Blood going bad because of lack of reagents

A young woman donates blood at Kenyatta International Conference Center. [John Muchucha]

At the reception of one of the buildings at Kenya National Blood Transfusion Services (KNBTS) sits Rebecca Ayoi.

And she does not hesitate to strike a conversation.

“Have you also come to donate blood? How long does it take to get the blood and take it to a patient?” she said.

She opens up about her daughter lying at Mama Lucy Hospital. She said she gave birth on Monday, but she is yet to be discharged. She needs blood.

“I have never donated blood. I have brought my son to donate for her. She is in a bad state, so weak and the doctors insist she needs blood. She is on supplements,” said Ayoi.

No reagents for blood screening

What Ayoi does not know, is even if her son donates blood, her daughter may never get it as Kenya has no reagents for screening blood.

At KNBTS, services are on stand still. The two main machines used to screen blood for HIV, syphilis and Hepatitis B are not working.

Since February 19, 2020, an insider told The Standard, no blood has been processed. Yet Kenyans of good will and desperate relatives of patients continue to donate.

“So far, we have 9,000 units of blood that have gone bad,” the source said. “It is disturbing considering one unit of blood can save up to three people.”

A warning on dwindling reagents was raised in August 2019. The source said with unstable leadership at the directorate level, it has become hard to procure more, since only the directorate has the signatory powers.

“It is disturbing that some of the blood collected during Valentine’s Day has not been screened and is now going bad,” the source said.

Expectant mothers, cancer and anemic persons are some of the patients in dire need of blood.

A report by the Ministry of Health in 2017 listed bleeding as the leading cause of death among pregnant mothers, accounting for half of the number. This translates to 181 mothers in every 100,000.

Just recently, Kenyatta National Hospital (KNH) had to defend its decision of discharging patients, referring them to other hospitals because of a blood shortage.

The hospital did admit it only has the capacity to mobilise 40 units of blood per day against a demand of 200.

“This constitutes less than 20 per cent of the requirement for normal operations,” said Mr Nicholas Gumbo, the facility’s board chairman.

KNH uses the most blood

KNH is the country’s largest and more specialised referral hospital and the biggest user of blood from KNBTS. Also, the hospital has its own capacity of screening blood.

Data accessed by The Standard for Nairobi shows KNH consumed 1,711 units of blood and blood components between January 1, 2019 and December 31, 2019

Other big consumers are Mbagathi District Hospital at 1,342, Nairobi Outpatient Centre (1,344), Pumwani Maternity Hospital (1,378), and Mama Lucy Hospital (1,436).

Shelf life

Once collected, four components of blood can be extracted: red blood cells, cryopecipitate, plasma and platelets. Platelets have a shelf life of five days while plasma can last for a year.

This separation should be done within 30 days as blood has a shelf life of a 35 days.

A walk through laboratories at KNBTS reveals a serious crisis that has left thousands staring at death.

While the fridges are full with blood, the two main screening machines have no pulse. Only the blood grouping machine is working. The machine also tests for Rhesus factor.

The crisis has forced KNBTS to send blood samples to Kisumu and Eldoret regional centres. This means it would take a patient in Nairobi up to five days to get the sample results of screening.

If the tests comes back as not compatible, then relatives of patients have to seek another donor, and wait probably, for another week.

Combined capacity

“The problem is the centres in Kisumu and Eldoret have a combined capacity of processing 360 units in a day yet the whole country is now depending on them,” the source said.

The two screening machines at KNBTS have a capacity of processing 135 units (samples) each. In a day, they process up to 1,200 units.

“The truth is, there is blood in this country. It may not be enough, but there is blood. We just do not have reagents. If we had, with just these two machines, you would not hear these cries across the country,” the source said.

Evidence on lack of reagents, while pointing to the lack of funding, seems to differ from a narrative that blood shortage has been caused by some cartels exporting blood to Somalia.

Health CS Mutahi Kagwe has said the Directorate of Criminal Investigations is already investigating the claim.

The CS however, on Thursday, could not share more on the case. “Obviously there is an investigation ongoing so we cannot reveal much,” he said.