Blood transfusion errors spark patient safety concerns

Oluchi Ubechi had run short of blood after she gave birth to her third baby at a private hospital in Lagos last year. She had the blood transfusion she needed, but she was transfused with infected blood – one that had a blood disease.

She was back on her feet before long, and the discharge process was completed. A week after, she began to notice side effects – boils that resulted quickly in deep sores all over her body, head, and face.

Upon her return to the hospital and after the files that had been opened for her were checked, “it was discovered that she was given the wrong blood,” her niece told BusinessDay.

They tried to remedy the situation but the harm had been done. “It was already too late medically, but they just had to go ahead with changing the blood,” she said.

She died in February this year and was laid to rest in April. She died at age of 32, leaving three young children behind.

While blood donation is meant to save lives, if due diligence is not done to screen, cross-match and ensure that the donated blood is certified fit for transfusion by clinical standards, it can endanger the health of the recipient, experts say.

Blood transfusion errors have been identified as one of the various kinds of medical errors and shortcomings in the country’s health system.

In a 2009 report, titled ‘Blood Transfusion Reactions: Evaluation of 462 transfusions at a tertiary hospital in Nigeria’, the issue of safety is considered a burden of concern in clinical practice due to the occurrence of adverse events or complications.

It studied a total of 462 transfusions in 258 patients at the Obafemi Awolowo University Teaching Hospital and found a total of 40 cases of adverse transfusion reactions out of 462 transfusions, giving an overall incidence of 8.7 percent. The reactions seen were fever, allergies, and rupture or destruction of red blood cells.

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“The overall incidence of transfusion reactions was higher in the adult population,” the report said.

Another report by the World Health Organization (WHO) in 2010 on the ‘Status of Blood Safety in the WHO African Region’ shows that access to safe blood supply is a challenge in many countries in sub-Saharan Africa due to economic instability, civil strife, natural and manmade disasters, and failure to translate government commitment to practical outcomes that would lead to further improvement.

According to the report, African does not only have 10 percent of the global disease burden, but also carries the highest burden of diseases transmissible through blood transfusion.

“With an average of 640 maternal deaths per 100,000 live births in 2008, Africa had the highest maternal mortality rate in the world. Bleeding remains the leading cause of maternal death, accounting for approximately one-third of deaths in Africa,” it said.

Eromosele Ikekhua, a medical laboratory scientist specialised in haematology and blood group serology at the University of Benin Teaching Hospital, in an interview with BusinessDay, explained that blood should only be requested by a doctor in the case that his patient is in dire need of it, otherwise, the patient could suffer from iron overdose.

According to him, blood should be administered by a trained nurse, under the supervision of a trained doctor and monitoring of the recipient (patient).

Studies show that blood transfusions can be used to treat numerous conditions that medications cannot cure, such as blood loss due to major surgery, trauma, childbirth, severe burns, and bone marrow disorders among other conditions.

“Though blood transfusions create positive outcomes for patients with diagnoses listed above, the procedure has great risks associated with sterilisation, correct blood type, reactions, and post-transfusion ailments,” a 2021 report by the University of Kentucky said.

Ikekhua said errors stem from “blood not properly screened, clerical errors, which could result to an individual receiving wrong blood type, and blood product not properly stored at the right temperature”.

Speaking on efforts to nip the errors in the bud, Bodunrin Osikomaiya, executive secretary of Lagos State Blood Transfusion Service, told BusinessDay that the service uses a vibrant monitoring and enforcement sub-committee that goes around blood banks. Those who contravene the checklists are either shut down, fined, or charged to court, she said.

While experts acknowledge the role of the government in meting out due punishment in cases of avoidable transfusion errors, they urged the provision of appropriate equipment for blood screening.

“Government can provide hospitals with these machines that can curb the incidence of transfusing infected blood,” Ikekhua said.