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General Joint Surgery Information
The Cutting Edge
If You'll Need Blood, New Options Offer Some Peace of Mind
You're scheduled for surgery, and you may need a blood transfusion.
This prospect makes many health consumers feel faint with apprehension.
But there are more ways to replenish this liquid commodity
than you might imagine.
The good news is that blood recycling reduces or in some cases
entirely eliminates the need for conventional transfusion. Use
of recycling began to grow in the 1980s after tennis star Arthur
Ashe and others contracted AIDs from blood transfusions. Instead
of wasting blood, surgeons now routinely save, cleanse, and
reinfuse a patient's own blood on the spot. Recycling, now spreading
fast, is a prime example of consumer demand driving medical
technology to be more efficient and safe.
Depending on your health and how many pints of blood you'll
need, you may still want to plan ahead with your physician and
surgeon, considering these further options:
Self Donation: Assuming your surgery is elective and
you have time to plan, you can bank your own blood in advance
to reinfuse after surgery. Medically, this is the smartest choice.
"Certainly, if you're in relatively good health, and you're
going to have surgery, giving your own blood is the best,"
says Rebecca Haley, a senior medical officer with the American
Red Cross.
About 5% of the blood used in transfusions today comes from
self-donations. Some HMOs argue the process is overused. Indeed,
only 35% to 40% of self-donations are actually used, since most
people set aside more than they need. But to many patients,
any extra peace of mind is worth it.
Peace of mind isn't cheap, however. Self-donated units can
cost $25 to $100 more per unit than anonymous donor blood. Blood
banks say the surcharges are necessary to cover the costs of
special handling, but insurers may not cover the charges.
When you make plans for surgery, ask your surgeon or primary-care
physician if you are a candidate for self donation. You can
bank blood for yourself once a week (every three days in a pinch)
and up to four days before scheduled surgery. You may be given
iron tablets to help replenish your oxygen-carrying red blood
cells.
Even though it's earmarked to be recycled in you, your own
blood still gets tested for hepatitis, HIV and other viruses.
If it tests positive, you may still get it reinfused, but it's
labeled with a biohazard warning to alert handlers. Occasionally
the hospital will refuse to accept certain units of blood due
to hepatitis and the doctor and patient will be notified in
this event.
If you're anemic, suffering from severe heart disease, or
battling a serious infection, you may be told you can't donate
for yourself. But many other conditions such as well-managed
heart disease and pregnancy don't automatically rule you out.
Directed Donation: Patients who can't give for themselves
can recruit family members and friends to donate blood. This
type of transfusion now constitutes about 2% of transfused blood.
Fear of contracting AIDS from anonymous donors has fueled interest
in this form of transfusion in the past decade. Despite a sharply
reduced danger of getting AIDS from a transfusion, the risk
isn't zero.
Patients have a sense of security when arranging such donations
from friends and loved ones. But ironically, good feelings don't
always make good medicine. Indeed, some blood experts are ambivalent
about this practice. They cite studies suggesting blood from
directed donors test positive for infection more often than
blood given by the corps of repeat donors in the general public.
The reason: social pressure.
Friends and family members may feel coerced to roll up their
sleeves, even if they have a history of unsafe sex or intra-venous
drug use. Who could decline blood for a sick parent or grandparent
— especially if that forces the donor to disclose a risky
lifestyle?
"People, in their desperation not to be thrown upon the
general blood bank, have gone to people they don't know that
well," says Dr. Haley, adding: "Maybe we don't know
(anyone) around us as well as we think we do."
Of course, tests and questionnaires at the blood bank almost
always prevent such blood from being transfused. Far from ruling
out friends and family donor networks, Dr. Haley urges patients
to recruit their donors "with tact, care and caution"—
as well as a sense of realism and a respect for privacy.
A woman planning a family shouldn't ask her husband to donate;
his blood could spark the creation of antibodies that would
complicate future pregnancies. These antibody reactions can
also occur in exchanging blood between blood relatives. Directed
donors are really only recommended in a small percentage of
cases.
— Health Journal Section of the Wall Street Journal,
Oct. 96, by Marilyn Chase
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