If you look in the mirror and pull down your lower eyelid, you will see its quite red on the inside. We do this to our patients here all the time to get an idea of how anemic they are – anaemia is when the amount of red stuff in the blood – haemoglobin - is reduced below normal – and if there is less of it in the blood the inside of the eyelid is shades of paler red , pink even, or in the woman we looked at a couple of days ago, virtually white. To get a better idea of the severity of anaemia a blood test measures the Haemoglobin level, and normal is above 120; in Australia if is below 70 this is regarded as severe and would usually be treated with a blood transfusion. Mine, when last checked was 143. And that woman with the white eyelids ? 19!! She is at serious risk of dying from heart failure as the tissue demand for Oxygen, which is what haemoglobin carries , makes the heart pump harder and faster trying to get what little useful blood remains in her vessels to whip round and supply all the oxygen starved tissues which themselves are functioning badly as a result. And those demands increase further if she is sick, fighting disease or the effects of surgery, or trying to recover from a difficult birth.
Everyone admitted to our unit has her Hb checked, and as virtually none is in the normal range , everyone gets a dose of antiworming medicine, iron tablets and a Malaria check. In my first week here we had a dozen or so pregnant women with malaria, so they received a standard antimalarial drug regime which usually cures them in three days. All women are given a brand new mosquito net which is impregnated with a mosquito repellant that lasts for five years, plus some soap, and they erect the net over their hospital bed and take it home with them when they leave. If the womans Hb is over 50, that’s all the treatment she gets. If its less, depending on her condition she may get blood but its in very short supply. Family members are recruited as donors, but if none is suitable but the very small Hospital Blood Bank has a suitable Unit of blood, it may be used as long as someone in the family donates a replacement unit, albeit of a Type that cant be given to the relative. That way the Blood Bank tries to maintain its meager stock of a few Units.
We give a maximum of two units to anyone who is not actively bleeding, and did so to that woman with Hb = 19. While she was receiving it I was asked by one of the Medical Assistants to prescribe for her drugs to treat malaria and also Syphilis. “I wasn’t aware she had malaria and syphilis” I said to him. “No, she does not have it” He replied “But the relative who donated the blood has and so we have to use it, but we must treat her as well”
So we gave her syphilis and malaria, as well as the blood.