Optimizing Blood Transfusion Service Delivery across the West Africa Sub-Region

The sub-continent of West Africa is made up of 16 countries: Benin, Burkina Faso, Cape Verde, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, The Gambia and Togo. As of 2018, the population of the sub-continent was estimated at about 381 million. The main challenge associated with blood transfusion service delivery across the sub-region concerns adequacy and safety. In this chapter, we highlighted the challenges associated with the delivery of a quality blood transfusion service in countries in the sub-region including: implementation of component therapy rather than whole blood transfusion, effective cold chain management of blood and blood products, alloimmunization prevention, implementation of column agglutination and automation rather than the convention manual tube method in blood transfusion testing, effective management of major haemorrhage, optimization of screening for transfusion transmissible infections, optimizing blood donation, implementation of universal leucodepletion of blood and blood products, effective management of transfusion-dependent patients, pre-operative planning and management of surgical patients, management of Rhesus D negative pregnancy and women with clinically significant alloantibodies, implementation of haemovigilance system, implementation of alternatives to allogenic blood, availability and use of specialized blood products, optimizing safe blood donation, enhancing blood transfusion safety, operating a quality management system-based blood transfusion service and implementation of non-invasive cell-free foetal DNA testing. There is the urgent need for the implementation of evidence-based best practices in blood transfusion service delivery across the sub-region to allow for excellent, safe, adequate and timely blood transfusion service delivery across the sub-region

Highly active antiretroviral therapy increases fibrinolytic and protein activity in pregnant women

BACKGROUND Various studies have examined optimal methods for Prevention of Mother to Child Transmission (PMTCT) of human immunodeficiency virus (HIV) and subsequent outcome of response to highly active antiretroviral therapy (HAART) as well as the impact of pregnancy on outcomes of HIV in the Pre-HAART era. Little is known of the impact of pregnancy in response to HAART in Africa. This study is aimed to evaluate euglobulin lysis time (ELT), protein C and protein S in HIV-positive pregnant women on HAART.   METHODS This was a cross-sectional study comprised of 150 participants attending Ante-Natal Clinic (ANC) in Central Hospital, Benin City. Pregnant women on HAART (Test subjects) (n=50, mean age 34 years), 50 pregnant newly diagnosed HIV-positive women that had not yet commenced HAART (n=50, mean age 31 years) and 50 pregnant HIV-negative women (n=50, mean age 30 years) which served as controls. The ELT was determined by methods described by Bain, protein C and protein S were determined using Enzyme Linked Immunosorbent Assay (ELISA).   RESULTS There was a significant increase in ELT in both pregnant women on HAART and not on HAART) when compared to HIV-negative pregnant women (p<0.05). There was a significant decrease in protein C in test subjects when compared with controls (p<0.05) and protein S increased significantly in HIV-positive pregnant women on HAART when compared to those not on HAART and HIV-negative pregnant women (p<0.05).   CONCLUSION There are changes in ELT, protein C and protein S parameters with the introduction of HAART in pregnancy

Haemostatic properties of Vernonia amygdalina and Chromolaena odorata leaf extracts using Wistar rat model

BACKGROUND The leaves of African plants are widely employed in Nigeria to control bleeding from wounds. This work is aimed at evaluating the haemostatic effects of Vernonia amygdalina (VA/bitter leaf) and Chromolaena odorata (CO/sunflower) leaves on some haemostatic parameters. METHODS A laboratory study of experimental design was conducted involving 35 Wistar rats that were randomized into seven groups. Groups 1 and 2 received leaf extracts of VA at concentrations of 150 and 250mg/kg BW, respectively; groups 3 and 4 received leaf extracts of CO at 150 and 250mg/kg BW; groups 5 and 6 received combined leaf extracts of VA and CO at 150 and 250mg/kg BW, respectively, for 30 days. The last group 7 as control group received only water. Parameters investigated were clotting time (CT), fibrinogen concentration, prothrombin time (PT), activated partial thromboplastin time test (APTT), factor VII, protein C and D – dimer. Results There was a significant reduction in CT, fibrinogen concentration and PT in the intervention groups compared to controls (p0.05). D-dimer levels were observed to increase significantly in rats treated with 150mg/kg BW of VA and 150mg/kgBW of the combined leaf extracts (VA/CO) compared to the controls (p<0.05). Conclusion The VA and CO extracts reduced CT, PT, fibrinogen concentrations and increased D-dimer levels in rats. This study suggests the possible incorporation of the leave extracts of VA and CO in bleeding diathesis as well as in coagulation studies

Relationship between Neutrophil-to-Lymphocyte Ratio and Inflammatory Markers in Sickle Cell Anaemia Patients with Proteinuria

The renal functions and structure in sickle cell anaemia (SCA) patients may be affected by chronic haemodynamic changes and consequences of vaso-occlusive events in the renal medulla. Few reports on neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios in SCA patients in Africans exist in the literature. This study correlates the values of NLR and PLR with measured traditional inflammatory markers in SCA patients with and without proteinuria and impaired kidney function (defined in this study as estimated glomerular filtration rate (eGFR), less than 60 mL/min/1.73 m2. Full blood count, C-reactive protein (CRP), and fibrinogen were assayed in 150 SCA patients and 50 control subjects using Coulter Haematology analyser (CELL DYE 37000) and ELISA method, respectively. The NLR and PLR were calculated by dividing absolute neutrophil or platelet counts by absolute lymphocyte count. Fibrinogen, CRP, NLR, and PLR increased progressively (p &lt; 0.001) in SCA patients with or without proteinuria, with the highest values seen in those with impaired renal function. NLR correlated positively with CRP and fibrinogen in SCA patients without proteinuria (p &lt; 0.001), with proteinuria (p &lt; 0.001), and impaired renal function (p &lt; 0.05). A positive relationship was also observed between NLR and fibrinogen in the control subjects. The need to determine cut-off values for these leukocyte ratios to be used in identifying those patients at risk and in the general management of SCA patients is suggested

Effect of highly active antiretroviral therapy on neutrophil/lymphocyte ratio using white rabbit

Background: There is an increasing reliance on neutrophil/lymphocyte ratio (NLR) as a prognostic marker in certain diseases. Observations have suggested the effects of administering highly active antiretroviral therapy (HAART) to human immunodeficiency virus (HIV) patients to be beneficial as well as having its side effects. Hence, this study is designed to examine the relationship of NLR of HAART in the management and disease progression of HIV infection. Materials and Methods: Twenty male white rabbits weighting between 0.8 and 1.8 kg were randomly assigned to five Groups A, B, C, D, and E with four animals per group. Two milliliters of venous blood was aseptically collected before HAART administration and on days 5, 10, 15, and 20 of treatment. Groups B, C, D, and E received graded doses of 15, 20, 25, and 34 mg/kg body weight of the drug combinations (efavirenz, lamivudine, and tenofovir disoproxil fumarate tablets once daily for 20 days). Neutrophil/lymphocyte counts were determined using hematology autoanalyzer. Results: Showed a significant reduction (P< 0.05) in NLR before HAART administration (controls) when compared to administration of HAART at 15, 20, 25, and 35 mg/kg 5 days after drug administration. The same trend was observed in the various groups at 10, 15, and 20 days after drug administration. Conclusion: Administration of HAART has a significant association on NLR

Evaluation of glucose-6-phosphate dehydrogenase activity and hematological changes in psychotic patients undergoing antipsychotic chemotherapy in Benin City

Background: Drug-induced hemolytic anemia can be life threatening and may pose a threat to the management and disease progression of some illnesses. The aim of this work is to evaluate changes in hematologic parameters and glucose-6-phosphate dehydrogenase (G6PD) activity in psychotic patients undergoing antipsychotic chemotherapy. Materials and Methods: A total of 70 participants comprising of 35 psychotic patients (21 males and 14 females) with mean age of 40.5 ± 5 years as test participants and 35 apparently healthy nonpsychotic individuals (20 males and 15 females) with mean age of 25.5 ± 1.5 years as controls were used for this study. G6PD was estimated spectrophotometrically using Randox G6PD assay kit while the hematological parameters were determined using the Erma hematology autoanalyzer. Morphology of the blood samples was manually done by making a thin film stained by Leishman stain and examined microscopically using the oil immersion objective. Results: G6PD activity was found to be higher in test participants (P = 0.075) when compared to the control group. Its activity was also observed to be higher in females when compared to the males (P = 0.051). Hemoglobin concentration, hematocrit, values, mean cell volume, and mean cell hemoglobin were observed to be lower in test participants when compared to the controls (P< 0.05, P = 0.001, P = 0.022, and P = 0.044, respectively). There were no significant differences in total white blood cell counts (WBCs), lymphocytes, granulocytes, platelet count, and red cell distribution width in test participants when compared to controls (P = 0.177, P = 0.665, P = 0.086, P = 0.159, and P = 0.060, respectively). Conclusion: There are changes in hematologic parameters using antipsychotic drugs, and these changes may predispose an individual to iron deficiency anemia and to hemolytic episodes