|Year : 2019 | Volume
| Issue : 1 | Page : 63-67
Pattern of blood procurement and utilization in a university hospital in Southeast Nigeria
Chide Okocha1, Ann Abiola Ogbenna2, Nkiru Ezeama3, John Aneke1, Theodora Ezeh1
1 Department of Haematology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
2 Department of Haematology, College of Medicine, University of Lagos, Lagos State, Nigeria
3 Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
|Date of Web Publication||14-May-2019|
Dr. Chide Okocha
Department of Haematology, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State
Source of Support: None, Conflict of Interest: None
Background: Blood is a scarce commodity and every effort needs to be made to use it judiciously and avoid wastage. This study reviewed the pattern of blood procurement, ordering, and utilization at a hospital-based blood bank. Materials and Methods: This was a retrospective study in which data on blood procurement methods, pattern of requisition of blood, and outcome of issued blood were obtained from blood bank registers over a 2-year period at the Nnamdi Azikiwe University Teaching Hospital blood bank. Results: Approximately, 99% of donors were family replacement donors. In 2014, total blood donated was 4003 which exceeded the request for red blood cell (RBC) transfusion by 921 units. The highest request for blood was from the accident and emergency and 90% of blood issued were used. Overall percentage wasted of RBCs was 19.8% and the major contributors to these were antenatal clinic and labor ward both having 80% and 55.8% issued blood returned to blood bank unused. Conclusion: The proportion of wasted units of RBC is high. Designing and adhering to maximum blood ordering schedule and blood transfusion guidelines with efforts toward converting family replacement donors to voluntary blood donors will help in maintaining a steady supply of safe blood.
Keywords: Blood donors, transfusion-transmittable infections, wastage
|How to cite this article:|
Okocha C, Ogbenna AA, Ezeama N, Aneke J, Ezeh T. Pattern of blood procurement and utilization in a university hospital in Southeast Nigeria. Ann Trop Pathol 2019;10:63-7
|How to cite this URL:|
Okocha C, Ogbenna AA, Ezeama N, Aneke J, Ezeh T. Pattern of blood procurement and utilization in a university hospital in Southeast Nigeria. Ann Trop Pathol [serial online] 2019 [cited 2019 May 25];10:63-7. Available from: http://www.atpjournal.org/text.asp?2019/10/1/63/258169
| Introduction|| |
Globally, the demand for blood or blood component transfusion is ever increasing either due to increasingly sophisticated surgical procedures, traumatic injuries, cancer care, obstetric complications, blood-related disorders, and many medical advances requiring blood transfusion for patient survival. The supply of blood is, however, often not commensurate to its demand, especially in the developing countries. The average donation rate in Africa is 4.3 donations/1000 populations which are 10 times less than it is in the developed countries, and in 2006, the WHO reports showed that only 41.5% of demand for blood was met.,
Ten donations per a 1000 population is required to meet a nation's blood supply demand. At our current level of healthcare delivery in Nigeria, an estimated 1.5 million units of blood is required annually, howbeit at the present donation rate of 0.2 donations/1000 population, this cannot be met., This implies that available blood must be used judiciously to avoid wastage. Many studies have looked at waste that comes from overordering leading to unnecessary crossmatch with minimal utilization.,,,, This includes waste of technical time, reagent, and unnecessary cost to the patient. However, real wastage of blood can be incurred when crossmatched blood is actually dispatched from the blood bank and subsequently returned unused to the bank. Timely availability of blood in health-care facilities is essential for patient survival; therefore, a very robust blood transfusion service with efficient strategies for blood procurement and mechanisms for reducing blood wastages is critical to the attainment of quality healthcare delivery.
This study aimed to review the methods of blood procurement, pattern of demand, and the effective use of blood in the blood transfusion service of the Nnamdi Azikiwe University Teaching Hospital (NAUTH) to provide recommendations for improvement.
| Materials and Methods|| |
This study was a retrospective review of blood bank records of NAUTH Nnewi for a 2-year period from January 2013 to December 2016. The information collected included donor data which included sex, age, blood group, type of donor, hematocrit of donors, and Transfusion-Transmitted Infections (TTI) status of donated blood. Information on blood transfusion request, units from which request were made, units of red blood cells (RBCs) issued, and the units of RBCs returned unused were retrieved from blood bank registers.
Ethical approval was obtained from the Hospital Ethics and Research Committee. Strict confidentiality was maintained throughout the research as participants' names were represented by initials alone and unauthorized persons were not allowed access to information of study that may reveal the identity of any of the participants. In addition, information gathered from this research was not used for any other purpose aside to increase the body of knowledge on the subject matter of the research and possibly to enable policy formulation that will further improve blood availability and safety in Nigeria.
Data management and analysis
Details of participants were stored in a computer, access to which was limited to the researchers, or other duly authorized persons Statistical Package for the Social sSciences, SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc. and Microsoft Excel computer software were used for all data analyses. Descriptive and inferential statistics were used as appropriate to show the patterns of blood procurement and utilization in the hospital within the study period.
| Results|| |
The study reviewed the data in blood bank over a 2-year period from January 2013 to December 2014. A total of 6689 pints of blood was donated over the 2 years. The median age of the donors was 25 years (interquartile range: 22–32) with a male-to-female ratio of 8:1. The majority (66.1%) of donors was blood group O positive and 98.8% were family replacement donors. The mean packed cell volume of donors was 0.41 ± 0.03 L/L [Table 1]. The proportion of male donors was significantly higher in 2014; however, there was no significant change in types of donor in the 2 years studied [Table 2].
|Table 2: Comparing the demographic characteristics of donors in 2013/2014|
Click here to view
The prevalence of TTIs was HIV (0.38%), hepatitis B surface antigen (HBsAg) (0.65%), hepatitis C virus (HCV) (0.41%), and Venereal Disease Research Laboratory (0.21%) [Table 3]. The rate of seropositivity for HIV, HBsAg, HCV, and syphilis was significantly higher in 2014 compared to 2013 [Table 3].
|Table 3: The prevalence of Transfusion-Transmitted Infections (TTI) among donors in 2013/2014|
Click here to view
The total blood request was 5868 over the 2 years. The number of units of blood donated increased by almost 50% from 2013 to 2014. In 2013, request outnumbered supply. However, in 2014, the blood supply was sufficient for the request [Table 4]. Approximately, 80% of blood requested was used, 19.8% were returned to the blood bank unused in median time of 2.27 h from the time of dispatch [Table 5]. The demand for blood type O Rhesus D positive was the highest [Table 6]. The highest request (51.5%) for blood was from the emergency unit; accident and emergency (A/E) accounting for 32.4%, children emergency room 5.4%, and labor ward 13.7% [Table 7]. The highest proportion of unused blood returned to the blood bank was from antenatal clinic (ANC) (80.0%), labor ward (55.5%), and surgery outpatient (SOP) (54.5%). However, regarding numbers, the labor ward had the highest number of blood units (446) returned to the blood bank unused. The longest median time for the return of unused blood to blood bank was from the ANC (12.03 h), followed by SOP (9.02 h) [Table 7].
|Table 5: Status of blood requested and dispatched in 2013/2014: used or returned to blood bank unused|
Click here to view
|Table 7: Proportion of blood returned by various units and time to return|
Click here to view
| Discussion|| |
The provision of safe blood is a major component of modern medicine and the goal of every blood procurement program is to have 100% voluntary donors. However, in this study, we found that 98.8% of the donors were family replacement. Despite this, the prevalence of transfusion-transmittable infections (TTI) was still low. The overall prevalence of seropositivity for HIV, HBsAg, HCV, and syphilis was 0.38%, 0.65%, 0.41%, and 0.21%, respectively. These are quite lower than most reported prevalence of TTI documented among blood donors in Nigeria;,,,,,,, furthermore, the reported prevalence of HIV among blood donors varies from one geographical location to another and may reflect the prevalence rate in each region. Similarly, low prevalence of HIV among blood donor has also been reported in Yola (0.7%) and Port-Harcourt (0.45%) Aside from Port-Harcourt, these two cities are in states with one of the lowest HIV prevalence (<2%). Earlier studies in Nnewi support this low prevalence of TTI among blood donors. Howbeit, an increase in the prevalence of HIV in blood donor was noted in this study from 0% in 2013 to 0.66% in 2014. This may be related to the usage of a comprehensive questionnaire for screening of blood donors which was stopped in 2013. Pointing to the fact that proper donor selection is very important in controlling TTI.
Global prevalence of anti-HCV is estimated at 1.6%. However, the prevalence among blood donors is diverse ranging from 0.1 in England  to as high as 19% in Egypt. The higher prevalence of HCV in Egypt is probably a reflection of the prevalence in its general population. Egypt has the highest prevalence (17.5%) of HCV in the world. In Nigeria, documented prevalence of HCV among blood donors varies from 0.86% in Ife, to 2.4% in Yola, 5.71%–6% in Benin and Jos,, and as high as 8.0% in Ibadan. These donor prevalence of HCV also reflect the general prevalence in the various states  as affected by the prevalent lifestyle in that area. The highest request for blood was from the A/E, and the majority of blood issued to this unit was used.
RBC component wastage in hospitals has been reported to range from 0.1% to 25%., Eighty-seven percentage of these wastages were from blood units issued out but not transfused. In the present study, approximately 20% of blood units issued out were returned unused with a median time of return of 2.27 h. This median time far exceeds the “30 min rule” which states that RBC left out of control temperature storage for more than 30 min should not be returned to storage for reissue. This implies that 1350 units of blood will have been wasted over the review period. Current policies in the hospital blood bank, however, are to inspect all returned blood which has been stored in household refrigerators for lyses and puncture. If these are absent, blood bags are returned to the bank and subsequently reissued. Although this “30 min rule” has been challenged by several studies,,, the fact still remains that the longer RBCs are kept out of optimal temperature of 2°C–6°C the higher the risk of bacterial contamination. Blood is an excellent milieu for bacteria growth, and hence strict temperature control is essential to avoid bacterial contamination and hence the likelihood of adverse blood transfusion reactions.
The department with the highest proportion of blood returned unused and the longest mean time to return is Obstetrics (ANC = 80% and labor ward = 55.8%). Meantime to return of blood from ANC being approximately 12 h. This may suggest a lack of blood ordering schedule and probably absence or lack of adherence to hospital guidelines on blood transfusion. The long median time to return of unused blood to the blood bank may also be due to dependency on household refrigerators available in various units for storage. However, these refrigerators cannot provide optimum temperature-controlled storage for RBC.
| Conclusion|| |
The prevalence of TTIs among blood donors is low which reflects the state prevalence. It can be kept low by reintroducing proper donor selection using appropriate questionnaires. However, there is a high probability that donated blood may be wasted which will impact the negatively on blood transfusion services in the hospital.
It is recommended that maximum blood ordering schedule for each unit in the hospital be designed and disseminated to relevant personnel. Hospital policy on RBC issuing and time to return of unused blood should also be developed and adhered to. Attempts should be made at converting family replacement donors to voluntary donors.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization and International Federation of Red Cross and Red Crescent Societies. Towards 100% Voluntary Blood Donation a Global Framework for Action. Geneva: World Health Organization; 2010. p. 123.
Tapko JB, Toure B, Sambo LG. Status of blood safety in the WHO African Region: Report of the 2010 Survey. Brazzaville, Republic of Congo: World Health Organization. Regional Office for Africa; 2014.
Federal Ministry of Health. Nigerian National Blood Policy Revised November 2005. Abuja; 2006.
Ebose EM, Osalumese IC. Blood shortage situation: An audit of red blood cells order and pattern of utilization. Afr J Biotechnol 2009;8:5922-5. Available from: http://www.academicjournals.org/AJB
. [Last accessed on 2018 May 18].
Musa A, Hassan AA, Kilishi A, Kwaifa I, Ndakotsu M. Pattern of blood transfusion request and utilization at a Nigerian university teaching hospital. Sahel Med J 2014;17:19. Available from: http://www.smjonline.org/text.asp?2014/17/1/19/129149
. [Last accessed on 2018 May 25].
Raghuwanshi B, Pehlajani NK, Sinha MK, Tripathy S. A retrospective study of transfusion practices in a tertiary care institute. Indian J Anaesth 2017;61:24-8.
] [Full text]
Deb P, Swarup D, Singh MM. Audit of blood requisition. Med J Armed Forces India 2001;57:35-8.
Fasola FA, Kotila TR, Shokunbi WA. Audit of the red cell units supply of a busy hospital blood bank in Nigeria. Niger J Clin Pract 2009;12:165-8.
] [Full text]
Fasola FA, Kotila TR, Akinyemi JO. Trends in transfusion-transmitted viral infections from 2001 to 2006 in Ibadan, Nigeria. Intervirology 2008;51:427-31.
Damulak OD, Bolorunduro SA, Egesie JO, Jatau ED, Yakubu RK, Godit P, et al
. Discordant sero-positive HIV antigen/antibody assays among voluntary blood donors in North Central Nigeria. IJMBR 2013;1:15-20.
Motayo BO, Faneye AO, Udo UA, Olusola BA, Ezeani I, Ogiogwa JI, et al.
Seroprevalence of transfusion transmissible infections (TTI), in first time blood donors in Abeokuta, Nigeria. Afr Health Sci 2015;15:19-24.
Buseri FI, Muhibi MA, Jeremiah ZA. Sero-epidemiology of transfusion-transmissible infectious diseases among blood donors in Osogbo, South-West Nigeria. Blood Transfus 2009;7:293-9.
Dirisu JO, Alli TO, Adegoke AO, Osazuwa F. A survey of prevalence of serum antibodies to human immunodeficiency deficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among blood donors. N
Am J Med Sci 2011;3:35-8.
Olokoba A, Tidi S, Salawu F, Danburam A, Desalu O, Abdulraham M, et al.
Human immunodeficiency virus infection in voluntary blood donors in North-Eastern Nigeria. Am J Sci Indian Res 2010;1:435-8. Available frrom: http://www.scihub.org/AJSIR
. [Last accessed on 2018 Jul 05].
Okocha E, Aneke J, Ezeh T, Ibeh N, Nwosu G, Okorie I, et al
. The epidemiology of transfusion-transmissible infections among blood donors in Nnewi, South-East Nigeria. Afr J Med Health Sci 2015;14:125. Available from: http://www.ajmhs.org/text.asp?2015/14/2/125/170183
. [Last accessed on 2018 Jul 05].
Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 2014;61:S45-57.
Petrik J, Hewitt P, Barbara J, Allain J. Large-scale HCV RNA screening in first-time blood donors: The first step towards genomic screening of blood donations. HCV RNA Screening Study Group. Vox Sang 1999;76:159-62.
Saeed AA, Fairclough D, Al-Admawi AM, Bacchus R, Al-Raseed AM, Waller DK.
High prevalence of HCV-antibody among Egyptian blood donors. Ann Saudi Med 1991;11:591-2.
Karoney MJ, Siika AM. Hepatitis C virus (HCV) infection in Africa: A review. Pan Afr Med J 2013;14:44.
Salawu L, Bolarinwa RA, Adegunloye AB, Muraina HA. HBsAg, anti-HCV, anti-HIV and VDRL in blood donors: Prevalence and trends in the last three and a half years in a tertiary health care facility in Ile-Ife, Nigeria. Int J Med Med Sci 2010;2:335-41. Available from: http://www.academicjournals.org/ijmms
. [Last accessed on 2018 Jul 16].
Dapus DO, To P, De J, Aa O, Sd K, Godit P, et al
. Hepatitis C virus antibody among blood donors: The experience in a Nigerian blood transfusion service centre. Glo Adv Res J Med Med Sci 2013;2:108-13.
Heitmiller ES, Hill RB, Marshall CE, Parsons BJ, Berkow LC, Barrasso CA, et al.
Blood wastage reduction using lean sigma methodology. Transfusion 2010;50:1887-96.
Kurup R, Anderson A, Boston C, Burns L, George M, Frank M, et al.
Astudy on blood product usage and wastage at the public hospital, Guyana. BMC Res Notes 2016;9:307.
Thomas S, Hancock V, Cardigan R. The 30 minute rule for red blood cells:In vitro
quality assessment after repeated exposure to 30 C. Transfusion 2013;53:1169-77.
Ramirez-Arcos S, Mastronardi C, Perkins H, Kou Y, Turner T, Mastronardi E, et al.
Evaluating the 4-hour and 30-minute rules: Effects of room temperature exposure on red blood cell quality and bacterial growth. Transfusion 2013;53:851-9.
Brunskill S, Thomas S, Whitmore E, McDonald CP, Dorée C, Hopewell S, et al.
What is the maximum time that a unit of red blood cells can be safely left out of controlled temperature storage? Transfus Med Rev 2012;26:209-23.e3.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]