Donating Blood for Yourself

By Claudia Wallis

Anyone facing major surgery has reason to be fearful. In recent years that fear has been magnified by the threat of a terrifying complication: contracting acquired immunodeficiency syndrome from a blood transfusion. Since 1981, 414 Americans have developed the deadly disease after receiving contaminated blood. The introduction last year of screening tests for AIDS antibodies has made the nation's blood supply much safer, but it has not completely eliminated the risk. Thus last week a panel of 13 doctors and blood-bank officials met at the National Institutes of Health in Bethesda, Md., to discuss what more could be done to ensure the safety of transfusions. Among the experts' conclusions: that patients facing surgery should, whenever possible, prepare by making autologous donations -- stockpiling their own blood for use when they need it. "If you have an operation scheduled," says the panel chairman, Dr. Thomas Chalmers of Mount Sinai Medical Center in Manhattan, "it's much better to get your own blood."

The threat of AIDS is not the only argument for autologous donation. "We would have endorsed this even if the AIDS problem had never come along," says Chalmers. Patients receiving blood other than their own run the risk of allergic reactions and the possibility of complications due to errors in matching blood type. Hepatitis is an even greater danger. Although blood is screened for hepatitis, one type known as non-A, non-B hepatitis cannot be readily detected. In some urban areas, it strikes 7% to 10% of patients receiving blood transfusions.

Still, despite the boost given to autologous donation when President Reagan mentioned it during a recent interview, the panel did not look kindly on its use by people who simply wish to stockpile their blood for a rainy day. The practice, which is made available by a host of new commercial blood banks, might threaten the supply of blood available to the general public. This concerns the American Red Cross. "The present system provides the opportunity for individuals who are healthy to provide blood for individuals who are sick," says Red Cross Vice President Gerald Sandler. If too many people reserve blood for their own use, he warns, "we will have fragmented an American institution that has been very beneficial."

NIH panel members emphasized that the risk of contracting an AIDS infection from donor blood is quite remote. "You have a greater chance of dying from the anesthesia," noted Dr. Richard Aster of the Blood Center of Southeastern Wisconsin. Stanford University Statistician Lincoln Moses estimated that about 120 AIDS-infected samples slip into the blood supply each year, out of a total of 12 million units donated. Since each pint donated can be split among two or three recipients, as many as 360 people could receive AIDS-infected blood each year, though how many will develop the disease is unknown. The main reason for the slipups, explains Chalmers, is that the existing blood- screening test detects antibodies to the AIDS virus rather than the virus itself. Since someone infected with the AIDS virus may take several weeks to develop antibodies, he says, "there is a dangerous window of time" when the test will fail to detect infection.

Given the limits of the test, the panel urged further steps to discourage the donation of blood by those at risk for AIDS. The group also recommended that blood banks notify donors whose blood tests yield ambiguous results. Says Chalmers: "They should be told that they probably don't have the AIDS virus, but to be safe, they'd better not donate blood." At present, only those whose AIDS test is clearly positive are notified. Most important, the panel called for continued efforts to develop more precise blood-screening tests. Such tests, says NIH Administrator Luiz Barbosa, are already in the pipeline, but they must be adapted for use on a mass basis. In two years, he predicts, "we will have a very sensitive test."

With reporting by Christine Gorman/New York and Dick Thompson/Washington