Somaliland: Supply, Safety, and State of Blood Transfusions

After extensive research and countless scientific experiments in this unprecedented advancement in technology and natural science, humans have not been able yet to manufacture an ounce of artificial blood to this day, and there is no substitute for human blood. Neither experiment with animal blood for human transfusions is providing a promising breakthrough.  

Erythrocyte (Erythro- means red & –Cyte means cell) is the scientific name of red blood cells. The life span of human red blood cells is estimated to be about 120 days or 3 months, and the spleen is the organ that removes old red blood cells from the blood circulation. All types of blood cells are produced in the bone marrow – the soft tissue inside the bone cavities. Blood is one of the organs in the human body in a liquid state – unlike kidney and heart which are termed as solid organs. Therefore, blood transfusion is a form of human organ transplant that is performed according to a standard procedure consisting of pre-transfusion testing, strict blood administration protocol, and post-transfusion monitoring.

Blood banking centers are an important component of both the healthcare and education systems, and a must for Somaliland. Such institutions are perfect ventures for public private partnerships in the form of not-for-profit organizations. In addition to providing the blood supply, they also serve as teaching institutions where medical professionals rotate in their clinical internships to have the hands-on experience of the blood transfusion therapy. They also indirectly boost the job creation and lessen the burden of unemployment in the country. 

Strangely, there is a Somaliland Blood Bank Application available on Google Play. It is attributed to be funded by the Ministry of Health, and the common sense raises quite few questions on the need for an App like this, when there is no physical location for a functioning Somaliland National Blood Bank. Ironically, once you download this App, it would not give you an option to create account and, surprisingly, the login screen displays “Somali Blood Bank.”

There is also a website created by concerned Somaliland youth in Hargeisa under the name of “Badbaadi Naf”, which serves as a data bank where anyone who is willing to donate blood can register. When blood transfusions are needed, hospital staff can contact the registered persons and solicit a blood donation. However, even though this project is a right step forward, it came too soon, and it cannot fulfill the role and the position of the banking centers. Such data lacks a vital information relating to the blood workup record of potential donors, as it merely captures only the demographic details of registrants.  

In early 2019 the Somaliland government announced the establishment of the Somaliland Nation Blood Bank which would have blood centers in all major cities in Somaliland. This project was under the auspices of the Ministry of Health. Thus far, there is no word on its whereabouts and whether it is in operational. The sole product available for blood transfusion therapy is the human blood, which most Somalilanders are able to donate in order to have a functioning blood centers in the major cities in the country. Without this, an unsafe practice has emerged when a patient needs blood, where the family members became the only source of blood donations.

Screening Patients for Transfusion 

Prior to the transfusion, the patient’s blood type and medical history should be checked to see if there were any previous blood transfusions or pregnancies (in the case of female patients).  

When an Individual gets sensitized for an antigen, there must have been a prior stimulus in the past such as pregnancies or blood transfusions. Those naturally occurring antibodies without any stimulus are insignificant for transfusions as they are incapable of eliciting any adverse reactions. 

After matching the basic blood types between the donor and the patient, blood transfusions always carry additional risk that your own immunity system might detect the other foreign antigens on the transfused blood, and subsequently start producing antibodies against those antigens, thus triggering an acute adverse transfusion reaction.  In the administration of blood transfusion, the process is slowly monitored with a very low rate of infusion that is less than 2ml/min for first 15 minutes.

Administering 15ml of the wrong blood type is lethal error capable of causing the death of the patient. Unlike many medications and drugs, the infused wrong blood cannot be neutralized with any other substance. When it comes to the blood transfusion, there is no room for error or standard deviation. Pre-transfusion blood workup of the blood donation recipient must be completely done prior the blood administration.

Testing Blood Donations 

Blood is donated as a whole blood donation and one unit of that type of donation – about 500 ml – can be separated into several components: Packed Red Blood Cells (PRBC) preserved in additives, Plasma, Platelet Concentrate and Cryoprecipitate. Packed red blood cells donations are stored in a monitored refrigerator where the temperature should remain in the range of 1-6 ⁰C all the time for 42 days, whereas plasma and cryoprecipitate units are stored in a freezer under –20 ⁰C for one year. Platelets are the only blood components with the shortest shelf-life of 5 days and stored in the room temperature (20 – 22 ⁰C) in constant agitation.

In the absence of blood banking centers, the whole blood donation cannot be efficiently utilized – as the case in Somaliland – since it is not being separated into its constituent components – packed red blood cells, plasma, platelets, and cryoprecipitate. Whole blood transfusion is not widely used today and is only reserved for military combat casualties, trauma patients, and mass casualty disasters. 

Blood donors are screened before they donate blood to make sure they are healthy, and donations would not endanger their wellbeing. Their donations are routinely tested for hepatitis and HIV viruses as well as for bacterial contaminations before releasing to the blood supply. Blood donation can be of three types:  

• • • Autologous donation where the donor is donating blood for self-use in case of needing blood in planned surgery in the future.  
    • Directed/designated donation where close family members and friends donate blood for specific recipient.  
    • Allogeneic donation where the public donates to replenish the general blood supply.   

Oversight on Infusion Clinics

Outpatient Infusion clinics and hospital-based transfusion services must be legal entities registered with the Ministry of Health, and have medical staff trained to perform this health service to safeguard the rights and lives of patients. Also, these sites should be monitored regularly with frequent unannounced visits to observing the delivery of these health services. Blood administration should never take place in a doctor’s office or a patient’s home. This service must not be performed by anyone other than a licensed healthcare professional.

Indications for Transfusion

Blood transfusions are only prescribed by a doctor on a written order indicating the blood component and quantity. Different blood components have different indications, which is the reason the whole blood donation is separated into its constituents.

Besides bleeding from traumatic injuries and accidents, during childbirth, and in the surgeries, certain chronic diseases such as Sickle Cell and Leukemia, and conditions like anemia and internal bleeding depend on regular blood transfusions as lifesaving treatment.

Red blood cells’ most important function is to carry oxygen throughout the body. Symptoms of anemia include fatigue, shortness of breath, feeling cold, pale skin, and rapid heartbeats. Platelets help stop bleeding by forming clots. Cryoprecipitate contains fibrinogen which is a clotting factor, without which the person would be easily bruising. Fresh Frozen plasma contains all coagulation factors and is used to manage bleeding patient or to prevent bleeding at risk patient for bleeding.

Even in this global health crisis prompted by the Covid-19 virus, the convalescent plasma derived from blood donations provided by the people recovering from this disease was rich in antibodies to covid-19 and it became one of the first drugs to be used in fighting with the virus before the vaccines roll out.

Ahmed J Yassin
ahmed.yassin@jax.ufl.edu
Clinical Laboratory Professional
Jacksonville, Florida USA