Where is the blood?

Sarah’s baby was born on an early April morning. The pregnancy was fairly easy as she was a healthy twenty-six-year-old and this was her first pregnancy. On the delivery day, she was induced at 9:30 a.m due to her exceeding her due date (EDD). The labour was well monitored and uneventful, with her being delivered […]

Sarah’s baby was born on an early April morning. The pregnancy was fairly easy as she was a healthy twenty-six-year-old and this was her first pregnancy. On the delivery day, she was induced at 9:30 a.m due to her exceeding her due date (EDD). The labour was well monitored and uneventful, with her being delivered of a baby boy about nine hours later.  She even bragged to the nurses: “Having a baby is easy compared to how it looks on TV. I could totally do this again.”

Two days later, she was discharged from the hospital, and she returned home with her baby. She was still bleeding, which is normally supposed to happen. Typical blood loss for a vaginal delivery is 500mL; for a cesarean section, it’s 1,000mL. The hospital where she delivered didn’t really define what normal vaginal bleeding was supposed to be like and so she assumed the clots of blood she was losing was normal.

A week after delivery, Sarah passed out on the bathroom floor where her husband found her and brought her to the hospital. Her entire wrapper was soaked in blood and the doctors in the emergency raced to find blood to save her life. She was in hypovolaemic shock from post-partum haemorrhage. In lay terms, it simply means she had developed complications from bleeding as a result of childbirth. By the next morning, she had received over ten bags of blood and two bags of plasma. Her blood type was O negative, and the hospital supply was depleted. There were no donors left as her family members had already donated. Her husband, father, brothers, and sisters had all volunteered blood. Even if more donors miraculously appeared, the lab doctors told us that there were no blood bags available for blood collection. Calls where made to other health facilities in the state but no blood bag was found. Apparently, blood bags had become like diamonds, rare and expensive. The whole situation was pathetic. The obstetricians considered doing a hysterectomy (removing her uterus) to save her life as she was losing blood just as fast as she was being transfused. The dreaded ‘Disseminated intravascular coagulation’ (DIC) had set in. Thirty-eight hours after she arrived at the hospital, Sarah passed away on the operating table.

This is Sarah’s story. And there are millions more like her. People who die daily from blood loss caused by accidents, trauma and pregnancy.

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Last week, the World Health Organisation (WHO) put the matter in perspective as the international community marked the World Blood Donor Day (WBDD) 2023, recently, with the theme ‘give blood, give plasma, share life, share often’.  The world body pointed out that in many countries, blood services face the challenge of making sufficient blood available, while also ensuring its quality and safety. Lack of access to safe blood and blood products – especially in low- and middle-income countries, it lamented, impacts on all patients, including those requiring regular transfusion.

As Nigeria joins the rest of the globe to mark World Blood Donor Day (WBDD), blood shortage may be worsened with the country having only five percent of voluntary non-remunerated blood donors, increased service charge for units of blood and dearth of blood bags for blood storage across the country.

In Nigeria, one of the primary concerns contributing to the blood crisis is the shortage of blood bags. Blood bags are an essential component of the blood transfusion process, ensuring the safe collection, storage, and transportation of donated blood. However, the scarcity of this crucial item has severely hampered the ability of healthcare providers to deliver life-saving transfusions. This shortage is exacerbated by the absence of a robust system for manufacturing and distributing blood bags in Nigeria. Presently, blood bags are imported into Nigeria for a minimum price of N4,000 per bag as against its previous price of N200. A pack of bags that used to sell for N86,000 has gone up to N400,000. As can be expected, with the petrol subsidy removal it will further increase.

Due to this increment in the price of blood bags, the service charge for blood transfusion has skyrocketed. In addition, hospitals now run on generators and investigations run on each unit of blood rely solely on imported reagents to do these tests.

Double wahala for dead body.

It is an open secret that Nigeria has not been able to meet her transfusion needs as the number of voluntary non-remunerated blood donors is less than five per cent of the total number of donors. And now that the availability and cost of blood bags have become a challenge, this will translate to a dearth of blood and blood products in the country.

There are two solutions- one short term and the other, long term. The long-term solution is of course time and capital intensive.

The short-term solutions are what we are already doing. Partnering with International organisations and NGOs to advocate for increased blood donation by organising blood drives. This year partners at the WBDD celebrations, included the World Health Organization (WHO), APIN plus Public Health Initiative and Rotary Clubs who all pledged support for blood donation drives, asking individuals to see blood donation as lifesaving. The Southwest Zonal Director of the National Blood Service Commission (NBSC) was quoted as he pleaded “It is quite difficult to support the transfusion service of our country when you are not a regular donor. So, we are using this opportunity to speak to our known donors to be regular and those not in the pool of voluntary blood donors to please seize this opportunity to donate blood, it is part of sharing lives and sharing often.”

The long-term solution is to manufacture the materials ourselves. It is imperative that the government and relevant authorities prioritize the procurement and distribution of an adequate supply of blood bags across the country. It’s about time we started manufacturing our own medical supplies. Do you know that we import the bags used for IV fluids? Cannulas, syringes and even the Intra venous giving set that is just a mere plastic tubing is imported! Even Water for Injection (WFI) is imported from India. Sterilized water fa!

Wonders shall never end.

Importation of these common commodities that are used in millions daily, is not sustainable. You know that; I know that, and the government knows that.

It goes without saying that, if these commonly used items like blood bags are made manufactured here and therefore readily available, blood donation would be easier and significantly cheaper.

In 2016, James Ocholi, the minister of state for labour and employment, died in a road accident which occurred near Rijana along the Kaduna-Abuja Road after the rear tyres of his car burst. He and his son died shortly after the crash, while his wife went into coma and later died at Doka hospital, Kaduna. Eyewitnesses say that the duo died after bleeding to death at the site of the accident.

Blood transfusions save lives. It also limits the complications of severe blood loss. We should all learn to donate blood at the closest general hospital to us. Who knows? Everyone of us is a potential victim and so we should all do our part.

Let us do our part. And let government do theirs.