Patient 1
It’s a quiet, slow Sunday evening at Alotau Provincial Hospital (APH) emergency department. Only a few staff working. Suddenly the ambulance arrives and stretchers in a young male in his teens. He was climbing a bread fruit tree when he slipped and fell from a height of almost 10 meters that same morning. He suffers a depressed skull fracture and a left open femur fracture. He loses a huge amount of blood. He is pale and confused. His dressings are soaked with blood and needs urgent stabilization and control of the bleeding. His haemoglobin is 4mg/dL. He is taken into theatre a few hours later. Intra-operatively, he loses more blood and suffers a major arterial injury that compromises his limb. His left leg is amputated. Blood loss is massive and estimated at 3-4L. He goes into shock and is taken to the intensive care unit.
His blood group is O and there is only one unit of blood available that was transfused during surgery. The blood bank is closed on the weekend and getting the staff to come in takes some time. Only two donors available but they cannot donate as they don’t meet the criteria to donate. There are no emergency donors available as well. No blood to give.
He spirals into kidney and heart failure due to haemorrhagic shock. Two hours post operatively he passes away.
Patient 2
A 30-year-old woman is referred from the outer islands to APH. She is 38 weeks pregnant in her 5th pregnancy. Baby was delivered at the health centre the previous night but she continued to bleed as the placenta has retained. Appropriate measures were done for her referral after communicating with the obstetricians at APH. She arrives the next morning in established haemorrhagic shock but is promptly managed by the medical team. Her haemoglobin is 4mg/dL. She is taken into theatre where the uterus was removed as this is the only way to stop the bleeding. Her blood group is A.
There is emergency O and group A blood available and she has donors willing to donate. She is admitted to ICU still in an unstable state and is given two units of blood. Over the course of her admission, she is given another three units of blood as she slowly recovers. She is finally stable on the third day of admission after receiving a total of five units of blood. Her haemoglobin is now 9mg/dL. She is discharged home with her baby.
Shortage of blood kills
The urgent need for blood donations in hospitals is growing. Blood or blood products have become a scares resource and its value in the management of the critically ill patient seems to be misunderstood by the general public. These two scenarios showcase the struggles that medical teams face daily to manage these patients. This is why we need blood donations on a regular basis. First to keep stores of emergency blood available for emergency situations. Second to continue the recovery of our critically ill patients. If patient one had blood available to maintain vital organ function, he would have survived after haemorrhage control. If patient two wasn’t given blood during her management she would have deteriorated and suffered the same fate as patient one. These complications of massive blood loss are often difficult to prevent in our resource limited and geographically challenged setting.
Blood transfusions; the facts. (part 2)
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