When a 4 month old girl was detected with Thalassemia

(Dr Reshma Srinivas, stationed at Samraksha shares her experience) A Family from Koppal visited Bangalore. They came to the Samraksha day care for thalassemia, located in the premises of Rashtrotthana Parishat with Rakesh, a two-year-old child. At registration, his father told me that Rakesh is their second child and was diagnosed with thalassemia. He is on regular blood transfusions ever since. Rakesh has an elder brother Ramesh who is 4-years-old and a younger sister Shweta. As a part of regular questionnaire, I asked them if they are doing fine. Ramesh has no complaints or symptoms to suggest thalassemia. They hadn’t tested her 5 month-old-sister Shweta for Thalassemia yet. Shweta looked like a one month old baby. She was very pale and drowsy. On examination, we found that there was no capillary refilling, her liver size was 2cm. I spoke to the parents and convinced them to give blood samples of the entire family for hemoglobin electrophoresis. I instructed our nurse Ashwini to draw sample for Shweta first and send for hemoglobin analysis as Shweta was very pale. She told me she was not able to access the vein because of her tender arms. After five pricks we were able to draw two milliliter of her blood but could not secure the cannula. Her blood was watery in consistency and did not look like blood. It was more like colored water. We were worried. We informed the blood bank to do her hemoglobin analysis on an emergency basis. The reports came out soon. Her hemoglobin level was 2.5 g/dl. We informed the same to her parents and told them that Shweta needs immediate blood transfusion or she will not survive. To our surprise, her parents refused and told us that they dint want to get blood transfusion for her and that they will come back next months for transfusion. They, however, agreed after some counselling and convincing. We tried to secure her cannula but we couldn’t, and hence rang up Rajat from Sankalp India Foundation, and explained the whole situation to him. He advised to send Shweta to IGICH for transfusion. We told the same to Shweta’s parents, but they did not agree and said that they were not ready to admit her in the hospital. We rang up Pushpa, the in charge of thalassemia clinic at IGICH, and explained the situation to her. We asked her to get cannula placed for Shweta and asked her father to collect it from IGICH. The IGICH nurses could not access Shweta’s vein either, even after repeated attempts. To secure the line, Shweta at once held her breath, was immediately rushed to the ICU, and was started on oxygen and stabilized. Her father called me up and told me that he didn’t want to admit her and requested me to tell Pushpa to release Shweta from the ICU so he could come back. Shweta’s mother told me that her in-laws would not agree if they found out that another child from their family is suffering from thalassemia. She requested for her child to be sent back. “We do not have hopes on her, we will take care of Rakesh well but we don’t want Shweta.” she cried. I tried to convince her but she told me only option left for them is suicide. I got call from Pushpa, who, to our relief, said that the doctors had secured the line and had transfused 50 ml blood to her. I had sigh of relief and explained her mother her to not disclose to her in laws that she is suffering from thalassemia. I asked her to get free blood transfusion for Shweta, every time they get blood transfusion from Rakesh. She was convinced and quite happy. After Rakesh got his blood transfused, we arranged from them to be sent to IGICH, and told them to follow up with us. I was happy that a life was saved.
Patrika Section