Establishing an Apheresis Medicine Program in a Resource-Constrained Setting: A 5-Year Experience From Lagos, Nigeria.

Abstract

Background: Establishing a comprehensive apheresis medicine program in a resource-constrained setting presents significant structural, financial, and logistical challenges. Despite the growing clinical importance of apheresis services globally, published experience from sub-Saharan Africa remains sparse. This study describes the 5-year operational experience of building and sustaining an Apheresis Medicine program at Next Hematology Medicare, a private hematology center in Lagos, Nigeria, including the challenges encountered, solutions implemented, and clinical outcomes achieved.

Methods: A retrospective review of all apheresis procedures performed between May 2020 and December 2025 was conducted. Therapeutic apheresis procedures included automated red cell exchange transfusion (RCE), therapeutic plasma exchange (TPE) and leukocytapheresis. Donor apheresis procedures comprised single-donor apheresis platelet collections for transfusion and stem cell collection (SCC) by donors. Data on patient demographics, clinical indications, procedural outcomes, and geographic distribution of platelet delivery were collected and analyzed.

Results: A total of 2405 apheresis procedures were performed over the 5-year period. Donor apheresis platelet (AP) collection was the most frequently performed procedure (n = 1772; 73.7%), followed by RCE (n = 617; 25.7%) as the most common therapeutic apheresis modality. TPE accounted for 12 procedures (n = 12; 0.5%), while leukocytapheresis (n = 2; < 0.1%) and SCC (n = 1; < 0.1%) were performed infrequently. For AP, Sepsis/DIC was the leading transfusion indication (n = 968; 54.6%). RCE was performed predominantly for patients with sickle cell anemia (SCA), with intractable recurrent vaso-occlusive crises (VOC) being the most common indication (n = 382; 61.9%). RCE significantly reduced hemoglobin S (HbS%) from 93.13% ± 12.4% to 18.74% ± 4.2% (p < 0.001) and improved hematocrit from 16.34% ± 3.5% to 26.01% ± 4.2% (p < 0.001). TPE was primarily indicated for neurological and transplant-related conditions. Apheresis platelets were distributed nationally across all six geopolitical zones and internationally.

Conclusion: A fully functional Apheresis Medicine program can be successfully established and sustained in a resource-constrained low- and middle-income country (LMIC) setting, delivering outcomes comparable to high-income country benchmarks. RCE showed significant hematological benefits for patients with SCA, and donor apheresis platelet delivery extended care across all Nigerian geopolitical zones. The operational framework described here, addressing funding, infrastructure, staffing, licensing, and blood safety, provides a possibly replicable model for Apheresis Medicine program development across sub-Saharan Africa.