Most of us grew up with the distinct impression that donating blood is a highly humanitarian act and helps to save many people's lives. Blood transfusions are currently a standard part of the medical emergency procedure on a patient who has suffered a life-threatening trauma with loss of blood or one who awaits major surgery. However, these transfusions may not be as safe or as necess
ary as commonly believed. An increasing number of medical experts regard blood transfusions to be an outmoded, unproved, and even dangerous procedure. Yet it is still routinely used as the main method of medical intervention in emergencies - in many cases without any medical justification for its use and without guidelines as to when it should be applied.
Different parts of the blood are used for the medical procedures, including blood albumin, plasma, and whole blood or red blood cells. In its 1989 publication titled 'Blood Technologies, Services and Issues', the Office of Technology Assessment Task Force in the U.S. examined the overuse of the various blood products. It came to the conclusion that as much as 20-25 percent of the red blood cells, 90 percent of the albumin and 95 percent of the fresh-frozen plasma transfused into patients are unnecessary. This situation has not changed since the study was done.
A major Canadian study, which was published in 1998 in the Journal of the American Medical Association, revealed that fewer patients died when they were given a restricted amount of transfused blood. During the trial, 52 percent fewer transfusions were given to the restrictive group, and transfusion was avoided altogether in one-third of those patients. The death rate in the control group, which received normal, liberal amounts of blood transfusions, was 24 percent, compared with 18 percent in the restrictive transfusion group. "The bottom line is; less transfusion is better than more transfusion," said Paul Herbert, the trial's principal investigator. The restrictive transfusion strategy could effectively save one life for every 17 patients transfused.
The most common trigger for authorizing a blood transfusion for hospital patients awaiting surgery is a low hemoglobin level (hemoglobin in red blood cells is used to transport oxygen to all the other cells in the body; and red blood cells need iron to accomplish that). Women naturally have a lower red blood cell count than men but medics use the same trigger levels for both men and women. "Iron deficiency anemia continues to be among the leading reasons for transfusions, even though it rarely warrants [them]," said the U.S. Office of Technology report in its concluding statement.
The standard hemoglobin trigger-level for justifying a transfusion lies at below ten gram (g) per 100 milliliters (ml) of blood. However, this figure emerged from a misreading by a hematologist during a study of hemoglobin levels in dogs! The results of the study, which showed no established links with human physiology, became the main referential guideline for all anesthesiology students thereafter.
Dangers Lurking in the Blood
It is commonly known that diseases can be transmitted by way of blood transfusions. But apart from receiving viruses through foreign blood, patients may develop even more serious complications as a result of a transfusion. Numerous studies show that blood transfusions given to cancer patients can cause depression of their immune system leading to a high rate of recurrence and secondary cancers.
In a controlled study of patients with larynx cancer, the recurrence rate was 14 percent among those who did not receive blood transfusions compared to 65 percent among those who did. More specific research showed that half of the patients who suffered from colonic, rectal, cervical and prostate cancers and received whole blood were reported to have a recurrence compared to a quarter among those who received only red blood cells.
Blood components are routinely irradiated, supposedly to avert rejection of the foreign blood by the recipient's immune system. No studies show that this practice is harmless for the blood cells; it is simply assumed that it has no negative consequences. But knowing what we know today about the dangers of radiation, it can be equally assumed that irradiated blood cells could be hazardous to health, especially if they are given to babies and pregnant mothers.
What makes blood transfusion so risky is that there has never been a randomized, double-blind control study to demonstrate its effectiveness and safety. No scientific proof at all is available to justify its use. Like an antibiotic drug, blood transfusion may have its place as a last resort measure to save a person's life. As a standard practice, however, it not only fails to achieve the desired results, it may be doing more harm than good.
A number of studies confirmed that receiving a transfusion during an operation increases the risk of infection fourfold. Considering the high sterility of the objects and environment in operation rooms, having a blood transfusion practically takes a patient back to surgical conditions that existed over two hundred years ago, when precautions against infection didn't exist. The risk of blood infection has practically remained the same and, with the increase in antibiotic resistant organisms, actually worsened.
Genetic blood research has proven that blood, like our fingerprints, is uniquely individual, implying that it cannot be transferred to another person without risking complications. Each person's blood contains a multiplicity of antibodies, antigens, and infectious agents, most of which science has yet to identify. This makes transfusions even more risky because the majority of infectious agents contained in blood have not even been identified and can therefore not be targeted with drugs. But even if a blood-borne infection is diagnosed, it is a little too late. In the United States alone there are 230,000 new cases of hepatitis a year that are purely the result of blood transfusions. Just as in the case of the AIDS test, the screening of blood for the hepatitis C virus has turned out to be an equally futile undertaking. Most of the newly developed tests, including Riba-2 and Murex ELISA, proved wrong three-quarters of the time.
Furthermore, a blood transfusion increases a patient's risk of acquiring human T-cell leukemia tenfold when compared with contracting HIV through blood. It may also trigger unforeseeable, life-threatening allergic reactions. In patients undergoing major abdominal surgery, blood transfusion is the dominant contributing factor to organ system failure. It is more and more obvious that neither a blood transfusion nor 'pure' foreign blood is safe.
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