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Blood donation practices, processing and utilisation of blood components in

government tertiary hospitals in Nigeria: a multicentre cooperative study

Article in International Health · November 2023

DOI: 10.1093/inthealth/ihad105

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International Health 2023; 0: 1–6
https://doi.org/10.1093/inthealth/ihad105 Advance Access publication 0 2023

Blood donation practices, processing and utilisation of blood

ORIGINAL ARTICLE
components in government tertiary hospitals in Nigeria: a multicentre

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cooperative study
Garba Umara , Ibrahim Abdulqadirb , Ngozi Ugwu c , ∗ , Titilope Adeyemod , Nabila Yaue , Abdulazziz Hassanf ,
John Olaniyig , Abubakar Musah , Sharafa Abubakarh , Muhammad Ndakotsuh , Jasini Jamesh , Chika Uchei ,
Awwal Musaj , Chikadibia Ukomak , Benedict Nwogohl , Ekaete Davidm , Angela Ugwun , Chizoba Nwankwoo ,
Olaitan Omokanyep , Aisha Abbaq , Temilola Owojuyigber , Mujtabba Isyakus , Esther Obis , Ezra Jataut ,
Timothy Ekwereu , Rashidat Oladosu-Olayiwolav , Hezekiah Isahw , Sirajo Diggix , Alexander Nwannadiy ,
Saleh Yugudaz , Obinna Iheanachoaa , Hadiza Tikauab , Ibijola Adelekeac , Mabel Ekanemu , Anazoeze Madun ,
Augustina Ikusemoroad , Celestine Chukwuae , Amal Galadanciae , Okon Basseyaf , Theresa Otuw , Obineche Agwuag ,
Patrick Oshoah , Aisha Gwarzoae , Sadiya Hassanai , Adepoju Majeedaj , Anas Umarak , Habib Abubakaral ,
Mohamed Gimbaam , Michael Ugboran , Abdulmalik Aliao and Clara Ajubaap

a
Department of Haematology, Federal Medical Center, Birnin Kebbi, Kebbi State, Nigeria; b Department of Haematology and Blood
Transfusion, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria; c Department of Haematology and Immunology, Ebonyi
State University, Abakaliki, Nigeria; d Department of Haematology, University of Lagos, Lagos, Nigeria; e Department of Haematology,
College of Health Sciences, Federal University, Dutse, Jigawa State, Nigeria; f Department of Haematology, Ahmadu Bello University
Teaching Hospital, Zaria, Nigeria; g Department of Haematology, University College Hospital, Ibadan, Nigeria; h Department of
Haematology, Federal Medical Center, Yola, Nigeria; i Department of Haematology, Abia State University Teaching Hospital, Aba Abai
State, Nigeria; j Department of Haematology, Murtala Muhammad Specialist Hospital, Kano, Nigeria; k Department of Haematology,
Federal Medical Center, , Keffi, Nassarawa State, Nigeria; l Department of Haematology, University of Benin Teaching Hospital, Benin
City, Nigeria; m Department of Haematology, Natioanl Hospital, Abuja, Nigeria; n Department of Haematology, University of Nigeria
Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; o Department of Haematology, Asokoro District Hospital, Abuja, Nigeria; p Department
of Haematology, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria; q Department of Haematology, University of
Maiduguri Teaching Hospital, Bornu State, Nigeria; r Department of Haematology, Obafemi Awolowo University Teaching Hospital
Complex, Ile-Ife, Osun State, Nigeria; s Department of Haematology, Federal Medical Center, Yenagoa, Bayelsa State, Nigeria;
t
Department of Haematology, Jos University Teaching Hospital, Jos, Plateau State, Nigeria; u Department of Haematology, University of
Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria; v Department of Haematology, Federal Medical Center, Abeokuta, Nigeria;
w
Department of Haematology, University of Abuja Teaching Hospital, Abuja, Nigeria; x Department of Haematology, Sir Yahaya
Memorial Hospital, Birnin Kebbi, Kebbi State, Nigeria; y Department of Haematology, Benue State University Teaching Hospital, Makurdi,
Benue State, Nigeria; z Department of Haematology, Federal Teaching Hospital, Gombe, Nigeria; aa Department of Haematology,
University of Calabar, Cross River State, Nigeria; ab Department of Haematology, Federal Medical Center, Nguru, Yobe State, Nigeria;
ac
Department of Haematology, Federal Teaching Hospital, Ido Ekiti, Nigeria; ad Department of Haematology, Delta State University
Teaching Hospital, Oghara, Delta State, Nigeria; ae Department of Haematology, National Neuropsychiatric hospital, Benin City, Edo
State, Nigeria; af Department of Haematology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria; ag Department
of Haematology, Federal Teaching Hospital, Umuahia, Abia State, Nigeria; ah Department of Haematology, University of Medical
Sciences Teaching Hospital, Ondo State, Nigeria; ai National Eye Centre, Kaduna, Nigeria; aj Department of Haematology, Federal Medical
Center, Gusau, Nigeria; ak General Outpatient Clinic, Federal Medical Center, Birnin-Kudu, Nigeria; al Department of Haematology,
Rasheed Shekoni Specialist Hospital, Dutse, Jigawa State, Nigeria; am Federal Neuropsychiatric Hospital, Kware, Sokoto State, Nigeria;
an
Federal Neuropsychiatric Hospital, Kaduna, Nigeria; ao Department of Haematology, Muhammad Abdullahi Wase Specialist Hospital,
Kano, Nigeria; ap Department of Haematology, Nnamdi Azikiwe University, Nnewi, Anambra State, Nigeria
∗ Corresponding author: Tel: +2348061177100; E-mail: [email protected]

Received 27 June 2023; revised 8 September 2023; editorial decision 11 October 2023; accepted 17 October 2023

© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. This is an Open Access
article distributed under the terms of the Creative Commons Attribution License (https:// creativecommons.org/ licenses/ by/ 4.0/ ), which
permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

1
G. Umar et al.

Background: Timely access to safe blood and blood components is still a challenge in Nigeria. This study aimed to
determine blood donation practices, processing and utilization of blood components across government tertiary
hospitals (THs) in Nigeria.
Methods: This was a descriptive cross-sectional study done in Nigeria in June–July 2020. Data were analysed
with SPSS version 21.0.

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Results: Data were collected from 50 THs. The majority (68%) of the THs lack facilities for blood component
preparation and only 18% and 32% provide cryoprecipitate and platelet concentrate, respectively. Whole blood
was most commonly requested (57.04%). All facilities tested blood for HIV, HBV and HCV, but the majority (23
[46%]) employed rapid screening tests alone and nucleic acid testing was not available in any hospitals. The man-
ual method was the most common method of compatibility testing in 90% (45/50) and none of the THs routinely
perform extended red cell typing. The average time to process routine, emergency and uncross-matched re-
quests were a mean of 109.58±79.76 min (range 45.00–360.00), 41.62±25.23 (10.00–240.00) and 11.09±4.92
(2.00–20.00), respectively.
Conclusion: Facilities for blood component preparation were not widely available. Concerned government au-
thorities should provide facilities for blood component preparation.

Keywords: blood, blood component, blood donation, hepatitis, hospital, Nigeria.

Introduction ratory scientist. Responses were collated directly by the research

server into an Excel spreadsheet (Microsoft, Redmond, WA, USA).
Blood and its component and products are necessary to pre- Data were imported into and analysed using SPSS version 21 (IBM,
vent morbidity and mortality, especially in developing countries Armonk, NY, USA). Descriptive statistics were used to compute
where reasonable alternatives are not readily available.1–4 For percentages and proportions, minimum, maximum, mean and
healthcare facilities to harness the benefit of blood in patient standard deviation (SD).
care, prompt availability and judicious use of safe blood must be Hospitals with incomplete responses or whose questionnaire
ascertained, requiring the right donor and standard processing was not received within the study period were excluded from the
of blood.5 This will minimize complications, shorten delays and analysis.
avoid blood wastage, especially when national blood transfu-
sion services are not capable of meeting the demand for blood
products and hospitals improve their capacities in terms of com- Results
patibility testing and transfusion transmissible infection (TTI)
screening.6–8 In Nigeria, the National Blood Transfusion Commis- Fifty government THs of 103 met the inclusion criteria and were
sion (NBTC) is yet to provide the desired support to individual included in the study. Use of a donor questionnaire and enrol-
hospitals to provide blood component therapy to citizens. This ment form was practiced by 50% (25/50) and 36.0% (18/50),
implies a tasking challenge to individual healthcare facilities pro- respectively, while 36.0% (18/50) had a donor clinic with a mobile
viding blood therapy to ensure self-sufficiency in blood processing donor drive to reach donors outside the hospital (Figure 1). Family
and availability.9–13 The aim of this study was to determine the replacement donors constitute the majority (68.0%) of blood
blood donation practices, processing of blood components donors, followed by voluntary non-remunerated blood donors
and utilisation across all government tertiary hospitals (THs) in (19.3%), commercial donors (12.2%) and autologous donors
Nigeria. (0.3%) (Figure 1). Of the autologous donors, 63.13%, 26.74%
and 10.13% were pre-deposit, preoperative haemodilution and
intra-operative salvage, respectively. All hospitals screened
blood for human immunodeficiency virus (HIV), hepatitis B and C
Methods viruses (HBV and HCV), but the majority (23 [46.0%]) employed
A descriptive cross-sectional study involving government-owned a rapid screening test alone and nucleic acid testing was not
THs in Nigeria was conducted using a web-based (data was col- available in any hospitals (Table 1). The majority of the hospitals
lected with electroiic google form) electronic questionnaire of (45 [90.0%]) screened blood for red cell antibodies using a man-
80 questions to collect information on hospitals, blood transfu- ual method and routine antibody screening and identification
sion infrastructure, equipment and personnel, donor recruitment, was obtainable in only 5 (10.0%) hospitals while extended red
blood donation and requisition, screening of TTIs, blood com- cell typing was not available in any hospitals (Table 2). Only 16
ponent preparation, blood security, inventory, records and blood (32.0%) centres had facilities for blood component preparation
transfusion management systems from June to July 2020. Data and, of these, 9 (18.0%) and 16 (32.0%) provide cryoprecipitate
were collected from a haematologist in each centre, except in and platelet concentrate, respectively, while leuco-depleted red
case of none available, where data were collected from another cells were not obtainable in any centre (Table 3). Whole blood,
physician with an interest in blood transfusion or a medical labo- packed cell/red cell concentrate and cryoprecipitate account

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International Health

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Figure 1. Donor recruitment in hospital-based transfusion in Nigeria.

for 57.04%, 28.55% and 2.29%, respectively, of the requests could collectively undermine the safety of blood in the country
for blood transfusion (Figure 2). The average time to process and cause legal issues in the operation of blood transfusion ser-
routine, emergency and uncross-matched requests were a vices. These run counter to the standard of administering ques-
mean of 109.58±79.76 min (range 45.00–360.00), 41.62±25.23 tionnaires, completion of enrolment forms and obtaining consent
(10.00–240.00) and 11.09±4.92 (2.00–20.00), respectively for risk stratification of prospective donors and legitimate protec-
(Table 4). tion of the process.15 A study by Salamat16 in Pakistan reported
that appropriate application of a donor questionnaire is important
in order to prevent unnecessary blood donor deferral and ensure
blood safety. A previous study also reported the use of informed
Discussion
consent in transfusion medicine to be low compared with other
Blood as a lifesaving tissue should be readily available to all per- procedures in medical practice.17
sons in need, with the utmost concern for its adequacy and The absence of a donor clinic in most centres and a lack of
safety as enshrined in the World Health Assembly resolutions facilities to establish and nurture donor mobilization and exter-
WHA28.72 (1) of 1975 and WHA58.13 (2) of 2005.14 Adequate nal blood donation drives will hinder the realization of a global
and safe blood depends on the soundness of the blood dona- framework for action to achieve 100% voluntary blood dona-
tion process adopted by the NBTC or blood banks. The low use tion, which ultimately aims to avoid family replacement and paid
of donor questionnaires and enrolment forms as well as the high donations.18 The present situation of donor clinics and external
rate of unsigned consent before donation recorded in this study donor drives in the participating THs may be partly responsible

3
G. Umar et al.

Table 1. Method of screening for TTIs in hospital-based transfusion in Nigeria

Routinely screened

TTI Yes, n (%) No, n (%)

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HIV 50 (100.00) 0 (0.00)
HBV 50 (100.00) 0 (0.00)
HCV 50 (100.00) 0 (0.00)
Syphilis 40 (80.00) 10 (20.00)
Method of TTIs screening Frequency (%)
Rapid screening only for HIV, HBV, HCV and syphilis 23 (46.00)
Rapid screening for HIV, HBV, HCV and syphilis then ELISA for only HIV 17 (34.00)
Rapid screening for HIV, HBV, HCV and syphilis then ELISA for all 10 (20.00)
Rapid screening for HIV, HBV, HCV and syphilis then nucleic acid testing for any 0 (0.00)

for the findings of low voluntary non-remunerated (VNR) donors

Table 2. Method of blood compatibility testing and higher family replacement donors as well as a significant
proportion of commercial donors reported by this study. Our find-
Method of blood compatibility testing Frequency (%) ing on blood donation in the country is an improvement from the
situation in the recent past when blood was almost exclusively
Manual 45 (90.00)
sourced from family replacement and paid commercial donors
Semi-automated 3 (6.00)
with negligible or non-existent contributions by VNR donors.18–21
Fully automated 2 (4.00)
Similar, but nonetheless variable, improvement in the contribu-
Do you routinely do antibody screening
tion of VNR donors was recently noticed in many countries across
and identification for all patients?
sub-Saharan Africa (SSA).22 , 23 Factors hindering voluntary dona-
Yes 5 (10.00)
tion in SSA were succinctly highlighted by Ugwu et al.,24 including
No 45 (90.00)
taboos, superstitious beliefs, low number of VNR donors and a
Do you routinely do extended red cell
predominance of family replacement donors. Another challenge
typing?
that can affect voluntary donation in the hospital setting is the is-
Yes 0 (0.00)
sue of a service fee charged for blood processing. These notwith-
No 50 (100.00)
standing, attainment of 100% voluntary blood donation is
vital to the safety of blood, especially in our setting where a high
prevalence of TTIs, poverty and unemployment make any other

Figure 2. Blood component requisition pattern in hospital-based transfusion in Nigeria.

4
International Health

The capacity to separate blood to its components across the

Table 3. Blood component preparation and availability THs falls short of the 37% reported by the WHO for low-income
countries.18 This lack of component preparation in most centres
Blood component preparation and availability restricts the availability of blood components such as red cell
concentrate, platelet concentrate, washed red cells, fresh frozen
Preparation Yes, n (%) No, n (%)
plasma and cryoprecipitate, as well as a total absence of leucode-

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Facilities for blood component 16 (32.00) 34 (68.00) pleted and irradiated red cells in any of the THs. A previous study
Red cell concentrate 16 (32.00) 34 (68.00) reported the low availability of blood components with conse-
Leucodepleted red cells 0 (100.00) 50 (0.00) quent blood wastage.29 This same issue of capacity to produce
Irradiated red cells 0 (100.00) 50 (0.00) blood components may be responsible for the blood requisition
Washed red cells 3 (6.00) 47 (94.00) pattern reported in this study, which was majorly whole blood.
Fresh frozen plasma 16 (32.00) 34 (68.00) All these could lead to inappropriate transfusions and wastage of
Cryoprecipitate 9 (18.00) 43 (82.00) blood and exposure of recipients to the preventable side effects
Platelet concentrate 16 (32.00) 34 (68.00) of unwanted components. The chances of exposing a blood re-
cipient to a preventable unwanted effect of blood is further con-
founded by the method of compatibility testing and the lack of
extended red cell typing in all THs. Although some authorities
favour transfusion of whole blood over product and component
therapy at present in SSA, owing to the peculiar challenges in the
Table 4. Time taken to process blood requests region, which includes the rate of emergency transfusion, cost
of product preparations, delays in preparation and utility of the
Time taken to process blood request (minutes) plasma for industrial use in view of stringent regulations guiding
such among other things.14 , 30
Type of request Mean±SD Range

Routine request 109.58±79.76 45.00–360.00

Emergency request 41.62±25.23 15.00–240.00 Conclusions
Uncross-matched request 11.09±4.92 5.00–20.00 Hospital-based blood transfusion services in Nigeria depend on
family replacement donors who were mostly enrolled without the
use of donor questionnaires or were tested for TTIs using a rapid
screening method alone. Blood is regularly transfused in whole
without blood component therapy and is always processed using
source of blood extremely dangerous, as prospective donors in manual serological techniques without routine antibody identifi-
the setting of family replacement or paid donations could con- cation or extended red cell typing. The time to process both rou-
ceal information on their risk to enable them to fulfil donation tine, emergency and uncross-matched blood remain longer than
criteria either for financial gain or family interest. The commit- necessary in most THs. These findings are a wake-up call for au-
ment of policymakers is the greatest step in transfusion safety, as thorities to provide facilities for blood product preparation and up-
weaknesses in the regulatory framework, governance and lead- grade serological techniques through budgetary allocations and
ership constitute major impediments to transfusion safety in poor partnerships and for reorientation of physicians and blood trans-
economies.25 fusion personnel in the use of blood components and prompt re-
All hospitals were in compliance with World Health Organiza- sponse through continuous education and training.
tion (WHO) recommendation of mandatory TTI screening for HIV, A limitation of the study was the low response rate from many
HBV and HCV, but for syphilis the compliance was not total. How- hospitals, which may have affected the results.
ever, the technology for TTI screening remains a serious concern
in the safety of blood in Nigeria, as none of the THs employed nu-
cleic acid testing. Nucleic acid, being part of the infectious agent
itself, is the first detectable marker of infection to appear before
Authors’ contributions: GU, IA, NU, NY and AH conceived the study. GU,
both antigens and antibodies, which form the basis of immunoas- IA, TA, JO, AM, SA, AM, JJ, TA, CU, MN, FM, MA, CN and TC designed the
says for rapid screening and enzyme-linked immunosorbent as- study protocol. AU, NB, ID and SY were responsible for the analysis and
say (ELISA).14 , 26–28 Thus the current methods of TTI screening in interpretation of data. GU, IA, NU, OA, OO, EO, AA, TO, MI, IB, EJ and TE
Nigeria have extended the window of infectious agents by an es- drafted the manuscript. TO, RO, KD, AO, PO, AK, AU, HA, AH, AM, AI, AU,
timated 11 to 22 days for HIV, 25–30 to 59 days for HBV and 12 HA, MG, CN, AA, UM, OA, OO, AA, TO, MI, IB, EJ, IH, SD, IN, HI, SM, IA, ME, AM,
to 70 days for HCV.26 This lengthy window period inherent in the AII, TA, AG, AI, OI and OB critically revised the manuscript for intellectual
current testing methodologies, together with non-use of donor content. All authors participated in data collection and read and approved
questionnaires and a low proportion of VNRs reported by this the final manuscript. GU and NU are guarantors of the paper.
study can collectively increase the chance of enrolling/recruiting
non-eligible donors and further jeopardize the safety of blood. Acknowledgements: None.
This concern is paramount in the setting with a high prevalence
of TTIs, as there could be significant numbers of window-period Funding: This work was supported by the authors. There was no external
donations that can be identified by nucleic acid testing.14 funding.

5
G. Umar et al.

Competing interests: None declared. 13 Abhulimhen-Iyoha BI, Israel-Aina YT. Emergency blood transfusion
in children in a tertiary hospital in Nigeria: indications, frequency and
Ethical approval: The survey protocol and questionnaire were re- outcome. West Afr J Med. 2018;35(1):20–4.
viewed by the Research and Ethics Committee of the Federal 14 World Health Organization. Screening donated blood for transfusion
Medical Center, Birnin-Kebbi and approved with reference number transmissible infections: recommendations. Geneva: World Health
FMC/BK/HP/045/P/517/VOL.III. Organization; 2009.

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© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. This is an Open Access
article distributed under the terms of the Creative Commons Attribution License (https:// creativecommons.org/ licenses/ by/ 4.0/ ), which
permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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