AIDS Fear Drives Thousands to Store Their Own Blood for Transfusions

Fear of catching AIDS from blood of unknown donors is driving thousands of people across the United States to store their own blood for use in elective surgery.

Doctors, hospital officials and directors of some of the biggest blood banks in the country say the number of autologous donors--people who donate for their own use--has more than doubled in the last five years and is growing steadily as people realize that their own blood is the best they can get.

Experts say they are sure that newly instituted tests for AIDS--which hospitals and blood banks now apply to every pint of blood collected--are close to infallible. But the public is harder to convince.

“If you ask the patient, the patient is still scared to death about the possibility of getting AIDS from blood,” said Dr. Dennis Goldfinger, director of the blood bank at Cedars Sinai Medical Center.

“I’m not crazy about getting AIDS or hepatitis,” said Susan Stull, 26, who has put aside one pint of her own blood for surgery at Cedars Sinai at the end of the month. “The idea of getting my own blood back sounds the safest possible method to me. I know where it’s been. I know it’s going to be compatible with my own body.”

Kept Fresh for 35 Days

At present, autologous donations are being used only for people who are anticipating surgery within the next 35 days, the maximum time blood can be kept without freezing.

In their search for greater safety, doctors and patients are also implementing “designated donor” programs, in which blood donors are limited to people the patient knows. But while autologous donations are universally accepted and recommended, there is a nationwide controversy about designated donations.

Many hospitals will accept blood from donors targeted for a specific patient, but most blood banks in the country will not take designated blood because they feel it offers no greater guarantee of freedom from contamination than blood from unknown donors.

“There are sometimes compelling reasons why those closest to you might want to hide things about their private lives,” said Dr. Robert Hirsch, director of medical services for the Greater New York and New Jersey Blood Program, which supplies more than 90% of the blood for 260 hospitals. “They don’t want you to know they are homosexual or that they are taking drugs.”

“If your brother is gay and he doesn’t want you to know it, he might donate just to keep quiet,” said Dr. Herbert Perkins, scientific director of Irwin Memorial Blood Bank, the only blood bank serving the San Francisco area.

Patients in Control

With your own blood, there is no risk of picking up any infectious disease you didn’t have before.

“Autologous donations are attractive to patients,” Goldfinger said. “People like to be in control of their lives . . . like driving your own car compared with getting into a plane you’re not piloting. They can choose their own sex partners, but they feel they don’t have any choice at a blood bank.

“When you get your own blood back, you are avoiding many complications. There are other viruses, besides AIDS, transmitted by blood transfusions. Hepatitis, malaria, human T-cell leukemia virus-1, which is endemic in Japan, the Caribbean and some parts of the South, can all be passed on by blood transfusions. They are relatively low risks, but they are all avoided with autologous donations.”

Some doctors are afraid surgery patients may be too sick to donate their own blood, Goldfinger said. “But the vast majority of patients well enough to undergo elective surgery are well enough to donate blood.”

Cedars Sinai has had an autologous blood program for a dozen years, but there has been a big upswing in its use in recent months, despite the new tests on blood.

“In the first few years we were collecting 50 or 60 pints of blood a month from autologous donors. Now it’s over 90, and steadily increasing,” Goldfinger said. “That’s partly because of publicity about Rock Hudson, but also because there is more AIDS around.”

Susan Stull’s doctor recommended that she have a pint of her own blood ready in case she needed it during her coming surgery. “If there was no choice, I’d have to trust the supply,” she said. “But I do have the choice.” It was the first time Stull, a saleswoman in Bakersfield, had given blood, but she said she would probably become a regular donor, not just for her own needs.

Cedars Sinai also accepts designated blood. “We’ve been big proponents of it,” Goldfinger said. “We feel there are some good reasons. Patients can, in fact, select safer donors. . . . We feel the donor might be more truthful if it (the blood) is going to a friend or relative. It’s true that if you ask your wife to donate (for you), you don’t know if she’s been fooling around. But you’ve been exposed to your wife already.”

Suggested by Hospital

Los Angeles County-USC Medical Center suggests autologous donations in a letter it routinely sends to patients scheduled for surgery.

“It’s just good medical practice to use a patient’s own blood,” said Dr. Ira Shulman, director of the center’s blood bank. “It’s one less thing for the patient to worry about. If patients have a choice between rounding up friends and family or their own blood, they should use their own.

“We collect between 300 and 400 units of blood a month. About 10 of those are autologous. More and more doctors are recommending it. More and more people are doing it.

The local Red Cross has more than doubled its autologous collections since 1983, said Dr. Steven Kleinman, associate medical director of the American Red Cross in Los Angeles and Orange counties. “We’re taking about 1,000 pints a year from autologous donors.”

Good for Most Surgery

Since blood can be kept 35 days without freezing and a healthy person can donate one pint a week, Kleinman said, a patient can save up to five pints of blood before surgery. “That’s enough to cover most kinds of surgery,” he explained. “In exceptional cases, blood can be frozen and a person could save more.”

The Red Cross charges the same price for autologous blood as it does for blood from the general supply. It means more bookkeeping and special precautions to make sure it goes to the specified patient, “but we feel it’s a good thing to do and we don’t want to discourage it,” Kleinman said.

In San Francisco, 1% to 2% of blood donations today are autologous and about 10% are designated for a specific patient, Perkins said.

“Most blood banks will not accept designated donations. My blood bank will let people designate because hysteria (about AIDS) reached such a point in San Francisco we felt we had to meet the needs of the public.”

Now that blood banks are testing blood, the risk of contracting AIDS from transfused blood is “negligible,” Perkins said. “Everyone in the blood field says it (testing) is working. But now the number of donors has dropped. This is because of a rumor that you can get AIDS from giving blood. This is ridiculous. We use a new needle from a sterile plastic container for every donor. When they’ve been used, they’re thrown away.”

Given a Statement

Today, all blood donors are told to read a statement from the U.S. Food and Drug Administration saying that if they are male and have had homosexual contact since 1977 they must not donate. The statement also says that if prospective donors are female and have had sexual contact with a male who has had sexual contact with another male since 1977 they must not donate.

The AIDS test, licensed by the federal Food and Drug Administration last March, reveals the presence of antibodies to HTLV-3, the virus that causes AIDS. In California, the test is now compulsory under law.

“No test is 100% effective, but we feel it (the AIDS test) comes close--about 93% to 95% in detecting antibodies to the virus that causes AIDS,” said Dr. John Ward, medical epidemiologist in the AIDS Branch at the Centers for Disease Control in Atlanta.