Overtransfusion?

Following a report in The Star about "Blood supply low in hospitals"

One of the said culprits was the increase in dengue cases leading to the need for transfusion. This raises questions as to whether we are transfusing patients necessarily.

Those of us who have treated dengue will know that on most occasions there is little need to transfuse. One of the main pathophysiology of dengue shock syndrome is the fact the plasma leaks out of the capillaries leading to hypovolemia and thus a drop in blood pressure. The treatment would be to replenish this fluid with intravenous fluids.

Even the drop in platelets rarely require transfusion unless there is evidence of excessive bleeding due to thrombocytopenia.

So are we overtransfusing our patients with dengue and putting them at risk of transfusion related complications?

ECASS 3: Thrombolysis Beneficial Up to 4.5 Hours After Acute Ischemic Stroke

The increase in the time frame for treatment will enable more patients to be eligible for treatment. The previous time frame was only 3 hours.

Unfortunately many centers in Malaysia is still not practising thrombolysis for stroke patients. When patients come in with a stroke, they are practically on their own. Only supportive measures are instituted. The use of thrombolysis is only limited to clinical trials. Costs has been a major hindrance to the wide usage of thrombolysis in stroke patients. Unfortunately administrators have never really realised the enormous costs involved in rehabilitation and care of post-stroke patients with severe disabilities.

Evidence-based medicine is still not practiced in the field of stroke. It opens the doors to litigations if patients do realise that they were not given the best of care.