Chronic blood transfusion for primary and secondary stroke prevention in Nigerian children with sickle cell disease: A 5-year appraisal

Authors

  • I.A. Lagunju MBBS,

    Corresponding author
    1. Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
    2. Department of Paediatrics, University College Hospital, Ibadan, Nigeria
    • Correspondence to: IkeOluwa A. Lagunju, Department of Paediatrics, University College Hospital, Ibadan, Nigeria.

      E-mail: ilagunju@yahoo.co.uk

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  • B.J. Brown MBBS, MSc,

    1. Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
    2. Department of Paediatrics, University College Hospital, Ibadan, Nigeria
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  • O.O. Sodeinde MBBS

    1. Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
    2. Department of Paediatrics, University College Hospital, Ibadan, Nigeria
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  • Conflict of interest: Nothing to declare.

Abstract

Background

Chronic blood transfusion (CBT) diminishes the risk of primary and secondary stroke in sickle cell disease (SCD). We appraised CBT and assessed its feasibility as an option for stroke prevention in a setting of limited resources.

Methods

All new cases of SCD seen in the Paediatric Hematology/Neurology units of the University College Hospital, Ibadan, Nigeria over a 5-year period were screened and followed up to identify those who had an indication for CBT for stroke prevention. Caregivers were counseled and offered CBT when indicated. Children of caregivers who accepted chronic transfusion were carefully followed up and outcomes documented.

Results

Five (10%) of the caregivers of the 50 children who had an indication for CBT for stroke prevention consented to the treatment. They all had homozygous sickle cell anemia and had suffered a stroke. None of the children with abnormal TCD velocities consented to CBT. Two children experienced transfusion reactions, fatal in one. The mean annual cost of chronic transfusion (without chelation) was $3,276 (SD = 1,168). Major reasons given for declining CBT were high costs of blood transfusion, unavailability of blood, the need to regularly seek for blood donors, and the indefinite duration of blood transfusions.

Conclusion

High economic costs, unavailability of blood, need to regularly seek for blood donors, cultural beliefs, and high frequency of transfusion reactions are major challenges to a successful CBT program in Nigeria. There is a need for government subsidy on blood transfusions and improved efforts towards provision of safe and affordable blood. Pediatr Blood Cancer 2013;60:1940–1945. © 2013 Wiley Periodicals, Inc.

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