BACKGROUND
The routine pretransfusion investigations in Southern Ghana involve only ABO‐D blood group typing and ABO compatibility testing without screening for irregular red blood cell (RBC) ...antibodies. The prevalence and specificities of RBC antibodies and frequencies of most minor blood group antigens in transfused patients with sickle cell disease (SCD) in Ghana are not known and are the objectives of this study.
STUDY DESIGN AND METHODS
This was a cross‐sectional study that investigated transfused patients with SCD for the presence of irregular RBC antibodies and Rhesus, Kell, Duffy, Kidd, and Ss antigens.
RESULTS
From a total of 154 patients (median age, 9 years), 10 patients (6.5%) possessed 13 antibodies, predominantly against D, C, and E antigens. In three patients, the antibodies (anti‐D, anti‐D + C, and anti‐C + e) were against antigens they possessed by serology. Genotyping showed that two of these patients had variant RHCE genes that encode for weak and partial e antigens and one patient had a partial RHC gene. Frequencies of most RBC antigens were comparable with frequencies established among the African American population; however, K–k– and Jk(a–b–) phenotypes were more frequent and were present in 21% and 17% of patients, respectively.
CONCLUSION
The prevalence of RBC alloimmunization in transfused Ghanaian patients with SCD was 6.5% and the majority of antibodies were against antigens of the Rh system. Our findings stress the need to include pretransfusion testing for RBC antibodies in patients with SCD, to improve transfusion safety.
Background and Aims
Type 2 diabetes mellitus (T2DM) individuals are at a higher risk of developing diabetes complications, with approximately 80% complication‐related mortality. The increased ...morbidity and mortality among T2DM patients are partly due to dysregulated hemostasis. This study determined the quality of glycemic control in T2DM and its association with markers of coagulation and inhibitors of fibrinolysis.
Methods
This case–control study recruited 90 participants involving: 30 T2DM patients with good glycemic control, 30 with poor glycemic control, and 30 nondiabetic subjects as controls at a Municipal Hospital in Ghana. Fasting blood glucose, glycated hemoglobin, activated partial thromboplastin time (APTT), prothrombin time (PT), calculated international normalized ratio (INR), and full blood count (FBC) were determined for each respondent. Plasma levels of plasminogen activator inhibitor‐1 (PAI‐1) and thrombin activatable fibrinolysis inhibitor (TAFI) were determined using the solid‐phase sandwich enzyme‐linked immunosorbent assay method. Data were analyzed using R language software.
Results
Plasma PAI‐1 antigen levels were significantly higher in the participants with poor glycemic control as compared to participants with good glycemic control (p < 0.0001). There was no significant difference in plasma TAFI levels between the participants with poor glycemic control as compared to participants with good glycemic control (p = 0.900). T2DM patients had significantly shorter APTT, PT, and INR than controls (p < 0.05). At a cut‐off of ≥161.70 pg/μL, PAI was independently associated with increasing odds (adjusted odds ratio = 13.71, 95% confidence interval: 3.67–51.26, p < 0.0001) of poor glycemic control and showed the best diagnostic accuracy for poor glycemic control (area under the curve = 0.85, p < 0.0001).
Conclusion
PAI‐1 levels were significantly increased in T2DM with poor glycemic control and emerged as the best predictor for poor glycemic control. Good glycemic management to control the plasma levels of PAI‐1 is required to prevent hypercoagulability and thrombotic disorders.
Background and Objectives
Blood services manage the increasingly tight balance between the supply and demand of blood products, and their role in health research is expanding. This review explores ...the themes that may define the future of blood banking.
Materials and Methods
We reviewed the PubMed database for articles on emerging/new blood‐derived products and the utilization of blood donors in health research.
Results
In high‐income countries (HICs), blood services may consider offering these products: whole blood, cold‐stored platelets, synthetic blood components, convalescent plasma, lyophilized plasma and cryopreserved/lyophilized platelets. Many low‐ and middle‐income countries (LMICs) aim to establish a pool of volunteer, non‐remunerated blood donors and wean themselves off family replacement donors; and many HICs are relaxing the deferral criteria targeting racial and sexual minorities. Blood services in HICs could achieve plasma self‐sufficiency by building plasma‐dedicated centres, in collaboration with the private sector. Lastly, blood services should expand their involvement in health research by establishing donor cohorts, conducting serosurveys, studying non‐infectious diseases and participating in clinical trials.
Conclusion
This article provides a vision of the future for blood services. The introduction of some of these changes will be slower in LMICs, where addressing key operational challenges will likely be prioritized.
Preeclampsia (PE) is associated with endothelial injury and hemostatic abnormalities. However, the diagnostic role of coagulation parameters and natural anticoagulants in predicting PE has not been ...explored in Ghana. This study assessed plasma levels of these factors as surrogate markers of PE and its subtypes. This case–control study included 90 women with PE (cases) and 90 normotensive pregnant women (controls). Blood samples were drawn for the estimation of complete blood count and coagulation tests. The prothrombin time (PT), activated partial thromboplastin time (APTT), and the calculation of the international normalized ratio (INR) were determined by an ACL elite coagulometer while the levels of protein C (PC), protein S (PS), antithrombin III (ATIII), and D-dimers were also measured using the solid-phase sandwich enzyme-linked immunosorbent assay (ELISA) method. All statistical analyses were performed using the R Language for Statistical Computing. Results showed significantly (p < .05) shortened APTT (28.25 s) and higher D-dimer levels (1219.00 ng/mL) among PE women, as well as low levels of PC (1.02 µg/mL), PS (6.58 µg/mL), and ATIII (3.99 ng/mL). No significant difference was found in terms of PT and INR. From the receiver operating characteristic analysis, PC, PS, and ATIII could significantly predict PE and its subtypes at certain cutoffs with high accuracies (area under the curve AUC ≥0.70). Most women with PE are in a hypercoagulable state with lower natural anticoagulants. PC, PS, and ATIII are good predictive and diagnostic markers of PE and its subtypes (early-onset PE EO-PE and late-onset PE LO-PE) and should be explored in future studies.
Sickle cell disease (SCD) is the most common monogenic disorder in sub-Saharan Africa (SSA). Blood transfusion to increase the oxygen carrying capacity of blood is vital in the management of many ...patients with SCD. However, red blood cell (RBC) alloimmunization is a major challenge to transfusions in these patients. Commonly in SSA, pretransfusion tests only involve ABO D grouping and compatibility without RBC antibody testing. Data on the frequency of RBC alloimmunization in patients with SCD in SSA are limited. We performed a systematic review and meta-analysis on available data on alloimmunization in transfused patients with SCD to determine the published prevalence of RBC alloimmunization in SCD patients in SSA. Six databases were systematically searched to identify relevant studies, without year or language restrictions. In all, 249 articles were identified and 15 met our selection criteria. The overall proportion of alloimmunization was 7.4 (95% confidence interval: 5.1-10.0) per 100 transfused patients. Antibodies against E, D, C, and K antigens accounted for almost half of antibody specificities, and antibodies to low- and high-frequency antigens were also common and represented almost 30% (20% to low-frequency antigens and 9% to high-frequency antigens) of specificities. Heterogeneity between studies was moderate, and meta-analysis found region of Africa as the major contributor to the heterogeneity. We also observed inconsistencies across studies in reporting of factors that may influence alloimmunization. This review provides an overview of the extent of the alloimmunization problem in SSA and provides a baseline against which to compare the effect of any interventions to reduce the alloimmunization risk.
•The pooled proportion of alloimmunization in SCD in SSA is 7.4 (95% CI: 5.1-10.0).•Almost 50% of antibody specificities were against D, C, E, and K antigens.•Antibodies to low- and high-frequency antigens accounted for 29% of antibodies.•Studies did not consistently report factors that influence alloimmunization.•SCD patients in SSA should be screened for RBC antibodies and IAT cross-matched.
Background and Objectives
The COVID‐19 pandemic brought about changes to daily life as measures to contain the spread of the virus increased across the world. The aim of this survey was to assess the ...psychological impact of the pandemic on young professionals (YPs) in transfusion medicine.
Materials and Methods
A cross‐sectional web‐based survey was distributed electronically to ISBT members inviting YPs (≤40 years) to participate. Statistical analysis was performed using SPSS software.
Results
Two hundred and fifty‐nine YPs completed the survey, including 107 clinicians/physicians and/or nurses. Almost half of the YPs (52.5%) indicated increased stress levels and 15.4% indicated symptoms of depression. YPs highlighted the loss of social engagement (59.1%) and increased pressure from information seen on media (35.5%) as factors negatively impacting their psychological wellbeing. Further, 20.8% expressed increased economic stress resulting from concerns about job security. Almost half of the YPs indicated that their organization provided moderate/occasional holistic support to them and their families. Sixty percent and 74.4% of YPs reported increased workload and staff absence due to COVID‐19 infection, respectively. Only half of clinicians/physicians and/or nurses indicated that they often had sufficient personal protective equipment. The majority of these (76.6%) had family/household members living with them, and 61% indicated that they were significantly worried about infecting them because of the nature of their work.
Conclusion
COVID‐19 had a major impact on the well‐being of YPs working in transfusion medicine. Measures are required to ensure that YPs are protected and mentally supported while undertaking their duties in current and future pandemics.
Blood transfusion in patients with sickle cell disease (SCD) is associated with the development of antibodies against the foreign transfused red blood cell (RBC) antigens, i.e. RBC alloimmunisation. ...Very few studies have reported on RBC alloimmunisation in patients with SCD in sub-Saharan Africa (SSA), where antibody testing and RBC matching beyond blood groups ABO and Rh D are not done in most centres. Even when antibody testing is done, it is performed with standard reagent test cells mostly from donors of Caucasian descent that lack antigens that are more prevalent or exclusively present in Africans. This may miss antibodies to the antigens that are predominantly present in Africans, putting patients at risk of haemolytic transfusion reactions upon subsequent transfusions with antigens to which patients have made antibodies.The overall goal of this project was to investigate post transfusion RBC alloimmunisation and adverse transfusion events in patients with SCD in Ghana and to explore ways of optimising transfusion practices to detect alloimmunisation to clinically relevant RBC antigens and, thereby, prevent transfusion reactions.To achieve this:1. a systematic review of published literature and a meta analysis were performed to determine the estimated frequency of RBC alloimmunisation in SSA.2. A cross-sectional study was performed and this was in two parts: - first, to determine the prevalence, specificities, and risk factors for RBC alloantibodies against a standard Caucasian antigen panel and eight selected antigens predominantly present in Africans (frequency 0.5% to 32%) and adverse transfusion events assessed by patient recall in multi-transfused patients with SCD.- second, to determine the frequency of 24 clinically relevant RBC antigens- routinely included in commercially available antibody screening panels- among patients with SCD and/or blood donors in Ghanaians of different ethnicity.The systematic literature review and meta-analysis included 15 studies of RBC alloimmunisation in patients with SCD from nine SSA countries. The overall proportion of alloimmunisation in patients with SCD in SSA was 7.4% (95% confidence interval (CI) 5.1-10.0). Antibodies E, D, C and K accounted for almost 50% of the specificities. Antibodies to uncommon and common antigens accounted for 20% and 9% respectively of the antibody specificities.The first part of the cross-sectional study recruited 226 patients with SCD. In these patients antibodies were present in 36 (16%); 25 patients (11.1%) with 26 antibody specificities were positive with the standard Caucasian panel and 11 patients (5.3%) with 11 antibody specificities were positive with the selected African antigens. Receiving the first transfusion after the age of three years (aOR 3.28) and the number of transfusions (aOR 2.00) were positively associated with alloimmunisation. Adverse transfusion reactions were recalled by 68 patients (30%), of which 23 patients had signs suggestive of haemolytic reactions. Adverse transfusion reactions were positively associated with the number of transfusions (aOR 2.06).The second part of the cross-sectional study performed RBC antigen typing for 24 antigens; antigens A, B, D, C, E, c, e, Jka, Jkb, M, N, S, s, Fya, Fyb by serology and low prevalent antigens Cw, K, Kpa, Jsa and Lua and high prevalent antigens k, Kpb, Jsb and Lub by genotyping. The numbers of samples tested per antigen ranged from 117 to 505. Among patients and donors, the antigens and antigen phenotypes frequencies did not differ, except for the C antigen, and the ccddee phenotype. Participants belonged to 26 different ethnic groups and this was categorized into four groups namely Akan, Ga, Ewe and Other. Among the four ethnic groups, frequency variations were observed for some antigens with the Ewe population showing the highest number of antigens (A, B, E, and Lua) and antigen phenotypes (ccDEe, ccDee and Ccddee) differences compared to the other ethnicity groups. The Ga population also differed from the other ethnic groups in the frequency of the Jsa antigen and the Js(a+b+) phenotype.Overall, my research shows that in Ghana patients with SCD do devleop RBC antibodies (16%) following blood transfusions to ‘foreign’ RBC antigens present in the donor blood, and some of these antibodies result in haemolytic transfusion (10%) reactions upon subsequent transfusions. Antibody testing to identify these antibodies and providing appropriate units lacking their corresponding antigens would improve transfusion safety in these patients. Furthermore, since these antibodies are mainly towards the major Rh antigens and some African antigens, standard test cells, which are generally of Caucasian origin, will fail to detect the antibodies to the African antigens, putting the patients at risk for haemolytic transfusion reactions. For effective management of anaemia requiring transfusion in SCD in Ghana, my findings support the routine testing for RBC antibodies using test cells that express the immunogenic African antigens V, VS, Goa, Dantu and Henshaw. Until Africa-specific red cell screening panel are available, in LMICs in sub-Saharan Africa with limited resources, all patients with SCD should be screened for RBC antibodies with the standard Caucasian panel prior to RBC transfusions and indirect antiglobulin crossmatched to select the best suited blood for transfusion.
Although anaemia is a common life-threatening condition among pregnant women, particularly those in low-income countries, literature remains very limited in Ghana in general and particularly in the ...Madina La-Nkwantanang Municipality of the Greater Accra Region, where no studies have been done. This study, therefore, assessed anaemia in pregnant women attending the Pentecost Hospital in the La-Nkwantanang Municipality, Ghana. This cross-sectional study conveniently recruited 300 Ghanaian pregnant women attending the Madina Pentecost Hospital for antenatal care. A structured questionnaire was administered to obtain data on sociodemographics (age, marital status, level of education, occupation and religion) and knowledge level of anaemia. Blood samples were taken for an automated complete blood count (CBC). SPSS software version 26 and GraphPad Prism were used for the statistical analysis. The prevalence rate of anaemia was 211/300 (70.3%). 159 (75.4%) of the anaemic subjects presented with a mild anaemia form, 51(24.2%) presented with a moderate form, and 1(0.47%) presented with severe form. Normocytic normochromic anaemia was the dominant anaemia type (33.6%), followed by microcytic normochromic anaemia (27.0%), and then normocytic hypochromic (24.64%). Pregnant women within their third trimester recorded the highest incidence rates of both normocytic normochromic 34 (47.89%) and mild types 71 (44.65%) of anaemia. The prevalence of anaemia among pregnant women is overwhelmingly high with a preponderance towards those in their third trimester. As such, high-risk pregnant women should be well-monitored to prevent exacerbating the condition.
On 4th February 2015, a group of Senior High School students from Fanteakwa district presented to the emergency unit of the district hospital with complaints of abdominal pain, vomiting and ...diarrhoea. All the students had eaten from a specific food vendor and had neither eaten any other common meal that day nor the previous day. A foodborne disease outbreak was suspected. We investigated to verify the outbreak, determine its magnitude, identify the source and implement control measures.
A retrospective cohort study was conducted. We reviewed medical records and interviewed patrons of the food vendor. We collected data on age, sex, signs and symptoms, date of illness onset, date of admission, date of discharge, treatments given and outcome. A case of foodborne disease was any person in the school with abdominal pain, vomiting and or diarrhoea from 4th to 11th February 2015 and had eaten from the food vendor. We conducted active case search to identify more cases. We conducted environmental assessment and collected clinical and food samples for laboratory testing. Descriptive and inferential statistical analyses were performed using Stata 12.0.
A total of 68 cases were recorded giving overall attack rate of 35.79 % (68/190) with no death. Of these, 51.47 % (35/68) were males. Mean age of case-patients was 17.8 (standard deviation +/-1.62). The index case, a 17-year-old female student ate from the food vendor on 4th February at 9:00 am and fell ill at 3:40 pm later that day. Compared to those who ate other food items, students who drank water from container at the canteen were more likely to develop foodborne disease at statistically significant levels RR = 2.6, 95 % CI = (2.11-3.15). Clostridium perfringens (C. perfringens) and Salmonella species (Salmonella spp) were isolated from water and stew respectively. Clinical features of case-patients were compatible with both organisms.
A foodborne gastroenteritis outbreak occurred in a Senior High School in Fanteakwa District from 4th to 7th February 2015. The most probable aetiologic agent was C. perfringens with contaminated water at canteen as the vehicle of transmission. Concurrent Salmonella spp infection could not be ruled out. Rapid outbreak response helped in controlling the outbreak.
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