ABSTRACT
Sickle cell disease (SCD) is a global health problem with Nigeria being the country with the largest burden worldwide, accounting for approximately 150,000 births each year. Evidence from clinical research shows that blood transfusion is still a vital therapeutic intervention in the management of patients with SCD. This treatment is often necessary because effective emergency management of the acute vaso-occlusive complications of SCD such as acute chest syndrome, and other painful events, requires the enhancement of the oxygen-carrying capacity of the patient's blood. With 40–60% of sickle cell anemia (SCA) patients requiring episodic or long-term blood transfusion even from childhood, the availability of safe blood in consistent supply and accessible cost, and its role in their care, is imperative. However, in Nigeria, and indeed much of sub-Saharan Africa, numerous challenges preclude the availability and ready accessibility of safe blood products for SCD patients. These constraints span the management of blood transfusion services, donor mobilization, transfusion-transmissible infections, policies on clinical use of blood, quality assurance, financial accessibility, and regulation of blood donor and recipient safety. Significant obstacles are thus encountered by SCD patients and their families which include inadequate blood availability in blood banks, and subsequently delays in accessing blood with costly financial implications and often tragic consequences on their survival, health, well-being, and quality of life. However, the nature of much of these challenges means that opportunities exist to tackle them and enhance the availability of safe and quality blood products for SCD warriors. Using the World Health Organization (WHO) health system framework, these opportunities are outlined along the building blocks of governance, financing, health workforce, medical products/technologies, information and research, and service delivery. By approaching these challenges along thematic lines, access to life-saving blood and blood products can be better addressed in an equitable and sustainable manner, leaving no SCD warrior behind in Nigeria and sub-Saharan Africa.
