AIDS-Wary Surgery Patients Use Own Blood

Shirley Leigh, a retired state government legal secretary, said she was “petrified” about undergoing an abdominal operation at Valley Presbyterian Hospital last week.

But it wasn’t the surgery itself that frightened her. It was the prospect of blood transfusions.

“You don’t know whose blood you’re getting, which is something to worry about with this AIDS thing today,” she said. “I was very apprehensive.”

So at the suggestion of her doctor, Leigh stored a pint of her own blood ahead of time at the Van Nuys hospital. “I had no idea you could do this until the doctor told me about it,” Leigh said.

Autologous Transfusions

Leigh is one of an increasing number of patients facing surgery at San Fernando Valley hospitals who are worried they might contract AIDS by receiving blood transfusions from unknown donors and are asking doctors to remove and store their own blood, and return it to them in the operating room.

The procedure, called an autologous transfusion, is not common. But it is being performed in growing numbers at five Valley hospitals.

Along with the increase in autologous transfusions has come a rise in the use of directed donors, the term used for blood donors selected by the transfusion recipient--usually relatives or close friends the recipient trusts to be free of AIDS, or acquired immune deficiency syndrome.

Fueled by Fear of AIDS

St. Joseph Medical Center in Burbank offers autologous and directed-donor transfusions, and an advanced model of a blood-recycling machine, which scavenges blood that ordinarily would be lost during an operation and returns it to the patient’s body, lessening the possibility that the patient will need a transfusion.

Physicians and hospital administrators agree that the trend is fueled by fear of AIDS, an incurable ailment that can be passed from a diseased blood donor to a recipient. It leads to death in five or more years by destroying the body’s ability to resist infection.

AIDS cannot be directly detected in blood samples. But, ironically, the increase in safeguards against it comes just as progress is being made in protecting transfusion recipients.

“There has been a clamor for autologous blood and directed donors because of fear of AIDS from random donors,” said Dr. Lesther Winkler, pathologist and director of the laboratory at Medical Center of Tarzana.

“There is a fear phenomena, fear accentuated by the public perception--which at the moment is accurate--that we can’t cure it, that these people die.”

The demand for autologous transfusions “has been on an upward trend since the beginning of the year,” said Tony Struthers, assistant director of Humana West Hills Hospital in Canoga Park.

The number of such transfusions there rose from 13 in February to 18 in April, although the hospital’s blood donor facility has been open only two days a week, he said. The hospital administration is considering opening the unit five days a week, looking at its own future demand and the possibility of serving other hospitals that lack blood withdrawal and storage facilities.

Call From San Francisco

“We’ve gotten a lot of individual inquiries about AIDS,” Struthers said. “We even had somebody call from San Francisco who wanted his relatives down here to contribute and have the blood shipped to his hospital up there, because he was afraid of getting blood donated in the Bay area” because of the large number of homosexuals there.

Homosexuals are among the groups most likely to have AIDS, along with Haitians, hemophiliacs and intravenous drug users.

The hospital turned down the San Franciscan’s request, saying it would be possible, but too expensive, to ship blood such a distance.

At Northridge Hospital Medical Center, autologous donations have been rising slowly, from a monthly average of about four in the first part of 1984 to about six a month today.

‘Favor for Doctors’

The number of autologous and directed donations handled by HemaCare, a private blood-processing laboratory in Sherman Oaks, has risen by more than 600% in less than two years to about 30 a month, even though the laboratory has not encouraged the business, said Tom Asher, HemaCare president.

“We’ve been doing it mainly as a favor for doctors who usually are good customers for our other services,” such as specialized blood-component extracts for hemophiliacs or others with blood ailments, Asher said.

However, Mac Lindsey, vice president of the laboratory, said: “Although we’ve been turning the business away, I think the increase in numbers indicates we may be getting into it seriously in the near future. We’re getting people here from 100 miles away.

“We’re thinking of setting up a separate facility just to handle” autologous and directed-donor business, he said.

The cause “is fear of AIDS, absolutely,” said Asher, who is also vice president of the American Blood Resources Assn., an industry group representing commercial blood banks.

“People have been greatly influenced by the publicity about it.”

Patients who have used autologous transfusions agree.

“I kept hearing about AIDS on television and read in the newspaper where it’s a very dangerous thing,” said Trudy Huff, 64, of Reseda, who recently had a hip replacement operation at Northridge Hospital Medical Center.

She stockpiled three pints of her own blood in the six weeks before the operation, and all three were returned to her in the operating room. But that wasn’t enough. She required two more pints, from a blood bank.

She had asked her doctor for advice before the surgery, she said, “and he advised me this would be a good idea, in case of AIDS and other kinds of sicknesses you can get from other people’s blood.”

Her physician, Dr. Seymour Gassner, a Northridge orthopedic surgeon, said he uses autologous transfusions for his patients “whenever feasible, because it eliminates a considerable amount of the risk of receiving blood.”

‘Subconscious Consideration’

If his patients don’t request autologous transfusions, he said, he suggests it to them. “Everybody is always receptive to the idea,” he said. “They’ve all heard about the possibility of getting AIDS through blood and nobody wants to take that risk.”

“I think AIDS is at least a subconscious consideration on the part of most people,” said Al Gardner of North Hollywood, a lifelong frequent blood donor. When Gardner’s wife entered Valley Presbyterian recently for abdominal surgery, she already had one pint of her own blood in storage and three more pints from her husband and other relatives.

The oldest autologous donor to go through Northridge Hospital’s program is 90-year-old Gertrude Hitchcock of Reseda, who has been showing up at the hospital’s blood donor facility every other week for more than a month to store four pints for the hip-joint replacement surgery she is scheduled to have Tuesday.

“I was a little scared about giving blood because I had never done it before, but there’s really nothing to it,” Hitchcock said. “I think it’s a good idea.”

Tom Muziani, chief perfusionist at St. Joseph, said that in his 16 years at the hospital, “this is the first time I can recall that people have been coming in for surgery asking if there’s anything they can possibly do to avoid a blood transfusion.”

Cell Saver Machine

Muziani operates the Cell Saver machine, which collects blood that normally would be lost in an operation and returns it to the patient. The machine sucks loose blood from the open body cavity, spins it at 5,800 revolutions per minute through a saline solution that carries away bits of bone, flesh and other contaminants, and pumps a mixture of red cells and saline solution back into the patient.

Although similar machines have been in use for years, dating back to the Vietnam War, St. Joseph obtained one of the first of an advanced model because the hospital provided clinical testing help to Baylor University Medical Center in Texas, where it was developed, Muziani said.

In the past, only about 3% of the 60 or so surgery patients the hospital handles on an average day would ask about the possibility of having their own blood returned to them, but now it is about 15%, he said. Use of the machine has cut the hospital’s blood transfusion needs for major surgery patients by 60%, said Dr. Raymond Schaerf, chief of cardiovascular surgery.

Dennis Sporny, chief medical technologist for the clinical laboratory at Valley Presbyterian, said the number of designated donors there has risen to 20 a week, four times the average a year ago, and the number of autologous donors has grown from almost none to about 10 a week--not enough, by his thinking.

‘The Ideal Situation’

“Autologous isn’t being used to the maximum and it should be, because that’s the ideal situation, where you no longer have a problem of picking up some unknown virus, hepatitis or AIDS,” Sporny said. “The American Association of Blood Banks is advocating physicians make more use of autologous programs, but there’s not enough awareness among physicians.”

The Valley Presbyterian medical staff is working on a letter expounding the benefits of the program that will be mailed to Valley physicians, a hospital spokesman said.

There are limits on a patient’s eligibility to use autologous transfusions. Some surgery patients, by the very nature of their ailment, are too ill to give up blood. The transfusions are easiest to arrange in cases involving surgery that can be delayed while a supply of blood is drawn over a period of weeks from a patient whose condition is not aggravated by the blood loss.

Unfrozen blood, either as whole blood or separated into fresh plasma and “packed cells,” can be stored for up to 35 days at 47 degrees, the temperature of an ordinary refrigerator.

Plasma is the liquid in which the red and white blood cells and other elements are suspended. Packed cells--the “blood” usually used in transfusions during surgery--are made up of a concentration of red blood cells washed of plasma and components likely to cause unfavorable reactions in the patient.

Paper Work, Expense

Blood can be frozen for use up to three years later. But freezing is rare because the process is expensive and because once the blood is thawed, it must be used within 24 hours. Freezing is an unusual option used mainly to preserve very rare blood types for emergencies.

Another problem with autologous and directed-donor transfusions is the paper work, and expense, needed to process and keep track of specific blood units and deliver them to an operating room as soon as a patient arrives.

Officials of the hospitals and HemaCare laboratory said that the fee to handle an autologous or directed-donor transfusion barely covers their costs, or that in some cases they lose money.

The going rate for autologous service is about $130 to $200 a pint, compared to the usual fee of about $55 to process blood obtained from the Red Cross or a similar blood bank.

At Tarzana Medical Center, Winkler said, the hospital breaks even at $200 a pint. But his hospital recently “got backed into a corner” by the growing demand for the service, he said, and temporarily suspended in-house donations, sending patients to HemaCare or other hospitals to do the work and deliver the blood on request.

Also, some cautious doctors have begun storing autologous blood for surgery patients “when there’s a 98% chance they won’t need a transfusion at all,” Winkler said.

‘Logistical Nightmare’

“The demands on a hospital of moderate size are very great because of the erratic nature of the work. The donors want to come whenever they want to. Or you have five or six days when there aren’t any donors at all, and then suddenly nine show up at once,” he said.

“It’s a logistical nightmare that interferes with the normal flow of lab work. It can dislocate your staff schedule so that you risk not having personnel available for an emergency.”

The hospital began offering the service about a year ago, he said, suspended it about a month ago and plans to resume it “in the next one to three months, after I can get some space for a blood bank, hire one or two more lab technicians or nurses and create a schedule compatible with the rest of the hospital’s operation.

“We needed a chance to retrench so we could resume offering this service for physicians and the community on an economically viable basis--not that we’re trying to make it profitable, we just don’t want to lose too much.”

Request by Physician

The Red Cross, which provides the majority of blood used locally--Red Cross centers in Los Angeles and Orange counties take blood from more than 35,000 donors a month--will provide autologous services, Red Cross spokesman Gerry Sohle said.

“A physician has to make the request, and then the patient goes to the nearest Red Cross center to have the blood drawn and we will deliver it to the hospital the physician specified. We offer this as a service to physicians, not to the public.

“Few people can afford to do this,” he said, because of the cost and the limited number of patients who can postpone surgery.

Yet, Sohle said, the Red Cross has seen a rise in requests for autologous service in Los Angeles and Orange counties, handling 70 people in March, the latest month for which figures were available, compared to 45 in December. No figures were available for each county, or areas within the county. But, Sohle said, “Orange County does quite a bit more of that than we do in Los Angeles--must be more nervous people down there.”

Some hospital laboratory directors and administrators say the Red Cross discourages autologous donations, focusing instead on trying to protect the general blood supply in the vast system it administers, so it does not get bogged down in the work of becoming caretakers for the blood of specific individuals.

Eager to Offer Services

Winkler said, “The Red Cross was originally cooperative, but they were overwhelmed by the logistics of handling this on the scale they operate on, so now they discourage it, and I don’t blame them.”

That left the field to individual hospitals, faced with an increasingly competitive economic climate and eager to offer services that would attract both doctors and patients.

Although most hospitals got out of the blood donor field many years ago, leaving it to the Red Cross and community blood banks that could benefit from economies of scale in processing thousands of donors, the AIDS scare and the demand for autologous and directed-donor services reversed the trend, Winkler said.

“Because of this scare, the hospitals are getting back to where they were 25 years ago,” he said, operating not just their own blood banks, but blood safe-deposits.