Transforming hematology care in LMICs: strategies for enhanced diagnosis and treatment

Hematologic disorders constitute a growing public health challenge in low-and middle-income countries (LMICs), where the burden of anemia, sickle cell disease (SCD), thalassemia, and many hematologic malignancies remains disproportionately high because of demographic, epidemiologic, and health system factors [1][2][3]. Healthcare systems in many LMICs continue to face persistent challenges, including inadequate infrastructure, shortages of skilled healthcare professionals, limited diagnostic capacity, and constrained health financing, all of which impede timely diagnosis and effective management. Consequently, hematologic disorders, including anemia, SCD, thalassemia, leukemia, and lymphoma, remain major contributors to morbidity and mortality, particularly among vulnerable populations such as women, children, and underserved communities [2][3][4].Despite major advances in hematology diagnostics and therapeutics globally, many LMICs continue to experience limited access to laboratory services, blood transfusion systems, specialist care, and essential medicines [2,5]. Delayed diagnosis and treatment interruptions frequently lead to preventable complications, disease progression, and poor survival outcomes. Furthermore, the increasing burden of non-communicable diseases, infectious diseases, malnutrition, and population aging has intensified pressure on already fragile healthcare systems across LMICs [6].As many LMICs have only a handful of specialists, who are often overburdened and concentrated in major cities. This has created a cycle of inadequate training and mentorship for the next generation of health care providers, further compromising the ability of health systems to manage hematologic diseases [3,7]. Strengthening hematology care is therefore essential for improving health equity and advancing universal health coverage (UHC). Therefore, this viewpoint discusses the burden of hematologic diseases in LMICs, then highlights key diagnostic and treatment challenges, and proposes strategic interventions and regional approaches to improve hematology services.Nonmalignant hematologic disorders impose a substantial public health burden across LMICs, particularly among women, children, and underserved populations. Anemia remains one of the leading causes of disability worldwide and disproportionately affects individuals in resource-limited settings because of iron deficiency, chronic infections, malaria, HIV, tuberculosis, and nutritional deficiencies [8,9]. Inherited red blood cell disorders also contribute substantially to morbidity and premature mortality. Approximately 75% of global SCD births occur in sub-Saharan Africa, where newborn screening and comprehensive care services remain limited [10]. Likewise, thalassemia is highly prevalent in South Asia, Southeast Asia, the Middle East, and parts of the Mediterranean region, placing considerable demands on healthcare systems because of lifelong transfusion requirements and iron chelation therapy [10][11][12]. Although the management of these disorders generally relies on less resource-intensive interventions than hematologic malignancies, effective care still depends on early diagnosis, reliable laboratory services, safe blood transfusion systems, uninterrupted access to essential medicines, and structured long-term follow-up. Without timely diagnosis and appropriate treatment, these conditions frequently result in severe complications, disability, and premature mortality.Hematologic malignancies, including leukemia, lymphoma, and multiple myeloma, are increasingly recognized in LMICs as diagnostic capacity improves and populations age [11]. Despite their lower prevalence compared with nonmalignant hematologic disorders, these cancers are associated with substantial morbidity, mortality, and financial hardship because their diagnosis and management require sophisticated pathology services, flow cytometry, cytogenetics, molecular diagnostics, multidisciplinary specialist care, and access to increasingly expensive targeted therapies. Survival outcomes remain considerably lower than those observed in high-income countries owing to delayed diagnosis, inadequate pathology infrastructure, limited access to chemotherapy and novel therapeutics, shortages of trained specialists, and insufficient supportive care [4,[11][12][13][14]. Consequently, patients and their families often experience catastrophic out-of-pocket healthcare expenditures and prolonged treatment-related financial hardship.Antimicrobial resistance (AMR) further compounds these challenges, particularly among immunocompromised patients receiving intensive chemotherapy or hematopoietic stem cell transplantation. Resistant bacterial and fungal infections are increasingly recognized as major contributors to treatment-related morbidity and mortality in LMICs, where limited access to microbiological diagnostics, antimicrobial stewardship programs, and infection prevention measures further compromises clinical outcomes [15][16][17].One of the major barriers to hematology care in LMICs is inadequate diagnostic infrastructure. Many healthcare facilities lack essential laboratory technologies, including automated hematology analyzers, hemoglobin electrophoresis, coagulation testing, flow cytometry, and molecular diagnostics [4,5]. Diagnostic services are frequently concentrated in urban tertiary hospitals, leaving rural and remote populations with limited access to specialized testing. Blood transfusion services also remain fragile in many LMICs. Weak donor recruitment systems, inadequate blood screening, and limited cold-chain infrastructure contribute to blood shortages and increase the risk of transfusion-transmissible infections [18]. Patients requiring regular transfusions, including those with SCD and hematologic malignancies, are particularly vulnerable to these challenges. Shortages of hematologists, hematopathologists, oncology nurses, and laboratory scientists further undermine