Haematology and Blood Transfusion-Conference Papers

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    Open Access
    Comparing Efficacy of Low Dose Cytoreduction and Manual Exchange Blood Transfusion in Managing Hyperleukocytosis: A Case Report
    (American Journal of Clinical Pathology, 2019) Otokiti, O; Ogbenna, A.A; Bolarinwa, A; Olatinwo, A
    Objectives: Hyperleukocytosis is defined as white cell count greater than 100,000 cells/mm3. Symptomatic hyperleukocytosis (leukostasis) is a medical emergency and can complicate hematological malignancies. It is commoner in myeloid leukemia but can occur in extremely high-count lymphoid leukemia causing tumor lysis syndrome and death. Immediate management is hydration, cytoreduction, and leukapheresis. In a developing country without leukapheresis, how effective is manual exchange blood transfusion compared to low-dose cytoreduction? We present a case of chronic lymphocytic leukemia with severe hyperleukocytosis, comparing response to different treatment modalities in the absence of leukapheresis. Case Summary: A 57-year-old woman with complaints of a vaginal protrusion and an incidental finding of a splenomegaly with moderate anemia. Hemogram showed a white cell count of 301,000 cells/mm3, and blood film revealed a chronic lymphocytic leukemia. She had two cycles of cyclophosphamide, vincristine, and prednisolone and presented 8 months later with worsening leukocytosis of 697,000 cells/mm3, severe anemia, dizziness, headaches, fatigue, and hyperkalemia. Two manual exchange blood transfusions insignificantly decreased count by 40,000 cells/mm3 with slight reduction of hyperkalemia. She had low-dose cytoreduction with weekly vincristine and prednisolone. White cell count reduced from 653,000 cells/mm3 to 467,000 cells/mm3 with normal electrolytes. She was then commenced on cyclophosphamide, mini-hydroxorubicin, vincristine, and prednisolone. There was a steady decline in counts with improvement in hematological parameters and overall well-being. Conclusion: Due to nonavailability of leukapheresis, we attempted a manual exchange without a significant decrease in white cell count. However, with low-dose cytoreduction, there was a considerable decrease in white blood cell count and improvement of electrolyte with no tumor lysis syndrome, and it was more affordable. Therefore, in a resource-poor setting, using lowdose cytoreduction might be cheaper, safer, and more effective than exchange blood transfusion in managing hyperleukocytosis.
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    Open Access
    Effect of the COVID-19 pandemic on blood donation and transfusion in Nigeria – A multi-facility study of 34 tertiary hospitals
    (Vox Sanguinis, 2021) Oreh, A; Bozegha, T; Ihimekpen, A; Biyama, F; Irechukwu, C; Aliu, S; Oshiame, D; Nnabuihe, A; Ndanitsa, A; Nnachi, O; Ogbenna, A.A; Abubakar, S; Olupitan, F; Akinkunmi, A; Ogunlade, C; Abayomi, T; Omokaro, U; Sylvester, C; Igiebor, U; Wokoma, B; Ebophni, S; Adewuyi, B; Dachi, R; Muhammad, H; Abubakar, M; Mgbang, J; Chineke, A; Ogbuabor, O; Fakai, G; Hashim, B; Adeluwoye, N; Olanrewaju, D; Agahiu, E; Etim, E; Alabi, S; Akinbola, I; Anibueze, C; Awogbami, O; Edowhorhu, G; Adekoya-Benson, T; Bello, S; Ojuade, Y; Amedu, O
    Background: The COVID-19 pandemic affectedblood donation activities. For countries like Nigeria that were already struggling with meeting blood needs, the possible impact on national blood supplies was terrifying. Mobile blood drive campaigns halted, and voluntary blood donations reduces, challenging available blood supplies. Furthermore, fears of the of virus transmission led to deferrals of elective surgeries and non-urgent clinical procedures with npoticeable declines in blood donations and transfusions. Aims: We aimed to assess the effect of the COVID-19 pandemic on the number of blood donations and transfusions across the country by blood product type across departments including accident and emergency, obstetrics and gynaecology, paediatrics, surgery and internal medicine. Methods: A retrospective descriptive study was conducted to determine the impact of the COVID-19 pandemic on blood services in thirty-four (34) tertiary hospitals in Nigeria, comparing January to July 2019 (pre-COVID-19) to January to July 2020 (peri-COVID-19). Data was collected from the country's web-based software District Health Information System, Version 2 (DHIS2), the platform for the National Health Management Information System (HMIS) and analysed using SPSS Version 25. Results: A 17.1% decline in numbers of blood donations was observed over the study period, especially in April 2020 (44.3%). Similarly, a 21.7% decline was observed in numbers of blood transfusions over the same period, with the month of April 2020 experiencing the sharpest declines (44.3%). The highest declines in transfusion were noted in surgery department for fresh frozen plasm (80.1%) p = 0.012 and accident and emergency department transfusion of platelets (78.3%) p = 0.005. The least decline of statistical significance was observed in internal medicine transfusions of whole blood (19.6%) p = 0.011. Summary/Conclusions: The COVID-19 pandemic significantly affected the numbers of blood donations and transfusions in Nigeria. STrengthening blood services to provide various blood components and secure safe blood supplies during public health emergencies is therefore critical.
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    Open Access
    Knowledge and perceptions of pregnant women with regard to collection and banking of umbilical cord blood stem cells in Nigeria.
    (Vox Sanguinis, International Society of Blood Transfusion, 2018) John-Olabode, SO; Okunade, K; Ajie, O; Oyedeji, O
    Background: Approximately 50% of patients who need an unrelated blood stem cell transplant are unable to find a timely suitable match due to the diversity of Human Leucocyte Antigen (HLA) alleles and antigens. This is particularly true for Nigerian patients who have unique stem cell matching needs reflecting Nigeria’s extensive ethnic diversity. To address this problem, the Bone Marrow Registry in Nigeria was launched on February 24, 2012 with 300 donors with the future plan of constructing a cord blood bank (CBB).Unfortunately; awareness levels remain a substantial limitation to harnessing the benefits of umbilical cord blood (UCB) especially among pregnant women whose support is crucial to the success of cord blood transplant program. Aims: To examine the knowledge and perception of pregnant women with regard to collection and banking of umbilical cord blood stem cells. Methods: On-going study with questionnaires administered to pregnant women attending antenatal clinics in Lagos University Teaching Hospital. Part 1 assessed issues of awareness and knowledge of UCB. Part 2 assessed perception and attitude towards UCB donation. Data was analysed using SPSS version 22.0 statistical package for windows manufactured by IBM Corp., Armonk, NY, United States. Results: One hundred surveys have so far been analysed in this on-going study; 73.7% of the respondents were aware that UCB can be used to treat some diseases. Though the level of awareness of UCB was high more than two-thirds (70%) of the respondents were not confident of their knowledge of UCB and would like their healthcare provider to provide more information on purpose and uses of umbilical cord blood. 50% of the respondents agree to cord blood donation if a CBB were available in the country. 66.6% of the respondents that agreed to cord blood donation said religion will not influence their decision and 62.2 % of these respondents said they would prefer a public CBB to a private one. 49% of respondents disagree that donated cord blood should only be for the use of family members. Summary / Conclusions: Nigeria with its large population is uniquely placed to set up the largest cord blood bank to cater for Nigerians and ultimately the whole of Africa. However, as is well understood there can be no blood donation without prioritizing donor education. The findings of this on-going study exemplifies this fact as half of the study population expressed willingness to donate cord blood if a cord blood bank was available in the country. Not only do majority of the respondents agree to cord blood donation (CBD), they also choose to donate cord blood to a public blood bank. Ironically, this positive attitude towards CBD is despite being poorly informed, uneducated and lacking knowledge regarding UCB. Also, surprisingly in a deeply religious country, two-third of the women open to CBD admitted that religion has no influence on their decision to UCB donation. Our results so far provide insights that infer that at the conclusion of this study the data gathered can be meaningfully incorporated into government cord blood banking policy