On Giving Blood

I was asked to donate blood for a patient yesterday. There is no blood bank at the BMC, which is why protocol asks that you wait until the hemoglobin level is below 5 or 6 to transfuse (the cutoff in the US is 7). All the same, it is not uncommon for patients to meet this criteria. I've already seen a handful of people walk (literally) into the hospital with a level below 3. What happens when someone reaches that threshold is a family member is asked to donate their blood, which is then immediately delivered to the patient as whole blood (in the US the red blood cells are separated from the rest of the blood to be given in a concentrated dose). And what happens when family members are not around? Well, you can probably guess by the title of this post. 

The patient I donated for was a young woman who was about 34 weeks pregnant when she was bit by a snake. She came to the hospital 3 days later. There are two poisonous snakes in this area I hope I never meet: one is the spitting cobra, appropriately named for blinding its victims by spitting poison in their face; the other is the carpet viper, whose venom is a potent anticoagulant. This lady was bit by the latter, and after 3 days without anti-venom she was bleeding profusely and mostly from her womb. Her hemoglobin level was about 2.7. 

The trouble was that she had travelled here from a village very far away, and most of her family had not travelled with her. The ones who had had already donated 4 units (roughly 2L) and her hemoglobin was still 5. So her doctors began scouring the hospital for willing, healthy volunteers with an O blood type, which narrowed the pool down to me. 

Basically what I want to get across is this: it's quite selfishly scary to be asked to give your blood in a developing country for the first time, especially when everyone keeps reminding you to make sure the needles and tubing come from new, unopened packaging. But when a hemorrhagic pregnant lady is at the other end of that request, you don't even have to think twice. It's the easiest decision I've had to make regarding a patient's care since I got here.

I was stupidly nervous about giving blood. You should know that although the lab was not much to look at, their procedures are routinely sterile. Nonetheless, I kept remembering a former volunteer saying that the tubing for paracentesis procedures was reused frequently. I crossed my fingers as my blood was typed and crossed that the patient would not need another transfusion after all. I tried to calculate how long it would take to pay for Sovaldi. I was being, for at least the hundredth time on this trip, the silly little white girl with her first-world misconceptions about medicine in Africa. The procedure itself was terrifically anticlimactic, and the lab techs soon handed my blood to the patient's grateful husband to take to the maternity ward.

I stopped by the maternity ward on my way out of the hospital, and saw the patient lying asleep in her bed as my blood dripped into her veins. Her nurses said she was getting better. Her husband said a whole slew of words in another language that someone translated simply as, "he's thanking you," and once again I felt so ridiculous for my selfish concerns earlier, and so grateful for this experience. I felt a strong sense of peace walking home to dinner that night, where I promptly found out from her physician the good news that she was now clotting and did not, in fact, need my blood after all.