System Description , Features and Justification
What is Autotransfusion ?
Autotransfusion is an established technique for the collection and subsequent reinfusion of the patient’s own blood. It not only prevents transmission of diseases but also avoids immunological complications of homologous transfusion.
Autotransfusion permits greater flexibility in the use of blood bank supply.
Advantages of Transfusion Rapid availability of blood. Does not require any blood storage facilities.
* No risk of disease transmission.
* No incompatibility of product transfused.
* No risk of alloimmunization.
* Conserves blood banks supply.
EAT – SET is a system for recovering blood from internal bleeding.
Its primary application is for patients with internal haemorrhage. Such blood can be safely reinfused if processed within the first 24 hours after haemorrhage Blood is aspirated through a multiple filtering unit into a collection container and is reinfused by gravity to the patient after a filtration process.
Brigadier General Dr Oviemo Ovadje in 1989, solved the problem of blood salvage from body cavities by pioneering and creating a design the EATSET to replace and improve on the gauze filtration technique as practiced in developing countries. The EATSET device has been described as a low cost and an appropriate technology relevant to the needs of developing countries. Its development is part of the global effort at ensuring blood
safety. The device is made up of a transparent rigid capsule, incorporating a V – shaped micro – filter and its part arrangements allow its adaptation to a manual source of low vacuum.
Brigadier General Dr Oviemo Ovadje, as a medical doctor undergoing specialist training in Nigeria, observed that a lot of women during pregnancy in developing countries die from internal haemorrhage (bleeding) arising from ruptured ectopic pregnancy.
The condition is common in developing countries and the absence of a well organized blood transfusion service is a factor in the increased morbidity and mortality in this group of women, many of whom cannot afford the cost of procuring blood from the laboratories. The gauze filtration and scooping technique adopted by earlier doctors did not seem to be attractive to most practioners who considered the technique messy and unsafe.
The initial skepticism that greeted the simplicity of the EATSET and it’s lack of sophistication led to the invitation of Dr. Watson Williams by the World Health Organization as consultant at the instance of the UNDP in its response to a request by Brigadier General Dr Oviemo Ovadje for financial support to enable him refine the crude device through a North _ South collaboration.
The EATSET was used in its primitive but sterile form by Brigadier General Dr Oviemo Ovadje to save intraperitoneal blood from 12 patients as presented at the world congress of the International Committee of Military Medicine (ICMM) in Augsburg, Germany in June 1994, and Published in the journal of the ICMM in 1995.
The UNDP sponsored the refinement of Brigadier General Dr Oviemo Ovadje’s EATSET in 1994, under the executive of the World Health Organization. By April 1995, the equipment was refined and in-vitro trials were conducted successfully at the University of Lagos Teaching Hospital by Brigadier General Dr Oviemo Ovadje, Mr. Fell and Professor Asalor, Professor Akinsete and Professor Dorothy Foulkes-Crabbe, (Chairman of the African Chapter of the World Federation of societies of Anesthesiologist.) (WFSA) both approved of the work.
Brigadier General Dr Oviemo Ovadje organized an International Scientific Conference and Workshop (April 29 – 31 1995 sponsored by the UNDP, WHO and the Federal Ministry of Health to determine the degree of the problem of heamorrhage in pregnant women in developing countries. About 430 medical professionals, (Doctors, Nurses, Hospital, Administrators, Scientists and Industrialist attended from Nigeria, Ghana, Switzerland, United Kingdom and India. His presentation of techniques of auto- transfusion and the EATSET to medical doctors undergoing specialist training at an OPEC funded conference at the University of Lagos Teaching Hospital (1990) and during a seminar organized by the Commonwealth Defence Science Organization at the Defence Headquarters in 1991 contributed in endearing the EATSET to many of his professional colleagues.
Brigadier General Dr Oviemo Ovadje’s work in the management of ectopics in developing countries was publicly acknowledged by Government. UNDP and WHO whose awareness of the need for a simplified, low cost device such as the EATSET in developing countries increased. Brigadier General Dr Oviemo Ovadje won the 1995 OAU-WIPO Invention Award in recognition of his significant contribution to African innovation in the field of Health Care. A Gold Medal was presented to Brigadier General Dr Oviemo Ovadje during the OAU summit in Addis-Ababa.
Prof Morel’s report from the Geneva University Hospital Cantonal confirmed the need for the EATSET and of its usefulness in clinical practice. Brigadier General Dr Oviemo Ovadje in 1996 won the National Council of Health and Ministerial Award for professional excellence and for his contribution to health technology.
Brigadier General Dr Oviemo Ovadje won the World Bank institute award in February 2000 after he was classified as one of the top 339 finalists at the developmental market place in Washington DC.
He became the first African to win the World Health Organisation Sasakawa Award in the year 2000.
He won the national honour of Member of order of the Niger MON
The main FEATURES of the EATSET are as follows:
* Rapid recovery of blood from internal haemorrhage.
* Simple to use: Can be totally manually operated.
* Closed system: No risk of infection transmission.
* Cost effective: Disposable except manual pumping unit.
DEVELOPING COUNTRY INITIATIVE HIV-AIDS CONTROL PROGRAM GLOBAL BLOOD SAFETY PROGRAM
Problem to be Addressed: The Present Situation
In Nigeria, as in most developing countries, there are no organised blood Transfusion services that can cater for emergency situations. Transfusion services are not effective. Victims of Road Traffic Accident and those with aneurysmal ruptures and ectopic pregnancies often die from bleeding internally into the peritoneal cavity. About 250,000 of blood requirements in Nigeria is needed to assist victims of Road Traffic Accident and women with ruptured ectopic gestation.
Victims of Road Traffic Accident and Ectopic Gestation on reaching the hospital are examined and diagnostic steps are taken to confirm internal bleeding. Once this is positive, the relations are requested to donate blood or where they cannot, they proceed to buy blood from the laboratories. Such blood may be contaminated with malaria parasites, Hepatitis B virus, Syphilis and the much dreaded AIDS Virus. Over 98% of patients with internal bleeding who require blood for survival do so from blood donated by other people. Blood is not usually available early enough and often the patient dies. About 60% of these would benefit from blood recycling. The absence of this, therefore accounts for the loss of lives of those who could have survived from recycling
their own blood.
Government has in a number of ways encouraged blood donations through campaigns and setting up of blood banks. However, many of the blood donors in Nigeria escape being tested for the AIDS virus through dubious professional practices that is rampart in the third world being a 40 to 200 fold increase observed from 0.02% in 1986 to 4.1% in a screening centre in 1999. Transfusion can play a major role in the spread of the disease which trend can partly be checked by autologous transfusion practices using the EAT- SET devices since the patient’s own blood is the safest blood.
There are currently no devices for blood recycling in this part of the world, and the cost of conducting research into an appropriate device and subsequent development for use in hospitals was borne by the UNDP with WHO as executing agency. In a broader sense of our technological need, the then President of the Federal Republic of Nigeria Gen. Ibrahim Babangida (in a message sent on 18 July 1990 to the All-Purpose Committee on Engineering infrastructure) called for innovations to develop appropriate application and adaptation of foreign technology in Nigeria to enhance self- reliance.
SUPPORT THE EATSET & CONTROL AIDS THROUGH BLOOD TRANSFORMATION
Expected End of Project Situation
A.( i ) The difficulty associated with blood procurement and the delays resulting from this will be minimised.
( ii ) The fear of acquiring AIDS and other blood borne infection will be eliminated since the Patient receives his own blood.
( iii ) The mortality figure and morbidity figure for patients who require blood recycling would be drastically reduced
B. The use of donor blood will be greatly reduced and the need to screen such blood will not be necessary in situations where the patient’s blood can be recycled.
C. At the end of the EATSET project, the basis for an emergency auto-transfusion service would have been initiated. The EATSET which would be introduced will alleviate the organisational problems since the unit is self contained and does not require the linkage of various health units in a medical setting.
D. The social religious and cultural constraints to blood transfusion are also by-passed by the EATSET since the patient receives his own blood. The fear of acquiring AIDS virus and other infection through blood transfusion would have been abated.
The project would benefit all trauma and accident victims, pregnant women with ectopic gestations and patients with congenital aneurysms all of whom may suffer internal bleeding. Thus the general populations stands to benefit
a.) The level of medical manufacturing in Nigeria is low presently. This has led to (equipment) dumping of inferior medical devices and lack of technical backup for imported ones.
b.) Nigeria will acquire the technological know how to produce basic medical tools since the ultimate objective of the EATSET project is to provide appropriate technology for medical manufacturing and prevent equipment dumping in Nigeria. EATSET Nigeria Ltd. as been setup to promote the industrial phase of the project