Created to bring together specialists with experience and interest in haematology issues in Low and Middle Income Countries, the BSH Global Haematology Special Interest Group aims to create a community with expertise and commitment to make a valuable contribution to BSH’s global activities, ultimately benefiting haematology practice within the UK and worldwide.
Chair - Professor Imelda Bates
Global Haematology partnership initiative
Malawi Blood Transfusion Service recruits voluntary numerated blood donors. Retains them as regular blood donors, collects blood from the blood donors. We have our blood donation centres here open, so blood donors can donate in our centre here in Blantyre as well as in their various communities, be it at school, a place of worship or a place of work.
This is the lab , the main lab where blood is tested for the markers like HIV, syphilis and hepatitis B and hepatitis C and malaria. If we are in critical need of blood and the doctor may think of transfusing the unit of malaria positive but after transfusing the patient will receive anti-malarial treatment. Virtually every Malawian has suffered from malaria. So if you used the criteria that donors who have had suffered from malaria before should not donate. Then no-one in Malawi would donate because we have all been infected. These units are with TTI markers all this blood is infected with HIV, Hep B, syphillis and also hep C. I haven’t yet counted it but here is quite a lot as it is. Here we prepare, whole blood red cell concentrates – adult, red cell concentrates – paediatrics, platelets, fresh frozen plasma and cryoprecipitates. So we prepare platelets every Monday, Wednesday, Thursday and Friday because of the demand in the hospitals. And for the red cell concentrates it’s every day because there are lots of anaemias in the hospitals.
We have a department of public relations assistants and officers who go out to places of worship to secondary schools and workplaces and give out a talk on blood donation. After which is followed by the blood donor collection teams who visit the same places and conduct blood donation sessions. Our main blood donors in Malawi are male students whereby about 80% of our blood donors are aged 25 years or below and mainly in schools and colleges and about 83% of all blood donors are male. For those that are donating for the first time you are most welcome. This is our donor form, I am going to guide you. You should only fill what is applicable for you. We assist them because they are students. Most of the time they forget the previous information they had filled. The next question is: Do you understand what constitutes risky behaviour? If our donor today is safe, nest time they will donate again because we want to retain these donors. In this country the population is 30 million. We only need about 80,000 units of blood per year but we are failing to reach even that amount which is really small proportion of the population. As of now we can only speculate as to why we think people are not donating blood. One reason is the high HIV prevalence in the country at about 12% or so and when we look at who our blood donor is we think that the fear of knowing their HIV result is probably contributing. It’s very important to have this consistent relationship with these young chaps because our blood collection ¾ comes from schools, colleges, secondary schools. After a set number of donations, like the second one they get awarded a t-shirt, fifth donation a cap. So the first question when I came here it was like, have you brought out t-shirts? So I said “yes” so everybody was saying “yeah!” It is encouraging that the young people have responded in this manner because the expectation is that they grow older they will continue to be blood donors and will not pose any hindrance at all to their children to become blood donors. Before I came here, I considered first what is the importance of giving blood, then I saw that giving blood brings some importance because it might save myself or my relative who maybe has an accident, so maybe I’m trying to save another life out there. On average roughly we supply about 50% of the orders that we receive from hospitals. It is a huge challenge as you can imagine, all clinician’s and doctors would want to transfuse blood that comes from the national blood service but they are unable to do that in 50% of the cases and that is not easy for us and it is not easy for the clinicians as well.
Chris can Steve see your anaemics? He can yes, one, two, three, four anaemics. So, these children mainly are anaemic from malaria sometimes from HIV and sometimes from other courses. If you look at the hands they’re not particularly white on this child actually, you see that they’re quite white, compared to red or pink. When they're very anaemic their palms go pale and when you look at their tongues they look very pale. It is often a real challenge to put there an IV line in them as well because they often need fluids as well. One year five months old boy, severely anaemic, malaria’s four +. If the PCV goes below 15, here we've got a 13 percent, four pluses is a pretty heavy parasitemiapair so there’s every possibility he’s going to drop his haemoglobin even lower. Quite honestly, I don’t think it’s level to which it drops it’s how quickly and from where it has fallen. So, some of these children run on a fairly anaemic level, maybe their normal haemoglobin is six and therefore if they drop to four they can manage they can sustain it but if they normally were up at ten and suddenly drop down they would be in big trouble. I mean you would be in big trouble if you're haemoglobin suddenly dropped to four! So, what we try and do is when we take blood for grouping and cross-matching we put a cannula in so the moment blood is available it can be given to them. And we try and transfuse them here before they go down the ward. How many children will we tend to transfuse in a day? Varies between about five and twenty, twenty-five. If we're lucky we get them all if we're not lucky then we don't have blood for some children. Children need a small amount of blood compared with adults so one unit donated by an adult can sometimes transfuse five or six children. This one has a PCV of seven which is extremely low. We’d normally transfuse at a PCV of 15 or below. A healthy child has a PCV about forty. So, seven percent means that only seven percent of the volume of their blood is packed cells, so very very low. At this time of year where there's a lot of malaria around and really, other than for surgery we only use blood in emergencies and we use it for acutely anaemic children 99 percent are due to malaria. A lot of need, a lot of causes and often more than one cause in one child and their chances are excellent if they get blood. If they don't get blood, then it's possible we could lose them.
Initially before they even get to be seen by a doctor each and every child has got to have malaria test done a PCV checked because of the frequency of occurrence of anaemias and the common cause being malaria. We don’t want to miss it out, we want to rule it out in the beginning and then look for other causes earlier on.
Even sister is asking will I find any drop of blood in there?
She is quite pale, she looks malnourished too. She’s small for her age and she’s very, very thin and she's irritable and not interested in anybody coming close but if you just look at their hair. It's very weak thin hair and that's so typical of malnutrition.
If you want to get a proper full profile, then you take a blood sample and send it to the main lab and that will take a longer process but this will take us less than 10 minutes to get the results back. So, from a PCV you can deduce the haemoglobin by dividing it by 3 but in the normal process you'll have to wait the whole day to get a haemoglobin result back from the main lab.
For our convenience, up here in the A&E it’s important to have the PCV because we can’t wait for the fill blood count for that long. Some children are very, very anaemic and you need to do something promptly.