The Blood Supply… How Safe?

tbshsThis year, an estimated four million Americans will receive blood transfusions. “The blood supply has never been safer,” says Jim MacPherson, executive director of America’s Blood Centers. While there are small risks involved with getting a blood transfusion, experts say they are far outweighed by the risks of not receiving blood. What’s more, blood banks continue to pursue “absolute safety” through the development of more sophisticated tests and more detailed questioning of potential donors.

Here, answers to some common concerns:

What are my chances of getting AIDS from a blood transfusion?

Researchers say that a new, more sensitive screening test required at all blood banks since last March has cut what was already a very small risk (one chance in 450,000 to 660,000) to, literally, one chance in a million.

For more than a decade, blood banks have been testing blood for HIV–the virus that causes AIDS–with an HIV antibody test, which is considered highly effective. For every “real” positive, the test produces 30 “false” positives, which require further testing to verify that the blood is not tainted. The reason why contaminated blood can still leak through is that there is a window period–the interval between when a person becomes infected with the virus and when tests can detect it in the body.

The window period of the old HIV antibody test is approximately 22 days, but the additional use of the new HIV antigen test has cut the time in half. “We will never totally eliminate the risk of HIV transmission through transfusion, but we have taken important steps to further reduce what is already a very small risk,” says Commissioner of Food and Drugs David A. Kessler, M.D.

What are my chances of getting other diseases form donated blood?

Besides HIV, infectious diseases that are known to be transmitted through blood are hepatitis B and C, and human T-cell lymphotropic virus (HTLV). According to research published last June in The New England Journal of Medicine, the risk of transmission by blood transfusion of hepatitis C is one in 103,000, the risk of hepatitis B is one in 63,000. Both viruses can be difficult to treat, but are usually not fatal.

The risk of transmission of HTLV through transfusion, according to the same study, is one in 641,000. This is a leukemia virus that’s more common in Japanese people and those living in the Caribbean. Untreated, HTLV can cause leukemia and paralysis of the nervous system, but it takes many years for the conditions to develop.

Can I put aside my own blood before elective surgery?

Hospitals nationwide encourage you to donate your own blood to reduce the risk of infection, and doing so will add only $20 to $40 to your hospital bill. Insurance companies typically do not pick up the cost if the blood is ultimately not used during surgery, which happens about half of the time. Friends and family can also donate blood for you, but doctors recommend that you choose people who are already regular blood donors. Research has found that “directed” blood has a higher incidence of infectious diseases than blood from anonymous volunteers. One reason may be that relatives and friends are too embarrassed to admit their own risky behaviors.

Another option that’s available in many hospitals is blood recycling. In this procedure, the patient’s own blood is collected during the operation, cleansed, and then reinfused on the spot. The procedure–which adds about $350 to surgical costs–can be used only for certain types of operations, such as vascular and orthopedic surgeries.

Saving Your Newborn’s Valuable Blood

If you’re pregnant, you may have received a glossy flyer suggesting you save the blood from your newborn’s umbilical cord. Once routinely discarded, cord blood is showing promise as a treatment for some cancers and immune disorders. For fees of up to $1.100 (not including a yearly storage charge of around $75), for-profit companies are offering to preserve that blood as a sort of life insurance policy should anyone in your immediate family fall ill.

Is it worth it? Cord blood has a high concentration of the same stem cells found in bone marrow, which are necessary for fighting disease and maintaining a healthy immune system. Until now, the only way to transfer stem cells from one person to another has been through complex bone-marrow transplants. Research indicates that using cord blood in such operations may be less costly and provide another source of donors. If there’s already cancer or certain genetic diseases in a family, some doctors say private storage (which can also be provided through some hospitals) may be advantageous; family members have a 25 to 75 percent chance that the cells will be suitable for their use.

However. a number of researchers are concerned that for-profit centers may be exaggerating the current benefits of cord-blood treatments and preying on the fears of parents. The Food and Drug Administration has proposed that it regulate the substance as an investigational new drug. That move would prevent anyone from collecting or storing cord blood for profit until it is proven safe and effective.

Meanwhile, if you’re interested in aiding cord-blood research. there are a few medical centers where you can donate cord blood free, including the New York Blood Center in New York City and Duke University Medical Center in Durham, NC. More centers are being funded through $30 million in grants from the National Institutes of Health, which hopes to eventually help set up a national cord-blood registry.

If you don’t live near a collection facility, the Pediatric Bone Transplant Program at Duke University Medical Center will send out free kits that allow your doctor to collect cord blood for research.

If you can do it, you should.” says Pablo Rubinstein, M.D., director of the Placental Blood Program at the New York Blood Center. “It’s a small effort to make and will create the potential for saving many lives.”

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