SCIENCE / MEDICINE : Stockpile of One’s Own Blood Is the Safest Option When Facing Surgery
Anyone preparing for elective surgery who may need a blood transfusion should look into stockpiling his own blood. The case for self-donated, or autologous, blood is simple: Because it carries no risk of infection, your own blood is the safest blood you can get.
However, while the American Medical Assn., the American Red Cross, and the Food and Drug Administration (FDA) all recommend the use of autologous blood, only a minority of the 18 million transfusions performed annually are self-donated--largely because too few patients are informed of this valuable alternative.
Autologous blood donation started to gain popularity several years back, primarily because of the risk of being infected with the AIDS-causing HIV virus during transfusion.
This risk has faded since a screening test for HIV, introduced in 1985, greatly reduced the possibility of receiving AIDS-contaminated blood. Your chances of contracting AIDS from a blood transfusion fall somewhere between 1 in 75,000 to 1 in 500,000 per unit of blood, depending on whether blood comes from an area with high or low incidence of AIDS.
More effective screening methods continue to lessen the risk of acquiring illness from a transfusion using donor (homologous) blood. Just this past May, the FDA approved a test to screen donor blood for hepatitis C, also called non A/non B hepatitis. (Since earlier screens had reduced contamination from hepatitis B, hepatitis C has been responsible for 90% transfusion-acquired hepatitis.)
However, recent research suggests that donor transfusions may suppress the immune system, increasing the risk of postsurgical infection. One study, presented at a recent meeting of the American Assn. of Blood Banks, followed the postsurgical infection rates of 105 hip replacement patients.
None of those in either the transfusion-free or autologously transfused groups acquired any infection, while 23% of the homologously transfused patients did. It seems that autologous blood--which naturally poses no threat to your immune system--allows the immune system to place its energies into getting you well rather than fighting suspicious foreign blood particles.
One deterrent of autologous donation is that, despite iron supplementation, many donors become anemic before an adequate amount of blood is stored because their body does not replace the depleted red blood cell (RBC) supply fast enough. On average, an “adequate supply” usually requires that three to four pints of “units” be donated in the month before surgery. (Fully stocked, the body’s blood supply is about 9.5 pints.)
Fortunately, new genetic technology may make it easier to store that much blood. A recent study published in the New England Journal of Medicine found that the anemia was the result of insufficient levels of the hormone erythropoietin, or EPO. Produced by the kidneys in response to a decrease in RBCs, EPC acts as a red flag and alerts bone marrow to produce more RBCs.
This multicenter study showed that administering genetically manufactured EPO intravenously allowed 96% of patients treated to store enough blood without becoming anemic.
The down side: At the moment, treatment costs are high--about $2,500 a patient--and, because the procedure is still investigational, insurance companies have not yet established a policy on reimbursement. Other ongoing studies are examining the effects of lower-dose therapy, which should bring costs down.
When autologous donations are not an option, as in an emergency or in operations such as open-heart surgery that involve massive blood loss, another option for utilizing your own blood is a technique known as intraoperative autologous transfusion (IAT). In this procedure, blood lost during the surgery is collected and recycled through a machine that filters and cleans it, and then feeds it back into your circulatory system. However, because of the possibility of contamination, intraoperative transfusions are not used for open-bowel surgeries, cancer operations, or cases where there is an infection at the site of the surgery.
A well-marketed option--donating your blood now, and then freezing and storing it for possible later use--is definitely not good transfusion insurance. One obstacle is the cost: Red Cross and hospital blood banks do not have enough storage space to hold frozen blood indefinitely, and commercial blood banks charge up to $275 a unit.
Transport is another problem: If you need blood in an emergency and are not near your stored supply, considerable expense is incurred in shipment, and the blood, which will take 90 minutes to thaw once your surgeon has it, might very well not get to you in time anyway.
Once thawed, blood must be discarded after 24 hours--and after three years of storage in the freezer, it must be discarded whether it is used or not.
In some cases, a homologous transfusion is unavoidable. “While autologous transfusions are the only way to guarantee 100% transfusion safety, and should always be encouraged,” said Dr. Paul Ness, director of the Johns Hopkins Blood Bank, “if you do need blood, the homologous blood supply has never been safer.”
If you are scheduled for elective surgery that might require a blood transfusion, make every effort to donate autologously. Even if you are able to make only a partial donation, that will minimize the amount of blood needed from the donor pool and so may cut your transfusion risk.
Donating autologously might mean extra footwork--not all hospitals collect autologously, but most area blood centers will--and extra cost (more tracking and paper work add an average of $40 a unit to the bill, which not all insurance companies will cover). However, improved safety may far outweigh these considerations.
DONATING BLOOD TO YOURSELF
* Different surgeries require different amounts: When discussing elective surgery with your doctor, ask if you are likely to need a transfusion, and how much blood your surgery typically requires.
Some surgeries that commonly require transfusions: open heart surgery (up to 6 units); orthopedic surgery (2 to 4 units); gynecological surgery (around 2 units).
* Schedule far in advance: Try to schedule your surgery far enough in advance--usually a month to six weeks--so that you will have time to stockpile enough blood. Usually, you can donate one to two units of blood per week for up to four to five weeks before surgery. (Blood can be stored for 42 days.)
To allow your body time to replenish its own blood volume for the surgery, you should not donate blood during the three days prior to the surgery.
* Find out the location for donations: Ask your doctor where to make the donations--usually a donor room at your hospital, or a local blood donor center--and call and schedule your appointments. Ask the doctor if you should take iron supplements to help you avoid anemia.
