Sickle Cell Trait and the Risk of Clotting in Donated Blood Bags in North West Nigeria: Is this a Call for Pre- Donation Hydration?

Abstract

Introduction: As a developing nation, Nigeria’s transfusion service is characterised by low quality control and a high incidence of clots in blood bags. About one-quarter of donors in Nigeria carry sickle cell trait (SCT), which is haemo-rheologically associated with pathological hyperviscosity and hypercoagulability. Hence, we  hypothesised that SCT is a risk factor for clotting in bags, and that the risk would be aggravated by non-O blood groups due to their physiological (natural) hypercoagulability.
Objectives: Determine risk of clotting in bags donated by persons with SCT and its interaction with ABO-blood groups, and proffer possible strategy to mitigate SCT-associated clotting risk in blood bags in Nigeria.
Materials and Methods: Analysis of 100 clotted blood bags. Frequencies of SCT and ABO-groups of clotted and control bags were compared by Student-t and X2-tests. Risks of clotting for SCT with respect to ABO-groups were expressed as Odds ratios by case-control logistic regression.
Results: Bags with ‘SCT and blood group-O’ had high clotting risk (OR=1.89, CI95%:1.43-2.34, p=0.031), while bags with ‘SCT and non-O groups’ had higher clotting risk (OR=2.97, CI95%:2.55-3.45, p=0.015); which suggested risk escalation by non-O groups.
Discussion and Conclusion: SCT is independently associated with high clotting risk, which is synergistically escalated by additional hypercoagulable effects of non-O groups. Clots in blood bags have economic and clinical implications. Hence, blood banks in Nigeria (and other African countries with high prevalence of SCT) should upgrade quality control, routinely screen donors for SCT, and consider feasibility of pre-donation hydration for SCT-positive donors in order to reduce hyperviscosity and clotting risks in blood bags, thereby avoiding blood wastage and shortage.