Challenges in the management of bleeding disorders in Nigeria

Abstract

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.

Keywords: Bleeding, hemophilia, thrombocytopenia, whole blood