Haematological Diseases in the Tropics

• Africa and Asia have more than 85% of the world's anaemic populations and anaemia burden is highest among children and women of reproductive age. • The accurate diagnosis of anaemia has been neglected; clinical assessment of anaemia is unreliable unless the anaemia is severe. • In low-income countries, anaemia in an individual is often due to multiple interdependent factors. Removing or treating a single factor may not resolve the anaemia. • Early diagnosis of sickle cell disease and rapid access to a specialist centre for emergencies such as severe pain crises, strokes and acute chest syndrome, can help to prevent permanent long-term complications. • Beta-thalassaemia major is fatal in the first few years of life unless regular blood transfusions are given; unless they are accompanied by iron chelation, these transfusions will eventually cause death due to irreversible organ damage from iron overload. • Malarial anaemia is a particular problem for children and pregnant women and severe anaemia can be caused by P. falciparum and P. vivax. Malarial anaemia can be reduced with chemoprophylaxis and intermittent treatment, and by anti-mosquito measures such as insecticide-treated bed nets and vector control. • Anaemia occurs in 70% of HIV-infected patients and is an independent risk factor for death. Prompt treatment of factors associated with anaemia, such as infections and poor nutrition, and commencement of antiretroviral treatment will reduce deaths. • Blood shortages are common in tropical countries. To increase the availability of blood, transfusions should be prescribed in accordance with guidelines and efforts made to encourage blood donors to donate regularly as repeat donors are the safest type of donor.