Over the last two decades, there has been substantial progress in the area of blood safety in Uganda. In contrast, little attention has been paid to transfusion safety in Uganda and there are gaps... Show moreOver the last two decades, there has been substantial progress in the area of blood safety in Uganda. In contrast, little attention has been paid to transfusion safety in Uganda and there are gaps in laboratory and clinical transfusion practices within hospitals. Assessment of the current practice at Mulago and Mbarara Referral Hospitals showed inadequate documentation of the transfusion process, and poor monitoring of blood recipients. Our findings also indicated that one in every 16 transfused Ugandans and a similar number of RhD negative pregnant women possessed clinically significant red blood cell (RBC) alloantibodies in their plasma. However, RBC alloantibody screening is not performed during pre-transfusion and antenatal testing in the country. Thus, alloimmunized recipients and babies of RhD negative mothers are at high risk of morbidity and mortality due to haemolytic transfusion reactions (HTRs) and haemolytic disease of the fetus and the newborn (HDFN). Furthermore, data on the occurrence of acute and delayed HTRs and HDFN in Uganda are lacking. A cost-effectiveness analysis showed that introduction of RBC alloantibody screening would be cost-effective and improve blood transfusion safety. Therefore, there is need to improve immunohaematological testing in Uganda so that RBC alloimmunization and the consequences thereof may be prevented. Show less
Natukunda, B.; Schonewille, H.; Ndugwa, C.; Brand, A. 2010
BACKGROUND: Blood transfusion is an integral part in the management of sickle cell disease (SCD) patients. Alloimmunization is a recognized complication of red blood cell (RBC) transfusions with... Show moreBACKGROUND: Blood transfusion is an integral part in the management of sickle cell disease (SCD) patients. Alloimmunization is a recognized complication of red blood cell (RBC) transfusions with consequences including delayed hemolytic transfusion reactions and difficulties in getting compatible blood for future transfusions. The objective of this study was to determine the frequency of RBC alloimmunization in SCD patients in Uganda where pretransfusion screening for alloantibodies is not practiced. STUDY DESIGN AND METHODS: In a cross-sectional study, SCD patients at Mulago Hospital Sickle Cell Clinic, Kampala, Uganda, were investigated. The demographic characteristics and transfusion history were recorded. Blood samples were drawn from consenting, previously transfused patients and RBC alloimmunization was demonstrated using immunohematologic techniques. RESULTS: There were 428 patients (median age, 12 years; female/male ratio, 1.0) and they had received a median of 3 units in a median of three transfusion episodes. Twenty-six patients (6.1%) possessed RBC alloantibodies and 21 (80.7%) of them had received up to 10 transfusions. A total of 30 alloantibodies was found; 20 (66.7%) and 5 (16.6%) belonged to Rh and MNS blood groups, respectively. Five of the alloimmunized patients had multiple antibodies. CONCLUSIONS: The rate of RBC alloimmunization in Ugandan SCD patients was 6.1%. The homogeneity between donors and SCD patients plus the low transfusion load may explain this immunization frequency. Nevertheless, our study confirms the significance of RBC alloimmunization as a complication in Ugandan SCD patients. Therefore, there is need to improve immunohematologic testing in Uganda so that RBC alloimmunization and its consequences may be prevented. Show less
