A severely anaemic two-year old boy was admitted at a district hospital in Kenya’s Coast Province a few months ago in urgent need of a blood transfusion.

Unfortunately, there was no blood in the hospital’s blood bank. Although the parents were willing to donate, there were no blood collection kits at the hospital either. A call was made to the regional blood transfusion centre but they did not have any stocks of blood. Within four hours of admission, the boy died.

“If that boy had received blood within an hour of admission, I am certain he would have lived,” said the clinician in charge, who did not want to be named for fear of victimisation.

This predicament, common to most district hospitals in Kenya, is linked to the manner in which the country has chosen to manage its transfusion services. The National Blood Transfusion Service is US (PEPFAR) funded service dedicated fully to blood collection and testing as well as assistance with related services.

“The trend worldwide, recommended by the WHO, is to get blood from voluntary non-remunerated repeat donors (VNRD) and test/process it in a centralised system to improve safety and reduce costs while releasing hospitals to be concerned with its use mainly,” said Dr Njau Mungai, the doctor in charge of the Nairobi regional blood transfusion centre.

Moving from the replacement/family donations to a centralised system was done at a time when the nation was grappling with the HIV/Aids crisis. A 12-week study conducted in 1994 by Dr Anne Moore and colleagues in six government hospitals in Kenya had reported that two per cent of transfusions were transmitting HIV.

There is the national blood transfusion centre in Nairobi, six regional blood transfusion centres in Mombasa, Nakuru, Embu, Eldoret and Kisumu. As is the case across Africa, this voluntary non-remunerated repeat blood donors system focuses mainly on high school and college students. This leads to major shortages during school holidays, a time when major road-traffic accidents happen. The Kenyan blood transfusion services totally discourages the use of replacement/family donors which before worked alongside the centralised system.

The belief that VNRD in a centralised system is the only source of safe blood is so deeply entrenched in Kenya that any hospital that is not a regional blood transfusion centre is rarely supplied with blood collection kits. This means that they are entirely dependent on the regional blood transfusion centres to give them blood. This renders doctors helpless in horrible situations that no health worker should be caught in and may actually lead to the spread of transfusion-transmissible infections.

Prof Imelda Bates from the Liverpool School of Tropical Medicine has conducted research that shows that blood was not available for about 1 in every 4 pregnant women in sub-Saharan Africa who die from post-delivery bleeding in hospital. “Bleeding after delivery can kill within two hours. Pre-screened blood has to be available at the hospital to save this woman’s life. Waiting for blood to arrive from a centralised place or searching for a family member to donate at that point is likely to lead to delays and death,” Prof Bates said.

The belief that only VNRD donors are safe is the drive behind pushing for a centralised system. However, Prof Jean-Pierre Allain of the Cambridge Blood Centre, UK, refutes the dogma that VNRD are the only safe donors and strives to show that the difference between the donors selected for VNRD and the replacement (family) donors is a result of the age and gender patterns of the donors. “Relying strictly on VNRD not only increased the cost of blood to a level exceeding local resources but also contributes to maintaining unnecessary blood shortage. Mixing VNRD and replacement donors has been proven to no longer be detrimental to blood safety and has considerable potential to help avoid blood shortages. Evidence should take precedence over a moribund myth,” said Prof Allain.

Dr Oliver Hassall, who does research on blood transfusion in Africa and has worked at Kilifi District Hospital, concurs. “Until a blood transfusion service is able to supply enough blood to all hospitals that need it, when they need it, there will always be blood shortages, especially away from the regional centres,” said.