Building capacities in research for blood services in Africa

BackgroundCapacity building of African based blood services researchers has been identified as key in developing a sustainable programme of generation local evidence to support sound decision making. There are a number of research training programmes that have been instituted targeted at blood services in Africa. The article shares programme experiences of building research capacities for blood services in Africa.MethodologyThe Francophone Africa Transfusion Medicine Research Training network, the NIH REDS-III and NIH Fogarty South Africa programmes and T-REC (Building transfusion research capacity in Africa) have been the key research capacity programmes targeting blood services in Africa over the last decade. To understand their experiences on the implementation of the capacity building programmes, data were drawn from research outputs, publications and end of programme reports. The success, challenges and the main research outputs from their initiatives were highlighted.ResultsThe Francophone research network achievements included more than 135 trainees and in excess of 30 publications. The NIH REDS study the achievements included more than 12 research publications with South Africa junior investigators as lead authors. The NIH Fogarty program currently includes 56 short course trainees, 5 Masters and 6 PhD candidates. The four year (2011-2015, funding period) T-REC programme produced more than 20 publications, 4 PhDs, 42 in-service Diploma in Project Design and Management (DPDM), and supported bursaries for 60 Masters/undergraduate research. The main common challenges in the running of the research programmes include shortages of in-country mentoring and identified needs in high quality research grants writing.Discussion and conclusionThe key achievements for the blood services research capacity building include a mix of short courses, medium-term (epidemiology & biostats) and MS/PhD degree training. Also, having a "train the trainers' programme to develop in-country mentors has been instrumental. Overall, the key recommendations for blood services research capacity building include the need for research collaborations with high-income countries which can jump-start research,and for more in-country grant-writing capacity building, which would help sustainability.     

Towards a safe and sufficient blood supply in Sub‐Saharan Africa

Most countries in Sub‐Saharan Africa (SSA) are either low‐income or low‐middle income countries, that is countries whose gross national income per capita is $995 (USD) or less or $996–3895, respectively. Added to this, they have very few health care professionals specifically trained in transfusion medicine and are the countries whose populations have a high prevalence of transfusion‐transmissible agents (especially HIV, hepatitis B and malaria) and whose patients (women haemorrhaging at birth, men in motor vehicle or motorcycle accidents, children with malaria or sickle cell anaemia) are often in urgent need of blood transfusion. This combination of few resources, both financial and human, combined with many potential donors at risk of transmitting infection and patients with urgent transfusion requirements renders the provision of a safe and adequate blood supply in SSA extremely challenging. In this review, we will discuss the current literature addressing how these challenges are being met and present one example of a SSA national blood transfusion service, the Uganda Blood Transfusion Service.     

Use of whole blood as the routine transfusion product in Africa

In many countries in sub‐Saharan Africa (sSA) whole blood is more commonly available from blood transfusion services than red cell concentrates. Although in recent years, many countries have made significant progress in the implementing component preparation, this has largely been facilitated by external funding support. The large majority of rather than none of the sSA countries are leucocyte‐reducing or irradiating blood for transfusion. Systems for the routine detection of adverse consequences of blood transfusions (haemovigilance) only exist where transfusion safety has been identified as a health priority by the government. As a resource, the availability of blood transfusion in these countries is limited since less than 5 units of blood were donated per 1000 population far below the recommended requirement of 20 units/1000 per year. Young children are the main users of blood for transfusion in these sSA regions, largely due severe anaemia secondary to infection and sickle cell anaemia. Outcomes for children with severe anaemia are poor, even in those receiving a transfusion. Although it has been speculated that this may be due to transfusion‐related cardiac or pulmonary events, available data from observational studies and clinical trials indicate that these are rare complications of transfusion. Evidence from clinical physiology studies including those examining myocardial functions before and after the receipt of whole blood provide reassuring evidence that volume overload is rare and clinical trials reporting outcomes in children receiving whole blood transfusion, including a Phase II trial examining higher volumes, indicate that there is no evidence of cardiac or pulmonary overload events.     

Frequencies and ethnic distribution of ABO and RhD blood groups in the Volta region of Ghana,towards effective blood bank services

BackgroundBlood is an essential body fluid for the transport of substances to all parts of the body. Knowledge of blood group distribution within any population is important in determining the direction of blood bank inventory for emergency blood services.ObjectiveWe report for the first time the blood group distribution pattern for the Volta region of Ghana.MethodData were extracted and analyzed from 14,360 medical records of blood donors and recipients at seven major hospitals within the Volta region for a period of seven years (2012 to 2018)ResultsABO distribution within the region was 46.3%, 18.9%, 24.4%, 3.1%, 4.4%, 1.7%, 1.3% and 0.1% for O+, A+, B+, AB+, O-, A-, B- and AB- blood groups respectively. Rh (D)+ to Rh (D)- ratio was 92.5/7.5% respectively. Blood group O+ (>35 %) was highest in all ethnic groups in the region.ConclusionHealthcare facilities in the region should adopt a strategy to stock-pile sufficient O+ blood which is the prevalent blood group in the region. All types of blood groups were reported hence our findings should provide information to guide clinical practice and/or blood transfusion services in the region.     

Differences in the genotype frequencies of genes related to blood pressure regulation - a comparative study between South-West Europe and Peri-equatorial Africa

BackgroundSince the emergence of the genus Homo, hominids have occupied a wide variety of environments, facing different selective pressures.ObjectivesThe aim this study is to compare genotype frequencies between South-West Europe and Peri-equatorial Africa in genes potentially modulators of blood pressure.MethodsThe analyzed sample consisted of 325 individuals from Portugal and 226 individuals from Africa (48 from Mozambique and 178 from São Tomé and Príncipe). The following genetic variants were analyzed: intron 4 VNTR in eNOS, rs1050829 in G6PD, -3.7kb α-thalassemic deletion in HBA, rs1800457 in CYB5R3, Hp 1/2 genotype/phenotype in Hp and intron 16 I/D in ACE.ResultsFrequencies of genotypes with the 4a allele in eNOS (p<0.001), the G allele in G6PD (p<0.001), the α-3.7 kb in HBA (p <0.001), the C allele in the CYB5R3 (p<0.001) were higher in Peri-equatorial Africa. The Hp 1.1 genotype of Hp has a higher frequency in Peri-equatorial Africa (p=0.002). ACE shows no significant differences.ConclusionResults show differences in five genetic variants. Conditions of extreme heat and humidity, characteristic of Peri-equatorial Africa, have been associated with increased sodium loss. This study suggests that selected compensatory mechanisms printed in the genome, are nowadays risk factors for hypertension in Peri-equatorial Africa.     

Transfusion and sickle cell anemia in Africa

Sickle cell anemia (SCA) is the commonest life-threatening genetic disorder in tropical regions, particularly in sub-Saharan Africa. It has been estimated that between 50–90% of SCA children will die in Africa before the age of 5, corresponding to a number of 150,000–300,000 annual SCA child deaths, which represents 5–10% of total child mortality. Transfusion support remains an essential component in the management of patients with SCA and has made a significant contribution to improving patient morbidity and mortality. In Africa where the majority of patients with SCA reside, many blood transfusion challenges remains, including shortage of blood supplies, risks related to infectious and immunologic potential side effects and limitation on the diagnosis and management of post-transfusion iron overload. The proportion of transfused SCA patients varies from different studies, between 30% and 90%. This variation can be related to environmental factors, disease genetic factors and other factors including the low availability of blood, difficulties in accessing to health care and inadequacies of the transfusion system. Because blood transfusion therapy is an integral component of the management of SCA, improved efforts and strategies to overcome these challenges and optimize blood transfusion practices are needed in African countries.     

血袋中的还原物质对袋装全血质量的影响研究

血袋袋体中的还原物质在血袋保存血液制品的过程中会逐渐析出到血液制品中,还原物质的积累会影响血液制品的质量.为了研究血袋中析出的还原物质对袋装全血质量的影响,本文选择还原物质含量不同的血袋采集志愿者全血,在保存初期、保存中期、保存后期分别测试每个血样血细胞数量、pH值、钠离子、钾离子浓度和血浆血红蛋白.结果表明,还原物质使袋装全血的白细胞和血小板的数量减少,钾离子浓度和游离血红蛋白浓度增加,而红细胞数量、pH值、钠离子浓度变化较小.     

Developing blood services in the Philippines

The goal of achieving reforms in the Philippine healthcare system has moved our government to push regulations in all key areas. With the objective of ensuring access to safe, quality and affordable blood products, improved facilities and services, the transfusion system in the Philippines is now in focus. Hence, the issuance of several administrative memos to guarantee the achievement of an effective blood service network in the country.     

Challenges in critical care services in Sub-Saharan Africa: Perspectives from Nigeria

Critical care services in Nigeria and other West African countries had been hampered by economic reversals resulting in low wages, manpower flight overseas, government apathy towards funding of hospitals, and endemic corruption. Since then things have somewhat improved with the government''s willingness to invest more in healthcare, and clampdown on resource diversion in some countries like Nigeria. Due to the health needs of these countries, including funding and preventive medicine, it may take a long time to reach reasonably high standards. Things are better than they were several years ago and that gives cause for optimism, especially with the debt cancellation by Western nations for most countries in the region. Since most of the earlier studies have been done by visiting doctors, mainly outside the West African subregion, this paper seeks to present a view of the challenges faced by providers of critical care services in the region, so that people do not have to rely on anecdotal evidence for future references.     

Challenges in transfusion-transmitted infection screening in Sub-Saharan Africa

In Sub-Saharan Africa, high clinical demand for transfusion faces endemic bloodborne infections and limited resources. Blood screening for transfusion-transmitted bloodborne pathogens is the cornerstone of blood safety. Although there have been substantial improvements over the years, challenges in transfusion-transmitted infection screening that have been identified repeatedly long ago still need to be addressed. Affordability and sustainability of state-of-the-art quality assessed serological and molecular assays, and associated confirmation strategies remain of real concern. In addition, limited resources and infrastructures hamper the development of adequate facilities, quality management, and staff qualification, and exacerbate shortage of reagents and equipment maintenance. It is also important to maintain effort in constituting pools of repeat voluntary non-remunerated donors. Alternative strategies for blood screening that take into account local circumstances might be desirable but they should rely on appropriate field evaluation and careful economic assessment rather than dogma established from high-resource settings.     

Towards equitable and sustainable availability of blood products in Zimbabwe: An analysis of strengths,weaknesses, opportunities and challenges

Blood transfusion can be a lifesaving intervention in a number of medical emergencies. To attain sustainable and equitable availability of blood products, it is important to understand the strengths, weaknesses, opportunities, and challenges of the national blood services programme. We, therefore, with this letter to the editor, discuss some of the strengths, weaknesses, opportunities and threats to the Zimbabwean programme since its inception. Despite several strengths and opportunities that the national blood services of Zimbabwe (NBSZ) leverages on, we argue that among other challenges, donor shortages and an upsurge of transfusion transmittable infections in the eligible donor population continue to be the biggest threats to the achievement of the programme objectives. These can be addressed through expanding the blood donor base and the catchment area. Additionally, improving the level of knowledge and attitude towards blood donation in the communities is critical for driving the sustainable and equitable distribution of safe blood products to the population.     

Artificial blood

Artificial blood is a product made to act as a substitute for red blood cells. While true blood serves many different functions, artificial blood is designed for the sole purpose of transporting oxygen and carbon dioxide throughout the body. Depending on the type of artificial blood, it can be produced in different ways using synthetic production, chemical isolation, or recombinant biochemical technology. Development of the first blood substitutes dates back to the early 1600s, and the search for the ideal blood substitute continues. Various manufacturers have products in clinical trials; however, no truly safe and effective artificial blood product is currently marketed. It is anticipated that when an artificial blood product is available, it will have annual sales of over $7.6 billion in the United States alone.     

Effect of the principal blood components on lung surfactant

The action of the principal blood components on surface activity of substrates containing lung surfactant was investigated. Mixing blood hemolysate, serum, albumin, and fibrinogen with extracts and washings from the lungs, application as a monolayer, or their injection into the hypophase of a monolayer of washings increased the surface tension (ST) of these substrates. Hemoglobin, serum lipids, and cholesterol had the opposite action. Contact of all these blood components, exhibiting opposite effects on ST of medium containing surfactant, with bubbles from the lungs during determination of their coefficient of stability (CS), by Pattle's method, led to an increase in CS.Department of Pathological Physiology, Karaganda Medical Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR P. D. Gorizontov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 88, No. 12, pp. 648–650, December, 1979.     

Role of heating in non-invasive blood pressure measurements in rats

The “tail-cuff technique for indirect blood pressure measurements was standardized, with respect to heating, in experiments on 47 adult Sprague-Dawley rats. The direct, intra-arterial, and the indirect blood pressures were simultaneously obtained. Pulse volume was recorded from the tail by a non-invasive technique, and was controlled by gradual application of heat. It was found that pulse volume and body temperature were poorly related. A stable relation existed, however, between the error in the indirect blood pressure recordings and the pulse volume. The error was minimized, provided that the heating was adjusted to induce a pulse volume of at least 25% of the maximum obtainable value. It was suggested that the validity of the indirect blood pressure recording could be improved, if heat application was regulated on the basis of observations of pulse volume in the tail instead of ambient temperature or body temperature. Errors due to excessive vasoconstriction, or discomfort due to overheating could thereby be minimized.     

The economics of blood transfusion in the 21st century

In the coming years, blood banking will face a number of big challenges in which economic analysis may help find the optimal solution. Pressures to curb cost increases without reducing perceived quality will shift the emphasis from excellence to efficiency. The financial incentive structure that allows costly but low effective technologies to be widely adopted will need to be revised and reshaped. This will require introducing regulated competition between blood suppliers and a closer alignment between the decisions on enforcing new safety measures and the economic consequences of the decisions. On the other hand, if blood shortages become more frequent and severe, as predicted by some experts, property rights on human blood will need to be assigned and fairly compensated, what will require resolving first the ethical issue that accompanies remunerated blood donation. Finally, availability at the bedside of an effective and safe blood substitute will help alleviate blood shortages, but may also profoundly disturb the very way blood banks finance their operations.