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There was another major success story of the same period which may be recorded and preserved for posterity. It is about Haemaccel (polygeline 3.5%).
Blood loss is a common occurring in surgery and trauma. Granted that with advanced techniques, blood loss has been minimized. However, there still may be situations causing significant blood/plasma/volume. If the patient is undergoing elective surgery, appropriate arrangement may be made to handle anticipated blood loss. But in trauma and emergency surgery, volume loss may pose a major threat to life of the patient.
Blood transfusion has been in practice for a long time. The spread of diseases like HIV and Hepatitis brought awareness that blood transfusion may be a major vector in spreading these dreaded diseases. Concerns about blood transfusion increased. New thinking came in and strategies to keep blood transfusion minimum and matter-of-last-resort were developed.
Haemaccel is a gelatin derived infusion. It is indicated to make up lost volume quickly and efficiently. Of course, it is not a substitute for blood, but it can help to delay or avoid the use of blood in situations of blood loss.
Prior to this, the cornerstone of volume replacement therapy were crystalloids (dextrose, saline infusions). These were effective in very short term, but these did not stay in the circulatory system and excreted quickly. Volume replacement with crystalloids was neither effective nor efficient. The other option was Dextran. Two variants, 40 and 70 were available denoting average molecular weight. Dextran was better as it stayed in circulation for longer time, sometime for too long; relatively higher molecular weight interfered with excretion. Whenever there is volume loss, the body reduces renal function in order to conserve volume. If the therapy also affected renal function, it could pose additional problems.
Haemaccel offered several advantages. Its range of molecular weight made it stay in circulation longer but did not affect renal function. In summary, Haemaccel provided effective and efficient volume replacement.
Communicating all this across required understanding of the subject and adequate clinical back up. The campaign was spearheaded by Tariq Umar himself. He then developed a small core team who could take up discussion. The primary focus was on Anesthesiologists who carried the burden of maintaining the patient while the surgeon performed surgery. At that time, surgeons acted more powerfully and prevailed about the volume replacement decision. It was an encroachment upon the domain of Anesthesiologists. The situation has changed a lot since then.
There were many questions and more discussions. Hoechst initiated and sustained academic discussion about problems associated with blood transfusion and safer alternatives. Internationally, more studies were coming on the same subject. In Pakistan, larger body of evidence was being collected. This subject remained a major topic during the technical sessions and gatherings of surgeons and anesthesiologists.
Haemaccel was accepted as viable option for volume replacement and remained so.
Some things remained common in all these success stories, be it Claforan or Haemaccel or Tarivid or others. Hoechst team gained knowledge, understood the concept and became convinced that they communicated correct, logical and evidence-based information. In cases like Haemaccel, we were also part of a change which helped the patients in short term and long term. We felt socially responsible and morally motivated that we were not just selling drugs, we were providing solutions beneficial for patients.
An effort with this mindset is powerful, self-perpetuating, convincing and contagious……
