I give lectures on Blood Conservation and especially on "Appropriate Clinical Use of Blood" to clinicians, nurses and medical scientists as well as being a Member of the College of Primary Care Physicians (CPCPZ), Zimbabwe.
During my 14 years as Director, Blood safety and Clincal Technology at WHO, Geneva, Switzerland, I published, amongst many other publications, the Manual on "Appropriate Clinical Use of Blood", which is in the format of a Clinician's pocket handbook and also as a full Manual for each Hospital Ward and Operating Theatre.
These publications were evaluated and assessed at global level, which is covered by WHO"s 6 Regional Offices and had to be evaluated against all conventional and documented evidence based materials (such as the well quoted "Cochrane Review", before WHO would translate and publish these into all 6 WHO official languages and at least 5 other languages, and many other languages. They have been published in hard copy and through the WHO's Web Page for global electronic access.
During the development I was also invited to present this material at a meeting hosted by the New York Academy of Medicine and at a NATO Conference, in Washington, on blood management and blood conservation for Nato Troops. In addition the concerns and philosophy of the Jehovah's Witness were addressed, through direct face to face discussions with their principals in USA and UK.
The overall message is that blood should only be administered to save a life or prevent severe complications of morbidity. The Blood Transfusion Service is heavily involved in lectures and promotional materials to ensure these principles are promoted at undergraduate and postgraduate levels. Clinicians are encouraged to ensure that they take responsibility to adhere to the principles incorporated in these materials, based on WHO's Recommendations and Guidelines, and take responsibility for their decisions and actions and are accountable.
In cases of emergencies there is often no alternative other than to replace the only Oxygen carrying product – Red Blood Cells. In chronic conditions, where the patient is stable, conservative management is always encouraged. The web pages referred to provide useful information for promoting appropriate clinical use of blood through transfusion and encouraging alternatives to "Volume Replacement" and red cell production, in a stable patient; (unrelated to red cell oxygen carrying capacity to sustain life or prevent tissue or neuronal damage, when the haemoglobin levels fall too low to ensure tissue oxygenation, with the result of permanent damage or death).
I shall be prepared to meet, face to face, with the correspondents, if they are genuine and wish to engage in a constructive medical and physiological discussion, other than a faith based ideological discussion; they may e-mail me directly and I shall provide them with an opportunity to debate their views with me, directly.
Dr Jean C Emmanuel MD
Consultant Medical Director
National Blood Service, Zimbabwe