There is a growing public awareness of the AIDS epidemic, and a resulting concern about acquiring the AIDS virus through blood transfusion. Systematic screening of blood donations is not yet feasible in all developing countries. Requests have been made by persons planning international travels, to have their own blood, or blood from their home country, available to them in case of urgent need. These requests raise logistic, technical and ethical issues which are not easy to resolve. Ultimately, the safety of blood for such persons will depend upon the quality of blood transfusion services in the host country. The strengthening of these services is of the highest priority. While efforts are being made to achieve this end, other approaches are also needed.

Basic Principles:

1. Unexpected, emergency blood transfusion is rarely required. It is needed only in situations of massive hemorrhage like severe trauma, gynecologic and obstetric emergency, or gastrointestinal bleeding.
2. In many cases, resuscitation can be achieved by use of colloid or crystalloid plasma expanders* instead of blood.
3. 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.
4. 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 emergency needs of indi-vidual patients and should not be attempted by private individuals or organizations not operating recognized blood programs.

Therefore:

1. There are no medical indications for travelers to take blood with them from their home country.
2. 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.
3. 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.

Proposed Options:

1. When urgent resuscitiation is necessary, the use of plasma expanders rather than blood should always be considered.
2. In case of emergency need of blood, use of plasma expanders and urgent evacuation home may be the actions of choice.
3. 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.
4. International travelers should:
   a. take active steps to minimize the risk of injury;
   b. establish a plan for dealing with medical emergencies;
   c. support the development within countries of safe and adequate blood supplies.

This information is taken from the WHO publication “World Health Organization Global Programme on AIDS: Blood Transfusion Guidelines for International Travelers.”

* See World Health Organization documents LAB/81.5: “Use of plasma volume substitutes and plasma in developing countries,” for further details, and WHO GPA/INF/88.5 “Guidelines for Treatment of Acute Blood Loss,” or standard medical or surgical textbooks.