GOING RED!!!

Visiting the Korle-bu teaching hospital for the first time, one is met with the curious sight of young doctors walking briskly with ice chests in hand. Could they be selling ice-cream, or is it just their packed lunch?  Valid questions, after all, we have all gone through the ‘lunch box’ stage at one time or another in our lives. Well, far from that, they are actually on their usual ‘blood products run’ that has come to be characteristic of being a house-officer in the country’s premier teaching hospital.

It is an essential service. Doctors move to and from the blood bank all day, securing much needed blood products for their patients. I have not as yet gone on one of those runs, thus have no experience of the intricacies of securing blood for patients. I have however, heard the stories. Doctors begging, literally, to get blood for their patients. All departments in the hospital are competing for these products which are always in short supply. What determines which patient gets it as opposed to the other? It is even worse, if the patient happens to have a rare blood group. The chances of securing your blood products are even slimmer.

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ACCRA GOES RED!!! Blood donation exercise.

Venue:Indafa Park Korle-bu.

Please come donate blood to help save lives.

The process, a patient’s blood is taken for grouping and later cross matching when a transfusion is required. Forms are filled and the request sent to the blood bank. Now, the blood bank being ‘virtually anaemic’ itself then provides the blood products needed by the patient. Demand certainly outstrips supply. Patients relatives our thus required to replace blood products.  That pretty much starts world war III.

For one thing, patients assume they pay for the blood, thus should not be required to replace it. Well, blood is not sold, not in Korle-bu Teaching Hospital. What patients pay for is the processing of the blood. Let’s consider this, the blood bank goes through several processes to get its products. Blood donation exercises, such as Accra goes Red are key. Voluntary blood donation is not common practice in Ghana, thus blood donation exercises are a means of obtaining the products. Then there is the process of ensuring its safety. You don’t want to be transfused with blood infected with HIV, hepatits B, or whatever other infection the donor may have. That is a costly process. I could go on to talk about storage, and everything else that is done to ensure safety of the blood patients are transfused with. This is actually, what you pay for. Curiously, if the blood is not replaced how are we expected to provide for others?

Now, blood! Oh bloody hell! There is so much apprehension with its usage. For religious reasons of course, some persons do not accept blood transfusions. I absolutely respect that. I may not agree, but, we all have the right to whatever religious belief we identify with. Then, there is sheer ignorance. It beats me how people can be so sorely mistaken about something and yet so passionately apprehensive of it. Last weekend, I was involved in a blood donation exercise, I have to say, I learnt a lot. It was a good experience.

ImageThere were a number of people, voluntary donors (the safest type there are) who actually came to the donation site, because they have decided to give blood to help save lives. There were a few people who came to attend to their own business at the mall, but on minimal interaction were convinced and willing to help. One guy was actually quite surprised that he had been convinced to donate. He was like; ‘I better go to heaven for this.’ And am like ‘mannn, you need Jesus for that!’ Cool guy, we had quite an interesting conversation. There were a few who were knowledgeable about the process, and  will straight up say, I donated recently, I can’t safely donate now, or I have been unwell I have malaria. I even had a guy say, I can’t donate, I have hepatitis B. A good number said, I partied a lot last night. I had a lot of alcohol. I loved that some people were aware of reasons why they were not qualified to donate. At least, there is some education out there even though a lot more needs to be done.

On the opposite end of the spectrum however, there were a few misinformed people. For one, fear of the blood being tested for HIV was an absolute put off. He will much rather not know. You can live a relatively healthy life with HIV if you are aware of it and get treatment early. Anyways, to clarify, HIV testing requires extensive counselling before you tell anyone their status. So, no, you won’t get called and told you are HIV positive even though in reality, that would inure to your own benefit. Of course the blood will be discarded. There were also a few people who just felt like they did not have enough blood to give. Again, by way of information, the screening process ensures that you healthy enough to donate blood safely. An Hb less than 12 for a female, or 13 for a male, weight less than 50kg and age less than 17 or above 60 are some reasons why a person, after  the screening process may not be allowed to donate. Simply, there are quantitative ways of determining whether your blood is ‘enough’ thus, subjective assumptions of low volumes of blood, which by the way will leave you in shock and unable to go shopping, just don’t hold water.

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My favourite, however was a guy, who claimed to be a pharmacist. To him blood transfusions are bad. Apparently, it is lazy doctors who resort to transfusion, instead of going with more appropriate therapy. Of what therapy he was speaking, I have no idea. Supposedly, there is a lot of research backing his claim, he just could not cite any. For one, you have to do better than that when you want to debate me on anything. For a pharmacist, I was disappointed at his line of thought. His argument was simply fleeting between the laziness of doctors and religious reasons why transfusions are inappropriate. Of course I wasn’t going to debate him. Maybe if he had a sound argument I just might have indulged him.

Now, the argument about haematinics ( blood tonics) is quite common. If I may, blood products are used in every field of medicine. Let us start with obstetrics and gynaecology. The foetus obtains its iron(and everything else) from mom’s blood, then there is the possibility of intra and post-partum haemorrhage (bleeding). In paediatrics, that neonate ( less than 28 days old) may be severely jaundiced, requiring an exchange blood transfusion. Yes, we do take out aliquots of the baby’s blood and replace with our blood products to treat the underlying condition. Shall we move on to surgery? Well, for one thing the anaesthetist will not touch the patient  if the Hb is low. The surgery just doesn’t happen, until all parameters are within normal range. Unless of course you will much rather have your surgery without anaesthesia

Accident centre/trauma unit, now if you ever happen to be involved in an accident and  lose a lot blood, by all means, allow me to scoop some Kontomire stew into  your mouth. After all, the green vegetables help the body to produce blood. In these situations, lost blood needs to be replaced immediately, else the patient will exsanguinate. Oh sorry, that is the option for the lazy doctor. When a pregnant woman is bleeding or someone’s cancer has a high probability of  spreading to other organs without immediate surgery, let’s just pour in the haematinic and wait for the body to go through its natural blood producing process. Shall we? Haematinics and other therapy have their place, and are used. After all, the blood bank barely ever has enough blood. I fail to comprehend how it can be assumed that blood products will be used for patients who don’t need them, just because doctors are lazy. Blood products like all other therapy, are only used when indicated and if there is no available alternative.

ImageNow, haematology. For persons with haemophilia, deficient in clotting factors, and who can pretty much bleed into their joint and anywhere else till it is destroyed. What is a doctor to do?  Freeze-dry factors? Well, they are prepared from blood too, shall we at this point shift the goal post, after all, it is not blood?  Anyways, we barely have that here, thus, make do with fresh frozen plasma (FFP), which is one of the products obtained from donated blood to help these patients, whose blood just won’t clot, to stop bleeding .

Of course sickle cell and thalassemia. There is a reason Hb genotype SS, is actually called sickle cell anaemia. Your red blood cell last 120 days on average, but in some persons living with the disease, it may be as low as 10 days, and in thalassaemia, not enough red cells are even produced to start with.  Again, what is a doctor to do? These persons need routine transfusion, to stay alive. Or we could just watch the sickle cells destroy every organ in the body and eventually kill them. There are several other indications for blood transfusion in a sickle cell patient, such as, in the acute management of a stroke.

That is not for everyone. Most of us do okay with daily haematinics, but a smart doctor always gives the best therapy to his/her patient. If blood products are indicated, certainly they must be used. Well, till our pharmacists come up with alternatives that are of course affordable enough for the average sickle cell patient in a lower-middle-income country like Ghana.

Till then, I suggest we just keep calm, read up and get accurate information, then make informed decisions about blood donation and transfusion.

ACCRA GOES RED. Currently ongoing at the new southern area blood bank. Indafa park Korlebu. Please pass by and give this precious gift to help save lives. The blood bank is always open to you to donate. Alternatively, pass by the Accra mall on the last Saturday of each month. (There is a mobile team stationed there)  Please spread the word, share this, educate a friend about blood products and their essential role in the field of medicine.Image

Regards,

Sefakor-Enam.

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