AIDS and Blood: Cooler Heads Needed : TV report on transfusions left out the good news

Most Americans are terrified of AIDS, and any reasonable discussion of the disease allows for that. Thus, many public health experts are troubled by the lack of precision in a recent television report that left some viewers with an impression that patients receiving blood transfusions are at high risk of being infected with the AIDS virus.

It is impossible to say there is no risk at all. But with a little more balance in the program’s reporting, viewers could have learned that, at worst, the risk is about four times smaller than the risk of dying in surgery from a reaction to anesthesia.

It might also have left some viewers with a diminished sense of dread if the federal Food & Drug Administration’s general view of the potential risk had been included.

Teams from the FDA conduct unannounced inspections of every blood bank in the nation at least once a year, according to an FDA spokesman. It was just such inspections of American Red Cross blood banks in Albany, N.Y., and Washington, in fact, that provided the basis for the report on AIDS and transfusions aired by CBS’ “60 Minutes.” The Albany center was closed because it consistently failed to comply with FDA procedures for screening donors and keeping records. The Washington center has corrected its problems.

To his knowledge, the spokesman said, there is no recorded case in which a unit of blood from a donor known to have tested positive for the virus has been used in a transfusion.

The federal Centers for Disease Control has estimated that 12,000 Americans had been infected through blood transfusions as of 1987. The actual number may even be larger than the CDC estimate.

The crucial point is that blood could not be screened for the AIDS virus before 1985 because scientists did not isolate the virus until then--some four years after doctors began encountering cases of AIDS. Once technicians knew what they were looking for, screening of both blood and donors became as routine as it had been for hepatitis and other diseases that taint blood.

One celebrated case in California involved tax reformer Paul Gann, who was infected between 1981, when AIDS was identified as a disease, and March, 1985, when the AIDS virus was identified. Gann received blood transfusions during open-heart surgery in 1982 and died in September, 1989.

The television report focused on the Red Cross blood operation in the nation’s capital, one of dozens of chapters around the country that supply about half of all blood used in medical treatment. Some of the blood centers that account for the other half had as much trouble as the Red Cross in getting up to speed on new testing techniques and record-keeping rules after 1985, said the FDA spokesman.

For example, FDA rules require blood banks to ignore the possibility that a blood test can produce a false “positive” result and keep the blood out of the supply stream when that happens. “In the past,” he said, “people who first tested positive might come back and test negative twice in a row. Some blood banks might decide that the blood was all right, but our rules say the blood still stays out.”

The federal agency thinks, on the basis of recent annual inspections, that blood banks around the country now have their acts together.

Since 1985, statisticians have said that the chances of being infected by the AIDS virus during a blood transfusion are 1 in 40,000. A statistical study published in the New England Journal of Medicine in the fall of 1989 put the odds at more like 1 chance in 153,000. A second study late last year agreed with the longer odds.

Risk is a tricky business, and some statistics can be more comforting than others. But in any discussion of AIDS and blood transfusion, the statistics surely have a place.