Awareness of Blood Donation among Tertiary Institution Undergraduates in Southern Nigeria

Background:The increased need of safe blood and blood products and their unavailability in hospitals remain a formidable challenge faced by healthcare providers in developing countries such as Nigeria.Aim: To determine the level of awareness of blood donation among tertiary institution undergraduates in an urban setting of Southern Nigeria. Methodology: Semi-structured questionnaire was used to collect information from undergraduates of the University of Benin and Delta State University both in southern Nigeria. Data analysis was done using SPSS software version 16. Results: A total of 396 people were surveyed. Of these; 370 (93.4) were aware that blood can be donated; while 172 (43.4) were aware of the WHO policy on blood donation. Three hundred and forty-one (86.1) were aware that blood donation should be nationally coordinated while 306(77.3) did not agree that medical workers have created enough awareness on blood donation. Two hundred and twenty-two (56.1) were aware that blood donation should be voluntary and 209(52.8) were willing to donate blood if there is an attached financial reward. Conclusion:This study has revealed a high level of awareness on blood donation among tertiary institution undergraduates in Southern Nigeria and have demonstrated a poor level of awareness of the WHO policy on blood donation

Safety, efficacy and acceptability of implanon a single rod implantable contraceptive (etonogestrel) in University of Benin Teaching Hospital.

OBJECTIVE: The study evaluated the safety, efficacy and acceptability of Implanon (etonogestrel) subdermal implant contraceptive amongst its acceptors. STUDY DESIGN: This was part of an on going prospective longitudinal study that involved 32 women out of 46 sexually active healthy informed volunteers recruited from our family planning clinic between February and March 2007. All the subjects received the single rod subdermal implant Implanon which contains 68 mg etonogestrel. Data on socio-demographic characteristics, menstrual pattern, haematological indices, weight, blood pressure, side effects and user's satisfaction were collected and analysed. The subjects served as their own control. RESULTS: The mean age and parity were 33.9 +/- 5.2 years and 3.1 +/- 1.7 respectively. The mean weight was 71.4 +/- 12.0 kg at pre-insertion. At 6 months the weight reduced to a non significant (p < 0.13) mean value of 70.0 +/- 10.5 kg and increased to a non significant (p < 0.88) mean value of 71.5 +/- 11.6 kg at 12 months. The mean systolic and diastolic blood pressures did not show statistical significant changes at 6 months follow up (p < 0.17/0.64). However at 12 months there were significant but within normal reductions (p < 0.003/0.05) in the systolic and diastolic blood pressures. The side effects were menstrual abnormalities. Eighteen (56.3%), 1 (3.1%) and 13 (40.6%) reported reduced, increased and combinations of bleeding patterns respectively. No participant had normal cycle. Other experiences were headache, 4 (12.5%) and reduced libido 3 (9.4%). The mean packed and white blood cell concentrations did not show statistical significant changes at 6 and 12 months follow up. At 12 months there was statistical significant increase (p < 0.04) in the mean +/- SD platelet count (205312.5 +/- 75694.8 per ul) when compared with the pre-insertion mean value (176343.8 +/- 52945.3 per ul). One acceptor had thrombocytopenia without any untoward effect. Two subjects discontinued method on account of menorrhagia and headache. The efficacy and continuation rate were 100% and 93.8% respectively. All the clients received adequate information about the method and most of them were satisfied with it at follow up. CONCLUSION: Implanon was an effective, safe and acceptable method of contraception amongst its acceptors. Menstrual abnormalities were the major side effects which most of the subjects found tolerable with adequate counseling. The reduced platelet concentration of the one acceptor would require follow up to ascertain the trend.

Haemostatic function in Norplant (levonorgestrel) users: a 3-year prospective experience in Benin-City, Nigeria.

OBJECTIVE: To evaluate the haemostatic function and menstrual pattern of Norplant acceptors after 36 months of use. METHOD: This was a prospective longitudinal study that involved fifty five healthy, non-breastfeeding, sexually active informed volunteers recruited from our family planning clinic, between September and December 2002. Blood samples were collected at pre-insertion, 12, 24 and 36 months follow up for packed cell volume, platelet count, prothrombin time and activated partial thromboplastin time. Statistical analysis was with paired t-test. The level of significance was set at p<0.05. Each acceptor received a menstrual calendar to chart all bleeding events. RESULTS: The mean age and weight of the 29 acceptors who had complete records at 36 months of study were 33.7 +/- 5.9 years, 64.1 +/- 9.9 kg respectively. The mean packed cell volume (PCV) was 34.3 +/- 2.5% at pre-insertion. This rose to significant mean +/- SD values of 37.6 +/- 3.5%; p < 0.0002, 37.4 +/- 3.2%: p < 0.0001 and 38.0 +/- 2.6%; p < 0.0001 at 12, 24 and 36 months respectively. The mean platelet count at pre-insertion was (239,724 +/- 85,886 per microl). There were significant reductions in the mean concentration at 12 months (p <0.04; 198,310 +/- 78,476 per microl) and at 36 months (p<0.0002; 154,241+/- 45,207 per microl). The prothrombin and the partial thromboplastin time at 12, 24 and 36 months did not show significant change over their pre-insertion mean values of 11.9 +/- 1.1 seconds and 36.9 +/- 3.0 seconds respectively. At 24 and 36 months 75.9% (22) and 72.4% (21) of the users reported abnormal menstrual patterns respectively. Only 24.2% (7) and 27.6% (8) had normal menstrual patterns at the respective months. Continuation rates at the end of 24 and 36 months of studies were 85.5% (47) and 80% (44) respectively. Reasons for discontinuation were planning for another baby, menorrhagia, lump in the breast and elevated blood pressure CONCLUSION: Acceptors of Norplant had mainly reduced bleeding patterns, which did not predispose them to anaemia neither did they have an adverse effect as a result of the reduced but normal platelet count.

Using serial haemorheological parameters to assess clinical status in sickle cell anaemia patients in vaso-occlussive crisis.

In a prospective study using standard methods, haemorheological parameters were assessed in 10 sickle cell anaemia patients in pain crises. Patients were investigated for possible changes in determinants of rheology in the course of painful episodes: blood samples were taken for plasma fibrinogen concentration (PFC); plasma viscosity (PV); haematocrit (Hct), whole blood viscosity (WBV) and the erythrocyte sedimentation rate (ESR) using standard methods. Samples were collected on presentation to the emergency unit and daily for 4 consecutive days. Whole blood viscosity and plasma fibrinogen concentration were significantly higher at onset of crises when compared with baseline values (p<0.01 and p<0.0001), respectively. Plasma fibrinogen and blood viscosity peaked within 24 h of onset of crisis and started declining 48-72 h later. These parameters approached baseline values by the 4th day of painful crisis.There was no significant change in the haematocrit and the erythrocyte sedimentation rate during the period of painful crisis despite change in whole blood viscosity and fibrinogen. In conclusion, this study showed elevated haemorheological parameters in sickle cell anaemia patients in VOC, it also demonstrated an acute rise in these parameters at onset of crisis and a return to almost baseline levels within 96 h of onset of painful episodes.

Thirst perception in dehydrated sickle cell disease patients in steady state.

Liberal fluid intake is one of the key management strategies in sickle cell anaemia [SCA] patients in steady state, but less work has been done on the desire of patients to drink water. Using the Visual Analogue Scale we studied thirst perception [TP] in 20 euhydrated SCA patients and 28 control [HbA] subjects, as well as during dehydration in 13 SCA patients and 9 HbA subjects. Serum and urine samples were collected and analyzed for Na, K ions, creatinine concentrations and haematocrit and specific gravity of urine were determined. During euhydration, TP was significantly [P<0.05] higher in male SCA patients compared to the HbA subjects. In females, TP in SCA patient was not statistically significant compared with HbA subjects. After 13 hours of dehydration, TP was significantly [P<0.05] reduced in female. While dehydration increased TP in HbA subjects, it reduced TP in SCA patients. Fluid intakes after dehydration in SCA patients were not significantly different from the control HbA subjects in both male and female. It can be concluded that female SCA patients do not have normal response to dehydration with regards to TP after a period of dehydration. Since dehydration stimulates the release of vasoactive hormones like vasopressin, this may explain why female patients are less prone to crisis than their male counterparts.

The effect of accessibility to drugs on outcome of therapy in patients with malignant lymphoma.

OBJECTIVE: To determine the compliance rate, reasons for default and factors affecting compliance. PATIENTS AND METHODS: A prospective study of patients with malignant lymphoma (ML) at the University of Benin Teaching Hospital, Benin City, Nigeria. A total of 190 patients on chemotherapy for ML were followed up for between 6 and 18 months during study period (1995-2003). The reasons for default were recorded. Compliant and noncompliant patients were compared in terms of survival and sociodemographic data. STATISTICAL ANALYSIS: Instat Package system for frequency counts, chi-squares and cross tabulations using Yates correction when necessary and the Fisher's exact test. RESULTS: Noncompliance rate was 63.2%. Major reasons for defaulting were high cost of drugs in 40 cases (33.3%), scarcity of drugs in 29 cases (24.2%) and side effects in 24 cases (20.6%). Compliance was significantly associated with higher levels of education, socioeconomic status, geographical abode (P<0.001) and gender (P= 0.031). Survival was found to be significantly associated with compliance in non-Hodgkin's lymphoma (NHL) (P>0.001) while the relative risk (RR) was below unity in ML. CONCLUSION: The level of compliance with medical therapy is still very poor. Health education and the provision of affordable, accessible and appropriate medical therapy are required. A multidisciplinary approach to improve compliance of patients with medical therapy is advocated.

A smoldering/indolent myeloma with extensive abdominal presentation--case report.

A case of indolent/smoldering myeloma in a 70-year-old man is reported. He presented with an unusual multiple symptomatic myeloma with extramedulary impairment and absence of bone pain. He was treated with pulses of high-dose dexamethasone with commendable clinical improvement.

Risk of transfusion-transmitted hepatitis C virus in a tertiary hospital in Nigeria.

OBJECTIVES: To evaluate the risk of probable iatrogenic hepatitis C virus (HCV) infection following transfusion of donor blood that has not been screened for HCV. STUDY DESIGN: Prospective study. METHODS: Screening for human immunodeficiency virus and hepatitis B virus is routine in the University of Benin Teaching Hospital. HCV screening was performed on transfused bags of donor blood selected at random. The detection of anti-HCV was based on the principle of double antigen sandwich immunoassay, in which purified recombinant antigens are employed sufficiently to identify anti-HCV. The outcomes of interest included the proportion of HCV-positive units of transfused donor blood, the source of blood and the total number of units of blood processed in the hospital blood bank. RESULTS: A total of 4532 units of donor blood were procured in the blood bank. Of these, 4132 units were certified as fit for transfusion following the hospital protocols. The sources of the transfused blood samples were commercial blood donors [89.2% (n = 3687)] and targeted donation [10.8% (n = 445)]. One hundred and ninety-two transfused blood samples were randomly screened for HCV, and 3% (n = 6) were found to be positive (95% confidence intervals 0.007-0.06). The likely risk of iatrogenic transfusion-related HCV infection was estimated to be 129 cases/year at the present rate of utilization of donor blood at the University of Benin Teaching Hospital. CONCLUSION: There is a risk of iatrogenic transfusion-transmitted HCV in the study hospital. Hospitals in Nigeria should screen for HCV prior to allogeneic transfusion, which may help in avoiding transfusion-related HCV and its probable long-term effects.

Pathology services delivery: policy analysis using a Nigerian tertiary institution as a prototype.

BACKGROUND: Laboratory services delivery face criticisms on daily basis by the patients (the beneficiary), the clinicians (the user), and the hospital management (the policy maker). The service provider (the laboratory) is faced with the task of trying to explain her problems. OBJECTIVE OF THE STUDY: Was to critically do a policy analysis of the problems of laboratory service delivery, with the aim of identifying the causes of these problems and making recommendations to the policy makers. SETTING: The University of Benin Teaching Hospital, a foremost tertiary institution in Nigeria. METHOD: George Kent's normative policy analysis model was used to analyse the laboratory guidelines and procedures of sample collection, transportation, analysis and eventual generation of laboratory results. All the steps in the guidelines are analysed using the fifteen steps in Kent's normative model of policy analysis. RESULTS: The policy analysis shows that problems of laboratory services delivery are triangular with the patient at the center of the triangle. The most important finding of this analysis is that there is no formal laboratory service policy to guide all the actors i.e. the hospital management, laboratory staff and the clinicians. Problems arising from the laboratory are solved through the use of circular letters, likened to administrative incremental model of decision-making. CONCLUSION: There is a need to have a formal policy. A formal policy on laboratory service delivery will guide the provider, the user and the policy makers in solving the problems that originate from the laboratory service on a permanent basis. It will also establish a regular method of evaluating the services that are provided by the laboratory.

Multiple myeloma : 2 case reports

This is a report of multiple myeloma in first cousins from the Niger delta region of Nigeria.The first patient was a 60-year-old Negroid male with a 3-month history of productive cough; chest pain; fever and 1 month history of weight loss. The diagnosis was confirmed by greater than 50neoplastic plasma cells in the bone marrow; monoclonal band on electrophoresis and lytic bone lesions in the skull. He was treated with cyclophosphamide; prednisolone and allopurinol and received a total of 4 pints of packed cells. His PCV improved subsequently.The second patient was a 54-year-old Negroid housewife. She presented with a six-month history of bone pains and weakness in both lower limbs. She also had cough productive of mucoid sputum. The diagnosis of MM was confirmed by the presence of more than 30neoplastic plasma cells in the bone marrow; a monoclonal band on serum electrophoresis and lytic lesions in the pelvic bones on skeletal survey. She had three 28-day cycles of vincristine; adriamycin and dexamethasone (VAD). She was also transfused with 3 pints of packed cells. We conclude that while we cannot rule out the effect of environmental factors in pathogenesis of MM in our patients; the occurrence of MM in first cousins is suggestive of a possible familial origin. We advocate screening of urine for Bence Jones protein and serum electrophoresis for relatives of patients with MM; especially those from the Niger Delta region

Multiple myeloma : 2 case reports

This is a report of multiple myeloma in first cousins from the Niger delta region of Nigeria.The first patient was a 60-year-old Negroid male with a 3-month history of productive cough; chest pain; fever and 1 month history of weight loss. The diagnosis was confirmed by greater than 50neoplastic plasma cells in the bone marrow; monoclonal band on electrophoresis and lytic bone lesions in the skull. He was treated with cyclophosphamide; prednisolone and allopurinol and received a total of 4 pints of packed cells. His PCV improved subsequently.The second patient was a 54-year-old Negroid housewife. She presented with a six-month history of bone pains and weakness in both lower limbs. She also had cough productive of mucoid sputum. The diagnosis of MM was confirmed by the presence of more than 30neoplastic plasma cells in the bone marrow; a monoclonal band on serum electrophoresis and lytic lesions in the pelvic bones on skeletal survey. She had three 28-day cycles of vincristine; adriamycin and dexamethasone (VAD). She was also transfused with 3 pints of packed cells. We conclude that while we cannot rule out the effect of environmental factors in pathogenesis of MM in our patients; the occurrence of MM in first cousins is suggestive of a possible familial origin. We advocate screening of urine for Bence Jones protein and serum electrophoresis for relatives of patients with MM; especially those from the Niger Delta region

Evaluation of haemostatic function in Nigerian Norplant acceptors after 12 months of use.

A total of 55 non-breastfeeding informed volunteers were recruited into a prospective longitudinal study from a family planning clinic between September and December 2002. Blood samples were collected at pre-treatment and at 3, 6 and 12 months follow-up, for packed cell volume, platelet count, prothrombin and activated partial thromboplastin time. Statistical analysis was with paired t-tests. The level of significance was set at 5%. Each subject received a menstrual calendar to chart all bleeding and spotting events. The mean age and weight of acceptors were 32.5 +/- 6.1 years and 63.6 +/- 9.6 kg, respectively. Mean packed cell volume (PCV) was 35.2 +/- 2.9% at pre-insertion. This rose to significant mean +/- SD values of 36.5 +/- 3.1%; p<0.05, 38.5 +/- 2.8%; p<0.0001 and 38.4 +/- 3.6%; p<0.0001 at 3, 6 and 12 months, respectively when compared with the pre-insertion mean value. The mean values of the platelet count showed no significant change at 3 months (238,448 +/- 68,618 mm(3); p>0.9), compared with pre-treatment value (240,545 +/- 96,769 mm(3)). There was a significant reduction in mean concentration at 6 months (p<0.009; 191,364 +/- 55,531 mm(3)) and at 12 months (p<0.003; 202,773 +/- 81,544 mm(3)) follow-up. The prothrombin and the partial thromboplastin time did not show significant change over their pre-insertion mean values of 12.0 +/- 1.1 s and 36.9 +/- 2.9 s, respectively. At 12 months, 79.5% (35) of the users reported an abnormal menstrual pattern, which included 54.5% (24) reduced bleeding pattern, 20.5% (9) increased bleeding and 4.5% (2) of combination of patterns. Only 20.5% (9) had a normal menstrual pattern. The continuation rate was 98%, as one user discontinued because of headaches. Norplant (the registered trademark of the Population Council for levonorgestrel subdermal implants) had an effect on the bleeding pattern - mainly reduced bleeding. The increase packed cell volume is beneficial in preventing anaemia. There was no detrimental effect as a result of the reduced but normal platelet count and users were not predisposed to clotting abnormalities.

The influence of foetal haemoglobin on the frequency of vaso-occlusive crisis in sickle cell anaemia patients.

OBJECTIVE: Several biological and environmental factors are presumed to account for the morbidity pattern in patients with sickle cell anaemia. Foetal haemoglobin is one of the biological factors thought to decrease morbidity in these patients. We studied the relationship between the foetal haemoglobin levels and vaso-occlusive crisis (VOC) as a measure of the morbidity pattern in this category of patients. RESULTS: The mean foetal haemoglobin level was 6.4+0.40% (SEM). Vaso-occlusive crisis was more common at lower levels of foetal haemoglobin particularly when lower than 12% (P=0.01). There was a negative correlation between foetal haemoglobin and vaso-occlusive crisis (r=0.561). These variables were also associated in linear regression and both showed statistical significance (p=0.001). CONCLUSION: We conclude that higher levels of foetal haemoglobin positively influence the occurrence of vaso-occlusive crisis in sickle cell anaemia patients.

Donor blood procurement and utilisation at the University of Benin Teaching Hospital, Benin City.

Banked blood is a limited resource in Nigeria. We sought to evaluate factors that may further limit the effective utilisation of donor blood in a tertiary hospital in Benin City. The records of the blood transfusion unit of the hospital were studied to identify the methods of blood procurement and utilisation from January 1, 2000 to December 31, 2002. A total of 11,021 units of blood were received in the blood transfusion unit within this period out of which 1491 (13.5%) donor blood samples were found unfit for transfusion and, hence, discarded. Commercial blood donation accounted for 95.3%, compared to 4.7% from replacement and volunteer donors. Commercial blood donation was a major risk factor for likely disposal of donor blood (chi2 = 74.3, p < 0.0001, OR = 21.1. 95% CI = 7.8-56.7). Expired units of blood with low PCV were discarded for lack of infrastructure to fractionate and store them. Over 0.8million naira (US$6000.00) is wasted annually on discarded units of donor blood mainly from commercial donors. A policy on blood procurement to include subgroup selection of donors and improved funding of blood banking services may enhance efficient and effective utilisation of donor blood.

Acceptance rate of HIV testing among women seeking induced abortion in Benin City, Nigeria.

Although the campaign against HIV has been intensive, it has been focused mainly on the public health implications. Little or no attention is specifically directed at encouraging the public to know their HIV serostatus. The actual public health burden due to this infection is therefore not known. Accurate data on the health burden is critical for national planning on preventive and other interventional measures. Using a semi-structured self-administered questionnaire, we interviewed 1051 women seeking induced abortion in four randomly selected private clinics in Benin City between January and September 2002. The blood samples of those who accepted HIV testing were collected and screened at the University of Benin Teaching Hospital. The women were aged between 16 and 46 years (mean 31.1+/-6.7 years). One hundred and thirty seven women (13%) accepted HIV testing. Of the 1051 women, 1001 (95.2%) had multiple sexual partners and 722 (68.8%) regularly practiced unprotected sex. All were aware of HIV/AIDS. The older women were more likely to accept voluntary HIV testing than the younger ones. Acceptance rate for voluntary HIV testing was low in both the employed and unemployed and much lower among full time housewives (p = 0.01). We therefore recommend that HIV campaign programmes should include strategies aimed at arousing public interest in voluntary HIV testing.

Prevalence of lupus anticoagulant in multiparous women in Benin City, Nigeria.

Lupus anticoagulant which in the past was regarded as a laboratory nuisance is now known to be associated with numerous clinical conditions including thrombosis and recurrent foetal loss, however, no work has been done to assess its prevalence in non-pregnant healthy multiparous women. Our aim therefore was to determine the prevalence of lupus anticoagulant in non-pregnant multiparous Nigerian women of childbearing age. Fifty non-pregnant multiparous women who were considered healthy following verbal interviews were studied. An eligibility criterion was used. Coagulation studies were performed on plasma samples from all the women using the Kaolin clotting time. Mixing experiments were conducted on samples with prolonged clotting time to detect the presence of the lupus anticoagulant. The Kaolin clotting time ratio of greater than or equal to 1.2 was considered positive for the lupus anticoagulant. Forty-four (88%) of the 50 women had a normal cloning time, 2(4%) had subnormal clotting time while 4(8%) of them had a prolonged Kaolin clotting time. Mixing experiments on these 4 samples revealed Kaolin clotting time ratios of over 1.2, signifying the presence of the lupus anticoagulant (i.e. 8 per cent prevalence) among the population of women studied Multiparous women with the lupus anticoagulant may not be symptomatic therefore the anticoagulant should be screened for in women with unexplained prolongation of cloning time. We recommend that these women should be followed up especially in pregnancy to forestall any of the obstetric complications that have been associated with the lupus anticoagulant.

Leucocyte counts in pregnant Nigerian women with sickle cell trait.

White blood count (WBC) with differential counts and packed cell volume (PCV) were studied in 100 pregnant and 30 non-pregnant control women aged 18-45 years. Eighty of the pregnant women were homozygous HbAA and 20 heterozygous HbAS. The non-pregnant women's PCV, lymphocyte and eosinophils counts were significantly higher (p < 0.005) while their leucocytes neutrophil counts were significantly lower (p < 0.005) compared with HbAA and HbAS pregnant women. However, HbAS pregnant women had higher leucocyte, lymphocyte and eosinophil counts compared with HbAA, but these were not significant. There were no variations in basophil and monocyte counts. HbAA pregnant women had no change in PCV but significant changes occurred in leucocyte and neurophil counts with increase in the second trimester with decreasing lymphocyte and eosinophil counts in the second and third trimesters. However, HbAS pregnant women had significant increase in PCV in their first trimester, leucocyte and neutrophil counts in their third trimester but no variation in lymphocyte, eosinophil and basophil and monocyte counts. The increased leucocyte and neutrophil counts in the second trimester in HbAA and third trimester in HbAS may be due to genetic factor and/or oestrogen secretion reaching production peak at different periods of pregnancy. The relative increase in these haematological indices in HbAS women may be a protective mechanism against infection during pregnancy.