By Thompson, Richard C.
FDA Consumer , Vol. 22, No. 3
The AIDS epidemic that first appeared in the United States in the late 1970s has had a great many consequences, few of them positive. But one favorable result has been increased use of a transfusion procedure by which persons facing elective surgery can donate their own blood to themselves before that surgery.
The procedure is called autologous (awtol-o-gus), meaning "related to self," donation. It is based on the fact that receiving your own blood during and after surgery is better and safer than receiving someone else's blood. (Blood intended for use by someone other than the donor is known as "homologous.")
Volunteer blood donations in the United States are now tested for the presence of such contaminants as the AIDS virus. Where these are found, the blood is discarded. This makes the risk of transmitting the virus through a transfusion almost nonexistent. Nonetheless, there are advantages to donating one's own blood for later use.
These include: * reduced risk of a transfusion reaction, * more rapid replacement by your body of blood lost during surgery, since the bone marrow where blood cells form has already been activated by the process of donating blood, and * less demand on the community blood supply.
When autologous donation is suggested, the patient's physician will make arrangements with the local blood bank. It's likely that iron supplements will be prescribed to help build up the number of red blood cells to avoid anemia.
In autologous donation, a person can give one unit of blood a week for up to six weeks, depending on the anticipated need. Each unit is just under a pint and is about 10 percent of the body's total blood supply.
As the blood is taken, it is labeled for that patient's use and kept ready at the hospital for the operation. The last donation is usually made no closer than three days before the scheduled surgery. This allows the body time to replenish the fluid volume that has been removed.
Conditions that might prevent someone from donating blood to others do not prevent autologous blood donation. People who have had hepatitis, for example, and who may still be carriers of the hepatitis virus, can give blood to themselves. This is also true of people who would be ineligible to give blood because they are on medication.
Nor do age limits and other restrictions on blood donors apply to autologous blood collection. The major consideration is simply the health of the patient. Taking blood for autologous transfusion is considered safe even for children and pregnant women.
Occasionally, some people may not be able to donate enough of their own blood to meet their needs. But even partial use of autologous blood will reduce the chance of an infection or adverse reaction from a transfusion of blood from other donors.
A study of 180 patients scheduled for elective surgery at a Boston hospital found that most could donate a unit of blood a week without becoming anemic. When the study was completed, it was found that a third of the patients had required no transfusions at all during or after their surgery, and another third had used only their already donated blood. Only one-third of the patients needed blood donated by other persons.
Despite the advantages of autologous transfusion, a 1987 study reported in the New England Journal of medicine found that only 5 percent of some 5,000 eligible patients at 18 hospitals nationwide had stored their blood in advance of planned surgery. Dr. Pearl Toy of the University of California at San Francisco and a coauthor of the report said that was surprising. "We had thought people would be donating blood for themselves because of newspaper stories about the risks of transfusion."
Toy pointed out that "it's safer if you use your own blood. It eliminates the chance of hepatitis and transfusion reactions, which are the two major risks of blood transfusion, and it also releases blood supplies for emergencies. …