Accurate and systematic screening of all blood donations is not yet feasible in all developing countries. Travelers planning international itineraries have requested to have their own blood or blood from their home country available to them in case of urgent need. These requests raise logistical, technical, and ethical issues that are not easy to resolve. Ultimately, the safety of blood for such travelers will depend on the quality of blood transfusion services in the host country. Strengthening these services is of the highest priority. While efforts are being made to achieve this end, other approaches are also needed.

Basic Principles

* Unexpected, emergency blood transfusion is rarely required. It is needed only in situations of massive hemorrhage, such as severe trauma, gynecologic and obstetric emergency, or gastrointestinal bleeding.
* In many cases, resuscitation can be achieved by use of colloid or crystalloid plasma expanders instead of blood.
* Blood transfusion is not free of risk, even in the best of conditions. In most developing countries, the risk is increased by limited technical resources for screening blood donors for HIV infection and other diseases transmissible by blood.
* The international shipment of blood for transfusion is practical only when handled by agreement between two responsible organizations, such as national blood transfusion services. This mechanism is not useful for the emergency needs of individual travelers and should not be attempted by private travelers or organizations not operating recognized blood programs.

Therefore, travelers should be made aware that:

* There are no medical indications for travelers to take blood with them from their home countries.
* The limited storage period of blood and the need for special equipment negate the feasibility of independent blood banking for individual travelers or small groups.
* Blood should be transfused only when absolutely indicated. This applies even more forcefully in those countries where screening of blood for transmissible diseases is not yet widely performed.

Therefore, the following options should be recommended in emergency situations:

* When urgent resuscitation is necessary, the use of plasma expanders rather than blood should always be considered.
* In case of emergency need for blood, use of plasma expanders and urgent evacuation home might be the actions of choice.
* When blood transfusion cannot be avoided, the attending physician should make every effort to ensure that the blood has been screened for transmissible diseases, including HIV.

International travelers should be advised to take active steps to minimize the risk of injury, such as avoiding night driving, employing safe driving practices, and wearing safety belts whenever possible.

Before departure, travelers should establish a plan for dealing with medical emergencies.

Health Information for International Travel 2003-2004

© 2003