Covid-19: Blood scarcity looms for childbirth, malaria, sickle cell patients

During this COVID-19 pandemic, Nigeria lost quite a lot of blood; over 200 units expired in the Abuja NBTS centre resulting from the lockdown in the country. Much more was lost in other states and the figures are quite alarming.

This is according to a report by the World Health Organisation (WHO), which it credits to Dr Omosigho Izedonmwen of the National Blood Transfusion Service (NBTS).

The centre further explained that approximately 750 units of blood were discarded all over the country due to the lockdown from April to June 2020 but with the gradual ease of the lockdown, it began embarking on small blood drives to ensure that safe blood is available.

In an article titled ‘Blood safety and availability,’ the WHO stated that of the 118.5 million blood donations collected globally, 40 per cent of these are collected in high-income countries, home to 16 per cent of the world’s population.

The Head of Planning, Research and Statistics for the NBTS, Dr Adaeze Oreh, stated that “These are countries that do not have challenges with pregnancy and childbirth like we have. They don’t have the challenges of malaria, sickle cell, high level of road accidents or trauma caused by conflicts and insurgency like we do, with some of these cases needing an urgent blood transfusion.”

She said the greatest hindrance the NBTS experiences while trying to convince people to donate blood are from myths and misconceptions.

Many Nigerians still believe that they might die, lose their fertility, their sanity and a lot more, from blood donations. According to her, these are issues that the NBTS is trying to educate people on through different forms of sensitizations right from the grassrootS.

“We are beginning to receive quite a number of positive responses now when we visit communities or go on radio call-in programs. People call and tell us that they are ready to donate when asked. But we tell them that they don’t need to wait until an emergency arises, to help. They can just walk into our offices and donate freely.”

Oreh also said the agency acquires its greatest donations when it embarks on special blood drives in higher institutions, churches and mosques. This is presently proving to be a challenge because of the COVID-19 pandemic and restrictions put in place to minimize the spread of the virus.

Why blood donation is necessary

The WHO estimates that 2 per cent of all new-borns in Nigeria are affected by sickle cell disease. This brings it to a total of about 150,000 affected children born every year, according to a statement made by the Permanent Secretary, Federal Ministry of Health, Abdulaziz Abdullahi on the 2020 World Sickle Cell Day.

In a June 2019 report titled, ‘Maternal health in Nigeria: generating information for action,’ the WHO stated that a Nigerian woman has a one in the 22-lifetime risk of dying during pregnancy, childbirth or postpartum/post-abortion; whereas in most developed countries, the lifetime risk is one in 4900.

April 15 was supposed to be Mary Yakubu’s due date and she was slated to deliver at the Kubwa general hospital in the Federal Capital Territory, which is not far from her residence in Dede but when it arrived, she was stuck in Dede due to the unavailability of vehicles because of the lockdown.

She was rushed to a small maternity clinic around her residence and the doctor asked her to provide at least three units of blood.

“I had already provided the same amount at the Kubwa General a few weeks prior in anticipation of my due date but when the day came, there was no vehicle to take me to the hospital. We started running around looking for who will help us, my husband could not donate because he has diabetes and the hospital said they did not have blood in their bank. My neighbour refused to help me, he said that it was against his faith and he did not want to go to hell.

“I almost died that day because I lost a lot of blood, my husband started calling my church members for help and eventually a few of them rushed to the hospital to help, I thank God for them,” she said.

Dr. John Agbo of the Lona City Care Hospital, Abuja explained what the situation is like. He said some women would need blood if they develop Antepartum Haemorrhage (APH) which is bleeding while pregnant. He said this is either because of the position of the placenta or if the placenta is low, a condition called Placenta Previa, which may result in the need for blood before delivery and most cases are during delivery where a woman delivers and start bleeding.

He said: “Women died from that, during the lockdown, there were quite a number of people who lost their lives because of the need for blood; in the general hospitals, private or maternity centres because people were not forthcoming when they should have gone and donated blood.”

WHO reports that in Nigeria between 2005 and 2015, over 600, 000 maternal deaths occurred with no less than 900, 000 maternal near-miss cases from hypertensive disorders of pregnancy, postpartum haemorrhage (PPH) and unsafe abortion.

Most of these result in blood loss in places without access to sufficient or safe blood, fragile or humanitarian settings that a simple transfusion or administration of plasma could have made a whole world of difference.

The website Severe Malaria Observatory, a knowledge-sharing platform that acts as a repository of information for the severe malaria community, states that Nigeria represents up to 25% of the malaria burden in Africa with nearly 110 million clinically diagnosed cases of malaria per year.

Dr Agbo also stressed that “Malaria is a known cause of anaemia in children. It brings their blood level down so much that if you don’t deal with it, they may need a blood transfusion.”

Oreh added: “Severe malaria can cause very high anaemia in patients that can stop the heart and cause disorders in the brain.”

Sufferers of sickle cell disease often have low numbers of red blood cells or anaemia because their red blood cells are not shaped as they should be. This results in the blockade of small blood vessels and could result in the need for a transfusion or organ damage if not properly treated.

To keep crisis at bay in these patients for as long as six months, they undergo a nonsurgical therapy using apheresis equipment, a machine that removes the abnormal sickle cell. This is then replaced with as much as eight units of AA genotype blood, depending on the patients’ haemoglobin level, says laboratory manager at Epiconsult Diagnostics, Chinyere Obiejemba.

She also said: “To save the lives of women at childbirth due to blood loss, even after they have been transfused with several units of blood, we give them frozen plasma components which are extracted from donated blood.” The Nation