Before submitting to any serious medical procedure, a thinking person will learn the possible benefits and the risks. What about blood transfusions? They are now a prime tool in medicine. Many physicians who are genuinely interested in their patients may have little hesitation about giving blood. It has been called the gift of life.
Millions have donated blood or have accepted it. For 1986-87 Canada had 1.3 million donors in a population of 25 million. �[In] the most recent year for which figures are available, between 12 million and 14 million units of blood were used in transfusions in the United States alone.��The New York Times, February 18, 1990.
�Blood has always enjoyed a �magical� quality,� notes Dr.�Louise J.�Keating. �For its first 46 years, the blood supply was perceived as being safer than it actually was by both physicians and the public.� (Cleveland Clinic Journal of Medicine, May 1989) What was the situation then, and what is it now?
Even 30 years ago, pathologists and blood-bank personnel were advised: �Blood is dynamite! It can do a great deal of good or a great deal of harm. The mortality from blood transfusion equals that from ether anesthesia or appendectomy. There is said to be approximately one death in 1,000 to 3,000 or possibly 5,000 transfusions. In the London area there has been reported one death for every 13,000 bottles of blood transfused.��New York State Journal of Medicine, January 15, 1960.
Have the dangers since been eliminated so that transfusions are now safe? Frankly, each year hundreds of thousands have adverse reactions to blood, and many die. In view of the preceding comments, what may come to your mind are blood-borne diseases. Before examining this aspect, consider some risks that are less well-known
BLOOD AND YOUR IMMUNITY
Early in the 20th century, scientists deepened man�s understanding of the marvelous complexity of blood. They learned that there are different blood types. Matching a donor�s blood and a patient�s blood is critical in transfusions. If someone with type�A blood receives type B, he may have a severe hemolytic reaction. This can destroy many of his red cells and quickly kill him. While blood-typing and cross matching are now routine, errors do occur. Every year people die of hemolytic reactions.
The facts show that the issue of incompatibility goes far beyond the relatively few blood types that hospitals seek to match. Why? Well, in his article �Blood Transfusion: Uses, Abuses, and Hazards,� Dr.�Douglas H.�Posey, Jr., writes: �Nearly 30 years ago Sampson described blood transfusion as a relatively dangerous procedure .�.�. [Since then] at�least 400 additional red cell antigens have been identified and characterized. There is�no doubt the number will continue to increase because the red cell membrane is enormously�complex.��Journal of the National Medical Association, July�1989.
Scientists are now studying the effect of transfused blood on the body�s defense, or immune, system. What might that mean for you or for a relative who needs surgery?
When doctors transplant a heart, a liver, or another organ, the recipient�s immune system may sense the foreign tissue and reject it. Yet, a transfusion is a tissue transplant. Even blood that has been �properly� cross matched can suppress the immune system. At a conference of pathologists, the point was made that hundreds of medical papers �have linked blood transfusions to immunologic responses.���Case Builds Against Transfusions,� Medical World News, December 11, 1989.
A prime task of your immune system is detecting and destroying malignant (cancer) cells. Could suppressed immunity lead to cancer and death? Note two reports.
The journal Cancer (February 15, 1987) gave the results of a study done in the Netherlands: �In the patients with colon cancer, a significant adverse effect of transfusion on long-term survival was seen. In this group there was a cumulative 5-year overall survival of 48% for the transfused and 74% for the nontransfused patients.� Physicians at the University of Southern California followed up on a hundred patients who underwent cancer surgery. �The recurrence rate for all cancers of the larynx was 14% for those who�did�not receive blood and 65% for those who did. For cancer of the oral cavity, pharynx, and nose or sinus, the recurrence rate was 31% without transfusions and 71% with transfusions.��Annals of Otology, Rhinology & Laryngology, March 1989.
What do such studies suggest regarding transfusions? In his article �Blood Transfusions and Surgery for Cancer,� Dr.�John S.�Spratt concluded: �The cancer surgeon may need to become a bloodless surgeon.��The American Journal of Surgery, September 1986.
Another primary task of your immune system is to defend against infection. So it is understandable that some studies show that patients receiving blood are more prone to infection. Dr.�P.�I.�Tartter did a study of colorectal surgery. Of patients given transfusions, 25�percent developed infections, compared with 4 percent of those who received no transfusions. He reports: �Blood transfusions were associated with infectious complications when given pre-, intra-, or postoperatively .�.�. The risk of postoperative infection increased progressively with the number of units of blood given.� (The British Journal of Surgery, August 1988) Those attending a 1989 meeting of the American Association of Blood Banks learned this: Whereas 23 percent of those who received donor blood during hip-replacement surgery developed infections, those given no blood had no infections at all.
Dr.�John A.�Collins wrote concerning this effect of blood transfusions: �It would be ironic indeed if a �treatment� which has very little evidence of accomplishing anything worthwhile should subsequently be found to intensify one of the main problems faced by such patients.��World Journal of Surgery, February 1987.
DISEASE FREE OR FRAUGHT WITH DANGER?
Blood-borne disease worries conscientious physicians and many patients. Which disease? Frankly, you cannot limit it just to one; there are indeed many.
After discussing the more well-known diseases, Techniques of Blood Transfusion (1982) addresses �other transfusion-associated infectious diseases,� such as syphilis, cytomegalovirus�infection, and malaria. It then says: �Several other diseases have also been reported to be transmitted by blood transfusion, including herpes virus infections, infectious mononucleosis (Epstein-Barr virus), toxoplasmosis, trypanosomiasis [African sleeping sickness and Chagas� disease], leishmaniasis, brucellosis [undulant fever], typhus, filariasis, measles, salmonellosis, and Colorado tick fever.�
Actually, the list of such diseases is growing. You may have read headlines such as �Lyme Disease From a Transfusion? It�s Unlikely, but Experts Are Wary.� How safe is blood from someone testing positive for Lyme disease? A panel of health officials were asked if they would accept such blood. �All of them answered no, although no one recommended discarding blood from such donors.� How should the public feel about banked blood that experts themselves would not accept?�The New York Times, July 18, 1989.
A second reason for concern is that blood collected in one land where a certain disease abounds may be used far away, where neither the public nor the physicians are alert to the danger. With today�s increase in travel, including refugees and immigrants, the risk is growing that a strange disease may be in a blood product.
Moreover, a specialist in infectious diseases warned: �The blood supply may have to be screened to prevent transmission of several disorders that were not previously considered infectious, including leukemia, lymphoma, and dementia [or Alzheimer�s disease].��Transfusion Medicine Reviews, January 1989.
Chilling as these risks are, others have created much wider fear.
THE AIDS PANDEMIC
�AIDS has changed forever the way doctors and patients think about blood. And that�s not a bad idea, said the doctors gathered at the National Institutes of Health for a conference on blood transfusion.��Washington Post, July 5, 1988.
The AIDS (acquired immunodeficiency syndrome) pandemic has, with a vengeance, awakened people to the danger of acquiring infectious diseases from blood. Millions are now infected. It is spreading out of control. And its death rate is virtually 100 percent.
AIDS is caused by the human immunodeficiency virus (HIV), which can be spread by blood. The modern plague of AIDS came to light in 1981. The very next year, health experts learned that the virus could probably be passed on in blood products. It is now admitted that the blood industry was slow to respond, even after tests were available to identify blood containing HIV antibodies. Testing of donor blood finally began in 1985, but even then it was not applied to blood products that were already on the shelf.
Thereafter the public was assured, �The blood supply is now safe.� Later, however, it was revealed that there is a dangerous �window period� for AIDS. After a person is infected, it could be months before he produces detectable antibodies. Unaware that he harbors the virus, he might donate blood that would test negative. This has happened. People have developed AIDS after being transfused with such blood!
The picture got even grimmer. The New England Journal of Medicine (June 1, 1989) reported on �Silent HIV Infections.� It was established that people can carry the AIDS virus for years without its being detectable by current indirect tests. Some would like to minimize these as rare cases, but they prove �that the risk of AIDS transmission via blood and its components cannot be totally eliminated.� (Patient Care, November 30, 1989) The disturbing conclusion: A negative test cannot be read as a clean bill of health. How many will yet get AIDS from blood?