mercoledì 13 luglio 2011

Guidelines for blood transfusion in Chaaria

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

Nessun commento:

Chaaria è un sogno da realizzare giorno per giorno.

Un luogo in cui vorrei che tutti i poveri e gli ammalati venissero accolti e curati.

Vorrei poter fare di più per questa gente, che non ha nulla e soffre per malattie facilmente curabili, se solo ci fossero i mezzi.

Vorrei smetterla di dire “vai altrove, perché non possiamo curarti”.

Anche perché andare altrove, qui, vuol dire aggiungere altra fatica, altro sudore, altro dolore, per uomini, donne e bambini che hanno già camminato per giorni interi.

E poi, andare dove?

Gli ospedali pubblici hanno poche medicine, quelli privati sono troppo costosi.

Ecco perché penso, ostinatamente, che il nostro ospedale sia un segno di speranza per questa gente. Non ci sarà tutto, ma facciamo il possibile. Anzi, l’impossibile.

Quello che mi muove, che ci muove, è la carità verso l’altro, verso tutti. Nessuno escluso.

Gesù ci ha detto di essere presenti nel più piccolo e nel più diseredato.

Questo è quello che facciamo, ogni giorno.

Fratel Beppe Gaido

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