Stanching Transfusions

"Thoughtless prescription of blood transfusion is playing Russian roulette with bottles of blood instead of a revolver," wrote Dr. William H. Crosby Jr. of Washington's Walter Reed Army Hospital. "While the odds are in the physician's favor that nothing will go wrong, the patient takes the risk." Doctors are familiar with such warnings; yet every week in the U.S. and Canada one or more patients die because what was meant to be a lifesaving transfusion turns out to be a death-dealing dose of incompatible blood (such as type A given to somebody with type B or O). How often does this happen? And why?

Last week, in the Canadian Medical Association Journal, doctors found a tentative answer and a disturbing charge. Toronto's Dr. Brian P.L. Moore sifted a mass of data, found that incompatibility reactions occurred at a rate ranging from i per 2,000 bottles to 1 per 10,000, with an average of 1 per 4,200. But for each obvious reaction there are at least four cases where incompatibility causes a hidden sensitization, preparing the ground for trouble with the next transfusion or the next pregnancy. So the overall risk is closer to 1 in 600, Dr. Moore concludes. And of patients who have such reactions, 15% to 50% will die, "depending upon the clinical acumen of the physician and the facilities available."

Blood typing is not difficult if done carefully, and Dr. Moore found that most mismatched transfusions were caused not by technical errors but by simple human failures--mixing up specimen tubes, mislabeling and similar clerical errors. Worst of all, Dr. Moore charged that in more than half the cases with fatal reactions, the transfusion was not necessary or even desirable. Many physicians, he suggests, give one bottle to be on the safe side. One bottle is rarely, if ever, enough to do any good--but may easily be enough to do harm.

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