This article is from: srnnews.com
Without Blood Donations, Magen David Adom Could Not Have Saved Tel Aviv Mother’s Life
Yael Bibi needed about 50 units of blood and blood components just 10 days after childbirth, revealing why hospitals must have tested donations ready before an emergency
By Gabriel Colodro / The Media Line
Ten days after giving birth, Yael Bibi was at home in Tel Aviv with her daughter. It was her husband’s first day back at work. She woke from a nap with the feeling that something was seriously wrong. “I just felt that something bad was happening to my body,” she said. Bibi called her husband and asked him to come home. While he was driving back, she phoned again. “Stay with me on the line,” she told him. “If something happens to me, someone should know.”
Within hours, Bibi was undergoing emergency surgery. She had suffered a severe postpartum hemorrhage and would receive approximately 50 units of blood and blood components before the crisis was over. Few patients ever require that much, but her case helps explain why Israel’s hospitals need donated blood on hand every day, including during the months when collecting it becomes more difficult.
Summer is one of those periods. Many Israelis travel or take vacations, leaving fewer people available to donate. Dr. Shafir Botner, who oversees Magen David Adom’s (MDA) paramedic training program, said MDA experienced a shortage during July and August this year. The supply had stabilized by September, when he spoke with The Media Line at the organization’s national blood center in Ramla, but the collection problem returns during vacations and holidays. “Summer is a challenging time in Israel,” Botner said. “A lot of people are on vacation, and collecting blood from the public is much more challenging than during the rest of the year.”
Collecting a large surplus earlier in the year is not a solution. Blood has a limited shelf life, so units gathered during winter cannot simply be held until summer. MDA follows its inventory and contacts donors whose blood types are in short supply. Botner said type O blood is frequently the hardest to maintain, prompting the organization to approach those donors directly during July and August. “We know that you want to have a vacation with your family,” he said. “We need you to come and donate blood.”
MDA handles both the country’s emergency ambulance service and its national blood bank. Botner said that combination is unusual and gives the organization access to communities throughout Israel as well as a picture of what hospitals are likely to need. Donations collected around the country are taken to the blood center in Ramla, where they are tested and prepared. From there, units are sent to hospitals, the Israel Defense Forces, and MDA helicopters. The blood center is underground and protected against external threats.
Deciding where the blood goes requires constant adjustment. MDA considers the size and location of each hospital, along with the kind of demand it may face. A medical center near the Gaza border, Botner said, cannot be treated in the same way as a small hospital in another part of the country. MDA also keeps an emergency supply in low-temperature storage. Units nearing expiration are moved into regular use and replaced with newer ones. “It’s a delicate balance all the time,” he said. “We need to supply enough units to each hospital according to the needs.”
Bibi had never given much thought to that system before she needed it. When her husband arrived home, she got up to use the bathroom and saw a large amount of blood and clots. Her vision went dark, and she told him to catch her because she was falling. Even then, she thought the bleeding might be a normal part of recovering from childbirth. Friends had told her that postpartum bleeding could stop and then return, so she called a nurse expecting to be sent to a clinic for fluids. The nurse heard what was happening and responded differently. “She told me, ‘No, no, no. You are not going anywhere. I’m sending an ambulance to your home,’” Bibi said.
By the time the MDA team arrived, Bibi said, the color had drained from her face. She still told the paramedics that she could walk to the ambulance. They put her on a stretcher instead. “I didn’t understand how serious it was,” she said. She left home without taking anything with her, convinced that she would receive fluids at the hospital and be back within a couple of hours. Doctors initially could not find where the blood was coming from. A CT scan revealed a bleeding artery in her uterus, and she was told she needed emergency surgery.
During the operation, Bibi said, she lost another liter of blood and developed DIC, a dangerous condition in which the body can no longer clot blood properly. Doctors tried several methods to control the hemorrhage and began transfusing blood and blood components. “I had lost almost all the blood in my body,” she said. “I received about 50 units of blood and blood components. I weigh 42 kilograms, so it was an unbelievable amount.”
Postpartum hemorrhage is seen regularly in hospitals, Botner said, but most cases are controlled with medication. Some women need one or several units of blood. A patient requiring approximately 50 units is a different category. “Fifty is very rare and very uncommon,” he said. “It’s a very exceptional story.” Bibi’s treatment depended on blood that had been collected, tested and made available before anyone knew she would need it.
Bibi remained sedated and on a ventilator for two days. When doctors woke her, she could not stand, and her legs were badly swollen. She needed physical therapy to help her learn to walk again. Having a newborn waiting for her changed the pace of her recovery. “There was someone who needed me,” Bibi said. “As soon as I left the hospital, I was already getting up with her at night, changing her, and taking care of her. That helped me return to life.”
She did not know at first how much blood she had received. Different hospital departments had administered units during different stages of the emergency, and Bibi only began putting the details together after she was discharged. MDA later checked its records using her identification number and told her the total was approximately 50 units and components. “I thought, ‘That’s crazy. How many people had to donate for me to receive all that and still be here alive?’” she said. Until then, she had associated major blood use with terrorist attacks, traffic accidents, and soldiers. “I was a regular person. I had never been sick and had never been hospitalized. Suddenly, 50 units. It can happen to anyone.”
MDA later asked Bibi to speak at an event about what she had survived. She prepared a presentation and assumed that the people in the room were involved in coordinating blood drives. At the end, an organizer asked whether anyone in the audience had donated blood to her. Several people stood and were invited onto the stage. “I started crying, and then they all hugged me,” Bibi said. “Apart from giving birth to my daughter, I don’t think I have ever experienced anything so emotional.”
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