Hemoglobin Cc in Pregnancy; a Case Series of 6-cases Managed Over 7 Years at the University College Hospital, Ibadan

Background: Hemoglobinopathies are the most common genetic defects globally, the majority of them are in sub-Saharan Africa and Southeast Asia. Hemoglobin C is a common hemoglobin variant although the prevalence of homozygous genotype CC (HbCC) is unknown. Approximately 28,000 infants are born annually with HbCC. HbCC is associated with intracellular hemoglobin crystallization with increased viscosity and reduced red blood cell life span. Although HbC is prevalent in much of sub-Saharan Africa, there is little data in the literature to address whether people with HbCC have clinical manifestations and even less is understood about this during pregnancy. Objective: This study describes the clinical features of pregnant women with HbCC. Method: This is a case series of all mothers who delivered at the University College Hospital between 2017 – 2023. All parturients had haemoglobin electrophoresis to determine their haemoglobin genotype in pregnancy. Women with hemoglobinopathies were identified and their case notes were retrieved. Data was extracted from their case notes with the aid of proforma. Results : Among the 11,496 deliveries over the study period, 180 (1.6%) had haemoglobinopathies and N (0.05%) had HbCC. The women with HbCC were aged 31 to 44 with a mean age of 35.7 years. Four (66%) of these women had previous deliveries. Two (33%) had their hemoglobin genotype diagnosed in childhood, others were diagnosed during their first pregnancy. The mean PCV was 27.7(±3.0)%, an they all had less than 33% which is the threshold for anemia diagnosis. Four (two-thirds of them had blood transfusions at least once. Complications reported were bone pain (n=1), hypertensive disorders in pregnancy (n=1), and malaria (n=1). Four had caesarean delivery for obstetric indications or maternal request. Conclusion: HbCC among parturients is rare. Anemia was prevalent among women with HbCC and, as expected, Although bone pain was reported in one of the six cases, there were no features of sickle cell disease among HbCC women. The majority underwent caesarean section for obstetric indications unrelated to their haemoglobin genotype.