Prof. Musa Muhibi, a Haematologist, is the Dean of Faculty of Applied Health Science at the Edo State University. In this interview with ADEYINKA ADEDIPE talks about blood transfusion and the need to create awareness for blood donation.
What does blood transfusion entail?
Blood transfusion is a medical procedure that involves transferring blood products from a strictly screened donor to a recipient. It is typically done to raise the targeted blood component from a state of significant deficiency to near normal reference value for the age and gender of the patient. Blood transfusion is an indispensable medical resource, and blood donation by eligible individuals plays a crucial role in maintaining a safe and adequate supply for those in need. The blood product may be whole blood, which contains red blood cells, white blood cells, platelets, and plasma, or it may involve specific blood components, such as red blood cells, platelets, or plasma, depending on the needs of the recipient.
What conditions warrant a person needing a blood transfusion?
The conditions that may warrant an individual to need transfusion include blood loss occasioned by injury, surgery, childbirth, sickle cell diseases, anaemia of chronic diseases and certain medical conditions that predispose to blood loss or low blood cell counts. Some products are administered to patients to treat conditions such as bleeding disorders, thalassemia (an inherited blood disorder), immune system disorders, certain types of infections, shock and burns.
What can be done to ensure that people donate blood voluntarily?
Voluntary blood donation is an essential part of a sustainable blood transfusion system and its importance has been recognised globally. It is defined as blood donation given freely, without payment, and any form of coercion, and is essential to ensuring the safety and adequacy of the blood supply. To potentiate voluntary blood donation culture, there is a need for public awareness, education campaigns, mobile blood donation drives, incentives for blood donation, strengthening blood donation infrastructure, protection of blood donors’ rights, tax incentives for organisations that support voluntary blood donation and ethical use of donated blood units in public and private facilities to sustain blood donor motivation.
How can the wrong notion or myth surrounding blood donation be quashed?
To quash wrong myths concerning blood donation, it’s important to implement an effective communication strategy that focuses on providing accurate information and addressing misconceptions, identifying prevalent myths through research and tailoring communication strategy accordingly, using adequate educational campaigns through social media, websites, brochures and community events, and promoting collaboration among healthcare professionals, relevant government agencies, bloggers and community organisations. Others are the provision of factual information, sharing of personal real-life stories and testimonials, training of volunteers as well as canvassers and continuous evaluation and review of the approaches.
What level of blood can a donor have to be able to donate?
The level of blood is determined at a blood donation centre, after physical assessments and consideration of responses provided by the potential donor to relevant questions in the donor questionnaire. A female donor must have a minimum of 12.5 grams per deciliter of haemoglobin and a male donor must have a minimum of 13.0 g/dL. The testing process is a technical job that will be handled by a medical laboratory scientist. The equivalents of these ranges of haemoglobin concentrations are known when any form of blood level determination parameter is used instead of haemoglobin concentration.
You talked about a big gap in blood donation and what is required, what can be done to bridge this gap?
The major gap has to do with using the right technology to assess donors, preserving blood products, determination of blood donor-recipient compatibility and making rational use of blood products. All these are to be addressed by building capacities of medical laboratory scientists and physicians, the provision of the right equipment and consumables, and efficient regulation of the practice, without making the cost of provision of blood transfusion services prohibitive.
How is screening of blood done and what are the things you screen for?
Blood donors are to be screened for HIV, hepatitis B virus, hepatitis C virus and syphilis. Using the right technologies for the screening is very key because the inefficiency of common rapid kits will create compromise and give false assurance that the product is safe when it is not. The minimum technology that is acceptable for screening blood donors for HIV, for instance, is the fourth-generation ELISA (Enzyme-linked immunosorbent assay) technique which reduces the window period (of false negative results) by testing the HIV antibodies and antigen simultaneously. All other transfusion transmissible infections listed above must also be screened using the ELISA technique, at the minimum. Any technology below ELISA may be appropriate for other uses they are known for, but not for blood donor screening.
How is a blood match determined?
Before a blood transfusion, both the donor and recipient blood types are carefully determined by tube grouping and an initial choice for further compatibility testing is predicated on the groups (A,B, O and Rh groups) of both the donor and recipient. What is preferred is giving the same group to preclude the possibility of donors’ antibodies lysing (destroying) the recipients’ red blood cells. This culture is known as homologous transfusion practice. It is wrong to assume that blood group O individuals are universally usable as universal donors. About 10.8 per cent of the O blood group donors in Nigeria have lysins (antibodies that destroy red cells of A or B individuals) and are referred to as “dangerous group O donors”. In addition, blood antibody screening and cross-matching of recipients’ serum against donors’ red cells are also done, depending on available resources and required turnaround time. These are done to minimise the risk of adverse reactions. Transfusions are typically performed in a controlled healthcare setting by trained medical professionals to ensure safety and to monitor for any potential complications. Adverse reactions to transfusions are rare but can include allergic reactions, fever, infection, and in rare cases, more severe complications.
Is it a good practice to pay blood donors?
Paid donors have a higher prevalence of transfusion-transmissible infections, as they do not always disclose risk factors or symptoms of infectious diseases or whether they have been deferred in the past on account of infection. Also, paid donors will not disclose the intervals of donation and will do anything possible to mislead the blood bank to accept them as donors because their central goal is to collect money as donors. Undue financial inducement of blood donors is discouraged across the globe as it is inimical to the safety of blood transfusion.
What are the criteria to fulfill before one can own a blood bank?
It involves getting the right premises that are incorporated, the right equipment and tools to be handled by licensed individuals and getting registered as a blood transfusion laboratory with the state Ministry of Health, Medical Laboratory Science Council of Nigeria and lately, the National Blood Service Commission. The issue of blood transfusion is on the concurrent legislative list.
How will you compare the practice to what existed 20 years ago?
A lot of transformation has been recorded with the dynamic nature of science and the gradual incremental responsiveness of the Nigerian government which culminated in the enactment of the National Blood Service Commission Act of 2021. The technology we use today is truly far more sensitive than what we used 20 years ago, the more reason we implore practitioners to be ethical by embracing the right technology according to the policy of Nigeria State.
What technological tools have been designed to make it easier for blood transfusion to take place?
A lot of gadgets, like apheresis machines, refrigerated centrifuges, blood unit refrigerators with the capacity to maintain the cold chain for hours during a power outage, blood unit meters, ultra-low freezers for some blood products prolonged storage, blood tubing sealing machines, platelet concentrate mixers, and leucodepletion filters, among other devices.
Brain drain is a big problem in the medical profession, how can this be halted or reduced?
The answer is simple. Medical laboratory scientists and other health care professionals should be remunerated reasonably, benchmarking with what is obtainable where they run to. Also, medical laboratory scientists who are properly called will have job satisfaction if adequate equipment is provided and the managers of Nigeria’s public health institutions accord them privileges and rights that are due to them, according to the law of the country and extant rules.
What kind of lift do you think the medical professionals need from the government?
Medical professionals need adequate budgetary provision for healthcare and ensuring that there is fairness, equity, not equality and justice in the appointment of ministers of health and chief executives of health facilities and institutions. To truly move forward, we need to now balance the centrifuge.
What can be done to improve healthcare delivery in the country?
To improve healthcare delivery in Nigeria, the government needs to deliberately involve other healthcare professionals in healthcare governance. Managers of health institutions must not be all physicians, or else the system will remain deprived at the governance level of the knowledge and skills of other players like medical laboratory scientists, pharmacists and physiotherapists. To reduce medical tourism, there should be a commensurate welfare package for healthcare professionals, benchmarking with what is obtainable in advanced countries. There should be a provision of modern equipment and the creation of an enabling environment where no professional is treated as a slave. This will breed job satisfaction and motivate a larger percentage to stay and deliver quality service.
Resident doctors were primarily on strike because of poor remuneration and poor working conditions. Unfortunately, the government is either not receiving the right advice or not implementing the same to keep the entire health team motivated without undue skewness. There is a need for an overhaul of the healthcare governance in Nigeria. If the services are of quality and accessible; many patients will prefer receiving services in the country. The way we operate now, even the poor beg to gather funds and move abroad to receive certain healthcare services.
Why do many Nigerians avoid donating blood freely?
It is due to a lack of adequate awareness, poverty and a lack of trust in the system as many believe such units (of blood) donated freely will be sold. There is also inadequate medical equipment that can facilitate components (specific blood parts) donation which some elite know to be obtainable in advanced countries.
What are the erroneous or superstitious beliefs Nigerians have about blood donation?
Some believe that donation kills or kills gradually. Some believe it diminishes fecundity while others feel it has negative spiritual consequences like having an unintended link between the donor and recipient in the spiritual realm. This is the reason some people insist that blood donated by them be used strictly by their spouses or relatives only.
Why are certified blood donation centres not common in Nigeria?
Running standard blood donation services is capital-intensive and has a low-profit margin. The costs of procurement of equipment and consumables for stringent screening of donors and storage of the products are not within the reach of an average Nigerian. Passion to invest is also low among those with affluence. Lack of collaboration among professionals also constitutes a hindrance.
Are you aware of unethical practices by some hospital workers who patronise unlicensed blood banks?
We have read in the news that many unethical practices, including bleeding unfit and underaged donors on unregistered premises were reported. Such cases are supposed to be investigated and culprits brought to book to serve as deterrence to others. We have heard and perceived cases of blood touting too, going on in many communities in Nigeria.
What can families of patients in need of blood do to avoid falling into the hands of such people?
By adhering to pieces of advice as may be given by licensed medical laboratory scientists and counsellors in the blood bank, patients’ relatives will not fall victim to unwholesome practices. Above all, if we all volunteer as blood donors not because we need blood products for our relations when we need them (if we do), the products will be available in abundance. There will be no temptation to patronise ‘anyhow’ facilities if our blood banks have enough in stock.
