'This machine helps keep my child alive'

An apheresis machine at KNBTS headquarters. [Cosmas Mwongela, Standard]

It’s a sunny evening in Nairobi’s Parklands suburb and 9-year-old Aisha and her sister are playing cheerfully outside their home.

Suddenly, Aisha feels a sharp pain in her body and tells her sister that she is feeling dizzy. 

Together, they go inside the house to tell their mother about the symptoms.

Aisha lives with thalassemia major, a blood disorder that blocks the body from manufacturing red blood cells that are key in oxygen supply.

The disease presents with yellowing of the eyes, general body weakness, skin paleness, and low haemoglobin levels.

She depends on a transfusion of two pints of packed red blood cells every month for survival. The blood component increases blood oxygen-carrying capacity and restores blood volume. 

Though too young to understand the details, she says the treatment improves her health.

“When the doctor gives me blood, I feel better. I do not feel dizzy,” says Aisha.

Despite her low immunity, Aisha is optimistic about a bright future.

With modern medical treatment, the girl is among thousands of patients receiving blood components to treat diseases and replace elements of blood that are missing.

Apheresis blood transfusion is a new technology that extracts different blood components for treating patients.

Previously, patients used to be transfused with whole blood.

The Health & Science team meets John Mureithi Mugo donating platelets at the Kenya National Blood Transfusion Services (KNBTS).

Mugo was inspired to be a platelets donor because of the high demand for the component, more among those battling cancer. He donates platelets every two weeks.

“I began donating platelets last year because, in our group, a lot of people needed the component, and some would default treatment because of low platelets,” says Mugo.

Victor Sirengo, a lawyer, is among individuals who depend on platelets for treatment. He is battling cancer of the lymphatic system.

Medical experts and studies reveal that platelets prevent active bleeding in cancer patients, as chemotherapy and radiation suppress bone marrow in cancer patients which stops the production of enough blood and platelets. Platelets help in the formation of clots that help stop bleeding.

Victor’s cancer treatment journey began in July last year. Before diagnosis, he was getting treatment for a bacterial infection because he had a swollen neck and lymph nodes.

The patient was referred to Kenyatta National Hospital (KNH) for a dental appointment, where an excision biopsy was done, whose results turned out to be cancerous.

In January this year, an oncologist recommended a full blood count alongside liver, kidney, and echo tests to determine the regimen of treatment.

By then, Victor’s platelets were only 21, out of the expected 150,000 to 450,000, levels that delayed his treatment. An oncology doctor recommended an urgent platelet transfusion.

“I eagerly waited for treatment, but my platelet levels remained low. The results meant my immunity and haemoglobin levels were extremely low. The doctor advised for apheresis blood transfusion to boost platelets level,” he recalls.

Transfusion of a single pint of platelets at a private hospital in Nairobi was Sh75,000.

Victor undergoes chemotherapy every three weeks, and before treatment, he has to do a full blood count that informs the need for a transfusion. 

He is scheduled for six chemotherapy sessions.

Though Victor gets platelets free, private hospitals charge him between Sh7,000 and Sh10,000 for bed and procedure during platelet transfusion.

Additionally, he uses about Sh10,000 every month on platelet supplements like papaya drugs.

To ease the treatment of patients, more so those battling cancer, he urges stakeholders to sensitise the public on blood components and the importance of donation.

“I did not have information about platelets being a component for treatment. We need such crucial information availed to the public through sensitisation,” Victor says. 

“Cancer of the lymphatic system requires me to regularly boost my platelets for treatment. This delays treatment yet there is no time to wait as the cancer could be advancing from one stage to another,” he adds.

An apheresis machine allows a donor to select the type of blood component they wish to donate, for example, plasma, platelets or red blood cells. The technology can prepare the blood components using centrifugation.

“Before apheresis machines, there used to be high mortalities for mothers who lost blood while giving birth. The machine is programmed to get the exact component that is needed. It can give red blood cells, platelets and plasma. It depends on what you want,” explains Kenya National Blood Transfusion Services (KNBTS) Chief Executive Officer Dr Maurice Wakwabubi.

The apheresis machine has been installed in all six regional blood centres in the country namely Nairobi, Kisumu, Eldoret, Embu, Mombasa and Nakuru.

KNBTS Nairobi Regional Manager Festus Koech says that all four components of blood are of medical importance.

For example, red blood cells transport oxygen to respective body organs and tissues.

Red blood cells also treat anaemia, and direct loss of blood caused by malaria, thalassemia, bleeding caused by road traffic accidents and prolonged infections like HIV.

Patients with burns are treated with fresh frozen plasma, a component that speeds up the healing period.

Plasma is also used to correct bleeding and Vitamin K deficiency, more so among leukaemia and haemophilia patients.

“The apheresis machine has helped reduce blood wastage because it focuses on the patient’s need, by collecting a component that is key in treatment,” notes Mr Koech.

Data by KNBTS reveals that maternity and cancer patients are the highest consumers of apheresis platelets.

Nevertheless, red blood cells are the highly consumed blood component, followed by platelets, then plasma.

Traditionally, blood donation entails collecting whole blood from a donor, which is sent to the laboratory for separation into whole blood cells, red blood cells, platelets and plasma.

But with apheresis, blood is received from a donor and separated into respective components, namely white blood cells, red blood cells, platelets and plasma, as per a patient’s need.

Before collection of components, a donor undergoes a haemogram test to determine blood count and any medical issues.

After the tests, the machine is set and begins to draw blood from the donor.

An apheresis operator directs the needed components blood bag and returns non-target components to the volunteer donor through a needle inserted into the arm.

The procedure takes approximately 49 minutes.

After donation, the components are stored in different environments and for different durations.

For instance, red blood cells are stored for 42 days, and fresh frozen plasma is within three years whereas platelet concentrates are stored at room temperature, for only five days.

“We need people to come over and donate blood, more so platelets because the lifespan of the product is short, yet its demand is high due to increased cases of cancer,” Mr Koech urges Kenyans.

Apart from separating components, Mr Koech adds that, unlike traditional technology, apheresis combines three processes namely centrifugation, filtration and hard sourcing which increases the safety of the blood.

Additionally, the machine provides high-quality products, whose concentration is five times more as compared to the manual machine.

The frequency of donation with the new technology also increases, for example, one can donate platelets every two weeks, a move that helps a recipient rely on one donor which reduces the risk of getting multiple drug transfusions from several donors.

“We want to educate Kenyans about blood components and tell them not to use whole blood, for example, if they need red cells, let us give them red cells. If a patient needs platelets or plasma, they should get that specific component,” notes Wakwabubi.

Amid the blood donation plea, the official pleads with private hospitals to regulate charges of blood components that are exorbitant.

“Blood donation is free. We do testing for free, we do the grouping for free, and we do storage for free.

Everything done on blood at KNBTS is done free, and we give blood to private and public hospitals free,” says the CEO.

He observes that the proposed Kenya National Blood and Transfusion and Transplant bill will help regulate blood donation and transfusion services in the country.

“We cannot price blood, but will enactment of the bill, we shall regulate the service charge,” Wakwabuba emphasises.

 To debunk beliefs that blood is sold, KNBTS has adopted the use of Damu-Ke technology to monitor blood from vein to vein and ensure the availability of safe and timely blood transfusions for patients.

The technology allows individuals to easily request to donate blood, track the availability of blood units and receive real-time updates.

Additionally, the technology monitors the availability of blood in banks, blood groups, its shelf life, areas of need and localities, a move that has improved quick turnaround, saving lives.

“With the technology, a donor receives a message after donating blood and is informed when it is stored.

At the time of transmission, a Short Message is also sent, notifying him or her that the blood has saved a life,” says KNBTS CEO Maurice Wakwabubi.