A Strategic Approach to the Problems of Providing Rhesus D–Negative Blood Transfusion in Geographic Areas With Low RhD Negativity: A Nigerian Perspective

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In contrast to the white prevalence, the frequency of rhesus D (RhD) negativity in the Nigerian population ranges from less than 1% to about 6% in the different ethnic population groups across the country. Consequently, there is often a severe scarcity of RhD-negative blood in Nigeria, leading to undue delay in transfusing RhD-negative patients. This situation has led to the prolongation of hospital stays as well as increased morbidity and mortality in affected patients. The problem is compounded by the general unavailability of donor RhD-negative blood, which is partially related to a suboptimal national blood transfusion service. This situation has thus relegated the responsibilities of donor recruitment and blood collection to individual hospital blood banks. This has led to the necessity of finding a variety of ways to mitigate the daunting problem of the provision of RhD-negative donor blood in Nigeria. In this article, we review the roles, advantages, and disadvantages of various methods including the use of autologous donations, Du testing, inter–blood bank transfers, voluntary RhD-negative donor recall, family donations, and cryopreservation to ameliorate the problem. The real need is nonetheless to optimize the functional capacity of the Nigerian National Blood Transfusion Service.

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Autologous Blood Donations

Autologous blood donation and transfusion have not yet been given the level of attention it deserves in Nigerian hospital blood banks, and the autologous blood procedure is largely restricted to the elites in whom the main motivation is the avoidance of transfusion transmissible infections.8 A rational approach toward solving the problem of RhD-negative blood scarcity in the hospital setting would be to scale down the number of requests for RhD-negative allogeneic blood through a process of

Inter–Blood Bank Transfer of RhD-Negative Blood

Most RhD-negative patients that require RBC transfusions would not qualify for autologous transfusion. Moreover, clinical experience had shown that most requests for RhD-negative blood are for emergency cases that need blood urgently, and only a few, 0.95% to 8%, of such patients would be Du-positive.4, 14, 15 We must therefore find ways of dealing with requests for RhD-negative patients that are neither eligible for autologous transfusions nor Du-positive. However, the hard reality in Nigeria

Cryopreservation of RhD-Negative Blood

The frequency of RhD negativity among Nigerian blood donors ranges from less than 1% to about 6%.3, 4, 5, 6 Therefore, a similar proportion of voluntary donor blood that is donated in Nigeria would be RhD-negative. However, it must be appreciated that such RhD-negative blood donations come randomly, sporadically, and in single units that are usually interspersed by several weeks. Blood banking experience in Nigeria had shown that on several occasions over the period of a year, such randomly

The Nigerian National Blood Transfusion Service

The decision to establish a sustainable National Blood Transfusion Service in Nigeria was conceived in 1975 at the World Health Assembly.37 However, since the signing and adoption of the World Health Assembly resolution in 1975, very little has been done by successive Nigerian governments to achieve the objectives of establishing a National Blood Transfusion Service that could be comparable to what is available in the developed countries of the world. Consequently, the Nigerian Blood

Conclusions

The solution to the problems of RhD-negative donor blood scarcity in Nigeria should be through a multifaceted approach that includes autologous donations, Du testing, inter–blood bank transfers, voluntary RhD-negative donor recall, family donations, and cryopreservation. In addition, there is an urgent need for upgrading and optimizing the capabilities of the Nigerian National Blood Transfusion Service.

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