DEPARTMENT OF HAEMATOLOGY AND IMMUNOLOGY
Past and Present Head of Department
PERIOD OF HEADSHIP
Dr. O. G. Ibegbulam
2002 - 2004
2007 - 2008
2010 till date
Professor G. O. Okafor
B.Sc. Hons, Ph.D., M.I.Bio
1993 - 1995
2000 - 2002
Dr. J. L. I. Odili
MBBS, Ph.D, FMCpath, FICS
1986 - 1989
1990 - 1993
1993 - 1994
Dr. S. Ocheni
2008 - 2010
The Department of Haematology and Immunology evolved from a pathological Sciences Complex Between 1971 and 1974. The composite Department of Pathology and Haematology was created, but due to lack of manpower, Chemical Pathology and Haematology Departments were administered conjointly. Immunology later detached from their primordial Department to joint the conjoint Department. The founding fathers of Pathology were Dr. I. O. Udeozor and Prof. A.N.U. Njoku Obi. During this founding period, there were notable Laboratory Scientists and Technicians who were involved in the building of the Department such as Chief Nlemadim, Mrs Nwosisi and Mr. T. O Onyekwere. Staffing improved subsequently with two Immunology Lecturers and one Haematologist. That gave basis for the Department of Haematology and Immunology to be self administring by Dr. G. O Obi. Along the line, Dr. J.L.I. Odili, Dr. G. O Okafor, Dr. O. G. Ibegbulam and Dr. S. Ocheni have headed the Department on various occasions. Dr. O. G. Ibegbulam is the current head of Department.
PATTERN OF GROWTH AND DEVELOPMENT FROM INCEPTION TO DATE
Personnel: The Department currently has a full compliment of professionals consisting of five academic staff, three medical Laboratory Scientists, one typist, and one Confidential Secretary.
Sub Units Lab: In the University Teaching University, the Department is currently made up of five Units: Routine Haematology, Coagulation, Blood Banking, Routine Immunology and Special Haematology/Immunology
Clinics: Clinical Haematology constitutes a high percentage of service rendered by the Department for the University. We run two clinics in a week: Tuesdays for sickle cell Disease Clinic and Fridays for Oncology and other specialized Haematology Clinics.
The Department has successfully mounted a postgraduate M.Sc programme in Immunology and a postgraduate residency training programme in Haematology.
Constraints: Laboratory bench Units and Offices had to be cramped up due to the fire incident that involved the Pathology Sciences Complex.
Infrastructure: The above mentioned five incident initially created limited work space. However with the movement of the University to her Ituku Ozalla permanent site, space problems have been improved upon.
HAEMATOLOGY CURRICULUM FOR MB; BS STUDENTS
The undergraduate academic haematology curriculum for the 3rd professional MBBS examination is undertaken in two postings:
1. Introductory haematology - 14 weeks
2. Block/systemic/clinical haematology - 16 weeks
A third student teaching contact in clinical haematology diagnostics is at the final year.
The general objectives and procedure of learning and evaluation is as follows;
By the end of the entire haematology course, students should be able to demonstrate a knowledge of the theoretical principles of haematology. Students should be able to perform side-room laboratory haematological tests and should be able to interpret haematological results in relation to patients clinical conditions as well as manage the haematological disorders common in the community and elsewhere.
At the end of the programme, the student should have become familiar with the pharmacology of cytotoxic drugs commonly used in Haemato-oncology. Students should have been adequately sensitized to the discipline, enough to pass undergraduate haematology examinations, apply the knowledge to clinical practice and should have received basic foundation for those who may wish to pursue haematology at the postgraduate level.
Courses in Haematology are taught along with courses in the other pathological sciences disciplines during the first and second clinical years. Instruction is by lectures, tutorials and by practical sessions (demonstrated or undertaken by students themselves). The clinical applications are further mastered in the wards, clinics as integrated sessions or clinicopathological conferences or seminars. It is hoped that the college curriculum would accommodate participation of students during haematology ward teaching and business rounds as well as haematology clinics.
FIRST BLOCK POSTING:
Title of course: Introduction to General Haematology
Code of course HAE 400
Number of Units (Credits): 2
Aim: To expose the students to the scope and limits of Haematology as a clinical and laboratory subject.
LEARNING OBJECTIVES: Comprehension of Haematology
Scope/Topics: 1. Definition of Haematology and sub-components
2. Spleen: structure and function.
TITLE OF COURSE: INTRODUCTION TO BASIC RED BLOOD CELL (RBC) HAEMATOLOGY
Code of course: HAE 401
Number of units (credits): 5
Aim: To acquaint students with basic ontogeny of the erythrocyte
LEARNING OBJECTIVES: 1. Comprehension of normal basic read cell haematology.
2.Comprehension of basic abnormal red cell haematology
TITLE OF COURSE: INTRODUCTION TO BASIC WHITE BLOOD CELL HAEMATOLOGY
CODE OF COURSE: HAE 402
NUMBER OF UNITS (Credits): 5
AIM: To acquaint students with the basic ontogeny of white blood cells.
LEARNING OBJECTIVES: 1. Comprehension of basic normal white
2. Comprehension of basic abnormal white
TITLE OF COURSE: INTRODUCTION TO HAEMOSTASIS
Course Code: HAE 403
AIM: TO acquaint students with the basic physiology of haemostasis
LEARNING OBJECTIVES: Comprehension of the basic haemostatic systems
Identifying the various components and their roles in haemostasis.
TITLE OF COURSE: INTRODUCTION TO BLOOD TRANSFUSION MENDICINE
CODE OF COURSE: HAE 404
NUMBER OF UNITS (CREDIT) 5
AIM: TO acquaint Students with basic Blood Transfusion Serology/Medicine
LEARINING OBJECTIVIES: - Comprehension of basic Immuno-Haematology
LEARNING OBJECTIVES: Comprehension of different classes of Anemia.
- Epidemiology of Anaemias
- Clinical features and differentials
- Laboratory diagnosis
- Management and prognosis
TITLE OF COURSE: HAEMATO-ONCOLOGY.
Course Code: HAE 412
NUMBER OF UNITS (CREDITS): 5
Aim: Acquaint students with Haematological malignancies
LEARNING OBJECTIVES: Comprehension of haematological malignancies
- Clinical features
- Laboratory diagnosis and differentials
- Management and prognosis.
TITLE OF COURSE: COAGULATION: BLEEDING DISORDERS AND
Course code: HAE 413
NUMBER OF UNITS (CREDITS): 5
AIM: Acquaint students to bleeding disorders and thrombosis
TITLE OF COURSE: BLOOD TRANSFUSION MEDICINE AND
CODE OF COURSE: HAE 415
NUMBER OF UNITS (CREDITS): 5
AIM: To acquaint students with the principles and methods in blood
TITLE OF COURSE: CLINICOPATHOLOGICAL HAEMATOLOGY
CODE OF COURSE: HAE 416 This course is taught in the Final Year
Number of units (credits): 5
AIM: To acquaint students with diagnostic approaches in Haematological disorders.
FOR MBBS DEGREE PROGRAMME
TITLE OF COURSE: UNDERGRADUATE IMMUNOLOGY
CODE OF COURSE: IMM 401 Basic Immunology
IMM 412 Immunopathology
IMM 422 Immunity
IMM 432 Immunization and Vaccines
NUMBER OF UNITS/CREDITS: 16: FIRST SEMESTER/POSTING
20: SECOND SEMESTER/POSTING
The Immunology course is structured to impart on the student the basic principles of Immunology and their applications in understanding the fundamental role Immunology plays in pathogenesis, diagnosis, prevention and treatment of certain diseases. On completion of the course, the student should be able to have a grasp of basic clinical immunology. He should be able to apply his knowledge of basic immunology and immunopathology in the aetiology, diagnosis (laboratory investigations), treatment (immunotherapy), prognosis and prophylaxis of diseases that have immunological bearing.
STRATEGIC PLANNING FOR THE EXPANSION AND DEVELOPMENT OF THE DEPARTMENT OF HAEMATOLOGY & IMMUNOLOGY
PROPOSAL FOR A MOLECULAR PATHOLOGY FACILITY IN THE DEPARTMENT
Molecules are the building blocks of life; the structural and functional units of the human body. Haematology is the study of blood, its diseases, their diagnosis, treatment and prognosis (outcome). Since the life of the individual is in the blood, the medium through which nutrients are supplied to all parts of the body to maintain health, blood diseases adversely affect all organs of the body. Therefore, research studies of the cause and successful treatment of blood disorders have a direct positive impact on the health of the entire individual; and the human society of which the individual is the building block. Many diseases are caused by abnormalities in the structure or function of biologically important molecules in the body, or presence in the body of biologically active foreign molecules. Generally, as illustrated by the inherited blood condition sickle cell disease which is a major health problem in our society, the severity of clinical illness correlates with the amount of the relevant biologically active molecules present in the affected person . Molecular pathology not only facilitates understanding of factors that affect disease severity, but also makes it possible to detect inherited conditions even before the baby is born (pre-natal diagnosis). A Molecular Pathology facility will enable the University of Nigeria carry out research on novel ways of diagnosis, cure, monitoring response to treatment and prognosis of countless human diseases across medical specialities. It can provide similar services to health institutions and people from outside the University, and so generate income to help defray its running costs.
Indeed, the benefits and potential uses of a Molecular Pathology Facility in UNIVERSITY OF NIGERIA are limitless; extending far beyond diagnosis of human disease into pharmacy and innovations that lead to more efficacious drugs or other useful chemicals. Such a facility with a high impact on academics, research and the society at large will undoubtedly place the University and its associated university in a vantage position to attract external funding/support for its academic/research programmes. It will perform molecular biology analyses on research and other materials from non-medical departments of the university, and generate income from services to bodies outside the university. So, the Molecular Pathology Facility will enable UNIVERSITY OF NIGERIA fulfil its roles to the wider community it serves. By charging fees for services provided, the Molecular Pathology Facility will help to sustain itself and recover the costs of its equipment and reagents provided below.
Taqman ABI 7900 with automation
TaqMan Genotyping Master Mix, Multi-Bulk Pack (2x50ml)
Taqman Pre-Designed SNP Genotyping Assay(small scale)
Taqman Pre-Designed SNP Genotyping Assay(medium scale)
Taqman Pre-Designed SNP Genotyping Assay(large scale)
Custom Taqman SNP Assay (small scale)
Custom Taqman SNP Assay (medium scale)
Custom Taqman SNP Assay (large scale)
MicroAmp Optical 384-Well Reaction Plate w/ Barcode (50 plates)
MicroAmp Optical 384-Well Reaction Plate w/ Barcode (500 plates)
MicroAmp Clear Adhesive Film (100 films)
Peripheral Arterial Tonometry Machine
2 High Output Electric Power Generators + Fuel
2 COBER SPECTRATM LRSTM Apheresis Machine/Cell Separator
2 Minus (-70 to -80oC) deep Freezers,
2 Minus (-20 to -30oC) deep freezers
2 Refrigerators, Storage Equipment, Uninterrupted Power Supply (UPS) Devices,
Development of a Liquid Nitrogen Unit for cryopreservation
DNA Extraction and Purification Reagents, Primers,
Microplate reader capable of measuring absorbance at 450 nm with the correction wavelength set at 620 nm or 650 nm,
Pipettes and pipette tips,
Deionized water, Squirt bottle, manifold dispenser, or automated microplate washer, plastic specimen containers,
Air-conditioners to ensure appropriate temperature for preservation of specimens,
3 waterbaths (1 at 37 degrees Centigrade, 1 at 42C, 1 at 75C), incubator to do the hybridizations of DNA probes the chromosomes, plastic or glass coplin jars to do the slide washing,
Glass coverslips (22mmx22mm), rubber cement or sealant to seal coverslips during the hybridization, and furniture
A Multiparameter Flow Cytometer
Cell Culture Facilties including Laminar Flow Hood.
Cytochemical stains such as myeloperoxidase, periodic acid schiff, sudan B black, acid phosphatase
SPECIALIST CENTRE FOR HAEMOGLOBINOPTHY CARE AND RESEARCH
Since 1 in 4 Nigerians has sickle cell trait (HbAS), population genetics calculations show that 1 in 100 of us has homozygous (HbSS) sickle cell disease. Based on a populationof 100 million people, 25 million Nigerians have sickle cell trait, and 1 million sickle cell anaemia. Therefore, sickle cell disease is a major health problem in Nigeria, and the provision of services to affected persons and the search for better treatment of the condition are national health priorities. To address these challenges, the University of Nigeria has recently secured the services of a world-renowned expert in haemoglobinopathy, Prof I. Okpala who is well-positioned to establish the Specialist Centre For Haemoglobinopathy Care and Research. For this to be possible, the followings are needed:
Prenatal and Neonatal Services
Haemopoietic Stem Cell Transplantation
High Throughput Diagnostic Service that can process several hundred samples per day
Community Outreach Services and Public Awareness Activities.
Facilities required for the above include:
A High Performance Liquid Chromatography (HPLC) machine, e.g Biorad Variant Hb Analyser II.
A Facility for Foetal Tissue Sampling and Genetic Analysis
A Cell Separator/APheresis Machine such as the Haemonetics Cell Separator or COBE Spectra machine.
A Transcranial Doppler Ultrasound Machine.
Proposal for the Establishment of a Haematopoietic Stem Cell Transplantation (HSCT) Centre at the University of Nigeria Enugu Campus
Currently, Haematopoietic Stem Cell Transplantation (HSCT) is the only known curative form of therapy for various malignant and non-malignant haematological disorders1,2. Just to mention briefly: leukaemias, lymphomas and sickle cell disease can now be cured with haematopoietic SCT. It is also very interesting to note that various solid tumors and benign non-haematological disorders can now be treated with HSCT. Paediatric tumors3 such as Ewing sarcoma, medulloblastoma, Wilm’s tumor, neuroblastomas, primitive neuroectodermal tumors (PNET) etc and auto-immune disorders such as multiple sclerosis and severe autoimmune haemolytic anaemias are now on the ever expanding list of indications for Haematopoietic Stem Cell Transplantation. Various Centers in different parts of the World, including Africa such as Tunisia, Morocco and South Africa, are now carrying out various trials using HSCT to treat various disorders previously regarded as incurable. This proposal is therefore written so that the UNIVERSITY OF NIGERIA can put in place, specific plans to set up HSCT Center in this Tertiary Centre of Excellence.
There are many basic things necessary for HSCT which are currently not available in our University. However, it must be pointed out, that with determination and political will, it is very possible to put in place the necessary facilities that will make HSCT possible in this University, in the very shortest time.
BLOOD TRANSFUSION SERVICES
Adequate blood product support is a very important necessity in HSCT. In fact, it is impossible to start any HSCT in any Center in the absence of an efficient blood transfusion system that ensures that blood products are readily available as and when required. Haematopoietic stem cell transplantation, either autologous or allogeneic is usually preceded by bone marrow ablation with chemo-radiotherapy, as part of the treatment to eliminate the malignant cells as well as suppress the patient’s immunity to prevent graft rejection. During this period of bone marrow aplasia (which is variable), before and post-HSCT, the patient is maintained on blood product supports such as red cell concentrates, platelet concentrates and granulocyte concentrates (in severe overwhelming septicemia). The duration of marrow aplasia as well as the quantity of blood products required by patients is very variable depending on how early or late neutrophil and platelet engraftments occur. Some patients have had to take about 20 or even >50 units of various blood products.
Currently, blood transfusion services in UNIVERSITY OF NIGERIA are largely dependent on family/relative donors. In our present scenario, whenever a patient needs blood transfusion, his/her relations are asked to source for people who will donate for him/her. This is because there is severe shortage of blood in our blood banks due to a very limited number of voluntary non-remunerated donors. For us to start HSCT, we must move our blood transfusion services to that level when we become largely self-sufficient in the production of blood products. In other words, we need to reach that stage when any patient can get blood products at any time of the day because enough blood units are available in the blood bank. This is very crucial because we cannot afford the luxury of waiting for relatives to look for blood donors for any patient who has been marrow ablated. There certainly is no such time to wait as such practice will only mean death for the patient. Even if we are not able to commence haematopoietic SCT immediately, with improved blood product services, there will be an improvement in the outcome and survival of our patients even with treatment with conventional chemotherapy. At this present time, we cannot even give our patients standard available chemotherapy because we are afraid that if we do that, our patients could die either from severe anaemia, overwhelming septicaemia or thrombocytopaenia with resultant uncontrollable bleeding complications.
The immediate gain from attaining self-sufficiency in blood products production, even while still waiting for the commencement of HSCT, is the ability to give standard available chemotherapy to our patients. In some acute leukaemias such as good prognostic acute lymphoblastic leukaemia and lymphomas such as Hodgkin’s and Burkitt’s lymphomas, standard chemotherapy alone can lead to high remission rates. Also, it is to be noted that as soon as we can have self-sufficiency in blood products production, we can start autologous SCT because in autologous SCT, myelosuppression and immunosuppression before transplantation is not as intense as in allogeneic SCT.
To ensure self-sufficiency in blood products preparation, the following facilities should be put in place in this University:
A: Equipments for blood products preparation and storage
B: Public education to increase the number of voluntary non-remunerated donors and C: Maintenance of a blood donor registry
A. NECESSARY EQUIPMENTS FOR THE BLOOD BANK
In other to be able to produce enough blood products, with the mind to set up a HSCT, we need to buy Apheresis machines/cell separators. This is to enable easy production of red cell concentrates, platelet concentrates, fresh frozen plasma, cryoprecipitate and ultimately, when we are ready, peripheral blood stem cells (PBSCs).
1. COBER SPECTRATM LRSTM System.
This is the most robust, well tested, apheresis machine that can be used to produce all blood products by installing different soft wares at the time of cell separation i.e. different soft wares are available for platelets (for collecting platelet concentrates), red cells (for collecting red cell concentrates), plasma (for collecting fresh plasma for further fractionation), granulocytes (for collecting granulocyte concentrates) and peripheral blood stem cells (PBSCs).This machine is currently produced by CaridianBCT4
This University should buy at least, two of these machines.
In addition, we should buy
2. 6-8 bucket refrigerated centrifuges
3. Two, minus 70- minus 80oC deep freezers
4. Three minus 20- minus 30oC deep freezers for conventional preparation of blood products necessary for the effective treatment of our acute leukaemias and other malignancies.
FACILITIES FOR CRYOPRESERVATION OF STEM CELLS
We need to build/purchase facilities for cryopreservation of stem cells in the Blood Transfusion Complex/Laboratories. This includes Laminar Flow Rooms with increasing degrees of sterility that eventually leads into the Room where the cryopreservative is put into the Stem Cell Blood Bags. This facility may be included in the physical structure of the HSCT Centre described below. Facilities for rapid freezing of the stem cells as well as cryopreservation such as liquid nitrogen should also be made available. In essence, this University should build a Liquid Nitrogen Production Unit.
B. Recruitment of Blood Donors. After buying the above basic equipments, the next thing will be massive serial education of the public, including University Staff, about the need for regular blood donation. The aim will be to recruit regular voluntary non-remunerated blood donors, from the University Staff, Students as well as the general public. Regular donor drives will be required, including regular advertisements in the Radio, Television and Print Media.
C. Maintenance of Donor Registry.
A Donor Registry will need to be established and maintained, to include the names of all voluntary regular donors, their residential and e-mail addresses and phone numbers. They should be contacted regularly, through all means to remind them about their next due dates for donation. In this regard, every Donor should be given a Card, similar to a University Card, which will always show their next appointments for Blood/Blood product donation. Depending on the number of Donors we are able to attract, especially if we have apheresis machines, some Donors may decide to donate only red blood cells, platelets, plasma, peripheral blood stem cells, granulocytes or whole blood.
Facilities for irradiation of Red Cells, Granulocytes and Platelets will need to be made available at the time of commencement of HSCT because all cells given to HSCT patients need to be irradiated.
IMPROVING DIAGNOSIS: SPECIFIC SUB-TYPING OF HAEMATOLOGICAL NEOPLASMS
Efforts must be made to improve on our current diagnostic facilities. We must strive to further sub-type or sub-classify whatever diagnosis we make. This is because certain subtypes of some disease conditions have different prognosis and this may, to a large extent determine the approach to management. Prognosis determines the timing of HSCT. Although HSCT is known to be curative, yet, we are aware of its intricate complications and the fact that HSCT is used for treating bad prognostic diseases and late stage disorders. The standard of care in most clinical conditions is to, for instance, start a patient with good prognosis acute leukaemia with standard cytotoxic chemotherapy, get the patient into remission for as long as possible while planning HSCT for a later date when relapses or disease progression has occurred. In a patient with bad prognostic factors, the plan will be to schedule the patient for HSCT immediately because it is known that such patients will not respond to chemotherapy. For instance, in patients with acute myeloblastic leukaemia (AML), we want to know whether he is CD 33 positive or not so that we decide whether or not to give him Gemtuzumab Ozogamicin (Mylotarg) which is the specific treatment for CD 33 positive AML. In AML, the karyotype is the most prognostic parameter. We want to know whether or not the patient has a good prognostic marker such as NPM1 so that we can commence him on the usual cytotoxic chemotherapies while delaying transplantation to a later date. However, if he has worse prognostic parameters such as the FLT3 gene mutations, we must immediately begin to plan him for HSCT as that will be the only hope for achieving any remission in him. If a patient has non-Hodgkin’s lymphoma, we want to know whether this patient is CD 20 positive or not because we now know that CD 20 non-Hodgkin’s lymphomas respond very well to monoclonal antibodies such as rituximab. We do not just want to say that a patient has chronic lymphocytic leukaemia (CLL). We want to know if he is CD 52 positive or not so that we know whether or not to give him CAMPACT 1H because this drug specifically targets CD 52 CLL cells. Outside Haematology, gastrointestinal surgeons/physicians now want to know whether or not their cancer patient is Philadelphia chromosome positive so that they can decide whether to give Imatinib Mesylate (a tyrosine kinase inhibitor) or not. The list is endless. As we plan for HSCT in this University, full complementary diagnostic procedures which will give us information about the prognosis of the disease we are dealing with should be put in place because not every patient with the same morphological diagnosis will be good candidates for HSCT.
The point being made here is that this University should put in place facilities that complement our present diagnostic skills and facilities.
The followings are some basic facilities we should put in place in our University as we prepare for HSCT.
Cytochemical stains (Myeloperoxidase, Periodic Acid Schiff, Sudan B Black, Acid Phosphatase etc).
Immunophenotyping- using single monoclonal antibody kits for the various clusters of differentiation antigens (CD) or preferably using multi-parameter flow cytometry/Fluorescence-Activated Cell Sorting, FACS machines
Cytogenetic/Mutational studies such as BCR-ABL (using polymerase chain reaction, PCR), JAK2 mutations (using PCR), Chimerism studies (using Restriction Fragment Length Polymorphism, RFLP method), Cytomegalovirus studies (using PCR), NPM1, FLT3 mutation studies (using PCR), and Florescence in-situ Hybridisation (FISH) studies.
Basic Facilities for Multiple Myeloma diagnostics
Multiple myeloma (MM) is very common in this environment and our first attempts at HSCT may very likely be in patients with MM. This is because, we may prefer to start our HSCT experiences in this University with autologous HSCT because it is much easier to do than allogeneic HSCT. Multiple myeloma currently tops the list of malignancies indicated for auto-HSCT. Therefore, every effort should be made to properly diagnose and monitor the treatment of patients with this common disease. Diagnostic facilities to put in place for MM include serum protein electrophoresis, total serum proteins, albumin, globulin, immunoglobulin quantitation assays including quantitation of Kappa and Lambda light chains, urinary Bence Jones Proteins, serum free light and heavy chain protein analyses, immunofixation tests, and ß2 microglobulin assays.
THE HLA TYPING LABORATORY COMPLEX
Haematologists and Medical Laboratory Scientists should be sponsored for training in HLA typing. Equipments should be procured for low and high resolution Human Leukocyte Antigen (HLA) typing. This will require the setting up of the following Laboratory Units in the HLA Laboratory Complex- the Serology Typing Laboratory, the Sequence Specific Oligonucleotide (SSO)- Laboratory, the Sequence Specific Priming (SSP)- Laboratory, the Sequencing Based Typing (SBT) Laboratory and the Stem Cell Culture Laboratory.
THE PHYSICAL STRUCTURE OF THE HAEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT) CENTER
We need to have a specific, purpose-built Center dedicated specifically for HSCT. This Center for HSCT, which should be centrally-air conditioned, should consist of the followings: the Outpatient Section, Offices, In-Patient Wards and Laboratories.
OUTPATIENTS’ COMPLEX AND OFFICES
The Outpatient Section should consist of a big Patients’ waiting Room, a Receptionists’/Patients’ Folders Room, Doctors’ Consulting Offices, Large Emergency Resuscitation Rooms, mini-Laboratory Room with automated/manual machines for emergency Full Blood Counts (FBC), Liver & Renal Function Tests, Extra-corporeal Photophoresis Room, Patients’ toilets, Staff toilets, The Transplant Director’s Office, Consultants’ Personal Offices, Study/Research Co-ordinator’s Office, Transplant Co-ordinators’ Offices, Statistician’s Office, Secretary’s Office, Male Changing Room with Ward Gowns (similar to theatre gowns), Female Changing Room with Ward Gowns, a Large Conference/Break Room, Male Doctors’ Sleeping Room, Female Doctors’ Sleeping Room and a mini-Kitchen with facilities for Tea/Coffee/Beverages and light refreshments.
IN-PATIENT WARDS AND OFFICES
The In-Patient Wards should comprise of High Efficiency Particulate Air-filter (HEPA) Rooms (also known as Laminar Flow Rooms) and non-HEPA Rooms. There may be an equal number of HEPA and non-HEPA rooms or there may be more non-HEPA Rooms.. This is because non-HEPA Rooms serve both for Autologous HSCT and for pre-neutropaenic and post-engraftment period rooms for Allogeneic HSCT patients. The number of rooms will depend on financial capabilities, but 20 Laminar Flow Rooms and 30 non-Laminar Flow Rooms is hereby suggested. Non-HEPA rooms should be self-contained large single rooms with a Toilet/Bath, a large cupboard for personal clothes, boxes and personal valuables and another large cupboard for medical consumables. Laminar Flow Rooms should be two rooms, one leading into the second inner room. The outer room serves as the disinfecting room as well as the changing room for medical personnel before entering the second inner room. There should be a large cupboard for personal items-boxes, clothes and personal valuables, another cupboard for medical consumables as well as a Toilet/Bath in the second inner room. The toilets and cupboards should be compacted into one corner of the rooms.
The In-Patient Wards should also have specially designed rooms for the Doctors’ and Nurses’ Work Stations with computers for patients’ documentations and Reference Journals/Books. There should be a Room for keeping Drugs and medical consumables and another Room with Laminar Hoods for mixing drugs. Toilet and Bath Rooms should also be available on the In-Patient Floors for Staff.
The HSCT Center should have a Complex for Laboratories specifically related to transplantation. These should include the HLA typing, quality control and other Research laboratories in Stem Cell Biology.
Prior to starting HSCT, it is important that we give a high priority to training key personnel required for running the HSCT Center. The following categories of people need to be trained:
1. THE HAEMATOPOIETIC STEM CELL TRANSPLANTATION PHYSICIANS
Haematologists/Trainee Haematologists should be sponsored for training abroad in HSCT in active HSCT Centers for at least one year and participate in both the out-patient and in-patient management of transplant patients. This University already has one trained Haematopoietic Stem Cell Transplantion Physician. The HSCT Physician serves as the Director of the HSCT Center.
2. THE CLINICAL TRANSPLANTATION IMMUNOLOGIST
This University should send abroad any Pathologist from any discipline for training in Molecular Biology/Immunogenetics for at least 6 months to one year in a HSCT Centre. Alternatively, any Pathology Resident can be sent abroad for a Masters Degree Programme in Molecular Biology/Immunogenetics (with Thesis specifically on Stem Cell Biology or a very related discipline). We may even encourage a fresh medical graduate to pursue this training immediately after completing the National Youth Service Corps Programme and build him/her up in transplantation immunology. The trained Clinical Transplantation Immunologist will be the Director of the Bone Marrow/Stem Cell/HLA Laboratory. He is responsible for setting up the HLA Laboratory, designing all the techniques for HLA testing, supervising all the Medical Laboratory Scientists working in all the benches/Laboratory Units of the HLA Laboratory Complex, interpreting all the HLA typing results of the Donors and Patients and signing them out. This should be a full-time job, should be the only job of this personnel and should not be a secondary job of anybody because of the intricacies and significance of HLA typing in HSCT. The person should also strive to acquire expertise in cryopreservation before returning to Nigeria.
3. MEDICAL LABORATORY SCIENTISTS
Some Medical Laboratory Scientists (MLS) should be sent abroad for training in HLA typing for at least 6-12 months. An arrangement should be made for these MLS to also train in cryopreservation. Some MLS should also be sent for training in immunohistochemistry, immunophenotyping, and cytogenetics.
4. ONCOLOGY/TRANSPLANT NURSES
Nurses should be trained in Medical Oncology/Transplantation. One or two of the Nurses should specifically train as Nurse Transplant Co-ordinators. These are Nurses, whose jobs include scheduling new patients’ appointments, contacting and arranging for relatives of patients to be HLA typed, liaising with the Donor Search Team to get suitable donors for patients and ensuring the general welfare of patients and donors. Such Nurses do not work as Bedside Nurses.
Other personnel that should go on biased courses in Oncology/Transplantation are Oncology Pharmacists, Clinical Psychologists, Physiotherapists, Occupational Therapists, and Medical Social Workers.
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2. Armitage JO. Bone marrow transplantation. N.Engl.J.Med. 1994 Mar 24;330(12):827-38.
3. Miano M, Labopin M, Hartmann O, Angelucci E, Cornish J, Gluckman E, Locatelli F, Fischer A, Egeler RM, Or R, et al. Haematopoietic stem cell transplantation trends in children over the last three decades: a survey by the paediatric diseases working party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant. 2007 Jan;39(2):89-99.
4. www.caridianbct.com OR http://www.caridianbct.com/cps/rde/xchg/caridianbct/hs.xsl/index.htm Accessed on 8th March, 2009