"Do-It-Yourself" Blood Transfusions
Rochester Physicians Outline Why They Should Be Used More Often
Thursday, June 19, 2003
For most of a century, blood transfusions have been a potent life-saving therapy. They have made possible such modern medical marvels as open-heart surgery and intensive cancer treatment. The most common collection and transfusion method today involves getting blood from healthy donors and then infusing it into people who need it. But a team of University of Rochester Medical Center physicians contend that autologous transfusion - the process of using a patient's own blood - is safer and should become a bigger priority among American health care providers.
This controversial view is supported by 20 years of research into the immunological effects of blood transfusions on patients. The research is outlined in a critical review article in the current edition of the British Medical Journal. The authors entered the spotlight in transfusion medicine in the early 1990s, when fear of contracting HIV and hepatitis C through transfusions was a major issue. Blood from other individuals (allogeneic blood) has also been implicated in post-surgical infections. But the authors were the first to report that autologous transfusions substantially reduce the risk of bacterial infections after surgery. In the BMJ article, they also discuss "bloodless medicine," a wave of the future, and other techniques that would reduce the need for donated blood.
"Many experts claim that autologous transfusion is unnecessary and expensive. They point out that due to improved testing of blood from donors, the risk of contracting an infectious disease such as HIV is one in a million or less," says Neil Blumberg, M.D., professor of Pathology and Laboratory Medicine and director of the blood bank at Strong Memorial Hospital of the University of Rochester.
"What we're saying is that yes, blood is safe, but there are substantial side effects to the immune system due to getting transfused with someone else's blood," Blumberg says. The University of Rochester group are pioneers in studying the immune effects of blood transfusion; they coined the term "transfusion immunomodulation" to refer to this concept.
The demand for donor blood nationwide is up because of surgeries that are more complex and other advances in health care. Of the 12 to 14 million units of blood donated annually in the United States, only about 5 percent is donated by patients who plan to use it for themselves. Meanwhile, the number of traditional blood donors is believed to be declining due to the aging population and more stringent eligibility criteria. This trend emphasizes the need to investigate new ways to collect and use blood, Blumberg and his colleagues say.
Cost is a major point of contention. Critics of autologous transfusion argue the process is too expensive. But Blumberg and co-authors Joanna M. Heal, M.D., associate medical director at the American Red Cross, New York-Penn region, and Elizabeth Vanderlinde, M.D., chief resident in Pathology and Laboratory Medicine at URMC, say that any additional cost would be offset by savings from shorter hospital stays and less need for antibiotics for post-surgical infections.
Blumberg and Heal documented their cost position in a study published in 1996 in the American Journal of Surgery, which showed hospital costs were actually $1,000 to $1,500 higher per transfused unit for patients who had hip-replacement surgery and received blood from someone else as opposed to autologous transfusions.
The BMJ article explores the three different types of autologous transfusion, including a process that collects blood lost during surgery and reinfuses it into a patient. Ultimately, Blumberg says, newer techniques could be used more often if the need for allogeneic blood was reduced.
"Hopefully this publication will encourage surgeons, anesthesiologists and transfusion medicine specialists to give more consideration to autologous techniques, to improve clinical outcomes, decrease hospital costs and increase the supply of allogeneic blood for patients for whom autologous blood techniques are not suitable," Blumberg says.