It appears Shaka Wilson, a citizen of Eilandgebied Sint Maarten (Island Territory of St. Maarten), and her unborn baby died because St. Maarten has no blood bank, and the St. Maarten Medical Center was unable to get blood from other sources in time. This is 2010, not 1950, and the people on St. Martin still seem to be treated as "unworthy indigenous natives" not entitled to the quality of medical care afforded to citizens of Hollard, France or the entire European Union. There is absolutely no excuse for St. Maarten not to have a working blood bank!
According to the brilliant interview conducted by SMN News, "...But he <Dr. Michel Petit> was informed that the doctor in charge did not want to operate because the patient had severe HELLP syndrome and her platelets were very low. According to what I <Dr. Michel Petit> was told by Dr. Friday the patient had no coagulation and the risk of operating was rather high." The risk of operation may have been high, but only due to the lack of a blood transfusion (see below).
He said the hospital did not have the amount of blood needed and the doctor felt it was better for him to wait for blood which was to be sent from Curacao the following day. "The patient was very sick but the doctor had to take an immediate decision to assist the baby and mother."
On St. Maarten it's the decision that counts, there is no blood bank and other necessities here and doctors have to use their best judgment to save lives." Wait for the blood until the following day?
From the article: "He said when the first blood test was done the patient had a platelet count that was over 170,000 and when the second blood test was done a month ago it was 70,000. This shows that her platelet count dropped by 60% and the doctor did not take heed. Even though all of this happened the doctor who treated her when she was in the hospital did not see it fit to notify him."
The platelet count has been found to be moderately predictive of severity: under 50,000/mm3 is class I (severe), between 50,000 and 100,000 is class II (moderately severe) and >100,000 is class III (mild). This system is termed the Mississippi classification. (Martin JN, Blake PG, Lowry SL, Perry KG, Files JC, Morrison JC (1990)) "The outcome for mothers with HELLP syndrome is generally good. With treatment, maternal mortality is about 1 percent." Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA (1993).
"Five to seven percent of all pregnant women in the United States develop preeclampsia and between two and 12 percent go on to suffer from HELLP Syndrome. Best estimates are that HELLP Syndrome occurs in one per 150 live births (about one half of one percent), with a maternal mortality rate of 3.50 percent. These numbers will vary with attention to the mothers care. If preeclampsia is diagnosed early and the baby is delivered, HELLP may not develop. The rate of HELLP and the mortality will then be lower than stated." -- Preeclampsia Foundation
Treatment for HELLP include blood transfusions (for severe anemia and low platelets), magnesium sulfate (to prevent seizures), antihypertensive medications (to reduce blood pressure), fetal monitoring (to check the health of the fetus), laboratory testing of liver, urine, and blood (for changes that may signal worsening of HELLP syndrome), medications, called corticosteroids, that may help mature the lungs of the fetus (lung immaturity is a major problem of premature babies) – all of which should be available to all patients on St. Maarten!
In clear language, with a blood transfusion, Shaka Wilson and her baby had a 97% to 99% chance of survival. So why not have a blood bank in St. Maarten? The cost? No need? No capability? No understanding of the urgency of blood in medical emergencies?
What are "blood banks" and what do they collect and store?
A blood bank is a cache or bank of blood or blood components, gathered as a result of blood donation, stored and preserved for later use in blood transfusions. Most hospital blood banks perform testing to determine the blood type of patients and to identify compatible blood products for blood transfusions, along with a battery of tests (e.g. disease) and treatments (e.g. leukocyte filtration) to ensure and enhance quality. "Whole blood" (WB) is the proper name for one defined product, specifically unseparated venous blood with an approved preservative added. Most blood for transfusion is collected as whole blood. Autologous donations are sometimes transfused without further modification, however whole blood is typically separated (via centrifugation) into its components, with Red Blood Cells (RBC) in solution being a commonly used product. Units of WB and RBC are both kept refrigerated at 1-6 C, with maximum permitted storage periods (shelf lives) of 35 and 42 days respectively.
The less-dense blood plasma is made into a variety of frozen components, and is labeled differently based on when it was frozen and what the intended use of the product is. If the plasma is frozen promptly and is intended for transfusion, it is typically labeled as fresh frozen plasma. If it is intended to be made into other products, it is typically labeled as recovered plasma or plasma for fractionation. Cryoprecipitate can be made from other plasma components. These components must be stored at -18C or colder, but are typically stored at -30C.
Blood banks have been around since 1915. By the mid-1930s, the Soviet Union had set up a system of at least sixty large blood centers and more than 500 subsidiary ones, all storing "canned" blood and shipping it to all corners of the country. An important breakthrough came in 1939-40 when Karl Landsteiner, Alex Wiener, Philip Levine, and R.E. Stetson discovered the Rh blood group system, which was found to be the cause of the majority of transfusion reactions up to that time. Three years later, the introduction of acid-citrate-dextrose (ACD) solution, which reduces the volume of anticoagulant, permitted transfusions of greater volumes of blood and allowed longer term storage.
Routine blood storage is limited to several weeks (5 for WB, 6 for RBC), and involves refrigeration but usually not freezing. Cryopreservation of red blood cells is done to store rare units, usually for up to three years. Very rare units may be kept even longer. The cells are incubated in a glycerol solution which acts as a cryoprotectant ("antifreeze") within the cells. The units are then placed in special sterile containers in a freezer at very cold temperatures.
Who needs blood?
The need for blood is great. Every day in the U.S., approximately 40,000 units of blood are required in hospitals and emergency treatment facilities for patients with cancer and other diseases, for organ transplant recipients, and to help save the lives of accident/trauma victims. In 2006, more than 30 million blood components were transfused. And with an aging population and advances in medical treatments and procedures requiring blood transfusions, the demand for blood continues to increase.
What are the criteria for blood donation?
Volunteer donors provide all blood used for transfusion in the United States. To be eligible to donate blood, a person must be in good health and generally must be at least 16 years of age (or in accordance with applicable state law). Minimum weight requirements may vary among facilities, but generally, donors must weigh at least 110 pounds. Most blood banks have no upper age limit. All donors must pass the physical and health history examinations given prior to donation. Individuals may be temporarily ineligible to donate due to mild illnesses (colds or flu), symptomatic allergies, hypertension, diabetes and anemia. The donor's body replenishes the fluid lost from donation in 24 hours. It may take up to two weeks to replace the lost red blood cells. Whole blood can be donated once every eight weeks (56 days). Two units of red blood cells can be donated at one time, using a process known as red cell apheresis. This type of donation can be made every 16 weeks.
Everyone should know what their blood type is, and your doctor should order a test and tell you for emergency situations. 39% of the general population has O positive blood, which are "universal donors" because anyone with another blood type can receive their blood. 31% have A positive blood. All others are between 9% and 1%.
It should be obvious that a blood bank is necessary. Hemorrhage is a medical emergency that is frequently encountered by physicians in emergency rooms, operating rooms, and intensive care units. Significant loss of intravascular volume may lead sequentially to hemodynamic instability, decreased tissue perfusion, cellular hypoxia, organ damage, and death. Hemorrhagic shock can be rapidly fatal – especially in car accidents when patients are not transported immediately to a medical care facility. The primary goals are to stop the bleeding and to restore circulating blood volume – through blood transfusion. In Afghanistan 98% of traumatic injury patients survive when they arrive at the U.S. hospital on the Bagram Air Base. Can the SMMC claim the same success without a blood bank?
With the 2010 hurricane season rapidly approaching and the probable high number of traumatic injuries from flying objects, blood supplies are urgently needed on St. Maarten. To delay the acquisition of everything needed to properly store large amounts of blood is to increase the chance of additional preventable deaths such as the case of Mrs. Shaka Wilson and Baby Wilson.
Dr. Claude Bordelon, M.D.
