Do You Need Blood? You May Be Your Own Best Donor!

Who Can Do It?

If you're healthy enough to undergo elective surgery, PAD is probably safe. Age will not rule you out, but an infection or low hemoglobin count will. Your doctor may especially advise PAD if there's an especially high possibility of an incompatibility reaction to allogeneic blood, which can happen if your blood carries antibodies that will attack the donated blood cells.

Why Use PAD?

The body may have an immune reaction to donated blood. Such "transfusion reactions" are usually mild and might include chills, fever, backache and ]]>hives]]> ; but more serious complications—such as ]]>kidney failure]]>—can also occur. Fortunately, the careful matching of blood that occurs before elective surgery makes these reactions very rare, so if you can't give your own blood, don't worry. Risk is higher in emergency transfusions and those who are seriously ill.

How Is It Done?

You'll need 4-6 weeks to stockpile blood. You can give the first unit (roughly a pint) no more than six weeks before surgery. That's because red blood cells—the component of blood used to replace blood lost during surgery—have a shelf life of 42 days. Generally you'll give once a week, up to within 72 hours of your surgery.

Because you're giving blood to yourself, you don't have to pass the strict screening required of volunteers. You'll need a doctor's prescription, which you'll take to a hospital, community blood center, or American Red Cross blood center.

Here's what you can expect:

• You'll be examined to ensure you're in good health that day.
• A nurse cleans the area inside your elbow, locates the vein, and inserts a sterile needle attached to plastic tubing and a collection bag. You'll probably feel a momentary sting.
• It takes about 20 minutes to collect one unit of blood.
• You'll remain briefly in an observation area where you can rest and eat a light snack.
• Your body will replace the fluid lost in about 24 hours.
• Red blood cells take longer to recover, so your doctor may give you iron pills to boost your hemoglobin count.

What If You Can't Use PAD?

"If you need a transfusion at all, it's probably safest to get your own blood," says Richard Davey, MD, chief medical officer for the American Red Cross. "However, the allogeneic blood supply is extremely safe."

Fear of contracting ]]>HIV]]> from tainted blood caused the popularity of PAD to peak in the 1980s. ]]>Hepatitis C]]> is also a concern. But Dr. Davey notes that increasingly rigorous tests and multiple safeguards have made today's blood safer than ever.

Paul M. Ness, MD, president of the American Association of Blood Banks and director of transfusion medicine at Johns Hopkins Medical Institutions, agrees. "In 1999, the blood community began implementing Nucleic Acid Amplification Testing or NAT," he says.

Unlike blood tests that detect infections like HIV or hepatitis C only after someone develops antibodies, NAT detects genetic materials of the viruses themselves. This increases the likelihood of detecting tainted blood from a donor who is newly infected.

"With antibody testing, the risk of HIV was one in 676,000 units," says Dr. Ness. "With NAT, it's probably one in a million or less."

A number of other safeguards are in place:

• Red blood cells always come from volunteer—not paid—donors.
• Only healthy donors are accepted. Donor screening includes questions that try to reveal behaviors that may increase risk of infection with transmittable diseases.
• Donors are informed about conditions that would render their blood unsafe and are given an opportunity to confidentially indicate that their blood should be discarded.
• Multiple screening tests are run on blood to identify diseases that can be transmitted by transfusion.

Before a transfusion, samples of the recipient's blood and donated blood are combined to test for negative reactions, a procedure called "crossmatching."

What Are the Other Options?

There are two transfusion options that make use of your own blood that involve procedures done right in the operating room. One is called intraoperative blood salvage, a practice that Dr. Ness says is common in vascular and cardiac surgery. During this procedure, the blood lost during surgery is washed and reinfused.

Hemodilution is another option. Several units of blood are removed and replaced with a protein or sugar solution. At the end of the surgery, your own blood is reinfused.

"Directed donations" from friends or family can be an option, but you should avoid choosing people who are not regular blood donors. Otherwise, you're probably better off using allogeneic blood whose donors have undergone testing many times. "If you look at the population in general, the volunteer supply is statistically safer than directed donations," says Dr. Ness.

What Is the Cost?

You might think that it would cost less to donate your own blood to yourself, but, surprisingly, the costs associated with PAD are higher than for allogeneic blood. Blood collection centers do not charge hospitals for the blood itself, whether it comes from you or a volunteer donor, but they must charge for their costs of donor recruitment, collecting and processing blood, and delivery. In addition, the hospital adds surcharges for testing and handling blood. Special handling drives up the cost of PAD. Shipping alone is a big expense.

"Here at Hopkins, half of our prostate surgery patients come from outside our area, and their blood is often shipped [via] Fed Ex," says Dr. Ness. "So, autologous blood costs at least as much as routine blood and might be as much as three times the cost."

While most health insurance companies cover the costs, check your policy. If you have Medicare, the website states, "You pay for the first three pints of blood, unless you or someone else donates blood to replace what you use." But, it's important to check the benefits information for your state.