Role of national blood transfusion service (NBTS) in promoting emergency obstetrics care (EMOC)

Background: Obstetrics haemorrhage is one of the leading cause of maternal mortality in our settings, this was compounded by the non availability to safe blood in situation of need. Hence the prompt access and availability of blood can avert this preventable cause of maternal death. Objectives: to highlight the benefits of effective collaboration with NBTS in ensuring prompt availability of blood for emergency obstetric services requiring blood for transfusion. Material And Method: All obstetrics cases requiring blood transfusion in FMC Nguru from 1st stJanuary 2006 ­ 31 December 2011 were retrospectively reviewed. Trends and pattern of the st strequest and source of blood were looked at within the two periods (from 1 January 2006 ­ 31 st stDecember 2008 and 1 January 2009 ­ 31 December 2011). Records of 1634 obstetric patients requiring blood transfusion or received blood transfusion in the maternity units were retrieved from the medical records, maternity ward record and blood bank. Information pertaining to their age, parity, indication for the transfusion or requests and source of blood was obtained for analysis. Data was analysed using simple percentage. st st Results: Between 1 January 2006 and 31 December 2008 only 513 (56%) of the units requested st st907 units of blood were supplied, while between 1 January 2009 and 1 December 2011 1367 ( 87%) of the 1567 units of blood requested were supplied. Within the earlier study period the only available source were from willing relatives and commercial blood donors, however between 2009 and 2011 more than 2/3 (64.2%) were supplied from the north east zonal NBTS office in Maiduguri. In 2006 through 2008, donation from relatives and commercial donors accounted for 53.22% and 46.78% respectively, but in 2009 and 2011 donation from relatives and commercial donors were recorded as 23.9% and 11.6% respectively. The commonest indication for the requests were anaemia, obstetrics haemorrhage (PPH, APH) and emergency C/S. Conclusion: Ready available source of blood will significantly improve timely availability of blood in our setting. There is the need to encourage this collaboration in other regions to ensure prompt availability of blood to attend to emergencies requiring blood transfusion

Spectrum of haematologic malignancies and survival outcomes of adult lymphomas in Maiduguri, north eastern Nigeria--a fourteen year review.

BACKGROUND: The incidence of Haematologic malignancies has been shown to vary according to gender, age, geographic region, and histologic subtypes, while cure rates can vary according to region and may be impacted by treatment availability and access to care. METHOD: This was an institution based review of data from the Medical Records Department, Department of Haematology and Cancer Registry of the Histopathology Department of the University of Maiduguri Teaching Hospital between January 1998 and December 2011. The aim was to study the spectrum of Haematologic malignancies and the survival pattern of adult lymphomas in this region and to compare our findings to studies reported elsewhere. RESULTS: The Haematologic malignancies represented 6.05% of all cancer cases seen and 0.31% of hospital admissions. Among the Haematologic malignancies, Non-Hodgkins Lymphoma (NHL) was the most frequent, constituting 51.3% while others include: Hodgkins Lymphoma (HL), 26.7% Chronic Myeloid Leukaemia (CML), 5.5%, Acute Myeloblastic leukaemia (AML), 4.2% Multiple Myeloma (MM), 4.2% Acute Lymphoblastic leukaemia (ALL), 3.8%, Chronic Lymphocytic Leukaemia (CLL), 3.4% Myelodysplastic Syndrome (MDS), 0.4% and Chronic Myelofibrosis 0.4%. Haematologic malignancies are more common in younger age group and also more common in males than females. Lymphomas are particularly common in young adults and the incidence tends to fall after 70 years. Similarly, the characteristic bimodal age incidence for HL found in western world has not been seen in this study. The histological subtypes for both NHL and HL are similar to the pattern reported elsewhere. Default rate was high and we found a strong association between cycles of chemotherapy given and survival in lymphoma patients. CONCLUSION: This study has shown that Haematologic malignancies are not uncommon in our environment. There is need to provide basic facilities and training for immunophenotyping and immunohistochemistry in all cancer treatment centers across the country. Cytotoxic drugs must be subsidized and also be made readily available to all patients with Haematologic malignancies.

Deferral patterns of voluntary blood donors at the National Blood Transfusion Service, North East Zonal Centre, Maiduguri.

Appropriate donor selection in an important step in ensuring safe supply of blood and blood products. In this study deferral patterns of voluntary non-renumerated blood donors were determined at the North-Eastern Zonal Centre of the National Blood Transfusion service. The study was conducted between April 2007 and April 2009, and it involved the administration of a structured questionnaire. A total of 4032 voluntary blood donors were recruited, seven hundred and thirteen (17.7%) were temporarily deferred. The commonest reasons for deferral were low haemoglobin, self-deferral, high blood pressure, low weight and high risk behaviour. Other reasons are use of certain medications, low blood pressure and failed venopuncture. Gender analysis showed that more females were deferred for low haemoglobin and more males were self-deferred. Following donor recall, 146 of the 173 donors temporarily deferred came back to donate. These consisted of 113 deferral due to low haemoglobin, 30 self-deferred and 3 induced in risky behaviour. Effective education or counseling, the old tradition of giving haematinics and good dietary advice to those with low haemaglobin values, improved the safety and availability of blood and blood products. Donors who are self-deferred and those involved in high risk bahviour should never be persuaded to donate blood. There is also the need for a review of operational guidelines with regards the uniform acceptable cutoff point of 12.5g/dl haemoglobin value for males and females.

Deferral patterns of voluntary blood donors at the National Blood Transfusion Service, North East zonal centre, Maiduguri

Appropriate donor selection in an important step in ensuring safe supply of blood and blood products. In this study deferral patterns of voluntary non-renumerated blood donors were determined at the North-Eastern Zonal Centre of the National Blood Transfusion service. The study was conducted between April 2007 and April 2009; and it involved the administration of a structured questionnaire. A total of 4032 voluntary blood donors were recruited; seven hundred and thirteen (17.7) were temporarily deferred. The commonest reasons for deferral were low haemoglobin; self-deferral; high blood pressure; low weight and high risk behaviour. Other reasons are use of certain medications; low blood pressure and failed venopuncture. Gender analysis showed that more females were deferred for low haemoglobin and more males were self-deferred. Following donor recall; 146 of the 173 donors temporarily deferred came back to donate. These consisted of 113 deferral due to low haemoglobin; 30 self-deferred and 3 induced in risky behaviour. Effective education or counseling; the old tradition of giving haematinics and good dietary advice to those with low haemaglobin values; improved the safety and availability of blood and blood products. Donors who are self-deferred and those involved in high risk bahviour should never be persuaded to donate blood. There is also the need for a review of operational guidelines with regards the uniform acceptable cut-off point of 12.5g/dl haemoglobin value for males and females

Anaemia in pregnancy: a cross-sectional study of pregnant women in a Sahelian tertiary hospital in Northeastern Nigeria.

This prospective study was carried out between June 2005 and June 2006, to determine the prevalence and determinants of anaemia among pregnant women attending a tertiary Sahelian Hospital in Northeastern Nigeria. A total of 1,040 pregnant women enrolled at their first antenatal visit were monitored through pregnancy for anaemia. The overall prevalence of anaemia, malaria parasitaemia and schistosomiasis was 72.0%, 22.1% and 3.8%, respectively. Mild, moderate and severe anaemia constituted 31.8%, 39.4% and 0.9%, respectively. Anaemia was most common among the multipara and women presenting in late stages of pregnancy. More multipara and primigravidae had malaria parasitaemia than grandmultipara. Schistosomiasis, malaria infestation and a short birth interval as well as illiteracy are additional risk factors for anaemia in pregnancy. This study confirms the high prevalence of anaemia in pregnancy in this area. Appropriate intervention strategies are necessary to reduce the prevalence of anaemia.

Ocular manifestations of Burkitt's lymphoma: experience in Ile-Ife south western Nigeria.

BACKGROUND: Burkitt's lymphoma is the most common childhood tumour in subSaharan Africa that typically affects the jaws and abdomen. Ocular involvement with blindness has been documented in some studies. OBJECTIVE: This was to evaluate the role of Burkitt's lymphoma (BL) as a cause of blindness in Nigerian children. METHODS: Cases of BL seen in the hospital between 1986 and 2003 were studied retrospectively. Some of the patients with orbital disease at presentation underwent ultrasonographic examination of the eyes. RESULTS: Forty-three (16.5%) of the 260 patients seen presented with orbital tumours; 29 (67.4 %) of the 43 patients had full ophthalmic examination. The patients studied comprised 22 males and 7 females with a M: F ratio of 3:1, and median(age range) of 7(3-15) years. Orbital tumours occurred concurrently with jaw masses on the same side in 19(65.5 %) of 29 patients; the eye diseases were unilateral in 23 (79.3%) and bilateral in six (20.7%) of the cases. Proptosis was the ocular presentation in 27(93%) of patients and it was associated with conjunctival injection in nine, chemosis in 11 and exposure keratopathy in five. Fourteen (48.3%) patients had associated blindness; 12 (85.7%) remained blind in the affected eye(s) and one regained vision to 6/36 after chemotherapy. The patients underwent Cyclophosphamide-Oncovin-Methotrexate (COM) regimen with intrathecal therapy. Eight (27.6%) patients had concomitant CNS disease; these included cases of 6th and 7th nerve palsies, one case of intra-cerebral extension of tumour and another case of total ophthalmoplegia. CONCLUSION: Burkitt's lymphoma is an important cause of childhood blindness in Nigeria and the orbital disease ismainly extra ocular.

Bone marrow macrophage iron stores in patients with HIV infection and AIDS-associated Kaposi's sarcoma.

Several observations have been made suggesting that excess iron is harmful to patients with HIV/AIDS disease. Bone marrow macrophage iron stores of 30 anaemic HIV infected patients (median age 32.7 years) and 20 anaemic AIDS-associated Kaposi's sarcoma patients (median age 37 years) were studied at the haematology department of the University of Maiduguri Teaching Hospital. Macrophage iron stores were assessed as either normal, decreased or increased by using grades ranging from 0 to 6. Marrow iron stores was increased in 16 (80%) of the patients with Kaposi's sarcoma and normal in 4 (20%) patients. Three of the 4 patients with normal iron stores were females of reproductive age. Regression analysis of iron status and opportunistic infection showed a positive correlation (p-value=0.001). Of the 30 patients with HIV infection, 22 (73.3%) had normal iron stores and 8 (26.7%) had decreased iron stores. All the 8 (26.7%) patients with no stainable iron in the marrow were females of reproductive age group. Iron deficiency anaemia can complicate anaemia of HIV infected patients. In view of the documented risk associated with iron supplementation in anaemic patients with HIV/AIDS disease, little caution should be exercise as regards the use of haematinics and/or blood tonics in anaemic HIV-infected or AIDS-associated Kaposi's sarcoma patients. The fact that noninvasive evaluation for iron deficiency is compromised in many individuals due to the presence of chronic inflammatory process and/or malignancy, bone marrow evaluation for iron stores still remains an important tool often underutilized by many clinicians attending to patients living with HIV/AIDS.

The burden of HIV and AIDS on blood bank reserves in northeast Nigeria.

This study was conducted to evaluate the burden of HIV/AIDS on blood bank reserves at the University of Maiduguri Teaching Hospital, Nigeria, during 1995-2005. The number of admissions due to HIV/AIDS rose from 43 in 1995 to 447 in 2005, and the proportion of blood units used in transfusing patients with HIV/AIDS rose steadily from 3% in 1995 to 19% in 2005. The proportion of blood units used in managing obstetric patients was also high and fluctuated between 36% and 50% during the period of study. Controlling the spread of HIV, effective treatment of patients with antiretroviral drugs and setting up a functional national blood transfusion service could lessen the rising burden of transfusion in Nigeria and improve blood availability for maternal and child health care.

AIDS-associated Kaposi's sarcoma in Northeastern Nigeria.

INTRODUCTION: Kaposi's sarcoma is an acquired immunodeficiency syndrome (AIDS)-defining illness, and with the size of the human immunodeficiency virus (HIV)/AIDS pandemic in sub-Saharan Africa, AIDS-related Kaposi's sarcoma (KS) are now being diagnosed more frequently, although the true incidence of HIV-associated KS is not known. The clinical presentations of AIDS-related KS varied markedly across the African continent. This article reports a series of unusual clinical presentations of the tumour in Northeastern Nigeria. METHODS: This is a prospective study carried out from September 2003 to August 2005, at the University of Maiduguri Teaching Hospital, Borno State, Northeastern Nigeria. RESULTS: 20 cases of histologically-confirmed KS were prospectively studied. There were 17 (85 percent) men and three (15 percent) women, giving a male to female ratio of 5.7:1. Their ages ranged from 21-45 (median 37) years. 18 (90 percent) of the patients were anaemic. Mean haematocrit value, CD4+ cell count and duration of symptoms for all the patients were 29.5 +/- 7.5 percent, 119.0 +/- 91.4 cells per microlitre and 3.5 +/-1.7 months, respectively. Multiple lesions were a common presentation affecting sites such as lower limbs, trunk, conjunctiva, upper limbs and rectum as well as penis, lymph node, scrotum and oropharynx. CONCLUSION: Contrary to other reports that KS is not associated with HIV infection, our study has demonstrated otherwise. This study also showed that both sexes are affected but with a male preponderance. KS is also a late presentation of the HIV/AIDS disease spectrum in our environment and has varied clinical manifestations. There is an urgent need to develop health education programmes to enhance the understanding of this disease and how it spreads, particularly among the young generation.

Declining frequency of blood donation among elites in Maiduguri, Nigeria.

This study evaluated the causes of declining frequency of voluntary blood donations among educated elites as seen at the blood bank of University of Maiduguri Teaching Hospital, Maiduguri, Nigeria, over the last decade. The number of blood units received from educated elite donors during a 10-year period (1995-2004) at the blood bank were determined and expressed as percentages of total donations collected annually. The reasons for elite donor default were obtained through the use of questionnaires filled by defaulting donors. The proportion of educated elite donations steadily fell from 28% in 1995 to 7% in 2004. Reasons for defaulting from voluntary blood donations included fear for HIV screening in 86.7% of respondents, economic hardship/poor nourishment in 50.6% of respondents, changed address/logistic difficulties in 4.8% of respondents and ill health in 2.4% of respondents. Therefore, the steady fall in the proportion of elite donors over the years was mainly due to fear of HIV screening coupled with economic difficulties. Hence, there is the need to review our donor campaign strategy with respect to predonation counseling for HIV, initiate regular haematinics supplementation for donors and introduce sustainable mobile donor clinic services for distant donors. Further more, there is the need for a functional national blood transfusion service in Nigeria.

Pre-treatment tumour lysis syndrome and acute renal failure in adult Nigerians with Burkitt's lymphoma: report of three cases and literature review.

Pre-treatment tumour lysis syndrome (pre-TTLS) is not an unusual clinical entity in high-grade lymphomas and lymphoblastic leukaemias. The overall incidence and frequency is unknown and to the best of our knowledge none has been published in Nigeria involving adult females with advanced stage Burkitt's lymphoma (ASBL). Three of the reported cases had pre-TTLS complicated by acute renal failure (ARF). The first two cases had a complete reversal of the ARF with aggressive supportive management and slow introduction of cytotoxic chemotherapy whereas the third case died of ARF due to delay in commencement of aggressive supportive management, chemotherapy and haemodialysis due to financial constraint. This paper stresses the importance of aggressive supportive management and slow introduction of cytotoxic chemotherapy in patients with a stage C and/or stage D Burkitt's lymphoma presenting with pre-TTLS.

The Prevalence and Clinical Significance of Du Phenotype in Rhesus D Negative Pregnant Women in Maiduguri; Nigeria

To determine the prevalence and clinical significance of Du phenotype in Rhesus D negative pregnant women in Maiduguri; Nigeria; samples from 800 pregnant women who attended routine antenatal clinic from January 2004 to March 2005 were analyzed prospectively with respect to their ABO and Rhesus Blood group system. All Rhesus D negative women had elaborate indirect antiglobulin test to detect the presence of Du phenotype. The commonest ABO blood group system was group O. The prevalence's of Rhesus D positive and Rhesus D negative was 90.3

Awareness and acceptability of prenatal diagnosis of sickle cell anaemia among health professionals and students in North Eastern Nigeria.

BACKGROUND: The genetic control of sickle cell anaemia through prenatal diagnosis was recently introduced in Nigeria. Its acceptability will depend on some factors such as religious, political and social attitudes of the populace. The aim of the study was to determine the awareness and acceptability of parental diagnosis of sickle cell anaemia among health professionals and students in North Eastern Nigeria. METHOD: Structured questionnaires were administered to health professionals and students. RESULTS: Of 353 respondents interviewed, 279 (79%) were from Borno State, while 36 (10.2%) and 38 (10.8%) were from Yobe and Bauchi States respectively. Two hundred and four (57.8%) practised Islam while 149 (42.2%) were Christians. Ninety-five (26.9%) of the respondents were doctors, 17 (4.8%) pharmacists 37 (10.5%) technologists while 107 (30.3%) were nurses, 82 (23.2%) medical students and 15 (4.2%) physiotherapists. Two hundred and fifty seven (72.8%) had heard about Prenatal Diagnosis (PND) of Sickle Cell Anaemia (SCA). Fifty three percent (187) of the respondents would not like to terminate pregnancy by abortion if prenatal diagnosis confirmed sickle cell anaemia (SCA) in first trimester with significantly more Christians saying no to abortion. Only 50 (14.2%) of the respondents knew where facilities for prenatal diagnosis are obtainable in Nigeria whereas 85.8% (303) did not. CONCLUSION: Religion may be a major factor militating against acceptability of prenatal diagnosis of SCA in North Eastern part of Nigeria. The awareness of where facilities for prenatal diagnosis are obtainable in Nigeria among health professionals and students is also lacking. There is a need to educate our religious leaders, government and non-government organizations and the populace.

Determinants of survival in Nigerians with Burkitt's lymphoma.

There is paucity of information on the factors influencing survival of patients with Burkitt's lymphoma (BL) in Nigeria. This work was undertaken to examine the roles of presenting clinical and laboratory features in the survival of a number of Nigerian patients with BL. Confirmed cases of BL diagnosed in the hospital between January 1986 and December 1999 were studied. Diagnosis of the tumour was based on fine needle aspiration cytology of easily accessible mass in a large majority of patients. Median survival was calculated for all the dead patients using Kaplan-Meier technique. SPSS 10 statistical software and EPI 6.04b were used for all statistical calculations. A total of 213 patients were recruited over the 13-year period; with ages ranging from 3-45 years (median = 9) at diagnosis. The male-female ratio was 1.8:1. At the time of analysis in December 2001, 166 (77.9%) of patients had defaulted, 44 were known to have died and 3 were still alive. Only 81 (38%) of the patients had adequate chemotherapy (4-6 cycles). Fifty one (23.9%) patients had an initial complete remission. The mean survival of the 44 patients that died was 10.5 weeks (95% Cl = 3.9-17.1). It is concluded that survival in Burkitt's lymphoma was significantly better in patients who had adequate therapy, mean 40.8 +/- 12.2 (SE) weeks compared to those who had less than adequate cycles of chemotherapy, mean 3.7 +/- 1.0 (SE) weeks (p = 0.0000). Inadequate therapy and high default rate were partly responsible for the poor survival results obtained in this study.