In my last article I made the comment “To lose a baby
is very sad. To lose the mother is a tragedy”. Tragically
this quote was a prophecy for a young mother and her unborn
child, who both lost their lives needlessly no more than a
few days ago.
My phone rang, and I was addressed by a very well spoken
Indonesian gentleman. He was calling me from Central Java.
“I am sorry to disturb you,” he said. “It’s
my sister, 25 years old, it’s her first baby. She was
very pregnant, ready to deliver, but she started bleeding
badly. Her blood group was AB Negative, and I heard that you
keep a list of people with negative blood groups that will
donate in cases of emergency”. “Yes I do”
I replied, “but they are all in Bali, I don’t
know if I could get anyone to you in time”.
“ You could not,” he said. “ She was bleeding
yesterday. She needed 5 units of blood and in the whole town
we could find only one person who had a negative blood group.
She died with her baby at 5 o’clock this morning”.
I could hardly compose myself through the shear anger, frustration
and deep sadness that I felt for this man and his family.
Why had this woman’s doctor not checked her blood group
long before tragedy struck? This is a standard practice in
pre-natal care. After expressing my condolences, I questioned
him as to how I could be of assistance. I felt entirely helpless
to this man. Somehow through his grief, he had the determination
to take action to ensure that this would not happen again
in his town. He was asking me for help to establish a Rhesus
negative donors register for his community.
Let’s look at the relevance of the Rhesus negative
blood group, and why it can be such a problem in this part
of the world. When we type blood groups there are basically
2 factors to consider. The ABO type, and Rhesus type. Of the
ABO type you could be A, B, AB, or O. Any of these groups
may be Rhesus positive, or Rhesus negative. (E.g. Blood type
A Rh Pos or A +). When we consider donors and recipients for
transfusion, the following matches can be made:
A + may receive from A+, A-, O-, and may donate to A+.
B + may receive from B+, B-, O-, and may donate to B+.
AB + may receive from A+, B+, AB+, O+, A-, B-, AB-, O-, and
may donate to AB+.
O+ may receive from O+, O-, and may donate to O+.
A- may receive from A-, O-, and may donate to A-, A +.
B- may receive from B-, O-, and may donate to B-, B +.
AB- may receive from AB-, O-, and may donate to AB -, AB+.
O- may receive from O-, and may donate to A-, A +, B-, B+,
AB+, AB-, O-, & O+.
As you can see from this chart, if you could choose your
blood group and you were a selfish person, I’d go for
AB +. You can receive blood from anyone! If you considered
yourself a generous person go for the O -, then you would
be the “Universal donor”. This explains why O
negative donors are so revered. A bleeding trauma patient
can be saved with this blood as no timely cross matching is
necessary.
So why the big hoo-ha about negative donors in Asia? The
Caucasian (white) population averages about a 15 -25 % negative
blood group type. The Asian population averages about 5%.
So, if you are a bleeding Caucasian (with a negative blood
type), in an Asian country, you are in trouble.
How did this unfortunate Mother in a Javanese town come to
have a negative blood group? She was originally from Jakarta,
one grandparent was British, one great grand parent was Spanish;
not uncommon in the colonies. Both grandparents had passed
a negative gene down the line; any of their descendants receiving
two negatives would demonstrate a negative blood group. (This
is getting a little complicated, but for anyone that is following
me, the Rh factor is a negative gene, and will not show up
if a positive gene is present).
Being Negative & Pregnant.
As I mentioned previously, it is standard prenatal care to
check a Mothers blood group early in the pregnancy. The relevance
is clearly demonstrated by the tragic outcome of our mother
in this story. If you need blood in a hurry, you need to know
your blood group, and whether or not that blood is readily
available.
There is another consideration for the pregnant negative
mother, Rhesus incompatibility disease of her baby. If the
father of the child has a rhesus positive blood group, the
baby will more than likely be positive (unless the Father
is carrying a hidden negative gene). This should not be a
problem unless the mother’s and babies blood accidentally
mix. Not a common occurrence, but can occur if there is a
small placental tear, or from previous births, or miscarriage.
Once the mother’s negative blood has been exposed to
the babies positive blood, she will build up antibodies against
the baby. In effect, she builds up an “allergy”
to her own child. This has serious implications for the unborn
child if it is left unchecked. This mother needs to have serum
antibodies assessed at various stages of the pregnancy.
She will need to receive an injection of Anti-D (or Rhogum),
if the antibodies rise and at delivery of each child to prevent
her from building up these antibodies against future pregnancies.
Some babies born affected with blood that is being “destroyed”
by mother’s antibodies will have to be treated with
an exchange blood transfusion at or soon after birth. In developed
countries they are actually performing these transfusions
while the baby is still in the womb.
Solutions.
So what do we do here to prevent situations of needless loss
of life when the correct blood is not available? That’s
right, give up your half a liter of liquid life, and give
it up soon! The recent Dengue fever epidemic has left the
blood supplies sadly depleted of every blood type, not only
the rarer Rhesus negative groups. The Rotary / Red Cross donor
unit is situated at Sanglah hospital, all their equipment
is sterile & single use (disposable),and they are very
professional. In addition, the Mobile Blood Ambulance can
visit your home or hotel for blood donations. Please contact
227224 or 247739.
Not all people are able to donate their blood. Those unable
to donate are:
Age less than 17 or over 65 years.
Hemophiliacs.
Anyone carrying a blood borne disease (i.e. Hepatitis B or
C, Malaria, HIV).
Those in poor general health.
Pregnant or breast feeding women.
Menstruating women.
Anyone suffering from any kind of anemia.
Persons recently immunized with live vaccines (Polio, BCG,
Rubella).
I do keep a register of negative people here on the Island.
If you would like to register yourself, please contact me
by Ph/fax 283541, or balikim2000@hotmail.com. If you do register
yourself as an emergency donor, remember that you have to
be prepared to be called at awkward hours, and give up a bit
of your time. It doesn’t happen very often, but when
it does, you can be assured that a genuine emergency is at
hand.
My Rhesus negative register currently stands at about 21
emergency donors. Two of them are Balinese, which means that
nineteen donors are Caucasians living on the island. Nineteen!
By my calculations with an expatriate population now in the
thousands, I would expect to have about 400 Rh negative “Bali
Bules” ready to give it up for their fellow neg’s!
Here’s what to do before the next Advertiser edition
goes on the stands:
Give yourself a “Gold Star” and find out your
own blood group. Any lab can do this for you, and it is not
expensive (Not more than Rp 30,000).
Give yourself 2 Gold Stars and give up your half a liter at
the Red Cross.
Give yourself 3 Gold Stars and register yourself as an emergency
donor or donate on a regular basis, if you are Rh negative.
Now sit back and enjoy that warm fuzzy feeling you get when
you know that you have saved a life!…………..’til
next edition, stay happy, stay healthy and stay young!
“ Kim Patra is a qualified Registered Nurse / Midwife,
and mother of three, who has been living and working in Bali
for past 15 years. She has assisted many traveller (... and
others) either as a flying medical escort or just a voice
on the end of the phone! Kim is happy to discuss any health
concerns that your may have. Her e-mail contact is info@chcbali.com
