Background: Scarcity of FVIII concentrate compels caregivers in poor countries to use multiple transfusions of fresh whole blood (FWB), fresh frozen plasma and cryoprecipitate for managing haemophilia A. FWB is the most frequently transfused blood product due to ease of production and its ability to simultaneously stop active bleeding and treat anaemia. Iron deficiency anaemia is common among haemophiliacs in poor tropical countries such as Nigeria, due to the combined effects of bleeding, malnutrition, and haemorrhagic parasitic diseases. Multiple FWB transfusion is usually initiated at local sub-tertiary hospitals before eventual referral to tertiary hospitals. The Nigerian blood transfusion service is underdeveloped, donor screening is rudimentary and transfusion safety is poor. The prevalence of transfusion transmissible viral infections (TTVIs), including HIV, and hepatitis B and C viruses (HBV and HCV), is therefore predicted to be high among Nigerian haemophiliacs. Aims: To determine prevalence and pattern of TTVIs (HIV, HBV, HCV infections) among paediatric haemophiliacs who have received multiple FWB transfusions in Nigeria. Materials and methods: Retrospective analyses of demographic and clinical data, disease severity, number of previous transfusions of FWB, and prevalence and pattern of TTVIs (HIV, HBV and HCV infections) of newly referred haemophiliacs as seen in five tertiary hospitals in northern Nigeria. Prevalence rates of TTVIs were expressed as percentages. Comparisons of parameters (age, disease severity and number of previous transfusions) between patients with and without TTVIs were performed using Students t-test for mean values and Fisher’s exact test for percentages, with p-values of less than 0.05 taken as significant. Results: Of 97 haemophiliacs studied, 24 (24.7%) were infected with TTVIs. The pattern and frequencies of TTVIs among the infected patients revealed HBV infection in 10 (41.7%), HIV-1 infection in five (20.8%), HCV infection in four (16.7%), HBV and HIV co-infection in three (12.5%), and HBV and HCV co-infection in two (8.3%). In comparison with haemophiliacs without TTVIs, haemophiliacs with TTVIs had a significantly lower mean age (4.9 vs. 7.8; p=0.007); a higher proportion of severe disease (62.5% vs. 26%; p=0.009), and a higher mean number of transfusions per patient (27.5 vs. 15.3; p=0.006). Conclusions: The prevalence of TTVIs among haemophiliacs in Nigeria is high, and the risk is correlated with disease severity and number of previous transfusions. There is need for the national transfusion service to be upgraded and for standard haemophilia care centres with an adequate supply of FVIII concentrates for optimal care to be set up. Haemophilia healthcare providers in Nigeria can minimise multiple transfusions by incorporating regular screening and treatment of haemorrhagic parasitic diseases, iron supplementation, and the use of pharmacological agents in the standard of care for haemophilia.
1. Ibrahim UA, Ahmed SG. Pathophysiology of bleeding diathesis in haemophilia A: A sequential and critical appraisal of non- FVIII related haemostatic dysfunctions and their therapeutic implications. Egypt J Med Hum Genet 2018; 19: 285-95. doi:
2. Brinkmann T, Kähnert H, Prohaska W, et al. Synthesis of tissue factor pathway inhibitor in human synovial cells and chondrocytes makes joints the predilected site of bleeding in haemophiliacs. Eur J Clin Chem Clin Biochem 1994; 32: 313-317.
3. Nieuwenhuizen L, Schutgens RE, van Asbeck BS, et al. Identification and expression of iron regulators in human synovium: evidence for up-regulation in haemophilic arthropathy compared to rheumatoid arthritis, osteoarthritis, and healthy controls. Haemophilia 2013;19: e218-e227. doi:
6. Ibrahim UA, Ahmed SG, Kagu MB, Abjah UA. Impact of intestinal helminths on the risks of gastrointestinal haemorrhage and iron deficiency among haemophilia patients in northern Nigeria. J Haem Pract 2017; 4: 1-7. doi:
7. Ahmed SG, Kagu MB, Ibrahim UA, Bukar AA. Frequency of iron deficiency among patients with haemophilia-A in northern Nigeria: correlation with the disease severity and clinical Implications. Egypt J Haematol 2015; 40: 85-9. doi:
9. Ahmed SG, Kagu MB, Ibrahim UA. Pattern of blood products transfusions and reactions among multi-transfused haemophiliacs in Nigeria: implications on haemophilia care in low resource tropical settings. Sudan Med J 2018, 54: 29-38. doi:
13. Okoroiwu HU, Okafor IM, Asemota EA, Okpokam DC. Seroprevalence of transfusion-transmissible infections (HBV, HCV, syphilis and HIV) among prospective blood donors in a tertiary health care facility in Calabar, Nigeria; an eleven years evaluation. BMC Public Health 2018; 18: 645. doi:
16. Osaro E, Mohammed N, Zama I, et al. Prevalence of p24 antigen among a cohort of HIV antibody negative blood donors in Sokoto, North Western Nigeria-the question of safety of blood transfusion in Nigeria. Pan Afr Med J 2014; 18. doi:
23. Keechilot CS, Shenoy V, Kumar A, et al. Detection of occult hepatitis B and window period infection among blood donors by individual donation nucleic acid testing in a tertiary care center in South India. Pathog Global Health 2016; 110: 287-291. doi:
24. Mehra B, Bhattar S, Bhalla P, Rawat D. Rapid tests versus ELISA for screening of HIV infection: our experience from a voluntary counselling and testing facility of a tertiary care centre in North India. ISRN AIDS 2014; 2014: 296840. doi:
25. Orkuma JA, Egesie JO, Banwat EB, et al. HIV screening in blood donors: rapid diagnostic test versus enhanced ELISA. Niger J Med 2014; 23: 192-200.
26. Yang JF, Lin YY, Hsieh MH, et al. Performance characteristics of a combined hepatitis C virus core antigen and anti-hepatitis C virus antibody test in different patient groups. Kaohsiung J Med Sci 2011; 27: 258-63. doi:
30. Abdelwahab MS, El-Raziky MS, Kaddah NA, Abou-Elew HH. Prevalence of hepatitis C virus infection and human immunodeficiency virus in a cohort of Egyptian hemophiliac children. Ann Saudi Med 2012; 32: 200-2. doi: