Dr Oladapo Aworanti is a consultant haematologist at the University College Hospital. In this interview by Sade Oguntola, he speaks about blood transfusion, its benefits, and steps being taken to ensure safe blood are available for medical treatment.
CAN you explain the importance of blood transfusions and the situations where they are typically required?
Blood transfusion is a medical procedure, a form of medical treatment in which a unit of blood donated is given to a patient with low or inadequate blood. Most patients who have a major surgical procedure will have a blood transfusion to replace any blood loss during their surgery. In addition, it comes useful for individuals who have experienced serious injuries from car crashes or natural disasters, women that have lost a lot of blood after childbirth, and individuals that have illnesses that can make it difficult for the body to produce healthy blood. Such conditions include anaemia, cancer, kidney disease, liver disease, severe infection, and sickle cell disease.
What safety measures are in place to ensure the proper matching of blood types during a transfusion?
Safety of blood transfusion starts with donor selection. There are criteria to be followed at the point of donation that facilitate deferral of potential donors that are not fit. After proper donor selection, blood grouping, usually ABO and Rhesus (Rh) typing of the donated blood is done. If there is a patient that needs blood, blood grouping (ABO and RhD) is also done on the patient’s blood. Group blood is then cross-matched with the sample of the patient in the laboratory. If found fit, it is released for the patient’s transfusion. There are instances where extended blood grouping is done, that is, the grouping done is beyond ABO and Rh D. This is done in the case of patients with sickle cell anaemia that requires repeated blood transfusion.
How does the process of blood collection and screening take place in a blood transfusion service?
The process of blood collection determines the safety of the blood. By World Health Organisation (WHO) standard, all blood donations should be from voluntary, non-remunerated blood donors. This process guarantees blood safety. However, the process of blood donation starts with donor selection. The potential donors will fill out, and the process of blood donation starts with donor selection. The donor questionnaire, where his or her details are documented, like ongoing fever, drug use, vaccinations, recent scarification, and sexual history, is also asked of the potential donors. If the potential donor scales through this phase, he or she will be taken to the next stage.
At the second stage, the potential donor will have the health status checked starting from the weight, blood pressure, pulse rate, and blood level. Potential donors can be deferred or excused from donation if the standard set for all potential donors is not met. Subsequently, a person that meets the criteria will be taken to the bleeding room for donation.
To avoid stigmatisation, especially in blood donation facilities that deal with voluntary blood donors, rapid screening for infectious agents is not done prior to the donation of the units of blood donated. This comes at a cost to these facilities because the units of blood with infectious agents are subsequently discarded, not minding the cost of blood bags and time spent on donation.
Also, the collected blood is screened for hepatitis B, hepatitis C, HIV, and syphilis in Nigeria. In some other parts of the world, other infectious agents like malaria tests are considered. The minimum type of test in blood banking is the ELISA method and not rapid screening. But rapid screening is being done in most blood banks in Nigeria today.
What are the common risks and complications associated with blood transfusions, and how are they mitigated?
Complications of blood transfusions are referred to as blood transfusion reactions, and there are different types. Some occur within 24 hours of blood transfusion, and others are delayed until after 24 hours of transfusion. They could also be grouped into blood transfusion reactions due to antibodies from the donors or recipients or reactions that are not as a result of antibodies. The commonest transfusion reaction is febrile non-hemolytic transfusion reaction, a case in which the blood recipient develops fever within minutes of blood transfusion. This is as a result of antibodies from the recipients fighting against the white cells from the donor. It is not a fatal blood transfusion reaction; the recipients could be given fever-lowering medicines like paracetamol and continue transfusion.
The fatal blood transfusion reactions include febrile hemolytic transfusion reactions, bacterial contamination, and anaphylactic blood transfusion reactions. Transmission of infectious organisms like HIV, hepatitis B, and hepatitis C are examples of delayed transfusion reactions that lead to chronic infections in the recipients.
Another example of a blood transfusion reaction is transfusion-associated circulatory overload, a condition in which the volume of blood transfused is greater than what the recipient’s heart could cope with. This is common in children and the elderly. Iron overload is also a form of blood transfusion reaction; this happens in patients that are repeatedly transfused.
Mitigation against blood transfusion reactions involves transfusing a patient only when it is necessary; transfuse only what the patient needs. If it is red blood cells, ensure this is what you give. If it is platelets that the patient needs, give platelets only.
Also, transfusion should be done only in the hospital; it is a form of medical treatment. We also advise that blood should be accessed from recognised and accredited blood banks in Nigeria. Blood and blood components are kept at different temperatures; blood banks operated by quacks and not accredited will most of the time not follow the guidelines in keeping these blood and blood components in the blood bank. Donor selection is critical in preventing blood transfusion reactions; voluntary non-remunerated donors are the accepted donors.
How does a blood transfusion service ensure the quality and safety of donated blood?
The blood transfusion service of Nigeria is being coordinated by the National Blood Service Commission, with headquarters in Abuja and zonal centres in six geopolitical zones of the country, with one in Ibadan. There are few states with blood transfusion service; prominent on the list is Lagos State. Other states like Oyo and Osun are also preparing to start a blood transfusion service in the southwest zone. The objectives of blood transfusion services are to provide safe units of blood, draw the attention of the people to the need for voluntary blood donation, and then regulate the transfusion service in their respective states and countries at large. By ensuring that each blood bank facility is accredited, it shows that there must be a minimum standard that the blood banks must meet before accreditation. These facilities will also be re-accredited, and unscheduled visits are also made to the blood banks. All these activities will improve the quality and safety of blood in Nigeria. It will further develop the transfusion service in the country.
Can you discuss the role of cross-matching in preventing adverse reactions during blood transfusions?
Cross-matching could also be referred to as compatibility testing. It prevents some of the transfusion reactions but not all. So compatibility is done at different temperature and time; this will prevent a fatal transfusion reaction and hemolytic transfusion reaction. But for total prevention of this reaction, there are levels of precautions. Mistakes could be made at the point of taking samples, where names are interchanged and, despite the cross-matching, the wrong unit of blood will be released. At the level of release of blood, a blood cross matched for a person could be mistakenly released to another person. Crossmatching is good, but every stage of the blood transfusion service needs to be properly managed to prevent adverse reactions.
How has technology advanced the field of blood transfusion, and what impact has it had on improving patient outcomes?
The role of technology in blood transfusion services could not be overemphasised, from donor selection to eventual transfusion of the blood on the ward. The donor questionnaire that is being filled out by potential donors can be automated instead of filling out a hard copy form at every attempt to donate. Technology will give a permanent identifier to the donor so that wherever the donor presents for donation in Nigeria, his or her details will come out on the system. This will take care of donors that change their location in the country and stop blood donation for payment. Also, if technology is properly utilised in the country, each blood transfusion service can trace blood donors with very rare blood groups when there is an urgent need. Technology is also important in screening our units of blood. In the developed parts of the world, nucleic acid amplification tests are being used to screen units of blood, thereby minimising the possibility of transfusing infectious organisms from donors to recipients.
Similarly, cross-matching could be driven by technology. There is automatic blood grouping and cross-matching equipment; there is one at the University College Hospital, Ibadan. However, technology in blood transfusion services will translate to more service funds; most of the equipment will be imported, and reagents will also be imported. As such, patients may likely need to pay more for the services being rendered.
What measures are in place to ensure the safety and quality of blood donations in Nigeria’s blood transfusion services?
The measures currently in place in Nigeria to ensure safety and quality include proper donor selection, screening using the ELISA method minimum, proper storage, and transfusion of only what the patient needs. The only aspect lacking is the National Blood Service Commission (NBSC) to start the regulatory role in a full capacity. This will give the opportunity to review what is being done in the blood banks and hospitals in Nigeria. I am sure this is the phase NBSC is entering now. The zonal centres will be empowered to lead this role in their respective zones.
Can you discuss the challenges and strategies associated with maintaining an adequate and diverse blood supply in south-west Nigeria?
There are a lot of challenges facing transfusion service that have not allowed us to maintain an adequate and diverse blood supply in south-west Nigeria. One of them is a lack of willingness to donate for altruistic reasons. We currently do not have the population to meet the transfusion demand of the zone. So many things are responsible for this, including the economic situation of the country. Most of the patients may need to transport themselves to the site of donation; a lot of potential donors want money for blood donation.
Another challenge is funding; it is quite difficult to depend on the government for funds to run the transfusion service in the country. There is a need for collaboration with non-governmental organisations, clubs, and associations that could share the responsibilities with the government. This will go a long way to maintaining the adequate units of blood needed in the different zones in Nigeria. Again, the epileptic power supply is affecting the activities to maintain adequate blood supply in our environment. To run an alternative power supply is quite expensive and boils down to funding too.
Q: What steps are taken to recruit and retain voluntary blood donors? What incentives or campaigns are in place to encourage regular donations in the Nigerian context?
To recruit and retain voluntary, non-remunerated donors, the blood transfusion centres organise campaigns in churches, mosques, and high institutions in the zone. It has been reported that most voluntary blood donations are from young adults, so higher institutions have become critical. Incentives like T-shirts, face caps, and bands are usually given to our donors. All these are souvenirs that also speak about transfusion services when the donors put them on. Certificates and plaques are also given to individuals who have donated to a certain level. This serves as evidence of community service rendered by the voluntary blood donors.
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