Conference Abstract | Volume 8, Abstract NACNDC/19JASH052 (Poster C18) | Published: 30 Nov 2025
Anna Ritah Namuganga1,&, Faith Balmoi Labote1, John Bosco Mwanje1, Rodney Kazooba1, Jamilah Namwanga1, Alex Musiime1, Diana Rutebarika1, Francis Ssali1, Mavis Naturinda1, Eddie Rubanga1, Maria Nannungi1, Joseph Wandege1, Benson Ouma Juma1
1Joint Clinical Research Centre, Kampala, Uganda
&Corresponding author: Anna Ritah Namuganga, Joint Clinical Research Centre, Kampala, Uganda, Email: annamuganga@gmail.com, ORCID: https://orcid.org/0000-0001-7793-8599
Received: 25 Sep 2025, Accepted: 20 Oct 2025, Published: 30 Nov 2025
Domain: Non-communicable Disease Epidemiology
Keywords: Blood transfusion, Sickle Cell Disease, Forward blood grouping, Reverse blood grouping, Alloimmunisation
©Anna Ritah Namuganga et al. Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Anna Ritah Namuganga et al., Sickle cell disease management: The plight of blood transfusion in resource-limited settings. Journal of Interventional Epidemiology and Public Health. 2025;8(ConfProc6):052. https://doi.org/10.37432/JIEPH-CONFPRO6-00052
Sickle Cell Disease (SCD) is a genetic blood disorder characterized by abnormal hemoglobin that causes red blood cells to become sickle-shaped, resulting in chronic anemia, recurrent pain crises, and multiple organ damage. In Uganda, patients with SCD often require repeated blood transfusions due to the persistent anemia. However, the limited access to comprehensive pre-transfusion screening and accompanying cost implications lead many to seek transfusion at lower-tier health facilities, which frequently lack comprehensive immunohematologic testing capabilities. The objective was to highlight the plight of blood transfusion in a resource-limited setting: a scenario of a sickle cell patient
Female SCD patient, born Group O, referred to our facility with persistent hemolysis, transfused 15 times in the past 9 months. To determine the choice of blood unit to crossmatch for transfusion, patient blood was subjected to forward and reverse grouping, extended rhesus grouping, antibody screening and identification, and Direct Antiglobulin Test (DAT). This was then followed by regrouping of the donor unit.
On arrival, patient presented with Hb 2.8g/dl, DAT positive with unexpected antibodies. Forward grouping reaction indicated reaction with anti- A & anti-B cells indicating presence of A and B antigens which is unexpected in a group O person. Reverse grouping showed high concentration of anti-A & anti-B antibodies which is typical of patient with group O. Upon anti-auto antibody treatment, forward & reverse grouping showed reduced presence of A and B antigen seen while reverse grouping showed absolute presence of anti-A and anti- B antibodies, confirming Bloodgroup O not Group AB.
Findings indicate the possibility of blood transfusion with the wrong blood group, which provided the source of A and B antigens, resulting in increased risk of alloimmunization. This could be due to the absence of comprehensive pre-transfusion compatibility testing (cross-matching and antibody screening) capacity in low-tier healthcare facilities, exposing SCD patients to preventable complications. There is an urgent need for policy action to procure and train the workforce in pre-transfusion compatibility testing to reduce transfusion-related complications. There is also the need to adopt comprehensive blood safety protocols that utilize forward and reverse grouping, extended rhesus grouping, antibody screening and identification, especially among patients who receive multiple transfusions.
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