Blood Transfusion Risks

New changes being discussed regarding AIDS risks and donor questionnaires.

I have done thousands of operations on patients. Only a slim minority of them required any blood transfusion. We used to require we send patients home with a “safe” hemoglobin level, but as we studied the efficacy of that, we surgeons gradually cut back more and more on sending home patients who were “anemic” by hemoglobin measurements (hematocrit etc). When I was growing up… we were taught - if patient needs a unit of blood either give them two or none… No logic, No science, just dogma.. “We always do it that way here at the (fill-in the blank) academic University hospital.” But now, we send people home with very low hemoglobin levels if they are doing well - knowing if they eat a healthy diet and get enough iron, they are gonna make their own red blood cells. It is okay to give only one unit of blood if that is all they really really need.

But, the point is that all blood transfusions come with some risk. Those risks are actually quite small. Incorrect cross-matching is probably the most common but very rare these days. Other infectious diseases can be transmitted from one human to another.. like AIDS.. I can say that in my entire cardiac surgery career.. having done maybe 4000 or so cardiac pump cases and thousands of other vascular and trauma surgeries.. I know of only one patient who came down with AIDS after the heart surgery I did and we gave him blood.. I must say I had a talk with him about that obviously after we made the diagnosis and he did tell me he had been an oil field worker in the Middle East. And he did stop by Paris for some R and R - Rest and relaxation that include some “women of the night”..So I am not 100% sure our transfusion gave him AIDS. Another notable with AIDS after heart surgery was the tennis great Arthur Ashe.. What a waste but who knew at the time.

So the points about blood transfusions is that 1. everything should be done to safely obtain/screen donors and storage of blood and 2. informed consent is essential. As to consent, I always mentioned it briefly in pre-op discussions with elective surgery. Honestly in trauma situations were it was life and death many times discussions didn’t occur. The refusals I got often were Jehovah’s witnesses and other religions that prohibited it. That did not keep me from operating as long as the patient realized lack of transfusion added to the potential complications of surgery. Do know that First responders in large cities often carry O-negative blood (universal donor) in their ambulance for severe bleeding issues - that way a life saving transfusion from a universal donor can occur immediately at the scene. I personally think that is a good thing and can save lives. I assume the responder can get a signed informed consent permission form.

But now, things are changing.. sort of . The two articles below point out there is discussion with attempts at eliminating the time honored questionnaire for donors regarding potential risks.. about THEIR health and travel history..Yes some countries have indigenous diseases that can be transmitted in the blood and some sexual practices can render donors less than ideal candidates to give blood— especially concerning risks.. for example AIDS. COVID risk is an unknown entity as far as I am concerned. Clearly safe donation ahead of time is a great way to have a source of YOUR blood available for upcoming surgery or unexpected needs for transfusion. But it requires a willing blood bank to do that.

Here are the two recent articles that prompted me to think about posting this information— This is not really a political issue but one that you should know about. Do not be afraid to talk to your doctor about these things. Avoid doctors who brush you off or who will not talk to you about informed consent issues.

FDA Eases Blood Donation Rules

Reuters (5/11, Satija) reports the FDA “on Thursday set guidelines for blood donation organizations, recommending they screen donors based on one set of criteria, ending a restrictive policy that applied only to men who have sex with men and their female partners.” According to Reuters, “The Biden administration had been seeking to end the previous set of time-based deferrals and screening questions for people who identified as men who have sex with men and their partners.”

NBC News (5/11, Lovelace Jr.) reports, “Under the latest guidelines, all potential donors would need to complete an individualized risk assessment – regardless of gender or sexual orientation.” Individuals “who have had anal sex with a new partner, or more than one partner, in the last three months would be asked to wait to donate blood.”