San Francisco Chronicle - Sunday, September 22, 2002
Ulysses Torassa

A reader from Los Altos wrote in, saying she'd recently given two units of blood for herself at the Stanford Blood Center, in anticipation of surgery. But she didn't end up needing it, and the units were thrown away.

With all the talk of shortages, she asks, "Why do they discard blood just because I donated it for myself? I don't fit any of the automatic exclusion rules and, in fact, they were encouraging me to come back sometime and donate for general use . . . It seems odd to me that they are discarding blood when there is a chronic shortage."

According to Dr. Susan Galel, medical director of the Stanford Blood Center, the Food and Drug Administration prohibits using such units for anyone other than the person who donated it, except in very rare circumstances.

The reason: extreme caution about doing anything that might jeopardize the safety of the blood supply. And with Thursday's announcement from federal health officials that West Nile virus is transmissible via transfusions, those concerns are only likely to grow stronger.

"Their unit is probably safe to transfuse, but they are really not volunteers," Galel said. "They are not coming out of a motivation to help other people, they are coming in out of a motivation to help themselves. We cannot say that their blood is as safe," as it is from strictly volunteer donors.

For instance, Galel said, the rate of hepatitis C in the general population is 1 to 2 percent, but it's 10 times less than that volunteer among blood donors.

Of course, you could argue that the number is skewed because blood centers screen out people whose behavior puts them at risk for hepatitis or HIV infection. But any thought that these autologous blood donations (as they are called) may be less safe is reason enough to forgo them, Galel said.

"We have this drumbeat which is: zero risk, zero risk, zero risk," Galel said.

Performing lab tests on the donated blood (as is done on all units) wouldn't necessarily catch all the cases because it takes a while for a virus to trigger antibodies in the body that are used as markers for infection, she noted.

This week's news that at least four people appear to have been infected with West Nile virus from blood transfusions or organ donations has federal health officials scrambling to come up with a test for that, too. Meanwhile, they are advising people to consider autologous donation if they have an upcoming surgery. (Rec Ironically, this hyper-alertness about blood safety -- in part a reaction to blood bank inaction in the early 1980s that led to many transfusion-related cases of HIV -- has led fewer people to opt for autologous donations in recent years.

There is a small but not insignificant risk that giving blood ahead of surgery could trigger problems, especially since most people in that category are already sick to begin with. And because the blood supply has been so safe, there has been less concern that getting someone else's blood during surgery will harm you. In fact, fewer doctors have been recommending autologous donations to their pre-surgical patients.

Meanwhile, a fairly recent change in FDA policy may help in a small way to alleviate some of the chronic blood shortages. As of 2000, blood banks can apply for a waiver that allows them to accept units taken from people with hemochromatosis, a genetic disorder that leads to a dangerous build-up of iron in the body. The treatment: taking out some of that iron-rich blood. To do this, blood banks must offer free blood drawing services to all people with hemochromatosis, whether or not they qualify as a blood donor. That way there is no incentive for someone to lie about their medical or behavioral history to get free treatment.

Only a handful of blood banks nationwide are now doing this, and none are in the Bay Area, although the Blood Centers of the Pacific is seeking federal permission for open a program here. Even if it were widely adopted, it probably would only increase the available blood by 1/2 of 1 percent, according to Dr. Louis Katz, chair of the transfusion transmitted diseases committee of the American Association of Blood Banks.

"It doesn't solve the problem, but it doesn't hurt," said Katz, who is also the director of the Mississippi Valley Regional Blood Center in Davenport, Iowa. At his center, they've recently begun using blood from people with hemochromatosis and found that patients are eager to see their blood go to a good use.

"They're happy and we're happy. So far it's working smoothly," Katz said.

E-mail Ulysses Torassa at utorassa@sfchronicle.com.
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