NoBlood

Jan B. Wade · #1 (**permalink**) 10-14-2004, 11:58 AM

http://allafrica.com/stories/printable/200410140027.html

Is Blood Transfusion Dying Out?

The Nation (Nairobi)
NEWS
October 14, 2004 </B>
Posted to the web October 14, 2004

By Victor Bwire
Nairobi

The current blood shortage in the country will continue and even get worse as demand rises and donors get fewer and fewer.

To put this into perspective, at any given day, there are about 10 patients waiting for blood transfusion at Kenyatta National Hospital's gynaecology ward alone.

Doctors at the hospital say almost half of cases requiring blood transfusion are either cancelled or postponed everyday because of lack of blood. And it is the same in all public hospitals across the country.

Patients have to stay in the wards for longer than necessary because blood for transfusion is not commonly available. The blood transfusion unit receives about 566 requests for transfusion every week but only 300 units are donated per week. Thus, in one month the hospital requires 2,264 units of blood to meet the needs of the service provider. The blood transfusion unit is only able to issue 260 units of blood per week, thus covering only 50 per cent of the requirement.

The department of obstetrics and gynaecology alone puts in 150 requests for blood. Out of this only 60 units are provided and these are for the most needy of the cases.

But this, says Dr Njoroge Gichuhi, head of department of obstetrics and gynecology at the hospital, can only get worse because the blood catchment areas are becoming fewer. Traditionally blood donation is not a very popular event in Kenya. Now with the advent of HIV, this problem has been further compounded.

The Armed Forces and the prisons had been the main sources of blood in most parts of this country. The result of all this has been a drastic reduction of the blood donor pool. Says Dr Njoroge Gichuhi: "That means patients die because of postponed operations rather than lack of blood. In this case their relatives are usually unable to link blood scarcity with the deaths."

To save lives and counter the dwindling blood donation levels, medical experts call for a radical, urgent and decisive action on the part of both the government and the private sector.

The advent of HIV/Aids has also had a negative response from recipients of blood. Even in the US, considered to have the safest blood supply, opinion surveys have it that a full one-third of the public disagrees with official statements that "the blood supply is safe" and that they would agree to accept blood transfusion if hospitalized."

The lack of enough blood in the banks, doubts over its safety and other clinical complications that could arise from a transfusion have kept up the search for ways to eliminate blood transfusions.

"It is not as if we have reached a cul-de-sac, there are several applicable and already tried alternatives to whole blood transfusions, but these must be adopted sooner than later," says a senior gynaecologist at KNH.

One area that has been identified as a possible candidate for newer technologies in 'bloodless medicine' is anaemia

Anemia is one of the major causes of admission or prolonged hospital stay which impact on hospital bills. Anemia occurs when the body isn't able to produce enough healthy red blood cells.

This can happen because of a deficiency of iron or certain other substances in the body or from inherited defects or diseases that interfere with the production of red blood cells

Iron is essential for the production of hemoglobin in red blood cells. Poor dietary iron intake (or excessive loss of iron from the body) leads to iron-deficiency anemia.

Blood loss such as that associated with schistosomiasis, hookworm infestation, hemorrhage in childbirth and trauma can also result in both iron deficiency and anemia.

There is now a greater awareness of the importance of preventing and treating anemia especially that related to iron-deficiency. New research suggests that this deficiency can be corrected with oral iron therapy, which is relatively safe and inexpensive.

However, for severe anaemia, blood transfusion has been the only way to correct the situation. But emerging issues of availability and safety of blood, points to a need to reduce blood transfusion. Diseases that can be transmitted through blood include HIV, hepatitis A, B, and C and malaria among others.

Clinicians now know that it is possible to help the body compensate for blood loss during surgery without the use of donor blood. For example, a number of approved pharmaceutical agents are used to treat or prevent anaemia. These mainly include parenteral iron and erythropoietin, which are typically used prior to surgery to stimulate the bone marrow's production of red blood cells. These same agents can be used after surgery to rebuild the red blood mass.

Using the experience gained in renal medicine, it is now possible to produce increased numbers of the patient's own red cells across surgery, during chemotherapy, after chronic blood loss and in immunosupression.

For those patients who for one reason or another have decided not to receive any blood transfusion, the use of a safe intravenous iron and recombinant human erythropoietin has proved to be very successful. Experience has shown that planned surgery and anaemia that may arise due to blood loss can be dealt with effectively by stimulating the production of red cells prior to or after surgery. Severe anaemia too can be treated with safe intravenous iron.

Intravenous iron has always been treated as potentially dangerous to the body. Many clinicians will recall having being told that intravenous iron is potentially dangerous. This is no longer true now that intravenous iron sucrose rather than iron dextran is used. It was Dextran in the old preparations that used to cause the dramatic anaphylactic shock.

Dr Ivor Cavill, senior lecturer, University of Wales medical school, cites cases where intravenous iron sucrose has been used widely and successfully in the Western world for more than 20 years without a single life-threatening incident. The alternatives to transfusion are often seen as impossibly expensive, after all blood is given freely.

What is not always appreciated is the huge cost of processing the blood and maintaining the bureaucracy of the National Blood Transfusion Unit. When the full cost of repeated transfusion to maintain a constant haemoglobin is taken into account, then the appropriate and judicious use of intravenous Iron Sucrose and erythropoietin will not only be more effective but safer and cheaper in the long run.

So when is blood transfusion absolutely necessary?

The limited supply of blood today available in the country should be reserved for those patients who must get a blood transfusion to save their lives such as accident victims, burn victims, gun-shot victims or those admitted to hospitals with severe anaemia but require other blood components too.

The use of safer alternatives for blood transfusion can be used for a larger group of patients, about 70 per cent, and thus avoid blood transfusion. By doing so, this would ensure that the blood bank has enough blood reserves in case of a major catastrophe such as the August 1998 bomb blast and the day to day road accidents.

Debate on whether blood transfusion has a future has been ongoing. It is generally agreed that it has but only in the medium term.

NoBlood

Nairobi - Is Blood Transfusion Dying Out?