Survey on the Knowledge and Management of Cancer-Associated Thrombosis (CAT) in Haemato-Oncology Patients with Thrombocytopenia among Haematologists and Haematology Residents in Nigeria.

BACKGROUND: Arterial or venous thrombosis can complicate cancer, and 20% of cancer patients may develop venous thromboembolic disorders. Venous thromboembolism (VTE) is common in some haematologic malignancies and may coexist with thrombocytopenia in those haematologic malignancies. We carried out this survey to assess the knowledge and practice of haematologists and resident doctors in haematology in Nigeria regarding the management of thrombocytopenia and cancer-associated thrombosis. METHODS: This was a survey that was shared electronically with participants who were consultant haematologists and resident doctors in haematology in Nigeria.. RESULTS: There were 106 respondents, 70 (66%) of which were consultant haematologists. About a third (30.2%) of the respondents saw 6-10 patients with blood malignancies monthly. Fifty-seven (53.8%) of the respondents carried out risk assessment in their patients for cancer-associated thrombosis (CAT); 63 (59.4%) of the respondents saw 1-2 cancer patients with thrombosis in 3 months. The most common mode of treatment was pharmacological - 94 (88%) respondents used low molecular weight heparin. The most common haematologic malignancies associated with thrombocytopenia were acute leukaemias (69; 67%). The most common decision taken by respondents was to stop anticoagulants and transfuse platelets because the most frequent concern was the risk of bleeding in this group of patients. CONCLUSION: Many haematologists and haematology residents had a high level of awareness, knowledge and good practice regarding thrombocytopenia with CAT in haematooncology patients; however, there is a need for improved knowledge and unified protocols for treatment in line with newer management guidelines.

CONTEXTE: La thrombose artérielle ou veineuse peut compliquer le cancer, et 20 % des patients cancéreux peuvent présenter des troubles thromboemboliques veineux. La thromboembolie veineuse (TEV) est fréquente dans certaines hémopathies malignes et peut coexister avec une thrombocytopénie dans ces hémopathies malignes. Nous avons mené cette enquête pour évaluer les connaissances et la pratique des hématologues et des médecins résidents en hématologie au Nigeria concernant la gestion de la thrombocytopénie et de la thrombose associée au cancer. MÉTHODES: Il s'agit d'une enquête qui a été partagée électroniquement avec les participants qui sont des hématologues consultants et des médecins résidents en hématologie au Nigéria. RÉSULTATS: 106 personnes ont répondu à l'enquête, dont 70 (66%) étaient des hématologues consultants. Environ un tiers (30,2 %) des personnes interrogées voyaient chaque mois 6 à 10 patients atteints de tumeurs hématologiques malignes. Cinquante-sept (53,8 %) des personnes interrogées ont procédé à une évaluation du risque de thrombose associée au cancer chez leurs patients ; 63 (59,4 %) des personnes interrogées ont vu 1 à 2 patients cancéreux atteints de thrombose en 3 mois. Le mode de traitement le plus courant était pharmacologique - 94 (88%) des personnes interrogées utilisaient de l'héparine de faible poids moléculaire. Les hémopathies malignes les plus fréquemment associées à la thrombocytopénie étaient les leucémies aiguës (69 ; 67%). La décision la plus fréquente prise par les personnes interrogées était d'arrêter les anticoagulants et de transfuser des plaquettes parce que la préoccupation la plus fréquente était le risque de saignement dans ce groupe de patients. CONCLUSION: De nombreux hématologues et résidents en hématologie avaient un niveau élevé de sensibilisation, de connaissances et de bonnes pratiques concernant la thrombocytopénie avec CAT chez les patients hémato-oncologiques; cependant, il est nécessaire d'améliorer les connaissances et d'unifier les protocoles de traitement conformément aux nouvelles directives de prise en charge. Mots clés: Thrombose associée au cancer, Hémato-oncologie, Thrombocytopénie, Hemorragie, Thrombose.

Understanding the RECORDS 3 Trial and its impact on anticiagulation practice in resource poor countries.

Venous thromboembolism is a significant cause of mortality and morbidity in patients following major orthopaedic surgeries. The RECORDS 3 trial revolutionised anticoagulation practice especially in patients with total knee arthroplasty and challenging the strong hold of warfarin and heparin in anticoagulation practice. With all these novel agents shifting the paradigm in anticoagulation management, Cost, in accessibility and lack of awareness of the availability of the agents amongst clinicians and surgeons alike are some factors militating against the use of these agents in patients in resource poor countries.

Awareness of Venous Thromboembolism among Doctors in a Nigerian Tertiary Centre

Background: Venous thromboembolic (VTE) is a preventable leading cause of morbidity and mortality worldwide and is a cause of sudden death. Awareness of VTE among doctors will reduce the incidence of unexpected deaths in hospitalised patients.Objective: To assess doctors' awareness of venous thromboembolism in our centre.Design: Cross sectional questionnaire based study.Setting: University of Port Harcourt Teaching Hospital; Nigeria.Subjects: One hundred and twenty four doctors attending a hospital grand-rounds session were recruited. Results: The response rate was 82.7% (124 of 150 questionnaires). Almost half (n=57; 46%) correctly identified VTE; but two (1.6%) did not know what VTE was and 27 (21.8%) stated it to be normal haemostasis. Commonly identified risk factors included: increased body mass index 113 (91.1%); diabetes mellitus 105 (84.7%); pregnancy 105 (84.7%); age 104 (83.9%); and immobility 104 (83.9%). Although clinical features were identified; VTE was acknowledged to be asymptomatic by 62 (50%) responders. About 68 (54.8%) did not know of a VTE risk stratification model and only one (0.8%) had used a model in practice. Responders commonly prescribed anticoagulants for prophylaxis. Although most had come across VTE in practice; 15 (12.1%) had not seen a case of VTE.Conclusion: The knowledge of VTE was average. There was a gap between knowledge and practice for this preventable disorder. Patients in our centre were not routinely risk stratified for VTE. Updating of medical knowledge is encouraged

The clinical and laboratory features of plasma cell neoplasialn the University of Port Harcourt Teaching Hospital.

OBJECTIVE: To analyze the clinical and laboratory features of Multiple Myeloma at presentation in a tertiary centre in Port Harcourt Southern Nigeria. METHODS: The medical records of all patients diagnosed for plasma cell neoplasia within a 10 year period at the University of Port Harcourt Teaching Hospital were reviewed retrospectively. Clinical presentation, investigation results, support and specific therapy used were documented. RESULTS: A total 20 patients were diagnosed with multiple myeloma, 70% were male, the mean age was 61.30 +/- 8.8 years, 50% of them had pathological fractures. The mean duration before presentation was 11.89 +/- 11.7 months (Median = 7 months) and associated with poor outcome. The most common method treatment was chemotherapy with Melphalan and Predisolone. CONCLUSION: MM is a disease of the elderly that can negatively impact on the quality of life due to the complications associated with it. A long duration of symptoms before presentation is a common problem and it has been associated with substantial morbidity and mortality in this study.