Letter to the Editor: A Last Resort When There is No Blood: Experiences and Perceptions of Intraoperative Autotransfusion Among Medical Doctors Deployed to Resource-Limited Settings.
Letter to the Editor: A Last Resort When There is No Blood: Experiences and Perceptions of Intraoperative Autotransfusion Among Medical Doctors Deployed to Resource-Limited Settings.
复制标题
致编辑的信：没有血液时的最后手段：部署到资源有限环境的医生对术中自体输血的经验和看法。
DOI：
10.1007/s00268-020-05878-4
复制
发表时间：
2021
影响因子：
2.6
通讯作者：
Roy,Nobhojit
中科院分区：
文献类型：
--
作者：
Raykar,NakulP;Jayaram,Anusha;Puyana,JuanCarlos;Roy,Nobhojit
我们祝贺Sjöholm、Algoum、von Schreeb和《世界外科杂志》对这一重要问题的深思熟虑的突出报道[1]。在低收入和中等收入国家（LMIC）中，及时输血的机会是可怕的。在119个国家中有1.02亿单位的赤字-主要是在撒哈拉以南非洲，南亚和东南亚以及大洋洲-血液需求大于供应。自建“术中自体输血（IAT）是一种在库存血液稀缺的紧急手术情况下弥补血液需求不足的差距的方法。我们在南亚和南美的许多中低收入国家的同事报告说，他们在这些情况下使用了这项技术。然而，从这项研究中可以清楚地看出，广泛采用“自建”IAT需要时间，培训和文化变革，因此存在挑战。我们借此机会强调两个潜在的选择，以改善输血的差距在中低收入国家：低成本的商业方法IAT和流动血库（WBBs）。Hemafuse是一种用于IAT的医疗器械，设计用于低资源环境，配有一个泵装置、25个过滤器（适用于25次使用）、一个附件套件，有效期为一年[3]。这样的设备可以加快血液采集、过滤和输血的过程，并提供目前缺乏的标准化措施。目前2500美元的价格对于世界上资源最少的环境来说可能仍然太贵，但我们希望随着技术的发展，价格变得更实惠。步行血库（WBBs）是另一项出色的创新，可以解决更广泛的输血差距。WBBs是一种输血系统，血液紧急从一群自愿的、预先测试的献血者中采购，这些献血者是根据需要通过当地网络招募的。捐献的全血在经过适当的检测后立即输给受体。几十年来，印度的农村医生一直在使用这种方法，作为在情有可原的情况下挽救生命的最后努力[3]。最近，在严峻的环境中输血在军队中得到了广泛的接受[4]。随着人们对全血输血在出血中的价值的认识不断加深，输血传播性疾病筛查试剂盒的改进，以及通过社交媒体快速动员供体的新技术，民用WBBs应该成为医疗设备中的另一种工具，以更直接地处理1.02亿单位的血液赤字[5]。我们承认，由于在这些环境中缺乏研究，IAT和WBBs的全部风险尚未确定。这就更有理由追求一个积极的研究议程，建立在Sjöholm，Algouth和von Schreeb的工作基础上，关于缩小中低收入国家未满足的血液差距的创新解决方案。无数人在等待传统血库系统扩大规模以满足血液需求时丧生;我们必须同时寻求所有途径。
We congratulate Sjöholm, Algå, von Schreeb, and the World Journal of Surgery for a thoughtful highlight of an important issue [1]. Access to timely blood transfusion in low-and middle-income countries (LMIC) is dire. There is a 102 million unit deficit in the 119 countries—mostly in sub-Saharan Africa, south and southeast Asia, and Oceana—where blood need is greater than supply [2].‘‘Self-built’’intraoperative autotransfusion (IAT) is one method of closing the gap on unmet blood need in emergent surgical situations when banked blood is scarce. Many of our colleagues in LMICs in South Asia and South America report using the technique in these circumstances. As is clear from this study, however, challenges exist in widespread adoption as ‘self-built’IAT requires time, training, and culture change. We take this opportunity to highlight two potential options to improve the blood transfusion gap in LMICs: low-cost commercial methods for IAT and walking blood banks (WBBs). The Hemafuse is a medical device for IAT, designed for low-resource environments, that comes with a pump apparatus, 25 filters (good for 25 uses), an accessory kit, and a shelf life of one year [3]. Such a device could speed the process of blood collection, filtration, and transfusion and provide a measure of standardization currently lacking. The current 2500 USD may still be too expensive for the world’s lowest resource environments but we hope to become more affordable as the technology scales.Walking Blood Banks (WBBs) are another excellent innovation that could address an even broader segment of the blood transfusion gap. WBBs are a system of transfusion where blood is procured urgently from a pool of voluntary, pre-tested donors who are recruited, on demand, through local networks. Donated whole blood is immediately transfused to the recipient after appropriate testing. This has been used for decades by rural practitioners in India as a last-ditch effort to save lives in extenuating circumstances [3]. More recently, it has gained widespread acceptance among militaries for blood transfusion in austere environments [4]. With growing understanding of the value of whole blood transfusion in hemorrhage, improvements in screening kits for transfusion transmissible illness, and new techniques in rapid donor mobilization through social media, civilian WBBs should be another tool in the armamentarium to more directly deal with the 102 million unit blood deficit [5]. We acknowledge that the entirety of the risks from IAT and WBBs is not yet defined due to scant research in these settings. This is all the more reason to pursue an aggressive research agenda, building on the work by Sjöholm, Algå, and von Schreeb, on innovative solutions to narrow the unmet blood gap in LMICs. Countless lives have been lost waiting for traditional blood banking systems to scale to meet blood demand; we must pursue all avenues in parallel.