Thoughts about blood transfusions and blood tests.

‘My mother—in—law died of hepatitis after she had a blood transfusion. So some years later when I was scheduled for surgery, my husband insisted that any blood I received come from friends who had offered to donate blood rather than from unknown donors. But this wasn't so easy to arrange. In fact, at first we were told this would be impossible——the

byMaflanTompson hospital blood bank just wasn't set up that way.But my husband persisted.

_ _5"°#W°D“°Q°" He contacted the director of the blood bank, got support from our physi-

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cian, and finally was promised that blood which would then be specifi- cally earmarked for my use would be accepted from my friends. It took a great deal of effort, including the threat of a lawsuit if I should contract a disease as a result of transfusions not traceable to the donor, before our conditions were met. A lot of energy was expended to ensure what seemed to us to be merely good common sense——knowing where the blood that was to go into my veins came from!

‘Sometimes one can get away without a transfusion. When our friend Iris' hemoglobin plunged to six after a long and difficult delivery, her friends were surprised to discover she hadn't been given a blood trans- fusion. But Iris' obstetrician, having noted that her physical condi- tion was basically stable, instead had prescribed two intramuscular iron shots along with iron supplements, and in a month her hemoglobin was back to normal.

Ilf you've ever had blood drawn in a hospital, you might have been under the same impression as I was that the phlebotomist (the person drawing your blood) had some special schooling or certification before being allowed to puncture your vein. A few years ago, I was surprised when a friend with no previous medical training walked into a local hospital and was hired as a phlebotomist. Within a few days, she was drawing blood from patients, including newborns. In most states, phlebotomists learn while they earn, which is fine, but until the National Phleboto—' mist Association was formed recently, there was no organized effort to establish standards of competency or to monitor adherence to those standards. Naturally, some phlebotomists are more capable than others. As my friend explained, some of them will poke around even if, in their determination to get a specimen, they can't see the vein. And they often will blame the patient for having veins that are too small or too hard to locate. If that's the case, my friend says, ask for another phle- botomist. The ability and experience of the phlebotomist might be the problem, and not the patient's veins. When you find someone you feel comfortable with, be sure to ask for that person by name the next time you have to have blood drawn.

0 Patients have no control over the volume of blood drawn for testing, and sometimes more is taken than is actually needed. I wonder about the negative effects on people who have blood drawn frequently during a hospital stay. Can they be monitored in a less invasive manner? Itsuro Yamanouchi, a Japanese doctor, has invented a device which measures the bilirubin in the blood of jaundiced infants without even puncturing the skin. Might this kind of approach replace other blood testing in the future? Obviously there is much more to learn.