Putting Blood to Work: Transfusions

More than half of Americans say they are "moderately" or "very" concerned about the safety of blood transfusions, and 36 percent believe the U.S. blood supply is unsafe.⁷

Is there any merit to their concerns? Yes and no. The truth is that the U.S. blood supply today is so safe that the risk of contracting a disease such as HIV can only be estimated through mathematical techniques.⁸

However, despite ever-increasing vigilance and safety measures by hospitals to avoid transfusion errors - errors in which patients are given the wrong blood for their blood type - the public's concerns are not completely unfounded. Of the more than 4.5 million blood transfusions in the U.S. each year, transfusion errors do pose a small, but not insignificant risk to patients, occurring at the rate of two errors a day nationwide, on average.¹ How many of these errors result in death is unknown though, since, until fairly recently, hospitals weren't required to report transfusion-related errors. Still, any kind of reaction to the wrong blood can slow your recovery and increase your risk of complications. And the reason for most of these errors? Human mistakes.

"Someone from the lab can go up to a room and draw a blood sample from a patient and mislabel it and take it back to the lab and then the wrong unit is sent to the wrong patient," says Louis M. Katz, MD, president of America's Blood Centers. Or, in the heat of crisis in the emergency room, someone forgets to double-check a patient's identity and match it with the blood type.

To avoid these errors, some hospitals have begun implementing bar code systems for blood transfusions, in which nurses use a scanning wand like those used in grocery stores to make sure the code on the container of blood matches the code on the patient's bracelet. Georgetown University Hospital in Washington, DC, for instance, hasn't had a single fatality related to transfusion error since implementing the bar code system nearly four years ago. But overall, less than five percent of hospitals nationwide have implemented such technology.⁹

In addition to your risk of getting the wrong blood, other risks, include bacterial contamination of blood products, and a condition called transfusion acute-related lung injury. "We also wonder if transfusion can affect the immune system and cause some mild immune suppression," says Dr. Katz.

For these and a multitude of other reasons-not the least of which is the chronically short blood supply-researchers have been scrambling to discover "artificial" blood products and means of maintaining blood products longer. For instance, clinical trials are underway on a biochemically manufactured solution that contains hemoglobin, but not red blood cells.¹⁰ But this kind of research is progressing slowly, notes Dr. Katz, with safety issues a key concern.

One of the simplest ways to stretch the tight blood supply might be changing physician practices about when patients get transfusions, says Dr. Katz. A growing body of scientific literature suggests that one in every four or five transfusions might not be necessary, he says. Traditionally, most doctors have transfused patients when their hemoglobin levels drop to 10 g/dL, says Dr. Katz. "But we now recognize that even in critical care units it should be 7 or 8 g/dL for many patients," he says.

More conservative transfusion guidelines could increase the available blood supply with no increase in donations because units saved would be available for other patients, notes Dr. Katz. Thus, the Mississippi Valley Regional Blood Center, for which Dr. Katz serves as medical director, has a full-time "transfusion safety officer" who works with hospitals on these and other transfusion-related items. But patients have a big role to play, too, he says. "Informed patients have to say to their doctors, 'Is this transfusion necessary?'"

For more information on women and blood donations, visit www.healthywomen.org.X