Department of Anaesthesiology and Intensive Care, Bayero University/Aminu Kano Teaching Hospital, PMB 3452, Kano, Nigeria.
Department of Anaesthesia and Intensive Care Unit, Livingstone Central Hospital, 2444/244B, Highlands, Livingstone, Southern Province, Zambia.
World J Surg. 2020 Jul;44(7):2094-2099. doi: 10.1007/s00268-020-05461-x.
Surgery and anesthesia are indivisible parts of health care, but safe and timely care requires more than operating rooms and skilled providers. One vital component of a functional surgical system is reliable blood transfusion. While almost half of all blood is donated in high-income countries (HICs), over eighty percent of the global population lives outside of these countries. High-income countries have on average 30 donations per 1000 people, and the average age of transfusion recipient is over 65. Most low-income countries (LICs) have fewer than five donations per 1000 people, where maternal hemorrhage and childhood anemia are the most common indications for transfusion. In LICs, greater than 50% of blood is administered to children under 5 years of age. This study aims to snapshot, by survey, available resources for transfusion and then discusses the infrastructure and cultural barriers to optimal transfusion practice.
In January 2019, a 10-question survey was sent electronically to physician anesthesiologists working in low- and middle-income countries to examine resources and practice patterns for blood transfusion. Subsequent discussions illustrate obstacles contributing to low availability of blood products and illuminate infrastructure and cultural barriers preventing optimal transfusion practices.
Acquiring whole blood takes hours. Clinicians wait days to receive packed red blood cells or platelets. Fresh frozen plasma is available but untimely. For many, protocols for massive transfusion are rare, and for transfusion, ratios are nonexistent. Complete blood counts take hours, and coagulation profiles are severely delayed.
With few voluntary, unpaid, donors and inconsistent supply of testing kits, donated blood is unsafe. Donors are seasonal for farming communities, endemic malaria areas, and student donors recruited through schools. Cultural beliefs fuel distrust. Transfusion specialists, concentrated in urban areas, see rural patients presenting late. Inadequate triaging and supervision jeopardize patients to shock. Inadequate blood storage leads to waste. Modeling systems from HICs fail to overcome hurdles faced by clinicians working with distinctive belief systems and unique patient populations.
手术和麻醉是医疗保健中不可分割的部分，但安全和及时的护理需要的不仅仅是手术室和熟练的医护人员。功能齐全的外科系统的一个重要组成部分是可靠的输血。虽然几乎一半的血液来自高收入国家（HICs），但全球超过百分之八十的人口生活在这些国家之外。高收入国家每千人平均有 30 人献血，输血接受者的平均年龄超过 65 岁。大多数低收入国家（LICs）每千人的献血量不到 5 人，产妇出血和儿童贫血是最常见的输血指征。在 LICs，超过 50%的血液输给 5 岁以下的儿童。本研究旨在通过调查 snapshot 获得输血的可用资源，然后讨论最佳输血实践的基础设施和文化障碍。
2019 年 1 月，向在中低收入国家工作的医生麻醉师发送了一份 10 个问题的电子调查，以检查输血的资源和实践模式。随后的讨论说明了导致血液制品供应不足的障碍，并阐明了基础设施和文化障碍，这些障碍阻碍了最佳输血实践。
采集全血需要数小时。临床医生要等几天才能收到浓缩红细胞或血小板。新鲜冰冻血浆可用，但不及时。对许多人来说，大出血的方案很少见，而且输血时也没有比例。全血细胞计数需要数小时，凝血谱严重延迟。
由于自愿、无偿献血者少，检测试剂盒供应不稳定，捐献的血液不安全。季节性的农民社区、地方性疟疾地区和通过学校招募的学生献血者都是献血者。文化信仰导致不信任。集中在城市地区的输血专家很少看到来自农村地区的患者，因为这些患者来得很晚。分诊和监督不足会使患者陷入休克。血液储存不足会导致浪费。从高收入国家（HICs）建模的系统无法克服与具有独特信仰体系和独特患者群体的临床医生相关的障碍。
