Facing an operation at St. Joseph Hospital last August, an 85-year-old Pikesville woman was told by her surgeon to make two visits to the hospital ahead of time, to bank a couple of units, or pints, of her own blood, which would be returned to her after surgery.
She had not given blood in years, not since World War II, in fact, and she was nervous. But in the age of AIDS, she said, she understood "that my own blood was the safest kind."
Experts will tell you that the U.S. blood supply is safer than ever, that careful screening of potential donors weeds out most of those who might be infectious, that new testing techniques enable blood banks to find and eliminate units that carry microbes of deadly disease, that allegations to the contrary undermine efforts to maintain an adequate supply of blood donated by healthy volunteers.
At the same time, they will tell you, autologous transfusion -- from you, to you -- is best.
"It's totally safe, 100 percent safe," declared Dr. Paul Ness, director of the blood bank at Johns Hopkins Hospital and executive head of blood services for the American Red Cross Chesapeake and Potomac Region.
"Rational thinking is that you should have autologous blood for elective transfusion whenever possible," agreed Dr. Robert Wenk, director of transfusion medicine at Sinai Hospital.
Neither physician doubts the safety of the general blood supply. "Your chance of getting struck by lightning is greater than your chance of getting AIDS from a blood transfusion," declared Dr. Wenk.
Your risk of dying from anesthesia is greater than your risk of getting AIDS from a blood transfusion, said Dr. Ness. Your risk of dying in a car crash on the way to the hospital is right up there, too, he added.
Unfortunately, no one knows exactly what the risk is. "The [Centers for Disease Control] put out a figure of 1 in 40,000 in late 1988," said Dr. Scott Holmberg, medical epidemiologist in the AIDS program at the federal CDC.
"But other studies have come up with 1 in 150,000, or 1 in 60,000. The most recent study, from the Hopkins School of Hygiene and Public Health, found two cases [of HIV-infected blood] in 100,000 transfusions in Baltimore and Houston; that's 1 in 50,000," he said.
Donor screening and blood testing do not, in fact, eliminate every blood unit that carries disease. A new test for evidence of a strain of hepatitis known as hepatitis C was instituted last May; it's believed that a few units of blood infected with hepatitis C are still slipping through.
So do other blood-borne ills, microbes that go unnoticed in healthy donors and then cause death in the already weakened people who need transfusions. In Maryland, a bacterium from donors, picked up apparently from the skin at the site of the needle-stick, has caused three deaths in the past few years, according to Linda Klein, spokeswoman for the local chapter of the American Red Cross.
Nationwide, an organism called yersinia entercolitica, which causes stomachache in most people, has reportedly killed a handful of blood recipients; it's believed that the bug gets stronger over time in stored, refrigerated blood, and experts are now considering a reduction in storage time, from the 42 days now allowed to 25.
Most people don't worry about skin and stomach bacteria, or even hepatitis. According to Dr. Holmberg, 60 percent of the people who need transfusions die anyway, from whatever disease or accident brought them to the hospital in the first place.
People are also afraid of AIDS, which erupted in this country in the 1980s and has been transmitted in transfusions to more than 3,936 Americans, most of them in the first half of the decade, according to CDC figures.
In 1983, however, blood banks began asking prospective donors to defer themselves if they had lifestyle factors that put them at risk for sexually transmitted diseases; in March 1985, a blood test for antibodies to the HIV virus, which causes acquired immune deficiency syndrome, was instituted. Risk of transmission via transfusion dropped considerably, though it was not eliminated. According to Dr. Holmberg, 14 cases of AIDS nationwide from blood that passed the HIV antibody test are known to CDC, "and," he said, "there are probably more out there."
More, that is, who have HIV infection, but no AIDS symptoms, which may not develop for 7 to 10 years.