Blood donation in Cameroon

1.INTRODUCTION

In developing countries and in Cameroon in particular, blood donation is still problematic. Many people still have reservations when it comes to donating blood. In the developed world, most blood donors are unpaid volunteers, who donate blood for community supply.

In 1904 – 1950, Charles Richard Drew, an American Surgeon and Medical Researcher, researched in the field of blood transfusions, developing improved techniques for blood storage and with this knowledge he developed large scale blood banks in early World War II.
This is to tell us how far back the importance of blood donation dates. [1]

In Cameroon today, there are several organisations that try to mobilise and sensitise the masses on the importance of free volunteering blood donation and, they organise campaigns for the free donation of blood for blood banks.
However, there are still some people who are informed about blood donation, but for one reason or several still refuse to donate blood.

2. GENERALITIES

1.1 Definition of Blood transfusion

Blood transfusion is defined as a therapeutic procedure in which whole blood or parts of blood is put into a patient’s bloodstream through a vein. The patient is called the receiver. The blood may be donated by another person or it may have been taken from the patient and stored until needed. [2]

1.2 Blood components
Blood is transfused either as whole blood or as blood derivatives.
Whole blood is transfused either as fresh whole blood or conserved whole blood. Fresh whole blood is collected in a plastic blood bag containing an anticoagulant solution and transfused within 24 hours with all blood components intact.
Conserved whole blood is blood collected and conserved for more that 24hours at a temperature of 4°.
It can last up to 21 days and even up to 35 days if it contains adenine [3].
Whole blood transfusion either fresh or conserved is the common blood component transfused in Cameroon.
Blood derivatives can be separated and transfused separately in a process called apheresis.
These blood derivatives include packed red blood cells, fresh frozen plasma, platelets, cryoprecipitate, granulocytes [4]

1.3 Conditions for blood donation
In order to be give blood, a donor should fulfil the following criteria: [5]
Aged between 18 and 60 year.

• Weight greater than or equal to 55kg
• Should have no medical condition like hypotension, hypertension, diabetes, nephrosis, anaemia (haemoglobin level greater than or equal to 12.4g/L).
• Should not be pregnant, breastfeeding or menstruating.

There are some blood tests that must be done before donated blood can be accepted for transfusion. The World Health Organisation (WHO) recommends the screening of all blood donations mandatory for Human Immunodeficiency Virus (HIV), Hepatitis B and C and syphilis. The donated blood should also be tested for ABO and RhD to ensure the safety and compatibility of the transfusion for the patient.
It is therefore important to know these compatibility possibilities for transfusion. We can transfuse: [6]

• All groups to AB
• A and O to A
• B and O to B
• O to O
• Rh – to Rh +
• Rh + to Rh – (in young women, it is recommended to give 100micrograms of anti D immunoglobulin, every 3 to 5 fresh frozen plasma of Rh+ group).
  
  1.4 Reception of the donors

We need to understand that the blood donor is the most important person during blood donation. Without his/ her blood the blood bank will not exist. So, blood donation, must take place in the best security conditions possible. The blood bank service needs to be organised. It is essential that all personnel be trained on the different tasks allocated them. Each blood bank or blood transfusion service must have their individual protocols. Members of staff must always have a clean elegant uniform, be receptive, converse freely with donors, especially during the venous puncture. They must adopt an amicable attitude and proceed with tact in order to encourage donors to respond frankly and precisely to the questions which will be asked about their past medical history, which will help to adequately evaluate their aptitude to donate.

When the donor steps into the blood unit, he should be examined as would any other patient. His blood pressure, pulse and weight should be taken. His skin should be examined to assess for any signs of intravenous drug use. Determine at what time the donor took his last meal; if it was longer than 12 – 24 hours, then he stands the risk of syncope during collection.

1.5 Different types of blood donors

There are essentially three categories of blood donors:

• Volunteer non renumerated Donors: they donate blood by their freewill and receive no form of payment for it. The blood is safer and sustainable in supply.
• Replacement or Familial Donors: From within the patient’s own family and community. There is the risk of hidden information and professional donors.
• Professional Donors: means a person who donates blood for a valuable consideration, in cash or kind, for any source, on behalf of the recipient or patient.
  Other types of blood donor include:
• Autologous Blood Donor: patients who donate their own blood to themselves. They conserve it for when it is needed for them.
• Apheresis: donate blood components through the process of cell separation.

3. THE SITUATION OF BLOOD TRANSFUSION IN CAMEROON

In Cameroon, 400,000 bags of blood are needed yearly for the treatment of patients in the hospitals with the deficit in the voluntary blood donations being about 350,000 bags. To manage the supply and use of blood worldwide, the WHO placed pertinent recommendations for blood safety and clinical use. [7]

Cameroon has several organisations which help to organise blood donation campaigns and grow awareness amongst the population to donate blood. It is through these campaigns that people are informed about blood donation and the importance of it.
These organisations help in breaking the myths and fears that act as barriers to blood donation. Most of these organisations are private owned, but the state has bodies that oversee the running of these organisations concerned with blood transfusion.

These governmental bodies are the National Blood Transfusion Program (NBTP) created on the 18/03/2013 and the National Centre for Blood Transfusion (NCBT) created on the 12/02/2019. They both have a common goal to ensure the availability of good quality blood and enough to serve the population. They achieve these goals by organising trainings, blood donation campaigns, finding international grants and partnerships, and organising conferences. [8]

Barriers to blood donation in Cameroon

A couple of months ago the NCBT indicated that, one of the reasons for a deficit in blood donation is the belief of some people that donating their blood is like giving away a part of their powers to someone else. For this reason, they refuse to give their blood. Others refuse to give their blood because they are afraid of getting contaminated during the blood draw. But this is totally false and unjustifiable because the material used for blood collection are sterile and single use only materials. In this report, another reason brought up as a barrier to blood donationwas the fact that blood products are sold. For this reason, people refuse to donate their blood freely and voluntarily.
They expect to be paid for each blood donation.
Therefore, the replacement donation type is common, and it is never going to be sufficient to meet up with the deficit of blood needs in the country. As if this was not enough, religious beliefs are also an obstacle to blood donation.
But the NCBT has not relented its efforts and is collaborating with religious communities who are very much respected by the population, to educate people on the life-saving importance of blood donation and encourage them to donate blood.
The partnerships will help fight against the beliefs that delay the development of blood donation in Cameroon which leads to thousands of deaths of patients due to lack of blood [9].
Comparatively, a study in the People’s Democratic Republic of Congo to evaluate the barriers to voluntary blood donation added to the above-mentioned reasons,

• Lack of information on the need for blood
• Fear of doing the HIV test.
• Fear of thee needle.

Blood transfusion during the COVID-19 pandemic

At the peak of the pandemic in September 2020, about 2000 pints of blood were urgently needed to save the lives of about 300 people, including haemodialysis patients in Cameroon.
But the fear of COVID-19 had scared away most blood donors, as people did not want to go to the hospital [11]
A studied carried out during this time to evaluate the knowledge practice and expectations of blood donation concluded that most blood donors were aware of COVID-19, its transmission routes and manifestations.
Without barrier measures, they felt unsafe to go and donate blood at the hospital.
So, to motivate donors, the distribution of face masks, hydroalcoholic solutions and strict barriers measures and social distancing were adopted. [12]

4.CONCLUSION

• Cameroon is still suffering a lot of blood shortage and this deficit can be attributed to the fact that Cameroonians have not yet developed the habit of free and voluntary blood donation.
• There are several organisations nationwide which are assisting with educating people about the importance and safety of blood donation, but there is still a lot of work to do.
• The government needs to implement policies to make the acquisition of blood less costly because this grossly hampers blood donations and discourages voluntary donors.
• The COVID-19 pandemic has scared most blood donors away from the hospitals and this has worsened the blood deficit the country is already suffering from. So, measures need to be implemented to remotivate blood donors to come back to the hospitals to donate blood.

REFERENCES

1. “Patent for Preserving Blood Issued November 10, 1942; Washingtonian’s invention made blood bank possible” (Press release). Brigid Quinn, US Patent and Trademark office. November 9, 2011. Achieved from the original on February 11, 2009. Retrieved February 3, 2009.
2. National Cancer Institute. (n. d.). Definition of blood transfusion. Retrieved from www.cancer.gov
3. Charles Salmon, Anne-Marie Julien. La transfusion sanguine homologue. In; Albert Naiman, Elisabeth Verdy, Gerard Patton, Francoise Isnard Givaux. Precis des maladies du sang. Tome2.Paris Ellipses, 1994; 626-72.
4. American Red Cross. (n.d). Plasma, Platelets and Whole Blood. Retrieved from www.redcrossblood.org.
5. Dr Guitteye H. Pharmacien, Solution de prelevement et de conservation des produits sanguins, CNTS, septembre 2006.
6. Enquete Demographique de sante (EDS VI) au Mali 2008, mortalite maternelle et neonatale p183.
7. Pearl OA. Assessment of clinical blood transfusion practice at the Mother and Child Centre – Chantal Biya Foundation Yaounde. The Journal of Medicine and Health Sciences [Internet]. 2018 June. Available from www.hsd-fmsb.org
8. Programme National de Transfusion Sanguine. Retrieved from pnts-minsante.cm.
9. Les croyances freinent le don de sang au Cameroun depuis des années. Retrieved from www.toutsurlatransfusion.com
10. Salomon BA, Joris LL. Obstacles au don bénévole de sang dans la population de Kisangani en République Démocratique du Congo. Pan Afr Med J. 2014 ; 17 : 306. DOI : 10.11604/pamj.2014.17.306.2663 [internet]. Available from www.ncbi.nlm.nih.gov
11. Cameroon says patient at risk as COVID scares away blood donors. Available from www.voanews.com/africa/cameroon-says-patients-risk-covid-scares-away-blood-donors?amp
12. Tagny CT, Lendem I, Ngo Sack F, Ngo Balogog P, Ninmou C, Dongmo A, Ndoumba A, Tante E, Ateba N, Ndemanou M, Tapko JB, Mbanya D. Trends in blood donations, blood donors’ knowledge, practices adnd expectations during the COVID-19 pandemic in Cameroon. Vox Sang. 2020 Dec 13. doi 10.1111/vox.13049. Epub ahead of print. PMID: 33314185.