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Transfusion Bulletin

Vol. 12, No. 2 (2004-08 - 2004-08)

Editorial

What do other health care workers think about us?
Transfusion Medicine specialists, paramedical staff and voluntary blood donor motivators are an integral part of the blood transfusion services (BTS). This group offers untiring life saving services con-tinuously to our needy fellow human beings. All of us have taken this profession as our career and are de-voting best years of our life in serving ailing human-ity. Some of us have willfully chosen this specialty; some have joined as a compulsion and some have taken this specialty by default. Whatever is the initial starting, all of us have shown dedication in service, showing interest in uplifting BTS and protecting the cause of our juniors/ staff from outsiders (of the department). This is applicable to all three groups men-tioned earlier. However, there is another group of colleagues who work in the clinical departments and usually carry different attitude towards our commu-nity. Clinicians who might have been our best friends in our medical days, take a different perspective once we take up this specialty as profession. Today, we will introspect why we are not able to establish our-selves on an equal platform with other clinical colleagues.

What is happening?
Let us all look back at our long experience in BTS. There are many instances of senior (even junior) clinicians behaving badly when they did not receive blood or there were differences of opinion. I am not saying that every body is like that but sometimes some of them even go to the level of abusing. There are even instances where clinicians came to the blood bank, opened refrigerators to check whether BTS personnel have spoken the truth or not. Arguments with clinicians may be a common feature whether it is for replacement donations or product transfusions. I even recollect that there used to be regular arguments with my clinician friends mainly because of replacement blood donation in my previous place of work. They are usually not in a mood to listen to you (even on telephone) and your advice. The usual term they use is ‘do not try to teach me’. They are not ready to accept that they also do not know enough about our specialty. Whenever BTS fails to supply blood or to do anything that does not conform with their request, the common phase they use is ‘give it in writing’. However, if you ask something in writing from them, clinicians usually try to avoid. It is usually observed with resident clinicians that they try to project the case as emergency (false) to get blood urgently. Improper filling up of forms and labeling of samples is often observed. Another dangerous situation existing with strict replacement system is the chance of corruption. Under pressure, patient’s relation brings paid people in the guise of relations or try to manipulate at ward-boy level. We must be vigilant to prevent these type of misdeeds. Clinicians have a general idea of using blood as a liquid fluid like saline. Probably, the motto is that patients should be examined, transfused blood (when required) without complications and discharged from hospitals. What they are scared of are the post transfusion complications.

Why it is happening?
I feel that it is our fault that we have failed to establish ourselves as colleagues to our clinician friends. We usually have a tendency only to run our BTS with sincerity and dedication, forgetting that there are also two ends (clients) of our services; one is our esteemed blood donors and the other is taker of our service i.e. clinicians. We cannot ignore both. We must look after the comfort and further requirements of our donors. On the other hand, we must also try to understand the needs of the clinicians. Most of our tussles are based on replacement blood donations by respective clinicians. Majority of Indian BTS is running on replacement blood donation. We must be thankful to our colleagues who send patient’s relative to donate blood. However, sometimes when they fail to help, we may take a lenient view. Of course, as per action plan of national blood policy, it will be our responsibility to start voluntary donation by the year 2005 (I do not know how much it will be feasible???). Another reason may be the communication gap between BTS and clinical departments.

How to prevent it?
During my post graduation, my guide told us that ‘you have to make a place amongst clinicians and you have to snatch your right’. I think he was quite right. We have to be more communicative and take part in clinical meetings and discussions at institutional level. In medical colleges, we should take part in clinical case presentations or take lectures frequently in clinical departments (e.g. medicine, surgery, O&G etc.). Moreover, it is our duty to organize lectures for real blood users i.e. for staff nurses of various wards or different hospitals where clinicians Editor : Transfusion Bulletin Ahmedabad. use blood and components. Initially, we should involve Medical Superintendent of hospitals for these types of activities. We should also activate our hospital transfusion committees and we can use this forum to influence clinical colleagues and interact more often with them. Some of our clinician colleagues works in odd hours and need help from us at odd hours. It may be in terms of supply of rare blood groups, therapeutic exchanges or apheresis procedures. We must help them whenever needed, to build up their confidence.

How we should move forward?
Coming days will be different for all of us. We have to prepare ourselves for ‘bed-side transfusion medicine’. It will include bedside consultation, post transfusion follow-up and hemovigilance. We should assert our position amongst clinicians. We should try to develop a respectable position in the clinical fraternity. We should probably devote more energy to newer technology (rather than collecting and distributing whole blood). We should try to develop a section of apheresis in our BTS for platelet and therapeutic apheresis. It will give us more confidence in handling and treating live patients. It is to be noted that platelet and other apheresis procedures (meant for transfusion in patient) can only be carried out in a BTS with a special license from FDA.

Future direction:
We should try to involve ourselves in any bone marrow transplant program in terms of stem cell collection, processing, preservation and transfusion. We can also be a part and parcel of a transplant team (e.g. liver transplant). The newly emerging horizon on BTS is the molecular diagnosis and identification. It includes study of cellular elements, various coagulation proteins, transfusion associated infections, HLA diagnosis etc. Nucleic acid test (NAT) will be a routine test in BTS like ELISA may be after 5-7 years. We should be open to take responsibility of HLA diagnosis, genetic study of RBC and blood and coagulation related problems. Of course it needs special training and expertise. These are all very specialized procedures. It is like a super-specialty among Transfusion Medicine specialists. We should focus ourselves rather than trying to become the ‘jack of all trades’. We can draw our own line and if we decide to take this type of responsibility we should start preparing from now onwards. As you understand, Transfusion Medicine is a semi-clinical specialty and we have not exploited our own specialty. If we go in depth in our subject and learn more, we will be automatically a part of the clinical team.

EDITOR, Transfusion Bulletin, Ahmedabad

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