Seeking Health Care Abroad

Blood Transfusions

A blood transfusion can be a life-saving intervention when the blood supply has been appropriately screened and managed. For travellers, transfusion should be required only in rare and unexpected situations of massive haemorrhage, such as severe trauma, gynecologic and obstetric emergency, or gastrointestinal bleeding. Not all developing countries have accurate and systematic screening of all blood donations for infectious agents such as malaria, HIV, and hepatitis viruses, which can result in transfusion-related transmission of these infections. According to a WHO survey, 11%-21% of countries surveyed had inadequate screening of their blood supply for those infectious agents. Additionally, transfusion reactions can occur if the blood products are not adequately characterised for compatibility with the recipient before transfusion. Because of these inherent risks, transfusion should be prescribed only for conditions for which there is no other treatment. When blood transfusion cannot be avoided, travellers should make every effort to ensure that the blood has been screened for transmissible diseases, including HIV. In many cases, resuscitation can be achieved by use of colloid or crystalloid plasma expanders instead of blood. Once stabilized, travellers should consider urgent evacuation for additional management.

In the past, travellers planning international itineraries have requested to have their own blood or blood from their home country available to them in case of urgent need. There are no medical indications for travellers to take blood with them from their home countries. The international shipment of blood for transfusion is practical only when handled by agreement between two responsible organisations, such as national blood transfusion services. This mechanism is not useful for the emergency needs of individual travellers and should not be attempted by private travellers or organisations not operating recognised blood programs. The limited storage period of blood and the need for special equipment negate the feasibility of independent blood banking for individual travellers or small groups. Travellers should, however, carry a medical card or other document, showing their blood group and information about any current medical problems or treatment.

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