By Dr. James Appel - June 1, 2014

“He got no blood!” The response is becoming familiar. When I ask the different parents of the floppy children they keep bringing in, that seems to be the most common chief complaint.

I’m sitting in church Saturday morning. We’ve just finished the Bible Study and now the choir is warming up the crowd. It’s Women’s Ministries weekend and the ladies are taking charge with enthusiasm. The choir sways down the aisles singing a song of welcome as they march up to the raised choir loft about 20 feet above where I’m sitting. The service moves along with many selections by the all female choir. On the platform, it’s all women. A lady has just finished giving her testimony about fleeing Liberia to Ivory Coast during the war and how she swore she was going to learn French, change her citizenship and never go back to Liberia….until a friend called and asked her to come help this new organization some Liberians were forming to help the young girl child soldiers to recover from their traumas after the war finished. So she prayed about it and has been helping women and children suffering from violence and abuse ever since in her organization’s safe house.

The choir is just about to let it rip again when I hear an ambulance on the street outside. I have a feeling about where it’s going so I pull my phone out of my pocket in anticipation of the call I expect to come. Sure enough, in the middle of the choir’s number, I get a call. I quickly leave my front row seat, duck under the bar across the open door and outside. I can barely hear over the roar of the church’s generator, but I do catch the word “emergency” so I say I’ll be right there and walk around the corner and up the half block to the Cooper SDA Hospital.

An ambulance is outside the main doors. Inside is a boy about 10 years old who’s actively seizing. I ask a couple brief questions, get the reply of “no blood,” verify by looking at his white palpebral conjunctiva and have security bring the child in. I call for a nurse from the inpatient ward since outpatient is closed on Saturdays and she quickly establishes an IV. I give him some glucose and then a loading dose of Quinine, have the nurse inject him with Artemether in his thigh muscle, give him an antibiotic and, since the lab is fortunately here, have them do a hemoglobin and type and cross for a transfusion. He’s still seizing so I give him so Diazepam in small increments until I’ve given him 20mg. Finally, he stops convulsing and is fortunately still breathing. 

He has a hemoglobin of 3 but the good news is that his older brother also has O+ blood and willingly donates. The lab tech only fills the adult blood bag about ½ full. I come in just in time to see her finishing up and tell her to take another pediatric bag from the brother so the kid will get a full adult bag dose of 450ml. It turns out to be a good thing the blood is donated in two separate bags.

I soon get called for another child. This one is about 3-4 years old and also has “no blood.” He is floppy, and appears to be intermittently seizing as well since the mom has put a tongue depressor wrapped in gauze between his teeth to keep him from biting his tongue. He looks like death warmed over. The mom is singing sweetly songs about Jesus as she intermittently prays in a loud voice, mostly repeating the name of Jesus. We get an IV in him, start the Quinine loading dose, give him an Artemether shot and have the lab tech type and cross match his blood. He also has O+ but he looks like he may pass before we can test the child’s young father. I grab the second bag of blood still waiting for the first child and get it running in. They can replace it later with another donor. We take him upstairs in 15 minutes as he is already doing better with the blood. He is no longer seizing and is actually awake.

The first kid, though, continues to intermittently convulse and so I have to keep giving him Diazepam. We keep him in the ER.

Another boy comes in, referred from an outside clinic where they did a hemoglobin since he had “no blood” and found it to be a little over 5. He seems alert, though, and not too pale. I start a quinine drip, give Artemether and send him upstairs. The on call lab tech has now left, so I wait for the evening tech who comes in at five and confirms that his hemoglobin is 7 so we don’t transfuse.

Meanwhile, the next bag of blood is ready for our still occasionally seizing 10 year old so we get that running and send him upstairs where he gets some more Diazepam. In less than 12 hours he’s gotten over 50mg of Diazepam, enough to stop me breathing for sure but he still isn’t completely convulsion free. I hear the mom talking to a relative on the phone: “I put my faith in God…”

That’s all we can do sometimes.

Later that evening, I check up on the Pediatric ward. The girl from yesterday, who also came in almost dead with “no blood” and a hemoglobin of 2.3 is lying comfortably in her bed. She’s been awake and eating all day, looking again like the cute little girl she is. Her second transfusing is running since the first one only got her hemoglobin up to 5. Her mother is just finishing up her prayers, bowing towards Mecca. She gets up, looks at her daughter and smiles.