Personnel for Blood Transfusion Services in Nigeria: A Multicenter Cooperative Study

Abstract

The intravenous infusion of blood components into someone’s circulation is known as a blood transfusion. For a variety of medical disorders, transfusions are performed to replenish lost blood components. In the past, whole blood was used for transfusions, but in modern medicine, just the blood’s constituent parts—such as red blood cells, white blood cells, plasma, clotting factors, and platelets—are frequently employed. A typical blood service is a multidisciplinary system that requires a wide range of specialists. These people include medical scientists, and technical professionals as well as the nursing staff. Several elements, including the workplace environment, the availability of essentials like PPE, gloves, and water, the training of employees, and the formulation of policies, affect how effective a transfusion service is. To comprehend Personnel for Blood Transfusion Services in Nigeria: A multicentre cooperative study, the study reviews pertinent literature.

1. Introduction

Richard Lower at Oxford carried out the first known animal-to-animal (a dog) blood transfusion in 1665, and Jean-Denis carried out the first known animal-to-human blood transfusion in 1667. James Blundell carried out the first human-to-human blood transfusion in 1818 [1, 2]. Ottenberg performed the first pre-transfusion cross-match in 1907 using Landsteiner’s classification of the ABO blood grouping system, which was created in the year 1900. In the year 1940, Landsteiner and Wiener developed the Rh-type system. Following this, significant discoveries in the twentieth century enabled the use of component therapy, including the development of anticoagulant and preservative solutions, refrigeration, plastic blood bags, component delivery, infectious disease testing, high-risk donor screening, etc. [1, 2].

Since its beginning in the early twentieth century, transfusion medicine has advanced. Among these was the realization that blood can be separated into its parts and supplied individually [1, 2]. Nowadays, blood transfusions almost invariably involve the infusion of one or more blood products. Whole blood transfusions are now only performed in cases requiring intensive restoration (trauma). The most well-known cellular constituents are packed red blood cells (PRBC), washed PRBC, leuko-reduced PRBC, and pooled or aphaeresis platelets. Hemophilic factor (CRYO), FFP, and cryoprecipitate are examples of plasma-derived products [1, 2]. In perioperative and peripartum settings, the transfusion of red blood cells (RBCs), platelets, fresh frozen plasma (FFP), and cryoprecipitate has the potential to improve clinical outcomes.

Blood transfusions can save lives, but they can carry hazards, such as noninfectious and infectious consequences [3]. Despite significant advancements in blood safety since the 1980s, when it was revealed that HIV could be transmitted through blood transfusions, blood transfusions still carry a distinct risk of poor patient outcomes [1, 2, 3, 4]. Blood transfusions have been linked to higher mortality rates, longer hospital stays due to infections and sepsis, and malfunction of several organ systems [4, 5]. In a recent meta-analysis of 19 prospective, randomized studies comparing restricted with liberal transfusions in more than 6000 patients, it was discovered that adherence to restrictive blood transfusion reduced hospital mortality and postoperative infections. These observed negative patient outcomes may be partially explained by erythrocyte damage related to the length of blood storage. Old blood may have a predisposition to hemolyze in vivo, producing vaso-constrictive cell-free hemoglobin, according to canine studies. Post-transfusion, patients also have lower erythrocyte membrane deformability that is correlated with blood storage time [4, 5, 6]. Finally, some people appear to limit the use of blood transfusions due to potential recognized and unknown hazards such as the spread of blood-borne viruses. Similar to the last example, transfusion is only necessary to enhance viscosity in extreme cases of hemodilution. Circulation may be hampered by high viscosity on its own. Additionally, the delivery or consumption of oxygen at the tissue level is not instantly increased by transfused blood [6, 7]. There are, therefore, few clinical circumstances in which a blood transfusion is advantageous to the patient and improves results. After assessing the advantages and disadvantages of blood transfusion, the decision to administer blood should be made [6, 7].

All medical professionals who deliver blood or blood-derived products must complete specialized training regarding safe transfusion techniques and have a comprehensive understanding of the transfusion administration procedure. Most commonly, people refer to them as Transfusion Personnel (TP). The phrase “Transfusion Personnel” or “Transfusion Practitioner” (TP) is a term used in the workplace to refer to a variety of positions, including those of transfusion nurse, transfusion instructor, transfusion health and safety committee, transfusion control officer, transfusion clinical nurse, and hemovigilance officer. The TP role has been in place for many years in some nations [7, 8], and more lately, additional nations are putting it into practice.

The majority of the TP activity is concentrated on patient blood management, transfusion governance, monitoring practice, adverse event management, and education (PBM). Very frequently, the TP serves as the informational hub, bringing together the available resources, studying the activities carried out by transfusion colleagues in other centers, gathering audit data, and assessing how these efforts might be advantageous within their healthcare facility [7, 8]. However, there is a need for all personnel involved in transfusion service to have a common goal and work together efficiently, this research will examine Personnel for Blood Transfusion Services in Nigeria: A multicentre cooperative Study.

2. Blood transfusion

The World Health Organization (WHO) recommends 10 units of blood per 1000 people, which means that in order to meet the demand for transfusions for an estimated 800 million people, 8 million units of blood are now required [7, 8, 9]. Blood transfusion is still a life-saving medication. While blood supply and blood safety are well recognized in developed countries, access to blood is extremely limited in Africa, and the availability of hazardous blood raises serious public health concerns about blood safety. A blood transfusion may be necessary in cases of obstetric hemorrhage, auto accidents, armed conflicts, sickle cell disease, anemia, particularly in youngsters, malnutrition, HIV, malaria, parasitic diseases, cases obstetric hemorrhage, auto accidents, violent conflicts, sickle cell disease, anemia, particularly in youngsters, malnutrition, HIV, malaria, and parasitic diseases, a blood transfusion may be necessary. Therefore, it is crucial to consistently draw attention to the reaction to blood transfusions, potential causes, anticipated symptoms and indicators, preventive measures, and suitable therapy [9, 10].

Intravenous infusion of blood components into a person’s circulation is known as a blood transfusion [3, 11]. For a number of medical disorders, transfusions are performed to replenish lost blood products. Early transfusions used whole blood, but in contemporary medical practice, only blood components including red blood cells, white blood cells, plasma, clotting factors, and platelets are frequently employed. Hemoglobin is a component of red blood cells (RBC), which carry oxygen to the body’s cells. White blood cells, which are a component of the immune system and combat infections, are not frequently employed during transfusion [10, 11].

Transfusion of blood employs either the donor’s or the recipient’s own (autologous transfusion) blood as a supply of blood (allogeneic or homologous transfusion). The second is significantly more typical than the first. Blood donation is the initial step in the process of using someone else’s blood. Whole blood taken intravenously and combined with an anticoagulant is the most common type of blood donated. Donations are typically anonymous to the recipient in developed nations, but blood bank products are always individually traceable throughout the entire cycle of donation, testing, component separation, storage, and administration to the recipient [3, 4]. As a result, any suspected infection transfer or transfusion reaction can be managed and investigated. In less developed nations, the donor may occasionally be specifically sought out by or for the receiver, who is often a family member, and the donation takes place right before the transfusion. It is not known whether using an alcohol swab alone or in addition to the use of an antiseptic can lessen contamination of the donor’s blood [10, 11].

Blood and blood products cannot be synthesized or kept in storage for an extended period of time, making blood transfusion services a vital component of healthcare services. Therefore, it is essential to control blood demand and availability properly to maintain a sufficient provision of safe blood [12]. Because sustaining a sufficient supply of safe blood is essential for many patients, the inability to manage blood inventory and the ensuing blood shortage is regarded as dangers to national and worldwide health security. If health officials do not take rapid corrective action, blood shortages cause the failure of blood transfusion services, which leads to the breakdown of the health system and health insecurity [11, 12, 13, 14, 15]. In addition to endangering public health, an imbalance between blood supply and demand is one of the biggest dangers to the stability of the national and global economies and security. The view of health concerns as a danger to global health security has advantages because it gets the support and attention of government and policy-makers. The management of blood supply and demand should be handled in accordance with international health rules and policies, which should be periodically updated [12, 16].

Replace the entirety of this text with the main body of your chapter. The body is where the author explains experiments and presents and interprets data of one’s research. Authors are free to decide how the main body will be structured. However, you are required to have at least one heading. Please ensure that either British or American English is used consistently in your chapter.

2.1 Personnel for blood transfusion services in Nigeria: a multicentre cooperative study

A typical blood service is a multidisciplinary organization that employs a wide range of specialists. These people include laboratory scientists and technical professionals, as well as the nursing staff. The efficiency of the staff who are properly trained for the jobs they must do in the service determines the effectiveness of a blood service in addition to the availability of appropriate tools and other working materials in a supportive working environment. Different fundamental academic and professional requirements apply to each category of professionals, although blood handling and management skills are exclusive to this workforce and are necessary for all cadres. One of the elements that contribute to an effective and efficient blood service is the availability of facilities and mechanisms for pertinent training [17, 18].

Any health intervention approach needs organization and oversight to be successful, and both are essential when developing a blood safety infrastructure. In order to build a working blood transfusion service, there must be national cooperation, backing from the government, and policy that is tailored to the requirements of a specific nation. One size does not, however, suit all [18]: despite their geographic proximity, the regional nations frequently have wildly dissimilar resources and infrastructure, thus it is important to understand each environment and customize policy making to it. In contexts with limited resources, it is crucial to develop goals that take into account the nation’s overall health issues as well as the logistics and cost. Although legislation can be used to enforce policy, it should not be utilized as a substitute for organized development [17, 18]. Liberal transfusion practice with poor standards is a result of prescribing physicians’ lack of expertise and training. Similar to this, strict adherence to laboratory transfusion triggers rather than clinical anemia leads to needless blood supply depletion. Additionally, the transfusion service is usually fragmented, resulting in little connection between the blood center and the hospitals or prescribing physician, which makes it impossible to supervise transfusion practice [19].

The requirement for strong organizational support is reiterated in strategies addressing the policy. The ministry of health collaborated with international and nongovernmental organizations, such as WHO-African Region, who would be potential candidates to oversee this on a regional basis [19, 20]. Regional transfusion services with more advanced infrastructures can potentially take the lead and support their neighbors. For instance, the South African National Blood Service (SANBS) now conducts donation serology and Nucleic Acid Testing (NAT) laboratory testing for Namibia blood transfusion service. Utilizing transfusion committees prepared to track blood usage and audit practice in accordance with established logical principles, national frameworks must be disseminated at the hospital level. Staff members who hold dual appointments at the hospital and the blood center may also help to close the gap between the two institutions. Finally, the successful implementation of clinical recommendations depends on education and training [20, 21].

Currently, a large number of both private and public institutions in Nigeria operate hospital-based transfusion services to sustain the country’s blood supply [20, 21]. In this case, each institution finds its own blood donors, checks them for TTIs, and then stores the units for use in clinical procedures. Blood units are frequently saved for intended recipients in hospital-based transfusion services [12, 16, 22], even if they might not need them until after their shelf life has passed. Due to this technique, there are more discarded blood products and few available blood products. Another significant drawback of decentralized hospital-based transfusion programs is the tendency for blood units to be “mal-distributed;” at one hospital, there may be an abundance with a propensity for waste due to expiration, while in a nearby hospital, there may be a severe shortage [20, 21, 23].

Effective blood usage is a part of rational blood use. Differential fractionation of whole blood into derived red cells, plasma, cryoprecipitate, and platelets—also known as component therapy—is a method to increase effectiveness [24]. In the developed world, when parent blood products can be varied, this is the predominant practice. In contrast, given the significant plasma portion that contains antibodies, entire blood must be transfused to a patient whose ABO type matches the donor. A group O unit of whole blood, for instance, must be given to group O receivers only until it has been determined that the recipient has a low antibody titer. Group O red cell components, however, can be safely given to any recipient. Additionally, the enormous amount of whole blood puts recipients at risk for circulatory overload brought on by transfusion. In the WHO study from 2006, only seven of the 46 nations had a national policy for the distribution of fractionated plasma products, and 24 of the 39 responding countries were still transfusing more than 75% of their blood as whole blood. The more recent assessment of 7 blood centers in Francophone, Africa [24] confirmed these findings.

Critical steps that must be taken to guarantee the safety of blood units include screening donor blood and quarantining blood and blood components. They should be released for clinical or manufacturing use, or they should be discarded, depending on the screening results. Blood samples taken at the time of donation should undergo laboratory testing for TTIs. All blood tests must be carried out and recorded using standardized protocols in laboratories that are fully equipped to do so [23, 24, 25].

TTI indicators (HIV antigen-antibody, HBsAg, anti-HCV, and syphilis) are regularly screened for in blood transfusion facilities at the same time [25, 26]. In order for the blood or blood components, particularly labile ones like platelets, to be discharged right away, screening time must be minimized. Reactive contributions are initially isolated and separated. The donor is then either disregarded or additional testing is done, depending on the technique the laboratory utilized. Sequential screening may be used in some labs by initially looking for one or two infection indicators. No additional testing is done on this donor if a reactive outcome is received. The prevalence of infections in the population of blood donors will have an impact on the screening approach for selecting the test or tests that are conducted first. In nations where the incidence of one TTI is higher than that of another, sequential screening may be used. For instance, HBsAg may be checked first when the prevalence of hepatitis B is higher than that of HIV and HCV [25, 26, 27]. Only HBsAg negative contributions would subsequently be subjected to syphilis, HIV antigen-antibody, and anti-HCV testing in this scenario. On donations that show a positive result on the HBsAg screening test, no assays for these viral markers would be run. There is hence a chance for cost reductions, particularly if donations that have already tested positive for HBsAg do not require the more expensive assays [25, 26, 27].

2.2 The need for laboratory staff in transfusion services

When performing the tests and assessing the data, laboratory staff should always follow the national screening approach, protocol, and standardized methods. The likelihood of analytical and transcribing errors, particularly false negative results, will be reduced when laboratory tests are conducted in a high-quality environment with knowledgeable employees and a functional documentation system [27]. Blood screening seeks to identify infection-related indicators in order to stop the distribution of contaminated blood and blood components for clinical use. Strategies for blood screening are intended to ensure the security of blood units; nevertheless, they should not be utilized to inform blood donors of reactive test findings. Before informing donors of their infectivity status, the proper confirmatory testing technique for blood donor management should be used. When deciding whether to release blood units for clinical use, all testing for infection indicators for TTIs and blood group serology should be considered.

In most cases, donors must consent to the procedure; as a result, minors cannot donate without the approval of a parent or legal guardian. In some nations, such as the United States, names are maintained in order to compile lists of ineligible donors, while in others, such as several European nations, only the donor’s blood is associated with the responses to ensure anonymity. A potential donor is “delayed” if they do not meet these requirements. Due to the possibility of later approval for many ineligible donors, this word is utilized.

The following skills are anticipated of a competent Medical Laboratory Scientist in the field of blood transfusion services [12, 17]:

• In the blood transfusion laboratory, have a working knowledge of quality management systems (QMS), validation, and good management practices.

• Understanding the clinical significance of all blood group systems’ serological features

• Mastery of all laboratory techniques for blood safety in terms of serology and microbiology

• Preparation and standardization of reagents used in blood transfusion procedures, such as antisera

• Proficiency in blood donation protocols, as well as in the handling, processing, and storage of blood and blood-related materials

• The resolution of unusual and negative situations, medical-legal concerns, and blood transfusion procedures.

• Using Electronic medical systems and being familiar with automation (BECS)

• understanding of the scientific techniques involved in hemopoietic stem cell transplantation and its immunology

With these skills in place, Nigerian medical laboratory scientists are trained to produce professionals who can work productively in the core laboratory functions of any blood service or hospital blood transfusion department.

2.3 Role of nurses in transfusion services

Nursing plays a significant part in ensuring transfusion safety since the nurse practitioner is responsible for understanding the indications for transfusions, double-checking data to prevent errors, educating patients on blood transfusion, identifying and responding appropriately to transfusion responses, and recording the procedure [27, 28]. Nursing’s role is essential for the effective management of transfusion reactions to achieve the desired outcomes for two primary reasons: nurses are the final link in the chain of the transfusion process and nursing-related tasks dominate the transfusion process. As a result, nurses must possess sufficient skills and knowledge in the transfusion of blood and blood products [29].

As the nursing team is responsible for recognizing the indications for blood transfusion, examining data to prevent errors, disseminating information about blood transfusion, diagnosing transfusion responses, and documenting the processes, a nurse plays a critical role in ensuring blood transfusion safety [29, 30]. As a crucial process, blood transfusion requires knowledge and skilled specialists to preserve patient safety. The risk of blood transfusion is reduced by qualified and experienced nurses. There are four phases associated with nursing performance, including pre-transfusion preparation, pre-transfusion actions, blood bag collection, and posttransfusion activities to maintain the patient’s safety. The preparation phase includes checking the written prescription of the physician [29, 30]. This gives sufficient details regarding the indications, risks, and advantages of blood transfusion. The second stage involves drawing blood from the blood bank, which is crucial for enhancing patient safety. In order to prevent blood incompatibility, the nurse must accurately match the patient’s identification details on the blood bag and collection paper. Transporting blood from the blood bank to the ward should be done using a special blood carrier box. Two authorized individuals verified the blood’s compatibility prior to transfusion. Checking the patient’s vital signs is necessary. Since this is the final opportunity to introduce any unsuitable blood component, it is a very sensitive step in the safety of blood transfusions. Blood transfusion must begin slowly during posttransfusion activities during the first 15 min after it begins. The nurse should continue to monitor the patient to look for any reactions. While receiving a blood transfusion, it is advised to take normal saline intravenously and morphine at 1 mg/ml, but no more medication is permitted [30]. To save a patient’s life, the nurse must be aware of any blood response signs and know how to treat them [31]. A handbook manual on blood transfusion services must be provided to nurses in order to continue their education in all healthcare institutions, and they must be continuously urged to attend national and worldwide blood transfusion workshops and conferences.

2.4 Establishing multicenter cooperative transfusion service

The community must get high-quality medical care through hospitals, which serve as the primary organization for the delivery of public services. In accordance with these provisions, there are four sections pertaining to hospitals’ obligations in providing medical services, namely: Responsibility for employees: competent personnel must be hired through an open and transparent hiring process, professional responsibility for quality: Professional bodies are always required to set up ongoing training programs for their members in blood transfusion services in order to comply with international best practices, responsibility for facilities and equipment; appropriate financing should be available to supply the tools and supplies that medical professionals, particularly those working in blood transfusion units, need; and Last but not least, the hospital is responsible for the building’s safety and upkeep [32, 33, 34]. This includes making sure that both patients and staff are safe inside the institution. Therefore, blood transfusion services must be safe for the patient, and the patient must be protected against the risk of developing an infectious disease through blood transfusion and even death.

Toward this shared objective, medical practitioners must collaborate. Every important participant in the transfusion chain must, therefore, share a shared objective. Healthcare facilities in Nigeria should make every attempt to keep everyone’s values and presumptions in mind as it may affect interactions with team members who are other professionals. Regardless of the talents and limitations of various team members, effective teamwork contributes to the provision of high-caliber and safe healthcare [33, 34]. Hospitals must create a blood transfusion committee that meets regularly to examine the current transfusion strategy, and best practices, compile a transfusion manual and handbook, as well as to take training sessions to stay informed about the current state of transfusion services [34].

3. Conclusions

In Nigeria, health professionals who provide transfusion-dependent patients’ care have a real and compelling responsibility to uphold their end of the bargain when it comes to being held accountable for the human, financial, clinical, and other resources involved in managing blood donations. All parties involved—from patients to laboratory scientists, physicians, blood collectors, and distributors—must collaborate if they are to use these priceless donations of human blood with judiciousness and excellence.

Acknowledgments

All glory to the Almighty for making it possible to write this paper. Likewise, I thank my mentors whose guidance and constructive criticism yielded this write-up in the person of Professor A.O Hassan, Professor Abubakar, A.A., Dr. Adeniyi T.D., and Mr. Ismail A. The contributory effort of Mr. Abdulkareem Aliyu is well appreciated and we say special thanks to all of you. We will also like to note that this review receives no funding.

Notes/thanks/other declarations

Special thanks to the publisher and editor of this journal for finding it worthy to place this review in their reputable journal.