Challenges in the management of bleeding disorders in Nigeria.

BACKGROUND: Bleeding disorders (BDs) are characterized by abnormal bleeding for which effective management requires a combination of skill, workforce, diagnostic facilities, and adequate therapeutic options. OBJECTIVES: The objectives of this study were to determine the capacity of Nigerian hematologists to handle BDs and to assess availability of required infrastructure, equipment, and treatment options. MATERIALS AND METHODS: This descriptive study was conducted during the 2016 scientific conference of the Nigerian Society for Hemetology and Blood Transfusion. A structured questionnaire was distributed to hematologists in attendance. Data were analyzed with SPSS version 21. RESULTS: A total of 55 (76.4%) hematologists from 27 centers responded. The most frequently carried out tests to assess bleeding were hemoglobin or packed cell volume (100%), full blood count (96.3%), and prothrombin time/international normalized ratio and activated partial thromboplastin time (77%). Many centers did not have a coagulometer (47.8%) or cold centrifuge (43.4%) and none had thromboelastography or rotational thromboelastometry. Fresh whole blood was the most accessible (88.5%) and up to one-third of the centers did not have access to component therapy. Only 39.1% centers had factor concentrates available. CONCLUSION: Facilities required for diagnosing and treating BD are significantly deficient in most centers in Nigeria. Funding to provide facility and training is required to improve on this inadequacy.

Peripheral blood film - a review.

The peripheral blood film (PBF) is a laboratory work-up that involves cytology of peripheral blood cells smeared on a slide. As basic as it is, PBF is invaluable in the characterization of various clinical diseases. This article highlights the basic science and art behind the PBF. It expounds its laboratory applications, clinical indications and interpretations in the light of various clinical diseases. Despite advances in haematology automation and application of molecular techniques, the PBF has remained a very important diagnostic test to the haematologist. A good quality smear, thorough examination and proper interpretation in line with patient's clinical state should be ensured by the haemato-pathologist. Clinicians should be abreast with its clinical utility and proper application of the reports in the management of patients.

Seroprevalence of parvovirus BI9 antibody in blood donors and sickle cell disease patients at Lagos university teaching hospital (LUTH): a comparative study

Introduction: Parvovirus B19 (PVB19) is a DNA virus transmissible by blood transfusion. It is a major cause of aplastic crisis especially in chronic haemolytic anaemic patients such as sickle cell disease patients.Objective: The study was aimed to determine the seroprevalence of PVB19 in blood donors and sickle cell anaemia (SCA) patients and to evaluate its association with blood transfusion in SCA patients. Methods: This is a cross sectional study conducted at the Lagos University Teaching Hospital; Lagos Nigeria. Three hundred participants; consisting of 150 voluntary blood donors and 150 sickle cell anaemia subjects were enrolled into the study. Seroprevalence of parvovirus was determined using ELISA kits for IgG and IgM anti-PVB19 antibodies by Immuno-Biological Laboratories; (IBL) inc. Minneapolis; USA. Results was analyzed with SPSS 11 software and presented in tables. Fishers Exact test; Chi-square and student T-test were used as appropriate to compare variables between both groups. P-values 0.05 were considered significant. Results: Ninety nine (66 ) blood donors were positive for anti-PVB19 IgG antibody while ninety two (61.3) sickle cell patients were positive. Two (1.3) blood donors were positive anti-PVB19 IgM antibodies while 8 (5.3) blood donors were positive anti-PVB19 IgM antibodies while 8 (5.3) SCD patients were positive for anti-PVB19 IgM antibodies. There was no significant difference in the seroprevalence of IgG and IgM antiPVB19 virus in both groups. There was no association of parvovirus seroprevalence with blood transfusion. Conclusion: The study has shown a high seroprevalence of IgG anti-PVB19 antibodies in both blood donors and SCA patients. Therefore routine screening for parvovirus infection for donor blood is not justified. However seronegative SCA patients who require blood transfusion should have the blood screened for parvovirus to reduce the risk of associated aplastic crisis