Blood Transfusion

Blood transfusion in Africa is critical for the resolution of severe anemia but also places recipients at high risk for post-discharge morbidity and mortality. Very little information is available about the need for and use of blood in sub-Saharan Africa, or the challenges faced by blood transfusion services. Sub-Saharan Africa faces significant resource limitations in blood collection, processing and supply, yet there is no data on how supply chain deficiencies, prevalent asymptomatic infections or red blood cell genetic disorders in African donors affect the quality of blood. How these factors influence the survival of anemic African children is also undetermined.

Sickle cell anemia (SCA) is the most important genetic disorder in sub-Saharan Africa, where over 280,000 affected children are born every year. Although such children represent only 1-2% of all births within the region, they receive between 10 and 25% of all blood transfusions administered to children <5 years old. While recent improvements in the diagnosis and management of SCA have resulted in survival improvements in Africa, this has led to increasing levels of hospital admission for the management of crises, which often involve transfusions. Frequent transfusions can lead to erythrocyte alloimmunization – the generation of antibodies to major, minor, or variant red blood cell antigens. In sub-Saharan Africa most transfusions are only matched on the basis of the major blood group antigens ABO and D, and most are given without even cross-matching before infusion. Blood matching for minor red cell antigens (such as Rh, Kell, Kidd, Duffy, Lewis and MNS) prior to transfusion is rarely undertaken, and almost certainly increasing the risks of alloimmunization.

Our laboratory, clinical and observational studies will provide the much-needed information about challenges faced in blood provision, prevalence of asymptomatic infections and alloimmunization, and the complications associated with transfusion. The data generated will potentially result in more effective management of this limited resource, better transfusion practices, improved patient survival post-transfusion, and reduce the need for re-transfusion.

Investigators: Sophie Uyoga, Alexander Macharia, George Warimwe, Anthony Scott, Ambrose Agweyu, Cheryl Andisi, Thomas Williams, Kathryn Maitland.

1. Uyoga S, George EC, Bates I, Olupot-Olupot P, Chimalizeni Y, Molyneux EM, Maitland K. Point-of-care haemoglobin testing in African hospitals: a neglected essential diagnostic test. Br J Haematol. 2021 Jun;193(5):894-901. doi: 10.1111/bjh.17431.
2. Maitland K, Kiguli S, Olupot-Olupot P, Opoka RO, Chimalizeni Y, Alaroker F, Uyoga S, Kyeyune-Byabazaire D, M’baya B, Bates I, Williams TN, Munube D, Mbanya D, Molyneux EM, South A, Walker AS, Gibb DM, George EC; TRACT Stakeholders meeting group. Transfusion management of severe anaemia in African children: a consensus algorithm. Br J Haematol. 2021 Jun;193(6):1247-1259. doi: 10.1111/bjh.17429.
3. Uyoga, S., Adetifa, I.M.O., Karanja, H.K., Nyagwange, J., Tuju, J., Wanjiku, P., Aman, R., Mwangangi, M., Amoth, P., Kasera, K., ………., Wright, D., Barasa, E., Tsofa, B., Bejon, P., Ochola-Oyier, L.I., Agweyu, A., Scott, J.A.G., Warimwe, G.M. “Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Kenyan blood donors“. Science 2021 Jan 371 79-82 doi: 10.1126/science.abe1916
4. Uyoga S, Mpoya A, Olupot-Olupot P, Kiguli S, Opoka RO, Engoru C, Mallewa M, Kennedy N, …… Walker AS, George EC, Williams TN, Maitland K. Haematological quality and age of donor blood issued for paediatric transfusion to four hospitals in sub-Saharan Africa. Vox Sanguinis 2019 Mar 5. doi: 10.1111/vox.12764.