Recently, we had a situation where a pregnant woman who was close to delivery was detected with Bombay blood group. She was shifted to Bangalore because the local doctors were uncomfortable handling the situation. The lady had haemoglobin on 12 gm/dl and it was then that it was discovered that the patient had extremely low platelets as well. The doctors decided to go for caesarean operation and told the family that the situation of the lady was extremely rare and critical. They were asked to get 2 single donor platelets from Bombay blood group donors beside a few units of packed red blood cells before they proceed. Gloom descended on the family as they started a frantic search for donors.
When the news reached our Bombay blood group team, we could immediately find one unit of packed red blood cells available off the shelf for the lady in one of the hospitals. Unfortunately, the doctors refused to say anything clearly about whether they would accept the unit organised by the family from some other blood bank and kept asking for a donor. The haemoglobin of the lady would be considered good as per the Indian standards and no guidelines would require units to be organised on an immediate basis prior to the procedure with this haemoglobin. Since the doctor insisted, the family found one donor and informed him that the lady was critical and his urgent donation was needed to save the day. Having heard a desperate request from the family, the donor rushed to donate. One is forced to ask some questions question.
1. Was it truly a critical emergency as it was made to appear?
2. Is not telling a donor that his donation is critical to save the life even in a situation which required only an elective backup unethical and coercive?
3. Did the medical team have any ground to insist upon a donor even as a unit of this rare blood group sat on the shelf elsewhere in the city?
4. Was all this suffering on the part of the family and emergency donation for the donor necessary?
Now, let's come to the demand for Bombay blood group single donor platelets. This request was completely unscientific and unmindful because a person with Bombay blood group can receive single donor platelets from any blood donor (within the ABO system of blood grouping). As it is, the donors of Bombay blood group are far fewer and meeting regular demands for blood for this group is a challenge. In such a scenario, asking for an unnecessary donation was shocking. It did take a little conversation to convince the medical team to rethink the rationale behind their decision until they figured out that it would be fine to get regular single donor platelets. They collected and transfused AB platelets thinking of those to be relatively safer. Though scientifically speaking, A, B or O group platelets would have been just as good.
The delivery happened and the child was fine. As for the unit of blood that was donated, thanks to the unreasonable decision making, it expired after the 35 days' period. The only good news is that it's presence on the shelf did prevent people from getting more "emergency donations" - as a backup for some other procedures elsewhere in town.