I have a love/hate relationship with blood. Thousands of years ago it was written that “the life of the flesh is in the blood.” There is so much truth to this. I do appreciate blood for this reason. But, I also hate it. It is often the time limiting factor to performing life saving surgery. It gets in the way of a nice dissection and can be time consuming.
In the west, blood banks provide hospitals with needed blood when a trauma patient comes in or when a patient bleeds during a miscarriage or C-section. Where I work, getting blood is a constant challenge. We have no blood bank, meaning any transfused blood must come directly from live donors. For elective surgery it means we have time to find compatible donors prior to a potentially bloody surgery.
Unfortunately much of the surgery we perform in Mandritsara is emergency in nature. A normal blood level is around 120-140 but we see people coming into hospital frequently with levels 40-50 and sometimes even 30.
As a surgeon, when someone is bleeding we are trained to resuscitate usually involving IV fluids and then blood. Too much IV fluid dilutes your blood and impairs its ability to clot.
So what happens when blood isn’t available?
This is where it gets tricky. In a bleeding patient, give your patient blood and they are often in better shape to tolerate lifesaving surgery, but if that transfusion doesn’t come, then your patient is in worse shape to operate.
So how long do you wait?
If your patient is actively bleeding, you need to stop the bleeding or they may die. But if they have lost significant amounts of blood, they may not tolerate the surgery you want to do to save them. Losing blood not only decreases your capacity to bring oxygen to tissue but it also impairs your ability to clot which makes bleeding worse. It also makes you cold impairing the biochemical processes necessary for life to occur.
A frequent transfusion threshold is 70 in the west and sometimes higher for certain conditions. But here, depending on blood availability and how stable the patient is, we are forced to operate on patients with levels below this.
Finding compatible donors is sometimes so challenging that recently in our town, a radio station was advertising on behalf of a family willing to pay a compatible donor to give their blood for their loved one in the hospital.
I have on several occasions provided blood for patients I have operated on. This is a strange experience but one that really puts into perspective the importance of giving so others can live.
Blood represents life in so many ways. It makes me appreciate the idea of Christ giving his blood (or life) in order to save me. It is not a stretch for me to grasp that I am hemorrhaging spiritually because of the sin in my life.
Thankfully, according to the message of the Gospel, the ultimate blood donation was given.
This post is dedicated to our amazing lab staff who tirelessly work finding donors so that lives can be saved! JESH
