Exposure to blood or other body fluids
Blood transfusion is a life-saving intervention. When used correctly, it saves lives and improves health. However, blood transfusion carries a potential risk of acute or delayed reactions and transfusion-transmissible infections and should be prescribed only to treat conditions associated with significant morbidity that cannot be prevented or managed effectively by other means.
For travellers, the need for a blood transfusion almost always arises as a result of a medical emergency involving sudden massive blood loss, such as:
- accidental injury, such as road traffic accident
- gynaecological or obstetric emergency
- severe gastrointestinal haemorrhage
- emergency surgery.
The safety of blood and blood products depends on the following key factors:
- A supply of safe blood and blood products through the careful selection of voluntary unpaid blood donors from low-risk populations who donate regularly, testing all donated blood for transfusion-transmissible infections, and correct storage and transportation at all stages from collection to transfusion within an adequate quality system.
- Appropriate prescription (only when there is no other remedy), proper cross-matching between the blood unit and the recipient, and safe administration of the blood or blood product at the bedside, with correct patient identification.
In many countries, safe blood and blood products may not be available in all health care facilities. In addition, evidence from every region of the world indicates considerable variations in patterns of clinical blood use between different hospitals, different clinical specialities and even between different clinicians within the same speciality. This suggests that blood and blood products are often transfused unnecessarily.
While blood transfusions given correctly save millions of lives every year, unsafe blood transfusions – as a result of the incompatibility of the blood, the volume transfused or the transmission of infections such as hepatitis B (HBV), hepatitis C (HCV), HIV, malaria, syphilis or Chagas disease – can lead to serious reactions in the recipients.
The initial management of major haemorrhage is the prevention of further blood loss and restoration of the blood volume as rapidly as possible in order to maintain tissue perfusion and oxygenation. This requires infusing the patient with large volumes of replacement fluids until the haemorrhage can be controlled. Some patients respond quickly and remain stable following the infusion of crystalloids or colloids and may not require blood transfusion.
In malaria-endemic areas, there is a high risk of acquiring malaria from transfusion. It may be necessary to administer the routine treatment for malaria to the transfused patients (Chapter 7).
- Travellers should carry a medical card or other document showing their blood group and information about any current medical problems or treatment
- Unnecessary travel should be avoided by those with pre-existing conditions that may give rise to a need for blood transfusion.
- Those on treatment of anaemia, should carry and take required medications to avoid worsening of anaemia.
- Travellers should take all possible precautions to avoid involvement in traffic accidents or other accidental injuries (Chapter 4).
- Travellers should obtain a contact address at the travel destination, in advance, for advice and assistance in case of medical emergency.
- Travellers should discuss with attending physician on the use of alternatives to transfusion, if the need arises.
- Travellers with chronic medical conditions such as thalassaemia or haemophilia, which may necessitate regular transfusion of blood or plasma-derived products, should obtain medical advice on the management of their condition before travelling. They should also identify appropriate medical facilities at their travel destination and carry a supply of the relevant safe products with them, if appropriate.
Accidental exposure to blood or other body fluids
Exposure to bloodborne pathogens may occur in case of:
- contact between blood or body fluids and a non-intact skin or with mucous membranes;
- percutaneous injury with needles or sharp instruments contaminated with blood or body fluids.
These exposures may occur:
- when using syringes and needles that are not sterile or that have already been used and may therefore be contaminated with blood or body fluids even if this is not visible to the naked eye;
- as a result of accidents or acts of violence, including sexual assaults;
- in case of sexual exposure if no condom was used, or if the condom was broken;
- as occupational exposure, within and outside health care settings, to health care and other workers (such as rescuers, police officers) in the course of the work or to patients;
- during natural or man-made disasters.
Accidental exposure may lead to infection by bloodborne pathogens, particularly HBV, HCV and HIV. The average risk of seroconversion after a single percutaneous exposure to infected blood is approximately 2% for HCV and 6–60% for HBV. For HIV, the average risk of seroconversion after a single percutaneous exposure to HIV-infected blood is 0.1–0.3%.
Pre-exposure vaccination. Hepatitis B vaccination can be given before exposure to protect travellers from HBV infection (Chapter 6). There are no vaccines for HCV or HIV.
Post-exposure prophylaxis. Post-exposure prophylaxis (PEP) is an emergency medical response given as soon as possible after potential exposure to reduce the risk of transmission of bloodborne pathogens. It is available for HIV and HBV.
Accidental exposure to potentially infected blood or other body fluids is a medical emergency. The following measures should be taken without delay:
- Immediate first-aid care.
- Refer to a service provider and report the accident.
- PEP, if applicable.