🩸 Men's Health

Blood Transfusion — What to Expect (Nigeria)

Q: Is blood transfusion safe in Nigeria?

Yes, when performed at accredited hospitals with proper screening. All Nigerian Blood Transfusion Service (NBTS) blood is screened for HIV, hepatitis B, hepatitis C, and syphilis. The remaining risks are incompatibility (prevented by proper crossmatching) and volume overload. The risk of not transfusing when needed (death from severe anaemia) far exceeds the risks of a properly screened transfusion.

Q: Can I donate blood for a specific family member?

Directed (family) donation is common in Nigeria. However, it is not necessarily safer than voluntary donation — family members may not disclose risk factors to avoid disappointing relatives. NBTS voluntary donor blood is routinely screened and often safer. Emergency directed donation is acceptable when voluntary blood is unavailable.

Q: Will blood transfusion give me HIV?

Properly screened blood from accredited blood banks has a very low risk of HIV transmission (estimated risk in Nigeria is approximately 1 per 500,000 units with NAT testing). The risk from receiving no transfusion when it is medically needed — dying from severe anaemia or haemorrhage — is much higher. Insisting on untransfused care to avoid HIV risk is a dangerous misunderstanding of the risk-benefit balance.

Q: How can I avoid needing a blood transfusion before surgery?

Discuss with your surgeon and anaesthetist in advance. Options: preoperative oral or intravenous iron to boost haemoglobin, erythropoietin injections, autologous predeposit (banking your own blood before planned surgery), and cell salvage during surgery. Stopping blood-thinning medications under guidance before surgery also reduces transfusion need.

Safe blood transfusion in Nigeria — indications, risks, and what happens during the procedure

Blood transfusion is a life-saving procedure used for severe anaemia, major haemorrhage, sickle cell disease, and many other conditions. In Nigeria, blood transfusion safety has improved significantly — all donations are screened for HIV, hepatitis B, hepatitis C, and syphilis. However, blood supply remains inadequate: Nigeria collects approximately 500,000 units annually against a requirement of 1.7 million. Family/directed donation is common and carries its own risks. This guide explains the procedure, safety, and what patients and families should know.

Signs and Symptoms

✓ Transfusion reactions — what to watch for during a transfusion:

✓ Fever and chills — febrile non-haemolytic transfusion reaction (most common, usually mild)

✓ Skin rash, urticaria — allergic reaction to plasma proteins

✓ Back or loin pain, dark urine — haemolytic reaction (wrong blood given — EMERGENCY)

✓ Breathlessness and low oxygen — TRALI (transfusion-related acute lung injury) — rare but serious

✓ Fluid overload — breathlessness, raised JVP — in elderly or cardiac patients

✓ Delayed haemolytic reaction — anaemia returning 1–2 weeks post-transfusion

Risk Factors

Emergency transfusion without full crossmatch — higher incompatibility risk
Multiple previous transfusions — alloimmunisation (antibodies to foreign blood antigens)
Sickle cell disease — particularly prone to alloimmunisation
Unscreened blood from unregistered sources
Massive transfusion — hypothermia, hypocalcaemia, hyperkalaemia, coagulopathy

When to Seek Help

Emergency — call nurse/doctor immediatelyAny fever, chills, back pain, or breathlessness during a transfusion — stop the transfusion immediately and call for help

UrgentDark urine during or after transfusion — haemolytic reaction; stop transfusion, IV fluids, notify blood bank

RoutineTransfusion in known alloimmunised patients (e.g., SCD) — must be performed at a centre with a full blood bank and antigen-typed blood

Plan aheadElective surgery — autologous blood donation (own blood pre-stored), cell salvage, or erythropoiesis-stimulating agents to avoid transfusion

Tests & Diagnosis

🧪 Pre-transfusion blood group and crossmatch

Group and screen: ABO and RhD blood group + antibody screen. Full crossmatch: tests compatibility of donor and recipient blood. Must be done before all non-emergency transfusions

🧪 Direct antiglobulin test (DAT/Coombs test)

Detects antibodies or complement on red cells — positive in haemolytic reactions, autoimmune haemolytic anaemia

🧪 Transfusion reaction work-up

Repeat blood group on pre and post-transfusion samples. Repeat crossmatch. Urine for haemoglobin. Blood cultures if fever. LDH, bilirubin, FBC for haemolysis

🧪 Ferritin and liver MRI T2*

Iron overload monitoring for chronically transfused patients (SCD, thalassaemia) — start chelation if ferritin >1000 µg/L or MRI T2* <15 ms

Treatment Options

Indications for transfusion — when it is needed

Symptomatic anaemia with Hb <7 g/dL (or <8 g/dL in cardiac disease). Active haemorrhage with haemodynamic instability. Pre-surgery in severe anaemia. Sickle cell disease crisis (acute chest, stroke). Severe thrombocytopenia with bleeding (<10,000/µL). Never transfuse for a haemoglobin number alone — transfuse for symptoms

Blood components — which product?

Packed red cells (PRBCs) — for anaemia and blood loss. Platelets — for thrombocytopenia with bleeding. Fresh frozen plasma (FFP) — for coagulopathy (DIC, liver disease, massive transfusion). Cryoprecipitate — for fibrinogen deficiency. Whole blood — in resource-limited settings for massive haemorrhage

Rate of transfusion

Each unit of PRBCs given over 2–4 hours. Faster in active haemorrhage. Slower (4–6 hours) in cardiac patients to avoid fluid overload. Furosemide 20–40 mg IV between units in fluid-sensitive patients

Transfusion reaction management

Febrile non-haemolytic: slow or stop transfusion, give paracetamol, restart slowly if mild. Allergic: stop transfusion, IV chlorphenamine, restart from a new unit. Suspected haemolytic reaction: STOP TRANSFUSION IMMEDIATELY, keep line open with saline, call doctor, send blood bank samples

Iron chelation for chronically transfused patients

Desferrioxamine (subcutaneous infusion over 8–12 hours, 5–7 nights/week) — available in Nigeria. Deferasirox (oral, once daily) — preferred for adherence, available at some centres

Blood conservation strategies

Cell salvage in surgery. Erythropoiesis-stimulating agents (EPO) for preoperative anaemia. Tranexamic acid to reduce surgical haemorrhage. Preoperative iron infusion for iron deficiency

NBTS — National Blood Transfusion Service

NBTS Nigeria collects, tests, and distributes blood. Voluntary non-remunerated donation is the gold standard. Donate at NBTS centres or teaching hospitals. Blood shortages are chronic — encourage regular voluntary donation

Frequently Asked Questions

Is blood transfusion safe in Nigeria?

Yes, when performed at accredited hospitals with proper screening. All Nigerian Blood Transfusion Service (NBTS) blood is screened for HIV, hepatitis B, hepatitis C, and syphilis. The remaining risks are incompatibility (prevented by proper crossmatching) and volume overload. The risk of not transfusing when needed (death from severe anaemia) far exceeds the risks of a properly screened transfusion.

Can I donate blood for a specific family member?