Letter to the Editor: A Last Resort When There is No Blood: Experiences and Perceptions of Intraoperative Autotransfusio
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LETTER TO THE EDITOR
Letter to the Editor: A Last Resort When There is No Blood: Experiences and Perceptions of Intraoperative Autotransfusion Among Medical Doctors Deployed to Resource-Limited Settings Nakul P. Raykar1,2,3 • Anusha Jayaram1 • Juan Carlos Puyana4 • Nobhojit Roy5
Accepted: 25 October 2020 Ó Socie´te´ Internationale de Chirurgie 2020
¨ lga˚, von Schreeb, and the We congratulate Sjo¨holm, A World Journal of Surgery for a thoughtful highlight of an important issue [1]. Access to timely blood transfusion in low- and middle-income countries (LMIC) is dire. There is a 102 million unit deficit in the 119 countries—mostly in sub-Saharan Africa, south and southeast Asia, and Oceana—where blood need is greater than supply [2]. ‘‘Self-built’’ intraoperative autotransfusion (IAT) is one method of closing the gap on unmet blood need in emergent surgical situations when banked blood is scarce. Many of our colleagues in LMICs in South Asia and South America report using the technique in these circumstances. As is clear from this study, however, challenges exist in widespread adoption as ‘self-built’ IAT requires time, training, and culture change. We take this opportunity to highlight two potential options to improve the blood transfusion gap in LMICs: low-cost commercial methods for IAT and walking blood banks (WBBs). The Hemafuse is a medical device for IAT, designed for low-resource environments, that comes with a & Nakul P. Raykar [email protected] 1
Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
2
Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02215, USA
3
Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, USA
4
Trauma and Global Health Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
5
World Health Organization Collaborating Center for Research in Surgical Care Delivery in Low-and-Middle Income Countries, Mumbai, India
pump apparatus, 25 filters (good for 25 uses), an accessory kit, and a shelf life of one year [3]. Such a device could speed the process of blood collection, filtration, and transfusion and provide a measure of standardization currently lacking. The current 2500 USD may still be too expensive for the world’s lowest resource environments but we hope to become more affordable as the technology scales. Walking Blood Banks (WBBs) are another excellent innovation that could address an even broader segment of the blood transfusion gap. WBBs are a system of transfusion where blood is procured urgently from a pool of voluntary, pre-tested donors who are recruited, on demand, through local networks. Donated whole blood is immediately transfused to the recipient after appropriate testing. This has been used for decades by rural practitioners in India as a last-ditch effort to save lives in extenuating circumstances [3]. More recently, it has gained widespread acceptance among militaries for blood transfusion in auster
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