Doctors are ordering patients to arrange for platelets even when not required, said Dr Anwarul Haq, the head of pathology department at Pakistan Institute of Medical Sciences (Pims).
Dr Haq and Dr Lubna Naseem — medical officer at the blood bank of the hospital — said there was a lack of awareness among doctors about the minimum amount of platelets in a dengue fever patient that necessitates transfusion.
“It is important for a doctor to know that only a dengue patient whose platelets count is below 10,000 requires platelets. Unfortunately the doctors dealing with the disease refer all patients to bring 5-8 units of platelets, which is wrong,” Dr Haq told The Express Tribune.
Injecting a patient with more platelets than needed can be very harmful for patients, Dr Haq added. Too many platelets can cause blood clots to form (known as thrombosis), which may obstruct blood vessels and cause stroke, myocardial infarction (destruction of heart tissue due to lack of blood supply) or pulmonary embolism (blockage of the artery that carries blood from the heart to the lungs).
Dr Naseem said dengue fever patients alone requested for about 60-70 units of platelets daily. This is in addition to requests made by other patients suffering from diseases such as hepatitis and thalassemia.
“Bullshit,” said Dr Rizwan Qazi, a senior physician at Pims. Dr Qazi said every dengue fever patient with bleeding required platelet transfusion.
The limited resources of the department are also to blame for the platelet crisis. The blood bank at Pims is housed in a small room that barely accommodates three beds. There is no separate arrangement to collect blood from female donors.
“The shortage of staff and machines has made it too difficult for us to facilitate patients on time,” Dr Naseem said.
The pathology department at Pims has three laboratories — one in children’s ward, second in maternal and child health care centre, and the third in the main building of the hospital — where it employs 100 people in three shifts.
The resources, according to Dr Haq, the head, are not nearly enough to meet the demands of the largest hospital in Islamabad. The department lacks a centralised laboratory, phlebotomy services (specialized staff that take blood samples of the patients), and kits for serology of dengue fever patients.
The department has turned into a “fish market”, said Dr Haq. Numerous small laboratories have been created throughout Pims, which wastes space, equipment and duplicates personnel.
Dr Haq said the department was first established in 1986 and has not been upgraded since then, even though it caters to patients admitted to Pims and other public and private hospitals in Rawalpindi and Islamabad, Northern Punjab, Gilgit-Baltistan and Azad Kashmir.
About 1000 patients visit the pathology department every day, according to a proposal submitted to the health ministry to extend the department.
The document proposes construction of a separate block for the pathology department, adjacent to the extended radiology department.
This block would bring all three laboratories of the department under one roof, which will help improve its services by better utilising the staff and avoiding duplications in test results.
Dr Mehmood Jamal, executive director of Pims, acknowledged the immediate need for a centralised laboratory and the extension of the pathology department.
“[However,] no funds have been allocated for extensions and upgrade projects in the current budget by the government,” he told The Express Tribune.
Published in The Express Tribune, November 4th, 2010.
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