Blood shortage bites harder with only 25% of transfusion demand met yearly
14 June 2023 |
4:15 am
As Nigeria joins the rest of the globe to mark World Blood Donor Day (WBDD) today, June 14, very little has changed in terms of the supply shortage facing her over 200 million population.
• Nigeria needs N90 billion yearly for self-sufficiency
• Transfusion is capital intensive, costs N60,000 to ‘procure’ one unit of blood
As Nigeria joins the rest of the globe to mark World Blood Donor Day (WBDD) today, June 14, very little has changed in terms of the supply shortage facing her over 200 million population.
According to latest figures from the National Blood Services Commission (NBSC), Nigeria is only able to produce 25 per cent – that is 500,000 – of the two million units of blood required yearly. To meet the required two million units of blood at the cost of N60,000 per unit, Nigeria needs N90 billion to produce the balance of 1.5 million.
The theme of this year’s WBDD is: “Give Blood, Give Plasma, Share Life, Share Often”. It focuses on patients requiring life-long transfusion support, such as patients with sickle cell anaemia, and underlies the role every single person can play, by giving the valuable gift of blood or plasma as indeed “Blood is Life”.
Acting Director General of NBSC, Dr Joseph Amedu, told The Guardian that Nigeria lacks sufficient blood to cater for its population of over 200 million people.
“Based on WHO’s standard, every country is to have a minimum of one per cent of blood unit of her population for operations. However, with Nigeria’s population, about 2,000,000 units of blood per year would be required. Out of this, Nigeria is yet to get 500,000 blood units per year, which is as a result of unwillingness to donate.” He said the greatest challenge of blood donation and blood transmission in Nigeria is that it is capital intensive.
“To produce a single unit of the same blood requires between N50,000 – N60,000 and this is a huge amount. By the time one spends over N100,000, he or she will realise how much has been spent so far,” he said.
Amedu said there is need to invest in the blood services so that the blood can be made available to every Nigerian, for people that live in the rural areas to have access to safe blood.
He said blood is hugely expensive and there is a need for the Federal Government, the State governments, and the Local Governments and the private sector to invest in producing blood components such as plasma. “All these could be produced and sold, it is also a good investment,” he said.
Amedu said another major challenge is the cost of producing safe blood for transfusion in large quantities for the country, and of course for sickle cell patients and cancer patients who depend on blood products. These are things that are very important and need to be provided to ensure the health of the nation.
“So, the Federal Government needs to understand the importance of blood services to the healthcare of the nation. This will help in having enough blood for the people because it requires a lot of cooperation, a lot of capital, a lot of investment and funds for other blood equipment that are really expensive, to keep the country safe.”
According to WHO, a blood product is any therapeutic substance derived from human blood, including whole blood and other blood components for transfusion, and plasma-derived medicinal products.
It said medicinal (medical therapeutic) products derived from human donations of blood and plasma play a critical role in health care. According to WHO, safe, effective and quality-assured blood products contribute to improving and saving millions of lives every year, as they address child mortality and maternal health; dramatically improve the life expectancy and quality of life of patients suffering from life-threatening inherited disorders, such as haemophilia, thalassaemia and immune deficiency, and acquired conditions such as cancer and traumatic haemorrhage; and support complex medical and surgical procedures, including transplantation.
It said an insufficient or unsafe blood supply for transfusion has a negative impact on the effectiveness of key health services and programmes to provide appropriate patient care in numerous acute and chronic conditions.
The WHO said ensuring access of all patients who require transfusion to safe, effective and quality-assured blood products is a key component of an effective health system and vital for patient safety.
On efforts to ensure that safe blood is transfused, Amedu advised that before allowing the transfusion of blood, the logo of the National Blood Services Commission must be checked. He said the commission in its quest in curbing unsafe blood practices has provided a technology to ensure the safety of transfused blood.
This, he said, helps in getting the central database of the report of blood across the country. He said a bar code has been established to help in verifying if the blood can be used or not, the donor, where it was donated, and where it was screened. Amedu said any blood transfused in any health facility without the barcode could be pronounced unsafe.
The NBTSC urged Nigerians to willingly and regularly donate blood to enable sufficiency of blood for those who need it. He said the donation and transfusion of blood is safe after undergoing a thorough examination.
“The transfusion of unsafe blood equates to the transfusion of diseases, which can result in the death of the patient, crisis in the form of shock, blood reaction and more,” Amedu said.
Reacting to report of investigations supported by some publications that show racketeering and underground sale of blood in some private and public hospitals nationwide, Executive Secretary, Lagos State Blood Transfusion Service (LSBTS), Dr Bodunrin Osikomaiya, said: There have been unconfirmed reports of racketeering of blood, which were investigated and acted upon accordingly by the Agency’s monitoring and enforcement sub-committee. Lagos State does not encourage this.”
Osikomaiya, who is also a consultant haematologist and blood transfusion specialist, said no blood is sold but an access/screening fee is paid at the time blood needs to be transfused. This fee, Osikomaiya said is funds used to ensure blood is safe that is, to screen for Transfusion Transmissible Infections (TTIs) such as Human Immuno-deficiency Virus (HIV I and II), Hepatitis B and C, and syphilis, as well as cross-matching blood to ensure it is compatible with the patient before transfusion, provide consumables required to collect blood and for all the processing and storage of blood. Osikomaiya said this challenge can be addressed, if there are adequate numbers of voluntary blood donors to provide blood at all times.
Corroborating Amedu, Osikomaiya said Nigeria is not self-sufficient in donated blood. “As estimated by the WHO, Nigeria needs one-two per cent of blood from its population to meet its blood transfusion needs. For a country with approximately 200 million, at least two million units of blood is required.
This number can be achieved by increasing the sensitisation on the need for blood, advocating for more voluntary blood donors,” she said.
On how one can maintain healthy blood levels, the haematologist said: “By maintaining a healthy lifestyle through the intake of meals high in nutrients like iron, vitamins example, fruits and vegetables, taking adequate water, exercising, taking adequate rest, abstaining from activities like smoking.
“Fluted pumpkin and other vegetables can help because vegetables are high in nutrients like iron and vitamins, which are needed for healthy blood production.”
Osikomaiya said the greatest challenges in blood donation and transfusion services in Nigeria are: poor sensitisation and education of the public/Nigerians about the need for and importance of blood donation; inadequate and ill-equipped donation clinics; poor staffing; cultural and religious myths; out-of-pocket payment for blood, which is an essential medicine.
“Essential medicines (EMs) are defined by WHO as those medicinal products that satisfy the health-care needs of the majority of the population. They should therefore be available at all times, in adequate amounts and in appropriate dosage forms, with assured quality and affordability,” she said. Osikomaiya said there is no alternative to blood transfusion and blood can only be produced within a human body and not manufactured.
“Blood donation is safe. Sterile disposable equipment and materials is used for each donor, so there is no risk of contracting a blood borne infection,” she said.
Head, Haematology Department, Lagos State University Teaching Hospital (LASUTH), Prof. Ebele Uche, said despite strict monitoring of the activities of these blood banks, some racketeering still occurs. Uche said the most dangerous implication of this would be the transfusion of unsafe blood to patients.
The haematologist said blood for human transfusion can only be obtained from humans and the demand for blood is very high; several studies have shown that in most large cities, supply is less than 50 per cent of demand.
She said Nigeria is in no way close to being self-sufficient in donated blood. Uche said with a population of about 200 million, Nigeria requires about 4,000,000 units of blood yearly to meet its transfusion needs.
She said the WHO in 1997 set a goal for all blood donations to come from voluntary non- remunerated donors who donate blood regularly three-four times/year and this ensures regular availability of blood and blood products at any given time. However, Uche said, this concept is still not well accepted by most Nigerians.
The haematologist said in most blood banks, the majority of donors are family replacement donors (who donate blood on behalf of their relatives or friends) and the commercial donors who donate blood in exchange for financial remuneration. These groups of donors, especially the commercial donors, according to Uche, are seen as dangerous donors as they are most likely to be people of low socio-economic class looking for a quick way to make money. These people, she said, have also been seen to be more likely to be involved in social behaviour like intravenous drug use, etc.
At present, Uche said, Nigeria has one of the lowest rates of voluntary non-remunerated blood donation in Africa where about 50 per cent of blood donations are sourced from paid donors.
Uche said there are alternatives to red blood cell transfusion and these are known as oxygen carriers and include the haemoglobin based oxygen carriers (HBOC) and the perfluorocarbons. These, she said, are however not readily available and even in the United States of America, no OC has been licensed by the United State Food and Drug Administration (FDA).
Chairman, Nigerian Association of Resident Doctors’ (NARD) Committee on Medical Education and its 2nd Vice President, Dr. Jumbo Eniefiok Hezekaih, said there is no clear cut answer to whether there is racketeering concerning access to safe blood since the majority of donors in the country are family/replacement or paid/ commercial donors, while the advocated donors should be voluntary and unpaid.
Hezekaih said when the donors are voluntary and unpaid the hospital bears the cost of screening both the patient and the blood but when it is from a family member/relative or a commercial/ paid donor, the patient cum patient relatives bear the cost hence this can be misconstrued as racketeering.
Hezekaih said the government should implement its policy on blood service, improve the living conditions of the citizens, promote awareness campaigns on the benefits of blood donation and most especially provide blood donation storage equipment, blood processing equipment like the Apheresis machine, which is lacking in most government hospitals since the world has moved away from whole blood donations when specific blood components are in need and of utmost importance conducive environment for blood donation/transfusion service.
He said blood donation helps to improve the blood flow in the body, which in turn reduces the risk of developing heart diseases. Hezekaih said donating blood stimulates the production of new blood cells in the body, helping to prevent anemia caused by a lack of red blood cells.
He said before donating blood, the donor undergoes various tests including blood pressure, blood count, blood group, iron deficiency, so any underlying medical issues can be detected early.
Hezekaih said regular blood donation could help to reduce the risk of certain types of cancer, including liver, lung, and colon cancer.
He said donating blood could give a sense of satisfaction to the donor, and promote feelings of community involvement and purpose.
“It is important to note that blood donation should only be done voluntarily, after consulting a healthcare professional and ensuring that the donor is eligible,” Hezekaih said.
Chairman, Nigerian Medical Association (NMA) National Committee on Blood Transfusion and Haematological Services, Dr. Ahmed Attah Jacob, said the issue of blood racketeering and sharp practices regarding blood transfusion services in Nigeria has been in existence for decades now. Ahmed said it is why the proportion of commercial blood donation is more than 90 per cent in Nigeria and most sub-Saharan African countries, and other developing countries across the world.
Ahmed said the consequences of the high proportion of commercial blood donation are a high level of racketeering, sharp practices and the risk of transfusion of TTIs to those who are transfused.
He said the National Blood Commission Act (NBSC) 2021 has made provision in Article 18, sections 1-7, and particularly in section 4 states ‘(4) A person who knowingly interferes with, tampers or obstructs in whatsoever manner, the proper donation, collection, screening, banking, processing, distribution, transfusion of blood and blood products, inspection of records and premises where blood is processed for transfusion commits an offence and is liable on conviction to a fine of at least N500,000.00 or imprisonment for a term of at least six months or both’.
Ahmed said the NBSC Act 2021 has made adequate provision penalties against those involved in blood racketeering and other fraudulent practices in the provision of blood transfusion services in Nigeria. He said what is needed is the full implementation of the law to regulate the provision of blood transfusion services in Nigeria.
Ahmed said only about four per cent of the eligible population donate blood yearly compared to 11 per cent in South Africa, 13 per cent in Canada and 25 per cent in the United States (U.S.).
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