Unlike private hospitals, which are experiencing increased blood product usage over the years, Universiti Malaya Medical Centre (UMMC) is seeing a drop.
Prior to the Covid-19 pandemic, the total blood usage annually was between 24,000 and 25,000 units of red blood cells.
But now, the hospital uses about 18,000 to 20,000 units of red blood cells a year, in addition to 6,000 units of plasma and 5,000 units of platelets.
“Doctors are now more aware about patient blood management, because during Covid-19, no one dared come to the hospital or donate blood, so we learnt to substitute blood.
“If the patient is iron deficient, we either give them iron supplements or iron infusion – there is no need for transfusion.
“There are also minimally-invasive procedures and bloodless surgeries using cell savers or plasma derivatives that use the patient’s own blood and eliminates the need for transfusion,” says UMMC transfusion medicine specialist Dr Christina Lee Lai Ling.
However, transfusion is still needed in the emergency department; for liver/kidney/bone marrow transplant patients, both in adult and paediatric populations; and in intensive care units (ICUs).
Since UMMC’s blood bank was established in 1965, it has been collecting blood for its own patients’ use, while also providing a nearby private hospital with blood products.
Besides housing a blood donation centre at its premises in Kuala Lumpur, UMMC also operates another one in the Sunway Pyramid shopping mall in Petaling Jaya, Selangor, and runs numerous campaigns throughout the year to replenish its stock.
Due to the high volume of patients, the hospital keeps a minimum of seven days’ worth of red blood cell stock, and at any one time, there are at least 400 units of screened red blood cells available in its blood bank.
Inventory is checked once daily, and twice when supplies run low.
“We are 95% independent, but since we are a hospital-based blood bank, at certain times or in special cases where we require extremely rare blood types, we still need blood from the National Blood Centre (also known by its Malay acronym PDN) because our pool is not very big.
“Every day, our blood stock fluctuates, so we also go by urgency, because in transfusion, we have this rule of thumb of elective transfusion, emergency transfusion or essential transfusion.
“So, in any emergency, PDN will try to accommodate us,” Dr Lee says.
For example, if UMMC has used up all its O negative blood and a patient is still bleeding on the table, PDN will help out by providing a few units until the patient is stabilised.
She adds: “At the same time, we also do our bit to reach out to our regular O negative donors.”
Answering the call
As more than half of their donors are of Malay ethnicity, naturally, there is a dip during the month of Ramadan.
In a recent case of a young man who was involved in a massive car accident on the second week of Ramadan and needed transfusion urgently, 26 of his friends quickly came to his rescue on the same day – some from out of state.
They queued in a long line to donate.
It tugged at Dr Lee’s heartstrings because the patient was so loved and had friends so willing to step up and donate.
Just a few weeks ago, a West African child was admitted to UMMC due to sickle cell disease and was badly in need of blood transfusion.
But his blood type was Duffy A negative B negative (Duffy-null phenotype), which is common among the African population, but extremely rare among Asians.
Individuals with the Duffy-null phenotype are generally immune to malaria due to the absence of the Duffy protein on red blood cells, which is a receptor for the malaria parasite.
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Dr Lee shares: “We had to tell the family that this blood type is very rare among Malaysians, so they started sending WhatsApp messages to their friends.
“It went viral and a lot of people from their country turned up at UMMC to donate blood for the boy.
“That was so beautiful.”
UMMC has a clause that you must be living in Malaysia for at least one year before you can become a blood donor, therefore all these donors must have been residing here for a while.
Based on her observation, Dr Lee says most young female donors are already iron-deficient, but don’t know it, so she advises them to space out their donating intervals.
