Fieldset
A first time for everything: learning fast in Bangui

With a patient bleeding heavily, Kariantti and the MSF team had to act quickly. He blogs from Bangui, Central African Republic...

Have you ever done an auto-transfusion in the field?

Me neither.

In theory, auto-transfusion is a brilliant idea. If a patient is bleeding heavily and you don’t have access to donated blood, you just harvest as much of the blood loss as you can, filter it and give it back to the patient.

Simple, right?

Wrong!

There’s a million things that can go wrong when you don’t have the proper equipment. One of the risks is that, if you’re not extremely careful, the blood can start to clot too soon, leaving you with something that’s of no use to the patient.

Today we didn’t have a choice, we just had to act quickly.

Or, even worse, if you don’t manage to filter the blood well enough, removing any materials that might have contaminated it, you can do some life-threatening harm to the patient.

And don’t even get me started with the risk of infections. 

Today we didn’t have a choice, we just had to act quickly.

A life-threatening condition

A woman in her late twenties had an ectopic pregnancy and was bleeding internally in the abdomen. The problem was that her blood group was O-negative, which we didn’t have in the hospital. The laboratory checked the other hospitals nearby but couldn’t find O negative blood anywhere in Bangui.

Meanwhile, the patient was still bleeding.  So, the gynecologist and I decided to take her to the operating theatre to start the operation.

Our idea was to perform an auto-transfusion with the patient’s own blood that had collected in the abdomen.

It was the patient’s best and only option.

I’ve done auto-transfusions back at the university hospital in Helsinki, Finland. It’s not a big deal with the fancy equipment we have back home, but I’ve never done one in circumstances like this. However, it was the patient’s best and only option.

Following the MSF medical protocol, we got some empty blood bags from the laboratory, collected as much of the blood as we could from the abdomen with syringes, filtered it, put it in the bags and transferred it back to her intravenously. To our surprise it worked amazingly well.

Recovering fast

After just one bag the patient had already started to stabilize.

The surgeons finished the operation and we moved her to the recovery room. She was still weak but much better, although her haemoglobin level was still too low. We continued giving her the other bag of her own blood and continued observing her in the recovery room.

We were able to discharge her to the ward later that evening.

Eventually, later in the evening, my colleagues found a donor for O negative blood, but it would have probably been too late. It makes you wonder what would have happened without the auto-transfusion.

I was still quite anxious about how she would recover from the procedure and if she would have any reaction to it. Happily, the following days we saw her recover well.

This was one of the few positive surprises during my posting here and one I guess I really needed. The moment when the anxiousness turns into joy, when you see the patient … then you can’t do much else than smile and let out a big sigh of relief. To make it even better, it was also a great group effort.

You try your very best with the resources you have in often very challenging circumstances, and sometimes it just works out.

I guess there’s a first time for everything.