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A dubious good deed

MagazineAugust 1994 (Vol. 5 Issue 5)A dubious good deed

A story published without fanfare in a recent issue of the British Medical Journal (see facing story, this page) revealed the astonishing statistic that one third of all people who have had transfusions have been given the wrong blood

A story published without fanfare in a recent issue of the British Medical Journal (see facing story, this page) revealed the astonishing statistic that one third of all people who have had transfusions have been given the wrong blood.

As this was the unsolicited admission of some 245 laboratories who voluntarily participated in the study one can only guess at their true batting average. However, this error rate corresponds with that of the US, which is supposed to have the tightest procedure on blood usage in the world.

Perhaps even more worrisome than the issue of human error is another professional revelation, hard at the heels of this first one, that medicine hasn't yet determined when blood transfusions should be given or even whether they do any good at all.

A recent conference by the Royal College of Physicians at Edinburgh underscored the fact that transfusions have never been subjected to proper scientific study that is, a randomized, double blind trial to see if indeed there are any benefits. In other words, like much of modern medicine, what probably is a useful court of last resort has been introduced and adopted as first line standard practice on the a priori assumption of benefit without one shred of scientific proof.

This question mark over the benefits of getting your own blood loss replaced with somebody else's has largely been denigrated by medicine publicly as a religious, rather than a medical issue the province of the likes of the Jehovah's Witnesses. However, the medical community has privately long admitted that with much of blood transfusion, they don't really know what they are doing. In 1987, a US Office of Technology Assessment Task Force estimated that up to 95 per cent of blood products transfused into patients wasn't needed.

The medical literature is awash with studies about patients undergoing operations who have done worse on foreign transfused blood than on autotransfusion (receiving their own stored or recovered blood).

Blood transfusion has been linked with organ system failure, recurrence of cancer, a higher risk of post operative infection and graft versus host disease, a condition in which the recipient rejects the blood, affecting the joints, the heart and blood cells. Numerous techniques are available to those undergoing elective operations to minimize the need for getting someone else's blood. Even during emergencies contaminated blood can be cleaned and recycled or circulating blood volume kept up with fluid replacements.

The best thing about our present climate of blood donation phobia and its consequent worrying shortage of blood (the worst in the US since World War Two) is that doctors are finally being forced into taking a hard look at transfusion practices and developing alternatives to them.

As all of us become increasingly reluctant to respond to ever more insistent drives for blood donation, the burden of proof is on medicine to demonstrate, through hard scientific data, that giving blood is a good deed after all.

!ALynne McTaggart


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