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.

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.

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.

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 unknown may be more cause for concern than the known,” writes Dr. Harold T. Meryman. “Transmissible viruses with incubation times measured in many years will be difficult to associate with transfusions and even more difficult to detect. The HTLV group is surely only the first of these to surface.” (Transfusion Medicine Reviews, July 1989) “As if the AIDS epidemic were not misery enough, . . . a number of newly proposed or described risks of transfusion have drawn attention during the 1980’s. It does not require great imagination to predict that other serious viral diseases exist and are transmitted by homologous transfusions.”—Limiting Homologous Exposure: Alternative Strategies, 1989.

[Box on page 8]

“Approximately 1 in 100 transfusions are accompanied by fever, chills, or urticaria [hives]. . . . Approximately 1 in 6,000 red cell transfusions results in a hemolytic transfusion reaction. This is a severe immunologic reaction that may occur acutely or in a delayed fashion some days after the transfusion; it may result in acute [kidney] failure, shock, intravascular coagulation, and even death.”—National Institutes of Health (NIH) conference, 1988.

[Box on page 9]

Danish scientist Niels Jerne shared the 1984 Nobel Prize for Medicine. When asked why he refused a blood transfusion, he said: “A person’s blood is like his fingerprints—there are no two types of blood that are exactly alike.”

“Some authorities,” the Harvard Medical School Health Letter (November 1989) observed, “worry that A, B, C, and D are not the whole alphabet of hepatitis viruses; yet others may emerge.” The New York Times (February 13, 1990) stated: “Experts strongly suspect that other viruses can cause hepatitis; if discovered, they will be designated hepatitis E and so on.”

Are blood banks faced with more long searches for tests to make blood safe? Citing the problem of cost, a director of the American Red Cross made this disturbing comment: “We can’t just keep adding test after test for each infectious agent that might be spread.”—Medical World News, May 8, 1989.

Even the test for hepatitis B is fallible; many still contract it from blood. Moreover, will people be satisfied with the announced test for hepatitis C? The Journal of the American Medical Association (January 5, 1990) showed that a year can pass before antibodies of the disease are detectable by the test. Meanwhile, people transfused with the blood may face ruined livers—and death.

[Box/Picture on page 11]

Chagas’ disease illustrates how blood carries disease to distant people. “The Medical Post” (January 16, 1990) reports that ‘10-12 million people in Latin America are chronically infected.’ It has been called “one of the most important transfusion hazards in South America.” An “assassin bug” bites a sleeping victim in the face, sucks blood, and defecates in the wound. The victim may carry Chagas’ disease for years (meanwhile possibly donating blood) before developing fatal heart complications.

Why should that concern people on distant continents? In “The New York Times” (May 23, 1989), Dr. L. K. Altman reported on patients with posttransfusion Chagas’ disease, one of whom died. Altman wrote: “Additional cases may have gone undetected because [doctors here] are not familiar with Chagas’ disease, nor do they realize that it could be spread by transfusions.” Yes, blood can be a vehicle by which diseases travel widely.

[Box on page 12]

Dr. Knud Lund-Olesen wrote: “Since . . . some persons in high-risk groups volunteer as donors because they are then automatically tested for AIDS, I feel that there is reason to be reluctant about accepting blood transfusion. Jehovah’s Witnesses have refused this for many years. Did they look into the future?”—“Ugeskrift for Læger” (Doctors’ Weekly), September 26, 1988.

Though most surgeons have claimed that they gave blood only when absolutely necessary, after the AIDS epidemic arose their use of blood dropped rapidly. An editorial in Mayo Clinic Proceedings (September 1988) said that “one of the few benefits of the epidemic” was that it “resulted in various strategies on the part of patients and physicians to avoid blood transfusion.” A blood-bank official explains: “What has changed is the intensity of the message, the receptivity of clinicians to the message (because of an increased perception of risks), and the demand for consideration of alternatives.”—Transfusion Medicine Reviews, October 1989.

[Box on page 13]

“We must conclude that currently there are many patients receiving blood components who have no chance for a benefit from transfusion (the blood is not needed) and yet still have a significant risk of undesired effect. No physician would knowingly expose a patient to a therapy that cannot help but might hurt, but that is exactly what occurs when blood is transfused unnecessarily.”—“Transfusion-Transmitted Viral Diseases,” 1987.