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Kroeze S, Kootstra NA, van Nuenen AC, Rossouw TM, Kityo CM, Siwale M, Akanmu S, Mandaliya K, de Jager M, Ondoa P, Wit FW, Reiss P, Rinke de Wit TF, Hamers RL. Specific plasma microRNAs are associated with CD4 + T-cell recovery during suppressive antiretroviral therapy for HIV-1. AIDS 2024; 38:791-801. [PMID: 38300257 PMCID: PMC10994156 DOI: 10.1097/qad.0000000000003853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE This study investigated the association of plasma microRNAs before and during antiretroviral therapy (ART) with poor CD4 + T-cell recovery during the first year of ART. DESIGN MicroRNAs were retrospectively measured in stored plasma samples from people with HIV (PWH) in sub-Saharan Africa who were enrolled in a longitudinal multicountry cohort and who had plasma viral-load less than 50 copies/ml after 12 months of ART. METHODS First, the levels of 179 microRNAs were screened in a subset of participants from the lowest and highest tertiles of CD4 + T-cell recovery (ΔCD4) ( N = 12 each). Next, 11 discordant microRNAs, were validated in 113 participants (lowest tertile ΔCD4: n = 61, highest tertile ΔCD4: n = 52). For discordant microRNAs in the validation, a pathway analysis was conducted. Lastly, we compared microRNA levels of PWH to HIV-negative controls. RESULTS Poor CD4 + T-cell recovery was associated with higher levels of hsa-miR-199a-3p and hsa-miR-200c-3p before ART, and of hsa-miR-17-5p and hsa-miR-501-3p during ART. Signaling by VEGF and MET, and RNA polymerase II transcription pathways were identified as possible targets of hsa-miR-199a-3p, hsa-200c-3p, and hsa-miR-17-5p. Compared with HIV-negative controls, we observed lower hsa-miR-326, hsa-miR-497-5p, and hsa-miR-501-3p levels before and during ART in all PWH, and higher hsa-miR-199a-3p and hsa-miR-200c-3p levels before ART in all PWH, and during ART in PWH with poor CD4 + T-cell recovery only. CONCLUSION These findings add to the understanding of pathways involved in persistent HIV-induced immune dysregulation during suppressive ART.
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Affiliation(s)
- Stefanie Kroeze
- Amsterdam Institute for Global Health and Development
- Amsterdam UMC location University of Amsterdam, Department of Global Health
- Amsterdam UMC location University of Amsterdam, Laboratory for Experimental Immunology, Meibergdreef 9
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
| | - Neeltje A. Kootstra
- Amsterdam Institute for Global Health and Development
- Amsterdam UMC location University of Amsterdam, Department of Global Health
- Amsterdam UMC location University of Amsterdam, Laboratory for Experimental Immunology, Meibergdreef 9
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
| | - Ad C. van Nuenen
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
| | - Theresa M. Rossouw
- Department of Immunology, University of Pretoria, Pretoria, South Africa
| | | | | | - Sulaimon Akanmu
- Department of Haematology and Blood Transfusion, College of Medicine of the University of Lagos and the Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | - Pascale Ondoa
- Amsterdam Institute for Global Health and Development
- Amsterdam UMC location University of Amsterdam, Department of Global Health
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Ferdinand W. Wit
- Amsterdam Institute for Global Health and Development
- Amsterdam UMC location University of Amsterdam, Department of Global Health
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
- Stichting HIV Monitoring
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, The Netherlands
| | - Peter Reiss
- Amsterdam Institute for Global Health and Development
- Amsterdam UMC location University of Amsterdam, Department of Global Health
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tobias F. Rinke de Wit
- Amsterdam Institute for Global Health and Development
- Amsterdam UMC location University of Amsterdam, Department of Global Health
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
| | - Raph L. Hamers
- Amsterdam Institute for Global Health and Development
- Amsterdam UMC location University of Amsterdam, Department of Global Health
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, The Netherlands
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Albshri M, Manikandan P, Allahyani M, Aljuaid A, Almehmadi MM, Alzabeedi K, Babalgaith M, Alghamdi M, Alharbi F, Alhazmi M. The Prevalence of Transfusion-Transmitted Diseases Among Blood Donors in the Central Blood Bank in Makkah, Saudi Arabia. Cureus 2023; 15:e48881. [PMID: 38106789 PMCID: PMC10724763 DOI: 10.7759/cureus.48881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Background This study aimed to analyze the health and demographic characteristics of blood donors in Makkah, Saudi Arabia, and assess the prevalence and correlation of two markers related to hepatitis B infection: hepatitis B virus surface antigen (HBsAg) and anti-hepatitis B virus surface antibody (HBsAb). Materials and methods The study used a retrospective design and collected data from the Central Blood Bank in Makkah, Saudi Arabia, in 2022. The sample size was 7,875 blood donors. The study used various methods, such as serological testing, nucleic acid testing (NAT), and statistical analysis. The data were analyzed using Pearson correlation to examine the relationships between different variables. Results The predominant age group was 29-39 years, accounting for 46.9% of the total donors. In terms of blood types, O+ve was the most common, representing 40.3% of the donors. The investigation into infectious markers revealed overall low levels of reactivity among donors. For HBsAg, a marker of active hepatitis B infection, only 0.36% of the units were reactive. Conversely, the anti-HBsAb, which indicates immunity to hepatitis B, was reactive in 6.83% of the units. The correlation analysis illuminated some critical relationships. The total number of units tested had a statistically significant, albeit weak, positive relationship with HBsAg reactivity, shown by a Pearson correlation coefficient of 0.030 and a p-value of 0.008. Conversely, the total number of units tested and anti-HBsAb reactivity showed a moderate negative correlation, with a Pearson correlation coefficient of -0.437 and a p-value of less than 0.001. However, no significant correlation was identified between HBsAg and anti-HBsAb reactivity, indicating that active infection and immunity status might not be directly linked. Conclusion This extensive study provides in-depth insights into the sociodemographic characteristics of blood donors and the prevalence of key infectious markers within this population. It underlines the imperative of rigorous screening of blood units, particularly given the low immunity levels to hepatitis B identified. Also, the study showed the importance of screening blood units and vaccinating people against hepatitis B. It also suggested the need for more research on blood safety and infection-immunity relationships.
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Affiliation(s)
| | - Palanisamy Manikandan
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, SAU
| | - Mamdouh Allahyani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, SAU
| | - Abdulelah Aljuaid
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, SAU
| | - Mazen M Almehmadi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, SAU
| | - Kamal Alzabeedi
- Department of Clinical Biochemistry, The Regional Laboratory, Makkah, SAU
| | - Mohamed Babalgaith
- Central Blood Bank, General Directorate of Health Affairs, Makkah Region, Makkah, SAU
| | - Mosa Alghamdi
- Central Blood Bank, General Directorate of Health Affairs, Makkah Region, Makkah, SAU
| | - Faris Alharbi
- Central Blood Bank, General Directorate of Health Affairs, Makkah Region, Makkah, SAU
| | - Mohammed Alhazmi
- Central Blood Bank, General Directorate of Health Affairs, Makkah Region, Makkah, SAU
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Gadji M, Cobar G, Thiongane A, Senghor AB, Seck R, Faye BF, Seck M, Guéye YB, Sy D, Sall A, Toure AO, Diéye TN, Diop S. Red blood cell alloantibodies in paediatric transfusion in sub-Saharan Africa: A new cohort and literature review. EJHAEM 2023; 4:315-323. [PMID: 37206261 PMCID: PMC10188460 DOI: 10.1002/jha2.645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 05/21/2023]
Abstract
Blood transfusion support predisposes transfused children to the risk of erythrocyte alloimmunization in Sub-Saharan Africa. A cohort of 100 children receiving one to five blood transfusions were recruited for screening and identification of irregular antibodies using gel filtration technique. The mean age was 8 years and the sex-ratio at 1.2. The retrieved pathologies were: major sickle cell anaemia (46%), severe malaria (20%), haemolytic anaemia (4%), severe acute malnutrition (6%), acute gastroenteritis (5%), chronic infectious syndrome (12%) and congenital heart disease (7%). The children presented with haemoglobin levels ≤6 g/dl, and 16% of them presented positive irregular antibodies directed against the Rhesus (30.76%) and Kell (69.24%) blood group systems. A literature review shows that irregular antibody screenings vary from 17% to 30% of transfused paediatric patients in Sub-Saharan Africa. These alloantibodies are in particular directed against the Rhesus, Kell, Duffy, Kidd and MNS blood group and generally found in sickle cell disease and malaria. This study highlights the urgent need of extended red blood cell phenotyping including typing for C/c, E/e, K/k, and Fya/Fyb, and if possible Jka/Jkb, M/N, and S/s for children before transfusion in Sub-Saharan Africa.
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Affiliation(s)
- Macoura Gadji
- Service of Haematology and Oncology‐Haematology (HBOH)Department of Biology and Applied Pharmaceutical SciencesFaculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
- National Centre of Blood Transfusion (CNTS)DakarSenegal
| | - Guéda Cobar
- Service of Haematology and Oncology‐Haematology (HBOH)Department of Biology and Applied Pharmaceutical SciencesFaculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
- National Centre of Blood Transfusion (CNTS)DakarSenegal
| | - Alioune Thiongane
- Service of PaediatricsDepartment of Medicine, Hospital Albert Royer of FannFaculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
| | | | - Rose Seck
- National Centre of Blood Transfusion (CNTS)DakarSenegal
| | - Blaise Félix Faye
- National Centre of Blood Transfusion (CNTS)DakarSenegal
- Service of HaematologyDepartment of Medicine, Faculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
| | - Moussa Seck
- National Centre of Blood Transfusion (CNTS)DakarSenegal
- Service of HaematologyDepartment of Medicine, Faculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
| | | | - Diariétou Sy
- National Centre of Blood Transfusion (CNTS)DakarSenegal
| | - Abibatou Sall
- Service of HaematologyDepartment of Medicine, Faculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
| | - Awa Oumar Toure
- Service of HaematologyDepartment of Medicine, Faculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
- Service of BiologyHospital Aristide le DantecDakarSenegal
| | - Tandakha Ndiaye Diéye
- National Centre of Blood Transfusion (CNTS)DakarSenegal
- Service of ImmunologyDepartment of Biology and Applied Pharmaceutical Sciences Faculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
| | - Saliou Diop
- National Centre of Blood Transfusion (CNTS)DakarSenegal
- Service of HaematologyDepartment of Medicine, Faculty of MedicinePharmacy and Odonto‐Stomatology (FMPOS)University Cheikh Anta Diop of Dakar (UCAD)DakarSenegal
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Trauma provision in South-West Nigeria: Epidemiology, challenges and priorities. Afr J Emerg Med 2022; 12:276-280. [PMID: 35795816 PMCID: PMC9249585 DOI: 10.1016/j.afjem.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/04/2022] [Accepted: 05/26/2022] [Indexed: 11/20/2022] Open
Abstract
This article highlights the epidemiology of trauma and common challenges of trauma provision in the region. It elucidates the urgent need to improve trauma care in Nigeria and other African countries. Furthermore, it advocates for the development of a regionalised trauma system and centralised trauma registry amongst others.
Trauma is a crucial public health problem that has been overlooked by developing countries including Nigeria. It has led to a worsening trauma trend as recent data suggests. The South-West Region of Nigeria remains one of the regions with the most injury prevalence. Since the introduction of the trauma system over half a century ago, regionalised trauma systems have become increasingly effective in changing the dynamics of trauma care and outcomes. However, similar to most developing countries trauma system is yet to be established in any region in Nigeria. This is also met by a lack of a centralised trauma registry, poor implementation of primary prevention practices, an informal prehospital care system, and poorly organised in-hospital care for trauma victims. Reversing these challenges could be a propelling force to the revolution of trauma provision in the region and extension to the nation, Africa, and other developing countries. Nevertheless, the stakeholders such as the government, legislature, Non-Governmental-Organisations, law-enforcement agencies, healthcare institutions, trauma experts, and the public have a huge role.
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Ogbenna AA, Akinsete AM, Kalejaiye OO, Matthew OK, Sharma D, Andrews J, Kassim AA. Reduction in seroprevalence of viral transfusion-transmitted infections in southwest Nigeria in children with sickle cell disease using an enhanced screening strategy. Br J Haematol 2022; 198:745-752. [PMID: 35719004 DOI: 10.1111/bjh.18313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/17/2022] [Accepted: 06/03/2022] [Indexed: 11/28/2022]
Abstract
Blood transfusion is an integral component in the management of children and adults with sickle cell disease (SCD). Concerns about blood safety due to the high risk of bloodborne infections in sub-Saharan Africa limits the application of this cost-effective strategy in the management of individuals with SCD. In a single-centre, retrospective, longitudinal study in southwest Nigeria, we hypothesised that the use of stringent blood donor selection, along with very sensitive enzyme-linked immunosorbent assay (ELISA) screening methods would reduce transfusion-transmitted infections (TTIs). Among 45 002 eligible blood donors at the Lagos University Teaching Hospital in Nigeria, over a 5-year review period (2015-2019), the seroprevalence rate of viral TTIs was 9.83%. The seroprevalence rates for human immunodeficiency, hepatitis B, and hepatitis C viruses were 1.37%, 6.2%, and 2.25% respectively. Among 172 children with SCD, 71% (122/172) on regular blood transfusion and 29% (50/172) who had never been transfused or had less than two transfusions per lifetime, none acquired any TTIs using our enhanced screening approach during the study period. Thus, safe blood transfusion practices can be provided for children with SCD in sub-Saharan Africa with the use of stringent donor selection protocols and fourth-generation ELISA kits for TTI screening.
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Affiliation(s)
- Ann A Ogbenna
- Department of Hematology and Blood Transfusion, College of Medicine/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adeseye M Akinsete
- Division of Pediatric Hematology and Oncology, College of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufunto O Kalejaiye
- Department of Medicine, College of Medicine/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oyewole Kunmi Matthew
- Department of Hematology and Blood Transfusion, College of Medicine/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Deva Sharma
- Division of Transfusion Medicine and Pediatrics, Division of Hematology/Oncology, Departments of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer Andrews
- Division of Transfusion Medicine and Pediatrics, Division of Hematology/Oncology, Departments of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adetola A Kassim
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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6
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Oreh A, Bozegha T, Ihimekpen A, Biyama F, Irechukwu C, Aliu S, Oshiame D, Nnabuihe A, Ndanitsa A, Nnachi O, Ogbenna A, Abubakar S, Olupitan F, Akinkunmi A, Ogunlade C, Abayomi T, Omokaro U, Sylvester C, Igiebor U, Wokoma B, Ebophni S, Adewuyi B, Dachi R, Muhammad H, Abubakar M, Mgbang J, Chineke A, Ogbuabor O, Fakai G, Hashim B, Adeluwoye N, Olanrewaju D, Agahiu E, Etim E, Alabi S, Akinbola I, Anibueze C, Awogbami O, Edowhorhu G, Adekoya-Benson T, Bello S, Ojuade Y, Amedu O. Effect of the COVID-19 pandemic on blood donations and transfusions in Nigeria - A multi-facility study of 34 tertiary hospitals. Niger J Clin Pract 2022; 25:786-793. [PMID: 35708419 DOI: 10.4103/njcp.njcp_1437_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic affected blood supplies globally. Mobile blood drive campaigns halted, and voluntary blood donations reduced, challenging available blood supplies. Furthermore, fears of virus transmission led to deferrals of elective surgeries and non-urgent clinical procedures with noticeable declines in blood donations and transfusions. Aims We aimed to assess the effect of the COVID-19 pandemic on the number of blood donations and transfusions across the country by blood product type across various hospital departments. Materials and Methods A retrospective descriptive study was conducted to determine the impact of the COVID-19 pandemic on blood services in 34 tertiary hospitals in Nigeria, comparing January to July 2019 (pre-COVID-19) to January to July 2020 (peri-COVID-19). Data were collected from the country's web-based software District Health Information System, Version 2 (DHIS2). Results A 17.1% decline in numbers of blood donations was observed over the study period, especially in April 2020 (44.3%), a 21.7% decline in numbers of blood transfusions, especially in April 2020 (44.3%). The largest declines in transfusion were noted in surgery department for fresh frozen plasma (80.1%) [p = 0.012] and accident and emergency department transfusion of platelets (78.3%) [p = 0.005]. The least decline of statistical significance was observed in internal medicine transfusions of whole blood (19.6%) [p = 0.011]. Conclusions The COVID-19 pandemic significantly affected the numbers of blood donations and transfusions in Nigeria. Strengthening blood services to provide various blood components and secure safe blood supplies during public health emergencies is therefore critical.
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Affiliation(s)
- A Oreh
- National Blood Service Commission, Abuja, Nigeria
| | - T Bozegha
- National Blood Service Commission; National Hospital, Abuja; Federal Medical Centre, Asaba; Delta State University Teaching Hospital, Nigeria
| | - A Ihimekpen
- National Blood Service Commission, Abuja, Nigeria
| | - F Biyama
- National Blood Service Commission, Abuja, Nigeria
| | - C Irechukwu
- National Blood Service Commission, Abuja, Nigeria
| | - S Aliu
- National Blood Service Commission, Abuja, Nigeria
| | - D Oshiame
- National Blood Service Commission, Abuja, Nigeria
| | - A Nnabuihe
- National Blood Service Commission, Abuja, Nigeria
| | - A Ndanitsa
- National Blood Service Commission, Abuja, Nigeria
| | - O Nnachi
- Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - A Ogbenna
- University of Lagos Teaching Hospital (LUTH), Nigeria
| | | | - F Olupitan
- Lagos State University Teaching Hospital (LASUTH), Nigeria
| | - A Akinkunmi
- National Orthopaedic Hospital Dala, Kano, Nigeria
| | - C Ogunlade
- National Orthopaedic Hospital Igbobi, Lagos, Nigeria
| | - T Abayomi
- Federal Medical Centre, Owo, Nigeria
| | - U Omokaro
- University of Benin Teaching Hospital, Nigeria
| | - C Sylvester
- National Blood Service Commission, Abuja; Prof. Kelsey Harrison Hospital Port Harcourt, Nigeria
| | - U Igiebor
- Igbinedion University Teaching Hospital, Okada, Nigeria
| | - B Wokoma
- National Blood Service Commission, Abuja; University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - S Ebophni
- Braithwaite Memorial Specialist Hospital, Port Harcourt, Nigeria
| | - B Adewuyi
- Olabisi Onabanjo University Teaching Hospital, Nigeria
| | - R Dachi
- Abubakar Tafawa Balewa University Teaching Hospital, Nigeria
| | - H Muhammad
- University of Maiduguri Teaching Hospital, Nigeria
| | - M Abubakar
- Federal Medical Centre, Birnin Kudu, Jigawa, Nigeria
| | - J Mgbang
- National Blood Service Commission, Abuja; University of Uyo Teaching Hospital; University of Calabar Teaching Hospital; Federal Medical Centre, Yenagoa, Nigeria
| | - A Chineke
- Enugu State University Teaching Hospital, Parklane Enugu, Nigeria
| | - O Ogbuabor
- Enugu State University Teaching Hospital, Parklane Enugu, Nigeria
| | - G Fakai
- National Blood Service Commission, Abuja; Ahmadu Bello University Teaching Hospital; Usman Dan Fodio University Teaching Hospital, Nigeria
| | - B Hashim
- Federal Medical Centre, Birnin Kebbi, Nigeria
| | - N Adeluwoye
- National Blood Service Commission, Abuja; Bowen University Teaching Hospital, Ogbomoso, Nigeria
| | - D Olanrewaju
- Ambrose Alli University, Ekpoma; Irrua Specialist Hospital, Nigeria
| | - E Agahiu
- Nisa Premier Hospital, Abuja, Nigeria
| | - E Etim
- Federal Medical Centre, Yola, Nigeria
| | - S Alabi
- University of Ilorin Teaching Hospital, Nigeria
| | - I Akinbola
- Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomoso, Nigeria
| | - C Anibueze
- University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - O Awogbami
- National Blood Service Commission, Abuja; Ekiti State University Teaching Hospital, Nigeria
| | - G Edowhorhu
- Bowen University Teaching Hospital, Ogbomoso, Nigeria
| | | | - S Bello
- National Blood Service Commission, Abuja; Ekiti State University Teaching Hospital, Nigeria
| | - Y Ojuade
- National Hospital, Abuja, Nigeria
| | - O Amedu
- National Blood Service Commission, Abuja, Nigeria
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Abstract
INTRODUCTION Globally, haemorrhage is the leading cause of both maternal mortality and preventable trauma death. For patients suffering from haemorrhage, prompt blood transfusion can be life-saving; however, safe and sufficient blood is often lacking in low-resource settings (LRS). Autotransfusion (AT), in which the patient's own blood is collected and transfused back, is an established alternative to donor blood transfusions, although one that is primarily performed with advanced AT systems. Research on basic AT in LRS is scarce. Therefore, we aimed to consolidate all available information on the current use of basic AT in LRS and to identify AT techniques and devices described for use in such settings. DESIGN Scoping review. METHODS We systematically searched four key databases: PubMed, Web of Science, Global Health and Cochrane Library as well as several grey literature databases and databases of relevant organisations. The final search was conducted on 22 April 2019. We included all types of studies referring to any information on basic AT used or sought to be used in LRS, published in English and dated after 31 December 2008. We synthesised the data from the included studies, results were charted or summarised narratively. RESULTS Some 370 records were reviewed, yielding 38 included documents. We found a paucity of scientific evidence as well as contradictory information on the extent of AT use and that AT use is largely undocumented. The most commonly described indications were haemoperitoneum (primarily among obstetric patients) and haemothorax. We identified three AT techniques used in LRS. Additionally, two new devices and one filter are described for potential use in LRS. CONCLUSIONS Basic AT is practiced for certain obstetric and trauma indications. However, context-specific studies are needed to determine the technique's safety and effectiveness. Extent of use is difficult to assess, but our results indicate that basic AT is not a widely established practice in LRS. Future research should address the bottlenecks hampering basic AT availability. New AT devices for use in LRS are described, but their utility and cost-effectiveness remain to be assessed.
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Affiliation(s)
- Maria Palmqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Johan Von Schreeb
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Älgå
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Donor Blood Procurement, Safety, and Clinical Utilization: A Study of Blood Transfusion Services in a Tertiary Care Hospital in Nigeria. Anemia 2022; 2022:2622291. [PMID: 35340624 PMCID: PMC8947933 DOI: 10.1155/2022/2622291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background Donated blood is an essential component of the management of many diseases, and hospital-based blood banks in Nigeria are saddled with the responsibility of provision of safe blood and coordination of its appropriate utilization for patient care. Objective This study reviewed the extent to which the hospital blood transfusion service ensures adequate safe blood supply and utilization. Materials/Methods. This was a retrospective study of 2 years record of the blood bank service of Alex Ekwueme Federal University Teaching. Methods of donor blood procurement, transfusion transmissible infection status, the pattern of blood, and blood component usage across the hospital's clinical departments were evaluated. Statistical analysis was conducted using IBM SPSS, and data were presented as percentages. Fisher's tests were used to test significance, and p value <0.05 is significant. Results The highest proportion of donors was male family replacement donors aged 26–35 years (3634 (39.68%)) while total voluntary donors were 315 (2.65%). Hepatitis B had the highest seroprevalence 267 (2.22%) among blood-borne diseases screened. National Blood Transfusion Service (NBTS) supplied only 3 (0.03%) of total blood units used. The accident and emergency department had the highest proportion of persons who utilized whole blood; 4568 (99.96%). Conclusion The hospital blood bank relies heavily on family replacement donors with little or no assistance from the National Blood Transfusion Service. Family replacement donors have the highest risk of TTIs, and hepatitis B infection has the highest prevalence. The high cost of blood component therapy increases the need for whole blood.
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Oreh AC, Irechukwu C, Biyama F, Nnabuihe A, Ihimekpen A, Oshiame D, Bozegha T, Leo-Nnadi I, Izedonmwen O, Oga E, Suberu EJ, Odiabara K, Amedu OJ. COVID-19 impact on Nigeria's national blood service commission - Lessons for Low- and Middle-Income Countries (LMICs). Niger Postgrad Med J 2022; 29:6-12. [PMID: 35102944 DOI: 10.4103/npmj.npmj_720_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background In February 2020, Nigeria officially announced its first case of COVID-19. As numbers rose, government-led non-pharmaceutical interventions such as lockdowns, curfews, restrictions on mass gatherings and other physical distancing measures ensued, negatively affecting blood donor mobilisation activities. Objectives We aimed to assess the blood service activities across 17 National Blood Service Commission (NBSC) centres in Nigeria, including number of blood donations, mobile blood drives, blood units screened, screening outcomes, number of hospitals NBSC provided services to and number of blood units discarded over the study period. Materials and Methods A retrospective descriptive study was conducted to determine the impact of the COVID-19 pandemic on blood services in 17 NBSC centres in Nigeria, comparing from January-December 2019 (pre-COVID-19) to January-December 2020 (peri-COVID-19). Results Mobile blood donation drives declined by 100% in the first 2 months following government-imposed lockdowns, the number of all blood donations and voluntary blood donations declined by 9.8%. The number of blood units screened declined by 11.9%, while the number of blood units that screened positive for transfusion-transmissible infections reduced by 28.6%. Discarded blood units reduced by 3.1%, while a 32.6% increase was observed in the number of hospitals that NBSC issued blood for transfusion. Conclusions The COVID-19 pandemic affected NBSC operations in Nigeria. However, by strengthening hospital linkages and employing innovative strategies, NBSC ensured continuity of operations, thereby significantly managing the challenges of COVID-19 to voluntary blood donor recruitment and the availability of safe blood for transfusion.
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Affiliation(s)
- Adaeze Chidinma Oreh
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Christopher Irechukwu
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Felix Biyama
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Agatha Nnabuihe
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Andrew Ihimekpen
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Daniel Oshiame
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Tariere Bozegha
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Ijeoma Leo-Nnadi
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Omosigho Izedonmwen
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Elton Oga
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Eneye Jimoh Suberu
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Kingsley Odiabara
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
| | - Omale Joseph Amedu
- Department of Planning, Research and Statistics, National Blood Service Commission Headquarters, Abuja, Nigeria
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10
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David KB, Simfukwe K, Musa MB, Munharo S, Lucero-Prisno DE. Impact of COVID-19 on blood donation and supply in Africa. Afr J Lab Med 2021; 10:1408. [PMID: 34853778 PMCID: PMC8602960 DOI: 10.4102/ajlm.v10i1.1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 06/23/2021] [Indexed: 01/28/2023] Open
Affiliation(s)
- Kenneth B David
- Faculty of Pharmaceutical Sciences, Kaduna State University, Kaduna, Nigeria.,Hull York Medical School, University of Hull, Hull, United Kingdom
| | | | - Mohamed B Musa
- Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
| | - Steven Munharo
- Training and Research Unit of Excellence, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Don E Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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11
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Albagshi MH, Saad M, Aljassem AM, Bushehab AA, Ahmed NH, Alabbad MM, Omer N, Alhamad OA, Sultan TA, Bahgat S. Blood Demand and Challenges for Patients With Beta-Thalassemia Major in Eastern Saudi Arabia. Cureus 2021; 13:e17470. [PMID: 34603865 PMCID: PMC8475924 DOI: 10.7759/cureus.17470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 01/19/2023] Open
Abstract
Background β-thalassemia major is a hereditary disorder of hemoglobin (Hb) that results in defective Hb synthesis, leading to severe chronic anemia. The mainstay of its treatment is lifelong regular packed red cell transfusions associated with iron-chelating therapy. Globally, there is a gap between blood donation and the actual needs of the patients who depend on transfusion. Patients with β-thalassemia major are no exception and have limited access to regular and safe blood transfusions. This study aimed to assess the gap between the demand and supply of blood for transfusion-dependent patients with β-thalassemia major treated at the Hereditary Blood Diseases Center, Al Ahsa, Eastern Saudi Arabia. Methodology This was a retrospective, cross-sectional study conducted at the Hereditary Blood Disease Center, Al Ahsa, Saudi Arabia, including patient data from January 2017 to December 2019. We used Excel 365 from Microsoft Office 2016, version 1706. Results A total of 158 patients were on chronic transfusion. Of the total patients, 65% were adults, while the remaining 35% comprised the pediatric population. The total number of units requested and received during the three-year period was 14,509 and 9,530, respectively, indicating a gap of 4,979 (34%) units. The age of most of the units received was more than 14 days: 36% of those in 2017, 49.9% in 2018, and 61.5% in 2019. Rare blood groups and alloimmunization accounted for <8% of the patients. Prestorage filtration was the policy for all units. Conclusions There was a gap between the demand and supply of blood for patients with β-thalassemia major treated at our center. We suggest raising awareness regarding the high demands for fresh red blood cell components in patients with thalassemia major, encouraging voluntary blood donations, enhancing national blood-banking policies, and reducing the fragmentation of blood services to reduce the gap between demand and supply.
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Affiliation(s)
- Muneer H Albagshi
- Pediatric Hematology, Hereditary Blood Diseases Center, Al Ahsa, SAU
| | - Mona Saad
- Internal Medicine/Hematology, Hereditary Blood Diseases Center, Al Ahsa, SAU
| | | | | | - Noura H Ahmed
- Pediatrics, Hereditary Blood Diseases Center, Al Ahsa, SAU
| | | | - Nawal Omer
- Internal Medicine, Hereditary Blood Diseases Center, Al Ahsa, SAU
| | - Osama A Alhamad
- Medical Affairs, Hereditary Blood Diseases Center, Al Ahsa, SAU
| | - Tarig A Sultan
- Integrative Medicine, Hereditary Blood Diseases Center, Al Ahsa, SAU
| | - Samy Bahgat
- Blood Bank, Maternity and Children Hospital, Al Ahsa, SAU
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12
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Obi E, Diette-spiff C, Omunakwe H. Knowledge and practices of physicians on blood component therapy: a cross-sectional study from two tertiary hospitals in Nigeria. Afr Health Sci 2021; 21:1230-1236. [PMID: 35222586 PMCID: PMC8843283 DOI: 10.4314/ahs.v21i3.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Comprehension of blood component therapy (BCT) has profound impact on transfusion outcomes. Variations from the standards in practices of BCT may jeopardize patient care. AIM To assess the understanding and implementation of BCT by physicians. METHODS The study was carried out at two tertiary health care centres. It was a descriptive cross-sectional study using a self-administered, questionnaire comprising of 30 questions. RESULT A total of 265 physicians responded from various clinical specialties. Physicians studied showed remarkable knowledge (98%) of BCT. Nevertheless, 92.8% of the respondents' were inclined to prescribing whole blood and the commonest reason given was ready availability at the blood bank. More than half of the respondents' have prescribed BCT with sedimented red cells and platelet concentrates being the most frequently prescribed blood components. Non-availability of blood components and cost implications were some of the identified limitations to the use of BCT. CONCLUSION Majority of the physicians have a good knowledge concerning BCT. Nonetheless, there was a knowledge-practice mismatch attributable to the unavailability of the various blood components limiting optimal practice of BCT. Strategies should be formulated to overcome these identified challenges to ensure quality transfusion services in our healthcare facilities.
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Affiliation(s)
- Esther Obi
- Federal Medical Centre, Yenagoa, Haematology and Blood Transfusion
| | | | - Hannah Omunakwe
- Rivers State University Teaching Hospital, Dept of Pathology
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13
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Cooper CE, Bird M, Sheng X, Choi JW, Silkstone GGA, Simons M, Syrett N, Piano R, Ronda L, Bettati S, Paredi G, Mozzarelli A, Reeder BJ. Stability of Maleimide-PEG and Mono-Sulfone-PEG Conjugation to a Novel Engineered Cysteine in the Human Hemoglobin Alpha Subunit. Front Chem 2021; 9:707797. [PMID: 34381760 PMCID: PMC8350135 DOI: 10.3389/fchem.2021.707797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022] Open
Abstract
In order to use a Hemoglobin Based Oxygen Carrier as an oxygen therapeutic or blood substitute, it is necessary to increase the size of the hemoglobin molecule to prevent rapid renal clearance. A common method uses maleimide PEGylation of sulfhydryls created by the reaction of 2-iminothiolane at surface lysines. However, this creates highly heterogenous mixtures of molecules. We recently engineered a hemoglobin with a single novel, reactive cysteine residue on the surface of the alpha subunit creating a single PEGylation site (βCys93Ala/αAla19Cys). This enabled homogenous PEGylation by maleimide-PEG with >80% efficiency and no discernible effect on protein function. However, maleimide-PEG adducts are subject to deconjugation via retro-Michael reactions and cross-conjugation to endogenous thiol species in vivo. We therefore compared our maleimide-PEG adduct with one created using a mono-sulfone-PEG less susceptible to deconjugation. Mono-sulfone-PEG underwent reaction at αAla19Cys hemoglobin with > 80% efficiency, although some side reactions were observed at higher PEG:hemoglobin ratios; the adduct bound oxygen with similar affinity and cooperativity as wild type hemoglobin. When directly compared to maleimide-PEG, the mono-sulfone-PEG adduct was significantly more stable when incubated at 37°C for seven days in the presence of 1 mM reduced glutathione. Hemoglobin treated with mono-sulfone-PEG retained > 90% of its conjugation, whereas for maleimide-PEG < 70% of the maleimide-PEG conjugate remained intact. Although maleimide-PEGylation is certainly stable enough for acute therapeutic use as an oxygen therapeutic, for pharmaceuticals intended for longer vascular retention (weeks-months), reagents such as mono-sulfone-PEG may be more appropriate.
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Affiliation(s)
- Chris E Cooper
- School of Life Sciences, University of Essex, Colchester, United Kingdom
| | | | | | | | - Gary G A Silkstone
- School of Life Sciences, University of Essex, Colchester, United Kingdom
| | - Michelle Simons
- School of Life Sciences, University of Essex, Colchester, United Kingdom
| | - Natalie Syrett
- School of Life Sciences, University of Essex, Colchester, United Kingdom
| | - Riccardo Piano
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luca Ronda
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Institute of Biophysics, National Research Council, Pisa, Italy
| | - Stefano Bettati
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Institute of Biophysics, National Research Council, Pisa, Italy
| | | | - Andrea Mozzarelli
- Institute of Biophysics, National Research Council, Pisa, Italy.,Department of Food and Drug, University of Parma, Parma, Italy
| | - Brandon J Reeder
- School of Life Sciences, University of Essex, Colchester, United Kingdom
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14
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Stroke and stroke prevention in sickle cell anemia in developed and selected developing countries. J Neurol Sci 2021; 427:117510. [PMID: 34077859 DOI: 10.1016/j.jns.2021.117510] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 02/02/2023]
Abstract
This comprehensive review provides an insight into the pathophysiology, epidemiology, evaluation, and treatment of sickle cell anemia (SCA)-related stroke in developed and developing countries. Vascular injury, hypercoagulability and vaso-occlusion play a role in the pathophysiology of stroke in SCA. Transcranial Doppler ultrasound (TCD) has lowered the incidence of ischemic stroke from 11% to 1% as TCD identifies children who are at risk for stroke, providing opportunities for interventions to reduce this risk. Whereas blood exchange is indicated in acute stroke, chronic transfusions (either simple or exchange on a monthly basis) are used for primary as well as secondary stroke prevention in developed countries. Children with abnormally high TCD velocities (≥ 200 cm/s) are at high risk of stroke and might benefit from hydroxyurea or hydroxycarbamide (HU) after a period of a successful transition from chronic transfusions. Hematopoietic stem cell transplant presents a cure for SCA. Gene therapy is currently investigated and may be offered to patients with SCA who had a stroke or who are at high risk of stroke if proven efficacious and safe. However, gene therapy is not likely to be implemented in low-income countries due to cost. Alternatively, HU is utilized for primary and secondary stroke prevention in developing countries. Further expansion of TCD implementation should be a priority in those settings.
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15
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Malu AO, Achinge GI, Utoo PM, Kur JT, Obekpa SA. Prevalence of Hepatitis B Surface Antigen and Antibodies to Hepatitis C in the General Population of Benue State, Central Nigeria. Am J Trop Med Hyg 2020; 102:995-1000. [PMID: 32043452 DOI: 10.4269/ajtmh.19-0649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
There have been various estimates of the prevalence of hepatitis B and C infections in Nigeria. Recent studies have shown the prevalence to be lower than previously reported. The different populations studied might be responsible for this. It is important to have a real population data that would inform the policies to be adopted for eradication. We set out to determine the prevalence, risk factors, and pattern of hepatitis B and C in Benue State, Central Nigeria. Four thousand and five (4,005) subjects, aged 1 year and older, were selected through a multistage random sampling to represent all parts of the state. Trained health workers administered a validated questionnaire. Rapid test kits were standardized and used in determining the prevalence of the respective viruses. Hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV) were found to be positive in 5% and 1%, respectively, of subjects screened. The prevalence varied from one local government area to another, with HBsAg being 8% in the highest to 2% in the lowest LGC, and anti-HCV being 3% in the highest and 0% in the lowest. Age, previous close contact with a patient, and multiple sex partners were the most important risk factors for hepatitis B virus (HBV) infection, whereas age and previous blood transfusion were the most important risk factors for hepatitis C virus (HCV) infection. HBV immunization may be having an impact in reducing the prevalence of the virus. Nigeria appears to be moving from high endemicity to the intermediate one.
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16
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Kroeze S, Wit FW, Rossouw TM, Steel HC, Kityo CM, Siwale M, Akanmu S, Mandaliya K, de Jager M, Ondoa P, Reiss P, Rinke de Wit TF, Kootstra N, Hamers RL. Plasma Biomarkers of Human Immunodeficiency Virus-Related Systemic Inflammation and Immune Activation in Sub-Saharan Africa Before and During Suppressive Antiretroviral Therapy. J Infect Dis 2020; 220:1029-1033. [PMID: 31086991 PMCID: PMC6688057 DOI: 10.1093/infdis/jiz252] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/13/2019] [Indexed: 02/03/2023] Open
Abstract
We evaluated immune biomarker profiles in human immunodeficiency virus (HIV)–infected adults (n = 398) from 5 African countries. Although all biomarkers decreased after antiretroviral therapy (ART) initiation, levels of C-X-C chemokine ligand 10 (CXCL10), lipopolysaccharide-binding protein, C-reactive protein, soluble CD163, and soluble scavenger receptor CD14 were significantly higher during ART than in an HIV-uninfected reference group (n = 90), indicating persistent monocyte/macrophage activation, inflammation, and microbial translocation. Before ART initiation, high HIV viral load was associated with elevated CXCL10 and tuberculosis coinfection was associated with elevated soluble CD14. High pre-ART levels of each biomarker strongly predicted residual immune activation during ART. Chemokine (C-C motif) ligand 2, lipopolysaccharide-binding protein, C-reactive protein, and interleukin 6 were differentially expressed between countries. Further research is needed on the clinical implications of residual immune dysregulation.
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Affiliation(s)
- Stefanie Kroeze
- Amsterdam Institute for Global Health and Development and Department of Global Health, Amsterdam, the Netherlands
| | - Ferdinand W Wit
- Amsterdam Institute for Global Health and Development and Department of Global Health, Amsterdam, the Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, and Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands.,Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Theresa M Rossouw
- Department of Immunology, Institute for Cellular and Molecular Medicine, University of Pretoria, Pretoria, South Africa
| | - Helen C Steel
- Department of Immunology, Institute for Cellular and Molecular Medicine, University of Pretoria, Pretoria, South Africa
| | | | | | - Sulaimon Akanmu
- Department of Haematology and Blood Transfusion, College of Medicine of the University of Lagos and the Lagos University Teaching Hospital, Nigeria
| | | | | | - Pascale Ondoa
- Amsterdam Institute for Global Health and Development and Department of Global Health, Amsterdam, the Netherlands.,African Society of Laboratory Medicine, Addis Ababa, Ethiopia
| | - Peter Reiss
- Amsterdam Institute for Global Health and Development and Department of Global Health, Amsterdam, the Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, and Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands.,Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Tobias F Rinke de Wit
- Amsterdam Institute for Global Health and Development and Department of Global Health, Amsterdam, the Netherlands
| | - Neeltje Kootstra
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Raph L Hamers
- Amsterdam Institute for Global Health and Development and Department of Global Health, Amsterdam, the Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, and Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands.,Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.,Nuffield Department of Medicine, University of Oxford, United Kingdom
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17
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Barriers to Effective Transfusion Practices in Limited-Resource Settings: From Infrastructure to Cultural Beliefs. World J Surg 2020; 44:2094-2099. [PMID: 32157404 PMCID: PMC7266790 DOI: 10.1007/s00268-020-05461-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Surgery and anesthesia are indivisible parts of health care, but safe and timely care requires more than operating rooms and skilled providers. One vital component of a functional surgical system is reliable blood transfusion. While almost half of all blood is donated in high-income countries (HICs), over eighty percent of the global population lives outside of these countries. High-income countries have on average 30 donations per 1000 people, and the average age of transfusion recipient is over 65. Most low-income countries (LICs) have fewer than five donations per 1000 people, where maternal hemorrhage and childhood anemia are the most common indications for transfusion. In LICs, greater than 50% of blood is administered to children under 5 years of age. This study aims to snapshot, by survey, available resources for transfusion and then discusses the infrastructure and cultural barriers to optimal transfusion practice. Methods In January 2019, a 10-question survey was sent electronically to physician anesthesiologists working in low- and middle-income countries to examine resources and practice patterns for blood transfusion. Subsequent discussions illustrate obstacles contributing to low availability of blood products and illuminate infrastructure and cultural barriers preventing optimal transfusion practices. Survey Results Acquiring whole blood takes hours. Clinicians wait days to receive packed red blood cells or platelets. Fresh frozen plasma is available but untimely. For many, protocols for massive transfusion are rare, and for transfusion, ratios are nonexistent. Complete blood counts take hours, and coagulation profiles are severely delayed. Discussion of Infrastructure and Cultural Barriers With few voluntary, unpaid, donors and inconsistent supply of testing kits, donated blood is unsafe. Donors are seasonal for farming communities, endemic malaria areas, and student donors recruited through schools. Cultural beliefs fuel distrust. Transfusion specialists, concentrated in urban areas, see rural patients presenting late. Inadequate triaging and supervision jeopardize patients to shock. Inadequate blood storage leads to waste. Modeling systems from HICs fail to overcome hurdles faced by clinicians working with distinctive belief systems and unique patient populations.
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18
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Buriak I, Fleck RA, Goltsev A, Shevchenko N, Petrushko M, Yurchuk T, Puhovkin A, Rozanova S, Guibert EE, Robert MC, de Paz LJ, Powell-Palm MJ, Fuller B. Translation of Cryobiological Techniques to Socially Economically Deprived Populations—Part 1: Cryogenic Preservation Strategies. J Med Device 2020. [DOI: 10.1115/1.4045878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Use of cold for preservation of biological materials, avoidance of food spoilage and to manage a variety of medical conditions has been known for centuries. The cryobiological science justified these applications in the 1960s increasing their use in expanding global activities. However, the engineering and technological aspects associated with cryobiology can be expensive and this raises questions about the abilities of resource-restricted low and middle income countries (LMICs) to benefit from the advances. This review was undertaken to understand where or how access to cryobiological advances currently exist and the constraints on their usage. The subject areas investigated were based on themes which commonly appear in the journal Cryobiology. This led in the final analysis for separating the review into two parts, with the first part dealing with cold applied for biopreservation of living cells and tissues in science, health care and agriculture, and the second part dealing with cold destruction of tissues in medicine. The limitations of the approaches used are recognized, but as a first attempt to address these topics surrounding access to cryobiology in LMICs, the review should pave the way for future more subject-specific assessments of the true global uptake of the benefits of cryobiology.
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Affiliation(s)
- Iryna Buriak
- Department of Cryomicrobiology, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, 23, Pereyaslavska str, Kharkiv 61016, Ukraine
| | - Roland A. Fleck
- Centre for Ultrastructural Imaging, Kings College London, New Hunts House, Guy's Campus, London SE1 1 UL, United Kingdom
| | - Anatoliy Goltsev
- Department of Cryopathophysiology and Immunology, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences, 23, Pereyaslavska str, Kharkiv 61016, Ukraine
| | - Nadiya Shevchenko
- Laboratory of Phytocryobiology, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, 23, Pereyaslavska str, Kharkiv 61016, Ukraine
| | - Maryna Petrushko
- Department for Cryobiology of Reproduction System, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, 23, Pereyaslavska str, Kharkiv 61016, Ukraine
| | - Taisiia Yurchuk
- Department for Cryobiology of Reproduction System, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, 23, Pereyaslavska str, Kharkiv 61016, Ukraine
| | - Anton Puhovkin
- Department for Cryobiology of Reproduction System, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, 23, Pereyaslavska str, Kharkiv 61016, Ukraine
| | - Svitlana Rozanova
- Department of Cryobiophysics, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, 23, Pereyaslavska str, Kharkiv 61016, Ukraine
| | - Edgardo Elvio Guibert
- Departamento de Ciencias Biologicas, Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada, Universidad Nacional de Rosario, Avda. Arijon 28BIS, Rosario 2000, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Avda. Arijon 28BIS, Rosario 2000, Argentina
| | - Maria Celeste Robert
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada, Universidad Nacional de Rosario, Avda. Arijon 28BIS, Rosario 2000, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Avda. Arijon 28BIS, Rosario 2000, Argentina
| | - Leonardo Juan de Paz
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada, Universidad Nacional de Rosario, Avda. Arijon 28BIS, Rosario 2000, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Avda. Arijon 28BIS, Rosario 2000, Argentina
| | - Matthew J. Powell-Palm
- Department of Mechanical Engineering, University of California Berkeley, 6124 Etcheverry Hall, Hearst Ave, Berkeley, CA 94720
| | - Barry Fuller
- Division of Surgery and Interventional Science, UCL Medical School, Royal Free Hospital, London NW3 2QG, United Kingdom
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19
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Okoroiwu HU, Asemota EA. Blood donors deferral prevalence and causes in a tertiary health care hospital, southern Nigeria. BMC Health Serv Res 2019; 19:510. [PMID: 31331326 PMCID: PMC6647304 DOI: 10.1186/s12913-019-4352-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 07/16/2019] [Indexed: 12/27/2022] Open
Abstract
Background Blood transfusion is a life-saving intervention. However, the safety of the donor and the recipient is paramount. This study was aimed at determining the blood donation deferral pattern of University of Calabar Teaching Hospital. Methods A retrospective analysis of the prospective donors’ data of University of Calabar Donor clinic within the period of March 2015 to February 2016 was conducted. Data were extracted from the donor register and analyzed. Prospective donors were screened and interviewed for causes of temporary and permanent deferrals. Result Out of the 1886 screened prospective donors, 164 (8.69%) were deferred. Though the minority of the donor population, female donors had the highest deferral rate (33.33%). There were 31.10 and 68.90% cases of temporary and permanent deferrals, respectively. Hepatitis B virus (HBV) was the highest (31.71%) cause of overall deferral as well as permanent deferral. Anemia was the major (21.95%) cause of temporary deferral as well as the second cause of overall deferrals. Commercial and replacement donors constituted 68.28 and 31.71% of the deferral cases, respectively. Conclusion HBV was found to be the overall leading cause of deferral in the studied area. This outcome poses a public health concern and should elicit measures to curb the infection rate.
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Affiliation(s)
- Henshaw Uchechi Okoroiwu
- Department of Medical Laboratory Science, Haematology Unit, University of Calabar, Calabar, Nigeria.
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20
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Shah FT, Sayani F, Trompeter S, Drasar E, Piga A. Challenges of blood transfusions in β-thalassemia. Blood Rev 2019; 37:100588. [PMID: 31324412 DOI: 10.1016/j.blre.2019.100588] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 01/28/2023]
Abstract
Patients with β-thalassemia major (BTM) require regular blood transfusions, supported by appropriate iron chelation therapy (ICT), throughout their life. β-thalassemia is a global disease that is most highly prevalent in Southeast Asia, Africa, and Mediterranean countries. However, the global distribution of patients with β-thalassemia is changing due to population migration, and Northern European countries now have significant thalassemia populations. Globally, many patients with BTM have limited access to regular and safe blood transfusions. A lack of voluntary nonremunerated blood donors, poor awareness of thalassemia, a lack of national blood policies, and fragmented blood services contribute to a significant gap between the timely supply of, and demand for, safe blood. In many centers, there is inadequate provision of antigen testing, even for common red cell antigens such as CcEe and Kell. Policies to raise awareness and increase the use of red blood cell antigen testing and requesting of compatible blood in transfusion centers are needed to reduce alloimmunization (the development of antibodies to red blood cell antigens), which limits the effectiveness of transfusions and the potential availability of blood. Patients with BTM are also at risk of transfusion-transmitted infections unless appropriate blood screening and safety practices are in place. Hence, many patients are not transfused or are undertransfused, resulting in decreased health and quality-of-life outcomes. Hemovigilance, leukoreduction, and the ability to thoroughly investigate transfusion reactions are often lacking, especially in resource-poor countries. ICT is essential to prevent cardiac failure and other complications due to iron accumulation. Despite the availability of potentially inexpensive oral ICT, a high proportion of patients suffer complications of iron overload and die each year due to a lack of, or inadequate, ICT. Increased awareness, training, and resources are required to improve and standardize adequate blood transfusion services and ICT among the worldwide population of patients with BTM. ICT needs to be available, affordable, and correctly prescribed. Effective, safe, and affordable new treatments that reduce the blood transfusion burden in patients with β-thalassemia remain an unmet need.
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Affiliation(s)
| | - Farzana Sayani
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Sara Trompeter
- University College London Hospitals, NHS Foundation Trust, London, UK; NHS Blood and Transplant, Bristol, UK.
| | - Emma Drasar
- Whittington Health NHS Trust, London, UK; University College London Hospitals, NHS Foundation Trust, London, UK.
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Liu J, Wang S, Sha D, Liu J, Cheng G. Effects of cooperative blood transfusion and homologous blood transfusion on the production of red blood cell irregular antibodies in obstetric patients. Exp Ther Med 2019; 17:3477-3482. [PMID: 30988726 PMCID: PMC6447778 DOI: 10.3892/etm.2019.7343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/19/2019] [Indexed: 11/23/2022] Open
Abstract
Effects of cooperative blood transfusion and homologous blood transfusion on the production of red blood cell irregular antibodies in obstetric patients were investigated. A total of 300 obstetric patients who underwent blood transfusion in the Maternity and Child Health Care of Zaozhuang from February 2016 to February 2018 were enrolled. There were 150 obstetric patients receiving the same type of transfusion who were included in the control group. Due to special circumstances the remaining 150 obstetric patients with ABO and Hr with cooperative blood transfusion were included in the research group. The positive detection rate of blood cell irregular antibody, the effectiveness of blood transfusion and the incidence of adverse transfusion reaction were observed in the two groups after the comparison of blood transfusion of both groups. The total positive detection rate of erythrocyte irregular antibody in the research and control groups was not statistically significant (P>0.05). There were no significant differences in the red blood cell counts, hemoglobin concentration, hematocrit and platelet count between the research and control groups after infusion (P>0.05). Comparing all the groups, the red blood cell counts, hemoglobin concentration, hematocrit and platelet count after infusion in both the research and control groups were significantly higher than before the infusion, and differences were statistically significant (P<0.001). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). The effect of blood transfusion and homologous blood transfusion on the positive detection rate of red blood cell irregular antibody in obstetric patients, the efficiency of blood transfusion and the incidence of adverse transfusion reactions are similar, and all have high clinical application value.
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Affiliation(s)
- Jiguo Liu
- Department of Blood Transfusion, Maternity and Child Health Care of Zaozhuang, Zaozhuang, Shandong 277100, P.R. China
| | - Shuyan Wang
- Department of Clinical Laboratory, Maternity and Child Health Care of Zaozhuang, Zaozhuang, Shandong 277100, P.R. China
| | - Dehou Sha
- Department of Clinical Laboratory, Maternity and Child Health Care of Zaozhuang, Zaozhuang, Shandong 277100, P.R. China
| | - Jihong Liu
- Department of Emergency, Maternity and Child Health Care of Zaozhuang, Zaozhuang, Shandong 277100, P.R. China
| | - Guangling Cheng
- Department of Gynecology, Maternity and Child Health Care of Zaozhuang, Zaozhuang, Shandong 277100, P.R. China
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Abstract
BACKGROUND Blood and blood products are essential in the management of injuries, medical illnesses, and childbirth. Chronic shortages in the blood supply perpetuates the high levels of morbidity and mortality from injury and treatable diseases. Patients in low- and middle-income countries are frequently unable to access blood units necessary for transfusion in a timely manner. OBJECTIVES This study aimed to gain insight into the community and hospital factors that contribute to the observed insufficient supply of blood units available for transfusion at a regional referral hospital in rural Eastern Uganda. METHODS A mixed-methods approach was utilized; community members were surveyed on knowledge, attitudes, and practices of blood donation and health professionals were queried on hospital factors affecting blood transfusions. Transfusion records were prospectively collected and analyzed, and the pathway of a single blood unit was observed and recorded. FINDINGS Among the 82 community members that were surveyed, knowledge was poor (<50% correct) regarding age, weight, and volume of blood to be able to donate, but participants were overall knowledgeable on general characteristics that would exclude individuals from donating blood. Major themes elicited during qualitative interviews included a positive attitude towards and lack of information regarding blood donation. Health professionals expressed frustration in delayed testing of transfusion transmissible infections. The majority of blood transfusions were allocated to female patients (55.8%) and children under five years of age (33.2%). CONCLUSIONS Broadened inclusion and education of the general population in blood donation and increased outreach programs may be promising interventions to increase the blood supply at the Soroti Regional Referral Hospital. To reduce the current bottleneck seen in TTI testing, the feasibility and cost-effectiveness of local TTI testing technology should be investigated further.
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Tagny CT, Laperche S, Murphy EL. Updated characteristics of blood services, donors and blood products in 11 French-speaking African countries. Vox Sang 2018; 113:647-656. [PMID: 30125053 PMCID: PMC6527108 DOI: 10.1111/vox.12702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/22/2018] [Accepted: 07/26/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The Francophone Africa Transfusion Research Network conducted the first large and comprehensive surveys on the status of blood safety in francophone African countries in 2009 and 2012. Since then, there has been substantial investment in blood safety but little is known about progress made in the region. MATERIALS AND METHODS This multicentre cross-sectional study describes characteristics of blood services, donors and blood products and compares results with previous data. A web-based questionnaire collected data of 2016 from 38 blood facilities in 11 French-speaking countries. Data were analysed according to type of blood services and compared to similar studies conducted in 2009 and 2012. RESULTS The study included data on 572 933 donations from 366 844 donors. Compared to 2012, there was an increase in the median proportion of voluntary nonremunerated blood donation (+22%) (P = 0·004), and a reduction from 2·1 to 0·9 (P = 0·01), from 10·3 to 6·7 (P = 0·00), from 3·2 to 1·3 (P = 0·006) and from 1 to 0·4 (P = 0·03) in median seroprevalences of HIV, HBV, HCV and syphilis, respectively. The median proportion of blood orders fulfilled decreased (-18·2%) (P = 0·001). The number of technical staff per 1000 donations ranged from 1 to 54 with hospital-based blood transfusion services having 12-fold more staff than National and Regional services. CONCLUSION Several indicators have improved in Francophone Africa Blood services during the last 5 years and national and regional services likely have better indicators than hospital-based services. These findings may support the need for ongoing blood safety initiatives.
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Affiliation(s)
- Claude T. Tagny
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Hematology and Blood Transfusion Service, University Teaching Hospital of Yaoundé, Cameroon
| | - Syria Laperche
- Institut National de la Transfusion Sanguine, Paris, France
| | - Edward L. Murphy
- University of California San Francisco and Blood Systems Research Institute, both in San Francisco, California, USA
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Okoroiwu HU, Okafor IM, Asemota EA, Okpokam DC. Seroprevalence of transfusion-transmissible infections (HBV, HCV, syphilis and HIV) among prospective blood donors in a tertiary health care facility in Calabar, Nigeria; an eleven years evaluation. BMC Public Health 2018; 18:645. [PMID: 29788937 PMCID: PMC5964952 DOI: 10.1186/s12889-018-5555-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/09/2018] [Indexed: 02/06/2023] Open
Abstract
Background Provision of constant and safe blood has been a public health challenge in Sub-Saharan Africa with high prevalence of transfusion-transmissible infections (TTIs). This study was aimed at determining the trend and seroprevalence of HBV, HCV, syphilis and HIV across the years within study among prospective blood donors at blood bank in University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. Methods A retrospective analysis of blood donor data from January 2005 to December 2016 was conducted in Blood Bank/Donor Clinic of University of Calabar Teaching Hospital, Calabar, Nigeria. Sera samples were screened for hepatitis B surface antigen (HBsAg), antibodies to hepatitis C virus (HCV), human immunodeficiency virus (HIV) 1 and 2 and Treponema pallidum using commercially available immunochromatic based kits. Results Out of the 24,979 screened prospective donors in the 2005–2016 study period, 3739 (14.96%) were infected with at least one infective agent. The overall prevalence of HBV, HCV, syphilis and HIV were 4.1, 3.6, 3.1 and 4.2%, respectively. During the period of study, the percentage of all transfusion-transmissible infections declined significantly with remarkable decline in HIV. The study showed male dominated donor pool (98.7%) with higher prevalence (4.2%) of transfusion-transmissible infections than in female donors (0.0%). Commercial donors constituted majority (62.0%) of the donors and as well had the highest prevalence of transfusion-transmissible infections. Majority (62.9%) of the donors were repeat donors. Conclusion HBV, HCV, syphilis and HIV have remained a big threat to safe blood transfusion in Nigeria and Sub-Saharan Africa at large. Strict adherence to selection criteria and algorithm of donor screening are recommended.
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Affiliation(s)
- Henshaw Uchechi Okoroiwu
- Haematology Unit, Department of Medical Laboratory Science, University of Calabar, Calabar, Nigeria.
| | - Ifeyinwa Maryann Okafor
- Haematology Unit, Department of Medical Laboratory Science, University of Calabar, Calabar, Nigeria
| | | | - Dorathy Chioma Okpokam
- Haematology Unit, Department of Medical Laboratory Science, University of Calabar, Calabar, Nigeria
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Blood Safety Status in WHO African Region Countries: Lessons Learnt from Mauritius. JOURNAL OF BLOOD TRANSFUSION 2017; 2017:1970479. [PMID: 29181226 PMCID: PMC5664371 DOI: 10.1155/2017/1970479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/07/2017] [Accepted: 09/17/2017] [Indexed: 02/02/2023]
Abstract
In 2001, the WHO Office for Africa adopted a strategy for blood safety defining four targets. This paper describes the progress made by Mauritius in the implementation of this strategy. The blood safety indicators were collected and compared with the norms recommended by WHO. The country has formulated its blood policy and developed a strategic plan for its implementation since 2004. The total number of blood donations increased from 31,228 in 2002 to 43,742 in 2016, giving an annual blood collection rate evolving from 26.3 per 1000 inhabitants in 2002 to 34.2 per 1000 inhabitants in 2016. The percentage of voluntary donations rose from 60% to 82.5%. Since 2002, all the blood units collected have been tested for the mandatory infectious markers. The Blood Transfusion Service has been certified ISO2008-9001 and nucleic acid testing has been introduced. The preparation of blood components increased from 60% to 98.2%. The most transfused blood components were red cell concentrates, platelet concentrates, and fresh frozen plasma. In addition to transfusion activities, there were other departments performing antenatal serology, tissue typing, special investigations, and reagent preparation. Despite the progress made, some challenges remain, namely, legal framework and haemovigilance system. A regulatory system for blood needs to be established.
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