Physicians’ Opinion on the Practice of Exchange Blood Transfusion for Treatment of Stroke in Sickle Cell Anaemia

Background: The current most effective preventive as well as therapeutic modality for stroke in sickle cell anaemia (SCA) is the use of exchange blood transfusion (EBT) in a chronic transfusion program. The challenges with this procedure abound in some settings without an organized transfusion service Aim: To assesses the extent of stroke in SCA and to evaluate the opinion of haematologists across Nigeria on issues of acceptability, practice of EBT and challenges of this life-saving protocol. Materials and Methods: A 12-item pre-validated and pretested questionnaire was used to obtain responses from doctors working in haematology units across the country who attended the annual general meeting of the Nigerian Society for Haematology and Blood transfusion held in October 2016. Results: 53 out of the 76 doctors who were in attendance, working in 30 health facilities across the country responded. There were 64 cases of stroke in the last 1 year out of 14,788 registered patients, giving a prevalence of 0.46%. Transcranial Doppler ultrasonography (TCD) was available in 50% of the centres while 75.9% had computerized tomography (CT) scanning facilities. Majority of the doctors (75.9%) counselled their stroke patients on the need to be placed on a chronic transfusion program while only 15.9% of them got on a transfusion program. EBT was not done in 38.7% of the cases due to poor patient compliance while paucity of safe blood and funds was noted in 16.7% of the cases.78.4% of the doctors would commence EBT if safe blood was available and they had adequate staff and facilities, while 21.6% of the doctors would not. Conclusion: More tertiary health centres had CT scanning facilities than TCD. The practice of EBT for management of stroke is still poor amongst Nigerian haematologists. Majority of haematologists suggested chronic transfusion program for their SCA stroke patients. The practice of EBT in most cases was hampered by lack of safe blood and poor financial state of the patients.