Recently Sankalp India Foundation came across a rare situation. In the week from 24-30 June 2012 the organization got requests from 8 different patients for Bombay Blood Group. The following are the blood requests which were received:
- Bombay negative from Omega hospital Hyderabad (Emergency)
- Bombay positive from M S Ramaiah Bangalore where the patient was in ICU battling from complications. (Emergency)
- Bombay positive from General Hospital, Tumkur where the lady is due to deliver in 2 months.
- Bombay positive from Kamakshi Hospital Mysore where the patient may need blood in a week's time.
- Bombay positive from Apollo Hospital Bangalore
- Kiran suffering from Thalassemia needs transfusion soon
- Bombay positive from KIMS Hubli for a pregnancy.
- Bombay positive from Belgaum for a lady suffering from post operative complications. (Emergency)
With very few donors who are eligible and patients across 5 cities in 2 states requesting for blood units making the right decision on when to get the donation done and where was a big challenge. While it's true that ideally we would have wanted to make the units available off the shelf for each one of these patients, we do not have that choice. With the blood requests for this extremely rare phenotype pouring in each day, every single unit has to be made use of most judiciously.
This incidence report shared with you the strange scenarios that we come across while trying to organise for blood for each of the patients.
The situation of the patient in Hyderabad was exceptionally critical. She needed 8 units of blood to undertake the surgery. We were aware of 3 Bombay negative donors but for various reasons all three of them could not have donated blood. In the mean time, since the lady had not taken any transfusions earlier, the doctors approved of the use of Bombay Positive units for the very first time alone. Think foundation from Mumbai had already done a great job (as usual) and organised for the shipping of 4 units of blood. We were also aware of the fact that in Hyderabad itself there is a good number of Bombay blood group donors(from past experience) and we passed the relevant contacts to the family. Fortunately they were able to manage all 8 units but not before one of the very regular donors travelled from Bangalore to Hyderabad just for the donation. Now this lady is posted for a second surgery where only Bombay negative will be acceptable. Attempts are being made to find more Bombay negative donors. It is important to note that we had recommended autologous donation for this lady and the doctors did go on to collect one unit of blood from her. In case of elective surgeries, making use of autologous blood donation has become the standard norm for Bombay blood group requests.
The conflict arose when we had no donor available immediately and blood requests from Mysore, Tumkur as well as Bangalore coming at the same time. Even as the patient's families were pressing for the units to be made available with highest degree of urgency, one call with the doctors treating the patients painted very different picture. The doctor from Mysore informed that blood may be required in next few days and there was no immediate need. The lady in Tumkur will be delivering in 2 months time. Though her hemoglobin was low and donation was required, it was not the most urgent case. The patient in Ramaiah was battling for his life with the doctors asking for the unit to be made available immediately. So on first priority, we were waiting for the donor for the patient in Ramaiah when two most reliable Bombay blood group donors had just donated for the patient in Hyderabad and in Tumkur. Fortunately the family members of the patient in Ramaiah organised for a donor to travel from Pune and 2 units were organised by them.
While we kept the request from Mysore on a standby (as per the treating doctor's advice) one donor each was kept ready for the patient in Tumkur and Mysore. These were the donors from Chikmagalur who had agreed to travel to the respective cities. However, the doctor told that blood is not required immediately and they would like to do the collection after a week. Two donors were available for the patient in Tumkur, on our advice the doctor had put her on iron supplements and EPO was being considered still the news about this patient had travelled far and wide and inspite of the fact that there were donors for the patient on a standby there seemed to be a panic situation all around. With media capturing this need, we got innumerable calls from people with partial information - each one making attempts to secure the Bombay blood group units for this lady. Inspite of the donor being available from Chikamagalur, willing to travel till Tumkur, the people searching for the donors went a step ahead and invited a donor from Bangalore to come and donate. Donation from Chikamagalur could not happen and in Bangalore a patient was struggling in the ICU.
It is very important that it is well recognized that when organising for blood the family members of the patient must have a single person coordinating the need. This person must maintain clear communication with the doctor and be sure of what is needed and when. At times a simple need snowballs into a situation where numerous people are trying to search for options to help the patient even when the real need may have been addressed long time back. When organizing for units of blood, Sankalp volunteers insist upon talking to the person who is taking care of the patient in the hospital to avoid multiple false alarms and confusion.
With the need from Tumkur, Ramaiah and Mysore taken care of we were just trying to breathe easy when there was a call at 9:30 PM from Belgaum. A lady who had undergone hysterectomy had post surgery complications and was in a critical state. The doctors wanted a unit of blood immediately. Looking at the grave situation we approached and convinced a donor from Bellary to travel overnight to Belgaum and donate blood early in the morning. The option of organising for blood from Hubli was ruled out since already we were in the process of searching for a donor for a patient there. Fortunately the gentleman from Bellary saved the day by travelling quickly and making the unit available by morning.
At the same time, the doctors in Mysore realised the fact that they can do the surgery without asking for donation by making use of EPO and additionally collecting a unit of autologous donation. With a hemoglobin of 10.5, the doctors in the right situation to manage the surgery using conservative techniques and a donor on the standby, the Mysore patient is expected to take the procedure without needing any donation at all.
One unit of blood was donated in KIMS Hubli for the lady who was due to deliver there. Inspite of the fact that her hemoglobin was 8, the doctors did manage to use iron supplements alone and not give her the transfusion. She delivered a healthy child. Fortunately, the same unit which was donated for her was utilised for the patient in Apollo Bangalore.
This left us with the outstanding request for Kiran. Fortunately a donor who had donated for Kiran before has just become eligible and he is waiting to donate for the child soon.
Situations like the ones which were faced in the last week bring out some important things:
- Being such a rare blood group, each unit of Blood group needs to be used very judiciously based upon actual medical need in order to match the frail supply with the large demand.
- If handled effectively it is possible to ensure that more people get treated without needing a transfusion at all. Use of modern medical techniques including iron supplements, EPO, autologous collection etc. is very effective in ensuring wellbeing of patients.
- It is important that the blood requests are handled rationally and on the basis of actual need.
- By better coordination we can optimally utilise the contribution of each voluntary blood donor and also minimise the amount of effort involved in collection and transport of each unit of blood.
Each blood request that comes to Sankalp's emergency team is handled with care and after completion, carefully scrutinized to identify how things could have been done in a better kind of a manner. Having done this week after week over the years the volunteers have gained reasonable experience at better managing situations where arranging for blood becomes difficult. However, this is a continuous learning process. We hope to see a time when the blood requests are clearly laid out, the availability of blood across institutions clearly known, the donors very well synchronized and the modern medical techniques that lead to better utilization of each unit of blood in place. The medical fraternity, the voluntary organisation and the blood banks will have to work in complete sync to ensure that each person needing blood is given the best possible chance.