39-year-old Irene was admitted at Dowa District Hospital in November 2016 due to severe anaemia in pregnancy. She was three months pregnant. Irene was pale and she was complaining of palpitations, headache and dizziness.
She was admitted and several tests were done. In pregnancy, anaemia is defined as an HB level of less than 10g/dl. Irene’s laboratory tests showed that her Haemoglobulin was a paltry 4.8 g/dl. The midwife on duty counselled Irene and her guardians on the need to be transfused, but they refused, saying that they belong to a religious group called Jehovah’s Witnesses and their religious beliefs do not allow them to receive blood. Her church elders brought her drugs instead. Despite more counselling, she refused to be transfused.
Four days later, Irene’s guardians called the midwife to check on her. Upon examination, Irene had vaginal bleeding and her cervix was 2cm open. Sadly, Irene had lost her pregnancy.
The health workers informed her about the need to perform an emergency Manual Vacuum Aspiration (MVA) to remove the remains of the foetus and she accepted. She was also strongly advised on the need for a blood transfusion, to which she consented. However, Irene changed her mind later after her guardians and church elders discouraged her, even after blood had already been collected from the laboratory. Irene continued bleeding profusely.
The evacuation procedure was done successfully. Since she had refused transfusion, she was to take 1000mg of cytotec rectally, blood supplements and a normal diet. Worryingly, Irene continued bleeding after the operation.
In the afternoon of the day of the evacuation, her condition worsened. She stopped talking, became restless and had difficulty breathing. A decision was then made that she should be referred to Kamuzu Central Hospital (KCH) on oxygen therapy escorted by a clinician and a midwife. At KCH, she was admitted to the High Dependence Unit (HDU); she was unconscious by then. Her guardians were counselled on the need of an emergency transfusion but they refused.
Two weeks later, Irene was referred back to Dowa District Hospital from KCH for physiotherapy and supportive care. Her CT scan results showed signs of a brain injury due to oxygen deprivation. Her blood vessels were also inflamed. She was still unconscious, although vital signs were normal. She was not able to walk and her limbs were not functioning. To help her regain the use of her limbs, the palliative care team recommended active physiotherapy. Her guardians were shown by demonstration the exercises she was to do daily. Irene now had to be trained to balance with maximum support to sit and relatives were to chat with her frequently to facilitate her speech. Two days later, she was discharged on palliative care.
Irene’s case is a clear indication of the significant implications of anaemia on the health of the foetus, as well as that of that of the pregnant mother if transfusion is not done in time.