Challenges in blood banking and transfusion practices in Nigeria: Insights from the ADLM Africa Subcommittee workshop

“Nigeria faces a 72% blood shortage, requiring 2.5 million units annually but collecting only 500,000 units, contributing to 27% of maternal deaths.”

With this stark pronouncement, Professor Saleh Yuguda, MBBS, FMCPath, the Director-General of the National Blood Service Agency (NBSA) opened his presentation at the joint workshop on Quality Management Strategies in the Era of Emerging Technologies in Abuja, Nigeria on November 12 and 13. The event was hosted by the Association for Diagnostics and Laboratory Medicine (ADLM), the Association of Clinical Chemists of Nigeria (ACCN) and the Academy of Medical Sciences of Nigeria.

Yuguda, a tall man in a Hausa cap, sporting a distinguished, salt-and-pepper beard and wire-rimmed glasses—the quintessential professor—stepped to the lectern, commanding attention. His credentials support the image. He has been working in the field for decades: with a medical degree from the University of Maiduguri and residency training in Hematology and Blood Transfusion at the University College Hospital, Ibadan. He also earned fellowships with the National Postgraduate Medical College of Nigeria and the International Hemophilia Treatment Center. And after decades in academia, he was appointed Director-General of the National Blood Service Agency (NBSA).

His experiences have prepared him for Nigeria’s blood banking crisis, all of which he has witnessed firsthand.

NBSA’s headquarters is tucked away in a quiet, tree-lined avenue in Abuja. It is just a short drive from the country’s political center and focuses narrowly on the needs of the country’s trauma wards and maternity clinics. Inside, a large and strong team of individuals work on ensuring safe transfusion services. But, as Yuguda emphasized, they face challenges meeting the needs of Nigeria’s trauma patients. Their current blood supply is only 28% of what is needed.

And the consequences are devastating. 27% of maternal deaths in the country, he said, occur because of postpartum bleeding, 40% of deaths from traffic accidents result from bleeding, and 70% of pediatric severe malaria causes in the country require blood transfusions.

The challenges do not stop there. Despite blood supply shortages, many facilities in Nigeria transfuse whole blood due to limited capacity for component separation. Limited access to laboratory testing with variable quality across centers, supply interruptions, cold chain challenges, gaps in regulatory oversight, and enforcement are also some of the constraints Nigeria faces.

Yuguda’s predecessor had remarked in 2007, “Blood banking and transfusion services in Nigeria are fragmented, uncoordinated and safety has not been satisfactory.”

Nearly two decades later, the challenges remain largely unresolved.

Undeterred, Yuguda is undertaking concerted efforts to expand and strengthen blood supply and safety nationwide. Through a range of strategic initiatives, including increasing blood donation campaigns focusing on voluntary donations, expanding blood collection and screening centers, deploying hemovigilance systems across all blood centers, and rolling out national blood management software and training programs, Yuguda aims to increase blood supply by 40% and reduce transfusion transmitted infections by 20% by the year 2030.

The ADLM/ACCN/AMS workshop served as more than an event. It was a chance for Yuguda to share the challenges his agency faced as well as his experience and knowledge. The presentation gave him a chance to work toward solutions with national and international colleagues. In attendance were representatives of the Nigerian Society for Hematology and Blood Transfusion.

At the same time, he would have the chance to hear from his colleagues in Nigeria and ADLM’s experts on quality management, POCT, blood banking and AI for lab usage—the team he needed to face his challenges.

Many of the presentations were helpful for Yuguda. Presentations by Sarina Yang, PhD, on AI’s usage in the laboratory sparked widespread discussion among the audience, and the challenges posed by POCT covered in Merih Tesfazghi’s, PhD, DABCC, presentations touched upon issues many in the audience faced. But it was Ileana Lopez-Plaza’s, MD, presentations on blood banking and Jumoke Oladipo’s, MD, DABCC, FADLM, FCAP, presentations on quality management that best suited Yuguda’s needs.

Lopez-Plaza, an expert in blood banking, delivered two significant presentations: “Quality Management Practices in the Blood Bank” and “Blood Banking: Donors, Testing, Component Manufacturing.” Both offered insight into international standards for blood banking, and Lopez-Plaza’s personal experience in the field that could be integrated into the solutions Yuguda was looking for.

Equally impactful was a presentation by Oladipo, who had gotten her training as a Pathologist and also practiced in Lagos, Nigeria and now Vice Chair for Quality and Safety at the Penn State Health Milton S. Hershey Medical Center, and member of ADLM’s Global Affairs Core Committee. Oladipo urged laboratorians to have quality indicators to monitor processes in the lab and also mentioned that sometimes, labs will need to run quality control materials multiple times a day to ensure the accuracy of their tests. But there was pushback.

“We can’t afford to waste the test materials,” one audience member replied.

Oladipo understood their struggle from her time in Nigeria. She worked in two labs while in Nigeria: one ISO 15189 accredited and the other constantly under-resourced.

“Due to the shortage in QC supply at that time, my colleague and I would get blood from the local slaughterhouse and use it for QC checks after the necessary adjustments to get the right concentrations of analytes,” she recalled. “Sometimes, I would collect blood from laboratory staff to prepare QC materials, mine included”

She could offer insight to the audience that others could not. She knew the issues deeply that each of the attendees faced and understood the level of ingenuity needed to overcome them.

The ADLM/ACCN/AMS workshop suggested methods to tackle Nigeria’s blood safety and quality challenges. But of course, the challenges cannot be solved by one person. They need a larger set of policies and standards in the country to do so. ADLM’s Global Lab Quality Initiative is there to bring people together to help them seek out solutions to their challenges and to offer international perspectives.

This is what the Nigeria workshop did.

The collaboration continued after the workshop. As a part of the exchange element of the program, the visiting experts joined Yuguda and his team at the NBSA.

The car pulled off Abuja’s crowded main street onto the quiet avenue where the agency sits. The group arrived as evening fell. The NBSA team welcomed the visitors at the gates, and showcased their work in the office.

Lopez-Plaza peppered the staff with questions about their processes and handling of issues. The team shared their practice and absorbed those she offered. The discussion was candid, practical and collaborative, and embodied the essence of GLQI: the exchange of ideas and mutual support.

ADLM’s Global Lab Quality Initiative will continue to support laboratorians in Nigeria and across Africa. And the program will seek out people like Yuguda and his team who are working to make a difference.