The dry blood banks in the country

There is a growing concern of blood shortage in public and private hospitals in the country. Adequate access and safe transfusion of this life-saving tissue is key to ensuring equal, timely, quality and affordable healthcare.

This is the situation of this special body fluid in the country.

During the 2020/21 financial year, the Kenya Tissue and Transplant Authority (KTTA) collected a total of 348, 566 units of blood product.

The World Health Organization (WHO) report 2022 stated that the demand for blood in Africa including Kenya surpassed the supply which has negatively impacted timely access to supplementary safe blood by patients who are in dire need of this critical fluid soft tissue.

In August 2022, the Western Region’s Health Executive Collins Matemba announced an impending health crisis attributed to reluctance by residents to donate blood due to an acute shortage of blood as stocks at the regional transfusion Centre in Kakamega with a fully equipped facility including storage refrigerators and other requisite equipment serving counties of Vihiga, Bungoma, Busia, Trans Nzoia and Nandi ran dry of the precious body fluid.

“What I would say to you is that when any facility has called on us, we have always stepped in… We have beenable to work closely with the Counties to establish county blood transfusion coordinators to liaise with us if they have any gaps to ensure a continued conversation on the same,” said Dr Nduku Kilonzo, the Chief Executive Officer (CEO) at The Kenya Tissue and Transplant Authority (KTTA).

Dr Nduku Kilonzo, the Chief Executive Officer (CEO) at The Kenya Tissue and Transplant Authority (KTTA) succeeding the defunct department of the Kenya National Blood Transfusion, Tissue and Human Organ Transplant Services (KNBTTS) which was on the spotlight over claims of malpractices by unscrupulous officials allegedly selling stolen blood from Kenyan blood banks to the neighboring Somalia.

“You asked me about selling of blood. This was the 2020 scandal. In 2020 we had a scandal an investigation by the government continued and was part of what initiated institutional reforms to the national blood service” Dr. Nduku observed.

However, Dr. Nduku now notes that the country has adequate blood stock in their blood bank.

“We were able to raise over 348,000 units of blood, the highest ever since independence, that being 248 per cent increment compared to the year 2020 as a result of partnering to collect blood” she explained.

KTTA was then birthed by the Ministry of Health Kenya (MoHK) under the immediate former Health Cabinet Secretary (CS) Mutahi Kagwe following the growing public outrage who expressed dissatisfaction over the allegations making the CS to deem the office unfit to exist and initiate radical reforms which resulted to its disbandment.

The service has initiated institutional reforms at the institute with an objective to ensure access to safe and ethical use of human cells, tissues, organs and the safety, biosafety and wellbeing of donors and recipients.

“Part of the reforms that were initiated in this institution include leadership, management, human resource and it is those reforms that have got us to where we are today,” concurred Dr. Nduku.

Dr. Nduku outlines plans on how the current institute will regulate the sale and or, sharing of donated blood between private and public hospitals to ensure transparency and accountability is adhered to.

“The World Health Organisation has strict guidelines on human derived medical products with no pharmaceutical replacement…. We are calling it a vain-to-vain system where banks can see what is going on and we can also use to request, so far deployed in six of the regional banks, 12 county satellites, plans underway for deployment in Eldoret…. We are in deployment phase and our target by the end of this financial year we should have reached out to a minimum of 250 institutions across the country… Now we will start to generate reports because we can track using a barcoding process”

“We expanded transfusion infrastructure, building the capacity functional for the country, we did quality systems, the capacity for regional centers, the capacity for blood testing, the number of blood satellites, the number of the ability to prepare blood products, you can see it is all there, where we were where we are,” Dr. Nduku noted.

KTTA’s focus on blood services during the FY2020/21/22 include leadership, management and human resource changes, expansion of transfusion infrastructure, building functional capacity including blood fridges, freezers, cold rooms, bio-banks, platelet agitators and centrifuges for components, quality systems, commodity security meant for forecasting and quantification system for blood bags, grouping reagents and testing reagents for HIV, Syphilis, hepatitis B and C and finally accountability and visibility.

All the infected units are then separated from the clean units where labeling and sorting happens in blood binds.

The institute has introduced new regulatory framework with new standards for regulation of blood services including Kenya Standards for Blood Transfusion Services, Kenya Standards for setting up Blood Establishments, the National Cold Chain Manual, Clinical Guidelines for Rational and Appropriate use of Blood Products and Hemovigilance manual.

The blood is first collected during a blood donation campaign.

Additionally, Dr. Sylvester Mukeni, the Laboratory Manager National Blood Testing Cooperative (NBTC) says the donors are first given each a questionnaire form to fill their details, proceed to weighing machines before proceeding to medical examining for a prospect blood donor to either qualify to donate blood or not by being given a blood bag to confirm their eligibility.

“I came out to participate in this noble cause and am glad that I have been allowed to donate for good to help save a life,” concurred Samuel Macharia, the Human Resource Manager Crown Plaza Nairobi Airport Hotel, JKIA.

The donated blood is first quarantined at the Cold Room before labeling and sorting when collected from field awaiting to be processed.

“This is the blood grouping lab where once the blood is donated, a sample is put in the purple top which aid in blood grouping,” confirmed Christine Karemi Yegon, the manager, Testing Services at KTTA.

After the long day in field, it is a day like any other, Experts on duty at Kenya’s national blood bank Centre based at the Kenyatta National Hospital.

“This is the blood grouping lab. This is where a once blood has been donated, a sample is put in the purple top and it is by using the purple top that we carry out the blood grouping; the ABO and RH system mainly found in Kenya. What happens is that we check the antibodies in the plasma and antidotes on the surface of Red Blood Cells to determine what blood group a donar has and we have different types of blood groups namely A+, B+ O+, AB+ and negatives of the same which are rare in the country,” Karemi reiterated.

According to Christine Karemi Yegon, the manager, Testing Services at KTTA says countrywide, Kenya has five Aphaeresis machines, an automated machine used for blood component preparation.

KTTA is however expecting four more machines during the financial year 2022/2023.

A dose by Aphaeresis is equivalent to 10 doses of manually processed components.

“An Aphaeresis machine prepares products mainly Platelets. It is a machine that when you are preparing Platelets, the Red Blood Cells go back into the patient and we remain with the Platelets since the machine is very efficient in terms of picking either Platelets, Plasma or packed Red Blood Cells,” confirmed Dr. Mukeni, the Laboratory Manager NBTC).

The plasma extractor component preparation separates plasma from the Red Blood Cells ready for freezing.

So far, the department has only 2 automated Plasma extractor machines.

Fresh frozen plasma (FFP) usually last for a year and are stored under -40 degrees Celsius.

The component contains all of the clotting factors including factor eight meant to help patients with burns, bleeding or accident victims.

Thawing “the process of ice, snow, or another frozen substance becoming liquid or soft as a result of warming up” takes place before transfusion is done.

Packed Red Cells kept at the sorting room help in anemia and patients who have lost a lot of blood as they improve oxygen carrying capacity of the cells and improve hemoglobin level.

Blood banking capacity increased by 110 per cent from 2400 to 53, 210 units countrywide.

For the platelets concentrate, the Platelets agitators are designed for storage of platelet concentrates and are designed to provide continuous gentle horizontal motion to the packs, typically at a fixed speed and at a temperature of 22 degrees Celsius.

The clotting factors are not frozen and can only last for a period of five days.

Blood is taken from grouping to the next, the screening stage for testing of HIV, Hepatitis B, Hepatitis C and Syphilis.

“This is where we use the Red top. This is where the plain that is uniquely identified and bar coded used to identify respective donor. The number on it is used for confidentiality purposes which has the year, unique number and team that went for the blood collection process. For blood screening of the four parameters recommended by WHO in Kenya, we use the two abort machines; the use the chemiluminescent microparticle immunoassay (CMIA) principle (an advanced serological diagnostic technique, provides a rapid, cost-effective and reliable way to detect HCV, and therefore, is the method that was implemented for the diagnosis of hepatitis infection). This are very sensitive and specific machines,” explained Christine Karemi Yegon, the manager, Testing Services at KTTA.

KTTA is expected to put measures in place to ensure Kenya is at par with global standards for governance and management of blood tissues, resolve the unregulated organs and other tissues transplantation such as illegal blood and organ harvesting, answer the unregulated safety and quality of blood.

The body plans to save Kenya from billions of shillings lost by those seeking medical services abroad through medical tourism, unravel the inequality in access to advanced medical care, poor donation culture, solve the blood and organs testing, banking and re-allocation infrastructure, crack the strategic reserves banks menace in case of emergency and securing Kenyans bio-data and tissue samples.

“I am not saying that you don’t hold us to account. Hold us to account but also remember that every time it is just a story because there is a story to say it will have an impact on someone’s life. If its working, give the good part of what is working and encourage more people to go and collect,” averred Dr. Nduku.

Since the United States Agency for International Development (USAID) stopped funding blood drive and harvesting processes mostly in learning institutions in the country, the noble initiative has since died off with key partners especially the of Kenyan government and other stakeholders including donors appearing reluctant and or unable to sustain such a programme.

“I laughed because we were having a session the other day and when young people were having their session the other day they called it ‘from soda and bread to sustainable donations’ because many remember the soda as an incentive. Covid-19 taught us quite a lot…Today we have partnerships with various stakeholders including rotaract, security personnel, ‘bodaboda’ (motorcycle riders) groups to steer the blood donation drives,” stated Dr Nduku.

The Kenya Tissue and Transplant Authority (KTTA) insists that there is enough blood in the country hence no need to worry.

However, Kilonzo is calling on more donors to turn up in large numbers to donate blood so as to ensure the national bank does not run dry of this special body fluid.