Why patients in need of blood should worry

Whenever an accident occurs, or a major operation is done, patients suffer heavy bleeding and require blood transfusion.
However, in the coming days, the life-saving commodity may not be easy to come by, after the director of Uganda Blood Transfusion Service (UBTS) indicated that the entity will scale down its operations and start rationing blood usage following cuts on its transport budget, among other issues.

In January, blood shortage in the country forced hospitals, including Mulago National Referral Hospital, to suspend major operations, putting the life of patients at risk.
The hospital spokesperson, Mr Enock Kusasira, then said some surgeries had to be rescheduled to save blood for emergency cases such as delivery and accidents.

At the same time, the Uganda Heart Institute (UHI), which was most affected by the shortage, had to suspend two major open-heart surgeries.
Dr John Omangino, the institute’s executive director, said it was almost impossible to mobilise six units of blood to carry out one of the peculiar cases, which required blood group O negative.
“Any patient we operate at the heart institute requires at least six units of blood,” Dr Omangino said.

Despite handling a sensitive commodity, the UBTS director indicated that their account for reagents and other supplies at National Medical Stories also remains inadequate.
In an interview last week, Dr Dorothy Kyeyune-Byabazaire, the director of UBTS, told Daily Monitor that the Shs197 million budget cut on fuel is likely to cripple their day-to-day blood collection activities across the country.
She said their woes started following expiry of a $2 million (about Shs7.2 billion) donor support from US President’s Emergency Plan for Aids Relief (PEPFAR).

“Our operational budget is a challenge, like in this financial year, they [Health ministry] removed Shs197 million for fuel yet our activities depend on transport. So we don’t know how we are going to manage because we still have a deficit caused by the end of PEPFAR donation,” Dr Kyeyune said.
She added: “We have to collect blood every day and our vehicles need to be serviced. In fact, we are going to see the Ministry of Health permanent secretary this week because we are not going to fit in this budget,” Dr Kyeyune noted.
She said they would also meet Dr Diana Atwine, Ministry of Health permanent secretary, to discuss blood usage measures and avert shortage.

When contacted, Dr Atwine said UBTS should work with the resources available.
“We can only work with what we have,” she said in a text message.
Once the Health ministry fails to find funds to bridge this gap, Dr Kyeyune warned, majority of clients, largely anaemic children due to malaria, pregnant mothers with delivery complications, road traffic victims, cancer patients and heart patients, may be denied a lifesaving transfusion.
On a daily basis, Dr Kyeyune said, UTBS needs 1,200 units of blood to meet the ever-increasing transfusion demand.

“As you know there is no alternative to blood, there is no factory that can manufacture blood, so the only source of blood is a human being. People should know that if they don’t give blood, it will not be available in the hospitals,” she added.

When Daily Monitor visited Nakasero Blood Bank recently, Mr Ezra Musisi, the laboratory supervisor, said they had about 250 units ready to be used. But he indicated the stock reduces depending on the hospital demands, both public and private.
At around 6pm, this reporter found about five ambulances preparing to rush the lifesaving commodity to health facilities across the country.

“Blood demand these days is so high and this is seen from Monday to Saturday. Sunday is the only day when there is no demand,” Mr Musisi said.
When someone donates blood, Dr Kyeyune said, it is taken to the Bank under cold-chain maintenance where it is stored before being subjected to World Health Organisation (WHO) mandatory screening for HIV, hepatitis B and C and syphilis.
“After testing, we prepare what we call blood components; we prepare platelets for cancer patients, paediatric red blood cells, three packs for children each with 60 millitres because children don’t need a lot of blood,” she said.

According to WHO, all blood donations must be screened for evidence of infection prior to the release of the blood and its components for clinical or manufacturing use.
“All patients requiring transfusion should have reliable access to safe blood products, including whole blood, labile blood components and plasma-derived medicinal products, appropriate to their clinical needs, provided in time and safely administered,” the WHO recommends.

The WHO recommends that every country collects blood units equivalent to 1 per cent of its total population. But Dr Kyeyune said the funding challenges have not allowed them to meet the 1 per cent of the required blood.
She, however, said Uganda’s target is to collect 260,000 units of blood per year since the country has not yet started to perform daily surgical procedures such as liver and kidney transplants.
She said more amounts would be needed when Mulago Hospital starts carrying major operations such as kidney and liver transplant.
“Two hundred and sixty thousand units of blood are enough to carry out small transfusion procedures. If we are a population of 38 million, we would need about 380, 000 units of blood,” Dr Kyeyune said.

Wasted
Of the total blood collected by UBTS, Dr Kyeyune indicated that about 10 per cent is discarded due to the four infections and other factors, including its weight and expiry. She indicated that blood has a lifespan of 35 days outside the human body.
“We discard about 10 per cent of the blood due to infections and bags that are not properly filled or when some has expired,” she said.
However, she said UBTS upholds high safety standards for blood transfusion.

“Most of our blood donors are regular donors and we screen these donors. We have a health questionnaire where people are supposed to answer truthfully because donation is voluntary,” Dr Kyeyune added.
She revealed that many Ugandans are blood group “O”, standing at about 48 per cent of the donated blood annually.
“We get a lot of blood group ‘O’ but all the other groups are important despite ‘O being a universal donor. It can give to other groups,” she said, adding that blood group ‘O’ can be used in an emergency situation.

On the scarcity of platelets, she said the blood component is hard to find since platelets are processed from fresh blood.
“The shelf-life of platelets is five days as opposed to normal blood whose shelf-life is about 35 days, so we can’t keep it for a long time,” she adds.
In the Bank, blood is stored between 2 to 8 degrees centigrade and needs a constant power supply to maintain the cold chain, platelets are stored at room temperature, explaining why they have a shorter lifespan and plasma is stored at -30 degree centigrade in order to be viable.

Blood access
Dr Kyeyune also said the blood donors with cards should be given priority in hospital whenever they are in need of blood.
“Blood is not for sell and that is why we give it out to hospitals and immediately go to collect another blood,” she said.
However, she said there are negative tendencies where hospital personnel are creating artificial shortages to take advantage of patients.

Through a toll free line, the Nakasero Blood Bank director encouraged members of the public to report whoever sells blood.
“According to the health policy in Uganda, blood is free like any other medical services even our labels indicate that, whoever sells blood should be reported and reprimanded,” she warned.
She asked hospitals to always store their blood in cold-chains powered with constant power to avoid wastages.
Although the institution would require an annual budget of Shs22b to effectively operate at optimum capacity, government currently contributes about Shs15b annually.
In April, UTBS entered a partnership with two specialised communications agencies to launch a countrywide blood donation a campaign aimed at raising 30,800 blood units by end of July.

Situation

Financial crisis: UBTS director Dorothy Kyeyune-Byabazire,
said their woes started following expiry of a $2 million (about Shs7.2 billion) donor support from US President’s Emergency Plan for Aids Relief (PEPFAR).

Blood units: On a daily basis, Dr Kyeyune said, UTBS needs 1,200 units of blood to meet the ever-increasing transfusion demand.

About blood

Eight blood types. Although all blood is made of the same basic elements, not all blood is alike. In fact, there are eight different common blood types, which are determined by the presence or absence of certain antigens –substances that can trigger an immune response if they are foreign to the body. Since some antigens can trigger a patient’s immune system to attack the transfused blood, safe blood transfusions depend on careful identification of blood types and cross-matching.

ABO blood group system. There are four major blood groups determined by the presence or absence of two antigens – A and B – on the surface of red blood cells:
Group A – has only the A antigen on red cells (and B antibody in the plasma)
Group B – has only the B antigen on red cells (and A antibody in the plasma)
Group AB – has both A and B antigens on red cells (but neither A nor B antibody in the plasma)
Group O – has neither A nor B antigens on red cells (but both A and B antibody are in the plasma)
Source: Uganda Blood Transfusion Service