The Need For Blood Transfusion Technologies To Lessen Surgery Deaths In Africa

Surgery deaths in Africa are twice the global average. Haemorrhage also known as bleeding, is the number one killer in surgery and the major cause of cardiac arrest in the operating room. Massive haemorrhage can be defined as; blood loss exceeding circulating blood volume within a 24-hour period, blood loss of 50% of circulating blood volume within a 3-hour period, blood loss exceeding 150 ml/min, or blood loss that necessitates plasma and platelet transfusion. Even though there is no universal definition, critical haemorrhage can occur even though the haemorrhage does not meet the above criteria.

Surgery mortality rate increases with increasing blood loss and with decreasing minimum intraoperative haemoglobin level. When a patient loses 10-30% of their blood volume; they start feeling light headed, experience shortness of breath, palpitations among other things. After appreciable blood loss (>1000 mL), the injured person enters a state of hypovolemic shock, which requires the administration of replacement fluids as part of life-saving medical treatment. To counter blood loss, blood transfusion is carried out. Blood transfusions are used to treat a number of medical conditions, to replace large blood loss during surgery, and for emergency treatment.

However there are two crucial issues related to blood transfusion in Africa, and these are blood shortages and unsafe blood, which both too frequently lead to severe problems, such as immunoreaction and infection. Patients receiving surgery in Africa are younger than the global average, with a lower risk profile and lower complication rates and yet are as twice as likely to die. 20% of deaths in these surgeries are due to loss of blood. Countries with developing economies especially in Africa have not considered surgical care to be a public health priority and thus access to enough safe blood is almost impossible and costly. If the blood lost is of a patient with blood group A or AB which are significantly less prevalent in sub Saharan countries like Uganda, death is inevitable. In sub Saharan Africa, only hospitals with a bed capacity of 100 beds and above have blood banks. In addition, 0nly 10% of the health centre IVs in Uganda can provide blood transfusion services. According to the New vision (Uganda news reporting organization) report, Uganda spends about 20 billion annually on obtaining blood units. Unsafe blood transfusions have contributed to the enormous burden of HIV infections in sub-Saharan Africa and still continue to add to this burden with an estimated 3. 2 million new infections of HIV in sub-Saharan Africa annually with 52, 000 in Uganda alone. The risk of HIV infection through unsafe blood and blood products is exceptionally high (95–100%) compared to other common routes of HIV exposure. The safety and availability of blood transfusion is particularly under threat among refugee populations and in emergency situations where health systems have collapsed or have been weakened as a result of armed conflict, displacement of populations, natural disasters and other complex emergencies. In these extreme circumstances, making safe blood available to all patients needing transfusion is currently impossible. .

Blood donation rates in Africa are generally very low, less than 1% of the population as per the WHO Fact sheet 2017. In its most recent global survey on blood safety and availability, WHO collected data from 40 of the 48 countries in sub-Saharan Africa. These data indicate that 35 (87. 5%) countries collect less than half of the blood needed to meet the transfusion requirements of their populations. Of the 20 countries with the highest maternal death rates, 19 are in sub-Saharan Africa where the risk of maternal death is in 16 per 1000 births. The most common cause of maternal death is severe bleeding, which can kill even a healthy woman within two hours, if unattended. An estimate of 500, 000 women die due to PPH annually, about 99 %of the deaths occur in low and middle income countries compared with only 1% in industrialized nations 97% of these women were hospitalized at the time of their deaths. (

In Africa, severe bleeding during delivery or after childbirth contributes to up to 44% of maternal deaths. Many of these deaths could be prevented through access to safe blood. According to a study, measured blood loss exceeds 500 mL in 6% of vaginal deliveries without episiotomy, 16% of vaginal deliveries with episiotomy, 30% of forceps deliveries, and 80% of caesarean deliveries. Paradoxically, despite a severely inadequate supply of blood in African countries, blood is often transfused unnecessarily. This needlessly exposes patients to the risk of HIV, hepatitis and other serious side-effects. This poor-quality clinical care also reduces the availability of blood for patients for whom transfusion is essential and is a waste of scarce resources. Injuries account for 63 million of the disability-adjusted life year (DALYs) which are a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. These injuries constitute 38 percent of the world’s estimated surgical DALYs, 79 percent of death from these injuries is due severe blood loss.

Operative Mortality with Elective Surgery decreases in older Adults, 70% of deaths of surgery in older patients is due to haemorrhage. Critical Haemorrhage might develop into cardiac arrest or permanent disability of the central nervous system are registered. There are several options of blood transfusion depending on time and health factors. Some people prefer to receive blood from people they know, these are called designated donors. This blood has been found to be no safer than the community donor blood. The replacement of blood losses by conventional allogeneic blood transfusion has for many years been the mainstay of management of major surgery and trauma. Because of heightened fears of virus infection transmitted through transfusion, as well as the better understanding of the risks and benefits of blood transfusion, there is an increasing demand for alternatives to allogeneic donor blood. Before some operations begin, doctors remove some blood and replace it with other fluids. This is called Acute Normovolemic Haemodilution. After surgery, the blood that was removed may be returned to the patient. In addition, the surgeon may be able to recycle your blood during surgery, but this is extremely efficient but quite expensive. Blood that normally is lost and discarded is collected, processed and returned to its owner. Sometimes blood that is lost after surgery may be collected, filtered and returned to you. It is becoming more common in orthopaedic surgery, such as knee and hip replacements

Autologous transfusion is where adults and some children use their own blood for a transfusion. It is widely used in orthopaedic surgery, such as scoliosis surgery, hip and knee replacements. Blood is collected before the operation and then given back during or after surgery. This technique is less popular now because it is very costly though it is highly efficient.

Therefore, designing a device for the low resource countries in Africa that will foster autologous transfusions with the capability of blood recycling after it is harnessed from a bleeding patient during any medical procedure will be impactful in the development health sector. This device in the likeness of the Auto Transfusion System (ATS), Cell saver and Ultrafiltration machines would save a country like Uganda more than ten billion shillings annually.