Challenging the Traditional Transfusion; Knowing the Alternatives Can Save Lives While Providing Peace of Mind for Patients Facing High-Blood-Loss Procedures

By Crenshaw, Theresa L. | The Saturday Evening Post, April 1989 | Go to article overview
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Challenging the Traditional Transfusion; Knowing the Alternatives Can Save Lives While Providing Peace of Mind for Patients Facing High-Blood-Loss Procedures


Crenshaw, Theresa L., The Saturday Evening Post


A precedent-setting lawsuit recently awarded $3.9 million to a blood-transfusion AIDS victim. The judgment against the Blood Center of Southeastern Wisconsin will have a major impact on the blood-bank industry as a whole.

John Carroll, a 63-year-old man from Brookfield, Wisconsin, told a jury that he expected to die of AIDS within a year.

He received infected blood products through transfusion during heart surgery in April of 1985. The blood he received had not been screened or recalled after screening became required in March of 85.

The blood bank conformed to the letter of the law by testing new donor blood but didn't test its inventory, which it continued to distribute for transfusion. The infected blood donor had given blood repeatedly, once in March and again in November. Mr. Carroll and his wife did not learn of his infection until nine months after the operation. By that time his wife could have become infected too.

This expensive lesson-in money for the blood bank, and in loss of life for the Carrolls-sends a message to all blood bankers that carelessness, insensitivity, and delays will not be tolerated by the courts, or the people. It also highlights the need for more legislation to protect patients from unnecessary transfusions.

The blood-supply system within the United States and the international exchange of blood and blood products have been seriously challenged by the HIV (AIDS) epidemic. Many experts feel the blood industry was slow to respond to the HIV crisis. The Presidential Commission on the HIV Epidemic states in its final report, "The initial response of the nation's blood banking industry to the possibility of contamination of the nation's blood by a new infectious agent was unnecessarily slow."

Even if the blood industry had responded with lightning speed, it would still have been five or ten years too late. When a virus, such as HIV, takes an average of seven to nine years before symptoms appear, the medical community is not even aware of the disease in our presence until it has been traveling through blood for almost a decade. And when the problem finally becomes evident, the response is often delayed.

A recent example is HTLV-1, a cancer virus transmissible through transfusion. The process of getting HTLV-1 tests approved and in use at the blood banks took several years.

Last June the Presidential AIDS Commission recommended that all blood banking facilities should implement screening procedures for HTLV-1."

It is fair to say that HIV and its relatives will not be the last blood-borne viruses to challenge the health of the human species. With this knowledge in mind, we must develop a national blood strategy that fulfills three criteria:

1. minimizes the use of banked blood (homologous blood);

2. maximizes the use of a person's own blood (autologous blood);

3. improves our rapid-response capability when new blood-borne diseases are identified.

Mr. Carroll received blood products-clotting factors--from infected donor blood that could probably have been avoided altogether if a technique called plasmapheresis had been used. In this way he would not have had to depend on the conscientiousness of the blood bank or the quality of its blood products.

Plasmapheresis is a simple procedure performed in the operating room just before surgery begins. Some plasma-rich in platelets and other clotting factors-is withdrawn from a patient's own bloodstream by a special machine and is saved for later. During the operation, another machine is used to recycle the patient's own blood during surgery. Even if a great deal of blood is lost, it can be recycled, but often platelets and necessary clotting factors are washed away in the process. When the surgeon is ready to close, he need not use a "six pack" of someone else's platelets. Instead, he returns the patient's own platelet-rich plasma that was standing by during the operation.

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