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) According to national guidelines,
when HIV test is negative, blood is to be considered safe, and there is no
need of confirmatory test. In case of discordant tests (1st
positive, 2nd negative), we discard the blood and we send the donor
for counselling asking him permission to do a 3rd confirmatory test.
4) Anyway, here and anywhere else in
the world, there is a slight possibility that a negative result, could be in
the window period (although with the last generation rapid tests the window
period is very short). 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.
5) Whenever possible, transfuse
blood from donor; best when donor is a close relative.
6) I believe it is still necessary
to continue with BLOOD REPLACEMENT FOR THE STORE: this is very important
to save the life of people in urgent need of transfusion, who have no donors or
whose donors did not qualify. The blood bank of Meru in fact has not enough
blood to cover for all our needs, above all because 80% of our patients are
Blood group 0 positive
7) We must also follow some general
guidelines to classify the patients in need of transfusion: let us say that we
consider the possibility od blood thansfusion 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).
8) Let us remember that chronic anaemia
(for instance secondary to Tropical Splenomegaly) is generally more tolerated
than acute anaemia (for example high density of malaria in children, or serious
Per Vaginam bleeding in case of abortion or post partum haemorrhage). 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.
9) We always perform cross matching,
before transfusion… even at night!
10) The normal amount of blood needed by
a child is 20 ml/Kg body weight; in case we have packed red blood cells
from the blood bank, the amount to transfuse is 15 ml/Kg body weight; we usually give blood under dexameth and
lasix to prevent minor reaction and pulmonary overload… but we do not give
lasix to patients already collapsed.
11) Adults can be transfused under
dexameth only, because it is very unlikely that he/she will develop pulmonary
oedema after 1 single pint of blood.
12) Apart from HIV our blood is screened
for VDRL, HBsAg and HCV.
13) 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.
14) 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 Dr Joseph Gaido
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