The Thin Line between Life and Death

By Ulimmachukwu Osele

Have you lost ever someone due to a shortage of blood in the hospital’s blood bank? Every few seconds, someone, somewhere needs blood. In fact, 34% of pregnant women die in labour as a result of complications from bleeding and lack of blood for transfusion. Undoubtedly, transfusion of blood and blood products saves millions of lives every year.

About 234 million vital operations are performed worldwide every year, with 63 million people undergoing surgery for traumatic injuries, 31 million more for treating cancers, and another 10 million for pregnancy-related complications. There is an increased need for blood transfusion for the survival of patients with certain illnesses like cancer and accident emergencies. In Nigeria, there are three sources of blood donation; voluntary donors, family donors, and commercial donors (or blood touts). Voluntary donors donate blood with the sole purpose of saving lives. Donors in this category are usually not in a consanguine relationship with the recipient of the blood, donation is out of free will without seeking remunerations. Most times,they are family members who donate to a relative based on emergency.

The World Health Organization (WHO) encourages all nations to work toward achieving 100% voluntary non-remunerated blood donation as voluntary, non-remunerated blood donors from low-risk populations are the safest. They have markedly reduced chances of harboring and transfering transfusion-transmissible infections (TTIs). This also provides quality blood and blood products, helps to promote and implement appropriate clinical use of blood, and to set up systems for the monitoring of the whole chain of blood transfusion.

Blood shortages and poverty in Nigeria have promoted the increase of commercial blood donors i.e they donate blood for the sole purpose of financial gain. They take advantage of desperation to get blood and blood products as they are usually expensive to purchase. Commercial (paid) blood donors, therefore, succeed and thrive in this part of the world to the detriment of blood transfusion safety in the country. 
During emergencies, relatives of the sick are at the mercy of “blood touts” who hang around hospitals scouting for unwary persons in need of blood in exchange for a ridiculous sum of money. An increase in the number of regular unpaid volunteers will go a long way in tackling the challenge of commercial donors; volunteers like you and me.

Currently, Nigeria National Blood Transfusion Service (NBTS) has 17 blood donation centers across six geo-political zones leading to a collection of over 60 000 units of blood annually but recorded a dwindling rate of donation in 2019 as only around 25 000 units were donated. Blood transfusion is necessary to save lives and improve health, but many patients requiring transfusion do not have timely access to safe blood, and adequate blood supply due to several factors, some of which includes;

The high prevalence of TTIs leads to wastage of blood and blood products that would have otherwise been useful for the recipient. It is one thing to transfuse blood, it is another to transfuse safe blood that would not be detrimental to health. The high prevalence of TTIs in blood donors has a negative impact on blood transfusion safety. The prevalence rates as high as 18%, 23%, and 12.3% for the human immunodeficiency virus (HIV), hepatitis B virus and hepatitis C virus (HCV) respectively were reported among prison inmates in a study conducted in Nasarawa, North-central Nigeria which is one of the major reasons WHO advocates blood sourcing from voluntary, non-remunerated blood donors as there is a lower incidence of TTIs. Unfortunately, several studies in Nigeria have shown that voluntary blood donors are outnumbered by family donors and blood touts. A study carried out in Enugu, Nigeria, by Angela O.U on the pattern of blood distribution unveiled the percentages of donors. Voluntary donors (633/3377, 18.7%) were the least when compared to family (1998/3377, 59.2%), and Commercial donors (746/3377, 22.1%).

Age distribution also has an effect on the safety of transfused blood. Amongst the blood donors in Nigeria, adults dominate the pool of blood donors, this age category is more associated with high-risk sexual behaviours, hence posing risk in attaining safe blood. HIV seroprevalence is lower in people under the age of 20. HIV seroprevalence is higher in the 20–45-year age group. HIV seroprevalence is also lower in people above 45 years of age. Hence, people in the age groups below 20 and above 45 years are safer than those in the 20–45-year age group and should be the main target groups for donor recruitment which isn’t so as voluntary blood donation starts at age 18 in Nigeria.
According to the NBTS, Nigeria uses about 2 million units of blood every year to cater for the health needs of its citizens, translating to far less than a pint of blood per person and further highlights the blood supply deficit in the country. This deficient blood supply is probably the major hindrance to the smooth operations of the National blood transfusion policy aimed toward boosting transfusion safety in the country. The issue of supply deficit can be solved with an increase in regular voluntary donors, the availability of voluntary donors is directly proportional to the low literacy level of the knowledge of the clinical use of blood and its products by members of the community. A pint of blood saves three lives. Mass and social media awareness campaigns should be utilized to enlighten the public, demystify misconceptions surround blood donation and ultimately increase the number of voluntary donors in Nigeria. The District Health Information System 2 database launched by the NBTS in the drive for blood donation with support of the World Health Organization, is designed to be used in reporting blood donation in the country.

DONOR UNIT SCREENING
NBTS has set guidelines in screening all blood samples obtained from donors. This screening involves the use of complex and sensitive equipment e.g. The screening equipment for HCV, hepatitis B, HIV, and syphilis, though available in most of the blood banks in the country, is still not sufficient, nucleic acid tests (NATs) are not yet universally available for TTIs testing. Blood donor screenings should be strengthened to accommodate all possible screening tests required in screening blood samples from donors.

In line with its mandate, Nigeria’s National Blood Transfusion Service strives to provide adequate supplies of safe blood, screened with modern fully automated enzyme-linked immune-sorbent assay (ELISA) technology. The NBTS also wishes to increase its scope of work, by scaling up its annual blood collection rate and sustaining ongoing efforts to expand the reach of its services.

When you donate blood, your body replaces the blood volume within 48 hours of donation and the red blood cells are replaced within four to eight weeks. This process of rejuvenating your blood cells keeps you healthy and active.

Blood donation is required now more than ever before, due to the recent COVID-19 oandemic. In her message to commemorate 2020 World Blood Donor Day, WHO Regional Director for Africa, Dr. Matshidiso Moeti said, “During this COVID-19 pandemic, the supply of safe blood is at risk. Regular blood donation drives are being postponed, and stay-at-home orders and fear of infections are preventing donors from accessing services. Disruptions to the global supply chain also put countries at risk of shortages of critical supplies and equipment needed for blood donation and transfusion”. Dr. Osagie of the Abuja NBTS center also said “During this COVID-19 pandemic, we lost quite a lot of blood, over 200 units expired in the Abuja NBTS center as a result of the lockdown in the country”.

Nigerians will not voluntarily and regularly donate blood due to several misconceptions. Olaiya et al. evaluated the attitude of individuals in Lagos (Southwest Nigeria) toward blood donation and identified a number of factors, ranging from fear of contacting TTIs (52.4%) to fear of side effects such as weight loss (23.8%), sudden death (3.3%), sexual failure (5.9%), high blood pressure (5.2%) and convulsions (1.5%) as impediments to blood donation.

The consequences of inadequate blood supply are life-threatening for women during childbirth experiencing bleeding, malaria-related anemia, sickle cell-related anemia, patients with blood and bone marrow disorders, inherited disorders of hemoglobin, and immune deficiency conditions, patients undergoing medical and surgical procedures and cancer patients.

ARE YOU HAVING MISCONCEPTIONS? THESE WILL CLEAR YOUR DOUBTS:

• You need to be 18 or older to donate whole blood.
• You have to weigh at least 110 pounds and be in good health to donate blood and blood products.
• You need to provide information about medical conditions and any medications you’re taking. These may affect your eligibility to donate blood.
• Feeling lightheaded after a donation is typical, resting for a few minutes will restore your agility. As long as you are not lifting heavy weights or conducting strenuous activities, donating blood will not interfere with your physical activities.
• Taking medications would not prevent you from donating blood, but may delay donation. Speak to the healthcare provider on the drugs you are on before donating.
• The entire process is usually completed under an hour. You can listen to music or engage in other activities to make you relax during the donation.
• Donating blood is not a painful experience but a helpful experience. There is a lot to gain and nothing to lose. Benefits of blood donation include; stress reduction, improved emotional wellbeing, free health checkup, lower risk of high blood pressure.
• Blood donation is safe for healthy adults, and there’s no risk of contracting a disease. Sterile equipment is used for each donor and the process is conducted by professionals.

The following are some suggestions to help you prepare for donating blood:

• Drink an extra 16 ounces of water before your appointment.
• Eat a healthy meal that’s low in fat.
• Wear a short-sleeved shirt or a shirt with sleeves that are easy to roll up.

References

Aneke J. C., Okocha C. E. Blood Transfusion Safety; Current Status and Challenges in Nigeria. Asian Journal of Transfusion Science 2017 Jan-Jun; 11(1) 1–5. doi: 10.4103/0973-6247.200781

WHO. Universal Access to Safe Blood. 2010. Feb 11, [Last accessed on June 22, 2020]. Available from: http://www.who.int/bloodsafety/universalbts/en/index.html

WHO. WHO Campaigns. World Blood Donor Day 2019. [Accessed on June 22, 2020] Available from: https://www.who.int/campaigns/world-blood-donor-day/2019/key-messages