10 Things That Africans Should Know About Blood Transfusion

 

By Foluke Akinwalere. Freelance Health Writer and DLHA volunteer. With medical review and editorial support by the DLHA Team.

Blood bag hooked on a stand with the donor lying on a couch in the background.

 

 

Introduction

 

Blood transfusion is a life-saving medical procedure involving transferring blood or blood components from one person (the donor) to another (the receiver in need).  It has been a medical marvel, a beacon of hope, and a cornerstone of healthcare for generations. For Africans, awareness and understanding of the intricacies of this life-saving procedure is not just a matter of knowledge but a potential key to survival.  

 

This article aims to provide you with clear information about blood transfusion, including what it is, when to have and not have it, how it’s given, potential risks, and its invaluable benefits. It also highlights the objections that some Africans have to blood transfusion. So, let’s dive in!

 

 

1. What is Blood Transfusion?

 

Blood transfusion is a critical medical procedure that involves the intravenous transfer of blood or specific blood components from a healthy donor to a recipient in need. It’s an intricate process that entails meticulous screening of donors and rigorous compatibility testing to ensure the safety of both the recipient and the integrity of the donated blood.  

 

 

2. What Are The Different Blood Components and Their Roles?

 

Blood is not just a single entity but is composed of different components, each with its unique role. They include:

• Red Blood Cells (RBCs): These carry oxygen from the lungs to the body’s tissues and return carbon dioxides to the lungs for exhalation. 

• Plasma: The liquid component of blood, which contains water, electrolytes, hormones, and waste products.  It helps maintain blood pressure and circulates nutrients throughout the body.

• Platelets: Tiny cell fragments crucial for blood clotting.  Platelet transfusions are often used to prevent or control bleeding in individuals with low platelet counts.

• White Blood Cells (WBCs): The body’s defense against infections.  WBC transfusions are rare and are generally reserved for specific medical conditions

 

 

3. When Do You Need Blood Transfusion?

 

According to the WHO, the African Region faces a high demand for blood transfusion due to bleeding related to pregnancy and childbirth, high prevalence of malaria with the attendant complication of severe malaria anaemia, high rates of road traffic accidents and other types of injury as well as other blood transfusion indications.^[1]

 

Blood transfusion has multiple indications that can be categorised into two major groups:

 

1. To Replace Blood Loss from Bleeding 
 

• Bleeding from Trauma or Surgery: This can occur due to various factors, which include accidents, injuries, gunshot or knife injuries, surgical procedures, and complications during childbirth.  In these life-threatening situations, rapid blood loss can lead to symptoms like dizziness, low blood pressure, confusion shock, and even death

 

In cases of acute and severe blood loss, blood transfusion is vital to replenish lost blood volume, restore the body’s oxygen-carrying capacity, and stabilise the patient. 
 

• Bleeding associated with a medical condition: Acutely severe or chronic blood loss may occur in some medical conditions (e.g., peptic ulcer, alcohol-induced bowel bleeding, cancers, blood clotting disorders, bleeding into the brain, etc).  Blood transfusion in such conditions helps to maintain the patient’s circulatory stability, ensuring safe and successful care of the underlying medical condition.

 

2. To Increase Low Blood Components (Due to Production or Destruction Issues)

 

• Anaemia: It is a medical condition characterised by a deficiency of red blood cells (RBCs) or a reduced hemoglobin level. Symptoms may include fatigue, weakness, shortness of breath, pale skin, and dizziness.  Blood transfusion is necessary in some cases of severe anaemia to increase RBC count and enhance the body’s oxygen-carrying capacity.

 

• Cancer Treatment: Chemotherapy, a common treatment for cancer that is used to kill cancer cells, ^[2] can have profound adverse effects on blood cells. 

Chemotherapy drugs can affect healthy cells in the blood and bone marrow, leading to decreased blood cell counts. This condition causes anaemia and may require blood transfusions.

 

• Bone Marrow Disorder: Certain medical conditions, such as aplastic anaemia and myelodysplastic syndromes, can damage the bone marrow’s ability to produce healthy blood cells.  This can lead to low blood cell counts and may require blood transfusion.

 

• Sickle Cell Disease: Africa has been associated with the highest prevalence of the sickle cell trait, with figures suggesting that between 10% and 40% of the entire population may be affected.^[3]  It results in the production of abnormal hemoglobin and misshapen red blood cells that get destroyed readily, causing episodes of severe pain, anaemia, and various complications. Blood transfusion is an integral part of managing sickle cell disease. 

 

 

4. When You Should Not Have Blood Transfusion?

 

Blood transfusion, while a life-saving intervention, may not be suitable for everyone. Understanding when you should not have blood transfusion (i.e., contraindications) is important to ensuring your safety and well-being. Here are some key situations when you should not have a blood transfusion:

 

• Allergic (Incompatibility) Reactions: Allergic reactions to blood components can occur when there is incompatibility between the donor’s blood and the recipient’s immune system. These reactions can range from mild symptoms like itching and rash to severe, life-threatening responses such as anaphylaxis. If you have prior history of severe allergic reactions or known allergy to specific blood components, then blood transfusion may not be right for you.     

 

• Iron Overload: Repeated blood transfusions can lead to iron overload in the body. While iron is an essential element, excess accumulation can have detrimental effects on organs such as the heart, liver, and pancreas. A person at risk of iron overload should not have a blood transfusion.

 

• Transmissible Infections: The risk of transmission of serious infections, such as HIV and hepatitis, through unsafe blood transfusion, brought global attention to the importance of blood safety and availability. If there are concerns about the safety of donated blood, a transfusion should be withheld.

 

• Underlying Medical Conditions: Certain medical conditions may impact the suitability of blood transfusion such as:

- Individual with severe heart or lung condition

- Those with a history of severe transfusion reactions

- Patients with specific metabolic disorders

 

They need careful consideration before receiving a transfusion.

 

 

5. How Is Blood Transfusion Given? 

 

The process of how blood transfusion is given is a precise and regulated series of steps.

 

• Donor Blood Collection: The process of blood transfusion starts with the act of donating blood which may be collected from either the recipient's family/relatives or from willing donors, who understand the importance of voluntary contribution to the blood supply.

Payment for blood donations are not accepted by most institutions. 

Donors go through a thorough screening to guarantee that their blood is infection-free and suitable for transfusion. This involves reviewing their medical history, assessing the risk of transmitting infections, and performing blood tests.

Donors are also asked to sign an Informed Consent Form attesting to their free will to donate blood and their clear awareness of any potential risks involved.

 

WHO also makes it mandatory that all donated blood should be screened for HIV, hepatitis B, hepatitis C, and syphilis.^[4] The collected blood would be typed and may be divided into different components (i.e., packed red cells, platelets, plasma, etc,)  based on the needs of the patient.

 

After a donor is approved, blood collection begins using sterile needles to extract whole blood. 

 

• Receiver's Assessment: Before a blood transfusion is administered, a thorough assessment of the receiver must be conducted. This includes:

 

Examining the receiver’s medical background, including the purpose of the transfusion and any previous responses to blood products

 

Performing blood tests to determine the recipient’s blood type and Rh factor, ensuring a match with the donated blood.

 

Identifying the necessary blood components based on the receiver's s medical situation.  For instance, a patient with severe anaemia may need red blood cells, while someone with a bleeding disorder may require platelets

 

This careful evaluation ensures that the transfusion is not only safe but also tailored to the receiver’s specific requirements.

 

• Transfusion Administration: Blood transfusions are typically administered through an intravenous (IV) line or catheter, allowing the donated blood or components to flow directly into the recipient’s bloodstream. This ensures a swift and effective response, particularly in emergency situations.

 

Before transfusion is started, the nurse or doctor who will set it up will obtain an Informed Consent from the receiver for both the procedure and the transfusion.

The Informed Consent is an attestation of the receiver's acceptance to receive the blood transfuion based on the needs and a clear awareness of and agreement with any potential risks involved as explained by the healthcare provider. 

Furthermore the healthcare provider will check that the receiver’s blood group and personal identifiers (i.e. patient ID) matches all the identifiers coded on the blood bag obtained from the blood bank from where the blood is supplied. This check ensures that the right blood is transfused to the right receiver. 

 

Throughout the transfusion, healthcare providers must closely monitor the receiver’s vital signs, including blood pressure, heart rate, and oxygen levels, to ensure safety and responsiveness. The transfusion rate is also adjusted as needed to prevent complications, such as circulatory overload. In addition, healthcare providers maintain meticulous records of the transfusion process, including the type and volume of blood products administered and any adverse reactions or symptoms.

 

 

6. What Are Your Blood Transfusion Risks? 

 

Blood transfusion, while life-saving, comes with potential risks that healthcare professionals carefully manage to ensure patient safety.  In the African context, several risks are important to consider:

 

• Allergic Reactions: This can range from mild, such as itching and rash, to severe manifestations like anaphylaxis.  Identifying individual risks, ensuring compatibility testing, and promptly addressing the reactions with medications are crucial steps in managing this risk.

 

• Transfusion-Related Acute Lung Injury (TRALI): It is a rare but severe reaction that is characterised by sudden respiratory distress after transfusion.  It occurs when antibodies in the donor blood react with the receiver’s immune system, leading to lung injury.  Strict donor screening and careful selection of blood components help to minimise the risk of TRALI

 

• Infections: While rigorous screening, testing, and proper handling of donated blood to prevent the transmission of infections are fundamental necessities for blood transfusion, there are still minimal risks of infection transmission. So, rigorous efforts should not be spared in ensuring that the whole chain of events involved in blood transfusion is safe from infectious agents.

 

• Transfusion-Associated Circulatory Overload (TACO): This occurs when the circulatory system is unable to handle the volume of transfused blood, leading to heart and lung overload.  Early signs include shortness of breath and fluid retention.  Monitoring patients during transfusion, adjusting transfusion rates, and identifying at-risk individuals are crucial to preventing TACO.

 

• Iron Overload: Repeated transfusions can lead to excess iron accumulation, posing risks to organs like the heart, liver, and pancreas.  Regular monitoring of iron levels and implementing iron-chelating therapies help manage and prevent the risk

 

 

7. What Are The Benefits Of Blood Transfusion? 

 

Blood transfusion can provide several benefits:

 

• Restoration of Blood Volume: Transfusions replenish lost blood volume due to severe bleeding, preventing shock and organ damage.

 

• Treatment of Anaemia: Transfusions boost oxygen-carrying capacity, improving energy levels and reducing fatigue.

 

• Support for Medical Conditions: It's a critical part of managing diseases like sickle cell anaemia and certain cancers.

 

• Surgery and Trauma Support: Blood transfusions ensure patients have the necessary blood components during surgical procedures and after severe injuries. 

 

• Emergency Care: Blood transfusions play a life-saving role in emergency situations, providing rapid blood replacement to stabilise patients

 

 

8. What Objections Do Some Africans Have To Blood Transfusion? 

 

In Africa, objections to blood transfusion often arise from cultural and religious beliefs, presenting unique challenges in healthcare.  Understanding and addressing these objections are crucial for providing effective and respectful medical care.

         

Cultural and Religious Objections

 

Some communities hold traditional beliefs about blood, considering it sacred or imbued with spiritual significance.  The introduction of foreign blood may clash with these cultural norms.

 

Also, many religions, including certain sects of Christianity, Islam, and Jehova’s Witnesses, have specific teachings regarding the sanctity of blood.  Devotees may object to transfusions based on religious principles.

 

Consequences of Objection

 

• Delayed treatment:  Objections to blood transfusion can result in delays in necessary medical interventions which compromise the patient’s health.

• Risk of complications: Refusing transfusions may lead to increased risks of complications, especially in emergency situations or critical medical conditions.

 

Negotiating with Blood Transfusion Objectors

 

• Cultural sensitivity: Healthcare professionals must approach objections with cultural sensitivity, respecting diverse beliefs and practices.

• Education and Communication: Providing clear and comprehensive information about the medical necessity, risks, and benefits of transfusion can help bridge the understanding gap.

• Involving Spiritual Leaders: In case of religious objections, involving spiritual leaders who may offer guidance and facilitate discussions can be of benefit.

• Exploring Alternatives: Collaboratively exploring alternative treatments or medical approaches that align with cultural or religious beliefs is essential.

 

 

9. Questions To Ask Before Donating Blood

 

Can I donate blood? 

 

Yes, many individuals can donate blood. To be accepted to donate, you need to be in good health, meet age and weight requirements, and have no history of infections such as hepatitis A, HIV, etc.

 

Are there any specific dietary requirements before I donate blood?

 

Before blood donation, it is advisable to have a balanced meal, especially iron-rich foods; stay well-rested and hydrated. Also, avoid alcohol.

 

Can I donate blood if I’m on medication?

 

It depends on the medication. Some medications may disqualify you temporarily, while others may not affect your eligibility.  Discuss your medications with the healthcare provider during the screening.

 

Is donated blood safe?

 

Yes, donated blood undergoes rigorous screening for infections, ensuring a safe blood supply. Healthcare facilities adhere to strict safety protocols to maintain the integrity of the blood transfusion process.

 

How is blood donation encouraged in Africa, and how can I contribute?

 

Blood donation campaigns, mobile blood drives, and community outreach programs are common methods to encourage blood donation in Africa.  To contribute, you can participate in organised blood donation events or visit local blood donation centres.

 

 

10. Questions To Ask Before Receiving Blood Transfusion 

 

What is a blood transfusion, and why might I need it?

 

Blood transfusion is the process of receiving blood or blood components from a donor.  You might need a blood transfusion to restore blood volume, treat certain medical conditions, or support surgeries.

 

What should I do to prepare for a blood transfusion?

 

There is usually minimal preparation. Your healthcare provider will inform you if any specific steps are necessary, such as fasting or medication adjustment.

 

How many blood transfusions can I a person safely have?

 

Currently, there is no set number of blood transfusions a person can have.^[5] But following its guidelines can reduce risks and improve outcomes.

 

What is the frequency of observations during a blood transfusion?

 

Frequent visual observation during transfusions is essential to identify signs of reactions or adverse events.  The patients must be observed closely for the first 15 minutes of each pack and at least hourly throughout the transfusion.^[6]

 

Are there alternatives to blood transfusion?

 

In certain cases, alternatives to blood transfusion, such as growth factors or volume expanders, may be considered.^[5] Some also consider medication. However, the suitability of alternatives depends on the specific medical condition.

 

Can I refuse a blood transfusion based on cultural or religious beliefs?

 

In some cases, people may decline blood transfusions due to cultural or religious beliefs. Healthcare providers should seek alternative treatments and respect the patient's choices while prioritising prioritizing their health.

 

 

Conclusion

 

Blood transfusion is a medical intervention that saves lives, improves health, and offers hope to individuals facing various medical challenges. By understanding what blood transfusion is, when it is needed, when it should be avoided, how it is administered, the potential risks, and the benefits it provides, Africans can make informed decisions about their healthcare. It is essential to acknowledge the critical role that blood transfusion plays in the medical field and its impact on the lives of countless individuals in the region and worldwide.

 

 

References

 

1. WHO African Region, Blood Safety [Internet. n.d]. Accessed November 9, 2023.

2. American Society of Clinical Oncology What is Chemotherapy? Approved by the Cancer.Net Editorial Board, 05/2022. Accessed November 9, 2023.

3. Adigwe OP, Onoja SO, and Onavbavba G, National Library of Medicine A Critical Review of Sickle Cell Disease Burden and Challenges in Sub-Saharan Africa J. Blood Med.2023;14:367-376 Published Online 2023 May 31, doi:10.2147/JMB.S406196  

4. World Health Organization Blood Safety and Availability [Internet 2 June 2023].

5. Medical News Today Blood Transfusions: Is there a limit? Last reviewed January 16, 2020.

6. Australian Red Cross Life Blood Transfusion Process: Monitoring and observation [Internet. n.d]. Accessed November 10, 2023

 

 

 

Published: October 12, 2023

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