Frequency and clinical significance of urinary schistosomiasis in haemophilia

Haematuria is not uncommon in people with haemophilia and is mainly caused by spontaneous haemorrhage or trauma. The frequency and clinical significance of urinary schistosomiasis in the aetiology of haematuria among haemophiliacs in schistosomiasis endemic countries such as Nigeria have not been previously studied. We retrospectively analysed the clinical and laboratory data of 45 haemophiliacs with haematuria in Nigeria with the aim of determining the frequency of urinary schistosomiasis and other causes of haematuria among haemophiliacs, the haematological profiles of haemophiliacs with haematuria and the severity of schistosomal haematuria relative to non-schistosomal haematuria. Haematuria was due to spontaneous haemorrhage in 23 (51.1%) patients, trauma in 14 (31.1%) patients and schistosomiasis in 8 (17.8%) patients. There were no significant differences in mean values of haematological parameters between patients with spontaneous and traumatic haematuria. However, compared to patients with spontaneous and traumatic haematuria, patients with schistosomal haematuria had significantly lower mean Hb concentration (8.5 vs.11 and 11.5g/dL; p<0.05) and significantly higher mean eosinophil count (0.42 vs. 0.21 and 0.2×10⁹/L; p<0.05). This study revealed that schistosomiasis was responsible for 17.8% of cases of haematuria in northern Nigerian haemophiliacs. Schistosomal haematuria was severe and caused significant anaemia in contradistinction to spontaneous and traumatic haematuria that were mild and did not cause significant anaemia. A superimposed pro-haemorrhagic host-parasite relationship was responsible for the severe haematuria seen in haemophiliacs with schistosomiasis, a situation that would potential increase their risk of iron deficiency and its attendant consequences including childhood cognitive impairment. Haemophiliacs with haematuria in schistosomiasis endemic countries should be investigated by urinalysis for early detection and treatment. Haemophiliacs who present with haematuria in association with eosinophilia should evoke the strongest clinical suspicion for schistosomiasis. Parents of haemophiliacs should be counseled on how to protect their children from exposures to infected waters.