Expats with Common Blood Type at Risk in Hong Kong

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Hong Kong Red Cross Blood Transfusion Service appeals for blood donations as Hong Kong blood inventory levels dropped below normal.

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The city’s blood supply... needs a daily donation turnout of 1,100 donors to get back to where it should be...

On January 8th, 2015 the Hong Kong Red Cross Blood Transfusion Service (BTS) released an urgent statement appealing for Hong Kongers to donate blood as blood inventory levels dropped to well below normal. Resting at 50% of its normal level, the city’s blood supply, already taxed by cold winter months and overcrowded hospitals, needed a daily donation turnout of 1,100 donors to get back to where it should be according to a BTS spokesperson.

Even if the BTS is able to meet its goals and replenish Hong Kong’s overall supply of blood, which can be used on the general population in treatment of everything from car accidents, to postpartum hemorrhages, to surgeries, to cancer, there will still be a demographic that is left in the cold should they be in serious need of a blood transfusion: Caucasian expats.

A Deadly Difference

Many expats in Hong Kong are at risk because Caucasian people are much more likely to need rhesus factor negative (Rh-negative) blood than ethnic Chinese people. In fact, while 1 in 7 white people are born Rh-negative, only 1 in 370 Chinese people are. The resulting low demand and supply of Rh-negative blood means that, given the right set of circumstances, any Rh-negative person in Hong Kong would end up dead even with the best doctors and technology that the city has to offer, simply because there is not enough of the blood they need to keep them alive.

Numbers Don't Lie

The average adult male body can contain up to approximately 5.5 litres of blood, which is the size of about 12 standard units of blood. (The amount of blood found in the average female body is substantially less.) 40% of blood in the body, or about 5 units in this example, can be lost before a person begins to go into shock. If 6-8 units are lost, the person could die. The scary thing is Hong Kong’s 6 major public hospitals only carry 2 units of Rh-negative blood.

What’s more, according to Dr Lucy Lord of Central Health Medical Practice, private hospitals in Hong Kong have no Rh-negative blood on hand, with the exception of Matilda Hospital. She added, “ The Queen Mary Hospital sometimes has Rh-negative blood, but not always.” This inconsistency is not reassuring to the Rh-negative patients of Hong Kong.

The American Red Cross states that a single car accident victim can require as many as 100 units of blood. So how many units of Rh-negative blood can be found in the entirety of Hong Kong? If you took the 2 units found at each public hospital, plus the 4 units at the Matilda, and combined that with the full reserve supply that can be found at the HK Red Cross Blood Transfusion Services Headquarters in King’s Park, you would get…66 units.

It should be noted here that after a person has received approximately 20 units of transfused blood, a patient is ‘washed out’, so Rh-positive blood can safely be used on most Rh-negative patients in conjunction with an anti-D reagent.

The real concern when an emergency occurs in Hong Kong for which Rh-negative blood is needed is how much time it will take to obtain enough blood. Depending on the location of the hospital a patient is being treated in and traffic conditions, it has been estimated that it could take up to 2 ½ hours for a delivery to travel from Hong Kong’s main store of Rh-negative blood.

Finding the Right Balance

Of particular interest to Dr Lord are her patients who are expecting mothers with Rh-negative blood. She highlights cases of postpartum hemorrhaging in which the patients lose blood at a rapid rate. One of Dr Lord’s focuses over the past couple decades has been stocking Matilda Hospital in particular with Rh-negative blood, as Matilda has a disproportionately large number of Caucasian patients when compared to Hong Kong’s other hospitals. Further complicating matters is that, due to Matilda Hospital’s location, if traffic is bad it can take up to 2 ½ hours to courier blood from the blood bank in Kowloon to the Matilda.

Thankfully, the Matilda now keeps 4 units of Rh-negative blood on hand, which is supplied from a 3rd party service outside of Hong Kong on a regular basis. However, some believe that this number of Rh-negative units on hand should be increased to 6, as many hemorrhages resulting from a delivery require 4 units of blood to treat, while extreme cases may require a full 6 units. In the event that the hospital does not have enough Rh-negative blood on hand, Rh-positive blood could be used, but this would lead to permanent sterility in the patient.

The concern for hospital administrators on this issue is finding a balance between having an adequate supply of Rh-negative blood on hand, and overspending on a blood type that is more likely than others to not be needed. Thus far, budgetary concerns have won out over supply concerns despite the recommendations of those like Dr Lord when it comes to increasing supply levels to 6 units on Rh-negative blood at Matilda Hospital.

Protecting Yourself

If you are an individual with Rh-negative blood, what can you do to ensure that there is an ample supply of your blood type in Hong Kong? Of course, donating blood regularly is the first step. Beyond that, seeking out and raising awareness among other people who would need Rh-negative blood would also be a great step towards creating a list of regular donors who could, in effect, look out for each other by donating their blood through the Hong Kong Red Cross Blood Transfusion Services.

Beyond this, there are people in Hong Kong actively working to get more Rh-negative blood into the city. Dr Lucy Lord herself works with a recently set up charity that is raising HK$140,000 to provide Rh-negative blood for a private hospital for 1 year. She commented to us that, “Rh-negative blood can be easily imported into Hong Kong. There is no [global] shortage. It is merely a cost issue.” Indeed, the UK’s own Blood Care Foundation, which supplies Rh-negative blood to Hong Kong, has a long history of importing blood into Hong Kong, so there is no apparent administrative, regulatory or legal reason that more blood cannot be held in reserve.

About Pacific Prime: Since 2000 Pacific Prime has worked with the world’s best insurers to provide people all around the world with International Health Insurance. From it’s headquarters in Hong Kong, Pacific Prime’s knowledgeable agents provide expatriates from all walks of life with guidance on how to find insurance plans that address their specific needs.

About the Hong Kong Red Cross Blood Transfusion Service (BTS): Since 1952, the BTS has been providing blood to all hospitals, public and private, in Hong Kong. As a public institution the organization is committed to ensuring an adequate and safe blood supply in Hong Kong, a supply created and replenished wholly from donations. Contact the BTS today if you would like to learn more, or donate.

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Neil Raymond
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