Blood transfusion is not free of risk-even in a carefully controlled setting in the United States.

In the event of a medical emergency, can you trust the blood supply in a foreign country? Can you be confident a blood transfusion administered to you meets the same standards as blood transfusions you would receive in the United States?

Blood transfusion can be a lifesaving intervention provided that it is performed correctly and that the recipient is receiving properly screened blood. For travelers, the need for a blood transfusion is almost always due to a medical emergency involving sudden blood loss resulting from a car crash, gynecological or obstetrical problems, severe gastrointestinal hemorrhage or surgery.

The safety of blood and blood products depends on careful selection of donors, testing of all donation for transfusiontransmittable diseases and quality control of all procedures involved in the process. The safety of the transfusion depends on appropriate ordering of the blood, careful checking of the compatibility of the blood or blood product with the recipient’s blood and again, control of all the procedures.

The American Association of Blood Bankers adheres to the highest standards in the world. Still, blood transfusion is not free of risk-even in a carefully controlled setting in the United States. In most developing countries, the risk posed by poor screening of donors is componded by the limited availability of technical resources to screen blood for HIV infection and other diseases including malaria, hepatitis B, hepatitis C and syphilis. In such settings, travelers can’t always count on safe blood products and medical professionals with the expertise to prescribe and perform safe transfusions. Local care providers may also face financial contstraints and limits on the availability of screened blood in their county.

The World Health Organization believes that all countries need to develop well-organized, nationally coordinated blood transfusion services. It is a prerequisite for the safe and effective use of blood and blood products. Such services are often given low priority by foreign governments and many remain very poorly organized. Those countries that have established national blood transfusion services, however, have seen major improvements in the safety and quality of their blood supplies.

WHO has been working on this problem for several years and will continue to do so, while simultaneously encouraging governments to establish and support (both financially and politically) nationally coordinated blood transfusion services. Although any such program would ideally function within the framework of the country’s health-care infrastructure, management may be delegated to a nonprofit, nongovernmental organization.

Fortunately, emergency blood transfusion is rarely necessary. In some cases, blood transfusions can be avoided by replacing the blood volume with plasma expander substitutes (crystalloid and colloids). Embracing a philosophy of “better safe than sorry,” concerned travelers may want to check out the Blood Care Foundation. A charitable, nonprofit organization registered in the United Kingdom, BCF operates a program that provides screened blood to its members in the event of a medical emergency anywhere in the world. The foundation will also supply, on an emergency basis, resuscitation fluids and sterile transfusion equipment. BCF will deliver this equipment to any location in the world and will oversee the administration of the transfusion, if necessary. BCF members include expatriates, business travelers, their families and vacation travelers. For more information, visit www. bloodcare.mas1.com.

Here are a few preventive measures you can take to ensure your safety and prevent injury when traveling abroad. Try to avoiding night driving; use only safe-driving practices; rent cars with air bags and wear seat belts; do not drive when drinking alcohol or under the influence of medications that can slow your reaction time. Bring a copy of your medical and health history, including a list of medications you take and your blood type with Rh factor (+ or -) with you on your trip. And plan ahead. Take time before departure to establish a plan to follow in the event of a medical emergency.