"Sir, we have given a number of anemic patients multiple packed cell transfusions. But despite three or four unit transfusions each, their hemoglobin levels rise barely by half or 1 g%" my Registrar told me.
"But each unit of packed cell has to increase hemoglobin level by 1 g%" I said.
"Yes sir. But our patients do not show such a rise."
"Have they been bleeding?" I asked.
"A couple of them bled a bit. But most of them have not bled."
"All cannot have hookworms. And hookworms cannot drink a unit of packed cells per day" I said. "Make a list of all such patients and the dates of their pre- and post-transfusion hemoglobin estimations."
When I got the list, I got the laboratory to check their hemoglobin levels carefully. They found the results as before. I got them to check the machines, which turned out to be OK. Then I contacted the blood bank, explained the problem and asked the Professor in charge about the hemoglobin level of the packed cell units issued out by them.
"We check 1% of all blood issued out as per FDA rules. I will arrange to have more samples checked. The FDA requires a minimum hemoglobin level of 12.5 g% for acceptance of a blood donor. The hemoglobin of the packed cells issued out should be at least 12.5 g%."
I thought about it after the call. After some time I realized the error in the statement. So I called the blood bank again. The Professor was away. I got the Assistant Professor. I explained the problem.
"Please tell me the hematocrit or hemoglobin level of the blood in the bag you issue out" I said.
The Assistant Professor told me the unit should increase hemoglobin by 1 g%.
"I know" I said. "What I want to know is the hematocrit or hemoglobin level of the blood in the bag you issue out. If the donor's hemoglobin is 12.5 g%, and then you remove plasma from the blood and issue red cells, the hematocrit should be 50 to 55."
"It should increase hemoglobin by 1 g%" she said doggedly, and the connection got lost promptly. I could not get her back on the line.
Then I arranged to check the hemoglobin levels of packed cells transfused to patients. The first two results were 11 g% and 12.5 g%. The word probably reached the person concerned in the blood bank. Third sample onwards the hemoglobin levels were 17.5 g%, 18 g% and even 24 g%.
"The problem is solved" I told my people. Now our patients' hemoglobin levels will rise by 1 g% per unit transfused.
It seems the problem was solved only for my department.
"Sir, we have received a call from the medicine ward. A patient of uterine leiomyomas and anemia has been transfused 4 units of packed cells. Her hemoglobin has risen by only 1 g%. They want us to transfer the patient for that reason."
"Is she bleeding?" I asked.
"No sir."
"Then tell them the source of the problem, our solution to the problem and ask them to do what we did."
"Sir, but how can the blood bank people distinguish between different patients and issue units of different hemoglobin levels?" my Associate Professor asked me.
"I am not saying they are doing that. But someone could be doing it without knowledge of others. It is quite simple. The blood requisition slip has the unit name and ward number. Our patients can be identified easily. Specially prepared blood bags can be identified by their numbers. The rest is easy."
"But each unit of packed cell has to increase hemoglobin level by 1 g%" I said.
"Yes sir. But our patients do not show such a rise."
"Have they been bleeding?" I asked.
"A couple of them bled a bit. But most of them have not bled."
"All cannot have hookworms. And hookworms cannot drink a unit of packed cells per day" I said. "Make a list of all such patients and the dates of their pre- and post-transfusion hemoglobin estimations."
When I got the list, I got the laboratory to check their hemoglobin levels carefully. They found the results as before. I got them to check the machines, which turned out to be OK. Then I contacted the blood bank, explained the problem and asked the Professor in charge about the hemoglobin level of the packed cell units issued out by them.
"We check 1% of all blood issued out as per FDA rules. I will arrange to have more samples checked. The FDA requires a minimum hemoglobin level of 12.5 g% for acceptance of a blood donor. The hemoglobin of the packed cells issued out should be at least 12.5 g%."
I thought about it after the call. After some time I realized the error in the statement. So I called the blood bank again. The Professor was away. I got the Assistant Professor. I explained the problem.
"Please tell me the hematocrit or hemoglobin level of the blood in the bag you issue out" I said.
The Assistant Professor told me the unit should increase hemoglobin by 1 g%.
"I know" I said. "What I want to know is the hematocrit or hemoglobin level of the blood in the bag you issue out. If the donor's hemoglobin is 12.5 g%, and then you remove plasma from the blood and issue red cells, the hematocrit should be 50 to 55."
"It should increase hemoglobin by 1 g%" she said doggedly, and the connection got lost promptly. I could not get her back on the line.
Then I arranged to check the hemoglobin levels of packed cells transfused to patients. The first two results were 11 g% and 12.5 g%. The word probably reached the person concerned in the blood bank. Third sample onwards the hemoglobin levels were 17.5 g%, 18 g% and even 24 g%.
"The problem is solved" I told my people. Now our patients' hemoglobin levels will rise by 1 g% per unit transfused.
It seems the problem was solved only for my department.
"Sir, we have received a call from the medicine ward. A patient of uterine leiomyomas and anemia has been transfused 4 units of packed cells. Her hemoglobin has risen by only 1 g%. They want us to transfer the patient for that reason."
"Is she bleeding?" I asked.
"No sir."
"Then tell them the source of the problem, our solution to the problem and ask them to do what we did."
"Sir, but how can the blood bank people distinguish between different patients and issue units of different hemoglobin levels?" my Associate Professor asked me.
"I am not saying they are doing that. But someone could be doing it without knowledge of others. It is quite simple. The blood requisition slip has the unit name and ward number. Our patients can be identified easily. Specially prepared blood bags can be identified by their numbers. The rest is easy."
