Medical workers wasting blood, say health experts

Health researchers said patients who do not require blood transfusion and those not tested to determine their need, are being transfused in hospitals, a vice they warn may endanger patients’ lives and waste the scarce resource. 

Uganda is currently collecting around 320,000 units of blood annually, an amount, which the Health Ministry says is 30 percent below the estimated requirement of 450,000 units for managing patients who require it.

 “Sometimes health workers are transfusing unnecessarily,” Dr Aggrey Dhabangi, a transfusion physician and lecturer at Makerere University Medical School said in an interview on Monday in Kampala. “If you are anemic you can die so, we sometimes give you blood, but a blood transfusion is not 100 percent safe.”

Dr Dhabangi warned that unnecessary blood transfusion should be avoided because there are “adverse outcomes” that can come from a transfusion. “If I give you blood, it is not water, and it is blood from another donor. We sometimes get acute transfusion reactions because the body is getting something foreign. The idea is to minimise the need for transfusion to minimise the associated risks,” he added.

His argument is reinforced by a 2018 research report by Prof Robert Opoka of Makerere University Medical School and colleagues on Lira and Jinja regional referral hospitals. The report was published in the scientific journal BMC Health Services Research.

The researchers found that blood transfusions for more than half of children admitted at the facilities and transfused between June 2016 and May 2017 were “given inappropriately” and that children transfused appropriately following the standard criteria “had lower inpatient mortality compared to those transfused inappropriately, 2.9 percent versus 7.2 percent”.

“Overall, 574/2,275 (25.2 percent) of the children admitted in the two hospitals were assigned a diagnosis of severe anemia (SA). However 551 (95.9 percent) of children assigned a diagnosis of SA received a blood transfusion, accounting for 551/560 (98.4 percent) of the blood transfusions in the paediatric wards,” read the report in part.

It added: “Of the blood transfusions in SA children, only 245 (44.5 percent) was given appropriately per criteria (Pre-transfusion Haemogloblin (Hb) less than or equal to 6 g/dL), while 306 (55.5 percent) was given inappropriately; (pre-transfusion Hb not done, number=216, or when a transfusion is not indicated [Hb greater than 6.0 g/dl], n=90).” 

The threshold for blood transfusion, the researchers note in the report, is when the level of Hb, an essential component of blood responsible for carrying oxygen, has reduced to six grams per deciliter (6g/dL). The normal Hb level for males is 14 to 18 g/do and that of females is 12 to 16 g/do.

Dr Dhabangi spoke in an interview in Munyonyo. He is among the scientists, government officials and researchers attending the 11th Africa Society for Blood Transfusion (AfSBT) Congress, a conference that is running from March 4-7  in Munyonyo, Kampala.

The theme of the conference is “Adopting Global Innovations and Technology Advancements in Blood Transfusions.” The ministry said the knowledge shared in the conference would help address many of the “challenges” in blood transfusion.”

Addressing journalists at the conference on Monday, Dr Jane Ruth Aceng, the Health minister, noted that although Uganda has made a lot of improvement in transfusion services, there is still much to do in increasing the number of blood banks and quantity of blood collected, among others. 

“We are not yet there. But we shall get there eventually. A lot of blood is used in this country, but also, a lot of blood is wasted in various ways,” she said. 

Dr Aceng added: “We have situations that demand a lot of blood. For the last three years, we have had a lot of strain on blood transfusion services because of the malaria epidemic, especially in eastern Uganda. But the road traffic accidents, which are also close to malaria in terms of mortality, take a lot of blood as well.”

She observed that some of these diseases and events can be prevented. “This congress will see us towards safer blood, more [blood] collection, and more [blood] products other than what we know,” she added.

Dr Mohammed Farouk, the AfSBT managing director, said Uganda has made significant progress in improving its blood transfusion services. 

“Uganda managed to achieve step two certification at the AfSBT which was a great achievement and I know the team at Uganda Blood Transfusion Service is working hard to achieve the step three, which is full accreditation,” he said. 

This is part of the Stepwise Accreditation programme born in 2009, which the AfSBT directors identified as a “practical, methodical way through which the blood transfusion services in Africa could be directed, monitored and measured”.

On the other hand, Dr Dhabangi, a transfusion physician who also works at Uganda Blood Transfusion Service, also noted that there is a need to increase awareness among health workers on the appropriate use of blood.

“We need to advocate for patient blood management. For example, if a mother has fibroids and they need to be worked on, you [the doctor] have options of building their blood before the operation without using transfusion. You can give iron tablets or a drip of iron. Build their blood and it takes a few weeks,” he said.

The expert said in this way when the woman with fibroids goes to the operation room, she would have a good amount of blood to reduce health risks related to surgery. 

“Your need for transfusion and risk of death will be much lower,” he added.

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