Improving blood screening for safer transfusion practices

Dr Sophie Uyoga is a medical research scientist, and an IDeAL fellow with an interest in blood transfusion and how to improve blood quality to aid patients’ recovery and survival post-transfusion. The Initiative to Develop African Research Leaders (IDeAL) is supported by the Alliance for Accelerating Excellence in Science in Africa (AESA) programme, the Developing Excellence, Leadership and Training in Science in Africa (DELTAS Africa).

DELTAS Africa is implemented through the AESA Platform, a funding, agenda-setting, programme management initiative of  the African Academy of Sciences (AAS) in partnership with the African Union Development Agency (AUDA-NEPAD) and with the support of Wellcome, Bill and Melinda Gates Foundation and the United Kingdom Department for International Development (DFID).

IDeAl is a high-quality training programme that aims to develop outstanding young African scientists into world class research leaders. It is available to young researchers, from undergraduate research attachments to postdoctoral fellowships, with the aim of keeping scientists at African institutions through a defined programme of recruitment, supervision, mentorship, multidisciplinary approaches and clear career paths.

Sophie is working on the first comprehensive study on donor blood in Africa. A better understanding of the quality of blood is important as this research will hopefully result in improved screening, storage and use of blood to effectively manage this limited resource and shape better policies for this medical procedure.

 Contextualizing blood screening procedures and policies to Africa

Severe anemia is a major contributor to mortality in sub-Saharan Africa (SSA). The adoption of National Blood Transfusion Services (NBTS) and policies from developed countries by local governments have provided a structure that ensures the availability of safe blood to patients by screening for HIV, Syphilis, Hepatitis B and C. Extensive research to guide policy development has been undertaken in the majority of the developed nations. However, little information is available on the quality of blood and its impact on clinical outcomes in Africa. The blood donors in SSA live in environments where several infections occur at high transmission rates and cause asymptomatic infections. In most malaria endemic regions in SSA there is no routine screening of blood donors for the disease.  

Several genetic disorders affecting the red blood cells are also present in 10-50% of the population yet the impact of these disorders on blood used for transfusion in SSA is not well understood.

The actual burden of malaria and viral infections on blood transfusion in Kenya remains unknown as transfusion services do not routinely screen for prevalent infections like malaria, chikungunya, dengue and parvovirus B19.

“I am investigating the development and treatment of severe anemia in the Transfusion and Treatment of severe anaemia in African children (TRACT), a multi-centre randomised controlled trial of children admitted to hospital with severe anaemia. As part of my work under TRACT conducted in Uganda and Malawi, I am focusing on the role of red blood cell genetics and the quality of donor blood on the recovery of patients and their survival post-transfusion.” This is also in collaboration with the Kenya National Blood Transfusion Services (KNBTS) to screen Kenyan blood donors for emerging arboviral infections and malaria that are prevalent but not part of the routine screening. These infections aren’t mandatory for screening and would come at an additional cost. We therefore need to ascertain whether it is important to screen for such infections in areas where they are prevalent.

Informing and improving safer transfusion practices

Uyoga’s study aims to describe the level of active infections among donors for infections that are prevalent in the region namely asymptomatic malaria, chikungunya, dengue and parvo virus B19 infections using molecular methods. This will inform transfusion services if there is need to add additional screening strategies to prevent transmission through blood transfusion.

The blood quality checks done within the TRACT trial highlighted the importance of close interactions and education between transfusion and clinical services and the importance of hemovigilance (the surveillance of blood collection and delivery) to ensure safe transfusion practice.

This is the first comprehensive study on donor blood in Africa with significant implications for current practice. The unique linkage to a clinical trial will provide important additional data. 

This study is contributing to improvements in the screening, storage and use of blood for more effective management of this limited resource. This will also improve patient survival post-transfusion and reduce the need for re-transfusion and consequent shortages. 

Earlier this year, the TRACT trial team co-hosted a meeting with the Africa Society for Blood Transfusion and the Uganda Pediatrics Association. A meeting with transfusion experts and pediatricians from 14 African countries to discuss the lessons learnt from the trial that would enable transfusion services to work in harmony with clinicians.

Uyoga’s work, along with the combined efforts of the TRACT trial team, and collaboration with the Africa Society for Blood Transfusion and the Uganda Pediatrics Association, should provide a better understanding of the quality of blood used for transfusion in Africa  to promote the development of better policies for the preparation and use of blood.