Dear Colleagues Residents and Readers of the Nigerian Journal of Haematology, It gives me great pleasure to write this editorial comment in this edition of the Nigerian Journal of Haematology at this trying time.
This particular edition highlights the first successful haematopoietic stem cell transplant in a patient with sickle cell disease (SCD) in a private hospital in a low resource country setting as it exists in Nigeria. With this successful transplant, there is hope for a number of patients with SCD to live a fairly stable life.
This edition also reports on the role of Transcranial Doppler (TCD) in the assessment of intracranial blood velocities in children with SCD. Stroke is a devastating and yet preventable condition which is a result of intracranial vasculopathy in children and it may also occur in some adults with SCD. Transcranial Doppler ultrasonography is an established imaging modality for monitoring of intracranial vascular velocities and stratification of children with SCD based on the velocities into different risk groups with the aim of identifying those at high risk of stroke.
Although blood transfusion therapy and hydroxyurea have been successful in the primary prevention of stoke however, screening with TCD is standard of care in the United States and other developed countries. Transcranial Doppler ultrasonography is poorly utilized in Nigeria with only few centres having availability of this procedure.
This traditional review article highlights the basic intracranial vascular anatomy, Transcranial Doppler protocol and current practices of intracranial vascular velocity screening and stroke prevention in Nigeria. The report on the sickle cell clinical phenotypes in Nigeria, based on serum lactate dehydrogenase levels, concluded that clinical phenotypes of patients with sickle cell anaemia in Nigeria are potentially more complex than those described outside the African setting. It is interesting to note that the transmission of hepatitis E virus, which is usually via the faeco-oral route, may occur, albeit at a low rate, via transfusion of blood and blood products from donors in Nigeria. This, however, needs to been validated. All in all, this edition would provide a better understanding of SCD and its management, which would make for a better outcome in the care and ultimately the quality of life of patients as seen in Nigeria.
Professor Yetunde A. Aken'Ova
March 31, 2020