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There is not enough blood to cater for the country’s needs

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A woman donates blood at Umeme offices in Industrial Area... One must be 18 years and above to be able to donate blood. PHOTOs BY Faiswal Kasirye 

By ANGELA NAMPEWO

Posted  Monday, September 1  2014 at  11:08

In Summary

History of blood donation and keeping. Blood is one of the most sought for body fluids in this country, and yet, it can be hard to find. In this series, Angela Nampewo, Mercy Nalugo, Ali Mivule, Brian Mutebi and Faiswal Kasirye explore the blood situation in this country. The first part of the series looks at the history of blood donation and keeping in this country.

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As long as we have blood running normally through our veins, we don’t give much thought to its purpose or the effect of its absence in our bodies. Blood is the red fluid that circulates in our blood vessels, that is, veins and arteries. This fluid acts as the body’s transport system, but it also has a major role in the body’s defense against infection.
Below, we look at the reserves the country has and how we got there.

How do we get blood?
According to statistics from World Health Organisation, around 108 million units of donated blood are collected globally every year. Nearly 50 per cent of these blood donations are collected in high-income countries, home to less than 20 per cent of the world’s population.
WHO also recognises that adequate and reliable supply of safe blood can be assured by a stable base of regular, voluntary, unpaid blood donors. These have proved to be the safest group of donors as the prevalence of blood borne infections is lowest among them.
Separating blood into its various components allows a single unit of blood to benefit several patients and provides a patient only the blood component which is needed. WHO states that about 95 per cent of the blood collected in high-income countries, 80 per cent in middle-income countries and 45 per cent in low-income countries is separated into blood components. Here is how it works.
Whole blood is unseparated blood collected into an approved container containing an anticoagulant-preservative solution.
A blood product is any therapeutic substance prepared from human blood.
The preparation of blood components allows a single blood donation to provide treatment for two or three patients and also avoids the transfusion of elements of the whole blood that the patient may not require.
“We collect whole blood from donors but we wish patients to receive only that part of the blood they need,” explains Dr Dorothy Kyeyune-Byabazaire, the director of Uganda Blood Transfusion Services.
In Uganda’s blood collection centres, several products are extracted from blood including; red blood cells, plasma, platelets and cryoprecipitate.
Red blood cell concentrates are mostly given to children while platelets are prepared mostly for cancer patients.
Plasma is the liquid portion of your blood that transports water and nutrients to your body’s tissues. Plasma is given where a patient needs to replace volume.
With the exception of the red cell concentrates, the rest of the products are prepared on order, for example platelets which have a five-day shelf life, are prepared for the cancer institute and bleeding patients.
Whole blood can be transfused to replace red cells in acute bleeding such as in case of accidents and also when there is a need to correct hypovolaemia, which, according to the online encyclopaedia, Wikipedia, is a state of body shock resulting from decreased blood volume, more specifically a decrease in volume of blood plasma.
Common causes of hypovolaemia include; loss of plasma as happens in the case of severe burns, external or internal bleeding and loss of body sodium and consequent intravascular water; e.g. diarrhea or vomiting.

History of blood transfusion in Uganda
The Uganda Blood Transfusion Services (UBTS) is a semi-autonomous centrally coordinated organisation in the Ministry of Health. It is the national body responsible for all blood safety activities in Uganda. UBTS enables surgeons and other medical professionals to offer units of blood that save patients’ lives. UBTS originated in 1957 and for 20 years, supplied all necessary blood to Ugandan hospitals.
During the 1970s and 1980s, civil strife and war led to insufficient equipment maintenance and eventual lack of blood supplies. Before 1989, all blood transfusion services had fragmented. Transfusions were then hospital based.
Until 1987, before blood could be tested for transfusion transmissible infections (TTI), blood transfusion was entirely hospital-based and blood donors were recruited from among patients’ relatives.
Those who had no relatives did not benefit from this life saving therapy and many lives were lost. With the advent of HIV and also due to increasing cases of accidents, it was no longer possible to call up patients’ relatives on short notice to donate blood.
According to UBTS and information from Centers for Disease Control and Prevention, the European Commission funded the rehabilitation of Uganda’s central blood bank in 1987 but, when that funding ended in 2004, the UBTS had not reached optimal operational capacity.
It was against this background that the European Union working in partnership with the Uganda Blood Transfusion Services and the Aids Control Programme undertook to support the revamping of the blood safety programme. EU supported the blood programme for 15 years since 1989.
“In 2004, UBTS started getting funding from PEPFAR. We are trying to move away from hospital-based blood banks to purpose-built blood banks,” says Dr Dorothy Kyeyune-Byabazaire, the director of Uganda Blood Transfusion Services.
WHO has determined that for a country to be self-sufficient in blood supply, the total amount of units of blood collected must amount to no less than the equivalent of one per cent of its population.
For Uganda’s population of 34 million therefore, it is estimated that the country would require an annual collection of at least 340,000 units of blood to meet the national clinical requirements for transfusion of blood and blood products.
UBTS currently distributes blood and blood products to all transfusing public and private health facilities and in the financial year ended 2012/13, a total of 203,286 units of blood, against a target of 242,000 units was collected and issued.
With the current level of blood collection, Uganda can hardly cater for the blood requirements of even a tenth of its population.

How blood works in the body

On average, a human being needs to have five litres of blood coursing through their veins on a regular basis. Typically, a healthy person can endure a loss of 10 to 15 per cent loss of the total blood volume (half to three quarters of a litre) without serious medical difficulties. For instance, a blood donation takes eight to 10 per cent of the donor’s blood volume.
However, if one’s blood volume amount drops by a litre or more, a person’s life will hang in the balance. A whole litre less and death is inevitable, if a transfusion is not done within a few hours’ time. That is how important blood is. More importantly, it has no substitute for blood. It cannot be made or manufactured. Donors are the only source of blood for patients who need it.

Numbers

108m
The number of units of blood collected globally every year.

1957
The year in which uganda blood transfusion services started work.

First recorded transfusion was done on dogs

1628: British physician William Harvey discovers the circulation of blood. The first known blood transfusion is attempted soon afterward.

1658: Microscopist Jan Swammerdam observes and describes red blood cells.

1665: The first recorded successful blood transfusion occurs in England: British physician Richard Lower keeps a dog alive by transfusing blood from other dogs. Lower bled a dog almost to death and then revived the animal by transfusing blood from another dog via a tied artery.

1667: Jean Baptiste Denis in France and Richard Lower and Edmund King in England separately report successful transfusion from sheep to humans. Denis who was physician to King Louis XIV, performed the transfusion of blood from an animal to a human. Denis transfused the blood from a sheep to a 15-year old boy and later to a labourer, both of whom survived the transfusions.

1818: British obstetrician James Blundell performs the first successful transfusion of human blood to a patient for the treatment of postpartum hemorrhage.

1901: Karl Landsteiner, an Austrian physician, discovers the first three human blood groups..

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