Why we are not collecting enough blood

Sometime back, a colleague posted on one of the social networks, how he had responded quickly to a plea by Francis Kitonsa’s family that was in dire need of blood at IHK to save his life.

In his own words, Simon Musaasizi, a journalist, posted thus; “Face book has made me save a life. Francis Kitonsa’s family posted on Facebook that he is in IHK intensive care unit in urgent need of blood. Kitonsa just like me, belongs to a rare blood group called O negative.

That in 100 people, you find ...only two or three people of this group. That perhaps is why i was given special attention by Dr. Annet at the Uganda Blood Bank. She abandoned whatever she was doing when she heard that I am O negative.

In fact, she said I should guard myself jealously. My blood was written on Francis and taken straight to the lab. Francis has so far received eight units of blood, but needs more. That the blood bank has exhaustively called all O negative people around Kampala and now making calls upcountry. If you belong to this blood group, kindly go save Kitonsa’s life.”

The distressed family had no alternative but to appeal to well-wishers on social media to come to their rescue. Most unfortunately, Kitonsa died days later.

This is one of a number of cases of the patients that die as a result of blood shortage in the country, which has remained a challenge because of various reasons.
So just how much blood is adequate to meet the country’s demand? According to Ms Dorothy Kyeyune, the director of Nakasero Blood Bank, the major facility, which operates through seven regional blood banks, the question regarding how much blood is needed cannot be answered by the blood agency since hospitals have failed to quantify what they need.

“If you ask them how much blood they need, they will not tell you. We however estimate that what is required depends on how much blood they have used. We can then budget accordingly. We also estimate according to the previous usage,” Kyeyune says.

While the question of how much blood health centres need remains debatable, she explains that blood unlike other products, is fragile by nature, and cannot be stored for a long time since it expires in 35 days. With such a short shelf life, the agency cannot stock much of it as it may expire.

“That’s why we cannot overstock it… And why we have to keep collecting and issuing it out. If we collect so much, it will expire and this is a big dilemma for us.

And remember no factories manufacture blood so it is up to us to ask Ugandans to donate voluntarily. Also, it is given to us free of charge so the donors do it reluctantly,” she says.

Shortages during holidays
The blood shortage is experienced more during vacation, according to Dr Steven Aisu, the director and head of Central Public Health Laboratories, since they get more of it largely from students.

The reason students are their largest donor group, is because their age group tend to have low percentages of positivity for HIV, Hepatitis B, Hepatitis C and Syphilis. Such blood from infected people is not used.

“During those long vacations is when we get a big shortage. That is when we resort to open gatherings to pick blood although about 20 per cent of it is disposed of,” says Dr Aisu.
The blood bank collects about 220,000 units of blood a year although about 250,000 units are needed annually.

According to World Health Organisation standards, however, the country needs at least 300,000 units of safe blood annually to meet the minimum requirement. Also, about 1,200,000 testing kits are needed per year.

A kit is used to test blood to determine its group and for transfusion of transmissible infections, including HIV, Syphilis and Hepatitis B and C.

Mulago hospital alone needs not less than 50 units of blood on hand daily, and elsewhere only health centre IVs qualify to receive the blood since there have facilities like functional theatres, a doctor and cold storage units. According to Kyeyune, there is a remarkable improvement in the blood collections since 10 years ago [in 2003] they were supplying only 100,000 units.

According to a study conducted last year by the White Ribbon Alliance, Uganda Chapter, in the 12 Health Centre IVs in the districts of Kabale, Lira and Mityana, none of the centres provides blood transfusions. This was mainly due to unreliable facilities such as power, to enable proper blood storage, lack of laboratory staff, reagents and supplies, among others.

“Stock outs of crucial drugs to prevent postpartum haemorrhage were reported at five out of 43 health centres. There is also frequent power shut down and some have no power back-ups.

Post mortem haemorrhage or excessive bleeding is the leading cause of maternal deaths in the country,” notes Farida Luyiga Mwanje, the communications expert at White Ribbon Alliance.

The shortage is also created as a result of increased number of complex therapies, for instance heart surgeries, chemotherapy and organ transplants, which require large amounts of blood.
“The heart surgery and cancer patients are increasingly taking blood followed by orthopaedic traffic accidents and HIV patients,” noted Dr Kyeyune.

Going by the demand, Kyeyune says they meet at least 90 per cent of all the hospitals’ demand. “But it depends on the emergencies.”
Dr Aisu explains that blood is usually enough save for those with blood groups that are hard to find, such as O negative.

Blood on standby
“There is always blood on standby in the emergency fridges and one which is booked before an operation can be conducted.

This blood can be accessed anytime whether it’s during day or in the night. The anticipated need is usually huge,” remarked Aisu. For those in groups hard to find, the blood bank keeps records of the donors who are contacted in case of emergencies. He factors in the challenge of inadequate funding contributing to blood shortage. He argues that blood is very expensive in terms of screening and processing.

Processing a unit of blood until its ready for use is estimated to cost about $40 (about Shs100,000), says Kyeyune.

The process requires re-agents bought from the National Medical Stores. Also, getting blood from Nakasero to other centres especially rural health centres is expensive as ambulances are required. Some shortages according to a source, are created by some corrupt health officials, who sometimes charge desperate patients money after convincing them there is not enough blood at the bank.

The government has given the blood bank an extra Shs2.3b on top of what they received last year to improve on blood collections and they are hopeful the gap shall be bridged.

BLODD SAVED MY LIFE

Perhaps until you have come close to a situation demanding blood, you might not be able to understand the importance of having enough blood in the reserves.

Rebecca (not her real names) is one of those who is now appreciative of that fact. Rebecca who lost her child while giving birth at Mulago hospital about four years ago, says if the hospital did not have enough blood in stock, she would be history.
“I waited for three days for labour pains to progress in vain and when I was induced, my baby could not make it and the doctors had no option but to save my life. I was bleeding profusely but because I am a blood group B, I was transfused and within four hours, I had stabilised,” she says.

On the whole, blood transfusion saves lives of incalculable Ugandans particularly women and children, which is why the government needs to direct more resources to the blood bank to enable the field teams operate efficiently and swiftly in the process of collecting blood.

The health bosses’ plea is to people to donate blood. They appeal to the media to encourage people above the age of 18 to donate blood every day.

This, they say should be a responsibility of everybody because it only comes from human beings. As you save someone’s life today, your very life could as well be saved in future.

THE NUMBERS

220,000: The number of blood units the blood bank collects a year although about 250,000 units are needed annually.

300,000: The number of safe blood units uganda needs annually to meet the minimum requirement according to who standards.

100,000: The cost in shillings of Processing a unit of blood until it is ready for use.

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