"Once," says Dr. Matthew, "I stayed up all night freaked the hell out about anything coming through the door of the emergency departments at the hospitals we service, because we only had four units in the entire system." So Dr. Matthew ordered more blood from a blood bank -- the facilities that store extra for emergencies -- only for his order to be held up at the airport and miss its flight. "If a trauma had shown up or a surgery turned into a massive transfusion situation, any or all of those patients would have died and there'd have been nothing we could do about it."
"Wait, does anyone know how to get our elevators to do that thing from The Shining?"
That problem is compounded by the fact that hospitals do more transfusions than they need to, as Ann explains. "Some of it might be due to ignorance of what blood [is] expected to do, and what sort of blood levels a patient can handle before transfusion is necessary. We see doctors 'topping up' their patients before a holiday weekend." They're like goddamn reverse Draculas.
It's not just a matter of waste, either -- overtransfusion can result in elevated blood pressure, reduced blood to the heart, and that infamously troublesome side-effect of death. Yet hospitals keep excessively topping off your vein oil, thanks to misinformation on when a patient needs blood. And on the other extreme ...
A Hospital Might Decide To Cut You Off
Misinformed doctors aside, the decision-making behind a transfusion seems simple enough. Simply perform one whenever someone needs more blood, right? But according to Dr. Matthew, it's rarely that simple. "We had a 20-something kid, purported gang member, who got stabbed in the gut. This kid is going through our entire inventory of blood for days on end. We kept trying to get surgery to take him and stop the bleeding, but they were afraid to do so until he got more stable. We had to convene an ethics committee to consider stopping supplying the kid with blood. Luckily for everyone, the mere fact that we called in the ethicist convinced surgery to take a risk and they fixed him up. He eventually recovered."
Hopefully with a little "careers where no one stabs anyone" advice on the side.
Not all of those dilemmas end well. Dr. Matthew had another patient who kept bleeding from his gastrointestinal tract. "He required up to ten units of O red cells per day. This was keeping us from having those units available for other patients, so I had a really long, heartfelt discussion with the kid's attending physician, and told him that if another patient showed up and needed [O blood], I would have to give them priority."
Yup, the decision of whether to let a child bleed to death to save someone else. Not really the thing they bring up on doctor shows.
In the end, despite having enough blood products available, the kid unfortunately died due to his disease. But that's the reality when there's not enough blood to go around. Hard, unpleasant decisions have to be made. All the blood he used wasn't considered a waste, though. As Ann put it, "the only time blood is considered wasted is when it's not transfused to a patient in need."
So go donate blood. You'll help save lives, and it's by far the most socially beneficial way to score free cookies and juice.
Dr. Matthew is a transfusion medicine specialist working at a large academic medical center continually freaking out that it's going to run out of blood. Ann is a medical laboratory scientist with a borderline unhealthy obsession with transfusion medicine. Cezary Jan Strusiewicz is a Cracked columnist, interviewer, and editor. Contact him at firstname.lastname@example.org.
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