Haematological Diseases in the Tropics

Anaemia is a major public health problem worldwide. Eighty-five per cent of individuals with anaemia live in Africa and Asia. In developing countries, it is not unusual for anaemia to be due to multiple interacting factors including nutritional deficiencies, infections, and genetic abnormalities. Clinical assessment of anaemia is unreliable unless the anaemia is severe but accurate diagnosis of anaemia is important to guide treatment and to avoid unnecessary blood transfusions. Anaemia is a very common complication of malaria infection and predominantly affects pregnant women and young children. Malarial anaemia can be reduced by chemotherapy and by preventing mosquito bites with insecticide-treated bed nets and vector control. In HIV-infected patients, anaemia is a risk factor for death and prompt treatment of infections and malnutrition, and early commencement of antiretroviral treatment, will reduce deaths. Haemoglobinopathies are concentrated in developing countries. Early diagnosis of sickle cell disease and rapid access to a specialist centre for acute symptoms such as severe pain crises, strokes, and acute chest syndrome can help prevent long-term complications. Beta-thalassaemia major is fatal in the first few years of life unless regular blood transfusions are given; if transfusions are not accompanied by iron chelation, they will eventually cause death due to irreversible organ damage from iron overload. The diagnosis and treatment of haematological malignancies requires expertise and technologies, including genetic analyses, that are usually only available in specialist centres. Blood shortages are common in developing countries. To increase the availability of blood and reduce unnecessary transfusions, blood should be prescribed according to guidelines and efforts made to encourage repeat donations since recurrent screening results in safer blood.