BLOOD TRANSFUSIONS - GENERAL

Blood transfusions

Before the AIDS epidemic, you probably wouldn't have worried unduly about this issue but now it's something you need to have at least thought about before you go, especially if you're travelling to less-developed countries that can't afford to screen blood for HIV infection. Although blood transfusion can be lifesaving in certain situations, it's worth remembering that it's a risky procedure wherever you are - it's just that this risk is increased in countries with limited resources for screening blood. It's not just HIV that's a concern, blood transfusions are associated with other problems too:

• transmission of HIV, malaria, hepatitis B, C and D, syphyllis, Chaga's disease and viral illnesses
• serious allergic and other reactions if the blood is not matched properly

Efforts are being made to ensure equity throughout the world in the provision of safe blood but there's a long way to go - currently fewer than 225 countries in the world can meet internationally agreed standards for blood transfusions, and most of these are in North America and Western Europe. Even where blood is screened for HIV infection, there's a risk of missing early infections, and this risk is greater in countries with higher HIV infection rates (for example Thailand). In Asia, the only country you can rely on getting safe blood supplies is Japan.

Before you get too paranoid, remember that the chances that you will need a blood transfusion while you are away are pretty small. One study estimated that in a two-week trip, about 1 in 10,000 travellers would need a blood transfusion. Your risk obviously increases the longer you are away, and if you are doing risky activities like rock climbing or trekking.

Although it's probably down to fate in the end, there's a lot you can do to minimise your risks of needing a blood transfusion:

• take steps to avoid injury, especially road traffic accidents (the most likely reason for needing a blood transfusion if you're otherwise healthy)
• avoid travelling in countries with unreliable blood supplies if you have a condition that might mean that you need a blood transfusion eg pregnancy or stomach ulcer
• be aware that blood should be transfused only when absolutely necessary, and in many cases non-blood fluids can be safely used instead in the short term - in practice, however, you'll have to rely on someone else's opinion on this
• if a blood transfusion is unavoidable, try to make sure it's from as reliable a source as possible - check with your embassy or the local expatriate community for safe local sources, or consider joining the Blood Care Foundation before you leave

If you're going on more than just a short trip, you might want to consider joining the Blood Care Foundation. This charitable organisation has a global network of blood banks that can supply travellers with safe blood and sterile transfusion equipment within 12 hours anywhere in the world. The blood reaches you via courier, who can be a paramedic, a transfusion specialist or an emergency physician. Membership rates are very reasonable considering the peace of mind you get, and various types of membership are available, depending on whether you are a short-term traveller, part of a group or taking the whole family.

It's a good idea to make a note of your blood type and to keep it with you on your travels.

Note that China doesn't have supplies of Rhesus negative blood. This might be a problem if you're a woman of child-bearing age who is rhesus negative. If you think this may be a problem for you, discuss with your doctor before leaving.

Injections & other medical procedures

Needles or other medical or dental equipment that may be contaminated with blood or body fluids can transmit HIV and hepatitis. Lack of resources and less rigorous sterilisation procedures in many less-developed Asian countries make this a real risk. Avoid injections as far as possible. It's a good idea to carry a few sterile needles and syringes with you in your medical kit (with an official note to say why you are carrying them) and to insist on them being used if necessary. Prepacked 'AIDS packs' are available from most travel health clinics and travel equipment suppliers. If you do need an injection, make sure you see the sterile wrapping opened in front of you.

A few points to remember

• minimise your risks of needing medical or dental procedures while you are away by having medical and dental check-ups before you go, and taking good care of yourself while you are away
• any equipment used for a medical or dental procedure can be contaminated if it is not properly sterilised
• avoid injections whenever possible - ask if there is a tablet you can take instead
• boiling needles for 20 minutes will inactivate HIV
• never share needles
• acupuncture needles, tattooing, ear, nose or body piercing all carry risks of infection

Associated Medical Information