By Enyeribe Ejiogu (enyeribee@yahoo.com)
Blood is a specialised fluid in the human body that transports oxygen and nutrients such as sugars, amino acids and lipoproteins to the cells and carries away carbon dioxide and other waste products. It also transports hormones. It is pumped by the heart to the lungs and all other parts of the body, and then returned to the heart for the process to be repeated, to sustain life.
Sanguis, as blood is known in Latin, is so critical that without it there is no life. That is why the Bible says in Leviticus 17:11 “the life of the flesh is in the blood.” Until the coming of Christ and his subsequent vicarious death on the cross of Calvary, blood of animals was used by Jews in altar sacrifices for sin. Even in traditional or pagan religion, blood was also used for sacrifices because it is symbolises life. Blood is essentially made up of plasma, which is the liquid that gives it the fluid nature; embedded in the plasma are three types of cells – red blood cells, white blood cells and platelets. Platelets help the blood to clot, a process that stops blood from flowing out of the body when a vein or artery is broken. Red blood cells (RBCs) carry oxygen to the tissues while the white blood cells (WBCs) carry out the extremely important function of being the core of the body’s defence architecture against infection. It is this critical function of the WBCs that helps give immunity to the body. Beyond these primary functions, the blood also transports antibodies that fight infections and helps the body to regulate temperature.
At the University of Calabar, Professor Anthony Emeribe, a Consultant Haematologist and former Registrar of the Medical Laboratory Science Council of Nigeria, has spent his academic career on the study of the blood. This field of study, known as haematology, covers blood formation, kinetics and function in health, disease diagnosis, management, and research. “Blood is readily the most used body fluid or tissue in the study of human and animal health and diseases including diverse clinical trials, diagnosis, monitoring, forecasting, surveillance, control, and prevention,” he told an august audience recently, when he delivered the 102nd Inaugural Lecture of the institution on the theme, “Sanguis: Gateway to Quality Human Disease Diagnosis, Management and Research.”
Proper and timely blood analysis is key to the ability of medical doctors to carry out effectual diagnosis of certain disease conditions. For this reason, doctors may order blood tests, including a full or complete blood count (FBC/CBC), and other tests to rule out other causes of symptoms. “Sometimes a blood disorder causes no symptoms but is discovered when a laboratory test is done for another reason. For example, a full blood count done as part of a regular check-up may reveal anaemia. When a blood disorder is suspected, a full blood count and other tests may need to be done to determine the specific diagnosis. Common blood disorders include anaemia, bleeding disorders such as haemophilia, blood clots, and blood cancers such as leukaemia, lymphoma, and myeloma,” Emeribe says, adding that there are many different blood diseases that are diagnosed and managed by haematologists. Some of these are benign (non-cancerous) and others are various types of blood cancer. They can involve one or more of the three main types of blood cells (red blood cells, white blood cells, and platelets) or the coagulation system.
Imagine a situation where haemostasis fails to trigger when the need arises. Really that is scary. Haemostasis is the body’s normal physiological response for the prevention and stopping of bleeding or haemorrhage. It results in the blocking of any vascular breach. Generally speaking, it helps ensure blood fluidity and blood vessel integrity. How does it happen, you ask? Emeribe explains thus: “Haemostasis is an orderly process. When a blood vessel is damaged, von Willebrand Factor (VWF) binds to both exposed connective tissue (e.g., collagen) and circulating platelets, resulting in platelet accumulation at the site of injury. These platelets become activated, and both recruit additional platelets and trigger the coagulation system, ultimately leading to the generation of fibrin, which overlays the platelet plug. This system is tightly regulated by substantial negative feedback mechanisms, including a series of coagulation factor inhibitors as well as the fibrinolytic system. Finally, repair of the damaged endothelium and remodeling occurs to ensure a smooth vessel surface. This process focuses first on the platelet and vessel wall interactions and then on the formation of thrombin, which cleaves fibrinogen to fibrin, and the subsequent formation of a fibrin clot.”
Then he makes this vital point: “There is at present no effective or acceptable alternative to human blood for therapeutic use. Human blood and tissues are scarce national resources which should not be traded like commodities. A good blood transfusion policy should facilitate the provision of safe and adequate blood and blood products for the population. Blood from regular, voluntary, and altruistic, non-remunerated donors has been proven worldwide to be the safest for therapy. Donated blood, being a scarce national resource must be shared equitably and used in the most effective and efficient manner. The procurement and administration of blood must protect and promote the health not only of the recipient but also the donor.”
It is heart-warming to note that President Muhammadu Buhari on July 29, 2021, signed into law National Blood Transfusion Service (NBTS) Bill, a move that cleared the way for the creation of the National Blood Transfusion Commission (NBTC).
The road to promulgation of the new law began when the Federal Government, through the Ministry of Health, set the vision and accepted ultimate responsibility to provide comprehensive blood transfusion service in Nigeria by establishing an efficient national blood service. To achieve this laudable goal, it put together the national policy that created the framework for the National Blood Transfusion Service in 2006. As Emeribe reveals, “The vision is to have a quality national blood service, complying to international standards, which will be acknowledged as being one of the best in Africa.” He adds: “The mission of the National Blood Service is to provide safe, quality, and adequate blood in an equitable and cost-effective manner to all people resident in Nigeria. The objectives of this policy shall be to establish and coordinate blood transfusion services on a country-wide basis within the National Health Plan.”
Like most other Nigerians, who have long dreamed that the country’s healthcare system will experience a rebirth, Emeribe earnestly hopes that the national blood service policy would lead to the re-establishment of relationships with partners and stakeholders for effectiveness and efficiency. To deepen the process, he makes the following suggestions: enlightenment and sensitization to communities and Nigerians on the importance and need for voluntary non-remunerated blood donation, while working on different strategies to attract and convince donors even in the face of the COVID-19 pandemic; re-organization of the administrative and functional structures, to pave way for carrying out the NBTS mandate, concentrating energy and resources on having functional zonal centres, letting states take over their centres and those without, to establish one, while providing technical support to them; creation of private-public partnerships for donor blood organization and distribution with the aid of Geographic Information System (GIS) mapping software; advocacy for functional hospital transfusion committees; replacement of old and dysfunctional equipment; enhanced capacity building; advocacy for blood components and plasma derivative medicinal products usage and lastly, support for autologous blood transfusion. Incidentally, autologous blood transfusion is the collection of blood from a single patient and re-transfusion back to the same patient when required. This is in contrast to allogenic blood transfusion where blood from unrelated/anonymous donors is transfused to the recipient. Creating the infrastructure, operational mechanism and deploying the expertise required to efficiently and effectively drive autologous blood transfusion in Nigeria holds excellent prospects for growing the health sector.