1) Blood transfusion cannot be 100% sure, because of window period for HIV antibodies, and because of a possibility of false results in 2-3% of the tests used.
2) Therefore blood transfusion must be performed only when it is strictly necessary to save the life of the patient.
3) Here and anywhere else in the world, there is a slight possibility that a negative result, could be in the window period. Therefore, blood transfusion can carry some risks, which are to be considered, and must be performed when honestly we believe that blood is necessary to save the life of the patient.
4) We must also follow some general guidelines to classify the patients in need of transfusion: let us say that we consider the possibility of blood transfusion only when the HB is 5 g/dl or below, unless there are clear signs of imminent danger (severe dyspnoea, fast breathig, much pallor of mucosas making us think that the patient could be even more anaemic, extreme tachycardia, collapse).
5) Let us remember that chronic anaemia (for instance secondary to tropical splenomegaly) is generally more tolerated than acute anaemia (for example high density malaria or serious vaginal bleeding). This means that a patient with HB=5 g/dl can be very stable, or in life threatening situation. It is the clinical presentation guiding us to decide on blood transfusion.
6) The normal amount of blood needed by a child is 20 ml/Kg; we usually give blood under protection of a bolus of steroids to prevent minor blood transfusion reaction.
7) We try to do our best to save the life of our patients, although we also know that in Medicine nothing is without risks and possible adverse effects. It is always true that we treat, but only God heals.
8) I hope those few ideas will help us to carry on, in spite of some crisis, which are unavoidable when we work with people in serious conditions.
Bro Beppe Gaido
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