Medicine: Better Blood Banking

In the U.S. last year, doctors used some 8.8 million units of blood to give transfusions to patients undergoing extensive surgery, suffering from injuries, hemophilia or such diseases as leukemia and aplastic anemia. Because voluntary donations fall short of the amount that hospitals need, much of the blood used for transfusions came from Skid Row derelicts or drug addicts who sold it for the price of a bottle or a fix. Many of those blood peddlers had hepatitis. Thus every year an estimated 17,000 cases of hepatitis result from transfused blood. One in twenty of these patients eventually dies from the debilitating liver disease.

To prevent infections from transfusions, hospitals in July 1973 were urged by the Department of Health, Education and Welfare to use only blood volunteered by carefully selected donors. Furthermore, HEW asked hospitals to freeze most of the blood they do collect; that process not only increases safety by eliminating the white blood cells that can cause transfusion reactions but stretches the shelf life of blood. This in effect increases the available supply. Most hospitals have not yet been able to comply fully with HEW’s request. But the half dozen or so that are nearing this goal consider their efforts well worth the trouble. Not only are they overcoming the problems of periodic blood shortages but they have significantly reduced the hepatitis risk to their patients.

Gift of Life. Establishing an all-volunteer system is not easy. Los Angeles’ Cedars of Lebanon Hospital, which used to buy 40% of its blood, is going all-volunteer despite the difficulty. The hospital sought donations from hospital staffers and then turned to the families of obstetrics patients, who rarely need blood transfusions as a result of childbirth. Doctors at Chicago’s University of Illinois Hospital tried a different tack. Rejecting the idea of bloodmobiles (“They’re like Vikings pillaging rural neighborhoods and carting the blood back to the city”), Dr. H.J. Rothenberg II obtained a list of the university’s 23,000 students, then used a computer system to send them birthday greetings that asked for a blood donation as part of their celebration of life. Other Chicago area hospitals stress “blood assurance,” a guarantee that donors will get blood free if they should need it.

Boston’s Massachusetts General Hospital and other institutions have also found another source: patients. An individual who knows that he will be having surgery in a few weeks is asked to donate his own blood, which can then be transfused back into him, if necessary, without any risk of a mismatch.

“There is no safer blood than your own,” says Dr. Dennis Goldfinger of Cedars of Lebanon. “There is no risk of transfusion reaction, and hepatitis danger is about non-existent.”

Added Antifreeze. Once blood is obtained, freezing it is simple. An antifreeze called glycerol is added to prevent destruction of the red cells. Then the blood bag is slipped into a metal casing and flash-frozen at a temperature of 320° F. below zero. After that the blood can be stored—apparently indefinitely. Some blood has been used after being on ice for more than ten years. The hour-long thawing process is equally uncomplicated. Concern that the blood, which must be used quickly once it is thawed, would often be wasted has proved groundless. Experience has enabled most institutions to calculate in advance —and with accuracy—how much blood they are likely to need each day. The cost of frozen blood (about double that of fresh or refrigerated blood) has been largely compensated for by a saving: a reduction in transfusion-carried hepatitis cases, which can require up to six months of treatment. Best of all, the number of patients killed by posttrans-fusion hepatitis has dropped. Cedars of Lebanon has not had a case of hepatitis in any patient given frozen blood.