Reaction to AIDS Threat : Surgery Candidates Opt for Own Blood

When Irene M. Sawvel checks into Huntington Memorial Hospital later this month for knee surgery, she won’t be taking unnecessary chances.

“With all the things you hear about AIDS and hepatitis that you can get from blood transfusions, I decided to use my own blood so that I would not have any problems with that,” said Sawvel, a banker who lives in Los Angeles.

Sawvel is one of an increasing number of surgery patients in the San Gabriel Valley who is opting to supply her own blood for transfusions. To prepare for her knee replacement, Sawvel has been accumulating the blood for her operation through a special self-donation program at the Pasadena hospital.

Although statistics indicate that only 2% of the reported AIDS victims in the United States contracted the disease through blood transfusions, San Gabriel Valley hospitals report a marked increase in the number of patients requesting autologous (self-supplied) donations since the AIDS problem came to light in early 1983.

For example, since the City of Hope National Medical Center in Duarte began offering its autologous service six years ago, requests have quadrupled, from 30 in 1980 to a record 120 in the fiscal year ending this month, said Jeanne M. Karr, blood donor coordinator for the hospital. In 1983, the year AIDS became a household word, the hospital had 41 requests.

‘Safest Transfusion’

The blood donor center at Huntington Memorial handled only one or two autologous donors in 1983, said blood services coordinator Mark Kaniewski. But that number jumped to 20 a month by 1984, and to 30 a month this year.

Although fear of acquired immune deficiency syndrome appears to be the primary motivator, the dread of other diseases--particularly hepatitis--and the belief among physicians that autologous donations are safest, is prompting patients to donate their own blood.

The autologous procedure, which for a number of years has been promoted by orthopedic surgeons performing elective surgeries such as hip and knee replacements, is now routinely recommended by a growing number of doctors.

“Autologous is the safest transfusion possible,” said pathologist J. N. Carberry, director of the blood bank at St. Vincent Medical Center in Los Angeles.

In addition to safety, the autologous procedure also helps to stimulate bone marrow production “so that when you undergo surgery, your recovery period will be shorter,” Carberry said. “If I was to have elective surgery, I would use autologous blood.”

While many patients cite AIDS as their main concern, physicians agree that the risk of contracting hepatitis through blood transfusions is also a major consideration.

“The chances of contracting tranfusion-related hepatitis . . . are much greater than getting AIDS,” said Dr. Roy Moffatt, an associate pathologist at St. Luke Hospital of Pasadena.

One person who is particularly concerned about the hepatitis risk is Linda Becker, a Pasadena mother who is expecting her third child in December. Becker, whose father survived a bout of hepatitis during World War II, fears the sometimes fatal disease that afflicts victims with jaundice, nausea and high fever.

“It’s not a pretty disease,” she said.

Becker required a transfusion three years ago when she hemorrhaged while delivering her second child, so her doctors suggested an autologous program in case there are problems with this delivery.

“There is a psychological benefit in knowing that it’s there if needed,” Becker said.

It was not fear of disease but doctor’s orders that sent 72-year-old Carl Schlatter to the autologous program at Huntington Memorial. In fact, Schlatter, facing knee-replacement surgery, had not been aware that transfusions would be required.

But his doctors prescribed the autologous program and he visited the center twice last month to donate two units, roughly the equivalent of two pints of blood.

“It’s nothing to get excited about,” he said as he joked with the nurses.

Can Stockpile Blood

Those who opt for the autologous program can schedule their operations so that they can stockpile their own blood over a period of time before the surgery, an option generally unavailable to emergency surgery patients.

Health experts say that donor requirements for autologous blood are less stringent than those for the general blood bank. For example, an autologous donor taking certain medications could still donate because he alone will receive the blood, said Elaine Kruse, blood bank supervisor at Pomona Valley Community Hospital.

But not all elective surgery patients can take advantage of the autologous program. Those who do not meet general height, weight, and blood count requirements or who have been weakened by illness are discouraged from donating.

Autologous blood is drawn in the same way as blood for a general donor bank, but the drawing center must set aside refrigerated storage room for the autologous blood and provide adequate staff to handle the additional paper work.

For example, the autologous blood center at Foothill Presbyterian Hospital in Glendora, established in March, cost about $10,000 to open, said nursing director Pat Titus.

Smaller Hospitals, Too

Smaller hospitals that do not have autologous blood-drawing facilities allow patients to use their own blood, storing it at other hospitals, the Red Cross center downtown or Red Cross mobile units.

In keeping with increasing demand, five of the 10 largest San Gabriel Valley hospitals--City of Hope, Foothill Presbyterian, Huntington Memorial, St. Luke and Methodist Hospital of Southern California in Arcadia--have added autologous blood-drawing services in conjunction with standard blood donor programs.

The hospitals, desiring to increase patient services in the competitive health care field, offer the autologous program mainly as a convenience for the patients.

Before Foothill Presbyterian opened its own autologous blood drawing facility, prospective surgery patients who wanted to use their own blood for transfusions had to go to the Red Cross facility in downtown Los Angeles and then arrange to have the blood transported to the hospital. Now they can give and store their own blood directly at the hospital.

The San Gabriel Valley hospitals that offer the autologous service continue to use the Red Cross blood bank as well. “We have a great deal of confidence in the Red Cross,” Foothill Presbyterian’s Hitt said.

Red Cross spokeswoman Gerry Sohle emphasized the safety of the Red Cross blood supply, pointing out that all blood is now screened for antibodies to the AIDS virus.

“The test is 99% accurate, and has virtually eliminated the risk of contracting AIDS from blood transfusion,” Sohle said.

The Red Cross draws autologous blood without charge but bills hospitals a processing fee of $54.75 a pint, the same price it charges for non-autologous blood.

Most hospitals then charge patients who are using their own blood a fee for the transfusion and for cross-matching, a final precautionary step designed to ensure that the blood used actually came from the patient.

The Red Cross is considering charging hospitals an additional fee for autologous blood, Sohle said.

‘Special Handling’

“It’s a special service that requires a lot of special handling,” she said.

Prices for autologous blood elsewhere range from $71 a pint at the Stanford Medical Center in Palo Alto to about $125 a pint at private blood centers such as Hemacare in Sherman Oaks.

Although cost does not appear to be a major factor in whether patients choose the autologous procedure, other considerations must be taken into account.

For example, there are limits on the amount of autologous blood a patient can accumulate. Most blood centers require a minimum 72-hour wait between donations, and, unless frozen, blood can be stored for only 35 days.

So far, frozen autologous blood has not been widely used because of the prohibitively high cost of the equipment needed to produce and store it, said Mac Lindsey, vice president of Hemacare. However, as the demand for autologous blood continues to increase, private blood centers such as Hemacare are exploring the possibility of providing frozen blood, at an estimated $250 to $300 a pint.