Whole blood pathogen reduction technology and blood safety in sub-saharan Africa: a systematic review with regional discussion

Background: Despite vast improvements in transfusion services in sub-Saharan Africa over the last decade, there remain serious concerns on the safety and adequacy of the blood supply across the region. Objective: This review paper ascertains the role of pathogen reduction technology (PRT) in improving blood safety and supply adequacy in the region. Method: The state of blood safety in sub-Saharan Africa was reviewed. Meetings, seminars and correspondence were undertaken with key clinicians, scientists and professional bodies in the region, including the World Health Organization's Regional Office for Africa, to examine the suitability of PRT for improving the safety of whole blood transfusion, a prevalent transfusion format in the region. Results: Existing literature suggests that combining PRT with current blood safety measures(such as serology) would improve the safety and adequacy of the blood supply for transfusions in sub-Saharan Africa. This was echoed by the findings of the stakeholder meetings. Conclusion: Following a detailed appraisal of two leading PRT systems, the Mirasol® PRT System and the Cerus S-303 System, we suggest that companies conduct comprehensive toxicological evaluation of the agents used for PRT and publish this in the scientific literature. We also recommend that the safety and efficacy of these technologies should be established in a randomised clinical trial conducted in sub-Saharan Africa

Polycythaemia in the Newborn

Background: Polycythaemia; or erythrocytosis; is a condition in which there is a net increase in the total number of circulating red blood cells in the body. It is an important clinical problem in the newborn. It is relatively rare with an incidence of 1-5in the total newborn population. It may manifest with serious and sometimes life threatening insults to the brain; heart; kidneys; lungs and intestines. It requires prompt treatment to prevent serious immediate complications; including death and permanent neurologic impairment.n Aim: To highlight the clinical features and management of polycythaemia in the newborn. Case report: A 9-hour-old male term; appropriate for gestational age neonate presented to the Children's Emergency Ward of the University of Port Harcourt Teaching Hospital with a history of seizures. The patient was febrile; plethoric; in respiratory distress with central and peripheral cyanosis and had repeated seizures. He had a packed cell volume of 81; thrombocytopaenia; hypoglycaemia and hypocalcaemia. He was treated with a partial exchange transfusion using normal saline. Electrolyte and metabolic derangements were also corrected. He recovered uneventfully and is currently being followed up in the Out Patient Clinic. Conclusion: Neonatal polycythaemia though uncommon; contributes to significant long and short term morbidity if untreated. Partial exchange transfusion is the treatment of choice and minimizes some of the physiologic complications