smoking, did not show any statistically significant differences between groups. (Table 2 ). Table 2 Lifestyle characteristics of study participants Variable Non-SCD (n = 80) SCD (n = 64) p -value Vigorous Exercise 0.925 Regular 30 (37.5) 22 (34.4) Irregular 45 (56.3) 38 (59.4) Rarely 5 (6.3) 4 (6.3) Activity Level 0.243 Regular 36 (45.0) 35 (54.7) Irregular 44 (55.0) 28 (43.8) Rarely 0 (0.0) 1 (1.6) Animal Protein Consumption 0.937 Regular 62 (77.5) 48 (75.0) Irregular 17 (21.3) 15 (23.4) Rarely 1 (1.3) 1 (1.6) Egg Consumption 0.562 Regular 58 (72.5) 50 (78.1) Irregular 22 (27.5) 14 (21.9) Portion Control 0.216 Regular 23 (28.7) 25 (39.1) Irregular 55 (68.8) 39 (60.9) Rarely 2 (2.5) 0 (0.0) Fruits and Vegetables Consumption 0.147 Regular 38 (47.5) 36 (56.3) Irregular 38 (47.5) 28 (43.8) Rarely 4 (5.0) 0 (0.0) Tobacco Smoking 0.168 Irregular 3 (3.8) 0 (0.0) Rarely 77 (96.3) 64 (100.0) Alcohol Intake 0.045 Regular 3 (3.8) 0 (0.0) Irregular 13 (16.3) 4 (6.3) Rarely 64 (80.0) 60 (93.8) Salt Intake 0.003 Regular 20 (25.0) 25 (39.1) Irregular 48 (60.0) 39 (60.9) Rarely 12 (15.0) 0 (0.0) Categorical variables were presented as frequency (%). Chi-square or Fisher’s exact test p -values were presented. P < 0.05 was considered statistically significant. Bolded p -values were statistically significant. Hematological Profile of Study Participants Table 3 presents the hematological profile of study participants. The median red blood cell (RBC) count was significantly lower in HbSS participants (2.72 ×10⁶/µL) compared to both HbSC (4.23 ×10⁶/µL) and non-SCD individuals (4.34 ×10⁶/µL), p < 0.001. Hemoglobin and hematocrit levels were also significantly lower in HbSS participants (8.68 ± 1.51 g/dL and 25.79 ± 4.90%, respectively) compared to HbSC (10.80 ± 1.67 g/dL and 30.38 ± 5.08%) and non-SCD groups (11.73 ± 2.08 g/dL and 34.89 ± 5.91%), p < 0.001. Mean corpuscular volume (MCV) (90.40 fL, p < 0.001) and mean corpuscular hemoglobin (MCH) (30.90 pg, p < 0.001) were significantly higher in HbSS than in HbSC and non-SCD groups. RDW-SD and RDW-CV were also markedly elevated in the HbSS group ( p < 0.001). Moreover, white blood cell (WBC), lymphocyte, and neutrophil counts were significantly higher in HbSS participants compared to HbSC ( p < 0.001). Platelet counts (PLT) also varied differently among the groups, with higher medians observed in HbSS (309.00 ×10³/mL) compared to HbSC (212.00 ×10³/mL) and non-SCD groups (241.00 ×10³/mL), ( p = 0.061). Additionally, reticulocyte count, nucleated RBCs, basophil, and eosinophil counts were significantly increased in the HbSS group ( p < 0.001). Table 3 Comparison of Hematological Parameters between SCD and Non-SCD Participants Variable Non-SCD (n = 80) HbSC (n = 17) HbSS (n = 47) p -value Hemoglobin (g/dL) 11.73 ± 2.08 10.80 ± 1.67 8.68 ± 1.51 < 0.001 ab Hematocrit (%) 34.89 ± 5.91 30.38 ± 5.08 25.79 ± 4.90 0.011 abc PDW (fL) 12.65 ± 1.90 13.45 ± 3.04 12.26 ± 2.99 0.127 RBC (×10⁶/µL) 4.34 (3.85–4.82) 4.23 (3.30–4.48) 2.72 (2.41–3.27) < 0.001 ab MCV (fL) 82.15 (76.83–85.90) 74.90 (71.95–92.95) 90.40 (80.60–96.50) < 0.001 ab MCH (pg) 28.00 (25.25–29.38) 26.80 (25.50–31.55) 30.90 (27.20–33.10) < 0.001 b MCHC (g/dL) 33.80 (32.60–34.80) 35.60 (34.65–37.45) 34.90 (31.40–36.50) < 0.001 ac RDW-SD (fL) 40.90 (38.50–44.10) 45.30 (41.20–54.05) 59.80 (55.10–67.70) < 0.001 ab RDW-CV (%) 13.80 (13.00–15.15) 17.20 (15.95–22.25) 19.90 (17.50–23.10) < 0.001 bc Platelet count (×10³/mL) 241.00 (211.25–287.25) 212.00 (156.00–346.00) 309.00 (209.00–426.00) 0.061 MPV (fL) 5.74 (5.09–7.10) 6.80 (5.40–9.45) 8.71 (7.07–11.30) 0.657 PCT (%) 2.99 (2.26–3.95) 3.22 (2.68–4.67) 4.39 (2.92–5.99) 0.193 WBC (×10³/µL) 2.15 (1.78–2.63) 2.77 (2.27–3.77) 3.30 (2.60–3.74) < 0.001 b Lymphocyte count (×10³/µL) 0.53 (0.43–0.66) 0.51 (0.35–0.79) 0.73 (0.45–1.02) < 0.001 bc Monocyte count (x10³/µL) 0.10 (0.05–0.16) 0.11 (0.08–0.27) 0.13 (0.09–0.24) 0.021 b Neutrophil Count (×10³/µL) 0.03 (0.02–0.04) 0.04 (0.03–0.10) 0.05 (0.03–0.09) 0.002 b Eosinophil Count (×10³/µL) 1.31 (1.01–2.04) 1.20 (1.10–1.50) 1.22 (0.93–1.69) 0.020 b Basophil Count (×10³/µL) 117.18 (93.43–151.40) 72.34 (52.01–138.23) 89.89 (62.43–127.95) < 0.001 b Reticulocyte count (×10⁶/µL) 0.04 (0.03–0.05) 0.11 (0.10–0.15) 0.20 (0.15–0.30) < 0.001 bc Nucleated RBC (×10⁶/µL) 0.00 (0.00–0.02) 0.02 (0.01–0.06) 0.07 (0.04–0.28) < 0.001 abc IG# (×10³/µL) 0.02 (0.01–0.02) 0.04 (0.03–0.07) 0.06 (0.03–0.11) < 0.001 bc Data presented as mean ± standard deviation or median (interquartile range) depending on the normality. WBC- White Cell Count, RBC- Red Blood Count, MCV-Mean Cell Volume, MCH- Mean Cell Haemoglobin, MCHC- Mean Cell, PDW- Platelet Distribution Width, MPV-Mean Platelet Volume, PCT-Plateletcrit, IG#-number of Immunoglobulins, a : significant when HbSS is compared to HbSC, b : significant when HbSS is compared with non-SCD, c : HbSC compared with non-SCD, p < 0.05 and bolded means statistically significant. Biochemical Profile of Study Participants The variations in biochemical profile of study participants are shown in Table 4 . Sodium levels were significantly increased in HbSC (143.00 mmol/L) and HbSS (143.00 mmol/L) compared to non-SCD (140.00 mmol/L, p < 0.001). Potassium levels were also elevated in HbSS participants (4.80 mmol/L) compared to non-SCD (4.50 mmol/L, p = 0.008). Liver function markers generally showed significant increases in HbSS participants, with higher aspartate transaminase (AST) ( p < 0.001) and alkaline phosphatase (ALP) ( p < 0.001) levels (50.10 U/L and 100.10 U/L) compared to HbSC (36.80 U/L and 90.70 U/L) and non-SCD groups (33.30 U/L and 71.80 U/L) respectively. Similarly, gamma-glutamyl transferase (GGT) was significantly increased in HbSS (43.30 U/L, p < 0.001) compared to HbSC (26.80 U/L) and Non-SCD (28.25 U/L). Total protein ( p < 0.001) and globulin ( p < 0.001) levels were also significantly higher in SCD participants compared to non-SCD. Notably, bilirubin levels were substantially higher in individuals with SCD compared to those non-SCD. Specifically, total bilirubin ( p < 0.001), direct bilirubin ( p = 0.001), and indirect bilirubin ( p < 0.001) levels were significantly elevated in HbSS individuals (36.40 mmol/L, 2.60 mmol/L, and 33.50 mmol/L, respectively) compared to those with HbSC.. However, urinary albumin (UALB) levels were significantly lower in SCD participants compared to non-SCD ( p = 0.009). Individuals with HbSS had significantly higher levels of fibrinogen (4.41 g/L, p < 0.001) and fibrinogen-to-albumin ratios (FAR) (0.11, p < 0.001) compared to those with HbSC (3.28 g/L and 0.08, respectively) and non-SCD individuals (2.50 g/L and 0.06, respectively). Additionally, Neutrophil Gelatinase Associated Lipocalin (sNGAL) levels were significantly elevated in SCD, particularly HbSS (6.25 ng/mL), compared to non-SCD (4.47 ng/mL, p 0.05). Table 4 Comparison of biochemical parameters between SCD and non-SCD participants Variable Non-SCD (n = 80) HbSC (n = 17) HbSS (n = 47) p-value Urea (mmol/L) 2.41(1.75-3.00) 2.52(1.56–2.89) 2.25(1.58–7.44) 0.984 Creatinine (mmol/L) 66.00(53.00–76.00) 63.00(47.00-76.50) 59.00(44.00-144.00) 0.509 BUN/Cr Ratio 16.85(12.93–20.53) 18.10(13.70–33.00) 17.30(13.10–24.50) 0.360 eGFR (mL/min/1.73m²) 123.79(103.72-155.08) 128.62(95.60-153.93) 130.24(51.69–164.10) 0.912 Sodium (mmol/L) 140.00(139.00-143.00) 143.00(141.50–145.00) 143.00(141.00-144.00) < 0.001 ab Potassium (mmol/L) 4.50(4.10–4.90) 4.60(4.30–4.90) 4.80(4.60–5.20) 0.008 b Chlorine (mmol/L) 104.00(102.00-107.00) 105.00(100.50-109.50) 107.00(104.00-109.00) 0.063 AST (U/L) 33.30(28.40-39.05) 36.80(33.70-49.75) 50.10(41.70–71.30) < 0.001 bc ALT (U/L) 24.90(18.78–31.70) 25.60(21.75–30.30) 24.10(20.60–28.80) 0.946 ALP (U/L) 71.80(59.25–93.23) 90.70(66.30-107.95) 100.10(77.90-127.80) < 0.001 b GGT (U/L) 28.25(22.80-40.05) 26.80(20.30-39.65) 43.30(28.00-54.20) < 0.001 bc Total Protein (g/L) 79.02(72.96–85.66) 86.82(78.76–93.31) 88.11(83.41–92.11) < 0.001 ab Albumin (g/L) 42.90(39.95–45.60) 40.70(38.30-42.25) 42.30(39.80–44.30) 0.116 Globulin (g/L) 36.50(32.75–40.18) 43.80(40.00-51.40) 45.00(42.20–49.80) < 0.001 ab TBIL (mmol/L) 6.40(4.03–12.20) 14.60(12.05–22.35) 36.40(20.00-59.30) < 0.001 abc DBIL (mmol/L) 2.00(1.00–3.00) 0.00(0.00-1.65) 2.60(0.00-8.60) 0.001 ac IBIL (mmol/L) 4.50(3.13-9.00) 14.20(11.40–22.80) 33.50(18.40–44.20) < 0.001 ab UALB (mg/dL) 2.40(1.10–4.38) 0.90(0.30–2.15) 1.70(0.50–3.50) 0.009 a UACR (mg/g) 22.01(11.26–41.65) 18.88(4.81–39.47) 20.69(7.68–34.84) 0.242 sNGAL (ng/mL) 4.47(3.95–4.89) 6.07(4.83–6.95) 6.25(5.58–6.92) < 0.001 ab Fibrinogen (g/L) 2.50(2.01–3.40) 3.28(2.09–4.60) 4.41(4.15–5.14) < 0.001 b FAR 0.06(0.05–0.08) 0.08(0.05–0.12) 0.11(0.09–0.12) < 0.001 b Data presented as mean ± standard deviation or median (interquartile range) depending on the normality. BUN: Blood Urea Nitrogen,Cr: Creatinine UACR; Urine Albumin-to-Creatinine ratio, eGFR; estimated Glomerular Filtration Rate, sNGAL; Neutrophil Gelatinase Associated Lipocalin, AST: Aspartate transaminase, ALT: Alaline transaminase, ALP: Alkaline Phosphate, GGT: Gamma glutaryl transferase, TBIL: Total bilirubin, DBIL: Direct bilirubin, IBIL: Indirect bilirubin a : significant difference between Non-SCD and HbSC, b : significant difference between HbSS and non-SCD, c : significant difference between HbSC and HbSS, p < 0.05 and bolded means statistically significant. Discussion Complete blood count (Hemogram) is one of the most useful tests used in the management of sickle cell disease. In monitoring the hepatic effects of blood transfusion in SCD patients, LFTs which includes aminotransferases, aminotransaminases, bilirubin and proteins are good predictors of liver pathology. In the same vein, kidney disease in SCD has become one of the increasing causes of mortality in all individuals including SCD patients. This study contributed to the management of sickle cell diseases patients by looking at how their complete blood count, liver and renal parameters differ from their non-SCD counterpart, in so doing guiding clinical practice and management of SCD patients in Ghana. Majority of the SCD patients were individuals with HbSS variant followed by HbSC variant which is in line with research mastered by Ohene Frimpong et al. , (2008) from Ghana. It is acknowledged that HbSS patients exhibit a severe form of SCD in comparison to other SCD phenotypes and this account for more clinic visits. In this present study, most of SCD individuals were less than twenty years, this may be due to higher mortality seen in older SCD patients as compared to healthy individuals ( 17 ). Majority of females were seen in this study in both SCD and control group which agrees with a research done by Asare et al. , (2018) in Ghana ( 18 ). The higher female-to-male proportion may be due to the fact that women typically outlive men in most populations and because women have superior health-seeking practices than men ( 19 ). In Ghana, the life expectancy (in years) for a male at birth is 61.0 and for a female is 63.9, per WHO data released in 2015 ( 20 ), this may also explain the higher female-to-male ratio reported in this study. Interestingly, most of SCD patients were single which supports a study done by Adzika et al ., (2017) (88.9%) in Ghana ( 21 ) and the reality that many individuals with SCD already experience stress and anxiety, which includes fear of getting married and having kids ( 22 ). The study sites were located in a city and this explains why majority of the participants were urban residents in both cases and controls. In a study mastered by Machado et al. , (2006), regular exercise was significantly associated with pulmonary hypertension in SCD participants ( 23 ) and this may explain why SCD patients do not exercise regular as indicated in this study. In this study, there was no statistical difference between cases and controls as far as meat and fish consumption is concern, however regular egg consumption was high in SCD patients as compared to controls which is in accordance with a study conducted by Ezepue et al ., (2003) who observed that SCD patients consume more eggs than meat and fish in a week. In this present study, we observed that HbSS patients have significantly lower RBC, hemoglobin and hematocrit than HbSC and healthy controls. In comparing this study with previous findings, we saw a similar trend in studies conducted by Anwti-Bosiako et al. ( 24 ): RBC (HbSS: 2.89 ± 0.77(×10⁶/µL), HbSC: 4.04 ± 0.94 (×10⁶/µL), controls: 4.97 ± 1.26(×10⁶/µL)), hemoglobin (HbSS: 8.31 ± 1.57 (g/dL), HbSC:10.74 ± 1.73 (g/dL) and controls:13.19 ± 3.32 (g/dL)) and hematocrit (HbSS:24.84 ± 5.18 (%), HbSC:33.02 ± 7.08(%) and controls: 40.91 ± 10.94 (%)). In the same vein, hemoglobin was lower in HbSS (7.54 ± 2.26 (g/dL)) than controls (12.93 ± 2.22 (g/dL)) in a study conducted by Omoti et al. ( 25 ). The red blood cells in SCD patients have a limited life rate of 12–14 days and are constantly hemolyzing ( 26 ). This explains the low count of RBC, hemoglobin and hematocrit levels in SCD compared to those of healthy individuals, with very low levels in HbSS than HbSC patients. We also observed high MCV, MCH, MCHC and RDW which conforms with findings from Antwi-Bosiako et al ( 24 ) in steady state SCD patients. As expected, HbSS and HbSC demonstrated high total WBC and differentials (Neutrophils, Monocytes, lymphocytes and basophils) in SCD patients compared to their control counterparts with a significantly higher level in HbSS patients. This was expected because the underlying mechanisms that lead to a rise in the concentration of neutrophils in the venous blood of SCD patients—such as demarginating of intravascular neutrophils, rapid release from the bone marrow, and a decrease in the pace at which neutrophils exit the circulation ( 27 ). In a study conducted by Antwi-Bosiako et al. ( 24 ), total WBC count was high in HbSS (12.18 ± 3.56(×10³/µL)) compared to HbSC (6.87 ± 1.77 (×10³/µL)) and controls (5.31 ± 1.11 (×10³/µL)) and this present study observed similar pattern. Similar observation also happened in a study done by Omoti et al . ( 25 ), WBC and differentials were elevated in HbSS in steady state (WBC = 12.72 ± 7.98(×10³/µL), neutrophils = 5.2 ± 1.6 (×10³/µL), lymphocytes = 6.5 ± 1.6 (×10³/µL), monocytes = 1.0 ± 0.78 (×10³/µL)) as compared to non-SCD (WBC = 5.71 ± 0.97 (×10³/µL), neutrophils = 2.3 ± 0.51 (×10³/µL), lymphocytes = 2.9 ± 0.69 (×10³/µL), monocytes = 0.4 ± 0.17 (×10³/µL)). Several research indicates that high WBC count in SCD patients are mainly due to infections ( 25 , 28 ), though this study didn’t look at the relationship between infections and WBC count. The platelets count observed in this study is comparable to a study conducted by Antwi-Bosiako (HbSS: 466.33 ± 121.39 (×10³/µL), HbSC:289.64 ± 18.31 (×10³/µL) and controls:224.22 ± 61.17 (×10³/µL)) and Omoti et al. (HbSS: 342.62 ± 143.03(×10³/µL) and controls:304.24 ± 61.47 (×10³/µL)). In vaso-occlusive states of SCD participants in the aforementioned studies showed significantly high platelets count in SCD with very higher levels in HbSS. Though this study only recruited study only recruited steady state SCD participants, the trend seen in other studies give a clear indication that thrombocytosis is more severe in SCD when they are in crisis ( 29 ). The increased platelet count observed in SCD patients may be due to the underlying chronic inflammation, splenic sequestration, splenic reduction or absence from autosplenectomy ( 28 ) or hyposplenism in SCD ( 30 ). Although a correlation was not established in our investigation, reports suggest that there is a relationship between platelet count and SCD( 31 , 32 ), which supports the higher platelet counts among SCD patients in this study. With respect to LFT parameters, enzymes such as AST, ALT, GGT and ALP were significantly high in HbSS and HbSC patients compared to controls indicating that there is some sort of liver inflammation in SCD, however ALT which is very specific to liver and other enzymes were apparently within the normal range ( 33 ) and similar in all participant groups which rules out liver dysfunction in study participants. LFT markers seen in this study is in accordance with a research done by Kotila et al . ( 34 ) who observed minimal elevation of transaminases in steady state SCD patients. Hence, routine liver disease monitoring is recommended for SCD patients at least once a year and serum ALT (> 2×ULN) and gamma-GT (1.5-2.0×ULN) levels indicate liver illness and should be explored ( 15 ). We also reported high levels of direct and indirect bilirubin in SCD patients with very high levels in HbSS. Indirect hyperbilirubinemia is prevalent in SCD, nonetheless, acute obstruction brought on by gallstones, inspissated bile, or a dominating biliary structure should be investigated in cases of direct hyperbilirubinemia ( 35 ). Obviously, fibrinogen levels and fibrinogen-to-albumin ratio levels were minimally higher in HbSS and HbSC compared to controls which demonstrate the link between fibrinogen and albumin levels and the trend of inflammation in the various participants ( 36 ). As far as the kidney biomarkers are concern, this study reported normal levels of creatinine and urea with lower levels in SCD participants. This is due to the fact that, serum creatinine levels (Cr) and urea are often misleading in their diagnosis of progressive renal impairment. The main clinical indicator of renal function, serum creatinine, is influenced by variables unrelated to renal activity, such as age, gender, race, and lean muscle mass, and is insensitive for detecting mild changes in renal function ( 37 ). However, NGAL which is a marker of kidney damage showed high levels in HbSS and HbSC compared to controls which conforms with findings from Marouf et al . ( 38 ) and Atere et al . ( 39 ) who found increased levels of NGAL in steady state SCD participants and its relationship with renal abnormailities as comapred to healthy individuals which is consistent with this present study. In a different study done by Twumasi et al , ( 40 ), we stratified the SCD patients based on microalbuminuria and we found out that, steady state SCD pateints have kidney dysfunction and diagnosis shouldn’t be based on the traditional markers. There was a minimal increased levels of potassium in the HbSS and HbSC patients compared to the controls which agrees with findings from Alhwiesh et al. ( 41 ). The main limitations of this is that, we didn’t monitor our patients to know the change in hematobiochemical parameters till when they get crisis. Moreover, gender and some of the age groups of cases and controls were not comparable and this could affect the study findings. Though, we excluded patients having symptoms of malaria, we didn’t screen for asymptomatic malaria parasitemia and compile data on pateints receiving hydroxyurea as these may affect the haematobiochemical parameters in the SCD patients. Further studies should therefore look at how these parameters will change in vaso-occlusive state or better still recruit both steady state and VOC state and see how the parameters differ in both states. Also, further studies should be done in other parts of Ghana to confirm earlier findings, give a baseline hematobiochemical profile and provide guidance in the form of an algorithm to help clicicians manage SCD patients. Conclusion This study reported reduced levels of RBC, hemoglobin and hematocrit as well as high WBC and platelets among HbSS and HbSC patients compared to controls. We also observed normal liver function parameters in our patients and finally we reported normal levels of traditional renal markers but found high levels of NGAL in HbSS and HbSC patients compared to controls. In addition to providing additional descriptive information about SCD patients in Ghana, these hematobiochemical parameters may also serve as a helpful tool and help physicians manage SCD patients in Ghana. Declarations Consent for publication Not applicable. Availability of data Data and materials for study are available upon request from the corresponding authors. Competing interests All authors declare that there is no competing interest. Funding The author(s) received no financial support for the research, authorship and or/ publication of this article. Authors Contributions ST and AO wrote the main manuscript. ST, ROA and AE did data analysis All authors reviewed the manuscript Clinical Trial Not Applicable Acknowledgements We are grateful for the immense contributions of the staff of Komfo Anokye Teaching Hospital, Suntreso Government Hospital and Kumasi South Hospital for their warm reception, not forgetting our participants. Special thanks to the serology department of Komfo Anokye Teaching Hospital on their support in storage of samples. References Organization, W. H. Worldwide prevalence of anaemia 1993–2005: WHO global database on anaemia. (2008). Ohene-Frempong, K., Oduro, J., Tetteh, H. & Nkrumah, F. Screening newborns for sickle cell disease in Ghana. Pediatrics 121 (Supplement_2), S120–S1 (2008). Kato, G. J. et al. 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Neutrophil gelatinase-associated lipocalin and Fibrinogen-to-albumin ratio are indicators of nephropathy in adult steady state sickle cell disease patients: A multicenter case-control study in Ghana. medRxiv. :2024.10.14.24315440. (2024). Alhwiesh, A. An update on sickle cell nephropathy. Saudi J. Kidney Dis. Transplantation . 25 (2), 249–265 (2014). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5529431","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":445040954,"identity":"530d8c97-2f37-4b85-98d0-87783adcc976","order_by":0,"name":"Stephen Twumasi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYBADHvvDjI0PPgBZbOyE1LJBtTAcZ242nAESYCZSCwPDefY2YR4Qg5AW+fk9ZlI3aupkGJsZ25htfm2T52NmYPzwMQe3FoNjPGbSOccO8zAzM7Y9zu27bdjGzMAsOXMbHi1svNukc9gO8LAxM7Yb5/bcBtoF9A4vHi3ybSAt/+p4eIC2SFv23LYnqIXhGFBLbhszjwRIC8OP24kEtRgcy/9sndt3mMeAmbHZsLfhdnIbkIHXL/LNxxJv53yrszfgP/7wwY8/t23ntzcf/PARn8NQAGMbmGwgVj0I/CFF8SgYBaNgFIwUAAA6h0kKRaqKdAAAAABJRU5ErkJggg==","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Stephen","middleName":"","lastName":"Twumasi","suffix":""},{"id":445040955,"identity":"debbfb00-365a-4e68-af7f-5c0c6bdec8db","order_by":1,"name":"Alfred Effah","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Alfred","middleName":"","lastName":"Effah","suffix":""},{"id":445040956,"identity":"8cb8d58c-89d3-4a61-a756-285bb5fa9920","order_by":2,"name":"Richard Owusu Ansah","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Richard","middleName":"Owusu","lastName":"Ansah","suffix":""},{"id":445040957,"identity":"9cefa1d5-e6c9-4bc9-970f-f835402ef664","order_by":3,"name":"Samuel Kwarteng","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Kwarteng","suffix":""},{"id":445040958,"identity":"94788a3b-5681-4115-bacb-7e7a97eec8fd","order_by":4,"name":"Benedict Sackey","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Benedict","middleName":"","lastName":"Sackey","suffix":""},{"id":445040959,"identity":"dac01768-f75c-48a1-8abe-f44c84749ae0","order_by":5,"name":"Allwell Adofo Ayirebi","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Allwell","middleName":"Adofo","lastName":"Ayirebi","suffix":""},{"id":445040960,"identity":"6944ec0e-ef2c-42df-8e46-eaa10f517707","order_by":6,"name":"Angela Opoku","email":"","orcid":"","institution":"Komfo Anokye Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Angela","middleName":"","lastName":"Opoku","suffix":""},{"id":445040961,"identity":"1982dcb3-05c0-41ec-8f8f-197c3499a678","order_by":7,"name":"Lilian Antwi Boateng","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Lilian","middleName":"Antwi","lastName":"Boateng","suffix":""}],"badges":[],"createdAt":"2024-11-26 16:08:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5529431/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5529431/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83881089,"identity":"6c7946f2-f2a6-49f5-ac90-0cf9b562789a","added_by":"auto","created_at":"2025-06-04 05:32:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1419047,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5529431/v1/6cef95a8-4d10-4c68-90c7-0d6d381575e9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Hematological, liver and kidney parameters among Ghanaian steady state sickle cell disease patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSickle cell disease (SCD) remains a significant public health concern globally. Millions of people worldwide are afflicted by SCD, although sub-Saharan Africans are disproportionately affected (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In Ghana, the overall prevalence of SCD remains at 2% of the population. According to Ohene-Frimpong \u003cem\u003eet al\u003c/em\u003e., (2008), SCD affects 1.9% of all babies in Ghana annually and is the cause of a number of premature deaths (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe majority of complications in SCD arise from the polymerization (sickling) of HbS in a concentration-dependent manner under conditions of stress and hypoxia. Red blood cells can take on the crescent or sickled form that gives rise to the disease when Hb tetramers containing two of these mutant sickle β-globin subunits (HbS) polymerize in the presence of deoxygenation or when hemoglobin is not bound to oxygen(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In SCD, a single amino acid substitution in the beta-globin chain causes the mutant hemoglobin S to polymerize, disrupting the flow properties and lifespan of red blood cells (RBC) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Subsequently initiating a series of pathogenic events that include oxidative stress, inflammation, hemolysis, infarction, and hypercoagulability (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). A mutation in both \u003cem\u003eHBB\u003c/em\u003e alleles, at least one of which is the βS allele, results in SCD. The presence of a single beta S allele with another beta S allele leads sickle cell anaemia (HbSS), or another hemoglobin variant (for instance, HbSC) or thalassemia (HbSβ-thalassaemia) constitude sickle cell disease. The presence of the beta S allele with a beta A allele characterizes AS heterozygosity, which is not sickle cell disease. People with sickle cell anemia(HbSS), the most common SCD phenotype, have two βS alleles (βS/βS) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The sickle Hb (HbS) allele, beta S, is an \u003cem\u003eHBB\u003c/em\u003e allele in which an adenine-to-thymine substitution results in the replacement of valine for glutamic acid at position 6 in the mature β globin chain The HbSC genotype is characterized by the presence of one beta S allele and one \u003cem\u003eHBB\u003c/em\u003e allele (HBB Glu6Lys, or βC allele) with a distinct nucleotide substitution, which results in the production of the HbC structural variant.\u003c/p\u003e \u003cp\u003eAnemia is the most indicator in SCD, indicating the necessity for blood transfusion. Low hemoglobin levels are associated with a bad outcome in SCD (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).Also, patients with SCD have a far lower prevalence of hypertension (2\u0026ndash;6% versus 28%, respectively) compared to the general population, and some may exhibit lower-than-normal blood pressure (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The following are explanations for this relative hypotension: Waste of water and sodium due to medullary deficit (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), systemic vasodilation compensates for microcirculatory flow abnormalities (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), enhanced synthesis of prostaglandins and nitric oxide (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), reduced vascular reactivity (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRenal disease is a common consequence of sickle cell disease (SCD) caused by prolonged anaemia and abnormal medullar capillary circulation (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In the latter research, renal failure affected 21 percent of the participants (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Acute renal failure (ARF) in sickle cell disease (SCD) might have multiple likely causes. SCD individuals are more vulnerable to intravascular volume depletion-induced prerenal failure due to their reduced capacity for concentration. Among the intrinsic renal causes of ARF are hepatorenal syndrome (hepatic failure due to hemosiderosis), rhabdomyolysis, sepsis, pharmaceutical nephrotoxicity, and renal vein thrombosis. Blood clots obstructing the urinary tract and, less frequently, papillary necrosis are examples of postrenal causes (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Creatinine is not a reliable indicator for estimating GFR in SCD (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Falsely normal plasma creatinine levels and creatinine clearance brought on by decreased production and enhanced clearance of creatinine can postpone the diagnosis of kidney disease.\u003c/p\u003e \u003cp\u003eThe most frequent liver condition linked to SCD is biliary issues. These conditions can range from gallstones and biliary sludge to cholangiopathy and cirrhosis. The main cause of gallstones and hyperbilirubinemia is increased hemolysis. There are two types of presentations: mild (bilirubin 80\u0026ndash;150 \u0026micro;mol/L, \u0026ge;\u0026thinsp;50% conjugated, elevated transaminases, without liver failure (or a bilirubin 3\u0026ndash;5\u0026times; the steady state), no liver failure) and severe (bilirubin over 150 \u0026micro;mol/L, \u0026ge;\u0026thinsp;50% conjugated), high levels of transaminases and conjugated bilirubin (more than 50 \u0026micro;mol/L), with liver failure and no liver failure (normal INR). Iron overload can occur in SCD individuals as a result of frequent blood transfusions. Roughly 10% of patient deaths are related to hepatic iron excess (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). More than half of asymptomatic people have abnormal serum AST (which also indicates the rate of hemolysis) and, to a lesser extent, ALT, but not at levels higher than 2 times the upper limit of normal (ULN). ALP, which varies with growth, is not a reliable diagnostic of hepatobiliary illness in adults. However, ɣ-GT is more sensitive and specific (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince SCD has a significant impact on the kidneys and liver, among other organs, this study compared the complete blood count, liver, and renal parameters of people with HbSS and HbSC phenotypes with those of healthy controls.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, duration and study setting\u003c/h2\u003e \u003cp\u003eThe study was a case-control study conducted from November 25, 2023 to August 31, 2024.The research was carried out at the Komfo Anokye Teaching Hospital (KATH), the Suntreso Government Hospital and the Kumasi South Government Hospital. The KATH is located at Bantama, Kumasi, Ashanti Region, Ghana. It is the sole tertiary healthcare facility in the Ashanti Region and the second-largest hospital in Ghana. Kumasi South Hospital is located in Atonsu Agogo and Suntreso Government Hospital is located at Suntreso.\u003c/p\u003e \u003cp\u003eThese facilities are situated in the Kumasi Metropolis in the Ashanti Region of Ghana. These are a 24-hour working health facilities that boast of services like laboratory, scan, obstetrics and gynaecology, emergency. These facilities also have a sickle cell clinic from where SCD participants were recruited for the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical Clearance and Informed Consent\u003c/h3\u003e\n\u003cp\u003e This study was conducted based on the Helsinki Declaration and the study protocol, consent forms and participant information material were reviewed and approved by the Committee for Human Research Publication and Ethics of Komfo Anokye Teaching Hospital (KATH IRB/AP/175/23) and Kwame Nkrumah University of Science and Technology's (CHRPE/AP/1037/23). Permission was sought from the research facility of Komfo Anokye Teaching Hospital (KATH), the Suntreso Government Hospital and the Kumasi South Government Hospital before commencement of study. Written informed consent was obtained from participants and confidentiality was maintained. In addition, the privacy rights of human subjects were observed.\u003c/p\u003e\n\u003ch3\u003eStudy participants\u003c/h3\u003e\n\u003cp\u003eThe study included known SCD patients who were registered with the sickle cell clinic of the Komfo Anokye Teaching Hospital and Kumasi South Government Hospital, Ghana. They reported at the clinic for a review as and when directed by their physician. Owing to their clinical history, haematology clinicians in both hospitals accessed SCD patients and declared them fit for the study before they were recruited. Normal individuals were recruited from the laboratory units of Suntreso Government hospital and Komfo Anokye Teaching Hospital.\u003c/p\u003e \u003cp\u003eSCD participants were individuals who were above eighteen (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) years without any history of diabetes mellitus, arterial hypertension, neoplastic, cardiovascular, renal, lung or endocrine disease were included in the study. In addition, cancer patients, individuals who have infections, pregnant women, G6PD defects and other known hemolytic disease aside SCD were excluded. Steady-state SCD was clinically defined as SCD participants who have been well for at least two weeks and without symptoms suggestive of sickle cell pain crisis, acute sickness (fever or requiring referral to an urgent care facility) and clinically suspected urinary tract infection or extensive hematuria. The control group involved healthy individuals without any history of SCD, diabetes mellitus, arterial hypertension, neoplastic, cardiovascular, inflammatory, renal, lung and endocrine diseases. Also, they were not supposed to be on any medication. Both SCD and control group were without symptoms of malaria and urinary tract infection.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eDemographics such age, gender, marital status and clinical history of participants were recorded using a well-structured questionnaire and patient medical records. Dietary habits were categorized qualitatively as occurring rarely (one per month), irregularly (seven times per month), and regularly (twice per month). Estimates were made for height to the nearest centimeter without shoes and weight to the nearest 0.1 kg when wearing light clothes. A wall-mounted ruler was used to measure height. A Zhongshan Camry Electronic Co. Ltd. bathroom scale (Guangdong, China) was used to assess weight.\u003c/p\u003e\n\u003ch3\u003eBlood sampling and analysis\u003c/h3\u003e\n\u003cp\u003ePhlebotomy was performed following standard protocol (World Health Organization, 2010). Five (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) millilitres (ml) (venous blood) were pulled from each participant and collected into K3 EDTA tube, sodium citrate tube and Serum Separator tube (SST) \u0026ndash; 1.8ml into sodium citrate tube first, 2.2 ml separated into SST second and 1ml into EDTA tube. Whole blood in EDTA was used for full blood count. Serum in SST was used to analyze Liver function markers, creatinine, urea, electrolytes (sodium, potassium and chloride) and NGAL. Sodium citrate was used for fibrinogen measurement. Participants were directed to collect a mid-stream urine in a cleaned dry urine container. They were told to allow the first part of their urine to fall into the toilet bowl before they collect about 1 to 2 ounces of urine, then urinate the rest into the toilet bowl. The urine sample was used for Urine Albumin-to-Creatine Ratio (UACR).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLaboratory assay\u003c/h2\u003e \u003cp\u003eTo confirm the phenotypes in all participants, cellulose acetate electrophoresis at pH 8.9 followed by high-performance liquid chromatography (Bio-Rad variant II dual program hemoglobin testing) were performed and results reported as HbSS, HbSC and HbAA. Full Blood Estimation was done using five (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)- part Automated Hematology Analyzer XN-550 (XN-550; Sysmex Corporation, Kobe Japan).\u003c/p\u003e \u003cp\u003eRenal function tests (electrolytes, urea, and creatinine), liver function tests (bilirubin, AST, ALT, ALP, GGT Total Protein and albumin), urine albumin-to-creatinine ratio were determined on Vitros 5600 integrated systems (Ortho-Clinical Diagnostics, UK). Fibrinogen was measured with Wonfo Fibrinogen reagent kit and OCG-102 Coagulation analyzer following approved procedures (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Fibrinogen-to-Albumin ratio calculations involved dividing the Fibrinogen (FIB) by Albumin (ALB) to arrive at values. A commercially available ELISA kit (Melson Shanghai Chemical Ltd, China) was used for the sNGAL measurement. Reagent was used in accordance with the manufacturer's instructions to measure samples from the controls and the participants using the solid phase ELISA technique. 5.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u0026micro;g/L is the commonly accepted reference value for serum.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe study's data was entered into Microsoft Excel (2016), and IBM Statistical Package for Social Sciences (version 26.0) were used for statistical analysis. Continuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (interquartile range) depending on the normality, whilst categorical variables were expressed as frequencies (%) and compared using the chi-square test or Fisher Exact test where appropriate. Depending on the normality, One-way ANOVA or Kruskal-Wallis test was also computed to assess the mean or median differences between three or more independent variables and it was followed by pairwise comparison test to determine the significant pairs within the group using the Bonferroni correction for multiple test. All computations of statistical significance were performed using a 95% confidence interval and a \u003cem\u003ep\u003c/em\u003e value of 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic Characteristics of Study Participants\u003c/h2\u003e \u003cp\u003eMajority of SCD patients were under 20 years of age (40.6%) compared to the non-SCD group (33.8%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.062). Most of the male participants were in the SCD group (39.1%) compared to non-SCD (25.0%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.070). Considering marital status, most SCD participants were single (75.0%), while non-SCD participants had a higher proportion of married individuals (38.8%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.079). Residence was predominantly urban for both groups, though more pronounced in the SCD group (90.6%) compared to the non-SCD group (73.8%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010). SCD participants had more secondary education (50.0%) compared to non-SCD participants, who had a higher basic education rate (37.5%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011).\u003c/p\u003e \u003cp\u003eMoreover, participants with SCD had a significantly lower body mass index (BMI) (22.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00 kg/m\u0026sup2;) compared to non-SCD participants (25.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97 kg/m\u0026sup2;) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Diastolic blood pressure was also lower in the SCD group [71.00 (64.25\u0026ndash;76.00) mmHg] compared to the non-SCD group [76.00 (4.00\u0026ndash;79.00) mmHg], whilst systolic blood pressure was slightly higher in SCD participants [119.00 (114.00\u0026ndash;122.00) mmHg] compared to non-SCD participants [113.50 (109.00\u0026ndash;119.00) mmHg] (both \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of SCD and non-SCD participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-SCD (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSCD (n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e -value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge(years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.5 (24.0\u0026ndash;40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.5 (22.3\u0026ndash;33.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.074\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (33.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreater than 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47 (58.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 (73.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58 (90.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (33.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (35.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAkan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54 (84.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFante\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.897\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73 (91.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58 (90.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003cp\u003e\u003cb\u003eBMI (Kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiastolic BP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76.00 (74.00\u0026ndash;79.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.00 (64.25\u0026ndash;76.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystolic BP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e113.50 (109.00\u0026ndash;119.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119.00 (114.00\u0026ndash;122.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCategorical variables were summarized as frequency (%), while continuous variables were reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation for parametric data and median (interquartile range) for non-parametric data. The chi-square test, \u003csup\u003ea\u003c/sup\u003eindependent sample t-test, and \u003csup\u003eb\u003c/sup\u003eMann-Whitney U test were used for comparisons. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant, with significant values presented in bold.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLifestyle Characteristics of Study Participants\u003c/h2\u003e \u003cp\u003eEgg consumption was higher among SCD participants, with 78.1% consuming eggs regularly compared to 72.5% of non-SCD participants (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.562). Similarly, fruit and vegetable consumption was more frequent in the SCD group, with 56.3% reporting regular intake compared to 47.5% in the non-SCD group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.147). Alcohol intake also differed significantly, with a greater proportion of non-SCD participants reporting irregular (16.3%) and regular (3.8%) alcohol consumption, whilst 93.8% of SCD participants rarely consumed alcohol (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.045). Salt intake also differed significantly, with 15.0% of non-SCD participants rarely consuming salt, in contrast to none of the SCD participants (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). However, lifestyle factors, including vigorous exercise, activity level, animal protein consumption, portion control, and tobacco smoking, did not show any statistically significant differences between groups. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLifestyle characteristics of study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-SCD (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSCD (n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e -value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVigorous Exercise\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIrregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38 (59.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eActivity Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.243\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (54.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIrregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44 (55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnimal Protein Consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.937\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62 (77.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIrregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEgg Consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58 (72.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50 (78.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIrregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePortion Control\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 (28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIrregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55 (68.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFruits and Vegetables Consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIrregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTobacco Smoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIrregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77 (96.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol Intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.045\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIrregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60 (93.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSalt Intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIrregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCategorical variables were presented as frequency (%). Chi-square or Fisher\u0026rsquo;s exact test \u003cem\u003ep\u003c/em\u003e-values were presented. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Bolded \u003cem\u003ep\u003c/em\u003e-values were statistically significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eHematological Profile of Study Participants\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the hematological profile of study participants. The median red blood cell (RBC) count was significantly lower in HbSS participants (2.72 \u0026times;10⁶/\u0026micro;L) compared to both HbSC (4.23 \u0026times;10⁶/\u0026micro;L) and non-SCD individuals (4.34 \u0026times;10⁶/\u0026micro;L), \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001. Hemoglobin and hematocrit levels were also significantly lower in HbSS participants (8.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51 g/dL and 25.79\u0026thinsp;\u0026plusmn;\u0026thinsp;4.90%, respectively) compared to HbSC (10.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67 g/dL and 30.38\u0026thinsp;\u0026plusmn;\u0026thinsp;5.08%) and non-SCD groups (11.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08 g/dL and 34.89\u0026thinsp;\u0026plusmn;\u0026thinsp;5.91%), \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001. Mean corpuscular volume (MCV) (90.40 fL, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and mean corpuscular hemoglobin (MCH) (30.90 pg, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly higher in HbSS than in HbSC and non-SCD groups. RDW-SD and RDW-CV were also markedly elevated in the HbSS group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eMoreover, white blood cell (WBC), lymphocyte, and neutrophil counts were significantly higher in HbSS participants compared to HbSC (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Platelet counts (PLT) also varied differently among the groups, with higher medians observed in HbSS (309.00 \u0026times;10\u0026sup3;/mL) compared to HbSC (212.00 \u0026times;10\u0026sup3;/mL) and non-SCD groups (241.00 \u0026times;10\u0026sup3;/mL), (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.061). Additionally, reticulocyte count, nucleated RBCs, basophil, and eosinophil counts were significantly increased in the HbSS group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Hematological Parameters between SCD and Non-SCD Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-SCD (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHbSC (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHbSS (n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e -value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eab\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematocrit (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.89\u0026thinsp;\u0026plusmn;\u0026thinsp;5.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.38\u0026thinsp;\u0026plusmn;\u0026thinsp;5.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.79\u0026thinsp;\u0026plusmn;\u0026thinsp;4.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003csup\u003e\u003cb\u003eabc\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePDW (fL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRBC (\u0026times;10⁶/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.34 (3.85\u0026ndash;4.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.23 (3.30\u0026ndash;4.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.72 (2.41\u0026ndash;3.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eab\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCV (fL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.15 (76.83\u0026ndash;85.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.90 (71.95\u0026ndash;92.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.40 (80.60\u0026ndash;96.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eab\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCH (pg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.00 (25.25\u0026ndash;29.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.80 (25.50\u0026ndash;31.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.90 (27.20\u0026ndash;33.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCHC (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.80 (32.60\u0026ndash;34.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.60 (34.65\u0026ndash;37.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.90 (31.40\u0026ndash;36.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eac\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRDW-SD (fL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.90 (38.50\u0026ndash;44.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.30 (41.20\u0026ndash;54.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.80 (55.10\u0026ndash;67.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eab\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRDW-CV (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.80 (13.00\u0026ndash;15.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.20 (15.95\u0026ndash;22.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.90 (17.50\u0026ndash;23.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003ebc\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet count (\u0026times;10\u0026sup3;/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e241.00 (211.25\u0026ndash;287.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e212.00 (156.00\u0026ndash;346.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e309.00 (209.00\u0026ndash;426.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMPV (fL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.74 (5.09\u0026ndash;7.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.80 (5.40\u0026ndash;9.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.71 (7.07\u0026ndash;11.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.657\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCT (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.99 (2.26\u0026ndash;3.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.22 (2.68\u0026ndash;4.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.39 (2.92\u0026ndash;5.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.15 (1.78\u0026ndash;2.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.77 (2.27\u0026ndash;3.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.30 (2.60\u0026ndash;3.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphocyte count (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.53 (0.43\u0026ndash;0.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.51 (0.35\u0026ndash;0.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.73 (0.45\u0026ndash;1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003ebc\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonocyte count (x10\u0026sup3;/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.10 (0.05\u0026ndash;0.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11 (0.08\u0026ndash;0.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.13 (0.09\u0026ndash;0.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophil Count (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.03 (0.02\u0026ndash;0.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04 (0.03\u0026ndash;0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05 (0.03\u0026ndash;0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEosinophil Count (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.31 (1.01\u0026ndash;2.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.20 (1.10\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.22 (0.93\u0026ndash;1.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasophil Count (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117.18 (93.43\u0026ndash;151.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.34 (52.01\u0026ndash;138.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89.89 (62.43\u0026ndash;127.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReticulocyte count (\u0026times;10⁶/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.04 (0.03\u0026ndash;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11 (0.10\u0026ndash;0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20 (0.15\u0026ndash;0.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003ebc\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNucleated RBC (\u0026times;10⁶/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;0.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02 (0.01\u0026ndash;0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.07 (0.04\u0026ndash;0.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eabc\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIG# (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.02 (0.01\u0026ndash;0.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04 (0.03\u0026ndash;0.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06 (0.03\u0026ndash;0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003ebc\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (interquartile range) depending on the normality. WBC- White Cell Count, RBC- Red Blood Count, MCV-Mean Cell Volume, MCH- Mean Cell Haemoglobin, MCHC- Mean Cell, PDW- Platelet Distribution Width, MPV-Mean Platelet Volume, PCT-Plateletcrit, IG#-number of Immunoglobulins, \u003csup\u003ea\u003c/sup\u003e: significant when HbSS is compared to HbSC, \u003csup\u003eb\u003c/sup\u003e: significant when HbSS is compared with non-SCD, \u003csup\u003ec\u003c/sup\u003e: HbSC compared with non-SCD, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and bolded means statistically significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eBiochemical Profile of Study Participants\u003c/h2\u003e \u003cp\u003eThe variations in biochemical profile of study participants are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Sodium levels were significantly increased in HbSC (143.00 mmol/L) and HbSS (143.00 mmol/L) compared to non-SCD (140.00 mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Potassium levels were also elevated in HbSS participants (4.80 mmol/L) compared to non-SCD (4.50 mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008). Liver function markers generally showed significant increases in HbSS participants, with higher aspartate transaminase (AST) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and alkaline phosphatase (ALP) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) levels (50.10 U/L and 100.10 U/L) compared to HbSC (36.80 U/L and 90.70 U/L) and non-SCD groups (33.30 U/L and 71.80 U/L) respectively. Similarly, gamma-glutamyl transferase (GGT) was significantly increased in HbSS (43.30 U/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to HbSC (26.80 U/L) and Non-SCD (28.25 U/L). Total protein (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and globulin (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) levels were also significantly higher in SCD participants compared to non-SCD. Notably, bilirubin levels were substantially higher in individuals with SCD compared to those non-SCD. Specifically, total bilirubin (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), direct bilirubin (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), and indirect bilirubin (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) levels were significantly elevated in HbSS individuals (36.40 mmol/L, 2.60 mmol/L, and 33.50 mmol/L, respectively) compared to those with HbSC.. However, urinary albumin (UALB) levels were significantly lower in SCD participants compared to non-SCD (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009). Individuals with HbSS had significantly higher levels of fibrinogen (4.41 g/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and fibrinogen-to-albumin ratios (FAR) (0.11, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to those with HbSC (3.28 g/L and 0.08, respectively) and non-SCD individuals (2.50 g/L and 0.06, respectively). Additionally, Neutrophil Gelatinase Associated Lipocalin (sNGAL) levels were significantly elevated in SCD, particularly HbSS (6.25 ng/mL), compared to non-SCD (4.47 ng/mL, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There were no significant differences in renal function parameters, including eGFR, BUN-to-creatinine ratio, creatinine, and urea levels, among the groups (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of biochemical parameters between SCD and non-SCD participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-SCD (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHbSC (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHbSS (n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrea (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.41(1.75-3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.52(1.56\u0026ndash;2.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.25(1.58\u0026ndash;7.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.984\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.00(53.00\u0026ndash;76.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63.00(47.00-76.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.00(44.00-144.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUN/Cr Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.85(12.93\u0026ndash;20.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.10(13.70\u0026ndash;33.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.30(13.10\u0026ndash;24.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.360\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR (mL/min/1.73m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123.79(103.72-155.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128.62(95.60-153.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e130.24(51.69\u0026ndash;164.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.912\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140.00(139.00-143.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e143.00(141.50\u0026ndash;145.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e143.00(141.00-144.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eab\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.50(4.10\u0026ndash;4.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.60(4.30\u0026ndash;4.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.80(4.60\u0026ndash;5.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChlorine (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104.00(102.00-107.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e105.00(100.50-109.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e107.00(104.00-109.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.30(28.40-39.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.80(33.70-49.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.10(41.70\u0026ndash;71.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003ebc\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.90(18.78\u0026ndash;31.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.60(21.75\u0026ndash;30.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.10(20.60\u0026ndash;28.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.946\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALP (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.80(59.25\u0026ndash;93.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.70(66.30-107.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.10(77.90-127.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGGT (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.25(22.80-40.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.80(20.30-39.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.30(28.00-54.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003ebc\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Protein (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79.02(72.96\u0026ndash;85.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.82(78.76\u0026ndash;93.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88.11(83.41\u0026ndash;92.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eab\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.90(39.95\u0026ndash;45.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.70(38.30-42.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.30(39.80\u0026ndash;44.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlobulin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.50(32.75\u0026ndash;40.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.80(40.00-51.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.00(42.20\u0026ndash;49.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eab\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBIL (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.40(4.03\u0026ndash;12.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.60(12.05\u0026ndash;22.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.40(20.00-59.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eabc\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBIL (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.00(1.00\u0026ndash;3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00(0.00-1.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.60(0.00-8.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eac\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIBIL (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.50(3.13-9.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.20(11.40\u0026ndash;22.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.50(18.40\u0026ndash;44.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eab\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUALB (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.40(1.10\u0026ndash;4.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.90(0.30\u0026ndash;2.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.70(0.50\u0026ndash;3.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUACR (mg/g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.01(11.26\u0026ndash;41.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.88(4.81\u0026ndash;39.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.69(7.68\u0026ndash;34.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.242\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esNGAL (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.47(3.95\u0026ndash;4.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.07(4.83\u0026ndash;6.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.25(5.58\u0026ndash;6.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eab\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFibrinogen (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.50(2.01\u0026ndash;3.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.28(2.09\u0026ndash;4.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.41(4.15\u0026ndash;5.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.06(0.05\u0026ndash;0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.08(0.05\u0026ndash;0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11(0.09\u0026ndash;0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (interquartile range) depending on the normality. BUN: Blood Urea Nitrogen,Cr: Creatinine UACR; Urine Albumin-to-Creatinine ratio, eGFR; estimated Glomerular Filtration Rate, sNGAL; Neutrophil Gelatinase Associated Lipocalin, AST: Aspartate transaminase, ALT: Alaline transaminase, ALP: Alkaline Phosphate, GGT: Gamma glutaryl transferase, TBIL: Total bilirubin, DBIL: Direct bilirubin, IBIL: Indirect bilirubin \u003csup\u003ea\u003c/sup\u003e: significant difference between Non-SCD and HbSC, \u003csup\u003eb\u003c/sup\u003e: significant difference between HbSS and non-SCD, \u003csup\u003ec\u003c/sup\u003e: significant difference between HbSC and HbSS, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and bolded means statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eComplete blood count (Hemogram) is one of the most useful tests used in the management of sickle cell disease. In monitoring the hepatic effects of blood transfusion in SCD patients, LFTs which includes aminotransferases, aminotransaminases, bilirubin and proteins are good predictors of liver pathology. In the same vein, kidney disease in SCD has become one of the increasing causes of mortality in all individuals including SCD patients. This study contributed to the management of sickle cell diseases patients by looking at how their complete blood count, liver and renal parameters differ from their non-SCD counterpart, in so doing guiding clinical practice and management of SCD patients in Ghana.\u003c/p\u003e \u003cp\u003eMajority of the SCD patients were individuals with HbSS variant followed by HbSC variant which is in line with research mastered by Ohene Frimpong \u003cem\u003eet al.\u003c/em\u003e, (2008) from Ghana. It is acknowledged that HbSS patients exhibit a severe form of SCD in comparison to other SCD phenotypes and this account for more clinic visits. In this present study, most of SCD individuals were less than twenty years, this may be due to higher mortality seen in older SCD patients as compared to healthy individuals (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Majority of females were seen in this study in both SCD and control group which agrees with a research done by Asare \u003cem\u003eet al.\u003c/em\u003e, (2018) in Ghana (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The higher female-to-male proportion may be due to the fact that women typically outlive men in most populations and because women have superior health-seeking practices than men (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In Ghana, the life expectancy (in years) for a male at birth is 61.0 and for a female is 63.9, per WHO data released in 2015 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), this may also explain the higher female-to-male ratio reported in this study. Interestingly, most of SCD patients were single which supports a study done by Adzika \u003cem\u003eet al\u003c/em\u003e., (2017) (88.9%) in Ghana (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and the reality that many individuals with SCD already experience stress and anxiety, which includes fear of getting married and having kids (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The study sites were located in a city and this explains why majority of the participants were urban residents in both cases and controls. In a study mastered by Machado \u003cem\u003eet al.\u003c/em\u003e, (2006), regular exercise was significantly associated with pulmonary hypertension in SCD participants (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and this may explain why SCD patients do not exercise regular as indicated in this study. In this study, there was no statistical difference between cases and controls as far as meat and fish consumption is concern, however regular egg consumption was high in SCD patients as compared to controls which is in accordance with a study conducted by Ezepue \u003cem\u003eet al\u003c/em\u003e., (2003) who observed that SCD patients consume more eggs than meat and fish in a week.\u003c/p\u003e \u003cp\u003eIn this present study, we observed that HbSS patients have significantly lower RBC, hemoglobin and hematocrit than HbSC and healthy controls. In comparing this study with previous findings, we saw a similar trend in studies conducted by Anwti-Bosiako \u003cem\u003eet al.\u003c/em\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e): RBC (HbSS: 2.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77(\u0026times;10⁶/\u0026micro;L), HbSC: 4.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94 (\u0026times;10⁶/\u0026micro;L), controls: 4.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26(\u0026times;10⁶/\u0026micro;L)), hemoglobin (HbSS: 8.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57 (g/dL), HbSC:10.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73 (g/dL) and controls:13.19\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32 (g/dL)) and hematocrit (HbSS:24.84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.18 (%), HbSC:33.02\u0026thinsp;\u0026plusmn;\u0026thinsp;7.08(%) and controls: 40.91\u0026thinsp;\u0026plusmn;\u0026thinsp;10.94 (%)). In the same vein, hemoglobin was lower in HbSS (7.54\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26 (g/dL)) than controls (12.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22 (g/dL)) in a study conducted by Omoti \u003cem\u003eet al.\u003c/em\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The red blood cells in SCD patients have a limited life rate of 12\u0026ndash;14 days and are constantly hemolyzing (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This explains the low count of RBC, hemoglobin and hematocrit levels in SCD compared to those of healthy individuals, with very low levels in HbSS than HbSC patients. We also observed high MCV, MCH, MCHC and RDW which conforms with findings from Antwi-Bosiako \u003cem\u003eet al\u003c/em\u003e (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) in steady state SCD patients.\u003c/p\u003e \u003cp\u003eAs expected, HbSS and HbSC demonstrated high total WBC and differentials (Neutrophils, Monocytes, lymphocytes and basophils) in SCD patients compared to their control counterparts with a significantly higher level in HbSS patients. This was expected because the underlying mechanisms that lead to a rise in the concentration of neutrophils in the venous blood of SCD patients\u0026mdash;such as demarginating of intravascular neutrophils, rapid release from the bone marrow, and a decrease in the pace at which neutrophils exit the circulation (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In a study conducted by Antwi-Bosiako \u003cem\u003eet al.\u003c/em\u003e (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), total WBC count was high in HbSS (12.18\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56(\u0026times;10\u0026sup3;/\u0026micro;L)) compared to HbSC (6.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77 (\u0026times;10\u0026sup3;/\u0026micro;L)) and controls (5.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11 (\u0026times;10\u0026sup3;/\u0026micro;L)) and this present study observed similar pattern. Similar observation also happened in a study done by Omoti \u003cem\u003eet al\u003c/em\u003e. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), WBC and differentials were elevated in HbSS in steady state (WBC\u0026thinsp;=\u0026thinsp;12.72\u0026thinsp;\u0026plusmn;\u0026thinsp;7.98(\u0026times;10\u0026sup3;/\u0026micro;L), neutrophils\u0026thinsp;=\u0026thinsp;5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 (\u0026times;10\u0026sup3;/\u0026micro;L), lymphocytes\u0026thinsp;=\u0026thinsp;6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 (\u0026times;10\u0026sup3;/\u0026micro;L), monocytes\u0026thinsp;=\u0026thinsp;1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78 (\u0026times;10\u0026sup3;/\u0026micro;L)) as compared to non-SCD (WBC\u0026thinsp;=\u0026thinsp;5.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97 (\u0026times;10\u0026sup3;/\u0026micro;L), neutrophils\u0026thinsp;=\u0026thinsp;2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51 (\u0026times;10\u0026sup3;/\u0026micro;L), lymphocytes\u0026thinsp;=\u0026thinsp;2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69 (\u0026times;10\u0026sup3;/\u0026micro;L), monocytes\u0026thinsp;=\u0026thinsp;0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17 (\u0026times;10\u0026sup3;/\u0026micro;L)). Several research indicates that high WBC count in SCD patients are mainly due to infections (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), though this study didn\u0026rsquo;t look at the relationship between infections and WBC count.\u003c/p\u003e \u003cp\u003eThe platelets count observed in this study is comparable to a study conducted by Antwi-Bosiako (HbSS: 466.33\u0026thinsp;\u0026plusmn;\u0026thinsp;121.39 (\u0026times;10\u0026sup3;/\u0026micro;L), HbSC:289.64\u0026thinsp;\u0026plusmn;\u0026thinsp;18.31 (\u0026times;10\u0026sup3;/\u0026micro;L) and controls:224.22\u0026thinsp;\u0026plusmn;\u0026thinsp;61.17 (\u0026times;10\u0026sup3;/\u0026micro;L)) and Omoti et al. (HbSS: 342.62\u0026thinsp;\u0026plusmn;\u0026thinsp;143.03(\u0026times;10\u0026sup3;/\u0026micro;L) and controls:304.24\u0026thinsp;\u0026plusmn;\u0026thinsp;61.47 (\u0026times;10\u0026sup3;/\u0026micro;L)). In vaso-occlusive states of SCD participants in the aforementioned studies showed significantly high platelets count in SCD with very higher levels in HbSS. Though this study only recruited study only recruited steady state SCD participants, the trend seen in other studies give a clear indication that thrombocytosis is more severe in SCD when they are in crisis (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The increased platelet count observed in SCD patients may be due to the underlying chronic inflammation, splenic sequestration, splenic reduction or absence from autosplenectomy (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) or hyposplenism in SCD (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Although a correlation was not established in our investigation, reports suggest that there is a relationship between platelet count and SCD(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), which supports the higher platelet counts among SCD patients in this study.\u003c/p\u003e \u003cp\u003eWith respect to LFT parameters, enzymes such as AST, ALT, GGT and ALP were significantly high in HbSS and HbSC patients compared to controls indicating that there is some sort of liver inflammation in SCD, however ALT which is very specific to liver and other enzymes were apparently within the normal range (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) and similar in all participant groups which rules out liver dysfunction in study participants. LFT markers seen in this study is in accordance with a research done by Kotila \u003cem\u003eet al\u003c/em\u003e. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) who observed minimal elevation of transaminases in steady state SCD patients. Hence, routine liver disease monitoring is recommended for SCD patients at least once a year and serum ALT (\u0026gt;\u0026thinsp;2\u0026times;ULN) and gamma-GT (1.5-2.0\u0026times;ULN) levels indicate liver illness and should be explored (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). We also reported high levels of direct and indirect bilirubin in SCD patients with very high levels in HbSS. Indirect hyperbilirubinemia is prevalent in SCD, nonetheless, acute obstruction brought on by gallstones, inspissated bile, or a dominating biliary structure should be investigated in cases of direct hyperbilirubinemia (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Obviously, fibrinogen levels and fibrinogen-to-albumin ratio levels were minimally higher in HbSS and HbSC compared to controls which demonstrate the link between fibrinogen and albumin levels and the trend of inflammation in the various participants (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs far as the kidney biomarkers are concern, this study reported normal levels of creatinine and urea with lower levels in SCD participants. This is due to the fact that, serum creatinine levels (Cr) and urea are often misleading in their diagnosis of progressive renal impairment. The main clinical indicator of renal function, serum creatinine, is influenced by variables unrelated to renal activity, such as age, gender, race, and lean muscle mass, and is insensitive for detecting mild changes in renal function (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). However, NGAL which is a marker of kidney damage showed high levels in HbSS and HbSC compared to controls which conforms with findings from Marouf \u003cem\u003eet al\u003c/em\u003e. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) and Atere \u003cem\u003eet al\u003c/em\u003e. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) who found increased levels of NGAL in steady state SCD participants and its relationship with renal abnormailities as comapred to healthy individuals which is consistent with this present study. In a different study done by Twumasi \u003cem\u003eet al\u003c/em\u003e, (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), we stratified the SCD patients based on microalbuminuria and we found out that, steady state SCD pateints have kidney dysfunction and diagnosis shouldn\u0026rsquo;t be based on the traditional markers. There was a minimal increased levels of potassium in the HbSS and HbSC patients compared to the controls which agrees with findings from Alhwiesh \u003cem\u003eet al.\u003c/em\u003e (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe main limitations of this is that, we didn\u0026rsquo;t monitor our patients to know the change in hematobiochemical parameters till when they get crisis. Moreover, gender and some of the age groups of cases and controls were not comparable and this could affect the study findings. Though, we excluded patients having symptoms of malaria, we didn\u0026rsquo;t screen for asymptomatic malaria parasitemia and compile data on pateints receiving hydroxyurea as these may affect the haematobiochemical parameters in the SCD patients. Further studies should therefore look at how these parameters will change in vaso-occlusive state or better still recruit both steady state and VOC state and see how the parameters differ in both states. Also, further studies should be done in other parts of Ghana to confirm earlier findings, give a baseline hematobiochemical profile and provide guidance in the form of an algorithm to help clicicians manage SCD patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study reported reduced levels of RBC, hemoglobin and hematocrit as well as high WBC and platelets among HbSS and HbSC patients compared to controls. We also observed normal liver function parameters in our patients and finally we reported normal levels of traditional renal markers but found high levels of NGAL in HbSS and HbSC patients compared to controls. In addition to providing additional descriptive information about SCD patients in Ghana, these hematobiochemical parameters may also serve as a helpful tool and help physicians manage SCD patients in Ghana.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData and materials for study are available upon request from the corresponding authors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that there is no competing interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) received no financial support for the research, authorship and or/ publication of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eST and AO wrote the main manuscript. \u0026nbsp;ST, ROA and AE \u0026nbsp;did data analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful for the immense contributions of the staff of Komfo Anokye Teaching Hospital, Suntreso Government Hospital and Kumasi South Hospital for their warm reception, not forgetting our participants. Special thanks to the serology department of Komfo Anokye Teaching Hospital on their support in storage of samples.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOrganization, W. H. Worldwide prevalence of anaemia 1993\u0026ndash;2005: WHO global database on anaemia. (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOhene-Frempong, K., Oduro, J., Tetteh, H. \u0026amp; Nkrumah, F. Screening newborns for sickle cell disease in Ghana. \u003cem\u003ePediatrics\u003c/em\u003e \u003cb\u003e121\u003c/b\u003e (Supplement_2), S120\u0026ndash;S1 (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKato, G. J. et al. Sickle cell disease. \u003cem\u003eNat. reviews Disease primers\u003c/em\u003e. \u003cb\u003e4\u003c/b\u003e (1), 1\u0026ndash;22 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSundd, P., Gladwin, M. T. \u0026amp; Novelli, E. M. 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Hematol.\u003c/em\u003e \u003cb\u003e100\u003c/b\u003e, 1401\u0026ndash;1409 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtere, A., Ajani, O., Akinbo, D., Adeosun, O. \u0026amp; Anombem, O. Serum levels of neutrophil gelatinase-associated lipocalin (NGAL) as predictor of acute kidney injury in sickle cell subjects. \u003cem\u003eJ. Biomed. Sci.\u003c/em\u003e \u003cb\u003e7\u003c/b\u003e (4), 17 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTwumasi, S. et al. Neutrophil gelatinase-associated lipocalin and Fibrinogen-to-albumin ratio are indicators of nephropathy in adult steady state sickle cell disease patients: A multicenter case-control study in Ghana. medRxiv. :2024.10.14.24315440. (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlhwiesh, A. An update on sickle cell nephropathy. \u003cem\u003eSaudi J. Kidney Dis. Transplantation\u003c/em\u003e. \u003cb\u003e25\u003c/b\u003e (2), 249\u0026ndash;265 (2014).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sickle cell disease, hematological, biochemical, complete blood count, liver and kidney function","lastPublishedDoi":"10.21203/rs.3.rs-5529431/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5529431/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e \u003cb\u003eSickle cell disease\u0026rsquo;s (\u003c/b\u003eSCD) clinical hallmarks include hemolysis and vascular occlusive symptoms. In sickle cell disease (SCD), red blood cells are distorted into a sickle shape by the polymerization of deoxygenated hemoglobin S (HbS) molecules, which results in tissue destruction, hemolysis, and vaso-occlusion. Vaso-occlusion can result in organ damage, which may cause changes in blood cells, liver and renal function. This study investigated the complete blood count, liver and kidney profile of steady state sickle cell disease patients in Ghana.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis case-control study involved 64 SCD patients and 80 healthy subjects. Participants' information was thoroughly documented using a structured questionnaire and patient case records. Venous blood was drawn from each participant for the estimation of their hematobiochemical parameters.\u003c/p\u003e\u003ch2\u003eFindings:\u003c/h2\u003e \u003cp\u003eMajority of SCD patients were under 20 years of age (40.6%) compared to the non-SCD group (33.8%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.062). Hemoglobin and hematocrit levels were significantly lower in HbSS participants (8.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45 g/dL and 24.50%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 respectively) compared to HbSC (10.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76 g/dL and 30.35%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and non-SCD groups (11.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08 g/dL and 35.40%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Platelet, white blood cell (WBC), lymphocyte, and neutrophil counts were higher in HbSS participants, compared to HbSC (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Liver function markers showed significant increase in HbSS participants, with higher aspartate transaminase (AST) and alkaline phosphatase (ALP) levels (52.30 U/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and 106.05 U/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 respectively) compared to HbSC and non-SCD groups. Fibrinogen and fibrinogen-to-albumin ratios (FAR) were higher in HbSS (4.59 g/L and 0.11, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 respectively). Moreso, there was high Urine Albumin-to-Creatinine ratio in HbSS 19.84 (6.77\u0026ndash;34.97) compared to HbSC 18.44 (6.26\u0026ndash;35.64) individuals. Neutrophil Gelatinase Associated Lipocalin (sNGAL) levels were significantly elevated in SCD, particularly HbSS (5.96 ng/mL, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), compared to non-SCD (4.35 ng/mL, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study reported reduced levels of hemoglobin and hematocrit as well as high WBC and platelets among HbSS and HbSC patients compared to controls. We also observed normal liver function parameters in our patients and finally we reported normal levels of traditional renal markers but found high levels of NGAL in HbSS and HbSC patients compared to controls.\u003c/p\u003e","manuscriptTitle":"Hematological, liver and kidney parameters among Ghanaian steady state sickle cell disease patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-23 18:16:14","doi":"10.21203/rs.3.rs-5529431/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"11bb3cb3-e3b5-4e97-a3f9-33be736bd8c2","owner":[],"postedDate":"April 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47385584,"name":"Health sciences/Diseases/Haematological diseases/Anaemia"},{"id":47385585,"name":"Health sciences/Diseases/Haematological diseases/Sickle cell disease"},{"id":47385586,"name":"Biological sciences/Biochemistry"},{"id":47385587,"name":"Biological sciences/Chemical biology"},{"id":47385588,"name":"Biological sciences/Immunology"},{"id":47385589,"name":"Biological sciences/Microbiology"},{"id":47385590,"name":"Health sciences/Diseases"},{"id":47385591,"name":"Health sciences/Medical research"},{"id":47385592,"name":"Health sciences/Neurology"}],"tags":[],"updatedAt":"2025-06-04T05:08:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-23 18:16:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5529431","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5529431","identity":"rs-5529431","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}