Friday, January 7, 2011

Update: Blood Transfusion?

A few weeks ago, I wrote about an 18 year old pregnant woman who had a hemoglobin of 4.4 after a case of severe malaria. We attempted to do a direct blood transfusion to improve her condition. (Read her story here.) But we failed. We just aren't set up for this kind of thing.

In fact, after several hours and many 'learning curve' situations, we were only able to infuse about 30-40 ccs of blood. She spent the night at the clinic and we discharged her to Wau the next day, so she could get a transfusion there.

Well. Today I learned she died.

I was surprised to think a grown woman could die for something so preventable, let alone a pregnant one. What happened? What went wrong? Didn't she go to Wau? Didn't she get the blood transfused?

One of our translators, Wilson, (who happens to be her cousin) told me the rest of her story today. She was too weak to travel so he (Wilson) went to Wau instead and inquired if there was any blood available. He was told they had no B+ blood but if someone came in to donate they'd do the transfusion. He came back, told his family the news and together they stopped trying.

She died two days later. (Three days after our attempt at a transfusion.)

I asked him why the two men (that we cross matched to her in our lab), didn't just go and give their blood; They still had plenty. He looked at me confused and said, "But they had no blood. Don't you remember? We couldn't get any from them."

Instantly my heart sank. Yes, I remembered. But I remembered it much differently than he did. We couldn't get blood from them because we didn't have the correct materials -- not because they were out of blood. (!#$%!@!)

I asked him if he remembered learning in class that a person has over 5 liters of blood in their body on average. He nodded and said he remembered. "Well, if a person has 5 liters, don't you think that they can give much more than 30 ccs?" He just cocked his head to the side and looked at me sadly. He didn't appear to understand.

"Wilson, your friends still had blood to give. She could have gotten the transfusion with their blood." I struggled to keep the incrimination out of my voice. He explained that the 'Fathers' decided that they shouldn't give anymore since they had tried and failed...

I tried to teach him more about how blood transfusions are (normally) done and how much can be given. I didn't want him to feel bad, just to know so this didn't happen again. But I cut my lecture short, seeing he wasn't listening.

He was tired. He was sad. He had done all he could... all he thought best in fact. So, I shut up and started lecturing myself instead. "He did everything he knew to do... He was trying by going to Wau, by talking to the 'Fathers'. He was fighting for her life and failed... just like we did."

The conversation moved on but my heart sank further down. What more could I say? I failed.

I failed to explain to them that a person cannot 'run out of blood'. I've failed because... this isn't the first time I've heard this excuse. I just never thought it could hurt anyone.

Generally when someone says they have 'no blood', I ignore them. I don't try to explain to them that it's impossible to live without blood, that we have liters and liters of the stuff... yada yada. I just move on with a prenatal or check-up or whatever. But now I see the damage this ignorance can do.

Another face of maternal mortality. Another needless death. Lord please don't ever let this happen again. May her death teach me to teach them better. May I never forget this lesson. Amen.