BLOOD BANK officials say the fear of AIDS and other diseases sometimes acquired through blood transfusions has created a sharp increase in the number of patients banking their own blood before surgery.
Your own blood is often the safest available to you, and most hospitals now actively encourage such "autologous" donations in non-emergency surgical procedures.
But the same fears are also prompting more people to ask close friends and relatives to donate blood for them. And while most area hospitals are willing to cooperate in these "directed" donations, they counsel patients that such blood is no safer than anonymous donations, and may even be riskier.
Friends and relatives urged to donate are thought to be more likely to lie about their medical history and conceal high-risk behaviors, increasing the risk that infected blood will slip by the imperfect screening tests.
"Publicly we all agree directed donations are not a very good idea and should be discouraged," said Dr. Robert Wenk, blood bank director at Sinai Hospital in Baltimore.
Privately, however, hospitals are unwilling to turn away patients or antagonize surgeons who insist on directed donations. "It creates a hostile environment," Wenk said.
?/ So, directed donations, too, are growing. * Blood bank directors insist that blood donated anonymously is 1/8 very safe, perhaps safer than it has ever been. All donated blood is tested routinely for AIDS, hepatitis, syphilis and a still-growing list of other infectious diseases before it is released for use.
But there are no guarantees. Scientists have shown, for example, that the blood of recently infected AIDS victims may test negative in routine blood screening, but would still be capable of infecting the recipient.
An ongoing study by the Johns Hopkins School of Public Health has found that despite the blood screening, an average of one unit of blood in 40,000 given to cardiac surgery patients in Baltimore and Houston would cause those patients to test positive for the AIDS virus following their surgery, said Dr. Paul Ness, blood bank director at Johns Hopkins Hospital and executive director of the Red Cross Chespeake Region blood program.
Wenk called the AIDS risk from transfusions today "infinitesimally small," and blamed the news media for perpetuating needless fears with recent reports of people infected by anonymously donated blood, and of federal criticism of blood bank management at some Red Cross collections centers.
"I think you have a six-times greater chance of being struck by lightning," he said. "There is a much greater chance of dying from your anesthesia or surgery. But people are primarily concerned about catching AIDS, mostly because of what's been in the press. So the risk is less than the perception of it."
"To be sure, there are other risks [from tranfusions], and I don't mean to belittle them," Wenk said. "The chances of catching hepatitis from a blood transfusion is more on the order of 1 in
100, even with screening."
There also are risks from improperly typed and matched blood, bacterial or viral infections, blood clots and other mishaps.
"The best transfusion is no transfusion," he said.
But except for hepatitis, "most everything else is of little clinical consequence or very rare."
Ness also noted that despite the disease's spread, the number of AIDS-positive people who donate is declining. And even the risk of catching hepatitis from a blood transfusion has been "substantially" reduced since a new test for hepatitis C -- the most frequent cause of post-transfusion hepatitis -- was licensed and implemented last May.
Groundless or not, the public's fear of being infected by a transfusion from a stranger has prompted more and more Americans to ask to donate blood for themselves in advance of elective surgery. And doctors and hospitals are now encouraging them, despite increased handling costs.
"Autologous donation represents the safest kind of transfusion," said Wenk. Your body will never reject your own blood, and "you cannot transmit disease to yourself." Receiving your own blood may even speed recovery.
Not everyone is healthy enough to donate for themselves. Any blood donation can also become contaminated at the time it is drawn, often from bacteria on the skin.
But for most patients, autologous donations are becoming the blood of first resort.
A survey reported in the New England Journal of Medicine last year by Dr. Douglas M. Surgenor, senior investigator at the Center for Blood Research in Cambridge, Mass., shows autologous donations grew from just 28,000 in 1980 to 397,000 in 1987, the latest data available for the study.
Simultaneously, Surgenor said, new concerns about the safety of the blood supply ended 40 years of steady growth in the total number of blood transfusions ordered by doctors in the United States.