The risks of surgery shouldn`t include getting sick from a blood transfusion, but they do: acquired immune deficiency syndrome (AIDS) and a common form of hepatitis are two possibilities. The simple solution in many cases is to use your own blood.
The AIDS risk is very small--about 1 in a million, according to the New York State Department of Health. (The risk of dying from an appendectomy is 1 in 5,000.) For the four years in which AIDS has been systematically tracked, more than 14 million people have received about 45 million units, or pints, of blood. Ninety-eight cases of AIDS in adults and 14 in children have been blamed on these transfusions.
On the other hand, there`s a 5 to 7 percent chance of catching non-A, non-B hepatitis. Symptoms of the disease, which is caused by viruses different from those responsible for type A and type B hepatitis, are mild, and victims can develop cirrhosis or become carriers before it is recognized.
Autotransfusion, often called autologous transfusion, bypasses the risks. It could be used in up to 40 percent of the transfusions in this country, says Ronald Gilcher, director of the Oklahoma Blood Institute. But he adds that physicians resist: ``It`s so easy to not do it.`` The current autotransfusion figure is about 1 percent.
There are two kinds of autotransfusions. A patient scheduled for elective surgery can have blood drawn and stored beforehand. Orthopedic surgery patients are the most frequent of these predepositors, since their procedures generally are elective. A 60-year-old woman undergoing a total hip replacement will probably require two units of transfused blood, says Thomas P. Sculco, associate professor of orthopedic surgery at Cornell Medical College and Hospital for Special Surgery.
Also, in surgery, in particular open-heart procedures, blood ordinarily lost can be recycled, a procedure called intraoperative salvage. A machine collects, processes and returns the blood to the patient in six to eight minutes. Many of the red cells are damaged as blood is rapidly suctioned off to give the surgeon good visibility, but they can still carry oxygen and supply blood volume.
In areas where AIDS is prevalent, some surgeons report that many patients, logically or not, fear blood transfusions more than surgery. Vincent R. Pennisi, a San Francisco plastic surgeon specializing in breast surgery, advises patients to give one or two units before surgery to avoid even remote risks.
Until recently, refrigerated whole blood couldn`t be stored longer than 35 days. But two preservatives developed in the last year have extended storage life to 49 days, says James Brassel, blood bank director at New York City`s Presbyterian Hospital. This means that a patient can accumulate up to six units before surgery by donating one unit a week for six weeks.
Blood constituents can also be frozen; red cells and plasma, frozen separately, can last three years. A woman expecting a caesarean section, for example, can donate her blood in the second trimester--the safest time--and have it frozen for use months later.
Harvey G. Klein, chief of the department of transfusion medicine at the National Institutes of Health in Bethesda, Md., is one of many doctors who endorses autotransfusion: ``For myself and my family, if we were going to have an elective procedure, we would use this approach.``
But autotransfusion isn`t always wise, and Klein advises patients to discuss it with their surgeon. Intraoperative salvage, for instance, isn`t recommended in operations involving cancer or perforated intestines because contamination or infection may spread.